My First Day of Practice
After eleven years of college, medical school, and residency, I finally completed my medical training. I designed and decorated my new office with matted and framed Monet and Cezanne prints. Opening day arrived and I proudly welcomed my first patient and escorted her back to an exam room.
She yanked up her sweater to reveal her back and abdomen. “I’ve got this really weird rash and I don’t have any idea what it is,” she said. I stared at her bizarre, splotchy rash and immediately thought, “That makes two of us!”
I inquired about any new detergents, lotions, foods, medications, or other allergens but no answers were forthcoming. I began to sweat and I wanted to bolt from the office—I hadn’t a clue what was causing her rash—I’d never seen anything like it. Great. My very first patient and I couldn’t diagnose her. This didn’t bode well. What if I was just as inept with my next patient? What if I couldn’t diagnose a single patient I saw today and they all stomped out of the office in disgust and posted on-line I was wet behind the ears and totally incompetent? Panic churned in my stomach like dirty socks in the washing machine. Eleven years of education down the drain.
I trumped up an excuse to leave the exam room and I dashed into my office. I shut and locked the door so my new nurse wouldn’t see me diving into my dermatology books hoping to find a picture that looked like this woman’s rash. I frantically thumbed through two dermatology textbooks with no luck. I yanked out a third, and thank God, there was a picture of the elusive rash: Pityriasis rosea. I skimmed the page for everything I could learn and then re-entered my patient’s exam room.
With an authoritative tone I announced, “Mindy, you have a rash called Pityriasis rosea. It's caused by a virus. Its distinguishing feature is a large “herald patch” on the back. Pityriasis rosea comes from the Latin word. . . and it lasts from three to eight weeks… it is not particularly contagious… blah, blah, blah.”
From my confident dissertation, she would never know that five minutes earlier my heart thudded in a full-blown anxiety attack. This wouldn’t be the only time in my twenty plus years of medical practice that I would be stumped, but it was definitely my most nerve-wracking. I have since learned it’s okay to say, “I don’t know, but I’ll research it until I do.”