Good old gossip girl

I caught two old ladies with dementia gossiping about me while I was in the ward round.

Lady 1: (pointing towards me) 'That lady, do you know her?'
Lady 2: 'She the student'
Lady 1: 'She will be a good doctor'
Lady 2: 'Yes, she's always got a smile on her face'

My registrar: 'See even demented old ladies think you are going to be a good doctor, so you definitely will be a good doctor'

Why are these demented ladies suddenly so clever?

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Unusual cause of diarrhoea

I think this lucky gentleman is one of those that I will remember forever. He presented to hospital with diarrhoea. I was the first to see him in our ward. I took a history from him - he lied all the way (ok, I'm being too harsh, he has dementia and was actually two years behind us as he was telling me stories of his life two years back...). I felt a mass on his abdomen arising from the pelvis which was dull on percussion and diagnosed urinary retention, the diagnosis confirmed by bladder scan and treated by urethral catheterisation. Such a brilliant diagnosis! It made me feel so elated for several days. Diarrhoea then settled, no particular cause was found. In the interim he also developed conjunctivitis and coryzal (cold) symptoms. We were going to send him back to his nursing home when the nursing staff reported some rash. It didn't bother him at all, in fact he looked so much more alert and alive. One day after on yesterday's ward round, we saw the rash again and it has spread all over his body. (Maculopapular, blanching, discrete at first then coalescing). It looks like a rash from drug reaction, but he has not been started on any new drug. The only other differential diagnosis would be measles. They actually really look like measles. We then had a look into his mouth - there were white spots all over particularly the buccal mucosa. Medical students - what are these spots called?

If you are a medic, I hope you can sense our excitement by now! Medical staff who are not immunised and might be pregnant were told to stay off - which was a bit too late I think because the disease is most contagious before the rash appears. Another thing was that he was next to another patient who is immunocompromised on chemotherapy. He was isolated in a side room after that. When typing up the notes, I had to tell the geriatricians how to spell 'Koplik' as it was really not something that they expect to encounter in their specialty.

Extremely exciting stuff!

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Bus

I'm getting stressed every single morning over the Oxford Road buses. Basically these buses have to stick to their own scheduele but then they arrive at my stop early. So getting from where I am to the city centre can take 10 minutes or 30 minutes, depending on my luck. If I'm lucky and the bus is in a hurry, it would zoom pass the stops very quickly, jump the red light, overtake the traffic etc. But if I'm unlucky, it would be stood stationary at my stop for a further 10 minutes, then drive at a speed of 5 km/hr and wait for another 5 minutes at every single stops. And the connecting bus to my hospital: it's suppose to run every 15 minutes, but it has a habit of skipping one or two of them. I've had to wait for half an hour with no bus, and then have 3 buses turning up togather. STUPID!!!! So I would arrive at hospital either 30 minues early or 30 minutes late... silly isn't it? I really hate these buses!!! I'm all for saving the environment but not at the expense of my mental health. Can't wait to drive my own car.

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Any strangers who talk to me in the bus out of the blue are bad unless and until proven otherwise. Unfortunately it happens quite a lot. I just don't understand. What makes people think that they have a right to talk to me and ask me all about what course am I doing, where do I come from, where do I live and sometimes what is my religion! Yesterday, a chinese guy in his 40s was sitting in front of me when he started turning around and asking me questions in chinese. I answered out of politeness. But he then immediately said my chinese was 'bu biao jun' (not accurate), how untactful! I also often find that when people from china need assistance, they would just spot a chinese face on the street, talking away in chinese and just assume that you'd help. Like I said, to me, strangers who approach me are bad until proven otherwise, so I'd normally pretend not being able to speak in chinese, that's usually enough to put them off. Haha!!!

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Free thoughts

It ought to be, but full confidentiality almost impossible when you are in hospital. We draw the curtains around, but they are not sound proof. I was just on the computer reading some patient notes when I overheard a pastor talking to one of the patients. It touched me. She has a terminal cancer and she has been low in mood and been angry at everyone ever since I first met her. She asked the pastor 'do you think I will live?'. The pastor said he doesn't know but everyone dies. The pastor then said a prayer with her. He blessed her and all the patients in this hospital, and all the doctors and all the nurses and every who have been looking after her. I'm not a Christian and I'm not particularly religious but it made me choke, it was very moving that our efforts are being appreciated and people remember us in their prayers. The student nurse who was also there and I looked at each other, I think we share the same feeling.

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He is recovering from a really bad chest infection. Part of the examination requires looking into the sputum pot. It was very unusual this morning. It is very watery light brown, not sputum like at all. We just wonder if he has been pouring the yakult probiotic drink into the sputum pot.

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Another death in the ward. Elderly patient with metastatic cancer. I did not expect him to go so quickly but obviously I haven't been experienced enough to anticipate death. We were treating him for his heart failure and chest infection, and I remember he smiled at me everytime I looked at him even with him being so poorly. Nice people like this shouldn't die.

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