Hostility-Part 2

Picture courtesy of Pauline W. Chen MD

Second day of attachment, exhilarated. Woke up at 7 in the morning, It took me quite some time to open up my eyes. Obviously I was deprived of sleep, I was in a state of inactiveness, sluggishness, and fatigue. Forced myself to get up as I do not want to be late, rushed into the bathroom.

I unclothed myself, switch on the water heater and I let the water run down my skin, enjoying each and every moment of that. Brushed my teeth and I was set to go, grabbed my backpack with my anatomy text book and my handbook of clinical examination, I headed to the bus stop.

I was emotionally aroused during these 2 days. I could hardly conceal my feelings of lively and cheerful joy when I get the chance to participate in the discussions led my the doctors, give my opinions regarding the underlying pathology, serving as the co-investigator in the clinic, and of course banging on differential diagnosis. I enjoyed the session where the doctors would ask me questions, forcing and encouraging me at the same time to put on my thinking cap.

" Calvin ( the name I use there), what is the differentials for this patient since he presented with palpitations, pulse 120, sweating and of course you can see that he is so skinny?" asked Dr Caroline who is holding the lab results of the patient.

"Umm..Umm..I don't know doctor", frustrated.

" Its thyrotoxicosis ( Grave disease )"

"Oh, that's why he is having palpitations and excessive sweating" I blurted out.

Darn it, I learnt about Grave disease during my lecture on harmful tissue reactions some time ago. It basically refers to the hypermetabolic clinical syndrome resulting from serum elevations in thyroid hormone levels. The expectations that I put on myself was defeated. I think I should at least be able to recognise the syndrome. The feelings associated with not achieving a particular goal or the belief that a goal has been prematurely interrupted is truly devastating.

As a first year meddie, I am very thankful as I have been given all the wonderful opportunities to see patients, examine them and of course put myself in their shoes, appreciating and understanding the socio-economic status of the refugees. No doubt, the barriers face by the doctors are language, culture, knowledge and of course financial. The clinic is indeed running over budget, staffs are trying their best to cut down the cost in each and every way that they can.

I wanted to document down all the interesting stuffs that I encountered. Not to mention about common cough and colds, diabetes, TB, hypertention and HIV, I managed to witness a few bizarre diseases like thyrotoxicosis, leukemia, chronic otitis media, prolapsed intervertebral disc and many more. Just to highlight a few of the cases that I find interesting, the story of a 16 year old girl being forced into prostitution caught my attention, hence prompted me to name this post "hostility".

Case 1
16 year old teenage girl from myanmar was forced and sold against her will into prostitution and was diagnosed as HIV+ after the first ELISA test was shown positive, comfirmatory test is pending. She was repeatedly abused sexually in Thailand. Serving as a sex slave, she was exposed to a never ending list of STD(sexually transmitted disease). You name it, syphilis, herpes, genital warts. Although she said most of her client was wearing condoms during the intercourse, I doubted it. Hostility is a form of angry internal rejection or denial in psychology. This is what I was experiencing that time. She is just 16, her future is ruined. If the test is still positive for the second time, she would need anti-retroviral treatment. Can she afford it? Counselling session was scheduled for her, counsellors had a hard time breaking the bad news to her.

" Is she mature enough to actually comprehend the whole situation?" I was worried, and at the same time curious about how she will react towards the news.

What is wrong with our society, I kept asking myself. 16 year old into prostitution? That's unacceptable. I was disgusted, stoned for words. When I know that she was not paid for her services, instead she was given new clothes after sleeping with a few strangers, I was utterly disgusted, angry, furious, but at the same time trying to be emotionally detached.

A hostile nation I would say. Sigh...

*****
Case 2

I then met a patient presented with leg pain, swelling at the ankle joint, no history of Fx (fracture) or fall. I laid my hands on the joint and I can feel the warmth around the joint. The temperature is significantly elevated.

"Calvin, common, what do you think" said Dr Kamarudin.

"The swelling and pain might probably due to increased intracompartmental pressure. I think its compartment syndrome." I answered, did not give a second thought about it.

" No history of fall or Fx, so its not" he said in a cynical way.

"Oh rite..I cant think of any of the moment sir"
I hated myself so much at that moment. I did the anatomy of the lower limb together with its clinical applications quite extensively I reckon. My confidence dropped below 0, I think I am not competent at all.

“What is it Sir?”

“Its gouty arthritis, its quite distinct you know”

Pain is elicited upon dorxiflexion.

I sucked. What is the point of knowing all the drugs involved in the treatment and management of gout if you cant even recognise and diagnose it. What is the point of know that allopurinol interrupts the formation of uric acid by inhibiting the action of xanthine oxidase if you do not even have the chance to prescribe it?

I sucked

Actually I have more to blog. Met one patient with no ear drums bilaterally. Another one presented with nystagmus due to who knows what reason. Will blog about it perhaps tomorrow. My brain is too tired to function. Its time to get some rest.

*Lights off*