There are so many kinds of interviews. From the factual nature of a journalist’s interview to the nurturing version of a therapist’s, I never considered all the different kinds that exist until now. The quality of interview that a nurse performs is unique in its own right but is also reminiscent of the compassionate contact that a friend might provide. In the didactic portion of nursing school, they teach you an alphabet of acronyms to remember, so that you don’t forget a single sign or symptom to ask for. But OPQRST, MAKING IT P, and OLDCARTS only get you so far. For me, the letters get jumbled in a heap in my brain and I can hardly extract one without tripping over another. It can be difficult to recall that the interview you are conducting is hardly more than a conversation. And most of the information you need will be provided if you just ask the right questions. Most of the questions we are told to ask are basic common sense.
Still, when my new nursing instructor for Med Surg charged us with the responsibility of taking a comprehensive patient history, the task was daunting. I went into my patient’s room timid and bashful, hoping that I somehow, impossibly, exuded confidence. My patient initially seemed reluctant to speak with me, a mere student, after he had shared his story probably a gazillion times before with people much more “important” than me. After a few minutes of probing gently, I was ready to throw in the conversational scalpel and call it a day. I had the basics: his chief complaint was chest pain that radiated down his left arm. He lost consciousness while doing pull ups and didn’t remember the specifics of his initial symptoms, but knew what it felt like when he regained consciousness. His past medical history consisted of a TIA when he was 30 years old, and an amputated leg from 1988. He is currently not much older than 30. Too early for a stroke and possible AMI? It seemed that way to me. Especially considering that he works out religiously, dare I say compulsively, six days a week. Genetics couldn’t be the sole cause of his problems. He is in good shape and it seems impossible that lifestyle factors play a big role. In asking about his nutrition (his cholesterol leaves room for improvement) he reported that he never cooks with salt, prefers to cook for himself than eat out, and consumes vegetables indiscriminately (except spinach, he amended with a shudder). We laughed together, and had a brief moment of friendly banter — about spinach, of all things! Without realizing it, our conversation began to flow. Soon I was able to insert more sensitive questions about drug and alcohol use without an inward cringe that he would close up tight like a clam. He responded well, albeit in the negative for drug use. Still no progress on why he was experiencing cardiac symptoms. Finally, I addressed the elephant in the room, his prosthetic leg.
By this point, our conversation was running smoothly like a well-greased bicycle. I was confident but still faltered over the question, not knowing what answer it would elicit. It was my patient that led the conversation now. He told me the story, with barely a word from my end as I listened and absorbed. As a young, prepubescent teen, he had been playing a game called “quarters” with a few friends on the sidewalk. Oblivious to their surroundings, they didn’t even look up as the events occurred around them in mere seconds that would change the lives of these young boys drastically. A drunk driver ran a red light and was T-boned by a car that had the right of way. The drunk driver’s car flipped up in the air and landed on the sidewalk, where the boys were playing. They were all hit. A few died instantly, a couple walked away virtually unscathed (physically, at least) and my patient was pinned between two cars. He spent two years in a hospital, recovering. One leg was mutilated beyond repair. The other one was in bad shape as well, but miraculously they salvaged it. His skull was “crushed,” although I didn’t get the specifics of what this meant. But suddenly, it all became clear. His early onset TIAs and unstable angina must be due, at least in part, to the trauma and stress he underwent as a young teen. All of this history-taking was essential for complete understanding of his current diagnosis and hospital admission. When I went to his chart, in hopes of filling in the gaps, I realized that I had more information in my head than was written anywhere on paper. Certainly I couldn’t interpret the troponin and creatinine kinase levels as well as one of his medical providers, but I had his background and health history, an essential part of his focused physical assessment. I felt like this was quite the accomplishment for my first day on the floor. I sincerely hope this bodes well for my five-week-speed-read immersion in the catchall speciality that is fondly known as “Med Surg.”
Now, if only I could take 30 minutes for history-taking with every patient, even after graduating from nursing school…Hey, a girl can dream.