Necessity is the mother of invention

Friday, July 30, 2010

I had an interesting encounter with a 75 y.o gentleman who was admitted with the chief complaint of passing black stools for the past 2 days. Upon clerking him, I found out that he has a number of pretty nasty co-morbids that require him to be on a long list of medication. When I requested for the medications that he is on, he showed me this:
A mini pharmacy. And he's such a good patient that he can tell you what is medication for, the dosage just off his head. I like the fact that he's such an organised person, obtaining the drug history can never be easier.
He's on Casodex, an androgen receptor antagonist that give rise to gynaecomastia.

Upon physical examination, I found this device attached to a part of his body. Upon questioning, this device is in fact his own creation. Speaking about the latest medical invention, this man could probably win himself an award or something!
Give it a guess, I'll buy you a drink if you manage to guess it right.

What's Surgery Like

Thursday, July 1, 2010

5 months in the Department of Medicine, Hospital Sultanah Aminah JB, was undoubtedly the best experience I've had so far in my medical schooling life. I owe it to the fantastic team of people in the ward I was assigned to. Because of their teaching and guidance, I am actually quite functional and versatile in terms of ward duties. I've done most of the procedures so far including a pleural tap, assisted in several peritoneal dialysis and peritoneal tapping. Venepuctures and IV cannulations were so frequently done that they call me a vampire.

But now, everybody is everywhere. The MO has been posted to some other ward, some of the HOs are doing their minor posting either in haemato/chest/ ID department. I miss those days where I was so gung-ho spending more than 12 hours in the ward, studying while waiting for the staff nurses to call me if there is any blood to be taken or any branullas to be inserted. I would wake up early just to join the morning rounds with the MO, caused that is the time I will get grilling for not knowing stuffs.

"Chee, kepala u kosongkah?", the MO will say when I fail to examine the hands properly. "Can't you see, the joints are swollen!". "Now tell me 5 syndromes that are associated with Rheumatoid arthritis". " Sorry Dr F, I know only 2". " Tell me 5 reasons why patients with RA develops anemia" "Tell me about all the organisms that cause atypical pneumonia, which one causes haemolytic anemia?". LOL. Then he will walked away feeling pissed, but I know he is not, he was just trying to act stern.

Patients, although they are sick will try to console me by saying its ok, and offered to let me examine them again after I've read. Having said that, I tried to recall the syndromes associated with RA and yet i am still missing 1 of them.

1) Nephrotic syndrome
2) Felty's syndrome
3) Kaplan's syndrome
4) Carpal Tunnel syndrome
5) ?? Ish..

Anyway, I will be spending my last weekend her before I head back to JB. Surgical posting is next and I wonder what is in store.

When you hear about surgery, do you think of TV dramas like "Grey's Anatomy?" But in reality surgery is not always so glamorous or so dramatic. I was told by some of the surgeons back in Sunway that surgery is challenging, exciting, varied and very rewarding.

I think what attracts me to surgery over a lot of other specialities is the hands-on approach. The directness of treatment is something very lacking in other areas of medicine. And Yes, the feeling of actively "fixing" someone is hard to resist when that could mean the difference between life and death.

But at the same time, surgery for me lacks alot of the cerebral diagnostic element that I love so much about internal medicine. In the medical ward, knowledge is the only thing that sets you apart from the others. In surgery, its more to skills and technique. As long as you can be a good assistant in the OT, you are considered to be a good surgical HO. Besides that, I find that the medical consultants are more gentle, in the way they approach their patients. Surgeons on the other hand are always called the butchers.

Anyway, I do keep an open mind. I'll need to have adequate knowledge in both the field of surgery and medicine before I can proceed any further. I remembered how I miss a gastric outlet obstruction secondary to post op adhesions in a pt with chronic renal failure who just underwent an exploratory laparotomy because of bacterial peritonitis. From the abdominal X-ray, the stomach was obviously distended and yet I could miss it. And the best part is, when she asked me what's wrong with her tummy I said everything is fine. See! It's dangerous to talk without knowledge.

I'm all hyped up for the coming posting. Besides, I've heard that I've got pretty good tutors. 5 Essential Features of a top surgeon
1) Fingers of a Lady
2) Eyes of an Eagle
3) Heart of a lion
4) Stomach of a Camel
5) Legs of a horse

I'll see whether I could acquire any of the above at the end of the posting, HAHA!