Wednesday, February 10, 2010

Private Practice

A young lady Dr, beaming, opens the door of her very own, clean, air-conditioned GP consulting room. Feeling particularly professional in her black satin pencil skirt, silk blouse and expertly applied make-up, she represents the polar opposite of the cranky, pee-stained, sleep deprived trauma doctor she was a few weeks ago.

A mornings only stint in a lovely private practice for the month of February.

This should be a breeze.

Would she like it? A gentle GP breeze as opposed to the tornado of trauma she's used to.

Snotty noses versus gunshot face?

Sore throats versus panga to the cranium?

Will she even have to engage in any taxing cerebral activity?

Flashing a radiant smile at the long queue in the waiting room she welcomes her first patient.

The patients all look at each other nervously.

Nobody makes eye contact with her.

Nobody stands up.

This is not going as planned.

She tries again, this time clutching the stethoscope around her neck. This serves both to remind the patients that she is a doctor, and to remind her of what that stethoscope has helped her to achieve in terms of patient care.

Number 5 in the queue, a middle-aged gentleman, eventually stands up and makes his way into her office.

“Are you new here?” He asks her.

She responds, “Yes, I’m filling in for one of the doctors who are on leave. How can I help you sir?”

“Are you really a doctor? You look too young. And you don’t look like a doctor. They are saying outside that you’re too young to know anything and that they would rather wait to see the older Doctor that’s been here for years. But he’s not here yet and I’m in a rush so I thought I’d try you out. I hope you can help me.”

She takes a deep sigh, this is not the first time she has been sorely accused of youthfulness.

She wonders if a few greying streaks and some crow’s feet would help instill confidence in her patients.

As the morning progresses and she is confronted with skin rashes that didn’t read the textbook definition of their supposed morphology, vague symptoms that do not tie neatly into one specific diagnosis, complaints of being stressed, and other such symptoms that she was not taught how to treat at medical dawns on her that there is more to being a GP than meets the eye.

Thankfully, The Universe has decided not to punish her completely for being so blasé about GP’s in the past, and has given her the gift of Dr BD in the consulting room next to hers. Dr BD, is a bubbly, enthusiastic doctor with what can only be described as an inspirational passion for GP medicine. (Who knew these Dr's actually existed!)

Dr BD is in possession of all the little secret GP tricks that one can only gain with experience and she makes excessive use of his knowledge throughout the day.

Luckily for her he is keen to teach her the art of this general practitioner stuff!

That first brave patient who took a chance on her poured out his soul in 20 minutes, and discussed very intimate details of his troubled relationship with her.
She is supremely humbled by this, and unsure of what concrete medical treatment to give him, she lets him talk, probing gently here and there for signs of depression or suicidality. There are none that she can detect. He leaves her office with a referral to a psychologist and social worker.

“I hope that I helped you in the end, sir.” She says before he leaves, wondering if the patient would be satisfied with the lack of anti-depressants/anxiolytics she had not prescribed.

“You’re young, but at least you listened to me.So yes, you did help me.” He says.


A new weapon to add to her medical arsenal?

Sometimes no medicine is the best medicine, apparently.

And like a war veteran returned home after surviving the battle, nervous that she would be bored by anything other than the constant adrenaline rush that had so dominated her life, she ended her morning satisfied that wherever she goes, there are knew things to learn and secrets to discover, both about herself and the world around her.

It's just a matter of being receptive to the lessons...

p.s. Stupidosaur, Deluded, Ketan...this one's for you. I have recently moved residences and have been without an internet connection for days, with no wifi on the horizon for at least a few more weeks thanks to the non-efficiency of our telecommunications company in SA. I won't go into the details of the killing,maiming, pleading and selling of my soul I had to go through to be able to publish this post...I'm just saying...I hope you're satisfied?!?! :)


Stupidosaur said...

Thanks! :)

Good to know what you are up to!
And to know that you are up to good.

BTW people being unreceptive to 'new people' and new ideas seems something very inherent to biology. Not just at the macro social-human level (reflected in your medical profession and my corporate world), but also at micro level. What am I talking about? Well, Ketan has an article on Wikipedia on immune syetem.

I caught a reflection of this 'young folks are naive and useless' phenomenon in that. Its in this paragraph:

"Limitation of immune system against rapidly mutating viruses

The clone 1 that got stimulated by first antigen gets stimulated by second antigen, too, which best binds with naive cell of clone 2. However, antibodies produced by plasma cells of clone 1 inhibit the proliferation of clone 2.[21]
Main article: Original antigenic sin
Many viruses undergo frequent mutations that result in changes in amino acid composition of their important proteins. Epitopes located on the protein may also undergo alterations in the process. Such an altered epitope binds less strongly with the antibodies specific to the unaltered epitope that would have stimulated the immune system. This is unfortunate because somatic hypermutation does give rise to clones capable of producing soluble antibodies that would have bound the altered epitope avidly enough to neutralize it. But these clones would consist of naive cells which are not allowed to proliferate by the weakly binding antibodies produced by the priorly stimulated clone. This doctrine is known as the original antigenic sin.[21] This phenomenon comes into play particularly in immune responses against influenza, dengue and HIV viruses.[25] This limitation, however, is not imposed by the phenomenon of polyclonal response, but rather, against it by an immune response that is biased in favor of experienced memory cells against the "novice" naive cells. "

I guess if the human society/immune system would give 'young blood'/young 'naive' part of the blood a chance, all problems of the world/dangerous diseases like HIV would simply disappear!

But then giving a free run to any young jerk would probably bring the whole world down/dissolve all proteins in all healthy body cells due to berserk immune system!

Actually this also sounds like what they say in another thing me Ketan and me happened to discuss at another blogger's blog - chaos theory, in which they talk something like very identical phenomenon repeating at various scales of the same thing - here the world of living tissues, which at larger scale makes the 'human world'!

I wanted to discuss Ketan's article with him first (read it first long back), but only after re-reading it and understanding it a bit more! But never got around to it. And I am only a class 12 Biology passed cretin getting dumber by the day! (reflected by reduced posts, in spite of getting regular internet without killing,maiming, pleading and selling of my soul!)

Netha Hussain said...

It is great to have done so much for posting an article on your blog..happy blogging..


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