8 Oct 2024
Dream
I had a nightmare about having a difficult and near-impossible patient encounter in the middle of a test. Normally in med school we have 14 minutes inside the room with a patient, and then another 14 minutes to type up our note about the encounter, and we’re graded on both elements (how we did in the room and how we did on our note).
In my dream I was standing in a hallway waiting for clearance to go into the patient’s room. I got a thicker-than-normal door chart to work with, but before I knocked on the door to go in, one of our faculty members stopped me and told me that I had the wrong program up on my computer. She then switched me to an exceptionally complex-looking webpage that I’d never used before that was full of clunky, scattered blue-highlighted boxes with tiny labels that were hard to parse through (which contrasts sharply compared to the normal webpage that only has 4 boxes on it). I thanked her but noticed my time was still ticking down, and then I had to go into the patient’s room but was stopped again by my friend, Delaney, who got out of her OSCE and was holding up a sign that said “If you don’t know something, don’t document ‘didn’t do this,’ instead, document: “unable to assess.” I thanked her and rushed into the room with only 8 minutes left. Inside I saw a patient who appeared to have a white coat, tie, and glasses on (he looked like a doctor). I introduced myself as Student Doctor Matt Coyne, and asked him what was going on. I then realized that I didn’t open the thick door chart and that I should probably take a look at that. But instead of talk, the patient started scribbling on the bed that he was sitting on. He wrote 6 things and I was reading along. The patient wrote: “Need a birth certificate to prove to my professor;” “Balantosis,” and a few other things that I couldn’t remember. He appeared normal but wouldn’t say anything. Then the director of clinical skills came into my encounter, and sat down in the corner of the room, scribbling notes on a clipboard, and watching a timer closely that I couldn’t see. I tried to continue my patient encounter and then my friend, Delaney comes into the room. She starts talking to the patient and doing a physical exam, so I stand back and wonder “Holy shit, I’m going to fail, am I allowed to use Delaney’s physical exam, or am I expected to do my own?” I walked over to the director and asked: “Hey, so does this count towards my time?” She nodded, indicated back to the patient and said “You have to leave as SOON as Ultrasound gets here (because for some reason the first years were having an ultrasound demonstration in the room that my test was scheduled in). So I thought “Oh no…how much time do I have left?” I ran back over to the patient and Delaney and said “Okay, I need to do this NOW. Can you sit up for me?” The patient sat up and then started wandering around the room. Delaney gave me a “you shouldn’t have done that,” look, and I went “Sir, can you PLEASE let me do this?! I don’t have much time left!!” He refused to sit down and the overhead announcement came over: “Time is up.” I had to exit the room and start my note.
As soon as I stepped outside the scene changed to an outdoor patio overlooking a relatively peaceful green grass-covered field. I had to type up my note on a tiny laptop screen with a keyboard that was falling apart, and I spent all of the 14 minutes trying to locate the right section to type in. I eventually found a few of the correct boxes but realized that I got next to no history, didn’t do a physical exam, didn’t give a diagnosis, didn’t get through a plan, so I barely typed anything. I remember thinking “I’m about to go before a committee and get dismissed from medical school again. How the hell did this happen in my BEST subject?!” And the dream ended.
