The Mysteries of Love and Medicine.

Picture this, Dr. Gregory House M.D. looking quizzically at some blood results, his exasperated sigh the subtle admission he has no idea what the diagnosis is. Then, out of nowhere, he leaps up with a sense of accomplishment – the fistful of paperwork held up in the air, his cane propping him up in the other – and he cries out “They have what I suspected all along”. His team look to him as he explains what turns out to be the most niche and complicated diagnosis, of what seems like a practically impossible level of rarity. This is what I imagined internal medicine to be.

To be honest with you all, I really did not know much about what internal medicine entailed, let alone know what a typical day looked like. It was described to me as ‘everything else’ that surgeons didn’t want to deal with, and frankly, that is a very apt description. Internal medicine is essentially all the ‘-ology’ fields of medicine; cardiology, haematology, hepatology, neurology… you name it, if it ends in -ology, it’s internal medicine. That’s what makes the excitement of internal medicine so interesting, the entire gamut of conditions is not limited to any one system. Even more reason why someone like Dr. House usually only exists in the world of fiction. On the other hand, in surgery, our rotation was predominantly abdomen focused. Maybe this was due to the structure established with our particular school, or perhaps it stemmed from the specific expertise of the surgeons we had at the time – who knows?

With the limitless potential that arises from internal medicine, it paves the way for the complexity of the human condition. Often, it is not just a single diagnosis that is of concern, other co-morbidities factor into what you do. The ward rounds in general medicine, which is mostly going around to see patient after patient, are more complicated in this way. Sometimes you do not unequivocally know what a patient’s diagnosis is. To find out, I noticed numerous doctors setting certain tests and justifying why it should be performed. All up, more time was spent on extensive plans formulated for the patient. Whereas, in surgery, ward rounds would be completed in 30 minutes max (30 seconds if you’re Dr. House)!

Internal medicine has enabled me to try new examinations and tests on patients. I performed my first Standardised Mini-Mental State Exam (SMMSE), which is a screening tool for cognitive decline, primarily dementia (you can have a go for yourself here). Basically, I ask a patient some questions about their orientation to time, place and location, memory, executive function and other components that constitute adequately functioning cognition. My patient for this examination was difficult when getting her to complete the test, but she was justified. She didn’t see the use of doing such a test, as she came in to get treatment for an unrelated condition. To her, receiving a cognitive test before discharge seemed out of place or unnecessary. She looked on in incredulity and found it almost laughable to be asked to remember simple words. In this case, it becomes really important to communicate the reasoning for a test like this. It eases the patient and places them at the forefront of their own management, especially when you make it relevant to their context. In this case, the patient desperately wanted to go home and successful completion of the test would see to it.

Just like the New Years Eve fireworks on the Sydney Harbour Bridge, my eyes did light up during this rotation (not that I want to be in Sydney at the moment!). This moment of illumination happened when I witnessed an upper limb neurological examination on a patient with some arm weakness. By far my most favourite examination to do and, by far, the nerdiest thing I have said on this blog! I think it’s a great exam, as it involves many components that depend on each other. I have mentioned before that neurology is a field of immense interest to me and that’s partially due to how fun I find the neurological examinations. Yes, I am taking requests to perform any neurological examinations – so, in helping me practice, you would be helping me on my journey. Any volunteers?

This rotation also made me reflect on the standard and yard-stick patient parameters that are consciously and unconsciously set and accepted. For example, for as long as I can remember, I have had below ‘lower reference range’ of white blood cells. However, it is common for black people to have this mild difference. For the most part, it’s okay. These low white blood cells don’t affect my health dramatically. It just means more white blood cells are situated in my bone marrow than circulating in my blood.

Now, if there was a well-known and agreed upon standard with adapted reference ranges for black people, I would be classified as normal. I’m not saying that results from the population of white middle-aged people, from which these blood reference ranges were derived from, are out of date or completely need replacing. I just think that, given globalisation and our multicultural population, we can’t very well call it ‘modern’ medicine when our general population of patients is not that which the standard is predicated on! This is why it’s important to advocate for patients and forego parochial, complacent, ‘she’ll be right mate’ attitudes. That’s why, last year, I worked with fellow students in drafting a cultural and diversity policy for our school, to motivate the introduction of curriculum changes, in conjunction with updated teaching practices, that recognise more diverse, darker-skinned patients. It’s been nearly 12 months and we are still waiting to hear back from the school about their thoughts on the policy… Perhaps delivering the world adequately prepared doctors is scrunched up somewhere in the too-hard basket? As Dr. House says “Things change, doesn’t mean they get better. You gotta make things better. You can’t just keep talking and hoping for the best.”

In other more positive news, dear reader, I must admit I did somewhat lie to you in my last blog post. I alluded to Dom likely beating me at Uno. That, in fact, did not happen. I beat him… multiple times. So, my apologies to you all on this faux pas.

I also managed to travel to Canberra for a short trip, and came back feeling joyous, well-rested and ready for the next semester. My time in Canberra was spent with my incredible, intelligent, and beautiful new girlfriend, Prisca. In a very short period, she has influenced my life in numerous ways and has taught me so much in what a loving and reciprocated partnership feels like. I’m falling deeply in love with her every day and it’s an exciting place for me to be on, this, my journey. Life is really taking a turn for the better.

My next rotation is psychiatry. I’ve been looking forward to this, mainly because I’m never been exposed to anything psychiatry related. It also seems like a rotation that will be far removed from anything else I’ve experienced so far, especially with the diversity of patients, mental conditions and the types of interventions used.

Exciting times ahead. Stay safe and…

Eat those pancakes!

Anei