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  3. I was a second-year medical student at the university, and was on my second day of rounds at a nearby hospital. My university’s

I was a second-year medical student at the university, and was on my second day of rounds at a nearby hospital. My university’s

admin2015-05-11  83
问题     I was a second-year medical student at the university, and was on my second day of rounds at a nearby hospital. My university’s philosophy was to get students seeing patients early in their education. Nice idea, but it overlooked one detail: second-year students know next to nothing about medicine.
    Assigned to my team that day was an attending—a senior faculty member who was there mostly to make patients feel they weren’t in the hands of amateurs. Many attendings were researchers who didn’t have much recent hospital experience. Mine was actually an arthritis specialist. Also along was a resident(the real boss, with a staggering mastery of medicine, at least to a rookie like myself). In addition, there were two interns(住院实习医生). These guys were just as green as I was, but in a scarier way: they had recently graduated from the medical school, so they were technically MDs.
    I began the day at 6:30 am. An intern and I did a quick check of our eight patients: later, we were to present our findings to the resident and then to the attending. I had three patients and the intern had the other five—piece of cake.
    But when I arrived in the room of 71-year-old Mr. Adams, he was sitting up in bed, sweating heavily and panting(喘气). He’d just had a hip operation and looked terrible. I listened to his lungs with my stethoscope, but they sounded clear. Next I checked the log of his vital signs and saw that his respiration and heart rate had been climbing, but his temperature was steady. It didn’t seem like heart failure, nor did it appear to be pneumonia. So I asked Mr. Adams what he thought was going on.
    " It’s really hot in here, Doc," he replied.
    So I attributed his condition to the stuffy room and told him the rest of the team would return in a few hours. He smiled and feebly waved goodbye.
    At 8:40 am, during our team meeting, "Code Blue Room 307!" blared from the loudspeaker.
    I froze.
    That was Mr. Adams’s room.
    When we arrived, he was motionless.
    The autopsy(尸体解剖)later found Mr. Adams had suffered a massive pulmonary embolism(肺部栓塞). A blood clot had formed in his leg, worked its way to his lungs, and cut his breathing capacity in half. His symptoms had been textbook: heavy perspiration and shortness of breath despite clear lungs. The only thing was: I hadn’t read that chapter in the textbook yet. And I was too scared, insecure, and proud to ask a real doctor for help.
    This mistake has haunted me for nearly 30 years, but what’s particularly frustrating is that the same medical education system persists. Who know how many people have died or suffered harm at the hands of students as naive as I, and how many more will?
While the author was examining Mr. Adams, all the following symptoms caught his attention EXCEPT
选项 A、moving difficulty.
B、steady temperature.
C、faster heart rate.
D、breathing problem.
答案A
解析 细节题。由题干中的Mr．Adams和symptoms定位至第四段。该段第一句就提到他“sweating heavily and panting”，即大汗淋漓，气喘吁吁；在第四句作者检查生命体征记录时又提到“his respiration and heart rate had been climbing，buthis temperature was steady”，即他的呼吸和心跳越来越快，但体温却依旧稳定。可见，作者对于体温、心跳和呼吸都注意到了。虽然作者在第二句提到亚当斯先生刚刚做完髋部手术，但并没有明确提到他行动是否困难，故[A]为答案。
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