Competence

I had the cuff ready on her delicate arm. She was 8 years old and was complaining of cough and colds. I started inflating the sphyg, carefully listening for any pounding sound from her brachial artery. I heard silence, amidst all the commotion in the patient waiting area.

It was my first medical mission. My senior buddy, a junior clerk, asked me to check her BP and so I did. I was excited. With my stethoscope and BP apparatus, I asked her to sit down, and to give me her right arm. I had BP-ed myself and my friends many times so I knew I could do it. But still, no Korotkoff sound registered in my ear.

I looked at her. She was still and calm as I slowly emptied the cuff. Then, I dropped my steth gently. I was actually dumbed by that flop BP reading. I started to panic. In principle, I failed my buddy and my patient. Forward-tracking, what if I become a surgical resident in front of a very complicated craniotomy and am asked by my consultant to clip a ruptured aneurysm of the middle cerebral artery, and I mess up and all?

I’m just a first year medical student without any clinical experience save for a history-taking interview with a patient with subdural hemorrhage, who vomited all over my face, and another with bacterial meningitis. This medical mission was my first hands-on experience in doing simple physical exam and history-taking. This time, there was no room for any mistake since it wasn’t a classroom (or clinical) exercise. It was the real thing.

Before the mission, I actually had apprehensions on joining since practically the only thing I can do, or so I thought, was to take a BP reading. I knew nothing of auscultation of the lungs and the heart. But then, they told us they can teach us so I signed up for it. When we arrived, they asked us if we can do PE and history-taking. I proudly told them I can do BP so they assigned me to assist the junior clerks in the PE. And what happened on my first attempt?

The medical mission was successful. I even extended my shift until the afternoon. After that one pedia patient, I took several more BP readings and this time, I did hear pulse sounds. They also taught me to listen to breath and heart sounds. I actually performed the history-taking for two or three patients myself. The only thing I was not allowed to do was to diagnose and prescribe a treatment.

In the end, thank God, my first BP fiasco wasn’t really entirely my fault. The cuff of my sphyg did not fit my pedia patient. It was understandable that I didn’t hear a sound using an adult cuff.

I may not be that proficient in doing the “doctor job”, but I know I'm getting there.