Beautiful Pathologies
Second year in medical school is no joke. I've survived so far (thank God) but I can't say that I feel like I've actually accomplished much. We have an average of 3 exams a week - and as book chapters, notes, preceptorials, SGDs, sports, practices, and everything else piles up each week I can't help but feel like a robot that's just going from one exam to the next, one lecture to the next, one week to the next, etcetcetc. But that is a rant for another time. Luckily, clinical exposure more than makes up for the school work we have to slog through in Roxas Hall. Yes, as cheesy as it sounds, seeing patients, interacting with them, and learning from them lightens the load a little bit. You get a glimpse of what you're working towards.
This afternoon's preceptorial session was one of the best so far (I might be biased because I like IM a lot more than pedia and derma). Dr. U. was a great mentor and I really learned a lot from her. As we reached the end of our discussion about patient PA, we were all tasked to come up with diagnostic tools that could help clinch patient PA's diagnosis and, as a group, narrow it down to just three. The group was entertaining the thought that patient PA might have pancreatic cancer, so the top 3 diagnostic tools the group decided to "order" were CA19-9 (a serum marker for pancreatic cancer), CT Scan and/or ERCP (to determine location and extent of growth of the tumor), and serum bilirubin (patient was jaundiced). To finish up, Dr. U. scanned patient PA's chart and read his results out loud, eventually announcing to the group that the patient's CA19-9 levels were at least 10 times that of the normal. Boom. Diagnosis clinched: Pancreatic Cancer. BUT as it turns out the patient actually has ampullary cancer (serum levels of CA19-9 are also elevated in this cancer, and it presents with symptoms similar to that of pancreatic cancer). Still bad, but at least prognosis is better after surgery (provided tumor hasn't penetrated past the mucosa yadayada). Cancer is cancer. He needs to raise 70k for a CT scan and the planned surgery. And with a monthly income of at most 2k things aren't looking so good.
It weirds me out to say that this was one of the best precepts so far when the end point is that someone just got diagnosed with cancer. I found the patient visit after the session to be particularly hard since we all knew the diagnosis and the patient was lying there thinking that this was just a case of gallstones gone bad :( Patient PA has a 5% chance of surviving for the next 5 years. Some things just remind you of reality.
His story isn't over and he can still have his happy ending (and I hope he does). I'm praying that he can get the funds he needs and that he defies the odds to be part of the 5%.
I got the title of this post from this article. An interesting read for med students (and non med students as well).
This afternoon's preceptorial session was one of the best so far (I might be biased because I like IM a lot more than pedia and derma). Dr. U. was a great mentor and I really learned a lot from her. As we reached the end of our discussion about patient PA, we were all tasked to come up with diagnostic tools that could help clinch patient PA's diagnosis and, as a group, narrow it down to just three. The group was entertaining the thought that patient PA might have pancreatic cancer, so the top 3 diagnostic tools the group decided to "order" were CA19-9 (a serum marker for pancreatic cancer), CT Scan and/or ERCP (to determine location and extent of growth of the tumor), and serum bilirubin (patient was jaundiced). To finish up, Dr. U. scanned patient PA's chart and read his results out loud, eventually announcing to the group that the patient's CA19-9 levels were at least 10 times that of the normal. Boom. Diagnosis clinched: Pancreatic Cancer. BUT as it turns out the patient actually has ampullary cancer (serum levels of CA19-9 are also elevated in this cancer, and it presents with symptoms similar to that of pancreatic cancer). Still bad, but at least prognosis is better after surgery (provided tumor hasn't penetrated past the mucosa yadayada). Cancer is cancer. He needs to raise 70k for a CT scan and the planned surgery. And with a monthly income of at most 2k things aren't looking so good.
It weirds me out to say that this was one of the best precepts so far when the end point is that someone just got diagnosed with cancer. I found the patient visit after the session to be particularly hard since we all knew the diagnosis and the patient was lying there thinking that this was just a case of gallstones gone bad :( Patient PA has a 5% chance of surviving for the next 5 years. Some things just remind you of reality.
His story isn't over and he can still have his happy ending (and I hope he does). I'm praying that he can get the funds he needs and that he defies the odds to be part of the 5%.
I got the title of this post from this article. An interesting read for med students (and non med students as well).