Patient H in Bed 17 provided a plethora of learning opportunities. A bit of a drifter who liked the occasional beer or six, he had just finished a year-long alcoholic binge and ended up in hospital with acute alcoholic hepatitis. Consequently, he offered me the opportunity to note his scleral icterus (something I had previously only read about in textbooks) and lay back patiently, letting me palpate his abdomen so I could get a sense of what the edges of an enlarged liver and spleen felt like as they hit the side of my probing hand. He was also uncomplaining as I fumbled around with gloves and butterfly needles and drew several test tubes of blood to send off for the multitude of tests the specialist consultant had ordered. In the hospital corridor his case gave me the chance to rehearse with the consultant the various differentials for pre-hepatic, intra-hepatic and post-hepatic jaundice and learn about algorithms such as the Glasgow Alcoholic Hepatitis Score and the Maddrey’s Discriminant Function which we would use once his results came in to evaluate his three-month mortality. I chased his results up periodically during the day. When they did come in, later that afternoon, I watched as the consultant input his clotting time and bilirubin and various other variables into an Excel spreadsheet which crunched out a number on the bottom row. “I’m afraid he’s going to die,” the consultant said. Suddenly it hit me. Over the course of my two pre-clinical years of dealing with hypothetical cases in PBLs, practising mock physical exams and taking fake histories from my classmates, I had somehow become desensitised to the fact that all of this was just a simulation of Hospital World. And in Hospital World people actually die. All at once, I resented the arrogance and precision of medical science, the fact that Henry’s fate could be determined by an Excel spreadsheet when, there he was sitting in his bed upstairs listening to his iPod, not in any apparent distress. Every day since, I scroll through his bloodwork, stop by to chat and see how he's doing and secretly will him to prove my textbook learning wrong.
* This blog is a fictionalised version of real events. Details have been altered to protect privacy.
