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Sunday, January 23, 2011

Interesting Medical Cases: Unusual Foreign Body In Boys Bladder

(From ISPUB) Click here for the full text.
Below is the unTL;DR, slightly less medical version.


So basically, a 14 year old boy complains of pain, difficulty in passing urine with dribbling and subsequent urinary retention that is 24 hours in duration. On further questioning he told the doctor that while he was cleaning the fish tank in his house, he was holding a fish in his hand when he went to the toilet. When passing urine, the fish slipped from his hand and entered his urethra and he developed the subsequent symptoms.

An X ray and abdominal ultrasound were done, with the ultrasound showing a 1.5cm echogenic object found inside his bladder. 

For management a cystourethroscopy was done (i.e. sticking a flexible scope up his penis). A 2cm long dead fish was found inside the bladder. The medical team tried to remove the fish with forceps but was unable to due to its slippery surface. Instead, a rigid ureteroscope with stone graspers was used to remove the fish whole. 

Afterwards, the child was asymptomatic and was sent for psychiatric counseling.

This story begs the question, what the fuck was the kid doing with a fish in his hand whilst in the toilet in the first place.

The article itself then goes on about the Candirú or Canero fish, found in the Amazon river. Below is the extract. 

"One of the strangest stories from the Amazon was a fish that was urinophilic and could swim up the urethra or into the vagina who urinated while bathing in the Amazon. It was said that this fish, known as candirú [in Brazil; as carnero. Once inside it would eat away the mucous membranes and tissues until hemorrhage would kill it or the host. It was also said that even if one caught the fish by the tail, once in the urethra it could not be pulled out because it would spread itself like an umbrella. in Spanish-speaking countries], was long, thin, and capable of forcing its way into the body's passageways following the trail of urine."
 
Charming.

Friday, January 21, 2011

Sounds like the future

Reposted from a MedKids Journal - http://boards.medscape.com/forums?128@559.f7mYawOqGzD@.2a063f93!comment=1

I Am Only Human After All

Kendra Campbell, MD, Psychiatry/Mental Health, 12:41AM Jan 14, 2011

"We are human, after all. Flesh Uncovered, after all.
We are human, after all. Much in Common, after all.”

-Daft Punk

It's 1:00 a.m. I just got home from an 18-hour shift at the hospital. I should really be sleeping, not typing. But I need to put in my weekly post here at the Ink Blot. And I don’t know when I’ll ever get the time to write again.

I remember when I was a pre-med student and even a med student...looking around at some of the doctors and wondering how they could sometimes be so short with their patients. I saw docs who didn’t really seem to care much for anyone, especially their patients. And I wondered how they could be in medicine and have such little empathy.

And now I truly realize why, maybe for the first time in my life.

As I’ve said before, there is an inverse correlation between the hours worked and the level of empathy towards patients. And not only empathy, but compassion as well.

I started the day at full speed, diligently caring for my patients. I comforted a patient in excruciating pain. I took the time to talk extensively with my patient’s mother. I went the extra mile.

But after around 15 hours into my shift, my empathy and compassion started fading. I began viewing patients not as humans who needed my help, but rather as obstacles in my path towards gaining sustenance, rest, and sleep.

Why did my patient have to go into respiratory distress and require intubation? Didn’t he know how fatigued I was? Why couldn’t he have waited until I left the hospital to become such a time sink?

Why did my demented patient have to keep ripping out her IV lines and foley catheter? Didn’t she know how much I wanted to see my bed?

I feel like I’m really starting to understand the dark side of medicine. I now comprehend The House of God with a whole new appreciation.

I want to care. I want to have empathy. I want to have compassion.

I know it’s within me. I know I want to be the best doctor I can be to each and every one of my patients.

But the reality...the truth...

Is that I can not.

I simply do not have that innumerable capacity.

I am only human, after all.