“So, how would we test for PBC?” my professor asks from the front of the room.
The small-group teaching room is quiet, the air still and heavy as the lunch in our bellies steals the blood from our brains. Some of us are recalling that the disorder was mentioned in class; others are racking their brains for three words that might fit the acronym, but none are going to attempt an answer. Eyes dart across the room, ducking behind the shield of a laptop screen, peering up to the ceiling or nestling between furrowed brows of a hopeful but knowingly futile search for the answer.
I look down to concentrate on contorting my own face into the perfect representation of thoughtful introspection, a skill I have honed over the past few months of medical school small-group discussions. The key is in the details: my squinted eyes signify the careful path of logic I’m traversing to reach an answer, and the hand resting across my mouth and chin demonstrates my frustration for innocently misplacing such a piece of information.
You’re nailing this, Chris. You definitely look smart enough to be here. And kudos for your speed off the block with that “malignancy” contribution to the differential a few minutes ago. There’s no way he’s going to call on you now. Just hold on a few more seconds, and you’ll be home free.
Right at that moment, my eye catches something spectacular. There it is, the corner page hanging out of my notebook, with the dark blue scribbles of my class notes from two days earlier: anti-mitochondrial antibody = diagnostic for PBC.
I can’t believe it has just appeared to me like that. This has to be Divine intervention. I quickly look up at my group mates to figure out how much time I have. The discomfort on their faces is getting stronger: I have time.
Okay, calm down, Chris. Keep a cool head here, and you just might pull this off. You’re holding the holy grail in your hands: You can let it carry you to glory, or you can squeeze too hard and watch it crumble under your grip.
Don’t just blurt out the answer: It’s been far too long a pause for anyone to buy that. Remember, they still don’t know you’re an impostor. Make it come across like you just organically followed your clinical logic and intuition. Yep, that’s it. That’s what you’re going for here. Astute but not arrogant. Intelligent but eager to learn: The perfect medical student.
Maybe start with a qualifier, something like,“I could be way off here, but…”
No, even better! Phrase it as a question. Give your adviser a chance to explain it back to you, and then hit him with the ol’ eyes closed smile-and-nod to show how it all just came together. It’s a win-win. Alright, it looks like he’s about to call on someone. It’s showtime.
“I could be way off here, but since PBC is an autoimmune disorder, couldn’t we diagnose it with an antibody test … perhaps, the anti-mitochondrial antibody?”
“Correct, Chris. Excellent.”
Oh yeah that’s the stuff — that sweet, sweet validation every first-year medical student is chasing. Yesterday, my professor responded with “good question” when I spoke up in class, and now this! I’m on a roll. I wonder if they give a specific award for being at the top of the class? Probably not, but a personal phone call from the dean to my residency of choice will certainly be useful. I hear Baltimore has a rat problem: Maybe Harvard really is the better choice. I just wish it was wasn’t so cold there in the winter. I’m getting ahead of myself, I should just savor the moment and appreciate how far I’ve come. Maybe I really do belong here after all…
Oh no. Why is he still looking at me?
“And so why would that be?” the professor probes.