4th Year Clinical Rotations – Internal Medicine

After three long years with no patient interactions, I was greatly looking forward to starting our hospital rotations. I didn’t know what to expect, but most of my friends would tell me that this year was “chill”. I saw it for myself, fourth-year students did not look seriously busy. The kind of year where everyone ventured out to do something apart from intense studying. We started the year off with internal medicine which was split into general internal medicine, dermatology and psychiatry. It was a little nerve-wracking for us to be going into the hospital during these unprecedented times. But you wear a mask, read your athkār and hope for the best.

Dermatology

We attended the dermatology rounds three times a week and saw various cases ranging from severe psoriasis to alopecia to vitiligo. And a fairly worrisome number of warts. Initially, I was a little apprehensive about this particular rotation since I disliked anything to do with skin diseases. I had mentally written off a career in dermatology, way before I ever applied to medical school. Not even cadavers in the anatomy lab, nor the sight of human blood would make me as squeamish. I had a similar struggle with parasitology last year when studying topics such as eye worms or tungiasis. Nevertheless, I planned on keeping an open mind. And to say the least, I was surprised. 

Although patients were volunteers who were compensated for their time, it still felt somewhat uncomfortable gathering around them to see the disease they suffered from. Moreover, I couldn’t help but notice the long sleeves to hide lesions on their arms or a cap to hide a bald patch on their scalp. The doctors advised us against inquiring about the patient’s prognosis in their presence. A kind reminder that you are looking at a human and not just a disease. I didn’t always find myself in agreement with the approach some doctors had in their patient interactions. However, just as you learn what to do in medicine, you most importantly learn what not to do – do no harm. 

Our lectures were conducted daily on Zoom and by the end of the rotation, I was a lot less squeamish about everything (yet to fully get over it) and had a new-found appreciation for this field. I thought about how something as treatable as acne could have a huge impact on someone’s quality of life. Undoubtedly, the perks of the job are many and speaking to a few dermatologists over the years, I can now see myself possibly pursuing it as a career. The flexibility, the working hours, the possible entrepreneurial aspect of it makes me think that it’s right up my street. I wouldn’t take my word for it though – some days I want to work in a hectic A&E under an intense adrenaline rush.

Overall, this round lasted two weeks. The exam included two cases of real patients we had to diagnose. One was a girl, so tiny I didn’t initially notice her and thought her mother was the patient. I said “Asalamu alaykum” and she cracked a huge smile at me. As I proceeded to examine her hands and write down my answer, the little girl repeatedly whispered to me through her mask, “Vitiligo, vitiligo”. I couldn’t help but laugh. The other case was an old man with athlete’s foot. He was not as willing to share the diagnosis, but I managed just well enough on my own 🙂

General Internal Medicine

I knew this one was going to take me very well outside of my comfort zone. I wanted that for myself – by the words of Yes Theory, “Seek Discomfort”. The doctor explained the steps of history taking and then asked us each to inquire about one point. Now, here’s something to note – I’m pretty fluent in Arabic. However, when it was my turn to take history from a patient with ulcerative colitis, I nearly froze. But I shook the nerves away, introduced myself and asked permission to proceed. I thought, how hard can it be to ask about a few gastrointestinal symptoms in Arabic?

Turns out quite hard. A lot of these symptoms I only knew in English, but thankfully the doctor helped translate for me and I could ask further questions. What really caught me by surprise was the patients’ medical knowledge. When hundreds of students ask you the same set of questions every year, and a doctor repeatedly explains it; you’re bound to become the expert. Patients regularly used medical terminologies to explain their symptoms, would correct us if we asked the wrong questions and sometimes unwittingly give away the diagnosis mid-conversation. Clinical examination was also taught to us and my most memorable encounter was a patient in his mid-30s. He was newly diagnosed with Hodgkin’s lymphoma and became so familiar with the disease that he started to explain the signs and symptoms we should look out for – as the doctor sat there. One by one, we examined his neck and underarm lymph nodes and he would guide our hands to place it correctly and feel the swelling. By the time it was my turn, I realised his neck felt warm from all our hands grabbing and feeling. But he didn’t complain, rather he insisted we do our examination properly.

I admired his positivity and eagerness to help us learn. I had not previously met anyone who had Hodgkin’s lymphoma, but I know it is not pleasant to be looked at as a textbook case of disease we study. When we get to know people, we’re interested in their life and the stories they have to tell. Doctors want to know what hurts and when it started. That day, I did not see a man with Hodgkin’s, named so and so. I saw so and so, a man, suffering from Hodgkin’s. I would hate to become desensitized and lose my empathy as a doctor one day, particularly when patients like him are so very eager for us to learn. This rotation probably had the most impact on me. It also gave me a sense of confidence asking all the right questions and my initial diagnosis proving to be correct. Another great benefit, it helps me avoid rambling at the doctor’s appointment and get straight to the point. Apparently, they don’t want the backstory to how it all started years ago..

Psychiatry

I was told that this rotation would be the most interesting one. However, patient interaction was no longer a possibility due to a spike in Covid-19 cases again. So instead we watched pre-recorded videos about psychiatric history taking, with the patient’s consent taken and their faces blurred. We made the most out of it though – I believe everyone had a person in mind that they now believed to have a certain mental disorder. You notice the almost identical clinical presentations and things start to click. A friend of mine wanted to know the approach to take in the case of a person who’s in denial of their mental illness. I realised that a little child I knew had ADHD and was not a troublesome and difficult son like his mother believed – a psychiatrist later confirmed. We all had our personal takeaways and conclusions from the psychiatry rounds. It helped some of us better understand ourselves and others around us, who may be fighting battles we have no idea about. And when things start to make sense like that, you, in turn, become more compassionate and have a clearer understanding of why some people are the way they are.