If I Could Teach Them One Lesson

Registrars are meant to be clever people. Duh, they’ve graduated medicine and practised a few years and are brave enough to specialise. I’ve seen a lot of registrars do a lot of stupid things, but I won’t dwell on that because that’s not what today is about.

I recently heard a registrar complain, “If you think fourth years are bad, wait til you get the third years next week. I feel like a total babysitter! They don’t know how to do anything and I keep having to check up on them!”

I laughed along and told them to team each third year up with a fifth year to solve their problem. But that’s not what I really wanted to say.

I wanted to tell them how fortunate they are. What a big gift they’ve been given. They get to INFLUENCE the way those third years will view medicine forever. They get to influence the way they will do things for the rest of their professional lives. They get to give those third years confidence in what they are doing… or to deny them that confidence.

Registrars… you get to either make them hate ward rounds, or you can turn it into an experience where they will learn more in a few weeks than they have in their entire medical education thus far.

Do you realise what a huge opportunity that is? And a responsibility, yeah. But you’re doctors. C’mon, responsibility shouldn’t be new to you.

I had an amazing registrar for Internal Medicine in my third year, and a horrid one for Surgery. And as readers of this blog know, those impressions have remained.

I think medical professionals (and students) sometimes forget the benefits of community. You know that saying about how it takes a community to raise a child? It takes a community to raise a doctor too.

I’m so thankful that patient people taught me the simple things like histories and physicals, and helped me not to give up when I struggled to get IV-access on patients. I’ve had my fair share of impatient mentors, and they have had the potential to leave lasting horrid impressions.

Third years aren’t babies. In the medical world they are, perhaps, but they are also adults. So give them responsibilities. Teach them where you can.

Cherish your role in raising tomorrow’s doctors.

Morbid Cartoon Anatomy

You know what’s awesome about fourth year? The lecturers go through so much effort to teach us. They put together nice slideshows, they share interesting tid-bits and they are friendly. They could have saved us all a lot of grief if all lecturers were this nice from first year. But I digress.

Anatomical art, which once took the world by storm (think: Frank Netter) is back and cooler than ever. Our lecturers have been alluding to some artists in their presentations. Here are some examples. I include links to the artists’ sites where I was able to find them. Please visit them, I will only include one example of each here.

Michael Paulus has an entire series of popular cartoon anatomy:

Jason Freeny has some really cool digitally animated anatomic drawings and cutaway sculptures. They include Mr Potato Head, Gummie Bears and Kewpie Dolls.

Perhaps the most realistic-looking (and slightly freaky) is done by South Korean Hyung Koo Lee. I couldn’t find his site, but this one is relatively good. He has sculptures of Goofy, Bugs Bunny, Tom and Jerry…

I find that these are a very different (albeit fascinating) look at characters from my childhood. I have to wonder how non-medical individuals feel about these. Let me know what you think!

We See a Light

As part of Infectious Diseases, we must learn about Syndromic Management. It is not the best approach for a qualified doctor, but it is important to understand – especially in a primary health care setup.

During one of these tutorials, the doctor in charge made us close our books and asked us about our approaches to the full waiting room and the possibly accute patient.

We answered well.

She told us we had good seventh senses. The seventh sense? Common sense.

Then she said: “Going by your answers, you are pretty much safe to go work in a clinic.”

We just sat and stared at her. Eventually we realised, “This woman has just complimented us. She just called us almost-doctors.”

I wish someone could take an f-MRI of our brains at the time. I bet you it would be alight and a-buzz and happy.

This doctor probably gave us enough motivation for the rest of the year. Why can’t they all be that nice?

The Original Guinea Pigs

We are currently doing our Infectious Diseases and Clinical Immunology theory block – which means lots of freaky latin names and difficulty staying awake in class.

Occasionally though, our class is graced by a lecturer with some spunk.

This is South Africa: needless to say, Tuberculosis was one of the first things discussed.

You know how we refer to test subjects as guinea pigs? Pretty good reason for that.

Apparently little Guineas share a whole lot of biology with humans – including susceptibility to TB.

Way back in the dark ages, transmission of disease was kind of a grey area. The pathogenesis and transmission of TB went around in circles – from being considered non-infectious, to congenital, to sexually transmitted.

Eventually somebody had a aha-moment and placed a bunch of guinea pigs in a hospital. They were not in contact with any patients, but they were in contact with the ventilation system. And not long thereafter, the little furries had all contracted TB.

Fun times. Poor little guineas (I hope they were treated), but it sure helps to know how to protect myself when examining a patient with TB.

Waterworks

My heart just breaks when people cry. And I have never had so many teary patients as I have had in Dermatology.

One lady was eighty years old, and drove herself to the hospital. What a lovely person! So lucid, so well-groomed, so independent. And she lives alone.

She had seborrhoeic scalp eczema – basically eczema in the regions of the body that produce sebum, like the scalp, nasolabial folds, groin and axillae. It’s itchy and embarrassing, producing a yellowish scaly plaque, but it’s not dangerous.

This lady had some secondary pustular infection, however, which made it more painful and more concerning. She also has a history of non-melanocytic skin cancer, so one has to check if it could be an abnormal malignant lesion.

The waterworks came when she told us about her scheduled cataract surgery later the week. She was afraid that they would see the lesion and refuse to touch her. She had been waiting for this surgery for over a year. She lives alone. She struggles to see. Then she starts crying, “It’s been too long, Doctor. I can’t go on not seeing.”

I just wanted to give her a big hug, but holding her hand till she stopped crying had to do.

She told us about her many grandchildren and great-grandchildren. She teased with us, and wished us well on the rest of our medical education.

The consultant promised her that her surgery would be able to take place. It was scheduled for today. I do hope that by now, she is in the recovery room. I cannot bear to think of her being told she would have to wait some more, with nobody to understand her tears.

Lost in Translation

It's apparently an iPhone game. I just like the font.

Little Brother (still) says the darndest things.

A while ago I posted the following as a status:

Practising Derms surgery on pig. Yummy!

But in my home language, “derms” means “guts”.

So, Little Brother tells The Family that Big Sister is removing pork gut for med school. Nomnomnom indeed!

The funniest thing is that a few hours later, one of my non-medical friends, ten years Little Brother’s senior, made the same mistake.

And people ask me why I love my country’s many languages…

Oink - look at the face!

First Ever Guest Post: Elective in India

A while ago, a friend suggested guest posts for my blog – which is completely understandable, as I represent only one sphere of med student life. At my school, we do electives at the end of fourth year and in the middle of fifth year. As is custom, most students attempt to use it as an excuse for some travelling. Last year’s fourth year group had students who went to Rwanda, India, Zambia and other fun places. I’m trying to get more students to write about their electives – I’m sure it will be of use to those of us still to plan said module.

This is Nabeela Adam, now a fifth year medical student. She went to India for her elective. This is what she has to say:

My time in India was magical. From my touchdown to a hot and humid Mumbai to the mosquitoes for possibly sucking me dry every night. If I could I would have stayed longer I would have, because when there are 1.2 billion people in the country, you are bound to see so many diseases and abnormalities that are not so common in our South African tertiary setting.

I found it truly amazing being surrounded by doctors who really wanted to part their knowledge. I also found it astonishing that many of them did their fellowships in America, Europe and Australia.

I thoroughly enjoyed the long hours in theatre, discussing cricket. My knowledge about the Indian cricket team grew from nothing to something I wish my medical knowledge was.

My knowledge in Anaesthesia grew in leaps and bounds, ensuring that I have a better understanding of the physiology of a pregnant woman and a known diabetic.

If it was not for Dr Butani (Head of Anaesthesia) I don’t think it would have been possible for me to see as much as I did.

I appreciated the fact that I was able to see so many surgeries and given a broader understanding of anaesthesia and congenital heart surgery while learning about anaesthesia in a baby at the same time.

I would definitely like to go back someday, and try and learn so much more.

Ode to the Hair Follicle

The picture on the right illustrates vitiligo, an autoimmune disorder causing destruction of the melanocytes of the skin, resulting in hypopigmentation.

We had a patient like this today, only with a very severe form. What she also had was many small round spots of repigmentation, like the few round spots seen in the picture here.

So the question is, why, when the skin starts to re-pigment, does it come back in small ROUND spots? The answer will blow your mind:

Melanin is secreted by melanocytes – and when the skin’s melanocytes are depleted, the melanocytes interspersed in the hair follicles jump into action. And what shape are hair follicles…?

Hair follicles, apparently, do not only contain a melanocyte reservoir. If needed, these follicles can also produce additional collagen and keratin.

Imagine that… Once a month I pay someone to rip lots of hair straight out of my skin, and in the meantime the follicles are regular little wonders.

I like it. I like it a lot.

Superspecialists use elevators?

Me. Gobsmacked.

So I had one of those gobsmacked experiences today.

Running to catch an elevator to the eighth floor, someone held the doors open for us.

Someone who is a very scary super-super-super specialist, and quite famous for his research. And he is a formidable professor who has the propensity to make one feel rather unintelligent.

So he smiles as we enter, and I mumble something incoherent in the line of, “Hullo Prof.”

Fortunately he suppresses the urge to tutor us on some or other topic we doubtlessly know nothing about. He laves, and all I can say to my ammused clinical partner is, “He uses an elevator?!”

Dermatology is just like in Grey’s!

Remember that episode in Grey’s Anatomy, where Christina, Meredith and Izzie discover “A Brave New World”, namely the Dermatology Department?

You know the one…

Yes, that one.

For the next two weeks, we get to discover Dermatology in a public South Afican hospital. And yes, it really is an oasis in the desert.

It is amazing. The doctors drag us away from presenting a patient to show us some or other interesting condition. They help is when we struggle with diagnoses. They tell us we can go home when our official time for the day is done.

The other nice thing is that these patients are actually relatively alive and lively. They are patients who care enough about their health to be concerned for weird appearances on their skin. They make jokes with us.

The parents are lovely too – caring enough for their children to sit in a line for hours to get their child’s skin seen too. What a refreshing feeling, after so many months of parents who couldn’t care less about a chronic cough, nevermind a strange rash.

I don’t mean to judge – in fact, it is not my place at all, but I cannot deny how good these patients are for my psyche.

An interesting clinical case… (Mind the image for sensitive readers)

A woman presented to us with punched-out ulcers on the lower legs, after having been taken off anticoagulant therapy for dilated cardiomyopathy. One can actually feel the areas of hypercoagulability in the lower limbs, where ulcers eventually form. She also has the most marked clubbing I have ever seen (I wish I could have taken a picture). She as Atrophic Blanche, but all we can currently do is wound care, while the lovely physicians try to figure out why they cannot get her coagulability under control.