be careful on what you say
Assalamualaikum everyone … as usual today we had case presentation in the ward .. this time Mr Lionel take us … hanisa present a case of pancreatic carcinoma .. this is the first time i saw such case during 5 weeks of surgical ward .. then izni presented a case of brest lump of right breast .. benign tumor grow into malignant .. 50 years old female .. note one thing fellow friends .. if a 50 years old female come with a lump on her breast … it is malignant tumor until proven otherwise .. As Mr Lionel finish I ran down stairs to SOPD .. coz the time is 9.35 a.m and Prof Ramesh mention earlier .. if we come to his clinic later then 9.45 we better don’t come in .. as i reach his room some of sem 9 student were already there .. waiting for "Boss" … we waited and he came around 10.05 a.m…. as usuall we had several hypospadias cases, one came with mild fits, 2 cases of hydrocele and others.. i remember seeing two of the patient in the ward .. one 1 years old femlae patient had cloacal anomali where her bladder, uterus and rectum fuse into one tube and open into her vagina… a major surgery was done by prof ramesh and she came for folllow ups .. her new rectum need to be dilated once a day using candle and so prof ramesh teach the mother how to do it .. the first time he did it there was a little fresh blood on the candle .. then time for the mother to do it .. there you go … fresh thick blood came out and the poor girl was screming and crying in pain .. prof explain that it’s normal to have gross blood discharge after performing the procedure but it was too scary for me .. scary woo … then come a young male patient age 8 with a hereditary spherocytosis .. he has to undergo splenectomy and cholecystectomy as the spleen has enlarge and he develope stone in her bladder .. when there is stone in the gall bladder it is useless and can cause choledocholithiasis which can lead to secondary ascending cholengitis .. for the spleen due to his abnormal blood it will rupture as it floes into the spleen and that leads to haemolytic condition which cause the stone formation and generalize jaundice on him .. poor kid .. such a young age .. already losing his spleen and gall bladder .. in the future he will be passing lot’s of bile every time he eats fatty food .. and prone to infection .. the rest is okey .. not so bad but there is difficulty he has to overcome …. all the best ..
our last patient came for a follow up .. he is 10 years old male malay patient had trauma on his left abdoment 2 months ago .. some kid kick a ball and hit his abdomen causing swelling associated with haematuria .. ct scan and abdominal x-ray was taken and the swelling resolve a few weeks later… he doesn’t passing out blood anymore as well .. to me the kid appear healthy and their parents smile at us as we talk to the boy .. they actually came to get the result of the ct scan and abd x-ray.. as I observe the ct-scan .. i couldn’t make out any abnormality … so as the others .. then prof open his mouth .. the kid had an enlarge pelvic of his left kidney and the right kidney appear to be enlarge .. the mild visibility of contrats dye on the right kidney showed that there is hydronephrosis of the right kidney .. it is clear to me that this kid is in big trouble … the worst thing is the whole family doesn’t have a single clue what is going on .. we were talking in english and unfortunately they don’t understand us .. probable due to all the medical term we used during the discussion … as we read trought the x-ray report .. the radilogist explain that the left kidney does not take up any contrast dye .. and the right keidney appear dilated .. prof ramesh refuse to except the report .. he feel that there is some error on the evaluation .. the 1st question is … what is the underlying pathology .. a 10 years oldoy had a ball hitting his abdoment and suddenly develope left kidney failure and right kidney hydronephrosis ?? odd you see .. we can’t make out any reasonable explanation .. then the prof open his mouth again .. a trauma that leads to this kind of condition usually due to underlying pathology .. it means that the kid already had some illness affecting his left kidney … the trauma worsen the underlying pathology and that’s why suddenly he develop such a severe conditin from a mild trauma .. otherwise it’ll remain asymptmatic until one day all of the sudden .. the boy will present with bilateral kidney failure … basicly the guy who kick the ball have save his life .. a surgery has to be done in order to asses the left kidney .. prof remesh feels that there is obstruction some where along the left ureter .. he feel the left kidney is stilll working .. .it doesn’t pick up the contrast dye due to the obstruction .. accumulation of fluid cause the kidney not able to filter anymore fluid not bacause of left kidney failure as mention by the radiologist .. thats why prof disagree with the evaluation … the decision will be made during the operation itself whether to keep the left kidney or remove it .. the importen thing is to save the right kidney … left kidney failure if we left unresected will cause right kidney failure .. the kid can still live a normal life with one functional kidney so .. thank good a ball hit his abdomen ..
Prof ramesh ask one of us to explain this to the parents .. i was the only malay in the room so no choice .. it has to be me .. you guys know can i’m only sem 6 and I tough it is like any other normal explanation .. so i just shoot to their face … guess what happen ???
the father was stunt and satnd up .. the mother turn away and came back crying … there was 6 of us .. thank goodness the other was sem 9 student and they help answering the question the father had .. you know the kind of question when you are confused and dissaponted and sad and surprised in denial .. why why why kind of question .. why my son appear normal and healthy all this time and you said he has been having this illness since earlier age ?? that was the bomb thrown to my face .. from the father of the child .. then i realize that the situation is very serious and tense .. we explain slowly and thank god the father is a rasional man manage to control his emotion and except the shoking news ..
I went back for zohor after wards and had a long tough a bout what just happen .. I feel that i should have been more sensitive in letting out the news .. i’m telling a parents that their son will lose his kidney just like that .. without explaining the underlying situation ..
the best way is to sit down with them .. then i should explain that the kid has got some problem with his left kidney since younger age and it remain asymptomatic .. and so on until the end .. i’ll tell them that he has to undergone surgery and the likehood that he might lose his kidney .. i felt sorry for the kid and his family .. the news i let out today will change the family ..
It’s is something valuable for me to learn this today .. Perhaps it make me a better Doctor in the future ..
