my date with thaibetes

Woah. Been such a long long time since I blogged!!! And sooooo much has happened since then. Medicine posting came and went, new friends made and farewells said. And yes, it hasn’t been the best 2 months I have had in my life but hey! Sure makes a deep impression in my mind.

Of course I must first relate my horror story of my encounter of the one and only kind with the famous thaibetes (for the privileged few who knows this infamous household name that is guaranteed to strike fear in the boldest hearts).

Now when I was once a rookie medical student new to the wards, I thought nothing can be worse than having a certain woman-hater as my tester. How wrong I was! Didn’t realize the errors of my ways until I received the name of my med posting tester. Hai. More famous than the woman-hater! And yet I had thought that I was ready to take on the world after surviving that ordeal.

Past history of thaibetes (as garnered from more than 10 medical students from yr3 to yr 5, registrars and a few consultants): high failure rate especially for MBBS final yr exams. Terror. Mean. Gave a myasthenia gravis case for an eclinics test. Purportedly gave addison’s disease case to another. Wants everything to be quantified. Must mug diabetes, pet subject of said tutor. Die die also must do fundoscope! Aiyo why so unlucky u got thaibetes!!! And from my own sgh tutor: *eyes popping out and suddenly straigtening from her chair* WHAT!?!! U got ….?!?!!?

Haha so it was with all these horror stories armed in hand that eugene and I stepped into The Ward yesterday at 9.10am. Trembling. Pallor noted. and thaibetes made her appearance at 9.27am.

She brought me to a lady, and left me with the words: this lady came in for a problem, but I do not wish you to focus on that problem. I want you to focus on other things.

And with this cryptic message, she left me.

10 minutes into my clerking time, I was all ready to scream. Yes. The patient presented with myalgia and diarrhea, and her comorbidities simply stretched on and on. Exactly which one is the one thaibetes wanted me to focus on!?! There simply wasn’t enough time to get a full history of all her current illnesses, which include hypertension, diabetes, cushing’s disease (wow disease leh, not syndrome...), IHD, menorrhagia and the list goes on.

With 10 minutes to spare, I did the impossible. Did physical examination for diabetes, cushing’s, cvs, resp, and abdo all within the ten minutes. With fundoscopy thrown in for good measure. Was starting to take the blood pressure when Eugene called me to report to her.

The nightmare began when I started presenting my past medical history.

“What?! What do you mean by past medical history?! You mean the patient has been cured?! She does not have this problem currently?!”

Profuse apologies and a humbled look.

“Wait. I thought you mentioned she was admitted from the cvs clinic! Shouldn’t you tell me about her IHD before starting on her diabetes!!!”

Which would have been what I usually would have done, except that the patient was NOT admitted for any hear problems, she just mentioned to her dr in passing that she has had a fever for the past 3 days.

And it all went downhill from that point in time. Instead of allowing me to present my history to her, she directed specific questions to me like “so does she have ____?”

And she ended her grilling by telling me “why do I have to dig all these out from you! Why can’t you just have volunteered the information yourself!!!”

I wish I could have too dr, if only you had allow me to present.

More scoldings: why didn’t you ask whether she noticed any darkening of her skin in recent months?! Isn’t it obvious you should have asked that since you know she has got cushing’s disease!

Well dr, basically she has got one zillion comorbidities, I simply couldn’t have asked about every single thing within that 20 minutes… *sob*

The rest of the test passed in a blur. I was shell-shocked, sitting in a chair in front of her just by the patient’s bed, while she took her time slaughtering me slowly and gleefully. I was in a daze. I usually pride myself in being able to keep my calm and remain in control however bed the examiner is, but I lost it this time. Not so much because I was scared of her, but she made me fell like the stupidest girl alive. She made me doubt how I even made it into med sch. It didn’t help that her most-used phrase to me was “I chop off your head ah!!! You say that again!!!” yep. Certainly not a morale booster was it. In my confounded state, I blurted out a murmur different from what I heard in my less than 1 minute exam of the cvs system.

And she moved in for the kill.

Ranted and raved, asked me how I can possibly tie up my cvs findings. Then issued the ultimatum “Now I am giving you one last chance, if you don’t do this correctly I am going to FAIL YOU!!!!! I am giving you ten minutes to examine this patient’s cvs, and it would be treated as your long case!!!”

Ok dr, does that mean I have to examine the peripheries as well? (and I thought it was a perfectly reasonable question; apparently not)
She went bonkers.

“Go to the CORE!!!! The CORE!!! Why would you bother about the peripheries!!! Now you want to confirm your murmur!!!!”

Okok I get the picture.

To tell the truth I was feeling rather mutinous already. If she was going to fail me I don’t see the point in trying to salvage a mudslide-like sticky situation I was stuck in. Quagmire I was sinking fast in. But I told myself: why should I be intimidated. I just show her my examination techniques and that’s it.

Alas. I forgot to listen for radiation of the murmur to the axilla, and hastily did it while the patient was sitting up. Naturally this brought on another barrage of scoldings regarding my incompetency. More “I-chop-off-your-head”s!!!!

Ah well. It was rather comforting that she ended with “I will pass you, but barely.” Hee.

Second short case was less frightening. I was told to examine the upper limbs and perform any other tests that I can think of to comfirm my diagnosis.

Ahhh. Cogwheel rigidity!!! Yay! Parkinson’s!!!!! *heart sings with joy*

After doing the relevant tests, I told the dr: I would like to walk the patient.

This brought on an unexpected onslaught of incredulity and she looked at me as though I was crazy.

“What!!!! Why do you want to walk the patient!! You mean u have finished EVERYTHING that you want to do!!!! You mean you can’t come to a diagnosis even with all you have done!!!”

(wondering what wrong I have committed again…) “erm yes I mean NO!!! I am very sure about my diagnosis but I would like to confirm or exclude it by walking the patient.”

This seems to calm her a little, and discussion followed as to why it was Parkinson’s and not some cerebellar problem. Whew.

And yet, my post-test discussion with Eugene revealed startling inconsistencies. She actually scolded him for not walking the patient, and yet she scolded me for wanting to walk the patient!!!

Tiens.


But you know, it is not such a totally bad experience after all. I do think that she is an extremely smart dr and she probably excelled when she was a medical student. I sort of realized how important it is to link everything together into one nice puzzle, instead of simply clerking blindly and getting this really detailed history without knowing what to do with it. I know I am not as terrible as she made me out to be, but I am not brilliant as well. True true a part of me felt that her expectations were too high for a mere yr 3 standard, but hey! Someday I would have to be able to reason everything through on my own. Haha all these are easy to say now that I have had time to nurse my post-test 8 hr migraine and to whine about this to countless people.

I realized I do respect her. Although I am envious of other luckier students who had more of a tutorial with all their nice nice tutors, at least I managed to get through this without shedding any tears. Whew. It was really a totally nasty experience though. And ridiculous for a test to last for 3.5 hrs! But yar. Her advice is very true. At the end of year 5, this is the standard I must be at. Oh gosh. What a scary thought.

Through all these, really glad to have the support of my family!!! And especially my CG who came down to support us even though they already had their tests… and all my seniors and clsmates who wished me luck! Not forgetting the classmates in The Ward who wished us luck, although I didn’t even know some of them… ah.

Advice to future generations:

I survived Thaibetes. So can you.