Digital Rectal Examination

5 years of medical school is a long time indeed. However, I did not have much opportunity to perform a digital rectal examination. I think I probably have done less than 10 as a medical student. Don't misinterpret me, I do not fancy sticking my finger into a stranger's ass. However, I have never felt for an enlarged prostate gland. So if a prostate gland is enlarged, I would not know it is actually big (coz lack of experience). You get what I mean?

Yesterday, my colleagues and I sat down to have tea. One of my colleagues, who was on-call for the whole week, complained that she was asked to do 5 digital rectal examinations, one after another. There were nothing interesting to find on the examinations. However, this topic led to another subject. Palpating for the prostate gland in male patients with them on all fours.....

hmmm....normally, the patient would be lying on his side with his knees bent at 90 degrees. According to a different colleague, he was told that it is better for the patient to be on all fours during the digital rectal examination, as it enables the examiner to get a better feel for the prostate gland. I do not know how true this is, but a few of them actually admitted that they have heard of this before.

All of us burst into laughter. And as expected, my fellow guy colleagues starting developing their own wild imaginations. (Imagine walking into the examination room, with the patient on all 4's and a finger in the rectum??!) You get the idea...... Don't think anyone of us would fancy doing the examination in that position.

A Weekend At The Hospital

Here are a few notes I wish to make about my weekend at the hospital.

SATURDAY

• It was a bloody long shift.
  
• My left eye felt sore.
• Oh great! I found that the contact lens in my left eye was torn. (no wonder it was sore)
• Had to remove it....and worked with one good eye = Headache at the end of the day.
• Spent 4 hours searching the entire hospital for a venesection kit. (Mind you, it was the weekend, most depts were closed. So, I phoned one dept to another, before finally, a specialist nurse, who was on-call from home, said she'll come over to the hospital to pass me a few kits).
  
• Acted as a translator. (Just realised that I have not been speaking Chinese for a looonng time...so I had some difficulty finding the correct words to ask the patient).
• Temperatures. Patients in the hospital just loved to get a fever, which gave me more work to do.
  
• 5 mins before I was meant to finish, a patient went into an epileptic fit. sigh.
  

SUNDAY

• Another long day for me. Arrived the next morning for work and found out that there were 13 admissions into my ward (it was meant to be 6 initially), and 2 from the other ward which I was covering.
• WTF?!
  
• A patient "decided" to fall out from her bed....so had to go and make sure she is alright.
  
• Referrals. I was asked by the consultant to refer a few patients to different medical teams.
  
• Noon. Most admissions have arrived, and so, I began to clerk them in.
• *gurling noise from my tummy. Hungry + Stress = :(
• By about 3 pm, I saw only 4 of the admissions. Still have 11 more to see!!! arrghhh!!!!
• A few other things cropped up and needed to be sorted out.
• 6 pm. Saw another 2 more admissions. And another 9 more to go!! And I'm due to be off my shift at 9 pm.
• Sat down for 5 mins to gobble some chocs to increase my depleting energy stores.
• I was nearly on the verge of breaking down....just felt I won't be able to finish them all by tonight. But, I managed to calm myself down and continued my work.
• 9 pm. 5 more patients to see. ("Go sl, you can do this," I whispered to myself).
• One patient was not happy that I saw him so late in the night. Sigh.
• 11 pm. I bumped into my colleague who was covering the wards downstairs. She looked awful and she admitted that she cried earlier on as she has had a rough day.
  
• 11.30 pm. With a few pre-op ECGs that need to be done and chasing results, I decided that I should leave the ward, before I missed the last train home, which was at midnite.
  
• 0015 hours. Arrived at home. Hungry. Headache. Knackered. Dead as a log.
• Could not sleep as the adrenaline was still kicking about in my body. Only managed 3 hours of sleep before I had to get up and leave early for work to complete my unfinished jobs.

hmm....reflecting back on my weekend, I was thinking.....maybe I was being slow in doing the jobs? don't think so...as I think I work quite fast. Maybe I was inefficient? Dunno. All I know is I was so glad that the weekend was over.

Itch

I hate itch. The moment you start scratching, the itch gets worse.

Recently, I have developed a funny rash. The skin around my neck began to feel really itchy initially. I began scratching away, thinking that it is caused by my hair poking around my neck. However, the next day, my body began to itch. This time, I put it down to dry skin, since the weather here in Glasgow is getting colder.

However, exactly a week ago, after coming back from a late shift at work, I realised that my whole body was covered with red little dots of rash. I was feeling super duper itchy. Nothing I do could help to reduce the itch. The rash also started to spread down both my arms the next day.

I became worried. Allergy? nah...neither did I use any new creams, nor eat anything different. Bed bug? Well, bugs won't bite me in this fashion. I was clueless. I did not feel ill at all. The only thing I had was a sorethroat which went away within an hour or so.

My whole neck area was (and still is) filled with red patches. I had to be careful with my clothes, so that I can hide the rashes . Otherwise, ppl would think that I'm suffering from a contagious disease (with the rash).

Clarythine did not help to relieve the itchiness. I decided to take Piriton instead, which worked wonders! Unfortunately, Piriton made me so drowsy that I felt so miserable trying to work and finish my jobs at the same time. hehe. Even the nurse in the hospital noticed that I looked so sleepy. But at least the rash is reduced. Not so red anymore and not too itchy. Tiny red dots are still visible though.

I think this rash could be a viral thingy or maybe just stress-related rash?? I dunno.

Intriguing

Fracture of the penis.

hmmm....intriguing eh? How could this happen? There is no bone at the penis....so how could you possibly "fracture" it?

After doing my homework about this, I learnt that fracture of the penis is defined as the rupture of the tunica albuginea of the corpus cavernosum secondary to trauma. Lets go into the anatomy of the penis for awhile. The penis is made of a few erectile tissues , i.e., corpus cavernosum (left and right) and the corpus spongiosum. The tunica albuginea covers the corpus cavernosum. During an erection, these tissues enlarge, which causes the tunica albuginea to become thin and stiff. At this point, the penis is vulnerable to injury.

Fracture of the penis is not common. Any sudden blunt trauma or bending of an erect penis can tear the thin tunica albuginea, resulting in a fracture.It usually occurs during sexual intercourse. (Don't think I'm going to explain how it can get bent...use your imagination). Apparently, you would be able to hear a "cracking" sound when the fracture occurs. Oh my, it sounds really painful, doesn't?? If the injury is severe, the urethra maybe damaged as well. (The urethra is a tube that carries urine from the bladder to the external). Urgent treatment of the fractured penis is required, otherwise, it may become deformed. Although complications from this injury is not common, they include erectile dysfunction and painful erections in the future.

So people, please be don't be too rough during sexual intercourse...the last thing you want is having a fractured penis and spoiling everything.

Just Hours Before Death

Have you ever heard that a dying man is usually more active just before he/she dies?? I think that statement is very true.

I was involved in a care of a dying man recently. He was not speaking much when I first met him. Most of the time, he tends to mumble to himself. The last day he was alive, this person became quite talkative and, in fact, verbally abusive.

I remember asking the patient how he feels. He just told me to leave him alone. Then, later on, he began to vomit a number of times and I decided to keep a closer eye on him. As I started to count his heart rate (by feeling for his pulse just about his wrist), he started scolding me. He said, "What are you doing, you stupid bitch!"

It was funny. I was actullay not offended. But the fact that a man could be suddenly so talkative. A few of my friends have told me about their experiences with the dying person and most of their stories did mention that the patients were more active on the day of their death. Weird eh?

2 looonnnng weeks again...

Its the weekend. But I'm working. Again. =(

Why do I seem to be working every weekend? hmmm...I just did night on-calls over the weekend about 2 weeks ago. And I had the weekend off after that week of nights. Last week, I was at work from 8-9 on Monday and Friday. It was tiring because I did not have much time to recover from my deranged sleeping habit. And I SO totally missed the first junior doctors night out held on Friday nite, because of my shift and culture. It was to celebrate our first paycheck. keke.

Anyway, I will be having the next weekend off, but unfortunately the Monday after that weekend, I start a 2 week long working days.....AGAIN!!! urgh!! I MISS MY WEEKENDS!!!

Wished I was a student now...hehe...

PAY DAY! PAY DAY!! =D

Did I just say "Pay Day"?

YES YES YES YES!!!!

hehe =D

I'm so happy. It was pay day on the 31st August 2006. And, of course, it was the Independence Day for Malaysia. (Although I am faraway, but I still have Malaysia in my heart). Selamat belated-Hari Kebangsaan folks!

Anyway, back to my pay day. See, this is my first proper job (I worked as a food server before). And to be paid after a few weeks of hard work really felt great!

Everyone at work was so excited. Rumours were spreading that our salary will be banked into the account at 12am automatically. So, I waited patiently till about 11pm. But I was dead tired and as usual, ended up falling asleep on the table. The next time I woke up it was about 4 something in the morning. And I remembered that I wanted to check how much I was being paid.

I quickly logged onto my bank account and was so happy to see my first salary!! I am now (hopefully) financially independent now. hehe. The good thing is the first salary is tax-free. Mind you, the tax here is rather high.

My friend and I decided to celebrate out first pay by having dinner at TGIF. The food was certainly much better than TGIF in KL. The atmosphere was great and for the first time, I actually did not feel guilty paying 20 quid for my meal. haha.