Rich dad poor dad

Ryan (my 9-year-old son) and I were watching TV the other day when the advertisement for The Apprentice Asia came on. This time round, the local billionaire entrepreneur, Tony Fernandez, gets to say the three dreaded words to potential candidates: YOU ARE FIRED!

My son was visibly impressed with Tony. He turned to me and said, “Daddy, do you know that this man owns Air Asia, a hotel chain and a football club?”

“Yes, I do”, I replied, feeling rather deflated.

I only fly in airplanes occasionally (and ironically, most times it’s Air Asia that I fly in), stays in hotels once in a while and doesn’t even like football!

A new sign?

I was just lamenting the other day to a group of medical students that very few clinical signs are discovered these days as most of them have been adequately described by various giants of medicine since antiquities. Nowadays we just read about them, rehearse looking for these signs while examining our patients and passing on the skills to others, often mentioning the persons credited for these famous signs – Murphy’s sign, Shamrock sign, Osler’s nodes, Janeway lesions, and the list goes on and on.

The other day, good fortune finally shined on me for I discovered, quite unexpectedly, a new clinical sign!

Or so I thought!

I was demonstrating to a group of medical students the proper way to palpate for the liver in a patient, being careful to time the insinuations of my fingers on the abdomen to the patient’s breathing rhythm. Just as I began to insinuate my fingers deeply on the patient’s abdomen as the patient breathed out, the patient suddenly cried out, “My foot! my foot!”.

I was stunned! I have never come across this peculiar sign before – an instantaneous reaction in the patient’s foot as a result of pressure applied to the abdomen! How amazing!

For a brief moment, I saw myself receiving the Nobel Prize for discovering a new clinical sign! I decided to name it the Jimbo Sign. The adulation! The praises! I could retire early! I could get my professorship instantly!

While I was ruminating about the implications of this new sign (the patient was quite vocal about the feeling on his foot at this point of time), it dawned upon me what had actually happened!

Just as I insinuated my fingers into the patient’s abdomen, the large number of medical students around the patient and I crowded closer to get a better look. The students who were at the foot end of the bed leaned their bodies against the movable table at the end of the bed, effectively pressing the table against the bed AND TRAPPING THE PATIENT’S RIGHT FOOT IN BETWEEN!!!!

I was mortified! A quick retreat by the offending students, a quick look at the much abused but undamaged foot and many humble apologies uttered thereafter left us with a much bemused patient who, while still in pain, accepted our apologies good heartedly.

Phew!

For love or for money?

Apparently Ryan, my 9-year-old son, has the perfect solution to the age-old question:

Would you marry for love or for money?

Here’s a conversation between him and my wife this morning:

Ryan: No, I won’t marry for money.
Wife: So you will marry for love?
Ryan: Errr don’t know. I am too young to get married.
After awhile, Ryan said excitedly, “I know! I know! I will marry for money , then after awhile (no sense of time), I will divorce her and take the money and run!”
Wife: Ryan that’s even more terrible!!!

I swear he did not get that from my side of the family.

Medical BS

I remember many years ago when I was a Masters student doing my neurology rotation, I was asked to perform a neurological examination on a patient and come up with the diagnosis during the dreaded ‘Tuesday Morning Meetings’. The reason why these meetings were dreaded by us (Masters student) was because we never knew who would be the unlucky one to be picked by the consultant to do exactly what I was asked to do that Tuesday morning, in front of an audience consisting of fellow (much-relieved-they-were-not-picked) students, senior neurology consultants, consultants, specialists, pathologists, pediatricians, microbiologists, etc.

Naturally I was a bundle of nerves. My understanding of neurology those days was shaky at best and after performing what I felt to be a disastrous physical examination on the patient, I offered my diagnosis. The words tumbled out of my mouth like verbal diarrhoea. I didn’t even understand nor believe what I said!

The room went silent. I suspected more than half the people in the room didn’t know the diagnosis either. And finally, after what seemed like an eternity, the senior consultant finally spoke. Hs words were few but the impact was great. He said:

“Let us congratulate Dr Jimbo here because today he has invented a new Syndrome! We should name it after him!”

He was being sarcastic of course. There was no standing ovation.

They say what goes round comes round and sure enough, many years later, I find myself in the role of a consultant trying to coax the diagnosis out of a 3rd year medical student. For two days I repeatedly asked him to give the diagnosis for atrophy of the quadriceps muscles in a man with advanced uncontrolled diabetes.

Numerous answers were offered by him and each time I said “No, that is incorrect”.

This morning, in what appeared to be a final exasperated attempt, the student came up to me confidently and said that he knew the answer! I was delighted naturally because finally the fellow has done some reading and found the answer!

He looked at me confidently and said:

“The patient’s thigh muscles are wasted because the nutrients have leached out from his thighs through the skin”!!!

Good grief!

I didn’t know whether to laugh or to cry in despair because the medical BS he dished out was both tragic and comedic at the same time!

My reply to him was, “Wow! That’s a diagnosis straight out of an episode of Fringe!”

LOL!

260912@2355.

Deflated

This morning, I discovered a laminated piece of paper in my pigeon-hole. It’s a parting gift from the recent batch of my students who have graduated to become doctors.

On the paper were these words:

WORLD’S BEST TEACHER

My first reaction was that of elation.

Wow!!! World’s best teacher – ok, maybe it’s a bit too grandiose but surely it’s not too far from the (stretched) truth, isn’t it?!

I was mighty pleased with myself until my eyes caught sight of the same laminated piece of paper in every single pigeon holes of other teachers!!

Back to reality….

Instant deflation.

19092012@1050

PS: To the graduating batch of C110, well done and congratulations! I know you mean well.

Healing from the Dark Side

Yesterday I read an entry written in a patient’s case notes. It was written by a surgical colleague who reviewed the patient for management of hemorrhoids.

Among the measures prescribed by my colleague, I found one particular entry rather amusing.

He prescribed this: SITH BATH three times a day.

I couldn’t help but have a good laugh! I think what he meant was ‘Sitz Bath‘.

Or perhaps the fella’s from the Dark Side.

Treating cellulitis

I received this email from a fellow ID specialist and it made me laugh. Thought I’d share it here:

Written by Mark Crislip, MD, Infectious Diseases, 10:37PM Aug 20, 2012.

Two of my 4 consults today were cellulitis. Common disease. Allow me to pontificate on cellulitis. I am not talking about potential necrotizing fasciitis or processes associated with abscesses. I am talking diffuse erythema with fevers, chills and leukocytosis and no odd risks like swimming in brackish dog spit or something.

The microbiology of cellulitis is complex:

Strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, S. lugdunensis, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, MSSA, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, strep, and MRSA.

That makes for potentially complex treatment regimens. My order, presuming no allergies, for antibiotics in acute cellulitis is

cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, cefazolin, and cefazolin.

With that kind of complexity it is no wonder I see patients on Vancomycin. And Zosin. And meropenem. And Cipro. And clindamycin. I recently heard of a surgeon treating a post op sepsis/wound infection with aztreonam and metronidazole. Make it stop, please make it stop, it burns, it burns soooooooooo much*.

Patience. It takes 3 doses of antibiotic to get therapeutic, so cellulitis will often worsen for 1-2 days on therapy, stabilize for a day, then either recede or fade. Be patient. Don’t order an MRI or CT. Be patient!

Tell me the first word that comes to mind when you see this!

Spotted this sign outside IKEA in Kuala Lumpur. The first word that came to my mind was something related to the male gonads.

Long lasting protection

I saw a house officer in my clinic this morning. Several days ago he accidentally pricked himself while drawing blood from a patient. Fortunately for him the patient was low risk in terms of HIV transmission.

As per protocol I had to go through all the essential points when counseling him. Here’s part of the conversation between us:

Me: are you currently in a relationship?
Him: no.
Me: are you sexually active?
Him: (pause)…. No.
Me: in case you are, for the next 6 months you will have to use protection during sex.
Him: *chuckle*

We then went on to cover other areas pertaining to the issue of occupational exposure. Just before I wrapped up the consult he turned to me and asked:

“So, what you are saying is I have to wear a condom for the next 6 months?”

I decided to be witty and replied:

“Don’t be absurd, you can only wear a condom once. No one wears a condom for 6 months! That would be quite disgusting!”

He was stunned for a while and then we both had a good laugh.

The Dark Knight’s RISES!

 

Geddit?!