Cardiomegaly

No doubt this is the biggest I've seen.

C/O: Penile Swelling, unable to pass out urine, bilateral pedal edema

Dx:

CCF secondary to non compliance to fluid restriction, with MR+MS secondary to rheumatic heart disease complicated by AF.

Smoking

The reason why I make it a point to drop by my designated ward everyday(at least for the morning) is not only to clerk patients for my learning, learn new procedures and etc, but also to experience bizarre incidents that could really baffle and puzzle my mind as a medical student. I often walked out from the ward smiling, telling myself I've enjoyed my day.

While I was doing my routine tasks in the ward this morning, I get a whiff of something burning. The cubicle was quiet as the visiting session has just ended. At first I thought I was having some problem with my olfactory bulbs and thus having some "smell hallucinations". But when it got stronger, I turned around and saw the bed of a patient burning in flame. Relax, it was just a small one at the side of the bed, not to the extend of burning the patient alive.

I alerted the nurse and she passed me a jug of water, I then splashed it on the bed to put it out. The climax is when the HO came to interrogate to find out who was the culprit. The nurses found a cigarette box underneath the pillow of the neighboring patient. But he denied. The nurses got upset and asked me to give his shirt a smell, LOL!

One of the housemen then came and threatened that they are gonna collect saliva samples from the cigarette butt found on the floor and determine whose DNA it belongs to. But still, her effort was futile as both the patient and his neighbor denied all the way.

Thank god he didn't smoke near the oxygen supply, I might not come out from the ward alive.

Respectful

My clinical training started officially and I will have to admit that this week has been the best week throughout my medical training so far. Had the opportunity to auscultate 2 pan systolic murmurs in a 15 year old kid with VSD and another 70 year old uncle with a mitral valve prolapse complicated by infective endocarditis. Although it is physically and mentally exhausting at the end of the day, i know that the more patients i see, the more i learn.

Clerked a 65 year old man who was referred for evaluation of his shortness of breath and chest pain. He is known to have hypertension diagnosed 3 years ago with previous history of ischemic heart disease. He was unable to ambulate himself due to the shortness of breath(NYHA class III) and was then put on oxygen therapy. Spoke to his son and managed to obtain a comprehensive history.

This is a classic example of textbook heart failure in which the heart is unable to pump out enough blood to sustain the body's demand. I thought this was an interesting learning opportunity for the group and hence decided to present to Dr W during bedside. However, throughout the session, the patient seemed rather uncomfortable with 12 of us surrounding him, talking in some odd jargons that he himself could not comprehend. The son and son in law weren't that happy with our presence as well. While presenting the case to my tutor and my fellow colleagues, i feel very bad for disturbing him, making him a subject of study for the 12 of us. Throughout the session, I was not paying full attention to what Dr W was saying, I was instead concerned about how the patient is feeling. Periodically, I will take a peep at him, or ask the son whether everything is ok. I adjusted the window beside the bed so that more fresh air could ventilate the already stuffy ward. The session ended in an hour and i thanked him before i leave.

Medical students should ask themselves a pertinent question, " Who taught me medicine?" Many would respond " My professor, my consultant, MO, lecturers" and so on. When they graduate, they will go knocking on the doors of their profs and lecturers to thank them personally for making them a good doctor.

If you come to think about that,

Did the professors really teach us the art of medicine? Did any of them developed heart failure and atrial fibrillation so that i could palpate an irregularly irregular pulse for the first time? Did they suffer severe shortness of breath to show us the cardinal sign of heart failure?

The ans is so obviously no. No doubt that they did facilitate our learning, guiding us along the way. They teach us the correct technique of physical examination not forgetting sharpen our skills in critical thinking which is utmost important in reaching a definite diagnosis. Mind you, they were heavily paid to teach us(in monash at least), but did the patients receive any monetary gain by teaching us? NO!

Parents taught us to respect our teachers, that's the reason why we should have utmost respect for the patients. They are our TEACHERS, and will continue to be one, throughout our career, until the day we decide to stop practicing medicine. Without them, we would never become doctors.

So now as students, and future doctors, what we could do is to at least respect them. They are not "cases". Quoting Dr W, a pencil case? or a brief case?

Show sincere care

A wise physician said to me, " I have been practicing medicine for 30 years and I have prescribed many things. But in the long run I have learned that for most of what ails the human creature, the best medicine is CARE."

"What if it doesn't work" I asked

"Double the dose" he replied.

Anonymous

Attitude not aptitude, determines altitude =)