Giving bad news

Yesterday I experienced giving bad news to someone. Well, I practiced giving bad news is closer to the truth. As part of a practical exam, I had 15 minutes to tell a patient of mine that he had pancreatic cancer, and most likely had 6 months left to live. In reality, this is going to one of the most difficult aspects of my job. Watching someone come face to face with death and witness them process just what that means will be heartbreaking as well as an extraordinary privilege. Before I go and start sounding too noble, I should say what was most difficult about my encounter yesterday.
Sunday (the day before this test), Heather and I watched the latest episode of Modern Family. During it, Claire, the mom, had to tell her son that an old man he was friends with had died. As she was telling him, she couldn't stop smiling, and it became a recurring them through the episode. She called it a "coping mechanism." Well, later that evening I asked Heather to be my patient so I could practice giving bad news in a clear and sensitive. But when I started into it, I couldn't stop smiling! All I could think of was Claire.
Imagine hearing "you have 6 months to live" from someone fighting back a huge grin. That person would be a sick person. Then the panic set in. What if I smiled during my exam? I would surely get kicked out of medical school entirely.
So, yesterday morning, as I stood outside the exam room, waiting for the proctor to tell us our 15 minutes had begun, I prayed that I could just keep it together.
It went fine, no smiling or anything of that nature. And I also don't mean to make light of delivering bad news. Real life will be very difficult, but on an exam, with a standardized patient working on his acting skills, trying desperately to make himself cry, I'm proud to say I did not smile.

My Journal of Medicine

There are several prestigious journals of medicine, and they can be really intimidating when you're just starting out in medicine in general. First off, they're extremely boring. Very few pictures, lots of tables and graphs, and really complicated, foreign words like "xanthocromia."
Their importance, though, is in keeping doctors relevant. They publish the latest research, consensus, and expert opinions on treatments, procedures, etc., and in doing so, help medicine to always better itself.
The idea behind this blog is something similar. It's just for me. It's to keep me relevant, especially as I move through the different phases of my education. I want to document my thoughts, feelings, and experiences, because I know one day doing a physical exam will be second nature, interviewing patients will be like breathing, and formulating a differential diagnosis will be automatic. Right now those things are awkward, and my medical experience is relegated to books, flashcards, and a bunch of stomach-churning anxiety.
So I want to make sure that I write down my experiences somewhere, so that down the road, when these years are distant memories, I can remember where I came from, and maybe have something to pass down or share with someone else. 

For now, I have Step 1 (my first board exam) in a little over a month, and I can't think about anything else. The review book everyone uses, called First Aid, is 600 pages long. People say that if you have First Aid virtually memorized, you'll kill the test.
Yea, ok.
*sigh* It's going to be a long 4 weeks...