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.

NAIL UPDATE:
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. :)