MedMusings

Vietnam War. 1969.
21 year old soldier. Mr X.

Landmine disaster.
Coma 18 months.

Left-sided paresis (weakness).
Dysarthria (difficulty with speech).
Intellectually 100% OK.

Nursing home.

Doctor’s office. 2009.
Pain.
Understood what the doctor meant and all.
Communication. Big problem.

Vomited in the consult room.
Cleaned by other people.
Sorry.
So sorry.
___________________________________________

Hospital. 198x.
Toddler. Miss Y.

Septic arthritis.
Damaged hip.

Contracture.
Leg length discrepancy.
Pain.

Wheelchair. Crutches.

Doctor’s office. 2009.
Femur corrected.
Tibia lengthened.
Ilizarov external fixator frame taken off.

Wound OK.
Knee flexed more than ever.
No pain.

Joyful tears in Mum’s eyes.
___________________________________________

Patients often don’t die in orthopaedic setting.
But their quality of life can be heavily affected.
As shown in real life.

“I’m dying.” seems to be the phrase of the month, or the term. Especially before i have my coffee after waking up at 545am after >12 hrs surgical shift and <6 hrs sleep.

but aren't we all dying all the time? it just depends on what rate you are talking about. =P

X

army uniforms (baggy pants) are awesome. they have infinite number of pockets everywhere. imagine how much i could fit in them!

i want a pair of those!

ooh! and consulting in the army makes me wanna play Red Alert again. yeap, that's where i learned a bit about the army and combating.

X

i can't stop dreaming about medicine. i dreamt of being quizzed by my surgeon yesterday night. geez, subconscious stress/worries.

and i have been having dreams of dead people. Me performing CPR on a dead person whose head was completely dissociated from his body.
WTH? You need lungs and heart to make CPR work?! DUH!

and they are not even nightmares.

X

dreamt of myself having really bad leg cramps (long surgical hours got into me in my dreams too!!). and somehow woke up with a sore calf. spooky.

on the same night, dreamt of having a boyfriend, who is waiting for me all the time cos i'm always late for dinner. (med life eh?)

sucks! so i woke up with a sore leg and feeling empty inside. great.

medicine should stop invading my dreams. GO. AWAY.

Interesting stories from 6 weeks of cardiology:
- A 20 year old non-obese guy admitted with what looks like a massive MI from his drug use, turns out he didn’t have MI, but more of myocarditis. Still, if he doesn’t stop the drug use, we’ll see him again.
- A lady in his 50s occasionally had this funny turn of ‘thousand bubbles buzzing upwards into her head and her ears’ for the past 3 years, turns out everytime she has the turn, her heart was actually stopped beating (asystole).
- A gentle ex-prisoner who had a heart attack but refused to stay in hospital & hence medical treatment because he wants freedom, and to use his legs while he can.
- A war veteran who initially treated me rather coldly, was quite rude to everyone on the wards, non-compliant and overly-defensive at times, said to me by the end of his stay that I was the only person who seems to respect him and didn’t treat him as someone stupid. I couldn’t help but feeling so proud of myself because all the effort that I put into trying different approaches when interacting with him paid off.
- A non-compliant old Italian man pulled out his IDC (In Dwelling Catheter) by himself, ouch!

Things that I’ve learned for the past 12 week Med rotation (beside those mentioned before):
- When putting in a cannula, never forget to take the tourniquet off, and APPLY PRESSURE ON THE TIP OF THE CANNULA before withdrawing the needle out
- Try to explain to patients why you are doing the procedure (eg: taking their blood specifically to test of XX levels/putting in cannula because you need XX drip etc.) beforehand, they really appreciate it!
- veins roll!!~~ chase them down.
- JMO’s job is hectic. It’s fun to be the JMO for a day or two, not fun for 4 days straight!!~~~ It’s a different story if I get paid.
- So much time is wasted chasing report/letters/investigation results from other health professionals/agencies.
- Hospital cannot function without phones and fax machines.
- It’s not fun when Powerchart is down, or when the printer is down, or worse still, when the computers are down!!!~ argh~~~~

We had an ex-prisoner admitted to the wards that day.

He isn’t totally free, still under supervision, with a bracelet attached on his ankle and a box, probably some sort of tracking device.

But he’s one of the nicest patient we have of the week. Like a very gentle Santa Claus. As opposed to some of the grumpiest, most aggressive, over-defensive, non-compliant patients we had throughout the week.

Which made me think:
ex-prisoner – nice guy
non-ex-prisoners – pain in the a**

anyhow, unexpectedly, his troponin level was found out to be very elevated, with ECG changes that indicate a possible NSTEMI. So we advised him that he would have to stay in the hospital for a few more days for an angiogram.

He refused straight away. He had the procedure before, had some bleeding and hated the fact that he had to be bed-bound for half a day or so.

The bleeding wasn’t his main concern, it’s the fact that he’s staying in the hospital that bothers him.

“This is like where I come from. You know what I am saying?”

“I appreciate your concerns, and I understand where you are coming from. But you don’t understand. You have to see it from my point of view. I’m going to lose my left leg soon because of my sugars, I just want to get out there and use them when I still can.”

“I cannot live without my legs. I’ll rather die if I can’t walk and run around.”

“I honestly don’t care if I die tomorrow.”

So he discharged himself against medical advice.

Such a different perspective. It was very hard for me to comprehend, but for one moment there, I understood and felt for him.

I wish him well.

8 weeks into hospital, I’ve come to a conclusion:

the hardest thing in year 3 is not the studying/patients/hospital work, the hardest thing is learning to juggle medicine and life.

I hope everyone still doing well.
I feel like i’m at the brink of collapsing, sometimes.

On another note, cardiology has been awesome!!~
it’s true that they are the only physicians who like to think of themselves as surgeons. hahaha…

angiograms & angioplasties are awesome!!
electrophysiological studies are not too bad too!

what surprised me the most though is that it all sound simple and straightforward while studying cardiology in the textbooks, but in reality, there’s soooooo much depth in this field!!!~~~~~

4 weeks to go before holidays….

“So, you are our mystery man!”

“Am I? Maybe I should keep on being one.”

It’s all jovial and cheery in the beginning of the consult.

Then 5 minutes later, the whole situation turned 180 degrees around.

Metastatic disease of multiple vertebra.
Where is the primary malignancy? To what extent the cancer has spread?

It’s a huge shock. Not only to the patient, but also for us. If only we’ve read the MRI report before he came in, maybe it wouldn’t be such a drastic change of atmosphere.

To someone in his mid-40s, no major health concerns, not even back pain, referred to an endocrinologist for an incidental finding of sclerotic vertebra (?osteoporosis ?vit D deficiency) on abdomen CT scan, the last thing we expect is this.

Worse, he has to endure 3 days (damn you! long weekends!) of uncertainty, as well as trying to just digest the bad news, before getting further investigations done next week.

It’s all too easy when we explored ways of breaking bad news to actors acting as patients.

In reality, it’s devastating.
It’s one of those times that reinforces the humanity of medicine. Textbooks thrown out of the window.

And at the end of the day, it’s all about people.

“Can I kill her?”
“I swear I’m going to kill her after this.”

So, I had a patient saying this to my fellow buddy while I was doing a Mini Mental State Examinaion on her. She was of course implying about me.

Hear me people! Asking someone to do maths or subtract 7 from 100 for 5 consecutive times makes people crazy.

Hmm… That’s funny. I’ve never thought the first person to threaten me would happen in the hospital. Why am I doing Med again?

BUT, she’s also a patient who laughed and giggled hysterically when the 2 pentagons she drew looked like a guy’s “dick” (in her own words).

She wasn’t stoned. (Probably has some sort of toxicity from gentamicin.) She also likes to watch Inspector Rex (in French), and nope, she wasn’t serious. Or so I hope. haha…

Ah!~~ Colourful patient keeps the day alive!

We see so many patients on the wards all the time in hospital, sometimes I forget that it is actually a big deal being admitted into the hospital. Their family often required to take time off work to stay with the patient, take care of the patient etc.

Everything has to stop.

I was reminded this today when I heard the news that one of my previous supervisor has taken long service leave because her partner is admitted to a palliative care unit. I was reminded for the past few days in the wards when I kept seeing the husband of a patient around the hospital grounds. I was reminded again and again by patients who have so many doctor appointments to attend, each of them with the support of their family, not easy nonetheless.

We only spend 10 minutes or so of our time with these patients everyday, but their family are the ones who have it hard, dealing with them 24/7. So compared to them, our job is actually relatively easy.