'By the way,' says the attending, 'she doesn't have guarding. So in your note, no guarding, no rebound. Got it?'
'But she did have guarding', I said.
'Involuntary contraction of the abdominal muscles with palpation', I said without hesitating. I had felt it, although it was brief.
'She didn't have guarding. If you distracted her, she didn't do it. It's a peritoneal sign. Maybe you're just a such a terrible brute,' he said, in fun.
'True guarding is rare', said the other resident, a year ahead of me.
This is why we have residencies. This is why Osler said that seeing patients without reading was going to sea without a rudder, and reading without seeing patients was like never going to sea at all. The 'true' signs we read about are dramatic and real. Guarding is a peritoneal sign; that is, some abdominal catastrophe is occurring. This lady either had reflux or gallstones. Neither one is a catastrophe. Annoying, painful. Not a full-blown catastrophe. I got schooled, but I can take it easily from that attending. He was taking night call on the floors at Beth Israel when I was still eating crayons and pureed carrots.