blast from the past

Dear Blog,

My first posting was in fact, today. INTERNAL MEDICINE.

A few lecturers of mine reminded us during our briefing the other day to "expect the unexpected". Boy, was that an understatement.

First day and all, all us silly gooses figured we'd have a brief introductory to IM and if possible a short round around the wards, just to get familiar with the whole ordeal. With that, I meant to say we didn't revise on alotta things significant to IM. We didn't expect anything more to happen.

The briefing started at 8am "sharp". I woke up at 0630 just for the hell of it. Who knows what time I slept the night before. Maybe I was too excited, I don't know, but I remember not being able to sleep. A lot of tossing and turning. It would be my first time ever to make ward rounds during my clinical years, and I'd like to think I was really enthusiastic.

So, after dividing ourselves into 7 different groups, my group received a task from our Registrar - Dr. Asri, wanting us to clerk a patient today and presenting the case later in the evening. Gosh, that was frightful. Making ward rounds is stimulating enough, but to clerk a patient when we're all still fresh from our holidays? Can you say "suicidal"?

We did, clerk a patient - Mr. T, a 33 year old Indian newspaper deliverer. Admitted to the hospital 2 days after a continuous high-grade fever. Associated symptoms include itchiness, dizziness and lethargy. However, there were no complaint of rashes (this is quite relevant, for most haemorrhagic fevers often present with rashes). Bla, bla, bla...DENGUE PATIENT! The fella lives in Cheras (an endemic for Dengue), housing area was recently fogged, meaning there had been dengue cases there recently.

It was nice to finally drag our rusty clinical skills out of the closet after a one month holiday, but I still think it needs more polishing. I wasn't one of the 3 who clerked, so most of us were just observers. What I saw was one of my colleagues - KLS (identity will forever remain classified), lacked rapport with Mr. T. The way she took history was too dominating and she lacked empathy. The other 2 were good. Soft-spoken and their questions were in chronological order. Questions were also significant to the case. All in all, what an experience!

2pm dawned, and there we were at the workshop. We looked at face masks, asthma inhalers, chest x-rays and Tuberculosis regimens. My knowledge on the respiratory system is very, very vague but I think I might be able to answer a few of the questions laid out for us. Dr. Andrea Ban, the Respiratory specialist gave us quite a scolding, though, for none of us paid close attention to some of the little, little details. Those little details were in fact, very minute and I wouldn't blame any of us for terlepas pandang-ing it.

What she asked was, "what color was the booklet for the TB patient and what color was it for the TB patient's family members?". (crickets and tumbleweed) - yellow for the patient, white/gray for their relatives.

"have you looked at the dry powder inhalers (DPI)? did you notice there were 2 purplr DPI's? were they of similar medication or different? what is the name of the drug and it's dose?" - N/A

"let's say i calculated a TB patient's age and weight to the proper dosage of Isoniazid, he/she requires 320mg per day. Since the dose for one tablet is 100mg, how many tablets are to be given to the patient per day?" - 3

"this is a chest x-ray of a patient that was ill for a week, complained of a runny nose, productive greenish sputum sometimes with streaks of blood. There were also histories of LOW and LOA. There is an opacity in the right, mid-lobe section of the lungs. Give me your differential diagnosis." - Pneumonia, Tuberculosis, Carcinoma (with increasing age)

"how do you differentiate Pneumonia and TB?" - Pneumonia would be an acute infection. After a week, the infection should have subsided. TB is a chronic infection that may last longer. History of LOW, LOA and night sweats prove to be significant.

In a nutshell, things I've learned in the last year in just 4 weeks were put to test in a matter of minutes!! What the fudge?!

.a very distraught l e n a.