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A few weeks ago, as I rotated through neuro in India I was working with this really nice resident. Excited or at least tolerant of having me there he bombarded me with questions- quizzing me on trivia about neurology. I was asked to recall through the fog of months of other material the tests for cranial nerves, how to determine mental function, and where the lesion was if a person couldn’t move his eyes together…

As the quizzing progressed and I did decently (much to my surprise, since I was convinced I’d forgotten most of my neuro) he seemed to grow more confident of my abilities. He then looks me in the eye, says I need to go talk to the attending about how to disposition some patients. Take the histories and physicals of the next few patients, will you?

I said yes, and sat down, secure in the knowledge that I’d been fairly well trained during doctoring and in the ED in how to ask a patient questions. Interpreting the answers- not quite yet.

Secure in my little knowledge I sat and started talking to patients. One of the first, was an elderly gentleman who’d developed a neuropathy in one eye losing sight completely. He seemed to be in excruciating pain, rocking back and forth in his chair with moans of agony. Now, he and his relatives were freaked out- totally terrified since they had been told by the person who referred them to this hospital that the eye in question was lost and the other could go too. The resident, was looking at over 12 patients waiting who needed full neuro exams and histories- an arduous task at least. He had been a little short with them before.

As I started seeing them, they answered all my questions and showed me the MRI’s. To my semi-trained eye, there was a lesion. However I’d at times been convinced something was a lesion only to be told later that it was an “artifact”.

I had a rough idea in my mind that I knew what the lesion was. And I thought I saw it on the scan. I anticipated answering the residents questions, but I hadn’t anticipated the patients. He and his family started questioning me. For them, I was the “doctor”. A term that showed the promise of understanding what was happening and a way to fix or treat it.

They started asking me what was wrong with him. I started trying to answer their questions with a simple I don’t know. They couldn’t accept it, even when I explained that I was a “junior doctor” green to the ways of medicine. They kept saying, we understand that, but what do you see? Unsure of what to say, I stayed quiet, waiting for when the resident would return. I sat there, realizing my not answering their questions was prolonging their agony. At the same time I realized if I answered their questions I’d add to their agony if I was wrong.

All the arrogance and pride I felt in my taking an excellent history had faded, and all I felt was the realization that I was doing a disservice to this patient. So I left and left the rest of the exam to the resident.

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