Tags
aiims, college life, college student, leprosy, life, mbbs, medical student, reast cancer, student, surgery
23rd February:
Today has been one of those rare, productive days when you are filled with energy and purpose! You know when everything looks bright and shiny and you just feel like working and learning 😀 . For three hours, me and my friend New Fight Seth (I am not joking, this is his name 😉 ) kept on observing and asking and learning in the Surgery Department today. Starting from common cases like lipoma, sebaceous cyst, haemorrhoids, ANDI (Aberrations in Normal Development and Involution), fistula in ano to serious ones like a painful pyocele, advanced breast cancer, massive ovarian cyst and a particularly gruesome case of leprosy, what a complete experience I have had in my Surgery posting today!
Both of us also got to see an endoscopy done and did a DRE (Digital Rectal Exam). It was my third DRE and well, I blame my small fingers for getting not results 😦 . My hopeless dainty fingers are hopeless during percussing the abdomen too!
As I write this, I am going through some of the questions that popped into my mind today. I am noting down some which I found rather remarkable:
- First of all: breast cancer staging is a tricky business. History of the patient I saw today and you will understand: 34 year old lady had a lump in her areolar region with dimensions of around 6 cm, slight puckering of the nipple, multiple central axillary nodes and no fixity to the chest wall. On palpation, my professor noted ipsilateral swollen supraclavicular lymph nodes and then everything changed. The stage of her cancer at once became ominous (Stage III at least if I am not mistaken). It had been her first visit to the doctor. Strange isn’t it? A woman comes with no complaints at all apart from a slight lump and her life changes. Another keeps on complaining about cyclical mastalgia (breast pain coinciding with the menstrual cycle) and all that is requiring is counselling and evening primrose oil (after exclusion of any serious pathology of course). For me, this staging business is very confusing. Bailey and Love’s Short Practice of Surgery has an overly simplified (their so called pragmatic) classification of breast cancer whereas Sabiston has a scary, complicated TNM classification table. Got to clear up the mess!
- The particularly gruesome foot of a patient who had had leprosy since many years left me quite shocked:
Huge abscess in the foot of a leprosy patient
Scary isn’t it? Yet, the patient doesn’t feel any pain. This loss of nerve function is the culprit which has mad the foot sustain multiple injuries and deform in this serious fashion.
In India, leprosy is officially eliminated which is misleading in itself because by elimination, government statisticians mean that the overall incidence is less than 1 in 10,000. Considering our population, you can manage the disease burden. With the advent of multi drug therapy effective treatment is possible. Like my Dermatology Sir rightly said in his stimulating class, it’s of utmost importance to know the clinical features and remove the myths and social stigma around it.
On this note, I end. I shall be grateful for feedback and discussions regarding topics related to medicine, science etc. So many questions, so many things to know!
The importance of knowing the science and never judging
Randomness of life 
And it’s images like that one that make me hate surgery. Also, I’m curious, is that last picture of the leprosy patient’s face real? Because it looks photoshopped to me!
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The last photo is off the net but I assume it is true in spite of the touch up. The foot is first hand though. Second time that I saw maggots coming out!!
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Did a little searching on the internet and it turns out that that picture of the lepromatous face was true after all. Mea culpa !
And I must say that you seem extremely interested in surgery. I can tell by the way you write !
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