Obs/Gyn and Paeds always have sad things.
Late third trimester intra uterine foetal death diagnosed a routine appointment is the worst. It’s when you wish that outpatient consulting rooms were soundproof, and that you have all the time in the world to deal with the poor woman concerned…and all the other pregnant women who have listened to her crys of anguish.
My worst day in OB clinic there were two of them- one at 36 weeks, one at 39. Both unexpected and unexplained, both gut wrenchingly sad.
My week in the NICU, one of “my” baby girls didn’t make it (severe Intrauterine growth retardation, she was less than 700g at 30 weeks and she had a chromasomal abnormality), her death wasn’t completely unexpected, but it was still a blow.
Another day that sticks in my mind was a quiet Monday (which is a rare thing) in the Emergency department. There were all the usual minor injuries, acopias (literally, elderly people who cannot cope, or whose families cannot cope), MIs, Strokes and alcoholics with acute pancreatitis after a weekend bender.
But there were also two patients I will never forget, because both of them presented with lethal conditions with apparently minor symptoms (a painless lump on the chest wall, and a red face and cough).
The first was a father of four in his 30s, presenting with a painless lump on the chest who turned out to have high-grade lymphoma.
The second was a lovely man in his 60s, who had gone from a cough on the Friday, to a chest Xray on the Saturday, to Superior Vena Caval Obstruction (where the major vein draining blood from the head and neck is blocked) on the Monday. He only came to the Emergency department because his wife insisted, he wanted to wait until the Thursday and his scheduled appointment with his GP for the Xray results. He was dead within weeks.
Looking back at the three years I’ve been on the wards, it is scary to think how many patients I’ve talked to will have died by now.
On a slightly lighter (but more gross) note- did you know that some testicular tumours, when they become necrotic, can literally explode at orchidectomy? The textbooks strangely fail to mention this, but I’ve experienced it first-hand.
Also, I’ve seen a paravertebral TB cold abcess drained in a rather rudimentary hospital in rural India. The patient was given a large dose of ketamine, a local anaestheic was injected into the skin of the back and the incision was made. My job was to hold a bucket (not a kidney dish or a fancy disposable emesis basin, but a big plastic yellow bucket, that had recently been separated from the mop used to clean the floor of the operating room) underneath the incision to catch the pus. By the end of the procedure, the surgeon had run her hand all the way down the psoas muscle into the patient’s pelvis, and my bucket was almost half full. May I add that this was in August, during Monsoon season, when it was 100% humidity, 30 degrees centigrade, and there was no aircon?
On a lighter note, I did my surgical clinical exam today, and it went as well as can be expected, i.e. I wasn’t called for a viva, so I’ve definitely passed. One down, one (medicine) to go, tomorrow…then I’m a doctor (woohoo).