Friday, March 21, 2008

Frightened Out of My Skin

When I started my itchy scratchy Dermatology posting, I hoped I could bunk classes and sleep at home, instead of in class. And then they announced that we have an end posting exam, and attendance is compulsory, blah blah blah. Damn!

This unit I am in, SUCKS. I am stuck with some of the most unfriendly kids in my class. They pretend that the rest of the world does not exist, and ignore a lost, lonely, unhappy medico* whose friends were all put in another unit. They are intolerable, and I should not really count this as a loss, but I hate being a stranger in a strange land.

And then one day Bandit (the unit representative) told me it was my turn to present the case. Having absolutely no idea how to examine a examine a patient with skin disease, I objected, but then the words ‘end posting’ and ‘long case’ were casually dropped, and I suddenly found myself eager to broaden my understanding of the most boring subject on earth Dermatology. Bandit led me to the patient, a man completely covered by a blanket, except for his head.

Do you know how pus smells? It has to be the most unbearable smell in the world. This guy’s whole body was covered with ruptured, infected blisters, and the smell would have put the Orthopaedics and Surgery (the gangrene headquarters) wards to shame.

By a superhuman effort, I managed not to wrinkle my nose or display any other external signs of the presence of The Smell, and wrote down the patient’s history, and examined him. His wife removed the blanket covering him, and I’ll just say that the sight more or less scarred me for life.

While I was performing all these trivial activities, the others (my beloved unit, all 22 of them) stood around chatting and giggling. The sound was driving me crazy, I tell you. I still couldn’t come up with a diagnosis, what had caused the blisters in the first place. I was going to go with SJS, but decided to peek into his case record before I committed it to paper. It was actually a variant of pemphigus, an autoimmune condition where the upper layers of the skin become separated from the lower layers. Armed with this information, I confidently proceeded to present the case before teacher. And then, get this, Bandit (the SLIME) had shown me the wrong patient. I wanted to STAB him. I got a ‘poor presentation’ and ‘this is not the way to present a case’ for the first time in my life. Gah.

I bought a Dermatology textbook that very evening. I was looking through the pictures (I do that with all my books- Ophthal is the worst, I think) and I came across a photograph that changed my life. The nail on my little finger has had a small, dark coloured band for about 4 years now, and I never thought much of it. The picture in the book looked exactly like my nail, and it had the highly encouraging caption ‘Subungual melanoma- a rare variant of malignant melanoma’ beneath it. The prognosis is pretty poor, apparently. I will be seeing a doctor on Monday.

I haven’t stopped shaking yet. Oh, God, please, please let it be benign.

*Me, in case you didn't get it.

Considering the alternative, I guess this is just a slap on the wrist.

Monday came. I had spent a sleepless night tossing and turning in bed, with dreams of my finger getting chopped off and my career ending with a bald me (courtesy of the chemotherapy) saying goodbye to all my friends and then going home to slash my neck (much quicker than the wrist, apparently) when I did manage to sleep. The funereal atmosphere at home did not help much (I couldn't stop myself from crying on my mom's shoulder) and left for the hospital with a feeling of dread. I did not want my parents around when I received my death sentence.

I consulted my Dermatology professor, told him I had had it for four years, and that a couple of other nails have similar dark lines on them. He took one look at the nail, and diagnosed onychymycosis. (Yeesh. I went through all that self torture for a fungal infection? was the only coherent thought I had then.) I was asked to get a nail clipping test done, and to get back to him with the result in two days' time. I looked at the prescription only after I was out of his room. That's when I noticed a question mark against the diagnosis. It could still be melanoma...

Scene 2: The Dermatology laboratory.
"Oh, nail clipping? Come here."

She put on gloves. Her assistant got two bottles ready, and then placed a glass slide on the table. She wiped my nail with saline, and fitted a new blade onto the scalpel, while I watched with increasing apprehension.
She took hold of my finger and placed it on the slide. The blade gleamed in the sunlight streaming in through the window. She was going to chop my nail off! Noooo....

She began to scrape away the nail surface. The shavings fell on the slide. She showed no signs of stopping even when it looked (to me) like there was just a millimetre before she reached the nail bed. Then she stopped, and I heaved a sigh of relief, which I soon learnt was premature, because she immediately put all the 'clippings' into one bottle. I closed my eyes while she began scraping my nail again...

Scene 3: Today
I got the results.
"No fungus found."
I was sweating bullets when I went back to my professor with the result. And then he told me that I probably have nail psoriasis.

I was told that it was not a serious condition, that it usually remains confined to the nails, that I had nothing to worry about and to please stop looking so horrified. All I could think was, "Psoriasis. I am going to end up looking like this." while everyone around me comforted me.

I do not have family history of psoriasis, I have no skin lesions, I have never had an autoimmune disease. It felt unreal, somehow.

I start steroids tonight. Some lotion that I have to cover my nail with after food, twice a day.

Anyway, I feel much better about the whole thing now. It really is rather trivial (I looked it up), and it should go away soon.

SPM exam on Saturday. And ObG on Monday. See y'all after. Thanks for sticking by me. :)


brocasarea said...

haha..we too have skin postings from net week and am pretty sure of bunking it!!!!...:)

Anonymous said...

And I thought docs never miss anything!!! You future docs - miss postings!!! Whoa

Cathy said...

your experience in class sounds awful! definitely not the career for me!

hope all is well with your finger!

Thinking aloud said...


now i know why i didn't choose a medical career...

all te best for monday...

Tys on Ice said...

u probably jammed ur finger in the door, u drama queen!

just mail me whn the doc throws u out of the examination room for wasting her time with blood clots...

btw, tht post was helpful in making me forego my breakfast..thnks, u r great for my figure...

Ziah said...

Your finger scene sounds scary :(:( Please keep me updated on what your doc sez today...

Pssst... You sure you bathed fine since the last time you voted? OR it aint a long term after effect of playing holi? :):)

Tea N. Crumpet said...

So many problems replicate other problems-- I hope Monday comes fast!

ToOothlEss WOndeR! said...

what the doctor say?

hope and love said...


ToOothlEss WOndeR! said...


Thinking aloud said...

that's a relief....

now all teh best for your exams!!!!

black coffee said...

Okie! Now melanoma? That must hav been a scare!
So it is psoriasis? Well thats not too bad!
I remember a patient with pemphigus from my skin postings! Otherwise we saw a lot of hansen's and psoriasis(they all look the same so i only went by wat my prof thot they were!)
sadly, everyone got to bunk the posting and not my batch! My skin prof liked our batch just cos we bothered attending!
I have my uni exams from april first( i hope i don make a fool outta myself)
all the best though i think this comment is a lil late in the coming!
Cheers! :)

love and squalor said...

hey, the phrase 'dark band on nail' caught my eye and I kinda knew what the rest of your post would be, almost exactly.
at least, you're studying to be a doctor and are surrounded by a whole buncha people who can tell you what's up with you. imagine what happens to a civil engineer who googles 'ugly band on toenails get rid of' and is informed it might be cancer. well, it turned out that my running shoes were crappy and the nail had been in distress for ages.

Madhumita. said...

How's that nail? Missed this post and you seem to have had a traumatic time of it. There there ... :)

Anonymous said...

the nail update was gratifying. so i can joke around now :)

'I will be seeing a doctor on Monday' - and i thought you were going out on a date! :P

The Icicle said...


i am Anu...your cousin Kiran's (FULL NAME: Kiran Bose)friend...

he gave me your blog link that day when i was telling him that i have started blogging...

had an absolutely awesome time reading both your're "awesomeness personified" indeed...truly!



Good to see ur med. college life goin great guns....mine ended all of a sudden with not so good aftermath...keep it up!

Tys on Ice said...

damn! iam never gonna open any links u send ever again, especially before lunch...

hope u r better now...just dont bite ur nails ...

how do u get it?

Prats said...

Gosh!! you docs have such vivid imagination....and such acute diagnosis...
How have you done your papers? Is the nail looking any better?

Adorable Pancreas said...

Everyone does! We had a two week skin posting in 4th sem, and we used to sneak out to go watch autopsies. Man, those were freaking awful.

We miss our sanity, what's a posting or two?

It's not as bad as it sounds. To use a cliche, you get used to it after a while.
The finger is still the same, minus its upper layers, from the scraping it underwent. At least I am not dying of cancer.

thinking aloud,
Thanks. :)

tys on ice,
I've had it for years! I took it to be a blood clot when I first noticed it, but it never went away, and I got used to it.
You can just buy a surgery textbook if you want to lose weight this way. Quicker, and you'll never go over 40kmph again.

I got a cream to apply over the naul, but it still looks the same.
I have never voted, by the way. I got my ID card after the elections. The last time I played holi was in 8th standard. Nah, can'tbe those. :)

tea n. crumpet,
Some days, it feels like the whole world is against me. And those are the days I wake up early. This is why morning people go crazy.

toothless wonder,
He didn't actually say much, he just looked at me pityingly and told me to return after two weeks.

hope and love,
I was shit scared at the time! But now it's funny.

Adorable Pancreas said...

toothless wonder,

thinking aloud,
The exams went badly. It was downhill from the time I saw "write a short note on the anatomy of the pelvic diaphragm". Anatomy was never my strong point.

black coffee,
The atmosphere was funereal afetr I told my mom! She would come up and hug me every few minutes. Now we are back to normal, or as normal as we can be.
Hansen's is really rare here. I haven't seen a single case!
How did the exams go?

love and squalor,
It's an awful profession for hypochondriacs! And the internet didn't help when I googled "subungual melanoma". It convinced me that I had about 3 months left.
Did it disappear after you got rid of the shoes?

You can say that again! Thank you. :)

He was at least FORTY FIVE! There is a limit for the 'older men' thing, you know. Besides, he was bald. :P

the icicle,
Thank you.
Help me convince him to take up blogging, will you? He writes excellent poetry. :)

doomed doctor,
It's still fun, although the SPM people try their best to turn us into short sighted community medicine specialists.

tys on ice,
I have no idea how you get it. It's not that common, and 'unknown aetiology' came up a number of times when I looked it up.

Too much imagination here! I was already picturing my funeral.
The exams weren't that good, apart from ENT and Ophthalmology, whose results are out. I have no hopes for SPM and ObG. :(
The nail looks the same. I have to see the doctor again after two wees.

monsoon-dreams said...

3rd year syndrome?hmm..hope u feel better now.

Anonymous said...

i hav dark toe nail since i remember and my mum had and also my daughter has and it is harmless dark colored toe nail slightly thick.if yours is similar dont worry doc girl.u are safe and go ahead with life happy and with high spirits.may god bless u

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