On Following ENT

We were scheduled for ENT surgery round today, under a specialist which turned out to be a guy instead of a lady. We walked around the hospital, wandering around finding where the ward is shifted to, since anyone who passed by the hospital would know there's some construction and renovation going on. Quite an eyesore I'd say, I wonder if there are increased cases of nosocomial infections in the ward.

There's a new term for ENT (Ear, Nose and Throat) in the hospital. ORL-HNS: Otorhinolaryngology-head & neck surgery. Whoa. Super longish. Impressive! *claps claps* Imagine walking around telling people, Good morning Mr Siva, I'm Dr. Bong, the resident otorhinolaryngological-head-and-neck surgeon in the hospital. Very annoying, no? *LMAO*

Well anyway, the ward round wasn't like the medical rounds that we had on Monday. Maybe because ORL-HNS isn't a big principal in our clinical years. We'd only be doing this sub-specialised surgical part in our phase 3B for just 3 weeks, compared to 8 weeks in the other major principals, namely internal medicine, surgery and paediatrics. Hmm wait. Now I'm lost. I think there's also posting on ObGyn, Primary Care Medicine and Emergency medicine as well. Oh whatever... when time comes, I'll know. *sniggering*

So I was saying, the surgeon didn't lead us to a patient and did some bed-side teaching like what we did in medicine and surgery ward rounds. Instead, we were led to a conference room something, like always, and were taught about the different equipments used. The traditional methods as well as the advance equipments such as some yada-yada-scope thingy. So I asked the surgeon, if there already are advance equipments namely all those scope thingy, why still learn about the traditional methods poking all those metalic stuff into one's throat? When we all knew one could easily puke. "It's provisional. Advance they may be, but what if they broke during the middle of an examination? Are you going to tell you patient you don't know what else to do?" *blush* Well he made us ask questions. And he said no questions are silly questions. So I asked!

Anyways, we followed him walking through the ward. He didn't led us to the bed, but rather tell us about all the patient's case in the main aisle.

This lady here is my patient. She's got maglinant otitis externa. It's not cancer, it's actually a kind of osteomyelitis. You know what it is right? Very hard to cure, so we're keeping her in here, and put her on 6 weeks of antibiotic. So yea, we have to monitor her stats, make sure she's stable and all.

Now over that end, there's a terminal stage cheek cancer. Indian lady. It's pretty common, you know, they like to chew betel nut. So we get quite a lot of cheek cancer in here. There's nothing we can do about it, we already did chemo and radiotherapy, everything we could. It's recurrent.

That gentleman over there, he's got pharyngeal cancer. Recurrent as well. The swelling and all, and he's admitted again after we discharged him a few months ago. Condition wasn't that good, on the verge of having carotid artery rupture. Almost 100% mortality rate. So we're keeping him in here, and make sure he's stable before we figure out what to do.

So you see, we deal with a lot of patients. There can be something just as simple as foreign body, or it could be surgical like the gentleman at the end, we did tracheostomy yesterday afternoon, and we also deal with neoplastic patients. NPC. Lots of them.

In this room here, young chinese lady, early 20s, terminal stage nasopharyngeal cancer. Very young. Poor lady.

This room, also nasopharyngeal cancer. Terminal stage as well. 3rd time he's in here. We removed the tumor the last time he was here, cleaned everything. But it came back. Metastasized all over the body. Can't do anything.

Now that room over there, also nasopharyngeal. Stage 4. Discharge 3 weeks ago after chemo and radiotherapy, but came back with recurrent. Also metastasized. Can't do anything as well.

...Nasopharyngeal cancer, terminal stage... Also, NPC, stage 4.... Another terminal stage NPC....

So, any question?

Dumb-founded. These patients are literally dying! There's nothing we can do about them? And they're practically just lying there waiting for the death God to come take them away!

I panicked. This is just a dream. It can't be happening. It's not fair to them! I was gasping for air. Hyperventilated... *wham* I lost my balance and fell down, muscle starting to cramp, all rigored from respiratory alkalosis. And the surgeon rushed over, "Nurse! Get a bag!" Everyone else in the group started to make way, Micheal ran over and get the brown bag from the nurse and handed it over to the surgeon. He placed the bag over my nose and my mouth, making me breath inside the bag. It ballooned and collapsed over and over. "Slowly boy, breath slowly." "I... I... ca.. cant.." "Breath in here, hold this. Hold this." My extremeties started to cramp up, I can't even hold anything with my hands. Fingers went numb, and I was literally curled up on the ground. Patients who were able to stand up came to see what's the mess. Nurses ran over to the crowd. And I still hyperventilated...

Okay, that was made up. ^.^ All dramatised.

But yes, in layman's term, more than half of the patients in the ORL-HNS ward were terminal stage cancer patients. No matter how advance the ward is, even with all those tenth of thousand bucks equipment, nothing can be done to save them. Seeing them on IV drips, and some on nasal prongs or oxygen mask, I felt really bad for them. Everyone in the group went "ohhh..." whenever the surgeon made a statement that the patient in reference is dying. My heart went really sour. Gosh, neoplasia have no eyes. Pitied the young chinese girl the most. She's really young! Like, very very young! Yet she knows, in the very near future, she's biding the world goodbye.

How fragile life can be... Appreciate and enjoy while you still can.



photos:
ENT chart by kristiewells
ENT cartoon doctor by perrabbit
ENT equipment by DREA SAN
Picture and imaging of Nasopharyngeal Squamous Cell Carcinoma courtesy of Bechara Y. Ghorayeb, MD, Houston, Texas
NPC MRI courtesy of American Family Physician
Rigor mortis by The Tidal Rabbit
Colourful life by ♥ China ♥ crystal咪-执着的想养猫的人