Clinical Lessons I’ll never forget – Part 1: The Lesson (David Mathew)

Five students gathered with their tutor around the patient. This one had a heart murmur, a rare one. The five students all had excited looks on their faces, waiting to detect this rarity. The tutor approached the patient.

“Could we all have a little listen to your heart? It won’t take long.”

The patient nodded. This had been the 4th group that day but he acquiesced. First the tutor placed his stethoscope on the chest of the patient.

Listened at the four valve sites. Asked the patient to inhale and exhale appropriately before ending off by listening to the carotids. Then gestured for the students to listen.

The first student stepped up, introduced herself, and proceeded to listen. Her eyes squinted as she knew she heard something. She listened more carefully, and for ten seconds there was dead silence as she closed her eyes and pictured the murmur, the valve.

Asked the patient to exhale, and hold it there. Another five seconds. To check and double check. She was satisfied. And then the next student approached.

“Hi, I’m Jess. Just gonna have a quick listen yea.”

Another nod. The patient closed his eyes. He almost knew the routine. The student listened. Her face twitched as she heard the murmur. Now to seal the diagnosis. She was quicker than the first. After the inhaling and exhaling it was all over.

The third student did the same, then the fourth.

And finally the fifth student approached.

“Last one here. Just another quick listen alright?”

It was almost a rhetorical question. One that needed no answering, yet the man nodded. A much slower and weaker nod.

The student, having watched the actions of his peers, could have well already known the diagnosis. A murmur heard best with the bell of the stethoscope in expiration at the mitral area could only be one thing.

He was the fastest. Placed his stethoscope on the chest right at where he thought he would hear it best and listened. He had no sign on his face that he’d heard something. But he performed the manoeuvers, and it was clear he had heard it. And he was done.

“All over Mr Jones. Thank you very much for this.”

He pulled down the patient’s shirt and covered his chest. The cardiology lesson was done. The murmur was heard, now to go away from the patient and discuss its causes, etiology, etc.

But the life lesson wasn’t learnt yet. Here was a patient, a sick person, warded for mitral stenosis due to his past history of rheumatic fever. His mitral valve cusps had become so tight they had resulted in him having heart failure. And so he needed surgery. Surgery to keep him alive, for him to see his children grow up. Surgery to let him see another day.

The students didn’t know this, they didn’t know the fear in the patient; fear of the surgery, fear of whether he would see another day. All the students knew was that this was a rare murmur, and they wanted to hear it. Sharpen their skills, they thought.

But here was a man, a living story in which the murmur was only a tiny component. Alas, the story would never be known, unless a soul were to sit by his bed and hear him out. Actually listen, not just take a succinct medical history. This was a man, who smiled at the students’ request, who nodded every time they asked. This was a man whose smile and nod hid a lifetime of worry and anxiety.

Worry and anxiety that needed listening to, not the heart murmur. The cardiology lesson would be remembered; the life lesson wouldn’t.

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Clinical Lessons I’ll never forget – Part 2: The Death Sentence (David Mathew)

“So you went for your PET scan already. And you went for your chemotherapy as well?”

“Yes doctor, chemotherapy 2 weeks ago, PET scan two days ago. Are the results out already?”

“I think they might be, let me check.”

The doctor scrolled down the list of imaging in the records and a twinkle appeared in her eyes.

“Yes they are. Let me have a look at it and explain it to you.”

The doctor took an extraordinarily long look at it, which was rather strange for a consultant who would have spotted the diagnosis instantly. She changed the views and tilted the pictures. I would realise much later that the doctor was more preoccupied with how to break the news to the patient, rather than decoding the scan.

“So basically the PET scan is a test where we inject a dye – some radioactive stuff, which move to where there’re blood vessels. And the dye makes its way all around the body. And where it goes most appears black. So you can see from the scan that these two little things are filled with black – referring to the kidneys – because they remove the dye. And your whole brain is filled with ‘black’ because it uses a lot of energy.”

The doctor shifted in her chair, thinking about her next sentence. It wasn’t one of the easiest things to say. 

“But we also see that there are a few black spots in your chest, in the middle. They’re not supposed to be there. Now those are the cancer which has not gone away.” 

The doctor paused a beat, waiting for a reaction. I didn’t see any change in the patient as the doctor let the information simmer and settle. And yet quick as a flash, the doctor reached for the box of tissues and handed it to the patient, just as she broke down. The patient’s right hand unconsciously grasped her husband’s limply. A tear squeezed out of her right eye. Reality had set in.

“So we just do more chemotherapy right doctor? More of the chemo and it’ll be gone?”

Another pause as the doctor collected her thoughts. Her eyes, still fixed onto the patient’s, maintained their steely composure despite the wealth of emotions in the room. It seemed like an eternity before the answer came.

“Unfortunately no my dear. We tried the chemo once and it didn’t help. How much we give wouldn’t matter in your case now. Yes, the cancer will reduce after the chemo, but it will not go away. It will be stagnant and then come back, come back more. So chemo is no use.”

Again silence.

The words took their time to settle. The sinew of hope left in the patient left sliced apart by the words. In fact nothing after the first five words entrenched themselves into the patient’s mind. The patient was going to die, she now realised.

And I, a mere observer, watched the doctor calmly proclaim the death sentence upon this innocent soul. This life which would be prematurely ended within the confines of a clinic – a place of supposed comfort. I watched as human emotions tried to comprehend the unthinkable. Sadness at the futility of the situation, grief at why this even happened.

Yet even though I was unrelated, just a mere observer, my emotions sync-ed in tandem with the general atmosphere. I watched the line between life and death crossed – and I would never be the same. All my life ‘death’ had always just been a word – an unfeeling, unreal print on a piece of paper.

But as I watched death extract this much emotion from the depths of this human being, I finally comprehended the complexities intertwined with the power of the medical knowledge. Power to above all, take a life.

O-Week & Medcamp Conveners’ Report

MUMUS O-Week 2013 was a huge success, with all the usual fun events like the MUKEG Scavenger Hunt and MedFest, as well as a few new ones – MedCruise and an outing to BOUNCEinc! The week kicked off with countless eager first years making their way to the MUMUS stall at the Host Scheme Carnival; many walked away happy with their new Monash Med jumpers and tickets to the upcoming MedCruise. Futures Forum later in the day had an amazing turn out of over 190 students, completely overfilling the lecture theatre, with some having to resort to sitting on the floor to listen to the amazing speakers lined up – one of which was our very own president Harshan Jeyakumar. One of the speakers even stayed behind for afternoon tea following the forum in order to give out signed copies of her book to the new medical students.

The next night, after an exciting all-day scavenger hunt and MedFest, everyone headed to the docks to board the Victoria Star in their fireman/construction worker/doctor costumes for the “When I Grow Up…” themed MedCruise. The night was an unforgettable one, with drinks flowing and music pumping. Even the weather deciding to play nice for the first time that week.

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In the following days, we had the International and Interstate Students Forum, which many first years recognised as an invaluable opportunity to meet other non-local students. They expressed gratitude for what they believe to be an extremely informative session. On Thursday, after a few dramas with the Wildfire BBQ and the rain, we managed to herd everyone onto the buses for the last social outing of the week – BOUNCEinc! The venue was hired out exclusively for the new medical cohort to bounce and play trampoline dodgeball as much as they wanted for an hour. It was ridiculous fun, and it turns out that going crazy on trampolines, diving into foam pits and throwing balls at each other is the best ice breaker we have discovered yet – many first years walked away from that hour chatting excitedly to each other and even swapping contact details.

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The last MUMUS event of O-Week, after Transition Camp ended on Saturday night, was another new initiative: the Free Slurpies and Q&A Session. We kept the setup quite casual, with just a few representatives from MUMUS and various clubs and societies floating around to address any questions that had been left unanswered. Wildfire served an excellent BBQ once again.

Overall, we’d say O-Week this year was an amazing success. Not only that, but it was the best fun to organise and be a part of! Many thanks to everyone who helped out, particularly Harshan Jeyakumar (President), Ed O’Bryan (Social VP) and the entire Wildfire team.

Luke Nelson and Jocelyn Shan
(O-Week and Med Camp Convenors)

Futures Forum 2013

The first afternoon of O-Week 2013 saw over two hundred enthusiastic first year MBBS students descend upon an ambient (read: stinking hot) lecture theatre to hear from some of the higher medical profiles in Australian society. This forum aimed to display to our most junior colleagues the wonderful, often neglected diversity available as a medical professional after graduating – not everyone needs to be a cardiothoracic surgeon (and with the advent and development of percutaneous valve repairs, maybe we won’t need too many…)! For nearly three hours, the lucky students benefited from the pearls of wisdom of (including, but not limited to):

  • Professor John Murtagh – general practitioner extraordinaire, the man who has, quite literally, ‘written the book’ on general practice. Professor Murtagh emphasized the importance of having broadly trained GPs in rural areas, iterating the pivotal nature of being able to treat, or manage the symptoms of, a spectrum of conditions in the country.
  • Professor Jeffrey Rosenfeld – the Derek Shepherd of The Alfred – paediatric neurosurgeon, highest ranked medical officer in the army reserves, expert musician. This world renowned doctor spoke of maintaining extracurricular interests throughout one’s medical career, and of the inauspicious nature of sacrificing innate passions in order to devote extraneous time to one’s career.
  • Dr Ranjana Srivastava – Monash graduate, media personality, full time mother and part time medical oncologist and general physician. Touched on the necessity of balancing commitment to family whilst dedicating sufficient time to ensure a prosperous career, as well as encouraging all budding female surgeons to pursue any career they feel an intrinsic pull towards, regardless of what may be perceived as a dissuading balance of male:female carpenters out there.
  • Professor Mike Toole – Professor of Public Health at The Burnet Institute.
  • Dr Ashleigh Witt – what is there to say about this blonde bombshell? Spoke fantastically about the progression through medical school, and embarrassed a poor kid who she had interviewed.
  • Dr Sean Davies – provided a fascinating, engaging account of an intense surgical rotation in the notorius Bara hospital in South Afirca.
  • Mr Harshan Jeyakumar – delivered a fine address, in true presidential style, about the top HJ tips to surviving medicine. Subliminally promoted Liverpool FC to all attending students, unfortunately none of them took the bait.

A fantastic and memorable afternoon was had by all, despite the sweltering conditions. Fortunately, many students were able to dismiss all thoughts of career pursuit the following night on MedCruise.

Daniel M Wein

MUMUS Academic Representative

MBBS II 2013