Wednesday, April 13, 2005
I just had one of the best experiences of my life J no.. it wasn’t bungee jumping , it was :
GIVING AN INJECTION.. haha ( ok. I gave 2 actually)
I can see you rolling your eyes. But hey, there’s a first time for everyone and this was first time I wasn’t on the receiving end of the needle. SO there we were, one brave man with his shirt sleeves rolled up, one very accommodating doctor and one very nervous but excited med student.
“ You sure you’re alright with me doing this?” I asked as Dr. T.V. handed me the needle.
Pt X nodded firmly. “ I always welcome beautiful ladies ,” He said with a grin.
Note : if there was a way to give a painless injection, I would have used it with this man..
Dr. TV demonstrated the technique. Hestitantly, I cleaned the site, blanched the skin with my fingers and stuck the needle in.
X’s face crumbled into a momentary grimace. I quickly pushed the plunger and lifted the needle free of its target. Feeling triumphant, I then skipped off to the dustbin.
“ ah ah ah… In the sharps container,” Dr. TV pointed across the room.
It was a brain wrecking day for me. Bits of knowledge acquired from the past semesters had been thrown out because my cortical and hippocampal neuronal circuits had ( as a patient described her eyesight) gone CAPUT! Dr. TV continuously quizzed me and challenged me. I examined patients, came up with differential diagnosis, ran through lab test and suggested treatment and diagnostic measures. Half of what I was saying was probably wrong, but Dr. TV was very encouraging. He taught me to be certain. Even if I missed the answer by a mile, every mistake was a chance to learn. I just realized how bad my surface anatomy was. I went for the leg when he asked for a radial pulse. ( anyway, the patient didn’t have a radial pulse, coz his artery was taken out for a bypass)
I liked Dr TV the moment he walked in through the door and shook my hand. He was a dignified yet friendly and warm person with a mischievious twinkle in his eyes. He reminded me of a kindly grandpa who knew every single kid in the neighbourhood.
The nurse had me worried for a moment because she informed me that half the patients only spoke Greek. Well.. she failed to say that half of the rest spoke Italian. But the patients were wonderful. Even when we couldn’t communicate, they were willing for me to probe them, subject them to clumsy blood pressure taking and other uncomfortable examinations.
General practices was nothing like I imagined. I was expecting an endless stream of colds and flus.. but what I was hit with was a wave of cases that lept out of my textbooks and rained upon me.
Siatica, tennis elbow, diabetic retinopathy, cataract, warts, pulled muscles, HSV-2, Pb poisoning, Thyroid adenoma, heart block, ulcerative colitis, celiac sprue, liver dysfunction, dementia, and “ supra tentorial cerebella lesions aka “ just in the mind.” ( MOM!!! You’ll be nodding your head on this one), pill prescriptions, warts, wart like legions, congenital derformatives, livers, high cholesterol… Patients! Test results! Examination results!.. I had to recall the facts, put in the symptoms and the context and clock out a diagnosis, a test or a treatment. Couldn’t do it half the time, but the patients and Dr TV helped me along.
There was a patient who let me peer into eyes for 10 minutes. I couldn’t figure out what I was supposed to see. I kept telling Dr TV I saw something black. I kept thinking that I had to see the red reflex. Actually, I was seeing what I was supposed to see all along. I was too afraid to tell the Dr because I was looking for something “typical”
“ In med, you’ve to describe what you see, not what you’re supposed to see, “ the doctor told me kindly.
The lady was sooo wonderful.. She described to the nurse outside..
“ oh.. and that student was such an angel.. “
seriously, I know that having a strong light focused into your eyes is extremely uncomfortable and even more is having someone right up in front of your face. if it was me, I’ll be probably cursing and swearing at that stupid med student who had no inkling on wat to find.
“ you’ve got to learn dear, “ one of the patients ( a frail old lady mind you!)_ patted my hands as I tried to take her blood pressure for the umpteenth time. She let me wrap it around again, tho’ I knew that at point of time, her arm had most probably gone numb.
. DR TV actually trusted my blood pressure readings, the visual acuity tests I graded and my clinical examination reports. True, he followed up when I messed up the readings, but as the afternoon wore on, I gained more confidence in strapping on the sphygnomanometer and getting the readings. At the end of the day, instead of holding the instrument as though it was a rattle snake poised to attack, I welcomed the opportunities to use it.
He took me along to a nursing home visit.
“ Are you volunteering for this?” I asked.
” Where they need me, I go… “ he laughed. “ That’s a doctors job.. where we are needed we go!”
The nursing home was little ditzy for me.. coz it was .. literally All greek to me. They conversed totally in greek. But I got to see a pt with hemiplagia and oh.. clonus!!! And on the drive there, I had a conversation with Dr TV about euthanasia, ethics, doctor patient relationships, paternalistic approach and imposing my morals on patients…
“ Even if the stinkiest, most filthy person walks in through your door.. you’ve to treat him like a king. When you practise, you’ve to do so with your conscience behind you. You’ve to show them care, but you’ve to also stop yourself from showing them too much care, coz this will cloud your judgement. It’s a balance you’ve to strike.”
“ You’ve to be careful about imposing your morals on other ppl. You’re there to prevent harm. You can educated them, treat them and help them but you can’t dictate what they have to do..” he said when I asked for his opinion about the case on Today Tonight where the GP refused to prescribe the pill to a 16 year old gal despite approval from her mother. “ Coz if you refuse to give her the pill, she could still go and have sexual intercourse anyway”
And of course my fav topic about the interstitial sex nuclei in guys was broached when we discussed patient –doctor intimacies.
“ Male docs have to watch themselves, women docs are less likely land in that mess,” he chuckled. I told him the anecdotal evidence of the brain scans of the guys. “ That’s true, “ he said. “ For ladies… sex is of least importance, but for the men! Ah..that’s all that matters. Everything else can just go right out of the window.”
“ go watch beautiful mind… “ he told me as we walked back to the clinic. “ It’s potrays schizophrenia to such a depth.. it took me 2 screenings to appreciate its true beauty. But there ‘s a quote that’s priceless, Nash told a blonde bombshell.. ‘ let’s just skip the whole dating, you’re so beautiful bull shit and go mix our juices.. “”
( see even the nobel price winner also exhibits the classic sex –visual stimulus –sex reflex of the male subtypes of our species)
It was a huge demand on the faint memories my brain held of Neuro, of gastro, of Cardio , skin , immuno and endocrine systems. I saw every single thing my ICM books had coughed up, but yet, it was like seeing all these abnormalities in a whole different way. I diagnosed a patient with sciatica and jumped with joy when Dr TV nodded his approval.
Some patients were really cute. They gave me hints along the way when Dr TV tested me. Like the one who kept doing a tennis ball serve to hint to me her condition of tennis elbow when Dr. TV was grilling me for a diagnosis. Another patient discretely pointed out a sore spot for me and appropriately grimaced and yelled when the Dr asked me to elicit the site of inflammation. I resisted the urge of giving them a high five.
I learned the art of pantomiming out symptoms to communicate with the patients who spoke no English. Grimacing, showing a thumbs up…
“ Sign language!” Dr TV said, when I asked him about how to cross that obstacle.” Lots of sign language! Speak Slowly, clearly and ARTICULATE properly.”
“ Do a neck exam on her,” He pointed at the patient in front of me.
I had not a faintest idea how to approach a neck exam. I stared at the neck. It looked abnormal, but I couldn’t quite place my finger on the abnormaility. I palpated the area. I suspected a lump, but wasn’t quite sure. I told him my suspicions. “ Cystic or solid?” he asked me. “ Cystic , “ I said uncertainly, after affirming wat the term meant. “ You sure? “ he asked. “ Yez, “ I said firmly. ( I had to take a gamble)
“ Well.. you’re right, “ he passed me the test report. “ The lab techs couldn’t make it out either. It’s a cystic lump with an adenoma ( solid) in it.”
Yeah, I had to make a decision. Looking stupid was an option. The yield? It was priceless.
I was hugely reluctant to leave but the sun was hovering around the horizon.. hai.. why does it have to be autumn..??? and I had to make my way to the train station to catch the vehicle back to the city.
It was an excellent first visit.. hope the rest will be just as great :) I love it so much, I don’t mind traveling the distance.. alas! If only we had it once a week instead of fortnightly :P
GIVING AN INJECTION.. haha ( ok. I gave 2 actually)
I can see you rolling your eyes. But hey, there’s a first time for everyone and this was first time I wasn’t on the receiving end of the needle. SO there we were, one brave man with his shirt sleeves rolled up, one very accommodating doctor and one very nervous but excited med student.
“ You sure you’re alright with me doing this?” I asked as Dr. T.V. handed me the needle.
Pt X nodded firmly. “ I always welcome beautiful ladies ,” He said with a grin.
Note : if there was a way to give a painless injection, I would have used it with this man..
Dr. TV demonstrated the technique. Hestitantly, I cleaned the site, blanched the skin with my fingers and stuck the needle in.
X’s face crumbled into a momentary grimace. I quickly pushed the plunger and lifted the needle free of its target. Feeling triumphant, I then skipped off to the dustbin.
“ ah ah ah… In the sharps container,” Dr. TV pointed across the room.
It was a brain wrecking day for me. Bits of knowledge acquired from the past semesters had been thrown out because my cortical and hippocampal neuronal circuits had ( as a patient described her eyesight) gone CAPUT! Dr. TV continuously quizzed me and challenged me. I examined patients, came up with differential diagnosis, ran through lab test and suggested treatment and diagnostic measures. Half of what I was saying was probably wrong, but Dr. TV was very encouraging. He taught me to be certain. Even if I missed the answer by a mile, every mistake was a chance to learn. I just realized how bad my surface anatomy was. I went for the leg when he asked for a radial pulse. ( anyway, the patient didn’t have a radial pulse, coz his artery was taken out for a bypass)
I liked Dr TV the moment he walked in through the door and shook my hand. He was a dignified yet friendly and warm person with a mischievious twinkle in his eyes. He reminded me of a kindly grandpa who knew every single kid in the neighbourhood.
The nurse had me worried for a moment because she informed me that half the patients only spoke Greek. Well.. she failed to say that half of the rest spoke Italian. But the patients were wonderful. Even when we couldn’t communicate, they were willing for me to probe them, subject them to clumsy blood pressure taking and other uncomfortable examinations.
General practices was nothing like I imagined. I was expecting an endless stream of colds and flus.. but what I was hit with was a wave of cases that lept out of my textbooks and rained upon me.
Siatica, tennis elbow, diabetic retinopathy, cataract, warts, pulled muscles, HSV-2, Pb poisoning, Thyroid adenoma, heart block, ulcerative colitis, celiac sprue, liver dysfunction, dementia, and “ supra tentorial cerebella lesions aka “ just in the mind.” ( MOM!!! You’ll be nodding your head on this one), pill prescriptions, warts, wart like legions, congenital derformatives, livers, high cholesterol… Patients! Test results! Examination results!.. I had to recall the facts, put in the symptoms and the context and clock out a diagnosis, a test or a treatment. Couldn’t do it half the time, but the patients and Dr TV helped me along.
There was a patient who let me peer into eyes for 10 minutes. I couldn’t figure out what I was supposed to see. I kept telling Dr TV I saw something black. I kept thinking that I had to see the red reflex. Actually, I was seeing what I was supposed to see all along. I was too afraid to tell the Dr because I was looking for something “typical”
“ In med, you’ve to describe what you see, not what you’re supposed to see, “ the doctor told me kindly.
The lady was sooo wonderful.. She described to the nurse outside..
“ oh.. and that student was such an angel.. “
seriously, I know that having a strong light focused into your eyes is extremely uncomfortable and even more is having someone right up in front of your face. if it was me, I’ll be probably cursing and swearing at that stupid med student who had no inkling on wat to find.
“ you’ve got to learn dear, “ one of the patients ( a frail old lady mind you!)_ patted my hands as I tried to take her blood pressure for the umpteenth time. She let me wrap it around again, tho’ I knew that at point of time, her arm had most probably gone numb.
. DR TV actually trusted my blood pressure readings, the visual acuity tests I graded and my clinical examination reports. True, he followed up when I messed up the readings, but as the afternoon wore on, I gained more confidence in strapping on the sphygnomanometer and getting the readings. At the end of the day, instead of holding the instrument as though it was a rattle snake poised to attack, I welcomed the opportunities to use it.
He took me along to a nursing home visit.
“ Are you volunteering for this?” I asked.
” Where they need me, I go… “ he laughed. “ That’s a doctors job.. where we are needed we go!”
The nursing home was little ditzy for me.. coz it was .. literally All greek to me. They conversed totally in greek. But I got to see a pt with hemiplagia and oh.. clonus!!! And on the drive there, I had a conversation with Dr TV about euthanasia, ethics, doctor patient relationships, paternalistic approach and imposing my morals on patients…
“ Even if the stinkiest, most filthy person walks in through your door.. you’ve to treat him like a king. When you practise, you’ve to do so with your conscience behind you. You’ve to show them care, but you’ve to also stop yourself from showing them too much care, coz this will cloud your judgement. It’s a balance you’ve to strike.”
“ You’ve to be careful about imposing your morals on other ppl. You’re there to prevent harm. You can educated them, treat them and help them but you can’t dictate what they have to do..” he said when I asked for his opinion about the case on Today Tonight where the GP refused to prescribe the pill to a 16 year old gal despite approval from her mother. “ Coz if you refuse to give her the pill, she could still go and have sexual intercourse anyway”
And of course my fav topic about the interstitial sex nuclei in guys was broached when we discussed patient –doctor intimacies.
“ Male docs have to watch themselves, women docs are less likely land in that mess,” he chuckled. I told him the anecdotal evidence of the brain scans of the guys. “ That’s true, “ he said. “ For ladies… sex is of least importance, but for the men! Ah..that’s all that matters. Everything else can just go right out of the window.”
“ go watch beautiful mind… “ he told me as we walked back to the clinic. “ It’s potrays schizophrenia to such a depth.. it took me 2 screenings to appreciate its true beauty. But there ‘s a quote that’s priceless, Nash told a blonde bombshell.. ‘ let’s just skip the whole dating, you’re so beautiful bull shit and go mix our juices.. “”
( see even the nobel price winner also exhibits the classic sex –visual stimulus –sex reflex of the male subtypes of our species)
It was a huge demand on the faint memories my brain held of Neuro, of gastro, of Cardio , skin , immuno and endocrine systems. I saw every single thing my ICM books had coughed up, but yet, it was like seeing all these abnormalities in a whole different way. I diagnosed a patient with sciatica and jumped with joy when Dr TV nodded his approval.
Some patients were really cute. They gave me hints along the way when Dr TV tested me. Like the one who kept doing a tennis ball serve to hint to me her condition of tennis elbow when Dr. TV was grilling me for a diagnosis. Another patient discretely pointed out a sore spot for me and appropriately grimaced and yelled when the Dr asked me to elicit the site of inflammation. I resisted the urge of giving them a high five.
I learned the art of pantomiming out symptoms to communicate with the patients who spoke no English. Grimacing, showing a thumbs up…
“ Sign language!” Dr TV said, when I asked him about how to cross that obstacle.” Lots of sign language! Speak Slowly, clearly and ARTICULATE properly.”
“ Do a neck exam on her,” He pointed at the patient in front of me.
I had not a faintest idea how to approach a neck exam. I stared at the neck. It looked abnormal, but I couldn’t quite place my finger on the abnormaility. I palpated the area. I suspected a lump, but wasn’t quite sure. I told him my suspicions. “ Cystic or solid?” he asked me. “ Cystic , “ I said uncertainly, after affirming wat the term meant. “ You sure? “ he asked. “ Yez, “ I said firmly. ( I had to take a gamble)
“ Well.. you’re right, “ he passed me the test report. “ The lab techs couldn’t make it out either. It’s a cystic lump with an adenoma ( solid) in it.”
Yeah, I had to make a decision. Looking stupid was an option. The yield? It was priceless.
I was hugely reluctant to leave but the sun was hovering around the horizon.. hai.. why does it have to be autumn..??? and I had to make my way to the train station to catch the vehicle back to the city.
It was an excellent first visit.. hope the rest will be just as great :) I love it so much, I don’t mind traveling the distance.. alas! If only we had it once a week instead of fortnightly :P
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