Long Reads

Confounding, Perplexing, Conclusion

Today, I gave my CPC presentation. I think it’s supposed to stand for Clinical Pathological Correlation…or was it Case Presentation Conference? Despite my lack of certainty on the acronym’s meaning, a CPC is kind of a capstone project for the Pediatrics component of my residency program.

Screenshot of pager displaying announcement for my CPC.
Any reports of amazingness have been greatly exaggerated.

An attending physician assigns a senior resident the task of diagnosing and treating a difficult clinical case, a puzzle that—over multiple conversations with the mentor—will send the intrepid trainee on a meticulous search for research papers and laboratory tests that lead to a solution. In addition to challenging the resident’s clinical skills, presenting the journey and its conclusion aims to also leave the other residents with a few valuable learning points.

I have been looking forward to this for a while and was very excited to hang out with my mentor, Dr. Begem Lee, one of the hospitalist attendings, to have coffee and talk about my progress as I went along. We’re relatively close in age; I appreciate talking to people who, only a few years prior, walked the path I now travel.

Especially after the year began with a spectacular CPC by my Neuro Bro Adam, I started imagining pulling off my own perfect presentation, complete with physiology diagrams, beautiful animations, and the presence of family and loved ones.

Unfortunately, COVID-19 happened. Hospitals closed their doors to visitors, CPCs turned into Zoom meetings, and homemade fabric masks became the season’s hottest fashion accessory. Residents, however, continued to work, making it easy to overlook the changes developing around me—I had a difficult time accepting that things were going to be different for my presentation. Previously I had shared the date; Rachel even took off work well in advance. But I had since stopped mentioning it to anyone; a message containing an online meeting link lacked a similar gravitas.

I went back and forth with Dr. Lee via email for a while until our communications were interrupted by my scheduled two-week vacation-in-place, during which I worked entirely on non-academic projects. As refreshing as that was, it put me another two weeks behind on my CPC progress, leading to a profusion of emails and text messages the week I returned to work—and a subsequent Douglas Adams whoosh of deadlines.

I love deadlines. I love the whooshing noise they make as they go by.

Douglas Adams (as quoted in Hitchhiker: A Biography of Douglas Adams by M. J. Simpson, 2003).

Despite my extensive medical workup, as recently as last week I was convinced I wasn’t going to be able to figure out what was going on with the patient (partially because so many otherwise-diagnostic tests were coming back negative). My chief residents kept asking to see my slides. Horrifically, they eventually asked if I thought I would need to reschedule the presentation, which I of course denied. Then, lo! I found a fantastic paper that convinced me the only way I would be able to determine the final diagnosis was to request a biopsy of the brain.

After discussing with Dr. Lee over Zoom, I re-activated my PhD powers in a mad rush to complete the presentation, spending at least twelve of the twenty four hours preceeding my 12:30 Stage Time on my slides. “Michael is going to completely faceplant” must have been an escalating concern for my poor chiefs: they only got my slides this morning. At 12:22 I still wasn’t in the conference room, promping a worried text:

Please come to your own cpc !!

Chief Resident Pat Passarelli

By 12;25, I was a masked whirlwind bustling through the door, ready to begin.

Everything went well. Once the initial nervousness wears off, I enjoy giving academic talks. A number of my colleagues were able to attend in person (socially distanced, of course). One resident, David Balyozian, nodded approvingly throughout, while Rachel and Mark attended through the Portal of Zoombles.

I received a number of positive comments afterward that can be summarized as, “You did a great job. I can’t believe you pulled it off!” Clearly I had set expectations low, as they seemed genuinely surprised.