In the beginning of the 2 nd year training during MBBS, the students get to see the live patients for the first time. The students have to talk to the patients, examine them meticulously, see the reports, present the case to the teachers and discuss with them. The patient's problems will be discussed with and by the senior doctors and explained to the students. The whole teaching process is called "bedside clinics" and is a much awaited event by the students.
The attire worn for attending the bedside clinics includes an apron, a stethoscope, and clean and fresh garments. A special feature is that all students seniors and juniors participate together in this without any discrimination. However, the case presentation is usually done by the senior students who are about to appear for the examination. The junior students observe the seniors and help them in the history taking and get prepared slowly for such experience in future. The whole duration of such activity lasts for about 1 t 2 monthes at a time. This is known as a "clinical posting".
In this duration students get to see many cases. The best part is interaction with the patients. We went to our first clinical posting with a lot of hesitation and inhibition and expectations. We were afraid of the teachers. We knew our limitations. But we were eager to learn. When we went to the ward on the first day, the first patient we observed was a short boy of about 18 years who was stunted and looked about 12 years old. He was a cherubic kid with a round face and prominent chest. He always had a ready smile and would cooperate with us freely for the clinical examination. All of us were fond of him and he was fond of us too. He would go out of the way to put the new young students at ease. We asked him the details of his illness s a par of history taking. He gave a fantastic story which was very impressive. He said he is suffering from"asthma".
Santosh was having spells of cough, breathlessness and wheeze since early childhood. His illness drained his family's meager savings and he was not getting any better. He went from one doctor to the other. And then he went in for herbal medicines - some roots were adviced to be brought from far off forests. He would tell amazing stories of how his"uncles" went to far off land s to get them. We would be awed by the stories and charmed by his mannerisms. Later the with doctor whom he consulted asked for the tiger's milk. Uncle first had to find a lactating tiger and then get its milk - heroic indeed! Finally when nothing seems to cure him permanently, he came to the Government Wenlock Hospital where he could consult any good doctor free. In fact he was in the hospital for over a year. When he was well, he would help other patients and also the nurses to distribute food and medicines. In all he would keep us entertained and informed.
One day we found him in a bad shape. He was very ill. He was blue and cyanosed. Confused and cometose. His body was swollen due to waterlogging. He was in Cor Pulmonale with Respiratory failure. This was not typical of asthma. Then we asked Post graduate students. We did reading from textbooks and research. We realised that the boy wasnot suffering from asthma ( an eminently reversible condition) but from Cystic Fibrosis rare genetic condition which can involve multiple organs - Lungs (Emphysema, Lung abscess, pneumonia, respiratory failure); Intestine (constipation, failure to pass meconium, malabsorption); Endocrine organs(Diabetes); Altered sweat content and other things. They can eventually go into advanced emphysema (he indeed had a huge chest) and respiratory failure the hallmark of which is Cyanosis (bluish hue). Hypoxia (lack of oxygen) can also produce bluish discoloration, confusion, headache among other features. Then sudddenly I realised something - the disease was not asthma; it was a much more serious, irriversible disease inherited genetically (autosomal recessive pattern) and the exciting stories s never happened - they were all born out of the Hypoxic state with low oxygen I could not just believe that there were no willing and daring uncles; no tiger's milk; no herbs and roots brought from far away lands! The boy who was always cheerful and always willing to help and cheer up others was very ill and cometose. However, he seemed very peaceful. We stood around his bed feeling helpless. We held his hands, thanked him and assured that we will pray for him and indeed he would be fine by the next day. We had a sense of sadness because he had become a part of our family. Next morning when we went to the hospital to Santhosh' bed it was empty!
The attire worn for attending the bedside clinics includes an apron, a stethoscope, and clean and fresh garments. A special feature is that all students seniors and juniors participate together in this without any discrimination. However, the case presentation is usually done by the senior students who are about to appear for the examination. The junior students observe the seniors and help them in the history taking and get prepared slowly for such experience in future. The whole duration of such activity lasts for about 1 t 2 monthes at a time. This is known as a "clinical posting".
In this duration students get to see many cases. The best part is interaction with the patients. We went to our first clinical posting with a lot of hesitation and inhibition and expectations. We were afraid of the teachers. We knew our limitations. But we were eager to learn. When we went to the ward on the first day, the first patient we observed was a short boy of about 18 years who was stunted and looked about 12 years old. He was a cherubic kid with a round face and prominent chest. He always had a ready smile and would cooperate with us freely for the clinical examination. All of us were fond of him and he was fond of us too. He would go out of the way to put the new young students at ease. We asked him the details of his illness s a par of history taking. He gave a fantastic story which was very impressive. He said he is suffering from"asthma".
Santosh was having spells of cough, breathlessness and wheeze since early childhood. His illness drained his family's meager savings and he was not getting any better. He went from one doctor to the other. And then he went in for herbal medicines - some roots were adviced to be brought from far off forests. He would tell amazing stories of how his"uncles" went to far off land s to get them. We would be awed by the stories and charmed by his mannerisms. Later the with doctor whom he consulted asked for the tiger's milk. Uncle first had to find a lactating tiger and then get its milk - heroic indeed! Finally when nothing seems to cure him permanently, he came to the Government Wenlock Hospital where he could consult any good doctor free. In fact he was in the hospital for over a year. When he was well, he would help other patients and also the nurses to distribute food and medicines. In all he would keep us entertained and informed.
One day we found him in a bad shape. He was very ill. He was blue and cyanosed. Confused and cometose. His body was swollen due to waterlogging. He was in Cor Pulmonale with Respiratory failure. This was not typical of asthma. Then we asked Post graduate students. We did reading from textbooks and research. We realised that the boy wasnot suffering from asthma ( an eminently reversible condition) but from Cystic Fibrosis rare genetic condition which can involve multiple organs - Lungs (Emphysema, Lung abscess, pneumonia, respiratory failure); Intestine (constipation, failure to pass meconium, malabsorption); Endocrine organs(Diabetes); Altered sweat content and other things. They can eventually go into advanced emphysema (he indeed had a huge chest) and respiratory failure the hallmark of which is Cyanosis (bluish hue). Hypoxia (lack of oxygen) can also produce bluish discoloration, confusion, headache among other features. Then sudddenly I realised something - the disease was not asthma; it was a much more serious, irriversible disease inherited genetically (autosomal recessive pattern) and the exciting stories s never happened - they were all born out of the Hypoxic state with low oxygen I could not just believe that there were no willing and daring uncles; no tiger's milk; no herbs and roots brought from far away lands! The boy who was always cheerful and always willing to help and cheer up others was very ill and cometose. However, he seemed very peaceful. We stood around his bed feeling helpless. We held his hands, thanked him and assured that we will pray for him and indeed he would be fine by the next day. We had a sense of sadness because he had become a part of our family. Next morning when we went to the hospital to Santhosh' bed it was empty!
Raghu I remember this patient very well.One night as a student I was posted in the same ward and this boy and I chased a big bandicoot
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