Rejoining internship after almost one and half year

Taking a break from internship is easy, but going back and doing the same tasks again is what makes you feel reluctant.

But that’s not the same case, when you are posted in MEDICINE. The vast diversity of cases and a wide range of interests, backgrounds, experiences makes medicine more particular. Differences among groups of people and individuals based on ethnicity, race, socioeconomic status, gender, exceptionalities, language, religion, sexual orientation, and geographical area. Every element tells a hidden story about a disease.

Hello, This is Satyakishore Ankam, Intern (2k16batch) with a great passion for medicine and strong communication skills in patient interviewing and assessing  their need for care. Dedicated  to focus on patient care with clinical and ethical objectives and deliver  them the utmost service to the best of my abilities. 

Assuring a patient that the test was not necessary:

I took a break from internship in order to start my USMLE journey and I rejoined after almost one and half year to complete my remaining 15days in Medicine. My first insight was into a 15Y old female student(currently in class 10), who presented with  recurrent episodes of giddiness. She was brought to OPD by her parents, who seemed a bit worried about their child. Looks like the girl is also somewhat anxious. They came on a request for MRI brain imaging advised by a local RMP doctor,  due to the recent syncopal episodes of the girl. She fainted for almost 3-4times while in her school, in less than a month.

She had pallor on examination, and her Blood pressures was 110/70(on supine) and 100/70(on standing). A drop in the BP on standing from supine position - Postural hypotension. That’s when I noticed, she was weak for her age and was under stress because of her upcoming exams. She also complained of occasional headaches, attributed to her stress. Their parents still want a MRI. Then I  took her to the ophthalmology department, for funduscopy (to look for any optic disc changes) which was normal. Vision is 6/6 in both eyes. CNS examination is also normal. We adviced the patient to eat properly and take plenty of fluids and assured her parents that there is no need of doing MRI brain. 

I then realised that not only advising patients to do certain tests, but also preventing them from doing some is a difficult task.

https://1601006007.blogspot.com/2024/02/a-15-year-old-female-with-giddiness.html

Recalling a case with similar presentation but with different etiology:

The 15Y old girl reminded me of a case, back when I was first  posted in Medicine. It was case of 70Y old female who came with episodes giddiness followed by loss of consciousness. Her GRBS was 33mg/dl before she was brought to the hospital. I found that she was on Insulin and T. Metformin 500mg for 4years after reviewing her medications. [Hypoglycemia secondary to Oral Hypoglycemic Agents……]

Some cases are unforgettable, remaining ever vivid. Recall them as often as you wish, a case with such history never fades out.

https://1601006007.blogspot.com/2022/05/a-70y-old-female-with-hypoglycemia.html

A never ending story of Alcohol and Liver:

Drink never made a man better, but it made many a man think he was better ~Finley Peter Dunne

As I entered the medicine ward, there was a 37year old Male patient lying supine in the bed. At the first glance, I can make out the yellowish discolouration of his eyes -Icterus(universal finding of elevated bilirubin levels) and his distended abdomen drove me towards ascites. 

I was curious about his history, so I began to dig. He presented with abdominal distension and swelling of legs since 2weeks. He used to regularly consume alcohol since 13years, but increased the intake to 180ml/day since the last 7months and his smoking history dates back to 20years with smoking half a pack cigarettes a day. A look into his laboratory values showed elevated ALP and Total Bilirubin. Hypoalbuminemia is present. SAAG is 1.72, which indicates the non-peritoneal cause of his ascites. While examining the patient, I also appreciated the shifting dullness and Fluid thrill. A classic case of Chronic Liver Disease.

After trying some ayurvedic medicine and having no effect, his family members brought him to the hospital to find hopes of cure. Unfortunately the patient is HBSAg positive…..

Even though a number of people have tried, no one has yet found a way to drink for a living.

https://1601006007.blogspot.com/2024/02/a-37year-old-male-with-abdominal.html

Sharing the knowledge:

The newly passed first year students stepped into the wards with thirst for knowledge. I was told to look after them So, I thought that I shouldn’t miss this opportunity to teach them something. I explained them about basic cinical history taking, General and systemic examination and gave some tasks to complete thereafter. I really blissed out teaching them as they reminded me of myself during my UG days.

As our HOD, Dr. Rakesh Biswas sir always says that, it’s not how much hard you work, but it’s the impact that you create matters the most. Even though my time is short to make an impact, I have learned a lot in these 15days. 

Looking forward to experience the art of medicine and the advanced healthcare system in my further rotations in USA.