MedMusings

So this regular routine I have to fall asleep at the computer late at night usually means waking up with an array of flashing lights of msn chat windows, and every now and then there will be someone whom I haven’t seen for ages asking some medically related questions. Usually it’s an itch, pain, “secretions”, burn, etc.
A couple of nights ago, I woke up at 5am to this:

random question
if yur pregnant would you still be able to have yur womans? or vice versa

Here’s hoping the best for this kid. Bleh.

So I did the K10 after we sat around on the saturday night discussing our various depressions.

I don’t know what it is but I seem to be losing motivation. I can’t get the thought of studying out of my head. Whereever I am. However, i can’t bring myself to actually study so I sit and stare.

I miss

Update: OK, so I just found this draft post that’s been sitting here since.. er…. July last year. I’m sorry for the sentence incompletion. Would you like to complete it for me? haha

Things I’ve learnt during my medical term of geris and gastro:

- walk faster
- turn your phone on silent when in the company of consultants
- nobody has time
- nurses get you to sign forms off for them thinking you are the JMO (of course, you’d refuse with professionalism! =P)
- regarding taking blood, before you remove the needle: REMOVE THE TOURNIQUET!!!
-don’t make old italian men angry
-never EVER let your dog lick your open wound. (some old guy came in with sepsis and stayed for a week because nobody could figure out what organism was in the blood culture…until they tested for dog flora or something..)
-always have foodbars handy
-accept it, scrubs will never fit you (maybe this one is just for me lol)

Ok, well as you guys all know, I was very much looking forward to geri’s. My expectations were:
1. all demented with lots of falls
2. lots of chronic illnesses
3. lots of drugs
4. typical pathology i.e. standard infections, pneumonia.. blah blah

And yes, the week did start that way.. it was pretty slow and 2 days in I was kinda thinking.. oh gee.. this place is sooo repetitive…
Anyway, my advice is this: DON’T TEMPT FATE.

While numbers 1-3 is true, 4 is SOOO far from the truth. The thing with geri’s is that they all present with seemingly “straight forward” presentations and then you realise after that they do not have what you think they have. Your medical judgement based on classic clinical signs and symptoms just pretty much shot out the window.

Case A:
89 y/o female came in with increasing dementia, especially in the past month. Typical.
A few scans and lab tests later… she was Dx with Lewy body dementia. Makes sense, clinical findings fit. Score! One ready for discharge.
5:00pm as we were winding down and getting ready to go home.. call comes in, “Oops.. she tested +ve to CJD”
Brain thinking.. HUH?!?!?!?!
Then realised: her dementia is due to manifestations of CJD.. something with an incidence of ONE per MILLION in a year.
Guess she’s not going home anytime soon…

I dunno what you guys mean by scooting off early every day either.. I find myself leaving the hospital later and later as the week progresses. Yesterday as we were getting ready to go, our man with recurrent aspiration pneumonia and in palliation started having seizures. At the same time another one went into AF and we get a call about the CJD lady.
Oh, not to mention the meningococcal scare we had – this woman was admitted under our team with decreased mobility and increased confusion (very typical) and a rash localised to one limb. We were all in contact with her.. so my reg and intern was freaking out. Anyway, it turns out the rash was due to some one in ED leaving the BP cuff on her for too long.

So, moral of the story: geri’s present with typical signs and symptoms but have VERY ATYPICAL Dx.

I just realised I haven’t explained the title. We were doing an MMSE on this lovely gentleman who decided to write that as his sentence to us and then started laughing hysterically. Cute.

That’s it from me. Have a good weekend guys!

So after a week of averaging 3hrs sleep, my student email read like this:

Dear Students,
Please ensure you are appropriately dressed for the physical examinations carried out by [name of teaching hospital] on Monday 27th April. You will be in a clinical setting with volunteers so this should be taken into consideration.
Thanks again for your co-operation.

So the first 3 questions that came to mind:
1. Why in the world are we getting physically examined??
2. In front of volunteers?!?!?!?
3. Appropriate clothes meaning….?

In panic attack mode I alerted my fellow friend, with the following reply:

..physical examinations carried out at the [name of teaching hospital] …you idiot..on volunteers..

oh.
OH.

Well that’s a relief.

I finished up my GP placement today (since it is a public holiday next Monday) and it was a bit of mixed feelings. On the one hand, I was inspired by the doctor – my teacher – for his level of care, concern and genuine interest in his patients and the impact he made on their lives. It was a good surprise compared to the cynical ones I have met. Yet, I cannot blame them, the system doesn’t help..

On the other hand, the repetition bored me at times a great deal. In particular, the ridiculous mountain of paper work, bureaucracy, and the amount of hoops that a GP has to jump through.. is quite annoying. I feel for them.

I’ve been doing lots of venopunctures, IM and SC injections. I’m getting better at finding veins..just need to learn how to coordinate and stabilise needle. Hopefully I’ll pick up that skill with more practice.

My time there has been varied with the kinds of patients I have met.

The Apologetic Patient (Who always apologises for “wasting” your time with “minor” complaints)
The Anti-Medical Intervention Patient (The ones who refuse to step foot inside a hospital despite raging infection causing massive inflammation and swelling making one limb unrecognisably double the size of the other)
The Screaming Patient (Mostly young kids and babies..had a boy today who would scream at 30 seconds intervals and would continue screaming until the mother shouts his name. A.D.D much? =/ )
The Grandmotherly Patient (The elderly who just looks like they can make a good old fashion cheesecake really well, I particuarly like these ones! ^^)
The I-Can’t-Believe-You-Are-Still-Standing Patient(These are the ones with multiple complex health issues that just amazes you at the tolerance of the human body and the resilience of the human person. Had one person with bipolar disease, chronic hypertension, hypercholesterolemia, type 2 diabetes, hyperthyroidism, chronic severe asthma resulting in a cocktail of daily medications. I’m sure there are patients who are worse in the hospital setting, still, yikes!)

All in all, the doctor has taught me and reminded me that it is about the people. I never forget my teachers, and I will never forget this one.