Life has been paused, lately.
Probably, there are obvious reasons for this. The guy I’m just beginning to get to know is out of the country. I’m settling into the dull routine of second year. Processes that were exciting last year have become second nature, now. The scene doesn’t change much these days; it’s just the quiet little puppet show that does.
That’s okay. There’s still enough to deal with – good and bad. Let’s start with the bad, so that we can finish on the good:
Bad:
- A friend has gone AWOL. We are worried.
- Centrelink has sprung me. Now I have to give them money.
- Facebook is destroying my soul. And my chances of passing Medicine II.
- My dad’s health is waning. He describes something that sounds a bit like angina, but the doctor thinks it’s due to sleep apnoea.
- Mum admits her health is waning. She describes something very much like angina. Yes, it is an issue if you feel intense pressure in your chest, a deep ache in your left arm and pain in your jaw, mother. For God’s sake, go to a doctor.
- My diet is deteriorating. As usual. Exercise barely exists anymore.
Good:
- I like a boy. That same boy likes me. It’s fun.
- I have a better relationship with my sister than with any other siblings I know.
- The weather is getting colder and darker.
- I’m now able to buy things like sweater vests and jackets.
- I’m very happy just being whatever I am.
- I met a boy.
So anyway, that’s the breakdown.
I’m really liking the hospital at the moment, which I’m thinking is a good thing, considering that’s supposedly where I want to spent most of my life, right? Last Thursday morning, I was on the train listening to some iPod when I decided to crack open my clinical examination text (which I normally don’t even bring) and read up on something randomly neuro. I chose cranial nerve examination, because we’d had a workshop on that the day before. I was amazed to discover how many cranial nerves there were (no, I did not know prior to last week) and their names.
When we got to the hospital, our doctor took us to a patients room, but before we were allowed in he told us that there was no diagnosis for her yet. The head of neuro was stumped, and so was everyone else. So were were to go in and talk to her, and then go downstairs for a coffee to try and ‘diagnose’ her. One by one, we squirted some microshield onto our hands and entered the patient’s room.
The doctor points at the girl standing next to me, “you. take a history, please.” I’m glad he didn’t point to me – I’d been singled out the last two weeks in a row to deal with diabetic patients and I just wanted to lay low. The history was taken.
“Good,” the doctor says. “You – ” he points at me, here – “do a focused cranial nerve exam, please.”
Thank GOD I had at least read the part of the book regarding cranial nerves. At least now I know how to do the exam! I gather all my little bits and pieces that I need for the exam like a red-tipped hat pin and start.
“What have you found?” The doc asks me. I tell him that I think the patient has multiple cranial nerve palsies on her right side, but then a different set of palsies on the left…which I suspect is wrong.
“I’m impressed,” he says to me. “You did miss cranial nerve 4 and 6 on the left, but I’m very impressed that you caught the 6 on her right side – it’s very subtle.”
Finally! I didn’t look like an idiot at hospital!
The doctor then took us downstairs to have a coffee. While we did, we talked about the syndrome of obscurity that this woman was displaying. We had charts and scans, and were mulling over diagnoses for real – this wasn’t some stupid fake PBL. Once we’d gotten all the Housian diseases out of the way (amyloidosis, sarcoidosis, SLE) and talked about potential toxins in her house and her lifestyle (perhaps a botox overdose?), we started talking about the tests that we’d order.
“Well, for sure we’d get another LP and MRI done. Right?” Says one of the other students.
“Yes, but how long between lumbar punctures is prudent?” The doctor asks.
“Hang on,” I say. My mind is still on diagnoses. “This might sound stupid, but what if her problem isn’t neuro?” And then I get the familiar look from my fellow students – oh God, where is he going with this? “What if there’s nothing wrong with her nerves at all – what if it’s myasthenia gravis? Maybe it’s her muscles that have become unresponsive to the nerves that supply them.”
The doctor grins, pauses, and the asks: “Have you seen the chart?” I tell him that I’ve not seen the chart, and ask if myasthenia gravis is right. He reminds me that there is no diagnosis as yet, but that myasthenia gravis was what the resident put on the call sheet last night as diagnosis, and it had just been ruled out this morning.
For about an hour and a half we talked obscure diagnosis. It was so much fun to actually be considering these obscurities rather than laughing about the fictional characters on TV who put them forward before considering something like a heart attack. They say art imitates life, and life can imitate art. This was life as a house episode. And it was awesome.
