Yak, yak, yak...

Dr. Annuar didn't turn up for the 7am ward round again this morning, so we all waited for him like idiots (except me lar, hehe, I waited 15mins then went for breakfast with Hema!).... but he made us stay for a bashing at 4.30pm just now (eventhough he said 4.00pm sharp).... and he kept us until almost 5.30pm... but that's ok... I heard the previous batch was made to stay until 6.30pm! It's not really a problem to stay back after 4.30pm... but it's just that we've been in the wards the whole day (with quite a lot of time wasted waiting for him) and we need to study sooo much... honestly I'm so tired at night I can't even read the words on the same line properly... I would be jumping lines, then paragraph and then I realize I just better stop and sleep.

So what I've been doing is juggling between CTW and the male ward... I'm actually more into the male ward.... but I "pretend" to be into the CTW as well.... actually I just check on my patient's progress through the doctors' notes and their charts and latest ECG and all... but really I have no time to clerk new patients there... as it is I can't even manage my patients in the male ward... I haven't even got the chance to do any procedures and I'm already in my 2nd week of Medicine posting. *sigh*

Oh ya, I heard for the group that our paediatric results will be out tomorrow.... *disturexcited*.... *making the sign of the cross*.... I heard that there are no failures for paediatric but I'm just really not keen to see what I got for my disastrous long case.

I do still miss paediatric terribly... I met Mei Hsia, Phyllis and Hooi Ming for lunch just now over at Hung Hung Inn... and they were complaining that paediatric was too pack for them.... and I on the other hand am very concerned that we have too much free time for medicine posting... I'm worried that we cannot be trusted to handle sooo much self-directed learning time...

In the morning I clerked a patient with suspected dermatomyositis... but unfortunately for me (but fortunately for the patient), he didn't have many typical signs.... and I have feeling that eventually his diagnosis may change.... I was very excited when I saw this case in the new admission list because I was told to look into this type of patient because it's a common exam case... they are not usually seen in the wards, only in the clinics. But the patient was gracious enough to entertain all my questions and let me examine him. My second patient of the day was one with suspected rheumatic fever, but again, he didn't have I would say enough of the typical symptoms.... and not even enough criteria for it to be diagnosed conclusively, but he's treated as a rheumatic fever anyways... and he's actually improving with his current treatment.

Yesterday I saw a boy who's diagnosis was ??? for the past few days.... came in with high-grade fever, really, really ill, disoriented, with hyperdynamic praecordium (meaning that movement of the heart can be seen on the chest) and his neck was pulsating... the doctors were not sure what he had, so he was isolated, and yesterday I had to wear a mask into the room where he was warded to clerk him... but he looked sooo much better, sitting up and reading... honestly I was very surprised to see the stark contrast of the boy yesterday and today, and I thought my colleagues gave me a "Are you sure you were telling us about the same patient?" kind of look.... I thought he looked a bit unusual... his hands were very big for his 13 years old.... and he had long spidery fingers and his arms seemed kind of longish... so I brought 2 colleagues to give me their "second opinions".... we took his armspan and it measured 175cm... compared to his height which was only 163cm! But he didn't have any other features of Marfan's Syndrome... so we didn't blow the trumpets on him to our other colleagues.... no murmurs, no kyphosis, no high-arch palate, etc. (we usually do this so that other students get to see the case as well....)

Then I managed to examined the neurological status of a very nice and sweet and very cooperative 61-year-old lady who presented with sudden onset of bilateral upper limb and lower limb weakness associated with some degree of sensory loss... my impression was Gullain-Barre Syndrome, but she had other atypical presentation as well, so the 3 of us (the most unlikely combination of me, Wushu and Chee Shee) had quite a nice discussion on the case...

Then in the afternoon, we made our way to the haemodialysis unit for a little refresher on the subject, which I thought was very brief but very, very useful for me today....

Tomorrow morning we're supposed to have bedside teaching with Dr. Annuar... but he already "announced" earlier in the posting that he wasn't going to give any bedside teachings, so we actually have the whole morning to ourselves, so I may just make my way to one of the many clinics going on tomorrow, cardiac clinic, gastroenterology, etc. and learn a thing or 2... or I may just hang around in the wards and clerk different cases.... for my case write-ups... I think for my final year, I'll attemp a neurology case and maybe a respiratory case... I did a cardiology and renal case in my 3rd year.... or maybe a haematology case sounds good too.... hmmmm... * thinking*

I'm feeling so lazy to study tonight... I'll just read-up on my patients' diseases today and also maybe brush up on my ECG... then later I have my House at 10pm! Remember, Stop, Look and Go! Hehe... pretty helpful in times as such.

Cheers!