Tuls, thank you

I'm really really tense.

My last class today ended at 8pm. My mind could barely absorb anything when someone was going through some of the inconsequential details of the management of hepatic encephalopathy based on the American Association for the Study of Liver Diseases.

I feel so tired. I feel like crying. I feel like collapsing.

I've got so many things to do. So many things to read up on.

I have to present a case of Crohn's disease to the head of the medical department tomorrow. I've got a case report which I've completed due to procrastination. I've just rejected a girl very politely by coming out to her. It was a spur-of-moment decision which I hope I won't regret. Apart from that, my beloved car is still being hospitalized. And I'm still waiting indefinitely for it to be discharged.

I texted Tuls out of desperation and frustration, compelling him to say something nice that would soothe my soul.

To my surprise, he did, very obediently.

I smiled.

I really did.

I wish I had my own boyfriend (instead of someone else's) whom I can exploit when I'm in such a predicament.

But, for a moment, I could forget the saddening fact that there'd been nothing really significant in my sexual history and grinned as I read his SMS-es for the second time.

Thank you, Tuls.

First day of the new posting

Fetched TB from the airport last night. He looked high-spirited and so immersed in love as usual. He flew back to hometown to meet his girlfriend.

Wish I had a boyfriend to go back to too during my holidays. It's rumoured that he'll be getting married next year. All of a sudden, I felt so depressed. And, not surprisingly, desperate.

Today's fun. Internal medicine is fun. It always reminds me that the irrevocable decision I made years ago to apply for med school was right. Well, perhaps, I don't quite fancy the exam part. As a matter of fact, I'm always at a loss whenever it comes to neurology. Yet, generally speaking, internal medicine is always one of my most favourite subjects. I do hope I can be come a physician in future.

I offered to present a case during the bedside-teaching by an internal lecturer today. The one who's supposed to refuse to. I don't know what's there to be afraid of. It's presenting the history and physical findings in an exam-oriented manner and in the fashion lecturers like. Sometimes, I resent being in the same group with mediocre people who piss me off with their cavalier and lackadaisical attitude. This is when I wish I were grouped together with those who're slightly more kiasu. They're always on the prowl and in a desperate search for patients with good signs. Kiasu-ism is not tantamount to self-centredness or selfishness. You actually learn things from them. There's positive competition. Sometimes, you develop a symbiotic relationship with them. Sometimes, you realize how far you're lagging behind in terms of knowledge as well as the need to buck up and strive harder.

The 64-year-old guy I clerked today had liver cirrhosis due to chronic hepatitis B infection besides other concomitant medical diseases such as diabetes mellitus.

I actually noticed in the case note that he was having Fournier gangrene.

Fournier gangrene is a necrotizing infection involving the soft tissues of the male genitalia. The predisposing factors include diabetes mellitus and cirrhosis.

I need to eat less doughnuts and croissants.

Liver metastasis

The consultant gastroenterologist asked me to clerk a patient with metastatic liver cancer and I'm supposed to present the case during the morning meeting tomorrow.

Based on the history, I guess the primary site of malignancy is the colon. Which means he's probably having colorectal cancer which had metastasized to the liver. When this happens, the treatment is almost always palliative. The prognosis is bad. Textbooks say these patients don't survive more than 6 months.

The liver ultrasound scan revealed bull eye's sign. When I palpated his huge liver, I could feel a nodular surface. These are suggestive of secondary spread.

I sympathize with the family members. I really do. I don't think they know the gravity of the situation yet. I don't think they get me when I'm asking them about other symptoms of spread to other organs which don't seem to be associated to his chief complaint. However, I'm not in the position to tell them the truth.

I'll try my best to present tomorrow and may you be strong, uncle.

The kids

Medicine has always been thrilling to me, be it internal medicine or paediatrics.

However, in internal medicine, almost half of the patients in the ward are there due to self-inflicted damages. You see people with chronic obstructive pulmonary disease due to chronic smoking. Chronic liver disease due to alcoholism. Uncontrolled type 2 diabetes mellitus. Sexually transmitted infections. AIDS.

However, in paediatrics, the picture is rather different. Stanley had biliary atresia and his liver is now cirrhotic although surgery had been done. For some reason, his mother refused to let Stanley undergo liver transplant though she knew that's the only option available to increase the lifespan of Stanley and without which his liver would definitely fail. She spoke to me so nonchalantly which reflected her courage and readiness for whatever that might come. I turned to look at Stanley. He shot a handsome smile as if he had lived his life to its fullest and didn't seem to be afraid of death.

There's another adorable girl with end-stage renal failure secondary to late cresenteric glomerulonephritis. The puffy girl with lupus nephritis who looked so depressed as a result of long-term steroid therapy. The constantly centrally cyanotic girl with pulmonary atresia whose mother declined to have her heart lesions surgically corrected.

The children are deprived of so many things in life that I've taken for granted. I don't know how they cope with their illnesses as such a tender age. It's sorta saddening to look at their angelical faces under which lie the suffering and torment only their mothers can understand.