After getting the final orders, finishing the exhausting formalities, I reported at the dean's office in medicine ward. He inquired 'Where from, your name?' After the formal introduction, I was directed to male medical ward Unit I. A nurse escorted me from the doors and led me to a senior resident, a tough person to look at. He recalled that there was another intern from Mauritius when he heard my details. He was doing his rounds, there was another intern with him and few nurses. I followed him by default, wondering what is next. He stopped at a patient who was crying with pain in abdomen and could not breath properly. He while examining the patient shot a quick question at me, 'What is Cirrhosis?' I got stuck as usual, when something sudden strikes me I am off to a transient limbo. But surprisingly I recovered too quick and recalled the best I could, 'Sir, It is a chronic condition of liver characterized by fibrosis and regenerating nodules.' He after a nod shot his next, 'Complications of Cirrhosis?' Here I stumble a bit and start, 'Portal hypertension, Carcinoma' and a mental shutdown! He then moved on to another patient, so I tried to recall as he got busy there. When he returned, I shot back, 'Portal hypertension, liver failure, hepatocellular carcinoma, hepatic encephalopathy, hepatorenal syndrome'. He just nodded, guess it was for good. I stood there like a kid joining first day at school, wondering what to do. Finally, the resident after finishing his morning work, turned to me and signaled me to sit down, 'get familiar with the ward today, will teach you stuff tomorrow'. He left. Then the intern took over, he had finished a couple of postings and this was his last week of medicine posting. He took me around and gave some insight about how things work there. As I was beginning to open up to the atmosphere, assistant professor enters, everyone rushes behind him, ward rounds I guessed. I too followed the crowd, he immediately recognized the new bird in the nest, called onto me making an inquiry. 'Intern, first day Sir', I smiled.
He stopped near a patient, case of pyothorax. He handed over the CXR to me, 'this is for you, comment on it'. I took a few seconds and started, 'It is a P-A view, good quality, inspiratory film, 'Is it inspiratory for sure?', he interrupted. I did not know what to answer, I kept mum. 'When you see 1 1/2 spaces above clavicle, it is no more expiratory', he said 'Go on'. 'penetration normal, bony structures normal, whiteness in the left lung field'. 'Whiteness?' he asked. 'Haziness', I replied and continued. Finally we reached at the differential diagnosis, elaborating all the possibilities. He moved to the next patient, while discussing about his treatment, turned towards me, 'what is the dose of calcium?' '1000 mg Sir' I replied. 'Yes, 1000 mg and 500 mg tablets available'. His next question came after a few minutes, 'Do you know how to read an ECG?' Yes sir, but I forgot most of them', I replied.
'I know reporting an ECG Sir'. 'What are the reporting points?' 'I will start with the patients name, date and move on to, 'Good!' he appreciated. 'Continue'. 'Then will report about the calibration, such as the speed and voltage'. 'Normal Speed?' '25mm/sec'. 'Ok'. 'When do we take lesser speed, say 10mm/sec?' 'When is the voltage too high or too low?' I could not recall, but learnt that in case of cardiomyopathy and muscle hypertrophy, speed adjusted to 10mm/sec to compensate overshoot. That was the end of his ward rounds, in the discussion room later on, he handed over the case sheet of varnish poisoning, asking me to outline management. I did not know what varnish contains, which poisoning category it belongs to, nothing in the case sheet to suggest the type of poisoning. So I was just thinking of symptomatic treatment but afraid to tell. Later he said, 'only symptomatic treatment possible, treat gastritis and other problems if any'.
In the noon, I was guided how to write a discharge summary and repeat notes, was made aware of the daily work of an intern. I took a good 10 mins to look around where the labs are situated.
I wrote a couple of repeat notes and a discharge summary later in the noon. There was a junior nurse who is worth mentioning, her cute smile made my day!
