A lot of the time in blogs, I talk about what I did (or didn't do), about what the hospital is like, and what I saw. Basically, a lot about me. Now, while I may enjoy talking about myself, this probably isn't why people read this blog, and it isn't really the most important (or interesting) thing in medicine. What takes this title probably varies between different people, but in my opinion it is the patients. While the diseases they present with can often be the same (with respect to their pathological cause), their stories about their lives, how they cope with their illness and everything else are invariably different and interesting. This week I will talk about some of the patients I saw in my last week on ophthalmology and at the GPs (in an anonymised way, of course, to prevent recognition...) from the morphine-dealing-mum to the side effects of Jonathan Ross
The ophthalmology clinic started with a wonderfully cheery looking Russian lady who had come in with a punctured eye. Worried about the risk of infection, the doctor wanted to find out how this had happened so as to get the best treatment. Despite all of his (and my) best efforts, we just had no idea what this lady was saying. It wasn't because of a language barrier as (I think) she spoke near perfect English. It was more that her accent was so thick it was unintelligible. The consultation meandered on for about five minutes with us absolutely unable to understand her, while she seemed to understand us perfectly. In retrospect, we probably should have communicated by writing things down, but embarrassed to admit that he couldn't understand what she was saying, the doctor just told her that he needed another opinion, sending her to one of the other specialists in the hope they would have more luck... Talk about passing the buck!
The next patient who came in talked English in a perfectly understandable accent, and on examination with the slit lamp, the ophthalmologist diagnosed him with a vitreous haemorrhage (basically a bleed in the eye). The ophthalmologist had left the room to collect a part of the notes, so I was talking to the patient about how this had happened. He works as a painter, and was having a night in, with some pizza and TV. He was watching reruns of 'Friday Night with Jonathan Ross' when he suddenly started getting floaters in his vision, along with loss of vision. My verdict? Jonathan Ross makes your eyes bleed...
A picture of the back of the eye (the retina) after a vitreous haemorrhage
A later patient, coming back after a year for a follow up appointment, on entering the consulting room proclaimed proudly to the ophthalmologist "you have lost weight". The ophthalmologist, a somewhat business like doctor, just replied that he hadn't and was the same. This lead to minutes of discussion where the patient tried to convince the doctor he was losing weight, while the doctor tried to start the consultation, but kept denying his weight loss. It would have been a lot easier to just accept it and move on! Later in the same consultation, after receiving the iris-widening eye drops that are used to look into the eye more easily, the 30 year old patient asked if he could buy some from the doctor, as it would make him look 'pretty cool' at raves, and could be useful for attracting ladies in coffee shops (after all, everyone knows big wide pupils are attractive). I told him that the drops made the vision blurry, so he may end up chatting up a coffee machine, which earned me a laugh from the patient and a scolding from the ophthalmologist...
There were many other patients worth mentioning, such as the patient who had seen a vitrectomy on youtube (such as the one below) and wanted one for himself, despite having no symptoms, but I could go on all day. A moment of self-indulgence means I want to say that I can now do ophthalmoscopy properly now, after just pretending I could for some time. The ophthalmologist was kind enough to get me to do it on each patient and tell him what I saw. By the end I managed to spot hard exudate in one patent, and microaneurysms in another, diagnosing diabetic background retinopathy in both. A successful clinic!
A vitrectomy, where the jelly inside the eye is removed. Apart form the start, it is surprisingly squeamish-friendly!
My time with the GP was equally interesting on the patient front. There was the vegetarian (macrocytic) anaemic 90 year old who the GP wanted to give B12 shots to help combat the anaemia, but who was petrified of needles. I recommended Marmite to her, and promised it would be a more pleasurable alternative (somehow she hasn't heard of it...) I just hope she doesn't hate it and wish she had taken the injections! Other patients I saw with the GP included the woman who had broken her arm in the USA and been sent back with some kind of cyborg-like-exoskeleton over it which no-one in the practice seemed to have seen before. The supporting documents she had been given were very sparse, and the DVD she also had wouldn't work on the computers. Very futuristic, but somewhat impractical when no-one knows what to do with it! There was also a mother who had just had a new child at 50 years old, and was struggling to cope with it, after her husband had left her. She admitted that the oramorph (morphine) the GP had given her for unrelated pain had all gone, as she had had a party and shared it with her friends for a 'high', and said she needed more. Not really the responsible behaviour of a new mother, or of a 50 year old lady...
Basically, the patients make medicine. The reason I enjoy clinics so much at the moment is because of the wonderful (and sometimes absurd) things you hear from your patients. Later, as I learn more, I am sure that I will enjoy the process of diagnosis and management of disease as well (not something I can do at the moment), but I hope that I don't lose the enjoyment from hearing about peoples lives. If I can get paid to do this for my whole life, I am going to be a very happy optimist!