Case of the Strep

Last night I knew my cousin Lynne wasn`t feeling too well after finishing work. She came home, throat killing her. She passed out, and I went to school the next morning to do my OSCE – an evaluation.

I had been practising my clinical skills all week with my friends. History taking and a focused cardiac, resp, abdominal and MSK exam. After completing the two hour OSCE, I drove immediately home. Found Lynne passed out looking feverish, her arms splayed, not being able to open her eyes.

Having done an entire OSCE this morning, I grabbed my stethoscope, and a light. I sat her down asked a few questions. So my history:

“20 year old female presents with sore throat. Onset of soreness began approximately yesterday. She describes no cough, no rhinorrhea or other coryza symptoms. No ear pain. A slight headache. She has fever and chills, as well as generalized weakness.”

Listened to her chest, palpated her cervical lymph nodes, which a few were tender. Look inside her throat, and bingo.

“Strep throat, you have strep throat.”

Also known as bacterial pharyngitis, or streptococcal pharyngitis. Here’s what I saw at the back of her throat:

A normal vs. strep throat. Notice the white exudates at the back, a key feature of strep.

I immediately took her to the doctor, who gave her some antibiotics, a 10 day course of Penicillin V. I suspected the symptoms were too severe for “just the flu”. Of course I had seen dozens of strep throat during my family medicine rotation.

I took her to Tim Hortons where she had some soup and hot chocolate (no milk). Now some R & R.

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Lost and found

So I purchased a roots “flat” handbag for my internal medicine rotation. Opting in to sport a bag rather than a white coat with all of its pockets. I am able to fit a few pocket handbooks, as well as having something to hook my pager onto.

Well, I realized since the start of this morning that I had no idea where my handbag was. I knew it had to be somewhere in my house. I searched every conceivable place, even calling up SM to see if it was there with him.

As I became frantic, I realized my bag has my pager. So I called the hospital’s paging system, and explained that I lost my pager and required just a few “pings”.

I heard it, and to my relief I heard it somewhere in the house (that pager is LOUD). I ran upstairs to my mom’s room, called the hospital again to ping my pager and they did. I discovered it hidden behind a towel hanging behind the door. How embarassing T_T My mom started lecturing me and my dad came in laughing, since he witnessed my relentless search and then my victorious find almost an hour later.

My aunt then said to me, “Some things never change…” in reference to all the things I used to lose when I was little (my sweater, my lunch bag, my gloves, my socks, my toys, the list goes on). I guess I’m just more clever at finding it (versus the lost and found at daycare for the things I lost when I was little) – really is just a matter of time.

Weekend to rejuvenate

We were short one staff this week, and only 3 people to cover 45 patients, some more active than others, we had to take on twice as many. At about around Wednesday I started getting a sore throat, fatigue and weakness.

I’m on week 5 of 6 of my internal medicine rotation. We usually take on a max of 2 or 3 “active patients”, and however many patients who don’t have as many critical issues. Being as enthusiastic a learner as I wanted to be, I never said “no” to my attending. I took on as much as I could, worked as hard as I could, because I knew that I had to take advantage of every learning opportunity I could. As much as I impressed my attending, it seemed to come at a price. I showed up Thursday morning, sharp stabbing pains down my throat, dizziness, fatigue despite a full night’s sleep – and I just did not feel right. I spent 3 hours trying really hard to work through the day, but I had been assigned 11 patients, 8 were active and 3 were not – and I had only 4 hours to get through them all as opposed to 8 due to a half academic day. I kept telling myself “5 hours left, 5 hours left”. But when the NP I worked with came and asked how I was doing, my first response, “I don’t feel so hot“. My attending checked my throat, and temperature (so my supervisor apparently was a GP before becoming an internist) and told me to go home.

To be honest, a sore throat would be something I would have stayed at work at anyway. I was going the entire week 2-3 times harder than my usual norm, maybe it was burn out too. I felt so emotionally depleted, and I felt guilty about going home. As SM told me, “If you’re sick and continue working, this will impact your health, and the health of your patients!”. I was finally convinced.

I had hot teas, soups, plenty of rest. Unfortunately I had to cancel on a friend’s birthday on Saturday. I spent Friday completely away from work and with SM. Today, I slept, a LOT, I read leisurely, and I also spent some quality time with SM. The throat is still sore, but I am feeling much better emotionally, and feel as if I have the strength to take on as many responsibilities as I need to. I’m lucky to have someone as nice as SM to look out for me.