Today I suddenly felt like writing something medical related. Well maybe not so related, but it's really an amazement. Towards the art of medicine. (See i got a looking-bombastic kinda opening zzz, well things might get boring)

I've always hated short case. Not because of scared of dealing with patients (well maybe there is fear hmm), but it's because of the eyes watching you. 8 pair of eyes, and well now 15 pairs inclusive those of the patients, are watching how you gonna humiliate yourself - what step you'll be missing, what funny instructions you will be giving, and what are the surprises from the patient's body we will be receiving.

Tadaa! There's a murmur where you put your stethoscope too near to the sternum that Dr has to help you to lift it up to the parasternal area. There's a raise in jugular venous pressure which you missed. Or simply just - you didn't kneel down at the bedside of the crowded ward, and you squatted instead - and your Dr sarcastically called that a newly invented praying mantis position of examining. And you have to continue with embarassment + sweat dripping down from your face. Phew.

And so. These explained my euphoric mode each time after short case. I felt like treating myself the best food in the world.

Things started to be enlightening when Dr asked us to make the techniques our second nature - and his eyes shone brightly and proudly when he said "There's just some students that made it so smooth.." (paused and smiled) "...when they met the patient they just pap pap pap and everything is done." (smile again, eyes looking to a far end dunno-where) and you listened with admiration. And when another Dr told you Jendrassik maneuver is for distraction only - well is it me who had only knew this today? @@

Today we started our class by examining a patient to rule out Guillain-Barre Syndrome. Just read that last night for my MCQ discussion in study group, still haven't understand a single thing about it, other than knowing the weakness ascend to feet up to trunk. And so everyone's head were down when Dr asked anyone would want to examine - and luckily Nabilah bravely stood out. Things went clumsy a little, but generally she managed to finish everything except requiring Dr's help to elicit a knee jerk reflex of the right knee.

Everything was normal, with proximal muscle pain and reduced power (due to pain). Intact sensation, reflex okay, tone normal. Okay bye I'm confused with that already. And Dr started explaining how the concept of Lower motor neuron lesion comes - the anterior horn cell, the peripheral nerve, the nerve roots, the neuromuscular junction, and the muscle. And it felt like you had been floating on the sea for long, and one day a ferry appeared and offered help *exaggeration*

And Dr came to a diagnosis of polymyositis - and we all understood the reason. "This is the beauty of short case. You do the examination, ask a few questions, and you know what's happening." Dr went into details of the neurological diseases of muscles, and the diagnostic test for the disease. Creatinine kinase, EMG, muscle biopsy. He talked about how Guillain-Barre Syndrome is not even in the differentials. The patient was being brought pass us, going for brain CT via lift. Dr looked in awe. "That's why you guys are here. Learn to not order unnecessary investigations." Dr shrugged his shoulder.

We brought Dr together for lunch in the afternoon. I broke the silence when everyone's eating awkwardly. "Dr you seemed so interested in neurology. Why do you pick up cardiology later on?" Dr smiled. "That's not much to be done in neurology." He sipped a spoonful of soup and continued, "I took you guys for more neurological classes, but this isn't implicating that cardiology is not important. Many other doctors will take you for cardio. Not much Drs will take you guys for neuro." We nodded in gratefulness.

We went in for lecture in the afternoon. "Hey you guys heard about it? The diagnosis of the patient changed to polymyositis!"

We were surprised and amazed. And I suddenly felt that it's possible to understand and finish the book of "Making Neurological Diagnosis At The Bedside" before my finals.