Sunday, July 31, 2011
They were couple in their 60s. The earned their living by selling clothes hangers at a market. It was around 4am on a Sunday and it had been raining throughout the night. It was cold and they were cold from the rain so they decided to skin the pedestrian overpass and just jay-walk across the main road. Anyway there were so few vehicles this early in the morning.
It was a rainy night and nothing was better than enjoying the night out with friends and some beer to counter the cool weather. It was almost 4am and most of his friends had already gone home. He was a bit tipsy but he decided he could manage driving his motorcycle home. It was still raining when he left the bar and he didn’t have a raincoat with him. He got into his motorcycle and drove as fast as he could, a bit irritated that the drops of rain flowed into his eyes.
They were almost at the other side of the road and watching their step on the slippery asphalt, anxious to put their heavy wares down. They almost made it safely.
He had just a little too much to drink and the cold rain wasn’t helping a bit. He had to focus all his concentration on avoiding the puddles along the road. He didn’t see the two people crossing the street.
The woman was suddenly flung from the side of the man. She hit her head on the pavement. The driver of the motorcycle that hit her thankfully stopped and brought her to the ER. She had a broken leg and although conscious, it was very likely at the very least that he had a concussion.
Who was at fault:
The motorcycle driver who should have waited until he was sober before driving home? [but it was raining, and he was cold, and he was within the speed limit]
The couple who should have used the pedestrian overpass? [but it was several steps high, and their wares were heavy, and it was raining]
Sunday, July 24, 2011
She kept pointing but her mom couldn't see who she was pointing at.
But the kid insisted that she could see someone...
So they decided to take a picture...
Thursday, July 14, 2011
Patient: I don't think the ear drops the other doctor gave me is working.
Doc Ry: why do you say that?
Patient: because when I place a few drops in one ear, they come out the other.
Tuesday, July 12, 2011
I saw him. He was a typical middle aged man maybe in his 40s. He didn't seem to have any difficulty breathing but he looked a bit anxious.
It turned out that his primary concern was throat pain which he had been experiencing on and off for about 2 months. He described it as extreme dryness of his throat and a sensation that not everything he swallowed would 'go down'. Then he added the other litany of complaints - difficulty breathing, tires easily, various muscle pains.
They say that an accurate diagnosis can be made 80% of the time just from the history. In this case I was fairly sure that he was under a lot of stress, maybe work-related which would explain all his complaints as well as cause hyperacidity which could cause reflux symptoms.
Usually an endoscopy would be needed to confirm my suspicions but due to technical difficulties that wasn't an option at the moment.
Instead I tried to explain what was going on in his body. Illustrations helped a lot. It turned out to be an interactive lecture about physiology in as simple terms as I could manage. If I had a laptop and projector on hand...
Usually this kind of thing makes the patient go, "I don't care about this stuff! Just give me something to feel better!" But apparently several of my educated "guesses" were spot on that he paid attention.
Eventually we came to the part of stress where he volunteered that he indeed had a demanding job and he was stressed out to the point that seeing the long queue for the train ride to work would almost cause him to panic.
It took me longer to talk to him than it took me to suture the wounds of several past patients. By the time we were done he was visibly relaxed (and I was tired)
No medications were given.
He still had his stressful job.
He still had throat dryness.
He still had the sensation of difficulty in swallowing food.
He still tires easily.
He claimed he felt better and the pain had subsided and he was breathing easier. But nothing had changed...
Except maybe the level of his self-awareness.
[PS: An accurate diagnosis can be made 80% of the time with a good history. So there's a 20% chance he'll be coming back mad as hell because I was way of course.]
Sunday, July 10, 2011
A referral was made to our department for evaluation. A camera was passed through her mouth to visualize her throat. Just above her voice box and covering half of the entrance to the food tube was a tumor. This was definitely the cause of the difficulty swallowing and voice changes. But the pain might be because of another problem.
A few nights before she left the hospital I came across her fully awake. She burst into tears. "I don't want to die," she said. She recounted the suffering she had been through for the past few months. "I'm loosing hope. My brother just died of cancer and I'm going next."
I talked with her. and left.
A few weeks later, I saw her again. She was back for a follow-up consultation.
Yes, she still was experiencing the pain.
Yes, it was still a chore to swallow food.
Yes, her voice was as raspy as ever.
Yes, the thing in her throat was cancer.
Yes, she had to undergo radiation therapy.
Yes, she was still frail to look at.
Yes, she still had difficulty sleeping.
In fact, everything that caused her recent confinement to the hospital was still there.
Now she even knew she had cancer.
But she was smiling. Her voice was energetic. She was making jokes.
She walked on her own. She was stronger.
The only thing different was that somehow, during the last few weeks...
She had found the will to live.
Thursday, July 7, 2011
I was on my way to the Emergency Room when I heard someone calling my name. It was a former classmate in medical school. She was sitting outside the ER, teary eyed. “It’s my father.” she said. “He has metastatic cancer. Now, he’s unresponsive. His pupils are dilated.”
I didn’t know what to say. Just in the hospital where I work, a consultant had already lost her mother to an illness. Another’s father
is loosing lost a fight against an infection. And yet another’s newborn son is fighting for his life.
Her father had prostrate cancer that had spread to his bones. “You know the course of this disease and how painful it is,” I told her hoping to imply that she should take comfort that the suffering would come to an end.
“I know,” she said, “but it’s still so hard.”
“I think I’ve forgotten that I’m a doctor.”
That froze my mind. How are doctors supposed to act and feel when it’s their loved ones who are slipping away? Are we expected to look on impassively, and intellectualize what is happening to loved ones who are suffering from disease?
Whether it’s our fault or not that many think we have power over death – Well, we don’t!
The process of loosing someone is more painful for us than for anyone else because we, of all people, know ahead of the others when nature has chosen it’s course. But we have to suffer with that knowledge, alone, while waiting for the others to accept that it is time to let go. And during that time we can only grieve while in private because showing grief even to family members may destroy what small hope they have left, despite the odds.
To my classmate, “No, you haven’t forgotten that you’re a doctor. You are part of the minority who now knows what it really means to be a doctor.”
Tuesday, July 5, 2011
Friday, July 1, 2011
Against the odds he survived the first 3 months and it was finally decided that he could go home with his parents as a complete family. He had been through a lot, and so did his parents. The good news was welcomed by everyone.
Three weeks later he was back in the intensive care unit. Something was wrong with his lungs. They wouldn't function properly. While life goes on, his and those of his parents are a standstill. Seeing his father telling him that he loves him and his mother smiling at him through tear-stained eyes would break anyone's heart.
But miracles still happen.
Maybe he will be one of them.