I got to the hospital at 6 a.m. to preround on all my patients. I saved my noncompliant patient for last (after what happened yesterday I was dreading seeing him), but when I went to his room he was in a much better mood. For starters, he's eating the ADA diet like he's supposed to, and his white count went down so the antibiotics are working well for his cellulitis. He was more agreeable to letting me check his wound this morning than yesterday, when he flat-out refused to let me examine him. He said that the reason he was being so stubborn about not getting Accuchecks was because he was afraid of needles (namely, the pain that needles cause) and that no one listened to him when he tried to tell them. We were in the middle of discussing which fruits were good or bad for diabetics to eat when Greg came in. He told the patient that he was doing very well, but that they still had to check his sugars regularly. Well, the patient didn't take that too well and said, "I'm getting angry again." Greg pretended that he had a page and said, "I'll let the two of you to talk." After he left, my patient growled, "He always does that when I try to talk to him. Can I get another doctor?" I said no, explaining that he was assigned to our team and that the doctors meant well and just wanted to help him get better. At any rate, I probably spent 20-30 minutes just talking to him, but I think he needed someone to talk to. He got a psych consult later in the day and was diagnosed with mixed narcissistic and borderline personality disorder. It's easy to see the borderline in him; the way he's nice to me and mean to Greg and Dr. C is a classic example of splitting.
I messed up in my presentation of my cancer patient today; I was going through all the details of how she got diagnosed with gallbladder cancer when Dr. C interrupted and said, "Ok, so she's already been diagnosed? Then just get to the point and say so." Damn. *sigh* Even though I'm a fourth year, I feel somewhat inferior to An b/c she's already been here a month and knows how everything in the hospital works. Not to mention she's on good terms with everyone on the team (especially the guys) and even has their cell phone numbers so that she can call them directly instead of paging them. On top of that, she's the perfect third-year medical student. It's almost like she wants me to look stupid. Of course, maybe I'm just paranoid. >_< Hopefully things will get better; it's only day 3 after all.
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I know what you mean about "feeling stupid." I remember a 4th year last year who was presenting a difficult case and that attending would pimp her in front of the team and give her a hard time. But when I was asked something and didn't know or got it wrong, he wasn't as tough with me as a third year. Maybe because we're still learning and that as a 4th year, they expect more from you. Besides, like you said, she's been there a month already. Perhaps, she had a hard time at the beginning (which is normal for a 3rd year) and is now adjusted and just thought it's your turn to have a hard time now. who knows?
btw, I didn't know it was against the law to give regular diet to a diabetic. That's good to know.
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