Embracement

Nooooo, nooo noooo. I did it again. It seems I found my lost talent. A unique one I tell you. I keep saying the stupidest thing possible. Uggghh. I am slowly dieing here people. My answers are so stupid that I be like: ewww that person inside me must has a rotten brain, if has one at all. I seem so lost and just not concentrating. In many occasions the reason is  presque vu " tip of the tongue" and my fight not to be a desk O.o)i.e. Mute( I  hate keeping silent when quizzed neither do I use the "no idea" line. But it shouldn't be by rapidly throwing nonsense.
One of the most important trick one of Our tutor told us is to at least pretend we are thinking " for the sake of God" he begged.
It seems my cognitive function is deteriorating. I no longer able to recognize distal from proximal.


Offfffffff to bed, then to spa. I need to make sure I know I am by my side. Seriously!

All pics in this blog are not mine, unless specified

Then I'll embrace internal medicine the way I love, hopefully:)

Saturday night

It just hit me. My friends will be graduating this year. Few weeks and they will say goodbye. I will not only need to search for people to live, eat, walk & chat with, I'll miss one of the most beautiful thing college offered. Funny they are all engaged and getting married shortly graduation ). This and them starting their internship, made all my hopes of spending reasonable time with them sink into vain. It is depressing. Really depressing ( yes, that is a tear fighting not drop).

 

pediatrics

 

I just finished my last presentation in my pediatric placement.  Three more days and I'll say goodbye to the sweet babes  and to traveling between 2 hospitals.

 

Working with children is really rewarding. It tests your ability to adapt, tolerate, hold your tears & sometimes to fight the urge to slap the shit out of few(didn't had such moments, yet). Their innocence made the strict working environments, the crazy reading materials, the unbelievable number of procedure  & reflective writing bearable. I truly enjoyed this placement. I worked really hard ( I usually work hard in the first 2 weeks, then let's say I just work.)..

A good reason to keep disinfecting our stethoscopes

Here is a glimpse of what  a normal day looked like:
_ wake up at 5:30 am, pray, shower, read and get ready.                        
 6:30  _ am take the bus
7   _ am ( or 7:30am  in the 2nd hospital) reach the hospital and have breakfast there (but not in the 2nd one)
_    7:30 to 8:30 am morning meetings where special cases and  new admission discussed.
  _ 8:30 to 9:30 we clerk patients to present them in the rounds (or not  , if they were in hurry)
_ 9:30_11:15 ward rounds, where we join the consultant and his team, get quizzed here & there (in the best of days) or just get ignored.   (Then 15 minute break where we rush to cafeteria, library or go check patients )
_ 11:30am_ 12:30 bed side teaching. Where  a group of 4_6 students(under the guide of consultant) torture a poor kid by practicing physical examination in turn ( not that bad). Then we discuss his/her condition in details, including management options.
12:30 _13:30 pm lunch break.
13:30_15:00 pm presentations  or seminars.
 _ 15:30 pm the bus take us home.  Or we  can stay on call  and return home at 22:30.

That was  my 3rd rotation (after Family medicine & psychiatry) in clinical years.  It hugely differ. But a good advice is to read about the condition you see, presentation you have i the bed side in the same day. Yes, you will have no social life, but for 2 months only. ( I start studying around 4 pm and hit the bed at 22:00 or 22:30). Also, take each chance (even in the rounds or bedside to make a procedure & get it signed immediately). YouTube is of great help esp. if you want a break from reading. Pretest also is a good way to motivate you to concentrate and to test how much you know and it is educational!

I obviously  wrote that weeks ago. I am clearing my overloaded desktop, so I post it for you guys ( yeah, you are welcomed  hehehe)J

Internal medicine rotation

2 weeks ago I started my internal medicine rotation. I am placed in a lovely hospital. The consultants are very keen to teach, the nurses are friendly and there is a good variety of cases.
It is so relaxing and there is plenty of time to read. unfortunately , I am not spending enough time reading.
I worked really hard in my previous rotation. I felt burned out when it was over( mom also was having a serious medical issue & I tried spending as much time with her, so minimum amount of sleep and load of stressors contributed to that feeling).

Enough ranting.

I saw a couple of interesting cases. One was a teenager who was electrical shocked while plugging her phone midnight. luckily her father was there. He decide to bring his unconscious daughter to our hospital (which is 90 minute drive) instead of the nearby hospital. ( Trust issue? vs. ignorance?) They were able to reverse her artial fibrillation and admitted her to ICU where she spent a couple of days. The damage to her brain from lack of oxygen is was unpredictable. Last time I checked on her she was on the world. She look like if she was just hit by a lighting ( speaking of which, lighting is a direct current, it cause asystole, unlike alternative current from electrical generator, which cause atrial fibrillation). Sometimes she responses to command like open your mouth, sometimes she doesn't. The doc think maybe she is psychologically traumatized. I really hope she gets better & no anoxic brain damage occur.

The other case was, a 57 year old gentle man with a large non symptomatic one sided neck swelling. It was a good chance to practice thyroid examination, which is  a common OSCE station. It turns out to be a rare case of nasty thyroid cancer with poor prognosis. Too bad, his lymph nodes were  involved & they are investigating him for metastasis.

symptoms of heart failure.

I also saw many acute coronary syndrome, heart failure, bronchiectasis and COPD. very sick people indeed.

pitting edema

The guy with heart failure was breathless even while setting. It was impossible for him to walk to the bathroom or lay flat and he needed many pillows to sleep. His whole body was grossly filled with fluids. (his weight increased 16 kg, which he lost by therapy). If you press on his leg, you can observe the indentation created by your finger for more than 30 second ( pitting edema grade 3). They load him with diuretics (drugs that promote urine production) and his symptoms markedly improved.

The consultant explained to us almost everything we need to know about heart failure, making sure we are paying attention to the pearls he spat out. When he asked me about NYHA classes of heart failure in the next round I shamelessly told him I forgot, just because I wasn't in the mood.. (Ugghh , few second please I need to hit my head against the wall, again ). I promised myself not to do that again (not the head banging of course) as it was rude and make people unwilling to teach. Lesson learnt.
I have presentation coming soon, so I better go get started;)