My Experience In The Course Of The Medical Elective
The first of July, my first day in the course of the medical elective, it was a dream for every medical student to have the opportunity to get a hands-on experience in the clinical and healthcare environment. I remember all the emotions and excitement I felt before entering medical school; happy, emotional, and ready to learn. Apart from the college studies, most of these feelings arise from what would be a real life experience as a doctor during those medical electives. When the day has come, I chose to startmy first elective in the pediatrics department, I was assigned with a specific group the “red team” that was led by general pediatrics consultant Dr.Asma Awadalla, may god grant her with success and good health, she was a doctor every medical student wishes to bea part of her team and under the mastery of her education and knowledge.
Every morning before the clinical rounds began, me, my sister, and my team partner amjad would sit together and discuss the basic sciences of pediatrics, we would assign a topic the day before and discuss it with each other for over an hour of time. Afterwards, a morning case discussion is held at the hospital conference room in which consultants, residents, interns, and medical students all attend to discuss a complex case. For example, one of the interesting cases that were discussed was an 8 year old female patient diagnosed with TB, already started her treatment plan, is experiencing some hallucinations and psychotic symptomswith no known cause of how. However, the resident that is presenting the case mentioned that it may be due to the TB medication the patient is using, proved by a reference of a research paperwhich stated that 1% of patients taking anti-TB medication may experience hallucinations and psychotic symptoms. The doctors were intrigued by the case in which the resident has presented, and started on negotiating other problems that could lead to those symptoms. Most of all, weren’t convinced that that 1% the research has proved would be the case here. Instead, they said that it might be due to isolation process at the beginning of diagnosis, consequently making the patient hallucinate, let alone keeping her away from her parents.
Right after the morning case discussion doctors and their teams would start their clinical rounds. We would always start from ward 47 at the 6th floor around 9:30 am, checking the newly admitted cases and patients. Before entering the patient’s room the doctor would ask the residentassigned to specific patient to read outtheirchart which included everything you need to know about the patient. For instance, the resident would start the case by identifying the patient, his date of admission and the reason why he was brought to the hospital which is called the chief complaint, he’d also mention the history of the presenting illness if it happened before, when did it start. After checking on the presenting illness the resident would state the medical history, specifically if the patient is suffering from any medical problems or has done any operations or has taken previous medications. In addition, the resident would also utter about thepregnancy or neonatal history mentioning the mode of delivery, the birth weight, and the length of gestation and so on.
Last but not least, after going through the milestones of the patient and his full history a whole systematic review as resort would be stated. During the time the resident mentions each step of the patient’s chart, Dr.Asma Awadalla would ask random questions about the patient and would testour basic science knowledge about the patient’s condition. When entering the patient’s room you’ll notice a precaution sign hung on the door that wouldindicate the severity of the patient’s case. For example, a patient with viral meningitis would have an airborne precaution sign which requires the visitor to follow a specific protocol before being exposed to the patient. Most of the following patients I encountered were the most shocking and influential events of my elective. As I will start writing about the interesting cases I’ve seen and practiced on, I’d like to begin with a very rare genetic case and end with the most tragic case I’ve seen in this summer medical elective.
Abdullah 7 year old patient with Canavan disease, it’s a disease in which nerve cells are deteriorated and are unable to communicate with one another thus signals are not transmitted. Abdullah was presented with an unusually large head size (macroencephaly), dysmorphic features, and short limbs.We first began on doing physical examination on the patient. Starting by the general approach we began by inspecting the overall look of the patient (skin color, dysmorphic features, etc.) then checking the vital signs, and palpation starting from the head till the very end of his lower limbs, and finally checking his developmental milestones for his age. We found that Abdullah has almost light control of his limbs or head due to weakness in his muscles a condition called hypotonia. Moreover, for a boy his age normally he is supposed to be able to speak and make full on sentences but unfortunately in his case he can only make sounds with no comprehensiveness. What was special and sad about his case is that neither family members nor close relatives used to visit him and he was always left alone with the nanny.
Khalid, a 41 day old infant brought to the General physician by his mom mainly due to fever and change in urine color from yellow to green but also due to crying on and off because of unknown irritability. The mother also added that her baby was vomiting in a projectile motion; she thinks it may be due to overfeeding. A complete history taking was done that stated the following: symptoms of upper respiratory tract infection were asked to eliminate it as a cause of fever, no change in activity and feeding which indicates that the baby is doing well in the basis of nutritional uptake, no joint swelling that would indicated systematic infection or sepsis, full term pregnancy, vaccination was all taken (hepatitis B, PCG vaccine). Physical examination was also done, starting with inspection the patient was looking well, well perfusion, warm extremities, no skin color changes, a previous lumbar puncture scar was done due to scar shown in the back , and no signs of pallet. Vital signs confirmed good and strong pulses, no tachycardia, and normal glucose levels. Some signs must be checked to eliminate future problems such as the femoral pulse is checked to make sure it is as strong as the radial pulse because if not that might be a sign of coarctations, also spleen and liver must be palpated to rule out megabytes and cholestas. Possible findings; may be viral infections because of history of urinary tract infection, pneumonia, bactermia, or beta streptococcal infection.
Finally for us to determine the specific diagnosis urine culture, cell blood count, blood culture should all be taken to determine the main cause of fever in our patient. The final and last patient was one of the most tragic stories I’ve ever heard and seen. Abdul latif a 12 year boy hospitalized since the age of 7 due to injury of spinal cord leading to quadriplegia. Dr.Asma Awadalla asked us medical students to take a detailed history from this patient specifically, and I’ll start writing his history in a story timeline from the very beginning till the present day. It all began when Abdul latif started playing in the neighborhoods of his home town with his neighbors, family, and friends. As he was walking down the street with laughter and excitement, a full speed car drove all the way from the opposite side of the street and crashed into Abdul latif, the driver carelessly drove away as if nothing happened, considering his case as a hit and run. As the ambulance arrived and brought him to the National Guards Hospital’s emergency department he was laying down still with no moments at all. Tests and investigations were ordered in which soon it showed an injury of C2-C6 level of the spinal cord which mainly controls the upper and lower limbs causing him to be completely paralyzed at the injured area.
As for the present day Abdulatif is on a specialized wheel chair unable to move his limbs but can speak and make words and sentences that are understood. I was only done with first year of medial basic sciences. By now, I feel like I have experienced most but I know that I still have only seen a small fraction of what the realities of doctors are. Working in the clinical bases gave e the opportunity to get some real experience about what it would be like working as an actual doctor. It taught me not to look at patients in systems but to think of them as a whole and thus considering their holistic care. Going forward into the clinical experiences I must always keep in mind that I am a student that is still willing to make mistakes and learn from them again and again until becoming a better student than yesterday’s and building the doctor that is engraved within me. The amount of practice in clinical rounds and the experience I obtained during this elective was valuable and will stand to me throughout my career. I have gained very useful practical pediatric skills such as taking a detailed history , physical examination, reading x rays, the milestones, and importantly how I had practiced speaking to patients without pouring out the medical terminology written in books. To recapitulate, it was a wonderful personal and professional experience, none of which would have been possible without Dr.Asma Awadalla’s guidance.
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