A Brief History of Not Knowing

In the olden days when we were still medical students we would flock to the conference hell—I mean hall—at 7 am, stuff our faces with turon and iced tea frantically purchased from The Nosocomial Canteen, and cower in our seats, as the all-mighty residents walked around the room brandishing cat-o-nine tails, wearing knee-high leather boots, or fashioning kinky fishnet stockings. I’ve been reading a bunch of Catwoman and Birds of Prey comic books featuring Black Canary, so my memory is probably all mixed-up, but the dread we felt back in clerkship in internal medicine ranged from “washable with ice-cold Jeka Juice” to “get me outta here!”.

In one instance when Intern Margie was called to the podium to present a case of myocardial infarction we watched as her face turned totally pale and drenched with sweat. This was immediately followed by hyperventilation and a full-on fainting spell. We expected the residents to scream “Arte! Tumayo ka nga Margie nasa CHIEF COMPLAINT pa lang tayo!”, but they instead morphed from villainous caricatures to real people with thoughts and feelings. They ushered Margie out of the room and proceeded to give her free breakfast, which immediately resolved all her symptoms. Margie never had to endorse again during the rotation, so we stayed away from breakfast turon and tried starving ourselves every morning. Sadly none of us ever required medical evacuation.

Sometimes after these endorsements the resident monitor would summon us for a post-endorsement special meeting where he would give us an extra sprinkling of residual sermon—I mean reminders. The post-endorsement special meeting would then be followed by one-on-one with our residents who would give us a list of the day’s chores—or teachable moments. A few weeks into the rotation we became inured to all of this, most of us finding it more and more difficult to balance our time between studying and doing scutwork, such that some of us have transformed from “I haven’t finished reading about hyperglycemic hyperosmolar nonketotic coma I am so irresponsible,” into “Oh what the heck! I just want to take a bath!”. As we were called one by one by our chief resident and quizzed on why warfarin needs to be overlapped with heparin, we were thinking: Who cares!—obviously a defense mechanism because deep in our hearts we knew: The patient cares! Their loved ones care! The Hippocratic oath cares! Ahem.

Dr. LP called us one by one. First in line was Smoketh. She had no idea why in the world warfarin and heparin needed to be overlapped—it all sounded very algebraic word problem on what hour the two leaky faucets running at different speeds would fill up the damn buckets—but she knew she had to say something smart, she knew she had to maintain a veneer of intellectual curiosity, she knew that

“Sir… I don’t know,” Smoketh said with a straight face. She then sat down. Next!

Mrs. T stood up. “Sir, I don’t know!”

It was my turn.

“Warfarin is…. Was… bale… I don’t know!”

Next in line, much to our relief, was The Talented Mr. Len-Len Chan, who knew his Harrison’s forwards, backwards, and inside-out. He gave a very succinct, spot-on answer, none of that time-buying “thank you for that wonderful question” crap, which we found so impressive that we clapped and cheered—none louder than the clap and cheer of Chepoy Marasigan, who has been heavily perspiring and fidgeting all this time because she would have been next on the firing squad. But she was all smiles now. Sitting next to Len-Len henceforth became prime spot during endorsements.

For all the unapologetic “I don’t know’s” we’ve mouthed off during med school Mrs. T, Smoketh, and I slipped through the cracks and got into the internal medicine residency program. We became experts in all that anti-coagulation stuff, because we knew we had to care. We had to care because the patients could experience a fatal shower of embolism if we didn’t step-up, and we had to care because the patients would bleed in the brain if we miscalculated our steps. We also won the right to finally wear the fishnet stockings and the kinky leather boots. Initially I thought it would be titillating, but as I sat there at the other end of the table pretending to crack my invisible cat-o-nine tails I discovered that I didn’t really want to ask any question at all. Not because I was trying to ingratiate myself, but because I was too sleepy and too lethargic. But most importantly, because the case that my batchmate Lochia chose to be presented, pulmonary alveolar proteinosis, was something I haven’t encountered in real life or even read up on.

It was to Lochia’s credit that at least one of us has read up extensively on the case, and I decided to just let him take over the entire endorsement. My other batchmates Djana, Aids, and JD all started asking questions as well—apparently everyone has read up on it, except me.

Intern Ericka was doing pretty well—she was confident, the history was complete, it seemed that she has really performed physical examination on the patient, and she was not making any Nanette.  Nanette is the term that pertains to the act of making-up information from thin air, in an attempt to bluff your way out of your seniors’ or your consultants’ questions during rounds. The etymology, clearly, is Nanette Inventor. Obviously Nanetting is bad, as it shows a lack of integrity which can adversely affect patient management. There is a rebel school of thought, however, that claims that there are details you can Nanette and details you should never Nanette, but whatever happens, the important thing is that you Nanette with conviction. No hemming and hawing and stuttering and nervous chuckling allowed.

And just when Intern Ericka thought that she could finish unscathed Lochia asked a question that would, one day, in post-graduate courses of Test Construction, be the prototype question on what to not do in test construction. Lochia asked Ericka thus:

“Ericka, what laboratory finding, which, if you do not find it, will not make you not consider, that it is a diagnosis other than pulmonary alveolar proteinosis?”

Intern Ericka was momentarily stumped—she didn’t know how to answer it, via Nanetting With Conviction or otherwise. Years later we would repeatedly rib Lochia about how the question didn’t make any sense, but every single time Lochia would explain his cartwheeling triple-negative double flip-flop question and we would somehow get it. Somehow.

After finishing our stint in internal medicine we went our separate ways and took up different sub-specialties. Smoketh took up nephrology, Mrs. T took up rheumatology. A few days ago while whining at how horrifically dismal our lives have turned out as subspecialty hell-ows Smoketh asked for my help in making general medicine exams for students.

“Ilang araw nga inooverlap ang warfarin and heparin? Paano nga ginagawa yun?” Smoketh asked.

“I… I don’t know,” I said, and I resumed reading Catwoman.

Photo by Pixabay on Pexels.com

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