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The Silent Killer (not diabetes)

It’s been awhile, partly due to the burden of having to speed through Legal and Forensic medicine in a mere three weeks. It’s still too early to laugh about the events that transpired during the OSCE exam. Though there were one or two gems worthy of being mentioned, I’ll leave the rest till after I (hopefully) pass with flying colours.

The Silent Killer

Seery, the respiratory consultant, is known for his charming smile, politeness and kind words. The man is loved by all, except when it comes to OSCEs.

When I walked into his station, I shuddered at the sight of him. I knew had to bring my A-game or risk being docked marks for the smallest of mistakes. There was no room for carelessness.

I spent the first few seconds observing the patient, not forgetting to count the respiratory rate. I counted the amount of breaths for the first ten seconds and multiplied it by six.

I finished the examination and was prompted to report my findings.

“Mr X is a middle aged man, lying comfortable on the bed with no obvious signs of respiratory distress. His respiratory rate was determined to be 16 breaths per minute which of is normal.”

“How did you get the respiratory rate?” he asked.

“I measured it for the first ten seconds and multiplied it by six,”

Swear words started to form in my head

“Okay, so you multiplied by six. And you got 16?”

As I started to scramble for answers, the audible scratch marks of the silent killer’s pen filled the already silent room.

EXAM!

Reiters Syndrome. Felty’s syndrome. Keratojunctivitis sicca. Epidermal necrolysis. Guttate psoriasis. Pulsus parvus et tardus. Pyoderma gangrenosum. Erythema nodosum. Sjogren’s syndrome. Budd Chiari Syndrome. Dressler’s syndrome. Charcot’s Triad. Reynold’s pentad. Troussier’s sign. Grey Turner sign. Cullen sign. Murphy’s sign. Hashimoto’s thyroiditis. Anticardiolipin antibody. Amyloidosis. Pernicious anaemia. Infectious mononucleosis. Vitiligo. Fallot’s tetralogy. Dysdiadochokinesis. Telengectasia. Buboes. Clostridium difficile. Polymyositis. Helicobacter pylory. Systemic lupus erythematosus. Myasthenia gravis. Polycythaemia Rubra Vera. Cor Pulmonale. Torsade de pointes. Citrulinnated C-Peptide. Polymyalgia Rheumatica. Paroxysmal Nocturnal Dyspnoea. Henoch Schonlein Purpura. Non Hodgkin’s Lymphoma. Koilonychia. Onycholysis. Leuconychia. Leukoplakia. Heberden’s Nodes. Bouchard’s Nodes. Boutennier’s Deformity. Dupuytren’s Contracture. Marfan’s Syndrome. Steatorrhea. Malena. Haematochezia. Thyrotoxicosis. Mallory Weiss Tear. Meckel’s diverticulum. Virchow’s node. Oliguria. Erysipelas. Caput medusae. Hydrocoele. Pancreatic pseudocyst. Chvostek’s sign. Pseudomona Aeruginosa. Escharotomy. Cholelithiasis. Sialolithiasis. Cavernous Sinus Thrombosis.Wegener’s Granulomatosis. Ceeruloplasmin. Syringomyelia

I’m not making this up. Show this to your nephews and nieces who want to do medicine.

PS : it took me an hour to type this up

PPS : im proud that i can define at least 90% of the terms above.

Bite me

Tendon reflexes differentiate the men from the boys. It is often the cause of many sleepless nights amongst medical students and even the most senior doctors. The variability that exists among patients’ means that there isn’t really a formula one can stick to when trying to elicit a response.

In order to enhance the reflexes in a tense patient, a distraction test is done so that the muscles relax. The text books reckon that one should ask the patient to clench their teeth just before the tendon hammer hits the desired spot.

“Ms J****, could you clench your teeth on the count of three?” I asked the elderly patient, with the tendon hammer ready to swing at her elbows.

“Oh I’m sorry dear, I don’t have any teeth,” as she smiled a toothless grin.

So much for textbooks...

Stormy days

A hospital can be a very dark depressing place. Within its walls, people often go through horrific experiences that they never ever want to relive.

Today was just one of those days...

I saw a man diagnosed with cholangiocarcinoma (bile duct cancer) break down and cry.

I sat through a family meeting to inform them that their mum was dying

We later visited them in the ‘suite of death’ to make sure that she was comfortable and not in any pain

I heard an old lady crying out in sheer agony and frustration because of unbearable chronic pain;

We had to call security to neutralize our patient who was so desperate to get out that he attacked the nurses with his walking stick

A breast biopsy of our patient who was admitted due to a fall came back positive for metastatic cancer.

A disabled kid in a wheelchair got stuck in the toilet because he wasn’t used to wheeling himself around yet.

A mother not recognizing her own daughter after suffering from an ischemic stroke

And at the end of the ward round, my normally cool registrar asked for a timeout so that he could be alone and just calm himself down after today’s events...