Tamara Bockow, BS
Corresponding Author: Tamara Bockow, BS, University of Pennsylvania Medical School, Philadelphia, PA 19104-6056; e-mail, firstname.lastname@example.org.
Bockow T.; The Doctor I Want to Be. Ann Intern Med. 2011;155:273. doi: 10.7326/0003-4819-155-4-201108160-00015
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Published: Ann Intern Med. 2011;155(4):273.
He spiked a fever of 102.3 last night. His brain MRI is unremarkable, his CSF cell counts are inconclusive, and his urine culture is negative.”
I reported these perplexing findings to my attending physician on morning rounds, pondering the next step in this patient's treatment. As a third-year medical student on my medicine rotation, I was eager to begin learning the art of differential diagnosis and medical management. However, during my time on the wards, I learned not only what it takes to be great doctor but what it means to be a healer.
Mr. Mitchell was an 83-year-old man with a history of mild Alzheimer's dementia and sarcoidosis. Three days after a simple right inguinal hernia repair, he suddenly became obtunded and unresponsive. Just after his surgery, Mr. Mitchell was found to have a large lung mass. I spent time examining him and trying to get a response from him, but he had suddenly become nonverbal, unresponsive, and unable to follow any verbal commands. I spent countless hours with Mr. Mitchell's wife and 3 daughters, who remained calm and were convinced that he would soon recover from whatever had caused his sudden change in mental status. I came up with more things to add to my differential diagnosis on rounds every day: listeria bacterial meningitis, urinary tract infection, pneumonia, carcinomatous meningitis, neurosarcoidosis, hyponatremia, and new worsening dementia with delirium. However, every test came back either negative or inconclusive. I desperately wanted to find the answer; I was convinced that I just hadn't thought of the right diagnosis, but once I did, I would be able to cure him so he could go home to his family. After a week of fluid repletion, broad-spectrum antibiotics, and heavy doses of antivirals, he was not getting better. He continued to deteriorate over the next few days. I felt that I just needed to try harder. It was a race against the clock.
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