Monday, February 16, 2015

Clinical Experience #1

Surgery OPD, sometime around midday.

Ramanuj sir had just asked the next patient to come in while we were busily examining a cute balloon like swelling on a patient's wrist. It was about one centimetre wide, translucent, painless, and honestly, doing the fluctuation test (For the uninitiated: Fluctuation tests are sort of like the medical man's bubble wrap) on a swelling like that is way too much fun.

“Ah, what an interesting case!” I heard him say softly, as he turned to look at us with a twinkle in his eyes.

“Baba, apni oi bed e giye shue porun.”, he told the patient, “Ei daktaar babu ra apnake ektu porikkha korben.”

We positioned ourselves around the examination table as the patient lay down on it. Sir appeared by the bed as soon as the patient was comfortable, and stood in between me and Bambi on one side and a bunch of girls on the other.

“Apni pant ta ektu namiye din”, He told the patient, and turning towards us, he said, “What do you see?”

Sir had lectured us on the differences between observing and seeing a few minutes back, and in an effort to interest us (quite successfully, I might add) he had compared the process to what Bennedict Cumberbatch (Yes, he is a fan) does in Sherlock. I peeked over Bambi's shoulder determined to get the diagnosis right. The abdomen seemed normal but there was a swelling in the left groin, and below that...

The uncomfortably long inspectory silence was finally broken by my voice.

“Sir, he doesn't appear to have a penis...” I said uncertainly, because I had been concentrating so hard on the swelling that I was suddenly very confused about the position of a penis. (Later I learnt that I wasn't the only one; Bambi had assumed that the penis was under the scrotum.)

“Hmmmmmmmmm, and why do you think is that?”

(Please don't judge me for what I said next. Not only was I still reeling from the observation, but I got the diagnosis right on my second attempt.)

“Sir, it looks like the penis has retracted, and is trying to come out from that opening,” I said, pointing at the swelling, trying to imagine the anatomical route the penis might have taken.

“Retracted? The penis has retracted? What next? Apoptosis of the penis? Well, well, well.”

[More about the case: The man was an amputee. He was diagnosed with penile cancer about 20 years back and was treated by a partial amputation of the penis. He has come back after so long because the cancer had not been removed completely and has now involved the inguinal lymph nodes. It was a case of metastatic lymph node.]

5 comments:

Chandrajit Rudra said...

erom o hoi!!!

Dev said...

Unfortunately, yes.

anwesha nandi said...

Loved ur sense of humor.. Love d way u write.. N ur observational skills. Mashallah

anwesha nandi said...

Please aro onek lekh..

Dev said...

Yay! Thanks, Anwesha!