Wednesday, August 15, 2007

Ulcerated corn-ya

Funny how a lot of terms in Ophthalmology seem to end in ya. Pseudo-fake-ya (that's redundant, but I did not coin the term), a-fake-ya, corn-ya, you've-ya... OK, I'm overdoing it. But I hardly ever do anything, so I tend overdo it when I do. (Bad sentence. Go stand in the corner.)

What I wanted to say was, I took a case! After giving attendance at the canteen, Skoda was distressed to hear that I hadn't seen a case yet, since I didn't know where the wards were. She decided to rectify this horrible situation, and took me to the ward, which was posing as a construction area in an attempt to keep me out, complete with loud noises designed to render a stethoscope non-functional. Errr... Not the stethoscope. No one auscultates eyeballs, so my Littmann is gathering dust at home. *sob*

The first sight that greets me in the wards is an old man being assaulted by a gang of hoodlums. Closer examination revealed the goons to be none other than Tall, Short and Bachhu. On seeing me, they immediately lost interest in the old man and transfered their attention to me.

Bachhu: AP has come to take the case, guys.
Me: But-
Tall: AP will present the case today.
Me: But-
Skoda: I love her presentations.
Me: But-
Short: Cute nurse.
Me: But-
Tall: I haven't heard her present a case yet.
Me: But-
Bachhu: We'll help you.
Me: But-
Skoda: Oh, thanks Bachhu.
Me: But-
Short: Cute nurse.
Me: But-
Tall: Ammava, enthu pattiyitha? [What happened to you?]
Me: But-
Patient: Ente ponnu mone, oru pani vannappo thudangi enikku kannu kanan vayya. [My beloved son, I can't see after a bout of fever.]
Me: But-
Skoda: Sure it isn't another hooch tragedy?
Me: But-
Short: Cute nurse.
Me: But-
Tall: Yeah.
Me: But-
Bachhu: Relax, AP. This will be a breeze.
Me: But-
Skoda: Don't worry.
Me: But-

Everyone ignores me and Tall proceeds to take the old man's history. His left eye (not Tall's, the patient's) was swollen shut, and Short gets the patient to prise it open so we can examine it.

Everyone: Gaaah! What's that????
Patient: A corneal ulcer of bacterial aetiology, secondarily infected with some fungal pathogen.

OK, the patient didn't say that, but it would have been cool if he did. Anyway, the poor guy had a huge ulcer on his cornea, a yellowish opaque area, right on top of the pupil. The conjunctiva was inflamed, red, swollen and fleshy, and looked like something out of a horror movie. It looked worse than the eye in the picture, and that cornea isn't ulcerated. Believe me, this is mild compared to the poor guy's eye. The corneal ulcer paled in comparison, but the two together made for a gruesome combination. I believe conjunctival involvement to this degree is less common.

After completing the case taking, I was led back to the lecture hall. Madam came and asked, "Who is presenting the case today?" Skoda lifted my hand into the air. Tall, Short and Bachhu merely grinned. They'd done it before.

I was made to stand in front of the whole class (29 suddenly unfamiliar friendly faces) and read out the case. I'm trying to forget the major chori [very loosely translated as scratch] I suffered at the hands of that chori Madam. She made me read out each line twice, and by the time I reached the end, I was a nervous wreck.

Madam(after I've read out the history and examination twice): So, what is your diagnosis?
Me(nervously): Corneal ulcer-
Madam: Which eye???
Me: And immature cataract. Oh. *pause* Left eye.
Madam: If you couldn't see the pupil, how do you know he has cataract?
Me: Oh. *pause* Mild immature cataract, right eye.
Madam: Class, is there anything such as mild immature cataract?
Class: No, Ma'am.
Madam (to me): You are such a moron.
Me: Yes, Ma'am.
Madam: So, tell me the diagnosis once again.
Me (sweating profusely): C-c-c-corneal u-u-ulcer, l-l-left eye a-a-and m-m-I mean, i-i-immature c-cataract, r-r-r-right eye.

She didn't let me return to my seat, and I had to stand there while she started speaking to me in Chinese.
Madam: How will you clinically diagnose the aetiology of a corneal ulcer without resorting to laboratory tests? In case you cannot make a clinical diagnosis, what are the lab investigations you will do? Will you do a corneal scraping or a direct illumination fundoscopy?
Me: Huh?

All right, that question is bull, but she did go on and on about aetiological clinical diagnosis and predisposing factors and GOK what else while I stood and sweated. She stopped the class after a collective groan when our watches showed 12.15 and she was still bulldozing along about stages of cataract. Greatly moved by the experience, Short and Bachhu carried me to the bus on a stretcher.

Anyway, I made Tall buy me a Jumbo Chicken Sandwich after we reached the college (the Ophthalmology department is not situated in the Medical College campus). Short and Bachhu couldn't be found.

The ENT people had scheduled a torture session after lunch, but it was cancelled, and we all went home. I spent the rest of the day alternating between the toilet and the bed. I think there was something in my sandwich that had no business being there.


Kottikkal said...

hi there doc

well literary sense mushrooming in a doctor is a good thing..keep writing...if u got free time just run through my blog also...

Tys on Ice said...

:) Iam going to term that blog as a dietery piece, since my lunch is now on its way to the Arabian Ocean as I write this...

theres levels of maturity for cataract? well, u learn something new everyday..tell this immature cataract to stop acting like a baby and grow up...maybe it will sport a mallu meesha later on ...hmmm

Sreejith said...

such interesting lives medico live. And i always thought a cataract was some sort of armed cavalry! err wait...was that a cataphract

Adorable Pancreas said...

@kottikkal: Firstly, thanks for calling me doc. :D
Thanks, I sure will. I've left a comment on your blog.

@tys on ice: About your lunch, glad to be of service. And yes, there are levels of maturity for cataract. Mature cataracts wear french beards these days; the mallu meesha has gone out of fashion. :P

@sreejith: You're right, whatever else it is, it sure is never dull, except the lecture classes. Cataract is a sort of waterfall, I remember reading thast somewhere.

Kottikkal said...

Can i have ur email id?

Adorable Pancreas said...

Hmmm... That should be :)

Spunky Monkey said...

I am done with Ophthal!
I am done with Ophthal!
I am done with Ophthal!

*does uncontrollably Huntington-esque victory jig*

I didn't abhor this one as much as I did ENT. Now, that's just sadistic of the university, or the patients to have any disease there.

Third year was fun!

Parul said...

real good blog!
you are the first doctor-blogger i have come across..
And i like the way you say , "i was taking a case..."
In sales parlance we use that when we feel like stripping someone's ego :P

manuscrypts said...

con medico in the making :D

Adorable Pancreas said...

@spunky monkey:
ENT's next. *gulp*
3rd year was absolutely the best! 4th year isn't a hardship either. If it's 6th sem you meant by 3d year, I meant the other one. We use the old term here.

That's interesting. In medical parlance, case taking is something of a synonym for history taking and examination.

Guilty as charged. :D

S said...

This is the first post I read in your blog. First of all I should complement you in the way you are writing your blog. The flow is good, interesting and making the reader to look forward to see what happened after that. Being a new person to blogosphere, I find your blog more interesting than some of the others I have visited.
Second of all, it makes me think of the days of my case presentations. i can understand the tension, butterflies in the stomach and sweating you would have gone through before and during your presentation. Thank God. It is a thing of past to me.
There was a typo (or was it not) in your post. The patient addresses you as ‘mone’ while it should have been ‘molae’. -

Anonymous said...

hello there thanks for your grat post, as usual ((o: