27 April 2007
This was a big day for me. All my effort in the past 4 weeks was mainly because of this end of posting exam. I had clinical and writing paper on the same day. This was my first clinical exam after ? 4 months, I think. Hardly to imagine how nervous and uncertainty was I.
I had Mr.L for my clinical examination at wad 8b, together with azman and pei lin. As I was the last candidate, I was told to have a drink and back after ½ hour. Ok, where should I go? My exam started at around 9am. I met Mr L outside the wad.
Mr L: U go and clerk a patient at bed 16. Talk to her nicely as she is in pain.
Me: Ok.
I walked with my heavy footsteps into wad 8b and looking for my patient. She was a middle-aged malay lady with nasal sprung and urinary catheter, lying on the bed. She looked quite ill.
Me: Acute abdomen. Another intestinal obstruction? My god. Mr L is going to ask me about fluid resuscitation. (by the way, I had presented a acute intestinal obstruction case during the case presentation to Mr L around 2 weeks prior and being criticized until I felt like running away….)
I introduced myself to the patient and started my clerking. My patient was quite happy to talk to me. How lucky was I! Thanks so much. A few minutes later, Mr L was here.
Mr L: Do u have problem communicate with this patient?
Me: No.
Mr L: Ok, continue. (He is reading the case note of this patient)
He was so caring and nice. I felt so warm about it. Of course, I knew what he meant. As a medical student, I encountered problems with patients eg language barrier, incooperative patient....
I finished clerking and physical examination around 40 minutes. I rearranged all information I had and tried to figure out the differential diagnosis and management.
After 20 minutes, here Mr L was. I presented the case to him and summarize at the end. Here was the summary..
This was a middle-age lady that admitted the day prior, presented with acute abdomen. He……
Mr L: He or She?
Me: She (my god, not again..i screw up again. I cant differentiate between he or she)
This was a big day for me. All my effort in the past 4 weeks was mainly because of this end of posting exam. I had clinical and writing paper on the same day. This was my first clinical exam after ? 4 months, I think. Hardly to imagine how nervous and uncertainty was I.
I had Mr.L for my clinical examination at wad 8b, together with azman and pei lin. As I was the last candidate, I was told to have a drink and back after ½ hour. Ok, where should I go? My exam started at around 9am. I met Mr L outside the wad.
Mr L: U go and clerk a patient at bed 16. Talk to her nicely as she is in pain.
Me: Ok.
I walked with my heavy footsteps into wad 8b and looking for my patient. She was a middle-aged malay lady with nasal sprung and urinary catheter, lying on the bed. She looked quite ill.
Me: Acute abdomen. Another intestinal obstruction? My god. Mr L is going to ask me about fluid resuscitation. (by the way, I had presented a acute intestinal obstruction case during the case presentation to Mr L around 2 weeks prior and being criticized until I felt like running away….)
I introduced myself to the patient and started my clerking. My patient was quite happy to talk to me. How lucky was I! Thanks so much. A few minutes later, Mr L was here.
Mr L: Do u have problem communicate with this patient?
Me: No.
Mr L: Ok, continue. (He is reading the case note of this patient)
He was so caring and nice. I felt so warm about it. Of course, I knew what he meant. As a medical student, I encountered problems with patients eg language barrier, incooperative patient....
I finished clerking and physical examination around 40 minutes. I rearranged all information I had and tried to figure out the differential diagnosis and management.
After 20 minutes, here Mr L was. I presented the case to him and summarize at the end. Here was the summary..
This was a middle-age lady that admitted the day prior, presented with acute abdomen. He……
Mr L: He or She?
Me: She (my god, not again..i screw up again. I cant differentiate between he or she)
She complained of epigastric pain, radiated to upper abdomen x 3/7, vomiting x 1/7, fever x 1/7 and constipation x 1/7. She was similar episodes for 20 years. She was known case of hypertension, on CTZ and KCL supplements.
Mr L: What was your provisional diagnosis?
Me: Acute cholecystitis TRO acute pancreatitis
Mr L: Differentiatial diagnosis?
Me: Perforated PUD, MI
Mr L: Perforated PUD????
Me: Actually the physical examination doesn’t show signs of viscus perforation.
Mr L: ok how u investigate this patient and tell me why?
Me: FBC-Hg,TWCC,platelet…
Mr L: this patient TWCC is xxxxx? What this show?
Me:xxxxxxxx
At the middle of the discussion, he got a message.
Mr L: Do u read Chinese?
Me: Yes
Mr L: Tell me what is this?
Me: xxxxxxxxxx
Mr L: ok, I’m going to delete it
Me: speechless…
The discussion took around a hour. He asked from tip to toe. Quite luckily he didn’t ask about anatomy and physiology which I did not remember much about it. At the end of the examination,
Mr L: U’re semester 9 now, I expect u to know what the normal value of potassium and ranson score for acute pancreatitis.
Me: :S
Mr L: U go back now and read about it, I will ask u about it when I meet u in the afternoon.
Me: ok thanks so much (Is he coming during the writing paper? Haih….)
That’s the end of my first clinical paper after 4 months. Ok, fine…I went back blossom, ate lunch and Zzzzzz, looking forward my writing paper at 2.30pm. I could fell the tiredness. Whatever, I just tried my best!!!!
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