Recently, I was dealing with my piles of used fool-scrap paper, ya, those progress sheets which we used for clerking patients. Whenever I read those names on the top right hand corner, their pictures appeared inside my head again.
--- This may be a breaking line ---
I remember Mr. Lam, a 58-year-old retired gardener, who suffers from Parkinson's disease for two years. He has a wife who had cancer, insists to visit him every day. From him, I was impressed how this disease brought him difficulty in looking after himself. He could do little about his living, not even sitting up from bed. I spent nearly two hours clerking his case and encouraging him not to give up his life. During physical examination, I tested his peripheral nervous system. As part of the test and also part of my encouragement, I said, "You have a wife who love you a lot. Face all challenges together with her. Can you? Try to hold my hands tightly." Of course, the power of his hand grip was full. Through his story, which stimulated me, I look up Parkinson's disease) in textbook for the whole night. I shall remember for the rest of my life that - Parkinson's disease does not affect power - as I cannot forget how forceful he held my hands with a thankful smile.
--- This can be a breaking line ---
At the same hospital I met a 45-year-old van driver Mr. Li who presented with progressive dysphagia for one month. It affected solid swallowing first before liquid. It was associated with skin rash on face and trunk, and there was proximal muscle weakness. He had been staying in the ward for one week and receiving steroid therapy. Extensive workup including EMG, muscle biopsy, autoimmune antibody and much more were done, but none of them was remarkable. He was clinically diagnosed to have dermatomyositis. He was optimistic enough to expect a discharge from hospital in a week's time. At that time it was my second or third week of attachment.
About four weeks later, just days to the end of attachment, I saw the same gentleman in a different cubicle of the same ward again. He was much weaker than before. I dared not to disturb him but to flip through his case note quietly. He was discharged from the ICU with a tracheostomy over his neck due to respiratory failure. He was unable to talk like before. This was my first time seeing a patient deteriorating so much and so fast. I cannot imagine how his life had elapsed with these months, when we were spending it playing, studying, or just hanging around. His prognosis was grave. After that, I did not visit him again, only because I was afraid that I could not afford seeing him worse.
Vien is a 33-year-old health inspector, diagnosed to have SLE for eight years. She was admitted for acute onset of shortness of breath and fever for 1 day. She was subsequently diagnosed to have pleural effusion and had it tapped. For an unknown reason, she received a Computed Tomography (CT) scan, and multiple well circumscribed hypodense lesions were found incidentally in her liver. Tumour markers were normal. They were unlikely to be amoebic cysts as the patient had been so well for months. Her mysterious CT drawn interest from many professors in gastroenterology, and also from me, who intoduced the films to lots of my classmates.
Susan is a 31-year-old accountant, suffering from SLE for 5 years. Her case was quite familiar to our crocodiles, since she was described as "well known patient of Dr. X" at the first line of her notes. This time she was admitted for fever. For a patient like her who was on immunosuppressant for SLE, this was a dilemma. It can be due to flare up of the disease, or due to infection because of immunosuppression . Finally her Magnetic Resonance Imaging (MRI) shows a lesion on the ventral side of L2-L3. A imaging guided bone biopsy diagnosed tuberculosis (TB) spine. This was me who made her MRI films famous among ourselves again. She was discharged just before my rotation ends in February. Last week I saw her again in patient's clothes at the hospital corridor. I have no knowledge about what has happened to her recently.
Diana is a 21-year-old university student, who have SLE diagnosed in her sixth form. This time she was admitted for renal biopsy. I chatted with her like friends, you know, it was better to talk in similar age. Although she kept the subject and university she studied a secret to me, I feel pity when I saw someone in our age, in the prime of life, being admitted to hospital for any kind of life-long disease. SLE is a particularly troublesome disease which ruins thousands of young girls' youth and beauty. I saw all of the above ladies in the same ward at the same period of time. How common of this disesae, my God.
Through reading back these progress sheets, I saw my patients once again. Those sheets when attached to the case file, recorded how the patient progress, no matter becoming better or worse. Learning through patient's progress progresses our learning. I realised that I have learnt a lot already insensibly, but there is still a long long way to go.
--- This may be a breaking line ---
--- This can be a breaking line ---
About four weeks later, just days to the end of attachment, I saw the same gentleman in a different cubicle of the same ward again. He was much weaker than before. I dared not to disturb him but to flip through his case note quietly. He was discharged from the ICU with a tracheostomy over his neck due to respiratory failure. He was unable to talk like before. This was my first time seeing a patient deteriorating so much and so fast. I cannot imagine how his life had elapsed with these months, when we were spending it playing, studying, or just hanging around. His prognosis was grave. After that, I did not visit him again, only because I was afraid that I could not afford seeing him worse.
--- This should be a breaking line ---
In my Lecture Notes on Clinical Medicine, under the heading of Systemic Lupus Erythematosus (SLE), there were names of three ladies written on it: Vien, Susan and Diana, (fictitious to protect privacy) who I met during the last rotation.Vien is a 33-year-old health inspector, diagnosed to have SLE for eight years. She was admitted for acute onset of shortness of breath and fever for 1 day. She was subsequently diagnosed to have pleural effusion and had it tapped. For an unknown reason, she received a Computed Tomography (CT) scan, and multiple well circumscribed hypodense lesions were found incidentally in her liver. Tumour markers were normal. They were unlikely to be amoebic cysts as the patient had been so well for months. Her mysterious CT drawn interest from many professors in gastroenterology, and also from me, who intoduced the films to lots of my classmates.
Susan is a 31-year-old accountant, suffering from SLE for 5 years. Her case was quite familiar to our crocodiles, since she was described as "well known patient of Dr. X" at the first line of her notes. This time she was admitted for fever. For a patient like her who was on immunosuppressant for SLE, this was a dilemma. It can be due to flare up of the disease, or due to infection because of immunosuppression . Finally her Magnetic Resonance Imaging (MRI) shows a lesion on the ventral side of L2-L3. A imaging guided bone biopsy diagnosed tuberculosis (TB) spine. This was me who made her MRI films famous among ourselves again. She was discharged just before my rotation ends in February. Last week I saw her again in patient's clothes at the hospital corridor. I have no knowledge about what has happened to her recently.
Diana is a 21-year-old university student, who have SLE diagnosed in her sixth form. This time she was admitted for renal biopsy. I chatted with her like friends, you know, it was better to talk in similar age. Although she kept the subject and university she studied a secret to me, I feel pity when I saw someone in our age, in the prime of life, being admitted to hospital for any kind of life-long disease. SLE is a particularly troublesome disease which ruins thousands of young girls' youth and beauty. I saw all of the above ladies in the same ward at the same period of time. How common of this disesae, my God.
--- This must be a breaking line ---
Through reading back these progress sheets, I saw my patients once again. Those sheets when attached to the case file, recorded how the patient progress, no matter becoming better or worse. Learning through patient's progress progresses our learning. I realised that I have learnt a lot already insensibly, but there is still a long long way to go.
