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A Day In The Life
(2010.07.19 - 2011.06.17)
Buqing Being An Intern
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
FOR MY MOM AND DAD
AS ALWAYS
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
Chapter 1 -- 2010
1.1 July
A Day In The Life 1.1 (2010-07-19 23:07)
My identity as an intern began at about 7:30 this morning.
* I typed the first formal admission record on the computer.
* I learned how to write a discharge note.
* I got four Zhongshan Hospital brand white coats.
* I pasted laboratory test reports on records for the first time.
* I made out laboratory test applications for a new inpatient.
* I witnessed a death this afternoon, accompanying family grief.
* I saw light from a plane moving across the sky.
* I saw a car accident.
My ”A Day In The Life”.
Buqing
2010.07.19
A Day In The Life 1.2 (2 010-07-20 23:07)
* I filled the stat order and standing order of a new inpatient.
* I studied contrast enhancement CT of a dextrocardia patient and did him an
auscultation.
* I attended a preoperative conversation.
* I witnessed an esophagectomy performed with the use of combined abdominal
(laparoscopic) and right chest incisions to treat midesophageal cancer.
* I had my first shower in Zhongshan Hospital.
Buqing
2010.07.20
A Day In The Life 1.3 (2010-07-21 23:07)
I have been standing on my feet, leaning the upper body forward meanwhile attentively
avoiding touching the operator in front of me for about 6 hours today, two and a half
hours in the morning and the remaining in the afternoon, trying to grab some clues on
the procedures of thoracic surgeries.
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The one in the morning was a lobectomy of the right lower lobe for lung cancer. It went
smoothly and successfully except one little interlude that the lung expanded
unexpectedly due to the slipping out of the tube (sorry I do not know the exact name of
the tube) which was solved by a very experienced anesthetist within two minutes.
The one in the afternoon was sort of irregular because of the deformity of the right lung –
merged upper and middle lobes – which should had begun when the female patient was
in her motherʼs uterus and made the separation of the lesion in the upper lobe somewhat
tougher and longer. The patient was diagnosed with TB and had received chemotherapy
for long with no significant improvement, thus followed this exploratory operation on a so
emaciated wasting body. Which made things worse was her complicating coagulation
disorders that had led to difficult-to-spot small artery bleedings. Nevertheless, the well-
trained operators had overcome all the obstacles, resulting a beautiful success.
Buqing
2010.07.21
A Day In The Life 1.4 (2010-07-22 23:07)
On my fourth day of internship, I got the chance to do something really surgical –
Dressing Change. A satisfying change requires a good preoperative preparation which
should be meticulous, including bringing all the must instruments and the concept of
asepsis from the very first step. Plus, the cooperation of the patient is also an
essentiality, though most of the time, the patient is too weak or in most cases, restrained
from cooperation by the pain of moving.
Todayʼs two exiting surgeries are esophagectomy and pneumonectomy. The former was
done on a middle-aged male who also had a lesion on cauda pancreas, so that a
surgeon form general surgery department joined at the beginning and handled that. The
remaining of this one was similar to the one performed yesterday. The latter was done
on the dextrocardia patient I mentioned in ”A Day In The Life 1.2”, a male older than 60
years. What truly made things horrible was that it was a central type lung cancer which
had eroded the right pulmonary artery, leaving a very limited space for operative
procedure. However, like every fairy tale, in the end, both of the two were of happy
endings.
I felt like having watched two Oscar-winning movies, starring all those surgeons with
superior skills and abilities.
Buqing
2010.07.22
A Day In The Life 1.5 (2010-07-23 23:07)
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I went for a dressing change all by myself this morning. I gave myself 3 out of 5 which
means I still have lots more to learn and practice.
In the afternoon, a surgery of right upper lobectomy was held at Room No.70. According
to the patientʼs CT report that the lesion at the center was probably a cancer that invades
the right hilum of the lung, and it was big. Luckily, the mass had not invaded superior
vena cava, as observed after the opening of the thoracic wall. Nevertheless, it was still
pretty hard to do a clean resection of the right upper lobe, with the potential occurrence
of pulmonary artery bleeding which may lead to death. The operator ceased the
operation on the way and spent some time introducing the situation to the operateeʼs
family for their opinion on whether to go on or stop the procedure. I was there when this
conversation took place. I bet anybody would be as sorry and down as me, or even
more, if he/she would be there, too. I tried hard to restrain myself from crying. It was a
hard decision not only for the patientʼs family, but also for the people who were trying to
save a life. ”We want you to do it, doctor.” ”Yes.” Nobody talked. Second after second,
people were so concentrated on the operation table, forging a scene which would be
forever in time. Not to say, the operation had turned out to be another success. One
other news was that, the lesionʼs frozen section indicated that it was a benign...
Buqing
2010.07.23
A Day In The Life 1.6 (2010-07-26 23:07)
I name today ”Surgery Day”.
Removal of intra-thoracic drainage
In the morning, a patient in SICU with two intra-thoracic drainages was in need of
removing one, so we went, a resident and me. It took me quite a long time to finish all
the procedures under the supervision of the resident due to my lack of experience. After
all, it was my very first time and so far, the most challenging one Iʼve ever handled during
my a-little-more-than-one-week internship. Not to say, in spite of the cool temperature in
the unit, my T-shirt became sodden with sweat afterwards. Luckily, another patient
provided me with an opportunity for one more try this afternoon and thanks to the
practice of the previous one, it was a much better job.
Removal of urinary catheter
Compared to the above one, this was a piece of cake. Simply deflating the balloon with a
20ml syringe and then gently pulling the catheter out, all was done. I made two this
afternoon and both were male patients.
Buqing
2010.07.26
A Day In The Life 1.7 (2010-07-27 23:07)
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My first task today was the removal of an intra-thoracic drainage for a five-day post-
surgical male patient. Unlike the ones I did yesterday, I came to a situation Iʼd never met
in my total two removals career life. Just after I stripped the gauzes off from the about 20
to 25 centimeters long incision across the right lateral thoracic wall along the fourth
intercostal space, a yellow, watery fluid flowed out and down from a little up the middle of
the incision. An attending doctor was immediately summoned. He removed some of the
skin staples with a stapler to expand that part of the incision and split the muscles
underneath with a pair of forceps, for the purpose of fluid draining. During the
manipulation, a microbiological culture was ordered in spite of his fat liquefaction first
diagnosis. After incision cleaning, three gauzes were placed inside for drainage. I, the
intern, finished the removal of intra-thoracic drainage smoothly afterwards.
In the afternoon, I attended a post-esophagectomy diatrizoate meglumine enhanced
chest X-ray examination which served mainly for the following purposes: 1.Observation
of the anastomosis. 2.Observation of existence of pyloric obstruction. 3.Observation of
existence of pneumothorax or haemothorax.
Buqing
2010.07.27
P.S. The pathological report of the lesion in A Day In The Life 1.5 was chronic
inflammation.
A Day In The Life 1.8 (2010-07-28 23:07)
A great leap today.
Being the second assistant, I participated in a right thyroidectomy this afternoon. From
hand washing to suturing of the incision, this one and a half hours experience had
brought me the distinct feel of a real surgery. My main job was forcibly holding the
retractor to create a better access to the tissues underneath the incision for the operator.
Before long, sweat soaked the clothes I was wearing, leading me to the necessity of the
existence of bathrooms near the operating rooms. Different from being a bystander,
standing at the second assistantʼs position had required more effort and brought a better
view. How does it feel to be standing at the first assistantʼs position or even, the
operatorʼs?
Back to the ward, I removed a patientʼs skin staples with a stapler which was of a lesser
tensile strength than I previously thought, making it easy to slip away from the fingers.
One more thing to mention was that a patientʼs family showed their greetings to me
when we bumped into each other in the elevator which made me very delighted.
Buqing
2010.07.28
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A Day In The Life 1.9 (2010-07-29 23:07)
This was the day Iʼd been waiting for 2 days ever since I got the permission of doing it
from the attending doctor and today I did it – thoracentesis, the procedure to remove air
or fluid from the patientʼs pleural space.
It was like a battle, from the preparation to the practice and finally, victory. As soon as the
sterile gloves were put on, any contact was prohibited except with those sterile
appliances, which had brought me a similar feeling when I was in a military training
about four years ago that in both situations, human beingʼs intrinsic motivational
tendencies were painfully refrained with his own will, especially when the sweat was
running down my forehead and later, chest. One skill I learned which would possibly be
neglected as a bystander was that moderate pressure should be applied to pull the
plunger when doing the drainage with a syringe, or either no air or fluid would be out due
to too small pressure gradient between the pleural space and the syringe or the rubber
tube between the needle and the syringe would be squeezed by the atmosphere due to
too great pressure gradient between inside and outside of the tube. This procedure took
about 15 minutes and at last, about 130mL fluid of red color was drained.
Buqing
2010.07.29
A Day In The Life 1.10 (2010-07-30 23:07)
A 36 years old female was admitted yesterday a month after the right lower lobectomy,
presenting cough, sputum with blood and consistent low fever. The CT scan report
showed two consolidations at her right upper lung, one at the front, adjacent to the chest
wall, one at the back. Neither could diagnosis be made according to the CT report, nor
could thin-needle thoracic biopsy provide any hint but inflammatory reaction. So this
afternoon, an exploratory thoracotomy was done. The moment when the front
consolidation was spotted, everybody in the operating room knew at once that the
flower-like mass was a cancer. A frozen section was ordered immediately and soon the
result was proved to be a very depressing one that it WAS a cancer, a very poorly
differentiated type. The family was called for a conversation and I could sense the
husbandʼs helplessness, who was trying very hard not to fall down. From that moment
on, Iʼve been longing for the day when cancer is overcame.
Buqing
2010.07.30
1.2 August
Eight Days A Week (Department Of Thoracic Surgery) (2010-08-01 02:55)
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Well begun is half done, two weeksʼ internship at Department of Thoracic Surgery is the
begun.
All started from nothing, this was the very best time to see, to listen, to do and to fail,
because I was naked and there was nothing for me to lose. Operating room of
comfortable temperature seemed a perfect refuge to hide myself from the torrid heat
outside, and whatʼs more, catered to me the curiosity of exploring the unknown. Learning
from life, far more interesting and efficient than reading boring and lethargy-catalyzing
textbooks, had truly brought me the sweetness following the realization of making
progresses every day.
My sincere gratitude to resident Jin Guo, attending doctor Liang Xue, resident Mingyan
Cai, attending doctor Yi Zhang, associate chief physician Di Ge and all who had given
me a hand in the past two weeks at Department of Thoracic Surgery, Zhongshan
Hospital.
Life was vivid, 24 hours a day, seven days a week, but not enough to show how I
enjoyed it.
Buqing
2010.08.01
A Day In The Life 2.1 (2010-08-02 23:07)
One weekʼs internship in Department of Emergency Surgery began this morning.
A husband refused to accept the admission of her thirty-six years old wife, who was
suffering from choledocholithiasis and in a bad condition, because their lack of money. A
six-two years old female suffering from appendicitis refused to undergo a surgery
because of the hot weather and agreed to make it when the days were getting cool. A
twenty-four years old female with abdominal pain refused to do urine HCG test as she
claimed had not done that kind of things. A thirty-one years old female beaten by
somebody some time earlier argued for a longer medical certificate as three days would
not satisfy her.
......
There were people from all walks of life.
Buqing
2010.08.02
A Day In The Life 2.2 (2010-08-03 23:07)
Shanghai is widely known as an international metropolis where modern and classic
merge. Today, I very well learned that it is also where rich and poor merge.
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Both the wife suffering from choledocholithiasis I mentioned in ”A Day In The Life 2.1”
and another wife suffering from acute purulent appendicitis preferred to stay at the hall
rather than being transferred to observation room as they both could not afford the pre-
pay charge. The two husbands told me they both had spent a large sum of money in just
the past two or three days and they had no idea why seeing a doctor was so expensive
which had already drained almost all their deposit and the end was still not seen. This
had brought me the classic dilemma that if there was a beggar lying outside of the door
of the hospital, painfully moaning, meanwhile with no money at all, should he be treated
or let die?
For the building of a harmonious society, itʼs high time the government took steps.
Buqing
2010.08.03
A Day In The Life 2.3 (2010-08-04 23:07)
A 64-year-old obese female with a history of cystectomy 18 years ago complaining left
lower abdominal pain which had lasted for about 12 hours had an abdominal CT scan
which showed swelling of the root of the mesentery. Her high level of leukocyte indicated
an inflammation and abdominal ultrasonography report indicated small amount of fluid in
the abdominal cavity. No further information was obtained. An abdominal paracentesis
was thus performed and non-condensing fluid of pale red was drained which contributed
to the possible diagnosis of necrosis of intestine as a result of occlusion of the blood
supply due to intestinal incarceration, canal formed after the previous surgery. She was
admitted for surgery immediately.
Buqing
2010.08.04
A Day In The Life 2.4 (2010-08-05 23:07)
The attending doctor put forward a question: ”How came the breast-conserving
surgery?” ”Because females could not accept their entire breast to be removed. So, a
doctor began to perform breast-conserving surgery in the early days and surprisingly, its
prognosis seemed similar to mastectomyʼs. Scientific researches were thus carried out
and had proven no significant difference between these two kinds of surgeries.” He then
added: ”Sometimes life was a mystery.”
Is success always favoring the prepared minds?
Buqing
2010.08.05
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A Day In The Life 2.5 (2010-08-06 23:07)
A 58-year-old male came to the department of emergency surgery at 9:30 pm on
2010.08.04. His chief complaint was severe left upper abdominal pain where in the PE,
presented tenderness and rebound tenderness, meanwhile, his percussion tenderness
over left kidney region was also positive. Blood test, urinalysis and abdominal X-ray were
performed and possible diagnosis came to perinephritis. He was treated by
antiinflammation drugs and antibiotics via intravenous injection. At 01:15 pm,
2010.08.05, the patient came back with the same complaint, proclaiming no relief of the
symptom. Blood test, urinalysis, abdominal CT scan were performed and his WBC count
was still high with no apparent abnormality on urinalysis and CT scan. He was treated
with the same way. At 10:45 am this morning, the very patient came back again, with no
improvement on his symptom. A CTA was done to have excluded thrombosis in
mesenteric vessels. The associate chief said: ”No big deal, if he continues to moan,
shoot him some dolantin.”
Buqing
2010.08.06
Eight Days A Week (Emergency Surgery) (2010-08-08 10:55)
Actually, emergency general surgery would be more accurate because some specialists
would take care of patients with urinary system diseases, traumata (bone fractures) and
internal diseases, etc, respectively. During the last week, three most common diseases
were acute cholecystitis, traumata (mainly viscus injuries, mild traumata) and acute
appendicitis. When the patient also presented with internal diseasesʼ symptoms or signs
or other special conditions like ENT and eye lesions, brain injuries, etc, a consultation
would be ordered. Most commonly used tests were blood test, electrolyte test, urinary
test, ECG and CT scan where ECG was done to exclude cardiac diseases which would
sometimes also cause abdominal pain. Patients with very bad conditions would stay for
observation or instantly be admitted for surgeries.
5One key in emergency surgery was ”Cope with the most critical problem first,
everything else is secondary.”
Buqing
2010.08.08
A Day In The Life 3.1 (2010-08-09 23:07)
Surgical outpatient department provides health care for people with similar symptoms
and signs as those visiting emergency surgery, except that it is not for emergencies.
One new examination I learned today was anoscopy which also included perianal
observation and DRE. Patient was directed to make an attitude the same as the one in a
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picture on the wall, namely lateral decubitus with the lower leg straight and upper knee
bent towards the chest. The physician performed the examination by three steps: 1.
Perianal observation 2. DRE 3. Anoscopy. Hemorrhoids, fistulas, swellings, polyps and
other abnormalities would be detected by an experienced physician during any of these
three steps.
If I am lucky enough, I would be very glad to perform one in the following four days.
Buqing
2010.08.09
A Day In The Life 3.2 (2010-08-10 23:07)
Thanks to pre-employment examination, Iʼd done about 10 thyroid gland palpations
today. At first, I tried on some patients with swollen thyroid glands to have a general idea
of the process and to establish myself some confidence, as I had more than once
correctly pointed out from the two lobes the right side of the lesion. With more attempts, I
gradually forged a better vision of where located the thyroid cartilage, the isthmus and
the wings of the butterfly-shape gland. Not to say, I will have more chances to improve
my skill on this in the following days.
As I was doing the palpation, one question occurred to me: what is the morbidity of
palpable swollen thyroid gland disorder?
Buqing
2010.08.10
A Day In The Life 3.3 (2010-08-11 23:07)
As the attending physician was replacing another doctor who went for an official travel to
perform in a Miles Surgery, I also spent the most of this afternoon in the operating room
to have a look at how it was done. The patient was a 72-year-old male who had already
undergone a colonoscopy to have discovered a mass about 2 cm above the pectinate
line and biopsy result showed it an early stage malignant lesion. During the process, the
operator asked me a question: ”Which is the main blood vessel that supplies the distal
colon?” ”Inferior mesenteric artery.” I said. Everything went very well and about two and
a half hours later, all was finished.
Todayʼs outpatients included one 101-year-old female who had had a head trauma
several days ago and came for stitches removal and two males with gynecomastia.
Buqing
2010.08.11
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A Day In The Life 3.4 (2010-08-12 23:07)
A 72-year-old female came for an examination this afternoon because of her recent
hematochezia. During the examination, she told me that she had experienced two breast
surgeries so far, first in year 1990 and second in year 2002, both were pathologically
diagnosed as malignant tumor. More than 20 years after the first surgery, she still
remained a happy and healthy life. In contrast, a 50-some years old female came to
Emergency Surgery several days ago had been refusing to undergo a surgery for about
one year after first discovery of the breast MT, causing perforation and metastasis,
making it an untreatable end-stage disease.
It is oneʼs attitude towards life determines the result of it.
Buqing
2010.08.12
A Day In The Life 3.5 (2010-08-14 23:07)
So far, Iʼve done about more than 10 times DRE and had a superficial knowledge of
what it is from an examinerʼs perspective. For a better understanding of this procedure, I
requested the attending doctor to perform one on me so as putting myself on the
position of an examinee to experience a real feel of it. The moment his finger was in, I
underwent a desire to defecate and subliminally constricted sphincter ani. I vaguely felt
something scratching my colon and then a feeling of emptiness replaced repletion, his
finger was out. Immediately after that came the anoscope, an instrument with a larger
diameter than the finger. Thanks to the previous stimulation, this one caused almost no
irritation and thereupon I heard the doctor saying: ”Your rectum looks good, with no
internal hemorrhoid.” He withdrew the anoscope and gave me some tissue to wipe the
lubricant on my anus.
Buqing
2010.08.14
Eight Days A Week (Surgery Clinic) (2010-08-15 21:00)
When I was a little kid, I was not always of well conditions and visited the hospital
frequently. I do not now remember undergoing any ultrasonography or CT scan, but I do
remember clearly every time I was sick, my body temperature was measured the doctor
would perform auscultation on my chest and palpation on my abdomen.
Nowadays, things are changing. Ultrasonography, CT, MRI, endoscopy and more highly-
advanced technologies have, to a certain extent, gradually replaced traditional skills of
inspection, palpation, percussion and auscultation. Doctors are divided into more precise
fields and cooperate with one another by reading othersʼ reports. As the attending doctor
told me: ”This is a more efficient and accurate way of performing health care.”
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I do appreciate the improvement of diagnostic methods which have made some
previously undetectable diseases past, but meanwhile, doctors are losing their abilities,
they are confined to be capable in certain places where all these modern technologies
are backing them up and outside hospitals, they may donʼt know how to start.
I hope I am wrong. My sincere gratitude to attending doctor Li Ren for his guidance and
help in the past week.
Buqing
2010.08.15
A Day In The Life 4.1 (2010-08-16 23:07)
I will be spending the next two weeks at the inpatient department of orthopedics.
Since there was no surgery today, I hung around in the wards to make myself familiar
with the environment and patients. My two weeksʼ life at the inpatient department of
thoracic surgery shortened this activity and within minutes, I began doing some routine
jobs: dressing change, removal of drainage tube, etc.
I attended a small lecture on basic knowledge of medical imaging at noon and enjoyed a
cup of coffee which successfully prevented myself from napping during the surgery
lecture later.
Tomorrow, there will be three surgeries.
Buqing
2010.08.16
A Day In The Life 4.2 (2010-08-17 23:07)
Three surgeries today.
I saw almost nothing for the first one because there was so many bystanders there and
one could hardly find an extra position.
The second one was a repair for a 29-year-old male who broke his T12, L1 and L2 due
to an unintended falling on the stairs. An eleventh intercostal incision was made on the
lateral thoracic wall and the operator emphasized on the location of the pleura in
particular which should not be injured. The remaining was unable to be seen.
As for the third one, I was part of it and this was the second time I participated in a real
surgery in hospital. The 59-year-old female had a history of lumbar disc herniation and
had undergone TLIF at another hospital.This time, as a result of disc herniation between
the fifth lumbar vertebral body and sacrum, she was admitted for a surgery. Although she
was of normal coagulation function, an unstoppable bleeding occurred during the
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procedure and in spite of all the methods such as using of electro-unite, stuffing by
gauze, then absorbable hemostatic gauze, and finally sprinkling of styptic powder,
limited effect seemed to be reached and after the surgery, she had lost a total of 2000ml
blood.
Buqing
2010.08.17
A Day In The Life 4.3 (2010-08-18 23:07)
I went for a thoracic surgery in the room across the passage to ours as the orthopedic
one was too hard to be seen. It was a VATS on a patient whose CT scan showed a
peripheral spiculated mass with pleural indentation at the right lower lobe, a highly-
speculated malignant lesion. As the mass was resected, it was cut across to reveal the
inside and both microbiological culture and frozen section were ordered. Contrary to
what the CT scan hinted, it was an inflammation according to frozen section.
I joined another orthopedic surgery after the thoracic one. This case was similar to
yesterdayʼs third one, a disc herniation between the fifth lumbar vertebral body and
sacrum. Like yesterday, I was holding the retractors to earn myself a better vision of the
procedure and this time, I saw the L5 nerve root, a white one about 5-7mm in diameter.
The operator tried to explain the reason of the non-stoppable bleeding yesterday by
over-pressing to the patientʼs abdomen, causing the retention of the blood in the vein
which then flowed out from where the surgery was performed.
Buqing
2010.08.18
P.S. One of these two was a male with hypospadias.
A Day In The Life 4.4 (2010-08-19 23:07)
Professor Dong gave us interns a little lecture this morning on a rare form of cervical
spondylopathy – The Esophageal Compressed Type (the others are The Spinal Cord
Type, The Nerve Root Type, The Vertebral Artery Type, The Sympathetic Type and The
Mixed Type). Symptoms of this type would be foreign body sensation while swallowing
which could be more apparent with a dorsally bent neck, leading to dysphagia in severe
cases, and was a differential diagnosis from Esophageal Cancer.
After the lecture, I had a very long conversation with a patient presenting typical Hornerʼs
Syndrome on the left part of the face with sighs including Ptosis, Miosis and Anhidrosis,
trying my best to explain everything I know about his disease to him and his family. His
original disease was a very big mass mainly at the left superior mediastinum which
extended from the lower border of C6 to the upper border of the left atrium, heavily
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compressing upper left lung and left sympathetic nerves. Though the pathologic
diagnosis was not yet available, judged from his CXR and CT scan report, it would
probably be a benign lesion and being five days after the surgery, he was recovering
rapidly.
As I stepped out of the ward, the mother of a 20-year-old boy, being in the same ward of
the previous conversation, chased out to request me of some time to secretly have a
consultation of her sonʼs disease with her because of her worrying about the prognosis
of his malignant tumor, though the surgery had been very successful. At that time, I was
sort of feeling like having been a real doctor.
Buqing
2010.08.19
A Day In The Life 4.5 (2010-08-20 23:07)
A 56-year-old female with a history of tuberculosis in the lung and left kidney, the latter
had been removed in a previous surgery, had a severe pain in the lower back. Her MRI
report showed destroyed L2, L3 and abnormal structures from T12 to L5. During the
surgery in the morning, I saw the real spinal processes from T12 to L5 when a middle
incision was made at the lower back and when spinal processes of T12 and L1 were
removed, I saw the real dura mater of a white surface scattered with small red blood
vessels and was of an approximately diameter of 4-5 cm.
In the afternoon, I performed a removal of jugular tube, one procedure which would
cause a very severe condition in rare cases, namely pulmonary embolism by air bubbles.
After the removal, the spot should be mildly pressed for at least 15 minutes in case of
bleeding.
Buqing
2010.08.20
A Day In The Life 4.6 (2010-08-23 23:07)
One skill which is a must for a practitioner should be the Full Physical Examination and I
did one this morning.
To be frank, I was by no means good at it and was doing it so slowly and disorderly and
when I was performing the percussion of the heart, the patient had fallen asleep and was
snoring out loudly! What a humiliating condition! This incomplete examination took me
more than three quarters and at last, I could sense the little discontentment from the
patient.
I swear I will work hard to master this before my internship ends.
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Buqing
2010.08.23
A Day In The Life 4.7 (2010-08-24 23:07)
I walked by Room 69 and saw about a million people in it watching a VATS, so I walked
in, to find out what was going on. It turned out to be a group of visitors viewing an
operation of an esophageal cancer in the upper part and the surgery was divided into
three part: VATS, laparoscopy and anterior neck. VATS: detaching the esophagus.
Laparoscopy: detaching the stomach. Anterior neck: anastomosis. I didnʼt finish watching
as I later took part in an other surgery.
It was a 65-year-old female who was of a dislocated right shoulder joint and broken
humerus as a result of an accidental falling down and when the incision was made, the
head of the humerus and fractures were clearly shown. The toughest part of the surgery
was to locate all these structures into the normal anatomical position and fix them with a
steel plate. During the operation, bedside X-ray was frequently used in case of any
improper location. This big surgery ended at 1:10 PM, a time I was finally able to have
lunch to comfort my starving stomach.
Buqing
2010.08.24
A Day In The Life 4.8 (2010-08-25 23:07)
I was on duty and sleeping in the hospital last night. In the evening, as I was sitting in the
Nursesʼ Station, writing medical history, a couple of family members of the patients came
over for consultation of their beloved ones, eagerly. Though their questions are common
and nonprofessional, I found myself not knowledgable enough to answer them precisely
and accurately. Nothing was worse than this for a doctor, not being able to explain
clearly what the family wanted to know.I felt terrible, I must work harder.
Buqing
2010.08.25
A Day In The Life 4.9 (2010-08-26 23:07)
During the lunch break, I went to the PACS workstation and did some image reading. As
I had worked in the Thoracic Surgery Department for 2 weeks, I was more familiar with
thoracic X-ray and CT scan than other positionʼs. The equipments there were really cool,
as you can scroll the mouse wheel to smoothly switch between the adjacent slices on
CT images, thus made every structure continuous and easy to follow and judge. I
encountered a problem though. So I went to the Thoracic Surgery Department for
assistance and this was where the story began.
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Just when I got there, a post-surgical patient was reported with a fast heart rhythm of
120 BPM and a disturbance of consciousness. As he was unsuccessful at expectoration,
a highly possible diagnosis was respiratory acidosis as a result of accumulation of CO2
due to hindered ventilation. A bedside ABG was ordered immediately. I went with the
performer and reviewed the previously learned process live. I was confident to make a
successful one when chance came in the future. No sooner than this was done, an
obstruction of the jejunal feeding tube was reported. The attending doctor injected about
20ml saline to free the canal and solved the problem. Then, I started my journey to the
SICU (Surgical Intensive-care Unit) with other two surgeons to await an inter-hospital
transfer. Before the patient arrived, I finally seized a chance to have got the solution to
my problem. The patient was a 82-year-old female with a history of idiopathic
esophageal rupture, which had led to aspiration pneumonia. A surgery had been done in
local hospital and in order to control her infection, a wide range of antibiotics had been
applied, including Tienam. She was asthenia and unconscious when arrived.
Buqing
2010.08.26
A Day In The Life 4.10 (2010-08-27 23:07)
Right after the morning conference, professor Jiang held a short lecture for us interns to
raise questions and answered them all. Before it ended, he emphasized on the
importance of retaining of the periosteum when repairing the fractures, as it was
essential to the healing process.
I attended two surgeries today to mark my last day staying at orthopedics inpatient
department and this time, I seemed to have known better about the procedures of the
surgeries that Iʼd got a vague vision of what the surgeons were doing when they were
doing it. At times, I would be lucky enough to have a quick peep of the structures
beneath the so-called minimally-invasive-surgeryʼs minimal incision. And, I found myself
already on the road of getting used to being a part of an operation.
Buqing
2010.08.27
Eight Days A Week (Department of Orthopedics) (2010-08-29 11:07)
I remember during our probation at orthopedics department about one and a half years
ago, somebody told me that orthopedic doctors were like advanced carpenters. I do
agree now. They understand mechanics, possess all sorts of apparatuses, and perform
acts precisely and forcefully. Plus, they are very strong and energetic.
The team I was in mainly focused on spinal conditions and diseases, and disc herniation
had been the most common disease around the ward. After two weeksʼ learning, I
accumulated little understanding of the construction of the spine, its unnormal conditions
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
and the ways to fix them, improved my skills of analyzing radiological images and gained
several opportunities to take part in real surgeries. A rich two-week.
My sincere gratitude to resident Binbin Ma and attending doctor Chun Jiang.
Buqing
62010.08.29
P.S. I am to do more body building.
A Day In The Life 5.1 (2010-08-30 23:07)
General surgery, a place to learn all essential skills and performances, I was here.
The two surgeries today were all gastric diseases, one gastric cancer and one gastric
ulcer. I participated in the second one and due to my lacking of experience, as I had
done very few though I had been taught before, I was making surgeonʼs knots clumsily
at first. Thanks to resident Liʼs presentation of the standard way, I learned how to make
them properly and swiftly later on. After the operation, he gave me a package of non-
absorbable suture for practicing at home and pointed out that it was a very basic skill for
all surgeons which should be taken very good care of. And, I will.
Buqing
2010.08.30
A Day In The Life 5.2 (2010-08-31 23:07)
A 54-year-old female was readmitted today one month after the previous radical
correction for her gastric cancer. Chief complaint included a gradually-worsen
uncomfortable abdomen in the last 4 days, asthenia and poor appetite while in existence
of defecation, flatulence and little urine. Physical examination showed a swollen
abdomen, normal abdominal sound (4 times per minute), tympanic resonance on
percussion and positive shifting dullness. No fever, jaundice or edema were detected.
CT scan showed a large quantity of fluid presenting at the lower and two lateral parts of
the abdomen, surrounding the abdominal viscera in the middle. An ultrasound-guided
abdominal paracentesis was thus performed and after the insertion of the drainage tube,
a reddish fluid flew out immediately. The patientʼs symptom was relieved as 500ml fluid
was drained.
Buqing
2010.08.31
1.3 September
A Day In The Life 5.3 (2010-09-01 23:07)
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
Sometimes, surgeries for breast and Thyroid diseases are not that big ones and patients
stay in the hospital for just one night and leave the day after the surgery. In the hospital,
there are operating rooms called ”Day Operating Rooms” especially for these surgeries
and I attended three there today, one breast disease and two thyroid disease.
The first patientʼs ultrasonography and molybdenum target X-ray highly indicated a
malignant lump in her left breast. Though, as it turned out, frozen section pathological
report proved it a benign.
According to their ultrasonographies, the second and third patients were both diagnosed
as having abnormal masses derived from their thyroid glands. And, as it turned out,
frozen section pathological reports proved theirs to be one parathyroid gland cyst and
one thyroid adenoma.
Three benigns today, a lucky day, huh?
Buqing
2010.09.01
A Day In The Life 5.4 (2010-09-02 23:07)
I was on duty and sleeping in the hospital last night. Everything went well till 5:00 am
when I was woken up for an emergent surgery. It was a 91-year-old male with a
strangulated indirect inguinal hernia on the right side. It was 2 months ago when his first
development of this reducible indirect inguinal hernia on the same spot occurred. Two
days ago, his condition became worsen with irreducible contents and was of painful
characteristic. This morning, he came to hospital due to unbearable pain and one
vomiting. Gas-filling enlarged intestine and several fluid levels were obviously shown on
his abdominal X-ray. Surgery was immediately performed and no necrotic intestine was
found. The patient was feeling well lying in the bed 9 hours after the surgery as I went for
a visit. Ingestion was prohibited.
Buqing
2010.09.02
A Day In The Life 5.5 (2010-09-03 23:07)
A 25-year-old male was pathologically diagnosed with rectal cancer which was about
2.5cm above his anus and could be felt by DRE. His initial symptom was bloody feces
discovered by naked eyes one year ago and local hospitalʼs biopsy proved an rectal MT.
During the past year, he had undergone two periods of chemotherapy and this time he
was admitted for surgery. Presurgical routine tests showed he was HBs (+), HBe (+) and
HBc (+). Miles was performed and waiting for him ahead was a whole lifeʼs living with
disposable colostomy bags attached to his left abdomen.
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Life is cruel, isnʼt it?
Buqing
2010.09.03
P.S. This 25-year-old maleʼs bed was adjacent to the 91-year-old maleʼs.
A Day In The Life 5.6 (2010-09-06 23:07)
One of my many hobbies is lingering in the ER to see how the doctors perform and
handle cases while I am free.
Last night, an approximately 155cm tall 38-year-old female complaining about gastric
distention and chest distress with a previous history of gastrointestinal decompression
was in need of an other nasogastric intubation. Without any real practice of this
procedure before, I performed one successfully within one minute. The toughest part
was when the tip of the up-going tube made its turn downwards near nasopharynx and
when it reached oropharynx the patient gagged and wanted me to cease. Comforting
and encouraging the patient was what I did and as she followed my indication to mimic
swallowing, the tube proceeded smoothly till about half between the second and third
mark on it. I then stopped pushing and pasted it to the patientʼs nose with some tape and
as the negative pressure in the aspiration bag was applied, a dark-colored fluid was
drained out. About half an hour later, the patient was feeling better and had no more
distress on the chest.
Buqing
2010.09.06
A Day In The Life 5.7 (2010-09-07 23:07)
Todayʼs only surgery was arranged in the afternoon so I went to the specialist outpatient
clinics for general surgery with Professor Chen. One 42-year-old 30-days-post-left-
thyroid-resection female came for consultation with radiation therapy as her physician
suggested one after the surgery. The problem was her remaining right thyroid which was
a not-that-proper substance for radiation therapy as 1. Currently, the main treatment for
thyroid cancer is surgery. 2. I131 could be used for lymph nodes metastasis cases. 3.
Both sides of the thyroid should better be resected if 2 were applied. 4. Endocrine
therapy may also be an appliable effective way. Physicianʼs job was informing the
patients of possible methods and it was patients themselvesʼ choice of the final
procedures that counts.
Buqing
2010.09.07
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A Day In The Life 5.8 (2010-09-08 23:07)
Today, in the operating room, Professor Zhang taught me a little about how to define the
border of the incision for a radical correction of breast cancer. First, locate the position of
the lump by palpation. Second, mark the border of the lump by four dots at east, south,
west and north. Third, connect the dots by curves to forge the border of the underlying
lump. Fourth, draw an eye-like outline around the lump which should be large enough for
a radical correction. Fifth, done.
Buqing
2010.09.08
A Day In The Life 5.9 (2010-09-09 23:07)
Todayʼs last surgery was a laparoscopic approach for a 47-year-old female one year
after her left oophorocystectomy with unknown paroxysmal abdominal pain and moving
gases in her lower left abdomen which had persisted for a year and had been more
severe during the last one month. She also had jelly-like defecation or constipation
sometimes. Physical examination obtained no apparent positive signs and coloscopy
and abdominal ultrasonography both indicated no abnormalities while abdominal CT
scan showed a possible mild chronic inflammation at distal ileum. During the operation,
two segments of swollen intestines separated by one section of normal intestine were
and three ligament-like adhesions between the intestine and the abdominal wall were
detected. The latter was located in lower left abdomen which may be the reason of
possible internal hernia to cause the patientsʼ symptoms. Ultrasound knife was applied
to cut off these adhesions and no more anomalies were discovered on the screen.
Buqing
2010.09.09
A Day In The Life 5.10 (2010-09-10 23:07)
At the end of my second week at department of general surgery, I participated as second
assistant in a socalled the simplest surgery – operation for acute appendicitis. This 32-
year-old male patientʼs onset of upper abdominal pain occurred about one hour after
dinner last night with no nausea or vomiting and early this morning it had transferred to
the lower right abdomen, a place called McBurneyʼs point where tenderness also
developed. His blood routine showed an elevated neutrophils indicating an acute
inflammation. No ultrasonography or CT scan was performed. We started at around
16:15 and finished at 17:00, a little more than 30 minutes for the operating part. About
nine months ago, I performed one on a dog as the operator so I sort of knowing the
processes. Epidural anesthesia was applied and a standard approximately 5cm long
appendix incision was made on this person, followed by everything standard till the end.
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Buqing
2010.09.10
A Day In The Life 5.11 (2010-09-13 23:07)
A 48-year-old female with a history of a non-calcified cervical mass discovered both by
palpation and ultrasonography at the position of her left thyroid was admitted for
thyroidectomy. She presented with no symptoms of hyperthyroidism, no dysphagia and
otherwise with no other medical problems. The mass was painless and immobile about
1.5 cm * 1cm large. No palpable lymph nodes were felt around it. All the blood tests were
within normal range.
During the operation, the mass was found to be a thyroid-like tissue right below
meanwhile adherent to the normal left thyroid gland. Professor Chen was suspicious of
an aberrant thyroid and the operation was immediately ceased. About 20 minutes later,
frozen section report revealed it a tissue of normal thyroid characteristics. So, the
operation ended here.
Buqing
2010.09.13
A Day In The Life 5.12 (2010-09-14 23:07)
What is the feeling of being a first assistant? No easy at all, especially for an intern like
me.
I participated in a thyroidectomy with attending doctor Yang this morning and it was my
very first time being a first assistant. After two weeksʼ watching and practicing (mostly
under the stage) in general surgery department, Yang was starting to let me do some
easy acts like knotting, cutting threads, loosing the hemostat when he was making the
knot, etc. I was doing awfully in the beginning for sure and after being criticized bitterly, I
was on the road now.
Only by doing can one know how to do it right.
Buqing
2010.09.14
A Day In The Life 5.13 (2010-09-15 23:07)
The very first thing a surgeon does in a surgery is disinfecting the body part where
incisions are to be made.
I performed two this afternoon.
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First of all, the performer should wash his/her upper arms to make them sterile.
Theoretically, the larger the area disinfected, the better. In fact, this is unpractical and
meaningless. Basically, about 15 cm larger the disinfected area for the incision would be
enough. Secondly, the disinfection should be started at the center and expands to the
surroundings with no drawing back. Thirdly, the same disinfection procedure should be
performed three times. Fourth, pave four sterile cloths to make a square surrounding the
disinfected area and leave it open in the middle, proper for incision by the following
steps: the opposite side of the disinfected area to where the operator stands, the inferior
side of the disinfected area, the superior side of the disinfected area and finally, the
same side of the disinfected area where the operator stands. Fifth, some towel forceps
may be used in case certain cloths unexpectedly slip.
Buqing
2010.09.15
A Day In The Life 5.14 (2010-09-16 23:07)
Mr. M, Part one 55-year-old Mr. M with a history of both colorectal and lung cancer was
detected of bradycardia of 48 bmp by ECG and was then tested a Holter monitor.
Consultation was ordered before the surgery and doctor from cardiology department
advised temporary transvenous pacing in case of jeopardized condition after the radical
correction of colorectal cancer. A pacemaker wire was inserted under the guidance of X-
ray imaging into his right femoral vein, up to the inferior vena cava, entered the right
atrium, went through tricuspid valve and finally reached the apex of the right ventricle
and stayed there, immediately adjacent to myocardium. The pacemaker was set to 70
ppm initially and was adjusted to 40 ppm one day after the surgery and as the patientʼs
own heart had worked successfully, it was removed two days after the surgery.
Buqing
2010.09.16
A Day In The Life 5.15 (2010-09-17 23:07)
Ms. F, Part one A 86-year-old conscious female with the presence of whole-body icterus
was diagnosed of obstructive jaundice by ultrasonography and was admitted for ERCP
this afternoon. Her liver function test showed a disturbed condition with 290omol/L of
total bilirubin, 265.2omol/L of BC, 94IU/L of ALT, 200IU/L of AST and 567U/L of GGT.
During ERCP, a large diverticulum was discovered in her esophagus which hindered the
process and resulted several vain attempts plus some undesired bleedings. Epinephrine
was applied to stop bleedings. She was then ordered a CT scan to distinguish the
obstruction between stone and tumor. Unluckily, no apparent stone was revealed. After
her returning to the ward, a nasogastric intubation was done for aspiration. Since she
had signs of dehydration, 100ml GS and 500 ml GNS were arranged.
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Buqing
2010.09.17
A Day In The Life 5.16 (2010-09-20 23:07)
Ms. F, Part two The second day afternoon after the patient was admitted, her heart rate
varied between 80 to 150 bmp shown on the bedsite electrocardiogram monitor while
her blood pressure was within normal limits. A consultation with cardiological department
was arranged and a bedsite electrocardiography was performed which resulted as sinus
rhythm, paroxysmal atrium fibrillation and atrial premature beats. Intravenous injection of
cedilanid with a slow speed was right away carried out and about a quarter later, her
heart rate started to maintain at about 70 bmp. Because of the existence of sputum in
her respiratory tract which could not be expectorated, aerosol droplets of
dexamethasone created by a nebulizer were also applied to release her symptom of
respiratory disturbance.
Yesterday morning, the third day after her admission, a PTCD was successfully achieved
and about 350ml bile was drained.
She is going back home tomorrow.
Buqing
2010.09.20
A Day In The Life 5.17 (2010-09-21 23:07)
A 22-year-old girl was admitted for removing a little mass in her left breast which was
about 1 cm away from the nipple at upper outer quadrant. Regional anesthesia was to
be applied and when I was doing the disinfection, she was so embarrassed that I could
sense she was trembling and would rather probably kill herself than exposing herself in
front of a young fellow like me. Cancer would very likely be excluded for a young girl of
her age and frozen section pathology did indicate it a benign lesion. Ingestion was
allowed right after the surgery and no uncomfortableness was reported in the morning
round the next day. She went home the second day after the surgery.
Buqing
2010.09.21
A Day In The Life 5.18 (2010-09-22 23:07)
A 58-year-old male with a history of cholecystolithiasis came to emergency department
at 20:00 in the evening. His main complaint was the onset of the upper right abdominal
pain three days ago and had not ingested ever since. Physical examination revealed a
rigid abdomen, tenderness and rebound tenderness at the upper right quadrant. Blood
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test showed a slightly elevated white blood cell count. He had received intravenous anti-
inflammation treatment this afternoon at the local hospital and was advised of a surgery.
For further diagnosis and treatment, he came to our hospital. Emergency open
abdominal surgery was immediately arranged and it turned out that there was a
perforation at the posterior of his cyst and bile had leaked everywhere in the abdominal
cavity. Cystectomy was performed and about 3500ml saline was used to wash his
abdominal cavity. Three drainage tubes were placed, one for the sub-hepatic space, one
for the pelvic region and one for the infrasplenic space. 600 ml blood was transfused.
Buqing
2010.09.22
A Day In The Life 5.19 (2010-09-23 23:07)
A 69-year-old female with a history of upper abdominal uncomfortableness and pain for
one month had undergone an esophagogastroduodenoscopy which discovered a big
lesion along the lesser curvature of the stomach and biopsy showed an existence of low
differentiated gastric cancer. No metastasis was revealed on enhanced-CT report and
open abdominal surgery was carried out whereas had to stop half way. Merging of lymph
nodes which was big and tough could be palpated around the celiac artery, making it
impossible to completely isolate the former from the latter. Meanwhile, the head of the
pancreas was also invaded by the cancer. Since no symptoms of obstruction were
presented with, no bypass was performed. Chemotherapy was one alternative for this
patient.
Buqing
2010.09.23
A Day In The Life 5.20 (2010-09-24 23:07)
I was on duty that day and a patient came to the nursesʼ station, complaining about
toothache. Oral metronidazole was pre-scripted. About five minutes later, he showed up
again, complaining that this was not the medicine he used to take for toothache when he
was at home. He wanted some antibiotic, he rejected the medicine. We explained to him
that he was taking the wrong medicine and the one we gave him was the correct. He
then left disappointedly, considering that the doctors were either incompetent or
mistreating him.
People are obstinate.
Buqing
2010.09.24
A Day In The Life 5.21 (2010-09-27 23:07)
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
A female patient came to surgical outpatient department this morning, complaining about
her worrying of developing a cancer somewhere in her body based on the proof of some
swollen lymph nodes detected by ultrasonography which were also palpable at her right
groin. She then demonstrated us a piece of clipped newspaper on which there was an
article explaining about the relationship between certain cancers and possible locations
of metastatic lymph nodes of theirs, the source where all her concerns originated. By
then, she had already undergone all the tests of cancer-related signals such as CEA,
CA19-9, AFP, etc, and all were within normal limits. Whereas, she still insisted on the
very likelihood of the existence of an insidious cancer.
Another example of ”People are obstinate”.
Buqing
2010.09.27
A Day In The Life 5.22 (2010-09-28 23:07)
A 60-year-old female with a history of hyperthyroidism for 10 years was admitted for
thyroidectomy. Both sides of her thyroid had separately reached out of the lateral
borders of the sternocleidomastoids and her symptoms got worsen during the previous
month which made her come for help. This surgery was arranged as the first one in the
day and began at about 8:00. As always, I attended as a human-powered retractor
pulling device and this was the first thyroid-related surgery I attended that had cut off
both of the sternocleidomastoids in the middle due to the large size of the thyroid which
was not commonly-seen nowadays as regular table salt in China all contained iodine.
Nevertheless, this was just the start. One characteristics of hyperthyroidism was the
abundant blood supply to the thyroid which made up the very big hurdle of dissecting,
that is, one gentle touch of the surface of the thyroid could be the whys of bleeding.
Thus, stopping bleedings had been on every once in a while during the procedure and
the neck being a bowl-like container full of red blood had been a frequent scene. This
operation had lasted for more than four hours and ended close to 13:00.
However, it was not over. Post-surgery complications might occur any time.
Buqing
2010.09.28
A Day In The Life 5.23 (2010-09-29 23:07)
The following scene happened at the professional outpatient department.
A 40-some female with a history of thyroidectomy of the right lobe 10 years ago came for
lumps at her breasts this time. As she was talking about her condition, she sort of began
to weep. Here is what she narrated. Her husband had been out of the country in
Germany for business for more than 10 years and had recently come back home for
family get-together. Unlike being a husband, he disdained everything in the house,
refusing any housework, rejecting any proposal and accusing life here from a feeling of
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self-superiority derived from his abroad experience. Plus, he earned money and
supported their daughter for her studying. She kept talking and weeping, with lots of
patients eagerly waiting outside. Despite of our great sympathy for her, we had to cut her
off.
Buqing
2010.09.29
A Day In The Life 5.24 (2010-09-30 23:07)
A 40-some female patient from an area far away from Shanghai was admitted for a
surgery to remove the accessory breast at her left breast. She swayed frequently
between whether to do it or not and had asked endless questions so that nobody wanted
to talk to her even once, including me. Before the surgery, we had to have her words
secretly recorded in case she regretted after the operation. The operation part was very
successful and everything was going on well until one morning, as we were on the
routine morning round coming out of the room she was in and heading for the next room,
she chased out and stopped us right in the passage, accusing loudly of our ignorance of
her, despite the real condition that weʼd done everything should be done for her. She
was shouting so loudly that all the patients and family came out of their rooms, gathering
in the passage, for the curiosity of what was happening. We were so embarrassed.
Attending doctor Ms. Zhuʼs face turned red as she continued to defend her so-called
rights until professor Zhang appeared in person to calm her.
Some people are just unreasonable.
Buqing
2010.09.30
1.4 October
Eight Days A Week (Department of General Surgery) (2010-10-10 23:07)
The one and a half monthsʼ studying in General Surgery Department was a really
wonderful memory, so wonderful that I wasnʼt even willing to leave. Words are not
enough to show how I am grateful for all the people who had helped me so much.
Professor Hongwei Zhang Being a nice and trustable tutor, your confidence, steady and
precise skills showed me an excellent example of what a reputed doctor was. With the
accumulation of knowledge and experience, I am looking forward to be acting in this way
myself.
Mr. Weige Yang Your strictness, sense of humor, and all the words said to me were such
great treasures, ones that helped to forge what I am as a beginner of surgery.
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Ms. Wei Zhu I treat this as a miracle to have met a female doctor so tender and
considerable like you. I learned from you the very characteristics of being a righteous
and responsible doctor, one who do put the patientsʼ welfare at the very first place.
Mr. Zhenglin Wang We were sort of like brothers, werenʼt we? Besides all these medical
things, Apple products had been another frequently discussed topic that shortened the
distance between us. The night we wrote medical history together after the emergency
surgery in SICU had left me a so deep impression that I benefited so much. Want more
beer and BBQ together?
Mr. Beihua Shen ”Life is tough.” The very words of philosophy you taught me. Despite all
those interesting stories happened in hospital, your hemostat and needle-forceps, ”the
token of our friendship”, as you say, were the best gifts Iʼve got. Thank you.
Mr. Qizhang Mo I will never forget your case-analyses which so much broadened my
vision of treating the patients as a whole. I will keep this notion in mind.
Mr. Weida Shi Your little book of encyclopedia was full of surprises without which, not
only us, but also the patients would suffer. Letʼs make time and do more exchange on
languages in the future.
Mr. Jiawei Gu Our friendship beginning with a card was an interesting start and even we
had just spent one afternoon together in the operating room, your comments on
cardiology still opened a new land for me. I am looking forwards to work with you again.
The place Iʼve stayed is the place I will always come back.
Buqing
2010.10.10
P.S. Got my first iPad today, a 32G wifi device.
A Day In The Life 6.1 (2010-10-11 23:07)
One film that has stroke me forcefully is the classic ”One Flew Over the Cuckooʼs Nest”,
a story happened in a mental institution for people with mental disorders. The moment
when I entered the door of the ward in Mental Health Center this morning, I felt like
walking into the movie. A nurse station was on the right, facing the public resting room in
which a TV was on and some patients were scattered in front of it watching while some
were dawdling aimlessly. Deep from the passage, however, came the sound of a female
screaming that startled the four of us interns and we found out later that the source of
the big noise was a 40-some schizophrenic women whose four extremities had been
fastened to the bed for her noncooperation with the doctors. A while later, she was
dragged for ECT.
I am wondering if I will encounter someone just like Randle McMurphy.
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Buqing
2010.10.11
A Day In The Life 6.2 (2010-10-12 23:07)
Tuesday afternoon is visiting time.
Visiting room was full of people this afternoon, gathering little family groups in twos,
threes or fours, eating, drinking and most essentially, gossiping together. I saw a patient
with major depressive disorder talking to his mother, with a smile on his face. For those
who were demanding for release all the time were also much satisfied this time as their
closest ones were by their sides, keeping them warm and full in the heart.
The center was holding a big party, wasnʼt it?
Buqing
2010.10.12
A Day In The Life 6.3 (2010-10-13 23:07)
We went visiting MECT (modified) this afternoon.
The patient was lying in bed supine while a doctor and a nurse were working on her
respectively. The nurseʼs job was injecting the drugs needed for the procedure which
included three: atropine, propofol and succinylcholine. The effects combined were
glands secretions inhibition, anesthesia and muscles relaxation. The doctorʼs job were
applying the two electrodes onto the patientʼs forehead and left part of the neck anterior
to the left ear, fastened the belt around the patientʼs head, fix two polars into the correct
places in the belt and most importantly, masking the patient with oxygen head box since
she was not able to breath under the condition of anesthesia. Electric stimulation lasted
for about 3-8s which could not be detected by naked eyes but was recorded by
electroencephalography. About one minutes later, the procedure was done whereas the
patient had to be lying in the bed, monitored for at least half an hour to recover from
anesthesia.
Indications for ECT includes:
• Moderate or severe major depressive disorders
• Mania • Schizophrenia
• Refractory mental disorders Complications includes:
• Headache • Loss of memory
A sample of data on an electroencephalography report:
• Energy Set ———————————– 35 %
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• Charge Delivered ————————— 146.3mC
• Current ————————————– 0.75A
• Stimulus Duration ————————– 6.5s
• Frequency ———————————– 30Hz
• Pulse Width ——————————— 0.50mSec
• Static Impedance ————————— 1400Ohm
• Dynamic Impedance ———————– 280Ohm
• EEG Endpoint —————————— 4.9Sec
• Average Seizure Energy Index ————17701.3uV2
• Postictal Suppression Index ————– 82.5 %
Buqing
2010.10.13
A Day In The Life 6.4 (2010-10-14 23:07)
Unlike medical record in other departments, record for daily round here focuses mainly
on the real dialogues between the doctor and the patients. Attending doctors are always
jotting down the conversations quickly when the doctor is seemingly chitchatting
(actually not) with the patients. So on the patientsʼ charts, the whole conversations can
be viewed which indicate the patientsʼ conditions and the effectivenesses of the
treatments.
Buqing
2010.10.14
A Day In The Life 6.5 (2010-10-15 23:07)
I went to the ward early this morning and since I didnʼt have the key for the meeting
room (where we interns keep our stuffs safely), I had to wait for my classmate who was
in possession of it amongst the patients, watching them have breakfast, dawdle around
or just sit there dumbly. The patient with manic signs when admitted five days ago was
now in a much better condition, quiet and calm sitting in the room which was highly
monitored. Another one with similar signs admitted two days ago was darting back and
forth between the two ends of the passage, with no attention to anybody or anything
around him. The one with major depressive disorder I had mentioned before was sitting
about one meter away from the television, leg crossed, watching meanwhile having his
breakfast which was on the desk in front of him. A female sitting in the far corner of the
public resting room was sort of singing a song, one that beyond my recognition, arms
and hands swung in the air accompanying the ups and downs of the music.
I wondered what would it be like to live with them for some days?
Buqing
2010.10.15
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A Day In The Life 6.6 (2010-10-18 23:07)
A 25-year-old male just graduated from a famous university in Shanghai was admitted
for obsessivecompulsive disorder, characterized by tardiness, with repetitive
handwashing in particular, which could take almost one hour a time. He began to
develop this habit slightly at junior high school (14 years old) which deteriorated and now
misleading his life into unnecessary excessive consumptions of time doing meaningless
activities, resulting in his very inner and outer turmoil. Since he was afraid of showing
this peculiar habit to people, including friends and strangers, he refrained himself by
staying at home and refused to go out playing or working with people. By communicating
with him for several times, I discovered that he was an honest and polite guy indeed,
behaving properly in public and with the ability to recognize his own mental illness, which
we call insight. He bagan to take anti-depressive and anti-schizophrenic medicine
regularly since about 7 years ago, which unfortunately was of limited effect and this was
the third time of his admission. Professor Wang analyzed this case and predicted a not
that good prognosis.
Buqing
2010.10.18
A Day In The Life 6.7 (2010-10-19 18:34)
A thirty-some years old female with a history of poliomyelitis admitted for schizophrenia
was screaming out loud about all the misery memories haunting her: the filthy words
from her neighbors, the malicious attacks from her desk-mates when she was at school,
and the so called three deaths of her Dharmakaya, etc. She began to develop these
”delusions” nine years ago under the dual hits of breaking up with her boyfriend and
losing her job which deteriorated and was uncontrollable now that she failed to restrain
her temper and aggressive behaviors whenever anything big or small that tickled her off.
On the morning round the next day, her voice had turned hoarse as a result of too much
screaming. As anti-schizophrenic and anti-maniac medicine were administered, her
condition had sort of palliated the third day after admission.
Buqing
2010.10.19
A Day In The Life 6.8 (2010-10-20 23:07)
It was directorʼs round today and all the communications were held in the reception
room. A 26-years-old male came in with a slow gait, stood beside the chair, arms at the
sides. Being surrounded by us whitecoats, he then lowered his head, chin to the chest.
Professor Wang welcomed him by trying all means to convince him to sit down in the
chair especially for him at one end of the desk, whereas he just made no response, still
standing beside the chair, kept silent. According to his medical record, he had been
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standing for days, meanwhile not talking to people. After 5 minutesʼ fruitless attempts to
raise a conversation, he left the room immediately as permitted by Professor Wang
which indicated the existence of his cognition. The diagnosis for him was schizophrenia,
presented mostly by pathological symbolic thought, namely the standing he treated as a
symbol of persistance. His not talking with people also indicated conditions of apathy,
which if left untreated, would probably develop into major depressive disorder. Both anti-
schizophrenic and anti-depressive medicines were administered.
Buqing
2010.10.20
A Day In The Life 6.10 (2010-10-22 23:07)
A 22-year-old female was admitted for mania. Here is the conversation between her and
Professor Wang. If you have patience to keep reading, it might amuse you. :-)[column
width=”47 %” padding=”6 %”] Professor Wang
”How old are you?” ”Where are you studying?” ”When are you going to graduate?” ”Now
you work as an internship?” ”Where?” ”Hong long?” ”How is your work?” ”Are you happy
there?” ”Where are we now?” ”Have you been here before?” ”Then why are you here
now?” ”Why admitted?” ”Are you always fond of chatting?” ”Are you busy in here?”
”What are you doing?” ”So you are very dexterous.” ”What the other things do you do?”
”What about singing or dancing?” ”Do you want to sing here?” ”What do you usually
listen to?” ”Sing one you are good at.” ”Which one is better?” ”What about Ying Naʼs?”
”Sing just one section.” ”Never mind, go ahead.” ”Thatʼs pretty good.”
34
”Whose song is this?” ”Who sings better, you or her?” ”What else do you do, ball
games?” ”Are you always so smart?” ”How about your sleep?” ”Howʼs your spiritual
status recently?” ”Seems that you have endless energy?” ”What about your finance?”
”What did you buy?” ”Your boss has a secret crush on you?” ”How do you feel?” ”Ever
heard anyone speaking to you?” ”Sound of other people?”
”Do them gossip you?” ”How nice?” ”The people next room.” ”Letʼs talk about sense of
security.” ”Why?”
”How about here?” ”Any problem?” ”Do you feel monitored?” ”Anything you want to say
but refrained?” ”Whatʼs your mood?” [/column] [column width=”47 %” padding=”0”]
Patient
22 years old. ”XXX University.” ”June, next year.” ”Yes, meanwhile work in the office.”
”XXX Company.” ”Two days.” ”Just playing around.” ”Happy.” ”Mental Health Center.”
”No.” ”Take a rest.” ”My heart is tired.” ”Always.” ”No. Just for fun.” ”Paper folding.”
”Worse off than some, better off than many.” ”Eat, drink, shit and piss. Daily routine.” ”I
sing, better than you.” Nod. ”With serendipity.” ”There is only better.” ”Havenʼt shown up
yet.” ”I donʼt like her.”
35
”I am nervous.” Then she began to sing. ”Thank you.” ”XXXʼs.” ”I sing better than her.” ”I
do. Everybody does.” ”Start form the recent half year.” ”I donʼt want to sleep. I can not fall
asleep.” ”Manic!” ”Yes.” ”I want to buy but donʼt have the money.” ”Bought nothing.” ”I
havenʼt said that.” ”I donʼt want to talk about it.” ”Yes.” ”I hear people in the next room
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gossiping about my roommate through the wall.” ”No, because I am a nice guy.” ”It
depends on whom I am compared with.” ”They are 75, I am 100.” ”I like staying at school
while home is unsafe.” ”I feel annoyed. My parents are over-caring.” ”I feel free.” ”Should
be dim light and narrow window.” ”Yes.” ”Yes.” ”Fluctuating. Unstable.” [/column]
Buqing
2010.10.22
Eight Days A Week (Mental Health Center) (2010-10-24 23:07)
This is a place intrigues you, irritates you meanwhile most of all, arouses your innermost
compassion.
People are always curious about life in mental health center, reputedly, a place full of
crazy guys, because theyʼve never been there. Admittedly, so do I. Whereas, are those
so called ”crazy guys” really crazy? I hardly agree.
I do have to admit that some peopleʼs minds are hard to understand, for the reason that
it is impossible to establish an effective way for communication. The question is why are
we on the right side? Just because we are among the majority? Then what about those
super-highly talented geniuses? Why hadnʼt [1]Albert Einstein been considered as
having mental disorder where there was only three persons on this planet understood
his ”[2]Theory of Relativity”?
Human beings are sentimental animals.
Several ladies developed disorders like depression, mania or schizophrenia after their
breaking up with ex boyfriends, or their husbands were having affairs. According to my
observation, mental attacks, such as heart break, losing huge sums of money, quarreling
with neighbors, etc had all been the factors to trigger the onsets of mental disorders.
I asked Yu: ”Which would you rather have, mental disorders or liver cancer?” He looked
back at me, shook his head and then said: ”Neither.”
Buqing
2010.10.24
A Day In The Life 7.1 (2010-10-25 23:07)
At about 7:00am, we boarded the regular bus, heading towards Shanghai Infectious
Disease Hospital which is located at Jinshan. I spent about half of the time sleeping
during the following one-hour journey and when awoke from dream, we were already at
the destination. It began to drizzle no sooner than we got off and the wind was blowing
strongly. I looked around, was immediately amazed. This place was Brobdingnagian,
with buildings of traditional-Chinese flavor scattered upon the green expanse of
grasslands. It was quiet, if the howl of the gale did not count. Upon us, the sky was dim.
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We checked in, a room with no lamp, no internet, no slippers, no plug, and no anything.
Oh, wait, there did was a television, one product which was worse than useless to me.
Anyway, this was just the place I need, away from the world with myriad temptations, but
the tranquility for a heart craving for knowledge.
Buqing
2010.10.25
A Day In The Life 7.2 (2010-10-26 23:07)
We are spending the first week at the Ward for Hepatitis in which most are patients with
Hepatitis B and during the morning round today, we met an interesting fellow who owned
a musical instrument store which mainly sold guitars. He was admitted for onset of acute
Hepatitis C three days ago, and primary symptoms included jaundice, fatigue, decreased
appetite, abdominal pain, nausea and vomiting. He regularly performed intravenous drug
injection and claimed to be very careful about the instruments used which were all
disposable and had never shared them with anybody. He also denied unsanitary coitus,
making the very likely possibility of his being infected an accident, as he said that once a
friend of his with Hepatitis C had used his safety razor. Who knows?
Before we left the room, he showed several songs playing his guitar and no boasting, he
was good.
Buqing
2010.10.26
A Day In The Life 7.3 (2010-10-27 23:07)
The chief director led us the morning round today and asked a lot of questions covering
aspects of various kinds of hepatitis about which I almost knew nothing since most were
clinic-related knowledge, like diagnostic standards. I was jotting the notes down all the
way and what the chief director said had so much widened my vision, meanwhile
intrigued my interest for reading more materials on this field. I really liked her style and
kindness.
Buqing
2010.10.27
A Day In The Life 7.4 (2010-10-28 23:07)
A 77-year-old female began to feel fatigue, abdominal swelling which worsen after meals
since September, 2009 with no specific inducement. She went to the local hospital and
had liver function examined with the result of ALT > 200U/L and TB > 50mmol/L,
meanwhile ultrasonography indicated hepatomegaly caused by schistosomiasis
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(according to the patientʼs narrative, no report available). She was treated with liver
protectant and other drugs aimed at reducing enzyme and TB levels in the blood. She
was discharged when condition improved with TB < 30 mmol/L and continued with
UDCA treatment. One month ago, the symptoms of fatigue and abdominal swelling
occurred again. Liver function examination at local hospital showed ALT > 300U/L and
other test reports included ANA 1:320, AMA (+). This time, she came to our hospital for a
better treatment.
Buqing
2010.10.28
A Day In The Life 7.5 (2010-10-29 23:07)
An 18-year-old male freshman from the same university I am in was admitted for
hepatitis C infection revealed in the entrance examination one month ago, with the result
of ALT 957U/L, which dropped to 80U/L after half a monthʼs rest. He then went to a
nearby hospital on October 14th and had liver function reexamined to result a 145U/L of
ALT (according to the patientʼs narrative, no report available). In the recent half month,
he was feeling fatigue and his appetite decreased. Physical examination produced no
significant positive findings. Liver biopsy was advised and liver protectant was
administered.
Buqing
2010.10.29
1.5 November
A Day In The Life 7.6 (2010-11-01 23:07)
We followed the morning round three times today at HIV-related ward, by the sequence
of attending doctor, chief director and another attending doctor leading a visiting
professor from the US. This was the first time Iʼd been so close to HIV infected patients
and the feeling was hard to depict. The massesʼ trepidation for AIDS is mostly caused by
the preoccupied notion that AIDS is a disease that can not be treated and its destination
is death soon. The fact is, they are wrong.
In areas where it is widely available, the development of HAART as effective therapy for
HIV infection and AIDS reduced the death rate from this disease by 80%, and raised the
life expectancy for a newly diagnosed HIV-infected person to about 20 years. (via
wikipedia).
One cause of HIV infection is mother-to-child trasmission. There is a website of a global
fund advocating for Born HIV Free. Besides, they also has a YouTube channel here.
HIV is not horrible, we shall all face it correctly and sanely.
Buqing
2010.11.01
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A Day In The Life 7.7 (2010-11-02 23:07)
This was the very first time that I encountered a patient die in the hospital. Gloomy mood
it then gave me.
When we arrived at the ward 8:20 this morning, the wife of the already-dead patient from
Spain who was first discovered HIV infected in the year 1988 was having a conversation
with a doctor at the nursesʼ station, with traces of tears on her beautiful face. Since the
patient was of very bad condition at morning round yesterday, a strong sense of
foreboding that something terrible had happened stroke me. As I walked by, some words
like morgue passed into my ears. In the shift afterwards, he was confirmed dead this
morning at bout 6:30 due to lack of oxygen since his wife audaciously removed the
ventilator, in the hope to make him feel more comfortable. When the report ended,
everybody kept silent. I walked by the window of his room and saw him lying there in his
bed, quietly, covered by a big sheet of white cloth. He would never be back.
Buqing
2010.11.02
A Day In The Life 7.8 (2010-11-03 23:07)
Two days in a row, two people passed away.
It was a 32-year-old female, with a history of intravenous drug using for more than 10
years. Last time I saw her (yesterday), she was lying in bed unconsciously, breathing as
fast as 60 times a minutes under the aid of a ventilator, and with each respiration,
sputum could be seen sliding out and in along the inner wall of the tube. Read from the
bedside monitor, her heart beating reached more than 100 bpm. Due to the very fragility
of her immune system, with CD4+ T cells only 8x106/L, she was severely infected with
bacteria, viruses and fungi in all, lingering over the border of a perpetual rest. Pustules
were all over her skin, from face to abdomen, including four extremities. Even though
strong anti-infection medicines had been administered, there was no sign of recovery.
Buqing
2010.11.03
A Day In The Life 7.9 (2010-11-04 23:07)
A 38-year-old male back from a half-a-month business trip in Equatorial Guinea began to
have fever on November 1st which was higher than 38 degree celsius. He then came to
the hospital and had his blood routine tested which showed a decreased level of WBCs
and platelets while RBCs was of normal level. Because he had a history of mosquito bite
at a malaria-endemic place, microscopic examination of his blood film was carried out
and parasites had been discovered. He then was admitted for supportive and
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antimalarial treatment. In most cases, a person infected with malaria are normally of low
RBCs level due to hemolysis in erythrocytic stage. However, this personʼs blood routine
result two days later (yesterday) was of lower levels of WBCs and platelets while RBCs
was also of normal level. Meanwhile, his ultrasonography result indicated neither
hepatomegaly nor splenomegaly.
Above is all the important information Iʼve got today.
Buqing
2010.11.04
A Day In The Life 7.10 (2010-11-05 23:07)
Letʼs get back to the Spanishʼs story.
This person was having regular intervals of staying between Spain and China as his
hometown was in the former and he was having business in the latter. He was first
revealed HIV-infected in the year 1988, about 22 years ago from now. This time, he was
admitted for acute hepatitis C infection, accompanying the condition of cirrhosis (caused
by chronic hepatitis) which severely hindered his liver function, making his health
condition terrible. Complications included viremia, hypokalemia, hypoventilation,
diabetes mellitus and more. Though ventilator, interferon, antiviral drugs, liver
protectants, electrolyte, insulin and some other drugs had been administered, his
condition deteriorated. What happened at the last moments of his life was before
described here.
Buqing
2010.11.05
Eight Days A Week (Public Health Clinical Center) (2010-11-07 11:07)
This was a two-week away from city full of sounds staying at a tranquil and comfortable
countryside-like resort. When we were departing on friday afternoon, I was kind of sad.
This is a place makes one feel calm, a feeling Iʼve lost for long, a feeling I sustained
when I was a little kid. Itʼs just wonderful.
Our everyday routine:
• 7:30 AM: getting up
• 8:00 AM: beakfast
• 8:20 AM to 11:20 AM: in the ward
• 11:30 AM: lunch
• 12:00 AM to 1:00 PM: nap
• 1:30 PM to 4:30 PM: in the ward
• 5:00 PM: dinner
• 6:00 PM to 8:00 PM: sport
• 8:30 PM: surfing the internet
• 11:30 PM: sleep
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Buqing
2010.11.07
A Day In The Life 8.1 (2010-11-08 23:07)
This was the beginning of my internship at Eye & ENT hospital.
I learnt how to perform some basic ENT physical examinations this morning. Preparation
of apparatuses included head mirror, tongue depressor, nasal speculum, rhinoscope,
laryngoscope and gauze.
EAR
1. Inspection and palpation of the pinna and structures around the ear. 2. Inspection of
the external and middle ear canal and eardrum.
NOSE
1. Inspection and palpation of the external nose. 2. Inspection of the nasal cavity using a
nasal speculum.
THROAT and LARYNX
1. Inspection of the oropharynx. 2. Inspection of the nasopharynx using indirect
rhinoscope. 3. Inspection of the larynx and the vocal cords using laryngoscope.
Buqing
2010.11.08
A Day In The Life 8.2 (2010-11-09 23:07)
A 75-year-old male began to develop a hoarse voice two years ago, meanwhile with no
pain in the throat, no coughing, no sputum, no hemoptysis, no swallowing difficulty and
no mass in the neck. One year ago, he began to feel a foreign body in his throat and
made a vain attempt to treat himself by trying some antibiotics. In October 2010, he went
to a local hospital and had a biopsy under the direct laryngoscope which revealed a
moderately differentiated squamous cancer at his left vocal cord. He was admitted for an
operation and preoperative preparation included a CT scan of the larynx which showed a
thickening at the left vocal cord, also indicating a vocal cord cancer.
Buqing
2010.11.09
A Day In The Life 8.3 (2010-11-10 23:07)
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Ever since 18:30 till I left at 22:20, the emergency room had never been of a quiet
moment. There was always a queue waiting for help, comprising of kids who could
barely walk, teenagers who wore school uniforms, adults whose hair had already been
white.
A thirty-some male began to bleed spontaneously from his left nose at about 2 PM this
day and compress was placed as a way of treatment. Several hours later, the condition
did not improve at all that he was still bleeding large amount of blood from his nose,
meanwhile some were swallowed into his stomach. His blood pressure suggested he
was of hypertension and since he was losing volumes of blood, intravenous therapy was
also carried out. At around 20:00 PM, he finally agreed to be admitted for surgery
tomorrow. Before that, one more attempt was tried. First of all, the doctor put a red slim
rubber tube into his left nostril and pushed forward for several centimeters till its tip
reached the oropharynx. Then she made the patient open his mouth, dragged the tip out
of his mouth and fastened a cotton ball to it. Just at that moment, the patient bursted out
a sudden vomiting of blood he previously swallowed, which went straight onto the floor
and sprayed everywhere. The now blood-soaked ball had to be replaced by a new one
and the doctor pulled the nose end of the tube to place the new ball into the deep space
of the nose. Rubber tube was then removed. The patient was escorted to inpatient
department.
Epistaxis in plain English, see here.
Buqing
2010.11.11
A Day In The Life 8.4 (2010-11-11 23:07)
Kids accompanied by parents came for emergency were mostly with troubles of foreign
bodies, like peanut in the nasal cavity, coin in the trachea, bean in the ear canal, etc.
Most little kids were lodging quietly in the fatherʼs arms or holding hands with and
standing quietly besides the mother. The scenes were just heart-warming and fragrant,
reminding me of when I was a little kid that mommy and daddy would rush me to the
hospital whenever late it would be or however cold it would be every time I did anything
stupid or anything careless to get myself harmed.
I am thinking about that, someday, when Iʼve got my own kids, I would do the same
things to them, anything to make them happy and strong.
Buqing
2010.11.11
A Day In The Life 8.5 (2010-11-12 23:07)
Operating room here was much smaller than those in Zhongshan Hospital so it seemed
a little crowded when about five people were in it at the same time.
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Operation for removing polyps on the vocal cords under laryngoscopy was really fast
that I was amazed. First of all, the patient was anesthetized, then the laryngoscope,
which not only served as ventilation but also was a part of the instrument the operation
relied on, was placed. Two lights were placed at either side of the canal which comprised
the optical system. With the aid of microscope, vocal cords could be seen very clearly
both on the screen and directly through the microscope, including the polyps. A long arm
with blades on the top was manipulated by an expertise to remove the polyp within
minutes.
The whole process lasted about less than half an hour.
Buqing
2010.11.12
Eight Days A Week (Eye & ENT Hospital) (2010-11-21 23:07)
I was assorted at the ENT department and thus had not experienced the other half of the
hospital, namely eye department.
Since doctors here are dealing with fine structures, they should be very careful and
patient when doing the surgeries. Though Iʼve never seen one in person, I guess eye
surgeries are especially the case. Compared with Zhongshan Hospital, this hospital is a
little small, small but complete. As the Chinese proverb goes: A sparrow may be small
but it has all the vital organs. The night visiting emergency room was not that easy to
forget since the two doctors did not have even a second to take a rest with so many
patients waiting in the line, albeit most of which were little problems like fishbones in the
throat, nosebleed, or acute otitis media that could be handled within minutes.
One feel that strongly occurred to me was that different hospitals had different styles. A
simple example was that surgeons here were performing the same actions in different
forms from those of Zhongshan Hospital, though both were for the same purposes.
There is no better as long as both can get things done. Nevertheless, the pursuit of
splendidness shall never end.
Buqing
2010.11.21
A Day In The Life 9.1 (2010-11-22 23:07)
I am going to spend the next two weeks at the Radiation Therapy Department of Tumor
Hospital. From my limited one-day experience, localizing and dose are the two key
elements in radiation therapy.
In the morning, I visited the localizing room and forged a dim idea of how to keep the
patient still and in the same position for every session of the ”fraction” by making up a
particular cast for the very patient.
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For patient with nasopharyngeal carcinoma, he or she fist lay on the machine which
used X-ray to localize the cancer and then when the patientʼs head was of the correct
position, a soft cast (heated to be so) was put upon his or her head and the upper part of
the shoulders which gradually hardened (as it cooled) and then the patientʼs face was
imprinted on the cast. So next time he or she lay under the cast, the head would be at
the same perfect position as before. Two perpendicular red lights on a horizontal plate
was also recorded by black pen on the cast as were cast on it for a spatial localization.
A CT scan is also demanded.
Buqing
2010.11.22
A Day In The Life 9.2 (2010-11-23 23:07)
An eight-year-old girl began to feel paroxysmal pain at her right temple about five
months ago, with nausea and vomiting. Her parents took her to a local hospital and had
her CT scanned which showed that the anterior wall of her tympanic cavity, the
horizontal segment and labyrinthine segment of her facial canal, bones at the lateral side
of the internal carotid artery were damaged. Meanwhile her MRI scan showed that there
was a lesion at the right side of the middle cranial fossa which became more obvious
after the enhancement, highly indicating a tumor with malignant characteristic. On
October 19th, 2010, she underwent a biopsy and was diagnosed as embryonal
rhabdomyosarcoma. She then was arranged with chemotherapy and radiation therapy.
Within the recent month, her body weight had dropped about 5 kg.
Buqing
2010.11.23
A Day In The Life 9.3 (2010-11-24 23:07)
Localizing the position of the tumor serves for a more precise and accurate treatment.
When this is done, with a properly calculated dose, fractionation and the angles of
beams are determined. There are three reasons for fractionation: 1. Recovery for normal
cells. 2. Turning into sensitive phase of the cancer cells. 3. Reoxygenation. As for the
angles of the beams, usually there are 9 of them emitted from different directions, each
with its own dose. With the aid of the cast previously made, radiation therapy is thus
carried out.
Buqing
2010.11.24
A Day In The Life 9.4 (Updated) (2010-11-25 23:07)
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Radiation therapy for nasopharyngeal carcinoma patients usually consists of 9 beams
from different angles which are distributed as following: AA0C, AA45, AA90, AA120,
AA160, AA200, AA240, AA280 and AA320, where the first letter stands for the time of
the session the region of the treatment, the second letter stands for the uses of
fractionation the using of the dose and the remaining number indicates the angle of the
beam. For example that a patient undergoes a third time of radiotherapy with a newly
determined fractionation (the first two stays the same), then the symbol goes like CB0C,
CB45... at the same region with a new dose (the first two stays the same), then the
symbol goes like AB0C, AB45...
Buqing
2010.11.25
A Day In The Life 9.5 (2010-11-26 23:07)
A 27-year-old male began to develop diplopia one and a half month ago that was caused
by his left eyeʼs inability to abduct. He then went to a local hospital and had his head
scanned which revealed a tumor at his nasopharynx, the very possible reason of his left
lateral rectus muscleʼs dysfunction. Biopsy proved it of malignant character. Both
chemotherapy and radiation therapy were arranged for treatment.
Since the patient was eager to know weather his left eyeʼs function would recover after
the treatment during a morning round, Professor Hu told him that basically speaking, the
majority would if the treatment had began within two months of the onset of the
symptoms.
Buqing
2010.11.26
A Day In The Life 9.6 (2010-11-30 23:07)
A fifty-some female with a history of dermatitis began to present with dysphagia and had
a PET scanned which revealed an intense radio-labeling at her nasopharynx that later
turned out to be a carcinoma by biopsy. Radiation treatment was applied that at some
specific regions her dermatitis deteriorated. So in the morning round, the patientʼs
husband proposed that anti-biotics be used. Since there was no need that anti-biotics be
administered, we declined. Then the husband started to get unhappy and argued that
when they were at the local hospital, anti-biotics were always used. We explained to him
that his wifeʼs dermatitis was not caused by infection but rather an autoimmune disease
where anti-biotics were not necessary. He just did not understand.
We did not blame him, this was exactly the situation here in China.
Buqing
2010.11.30
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Eight Days A Week (Department of Radiation Therapy) (2010-12-05 23:07)
A little more than three years ago when I first moved to the current campus near Cancer
Hospital (I donʼt know why they call it Cancer Hospital since as I see, Tumor Hospital is
better), the construction was only in the cradle. Things were totally different when two
weeks ago, I came for my internship. As I entered the front door, a fountain was right
there jetting water into the air. Behind it were several tall buildings serving for different
purposes, like outpatient department, inpatient department, operating building, etc.
Radiation Therapy Inpatient Department, which occupied three floors of the inpatient
department building was my destination.
The floor I went to mainly focused on nasopharyngeal carcinoma, plus some other
cervical or facial tumors. There were about more than 60 beds in this floor and our group
took charge of the first 30 some beds. In spite of some nausea and vomiting reactions, in
fact which were not very common, most of the patients were of steady life conditions so
that the wards were quite quiet and clean. Morning rounds always went quickly and
briefly, with doctor-patient relationships easy and harmonious. The busiest times were
always in the morning after the rounds when routine physical examinations were carried
out, new patients were admitted and sometimes accompanying patients to B2 of another
building to do the locating job. Though radiation part was machinesʼ duties, the
preparation work was skillfully practiced by the doctors including locating, dose
determining, fractionating, etc.
Twice a weekʼs case analysis meeting was also mind blowing that everybody was
encouraged to express his or her opinion to guarantee the utmost benefice of the
patients.
This is a hospital full of vigor.
Buqing
2011.12.05
1.6 December
A Day In The Life 10.1 (2010-12-06 23:07)
Monday morning is chief physicianʼs round time. In Dermatology Department, there were
eight beds, four for male, four for female. Among these eight patients, there were two
lupus, two scleroderma, two psoriasis, one dermatomyositis and one skin infection on
the nose. The doctor lectured on scleroderma for long and the problem was that I had no
idea about it at all. For one, dermatology class was long time ago, for another, the
teacher had not mentioned this disease in the class. The lucky part was that I had
brought the textbook with me so that I could refer to it as soon as the round was over.
We will be staying at the outpatient department the following four days and meet people
with various stories.
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Buqing
2010.12.06
A Day In The Life 10.2 (2010-12-07 23:07)
A 36-year-old female came to dermatology outpatient department, complaining about the
sudden onset of puffiness of her face 3 days after her first use of some hair oil, which
was supposed to promote hair growing and polishing. Her face was red and swollen,
especially on both sides of the eyelids and cheeks. Using of hair oil was forbidden and
low dose of short-term corticosteroid was administered meanwhile cool waster spray for
the whole face which continued for about 20 minutes was also carried out.
Buqing
2010.12.07
A Day In The Life 10.3 (2010-12-08 23:07)
A forty some years old male came to the STD outpatient department with the chief
complaint of the discovery of three or four little growths which were about 1 mm big on
his foreskin when taking showers. Judged by their appearance, genital warts were highly
suspected and some acetic acid was applied. Several minutes later, these little growth
turned into white-colored appearance. Prodofilox was to be administered twice a day for
three continuous days in a row as a treatment.
Buqing
2010.12.08
A Day In The Life 10.4 (2010-12-09 23:07)
When a patient with a history of Lupus comes to outpatient department, what are the key
elements to inquire within such a short period of time?
1. Duration of the disease.
2. Viscera that are affected.
3. History of the use of drugs.
4. The reason for coming this time.
Buqing
2010.12.09
A Day In The Life 10.5 (2010-12-10 23:07)
A 35-year-old male came to the STD outpatient department with a history of drop stains
of excretion on his underwear. There was no dysuria or gross hematuria. Urinary tract
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infection was suspected and culture was ordered. The patient took his pants off,
exposed his penis and was then instructed to used both his hands to pull the glandes
apart for a better exposure of the meatus. I inserted a sterile cotton stick into his urethra
about one centimeter deep and rotated three circles. This procedure was repeated three
times for different purposes and had to be done very gently for the patient kept
complaining about the pain caused by the insertion. Culture would reveal the underlying
cause soon.
Buqing
2010.12.10
Eight Days A Week (Department of Dermatology) (2010-12-19 23:07)
I used to be suffering from urticaria when I was in senior high school which had caused
me endless troubles in my everyday life. Fortunately, I got cured by some secret recipe
from a private hospital in Peking after 15several vain attempts in big hospitals like the
famous Dermatology Department, Huashan Hospital which in retrospective was highly
suspected that glucocorticosteroid might be administered.
The most unusual experience in the last two weeks was the staying at STD outpatient
department. Most patients were so embarrassed when they stepped in that they barely
spoke a word and always lowered their heads, avoiding to look the doctor in the eyes
and pretending to be speaking on behalf of someone else. On the contrary, when they
were leaving, they were making it as briskly and swiftly as they can. Judged form my
two-week experience, this population consists mostly of male from relatively low social
statuses. Every patientʼs personal information was secretly and legitimately recorded.
The days are getting chilly, do yourself a favor by applying cream for the protection of
your skins.
Buqing
2010.12.19
A Day In The Life 11.1 (2010-12-20 23:07)
From this day on, I am entering the field of internal medicine, and the very first
department – Department of Neurology, according to those who had been there, is one
that is terribly tough.
I was at the outpatient department this afternoon, watching how Professor Zhong deal
with patients and there was one 33-year-old female who had been feeling nauseated
intermittently for about one week. She had gone to several hospitals before and had
excluded pregnancy. When she was reporting the history, I was thinking hard for any
nervous disorder that would cause nausea. After the physical examination, Professor
Zhong concluded that there seemed no apparent problem with her nervous system. He
then asked a question that greatly enlightened me: ”Have you ever had your liver
function checked?”
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I was blinded, totally. Broaden the mind, urgently!
Buqing
2010.12.20
A Day In The Life 11.2 (2010-12-21 23:07)
Iʼve measured more than 50 BPs today. Believe it or not, this is what interns do in the
hospital. This is what medical education system in China is.
There is a place called observation room in the hospital where some patients stay for a
close observation on their vital signs. I was dispatched there twice, one in the morning
and one in the dusk, measured 25 BPs respectively. Though the process was rigid and
boring, having conversations with the patients about their histories was interesting and
meaningful. There were some patients having their vital signs monitored by the bedside
monitors on which there were BP readings. I did a little experience by measuring these
patients and compared the figures I got with the ones on the monitors and had
discovered that these machines actually did not work that well.
As I always say, digital apparatuses are not always reliable.
Buqing
2010.12.21
A Day In The Life 11.3 (2010-12-22 23:07)
It was big shift this morning and I, as an intern, had to report the basic information of the
patients I was in charge of. Iʼd never done this before, despite of a very brief one in the
general surgery department, one that I just memorized what the supervisor told me and
repeated it. This time, I had to summarize all by myself. I had four.
I began the preparation last night by writing down what I was to say on a piece of paper.
At first, I jammed in as much information as I could and made a case prolix. Under the
guide of a training doctor, half of the narrative was cut off. The remaining three were
finished in the same way.
Seemed well prepared was I, nervous was I. It went OK the first case since Iʼd practiced
reporting for times then from the second case on, my mind turned blank that even the
formula* had no way to save me. Reading was allowed and it was the last shot I had.
Next time, I would not let this happen again.
Formula: male/female, age, chief complaint, meaningful examination, diagnosis,
treatment.
Buqing
2010.12.22
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A Day In The Life 11.4 (2010-12-23 23:07)
I attended the group discussion of a rare case this afternoon. To be frank, I could hardly
catch up with what the presenters expressed and whenever a concept or terminology
was mentioned, I would quickly turn to my beloved Oxford Handbook of Clinical Medicine
and grab as much information as I could.
This was a 24-year-old male with a history of cutting by a blade on the left sole at the
age of 12 and ever since gradually developed weaknesses and atrophy on both legs. PE
revealed an enhanced right patellar reflex and negative ankle jerk reflex on both sides.
Possible diagnosis included ALS, Kennedyʼs Disease, Post-polio syndrome, etc,
probably a Motor Neuron Disease.
The scene I dream is one day, I will be able to express as an authority.
Buqing
2010.12.23
A Day In The Life 11.5 (2010-12-24 23:07)
I failed today.
There was a 65-year-old male in the ICU of neurology department that needed an
ABG. Iʼd never done this before, and I failed. Palpating the radial artery was
simple, inserting the needle into the subcutaneous space was simple, but the
locating of the artery caused my big trouble. Although I knew exactly that this
artery was right below the index finger of my left hand (I am a right-handed man),
I could not judge the precise spacial positions of it and the tip of the needle. I did
not know which direction the needle should go. I dared not to puncture randomly
and pushed a little further towards where the artery would probably be and began
to withdraw meanwhile evacuating the syringe. I got nothing.
I change to another forearm of the patient and resulted one more failed attempt.
Buqing
2010.12.24
A Day In The Life 11.6 (2010-12-27 23:07)
A 44-year-old male with a sudden onset of alexia for two weeks was admitted for further
examinations. His perception, orientation, speech, long-term memory, cranial nerves,
extremity tone, power, reflexes, coordination and sensation were observed normal while
calculating ability, short-term memory were decreased. He denied history of HTN, DM,
infectious diseases, surgery, blood transfusion, penicillin allergy while confessed a
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history of extramarital love affairs as his RPR test was positive. He used to smoke one
pack of cigarettes for 25 years and drink 2 tael of yellow wine every day for more than 10
years. Cranial MRI and lumbar puncture were carried out and the results hadnʼt been out
yet. Possible diagnosis included: 1. acute cranial blood vessel infarction, 2.
neurosyphilis.
Buqing
2010.12.27
A Day In The Life 11.7 (2010-12-28 23:07)
Three levels of disturbance of consciousness, from mild to severe:
• Somnolence In this level, the patient could respond to what was inquired and falls
asleep after the stimulus ceases.
• Stupor In this level, the patient could respond to what was inquired but falls asleep
even the stimulus is incessant.
• Coma In this level the patientʼs consciousness is lost and this condition could further be
divided into the following three levels.
– Mild Reflexes existed.
– Medium Declined reflexes.
– Severe No reflexes.
Buqing
2010.12.28
A Day In The Life 11.8 (2010-12-29 23:07)
A 50-some male was transferred to neurology ICU for a better care the day before after
a severe stroke, accompanied by multi-antibiotics resistance including advanced ones
like tienam, vancomycin, etc. His trachea had already been incised at the local hospital
for the purpose of aspirating sputum. At around 20:00, dropping of BP (60/40 mmHg)
and SAT (60 %) suddenly occurred and emergency steps like ABG, ventilator, IV
dopamine drip were immediately applied and his relatives were also summoned.
According to the result of antibiotic sensitivity, there was only one effective antibiotic
available whose name I forget. The attendance physician from Respiratory Department
deduced that the patient might possibly be suffering from a severe sepsis and was of not
enough ECV which both caused the dropping of his BP and SAT since there was no big
problem of the result of his ABG and the crucial treatment would be supplementing his
blood volume and maintaining his BP while keenly observing the SAT. Two routes of
intravenous drip with an added amount of dopamine and the only effective antibiotic
were set up. Several minutes later, the patientʼs relatives arrived and were apprised of
the condition.
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At 21:00, I measured his BP by mercury sphygmomanometer again which raised to
80/40 mmHg and his condition was improving.
P.S. Hypotension and Heart rate Normally, when a personʼs BP drops, his HR increases.
In this case, however, the patientʼs heart rate had been less than 100 bpm. There were
two possible explanations: 1. He had cardiac problem. 2. He was too weak to make it.
Buqing
2010.12.29
A Day In The Life 11.9 (2010-12-30 23:07)
Four days in the observation room, measured more than 200 BPs, I took most of the
time not only observing, but also communicating and trying to convey my compassion to
the patients, especially those could not talk or move while were conscious. Some
constant residents relied on ventilators and nasogastric feedings to live, their only
enjoyment would be silently repeating the wonderful memories of the past, I guessed.
When I looked at their emotionless faces, an article I happened to have read the other
day on NYTimes occurred to me that ”Americans are living longer, but those assed years
are more likely to be a time of disease and disability.” I am wondering if people in the
observation room would exchange their remaining life with a shorter period of healthy
time? And if it were me, would I?
So pity that MEDICINE IS NOT OMNIPOTENT.
Buqing
2010.12.30
A Day In The Life 11.10 (2010-12-31 23:07)
Professor Zhong came to ward this afternoon and after seeing the newly admitted
patients in person (he also did the physical examination himself), he made conclusions
of each patientʼs condition and pointed out possible diagnosis, differential diagnosis and
what else should be paid attention to. He also raised questions to me and since I had no
idea of the answer, he patiently made it clear for me. When reading the MRI scan of one
patient, he explained the main structures on it to us. At the end of his staying, he
encouraged us residents and interns to work harder and learn as much as we could.
Unlike some of the ”busy” and ”great” snob professors, he is cordial and nice, a person
deserves respect.
An expert like him is made by diligence, persistence and experience.
Buqing
2010.12.31
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
Chapter 2 -- 2011
2.1 January
Eight Days A Week (Department of Neurology) (2011-01-03 23:07)
”The neurological system is usually the most daunting examination to learn, but the most
satisfying once perfected.” – OHCM
This has been a rich two-week experience. With the help of OHCM, I got answers to
most of the questions on-the-go. I learned how to perform physical examination for the
neurological system and did one for grandmother. I measured more than 200 BPs and
by communicating with the patients both directly and indirectly (by eye contact, since
some of whom were unable to move and talk) in the observation room, I came to
understand that medicine is not omnipotent, there is more we doctors should do. I
participated in one emergency rescue, though only by doing some easy jobs like
delivering ABG, compressing air bag, etc, I distributed my little efforts to the saving of a
life. I failed in performing ABG, I will succeed.
Let me give my great gratitude to resident Xin Lin, for all the patient explanations and the
plexor; to Professor Zhong, for all the concern and encouragement. Thank you all.
Buqing
2011.01.03
A Day In The Life 12.1 (2011-01-04 23:07)
”Day 1 on a new ward should include a visit to the ”defib trolley”.” – OHCM
Day 1 on Cardiology Department today, the supervisor showed us where the ”defib
trolley” was and how it should work. There were two modes of defibrillation, automatic
and manual. Since we attended the opening ceremony of internal medicine internship,
we missed the automatic part. As for the manual part, two keys were emphasized: 1. the
voltage to be used, 2. the places to put the electrodes. Whatʼs more, recharge the
machine when it is not working!
I donʼt know how many people dies each year due to cardiac arrhythmia, what I do know
is that the concept of defibrillation should be popularized and that these essential
machines should be available in public areas.
Buqing
2011.01.04
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A Day In The Life 12.2 (2011-01-05 23:07)
This is a story of a bedside defibrillation.
A 47-year-old male two days after PCI had developed SVT of more than 150bpm. A
bedside defibrillation was arranged and an anesthetist was also summoned for general
anesthesia with propofol. After the patient had fallen asleep under bedside monitor, two
electrodes were placed on his chest, one under the right clavicle, one above the apex of
the heart. The moment the current was applied, both the patientʼs two arms and his torso
bounced up for about 5 cm all of a sudden and shown on the monitor, his rhythm was
immediately reestablished to Sinus rhythm at 85bpm. Before long, he woke up and was
tested of consciousness, muscle power and sense of touch.
Buqing
2011.01.05
A Day In The Life 12.3 (2011-01-06 23:07)
Noninvasive, cheap and effective ECG is the first procedure every patient takes after
admission. There are 9 electrodes to be placed on the patient, 3 on the extremities, 6 on
the precordium. The former 3 are easy to put whereas the latter 6 causes me a little
trouble. Fortunately, OHCM has everything in it. With an illustration, it is clearly
presented the position of the 6 precordial electrodes. Modern bedside
electrocardiograph machine not only records the 12 leads but also automatically
analyzes the result (whether or not trustable depends). It has not finished yet. Patientʼs
information such as ward and bed number, admission or post-operation, symptoms he or
she is having when recording, etc. should all be labelled on the record.
Buqing
2011.01.06
A Day In The Life 12.4 (2011-01-07 23:07)
The supervisor gave us a little lecture on how to read ECG.
1. Rate. 300 divided by the number of big boxes between two consecutive R waves.
2. Rhythm. Judged from the intervals.
3. Search for P waves on lead II. Observe its morphology, its relationship with QRS
complex.
4. Measure the PR interval for AV blocks. Regular or irregular?
5. Morphology of QRS complex. Height? Width?
6. Morphology of ST segment. Depression or elevation? Concave or convex?
7. Morphology of T wave. Inverted? 8. Notice other abnormalities.
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Buqing
2011.01.07
A Day In The Life 12.5 (2011-01-10 23:07)
Two exchangers from Australia came to cardiology department this morning for a weekʼs
visiting, one male was Gary, one female whose name I did not catch. Both were having
OHCM with them, and Garyʼs was the 7th edition. He told me that every student in
Australia possessed a copy of OHCM and was mandatory for a foreign hospital visiting
to see how were things getting done elsewhere during their study period. They were of
Malaysia descent and went to Australia the last year of their senior high school. His
OHCM was colorful, not the way printed, but daubed by the owner as a symbol of
diligence.
I must work harder.
Buqing
2011.01.10
A Day In The Life 12.6 (2011-01-11 23:07)
A 50-year-old male began to develop recurrent precordial pain radiating to the mandible
and left shoulder three months ago after mild exercise which now most commonly
occurred in the morning and could be relieved after rest. There was no diaphoresis,
dizziness, syncope, cough, tachypnea and paroxysmal nocturnal dyspnea, etc. He had a
history of HTN and was taking beta-blocker and ACEI for maintaining BP. The most
possible diagnosis would be ACS and this time he was admitted for coronary
angiography and PCI if necessary.
Buqing
2011.01.11
A Day In The Life 12.7 (2011-01-12 23:07)
Heart murmur is divided into six grades and an experienced physician should easily tell
them apart. As for me, the following scene always happened in the ward.
After PE, the physician would tell us that a third grade murmur at some place could be
heard and I jotted it down. When the round was finished, I would try to figure it out
myself. Unfortunately, I sometimes failed to hear it even though I knew it was there. Third
grade murmur is described as ”Clearly audible” in OHCM, and I probably have no
hearing impairment, the thing I lack is practice, practice and more practice.
Buqing
2011.01.12
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
A Day In The Life 12.8 (2011-01-13 23:07)
A 13-year-old boy got frightened half a year ago and had thereafter developed
arrhythmia. His heart was under monitor for 24 hours a day by remote monitor in the
nurse station and whenever arrhythmia occurred, very quick steps would be taken
immediately. There was a time when he developed SVT, judged from the monitor, and a
bedside ECG was carried out for the record. When I was doing the placement of the
electrodes, I asked him how did he feel and he answered with no abnormal feelings and
continued reading the book he had. He did not know the disease and he was intrepid.
Buqing
2011.01.15
A Day In The Life 12.9 (2011-01-14 23:07)
Patients admitted in the cardiology department are always with histories of HTN, DM,
previous heart diseases and are always taking pills, tablets or other medications already
so it is very important to inquire their past medical histories and drug histories and
prescribe proper medications for them. Once they are admitted, dugs taken at home are
prohibited and they are only permitted to take the ones given by doctors here. Some
routine medications include aspirin, beta-blocker, clopidogrel, atorvastatin, ACEI, ARB,
etc. For some patients with hard to control HTN, several drugs of different mechanisms
are always used at the same time.
Buqing
2011.01.14
Eight Days A Week (Department of Cardiology) (2011-01-16 23:07)
My 2011 began with cardiology department, the very first internal medicine department
on my list.
One task of staying in cardiology department was recording and reading ECG, one I
tried hard to but still could not make it. Taking an ECG was easy once the places of the
electrodes were learnt, and the analyzing part needed efforts.
Professor Chen was supposed to give an English morning round not for his illness of
catching a cold. So I missed the opportunity.
I myself got a cold and had a 38 degree mouth temperature for several days which
greatly hindered my 17energy and ability to enjoy life in ward.
The second week two exchangers from Australia opened my mind by behaving in a
different way of learning and using medical knowledge. They were taking OHCM with
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A Day In The Life -- Buqing Being An Intern More at BUQING.ORG
them and had tightly combined what they had learnt with clinical using. Though they did
not understand most of the Chinese being spoken, they applied themselves by using
medical languages – inspection, palpation, percussion and auscultation. If I have the
chance, I also will go abroad to see how things are getting done around the world.
Buqing
2011.01.16
A Day In The Life 13.1 (2011-01-17 23:07)
Life in the second department of the new year – Department of Gastroenterology began
today and on the very first meet, the supervisor proposed a discipline that no ”late for
work” was allowed, which meant we should be prompt in the chilly days. The attending
physician was the one who led me when I was on my probation so that we got to be very
familiar with each other, making the atmosphere easy-going. Moreover, she tended to
tell me more, about the conditions of the patients, the knowledge of the diseases, the
usages of the medications, etc.
The following two weeks would be nice.
Buqing
2011.01.17
A Day In The Life 13.2 (2011-01-18 23:07)
I went to the Advanced Expert Clinic this morning and witnessed Professor Houyu Liuʼs
dealing with the one and only patient and in our half an hour encounter, the way he
behaved, the thread of his diagnosis, his attitude towards student, namely me, all greatly
impressed me. Communicating with him was stressful as when it came to medical terms,
he would use English and it took me for a while to adjust to cope with him in half
Chinese and half English.
Letʼs talk about the case. It was a 55-year-old male with a history of epigastric pain
caused by gastric ulcer shown on an upper GI endoscopy in January 2010 who had
came for professor Liuʼs consultation at that time and after taking the medication
prescribed, his condition improved. This time, he developed a new epigastric pain and
had undergone another upper GI endoscopy which discovered no gastric ulcer while
showed a new one at duodenal bulb. He was required to point out the location of the
pain and had succeeded in doing so by one finger. He then laid down and professor Liu
did an uncommon abdominal physical examination preceded by a routine one. The
uncommon one went like this: the patient laid supine, with both knees extended. He was
then asked to tilt his head up, contracting his rectus abdominis, and feel the pain when
the spot was pressed, put his head down on the pillow, feel the pain again and compare
the severities in these two situations. ”It felt less severe with head up.” He said. ”So, this
is a somatic not visceral pain, and has nothing to do with the ulcer. Because it is
localized.” Professor Liu made a conclusion. ”For patients complaining about abdominal
pain, make it clear of the origin.” He emphasized later on. ”As for this patient, we
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continue to treat the ulcer at duodenal bulb. The classical treatment should be Triple
Therapy, but nowadays, we use Quadruple Therapy instead because of the rise in
antibiotic resistance...”
It was snowing outside.
Buqing
2011.01.18
A Day In The Life 13.3 (2011-01-19 23:07)
Professor Xizhong Shen came to morning round and had a look of all the patients today.
During it, he told us an interesting story of how in the past days, when the technology
was undeveloped, patients with gallstones were treated.
When awoke in the morning, the patients would take fried chicken as breakfast to
stimulate bile excretion. Later on, acupuncture was applied to relax oddiʼs sphincter
meanwhile magnesium sulfate was taken orally for the same purpose. By doing so,
some patientsʼ gallstones would successfully be excreted into the duodenum. What left
for the patients to do was trying to find them out in their feces.
Buqing
2011.01.19
A Day In The Life 13.4 (2011-01-20 23:07)
A 30-year-old female began to feel uncomfortable at the location of subxiphoid 7 months
ago which worsened after eating and had been experiencing upper abdominal
uncomfortableness intermittently for the last half a year. Her upper GI endoscopy
(2010.6.21) at the local hospital indicated chronic gastritis and HP test was of a negative
result. She received regular allopathy but reached no improvement. So she went to
another local hospital and did one more endoscopy (2011.01.06) which discovered
lesions on gastric body, histology test revealed Signet ring cell carcinoma,
immunohistochemical test showed CK(+). She also did an enhanced abdominal CT
which presented thickened cardia, multiple swollen lymph nodes and swollen spleen.
She came to our hospital and upper GI endoscopy here disclosed linitis plastica and was
later diagnosed by biopsy as poorly differentiated adenocarcinoma and was further
confirmed by immunohistochemical test as CK7(+), LCA(+), CD68(+), K167(50 %+),
CD20(+), CD3(+) (actually, I donʼt exactly know what all these mean). At first, she
refused to accept the reality since she was so young and was the mother of a 4-year-old
boy. Later, her eagerness to live vanquished her fantasy and she was in a desperate
seeking of any possible treatment regardless the poor prognosis of this kind of disease.
She then transferred to Tumor Hospital for further treatment.
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Buqing
2011.01.20
A Day In The Life 13.5 (2011-01-21 23:07)
It was the big shift this morning and I had 9 beds to report. Unlike in the Department of
Neurology, I was experienced this time and did a much better job by overcoming
nervousness and being confident. Make progress every day and be a good doctor.
Later, I accompanied with a 55-year-old male to a fine needle aspiration for the swollen
jugular chain lymph nodes to differentiate cancer metastasis from lymphoma. I
remembered we were asked how this procedure was performed in a test some time ago
and finally had the chance to witness it today. The skin above the LN to be biopsied was
swabbed with an antiseptic solution. The performer then used her two fingers to fix the
LN and used a syringe with a needle of a very fine diameter to insert and withdraw
several times. Aspirated tissues was then injected onto a glass slide, stained, dried and
observed under a microscope. She then told me, it was not lymphoma and there was no
need to do one more on the other side of the patientʼs neck, different from what was
planned. I was baffled and did not understand what she meant. When we got back to
ward, our group was on the morning round already and the attending physician asked
me whether it was lymphoma or not. I repeated what the performer told me and suddenly
came to myself. Since it was not lymphoma, there was only one possibility – cancer
metastasis! She saw the cancer cells and since it was improper to say so in front of the
patient, the performer just gave me a hint.
Doctors should be very careful of what to say in front of patients.
Buqing
2011.01.21
A Day In The Life 13.6 (2011-01-24 23:07)
An 80-year-old female was transferred from a rest home with the diagnosis of ascites,
pulmonary infection, pleural effusion, hypertension and typer 2 diabetes. PE showed a
swollen abdomen with dullness two finger widths below the umbilicus on percussion,
negative fluid thrill, negative shifting dullness and basal wheezes on auscultation on the
right side. Anti-infective and supportive treatment were applied. She then went for an
ultrasonography and the result astonished everyone that it was not ascites in her
abdomen, but an enlarged bladder containing 700mL urine! Urinary catheterization was
immediately carried out and urine was to be drained by several times in case of a
sudden drop of pressure in the abdomen. As the patientʼs symptom relieved, the
following problem was ”what caused the urinary retention?” There were some
possibilities: 1. Neurogenic bladder (diabetes-related), 2. Carcinoma (compressing
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related spinal cord), 3. Drug-induced, etc. Abdominal CT, tumor marker test were
arranged.
Buqing
2011.01.24
P.S. Since the patientʼs family did not want further examinations, the cause remained
unknown.
A Day In The Life 13.7 (2011-01-25 23:07)
A 30-year-old female came back from South Africa with a history of abdominal pain. The
case is not what I am going to discuss today, it is the reports she brought back that
intrigues me.
This was the first time I encountered really paper reports printed in English and one
other language I did not recognize since Iʼd never been abroad. The English ones were
reports on auxiliary examinations. On top of every report, there were the name of the
hospital, the information of the patient, and the name and date of the examination. The
body part was the report written by the examiner. There was one ultrasonography report
on which the examiner described what he/she saw in the patientʼs abdomen and pelvic
cavity with only a few words in plain English, not as detailed as here in our hospital.
Another CXR report showed only one sentence: ”No pleural effusion.” The ones printed
in the language of which I had no idea seemed like reports on tests of blood or urine,
etc. because there were numbers, upwards and downwards arrows on them (I did not
read them attentively, otherwise I would probably likely to figure out what they were by
the numbers). Bottom of the reports was where the detailed information of the hospital
located.
Buqing
2011.01.25
A Day In The Life 13.8 (2011-01-26 23:07)
A 66-year-old male who used to be the chief surgeon of a department of our hospital
was admitted this afternoon based on the diagnosis of ”pancreatic cancer with lungs,
bones and lymph nodes metastasis”. He was weak, slim, and talked in a low voice, hard
for anyone to imagine his glorious days when he was healthy and did tough surgeries to
save patientsʼ lives in the past. Several chief doctors from different departments all came
for consultation to work out a best plan for his treatment this afternoon and I was
”amazed” by the punctuality of the arriving of these chiefs because according to my own
experience during this internship, it always took days for consultants to show up for
ordinary patients. We spent almost half the time of evening round in his single room.
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Buqing
2011.01.26
A Day In The Life 13.9 (2011-01-27 23:07)
Professor Jiyao Wang came for a not-so-easy to diagnose disease this morning. It was a
57-year-old jaundiced male with an impaired liver function who used to constantly
consume alcohol 2 tael/d since his 20ʼs and a kind of self-made tincture for four years
and had stopped drinking one year ago when he was diagnosed as ”Drug-Induced Liver
Disease (DILD)” in another hospital. After inquiring and examining the patient, we went
back to the office and listened to Professor Wangʼs analysis. She first took out three
pieces of paper on which printed one criterion of diagnosing DILD set up by us Chinese
and a newly published English article on several other criteria and the comparisons
between each criterion. She then applied these criteria to the patient and made
conclusions based on each of them. She was well prepared.
What I learnt most today was: ”Take seriously of each patient.”
Buqing
2011.01.29
A Day In The Life 13.10 (2011-01-28 23:07)
I filled out a long-term doctorʼs order yesterday and showed it to the attending doctor
who strictly pointed out at least five impropernesses. A photo was shot to mark an
internʼs growing up in daily practice of medicine.
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Buqing
2011.01.28
Eight Days A Week (Department of Gastroenterology) (2011-01-30 23:07)
I was right, this past two weeks was nice. I was wrong, this past two weeks was more
than nice, it was fantastic!
My supervisor was the most dynamic guy Iʼd ever met! His name was called in every
corner of the ward as everybody seemed to need a little help from him. His command of
medical knowledge greatly shocked me that no matter what issue was raised, he could
always explain it to me sort of in the form of little lecture that he would expand the issue
to other important points which should not be neglected. His tag was ”OK!”, a word not
only guaranteed people seeking for help, but also a confident mark for his ability. Iʼd
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learnt so much form him and my eagerness for medical knowledge was also
tremendously intrigued by him. He was only a resident.
I came to know the attending physician about one and a half years ago when we were
on our probation. She was quick-minded and liked to talk about interesting stories
happened in the hospital. She also talked a lot to the patients about their conditions and
tips for better lives. The scene impressed me most was when she was sitting beside the
desk in the office and checking all the orders written by residents and interns to make
sure nothing went wrong for the patients and my respect for her immediately aroused at
that moment. The chocolates she shared with us were delicious, I liked them!
Another big progress I made was that the very first time in my life, I successfully
performed an ABG at the site of a patientʼs radial artery.
My sincere gratitude to resident Shiyang Gu, attending physician Taotao Liu and
everybody in the Department of Gastroenterology, thank you all.
Finally, Iʼd like to quote the [2]tweet I posted the afternoon of the last day:
Saying goodbye to Department of Gastroenterology. I am missing you guys already.
Buqing
2011.01.30
A Day In The Life 14.1 (2011-01-31 23:07)
ER, a place full of risks and miracles.
I arrived at ER five minutes earlier than due time and hung around to see doctors and
nurses all wearing masks, so I also put one on. Then I followed an attending physician
on the morning round and learnt a little how to take medical records at ER by observing
her way of doing this. Above all, patientsʼ consciousnesses were recorded as the first
impression of their overall status. Vital signs including Heart Rate, Blood Pressure and
Respiratory Rate, were the most important subjective indicators that were to be recorded
subsequently. Since most of the patients staying here were likely to be bearing cardiac
diseases, their body positions, conditions of edema were therefore also recorded.
Proceeding recordings were aimed at certain patientsʼ problems and varied from one
another.
Buqing
2011.01.31
2.2 February
A Day In The Life 14.2 (2011-02-01 23:07)
At ER, time is everything!
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Once a medical order was filled out, all the drugs should be input into the digital system
as well as all the examinations be arranged. I was taught how to input drug names,
doses, ways of administration, etc. this morning and apparently, was doing it so slowly
that my supervisor seemed dissatisfied with my speed and what I learnt from her
beautiful eyes was ”Hurry, hurry and hurry!” Anyway, I must first guarantee the accuracy
of the prescriptions input and then make it as fast as possible. I found this a good way to
get myself familiar with the drugs, even better than fill out medical orders.
A physician should be decisive so as to meed the tremendously tense workload in ER.
Buqing
2011.02.01
A Day In The Life 14.3 (2011-02-04 23:07)
An Australian female came to ER this afternoon and since she spoke poor Chinese, I
suggested myself be her interpreter. After registration, as we were waiting in the queue
for our turn, I inquired her history. She began to feel sore and pain at one point at the
back of her head eight days ago when lying down on pillow and then discovered by
fingers a tender lump which she thought was a pimple and squeezed heard to try to
make out the pus and failed. It grew bigger in the following days and two days ago,
another small one of similar characteristic appeared below it near her neck. She denied
pyrexia, history of brain trauma or any other abnormalities. She was scared and seemed
very annoyed by this incident. After the consultancy of both a physician and a surgeon
from department of general surgery, the truth turned out to be sebaceous cysts and
mupirocin ointment was prescribed for topical treatment. She was also told if, unluckily,
the lesion grew bigger, came back for a drainage surgery.
She left the hospital with gratitude to me and I felt very pleased to have done somebody
a favor.
Buqing
2011.02.04
A Day In The Life 14.4 (2011-02-05 23:07)
A 29-year-old male diagnosed as cerebral vasculitis according to his cranial CT in a local
hospital was given corticosteroid as a treatment. He then had an onset of pyrexia
(highest reached 40) and was discovered by chest CT scan as having pneumonia,
probably caused by fungus. Amphotericin B was used as a treatment but had reached a
limited effect. He was rescanned after being transferred to our hospital both at the head
and the chest to reveal that the lesion in his head had improved a little while the ones at
his lungs should be further investigated to rule out TB. Because of their familyʼs
restricted economic condition, all drugs and tests were applied as planned. The patientʼs
elder sister kept inquiring about the possibility of her younger brotherʼs full recovery and
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if the continuously spent money on his treatment was worthwhile. They were about to
give up any time.
Buqing
2011.02.05
A Day In The Life 14.5 (2011-02-06 23:07)
First aid cart is a cart in the ER. Let me show you what it is.
This cart is composed of five parts: attic, first floor, drawer, second floor and third floor.
Here is the list of stuffs in each part.
Attic:
• Adrenaline Hydrochloride Injection, 10 mg * 5 (lucifugal)
• Isoprenaline Hydrochloride Injection, 1 mg * 5 (lucifugal)
• Atropine Sulfate Injection, 0.5 mg * 5
• Nikethamide Injection, 0.375 g * 5
• Lobeline Hydrochloride Injection, 3 mg * 5
• Dopamine Hydrochloride Injection, 20 mg * 5
• Dobutamine Hydrochloride Injection, 20mg * 5
• Lidocaine Hydrochloride Injection, 0.1 g * 5
• Metaraminol Bitartrate Injection, 10 mg * 5
• Dexamethasone Sodium Phosphate Injection, 5 mg * 5
• Furosemide Injection, 20 mg * 5
• Diprophylline, 0.25 g * 5
• Deslanoside, 0.4 mg * 5
• Diazepam, 10 mg * 5
First floor:
• Tracheal intubation kit * 1
• Laryngopharyngeal mirror kit * 1
• Speculum oris * 1
• Tweezers (for pulling the tongue) * 1
• Pulley * 1 • Rope*1
• Triple-lumen catheter * 1
• Sodium lactate 2.24 * 5
• HCSS50mg*5 • Propafenone * 5
Drawer:
• Latex tube for transfusion * 2
• Latex tube for infusion * 2 • 20 mL syringe * 2
• 5 mL syringe * 10
• Scalp vein needle * 2
• Pneumothoracic needle *2
• Long needle *2 • Suction tube *10
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• Test tube * 5 • Electric torch * 1
• Sphygmomanometer * 1
• Battery * 2
• Connection tube * 5
Second floor:
• 20%Mannitol250mL*2
• 5 % Sodium Bicarbonate Injection * 2
• 0.9 % Physiological Saline 500 mL * 2
• Voluven 500 mL * 2
• Ringerʼs solution 500 mL * 2
• Dextran 40 Glucose Injection * 2
• Tracheostomy kit * 1 • Phlebotomy kit * 1
• Sterile gloves * 2
• Injection tray * 1
• Glass vial opener
• Emery wheel * 1
•
Third floor:
• Wiring board * 1
• Simplified respiratory device * 1
• Oxygen mask * 1
• Lung simulator * 1
•
Stuffs are checked every shift to make sure their availability in emergency.
Buqing
2011.02.06
Eight Days A Week (Emergency Department) (2011-02-08 23:07)
This had been the most exciting and exhausting week ever since my internship began.
Iʼd witnessed crying, smiling, worrying, conflicting, and more seriously, deaths.
ER is probably the warmest place in the hospital and the first morning I came here, I
noticed that every physician and every nurse was wearing a mask so I also put one on.
Since I was a little early, I began to take a look at the innermost room of the department.
There were a wall in front of which all equipments were lined up and prepared for use
right away, including ECG machine, gastric lavage fluid (changed every day), gastric
lavage machine, electric suction apparatus, defibrillation machine, bedside monitor, first
aid cart (detailed information is [1]here) and CPR board. As I was standing there,
enclosed by all kinds of sound such as ”di, di” from monitors, sobbing from people, and
calling for physician from the reception as new emergency arrived, I was like indulging in
the drama ER.
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In this past week, I did a CPR to have rescued a 82-year-old female and I was so proud
of myself. I also improved my skill of performing ABG by beating the fear of failure.
There is a CongÈ Room for saying goodbyes. Death has been a so commonly
happening occurrence in this department that physicians understand no matter how
deep a grief the families are in, lives of the livings go on, jobs of the livings go on, and
the race of human beings go on. Do what should be done and let bygones be bygones.
Buqing
2011.02.08
A Day In The Life 15.1 (2011-02-09 23:07)
A 55-year-old male was admitted for anemia of unknown cause. His blood routine
revealed the presenting of nucleated erythrocytes and promyelocytes. Bone marrow
examination had been done and the result was awaited.
Attending physician Mr. Wang did an analysis on differential diagnosis based on the
information given by blood routine.
Causes of Leukoerythroblastic Anemia
• Hematological malignancies: Leukemia, etc.
• Bone metastases: where lodging of metastatic carcinoma squeezed immature cells out
of bone marrow into blood stream.
• Myelofibrosis: where extra-medullary hematopoiesis occurs, blood film with
characteristic teardrop erythrocytes.
• Granuloma.
• Else: acute hemolysis, etc.
Buqing
2011.02.09
Update: According to his bone marrow examination, it was a bone metastasis.
A Day In The Life 15.2 (2011-02-10 23:07)
I did my first bone marrow examination today.
It was an 82-year-old male who was very slim due to the gastric cancer he was having
(unknown at that time, revealed later on CT scan). He laid on his left with left leg straight
and right ankle to the chest for a better exposure of posterior superior iliac spine. Since
he was so slim, I could easily feel it, the spot where the examination took place. Bone
marrow aspiration went smoothly as I followed the steps to feel a ”give” when the needle
advanced through the cortex and then successfully aspirated about 1mL red semi-liquid
using a 20 mL syringe. Technician from department of laboratory medicine made the
smears immediately by my side. My trouble began as I did the biopsy part. I inserted the
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trephine needle into the patientʼs bone as it anchored in the bony cortex, then put on one
coat and advanced it by rotating at the same direction. I proceeded several more
centimeters, dared not go on and twisted the needle out. Unfortunately, no marrow was
obtained. I did not know what to do since the patient was so slim and the needle had
advanced so much (though there was still a distance remained), I called for my
supervisor. He repeated what I had done and made further advancement by inserting the
whole needle into the bone. This time, a small solid piece of bone marrow was removed.
Sometimes, a little more braveness will bring success.
Buqing
2011.02.10
A Day In The Life 15.3 (2011-02-11 23:07)
Attending physician Mr. Wang told us a story.
It was about 10 years ago, a 22-year-old youth from Northeastern University was
diagnosed as anemia at a local hospital. He was admitted for investigating the cause on
Thursday and on Friday a bone marrow examination was performed and later proved
myeloid sarcoma. His blood routine showed erythroclasis (broke when passing through
narrowed capillaries caused by cancer emboli). He died 6 days after admission due to
massive cancer embolism. Granulocytes have about eight hours life span in the blood
and how can they accumulate and develop into myeloid sarcoma at a place in such short
periods? The answer remains unknown so far.
Chloroma is a kind of myeloid sarcoma which when incised, presents with a greenish
surface that would change due to immediate oxygenation so as has to be stored in
glycerol.
Buqing
2011.02.11
A Day In The Life 15.4 (2011-02-12 23:07)
A 22-year-old girl was diagnosed as AML-M5 and began chemotherapy (idarubicin +
cytarabine) on January 4th, 2011 and stopped on January 10th, 2011 when,
unfortunately, her menstruation came that her hemoglobin dropped rapidly to 390 g/L.
On the same day, testosterone propionate was administered once to cease the bleeding,
RHG-CSF was administered continuously until January 27th, 2011 to ameliorate
neutropenia, meanwhile transfusion was also immediately carried out the day after. At
the evening of January 11th, 2011, she suddenly developed left heart failure with heart
beat of 140 bpm that oxygen mask and morphine had to be applied. BIPAP and
meropenem were later used to revise Type I respiratory failure and pulmonary infection.
On January 16th, 2011, onset of gross hematuria occurred, probably due to the
impairment of coagulation caused by thrombocytopenia. During the following several
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days, her condition improved and when second chemotherapy was about to be
scheduled, her cranial CT scan revealed a growth in her head. Radiation therapy was
arranged, chemotherapy was on its way, would she be strong enough to overcome these
toughnesses ahead?
May God bless her.
Buqing
2011.02.13
Eight Days A Week (Department of Hematology) (2011-02-13 23:07)
Due to spring festival, I only stayed at this department for four days, but Iʼve learnt so
much.
Attending physician Mr. Wang was such a kind guy that he always told us interesting
stories so as to clearly explain a certain kind of disease. On morning rounds, when we
came out of a room, he would make little lectures in the passage based on the patients
we just saw. He was also very nice to patients and their families that had earned all their
respect. I am wondering how many years will it take for me to be as knowledgable as
him.
My supervisor Mr. Jiang also treated me well. He would analyze cases for me and give
me a hand whenever I encountered a problem.
Attending physician Ms. Chengʼs lecture on how to read a bone marrow aspiration report
was also pretty useful.
Short may it be, abundant it is.
Buqing
2011.02.13
A Day In The Life 16.1 (2011-02-14 23:07)
A 46-year-old female with an elevated blood glucose for 10 years developed paroxysmal
symmetric paraesthesia of all four extremities and inability to uplift upper two extremities
three weeks ago was suspected of myasthenia gravis, so an exertion test was arranged.
She was first required to swing her two forearms repeatedly for 20 times to observe the
ability to maintain speed and strength. Then, 10 mg neostigmine was injected
intramuscularly and her muscle power was recorded at 15-minute intervals for 2 hours.
After these two tests, no apparent positive results were got which meant she was
probably unlikely to have MG.
Buqing
2010.02.14
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A Day In The Life 16.2 (2011-02-15 23:07)
I was on duty today and had to measure patientsʼ blood glucose at specified times. I
completed my job properly at 9:30 am. Then, as we were on the morning round, coming
out of a room, I discovered that one female patientʼs husband was quarreling loudly at
the nurse station, claiming that I mis-recorded his wifeʼs BG on the recording book. As he
saw me, he came right straight to me, criticized my work attitude as irresponsible. I was
totally bewildered as everybody in the passage was looking at us. I suppressed the
exploding anger from the bottom, tried to communicate with him. He just gave me scorn
facial expressions. I left him alone, rejoined morning round.
When I came to work in the afternoon, somebody told me that the machine for
measuring BG had recording function and the chief nurse had reviewed all the data
collected and found the one and only number matched the one I recorded on the book
and thus shut the husband up. I just smiled.
Sometime, ignore people who are nonsense.
Buqing
2011.02.15
A Day In The Life 16.3 (2011-02-16 23:07)
Patients with diabetes mellitus should be under strict monitor of their blood glucose
levels and there is one quick and easy way to do so–fingerstick. With a simple prick on
any fingertip, blood could be immediately gained for measuring glucose level using a
portable automatic machine–glucose meter. Nevertheless, there are some tips for a
better performance.
• For patients with cold hands, warm them up for better capillary circulation.
• Use alcohol to disinfection the skin and wait for it to evaporate so that blood wonʼt be
diluted.
• Prick near the end of a fingertip allows an easier outflow of blood.
• Tenderly squeeze the fingertip to avoid interstitial fluid.
• If the skin is too much keratinized, choose a deeper-sized blood lancet.
• Retest if the result is doubtable.
• If failed to obtain blood from fingertip, try earlobe or directly from vein.
Buqing
2011.02.16
A Day In The Life 16.4 (2011-02-17 23:07)
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A 64-year-old female diagnosed as ”Addisonʼs disease” 30 years ago at our hospital had
been continuously taking oral cortisone as a replacement therapy. In February 2007, she
was diagnosed as hypoglycemia due to hyperinsulinemia possibly caused by
nesidioblastosis. About five days before admission, she developed a sudden onset of
cough with expectoration of white sputum meanwhile there was no pyrexia, dyspnea, or
diarrhea, etc. She had taken some medications herself which unfortunately, had no
improvement on the condition. On PE, weak wheezes and crackles at the bases of lungs
could be heard. Tests on c-peptide level, cortisol level, insulin level, ACTH level, etc.
were arranged. Glucose saline was used for glucose supply and antibiotics was used for
pulmonary infection.
Buqing
2011.o2.17
A Day In The Life 16.5 (2011-02-18 23:07)
When I was in the department of cardiology, there was a patient who was of high blood
pressure and hypokalemia. In the morning round, when the chief heard of this, her first
response was if this patient had primary hyperaldosteronism and thus forged my deep
impression on this disease which I guess I would never forget.
Here, in the department of endocrinology, hyperaldosteronism could be seen without
difficulty. There are three tests for diagnosing and differential diagnosing
hyperaldosteronism: ”saline infusion test”, ”captopril challenge test” and ”standing up
V.S. lying down test”.
Learning from life is amazing, it keeps memory vivid.
Buqing
2011.02.18
A Day In The Life 16.6 (2011-02-21 23:07)
Subcutaneous insulins are used for controlling blood glucose in patients who are unable
to self-produce enough insulins to meet the bodyʼs metabolic demands or those have
poor responses to anti-diabetic medications. The total amount a patient needs per day is
about 0.3-0.5U/kg and there are several regimes in use.
• Equally divide the total amount into four parts, three Rs are injected half an hour pre-
meal, one N is injected before-bed.
• ”QDS regime”: 1/2-2/3 of the total amount is injected in the morning before breakfast of
which 1/3 is R and 2/3 is N. The remaining amount is injected pre-dinner in the evening
of which 1/3 is R and 2/3 is N (this may also be injected before bed).
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If, blood glucose is thus unsatisfactorily controlled, regimes should be adjusted
according to the patientʼs condition.
Example:
A 60 kg maleʼs total amount per day would be 60kg * 0.4U/kg=24U
6U (24/4) R before each meal and 6U (24/4) N before bed.
Or
5U ( 24*(2/3)*(1/3)) R and 11U ( 24*(2/3)*(2/3)) N before breakfast, 5U ( 24*(2/3)*(1/3)) R
before dinner and 3U ( 24*(1/3)*(1/3)) N before bed.
(*R stands for short-acting insulin. N stands for medium-acting insulin.)
Buqing
2011.02.21
A Day In The Life 16.7 (2011-02-22 23:07)
Vice-president, Professor Gao came to afternoon round today for a intractable case.
Everybody was scared as hell, like mouse meeting the cat. One oʼclock in the afternoon,
an informal limbering-up seminar was held for an introduction of the case and an
attending physician reviewed some key concepts and made a brief analysis. A little more
then two oʼclock, Professor Gao arrived. She was a very nice person as I see, always
smiled to the patient and talked in a very gentle manner. I didnʼt understand why the
atmosphere was so tense before her arriving. You shouldʼve been there, it seemed all
the people in the hospital were in the ward and dared not make any sound. Meanwhile,
the hotness nearly suffocated me. After the inquiring, we settled down around a table
and listened to what Professor Gao had to say. She not only made it clear, but also
guided us what to do next.
Suddenly, I realized that I was the youngest in the room.
Buqing
2011.02.22
A Day In The Life 16.8 (2011-02-23 23:07)
A patient was suspected of distal renal tubular acidosis and thus an oral calcium chloride
(ammonium chloride is more commonly used) load was given for investigation. ABGs
were performed at 0m (before taking calcium chloride), 60m, 120m, 180m and 480m to
check the patientʼs blood pHs. This female patient was more than 80 years old and had
a very fragile pulse that could hardly be palpated at radial artery. I tried to make it at the
first two and failed at the 120mʼs. So, I decided to try femoral artery for the first time in
my life. Usually, 1mL syringe is used for radial artery and for femoral artery, 2mL syringe
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is more proper. I could clearly feel the femoral artery beating beneath my finger tip and
inserted the 2mL syringe vertically into the skin. Unlike more superficial radial artery,
femoral artery was deeper than I conceived and due to its larger radius, the needle could
reach it easier and more accurately.
Buqing
2011.02.23
P.S. For this test, the patientʼs urine were also collected at 0m, 60m, 120m, 180m, 240m,
300m, 360m, 420m and 480m to check their pHs.
A Day In The Life 16.9 (2011-02-24 23:07)
A 34-year-old ”boy” was admitted for a problem which would be favored by most that he
was gaining too much height. The reason he was called a ”boy” was because though he
was already 34 years old, he looked like a child due to hypogonadism that his gonads
were underdeveloped while his intelligence seemed to be normal by being able to
communicate with doctors and proclaimed all passings in primary school. At the age of
19, he was about 147cm tall and went for a referral at a private clinic to have unveiled
the hypopituitarism he was suffering from and was prescribed some medications and
injections (growth hormone, most probably) to help him grow. He accepted this treatment
immediately and was happy to see himself grow 9 cm a year until his body shape began
to seem strange: growing extremities and no change of the torso, which, quote his word,
was ”freaky”. Out of terror, he stopped oral medications near the end of a two-year
treatment. But! His extremities continued to grow and now at the age of 34, he was
175cm tall, wighted only 45kg, with a sitting height ratio of 0.49 (86/175). His cranial CT
scan showed an empty sella, blood hormones revealed very low levels of sexual
hormones and adrenal hormones while his thyroid hormones were of normal levels.
Buqing
2011.02.24
P.S. Department of Endocrinology held a get-together at ”Melody” after work, a place for
Karaoke. I played high tonight and almost sang my throat to death. Tomorrow morning
when I get up, I hope Iʼd be able to speak as usual.
A Day In The Life 16.10 (2011-02-25 23:07)
A 52-year-old female complaining about recurrent low back pain for a little more than
one year was first discovered of renal calculus 12 months ago and at that time
underwent ESWL to remove the stones. 5 months and half a month ago, her low back
pain reoccurred separately and both were treated with anti-inflammation therapy. One
week ago, her ultrasonography examination at our hospital revealed left renal end-duct
stones with enlarged upper duct, left hydronephrosis, right renal calculus and a solid
lesion at the inferior extreme of left thyroid gland. Her blood test showed elevated PTH
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and calcium ion concentrations and decreased phosphorus ion and magnesium ion
concentrations. After admission, an MIBI scan was arrange and the result disclosed a
hyper-functioning parathyroid gland at the inferior extreme of the left thyroid. T-score of
lumbar spine in DEXA was below 2.5, indicating a high fracture risk (osteoporosis) while
T-score of the left hip was between -1 -2.5, indicating an increased fracture risk
(osteopenia). She was diagnosed as hyperparathyroidism and transferred to department
of general surgery.
Buqing
2011.02.25
Eight Days A Week (Department Of Endocrinology) (2011-02-27 23:07)
Diabetes Mellitus is definitely a miserable disease, I assure you.
A patient told me that she was starved to death but dare not eat the delicious food laid
before her. ”Youʼd better kill me.” She was of a very low spirit.
Some patients, especially newly admitted and ones with unstable BGs, are having their
blood glucose measured 7 times a day (6am, 8:30am, 10:30am, 1pm, 4:30pm, 7pm,
9pm), by means of fingerstick. A patient described his fingertip as ”having thousands of
sores and hundreds of holes (C!~T)” and in due time for measuring, he was so afraid to
see the doctor approaching. On the contrary, people with addisonʼs disease are suffering
from low blood glucose, leading to weakness, faints, depression, low self-esteem, etc.
Happy things happened during the last two weeks are so many to mention. I met an
animated supervisor who laughed a lot and had taught me a lot, ranging from how to
accept a patient on admission to write discharge paper. Learning from her is always a
joyful experience.
The night out Karaoke was a wonderful memory, too. Apart form solemnity when dealing
with patients, doctors could be vivid as well.
I guess I will never measure so many blood glucoses with a two week span any more.
Buqing
2011.02.27
A Day In The Life 17.1 (2011-02-28 23:07)
Chief physician professor Hu came to round this afternoon and several intractable cases
were put forward for his opinions. Keys he mentioned during the deeply impressed me
are listed below.
• Patientsʼ jobs are important for diagnosis.
• When pneumonia is suggested, DO take an ABG!
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• In pulmonary disease diagnosis, CXR and thoracic CT are essential imaging means
routinely taken, not only for differential diagnosis, but also to record the progression of
disease. Usually, three levels are used for comparison which are section at tracheal
bifurcation, section at the beginning of the middle bronchus of the right lung and section
at diaphragmatic roof (not as specific as the previous two, may vary due to respiration).
Buqing
2011.02.28
2.3 March
A Day In The Life 17.2 (2011-03-01 23:07)
A little seminar was held this morning in the demonstration room and all the professors
had come to have a panel discussion of the intractable cases. Chief of department of
respiratory medicine also showed up and was sitting at the front row, facing the reporter.
I was sitting at the back row and due to my unfamiliarity of the cases, I spent most of my
time browsing OHCM when a certain disease was mentioned. Listening to what masters
say has always been a journey of delight. For me at present, there is always something
of great importance to be neglected, which tells greatness apart from ordinary.
Buqing
2011.03.01
A Day In The Life 17.3 (2011-03-02 23:07)
Tuberculosis is a widespread infectious disease in China and should be highly
considered in pulmonary inflammation patients. This afternoon, a PPD test was done.
0.1mL volume containing 5 TU PPD was injected into a patientʼs dermal layer of the skin
about 4cm above the right wrist, ulnarly 2.5cm to the middle line of the forearm, where
there was no blood vessels or abnormalities. After injection, a discrete, pale elevation of
about 5mm in diameter was produced. The patients was required not to scratch the spot
despite possible itching and should avoid applying pressure over it, either. The result of
the test is to be read 48 to 72 hours after the injection which I will update later.
Buqing
2011.03.02
Update: This patientʼs PPD test result was negative (0mm) which indicated the following
possibilities:
• Not infected.
• PPD injected subcutaneously.
• Immunologically compromised caused by HIV, etc.
• Drugs that suppress skin reactions.
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Buqing
2011.03.11
A Day In The Life 17.4 (2011-03-03 23:07)
A 41-year-old male had been complaining about paroxysmal lower left stabbing chest
pain for almost half a year. He denied cough, expectoration, chest distress, tachypnea,
pyrexia and hemoptysis during the whole course. He once went to Chest Hospital and
had undergone a chest CT which revealed increased markings and multi-nodules of soft
tissue opacity on both lungs. Bronchoscopy and two times percutaneous fine needle
biopsy at that time reached no positive evidence of lung cancer. Four days later, a
second time chest CT unveiled some enlarged nodules meanwhile sputum microscopy
resulted in positive candida albicans. Doctors at Chest Hospital considered it as fungal
infection and began to treat him with moxifloxacin and fluconazol for a week and
rescanned his chest by CT to find that the lesions had become smaller. He was then
discharged and began to take oral itraconazole(20mL, bid) at home. One month later, his
follow-up LFT showed an elevated level of transaminase so that itraconazole therapy
had been ceased and hepatoprotectant was administered. Two months later, his LFT
returned to normal levels and itraconazole therapy (20mL, qd) resumed.
Buqing
2011.03.03
A Day In The Life 17.5 (2011-03-04 23:07)
An 18-year-old tall, thin nonsmoker boy with a sudden onset of mild dyspnea and no
other uncomfortable feelings after moderate activity one week ago was discovered of
having left pneumothorax on routine physical examination before University Entrance
Examination three days ago. His chest x-ray showed a collapsed left lung of about 20-30
% of the normal size, a depressed left hemidiaphragm, a shallow horizontal fluid level
and slightly right-shifted trachea. A chest tube was immediately inserted at the location of
left midclavicular line across 2nd intercostal space to drain out about 600mL air. Two
days later, a CXR was retook and his left lung had inflated to the size of about 80 %.
Negative pressure drainage had been continuously applied and a chest CT was
arranged for further differential diagnosis of emphysema and other diseases.
Buqing
2011.03.04
A Day In The Life 17.6 (2011-03-07 23:07)
I went to the operating room at outpatient clinic this afternoon and successfully
performed two chest aspirations. Last time I did one was at the beginning of my
internship when I was at the Department of Thoracic Surgery more than half a year ago.
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I could merely remember details of in the afternoon of that hot summer day, how gingerly
did I insert a tube into that old maleʼs thoracic cavity, nor could I ever again be that
excited to gain a chance to do one.
When one thing turns into a routine, when all the passions are gone, when repulsive
emotions arise, will you still treasure it as much as you used to be?
No, I wouldnʼt. Iʼd go on, Iʼd transcend the next.
Buqing
2011.03.07
A Day In The Life 17.7 (2011-03-08 23:07)
A 42-year-old male had a sudden onset of continuous left chest constricting pain and
wandering abdominal pain with no apparent inciting factors on the fifth day of the new
year of lunar calendar (February 7th, 2011). He also developed dyspnea after activity,
was unable to lie flat, coughed and expectorated yellow dense sputum then. The
abdominal pain was first at lower left quadrant then migrated to lower right quadrant and
finally fixed at upper middle abdomen which progressed by time and was worsened by
deep inhalation. He went to a local hospital and a chest CT which revealed lung lesions
and swollen hilar lymph nodes, indicating pulmonary TB. His PPD test was positive.
Treatment aiming at anti-infection and dissipating sputum were applied but reached no
apparent improvement. Five days later, he underwent another chest CT which showed
inflammatory changes at both lung bases and thickening of both pleurae. For further
investigation, he came to our hospital and retook a chest CT which unveiled
inflammation at both lungs with little pleural fluids at both sides, diffuse miliary nodules
and swollen hilar lymph nodes. Since he had a history of contacting coal dust for almost
10 years, coal workerʼs pneumoconiosis was highly suspected. Rheumatic test disclosed
positive p-ANCA in his blood and referral of Department of Rheumatology was arranged.
Final diagnosis was made as idiopathic oligo-immune complex pulmonary arteritis and
stosstherapy of corticosteroid and CTX (cyclophosphamide) were applied.
Buqing
2011.03.08
A Day In The Life 17.8 (2011-03-09 23:07)
A 67-year-old female developed apparent dyspnea with no cough, expectoration, fever
or dizziness after activities two years ago which manifested after climbing up stairs of
three floods or walking tens of meters on the flat ground. About 20 days ago, the patient
caught a cold and her body temperature raised to highest 39 with dizziness, vertigo,
nausea and vomited for about 10 times. There was no cough, expectoration, dyspnea or
tachypnea. She went to a local hospital and underwent treatment of mannitol, Diphenidol
Hydrochloride and Nimodipine to have only relieved the temperature. Four days later,
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she had an onset of cough and expectoration of mild white sputum, body temperature
was 37.5. Local hospital used Piracetam, Extract Of Ginkgo Biloba Leaves lnjection,
Cefuroxime, PPI and anti-emetics to treat. Chest CT revealed diffuse inflammation of
both lungs and mild pleural fluids on both sides. ECG showed sinus bradycardia and
incomplete right bundle branch block. Lung function test unveiled mixed ventilatory
disorder, mild restrictive ventilatory disorder. Bronchodilation test was negative. For
further diagnosis and treatment, she came to our hospital. ABG on admission showed
SpO2 90 %, PO2 72 %, HRCT disclosed diffused inflammation of both lungs,
bronchoalveolar lavage recollected milky fluids containing large quantity of PAS positive
protein-like substances with scattered macrophages, lymphocytes and neutrophils.
Biopsy proved chronic inflammatory changes and mucosa membranes with squamous
metaplasia. Diagnosis was Pulmonary Alveolar Proteinosis and after bronchoalveolar
lavage, the patient was discharged and required of follow-up checks.
Buqing
2011.03.09
A Day In The Life 17.9 (2011-03-10 23:07)
We went to the endoscopy center this morning to watch the procedure of fiberoptic
bronchoscopy.
The patient was asked to lie supinely and had her eyes covered by a gauze. An oxygen
tube was inserted into one of her nostrils while oxygen saturation was monitored by
fingertip pulse oximeter. At the same time, the flexible bronchoscopy was disinfected by
ethanol and then washed by 0.9 % saline once. It was then inserted into the other nostril,
through larynx, trachea and finally into the bronchial system, all steps were monitored on
the screen and were thus inspected. During the course, anesthetic were squirted at
places like larynx, trachea, left and right main bronchi, etc. to reduce stimulations caused
by scrubbing. Biopsy and brush were also carried out aiming at a possible neoplasm.
Fine needle aspiration under ultrasonography was used to take samples form a swollen
lymph node. When finished, bronchoscope removed out of the patientʼs body, she began
to cough forcefully and spitted white bloody sputum.
Buqing
2011.03.10
A Day In The Life 17.10 (2011-03-11 23:07)
A 55-year-old male developed a sudden onset of paroxysmal left chest stabbing pain
which lasted for about 1-2 minutes and relieved spontaneously every time with no
apparent inducement about one month ago. The recurrences were not related to
exertion, body position or respiration, meanwhile there was no fever, night sweats,
cough, expectoration, hemoptysis, chest distress or dyspnea. Eight days ago, he went to
a local hospital and underwent several tests. Tumor markers including AFP, CEA and
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NSE were within normal limits. Chest CT unveiled left pleural fluid, one nodule at lower
lobe of the left lung. Thoracentesis defined the fluid as exudate, CEA in the fluid was
75.77ng/mL, ADA 3U/L and cytology revealed adenocarcinoma. He came to our
hospitalʼs outpatient clinic and brought the smear for referral and unfortunately,
technician in department of pathology confirmed the presence of adenocarcinoma cells.
Cranial MRI and bone scan both reached no apparent abnormalities. Diagnosis was left
lung adenocarcinoma and he was admitted for chemotherapy.
Buqing
2011.03.11
Eight Days A Week (Department of Respiratory Medicine) (2011-03-13 23:07)
Thanks to the practice at ER, I am confident of myselfʼs ABG skill and not afraid of doing
one now. When a patientʼs radial artery is too weak to be palpated, I can always make
one from the femoral artery. When there are two options to choose, success rate is
greatly raised.
I was lucky, during the very limited two-week time, to have encountered one case of
idiopathic oligo-immune complex pulmonary arteritis, one case of pulmonary alveolar
proteinosis and one case of rapidly progressive pulmonary interstitial fibrosis, all which
did not commonly happen.
At the beginning of the second half, namely on the Monday of my second week, a big
shift of people occurred and a new leader showed up–associate professor Ms. Pan. Due
to her abundant experience and knowledge, she was thinking and acting very fast and
accurately. She liked to question a lot, especially me. Sometimes, I was unable to
answer but there was nothing to be embarrassed of since this was a way of learning.
Under such circumstances, Ms. Pan would be very pleased to impart to all of us in the
group. My genuine gratitude to Ms. Pan. Resident Ms. Ji was also very helpful to me.
Not only did she teach me a lot on various things, but also provided me opportunities to
perform thoracentesis at the outpatient clinics. Thank you so much.
Resident Ms. Wangʼs advices on writing medical record was also very useful. Thank you,
too.
Buqing
2011.03.13
A Day In The Life 18.1 (2011-03-14 23:07)
My internship rotationʼs last ward began this morning at Department of Nephrology. It is
said that this was the strictest ward and they were right, immediately after morning shift,
we interns were assembled for a meeting. Pieces of paper were distributed by the
supervisor to each of us on which all instructions and notices were clearly listed. Apart
from routine works on the ward, we were also required to deliver kidney biopsy samples,
help professors type prescriptions into the computer, assist surgeries, etc. I spent some
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time browsing patientsʼ histories and found that these were the longest ones Iʼd ever
seen since my internship began. Some patientsʼ records were so complicated that much
time should be cost before all the clues were made clear. So much unknown, so much to
learn.
When I came out of the hospital in the evening, it was 18:30 already, and my stomach
was as empty as air. These two weeks ahead must be busy and rich.
Buqing
2011.03.14
A Day In The Life 18.2 (2011-03-15 23:07)
Chief Mr. Ding came to round today and everybody was so well prepared that no
mistake was allowed. Iʼd heard a lot about this famous chief that no sound was allowed
when he was reading the record, that he might suggest that a coma be replaced by a
period in history, that all test reports should be pasted orderly according to their
categories, etc. Before, Iʼd met him times when he came to give lectures that had deeply
impressed me, I loved them. His analysis on cases today were also pretty brilliant. In
spite of limited information provided by residents and short-time inquiring, he would
quickly and accurately hit the crucial points. I was sitting at the other side of the long
desk, facing him, looking directly at his eyes, saying to myself: ”this is your future.”
Buqing
2011.03.15
A Day In The Life 18.3 (2011-03-16 23:07)
It is renal biopsy day and we did seven this morning.
Before the procedure, make sure there is no contraindications. The patient is lying
prone, exposing one side of his/her loin which is then disinfected. Sterile ultrasound
probe is applied to locate the kidney and local anesthesia is given to minimize pain. At
the upper surface of the probe used there are three holes through which biopsy needle
goes, and all three holes converge toward one exit, where the anesthetic is previously
injected so that biopsy will be performed at three different angles. When the needle is
inserted into the patientʼs abdominal cavity, he/she is required to take a deep breath and
hold it. A swift proceeding and withdrawal of the needle is carried out and a part of the
kidney sample is taken this way and immediately soaked in fixation solution. Dressing is
made over the insertion point and a small package of sands is placed above as well.
After retained with a abdominal belt, the patient is helped to turn over and lie supine in
bed for at least 6 hours. His/her blood pressure is measured separately at 0 min, 30 min,
60 min, 90 min and 120 min to make sure there is no bleeding.
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Buqing
2011.03.17
A Day In The Life 18.4 (2011-03-17 23:07)
I went to the Blood Purification Center today.
There are about 80 beds in the center, ready to serve hemodialysis for ESRD patients.
Most of the patients are regular visitors, coming 4 hours a day, 3-4 days a week. The
most commonly used pathways here include surgically created arteriovenous fistula and
central venous catheter. During hemodialysis, the patientsʼ vital signs are strictly
monitored. One concept that has not been fully understood is the so-called ”Dry Weight”,
which is now adjusted according to patientsʼ conditions after each hemodialysis and
finally set up to a comparably most proper level. For patients with hepatitis B or hepatitis
C or HIV, special machines are used. Every day, three groups of patients are accepted,
which means more than 200 patients are getting treated.
Buqing
2011.03.18
A Day In The Life 18.5 (2011-03-18 23:07)
A 59-year-old female with a history of HTN for 16 years and DM for 2 years had an onset
of lower extremities edema with no apparent inducing factors, no sore in the back, no
oliguria, no fever and no chest distress on June 27th, 2010 and went to a local hospital
where her urinalysis showed urine protein(+++), urine RBC(++++); liver function tests
showed serum albumin was 30g/L; kidney function tests showed SCr 83.1μmol/L, serum
uric acid 562.5μmol/L. Enalapril, bumetanide, aldactone, allopurinol and more were
administered but gained no obvious improvement on the edema. She was admitted to
another local hospital on August 2nd, 2010 where urinalysis revealed protein>300mg/dL,
RBC 18/μL and her 24-hour urine protein was 1.82-2.73g. Furosemide and aldactone
were used for diuresis, fosinopril for lowering BP and her edema subsided. On
September 13th, 2010, she had a renal biopsy at our hospital and was diagnosed as
Membranous Nephropathy. Diuresis and antihypertensive treatment continued. She
caught a cold on March 7th, 2011 and began to cough intermittently with thick yellow
sputum and fever highest of 37.5. She came to our hospitalʼs outpatient clinic on March
11th, 2011 and tests results showed WBC 11.79*10ˆ9/L, N % 93.2 %, SCr 109μmol/L,
BUN 18.6mmol/L, urine protein (+++), urine RBC (+/-), CXR: right pulmonary
inflammation. For further treatment, she was admitted.
Buqing
2011.03.18
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A Day In The Life 18.6 (2011-03-21 23:07)
One method for hemodialysis is artificial arteriovenous fistula. About half a year later
since the end of my rotation at Department of General Surgery, I once again stepped into
the operating room, participated in one.
After disinfecting the patientʼs whole left upper extremity and paving cloths, local
anesthesia was applied at about 5-10 cm above the wrist where radial artery and
cephalic vein went underneath. A semicircle dissection was made, tissues were
separated and radial artery and cephalic vein were isolated. Four small arteriolae, two at
each side of the radial artery, were ligated. Three clips were used to clip the relatively
proximal part of cephalic vein and its two distal branches, the latter, were also ligated
and cut off, leaving an opening of the cephalic vein which was then shaped into a wedge
about 5-8mm long. In a similar way the radial artery was clipped by two clips and a
lateral opening of about 5-8mm long was made on one side and anastomosis between it
and the wedge of the vein was sutured. All clips were removed to check blood flow and
bleeding. Skins were then sutured and operation was completed.
Buqing
2011.03.21
A Day In The Life 18.7 (2011-03-22 23:07)
A 58-year-old female was diagnosed as having HTN 30 years ago in a health
examination and since to take oral medications and regularly monitor BP which was not
well controlled, maintaining around 160/80mmHg and elevated highest to
200/100mmHg. 15 years ago, she was diagnosed as having DM and since to take oral
medications which was replaced by insulin injection due to their limited effects. 5 years
ago, she was discovered as having proteinuria with protein(++) in the urine but did not
take follow-up tests. Half a year ago, her tests in a local community hospital showed
urine protein(+++), BUN 130.5mmol/L, SCr 135μmol/L, UA 513μmol/L, serum albumin
44g/L, glycosylated hemoglobin 7.8 %. During the whole course, there was no recurrent
fever, photosensitivity, rash, oral ulcer, alopecia, epistaxis, purpura, blurred vision,
unconsciousness, chest distress, chest pain, palpitation, abdominal pain, facial or lower
extremity edema, oliguria, odyuria, frequent micturition, urgent micturition, gross
hematuria, itch, paraesthesia or movement disorder. For further diagnosis, she was
admitted and prepared to take a renal biopsy.
Buqing
2011.03.22
A Day In The Life 18.8 (2011-03-23 23:07)
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A 66-year-old female was discovered hematuria two years ago on a routine examination
at a local hospital, diagnosed as nephritis and treated with Bailing Capsules and some
other herbal medicines. During the course, her following-up urinalysis showed hematuria
fluctuating between ++~+++, urine protein fluctuating between -~+; 24-hour urine protein
was once 0.73g; blood routine and kidney function tests were all within normal limits.
Four times phase contrast microscopic examination of urine all revealed RBC > 8000,
and the percentages of poikilocytes were 85 %, 75 %, 70 % and 72 %. Her coagulation
screen, tumor markers and autoantibodies were all normal. She was admitted and for
further diagnosis, a renal biopsy was arranged.
Buqing
2011.03.23
A Day In The Life 18.9 (2011-03-24 23:07)
When a patient with a previously inserted catheter no longer needs it, a surgery is to be
carried out to remove it. I took part in one this afternoon.
There were two scars on the patientʼs abdomen due to former suture when the operation
of insertion was performed: one at the lower middle abdomen above symphysis pubis
about 3-4 cm long, one below the right costal arch around the opening the catheter went
through. Both sites were anesthetized and then the lower scar was dissected,
subcutaneous tissues separated, parietal peritoneum cut off, a tube disclosed beneath
and was then cut off. The distal part of the tube attached to the parietal peritoneum was
separated and was removed. Cutting closed. The other part sutured to the opening was
removed in a similar way.
Buqing
2011.03.24
A Day In The Life 18.10 (2011-03-25 23:07)
A lecture of hemodialysis was given to us by a doctor in the Blood Purification Center.
He emphasized indications and contraindications of hemodialysis separately with two
tricks to easily memorize.
Indications (AEIOU):
• Acidosis (except ketoacidosis which can be revised by internal medicine treatment)
• Electrolytes disturbance
• Intake (drugs, toxins, pesticides, etc)
• Overload
• Uremia
Contraindications (SHIFT):
• Shock (hypovolemic)
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• Heart failure
• Infant
• Fool (indicates uncooperative patients such as psychopaths)
• Tumor related cachexia
Buqing
2011.03.25
Eight Days A Week (Department of Neurology) (2011-03-27 23:07)
My final internal medicine department-Department of Nephrology has ended.
This has been a wonderful two-week experience that I feel like living in a big family
where everybody is so kind and generous to one another, where all obstacles will be
conquered with combined strengths.
Everyday after the morning shift, senior resident Ms. Jing Lin would give us a mini-
lecture on all kidney-related topics varying from mechanisms of kidney functions to
diagnosis of renal diseases to drugs and dialysis for nephropathies, etc. I enjoyed them
a lot, I learnt a lot.
The two operations I participated in had took me back to my days at Department of
General Surgery that when I stepped into the operating room, facing the apparatuses
and familiar nursesʼ faces, I couldnʼt help but wonder at the amazingness of memory.
Senior resident Ms. Pan Lin, Ms. Jing Lin, resident Mr. Shiyang Gu, Ms. Jing Cheng and
Ms. Xiaohong Chen, thank you for all the supports given to me, I do appreciate them.
Buqing
2011.03.27
A Day In The Life 19.1 (2011-03-28 23:07)
I was supposed to begin my days at Pediatrics Hospital today but I asked for a leave and
kept company with Monica to show her around Zhongshan Hospital. We went to the
office to complete some procedures this morning and attended the morning round at
Department of Gastroenterology. After that, we stayed there for a while to get ourselves
familiar with the histories of the patients. I tried to translate those for her and learnt
several terms I did not know. Pretty cool. In the afternoon, we paid a visit to Professor
Wang and took a tour around the whole hospital. We went out dinner together and
worked on a case given to her from the supervisor this afternoon. I had taken out Oxford
Handbook of Clinical Medicine, a drug reference on which I can find the English names
of some commonly used drugs and was still short of words sometimes. I must work
harder and be more acknowledged to meet the demands of efficient communication on
medicine!
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Buqing
2011.03.28
Update: 1. Monicaʼs stethoscope is worth about $150! 2. She didnʼt know how to switch
to English input on the Chinese input Nokia she rent, neither did she turn on Chinese
input on her MacBook Pro. Being a native English user is so cool that they donʼt have to
worry about different inputs, the keyboard has everything on it!
Buqing
2011.03.29
A Day In The Life 19.2 (2011-03-29 23:07)
After an one-hour trip, I arrived at Childrenʼs Hospital, Fudan University this morning. My
first department was NICU which had left me a wonderful memory about two years ago
when I came for probation: quiet environment (kidʼs cryings were exceptions), cozy
temperature, 24-hour coffee machine, etc., it was great!
This whole ward was exactly the same, only that doctors were of strange faces. At about
13:30, when I was sitting beside the desk reading patientsʼ records, the nurse in the
ward called for help that a 3-day-old male neonate had stopped breathing (apnea),
meanwhile with a dropping heart beat. Emergent actions were carried out immediately.
Mask ventilation and cardiac compression were applied separately by two doctors
immediately, at the same time, nurses were busily preparing epinephrine for injection.
Luckily, one or two minutes later, with no injection of epinephrine, the little creature
regained breath and his heart rate returned to 98bpm, blood pressure to 68/54mmHg.
In the evening, I and Monica worked out another case in her dormitory. I have so much
English and medicine to learn!
Buqing
2011.03.29
A Day In The Life 19.3 (2011-03-30 23:07)
More breathtaking than yesterdayʼs, this morning, another little baby in NICU had had a
sudden onset of apnea and after the failure of CPR, tracheal intubation had to be carried
out. The baby was lying across the bed and a male doctor was standing at one side of
the bed, holding tight of his four extremities in case of unexpected movement. One
female doctor was standing at the other side of the bed performing intubation. She tried
several times both orally and nasally but did not succeed. Another female doctor took
over the tube and made several attempts to have finally orally put it into the right place,
confirmed by respiratory sounds auscultated by a stethoscope on the babyʼs chest when
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mechanical ventilation was applied. During the whole course, bloody fluids were
suctioned out times.
Bedside chest X-ray was also performed with the babyʼs four extremities fixed but by
heavy sandbags not by human power.
Buqing
2011.03.30
A Day In The Life 19.4 (2011-03-31 23:07)
I was curious about how ABGs were performed on babies. It turned out they were
exactly the same as on adults except that they were much more difficult due to babiesʼ
fragile pulse and uncooperativeness.
One very sad thing happened today was that a hydrocephalic full term new-born baby
died just several minutes after admission. I went to see it when the news was spreading
around the ward. It was lying quietly in the incubator, cyanotic all over, with eyes open,
and a head as big as its torso, or even bigger. I tried to feel its heartbeat but got nothing.
People were buzzing behind me, sighing for the leaving a life which would never be able
to see this colorful, filthy world.
Buqing
2011.03.31
2.4 April
A Day In The Life 19.5 (2011-04-01 23:07)
I went to Emergency Room this afternoon and stayed there for a whole shift. One thing
that one would never fail to notice was that, usually, a sick baby was companied by at
least three adults: its mother, father and grandmother, etc., making the little clinic full of
people always. Respiratory tract infection had been the commonest disease around and
other diseases I encountered included constipation, diarrhea and more. Severely ill
babies were being rescued in the room at the back of the clinic, where bedside monitors
and other equipments were supplied.
In the evening, I learnt how to test blood glucose on newborn babies. The only technical
difference from adults was the position of pricking that for babies, it was at the outer side
of the heel.
Buqing
2011.04.01
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A Day In The Life 19.6 (2011-04-04 23:07)
A 2-day-21-hour-old preterm(36+4w) male baby was vaginally delivered at 09:40a.m.
March 25th, 2011 due to PPROM seven hours before contraction (courtesy to Julie). The
amniotic fluid was clear, his Apgar score was 7 at one minute and 8 at five minutes after
birth, body weight was 3200g, details about umbilical cord and placenta were unknown.
He was diagnosed as ”perinatal asphyxia, premature infant” and given piperacillin,
fasting and intravenous infusion. Two days ago, he had an onset of vomiting yellow
green fluid. After 1 % sodium bicarbonate gastric lavage, glucose water was fed. One
day ago, he vomited coffee-like fluid so fasting and nasogastric intubation were applied.
Today, his abdomen began to swell and chest-abdomen X-ray showed
pneumoperitoneum. For further treatment, he was admitted into NICU of our hospital.
GP history of his mother was G1P1, 0-1-0-1 (full term, premature, abortion, live). She
had a history of cold at the second trimester and received IV infusion treatment (details
unknown). PE of the neonate: T: 35.7, P: 130bpm, R: 55/m, BP: 85/60mmHg, HC (head
circumference): 33.5cm, CC (chest circumference): 33cm, AC (abdominal
circumference): 38cm, height: 49cm, weight: 3.18kg.
Buqing
2011.04.04
A Day In The Life 19.7 (2011-04-05 23:07)
A 22-hour-old full term male neonate had an onset of moaning 4 hours after birth. He
was delivered vaginally at the gestational age of 37+2w, his birth weight was 2790g,
amniotic fluid was clear, umbilical cord and placenta were normal. Apgar score were 10
at both one and five minutes after birth. 18 hours ago, he began to moan, with spitting,
tachypnea and cyanosis all over the body. He was immediately oxygenated which raised
his SpO2 to 100 %, improved cyanosis at the extremities but had no effect to relive
moaning. He was then transferred to our hospitalʼs NICU. When admitted, he was still
moaning, with mild spitting, and had already begun breastfeeding. There was no
vomiting during the whole course. GP history of his mother was G1P1, 1-0-0-1. PE
showed T: 36.8, P: 138bpm, R: 70/m, BP: 50/35mmHg, HC: 33cm, CC: 31cm, AC: 30cm,
weight: 48cm, weight: 2,665g. Auscultation sounds of the lungs were coarse. Possbile
diagnosis would be TTN or neonatal pneumonia.
Buqing
2011.04.05
A Day In The Life 19.8 (2011-04-06 23:07)
An 8-day-old female neonate with a soft, cyst-like sphere protrusion at the sacral area
was diagnosed as spina bifida cystica with the aid of MRI and underwent a surgery
today. Two transverse dissections were made separately at the upper and lower borders
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of the protrusion to form a round opening, meninges were cut off, the plate-like mass of
nervous tissues were removed (including her coccyx), the remaining spinal cord and its
roots were put back into the spine. Meninges and skins were sutured. Since some of the
nerves at the caudal end of the spinal cord were cut off and removed, the patient would
have to live with incontinence (fecal and urinary) for all her life.
Buqing
2011.04.06
A Day In The Life 19.9 (2011-04-07 23:07)
I saw a lot today.
In the morning, an 8-month-old boy underwent a biopsy of a growth at the left of his
cheek which had intruded the left zygomatic bone. Previous PET-CT showed some other
abnormal locations throughout the body. During the surgery, specimen were delivered for
frozen section processing which defined it eosinophilic granuloma. So the dissection was
closed and chemotherapy would soon be arranged.
In the afternoon, before our myelomeningocele repair surgery began, I went to Room 12
where an open chest VSD repair operation was going on. This was the first time in my
life I saw a real heart bumping in someoneʼs chest. The pericardium had already been
cut off, disclosing the myocardium beneath. Just after the operators completed three
purse-string sutures before inserting the catheter into the aorta, I was phoned to attend a
small lecture for us interns. I went and when I came back, there was no one in there.
Then I caught the last several steps of our groupʼs surgery. A biological patch was
sutured with dura mater to prevent adhesion between it and the spinal cord. To be frank,
being a layman of neurosurgery, I didnʼt get much of what they were performing. I am on
my way, though.
Buqing
2011.04.07
A Day In The Life 19.10 (2011-04-08 23:07)
Our group had three surgeries today, I witnessed two and took part in the last one.
The first one was a indirect inguinal hernia of a boy. The key point of this surgery was to
find the spermatic cord, separate it and make sure it did not get hurt.
The following two were hydrocephalus babies underwent ventriculoperitoneal (VP)
shunt. An occipital burr hole was firstly made and a catheter was then inserted through it
to successfully drain clear, colorless CSF drips out. At the other side of the head, the
skin was cut off to form a little opening, and a long straight steel tube was used to create
a longitudinal subcutaneous canal down through the head, neck, chest and finally
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abdomen to a previously made longitudinal dissection above the umbilicus. It was so
brutal that I could barely keep looking! A catheter was place through the canal and
connected with the one inserted to the ventricle with a valve which only permitted CSF
flow towards the peritoneum. All dissections were sutured after making sure the catheter
was patent and worked well.
I am not sure if VP shut is worthwhile. One babyʼs lateral ventricles were as large as
almost half the diameter of the skull shown on MRI and parts of its occipital and temporal
lobes had already softened. Weʼve done what should be done, and all the remaining
depends on Lao Tian what we Chinese people pray to.
Buqing
2011.04.08
A Day In The Life 19.11 (2011-04-10 23:07)
During the teaching round, the chief doctor selected a hydrocephalus case where the
kidʼs lateral ventricles were almost 1/3 the diameter of the sections shown on cranial MRI
while the forth ventricle was of normal shape, thus defining it as a non-communicating
hydrocephalus.
Keys mentioned: Causes of hydrocephalus include:
• Obstructive (non-communicating): 4th ventricle does not enlarge
• Communicating: 4th ventricle also enlarged
Treatment for hydrocephalus:
• Remove obstruction
• Damage plexuses
• Drainage
Buqing
2011.04.10
A Day In The Life 19.12 (2011-04-11 23:07)
Today is my first day at Department of Neurology and I am on-call today.
In the evening after dinner, we three on-call doctors were sitting at the doctorʼs office and
shooting the bull. One happened to mention that he majored in Neurology and was doing
a research on EEG. Iʼd encountered some EEG reports in the daytime and was
confused about how to read them. Luckily, there was no emergencies requiring handling,
so we opened an EEG record on the computer and had a little discussion on this very
topic. Here are some clues I got: 1. Check the patientʼs age. 2. Check their mental
status. 3. Judge wave rhythms. 4. Compare records with reference. 5. Locate the
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abnormalities if there are. 6. Combine history, symptoms, signs, imaging, etc. to made a
diagnosis.
Buqing
2011.04.11
P.S. Seen from the highest building here, Childrenʼs Hospital at night is covered under a
tranquil while mysterious atmosphere. Good night.
A Day In The Life 19.13 (2011-04-12 23:07)
An eleven-year-old girl had a sudden onset of disturbance to move both eyes
horizontally and sometimes diplopia one month ago. She went to Eye & ENT Hospital
twelve days later and was diagnosed as strabismus. A pair of glasses were worn but
achieved no effect. Two weeks ago, she began to present with ptosis which worsened
from morning to evening with no dysphonia or dysphagia. Severity of ptosis advanced
day by day and she soon developed post-exercise fatigue. Five days ago, she went to a
local hospital and had a chest CT and cranial MRI which revealed no abnormalities of
her thymus and brain. For further diagnosis and treatment, she came to our hospitalʼs
outpatient clinic and was admitted as Myasthenia Gravis. Results of neostigmine test
and anti-nAChR antibody test were both positive. Pulse therapy of methylprednisolone
was administered immediately.
Buqing
2011.04.12
A Day In The Life 19.14 (2011-04-13 23:07)
Chief Professor Zhou came to morning shift and morning round today. During the shift,
when the residents were reporting patientsʼ conditions from bed to bed, she jotted key
elements for each one down on her little notebook and then selected several typical
ones for the following teaching round.
She spoke really fast but in a logic way, indicating that her brain was running at a super-
high speed. With a simple review of a patientʼs history, loads of questions would be
raised by her which were always the keys towards differential diagnosis. She was like a
walking textbook, if you really want to know the truth. Apart from being knowledgable,
she was very nice to us interns. After reviewed beside a patientʼs bed his disease, she
once again impart to us in the corridor on how the diagnosis was made. Seldom was a
professor so amicable. I enjoyed the teaching round much and am anticipating the one
next Wednesday.
Buqing
2011.04.13
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A Day In The Life 19.15 (2011-04-14 23:07)
One method for diagnosis of cranial infection is lumbar puncture and in Department of
Neurology, LP is a routinely performed process for patients with suspected CNS
infection. One big challenge here is that little babies are always uncooperative, thus
needing an assistant to hold tight of them. Another difference from adult LP is the
insertion spot. While L3/4 is always chosen for adult LP, L4/5 is more suitable for babies
since their conus medullaris are at a lower position. The distance of needle inserted is
always flexible on babies that when the ”give” is not clearly felt, several checking
(remove the stilette for CSF to flow out when the needle is at the right position) should
be done.
May I am lucky enough to do one in the following days.
Buqing
2011.04.14
A Day In The Life 19.16 (2011-04-15 23:07)
A 1-month-21-day old female baby was discovered by her mom of having a sudden
onset of rolling up both eyes and stiffness which lasted for several seconds and relieved
spontaneously for times at around 6:30 a.m. one day two months ago. An ambulance
was called to deliver it to a local hospital where intramuscular drugs (details unknown)
were injected immediately. It was then transferred to another local hospital where its
blood test showed WBC 24.45*10ˆ9/L, Hb 138g/L, PLT 213*10ˆ9/L, CRP 0.5mg/L;
cranial CT revealed possible intraventricular hemorrhage and calcification, external
hydrocephalus. Since they were not capable of handling this case, the baby was
transferred to our hospital.
Two months later, after a series of treatment, it is getting better except occasional
occurrences of swift, mild seizure. With the consent of its parents, Iʼve took some photos
of the cranial MRI performed two days ago.
Buqing
2011.04.15
A Day In The Life 19.17 (2011-04-18 23:07)
I went to the outpatient clinic this afternoon. There was a huge hall full of kids and their
parents waiting for consultancy. You can always guess, it was a mess. The physician told
me that each of them had to see more than 100 patients and there were more than 10 of
them which meant more than 1000 patients were received per day here.
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Judged from the patients we received, ”fever” had been the commonest chief complaint
due to either upper respiratory tract infection, diarrhea or some other causes.
One interesting thing happened this afternoon was when the mother of a kid with
respiratory tract infection took out her sonʼs cranial MRI to show us, the physician
pushed me forward because I was a to-be neurosurgeon. I scrutinized attentively and
saw nothing abnormal. Before making a conclusion, I required the report on which the
conclusion was the same. I then explained her sonʼs condition to her confidently and
advised her to do follow-up examinations if she was still worried.
Buqing
2011.04.18
A Day In The Life 19.18 (2011-04-19 23:07)
During the morning round when we were about to check a 10-year-old newly admitted
CNS infection (possible bacterial meningitis) little boy at his bedside, the associate chief
suddenly turned to me and required me to do a neurologic examination. Everybody cast
their eyesight on me immediately and I began to feel sort of nervous. Luckily, last
evening, when I was writing the history of a patient admitted, I reviewed some key points
in neurologic examination including names of the pathologic reflexes and their
presentations. With the cooperation of the little boy, I finished the whole neurologic
examination and the physician seemed satisfied.
In the evening, I attended a lecture on ”Reasonable Use of Antibiotics” which was great.
The lecturer was sure to be a very experienced physician and the slides showed were
clearly made. Once again, I reviewed antibiotics from different aspects and though I still
find it pretty hard to handle, I now have a better understanding of them.
Buqing
2011.04.19
A Day In The Life 19.19 (2011-04-20 23:07)
Wednesday again, Chief Professor Zhou came for morning round today. This time, she
brought her computer and showed us a clip of a patient with a kind of very uncommon
disorder – Exercise-induced Paroxysmal Dyskinesia.
Dystonic/dyskinetic attacks are precipitated by prolonged exercise which supervenes
after 30-60 minutes of exercise and lasts 5-30 minutes, may also respond to
carbamazepine. Seen from the clip, the 8-year-old girl presented with imbalance due to
dyskinesia after a 10 minutes walking which was relieved following a short period of
time, thus excluded Myasthenia Gravis. Treatment was to take oxcarbazepine orally.
Since few papers reported this rare disorder, prognosis remained unknown.
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Some other key points Professor Zhou mentioned today are listed below:
Persistent increasing ICP with no infection or congenital malformation of the brain should
be considered of venous sinus occlusion.
Notes about CNS infection:
• Herpes simplex may induce intracranial hemorrhage which leads to stiffness.
• Pyogenic infection may impair auditory acuity.
• Fungal infection may lead to blindness.
Buqing
2011.04.20
A Day In The Life 19.20 (2011-04-21 23:07)
An 8-year-7-month old girl was discovered of having lower IQ compared with peers
about 3 years ago when she first went to kindergarten. She was then unsociable, easily
irritated, able to recited 7-8 poems, understood only simple instructions, and could not
comprehend stories. She was diagnosed as ”mental retardation” at a local hospital with
an IQ<55. Cranial CT scan showed enlarged sulci, thickening of the outer and inner
tables of the skull and diploe. Chromosome testing showed: 46, XX. She was given
cerebroprotein hydrolysate orally for half a year which gained no effect. Meanwhile, the
kid began to develop a diminished speech ability and disabilities to put on clothes, eat,
urinate and defecate. For further diagnosis and treatment, the family came to our
hospital. DST showed her motor ability equal to that of two-yearsʼ, social adjustment
equal to that of 7 monthsʼ and IQ equal to that of 9 monthsʼ. Cranial MRI depicted
cerebral atrophy, little softening at the right insular lobe and gliosis lesions at both
thalami. Chem-7 were all within normal ranges. Awake EEG showed slowing of the basic
electronic activity at both posterior hemispheres, mainly 5-6Hz theta and delta waves;
spikes, sharp and slow wave complexes, spike and slow wave complexes were seen
bilaterally, especially anteriorly bilaterally. Sleep EEG showed normal sleeping waves
bilaterally; spikes, sharp and slow wave complexes, spike and slow wave complexes
were seen bilaterally, especially anteriorly bilaterally. She was admitted as
”nonconvulsive status epilepticus”. Physical examination showed intact consciousness,
good mental spirit, hyperkinetic behaviors, no reply to questions, uncooperativeness in
examination, low nasal bridge, mild hypertelorism, grade V muscle power, normal
muscle tone, no simian line, normal reflexes and no pathological reflexes.
Today, a respected old professor came to morning round for this case. He put forward a
diagnosis that none of us had ever considered before (I hadnʼt even heard of): Rett
Syndrome. Everybody began to read the textbooks immediately and was amazed by the
high similarity between the patientʼs presentation and description on the books. The only
defect was that she lacked a history of loss of purposeful hand movements. Genetic
testing was arranged for confirmed diagnosis.
Buqing
2011.04.21
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A Day In The Life 19.21 (2011-04-22 23:07)
A 10-year-old girl began to have sudden onsets of falls during the last half year. She was
tested by examinations possible for diagnosis and all the results were normal. Typical
onset was a sudden fall straight down to the ground with no inducing factors at all. This
might happen any time at any place. She was admitted for 24-hour EEG at our hospital
which also revealed no abnormality. Her IQ was 120 and she always scored No.1 at
tests in school. Psychotherapist was called for consultancy. After the conversation, we
learnt that her parents lived separately at two places and most of the time she lived with
her mother. Every time her father was about to leave the place where she and her
mother lived, she began to take falls.
A smart girl yearning for love acted in real life.
Buqing
2011.04.22
Eight Days A Week (Childrenʼs Hospital, Fudan University) (2011-04-24 23:07)
Two hours commute a day, Childrenʼs Hospital is that far from school.
During lunch time the first day I worked there, I tweeted ”The most delicious cafeteria
Iʼve ever been to!”. Lunch provided by the hospital cafeteria are so fabulous that I rank it
the best of all the hospital and school cafeterias Iʼve ever been to.
Being a hospital for kids, there are cartoons everywhere: in the elevators, in the clinic
rooms, on the floors, even in the rest rooms. Guess what, some doctors also have small
toys on their stethoscopes to use for the examination of the patientsʼ eyesight and eye
movements.
NICU was the fist department I went to. It was cozy in there and free coffee was
provided. Doctors at 21NICU are required to wear clean clothes like the ones surgeons
wear in the operating rooms which are dumped everyday after work and the trousers
seem to have more pockets than you need – 5 in all: one on the back, four on the side –
two for each side. Those pass-aways and successful rescues all left strong impressions
on me. How can a new soul so fragile undertakes so much miseries? With the giving by
the doctors, they will get better and see how colorful this world is. My sincere gratitude to
Attending doctor Lan Zhang for all the care.
Neurosurgery Department was the second one I visited. The teachers there were all very
warm-kinded. They taught me a lot within this so short 4-day rotation. Time spent in the
operating room was valuable, I indulged myself closer to neurosurgeons and their efforts
to save patientsʼ lives. My sincere gratitude to chief Mr. Hao Li, attending doctor Wei Shi
and resident Haitao Zhu for all the help.
Neurology Department was the last department and I spent two weeks there, witnessing
doctors taking care of kids, encouraging them and helping them to finally get better.
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Some patients were regular ones for serial therapies and you could feel they and the
doctors were like a big family. Thanks to the two-week rotation, I now have a deeper
understanding of neurology physical examination, laboratory tests, certain kinds of
diseases and more. My sincere gratitude to chief Shuizhen Zhou, attending doctor Lifei
Yu, resident Shujuan Guo and Yunjian Zhang for all the support.
Kids are the hope , the future of our society. I wish them all healthy and happy growing
up.
Buqing
2011.04.24
A Day In The Life 20.1 (2011-04-25 23:07)
We had a meeting this morning in which the supervisor gave us a brief introduction of
our tasks in the following month. Seemed it would be a much different experience
working at a community hospital than at a third-level 1st class hospital (see below). I am
expecting that.
In the afternoon, we went to a community hospital and a director hosted a lecture on
current conditions of that hospital and all the work they were doing there. It was
fantastic! Besides providing patients with medical cares, they also established with
patients a more close relationship than ordinary physician-patient relationship by
spending more time with them and checking regular follow-ups for them (sometimes they
even went to the patientsʼ homes to do the examinations). All these were not that
realistic in big hospitals where it was always so crowded that doctors even did not have
much time to communicate with patients and their families.
I will have a better feel of how things work out in community hospitals in the following
days.
Buqing
2011.04.25
A Day In The Life 20.2 (2011-04-26 23:07)
We were on the wheel today.
In the morning, we visited Minhang CDC where a lecture was given on their main tasks
such as advocating on how to prevent diseases like hypertension, diabetes mellitus,
tumor, etc. from happening. I hadnʼt realized before the significance of their work that
covering the populaceʼs health from a gross point of view and making a difference by
beating the diseases ahead of their happening is so remarkable.
After that, we visited Minhang Maternal and Child Health Care Service Center (tertiary).
Under the lead of a guider, we toured the whole hospital and were amazed by their
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modernness. They owned new wards with advanced equipments, allowing patients to
live comfortably with no disturbances. I considered it a very good concept to be
examined and diagnosed at tertiary hospitals and treated here. They also offered various
free tests for little kids which composed an essential part of child care service.
We then went back to Minhang CDC, had our lunch and took a rest.
At about 13:00, we started our trip towards a primary health care service center. I donʼt
know why we skipped the secondary health care service center. It was set up besides a
river and since it was so small, there were only about 4-5 rooms. We sat at a
communicating room and a middle-aged women accepted us. She talked a lot about
their achievements in a vivid way that we began to treat working here as maybe the best
job ever. There was a cabinet in the room in which some contraceptive tools including all
kinds of condoms and books and VCDs on how to have a happy husband-wife life were
on exhibit and could be borrowed for free. On the wall, slogan ”Warm, Kind, Considerate,
Confidential” was also very attractive.
We were back at school at about 15:30.
The experience today greatly changed my understanding of the health care service
system in China. I learnt that third-level 1st class hospitals are only a small part of the
system and the contributions of the remaining hospitals are non-negligible. Money
devoted by the Chinese government reasonably used for the care of ordinary people is
another deed I appreciate.
Buqing
2011.04.26
A Day In The Life 20.3 (2011-04-27 23:07)
My first day working at a community healthcare center.
At first, the supervisor gave me a brief introduction of the online network system for the
residents under control of this center which contained all their information including
name, gender, age, address, ID card number, social security card number, phone
number and a core sheet, etc. The core sheet recorded not only each residentʼs basic
information, but also covered their education, occupation, past medical history,
vaccination condition, risk factors, exercises and more. At present, these data are not
available from other hospitals. But in the near future, a patientʼs complete profile could
be obtained online from any hospital, thus helping to made a more individualized
treatment for them.
One community healthcare center takes charge of several communities and the
supervisor assigned me a task to input date for the communities this center is
responsible for. A house is treated as a unit and a list is made to identified whether the
profile of a certain house is established. There are several categories: some established,
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some not, some rented, some not used for living, some rejected, etc. After finishing this
list, staff members will go to the un-established ones to set up a profile for them.
Buqing
2011.04.27
A Day In The Life 20.4 (2011-04-28 23:07)
I interviewed a senile women this morning and made a health promotion plan for her.
She was an 80-year-old female who had been suffering from hypertension for 5 years
and DM for 3 three years. She had been taking oral medications to control these two
diseases and was in a not-bad health condition. Her BMI was 28.04, indicating she was
in an overweight status. She told me that she seldom exercised so I proposed to set up
a walking plan for her. During the following weeks, she would be getting up early in the
morning and going out for a half-an-hour walk from 6:30 to 7:00. The exercise intensity
would be reaching mild perspiration and raising of heartbeat. She accepted this plan
contently and had 100 % confidence to achieve it. We agreed to meet again on 9th, May.
Buqing
2011.04.28
A Day In The Life 20.5 (2011-04-29 23:07)
An 81-year-old male came for IV infusion to treat his upper respiratory tract infection. We
talked for a while and I learnt that he had been suffering from hypertension for 10 years
and DM for 7 years, and both, were steadily maintained by taking oral medications.
About five years ago, he got a stroke and had ever since had trouble walking. So he was
carrying a stick with him everywhere. He was a sailor before and used to swim a lot, but
could not do so after the stroke, neither could he do any other exercises. He liked salty
food which was a risk factor for his hypertension. We made a health promotion plan of
lowering the salt concentration (about half quantity as before) in the dishes he took for
the following several weeks to help control his hypertension, but he had only 70 %
confidence in accomplishing this plan. I encouraged him by listing all the benefits he
would gain and we agreed to meet again soon.
Buqing
2011.04.29
2.5 May
A Day In The Life 20.6 (2011-05-03 23:07)
I was inputing the data and the supervisor was making some phone calls. She was doing
the follow-up of several infectious disease patients. When a patient from Shanghai was
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diagnosed as having infectious disease (e.g. hepatitis A, etc.) in any hospital at
Shanghai, the case would be immediately reported onto an online network so that
people working in the CDC would get the information at once. Then, follow-up task would
be assigned to the health care center taking charge of the patientʼs community. There
was a sheet on which the important information is listed all which should be inquired
during the follow-up. The supervisor showed me one sheet and I consider it a very good
teaching material for infectious diseases.
Buqing
2011.05.03
A Day In The Life 20.7 (2011-05-05 23:07)
With several daysʼ hard working, I finally completed inputing all the data into the sheet.
The job itself was easy to manipulate, meanwhile the process was long and sort of
boring. Thanks to Excel, the software designed by Microsoft, I could simplify some
procedures by its ”search and replace” function. The only problem was on Windows,
when the cursor is hovering upon a window that is inactive, you can not just roll down
the roller on the mouse to see the content beneath the border of that window. Which, on
Macintosh, is feasible, no matter weather the window is active or not. So I had to switch
between windows all the time which was pretty annoying. Anyway, I am happy to be part
of the project for the better health of the residents in the community.
Buqing
2011.05.05
A Day In The Life 20.8 (2011-05-09 23:07)
I went to a patientʼs home this afternoon with physician Ms. Sun to do a family care plan.
It was an 80-some-year-old granny who lived alone because her husband had just
passed away half a year ago. She had been suffering from type2 diabetes mellitus,
hypertension and COPD for years. Ms. Sun was doing the physical examination and
prescribing medications and I was inquiring the information I need. Judged from her
current condition, the biggest problem troubling her was the feeling of loss and
loneliness. Because she had a history of tibial fracture and did not move much, basically
doing indoor activities, the only feasible entertainment left was watching TV. So we made
a plan. We picked up a TV program she was interested in and averagely divided it into
several parts, allotted each to a certain day during the following week (she watches it
using a DVD player). Now, sheʼd got things to do!
We agreed to meet again one week later.
Buqing
2011.05.09
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A Day In The Life 20.9 (2011-05-10 23:07)
In A Day In The Life 20.4, I and a granny worked out a morning exercise plan and the
follow-up turned out to be a pretty good result. She was feeling satisfied with her
performance and was very pleased to hear me appreciating her persistence. But, as
summer is approaching, even though in the early morning, itʼs getting hotter each day
and she intended to quit. We negotiated on the possibility of continuing the plan for quite
a while and finally came to a compromise: during summer days, morning walk time was
advanced to 6:00 and shortened to 20 minutes. I do hope she will hold on and be
healthy.
Buqing
2011.05.10
A Day In The Life 20.10 (2011-05-11 23:07)
Several days ago (A Day In The Life 20.5), I and a grandpa worked out a health plan,
trying to better control his blood pressure by limiting the sodium contents in his dishes.
The follow-up turned out to be a disappointing. He was used to be a sailor and fond of
eating salty so that the plan was almost abandoned. His inability to do exercises also
constrained the carrying out of this option. Nevertheless, he was optimistic about life,
always in a mood of happiness which constituted a great portion of the hope to live
longer. His wifeʼs health condition was not bad and they two shared a harmonious
atmosphere living together. I do wish them a joyful remaining.
Buqing
2011.05.11
A Day In The Life 20.11 (2011-05-12 23:07)
For people older than 70 years, a follow-up card is established for each to record their
ophthalmic conditions. I made several calls to take down a fewʼs current conditions.
While some phone calls went pretty well after I made clear of my identity, some didnʼt.
No matter how hard did I explain the purpose of setting up such a database, people just
did not believe me. There was one who treated me as a fraud, using phone calls to try to
cheat her. Finally, my supervisor took the phone over and amazingly handled it
successfully. Err, the art of communication? Exactly, this was not what was important,
the real problem was this is a society where there are all kinds of deceits that people do
not trust each other.
Buqing
2011.05.12
A Day In The Life 20.12 (2011-05-13 23:07)
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A 75-year-old post-stroke patient came to community hospital for anti-coagulation
intravenous fusion therapy. He used to be a leader in a government institution. Three
years ago, he experienced a sudden onset of lacunar infarct which, fortunately, left no
functional disability. He also had hypertension for 30 years and DM for 20 years. He had
a very regular living habit, meanwhile did not smoke nor drink alcohol. I suggested him
do more exercise since he spent most of the time staying at home watching TV. Finally,
we agreed on a bicycling plan that he would spend the following week riding bicycle
twice a day, from 7:00-7:30 and 16:00-16:30 separately.
Buqing
2011.05.13
A Day In The Life 20.13 (2011-05-16 23:07)
I went to the community health center today. To my surprise, unlike rumored ”Patients all
like jamming into tertiary hospitals and leaving community hospital empty”, there were
loads of patients coming for consultancy, among which most were senile ones. I helped
the supervisor check the already input information of some reported death cases from
some nearby hospitals among which I saw several familiar reportersʼ names from
emergency room of Zhongshan Hospital I met when I was doing my rotation there. I
remember at that time, my supervisor once filled out one thus card and now I understand
why it was done and where it finally went to. Most of the death cases were people older
than 60 and the most common cause was stroke, with acute MI following.
Buqing
2011.05.16
A Day In The Life 20.14 (2011-05-17 23:07)
One thing community doctors do is to pay postpartum follow-up visits to the patientʼs
homes. I and Ms. Wang visited three families this afternoon.
For the baby, its temperature, weight, feeding method, sleeping time, defecation
condition, etc. are checked. For the mother, her temperature, lochia, abdominal scar
condition (for cesareans), vaginal scar condition (for normal labors), breast secretion
condition, etc. are checked.
The first family we visited where the mother just caught a cold and was separated from
the little boy. Her temperature raised to 38.5 and was advised to see the doctor by Ms.
Wang, in case of puerperal fever. The second family kept a huge dog which almost
scared the shit out of us. The third mother gave birth of baby via normal labour which
caused a hematoma at the left side of its head.
All three babies were boys.
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Buqing
2011.05.17
A Day In The Life 20.15 (2011-05-18 23:07)
I visited the child care outpatient clinic this morning.
The clinic was divided into two parts: ”Vaccination Department” and ”Development
Evaluation Department”. At the vaccination department, babies at due time came to get
shot of vaccines. Their health conditions were at first evaluated to exclude unsuitable
ones. After the shot, the babies were required to stay for at least 30 minutes in case of
emergencies such as acute allergy. At the development evaluation department, a babyʼs
condition was evaluated according to its age, while weight, height, feeding method, etc
were all measured no matter how old the baby was. Parents were also taught by the
experienced physician what to do to better support their kidsʼ development both
physically and mentally.
Buqing
2011.05.18
A Day In The Life 20.16 (2011-05-19 23:07)
Community hospitals are responsible for the health of the populace, they do reports
annually to cover facts including the populaceʼs total health condition, risk factors
existing, and what can be done to avoid diseases, etc. From these reports, not only
could information about current state of the populace be obtained, but also trends
concerning these facts could be deduced by comparing figures from different years. I
helped to organize one at the health care service center and thus forged a brief
impression that hypertension being the most frequently occurred disease among the
populace, with CAD, COPD and DM following behind. As for infectious diseases,
dysentery ranked first and hepatitis B was the second. Breast cancer was the top on the
list of malignant tumors, with gastric and colon cancer on the second and third place.
The number of people who are suffering from lacking of exercise, the main risk factor,
doubles that of those who are complaining about stress. Prevention strategies including
health education, regular examination, and more.
Buqing
2011.05.19
Eight Days A Week (Preventive Medicine) (2011-05-22 23:07)
This one month internship greatly changed my understanding of medicine. This is the
first time I become aware of that there exist a group of people, who are doing things for
the better of the whole population. I also learnt that doctors and patients can be more
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than merely a relationship of treating and being treated, they can be like a family: the
doctors treat the patients in the way they do to treat family members meanwhile the
patients 100 % trust the doctors and tell them whatever from the bottom of their hearts.
Different from consultancies in tertiary hospitals, you feel warmth and sentiment here.
The trip visiting infrastructures of the three-grade health care web was another
unforgettable experience. It was where I realized tertiary hospitals were only a small
fraction of the whole health care system and the efforts of the government in maintaining
a more stable and healthier society. I am strengthened.
Buqing
2011.05.22
A Day In The Life 21.1 (2011-05-23 23:07)
Anybody expected a test the very first morning arriving at the hospital? I did not.
After the check-in, the supervisor gave us a little lecture on how to perform obstetric and
gynecological examinations. There were models mimicking real person lying on the desk
and the supervisor explained the key points orally while performing on them. After that,
she gave us about five minutes to review the textbook and then began the test. We
learnt fresh, and did fresh on the models. The gynecological model I performed on
seemed to have a mass at her uterus which was very easily palpable. When palpating
the obstetrics model, I found it hard to tell the fetusʼs head from its buttocks by applying
the principle the supervisor just told us: ”The fetusʼs head is always harder.”
God knows how much I scored.
Buqing
2011.05.24
A Day In The Life 21.2 (2011-05-24 23:07)
This afternoon was bedside teaching time. We went to visit a to-be mother suffering from
hypertension, proteinuria and edema, who was newly-admitted this morning. This patient
was a typical example of preeclampsia admitted for further examinations including 24-
hour urinary protein measurement to evaluate the severity of her condition. Her blood
pressure was 160/115 mmHg, proteinuria (+ ++) and had obvious pretibial pitting edema.
However, her condition was stable at present. After familiarized with her history, we went
to a conference room and were given a lecture on pre-eclampsia by the supervisor.
Buqing
2011.05.24
A Day In The Life 21.3 (2011-05-25 23:07)
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Two doctors shared one big outpatient clinic room which was separated by a board in
the middle, with a passage at the far end to the door. A mother came for post-partum
regular examination when it was approaching the closing time, bringing her little 45-day-
old baby along. When she was about to lie down in the examination table, she found
there was nowhere to put the baby as only she and the doctor were in the one half of the
big room. The doctor asked me, the time at the other half of the room, to help. So I stoop
up immediately, went over and took the baby from the mother. The little creature was a
little nervous lying in my arms, frowning and glancing aimlessly around. It was so cute. I
patted its fatty buttocks gently, and laughed as it began to smile.
Its eyes were so pure and bright.
Buqing
2011.05.25
A Day In The Life 21.4 (2011-05-26 23:07)
I was in the delivery room today, with seven soon-to-be-real mothers. Two of them were
accepting IV oxytocin to promote labor, and was under fetal monitoring, which recorded
both the heart beat of the fetus and the contraction of the uterus. Then, after Iʼd finished
measuring all the mothersʼ blood pressure, there was a third mother in need of fetal
monitoring. The supervisor suggested me go and set up the machine. Even though Iʼd
learnt how, it was one and a half years ago, which meant I totally forgot the procedures.
The supervisor, with no other choice, had to teach me step by step from the very
beginning. It was not that hard, I had to say, at least one could find the fetusʼs heart
accurately and hear its beating clearly from the machine.
Buqing
2011.05.26
A Day In The Life 21.5 (2011-05-27 23:07)
As I mentioned yesterday, some mothers in here were undergoing IV oxytocin to
promote labor. For these mothers, fetal monitoring was a must. Doctors were taking
down some data at 15-minute intervals to make sure everything went well. These date
included time, fetal heart rate, position of the fetusʼs heart related to the motherʼs
abdomen, uterine contraction intervals, intensity of the contractions of the uterus, speed
of IV oxytocin, etc. In conditions where the contraction hindered the fetusʼs respiration,
or the contraction implied labor, termination of pregnancy should be considered.
Buqing
2011.05.27
A Day In The Life 21.6 (2011-05-30 23:07)
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A 25-year-old G1P0 female pregnant for 40 weeks and 5 days was admitted 7 hours
after an onset of abdominal pain. There was no vaginal bleeding or rupture of
membranes. Since four months of pregnancy, she could feel the move of the fetus. Her
regular examinations all went well which had ruled out certain hereditary diseases as
well as abnormalities. She used to have regular menstruations of 4-5d/28d and her last
one was on August 15th, 2010, expected date of delivery was May 22nd, 2011. There
had been no diarrhea and coitus in the last week, no hepatitis or any other disease
history, no history of surgery and trauma, no drug or food allergies. Physical examination
demonstrated no positive discoveries. She was given nasal oxygen and fetal monitoring.
Buqing
2011.05.30
A Day In The Life 21.7 (2011-05-31 23:07)
Bedside teaching this afternoon again. We first went to a 38-week pregnant mother to
have a little lecture on how to read fetal monitoring report. Attending doctor Mr. Ruzhi Li
took out one pile of paper from this patientʼs chart, unfolded it, turned it into a long piece
and presented it on the bed. He talked about half an hour about how to analyzed the two
waving lines on the paper.
Then, we went to a newly discovered cervical cancer patient on another ward. The
teacher left us alone to inquire her past history. I went forward and acted as the
representative of our group. Apart from ordinary information, I paid extra attention to her
past history on delivery times and means, menstruation conditions, vaginal bleedings,
abdominal and pelvic pain, etc. She seemed very nervous and refused my offer of a
physical examination.
Buqing
2011.05.31
2.6 June
A Day In The Life 21.8 (2011-06-01 23:07)
One thing doctors do here is to change dressings for post-caesarean mothers. As I
came, I took over the job. After my entering the rooms, with dressing-changing package
on hands, most patients and their familiesʼ fist reaction was ”How come you are a male
doctor?”, which, though seldom embarrassed me (many times encountered), still tensed
the atmosphere. Some patients were very unwilling to pull their pants just a little down to
expose the section. Thanks to the practice at Department of General Surgery, I now can
handle dressing changing smoothly and confidently which undoubtedly eased their
nerves soon. Transverse resection is the standard method in this hospital and due to the
doctorsʼ great expertise, little to none seepage could be seen.
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Buqing
2011.06.01
P.S. Happy childrenʼs day!
A Day In The Life 21.9 (2011-06-02 23:07)
Every month, doctors in this hospital change shifts. Today, the second day of June, the
new resident did not show up, though some of her stuffs including the water bottle with
her name on it were on the desk, and her account had already logged in on the
computer. Bed No. 12 was going to be discharged tomorrow so that the task of writing
the discharge summary fell on me. The job itself was not new to me, what I needed to
learn was obstetrics-specified details which could be obtained from other patientsʼ
discharge summaries on the computer system. Then, I sat down and began to write.
About half an hour later, I finished. I was about to print it out as I took over this patientʼs
chart and suddenly found a discharge summary in it! It seemed the previous resident
had done her job better than could be expected. The strange thing was that there was no
discharge summary in record on the computer, otherwise, I could have discovered it at
the first place. Anyway, I had written one more discharge summary and thus improved
my ability.
Buqing
2011.06.02
A Day In The Life 21.10 (2011-06-07 23:07)
My first day at the gynecology inpatient department.
The first thing I learnt was the supervisor on the list had shifted to another position and I
had to wait for the chief to assign a new supervisor. A similar situation followed. Both our
middle groupʼs attending doctor and chief were at the outpatient department today,
leaving no one to lead us through the morning round. Finally, the 1st groupʼs attending
doctor joined us after finishing their groupʼs morning round.
In the afternoon, we were given a lecture on antepartum vaginal bleeding. The lecturer
was amazing. Heʼd got very clear thread on what to say and guided us just smoothly and
logically. I loved that.
Buqing
2011.06.07
A Day In The Life 21.11 (2011-06-08 23:07)
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A 27-year-old female with a menolipsis of 31 days had an onset of vaginal bleeding 14
days ago came to our hospitalʼs outpatient clinic (3rd June, 2011). Her menstruation was
regular ever since she was 16 years old with a 5 days span of 30 days intervals. Her
LMP was on 20th April, 2011 and PMP (previous menstrual period) was on 1st March,
2011. Since 20th May, 2011, she had been having a continuous vaginal bleeding of little
volumes with no abdominal pain and no discharge of fleshy tissues. Urine HCG test on
the same day was positive. Ultrasonography done at our hospital demonstrated mixed
mass at the left pelvic cavity, probably originated from the Fallopian tube from which,
fetal heart could be seen. Ectopic pregnancy was thus highly suspected and she was
admitted for surgery.
Buqing
2011.06.08
A Day In The Life 21.12 (2011-06-09 23:07)
A couple came to our hospital after two years' trying to conceive but failed. The 32-year-
old female's menarche came when she was 15 years old and her menstruation was
regular, lasting for 6 days between 30 days intervals. She underwent an artificial abortion
7 years ago, and during the last two years, though no contraceptive methods were
applied, she failed to get pregnant. The husband's semen test result was normal. During
laboratory tests, dominant follicle could been seen under ultrasonography and HSG
revealed both Fallopian tubes patent but not smooth, with great possibility of adhesion at
the fimbriae, especially the right side. She was then admitted as "secondary infertility,
Fallopian tubes inflammation".
Buqing
2011.06.09
A Day In The Life (OSCE) (2011-06-11 23:07)
Terminology:
OSCE: Objective Structured Clinical Examination; SP: Standardized Patient; LS: Long
Station; SS: Shot Station, OS: Operation Station.
Being a part of the internship, I took the OSCE today. My process went as LS2, LS1,
SS2, SS3, OS, and SS1, from 11:00 a.m. to 12:20 p.m. I was a little nervous at the first
station, mostly due to the lack of experience for this kind of test so that I sort of screwed
it up by forgetting to inquire some key information about the patient's disease. As for the
second station, I began to have some feeling and acted more confidently. SS did not
require physical examination and the emphasis was on past history inquiring. I followed
the sequences on written medical history to do the inquisition so that nothing got missed.
The best part, the one I like most was the feedback given by the SPs. They would point
out what I'd neglected and what was essential concerning the patient's condition. No
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doubt, this is what makes this kind of test different from the conventional ones and where
its true value is. I really benefited a lot.
Buqing
2011.06.11
A Day In The Life 21.13 (2011-06-13 23:07)
I went to the outpatient clinic this morning. The doctor there was a very tender female
attending who talked slowly and nicely to everybody. She was very experienced and
most of the patients were her regular ones who were suffering from infertility and were
doing the follow-ups to try to get pregnant. One thing impressed me most was when she
prescribed three different kinds of drugs for a new patient, the patient just could not
understand how to take them correctly. She did not get irritated, but had reiterated for
three times to finally make herself understood. For the patient's convenience, she even
gave the patient her personal mobile number. What a responsible doctor!
I've discovered another model today.
Buqing
2011.06.13
A Day In The Life 21.14 (2011-06-14 23:07)
The gynecologic department I was in was an integrated TCM and Western Medicine
department and not only did doctors here use western drugs to treat patients, they also
prescribed herbs for their patients. During the rounds, the attending doctor would require
the patients to stick out their tongues for inspection. This reminded me of the anti-TCM
activity on the internet not long ago that a bunch of guys on Twitter claimed that TCM is
not science, but superstition and should be dumped. At present, western medicine has
undoubtedly surpassed TCM in treating the patients all around the world and TCM is
widely considered to be a complement for the former. Either way, TCM still has its
vigorous action in China.
Buqing
2011.06.14
Eight Days A Week (Obstetrics And Gynecology Hospital) (2011-06-17 23:07)
My last stop: Obstetrics and Gynecology Hospital, Fudan University.
We were assigned to the newly-set-up location and in order to avoid trouble, I paid a visit
to the new hospital the Sunday before rotation. As anticipated, only by inquiring several
passersby did I finally find it. This new hospital was beautiful, followed the traditional red
tone as the old one, and all the infrastructures were fresh.
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Being a hospital especially for women, there are several features distinguishing it from
others. First, the number of female washrooms is twice as many as male washrooms, or
more. On some ward, the male washroom was just labeled as female. My supervisor
informed me the first day I went to ward, "Knock first before entering the washroom."
Second, there are many female security guards around the hospital. Among them, there
is one who have left me deep impression as every time I passed by, she was beautifying
herself. Third, "Female Only". Actually, this is what written on boards which can
frequently be seen at the entrance of many rooms. Several times, I was called to stop
without wearing my white coat on the way. Monica once told me that she could not
believe that on wards here several patients share a room together, only separated by
curtains. In the U.S., patients are very sensitive about their privacies and two is the
maximum number of the patients in a room.
The place I like most in this hospital is definitely the library. During break times, I would
come over and study. Most of the time, it was quite and cozy, perfect for taking a rest as
well.
Almost one year ago, I started my days as an intern. Today, it is all over.
Buqing
2011.06.17
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The End (2011-06-21 23:07)
From 19th July, 2010 to 17th June, 2011, 209 posts from "A Day In The Life" series, 21
posts from "Eight Days A Week" series plus this final post, my days as an intern should
be ended as perfect as a round circle.
I still remember when interviewed for Teacher's Day last year, I said this: "Learn from life
and save lives." It is no wonder that days in hospital were hard though happy and rich.
Everyday, new problems appeared one after one nonstop, reminding me to learn more
diligently. When miserably witnessing a patient's life lost just in front of me, I knew
medicine was a subject to be taken solemnly and there would be no finishing line on the
journey.
During the past year, these four wonderful books have served me so well that words are
not enough to express my gratitude. "Oxford Handbook of Clinical Medicine", "Dorland's
Medical Dictionary", "Lab & Diagnostic Tests" and "Merck Manual (Professional)", thank
you all so much!
There are so many people I want to thank as well. Not for your generous help and
patient teaching, I could not have learnt so much. Zhongshan Hospital is such a great
hospital that I do anticipate that my following two years working here would be
wonderful, too!
All in all, in retrospect, I am so proud of myself.
Buqing
2011.06.21
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