Thursday, March 26, 2015

Res Ipsa Loquitur

"Res Ipsa Loquitur" is Latin for "The thing speaks for itself". With respect to Forensic Medicine it means that the nature of the injury itself suggests the negligence of the defendant and thus requires no further proof. Sometimes, somethings require no further proof, validation or explanation because it speaks for itself. 

Our life is not measured by the highs and lows but by our adaptations to change. Change is inevitable and one can never predict what changes each day will bring. We are defined by our ability to cope with the Wild card that Life throws at us. 

Our post-dinner ward visits have resumed and every day we look at a few new cases and try to learn something new. (and try to remember what we've seen earlier) Recently we got the chance to see:
  • Abdominal Aortic Aneurysm (thrill could be palpated, atherosclerotic plaques clearly seen in the Scan via the dye injected)
  • Follicular variant of Papillary Carcinoma of Thyroid gland 
  • Capsuloganglionic hematoma of the right side (this was clearly seen in the CT Scan) leading to hemiparesis and decreased visual field of the left side.
  • Carcinoma of Breast (BIRADS Type 4)
Last weekend I'd been home after about 2 months (for a very short duration: 50hours) and it felt good to spend time with family. I also got time to catch up with Mani after a long time and listening to the medical stories at BGSGIMS, I felt slightly relieved. Maybe it's the pressures of the profession that drives people to be the way they are. But after exchanging stories of our respective colleges, it felt as though we're both in the same ocean, heading in the same direction, just in different boats. 

On Tuesday (24th March), we got to see our first surgery in the OT (ENT). 

The Patient presented with 
  • extensive deafness
  • discharge (mucoid to mucopurulent, without blood) from ear (exacerbated by head bath, relieved on medication)
  • post nasal drip 
  • facial nerve dehiscence
Previous history of CSOM (Chronic Suppurative Otitis Media) in left ear. Granulation tissue is present. 

It began as an exploratory procedure as Cortical Mastoidectomy and then they opted for Modified Radical Mastoidectomy because they had to delve even more extensively to locate the cause of dehiscence. After finding a cotton piece at the centre of the granulation tissue, Dr Harish performed Type 3 tympanoplasty (by making changes to the incus and re-attaching it and this was followed by autograft of Temporal fascia of the patient) and meatoplasty (to widen the canal). After this, he completed the procedure with inverse suture using catgut.

To read more about this procedure:

  • Modified Radical Mastoidectomy
  • Meatoplasty
  • Type 3 Tympanoplasty
Cotton piece found, granulation tissue around this cotton piece which was causing compression near geniculate ganglion.

Pre Anaesthetic Medication: Xylocaine Adrenaline infusion

Post Operative Medication: MonoCef (antimicrobial-Ceftriaxone), Periset (Antiemetic-Ondansetron) and Dynapar (NSAID)

Distribution of Facial Nerve. Compression of the nerve can lead to altered facial
expression since the nerve supplies the muscles of face.
So this was our first OT and we were super excited. It was indeed a deja vu moment that reminded me of Grey's Anatomy when Harish Sir scrubbed up and elbowed his way into the Operation Theatre. 
All Scrubbed Up.
So it was indeed a test of endurance since the procedure lasted for a good 4 hours. Here's hoping that we get to see many more surgeries! We (Abhi and I) saw the patient in the MICU during our night visit (where we happened to meet Harish Sir again) and her smile was normalized now as was her ability to close and open her eyes.

Us! :P
Pharmacology and MicroB tests are coming up in the month of April as is the much awaited Medical Conference DEMEDCON at SDUMC, Kolar. ENT Postings are coming to an end and we will then begin Community Medicine. Hopefully we will have a few field visits and rather than merely giving attendance and walking out.

Songs update:
  • Heroes: Alesso Ft Tove Lo
  • Tere Bin Nahin Lage Jiya
  • Love Me Like You Do: Ellie Goulding 
  • Meeti Boliyan
  • Yeno Yeno Agide (All the songs are awesome actually)
Seeya :)