Friday, October 05, 2012

Skipped Days

1) Forgive me for the hiatus. I needed a break. But now I am back ;)

2) Sulking days are over. I promised myself to be a better person than I have been in the past. I know it's going to be hard, but I'll put my best foot forward.

My friend said I need to vent my feelings more often. Haha. It's not that I don't like to share my problems with my friends, but it's just easier to keep some of it to yourself.

3) Back to educational stuffs now :) Last week, I had selected a patient to follow-up as my Case Write-Up, a 18-year-old girl with Symptomatic Anemia due to Beta Thalassemia Major. She underwent splenectomy when she was 9 years old. She has thalassemic features like frontal bossing, prominent maxilla and malar eminence.

But I didn't do physical examination on her, because she looked very pale and tired a few days after the admission. By the time I remembered, she was already discharged from the hospital.

Aww Pickles.

4) My friend and I examined a 17-year-old girl suspected with Guillain-Barre Sydrome. It occurs when the immune system attacks the peripheral nervous system, leading to weakness or tingling in the legs. Symptoms sometimes affect the arms and upper body. Severe cases of Guillain-BarrĂ© can lead to paralysis and are life-threatening. 

In our patient, she had sudden onset of joint pains two weeks ago, then she developed lower limbs weakness. It became worsen when the upper limbs became weak as well and she couldn't move half of her face (facial paralysis).

She was discharged from the hospital because her parents would like to seek for traditional Islamic treatment.

5) I grew tired of explaining to people that I am actually a Third Year Medical student, I am not a House Officer or a Doctor just yet.

So, when I was walking along the hospital corridor and a Nurse greeted me, 'Nak balik dah Doktor?', I answered with a confident smile, 'Haah, nak balik dah..' without even bothering to explain the misconception.

I think I need to stop wearing my black-rimmed glasses. They make me look older. LOL

6) Newsflash : I am falling hard for someone, but I don't think he notices me. Heck, I bet he doesn't even know my name.

Ah. Silly me.

7) Case Write Up - I have found a new case. It's Symptomatic Anemia secondary to Autoimmune Hemolysis AIHA (Paroxysmal Nocturnal Hemoglobinuria). This 37-year-old kakak was admitted yesterday, I happened to be in the Ward at that time. I was the first person to interview and examine her. She had hepatosplenomegaly, but I couldn't specify their size because the areas were tender. However, I could feel her spleen - it was big! She appeared pale and lethargic. Fortunately, her 22-year-old sister, Ila was there to help me answering the questions.

Later, a H.O came to clerk her. Then a M.O joined in. I listened to them repeating the same questions I had asked her before. When the M.O palpated her abdomen multiple times, she cringed in pain. Her liver was palpable 2 finger-breadths under the costal margin and her spleen was 5-finger-breadths big! Wow.

8) I followed up a case of Typhoid Fever (Salmonella typhi infection). His name is Fais, a bright and cheerful 12-year-old kid. He came from a poor family and I got to know that he didn't attend school, so he doesn't know how to read. Sad, isn't it?

I've met with two sporting pakcik abang officers from Kementerian Kesihatan Malaysia (KKM) who came by to interview Fais to investigate the source of infection. They told me about a few similar cases happened few weeks ago. They are trying hard to solve the cases to prevent future outbreaks in Pahang.

Fais had to stay in the Ward for a couple of days more for stool clearance. He looked frustrated because he had been here for about 2 weeks time. He wanted to go home badly.

9) I had been to the First Class Ward at Level 8 several times before to follow-up a case of Decompensated Congestive Cardiac Failure. The Ward is fully air-conditioned, it's very nice.

I met the patient when she was warded in Mawar 7C weeks ago due to sudden onset of shortness of breath. On auscultation of the heart, she had prosthetic clicks due to her previous valve replacements in IJN before. She was diagnosed to have Community Acquired Pneumonia (CAP).

When she was stabilised and transferred to the First Class Ward, of course it was very awkward to start the conversation at first. I mean, I called her makcik before, now I got to know that she carries the title of Yang Mulia (YM) Tengku!

I met her this evening to observe her progression and say goodbye since I wouldn't be seeing her when she'll be discharged next Monday.

She's going back to Pekan. Ah, now I have got no reason to enter the First Class Ward again.

10) I had sent my fourth Clerking Notes to our Mentor. Hopefully I'll get a higher mark this time. I scored 5.5/10 for my last two Notes and I felt bad for myself. Now I need to select good cases (with significant positive findings, if possible) and fully understand the Investigations + Principles of Management of the patients.

It's nice to have your notes checked by Dr.Naim. He is very particular about our English grammar. With his red ink pen circling certain words and big crosses over some wrong interpretations of the results, you couldn't help the feeling of being like a high school kid all over again :)  

11) My friends and I are going to Hospital Sultan Haji Ahmad Shah (HosHas), Temerloh this Sunday morning and we'll be back in HTAA next Friday. I've heard good things about HosHas, how I can't wait to experience the 'new' hospital.

So long, everybody. Have a very pleasant weekend! :D

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