Thursdays at the Valley
Posted 11:32 PM, March 01, 2007, by thomas.tsaiEvery Thursday, Margie, Jayson, and I trek down to the Santa Clara Valley Hospital, known affectionately as "The Valley."
As part of our second-year Practice of Medicine course, we have the opportunity to hone our history taking and physical exam skills at various clinical practicum sites. I chose to go to the Valley, a rater unpopular location for most due to the 30 minute drive from Stanford, because I wanted to see different patients than those we get at Stanford hospital. So far its been a phenomenal experience.
The attendings have been extremely nice and welcoming, taking time out of their busy schedules to critique our presentation skills and go over pertinent physical findings.
I had a really interesting case today of a 40-year old man who presented with complaints of pain around the left orbit that has progressively worsened since December. He also had fairly prominent proptosis of the left eye. He's been in the hospital since Thursday, and the physicians here have empirically treated him for orbital cellulitis with vancomycin, cefapime, and flagyl to cover potential bacterial or fungal abscesses. His CT showed a large mass behind his left eye that was causing the proptosis, and they now believe it to be a neuroendocrine tumor.
What was most memorable for me thought was in the course of the hour I spent with him, he did not mention the fact that he was HIV positive. I asked him about his past medical history and HIV never came up, and it was only when I asked about his current medications that he mentioned he was taking Atripla, a new combination pill of nucleoside and non-nucleoside RT inhibitors. Of course, this opened up a whole avenue of history.
It's scary to think that I could have also missed such an important part of his history. Luckily, our clinical practicum is mostly for us to practice, as we are not yet responsible for managing the patients yet. The patient also had a really compelling story--he had a detached retina from physical abuse at home when he was 15, leading to loss of vision of his right eye. As a result of his family issues, he's now dealing with PTSD and depression, and talking to him made me appreciate the importance of the patient-doctor encounter and the medical interview. For the first 45 minutes he was a patient with proptosis, but then all of a sudden the details of his life were filled in and he became a more complete individual and not just a patient.
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