Sphincter tone

Sphincter tone

I had the great honour and misfortune of being on a ward round with this consultant. A great misfortune because of his reputation of being one of the ‘toughies’ that ask medical questions designed to make you feel like a stray cat cornered in a dark alleyway. A great honour because the ward round was spiced up by a pseudo-round of charades. You don’t play charades on every ward round.

The ward round was slowly coming to a close as we were reading the clerking notes of the last patient in the bay. Frail old dear with a history of advanced lung cancer came in the previous night with back pain and incontinence. A bit of bog-standard chest and abdominal examination finished off with a grand finale of urine dipstick. Then the consultant turned to me and spoke. (ARGHHHHH)

Doctor: “What is wrong with this clerking?”

Me: “Uhhhhhhhh…” (insert deer-caught-in-headlights-face)

The embarrassing pause felt very long. I knew there was something I should know. Of course there’s always something I should know. Darn, I don’t even have the “We haven’t covered that in the syllabus yet” excuse!!!!!!

Doctor: “SHE DIDN’T GET A NEUROLOGICAL OR PR EXAM! We just gave her a urine dipstick!!! We have done NOTHING for her!!!!”

Okay, so he didn’t really say that in at a decibel level warranting capslocks… but it felt loud, clear and very irritated. No good-medical-student points for me today.

Doctor: “Why do you think she needs a neurological and PR exam? What are we afraid of?”

I wasn’t exactly doing too well in the answering-ward-round-questions department. I proceeded to give “panicked face #’2”. It’s a bit like the first face but with wider eyes and maybe a touch of blushing in the cheeks. The next thing that happened before my eyes was rather surreal. Instead of the predicted “Consultant 1, You 0. I am smart, you are not.” answer, I was given a theatrical delight.

The consultant began to spray his hands in the air like imaginary fireworks. Dotting across an invisible canvas. I was not sure how to respond to this. I stared blankly. The FY1 doctor then joined in as they both waved their arms in synchrony – kind of reminded me of a water fountain. Not just a water fountain but……

Me: “METASTASES!”

Doctors: “YESSS!!!”

I had a split second of feeling smart until my initial stupidity dawned upon me to dampen the high. Why didn’t I think of that one immediately??? It was so obvious! History of lung cancer, back pain and incontinence – this poor lady’s history correlates closely with spinal metastases. Yes, I got the answer in the end but this lady needs a neurological and PR exam in case she has cauda equina syndrome… and we need to tell her respiratory physician quick…

almostadoctor

Posts by the "almostadoctor" user are written by junior doctors or medical students and have been deliberately anonymized to protect the identities of the medical professionals and patients involved.

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