Last night, some friends and I went through about 100 practice problems together, arguing about whether we’d really want to use rifampin in a TB pregnancy (we would), whether the lecturer actually went over that (she did), and whether the DSM-V should include a Highlighter Abuse diagnosis for me personally (general verdict: “for the love of god, you have three different shades of orange“)1.
We do this before every major test, but last night was shocking – we knew every question. We were rockstars. We were unstoppable. Of course the heroin user coming in with those symptoms has right-sided infective endocarditis! Hell, we knew it before we even heard about that murmur. Most likely Staph aureus, so just start the amp + gent already, or sub in vanc if he’s allergic – slow infusion, of course.
Also, nurse, bring us more pizza. OUR HOTSHOT BRILLIANCE REQUIRES ANOTHER PIZZA.
The self-congratulatory mood was somewhat broken when someone asked how we knew the heroin user didn’t just, you know, overdose.2
It’s funny how last semester, it seemed like every 3rd entry I wrote was about how we knew absolutely nothing. And now, if a family member called me to ask about, say, a bad cough – instead of emphasizing my lack of any experience whatsoever, I’d be tempted to do what everyone else does now: ask a lot of questions, get a half-assed differential, and make an armchair prediction before telling them to see their doctor.
Luckily for my family, my mom’s a nurse – so nobody’s going to need to ask me any medical questions for a very long time. My half-assed differential skills will have to wait.
In summary, it’s a little stunning to realize that in just the past month, we’ve gone from knowing “absolutely nothing” to simply knowing “nothing” – all due to our extensive experience in managing fake patients with textbook infections.
It’s the little things in life.