interesting cases during foundation

TLDR : recounting interesting cases in my first 2 years of medicine

I wish I had taken more notes. Created some form a logbook. There are too many interesting patients and stories, and already I find myself forgetting. Here are a few anonymised prominent cases (in no order), from the top of my head.

I think I will keep a logbook during radiology training (or maybe make a digital one).

Cases

  1. Potato ileus : 48 year old man presenting with small bowel obstruction. CT identifies mechanical obstruction secondary to multiple rounded opacities within the bowel. On history, he reveals he swallowed 6x baby potatoes without chewing. He had to have a laparotomy(!) to remove these, and subsequently ended up on the ward for a few weeks. The surgeons were quite mean to him.

  2. 21 year old RTA - the passenger died at the scene who was the father in law. I only remember this since it was my last surgical oncall shift, on Christmas morning.

  3. COVID related deaths : speaking to family over the phone was the most painful aspect.

  4. Swallowed foreign bodies : I spent a total of 8 months on gastro. Many swallowed foreign bodies that the reg/consultant had to hook out

  5. Alcohol related deaths : these are the most brutal. Confused due to encephalopathy, Ascites leading to shortness of breath, jaundiced and itching. Sometimes young. One Asian man who was 35 years old with children and family.

  6. Pancreatic cancer related deaths : one particular Scottish lady I met in Addenbrookes. I cried when she passed away.

  7. Paradoxical embolus : causing a stroke. Interesting CT - had a patent foreman ovale, and a DVT…

  8. Arm clot leading to amputation : Eastern European lady who developed multiple clots (during vascular attachment), who ultimately ended up having an arm amputation. Young.

  9. Incidental brain tumour (x 4) on CT heads : During medicine rotations in ED, I distinctly remember multiple cases where they found incidental brain tumours. Crazy

Memory and documenting

There are too many cases. Availability bias : I can only remember the most recent ones in psychiatry, but those are too specific to mention here. Also too sad in many cases, domestic violence, rape and suicides.

I look back and realise I did reflect on many of the cases. But I never formally wrote it down or addressed them directly. I can’t go back and look through my notes, because I didn’t take any. I think that it is a shame.

Part of the reason I write anything down, is to examine how my views have changed, and how you handled a situation at the time / take away any lessons. Ultimately its a form of self knowledge.

So this is a reminder to document more : write more, take more pictures, take more videos. It makes you pay more attention.

I was talking to my registrar about how time seems to be moving faster, especially as you get older. You become set into a routine and the days take on the same flavour. This isn’t a bad thing. It is that your priorities change. Having children, a stable meaningful job, all provide a sense of purpose, even though they can seem mundane. She’s actually been a huge influence during my psychiatry attachment, perhaps why I have been so reflective in the past couple of months.

The problem with mundane, is that you can take it for granted. You forget those moments, even though they bring great joy. One way to mitigate this, is to write, take photos, take videos of your daily life. Not so that you can ‘hold onto them’, but so that you pay attention to them when they happen.

Take Away

  • Keep a medical logbook
  • Regularly write
  • Take more pictures, take more videos, create
  • Project ideas : Add a gallery to the blog, Medical logbook app