Today I went to clinic around 11AM. It was peds rheum clinic. I saw an 15 y/o girl with JRA who complained of TMJ, left shoulder, and ankle pain, an 11 y/o boy with ankalosying spondylatisi who complained of back, ankle, knee, and wrist pain, as well as palpitations, and a 16 y/o girl with JRA with left knee pain.
The boy turned out to be a very ill. The whole interview, he was souched in his chair, his head was down, it took him forever to find his words. In retrospect, he was very lethargic. But at the time, I thought, "What is wrong with this boy? Is he developmentally slow? Or just very shy an intimdiated by doctors?". I thought maybe there was a cultural barrier too since he was Bengali and the father was using an interperrture. The physical therapist who examins pts during rheum clinic noted he was wearing an insulin pump. The registrar (=PGY3) asked about his sugars. He said that last night they were 32 mmol/L (=579 mg/dL in US system). The doctors eyes nearly came out of his head. He kept making sure he heard right. "Thirty-two?? As in in greater than 20?" he asked to clarify. He asked if the dad called the diabetic nurse and the dad said no. I couldn't believe it! I wanted to scream to the dad, "Do you know how high that is, how dangerous that is?" Then we found out the boy had also been nauseous and feverish. We looked at his tonsils and they were so enlarged, practically touching one another. The registrar phoned down to the A&E department, spoke to the doctors there and told them that he was sending down a pt from clinic.
If I were that doctor, would I almost have missed how sick this child was? Its such a scary thought to think that maybe if I was the one seeing this patient I would have sent him home after having focused on joint paint. It was rheum clinic after all. I can't imagine how guilty I would feel if someone died of DKA the day after I saw them in clinc and sent them home. Really, in clinic, you are meeting someone for the first time and have to assess them based on your judgment and experience, if you think they are well or if something is off. I thought something was off when I saw the boy slouched over in his chair, searching for his words. But not knowing what exactly it is, its hard to know the next step. In fact, prior to mentioning the sugar, the physical therapist, who had worked with the patient before, told the registrar that the patient didn't seem his normal, cherry self, but we all thought it was due to his worsening joint pain.
After morning clinic, I took the afternoon off and visited the Museum of London. The musuem begins with the pre-historic era and mostly describes the changing geography of London. For instace, the Thames river used to be far north of London. Over thousands of years, it moved southward, and has become more narrow and nore steep. According to our tour guide, if you walk along the banks of the river today, it is not uncommon at all to find clay pieces of pottery or tool from the Roman era. How cool! This is because the tide of the river is constantly turning over the sand so things that were buried are coming to the surface. Most of the collection in the museum was found from digs in the Thames. Water is great at preserving things like shoes, arrowheads, and skulls, because when an object becomes water logged, it locks out air. Air is what causes objects to decay.
As you move though the museum, the displays also progress forward in time. For instance, we walked though the Roman era, and saw marble sculptures of Roman gods. The great fire of London which took place in the 1700s is also on display. In fact, the famous dome of St. Paul's Cathedral was NOT the original design. Instead, St. Paul's church had an arched steeple. The dome was built after St. Paul's was destroyed in the Great Fire.
I think I liked the Victorian era the best. Dresses the ladies wore were on display. There was also the walls of a prison cell in the Tower of London on display and you could see people's carvings and graffitti on the wall.
I ran out of time before finishing the museum but must go back, especially as it is free!
No comments:
Post a Comment