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;)

No patients

Today is supposed to be a clinic day. After an hour ride to the hospital we finally arrived to find out the hospital was evacuated 3 days ago due to risk of drowning. (yep, it drowned once, but no fatalities thankfully). There were no way we could go back. The bus will, hopefully, come pick us at the end of the day. Yay. We got to stay in the library and keep praying it doesn't drawn while we are there.  The hospital is full of doctors though. I guess the hospital administration hates them all! 

Why am I writing this? No one will take care of you if you didn't . We should have checked first.  Missing a clinic, especially as student, because of bad weather due to safety measure is by far better than risking your odd. 

Farah

Today, I was asked to do a full neurological examination on a five years old boy. Now, I was told from the early days in med school that neuro examination is one of the hardest. I guess that is why I am good at it. I simply paid attention every time neuro was mentioned! I did a quite good job and the consultant was happy (actually satisfied) about it. I was proud of myself until he asked for my differential (meaning: possible explanation for the examination finding). I went blank for a moment then muttered (while still in blocked mind land): cool stroke?

Now, if you are standing, please set down. There is nothing as "cool stroke". But my examination findings, along with the patient history will explain that "cool" answer.

 

 

Farah was four when his parents noticed him waving his hand occasionally around his right eye, as if he was checking if it is still working. Months later, he became clumsy. He then, was limping and having difficulty building towers as he used to do. He even became worse than his little sister in painting.  As if it wasn’t  bad enough, he started having frequent seizures.

 By the time I examined him, he was almost paralyzed in the whole right side (hemiplegia. Actually scored 2 in power examination). And despite being on cocktail antiepileptic medications, he was still frequently seizing. He seized three times while  I was examining him ( I took less than 15 minute ). It was the first time I see someone seizing. Yet I wasn’t scared. Let me tell you, I am a PANICY person. The reason was, he smiles at me after each attack, turns to his mother and laugh!

 Now you know why I went to blocked mind land. I couldn't think of anything more rewarding than working with kids. Their innocence remind you how wonderful life can be ( Wait what? You thought I was searching for possible causes? I'll take that as a compliment and just leave it there).

Back to Farah,  ( and the disappointed consultant). It turn out  the poor boy has a rare case of encephalitis (i.e. brain inflammation), called rasmussen's encephalitis. It is not clear what cause the inflammation. Some think viral infection, others think it is an auto immune disease. What is know is that it only affects one brain hemisphere causing the above symptoms. The patient enter a vicious cycle where the brain inflammation cause seizures, and seizures cause brain damage leading to more seizures. Some children eventually become demented.  

 

I was moved by this boy, his smile and his loving mother. I was so moved that I struggles not to sob as the consultant explained the prognosis.

Sometimes, I wonder how people survive without faith.

Farah happens to be an Arabic name that means happiness.

 

 

Welcome to my blog

Hi there,

So this is my first entry. This blog is going to be about the change med school did in my life. Mostly ranting about the bad impact in the quality of life I have now. But some will be about a beautiful and rewarding experiences that made hanging in med school, despite all the downs, worthy.

And yes Grammar Nazis are most welcomed here. English is not my first language and I  had no formal education to ensure quality. So, be nice and teach me. No need to eat me. (See, I can be a rapper as well. I heard you there. Whom am kidden you said! One day folks, One day).