Saturday, May 31, 2008

One patient, five minutes, I'll never forget

Even though we only had about six hours a week during which we saw actual patients in our first two years, we’ve seen enough by now that the details of individual patients start to blend into each other and fade away.

As for some patients I’ve met, though, I won’t forget them as long as I live.

It was during one of our many small-group clinical skills sessions that I met one of those patients. The goal of this particular session was to apply some of our neurology physical exam skills by practising them with some chronic paediatric patients who displayed neurological symptoms.

Memorizing a set of symptoms suggestive of a lower motor neuron disease (as opposed to an upper motor neuron disease) can be mundane when you read it in a library (or on a blog), but it can be life-saving in an emergency room – learning the intricate connections between the brain and the muscles is one way a doctor can tell if a patient’s sudden-onset drooping face could be because of a harmless palsy that will settle back to normal in a couple days, or if it might instead suggest a life-threatening blood clot cutting off the oxygen supply to the patient’s brain.

On the paediatrics ward, we went from room to room, playing with the cute kids, meeting their parents, and checking reflexes, feeling for stiffness, and looking for other neurological symptoms. At the same time, my efforts to keep my eyes open competed with my efforts to remember the relevant physiology. It was sad to see a number of children who are bedridden and have severe cognitive deficits…but everyone has seen a child in a wheelchair at some time or another, and the pre-exam study blitz was starting to take its toll on my sleeping habits.

Then we entered her room.

As he had done in all the rooms before, the doctor asked us to check for reflexes and stiffness as he started to tell us about the reason the girl was in the hospital. “Chloe came to us about six months ago after a non-accidental injury, suffering from cigarette burns, broken limbs and a fractured skull.”

I suddenly wasn’t sleepy anymore at all.

“What did he say?!” I thought to myself. “Non-accidental injury??!”

The doctor had already moved on and was talking about the clinical signs. “Notice the hyperreflexia, and positive Babinski sign on her feet,” he continued, but I couldn’t get past what I thought he had said.

“Non-accidental injury?? What, like abuse?” I thought.

That’s exactly what the doctor meant. After going over some more of her symptoms, we asked for more details about what the doctor meant by “non-accidental injury.” I regretted asking that. The doctor went on to explain the atrocious abuse this poor, beautiful young girl had suffered at the hands of her stepfather.

I was shattered. She was about nine years old, in a purple dress, with her blonde hair tied up in cute piglets, sitting in a tiny wheelchair just the right size for her small figure. I looked into her big, blue, eyes… they didn’t work quite in unison after being struck in the head so many times, but every so often she would look right at me, and smile so big, and I actually felt like crying. I was looking at a beautiful young girl who will never be able to live up to her full potential, because some utter idiot could find no better way to take out his rage than to use her tiny head as a punching bag. Honestly… can someone sink any lower?

It was then I realized I could probably never work in a chronic care paediatrics ward. I don’t have what it takes. I based that on my sudden urge to want to find out who the person was that did this to Chloe, hunt him down, and beat him utterly senseless. Nothing so far in my medical training has made me so angry as seeing the effects of the abuse on this poor girl.

Apparently Chloe had recovered immensely since she first came in to the hospital. She had been in a coma then, and here she was four months later sitting up, making noises, responding to people calling her name – much more than any of the doctors thought she would be able to do by now.

I hope she continues to recover beyond expectations, and that her life’s potential isn’t completely obliterated because of the useless sack of dirt who abused her. And I have high hopes for her, because despite the fact that she cannot talk, or walk around her own, she’s already making a life-changing impact…in those few minutes, without so much as a word, she left an impression on me more unforgettable than any conversation I’ve ever had.

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Tuesday, May 20, 2008

Unleash the medical students.

I just found out that, should I pass my finals and make it to third year, within just a few months I'll be able to prescribe things and order some lab tests.

Here I thought you had to be a doctor to do those things. But no, they'll be letting me and my classmates, fresh out of the pre-clinical years of med school, play doctor. With real patients.

The best part is they're giving us plenty of time between us learning how to do these things... and us actually being on the wards.

That's right. Rather than putting us in the hosptial as soon as we have written our finals, which is when we have proven that we know which lab tests to order and which drugs to prescribe....ok, well, we've really more just demonstrated that we can memorize thousands of PowerPoint sides containing millions of trivial details (example: "in UK, 1 unit is defined as 8 grams absolute alcohol = .5 pint ordinary beer")...they've chosen to give us an entire summer to forget the relevant parts of medicine before they set us on the wards.

I'll even be allowed to order some investigations without permission: X-rays, electrocardiograms, most blood tests and cultures.

Don't get too concerned, though. I won't be handing out scripts for narcotics, heart medications, or medical marijuana anytime soon (note to friends: notice that last one, and please stop asking). Here's what I will be allowed to prescribe without permission:

  • Non-controlled analgesics and anti-pyretics (examples: aspirin, tylenol)
  • Shampoos, dermatological preparations other than those containing steroids (examples: head & shoulders, pert)
  • Vitamins (examples: umm... Vitamin C, Flinstones multivitamins)
Okay, you're probably a lot less worried now. And I'm not sure they even call it "prescribing" - it's no secret that anyone can buy all those things at a 7-11.

Still, I'll be able to write those things in the patient's, who doesn't really know anything about medicine yet...and the nurses will actually go ahead and give it to the patient.

Those poor, poor nurses.

I'm not sure who I should feel more sorry for... the nurses? or the patients?

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Monday, May 12, 2008

Vomiting is more fun than PBL.

On a scale of 1 to 10, how ironic is it that I got food poisoning at the hospital cafeteria?

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Sunday, May 11, 2008

Learn the brain in 1 minute, 24 seconds

This is all I'm using to learn the neuroanatomy of the brain for my neuro final.

Even if you aren't interested in neuroanatomy, I highly recommend you watch it - the technology they use for animation is stunning and it really captures the essence of what happens in real life. As well the narration helps embed the anatomy in your memory.

Helps that this was one of my favourite shows as a kid.

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Tuesday, May 06, 2008

Cool body tricks: Nystagmus

In class a few weeks back, we learned that if you put hot water in one ear and cold water in another (the "Caloric test"), you can induce nystagmus, a symptom that involves your eyes quivering back and forth.

A guy in my class changed his MSN name today to: "I just did the caloric test to myself... it works."

Med students are a funny breed.

Of course, the coolest tests come with a cool mnemonic: the mnemonic for this one is COWS.

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