Security was fairly tight at the Scientific Assembly for the American College of Emergency Physicians. Not that I tried to barge my way into the conference—I merely noticed the many, many suited men who stood guard at the glass doorways and escalator bases at the Washington State Convention Center.

I also noticed the many, many attendees of the conference. It was simultaneously comforting and disturbing to know that there were probably hundreds of emergency room employees collected in one place.

Though I had just seen my emergency medicine resident friend in New York City a few weeks ago, we had the chance to catch up. I don’t know when we will see each other again. That sounds more dramatic than I intend, but it is entirely true. I had the opportunity to slip away from work and chat with him in the foyer while dozens of emergency room personnel streamed past, all looking calm, focused, and serious.

He and I met as interns and our encounter at the conference reminded me of the following incident, which I originally wrote about in December of 2004. (This friend is “my fellow intern”.)

(And I am proud to write that I have not committed the error described below since!)

I received the text page on the bus:

Sorry, Maria. A patient was transferred from the consult service to the inpatient service. I put her information on the computer patient list program. Basically, we’re trying to figure out if she has Obscure Diagnosis #1 or Obscure Diagnosis #2. Call with questions.

My fellow intern had left a thorough summary on patient list—but I was still concerned that I would not know how to answer any phone calls overnight. What if badness happened? I had never even seen this woman before.

I was paged at 3:00am (and, as usual, bolted upright in bed, totally disoriented and confused) regarding another patient. I spent the next two hours tangled in an unpleasant dream that involved me riding a bike to the airport, luggage on my back, panicking because I had missed a flight.

My conscious stress is now contaminating my sleep.

The bus was late this morning and I flew through the hospital, checking up on the inpatients (”pre-rounding”) prior to the team meeting (”rounding”). I checked my list to learn of the location of The New Patient.

Sixth floor, Northeast wing, I read.

Her name was misspelled on her door. I opened it gingerly and spied an elderly woman laying in bed.

“Hi, New Patient,” I said. “My name is Dr. Maria and I am one of the other docs on the neurology team. We didn”t have the chance to meet yesterday, but I’m just coming by to see how you’re doing.”

She was completely non-plussed.

“Can I examine you?” I asked. It’s not really so much of a request as it is a statement of intention—but most patients oblige.

The New Patient acquiesced. Lights in the eyes and mouth, cold hands on warm skin, stethoscope over heart, gentle mashing on stomach. None of this had anything to do with either Obscure Diagnosis, primarily because both Obscure Diagnoses cannot be assessed with the physical exam.

I thanked her and said, “The whole gaggle of white coats will be around in about an hour.” It’s my usual line to patients in an effort to warn them of our descent upon their diseased bodies.

She grunted her agreement, rolled over, and was silent.

About an hour later, I led the team (like any other good intern) to The New Patient’s room. I looked at my sheet and realized that she was young—not even 50 years of age.

“She’s not even 50 years old yet?” I asked, totally surprised. The woman looked well over 70 years old, complete with white hair, many wrinkles, and that papery, atrophic skin. The consult portion of the team—which included the same attending—had seen her yesterday. I was the only one who had not seen her and as such, she was basically unbeknownst to me. I wasn’t even completely sure of her story.

“Yeah,” my attending replied. “Steroids.”

“WOW,” I breathed. I knew steroids were harsh on the body, but this woman looked old.

We approached her door and I gallantly swung it open (like any other good intern). The team stopped in their tracks and the attending said, “That’s not her.”

What?

“Uh… sorry,” I apologized. But… but… the sheet said that she’s in this room…

“She was in this room yesterday, but that’s not her,” my fellow intern said, grinning at me.

Well, that would certainly explain why I thought she looked much older than she really is. Since she’s not the patient, anyway.

So yes, it was embarrassing, but the repercussions for the patient are probably worse. Some random doc went into her room this morning and examined her. And patients have so much faith in the system that they will let anyone in a white coat touch them.

Why she responded to another woman’s name, I’m not sure, but anyway—

But you see, when her real docs went in to examine her later on this morning, she might have said, “You know, this doctor I’ve never seen before came in this morning and examined me. Who was she? And why did she come in? Something about neurology?”

If she even caught that much.

And then her primary team will nod, smile, and shrug, but once outside her room, will say, “What is she talking about? She’s delusional. Or hallucinating. She’s nuts. Psych consult!”

It is so, so wrong.