Refections on Internal Medicine

Internal Medicine is over. For this year at least. 8 weeks plus 1week exam. Khalaas.

This post is also rather old but I promised Fadiosis a post on Internal Med so here goes.

Pelonomi Hospital – General medicine.

The reality of the HIV/AIDS struck me here. We get really excited when our patients actually test negative. It’s true. And it’s sad. The biggest need is to get rid of the stigma attached to the disease. If people start accepting Aids like they accept diabetes and come for tests earlier, then we can use ARVs as Allah has provided us. Which (just like diabetes), doesn’t cure but controls the course of the disease.  Ok, let me get this clear – I am in no way condoning promiscuity – it’s just frustrating to see so many people discarded for palliative care. And often patients are victims of their circumstances. Sigh.

Anyway, the three weeks at PH were long and tiring. Pelonomi is hot and sweaty, devoid of purposeful air-cooling systems and lacks stock. Get used to making do. This is Africa. Also it seems to be constantly under construction so you have to quickly learn the labyrinthine ways of getting around.  At night we have a security guard that escorts the girls around because of previous ugly incidents.

But all’s not bad – the consultants & regs & interns are really cool and I learnt a lot.

Endocrine (Univeritas Academic Hospital)

You never want to get fat after rotating there!

Geriatrics (UAH)

It happened to be my birthday again during my rotation at geriatrics. (On a side note, one of the birthday messages I received said I should count years by the number of friends I have. Bleh. By that calculation, I should be dead already.) One of my patients was quite excited about it being my 21^st birthday. I smiled fakely at her - my thoughts were contrary to this big smile. As a child, I always yearned to be older.*rolls eyes. And to reach a super-old age like my grannies (86 and 90years)(May Allah grant them Jannah). I associated old-age with wisdom, experience and big families. With being retired and having free time to recite pages of Qur’an. True, it is an opportunity to be forgiven. Naively, I associated it with being without responsibility. I didn’t think that loss of elasticity meant more than wrinkles. It means being blind and deaf and incontinent and demented. It means being dependant on other people’s good nature and values to not laugh at you when you say something silly, to be patient when you can’t hear. To walk you to the bathroom in case you fall and get a death-sentence-hip-fracture. To speak for you coz most people can’t understand what you’re saying after that stroke. You are stiff all over. Your hands are tied coz the nurses complain about you pulling out the drip. The problem list fills the page. Somehow, you seem in the way.   

I don’t want to get old.

                      View from Geriatric ward, Universitas Hospital. Lol, I can see my flat in this pic!

Haematology (UAH)

The haematologists seem to be the happiest people around (and the cleverest IMO.)(All the internal people are too clever. I could never specialise in Internal Med – its too clever). Shame, the dr that assessed us at the end of the week kept asking us if we were satisfied with the mark he gave us. He really felt bad about the possibility of under-assessing us. J  Imagine me saying: “I don’t like this mark.” :D

Neurology (UAH)

I think I could probably write a separate blog-post for each one of the patients that we saw in our two-week rotation here. Neurological disease always seems to touch some softer part in me – I really pity most of them. Or indeed, I more admire their resilience and strong coping mechanisms. Neurology is very interesting but the frustrating thing for me is the most you can do for your patients is diagnose their condition and identify the lesion. Not many treatment options, many of the available treatment options have such horrid side-effects.

The OSCE

The most stressful thing ever. Read the question, enter the room, examine the patient with a commentary, say what you find and think the possible diagnosis and get out. Total of 6minutes.  9 patients (plus 7 rest stations).

Station9

This was my first one and I’m glad coz it was the easiest give-away BMI & blood pressure measurement.  Wow, they even have a stethoscope with two ear pieces so the examiner can also hear those korottkoff sounds!

Station1

In retrospect I feel like quite an idiot for not identifying the mitral stenosis. The dr was trying to give so many clues and I still didn’t figure it out. Whatever.

Station2

COPD – this station was fun enough. I had episode of blankness – not knowing what to do next. Then it all came back in time so Alhamdulillah, went wellJ

Station3

I thought I would have failed this station (surprisingly I didn’t). I’m not sure what I was doing or what was wrong with the patient L

Station4

Our instructions asked us to complete another respiratory exam – and apparently the patient had SLE. I didn’t get that far. Lol, the dr had his eyebrow raised throughout my examination –not a good sign.

Station5

Thyroid exam – honestly wasn’t all that bad. I could have given a better differential though.

Station6

Examination of lower limbs – patient had spastic motor paralysis. And hyper-reflexia. Also wasn’t all that bad.

Station7

This patient had the most awesome lymph nodes ever. I never felt such large ones before! Missed the epitrochlear one though.

Station 8

The epic fail station. Abdominal exam. There was no way I was going to know what was going on that obese patient in less than 5minutes. I had no clue what I was palpating there. I got nervous. And I failed L. I heard afterwards that saying the examination is difficult would have got you some decent marks. Abdominal exam and I scarred for life.

We had to get over 60% and fail only a max of two stations in order to promote. Alhamdulillah! I promoted so I don’t have to go through that torture again. Well... at least for Internal Medicine. JJJJ