"Is it...gonorrhea?"

The thing that excited me the most about going into the nursing program was the standardized patients. I'm not gonna lie. You know what a big Seinfeld geek I am and one of my favourite episodes is "The Burning" where Kramer and his friend, Mickey, are standardized patients acting out symptoms for med students to diagnose.
Of course, as a nurse, I can't diagnose anything, but the main thing was to do a physical assessment and get enough information to recommend further action, like a triage nurse.

Anyhoo, I got a tip-off before my turn that I would be doing a cardiovascular assessment. I felt ready. I had all my questions prepped and a mental schedule and everything.

The Plan
0:00 - Introduction of self; ask for client's name and age; questions about chief concern (PQRSTUIA)
0:04 - Past health history (surgeries, hospitalizations, injuries, allergies, meds); Social history; Health maintenance activities (sleep, diet, exercise, stress reduction)
0:06 - vital signs
0:09 - cardio assessment
0:15 - end of session

Now, to be quite honest, I thought that it would be sufficient to get far enough into the assessment by the end of the 15 minutes. After all, it was only practice and if you want to be a nurse who follows the McGill model of health, you want to be holistic, man! That means asking a whole ton of questions that, believe you me, my family doctor has NEVER asked me. I can only assume he has either a magic crystal ball or a private investigator at his disposal.

So there I was, being all professional and interested in what he had to say and good grief, how much he did have to say! It turns out that my standardized patient was actually a cardiologist on his day off who had made up an intricate and compelling background story to his character and was determined to say all of it, damn you and everything else.

It was like that episode of Frasier when they were trying to do the radio play.
Frasier: A gun! A gun is what he's got. When the lights came back
up, a smoking gun lay on the table. The maid lay dead,
unable to name her killer. Nigel Fairservice lay mortally
wounded.
Gil: I'm dying!
Frasier: Poor man was gone.
Gil: Never again to visit the scene of my boyhood in Surrey,
romping with my school chums in the fens and spinneys...
Frasier: Just then the lights went out again. [gun sound] Nigel
Fairservice was shot again.
Gil: Only grazed me. When the twilight bathed the hedgerows like
a lambent...
Frasier: [creates another shot] The final bullet, blew his head clean
off his shoulders. All right people, let's try to keep calm
although it's hard when the killer is among us.
Gil: [walks over and makes the door sound effect] Hi-ho, I'm
Nigel's brother Cedric, who I haven't seen since my boyhood...
Frasier: [creates yet another shot] And so died the last surviving
member of the Fairservice family.

[In Frasier's apartment, Martin and Daphne are still listening in
disbelief.]

Martin: Boy, I sure didn't see that one coming!
Gil: [radio:] Hello, I'm the ice cream man. Years ago I went to
school with Nigel Fairservice. We used to romp in the fens
and spinnies... [gun shot]

Not that I blame the cardiologist. I myself have a tendency to create intricate storylines for trivial roleplaying and lab reports (the journalist who went to Russia for 6 months and caught tuberculosis while dallying with a consumptive hooker, hello?). What if his secret passion was acting and the only way he could let it out was to volunteer himself for these sessions with student nurses and doctors lest he die of never being able to fulfill his dreams? Oh the tragedy!

See what I did there? It's like I can't stop.

I came out of this revery when the voice came over the PA system telling me that I had FIVE minutes left and the standardized patient had JUST finished answering all my questions. So I washed my hands, did the vital signs as quickly as I could and started palpating the precordium (5 landmarks of the chest used for the assessment). The final obstacle, which just made me want to laugh and cry at the same time, was that the man was too muscular. I couldn't feel the intercostal spaces! So I just imagined in my head where they would be and palpated the chest anyway. Like I could feel anything through at least 4cm of pectoral muscles, really.

It was awkward, feeling this man's chest without saying anything, so...

Judy: You're very muscular.
Client: Oh really? I've been reading the Men's Health magazine [indicates one sitting on the table next to him] and I look nothing like those guys.
Judy: Well, they probably spend 4 to 6 hours working out everyday.
Client: The women in it are extremely buff.
PA System: END OF SESSION. BEGIN DEBRIEFING.

The comments I got were that I was very methodical and thorough in my questioning, but that I needed to be more aware of the time. I was very good with taking the vital signs, but that if they were normal, I could reassure the client with the results instead of just moving onto the next procedure.

In brief, I listen a little too well, it seems, which makes me an awesome McGill nurse, but it's not very practical in the real world. Hmm. Do you know what I say to that? If you're going to teach me to be a holistic nurse, give me more than 15 minutes to do an assessment. 5 more minutes would have been a huge help, in my case. Anyway, I learned a lot from my first standardized patient encounter and definitely have some things to work on, but I'm getting more confident day by day.

Oh yeah, I should be getting my scrubs in a few weeks. They're not as ugly as I thought they would be, which is a comfort. I must get back to work on a family interview report that rivals Alexandre Dumas novels in their intricacy and drama!