Lesson learnt: when you see a patient with chronic liver disease secondary to alcoholic liver cirrhosis, always take the psychosocial history (finances, family situation at home, history of accidents / fights due to subdural bleed), psychiatric history (Wernicke and Korsakoff encephalopathy), gastrointestinal history (variceal and GI bleed).
Woke up early to observe a kidney biopsy on a patient under my follow up. Before I could finish introducing myself, already got scolded by the specialist to stand at the corner - managed to watched the biopsy though, amidst the firing received by the nurses and MO. The houseman whispered, "You are lucky that this is one of the extremely rare cases when she didn't mind, usually she will chase everybody away when she is doing the procedure."
2 on calls this week. Duno why when I follow a particular specialist, you can be sure the night will not end early..
Interesting cases seen:
1. Middle aged Chinese patient with 6 month history of chorea (ruled out Huntington's), CT shows generalised cerebellar atrophy and small vessel ischaemia, the housemen went hunting for autoimmune causes of vascular disease (due to his young age). MRI came back with a long list of findings (which the 3rd years would know better), I could only remember cerebral atrophy and nasopharyngeal carcinoma compressing certain regions.
2. 5-year old girl presenting with exacerbation of asthma, has an incidental finding of dextrocardia.
3. Patient diagnosed to have pemphigus vulgaris by dermatology, but the history sounded to me more like an outbreak of herpes simplex (painful oral and throat ulcers), treated with antibiotics (?URTI) which led to Steven-Johnson syndrome (lesions on upper limb, trunk, lips and neck).
4. Patient with atypical pneumonia, probably due to Legionella from air conditioning.
Old lady from mainland China admitted for pulmonary embolism. Can see that she was really unwell and could not sleep (the nurses transferred her back and forth in the wards to make way for sicker patients).. tried my best to reassure her, the husband and daughter that the cardiologist needs to see her before she gets upgraded to a higher class ward. I think the husband appreciated the concern, despite my broken Mandarin. Looking from a distance, specialist asked my friend, "I thought his Chinese was extremely limited? Looks quite ok to me.." Anyway, need to start reopening my 'Learn Mandarin in 40 days' book.
It's pretty tough being a foreign worker in this country, especially when it comes to healthcare. You fall sick, your employer not willing to foot your medical bill (coz foreigners get charged more on hospital admission), so you see doctors getting phone calls from bosses asking when their employees can be discharged, or requesting a letter to certify him/her as having a medical illness and needing to be deported back to their home country.
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