Wednesday, 24 November 2010

Psychiatry : SCARY

i underestimated psychi.

1st when they said "oh after neurosurgery, its gonna be psychiatry" so i hieved a pretty big sigh and the only thing on my mind about psychi is "i'm gonna die of boredom and sleep during classes"

little did i know.. that there's something quite interesting about psychi. its the part where u actually meet the 'scary' patients!!!!

i believe that, to be a psychiatrist, u have to have insurance for ur face cuz i think u can get punched by your patients. SERIOUSLY.

i even asked the doctors, she said "there was one doctor who was nearly strangled by a patient"

so.. u gotta be extremely professional in handling these kinda patients. and staying calm is up-most important. You need patience too since ur patients will be creating lotta stories that you can use to create a movie with~ like schizo patients tend to have delusions like "doctor, i think my neighbour is trying to kill me using laser beams" or "the president is trying to steal my money under my pillow" that sorta stuff. But u gotta gain the patient's trust or he'll just run away and wont be able to receive the proper treatment!

Usually la kan~ u would wanna sit near the patient, in order to listen what he's saying.. getting to know the patient better.. but in psychi, i try to stay as far as i can but still at range that i can hear what he's saying.. cuz I DONT WANNA GET PUNCHED. or strangled.
seriously scary ok!! yesterday, when we were with one patient, there was another one who came barging into the room and screaming (i dont understand what he said. i heard something like "i have no money")

here's another fascinating fact, when the disturbed patient came in scolding the doctor, she (the doctor) was absolutely CALM. (sumpah aku respect Dr psychi, how could they be like that when they have to deal with psycho patients EVERYDAY!!!!)

The 1st patient that i met, i thought he was a one-of-a-kind, when he mentioned (quite a few times) that he just wants to get MARRIED. but he wasnt the only patient who wanna tie the knot. (we noticed that he kept staring at the females ) keke.
even the patient that we saw yesterday, 39 yr old male, single, was smiling so widely when responding to one of our female doctors that made is all laugh! i guess they just wanna get married! =D (i cant deny that the female doctors there are kinda good-looking~ hik2)

my advice?
stay calm. try to get to know them better. know the difference between fantasy and reality. try not to get punched.


Monday, 8 November 2010

Its been a while! =)

i lost my inspiration to write, so now i've got it! imma blog my thoughts =)

this is week our 2nd week in neurosurgery. as far as it goes, i kinda enjoy neurosurgery! its more interesting than neurology (honestly i find surgery very exciting!)

so yesterday, my group and I were scheduled to be in the OT in Mansoura University Hospital. We're so lucky i tell u!!!

here's the story. (it might be too complicated for preclinicals to understand this, but i'll try to make it simple to understand)

Last week, we met a patient named Miss XXX age 25. I cant remember her complaint, but she came to the hospital, and mentioned that she was unable to close her eye completely, and we noticed that half of her face is paralyzed. Is 'paralyzed' the right word to describe it? Like when we did the cranial nerve examination, the angle of her mouth dropped, she cant kerutkan her forehead. so my colleague asked her some more questions and she also mentioned that one side of her hearing is not that good.

so we suspected that something's compressing her 7th and 8th cranial nerve.

muscle of the face (like smiling, raising your eyebrow, closing your eyes) are supplied by the 7th nerve (facial nerve)
hearing is supplied by vestibulococchlear nerve (8th nerve)

so now we have to determine whether its an upper motor neuron lesion or lower motor neuron lesion. (UMNL/LMNL)

why? cuz nak tau mana site defect tu~ if UMNL, its somewhere from the origin of the nerve to the brain. if its LMNL, its from the nerve to the muscles supplied by it. you get what i mean? hehe. takpe, tak faham, nanti belajar~ keke

alright, for facial nerve, senang je nak tau its an UMNL or LMNL. if only the lower half of the muscle of the face is affected, then its UMNL. if the whole face is affected, then its LMNL.
So from the examination, we concluded that its a LMNL!!!

Therefore the doctor showed us the MRI of that patient~

nampak tak lesion tu? clue : its whitish in color a.k.a hyperdense~

so the lesion is at the cerebellopontine angle. which explains the 7th and 8th cranial nerve affection.

i was confused at first, why is it LMNL ? then my groupmate explained, he said
"the tumor is arising from the vestibular nerve itself, not from the brain. so that is why its LMNL, not UMNL."

then i recalled our morning lecture, and asked him "is it a Schwannoma??" (nasib baik baru belajar~)

"yes bizzob mariooomaaaa!!" (ok he didnt actually say marioma, its just that they always call me with that name..sounds like a benign tumor ha...)

Schwanomma is a nerve sheath tumor. its a slowly growing tumor of the Schwann cells, surrounding cranial nerve roots (usually the vestibular part of the 8th nerve)

so when it grows big enough, it could compress its adjacent structure, which includes the 7th nerve!

So when we came to the OT yesterday, we were lucky enough to watch the surgery of that patient~ Doctor did an operation, approaching from behind the mastoid process, he opened up the skull, using a HUGE microscope, he elevate the cerebellum to have a good view on the tumor and scrape the tumor shuwayya shuwayya~ in cases of brain tumors, u cant just take the whole thing out or make a safety margin, cuz its the brain for God's sake!! anything you take out, you'll interfere with the brain's function~~~~

the microscope! told u its big!

so tiny. thats why he needs the big microscope.

exposing the cerebellum~

Neurosurgeons need delicate hands and extra patience.. the whole surgery will take 8 hours to complete (thats what he said that day) gila, i didn't wait til it finish of course~ i got class to attend to!! i met the doctor the next day, he finished it in 4 hours @___@

pretty cool case. honestly it took me quite a while to understand the whole case.

kehkeh~ i forgot to mention, there was a fly that accidentally flew in the OT. A man sprayed ridsect in the OT! it was so funny! cant imagine what will happen if the fly mistaken the brain as food and landed on the exposed brain~ kehkehkeh~

hooray to the guy who killed the fly!

well thats the end of this post.
sorry if susah nak faham~ heeee.
i still think neurosurgery is awesome!
til next time!