Oddities, Fatigue & Headaches

1. Oddities

Q: When does a medical student get praised heartily for taking a good history, by asking only 2 questions?
A: When the doc made a mistake himself about the diagnosis (a terrible one at that - they almost operated on the patient), was trying to do you in by trying to trap you, and you somehow hit the nail right on the head. =)

Elderly 70+ year-old Caucasian gentleman as a "short case" in the clinic, he presented with right-sided ptosis. Dr. C: "What questions would you ask in this history?"

Q1: "Is the onset acute, or gradual?"
A1: Acute, patient noticed it suddenly.

Q2: "Is there ptosis first thing in the morning, or does it get worse at night?"
A2: Patient launched into a lovely explanation of how he can't watch "the pictures" because his eyes would droop halfway through.

There you go. =) Seems like ocular myasthenia gravis is not really common here either. It was a brilliant stroke of luck, mind. I had absolutely no idea what the man had - was about to follow up with a history of stroke, facial asymmetry, limb weakness, diabetes and ocular trauma. In any case, that Dr. C was definitely a (word block) kind of person. Initially he took very little notice of me, but after I accidentally (he wasn't to know that) got the diagnosis, he started being extremely friendly. Hmph.

I'm not in Dr. C's clinic though, I'm with the HK doc, Jason, in the oculoplastics clinic. Quite interesting, learnt a few obscure things like a phenomenon of droopy eyelids causing corneal abrasions on a pillow (reminds me of our dear HypoC and his proclaimation to an alarmed taxi driver that his eyeball was about to burst). Also saw plenty of lacrimal syringing, a particularly difficult patient with tardive dyskinesia, and also a Schirmer's Test being done.


N.B. This is not the patient we saw.

Decided to take the afternoon off, before my supervisor comes along tomorrow, so as to settle a few things and to take away this awful homesickness inside.

2. Fatigue

Fell asleep in front of the TV last night, and woke at 3am! Didn't sleep till now, and I'm now paying the price for it. Just plain tiredness. Not just from last night's early morning awakening (DSM-IV criterion for a major depressive episode?) but generally from everything that needs to be settled. Which ties this to the next section -

3. Headaches

Arghhh so many things to settle!!

May not be able to make the trip down to Birmingham after all. He made a mistake about being free on Sunday, and asked if it's alright to meet on Monday, a bank holiday. Of course it's alright. The only problem is TIME. Let's say I turn up on Monday morning, 11am-ish. We do our plant stuff till 3pm? That's short already. And I make my way to the Telford train station at about 4pm. 5 hour train to Glasgow - that's 9pm. That's really awful, it's a case of more time spent travelling than on plants! Trouble is that I'm limited by the time I need to come back, rather than the time I leave. Of course, I could make it more worthwhile by doing a Glasgow -> Birmingham -> Telford trip, instead of a Glasgow -> Telford trip. ARGHHH. I really want to go, but it's not quite fun going alone. =( And Telford's damn hell far from London too, else I could go with mom and yx at the end of the trip. This trip's going to be terribly expensive; I might as well fly over to Toronto to join everyone there.

There's the car hire too, but that's relatively minor. Should be settled by mid-week.
And also the Skye itinerary. Brrrr.