End of week 4

it's been three weeks since i last updated. haha.. macam sibuk.

i've just finished my first case write up. i couldn't do anything else until i completed the assignment. it was on a retroperitoneal tumour. (if ur thinking huh? wats that, then ur normal. i wouldn't have known it existed if i hadn't met the patient).

my patient, a 44 year-old malay man presented with lower urinary tract symptoms with simultaneous defaecation problems for about a month. he had significant loss of appettite and weight. he was constantly nauseated and vomited out everything he ate. from the ultrasound and CT scan done, a tumour in the retroperitoneum was found which compressed on the bladder anteriorly and the rectum posteriorly. he has been warded for more than a month. it was very tedious to go through all the investigations and treatment done.

when i clerked him, his condition had already stabilized and he was scheduled to have his tummour resected yesterday. however due to the overbooked operation theatre, his operation had to be rescheduled to two weeks time. sian die. there's loads of patients who come just have their operation rescheduled. kalau yg dekat2 tak pelah tapi kalau yang dari rompin... jauh tu. to complete my write up i had to do a per rectal examination (basically just insert my index finger into the anal canal to make the necesary assessment). the patient was very cooperative with everything else except that examination. he said that he feared it might worsen his constipation. my supervisor told me that i had to do a PR by hook oor by crook.

i presented his case for my group's long case and when the time to present the physical examination findings came, the doctor told me to do it there and then in front of my twelve groupmates. what choice did i have, or even the patient for that matter. my uneducated finger could not tell what it was touching. sian dia. the patient complained later that there was some bleeding afterwards. i felt soooo guilty.

even after 4 weeks in the ward, i still feel at a loss sometimes. there are slow days and busy days. during the slow ones, u just don't know what to do. i've only been able to perform 4 venepunctures (amek blood orang). teringin nak buat bladder catheterization tapi tak berpeluang lagi. nak pasang branula tak confident lagi. i was scolded by one consultant for not being able to perform a basic abdominal examination. horror gile.

so many patients in the ward don't pray because they have a bladder catheter attached to a drainage bag. i've told them that they can pray because the fluid doesn't leak, but they don't believe me. selama mane derang dalam ward, selama tu lah derang tak solat. hmmm...

i can't help feeling sorry for patients who get nosocomial infetions (hospital acquired infections). penat2 datang for treatment kat hospital, lagi sakit je. especially those with wound breakdown or infected wounds. the cause could be any of the hospital staff or attendants or even med students yang tak practice sangat aseptic technique.

when clerking patients, we have to take a thorough history and leave no relevant details out. that's where we have to ask sensitive questions like history of sexual promiscuity, drug abuse and alcohol abuse. some patients seems 'baik' but u can never be too sure. there's always those skeletons in the closet. tu pun ade yg tak rase bersalah langsung. i guess if u wanna know what kind of social ills are prevalent in the society, go to the hospital!