a lady with bell's palsy

Had been frequenting the wards a lot recently.

Today, I was asked by a senior to have a 'peek' at a patient's face. It is perhaps not a good time to talk to her, since she had just been broken a bad news yesterday, he said. I noticed that she is jaundiced, and has R sided facial weakness. Flipping through her chart - patient was presented 3 months earlier with Bell's palsy, which has not resolved over months.

A familiar scene flashed through my mind. I met a patient with Bell's palsy earlier, with the same first name as her. And she has the same side of facial weakness. I even wrote a case report on her. I dont know if she was the same lady I met.

This time, she came back to the hospital with weight loss and pruritus. Her U&E and LFTs are deranged. And she reported having an insect bite 5 months ago (?Lyme). Scans showed that she had extensive mets to the brain, bone and liver. Primary lesion unknown, there are still ongoing investigations. It seems that Bell's palsy is her first symptom of the still unknown culprit, which is now may no longer be termed Bell's.

Poor lady. :(

OSCE

The wards are flooded by me and my batchmates these days. Some biatchy nurses were complaining but what to do, OSCE is near.

It is definitely not fun to be asked the same questions over and over again or be examined multiple times in a day. I can truly understand how the patients feel. I feel sorry to bother a patient too much, especially when they said 'you are the 5th I see today' or just rejected us even before we get near to them.

There was this one patient with drips and jaundice and tremor etc, who looked really ill on first sight. Not knowing his medical background, we went to examine him. Upon unbuttoning him, the findings were even more shocking. The most obvious ones are a midline sternostomy scar, a midline laparotomy scar and also a ileostoma. His lung expansion was almost unnoticeable. Guess what he has - colorectal carcinoma with mets to liver and lungs. Felt quite bad for seeing him. Because normally, we wouldn't disturb patients who are very ill.

So we changed our strategy - to practise with an intern around. This time it works much better. We got good feedbacks as well as get patients with good clinical findings. At least, the patients are more willing to be seen with a doctor around.

And we went to clinics as well. The patients there are 'fresh' (aka not being seen too many times) and more clinically stable to be seen by students. Yes clinics are good for students.

Here goes my days - OScE, OsCE and OscE.

history presenting

YY was kind enough to gave us an opportunity to present histories.

Presented 1 myself, and witnessed a few presented by fellow coursemates. Somehow I think I'm 1 step behind the locals, but 1 step ahead of some of my countrymen. In this foreign land, there's something that we are far behind the locals - confidence. As Asians, we were taught to be humble since young. But in this field, confidence wins.

I used to present the way my countrymen did, until I presented to an Irish intern. She was very particular, strict and stern, but I really like it. She was like splashing a pail of water onto my head, that I finally have a clear view of the utmost importance in history presenting. I really really appreciate that only chance I had with her.

Had a great weekend eat-out and more-than-enough sleeping hours. Now, it's time to rearrange the knowledge gained throughout this strand, and get ready for the next. ;)

memorable paddy's

Felt like a Monday today, because I just had so much fun yesterday on St Paddy's. So fast, it's Friday tomorrow. Feel like the week has just started.

The weekend before Paddy's was a busy one. Early celebration of H's bday, and potluck in Charm's. The whole church-lunch-afterlunch lasted till late evening. But at least, we got all the masks ready, with the help of many of us!

This year, I was in the parade, as a green faced robot distributing free masks/stickers/tattoos. I enjoyed seeing the smiles upon receiving free goodies. There's one middle aged lady asking for stickers. When I gave her the whole stack (about 10), she uttered in surprise "God bless you!". I didn't get to see the parade, but I had lots of fun, my way! :D

GI medicine doesn't seem too interesting to me. Very slack, a lot more free time compared to surgery. But the medicine staff are wayyyyyy more friendly than the surgeons. I like them, I respect them, but undeniably, I miss the theatre. Or probably, I have got most on the checklist signed, that I have lost the enthusiasm in this rotation. Instead of attending clinic, I followed seniors in the wards for revision. It somehow helps me more, I think. ;)

I love Friday.

transhiatal oesophagectomy

Can I believe myself that I actually scrubbed in for the above surgery??

It was a big big surgery involving big big steps on a oesophageal cancer patient. To simplify it..
1. An incision made on the upper abdomen.
2. Stomach mobilized.
3. Incision made on the neck.
4. Oesophagus cut at the neck level.
5. Oesophagus pulled downwards through the diaphragm (hence 'transhiatal') and was removed together with part of the stomach.
6. The stomach was made into a tube shape and pulled upwards through the diaphragm to 'replace' the oesophagus.
7. Anastomosis between oesophagus and stomach.

One word to describe - GRAND! I'm really very lucky to get to scrub in for it. Not only I get to assist (though in a very minor way) but more importantly I get to have a very close look at the entire procedure OMG!! It's totally worth it staying in the theatre till 6pm!
Also for today: appendicectomy, sleeve gastrectomy, diaphragm repair, oesophageal stent removal.
Super contented!! XD

panproctocolectomy?!

I was only home 7pm today. Thanks to the above surgery.

First of all:
pan = total
procto = rectum
colec = large intestine
tomy = removal
Hence - total removal of large intestine and the rectum.

It was a 3hr surgery involving digging the tummy and the back passage. A large portion of the large bowel was first removed through the tummy. The rectum and the anus was then removed through the back passage. The latter took quite a long time due to severe inflammation of the rectum, in which it attached itself to the pelvic wall, making the procedure more difficult than usual. After that, an ileostoma was created in which a hole is made on the tummy, and the terminal ileum (small intestine) was dragged through it to the surface of the tummy. Escaped before stitches were completed. Long hours of standing was torturing. More about this patient, he had inflammatory bowel disease (IBD), and he is an inmate.

Also, witnessed hemicolectomy and multiple colonoscopies. Was quite impressed with hemicolectomy, until I saw the panproctocolectomy.

More interesting thing coming up tomorrow. Stay put!

of ingrowth toenail and sleeve gastrectomy

So fast the weekend came, and so fast it ended.

Witnessed a ingrowth toenail surgery on Fri. It was just..ouch! The patient was a teenage girl who almost cried when being injected local anaesthetic. It was a minor surgery that involved cutting the sides of the toenail all the way to the 'root', then cut the flesh at the inner edges of the nail to 'dig' out the 'root'. Ouch ouch!! So painful! How powerful an anaesthetic is, the nervous girl was smiling and joking throughout the whole procedure. The whole procedure was really 'painful' but the toe looked much cleaner and tidier in the end. Wow!

Half of the weekend daytime were spent sleeping. Attended a potluck dinner with China chinese and Hongkee. Ooh ohhh I love gathering I love potluck! We played mafia and sang K till 2am and as a result, I missed the next day's church. Don't misunderstand, I'm still a Buddhist, was intending to join their St Patrick's day parade that's why planned to show up once.

Today is a busy day that I stayed till almost 6pm. Witnessed a laparoscopic sleeve gastrectomy in the morning. So many things went wrong that Prof McA got very mad. Took a history of a teenage girl having pancreatitis, and presented to McA's intern. She was so particular and strict but so helpful! I got back my semangat to take histories and present to her!

Am recently planning a trip during summer and please please..I need cheaper air tic!

GI surgery

Day 5 in new house!

It was just last Sunday that we officially occupied this house, but it felt that we have been here for some time. Except the first morning when I woke up in confusion, I'm already used to this room, and have been looking forward to come back everyday. I missed my previous room, but I'm so loving this room, more than the previous!! ^^

Attachment with Prof McAnena (yes, he is a 'Prof' now!) was enjoyable so far. He was in such a good mood that he talked to us a lot. Plus, he has a very helpful team! Recalling the gastrectomy surgery witnessed 2 months ago, I was being quizzed about gastric carcinoma outside the theatre, and yea, by his Reg. Wonder if he still remembers me, which I doubt. ;)

Felt quite bad to disappoint Nuala again. Kept her waiting for 30mins the other day, and another 15mins this morning. Doing geriatrics makes me absent-minded? Nonsense!

It has been a long day, and it has been a long week. Luckily weekend is not far ahead! =)