“Alright, the last four, come with me.”
It is clinical skills at the General and we mechanically split ourselves into neat packages of twos, tasked to take a history and physical and report back with a working diagnosis. We are led around corners and through doors, moving past workstation hubs bustling with activity despite it being dinnertime. My mind is quiet. We enter a room, our preceptor facilitating quick introductions and just as quickly whisking away to deposit the last pair with their patient. I see him, a large middle-aged man dressed in a thin blue gown with electrical lead wires disappearing underneath the dark blue neckline.
The interview begins and Rational Me leaps forward unrestrained, feeding off of the energy of my colleague and this task that I have been given. She fills my brain, already reflexively flipping through filing cabinets of risk factors, clinical prediction scores, triads/quadrads/pentads of signs and symptoms, nudging items on my list of differentials up or down with each spoken response like a real-time scoreboard. She interprets, she anticipates, she deducts, she questions. Always thinking ahead, using answers to inform her meticulous selection of subsequent questions to eliminate the possibility of one disease and engage the possibility of another. The Past Medical History stream of questioning slowly dwindles to an end, and we approach the Family History.
Deep breath in. “Are your parents still with us?” Tone slightly softer, eyebrows slightly knitted – body language poised at a low 2 out of 10 on the scale of inquisitive concern.
He speaks briefly about his parents and traces out a history of colon cancer in his family, like he’s been through this before. He lingers on his favourite aunt. “I was beside myself when she passed away from cancer before she hit 50.”
Emotional Me peeps out; this is her trigger. She notices how he willingly elaborated, she hears and sees his bearing, she’s aware of my colleague standing silent beside me. I wait for her to express empathy but she’s dazed and blinking, feeling his emotions and recognizing the opening but not knowing how to say or what words to choose. Rational Me presents a rational response, and I grab at it desperately as a last resort: “I’m so sorry to hear that.” Robotic. Unfeeling. I start to cringe even before my mouth forms the sounds; I continue cringing as the words grate out of me like clumsy gears in antique clockwork. My expression of concern overcompensates for the squeaky superficial phrase as my cheeks inadvertently flush at the failed attempt at empathy.
“Oh it’s not your fault,” he says, as if confused at my apology, and the awkwardness, the miscommunication, and the misunderstanding make me squirm but thankfully my colleague jumps in and the questions resume.
The rest of the interview continues without a glitch and I walk away with my two selves retreating back into the hollows of my mind, still disunited.