The following post follows the story of Aaron Tan, a third
year medical student sent out into the land of general practice for the first
time ever. A foreign and uncharted land, what tales shall Aaron bring back from
his maiden voyage into the unknown? Here are his top 5 moments.
5
It was Aaron’s last day of his attachment. Bittersweet with
a hint of dreariness for it has been a relatively uneventful day. His supervisor
had been entertaining and engaging but the knowledge of impending exams and the
lack of variety has taken its toll on his psyche. Things were not looking good
for this keen bean. That was until this middle aged lady came in complaining of
chest pain, palpitations, presyncope on exertion 1 week ago. She had a similar
episode waking her up from her sleep 3 days ago. Initially hesitant to have
Aaron sitting in during the consult, she eventually decided to allow it.
Cheerful but facetious at first, Aaron watched in amazement
as his supervising doctor skilfully yet subtly coaxed the lady to open up to
her. Details regarding the lady’s distresses were eventually shared with the
doctor in a tearful manner. Aaron wishes he was more of an approachable
character but he understands that it was a privilege to have even been in the
room in the first place. He was sent out of the room just as the lady broke
down in tears.
4
Brimming with potential and hope for the future, this
newlywed couple and their 12 week old baby has come in for a regular check-up. The
husband, a hardworking man who works most of the time and good at handling his
daughter. The wife, a loving mother who has some difficulty in speaking
English. She has been living in this foreign land for a while, away from
family, and her closest friend had recently gone home.
The loving mother broke down as she describes her
disappointment of not being able to produce enough breastmilk for her daughter.
She struggled to find the words to express herself but heart wrenching sobs
were all that came through her mouth.
A true conversational gymnast; her doctor weaved through the
conversation moving between medical facts, consoling words and light hearted
jokes. Tensions and emotions were relieved, and the loving mother smiled for
the first time throughout the hour long consult. Impressive.
3
For all weekend, this eager and excited medical student has
been hyping himself up. Hours of envisioning, minutes of simulation practice,
and seconds of ecstatic excitement. Today was the day. 5 patients booked in,
and a friendly doctor. He checked his smile and attire, “I look approachable”
he thought to himself.
Things were looking good. The first one he watched and
assisted. Prepare the equipment, position the patient, point the light. Insert
the speculum and dilate. Sanitize and apply the local anaesthetic. Measure the
fundal height to pre-set the device. Insert the device and draw back its
sheath. Wait 10 seconds and voilà! Mirena inserted! Trim the strings and check
for patient comfort too, of course, let’s not get too far ahead of ourselves.
The medical student was now ready to do an insertion under
supervision. 4 more patients to go, and all they had to do was agree to allow
him to help out... Rejected, rejected, rejected, and not even allowed to be in
the room. Oh well, but at least you got to see one.
2
The hormone cortisol is more commonly known as the stress
hormone. It controls metabolism, blood pressure, inflammation, and basically
helps get us ready for a fight or flight response. Addison’s disease occurs
when an individual’s adrenal glands are unable to produce enough cortisol for
the body. Someone with Addison’s disease has to take steroid medications every day
to ensure that his body remains balanced.
Stop taking your medications, or develop a bad case of
gastroenteritis, and your body stops absorbing the steroid medications it
needs. Your body goes into an Addisonian crisis.
Nausea, vomiting, hypotension, hypoglycaemia and an altered
mental state. An ambulance was called. Suspense was ringing in the air. Aaron
asked for permission to insert a cannula just before the patient is taken into
the ambulance. He ran through a mental simulation quickly and started prepping
the patient. In the corner of his eyes, he noticed his supervising doctor
briefing the nurse on what to do if he missed. Flashback. All was good in the
world.
1
It was Aaron’s third day of placement. He had had a good run
so far with lots of new experiences and people to meet. To add on to his
rapidly growing list of experiences, he was allowed to tag along on an
impromptu home visit.
The patient was an old lady under palliative care. She had
multiple chronic diseases and has been asking to be allowed to die for a few
years now. Aaron was nervous, he was unsure of how to behave in a patient’s
house.
He smiled. She was lovely. Sitting up and smiling despite
her struggling to breathe. In a soft, wobbly voice she says that she has fallen
3 times since her last home visit 5 days ago, and did not feel like taking her
medications today. “Is everything okay?” the doctor asked.
The old lady broke down in tears. Her son and main carer had
passed away 3 months ago. “A part of me thought that if I fell, he would come
and help me up. He promised that he would be here to take care of me.”
“I know, no mother should ever have to watch their children
die. But this is just grief, it’ll get better, you just have to let yourself
feel the emotions.”
“It should have been me. If the devil come around to take me
this morning, I would have gone with him.”
The old lady looked up at Aaron with her weeping eyes, “You’re
going to become a doctor like Laura and
help old people like me right?”
Aaron looked back into her eyes and replied, “I want to.”
