The Burdened Learner

I was presenting my first patient of the day, a 68-year-old woman admitted with dyspnea. Dr. Smith was the new attending that week, and she already seemed annoyed, like she had somewhere else to be. I had just finished rattling through the morning labs and reading the chest X-ray. My heart was beating rapidly as I started my summary statement. I had been up with my wife the night before practicing what I was going to say at this point. I was even going to present a study which discussed the role of inflammatory markers in acute asthma exacerbations. I wanted to make a great first impression. But before I could finish, Dr. Smith said, without looking up from her paper, “The patient is not on any anticoagulation. What medication would you start her on?” I stared at her blankly. I was so caught off guard that I barely remembered what she asked. “Warfarin?” I said, with no confidence at all. She looked at me, tsk-ed, turned to the resident, and said, “Start Lovenox.” I caught the intern’s eye, who looked empathically at me as if to say, “Don’t worry, we’ve all been there!”

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