Monday, November 1, 2010

What A day~

Setinggi-tinggi kesyukuran ke hadrat Ilahi.

Alhamdulillah, I already went through my first day. As usual, I woke up early, pray to Allah to ease my way today & upon reaching JHC, I took good breakfast. I always noticed,having good breakfast in the morning makes my endorphin&serotonin level increased & I feel more relax, happy & could think clearly.

When I reached the ward, I reviewed few patients. Do simple clerking but no PE done yet. I saw Dr Goh reviewed his patient & straight away went to him & introduced myself. But unfortunately he was not the MO doing round that morning. So he just gave me a list of things that I need to cover for my second Professional exam & he told me to focus on it.

So today, I followed Mr Azril at his clinic. He was my supervisor back then when I was Year 4. He still recognised me as one of his mentee.

Currently, Im happy to see Mr Azril in a good health because I still remember previously he had hematemesis & collapse in JHC. He was resuscitated in the A&E & everybody was sooo worried about him. After investigations, he was found to have gastric ulcer due to chronic usage of NSAIDs. After that, he took long MC & we, the mentee had only few classes with him. But that doesnt mean we can skip from going to ward. Instead our groupmates always joined other lecturers for teachings.

Today, most of my time spend in the clinic seeing lots of oncology patients under Mr Azril's supervision.

There was a patient middle age gentleman, medium body build came in with a small lump at his right hand - medial tu cubital fossa. Estimated size was 4x5cm, oval shape, not erythematous, no punctum, no discharge. The mass was non tender & not warm, has regular border, firm to hard consistency, irregular surface, slightly mobile & attach to underlying muscle. suggestive of a tumor.

Mr Azril : What muscle do u think it might attached to / arise from??
Me: Superficial flexor muscle.
Mr Azril: Just say flexor muscle, by palpation it can still arise from deep group muscle.
Me: understood~

Afterwards, mr Azril was flipping through the patient's radiograph but couldnt find the xray of the forearm. But there was CT Scan & MRI belongs to the patient & he look at me....

mr Azril: would like to see the patient's CT scan??
Me: me Looking puzzled~ why?is there any finding??But sorry doctor..what is actually your question?? (laughing~)
Mr Azril: Im trying to find the, would you like to look at The CT scan??
Me: No~ (with confident)
Mr Azril: Good..If not I would ask you to go back & read books. (& the laugh continued)

Later,the patient was plan for tru cut biopsy of the small mass to send for HPE next week. The diagnosis was not confirmed yet.

Second patient:
A 50+ year old gentleman came in with a very gross & enlarged swelling of his left arm.

The swelling was from the middle third of upper arm extending down to the middle third of forearm (Series sangat besar - bayangkan macam popeye nye arm. tapi popeye hanya dekat forearm).

Estimated size nearly 40cm length but I coudnt estimate the circumference of the arm. There was scar at the lateral side (incision post biopsy), well healed & presence of dilated veins seen. Otherwise, not erythematous & no discharge
The mass was nontender, not warm, hard in consistency (felt like bone) & irregular surface.

Patient still able to lift the hand, flexed, extend & pronate the hand but the range is reduced compared to the normal side. To my suprise, you could no longer feel the elbow from below when you flexed the affected hand. If you just hold the upper arm & move only the distal forearm. You could feel as if this patient had pseudarthrosis - the forearm was able to move side to side & up& down. The joint was actually destroyed. However, the sensation was intact.

Reviewing the patient's CT scan of left arm. The diagnosis made was synovial chondromatosis. In this patient, it is a benign condition.

Other cases, I able to see were fibrous dysplasia (the deformity in the femur called shepherd's crook deformity - I cant answer this Q, luckily all the HO also cant answer the Q. haha), exostosis & osteoarthritis.

Later, I made an appointment for short case with Mr Azril tomorrow morning at 8.30am before he went for his clinic duty.

Im sooo looking forward for tomorrow's lessons. *Bersemangat mode*

p/s - ouhh ye, one HO asked me "dik, cari ape??" & I was like...erkk..ermm...cari kes tuk shortcase esok with Mr Azril"

HO: kamu year berapa??
Me: Final Year
Ho: bukan exam ke??
Me: saya special skit. kat ortho nie 2mggje
HO: aikk..asal waktu kitorang takde pun??
Me: eh??doktor nie UIA ke??xpenah nampak pun..doktor batch brape??saya sbenarnye remedial...
HO: oo yeke...a'ah.saya batch 8..saya mmg tak duk hostel.duk umah & xbercampur dgn orang sangat. Haha
Me: ouhh 8???atas saya je tue..saya batch 9..meaning doc nie batch mok, nazhan,etc
HO: a'ah angguk2...kamu camane??ada stress2ke??jgn risau ok, kamu mesti boleh wat nye. Kalo ada apa2 xpaham, tanye je saya. tanye je ape2, surgery,paeds, Im, O&G, sume boleh. Nak ajar shortkes pun boleh. If saya takde wad masa tue, call je operator suh sambung kan ke Dr Azrul HO ortho. Biasanya orang macam kamu nie yang akan sambung blaja sampai speacialist... (sambil tersenyum~)
Me: erkkk.. (terkedu seketika)..tima kasih doktor...(dalam hati terkejut dgn keramahan senior yang sorang nie)
later,I end up review some patient with him =)

Sesungguhnya, pertolongan Allah itu selalu ada dimana-mana, btul tak???
Jadinya, kenapa kita selalu bersedih & menyalahkan takdir??

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