Surgery: Day 3

I had quite an interesting morning at the outpatient General Surgery (GS) clinic today. This was just my second clinic duty of the week, and I was expecting to see either a breast mass or a neck mass case since these were the more common conditions seen at the surgery OPD. But I forgot that this is GS after all, and what I would see could be anything.

Enter patient #1: B.L., a 22-year old male from Pasig. "Magandang umaga... so anong ipapa-konsulta mo ngayon?" I asked. The patient answered,"Luslos po." At first I was a little confused because I couldn’t remember what the colloquial term meant. But as the interview went on it dawned on me. Oo nga pala, hernia... For a fleeting moment I felt awkward. Buti na lang may ka-partner akong classmate! I can't imagine encountering my first hernia patient on my own. It would probably take a bit longer for me to 'recover' and be efficient in my interview. Siyempre 'di pa naman ako sanay tumingin ng hernia patients noh.. hahaha! He first noticed the hernia when he was Grade 3 or 4... Sobrang tagal na! But he said he experienced pain only three times (first during high school and the next two in college). We managed to examine him with the guidance of the resident surgeon on duty. We actually insisted, even if he said, "Ok lang yan, kaya nyo yan." Hahaha. Then we sent the patient off with a referral to Urology for repair of his hernia.

Patient #2: N.R., 31-year old male from Bulacan. Chief complaint: "Luslos". Wahaha! Second hernia patient! This time 2 months lang ang history nya. At inoperahan na rin sya nung bata sya para sa luslos sa kanan. (Kaliwa ang nirereklamo nya ngayon.) Sabi ko 'pag yung susunod pang patient hernia pa rin, ay exagg na. Haha..

To our relief (which was kinda relative now, on retrospect), patient #3 was different. A.D., 16-year old male from Tondo, had a painful mass on his lower back, which grew from a size of 1 1/2 inches to about 4 inches wide in just one month. He also had on and off fever. He consulted a private doctor two weeks ago and was prescribed antibiotics and paracetamol for a week, but the pain still persisted. The mother also said he was prescribed cough meds (which she couldn't recall), but they were not able to buy them. We tried to further explore the cough for a moment, and we didn't get much except it was non-productive, and that the mom and a sibling had chronic cough as well (about a year's duration). I was thinking (and I'm sure my partner Jill was, too): TB kaya yun?? And when I listened to his lungs, I heard something like wheezes on all lung fields. Warning signals began to go off in our heads, but on we went... His mother also said he had similar masses in 2004--two on his back and one on his left upper thigh. One was excised in a hospital and the other two 'erupted', with pus draining out. On examination, his current mass was reddish, and on palpation it was warm and felt like it was fluid-filled, most probably due to pus also. We endorsed our case to the resident, and in just one minute, he said, "Naku, hitsura pa lang Tuberculosis na! Ipa-AFB smear na tsaka thoracolumbar x-ray… Baka Pott's disease yan..." Yikes! We just got ourselves exposed to a TB suspect… I sure hope my immune system doesn’t get weak enough that my lesion (if I already have one) gets activated…

Back to our patient—the resident asked me to aspirate some pus to submit to the laboratory, but for some reason I couldn’t get enough. So he decided to proceed with incision and drainage (I&D). Poor kid—no local anesthesia was given (even if the Pain Clinic was just next door), so he was shouting and wincing in pain while the resident stabbed his abscess with a blade and milked out pistachio-green pus (yeah I know it’s gross... hahaha). We didn’t get to see the resident finish up though because we had to leave for a small group case discussion. On our way out we saw the mother looking quite worried that we had to assure her that the I&D was done for her son’s sake (although I agree with my classmate that giving anesthesia would also be a big help… =/). Kawawa yung patient… pati yung family members nya kelangan nang matingnan, malamang may TB rin sila.

This day at the OPD was a lesson for me to be observant and alert, especially when an obvious case is already staring me in the face. Looks like Surg will be another fun rotation… =)