saved

My feet ached. My energy ached more. Gatvol is that not-so-pleasant (eek) Afrikaans word that describes me. We are just pushing along this 24hours.

I do a zombie walk to the gynae ward at 3am, and scrutinize the files through the light of the passage. The patients' groans don't strike me as anything strange - most woman in this rotation are groaning anyway. As I scan the drs notes, the pt whispers "bietjie water asseblief" (some water please).

The gatvolness in me flares up - in retrospect unnecessarily so - my thoughts race... this is not my job, does anyone know how tired I am... I'm not a Sister, speaking of which where are them Sisters? Uff, sleeping as usual. If I have to walk around handing pts water I will never learn what I'm supposed... there's not even any cups in sight...

 Wait a min.

A parable of primary Madrasah comes back to me through my zombieness - 'that sinner-lady of long ago was granted Jannah (heaven) when she gave the thirsty dog water, using her shoe as a cup.'
I shook my sleepy head, severely rebuking myself for allowing my frustration get the better of my humanity. Of me, being Muslim.

Everything around me suddenly took the shape of a possible water-holding utensil.

I thanked Allah, glad that thoughts were not counted as deeds. It still bothers me as to why I was thinking of myself as not worthy of handing out water. As a Dr once told me  - its time for a career change if patient care is no longer the most important.
 May all my evil thoughts be highlighted so I can stop them in time.

The Eye

"...Now do you not see that the eye embraces the beauty of the whole world? It is the lord of astronomy and the maker of cosmography, it counsels and corrects all the arts of mankind, it leads men to the different parts of the world, it is the prince of mathematics, and the sciences founded on it are absolutely certain. It has measured the distances and the sizes of the stars, it has found the elements and their locations; it has given birth to architecture, and to perspective and to the divine art of painting. Oh excellent thing, superior to all others created by God! ....What peoples, what tongues will fully describe your true function? The eye is the window of the human body through which it feels its way and enjoys the beauty of the world. Owing to the eye the soul is content to stay in its bodily prison, for without it such bodily prison is torture"  

                                                                                                Leonardo da Vinci (1452-1519)


Glory be to Allah, the Creator of all.

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

Only at Pelonomi Hospital

Hijab and stethoscope

So being a health-care professional requires you to be neat and also to have access to your ears for a stethoscope. (Ha-ha, some doctors [rigid in their belief that a stethoscope has very limited uses] would probably cringe at my juxtaposition of health-care and stethoscopes)

Unfortunately I’m not willing to make ear-holes in all my scarves so we have to come up with other options.

The orni/khimaar

Having a long scarf held together with a pin might be an option but may become a little overwhelming when you start concentrating on preventing your scarf from touching the patient.

The Kuwaiti style is an option. I’m not sure of its correct name and come to think of it, I’m not even sure why we refer to it as the Kuwaiti style :o It reminds me of an adaptation of the MMSG (Maritzburg Muslim School for Girls) scarf.  Essentially a sort of tube with a long end that can be draped over your head.  Works great.

The Ameera

This is the most useful option especially with a recent flood of their availability in South Africa. The Ameera (small burqa as some prefer calling it) can be neatly tucked away inside the white coat and obediently stretches when you require your stethoscope.  No problems J

You could also spice up your ameera-look by adding a Spanish-style atop it. This doesn’t interfere with your ear access. Just make sure you secure it well with some sewing pins lest it slips off.

Or else try wrapping a long scarf loosely over the ameera, and again securing it with pins

Shukran to Sabeehah for style tips and comments. And to Hamada for the mannequin head.

Apology for the hasty photos, obviously not my speciality :p 

Update

I too seemed to have without warning, disappeared from the blogging world. I actually had to remove the word “blogger” from my Twitter bio – I can’t be keeping the title when I only force out a post once a month. I felt a little relieved to find that many of the blogs I follow are also somewhat slack on posting. Glad I’m not the only one wrestling with time.


Twitter is one of the problems – it is a micro-blogging site after all, and it just seems so much easier to tweet if I need to vent. Also, I’m exposed to soooo many (too many) opinions on twitter that sometimes I feel I need not create more. We should start living by what’s already been said tweeted and facebooked.

The other big change is that I’ve got wheels :) I’ve finally mastered parking my Toyota Aygo (thanks to my friend) so my worst nightmare is over and I hardly ever switch off anymore. So of course the Waterfront and Mimosa Malls are becoming accustomed to my presence, or if I’m fed up of shopping then I go visit some Muslim families out here. (Strange how one clings onto anything remotely similar to home). It’s weird having a petrol expense to account for now, but I’m loving the independence. I no longer have to ask anyone to take me on a termly grocery shopping expedition, where I would buy everything in excess just so it lasts until another trip. I hate constantly asking people for favours – our family always maintains “ask from Allah, not from people” so I’m terribly grateful I don’t have to anymore. (a Big shout out to all my friends for never making me feel like a burden – may you be rewarded for your kindness).
May Allah keep me safe in my Nura.

And then the other thing is that, we are now academically forth year students. Allahu Akbar. It’s almost frightening to say forth year, I feel I know so little. Anyway, so we’ve began our clinical phase and now I’m convinced I love what I’m studying. It’s amazing to actually see patients, to see the signs and symptoms we’ve tried to by-heart. We’re currently doing our 10weeks through Internal Medicine =very chilled compared to the surgical rotation. Though I must admit, I often experience “that stupid moment in combo with the dumb-look”, coz we don’t know that much and have to guess our way through the drs questions. So we have to keep our Tally (insert Dr N’s accent) in easy access.


Seeing patients is also a source of reflection for me.

Our Geriatric patients remind me of where we might be heading if we reach a similar age. Value youth before old-age.
Our Paeds patients (&their parents) remind me of the trouble my own mother must have experienced with my numerous Sicknesses I used to have as a child. And do not even say uff to them.
And then the 22-year old neuro patient - I recall being bleek after seeing him with his severe cerebellar signs (which he suddenly acquired within three months). Without going into too much detail – he had total loss of coordination and balance. His speech was incomprehensible, he had severe dyskinetic movements on intention. In other words whenever he tried to do something, he would be unable to due to additional movements. He cannot sit-up nor walk. I can only try to imagine his frustration as he can perfectly understand everything we say or ask him to do. Imagine being unable to touch your nose…because you just can’t! Value health before sickness.

My awesome pink stethoscope (sorry for the krappy pic) that my dear sister bought for me. It attracts a lot of attention though. Also not the best thing to have around when I don’t want to be remembered by those doctors. “small girl with the scarf and pink stethoscope”. Whatever.


Until the next post, Ma'salaam

Studying Medicine

[This post is over a month old, written in the midst of my year-end exams and edited just after that. The new academic year brings a number of updates to this already, but I decided to leave it as is]

So I met a Grade 11 girl briefly at the airport, the other day; and she
asked me what I think about studying Medicine? I stared at her for a while not quite certain on how to answer. I was still waiting for exam results (*Nightmare*) so she got me in a wrong mood. Anyway, I managed to evade the question by elaborating on "hard work /consistency/IfYouLoveItDoIt" stories.

In retrospect, I decided studying Medicine can be likened to Bipolar Mood Disorder. This is especially true since mania and depression can occur within the same month, if you're lucky even within the same day.
(For the record: this post was written in jest and has nothing to do with bipolar disorder)

Manic Phase

• Experienced when you elicit the biceps reflex on your colleague for the first time. No wait. The knee-jerk is a lot much more fun.
• You can say dysdiadochokinesis. And you know what it means.
• Can impress people by talking about the small and rather insignificant facial muscle called "Levator labii superioris alaeque nasi" or when you say "keratoconjunctivitis sicca" and all you mean is 'dry eyes'.
• You actually understand the nervous system- you can talk about pathways and synapses with understanding. And think of everything that's happening when move your toes and when you're brushing your hair or driving or playing basketball (oops, I sound like Dr Z).
• The most hilarious jokes have to come outta med school. Everyone would agree on this :D
• You managed to spot aptly enough to get a distinction for a test. WOW. Brilliant. Note – these students are fully aware that they know bugger-all about what they just wrote. Spots and short-term memory fit well together.
• You are asked what you studied. This is the best high-school-like feelings ever.
• An ECG is no longer a series of squiggly lines.
• You draw blood successfully on a real patient (not Mr Cronje/Mr Green) for the first time.

Depressive Phase
This is characterised by tremors, palpitations, hysterical laughter and sporadic increased lacrimal gland secretions. "Why the hell am I studying Medicine???" is dilemma often faced during this phase.

• You fail an OSCE because you could not put up a neck brace. #Fail. (WTH! If the neck brace is there in that emergency situation, surely someone who can use the darn thing would be accompanying it. Just saying)
• The impending doom experienced when you sit staring at the question paper wondering how you can suck out 10marks worth of pharmacology. Ah well, it's drug interactions so we'll just alternate between increase and decrease drug concentrations. Why not throw in a 'no effect' as well. (you would probably manage to score 1/10, or 1.5/10 if you're good at this game).
• You see (in a test) the name of a drug or syndrome or bacteria that you've never heard of before. And now they asking you some detail about it.
• The assessing doctor smirks at everything you do in a practical. Or worse still, you catch sight of a frown, or a raised eyebrow or a stifled laughter. WTH is he trying to sssaaayyyy! (Personal story: I am remembered because of my conspicuous scarf wearing. They going to remember my dumbness *aaaarrrghhh*)
• You are sitting before a test with a list of acronyms or pneumonic, learning the answers to three basic questions:

                    What is the acronym?
                    What is it for?
                    What each letter stands for?
          You look pretty demented at this stage.

• Your ECG interpretations are wrong. Oops sorry. Mistake. Maybe they are just squiggly lines after all? O_o
• You screw an easy station in an OSCE by doing something so utterly stupid. It becomes immensely difficult to forgive yourself for this.
• Other physical signs (especially before exams) include, hair loss, pimples and related scars, raccoon eyes, caffeine stained teeth. Weight gain or loss might also be noticed.
• You start diagnosing yourself after every disease condition you learn about. A sore throat was probably some life-threatening pharyngitis. Ok, you're still living so it wasn't that; but something like it. Hoarseness of voice is often caused by laryngeal nerve compression. What! Carcinoma? Goitre? God forbid. Ag chill, you were just studying out loud. *Gasp*, are you now psychotic – talking to yourself???

You are welcome to add to any of these signs and symptoms.

Sent from my BlackBerry® wireless device