I had the great honour and misfortune of being on a ward round with this consultant. A great misfortune because of his reputation of being one of the ‘toughies’ that ask medical questions designed to make you feel like a stray cat cornered in a dark alleyway. A great honour because the ward round was spiced up by a pseudo-round of charades. You don’t play charades on every ward round.

The ward round was slowly coming to a close as we were reading the clerking notes of the last patient in the bay. Frail old dear with a history of advanced lung cancer came in the previous night with back pain and incontinence. A bit of bog-standard chest and abdominal examination finished off with a grand finale of urine dipstick. Then the consultant turned to me and spoke. (ARGHHHHH)

Doctor: “What is wrong with this clerking?”

Me: “Uhhhhhhhh…” (insert deer-caught-in-headlights-face)

The embarrassing pause felt very long. I knew there was something I should know. Of course there’s always something I should know. Darn, I don’t even have the “We haven’t covered that in the syllabus yet” excuse!!!!!!

Doctor: “SHE DIDN’T GET A NEUROLOGICAL OR PR EXAM! We just gave her a urine dipstick!!! We have done NOTHING for her!!!!”

Okay, so he didn’t really say that in at a decibel level warranting capslocks… but it felt loud, clear and very irritated. No good-medical-student points for me today.

Doctor: “Why do you think she needs a neurological and PR exam? What are we afraid of?”

I wasn’t exactly doing too well in the answering-ward-round-questions department. I proceeded to give “panicked face #’2”. It’s a bit like the first face but with wider eyes and maybe a touch of blushing in the cheeks. The next thing that happened before my eyes was rather surreal. Instead of the predicted “Consultant 1, You 0. I am smart, you are not.” answer, I was given a theatrical delight.

The consultant began to spray his hands in the air like imaginary fireworks. Dotting across an invisible canvas. I was not sure how to respond to this. I stared blankly. The FY1 doctor then joined in as they both waved their arms in synchrony – kind of reminded me of a water fountain. Not just a water fountain but……

Me: “METASTASES!”

Doctors: “YESSS!!!”

I had a split second of feeling smart until my initial stupidity dawned upon me to dampen the high. Why didn’t I think of that one immediately??? It was so obvious! History of lung cancer, back pain and incontinence – this poor lady’s history correlates closely with spinal metastases. Yes, I got the answer in the end but this lady needs a neurological and PR exam in case she has cauda equina syndrome… and we need to tell her respiratory physician quick…