congratulations Marilyne and to Ben as well for your new bouncing baby girl. I'm pround of you both and I pray that your daughter has good health and God's blessings forever and ever...Amen!
They got married about a year ago and now have their little one. How sweet.
Saturday, June 27, 2009
There is laughter in Medicine too; what about the Stethoscope sign?
I started a couple of months to post quotes that I wanted to remember some years from now and this's just a continuation of that:
-so we're in morning report and the next patient is an HIV +ve male who was admitted for Epididymitis (he had swollen testis). Then immediately after the resident calls the patient's name and gets ready to present him, here goes the attending "so how does his balls looks today?" The pharmacists who sits in on rounds burst out laughing but in a discrete way and I couldn't help either.
-"The stethoscope sign?"
so I had seen a patient earlier and was presenting the abdominal findings to the resident, who had also seen the patient after me. My abdominal exam was impressive in that it was tender to palpation but the resident want impressed with the abdominal exam. So she said "have you ever heard of the stethoscope sign?" I was like "no". So she said "when you palpate on the patients abdomen and they act like they're in pain and you want to validate your exam in suspicious cases, just place your stethoscope on their abdomen as if you're listening to their bowel sounds but apply pressure equal to that which you used during bare hand palpation and if the patient doesn't act like they're in pain, then the stethoscope sign is +ve" which means patient is just feigning.
- The cry for "vigina"
So this woman in her 40s comes in with chief complain of vertigo (felt as if she was spinning while in reality she was still) and had unstable gait. So we decided to r/o any Cerebro Spinal Fluid (CSF )infection etiology. She had earned a Lumbar puncture (which is where you basically insert a needle into some one's spinal canal -while avoiding the spinal cord and nerves) in order to collect some CSF for testing. Usually the area of needle penetration is numbed by injecting Lidocaine. So as the resident penetrates the spinal canal, the patient starts to really becomes anxious and I calmly talk her into being as calm as she can but she was still a little anxious. Then all of a sudden she says "awww, I can feel it going down me." "Do you feel pain or pressure? the resident asks" patient replies " I feel presssuuurreee" then a couple of seconds goes by and patient shouts " awwwww my viiiiigiiiiinnaaa; a sharp pain just went down my viigiinaa" and at this point we're looking at each other is dismay and thinking what's possibly happening here. Not to mention that the LP ended up being unsuccessful i.e no CSF could be obtained.
Thanks for reading,
Later.
-so we're in morning report and the next patient is an HIV +ve male who was admitted for Epididymitis (he had swollen testis). Then immediately after the resident calls the patient's name and gets ready to present him, here goes the attending "so how does his balls looks today?" The pharmacists who sits in on rounds burst out laughing but in a discrete way and I couldn't help either.
-"The stethoscope sign?"
so I had seen a patient earlier and was presenting the abdominal findings to the resident, who had also seen the patient after me. My abdominal exam was impressive in that it was tender to palpation but the resident want impressed with the abdominal exam. So she said "have you ever heard of the stethoscope sign?" I was like "no". So she said "when you palpate on the patients abdomen and they act like they're in pain and you want to validate your exam in suspicious cases, just place your stethoscope on their abdomen as if you're listening to their bowel sounds but apply pressure equal to that which you used during bare hand palpation and if the patient doesn't act like they're in pain, then the stethoscope sign is +ve" which means patient is just feigning.
- The cry for "vigina"
So this woman in her 40s comes in with chief complain of vertigo (felt as if she was spinning while in reality she was still) and had unstable gait. So we decided to r/o any Cerebro Spinal Fluid (CSF )infection etiology. She had earned a Lumbar puncture (which is where you basically insert a needle into some one's spinal canal -while avoiding the spinal cord and nerves) in order to collect some CSF for testing. Usually the area of needle penetration is numbed by injecting Lidocaine. So as the resident penetrates the spinal canal, the patient starts to really becomes anxious and I calmly talk her into being as calm as she can but she was still a little anxious. Then all of a sudden she says "awww, I can feel it going down me." "Do you feel pain or pressure? the resident asks" patient replies " I feel presssuuurreee" then a couple of seconds goes by and patient shouts " awwwww my viiiiigiiiiinnaaa; a sharp pain just went down my viigiinaa" and at this point we're looking at each other is dismay and thinking what's possibly happening here. Not to mention that the LP ended up being unsuccessful i.e no CSF could be obtained.
Thanks for reading,
Later.
You must be really good then if you're still in trianing...
As I mentioned in my last posting, I spent this entire month doing my Internal Medicine rotation. I have a short story to share about what happen during one of my patient encouters.
So my team (which I really really enjoyed working with) was on call. The day had been going slow so I decided to go through some questions and readings. All of a sudden I heard "BEEP" "BEEP" that was my pager going off. I instantaneously called back and the resident said "Anselm, we've an admission here. Wanna take it?" I was like "Sure, of course". With my long legs, I was in the ER within the next 2-3 mins, ready to get an History, do a Physical and discuss about the work up plan with the resident and go from there. As I arrived at the ER, the met the resident who told me that ... "so your pt is a 49y/o African American female who has Abdominal pain and was has been admitted at an Outside hospital twice in the last 2 months for thesame complain. I really don't have much on her, go see her and see what you come up with." I said sure and was gone.
So I met the pt, introduced myself and began to talk with her. She initally gives me a very scanty history in the sense that she didn't want to give me much about her past history regarding her abdominal pain. Rather she wanted to focus on the present episode. I told her that obviously there must be something wrong going on, since she's had this same quality of pain for a couple of yrs with the severity getting worse. I pulled a chair and sat right across from her as she laid in bed on her right side with hips flexed. I asked her to take me back to the first episode and walk her way from there to where we are today. I was interrupting at times of course to guide her towards waht I thought was pertinent. From the look on her face, I could infer that she couldn't believe that I wanted to spend all this time with her and listen to what has happened to date. Well, she was a descent historian and even kept some discharge summaries from the OSH with her. I collected them, quickly glanced through some and read some, copying what I thought was pertinent to her presentation ( I guess as a med student you have more time to go through stuff like this). She described her pain as starting from the Right upper and lower quadrants and radiating to the Left quadrants then to her entire lower back; the pain was sharp, throbbing and aching with a severity of 10/10. She had an extensive history and throughout our conversation, she didn't request for any pain medicine but prior to that, she was getting Dilaudid quite often and had just received Toradol IV prior to me entering her room. The Toradol must have been doing a fine job. So as I was getting ready to do my Physical Exam, a nurse came in and said there was a bed ready on one of the floors and she needed to be transported to her room where she'll be during her admission. I told her that I'll meet her in her room.
A couple a minutes later, I was in her room ready to do the Physical Exam (PE) and the Husband walked in. He was a little helpful as he was able to tell me some results of imaging done at outside hospitals. I proceeded to do the PE and when I got to the Abd (where the money is), her Abdomen was diffusely tender but moreso on the lateral aspects. Both flank regions were tender to palpation (with the patient retracting herself from my hands) but the Left was more than the Right. Her labs were remarkable for a microscopic hematuria for which she said she has had a history of that.
From my exam, I was convinced that the kidneys were involved (the impressive flank tenderness) plus hematuria. This would explain the back pain but what about the abdominal pain - maybe it was radiating to her abd especially given that the lateral aspects were more tender. I did some search and reading and came up with a theory of my own: Was it a possible case of - Loin pain humaturia Syndrome (LPHS)?
Briefly, LPHS, is when the glomerular basement membrane (in your kidney) is very thin such that the normal pressure from blood supplying (perfusing) your kidney causes micro damage and bleeding hence the Pain and blood in urine. Classic presentation is unilateral flank pain and blood in urine (either microscopic or frank blood in the urine).
Well, the resident was quite interested in the case and asked my to present it at the morning report the following day but she cautioned me that students do NOT usually present and she'll be on the podium with me in case I needed any assistance. Well I did and she was wonderful in chipping in here and there and it went great. My attending congratulated me after the presentation. More tests and imaging studies will be done to workup the possible etiology of her pain. Too bad I wasn't going to be there any longer to see how it turns our. Usually the LPHS is a diagnosis of exclusion and if the w/u came back negative for the suspects then it makes my theory more credible.
Well, so back to my patient. Later that night I stopped by her room and she asked if I was going to be her doctor the entire time while she was at hospital. "I'm a medical student that is, I'm still in training, your doctor will be doctor P. But I'll be following you and working together with Dr. P" I replied. She then stated "You must be really good then if you're still in training. I was talking with my husband about how you really cared about asking me all the questions. About how you wanted to know everything about my pain and what I've been taking for it. Usually other doctors are just like okay we'll give you pain medicine and then they get me out of the hospital but no one has ever showed that they really care about my pain as you did." At this point my heart was racing and she continued "so I was telling my husband that I think this time, they gonna find what's wrong with me because someone's acting like they really wanna get to the bottom of this pain." Then I gave my little reason of why I went to medicine "b/c I really like to do my best to help people feel better and if there's anything possible that I can, I will which is why I was going through all what I did earlier and I also appreciate you being open to willing to discuss your history with us because it'll help us take good care of you" and also added that "the doctors that I work with here all care too and we'll do our best to get to the bottom of it." Then she said "well if they all care like you then I'm glad because I just wanna get this pain away, it's been bothering me for too long now and all I do is just pop pain pills which don't really help me."
I wish I could see how this case ends. Just one of those things that really gets me thinking even as I drove on my way home from the hospital.
Thanks for reading/visiting. Will be sure to write sooner.
So my team (which I really really enjoyed working with) was on call. The day had been going slow so I decided to go through some questions and readings. All of a sudden I heard "BEEP" "BEEP" that was my pager going off. I instantaneously called back and the resident said "Anselm, we've an admission here. Wanna take it?" I was like "Sure, of course". With my long legs, I was in the ER within the next 2-3 mins, ready to get an History, do a Physical and discuss about the work up plan with the resident and go from there. As I arrived at the ER, the met the resident who told me that ... "so your pt is a 49y/o African American female who has Abdominal pain and was has been admitted at an Outside hospital twice in the last 2 months for thesame complain. I really don't have much on her, go see her and see what you come up with." I said sure and was gone.
So I met the pt, introduced myself and began to talk with her. She initally gives me a very scanty history in the sense that she didn't want to give me much about her past history regarding her abdominal pain. Rather she wanted to focus on the present episode. I told her that obviously there must be something wrong going on, since she's had this same quality of pain for a couple of yrs with the severity getting worse. I pulled a chair and sat right across from her as she laid in bed on her right side with hips flexed. I asked her to take me back to the first episode and walk her way from there to where we are today. I was interrupting at times of course to guide her towards waht I thought was pertinent. From the look on her face, I could infer that she couldn't believe that I wanted to spend all this time with her and listen to what has happened to date. Well, she was a descent historian and even kept some discharge summaries from the OSH with her. I collected them, quickly glanced through some and read some, copying what I thought was pertinent to her presentation ( I guess as a med student you have more time to go through stuff like this). She described her pain as starting from the Right upper and lower quadrants and radiating to the Left quadrants then to her entire lower back; the pain was sharp, throbbing and aching with a severity of 10/10. She had an extensive history and throughout our conversation, she didn't request for any pain medicine but prior to that, she was getting Dilaudid quite often and had just received Toradol IV prior to me entering her room. The Toradol must have been doing a fine job. So as I was getting ready to do my Physical Exam, a nurse came in and said there was a bed ready on one of the floors and she needed to be transported to her room where she'll be during her admission. I told her that I'll meet her in her room.
A couple a minutes later, I was in her room ready to do the Physical Exam (PE) and the Husband walked in. He was a little helpful as he was able to tell me some results of imaging done at outside hospitals. I proceeded to do the PE and when I got to the Abd (where the money is), her Abdomen was diffusely tender but moreso on the lateral aspects. Both flank regions were tender to palpation (with the patient retracting herself from my hands) but the Left was more than the Right. Her labs were remarkable for a microscopic hematuria for which she said she has had a history of that.
From my exam, I was convinced that the kidneys were involved (the impressive flank tenderness) plus hematuria. This would explain the back pain but what about the abdominal pain - maybe it was radiating to her abd especially given that the lateral aspects were more tender. I did some search and reading and came up with a theory of my own: Was it a possible case of - Loin pain humaturia Syndrome (LPHS)?
Briefly, LPHS, is when the glomerular basement membrane (in your kidney) is very thin such that the normal pressure from blood supplying (perfusing) your kidney causes micro damage and bleeding hence the Pain and blood in urine. Classic presentation is unilateral flank pain and blood in urine (either microscopic or frank blood in the urine).
Well, the resident was quite interested in the case and asked my to present it at the morning report the following day but she cautioned me that students do NOT usually present and she'll be on the podium with me in case I needed any assistance. Well I did and she was wonderful in chipping in here and there and it went great. My attending congratulated me after the presentation. More tests and imaging studies will be done to workup the possible etiology of her pain. Too bad I wasn't going to be there any longer to see how it turns our. Usually the LPHS is a diagnosis of exclusion and if the w/u came back negative for the suspects then it makes my theory more credible.
Well, so back to my patient. Later that night I stopped by her room and she asked if I was going to be her doctor the entire time while she was at hospital. "I'm a medical student that is, I'm still in training, your doctor will be doctor P. But I'll be following you and working together with Dr. P" I replied. She then stated "You must be really good then if you're still in training. I was talking with my husband about how you really cared about asking me all the questions. About how you wanted to know everything about my pain and what I've been taking for it. Usually other doctors are just like okay we'll give you pain medicine and then they get me out of the hospital but no one has ever showed that they really care about my pain as you did." At this point my heart was racing and she continued "so I was telling my husband that I think this time, they gonna find what's wrong with me because someone's acting like they really wanna get to the bottom of this pain." Then I gave my little reason of why I went to medicine "b/c I really like to do my best to help people feel better and if there's anything possible that I can, I will which is why I was going through all what I did earlier and I also appreciate you being open to willing to discuss your history with us because it'll help us take good care of you" and also added that "the doctors that I work with here all care too and we'll do our best to get to the bottom of it." Then she said "well if they all care like you then I'm glad because I just wanna get this pain away, it's been bothering me for too long now and all I do is just pop pain pills which don't really help me."
I wish I could see how this case ends. Just one of those things that really gets me thinking even as I drove on my way home from the hospital.
Thanks for reading/visiting. Will be sure to write sooner.
Then end of third year and a look ahead
Ladies and gentlemen, it has been a good while since my last post. I've spent the last month at Union Memorial Hospital (a community hospital in Baltimore City) doing my Internal medicine rotation which is my last third year rotation. I just took the shelf exams (a National Medical exam for 3rd yr medical students to access their competency at the end of each rotation). The shelf exam is not obligatory and as such, only certain schools subscribe for their students to take it and in each school some rotations don't offer shelf exams. For instance at the University of Maryland SOM, Family Medicine and Neurology do not offer Shelf exams. They have an "in-house" exam instead.
With that said, the Medicine Shelf exam went really well and I expect to perform well. Eventhough I'll be going into Surgery, I'm a strong believer that a solid foundation in Medicine sets the stage for whatever field you're interested in. I'll be managing patients on the floor pre- and post op moreso as an intern than ever and these medicine skills will come in very handy. I'll be called for consults to the ER or to see pts admitted by the medicine service and in order to rule in any case as a surgery case, I'll need to r/o potential issues that could be managed by medicine first because Surgery is usually called in, most of the times, when medical management fails or isn't the best route to take in a particular situation.
I really enjoyed my last month of third year and will as of July 6, be a 4th year, officially! I'm excited to take on my new role as a Sub-Intern in Cardiothoracic Surgery. I KNOW that it'll be hard work. It'll require getting up really early in the morning, 5AM or so, and getting to the hospital early to have an early start. I feel like my background has really set the stage for me as far as having work ethics, being hard working, resilient and a "no whinner" which are definite qualities expected of a student of Surgery. As young as I can remember, where I grew up in Cameroon, W. Africa, I and the rest of my family would get very early not later than 5Am and get ready to start treking to far away bushes and farms. We would trake at times for over an hour to get to the farm and then start working. I and my brother would clear the bush while my sisters and mom would tilt the soil. Once in a while I would visit my uncle in the village during summer vacations (in Lewoh) where we'll build fences out of sticks that we would cut from the forests. We would go to far away farms and carry cocoyams on our barehead and trake hours upon hours to get home. Well, Surgery doesn't require any building fences, no treking for long distances, no clearing of bushes BUT it DOES require you to stand for long hours, use your hands all day long and above all, you have to be READY AT ALL TIMES to GET THE JOB DONE. My background sets my ready for this already. I do not have to force myself, push myself, set my mind ready for this since it's more or less part of me and I just need to be a student of surgery and learn from many wonderful surgeons on how to be the best surgeon. All what I want from any surgery program that I end up with is that I be thought EVERYTHING that the surgeons know so that in the future, whenever I decide on "cutting" on someone I will know without any doubt that the patient is getting the best care.
For the couple of days that I have left to begin 4th year, I have a couple of things to complete.
1- I'm currently working with Dr. Turner, the Program Director for Surgery at the University of Maryland on a research project. Our abstract was appected for presentation at the National Medical Association annual meeting. I should complete my poster for that presentation in a couple of days; already started on that.
2- I'll tie the loose ends that I have on another manuscript that we're working on.
3- Reading towards my Sub-internship. I've got to read up on Anatomy especially pulmonary and Cardiac, different types of Ventilation machines and their settings, LVAD (Left Ventricular Assisted Device) which are machines that help the Left Ventricle pump blood to the Aorta - it's used in End Stage heart Failure and for some, it helps "buy time" while they're waiting for a heart transplantation. Also I'll have to look at Chest tubes and Cardiac drips (medicines given to patients who undergo cardiac surgeries).
and then in August I'll be doing an away rotation at Mayo clinic. I'm so excited about the opportunity to spend a month in a world class institution of medicine. Can't wait!
I'll keep you posted and thanks for visiting the site. Again, feel free to share your experiences be it in 1st, 2nd or any other year of medical school. Together, we can learn from each other, make ourselves better and subsequently make the people around us feel better and thus the world.
There's that place deep within each and everyone of us that we may never discover. You do not want to leave this earth without reaching deep down within you, deep in that place to pull out what you can offer to your patients (neighbors, strangers, community and friends). You will know it when you are close or deep in that place ... but you must make allowance for challenges and criticisms from within and without because it is only through pushing yourself beyond your domain, beyond what makes you cozy that you will be able to reach that place; deep within and you'll know it.
With that said, the Medicine Shelf exam went really well and I expect to perform well. Eventhough I'll be going into Surgery, I'm a strong believer that a solid foundation in Medicine sets the stage for whatever field you're interested in. I'll be managing patients on the floor pre- and post op moreso as an intern than ever and these medicine skills will come in very handy. I'll be called for consults to the ER or to see pts admitted by the medicine service and in order to rule in any case as a surgery case, I'll need to r/o potential issues that could be managed by medicine first because Surgery is usually called in, most of the times, when medical management fails or isn't the best route to take in a particular situation.
I really enjoyed my last month of third year and will as of July 6, be a 4th year, officially! I'm excited to take on my new role as a Sub-Intern in Cardiothoracic Surgery. I KNOW that it'll be hard work. It'll require getting up really early in the morning, 5AM or so, and getting to the hospital early to have an early start. I feel like my background has really set the stage for me as far as having work ethics, being hard working, resilient and a "no whinner" which are definite qualities expected of a student of Surgery. As young as I can remember, where I grew up in Cameroon, W. Africa, I and the rest of my family would get very early not later than 5Am and get ready to start treking to far away bushes and farms. We would trake at times for over an hour to get to the farm and then start working. I and my brother would clear the bush while my sisters and mom would tilt the soil. Once in a while I would visit my uncle in the village during summer vacations (in Lewoh) where we'll build fences out of sticks that we would cut from the forests. We would go to far away farms and carry cocoyams on our barehead and trake hours upon hours to get home. Well, Surgery doesn't require any building fences, no treking for long distances, no clearing of bushes BUT it DOES require you to stand for long hours, use your hands all day long and above all, you have to be READY AT ALL TIMES to GET THE JOB DONE. My background sets my ready for this already. I do not have to force myself, push myself, set my mind ready for this since it's more or less part of me and I just need to be a student of surgery and learn from many wonderful surgeons on how to be the best surgeon. All what I want from any surgery program that I end up with is that I be thought EVERYTHING that the surgeons know so that in the future, whenever I decide on "cutting" on someone I will know without any doubt that the patient is getting the best care.
For the couple of days that I have left to begin 4th year, I have a couple of things to complete.
1- I'm currently working with Dr. Turner, the Program Director for Surgery at the University of Maryland on a research project. Our abstract was appected for presentation at the National Medical Association annual meeting. I should complete my poster for that presentation in a couple of days; already started on that.
2- I'll tie the loose ends that I have on another manuscript that we're working on.
3- Reading towards my Sub-internship. I've got to read up on Anatomy especially pulmonary and Cardiac, different types of Ventilation machines and their settings, LVAD (Left Ventricular Assisted Device) which are machines that help the Left Ventricle pump blood to the Aorta - it's used in End Stage heart Failure and for some, it helps "buy time" while they're waiting for a heart transplantation. Also I'll have to look at Chest tubes and Cardiac drips (medicines given to patients who undergo cardiac surgeries).
and then in August I'll be doing an away rotation at Mayo clinic. I'm so excited about the opportunity to spend a month in a world class institution of medicine. Can't wait!
I'll keep you posted and thanks for visiting the site. Again, feel free to share your experiences be it in 1st, 2nd or any other year of medical school. Together, we can learn from each other, make ourselves better and subsequently make the people around us feel better and thus the world.
There's that place deep within each and everyone of us that we may never discover. You do not want to leave this earth without reaching deep down within you, deep in that place to pull out what you can offer to your patients (neighbors, strangers, community and friends). You will know it when you are close or deep in that place ... but you must make allowance for challenges and criticisms from within and without because it is only through pushing yourself beyond your domain, beyond what makes you cozy that you will be able to reach that place; deep within and you'll know it.
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