In our blessed faculty’s hospital , known as el Demerdash (a governmental/university/teaching/really cheap and miserable for the most part hospital), you’ll find a huge display of human misery. It’s really one of the bleakest places I’ve ever been, particularly the children’s hospital which is always overcrowded.
When you’re in your 5th yr of med school and you’re actually dealing with patients hands on, you realize with a great degree of shame that you’re intimidated by them. You actually perspire, tremble a little and wonder if you were really cut out for this when you have to perform an examination or even take their history.
Is it because we still haven’t gotten used to the idea that we’ll be dealing with human beings and not just answer sheets? Sure.
Is it because not an insignificant number of our professors will make fun of us at the smallest mistake in front of the entire round?
Well, sometimes. Depends on how resistant you are to ridicule really
Mainly though…It’s because Demerdash patients are professionals and I’m talking about the chronic patients especially. They know more than you do. Much more than you do. The thing is, someone say, with hepatitis or with a valve disease has been coming to this hospital for 10+ yrs. He’s listened to the professors talk and talk and talk in both rounds and in private lessons. So basically these patients have graduated from med school twice over. When you go up to one of them all full of the intention to act as ..errr…doctorly as possible, he/she gives you the complete scientific explanation of their condition and how to examine them(where to put your hand , how hard to press , which order to use..etc.). Naturally, you’re crushed and the idea of crawling into the foetal position in a corner somewhere doesn’t seem so bad considering what a silly little thing you actually turned out to be.
Ah yes... I remember my first sheet when the patient pointed out that I had forgotten to ask him his job and marital status and started to tell me point by point what to write about his disease and what not to write . I particularly remember how he said in the exact scientific (English) terms : “I had rheumatic fever when I was eight now I have a double mitral lesion and my father died of coronary heart disease “. I didn’t even know what a double mitral lesion was at that time. There are actually ones who taunt you when mess up something. Like a couple of weeks ago a cardiac patient asked me “ How do you expect to auscultate the femoral without palpating it first?" with a smirk and a sinister look from behind his glasses. “ Well um…I …um…know where it is already!” was all I managed.
Yes, great comeback , I know.
There are even famous patients who get phoned (via their cellphones or special patient “caterers”) in especially for exams and for lessons. These are usually the ones with textbook cases and clear enough cardiac murmurs or signs for our inexperienced ears and eyes or just really rare ones we usually expect to only hear about but never see.
This is all for a price, of course. Rounds are cheaper than lessons as expected ; an hour or 2 is a pound or 2 from each student making up about 40-60 pounds depending on the round each day. Lessons though are about 70 L.E / student for about 6-8 patients and there are roughly about 80 students per lesson. Exams though, well, now we’re talkin’! If you look gullible, a patient can actually squeeze over 150 pounds from you during an exam. There are stories about having to give up earrings and watches. I have even heard a girl actually got asked to give up her wedding jewelry during the exam. Why pay up? Well, there’s always the fear that the patient may give you the wrong information during history taking, therefore steering you away from the correct mode of examination or diagnosis. When your examiner spots something shady in your sheet and asks the patient to confirm, they of course say something completely different. There goes quite a chunk of your grade and your future plans.
Why,thank you very much Mr. Chronic patient sir.
I don’t know if this makes me sound cold-hearted or if the entire situation is too bizarre to make me sound otherwise. It’s like the people you go into medicine to try and help end up being the bane of your existence for the last 2 (and most crucial) years of your undergraduate studies. I don’t resent paying the money but I do resent being taken advantage of, I resent this entire system of teaching medicine and come to think of it, I resent having to feel resentment towards somebody with a chronic illness actually.
Good God, that was long…Ah , well …till next time !
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