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what sort of things would you be thinking, if you are in a room full of people who are either drooling with saliva, or hands that can’t stop shaking, or keep making jerking purposeless movements every 10 seconds, or can only grunt unintelligibly, or whose eyes just stare at nothingness in front of them. thankful because i am ‘normal’? bursting with sympathy? or proabably start making promises that i would study hard and become a brilliant nurologist that will come up with a cure for all these neurological diseases?

amazingly enough, i just felt amazed at that time. i kept count of how many times julie have to kick around untill her socks fell off. i kept note of how charlotte’s grunt sounded like an intersection betweeen a laugh and a cry. and every 5 minutes or so i would turn just in time to see denise bite her right hand, or rather, her bandaged right hand, and another strand of fibre came loose each time. and i jumped everytime paul screamed about nothing or at no one in particularly, just out of randomness.

i am not incapable of emotion. but let’s think about it. emotion only comes when we start to label these people.sufferrers of neurological diseases, or recipient of head injury or stroke causing lasting brain damage, that’s what they are according to society. julie has huntington’s. charlotte has huntington’s too. the frail lady at the corner has advanced parkinson. paul has had rta, brain injury. denise..well i seriously don’t know.( what disease condition leads to hand biting? )

so yeah..when we start to talk about julie, we’ll say julie who? ohh the one who had huntington’s when she was 45? ooh the one who couldn’t speak, eat, or do anything for herself that made her family send her to the care home? yeah..the one whose husband is very loyal and hasn’t remarry to this very day and dutifully come to visist her every other day..and her kids, yeah her kids can barely recognize her anymore..she isnt anything like the mother they remember..

i looked at julie. she’s well taken care of. she has someone to wash her twice a day. someone by her side 24/7, someone to keep her company. and set all the tangible, visible things about her aside, is she aware of what’s happening to her now, of what she has become? has she not also lost the ability to feel any emotion because of  the disease; to reminisce about her past, to regret about the things that she couldn’t do now, to be angry at the disease for stripping her off everything she treasures in life. if that is the case, then probably the only thing she is feeling right now is..content.

of course it’s sad. i wouldn’t wish anything like this even to my biggest enemy. but it has happened. after the initial shock and denial, after the tears and more tears, adjustments were made and lives move on. although things never is the same.

and that is life. things happen and we just have to deal with it. and in a way that is how medicine works too. sure, doctors may be pictured as that angel in white with sthetoscope dangling around the neck with a healing touch and save lives. but that only happen very rarely for neurological diseases for example, sure the doctor deserve a clap in the back after correctly diagnosing the patient’s medical condition. but after that, what? there’s only so much drugs can do. nothing else has proven to be curative. and that angel in white can only stay in the sidelines, watching helplessly as the patient deteriorates, losing a little bit of themselves to the disease with each passing day.

i walked out of station 13 feeling a bit dazed. luckily there was linda to guide me outside. oops wait a minute linda. in all my "dazedness", i still remember that both of my hands now smelled of someone’s armpit (station 13: perform an examination of the axillae and present your findings). and of course, having osce in june when it’s sunny and 23 degrees outside cause all axillaes to sweat, the stimulated patient in station 13 included. scrub scrub scrub. then i’m out of there. slumped in the chair.

now 2 days after, what did i remember from osce.hmm.. my very first osCLINICALe that takes 1 and a half hours. probably the most tiring 90 mins i have had for a long time

station 2: T1 diabetic coming for foot check up
manage a cute smile at the examiner…check
smile and be polite to the patient..check
inspect and rant aimlessly about what to look for…check
feel all the pulses..check
tickle the patient’s feet with cotton buds..check
stab the patient’s feet with micro-wire…check
now, there’s one more instrument there that you havent used, farah. right, ok. not that i havent noticed it. i picked it up. and i stared at it intently. then i look at the examiner. i smile. and i stared at the thing in my hands again. err..this is a tuning fork to check for conduction deafness by performing rinne’s and weber’s test. (how smart was that?) to be honest with you, i have no clue how what it is for in this patient’s case (ouchh, admitting stupidity is never easy).
the examiner was trying his best to stiffle a laughter. now, now, what does the tuning fork do when you hit it? hmm, it vibrates, sir. ( it felt like kindergarten all over again, i was half expecting to get 3 stars for answering correctly) And..?(ooh the question doesnt end there?)1 second, 2 seconds, 2 and a half second..i’ll check for vibration sense! Eureka! (u know when newton saw the apple falling from the tree? i probably had the same feeling then. ha!)

station 9: a patient with RUQ pain, found to have multiple stones. advise treatment.
my mouth was very dry by then. all my face muscles ache from smiling too much.
right, here we go again..smile, shake hands, be polite (the usual drill)

right we are going down the line of relatively invasive treatments, and there are a few options.  we can consider ercp, endoscopic retrograde cholangiopancreaticography (the patient’s eye bulge, and i almost kick myself for saying that). then i went on and on about the stupid procedure. then i mentioned laparoscopy. then i mentioned open surgery. the patient’s eye bulged even more.
but can we not try less invasive treatments first. surely there’s somethig else that can be done other than opening me up. can i not just change my diet by not taking certain foods?
there it came again. the urge to kick my self hard. on the head.
i smiled. and 2 seconds later i still smiled. of course! u are absolutely right! i was about to come to that..(kaver line kaver line).
tehn i said something like..(till now i dont know whether i got marks, or penalized for that) obviously because there are more than 1 stones. and it is unlikely for the problem to go away on its own by diet alone. and we need to monitor you, and should u develop symptoms again then we have to consider all those treatments i have mentioned. ( so that all the time i happily indulge on the gory details  of how we would put a tube down his throat, or make tiny holes in his tummy, or even cut his tummy open unreservedly didnt come to waste.)
and i ran out of time, again, in this station. and i had to stop mid-sentence and sprint off to my next station.
i blamed this all on all the countless ercp and lap chole i watched in my first firm. and not following up the patients later to find out what food he/she couldnt eat.

station 11: take history from this patient who had haematuria.

can you please tell me what seems to be the problem?
hmm..it was my gp, and he asked me to come here because of this problem i’m having.
**stick to the rule..open qs, open qs.
and the problem you are having…
yeah. this problem. it didnt bother me as much then.
**is it just me or this lady is deaf
the problem seems to bother you now, is that right? can you tell me more about it?
**i’m on the verge of losing my temper and just throw off closed qs now.
she opened up in time. which was a relief. i also got to find out that she has this problem with his lung. ( she realy isnt the type of person to get bogged down by details, aye?) but no haemoptysis. sob probably?
then during systems review i asked questions, which i hoped, made me look intelligent. questions like..do you have a temperature? do you get night sweats? do you have loin pain? do you have family history of autoimmune disease?
then when i presented, i mentioned things like renal cancer, vasculitis, even good pasture as the differentials. only at the end i mentioned transitional cell ca in bladder or ureter. later as i chatted with my mates, i found out from them that she used to work in dye factory. damn!!!

so all in all, it wasnt so bad that i cried after a station or two. it wasnt so good either to make me skip all the way home.

now i’m too deeply immersed in post-osce bliss to care anymore. just as long as i dont have to resit.  all in all it was a fun morning.