Ask me or any other medical student and they will assure you that we live in world of clinical vignettes. Starting as early as our first year we are promised “clinical” integration of our curriculum. That is, after all, why we showed up. Sometimes this desire for integration can border on the absurd. I have to note that putting the words “a patient presents with . . .” before a question about cardiac sodium channels or first-order drug metabolism does not magically transform a basic science question into a “clinical” one. I was a fourth-year medical student about halfway through my second elective in emergency medicine at Hennepin County Medical Center and starting to get the hang of things. On a late evening in one of the lower acuity areas I “picked up” a 39-year-old gentleman who was feeling horrible. He complained of chills, an occasional dry cough, headache, myalgias, and malaise. A quick peek at the computer told me that he also had a fever. My patient began to ask me knowing questions about my upcoming rotations and then revealed that he was a nephrologist. I cheated. “Well doc,” I said, “what do you think is going on?” “I honestly have no idea,” he said. At that point neither did I, but it was physical exam time. Head, neck, heart, and belly were all unrevealing, but he did have some crackles in his right middle lung field. I mentioned this to my physician-patient. “Really?” he said. “Yep,” I replied, “what do you say we start with a chest x-ray?” He laughed weakly and said, “sounds good to me.” Sure enough, there on the chest film was a right-middle lobe infiltrate. I wheeled one of the computers into his room and pulled up the image. We had our answer—and he soon had a flouroquinolone. For a medical student it was a pretty cool experience. History, targeted physical, appropriate studies, treatment plan, disposition—it was just like in the books. I could almost see it in my mind as a test question: A 39-year-old male presents with 2 weeks of fever, cough, and malaise. He has crackles in his right lung and a right-middle lobe infiltrate on CXR. What is your diagnosis? It actually gave me pause for thought about just how rare such experiences are in medical school. In point of fact we spend a lot of time collecting vitals, following residents around, and trying to write progress notes. All that stuff is part of the master plan of course, but we never lay in our college dorm rooms and dreamed of collecting lab values. We never pushed ourselves through organic chemistry with thoughts of holding a retractor in one hand and the suture scissors in the other. We did not walk into the MCAT with a burning desire to write discharge summaries. Most of us figured that at some point we would get to actually play doctor, meaning that some sick person would come in to see us, we would figure out what was wrong, and then we would fix it. The emergency department is one of the few places in medicine where such scenarios play out all the time. If you are an attending physician, or even a senior-level resident supervising a medical student, and you see that light go on in his or her head, I would humbly ask you to think of this piece. That student has lived in a world of “clinical vignettes” for years but may be feeling like a physician for the very first time. For those of you who don’t remember what that feels like, it’s awesome.