The Mental Status Exam

            As we all know, strokes are no laughing matter, nor is ending up in the emergency room. 

            It was my first call on my neurology rotation.  Being on call as a medical student means very little, at least on this service.  You work 4 extra hours, from 4-8pm, and you follow around a very frazzled-looking intern as he checks up on all the different patients from the different teams.  My biggest challenge of the night was simply finding the guy with whom I was assigned to follow.  After going to all the usual places, I finally found him in the Emergency Department.  After a brief introduction, he sent my off on my first task of the night—to do a Mini Mental Status Exam on a patient who came in for a stroke. 

            Among the organized chaos of the ED I found the patient in room 7, lying quietly in his bed.  I approach and introduce myself (Introducing yourself as medical student is tricky business.  You can say, ‘I’m just a medical student’ and risk losing all credibility [not that I really have much at this point].  Or you can say ‘I’m student-doctor Katie,’ and hope that gives you a little more credence without the responsibility.) and then began the assessment. 

                        What is your name?

                        What is the day?

                        Spell WORLD backwards

                        Make up a sentence. 

                        Draw these two blocks intersecting…?  ( I didn’t make this up)

            It all seems rather basic, but it does give you a good picture about the possible damage you might be dealing with.  Luckily this guy did pretty well and I had good news to report back to the attendee.  Apparently there is quite a bit more to the assessment, so back we went for round two, except this time asking much more detailed questions as well as examining strength and reflexes.  He was answering some questions right, and some questions wrong, but that was to be expected.

 At one point in the conversation, the resident asked what seemed to be a pretty straight-forward inquiry.  “Sir, what color is the sky?”

The patient looked up at him, a smile slowly creeping onto his face, as he answered, “Well to be honest, doctor, it all depends on the weather.”

I tried with all my might not to laugh too loudly while the resident suppressed a smile with his best effort.  It was definitely not the answer he was looking for, but at least his wit and humor were fully intact. 

It’s difficult to find anything to laugh about in the hospital sometimes.  When people are sick, usually they are really sick.  The rare light-hearted moment amidst all the somber ones can really brighten a day!