Because at the end, WE ARE DOCTORS AND WE DO CARE ... !!!

Today ... !!!

I got a patient from ER with the complaint of PR BLEED and Shortness Of Breath ... !!!


He was a patient of Decompensated Chronic Liver Disease, Hypertension, Pulmonary Tuberculosis with Hemoptysis, Massive Ascites previously 2 times Therapeutic Ascitic Tap and 2 times Endoscopic Band Ligation for varices ... !!!


He was managed accordingly ... !!!


I thought, it is Saturday today and if patient will get late then we will get his work up by Monday.


Instead of giving orders on file, I decided to do everything for him myself.


I took his samples myself and send for Baseline Investigations ... !!!

I took him to Radiology Department and got his USG Abdomen and X-Ray Abdomen Erect ... !!!

I did his Diagnostic Ascitic Tap and send for examination.

I did his Therapeutic and Diagnostic Pleural Tap and send for examinations.

...........


It took me 4 hours to get everything done and while i was sotting in Doctor's Room for having a glass of water, his wife came and said ,,,

    " Doctor, My patient had been in the ward since morning and none of doctors even bother to attend him "

I was so furious, I was so angry. I just wanted to throw her down from Burj Khalifa ... :/


I took a sip of water and said very calmly;

    " Khatoon, blood pressure of your husband is high, go and fetch this medicine ... * Handed her a slip * "

All she had to do is; go in OPD, have a OPD Slip for Medicine from the line of 30+ women , then  go to OPD medicine and have it written and stamped from Medical Officer through the line of 30+ women then go to pharmacy and get medicine after 50+ women already standing there ... !!!


After 1 Hour and 48 minutes she came in the office and said;

    " Pharmacy has been closed. They don't give medicine after 2 pm. I had been there for 2 hours but couldn't get due to crowd. "

I said;

    " Exactly ... Humaray logon ko izzat raas nahin hai ... Main ap logon k liay subha say khajal ho raha hun aur ap nay mughay aa ker ye kaha k humara mareez dakha nahin gaya ... Ho he isi kabil ap log ... "

    ( Exactly, Our people aren't very used to respect given by others. I had been running for you people since morning and even then you came to and said none of you have attended the patient. You people deserve this. )

P.S ... I provided her Medicine from Ward Emergency Pharmacy ... !!!

 

Because at the end, WE ARE DOCTORS AND WE DO CARE ... !!!

Medicine Case

A 60 years old lady presented in Emergency Department with epigastric pain from last 4 hours.
She is a diagnosed case of Hypertension.

O/E
Pulse : 84
Temperature: 99 FH
B.P : 180/110.

ECG showed S wave in V2 > 1.5 mV
R wave in V5 > 2.5
and Q wave more than 3 small squares in V3

She was given oral NITROGLYCERIN ... Blood pressure lowered down to 130/85 ... and pain got relived unexpectedly. She was discharged on Ca channel blockers.

On follow up, her blood pressure was 150/100. Doctor changed her Medication to Beta blockers instead of Ca channel blockers.

After 2 days she again presented with sever epigastric pain and her blood pressure was 125/85.

What is your diagnosis?

Feel free to comment your answer.

فراق ...

قصہ ہے روایت ہے
چاہت میں ذرا ڈوبی
چند لفظوں کی حکایت ہے

وہ بیٹھی سامنے بولی
ہم یوں بھی تو پتھر ہیں
پتھر کی اس دنیا میں
پتھر کب راس دیوانے کو

!سنو
کیا مستقبل اس پتھر کہانی کا
کہیں دریچے ہیں مقفل
اور کہیں قصہ جوانی کا

پیروں میں بیڑیاں بھی تو ہیں
اڑنے کی چاہت لیے دل میں
قفس میں دل چہچہاتے ہیں

چلو یوں کرتے ہیں پتھر صنم
ہم یہ نہ ناطہ توڑ دیتے ہیں
جہاں مستقبل کی آس ہی نہ ہو
وہ درد رشتہ توڑ دیتے ہیں

شروع میں ، ہاں ، تھوڑا مشکل ہو گا
چاند آنگن میں اماوس بن کے اترے گا
تمہاری یاد کے جھونکے تن بدن سے
نشتر کی مانند روح میں اتریں گے

کئی روز آنکھیں بھی تو سوجیں گی
کئی دن کاجل بھی تو پھیلے گا
مگر وقت کی گرد ان جسموں کو
پھر سے پتھر ہی بنا ڈالے گی

بڑی چاہت سے بڑھا آگے
ہاتھ تھامے کرب سے بلبلایا وہ
چہرے پر بے معنی سا خالی پن لیے
سکوت اس ماتمی سی شام کا توڑا

اچھا چلو ہم مان لیتے ہیں
صنم پتھر کدوں کی ہی زینت ہیں
جہاں ہر تراشے خوبصورت بت کو
زمانے کی سچائیاں توڑ دیتی ہیں

مگر کیا ہر ستارے کو دوام حاصل ہے
کیا ہر کہانی کا کوئی انجام ہوتا ہے
ادھورے لفظ اور نظمیں بھی تو ہوتی ہیں
ادھورے نامکمل لوگوں کو بھی دیکھا تم نے
بہت سے پھول بھی تو ادھ کھلے ہوتے ہیں

چلو ہم ناطہ توڑ دیتے ہیں
مگر کچھ مانگنا ہے تم سے
اک بار پھر سے چاہت سے
کچھ حروف خالی پنوں پر
میرے نام ہی لکھ ڈالو

ضروری نہیں کے ان کا مطلب ہو
میں ہر روز فرقت میں پریشاں بیٹھے
پنوں پر میں حرفوں کو ملا کر سجاؤں گا
اور پھر اپنی مرضی، اپنی عادت سے
نیا اک لفظ، نیا مطلب بناؤں گا

چلو اک آخری وعدہ بھی کر لو
تم اپنا آپ واپس لے لو مجھ سے
مگر یہ آنکھیں میرے نام رہنے دو
بھلے ان سے کبھی نہ دیکھنا مجھ کو

دعا ہے جلد مسکرانا سیکھ لو تم
اور میری حقیقت کو بھی بھلا دینا
بس اک بات ابھی سے زہن نشیں کر لو

مجھے تمہاری ان "میری" آنکھوں میں
یہ لالی یہ نمی اچھی نہیں لگتی

عاصم نقوی
٣:٤٠ صبح
١٣/٠٩/٢٠١٥ 

Why Called Bloody Pakistani ?

My whole class was silent when Medicine Professor pointed his finger towards me;

Professor: Yes ,,, Youuu ... Why you want to become a doctor ?

Me: (Bowed my head) ... Sir ... *Sigh* ... I lost certain someone to unavailability of the doctor. I don't want anyone lose anyone due to the lack of medical personnels.

........................

I decided no matter what happens now on, I will fight for this humanity at my part. People use to laugh at my delusion of causing the end of suffering of this humanity.

At 6 AM in the morning.

I was thinking the same humanity and suffering when two 16 years old boys entered the Surgical Trauma and came to me;

Boy: Dude. this guy is having chest pain. Kindly do EKG.

Me: whoa ... Slow down kid.

(After the evaluation of patient.)

Me: Go Medical emergency and there it is being done.

Boy: They sent me to Cardiac Care Unit and I came to Surgical Emergency and you saying me to go back there. What type of bloody doctors you are. You bloody idiots are running away from your responsibility.

Me: * In Heart * ... "Humanity and its suffering" ... *Sigh*

........................

A couple of days after this incident;

At 2 AM night;

Attendant: I need this medicine.

Me: Sir. the medicine we give is the only IV injections. You will have to purchase oral medicine from outside.

Attendant: If i will have to buy medicine then why it is called Civil Hospital. Doctors are the biggest thieves. Bloody doctors. I will see you tomorrow.

Me: And what will you see ?

Attendant: I will shoot you in the head.

Me: Humanity and it's Insanity ... *Sigh*

......................

Everything gets difficult once you are discouraged and disrespected. These were the lines going through the tormented lanes of my memory when i was passing through the corridor when some Mullah grabbed me from my arm;

Mullah: What is your name? Come here. I will teach you a lesson today.

Me: What happened sir? I am a doctor in this hospital and if you have complaint then go to authorities.

Mullah's Daughter: Yes, he was the one who asked me to show him my belly by ordering to strip my clothes.

Me: What the hell? I am doing my clerkship in Obstetrics Emergency Labor Room. In that place where 4 other patients were present in the same room along with 2 nurses and 2 other doctors, will i ask her to strip her clothes? Are you people insane? And by the way how can i do ultrasound scan without exposing her belly?

Mullah's Wife: No you are lying.

Mullah: I am Imam Masjid and i have gathered my Islami Brothers to teach you a lesson.

Me: and what does Islam tell us about making a false accusation on innocent ?

Mullah: Grabbed my collar. No i will teach you a lesson.

Me: *Sigh* ... Damnnn ... Humanity is really sick. I will have to work harder even on morals and values of people as well.

...........................

As i entered the teaching session on the round of ward hospital, I saw a female patient who just collapsed in front of all doctors. After complete examination;

Professor: Gentlemen ! This is a functional patient who is acting to be really sick. If you will apply supra-orbital pressure. She will react.

* Professor applied pressure and patient responded fine. We moved to next patient. *

After 45 minutes, a couple of people entered the ward. They held the professor from arms and started abusing him and when we asked what happened.

Female Patient: Yes ... He is the one who had been pinching above my eyes just to satisfy his pervert nature.

Me: *Sigh* ... Are we Pakistanis ever gonna change our sick minds? 

Is there any appreciation for a doctor for his hard work?

Is that our filthy thinking, for which we are called BLOODY PAKISTANIS everywhere?

Where are people for whom Jinnah made Pakistan?

Why did Fake Mullah and illiterate Islamic scholars hijack Islam ?

* I lifted up backpack *

"NO I WILL BE SAVING MY HONOR TODAY"

............................

Now, i am having books in my hands, preparing for international exams and speaking to myself;

"I am sorry CERTAIN SOMEONE. I won't be saving anyone here because i will be no longer here"

"May be one day someone who will be more stronger than me will come and KEEP HIS PROMISE"

And those Hypocrite Internet Mullahs and Pakistanis plus keyboard Jihadis are not welcome on my blog.

I am sorry Dear True Muslims and Pakistanis for my words because change needs "Iqbal's KhudAgahy".

Long Live Pakistan. 

Professionalism Or Empathy ... !!!

You know why do the doctors deserve RESPECT ... !!!

Patient ... Bleeding from a wound ... !!!
Attendants ,,, Misbehaving with doctor ... !!!
Doctor ,,, Having photophobia, headache and nausea ... !!!

....

Patient ... Shifted to Operation Room ... !!!
Attendants ,,, Still misbehaving with the doctor ... !!!
Doctor ,,, Started vomiting BUT DOES NOT CARE ABOUT IT ... and goes to OR ... !!!

...

Patient ... On OR table ... !!!
Attendant ... Yelling in front of OR ... !!!
Doctor ... Securing the bleeders ... * vomiting * ,,, *Gets de-washed* ... *Gets Washed again* ... Again starts managing the patient ... !!!

...

Patient ... Shifted to Ward with satisfactory surgical procedure outcome ... !!!
Attendant ... Holding the Dr from his collar ... !!!
Doctor ... Smiling ... and ... saying ... "Your patient is fine" ... *Starts Vomiting* ... *Collapsed*

Why Always The Good Guy

*At 3 AM*

*Knock at my room*

Attendants: There is a problem.

Me: What ... ? *Grabbed my Steth and rushed towards ward*

*Examined the patient*

Me: He seems alright. unsure emoticon unsure emoticon unsure emoticon

Attendants: ... Dr ... He wanted to go to toilet to pee. smile emoticon

Me: unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon ... smile emoticon ... No problem ... Just take him to the toilet and get it over with ... unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticonunsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon smile emoticon

* At 4 AM *

Patient: Dr Sahab ! ... We have a problem ... !!!

Me: ... Yeahhh ... Purge it ... What is it now ... ???

Patient: Actually we have brought Vanilla Ice Cream and Qulfa flavor ???

Me: ... So ... ???

Patient: Which one will be better for patient ?

Me: unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon unsure emoticon :/ :/ :/ ... Whatttt :/ :/ :/ ... Don't give that to patient. It will cause him Intestinal Obstruction that may lead gut dilation resulting in gut perforation giving patient peritonitis that will cause overwhelming sepsis in him leading to ... you know what ... :p ... You too don't eat it or else it might happen to you as well.

Patient: :O ... Chotayyyy BAAR SUTH DAY ACE CREAM NUN ... (Throw this ice cream outside) ... !!!

Honor And Respect Of A Doctor ... !!!

Last night a young female presented in medical ER of Hospital, with pinpoint pupils, foaming around mouth, increased nasal secretions, lacrimation, salivation, dyspnea, with high suspicion of organophosphate poisoning, an immediate gastric lavage and intubation was performed, with continuous cardiac monitoring and pulse oxymetry, she was being managed exclusively by 3 senior most Post Graduates of the unit, 1 House Officer and a staff nurse, despite the fact that all these staff members had other patients in the same ER, waiting to be treated, but they were not as serious as this patient and didn't require immediate attention as this patient, all working with only one goal in mind,"to save the patient's life".

And during all this process there were patient's attendants standing there around the bed and constantly yelling the following lines:

"What did you do?" 

"You don't know how to manage" 

"You injected him a wrong infusion. Our patient didn't take any poison" 

"I will complain against you." 

"We brought him in good condion and you made his condition worse."  

bla bla bla

And alot more and alot filthier lines which I don't want to write here.

And the doctors didn't even care about it, they just kept listening and kept managing her, why? 

Because they cared about her life, more than about there own self respect, they wanted to save her, they could have asked the attendants to take her to a different hospital if they are not satisfied there, but they didn't, because they knew that she didn't have enough time to be shifted somewhere else.

But the attendants failed to see that her life was as precious for the doctors as it was for them.

This is only one example, a lot of similar incidents happen daily at these hospitals,doctors have a tough job, but they are not given credit for it, thanks to the continual negative media coverage.

"Doctors are soft targets. Continual negative media coverage is leading to further feelings of suspicion towards the medical fraternity. Incidents of assaults on doctors should be covered with the same zeal as articles attacking doctors."

Courtesy: My dear colleague Dr Waqar Arshad Bhatti ... !!!

Don't Forget To Share This Article To Spread Awareness About The Respect Of Doctors.

Waiting For Your Thoughts.

I Had Short Attendance Due To ...

Once in OPERATION THEATER ... !!!

One House Officer talking to another House Officer ... !!!

House Officer 1 : You know what, today I assisted Thyroidectomy ... !!!

House Officer 2 : Oh wow ... You are sooo cool.

Asim and Hanan : WTF ... confused_rev emoticon ... unsure emoticon unsure emoticon unsure emoticon

H.O 1 and 2 : ... :@ :@ :@ ... unsure emoticon unsure emoticon unsure emoticon

*I updated my status on page " No, you didn't assist surgery. You were standing there just holding instruments ... grin emoticon *

*They both liked the status ... gasp emoticon"

*Next Day ... We were 5 minutes late from class*

H.O 1: ... I won't mark your attendance ... !!!

*Next Day ... In time*

H.O 2 : ... I won't mark your attendance because you aren't in proper uniform ... !!!

*After one month Me and Hanan both had short attendance*

Cardiology Case 1 ... !!!

95 years old male, smoker for 70 years, have chronic bronchitis, grade 3 dyspnea,
Complaints of off and on tachycardia.

On GP examination 

Pulse: 120 bpm
Blood pressure: 118/78

30 minutes later

Pulse: 60 bpm, Irregular rhythm.
Blood Pressure: 132/65
Patient feels weakness in bradycardia.

No clubbing, no splinter hemorhages, no osler's or heberden's nodes or any janeway lesions, no spider neivi, no odema. ( skipped findings are normal)

Chest Examination:

Trachea Midline ... B/L equal entry of air with vesicular breathing. However chest is slightly resembles the condition called pectus excavatum.

CVS Examination;

During Tachycardia: ... Visible pulsations in neck, left para-sternal heave, apex beat at 5th intercostal space mid-clavicular line, S1 and S2 are clear but so close that I can't comment on murmur or S3 or S4.
No basal crepts and no pedal edema.
As abdomeno-jugular reflex was checked for pulsating neck vessels then suddenly neck pulsations vanished.

During Bradycardia: ... Pulse was irregular. No pulsating neck vessels. No Left para-sternal heave. S1 and S2 were weak and again sounds were so muffled that one can't comment about murmurs, S3 and S4.
No basal crepts. No pedal edema.

Normally when patient isn't going through these spells, he does not complain about anything except dyspnea and weakness.

EKG investigation was;

EKG

Echocardiography turned out to be;

Echocardiography

Solve this case ... If you think you can become a cardiologist.

Don't forget to share and take opinion of different consultants and students.

For learning purpose only.

5 Realities ... The Life Of A Medical Student ... !!!

It has been four and half years that I have been going through tiring life of MEDICAL with a lots of ups and downs. People say that medical is a fun field but I say NO at the top of my voice because the profession we opted had no room for mistake. No matter how brilliant you are but you always come across certain things in medical life at some point through your journey to the way of being a doctor.

1- Wrath of Professors ... !!!

                           I saw movie WRATH OF TITANS some days ago. I thought there should also be a film that can show you guys how the WRATH OF TITANS can be similar to WRATH OF PROFESSORS. No matter how smart and good you are in your skills but there is always a teacher who is gonna hate you for you any tiny piece of good or bad work and it is consistent with the history or at least my during my schooling. :D

2- Student Doctors ... !!!

                           Once you enter the medical college then suddenly the expectation graph of the community is so sky high for you and you don't know what to do about it. They expect us to treat their every weird functional, physiological or pathological disease as if we are the supra specialist in our field. Calm down people, we are just medical student. We are still in learning process. Community want us to kill our fun thing inside us and be as serious as someone is about to do a press conference.

3- Pointless Skills ... !!!

                         I often ... not perhaps often ,,, but has ALWAYS declared myself as a best student among my fellows for clinical skills but somehow we do a mistake that make us feel like that our skills are as pointless as the smile of this blog reader :D ... What I did was, when I was in 1st year, i was asked to auscultate the heart sounds of a patient. When I put the stethoscope over the heart there was a silence as if i am in space. I started acting like a cardiologist and auscultated the whole are and proudly said " Sir, S1 and S2 heart sounds are normal". The teacher replied " Son! First of all try to learn to switch on the stethoscope by rotating the diaphragm". I was like "Please kill me now"

4- Weird Friends ... !!!

                         Group of friends laughing in the corridors, a little cute fights but at the end of the day, just standing beside you is the perhaps best memory of a medical college. Admit it, you would have thought for a moment that how difficult your time at college would have been if there were no friends that you are having right now. When you will be leaving the college then there will be promises of staying in touch and tears in the eyes for the fun that has been passed.

5- Proud To Be A Doctor ... !!!

                          Well ! ... I don't know that becoming a doctor was your choice or your parent's wish or you may have hated your journey through MBBS but at the end of the day when you will be having degree in your hands, you will be having your stethoscope around your neck like your super power and you will be saving lives then you will proudly say;

" Yes ! I am a guardian ANGEL of HUMANS. I save them from the havoc of death. I am the chosen one. Yes ! ... I am a DOCTOR "

Relationships In Medical Colleges ... !!!

When I had taken admission in the college. from here and there I was always bombarded with the questions that how many relationships are you gonna make. Friends were like " Hey Pal ! I heard last night that you got a new girlfriend". Family was like " Son ! ... If you like someone then you may tell us. It's OK. We can handle this". I was totally on the floor crying instead of laughing and saying NOT NOW ... !!!

" I AM A FREE MAN ... ASIM IS A FREE MAN ... LET ME LIVE "

Jokes apart, that does make me a gay. :p ... Just kidding. lol

After keenly observing the five years of MBBS. I have drawn a conclusion and plotted it as MAGICAL GRAPH OF RELATIONSHIP in the medical life.

On x-axis, these are medical years.
y-axis, there is percentage of interest indicated by hearts.
Pink color line + ♀ sign indicate LADIES.
Blue color line + ♂ sign indicate MEN.

Now what happens is, when medical school starts all boys be like " Dude! Hell with medical. It is gonna be a long long journey. Why shouldn't I have someone by my side to share ". Well, this sharing thing does not work much often and turns out to be exchange of conversation, informal chats, bunking.
Ladies are like " OMG ... We are sent in medical school to learn something. We don't have anytime for some crappy friendship or whatever "

Result : In 1st year the boys are clingy, annoying and eager to make relationships. On the other hand, girls are full of attitude, focusing on their studies and ignoring boys completely.

As the time passes on and it comes to final year. Situation becomes reverse.

In final year, boys are like; " Oh man ! ... I have to prepare for FCPS, post graduation, USMLE STEPS and PLAB. I honestly have no time for some relationship thing"
Girls in final year will be thinking; " Now! ... No further study. I have already had enough of it. Now, I want to fall in love and wanna get married "

Result : In Final year, Men are more interested to built their future instead of relationships. Ladies are more inclined to get settle for life WITH A SECURE FUTURE.

Then there is a magical era of 2.5 years of medical school when if there is a relationship, we can expect it to be long lasting. Both, stand by each other. So I am sure, at this time they can develop pretty much chemistry between them for a happy future. How cute ... !!! :D

Those who think my this post is gender biased or inappropriate then PLEASE BUY A MAP TO HELL AND HAVE A HAPPY JOURNEY.

Some Questions West Should Answer ... !!!

It was 7th January 2015 in Paris when 2 apparently called Islamist gunmen entered and opened fire at Charlie Hebdo office killing 12 and wounding 11. Suddenly the Western media has got a fierce news to ignite the ongoing hatred for Muslims.
            A battle on social media had started in defense of Muslims and against the Muslims. A worldwide trend was started with the hash-tag of #KillAllMuslims.

I was quite amazed with the thinking of these Islamophobic people that made me realized that a killing is a crime only when anyone get's killed in West while in East it is war against terrorism. I won't talk here about Iraq and Afghanistan because the world is fighting against terrorism over there. The innocent people that are being killed there are nothing but lambs or I think they are Muslims so let armies kill them. They are not humans for the West.

I want to quote here the verse of QURAN, the book Muslims follow;

On that account We ordained for the Children of Isra`il that if any one slew a person - unless it be for murder or for spreading mischief in the land - it would be as if he slew the whole humanity: and if any one saved a life, it would be as if he saved the whole humanity. Then although there came to them Our messengers with clear (guidance), yet, even after that, many of them continued to commit excesses in the land. (5:32)

 In the light of this verse you can well imagine how much a human life is being valued in Islam.

               Mark Zuckerberg the CEO of Facebook uploaded and justified the acts of blasphemy and mocking the religion Islam under the notion of freedom of expression and thoughts.

                It wasn't surprising for me because I already witnessed the stance of Facebook over the Israel's attack on Palestine in 2014 when people started talking over social media about the brutality of Israel's army. These so called hypocrite policies of Facebook lead the people to protest against Mark Zuckerberg over social media with the hash-tag #ShameOnMarkZuckerberg.

I know a person name Farhan Virk from Pakistan whose account was suspended for posting against Israel.

Is this the freedom of expression ?

          I myself saw a profile and reported it against the hatred speech against Islam and Prophet Muhammad and this is what I have got;

I want to ask some questions from the West.

1- You always talk about freedom of expressions. Is this freedom only labelled with the hatred against Islam and why so quiet over Palestine, Iraq and Afghanistan ?

2- An act of terrorism happens in West and labelled it with  Islamic Jihad movements without investigations. Can't anyone else do that pretending to be Muslim just to spread hatred against Islam?

3- Why there are two types of terrorists i.e simple terrorists and Islamic Terrorists when Islamic scholars clearly condemn the attacks and tell that these organization has nothing to do with Islam?

4- Why this world is forgetting every peaceful Muslim throughout the world when these terrorists are not even considered Muslims by even Muslims ?

I wonder how people are so low in their IQ that they even can't understand the simple conspiracy. Some so called well wishers on earth are dividing the whole humanity just for ruling them and due to this very conspiracy we have already been divided in East and West.

House MD ... Disease And Diagnosis ... Final Year MBBS

Hanan

Asim

Ashur

Case 1 :

* Entering in Surgery OPD  ... Asim, Ashur and Hanan ... *

Professor : You are late. Where were you?

Ashur : Sir ! ... There was a class on Thyroid by another Professor.

Professor : ... Yes ! ... Which is long over.

Asim : ... Sir ! ... We were in cafe.

Professor : :@ ... Ok ... Here is a patient. Prepare and present her case.

Patient's History : ... 40 year old female patient ... with hypogastric pain ... radiating to back from last one month ... blah blah ... !!!

Asim : ... Ok guys ... Differentials ... ?

Ashur : ... Endometriosis ... ?

Asim : ... No ... The pain isn't cyclic ... !!!

Hanan : Inflammatory Bowel Disease ?

Asim : ... No blood in stool ... and other associated symptoms ... !!!

Hanan : ... Pelvic Inflammatory Disease ... ?

Asim : ... No vaginal Discharge ... !!!

Hanan : ... In chronic condition there can be no discharge.

Asim : and ... as she is in menstruation phase. So, ectopic pregnancy is also ruled out ... This leaves PID high on our list.

* In front of professor *

Professor : ... What are your differentials ?

Asim : Endometriosis => no cyclic pain ... ruled out ... !!! ... IBD => No blood in stool ... ruled out ... !!! ... GIT carcinoma => highly unlikely cuz no GIT symptoms plus no palpable mass ... Ectopic => currently menstruating ... and ........................... IN OUR OPINION, IT IS PID ... !!!

Professor : Then PV examination is required.

Asim : ... That is why we want to consult Gynae department.

* In Gynae OPD *

Asim : ... Pain in hypogastric region ... Ma'am we are suspecting this patient to have PID ... your expert opinion is required.

Ma'am : ... There can be 3 differentials ... !!!

Asim : ... Already ruled out ECTOPIC ... and as far as Cystitis is concerned ... There is NO Urine Routine Examination Report. Moreover, there are no symptoms like frequency, urgency, dysurea, heamaturia, nocturea ... ALL YOU LEFT WITH PID ... !!! ... Kindly confirm cervical motion tenderness ... !!!

* After examination *

Ma'am : ... Yes !!! ... You guys were right ... !!!

* Again in Surgery OPD *

Asim : Yes Sir ! ... Cervical motion tenderness turns out to be positive ... and the patient has PID ... !!!

Professor : ... * Patted the shoulder * ... You guys have diagnosed it ... !!!

Asim, Ashur and Hanan ... The Team ,,, :D

Case 2;

Professor : ... Now go to ward at bed 9 ... Prepare the case in 10 minutes ... !!!

Asim, Ashur and Hanan : ... Ok ... !!!

* In Ward at Bed 9 *

History : A 45 year old lady with pain in right hypochondrium ... + backach + nausea ... and had right sided mastectomy for Ca breast ... with positive family history of Hypertension and Diabetes ... O/E ... pallor, Murphy sign and Boas sign are positive.

Asim : ... Ok Guys ... Start firing your differentials ... !!!

Ashur : ... Cholicystitis ... ?

Asim : ... Yes ... you are right ... !!! ... Any other Ideas ... !!!

Hanan : ... Liver abscess ... ???

Asim : ... Fever is absent ... and ... i am not sure about AMOEBA ... The Nasty Little Bastard ... !!!

Asim : ... What about LIVER METS ???

Hanan : ... May be ... !!!

Asim : ... Liver is not palpable. Let USG decide about nodules ... !!!

Ashur : ... May be cholelithiasis ... ???

Asim : ... leading to cholecystitis ... I thought you only look like Dr Chase ... but ... you can act like him too ... !!!

* Ultrasonography showed 24 mm stone in gall bladder *

Case 3 :

Ma'am : ... There is a patient in ICU who has a typical finding related to his condition ... let me see if you can dig that out ... Examine him and tell me the positive findings on abdomen ... !!!

* Asim, Ashur and Hanan examined the patient and came back to Ma'am *

Ma'am : ... Yes ... What are the findings ... !!!

Asim : ... Yellow discoloration of abdominal skin ... On percussion, upper border was at 8th intercostal space ... and the finding YOU ASKED FOR IS ............ THE PATIENT HAS A MASS 2 cm BELOW RIGHT HYPOCHONDRIUM, IN MID CLAVICULAR LINE AND THAT IS PALPABLE GALL BLADDER ... As the patient is having jaundice and itching all over the body plus that mass ... so it will surly make it obstructive jaundice ... and according to Courvoisier's Law ... THERE CAN'T BE STONES ... BUT ... THERE IS CARCINOMA ... !!!

And .................... Responsibility of rest of the management is on your shoulders ... !!!

I am posting my today's routine because may be someone is looking for a push to study or may be someone instead of saying MEDICINE a boring thing, will get the real thrill hidden in this apparently hard field ... !!!

Keep Smiling and Keep Reading ... !!! 

Oh my FRIEND ! ... Forgive me ... ! ... I quit ... !!!

Since last two days I have been thinking over the word STRESS and its outcome. How the control of mind just slips away from under your fingers having drastic impacts over your life. How can it change every smile into life long tormenting thoughts.

                               "The worst dilemma of HUMAN RACE. "

Let me share a heart breaking incident here. In my village, in our neighborhood, there was family who used to live quite happily. A young guy who was perhaps a pro in Mathematics, thought to do something extraordinary among his family and friends. A village where there was only one child who was going to be a DOCTOR and he stood beside him, joined him to end the reign of illiteracy in his village.I was quite stunned when my uncle told me about that guy that one day he came to him and said;

" Sir ! ... Thank you so much for teaching me ... for giving me a chance to change the fate of this village ... Thank you so much for enlightening me from my inner potentials ... Still I am 4 marks behind in result from your son ... but ... that won't make any difference for what I have achieved "

That guy became an ELECTRICAL ENGINEER. Then he applied in Armed Forces to serve as an officer. I know every institute has its own criteria for selection but somehow he was rejected. His mother says that soon after that incident he started staying quiet.

"A silent stare at the ceiling fan but a scary noisy brain in head."

His mother says that once I went into his room. He was silent with wide open eyes and starring at his future that was at the verge of shattering. His mother said;

" Son ! ... This is not the end of life for you ... May be GOD has planned something better than this. "

The guy smiled and hugged his mother and cried like a kid. A week later when he left his office after work. He went to his bike with a pile of files in his hand. He put those files on bike when they fell down with a strong gust of wind. He was so absorbed in his thoughts that he pulled his hands away from bike and lean forward to pick then up.

And then ........................................ ;

" His head came to earth with bike over it, crushing his brain. He had multiple fractures of skull bone that made him silent eternally. "

A stressed out soul gave his life because he couldn't handle the burden of being rejected. I think situation had been much different if someone might have understood him, if someone might have talked to him.

" No ! ... This should not be the fate of a stressed person. How many innocent lives and beautiful minds will we let this stress endeavor. "

If stress is the part of life then it should be better to pay attention to this monster before it engulfs the new generation.

" Join hands and let the message of LOVE flow through generations. Enough with the HATE because it will never bring any good to the humanity. You need to talk to them to save their lives or otherwise you will be hearing voices as I hear quite often;

Young Man : .... " Oh my FRIEND ! ... Forgive me ... ! ... I quit ... !!! "

His Father : ... " ... No ! ... You all are lairs ... My son will be back soon ... !!! "

His Mother : ... * Says nothing but STARE with wide open empty eyes. * "

Medical Camp ... IISSWA ... The Things No One will Ever Talk About ... ;)

There were rumours in our college since quite long that IISSWA ( Islamic International Students Social Welfare Association ) is arranging a MEDICAL camp at the village Taret Village near which is around 15 KMs from Murree. I waited and waited andddddddddddd waited. Then finally the President of IISSWA Mr Muhib Ullah Hussaini and the senior Executive Member Mr Ahmed Hashmi announced that we have finally arranged The Free Medical Camp. I personally requested Mohib to make me the part of his team specially the MEDICINE TEAM.

When I saw the IISSWA team today I was totally like where the hell they have been. Someone was looking like a consultant and others were looking like they are going to attend some UNO meeting. Jokes apart but strict dress code was followed and BLAH BLAH BLAH ... and then we reached the camp site where all arrangements were made. When I saw people I thought for a moment if that much population in a village is sick then how on earth PAKISTAN is surviving.

We started Medicine OPD under the supervision of Dr Shehram and Dr Aqil. The most amazing thing was, I and Dr Nauman Raheem both were working in that team with two other future lady doctors. As we started checking the patients I was quite amazed that every single case was related to CVS somehow like shortness of breath, hypertension and chest pain. Every third lady was hypertensive. Every fourth one was diabetic. While among males problems related to GIT was quite common.

I have never trusted a lady with magical mathematical blood pressure reading BUT today I have learnt that IF THERE ARE 200 PATIENTS WAITING FOR THEIR TURN THEN YOU CAN TRUST HER WITH HER BLOOD PRESSURE MEASURMENTS. ... :D

Well ... It wasn't meant to hurt someone but the way juniors worked and their efficiency was quite ASTONISHING. Once I thought to ask from them " ARE YOU REALLY FROM IIMC "

If a female patient presents in medicine OPD of free medical camp and her blood pressure is NORMAL then she will be having complaint of generalized bodyachs and joint pains.

We checked around 30 female patients and around 15 of them were hypertensive and 15 were with joint pains and generalized bodyachs. If we keep in mind their age and nutrition status then definitely we will definitely labelling them with malnutrition and post menopausal symptoms. So, if you are thinking to arrange a medical camp then you should have a plenty of multivitamins, iron and folic acid tablets.

Then there was a moment when I asked an elderly lady her age and she was like " Dr saab ! koi 40 saal umer hai meri " ... I was like O.o ... When I asked that how old her elder child is, she replied " Us ki umer koi 50 saal hai " ... I thought to have a case report over this issue worldwide. :D

Keep in mind, no matter how many times you ask about age of the lady. THEY ALWAYS TELL LIES. ALWAYS ASK THE AGE OF HER FIRST BORN.

If you are on FREE MEDICAL CAMP then keep in mind that every patient, who will be there in front of you, will always have multi system problems. Like if a patient is having Epigastric pain then he will surely ask about his eye pain, joint pains, ear ach and he may involve his family or some magic stuff in his story.

Keep your head clear that you are treating him, NOT HIS FAMILY.

Ninety percent of patients have the bad habit of telling lies. Like i saw a patient who was currently on hypertensive therapy and was denying the she has never been diagnosed hypertension. Then she told us that her blood pressure was taken that turned out to be 400. I really wanted to ask her " Bibi akhir itna blood pressure kaisay measure ker lia " :/

Yeah ... you have to be very specific about the disease. Patient can tell you 1000000000000000000000000000000000000 stories that you never had heard of.

If you are in the camp then never ever think that you can check all the patients because in every house there are 20 patients i.e. mother, father, sister, brother, son, daughter, wife, uncle, aunt and their families.

It is much convenient that you mention the timings before starting the camp and try to be quick in your work so that eligible patients can get at least symptomatic treatment for time being before referring them.

Another shocking fact is that if you are a boy and think that you are a devil then you are wrong. The way girls make fun of yours in their own groups you can’t even imagine that.

Yes ! ... Its true guys ... If you don't believe me just stay quiet while passing through a group of girls. you will hear a devilish laughter. I AM THINKING WHAT MIGHT HAPPEN IF THAT LADY READS THIS HIGHLIGHTED PART... :S :S :S

The way your beloved juniors ask you to join them in dinner is really breath taking BUT keep in mind ...................... IT IS A TRAP ... I REPEAT ... IT IS A TRAP ... THEY WILL SURELY BE HAVING SOME PRANK IN THEIR EVIL MINDS.

Well I don't know many names but SHAHWAR, SHEHRYAR, MAMOON, SUFYAN AND AWAIS ,,, koi kameena pan to nahin kera na ??? ... :D ... you guys were very nice. Thanks for the respect little brothers.

No matter if a lady can cook or not BUT Dr Numra ! we really needed the ORS that you made for us. I wish you had made that for 3 times. :D

No matter what, class fellows always help each other.

Nature is a distraction ... and ... If it is not then surely people can get tired after 6 hours of hard work in summer.

Dr Nida ! ... No matter how calm and cool the nature seems to be while walking on the road, under the trees ... but ... there is always a car coming from behind at high speed.

No matter if we can't get good grades, we will be good at pharmacy.

The way Dr Ammar was handing over the medicines to patients. I want to say " Ammaray ! ... ager apni doctry na chali na to pharmacy zarur chalay ge " ... :D

No matter how I feel about myself but there is someone who often beats me in diagnosis.

Dr Noman Raheem ... Tell me the truth ... " Have you really started studying or is it ABBAY KA DER that makes you to pull through anything somehow ... :/ :/ :/

Some people may look quiet but when they shout or screech they surely make everyone listen.

Dr Ahmed Hashmi ... Next time ... Do tell me that you are going to shout at someone ... I will surely plug my ears ... :D

It does not make any difference whether it is IISSWA or SWORD ... but ,,, I want to change its name to MIISSWA just for a day ... Muhib's Islamic International Students Social Welfare Association.

Dr Muhib Ullah Hussaini ... I never ever thought that you can be so hardworking, truly supportive and an outstanding person regarding the management of welfare organization on this level. May ALLAH grant you His mercy for your efforts.

There are some people who yell at the top of their voices for their love for MEDICINE.

Dr Bilal Habib ............ You were ABSENT ... :/

Medicine is not that much scary thing.

Dr Dehneez ... If you weren't there in the Medicine OPD today ... you have missed a lot of things today.

and then there are people about whom THE HISTORY NEVER SPEAKS ... !!!

yeahhhhhhhhhhhhhhh and I am one of them.

Human Race ... At The Verge Of Gender Conflict ... !!!

I came across a meme over internet in which a guy was having his weapon in one hand and dragging a female from her hairs from other hand. There was another picture attached to it that was opposite to this one and a woman was dragging a man from her hairs. The caption of this Meme was "Soon".

Today various campaigns are started to empower the woman. What does empowerment mean here "Disruption of family system by luring a woman in the illusion of gender conflict". These campaigns has raised the suspicions of certain women to such a level that they started feeling insecure in themselves. The human civilization is on the verge of gender conflicts.

I won't quote anything from any religion here because that will make these statements a little bit in the favor of that religion. Generally speaking, as Nature has created humans by dividing it in males and females. It has also given both the specific the characters physically, mentally, socially and defined their abilities. Nature made these two to be an inevitable part of each other. If one has been made dominating then other has been made humble so that by uniting them make the nature's creation to its perfection. If woman was made physically weak then men was made physically strong for her protection, perhaps a divine way for uniting them together. Now, both genders have their own traits defined already by nature.

It has become the belief of women now a days that men think them weak, despise them, dishonor them, slaughter their rights and what and what not. Let me put it in this way, if a man thinks that woman is weak that is because he wants to protect her as if she belongs to him. How can someone despise the inevitable counter part of his soul. If woman is the counter part of the man's soul then how can a man dishonor his part of soul. AND IF SOMEONE DOES NOT TREAT LADIES WITH HONOR AND RESPECT THEN SURELY HE IS WRONG.

I wish I could read the biography of each lady who is raising the chances of gender conflicts by making other ladies rebels from the basic rules of nature. I just want to see that how happy they are in their own family life. How successful they have been in their relation. STOP RUINING THE LIFE OF INNOCENT LADIES BY LURING THEM IN YOUR CHARM JUST TO GET A LITTLE POPULARITY.

Have you ever wondered what will happen if gender conflicts has risen to it its peak. MAY BY HUMAN CLONING WILL BE THE RESULT, MARRIAGES IN THE SAME GENDER. In short, " AN OPEN MUTINY AGAINST NATURE ".

P.S ... who thinks my statements are gender biased or targeting today's women freedom, they surely can go to hell.

Traditional And Integrated System Of Medical Education In Pakistan

During conversation;

Friend: "What type of medical student you are. How on earth you are suppose to study PATHOLOGY in 1st year of medical school."

Yes! This is the sentence that i have heard hundreds of times during my stay at medical school. I wish making someone understand the difference between a traditional system and medical system would have been an easy thing.

In traditional system of medical education, students used to study anatomy, physiology and biochemistry in 1st two years irrespective of their system correlations while rest of subjects in next 3 years. This system is more oriented towards teacher student interaction.

In integrated system, the teaching is based upon student patient relation in which teacher acts like a facilitator.Five years of medical school are divided into two spirals of 2.5 years.

Spiral 1 : It consists of 70 percent basic sciences and 30 percent clinical sciences with integration of topics systematically. For example if we have started Cardiovascular system then we will study CVS from all basic sciences subjects and clinical sciences at the same time in the ratio of 70:30 respectively.

Spiral 2 : It consists of 70% clinical sciences and 30%  basic sciences with systemically integrated topics from various books.


Now a recent advancement has been introduced in this system in the shape of final year clerkship modules. Two spirals has been shrunken to 2 years each and final year has been given to fully patient oriented application of knowledge in Surgery, Medicine, Psychiatry, ENT, Eye, Derma, Gynae, Obs, Pediatrics, Anesthesia and Radiology.

This system has already been followed in Agha Khan University, Shifa Medical College and Islamic International Medical College. Various other colleges has started following this system. There are rumors that USMLE and PLAB exams will be taken only from those candidates who had been following this Integrated System.

Outcomes of this system will be better understood after many years when who students, followed this system, will be serving in hospitals and will be providing health care at greater level.

Exam Tension

During OSPE ( practical exam ) !!!

( I was sitting on the rest station, nodding my head and murmuring. Ma'am suspected as if I were helping someone and started staring me furiously )

Asim ... !!! : ( innocently ) " Ma'am ALLAH ki kasam cheating nahin ker raha tha "

Ma'am asked the attendant sitting beside me ... !!! : " ap batain ! ... what he was saying "

Attendant ... !!! : " Madam ! he was saying ... AB TO ADAT C HAI MUGH KO ...... actually he was singing a song "

and

my expressions were ... :-| :-| :-| ... !!!

and

Ma'am's were ... :O :O :O ... :@ :@ :@ ... !!!

:p :p :p ... xD xD xD !!!