不少单位面试的时候会要求你给一个有趣的病例，我在临床时间比较长，这是我的强项，所以即使没有要求我谈病例的地方，我也会想办法拿出一些有趣的病例来谈。比如，问到 What is your strength and weakness？的时候，你干巴巴的说几个词出来，显然是没有影响力的。这时候，我就会说: I am enthusiastic, I pay attention to details, bla, bla, bla……然后，我马上就会开始讲故事来说明这些优点和缺点。另外，如果面试时间足够长（特别是病理面试），你肯定得准备很多有趣的话题来谈。我面试前分别为内科和病理准备了6个病例故事，写出来，并且打印出来随身带着去参加面试，根据需要随时都可以很流畅地讲出来，也根据面试时间随时调整讲故事的长短。
I worked as a physician and hematologist in China for many years. A lot of interesting cases were memorable and added to my clinical experiences. But the case I remembered most clearly is this 23 year old male I encountered almost 20 years ago, when I was a second year resident rotating in the division of pulmonary disease.
The patient was a college student with high fever and hydrothorax. He brought with him an PA chest X-ray film from his college clinic which clearly showed pleural effusion up to the third intercostal level on the left side. We suspected it was caused by tuberculosis, which was the most common cause of hydrothorax in China at that time. After a brief history and PE, my supervising attending told me to do thoracocentesis because we realized that it would not be easy to control his high fever and TB infection without first reducing the massive amount of pleural effusion.
Before the procedure, I thought it was important for me to do a careful PE myself. To my surprise, I found that I could hear weak breath sound over the back of left chest, and the percussion sound over that region was not as dull as I would expect from a hydrothorax patient. I reported my PE findings to the attending and suggested a lateral chest X-ray in our own hospital. The attending was not very convinced. He said it was not necessary to waste 2 hours on the x-ray while we were quite sure of the hydrothorax, and the standard procedure was to drain at the tenth intercostal space over the back. I told him that I suspected that the effusion was restricted to the front of the pleural space. If we do needle drainage over the back, we may hurt the remaining lung and make a pneumothorax. I insisted to get a lateral chest x-ray before we could do the procedure. Finally, the attending went to have a careful PE over the chest and then agreed to send the patient to radiology. One hour later, we got the chest x-ray film back. Sure enough, the pleural effusion was restricted to the front half of the chest. I chose an entry point based on the chest x-ray and drained about 1 liter of exudates. Pleural biopsy confirmed TB infection. The patient was put on anti-TB protocol and discharged in one week after his fever was controlled.
My memory of the case lasts to this day. Because I learnt a lesson from this case that, as a physician, we should find an explanation for any unusual clinical findings. A proper management may just depend on those negligible findings. Also, I am very sure that the attending remembered this case for a long time. After I got my PhD degree and went back to my university hospital, the attending was already the associate director of the Department of Medicine. When I applied for a promotion to associate professor of medicine, he gave me a very strong recommendation in the university’s academic committee. He said that I had an exceptional talent and strong potential to become an excellent physician.
What do you think is the reason caused the pleural effusion restricted to the front?