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“Good morning,” he says, his gaze skirting past me as he takes in the tiered classroom. “I know you’re all anxious to get to your case studies, and I’ve had the chance to review your submissions. We’ll go through all of it, and you can explain and defend your reasoning. Remember, medicine is both an artanda science, and the correct diagnosis isn’t always so easily found. I will tell you this, only one of you in this class made the correct diagnosis. Several of you were on the right track but disregarded a crucial piece of information, and I think that’s something we should talk about. This is also something I plan to do each week and will hand out rewards to those who get the correct diagnosis.”
He starts to pace but stops when Daria raises her hand like she’s in first grade. “What’s the correct diagnosis?” she asks. “Who got it right?”
“Let me ask you this instead.” He pauses right in front of her since she’s in the first row. “What do you do when you first go in and meet a patient? What information are you there to gather and assess?”
Daria sits up and studiously thrusts out her tits. I mentally roll my eyes at her pathetic display to get his attention. Only I can do that with him. Because he’s mine. Not hers.
“I introduce myself and get a history of present illness as well as a past medical history.”
“Correct. What else?”
She falters, shifting in her seat. “Um. Well…”
“How about a family history?”
Her face flames up because that seems to be the thing we were all missing. Myself included, until I realized my blunder.
“The only person who clicked on the family history tab is also the only one who got the diagnosis correct,” Callan continues, addressing the class once more. “Do you not believe family history plays an important role in your patient’s overall health?”
“Well, yeah, but not as important as present symptoms,” Murphy chimes in. “I’ve heard doctors say that family history can be misleading.”
“Potentially,” he replies. “But it can also be the key to your case. Genetics plays a role in all of us. In this situation, it did, and I had a feeling that was going to be what tripped everyone up. The diagnosis was Crohn’s disease, and both the paternal grandmother and paternal grandfather had a history of it.”
“But the patient had only a few symptoms that would correlate with that diagnosis,” Daria protests.
“The patient had more than enough symptoms to correlate with the diagnosis. I think you’ll find that most patients very rarely exhibit all symptoms in any disease process. Crohn’s relies on a genetic component and an environmental trigger. If a thorough family history had been taken, that pathology would have made itself clearer given the symptoms the patient presented with, don’t you think?”
The whole class grumbles, and I get a stink eye from Murphy. “You got it right,” she hisses to me, and the note of accusation in her voice hits me strangely.
“It was right there in family history,” I defend. “I just put the pieces together after that.”
“Uh-huh. And no one helped you with that?”
I blow out a silent breath. “What are you suggesting?”
“Just seems as though you have a lot of doctors at your disposal. You live with Oliver, right?”
Um. Not anymore. “Oliver didn’t help me with it. He was at the Red Sox game last night with Amelia and the girls.” That’s actually true. It’s why I was wearing Meil’s Red Sox shirt. She might not think it’s good luck, but I still do.
“And what about one of your other Fritz uncles? Did you ask them for help?”
I narrow my eyes at the way she says that. “No one helped me.” Which is true. Callan didn’t help. He gave me no prompts or feedback until I submitted my work.
“And what about Dr. Hottie McSterious as you call him?”
Shit. That was a mental blunder. Not to mention the way she sneers his name is very different than the way she mentioned Oliver or the other Fritzes. Could she know about me and Callan? I don’t see how, though even if Patrick had implied I was fucking Callan before. Still, I don’t see how she could know anything.
There’s no way. She’s just grasping at straws.
“No,” I snap, miffed she’d think so little of me. “I told you no one helped me. I clicked fucking family history and two of the patient’s relatives had it. Look over the disease pathology, Murphy, and get a better history next time. And maybe don’t consult Dr. Google.”
Murphy turns back to the front of the room, as pissed with me as I am with her, and the lecture continues. Others attempt to defend their answers, and Callan patiently goes through each one, explaining his own experiences with the patient and his attending.
He’s good at this.
I know it’s not what he wants to do, but he’s an excellent teacher. Even last night with me.
He’s patient and listens and doesn’t discourage, even when the answer isn’t correct. As much as I wish he weren’t my professor and wish the school would hire someone else to take over, I’ve learned a lot from him, both here and at the hospital. I’m going to miss that terribly when it’s all over.
