When I was putting my account summary, bills and letters into my newly bought shredder, pieces of "blue sheets" were found among the pile of confidential documents.
Judy was a 30-year-old unemployed lady, with known anorexia nervosa and BMI of 11, admitted for dizziness, abdominal pain, diarrhoea and vomiting. She was admitted 3 months ago for similar episode. After that, she had been referred to obstetrics and gynaecology for amenorrhoea and clinical psychology.
In the O & G clinic, the professor who saw her denied to take up her case - as her amenorrhoea was only secondary to anorexia nervosa, but not a primary gynaecological problem - they just cannot help.
For the clinical psychology part - Judy denied the psychologist. She claimed that she was sick, tired, having a headache, and many many whatsoever reasons, to keep the psychologist away since the third consultation. The perseverant psychologist tried to postpone the appointment for five times before giving up. Her incredible reasons were clearly documented by our staff.
May be she thinks that psychologists were not helpful? Anyway. This time she was admitted once again. Who to blame?
Winnie was a 18-year-old HKCEE candidate admitted for an increasing goitre for 3 months. It was associated with mild dysphagia of solid food, change of voice, palpitation and unintended weight loss of 4 kg over the last month. Her aunt had a history of thyroid disease and was treated with anti-thyroid drugs. Yes, this is Graves' disease.
After the evening round, a group of youngsters in school uniform was surrounding Winnie, brought her with lots of jokes and gifts - two Teddy bears at least. Being young in wards is so endearing and invidious. What a strong contrary to those who lying on the opposite beds, they were grey-haired ladies, without any visitors or gifts, but a heparin block.
This makes me think of babies that most of us love. Even they were helpless, crying loudly, pee-or-poo here or there, their parents look after them with love and care without any reserve. Only when the parents becomes old and babies grown up, those in their prime time could not hear the cry from Dada and Mama, and grumbles when they wet their diapers.
Timmy was a 28-year-old computer technician, with known ulcerative colitis for 5 years, clinically admitted for colonoscopy. This was the fifth colonoscopy follow up after the diagnosis. His Barium enema study made me remember him, and also the classical striking full-house radiological features of the disease as described in Lecture Notes on General Surgery. He also made me remember ulcerative colitis was slightly male predominance.
While Molly, a 23-year-old university student, who was suffering from Crohn's disease for 2 years, and presented with similar vague abdominal pain and chronic diarrhoea as Timmy, made me remember that it was slightly female predominance. From them, I remember the age of onset for inflammatory bowel diseases, of course.
Do learn medicine from wards, and correlate it to books. Once you have got the "index" patient, stick to s/he, then you will remember the disease - except microscopic appearance and molecular pathogenesis.
Mr. Ng was a 30-year-old fireman, admitted from A&E for neck injury in Dragon dancing a year ago. He was struck by his partner who jumped from poles behind him, causing immediate loss of motor and sensory function of bilateral lower limbs. Neurological functions of upper limbs were weaken but not lost. No other injuries were reported.
He was conscious throughout, with Glasgow Coma Scale of 15/15, and was mildly dyspnoeic. Physical examination for upper limbs reveals a power of 5/5 for shoulder movements, 3/5 for elbow and wrist, but 0/5 for finger bilaterally, with impaired sensation at fingertips. Tone and reflexes were normal. For lower limb the tone was increased, with hyperreflexia and total loss of power and sensation. Plantar reflex was upward. Clonus could be elicited.
Magnetic Resonance Imaging shows a fractured fifth cervical (C5) spine, and combine with his physical findings, he was diagnosed to have spinal cord injury at C5 with paraplegia. This means that he had to be bed-ridden. For an immobilised patient on bed it is not uneasy to develop bed sores. Yes he did, especially since his sphincter function was lost, his excreta made his perineum a fertile soil for bacterial growth.
The story went on when he was transferred to the Intensive Care Unit (ICU) one month after the accident for further management of pneumonia-caused respiratory failure, including creation of tracheostomy for hanging him onto a mechanical ventilator, insertion of Ryle's (nasogastric) tube and Foley (urinary) catheters for his in and out respectively.
After stabilisation in the ICU, he was transferred to the rehabitation ward half a year after his injury. He had a long way to go. He was unable to return to his fire-fighting job, and it seemed that the Fire Services Department could arrange him with some soft duty. He had two elder brothers who were married and busy with their own families.
Mr. Ng also had a girlfriend who had been dating for 5 years and planned to get married in few years' time. Two months after the injury, he knew well that a total recovery was impossible for him. Therefore, he asked his girlfriend to leave him, to find a healthy man who could look after her and bring her a good life.
The girl rejected.
She insisted to visit him daily, to wipe her love's body day by day, weeks by weeks. She was totally devoted to him. In this disaster, I can see both of them were loving each other. Mr. Ng wanted her to have a better future, but not to be dragged by him. The girl knows that he needed her in this critical moment, so denies to leave him and flood him with lots of support. Here comes the excerpt of a famous vow of love:-
This is not my first time to describe the uphold of this vow. Do you still remember Mr. Lam's story in my previous note Progress? Yes. I believe, there is something only love can do.
***
Judy was a 30-year-old unemployed lady, with known anorexia nervosa and BMI of 11, admitted for dizziness, abdominal pain, diarrhoea and vomiting. She was admitted 3 months ago for similar episode. After that, she had been referred to obstetrics and gynaecology for amenorrhoea and clinical psychology.
In the O & G clinic, the professor who saw her denied to take up her case - as her amenorrhoea was only secondary to anorexia nervosa, but not a primary gynaecological problem - they just cannot help.
For the clinical psychology part - Judy denied the psychologist. She claimed that she was sick, tired, having a headache, and many many whatsoever reasons, to keep the psychologist away since the third consultation. The perseverant psychologist tried to postpone the appointment for five times before giving up. Her incredible reasons were clearly documented by our staff.
May be she thinks that psychologists were not helpful? Anyway. This time she was admitted once again. Who to blame?
***
Winnie was a 18-year-old HKCEE candidate admitted for an increasing goitre for 3 months. It was associated with mild dysphagia of solid food, change of voice, palpitation and unintended weight loss of 4 kg over the last month. Her aunt had a history of thyroid disease and was treated with anti-thyroid drugs. Yes, this is Graves' disease.
After the evening round, a group of youngsters in school uniform was surrounding Winnie, brought her with lots of jokes and gifts - two Teddy bears at least. Being young in wards is so endearing and invidious. What a strong contrary to those who lying on the opposite beds, they were grey-haired ladies, without any visitors or gifts, but a heparin block.
This makes me think of babies that most of us love. Even they were helpless, crying loudly, pee-or-poo here or there, their parents look after them with love and care without any reserve. Only when the parents becomes old and babies grown up, those in their prime time could not hear the cry from Dada and Mama, and grumbles when they wet their diapers.
***
Timmy was a 28-year-old computer technician, with known ulcerative colitis for 5 years, clinically admitted for colonoscopy. This was the fifth colonoscopy follow up after the diagnosis. His Barium enema study made me remember him, and also the classical striking full-house radiological features of the disease as described in Lecture Notes on General Surgery. He also made me remember ulcerative colitis was slightly male predominance.
While Molly, a 23-year-old university student, who was suffering from Crohn's disease for 2 years, and presented with similar vague abdominal pain and chronic diarrhoea as Timmy, made me remember that it was slightly female predominance. From them, I remember the age of onset for inflammatory bowel diseases, of course.
Do learn medicine from wards, and correlate it to books. Once you have got the "index" patient, stick to s/he, then you will remember the disease - except microscopic appearance and molecular pathogenesis.
***
Mr. Ng was a 30-year-old fireman, admitted from A&E for neck injury in Dragon dancing a year ago. He was struck by his partner who jumped from poles behind him, causing immediate loss of motor and sensory function of bilateral lower limbs. Neurological functions of upper limbs were weaken but not lost. No other injuries were reported.
He was conscious throughout, with Glasgow Coma Scale of 15/15, and was mildly dyspnoeic. Physical examination for upper limbs reveals a power of 5/5 for shoulder movements, 3/5 for elbow and wrist, but 0/5 for finger bilaterally, with impaired sensation at fingertips. Tone and reflexes were normal. For lower limb the tone was increased, with hyperreflexia and total loss of power and sensation. Plantar reflex was upward. Clonus could be elicited.
Magnetic Resonance Imaging shows a fractured fifth cervical (C5) spine, and combine with his physical findings, he was diagnosed to have spinal cord injury at C5 with paraplegia. This means that he had to be bed-ridden. For an immobilised patient on bed it is not uneasy to develop bed sores. Yes he did, especially since his sphincter function was lost, his excreta made his perineum a fertile soil for bacterial growth.
The story went on when he was transferred to the Intensive Care Unit (ICU) one month after the accident for further management of pneumonia-caused respiratory failure, including creation of tracheostomy for hanging him onto a mechanical ventilator, insertion of Ryle's (nasogastric) tube and Foley (urinary) catheters for his in and out respectively.
After stabilisation in the ICU, he was transferred to the rehabitation ward half a year after his injury. He had a long way to go. He was unable to return to his fire-fighting job, and it seemed that the Fire Services Department could arrange him with some soft duty. He had two elder brothers who were married and busy with their own families.
Mr. Ng also had a girlfriend who had been dating for 5 years and planned to get married in few years' time. Two months after the injury, he knew well that a total recovery was impossible for him. Therefore, he asked his girlfriend to leave him, to find a healthy man who could look after her and bring her a good life.
The girl rejected.
She insisted to visit him daily, to wipe her love's body day by day, weeks by weeks. She was totally devoted to him. In this disaster, I can see both of them were loving each other. Mr. Ng wanted her to have a better future, but not to be dragged by him. The girl knows that he needed her in this critical moment, so denies to leave him and flood him with lots of support. Here comes the excerpt of a famous vow of love:-
"...to have and to hold from this day forward,
for better, for worse, for richer, for poorer,
in sickness and in health,
to love and to cherish, so long as we both shall live."
for better, for worse, for richer, for poorer,
in sickness and in health,
to love and to cherish, so long as we both shall live."
This is not my first time to describe the uphold of this vow. Do you still remember Mr. Lam's story in my previous note Progress? Yes. I believe, there is something only love can do.
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