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;)