Wednesday, September 12, 2012

It's Day 3 and I Feel Stupid Already




1) Today I clerked two patients but did only one physical examination. No procedure today, how frustrating :( While I was walking around, I saw this pak cik wearing a kopiah on bed, with many yellow files on his overbed table. 

I went to his bed and ask him, 'Pakcik, kenapa banyak sangat file ni pakcik?' to initiate a conversation before I jumped into history taking.

Then, he answered, 'Dah, banyak kali dah pakcik masuk hospital ni, macam macam penyakit ada.. Gout, darah tinggi...'

There are nine files stacked on his table. That many.

He appeared thin, but his eyes were squinty. Maybe he had eye problems due to his overlapping ilnesses. I scanned through his records, he was diagnosed to have Chronic Obstructive Airway Disease (COAD) with bronchiectasis. (Dyspnea, Pleuritic Chest Pain + Productive cough with greenish sputum)

I was told that we medical students are not supposed to read the file before we clerk the patient. We have to ask questions to the patients and formulate our provisional diagnosis from the information we had collected. But I couldn't help myself. The yellow file was there, right on the table, it was like whispering to me, saying 'Read me.. Read me... Don't you want to know what happen to his pakcik? Read me..'   

So I promised myself. This is the last one. Next time I clerk a patient, I will not look at his case file first. 

Well, just a peek over the Diagnosis, perhaps? :D

I was still reading when the pakcik called his friend. I overheard him talking through the phone, with a cheerful tone.

'Helo, apa kabo? Kat mana tu? Kat spital? Ye, ambe pun kat spital juge..' Then he laughed loudly. 

I imagined there's another similar pakcik lying on a hospital bed somewhere on the other line of the phone. I smiled and eased away from his bed, not wanting to interrupt him. 

2) Then, Shake and I went on to examine a patient with generalised edema. Shake percussed the patient's abdomen, mentioning that he had ascites and we could examine the fluid thrill over his body.

I percussed his abdomen, moved him to left lateral and wait for about a minute, then percussed again. I thought I could hear a change in the sound. Or is it just my imagination? 

I am not good at these kind of things, seriously.

3) At 2.30pm, we had Tutorial on TB and Pleural Diseases with Dr.Naim. He showed us OBA, MCQ, OSCE questions on PowerPoint slides. He called out a 'lucky' name from the attendance list and that person must answer the questions on the spot.

I realised that although I have revised the topic the night before, there were still a lot more chapters I did not manage to cover. It was a broad topic and obviously, you cannot cover them all in one night. So I was fairly nervous all the time, praying silently that Dr.Naim will not call out my name. And thank God he didn't.

It was a 2 and a half hour Tutorial session. Dr.Naim provided us explanations after explanations regarding PTB and other associated pleural diseases. I wonder how many textbooks/articles/encyclopedias he have read up till now to acquire such knowledge.

As for me, it was like 'Information Overload!!'

I don't have bad handwriting, I have my own Font - my favourite Quote of the Day. Lol




I did not read on Light's Criteria, Upper and Lower Zone Fibrosis, Bridging Therapy and a few more. Dr. Naim gave us the slides after class, saying that we should read more about this topic. 

'Pulmonary Tuberculosis (PTB) is very common in Malaysia, you should know the disease inside out. Lastly, remember to RURA - Read, Understand, Remember and Apply', he told us. He once mentioned that he remembers things by using mnemonics. 

I think I should learn a few too, I have difficulties in remembering boring uninteresting medical facts.

4) This night, my friends and I went to the Ward. I drived from home and reached the hospital at 8pm. It was my first time driving alone at night and my parents (even my Mom!) gave me the the permission to drive! It was surprisingly easy to acquire a verbal consent from them ;) 

I clerked a patient with Pleural Effusion, with significant lung findings. I could hear crepitations at his left lower lung, reduced breath sounds and reduced tactile fremitus.

He is referred to Hospital Serdang because his lung cannot expand even after a Pleural Tap was done. He will be transferred tomorrow morning at 7am.

I was thinking of presenting this patient during my Long Case Presentation this Friday with Dr.Che Rosle.

It was nearly 10pm and all of us exited the Ward. I reached home at 10.30pm :)

5) So that's how my Day 3 progressed. I should organise my Tutorial Notes and made my own Notes to remember things.

There's too much to read and revise in Clinical Years!

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