Tony’s Anatomy-#7.Seeing is not believing!

Finally,my internship program came to the end course,Pediatic medicine.I pick up hematolgy department for my 1st rotation.In the grand round by all the staff,me included, I saw a little young girl who looks like 6 years old. However,her real age is 12 years old.How come? There must be something wrong! To everyone’s surprise, her family abandon her in the hospital and we can’t get contact with her family members to know any information about her disease history.Her kidney is going down due to the tumor obstruction. What a pity it is ! Finally we arranged a tube into her body to relieve the kidney obstruction and she was now transfered to ICU.We still don’t know why she had retarded growth.Through this true story, you can know the difference of the accompany between adults and childs. Without accompany or wife, we,doctors, still can take history of patients’ disease process. But in pediatric patients, it’s obvious that we can’t.Patients’ role is very important.  There’re some news about adoption and discard in recent days. I truely hope that every child will be well cared and accompanied.Children are so cute that many people like them.But you will know how much you love them until you have to face the problems and difficulty they made.Children are not toys that you can’t discard when you don’t need them. They are truely alive persons. Don’t discard any child,please.

Tony

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Tony’s Anatomy-#6:Unforced error and ACE

It’s at the last day of my internal medicine program. The emergency department(ER) transfered a man presented acute progressive back pain to our pulmonary medicine ward.Initialy,he was diagnosed as pnuomonia(lung infection) by ER doctors.However, after detail analysis, we suspected he may have a internal bleeding.We arrange a CT image scan for him which showed internal bleeding and colon PERFORATION! Oh~~~my god! Comparing to ER’s impression,it’s totatly different impression. This man was dyeing! Then we arranged endotracheal tube insertion and intra-venous(IV) line on the man. However, until one anesthesia doctor came , we found we forgot to insert a larger diameter IV tube(CVP) on this patient. Without this large IV tube, it’s quite impossible to infuse sufficient blood to compensate acute server internal bleeding.Thanks god.We did it before acute internal bleeding happened and arranged emergent surgery immediately. However, when I was writing medical summary note, I found my team member,the decision marker, was crying. Why? She felt guilty for making a unforced error( a term from Tennis). I told her it’s really a mistake but we also made an ACE  ball that we found the most life threatenng disease he got and fix the problem in time.A great docot bears strong resemblance to the great Tennis player like Roger Federer that they rarely makes double fault and learn from experience. I am not a great doctor yet.Hope I can make many ACE balls in the furture.

 

Tony

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Tony’s Anatomy-#5:100 meter running!

When did you ever try so hard to run 100 meter again after senior high school? I got a call asking me to Emergency department in one afternoon.When I arrove,the patient got trauma injury by falling from four-story-high building's roof was lying on the bed and had no consciousness.Hemothorax(much blood in lung space) was highly suspected and blood pressure was gradually decreasing.Vital signs were obviously worsing.We decided to sent this patient into operation room for emergency surgery.There're three people for this mission.One senior doctor for keeping ventilation and checking vital sign, and one nurse and me for driving and CPR if necessary.Then we started to take this patient to receive surgery.We ran veryyyyyyyyyyyyy quickly!But unfortunately,in the process of delivery,the oxygen saturation was decreasing sharply and we adjusted oxygen volume immediatly.Then we speeded UPPPPPPP as possible as we can!Finaly through 100 meter running,we arrove the operation room.But the story did not end yet!In the operation room,when anesthesia doctors were preparing,the pulse of this patient was lost! Damnnn it! Without any doubt,I immediately did cardiopulmonary resuscitation by delivering chest compressions with rate of 100 times per minute.Thanks God! Few minutes later,his pulse and blood pressure came back.Then after sugery,his vital signs became stable.The 100-meter-running on that day was not a race with any athlete or friend but with THE GRIM REAPER!I didn't record how fast I really ran but I tried my best to run for sure.

Tony

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Tony’s Anatomy-#4:Resistance helps light bulb shine!

 

 

 

 

The story happened when I rotated to neurosurgery department.One day,a patient was sent into the operation room due to intracranial hemorrhage(bleeding inside the brain).I was paged to assist in this emergency surgery.To my surprise,I finished my first experience  of drilling a hole on the skull bone by other two doctors’s assistance.After then the chief resident doctor started to talk about what kind of peosons he wants to be his assitant.He needs someone who will be assistant rather than resistant.Well….it’s common sense ,right?Since I’m quite new to sugical medicine,I was thinking whether I assist the surgery or become a obstuace of others.Then I got a warming answer from another resident doctor who was also assisting in this surgery.Dr.Yeh said to the chief resident doctor:”A light bulb need resistance(R) to shine or radiate light.” I guess whenever I meet diffiuclties, I’ll thnik of these words.

Tony

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Tony’s Anatomy-#3:If placebo is also effective in clinical trial

This week,our main training course is evidence base medicine(EBM).In EBM,all we often to do is to find and study associate research and studies.Usually,new drug is expensive.What will you do if placebo is also effective in the clinical trial about  your patient's disease? Money really matters especialy for poor family.Can doctors just precirbe a placebo drug for them if placebo drugs are also effective in evidense based medicine research?

Anyone have good idea about this question,welcome to mail me or even just drop me a line.

 

Tony

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Tony’s Anatomy-#2:Cooking Labs & World Games in Kaohsiung

Since my internship,I am very very busy but trying to cook is really fun and always in my mind. I arranged a quite easy course in these 2  weeks.I am runing Family Medicine now.TGIF! I cooked curry rice this week.....not really good appearance but it tastes good at least.

 

The World Games 2009 Kaohsiung is starting now.It's Taiwan's first time to host international multiple sports games.Can't wait to see the sport dancing competitions in World Games next week.

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Tony’s Anatomy-#1:As days go on,my libido goes down

I started my internship from 1st June 2009.My first program is Obstetrics and Gynecology (OBGYN) deparment.I have to touch and examinate lots of female patients every day but as days go on,my libido is actually going down.One day,there’s a pretty woman with Louis Vuitton bag came to out-patient clinic.I can’t quiet believe my ears and my eyes since she got a fungal infection at women’s private part!OK,pretty  appearance doesn’t grantee any thing inside.

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