No Doctor In the House

I have probably slept for less than an hour, when I woke up to a rude awakening. My dad was banging at the door of my bedroom as if it was the end of the world. Turns out my grandmother was not feeling well. I'm used to this situation, so I didn't feel like it was an emergency. Usually her blood pressure is elevated. Turns out I was right, it was 230/110 mmHg. Honestly, I'm at a loss when this happens. I just ask her to take her prescribed medications for hypertension. At the hospital, such a high blood pressure reading constitutes an emergency (or to be more precise, an urgency since there is no acute end organ damage present). We have to lower the blood pressure gradually. But her doctor who's a cardiologist/ cardiothoracic surgeon says it's normal for her blood pressure to be 170-180 systolic, it doesn't have to be lower than that. He's the consultant, I'm just a lowly... er--- medical bum (what else would you call a person who's finished med school and currently unemployed, just studying for the upcoming physician licensure exam?). Maybe her previous heart operation has something to do with it. I dunno. He's more experienced, and he's the expert, so I took his word for it even if it doesn't really make sense--- you know, it's a bit contradictory to what they've been teaching in med school. I should pay him a visit one of these days to know the rationale of the management. Or maybe I should finally open that highly technical cardiology book that I have that's been gathering dust ever since i bought it. hehe.

Anyway, this time, there's something a bit different, not the usual hypertension induced headache/dizziness. There are clusters of bullae on her upper back, with erythema, accompanied by pain. The whole affected area probably measured 10x10 cm. And there was a 4x3 cm erythematous patch on her right upper quadrant. (Am i getting too technical here?) Apparently, the lesion on her back started 3 days ago, spontaneously, with no predisposing factors, and it looked like the one in her abdomen initially. She self medicated with betamethasone + Gentamycin cream, which allegedly dried up some of the bullae and lessened the pain. Now was that right? A topical steroid for a patient with diabetes mellitus?! I couldn't think straight at such an ungodly hour! And I was confronted with a dermatological problem! Dermatology may seem simple to some people, but it's not. It's one of those subspecialties, wherein a certain common manifestation like bullae or erythema has so many differentials to be considered. And with such symptoms that are not pathognomonic (i.e. pointing to a certain disease), it's harder for someone like me to diagnose. Heck, I don't even have the license to act as a general practitioner yet. At least my head was clear enough to attribute her increased blood pressure to the pain on her back. After a few minutes, it lowered a bit. Gave pain medications too. Told her she doesn't have to be rushed to the hospital wherein only residents and interns would attend to her. It's better to wait for regular clinic hours. As for the skin lesion? officially, my diagnosis as of this time is--- TO BE ANNOUNCED. hehe. i have to scan my dermatology book first.

People in other professions seem to have it easier... I mean, if you're a lawyer, others would approach you if they have problems with the law--- that's not everyone. Same with being a policeman. If you're in the business profession, only people who want to do business with you, or those who seek business advice would approach you. It's different for physicians... virtually every person you'd encounter, even the healthy ones, can approach you for consultation regarding health matters. And most often, those people include your own family.

There's so much pressure when your own family or relatives consult you for their health problems. If I'm dealing with strangers, I can be a bit lax, there's less pressure. I'm not that afraid to make the wrong decisions, I could try again after all (as long as it's not an emergency!) It's also easier with friends, they seem to understand if you don't know the answer. And it seems okay with them if you say you don't know. hehe. But when it comes to family, there's this pressure that I have to perform well, to get it right the first time, even for trivial complaints. I guess they want to get their money's worth, that's why they keep on asking these health related questions. They spent a fortune to get me through med school after all. I'm literally bombarded with health related questions every day. Sure, these questions help. If I don't know the answer, I read up on the topic and therefore I gain more knowledge. I have this cousin who keeps asking me about the treatment for a lot of STDs like crabs, gonorrhea, syphilis (For crying out loud what has he been doing?!), that I seem to be an expert now on the topic. I can tell you the proper treatment at a drop of a hat. hehe. It's just depressing that many times I don't really know the answer. For crying out loud I don't know everything!!! It's impossible to know everything! Sometimes I'm wonder If I really should know these things, that I won't be a good doctor if I don't know the answers to every health related question thrown at me. Maybe I didn't study well enough. Maybe the answers are "must knows" after all, and not as esoteric as I think. For every question unanswered, I can't help but feel so down. And the look on their faces aren't helping. I could almost read their minds, they're thinking that I SHOULD know the answers. I SHOULD. This could be a sign of things to come after all. Maybe I won't be a good physician. In a few years, I could still perform the same way. What a bleak future. What a depressing career.

Geez, I think I'm going to be a lousy doctor.