a thoughtful day...

As usual,we had our skill class today(Monday)from 2-4 p.m..Sometimes(sometimes ok not usually) i felt tired and sleepy at this time..I think most all of my section class partners had same symptom just like me right?NO!!NO!!elele...Just admit it la my friend..:P


But,it's really differ for today.Guess what?hehe..we had chance to see a real patient that manifest jaundice.Jaundice is yellow discolouration of the skin,sclera and mucous membrane due to an increase in the level of bilirubin in the blood. I will not tell u details about the patient's background because it is non ethical and obliged to mention the patient's name or any information that can lead to recognization of this patient and also to prevent any harm or manipulation of the patient's data and his life(application of Medical Ethics..huhu)..


Then,the times came when the professor asked for volunteer and for sure there will be no one that are willing to do so.Moreover we must speak arabic with this patient.Then,the professor looked at me with her gleaming eyes and said,"can u come first,just only to take the history taking of the patient.We will help u to go through"Then,i just stand up and come nearer to the patient..

Although i'm felt a bit nervous as this is my first patient(there's 4 years more for us before graduated but i'm felt lucky that we had opportunity to see the patient now when we are in 2nd year).Then i just proceed by asking the patients some questions related to him-name,age,marrital status,occupation and so on..After that my collegues continue the rest-->symptoms,since when he developed this jaundice,past history,any realted disease,past medical treatment, etc..


After all,actually we were so fortunate bacause this patient can speak english also but not fluently.But,it's had help us more in diagnosis his disease.Point also must be given to our Professor that willing to become a transilator for us when the patient speak arabic word(with a very low voice and speed up frequency) that we don't understand at all into english..Although there is lack of communication between us and the patient but for me it's not burden us too much and it's so great to learn some arabic medical word.


Now, we come to the complaint of the patient.Let's all go through it together to understand it better.There are:
~weakness and fatigue
~lack of concentration when doing something
~changes in the colour of urine and stool
~stool is very hard in consistency
~pain in abdomen region(pointed to his stomach)


He added that he didnt noticed at first that he had yellow discolouration of his sclera but this symptom was noticed by his family-So,family concernity is important of course.

Professor told us that after some medical investigation and examination this patient actually had been infected by Hepatitis C Virus that cause cirrhosis of his liver.On top of that there is also tumor that present also at his liver..Hmmm...I'm felt empathy to him.

We had been given some time to check the patient by ourselves.I had chance to touch the lower limb of the patient that show pitting edema..why there is edema manifestation in this patient?It is because his liver was already impaired and can't functioning well like the normal liver.So,in this case the patient had hypoproteinemia that lead to decrease oncotic pressure in the blood that lead to failure of reabsorption of water thus lead to accumulation of water in the interstitial space between the tissue.

This patient also had tremors.This is diagnosed when we tried to stretch(hyperextension) his hand backward then after we set it free,we saw his hand contract uncontrollable for a few seconds.I tried to do so,(Alia put me in her experiment),and i'm stunned as my hand also had tremors.Did I had undetectable disease?Fortunately, professor explained that occasional tremor is felt by almost everyone, usually as a result of fear or excitement. We are shaking when the examination is about to start right?However, uncontrollable tremor related to certain disease.In this case,there is increase in ammonia level due to impaired liver function.Ammonia can pass Blood Brain Barrier(BBB)and affect CNS or neurological system of a person..





At the end of the section,I asked the professor why this patient had jaundice for a long time,reach to 2 years?is it this can't be treated?Professor then told me that his liver began to deteriorate,although the symptoms is been reduced but the fact is the liver's condition began more worse.The treatment now is just to reduce the symptoms of the patient.It's too late to perform operation for removal of the tumor.Masyallah.I'm very shocked to hear this.So,that's mean this patient in front of me will die within several years from now.I'm not denied that we as human being will die ,but how come i can hidden my feeling of sympathy and pity to him and his family..

Someone also asked if his liver was damaged then why didn't the liver transplant is not performed.The professor sighed and said that this is one big problem because it is very difficult in Egypt to perform liver transplantation.If i;m not mistaken prof also said that it is illegal to do that in Egypt.But,i'm not sure yet..I will go for a confirmation with prof tomorrow..


At last,although he can't be considered to be my first patient,but he is the first real patient i met in the 2 years i had studied medicine.I will not ever forget this time and i hope that one day,in the future there will be an advanced and high technology with a revolution of surgical equipments that can help us to remove and treat the patient with tumor although it is in the final stage..Is it sounds ridiculous?nope,right?Nothing is impossible unless Allah said that it can't be done...insyallah...