The Last Laugh

It's a pity that 'the last laugh' was not mine, belonged to 'redhead' instead. Here i stand defeated towards her. I've had enough in the past 4 weeks, and thank goodness it's all over now.

Was really my luck that my patient overlapped with someone else's. Arggh. I was overjoyed when i got the slip from AAD, was 100% sure that it was a liver case, & i had 'taruh kau kau' on the topic the night before. To my HORROR when i approached the bed, it was a case of COPD! I flipped through the BHT then realised that WAS NOT THE PATIENT! Approached the nurse at the counter, was told that my patient apparently had 'changed beds'. Skipping along towards the designated bed, to find that another student was already clerking him for her exam. DARN! I FREAKED! Called AAD immediately, was standing in front of the census book. Skeeming through the names and bed numbers as the lady on the other side read it out loud, only to find that ALL OF THEM WERE ALREADY DISCHARGED!!! Finally she came up with a reserved patient of another examiner, and it was from the ward opposite! #@*$!! I totaly had NO IDEA what cases were in that ward...

Hopped over, finally found my patient & started calming my nerves down as i flipped open the BHT. My the time i settled down it was already half an hour gone, at least AAD had the courtesy to tell me that they would inform my examiner that i started late.

Clerked the pakcik, was irritated initially because when i asked him stuff, i would tell me 'saya tak ingat lah'. Anyways, i had to proceed. As time past we made friends and he began to be more open to me. Finally, we even joked with each other at times. He was such a complicated person with MULTISYSTEMIC problems. His problem list went on and on and on, from DM > HPT > previous stroke > previous MI > gastritis > recent cataract surgery > erectile dysfunction! A complete disaster waiting to happen! Ironically, he was PERFECTLY WELL when i examined him, NOT a single physical sign. I did every physical examination as in the textbooks (except fundoscopy, which i totally forgot about it & was screwed later). I had so so much time till he even interviewed me.

Exams started at 1030, where all the 4 of us were ushered into the dr on-call room. Was rather awkward. All 4 facing 'redhead', the air-cond was NOT functioning, chairs were so uncomfortable, fan kept blowing into my face, tummy churning inside out, i was about to collapse, dead tired (after a sitting on the toilet bowl the whole night, ending up in KFC at 5am as there was a power cut, had a morning bath while groping around in the dark, in IMU by 0715...) Slept through the Mr P's entire presentation, when she wanted to go see the patient, i was so reluctant to get off my seat! Slumbered to the bedside, continued to STONE! The next in line was Mr A, that time it had got to my nerves. I did not have the patience anymore to listen to ALL THE CRAP! He could hardly answer any of the questions, and i was getting irritated by the minute. (not that im good, it's just that when you are in a situation like that, you would like it to end ASAP!). After the grueling process of poor Mr A being srewed, i was up. It went like this...

Me : My patient is Mr blah blah blah, till when i reached... He presented with epigastric pain 20 minutes prior to admission at 2.45 in the morning.

R : I heard that your patient is not coorperative & is unwilling to talk. How did you manage to get the history?

Me : HUH? He was a nice man. I got the history from him.

R : (with a sarcastic smirk) I guess your 'charm' worked on him! Go on...

I repeated the whole thing once more when...

R : HUH! 20 MINUTES???

Me : Yeah, it only takes him 15 minutes to get to the hospital, & his grandson drove him here.

R : Do you know that it's not easy to wake someone up especially at 2 in the morning? You know how hard is it for you to get up? (Smirking away sarcastically!)

Me : Haha. (thinking aloud : Im still wide awake at 2, so what's the fuss about? Why should i even care? As long as he came here in a piece & is still alive now! )

Anyway, i continued, when i reached the differential diagnosis part...

R : What's your diagnosis?

Me : Gastritis... (before i could continue...)

R : WHAT?? How can that be your diagnosis? Based on his age and .........

(FATAL MISTAKE! I totally got screwed. But, she could had given me a chance to talk 1st! I had my reasons, which i DID NOT EVEN had a chance to tell you!)

Then it went on...

R : More differentials...

Me : Ahem, gastritis, PUD...

R : Aren't those 2 the same?

Me : Yeah. (but inside me i knew it was different, i was just not in the mood to argue with her). Pneumonia, pulmonary embolism, acute pancreatitis... (by now, i was exhausted of diagnoses...)

R : More! More! Remember, an elderly gentleman...

Me : Ruptured aortic aneurysm!

R : HE WOULD BE DEAD ON ARRIVAL IN THE A&E! Dissecting aortic aneurysm u meant?

Me : Yeah, whatever.

I was already so FED UP with her sarcasm then. My tummy was KILLING INSIDE! Finally, we proceeded to the patient's bedside.

R : What's the BP?

Me : (It was my chance to talk!!!) 120/80mmHg, Pulse ... I just blurted out everything that i could remember. I stopped short when she stared at me as if her eyes would pop out! I ended with 'he has no findings. Everything IS NORMAL.'

R : Lets interpret the ECG.

Me : Ok. Went on with blah blah blah... There's a LBBB.

R : So, how would you know if it's a full block or half block from the ECG?

Me : I have absolutely NO IDEA!

R : This time she was speechless... Stared at me hard. She taught us anyway.

Finally it was over... What a relief. But the worse was yet to come! The 1 to 1 feedback session...

R : How are you?

Me : LOUSY! (I slumped into the chair. I was tired. I was about to collapse. I just wanted to GO HOME!!!)

R : Anyway, u did OK. Above average. Good try.

Me : Aha. (i did not response further, was just too tired to do so!)

R : I give you a *0.

Me : Aha. (common, whaddya expect? Me jumping in joy? You are so so freaking 'chiam siap'! As expected la, i was already prepared for it since DAY 1! I could barely sit upright then!)

R : You may go now.

I was just so overjoyed & relieved that everything was over! I think i forgot to even THANK her!

As you see, that's how MEDICINE ended. The SAQ's were fair, it's just that i did not study for them! I think i screwed it up, as i ALWAYS screw up for MEDICINE! Im just not born to do it i guess. I can never get those thing's right. Just hope & pray that if i don't make it through i won't get a 1 to 1 counselling session with 'redhead' (coz she's the head of department you see!).

@ 1654, 31122007... she had all the fun, INDEED!