Monthly Archives: January 2011

SOPD

The past Wednesday I had a chance to be posted on the SOPD (Surgical Outpatient Department). I was placed under a supervision of a medical officer. Though he does not show much passions in teaching medical student, still I had to find a way to learn something from there as it was part of my principles- not to walk out from a place in hospital without any learning.

This time I learnt about breaching the bad news to the patients. Almost the cases I saw in the consultation rooms were consisted of malignancy. Despite the fact that I does not feel much admiration towards the attitude of the medical officer, I had to admit that he is quite experienced in his fields because he breach the bad news in such a quick and easy way. Its like pulling off the bandage/plaster in one quick motion.

Case 1: There is this one 60-something-uncle whom I recognised from the operation room where he had TURP and rigid CU done on him. During the procedure, there were some abnormal masses in his urinary bladder. Now he came back for the histopathology report. As I mentioned earlier in one of my post, this uncle always look emotionless. His daughter was told by the medical officer that he had a bladder carcinoma and it’s already metastasize to his liver.

Case 2: A chinese lady with previous history of breast carcinoma in one of her breast. She came for the mammogram and FNAC result. “It was not good” as told by the medical officer after a brief of silence. The first response she gave was I don’t want to hear. However, the medical officer continued by telling her its resectable and she should consider that option.

Case 3: A Malay lady with a lump in her breast, nipple retracted came for a detailed examination. The medical officer explained the possibility of breast carcinoma and ordered a biopsy to be done on her.

For all cases above, I realised that the medical officer did it in a simple yet comprehensible way. It’s true that it may be very hard for the patient to accept the bad news, but somehow the bad news must be told. For every cases of suspected malignancy, he never hesitate on pointing out. There was once I read from an article that doctors are hope-givers. I won’t deny that statement but to some extent, I still believe we are there to tell the truths. I’m not sure it’s because years of experience that the medical officer could now breach the bad news in such effective way.

There is time when I placed myself in the patients’ shoes. Get a call from hospital regarding the result ->waiting anxiously outside the consultation rooms even though thousands of repetition on comforting oneself that everything is going to be alright and if it turn out to be bad, I can face it -> saw the expression of the doctor and heard the first sentence coming out from his mouth stating that “It’s not good” . Yes, we can psycho ourself numerous time that we can accept it, but most of us will never escape the 5 stages of grief- Denial, Anger, Bargaining, Depression, Acceptance. It’s exactly how I observe in the consultation room. Some people might stay in one of the stages and never get pass it. This is why I really salute the fighters of terminal illnesses. You ALL are very BRAVE.

In my journey of achieving my dream to become a medical practitioner, I learn from books, lecturers but at the same time I also learn a lot from the patients. THANK YOU FOR THE INSPIRATION AND VALUABLE LESSONS FROM YOU ALL.

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First Sadness In The Ward

From the first day of picking up medicine, we are told to be emotionally detached. However, I can’t help but to feel sad 2 days back when I was in the surgery ward. This is the first time I practically have my mind blank for few moments.

There was this lady who came for the chief complaint of right upper limb swelling. When we (me and along with one partner) clerking her, she seemed to be depress as most of the questions were answered by her relative while she was lying on her bed, facing the other side. 42-year-old woman, married with 5 childs and on one referral to the hospital due to some blockage of milk, biopsy was taken from her breast. Later on she was diagnosed as invasive ductal carcinoma. When we were trying to examine her, the moment she unbutton her clothes, I felt very hard to swallow my own saliva. Diffused pigmentation, peau d orange skin, hard consistency. Her right upper limb was very hard and there are swellings on her neck as well which rendered her to lie on one side and can’t turn around. After finishing our examination, we stepped out from her cubicle and discussed.

We felt its the best not to tell the teaching doctor regarding the case. It’s not due to the fact that we refuse to share the case. It’s because we felt it would be very hard for her if we were to share it out. The doctor would certainly bring us around her bed side and discuss the case. How would she felt and she is already in a depressed state. In the end, one of the student mention about this case. I tried to explain to the doctor how depressed she was and it’s not the right time to linger on her bedside for such a long time. We ended up inspect her for a very short whiles and discussed on other place.

From the discussion, I found out that only palliative treatment will be her only choice and mastectomy wouldn’t benefit her. Tender, love and caring to improve her quality of life, the only choice for her. I felt very sad. This is the first time I have ever felt so sad in the ward. She reminded me of how fragile life could be. It’s for the fact that I fear that what if my loves one are at such state. I might sound juvenile or unprofessional, but I’m only human being, made of flesh and bloods.

The only thing we could do is to appreciate every moment in our life. Not only appreciate our own life, appreciate the people beside you 🙂 We arise from one single cell which divide and multiply until a fetus is formed. This itself is already a miracle.  Held up this miracle and create more 🙂

Thank You God for everything that we have 🙂

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Surgery and Life

First post in 2011 🙂

I always tell the people around me, I’m able to handle life and death well, or at least I think I psycho myself enough to feel that way. In fact, the second week in surgery ward, I started to doubt myself. I’m not taking life and death mature enough. There are emotions running and crawling all over my stomach, my heart and my mind. Perhaps, being too emotional and sentimental is a disadvantage because you could easily pull into their situation. When you place yourself in their shoes too often, you could easily drown in feelings of empathy and sadness.

During this week, I saw 3 patients with different backgrounds and stories:

A: An old man with urinary retention and hematuria. He looked quiet and always stare into the space.
B: An old man with prostate cancer and frank hematuria for months.
C: A woman with lumpy breast who is ordered to have hook wire localization procedure to rule of breast ca.

In the OT, I got to observe CU, lithotripsy, TURP done on the respective patients. It certainly does not seem to be a painless procedure especially during the initiation of anesthesia. Both A and B need a spinal anesthesia. 3 attempts were made on the A in order to get the medication into the spine. You could see the old man crumpled his face, hugging the pillow so tight while the anesthesiologist was using her high tone voice instructing the old man not to move. During the CU, the urinary tract of both A and B doesn’t seems to be in good condition. The tissue is exactly like how a cauliflower would look like. As for C, she had a different anesthesia- injection and inhalation anesthesia. I could tell how nervous she was in the OT even though she repeatedly emphasized being positive when I was clerking her. Who on earth would not terrified or nervous when you are being push into the cold OT without knowing what is going to happen next?

Anesthesiologist could have been gentle and sensitive towards the patients’ feelings instead of raising their voice and focus on their chit-chats. They could have been attentive towards patients’ feelings instead of pushing the needle in such a hard way into the cannulation. They would have notice the painful expression on C if not for their chit-chats. I felt bad for the patients. I really do. If only I could voice it out in the OT, I would.

Today when I was back to the ward to see the A and B, there is still hematuria with B. I felt so frustrated which I know I shouldn’t. I knew its a prostate cancer and the procedures were done to relief his urine and decrease the blood in urine. Still, I can’t help but to feel sad. It’s like you are trying so hard to put the thread through the needle’s hole and you just cannot get it through.

I really should learn to handle life and death better.

We should be thankful for each and everyday that we wake up to and for being healthy.

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