THE LONGEST CLINICAL PRESENTATION

THE LONGEST CLINICAL PRESENTATION

It was a bright Monday morning. The rays of the sunlight descended in brilliant fashion upon the horizon without an iota of scorching heat. The sky was gorgeously adorned in its white -blue regalia. The whole atmosphere exudes a positive prospect. I looked around and nodded in affirmation. 'Today must be great!', I muttered to myself.

I had worked like a Trogan throughout the night in preparation for my clinical presentation. I had undergone so an in-depth study on the case that I've learnt it by heart and can recite it offhand. It's a day I had anxiously awaited to display my clinical ingenuity before my teachers and colleagues.

I stood by the bedside of my index patient asking further pertinent questions as regards the aetiology of the disease she had presented with so as to clear any hitch that may arise in the course of my presentation.

At about 7:30am some group of doctors in their white ward coats worn over T-shirt knotted with tie had begun to troop into the Female Surgical Ward which was the scene of the event.
A moment afterwards the whole atmosphere turned into boisterous one as a mammoth crowd of doctors had arrived exchanging pleasantries and discussing some medical issues.

A dead silence fell as soon as the moderator, Dr Nzekwe entered the scene and led the procession to the patient's bedside. At this juncture my confidence had almost begun to wane as I suddenly began to experience exaggerated sympathetic discharge evidenced by my sustained palpitations and asynchronous body movement. However, I tried to subdue it by taking a deep breath and thrusting my chest forward in a swagger of confidence.

I stood by my patient's bedside with my arms by my sides in a humble and obedience manner as we had been taught in the medical school. I was surrounded by my teachers and colleagues in such a manner that I appeared to be the cynosure of the whole events. Even the patients could see the difference between me and other doctors.
A deep silence fell. Zillions of unblinking eyes were steadily focused on me. The moderator flashed an intimidating hostile smile at me with a strong dreadful gaze that triggered a cold feeling down to the root of my nerve and my whole feet began to wobble. The whole atmosphere was tensed to a climax. In a jiffy and without preamble I was motioned to proceed with my presentation.

'I present Okoro Theresa, a 48year old female trader who lives at....' I began.
No sooner had I delved into the real nitty-gritty than I was stopped by the moderator for not describing the size of the breast mass in a supposed term that unequivocally and unambiguously depicts the mental picture of the mass.
'Is it the size of Arochokwu palm kernel or that of Okija or that of Isikwato or that of your village? ' he roared at me. I was startled. I had earlier described the mass to be of palm kernel size. The rationale behind the moderator finding fault with my descriptive term seemed to have eluded my mind. I had encountered several periodic interruptions before I could draw the curtains for my history and physical findings.
Hardly had I dropped my last sentence, when I was bombarded with a myriad of questions emanating from all angles beginning from the House Officers through my fellow Registers to the Senior Registers, Consultants and Professors.
The questions rained in torrents and landed on me like a barrage of bullets.
What is the stage of the tumour?
What in your history and physical examination can tell us about the stage of the tumour?
Is the patient in respiratory distress?
What are the first line investigations you will do for the patient?
Do you intend starting up chemotherapy for the patient today and why?

That was how the questions were spurting out in jets and each jet coincides my heart beat. I almost thought that the whole doctors had indulged in a conspiracy against me.
In a moment, I was swimming in a deep blue sea of unanswered questions. It was really a brutal clinical tussle. In an attempt to answer the first question in the multitude of questions presented before me, I was hammered with several further blows of questions emanating from my humble answer. This nearly tilted me into a state of acute confusional state. I was obviously losing my mental and clinical balance. 'If my first answer could yield three more malignant questions amidst a myriad of unanswered questions, this means that before I could answer half of the questions, I would have been consumed or even buried with questions'. I thought. Nevertheless, I persevered with a spirit of doggedness.

'Be courageous, it is not yet over, I suggested to myself. What appeared unfathomable to me was that my fellow registers with whom we had been struggling to lift our beings above the limits of stagnating natural phenomenon joined the consultants in unleashing even more malignant questions against me. I was tossed to and fro almost to a gasping point. I could decipher that a handful of the criticisms levelled against me were not only constructive but destructive, taking into cognisance of its detrimental effect in collapsing my whole body of confidence.
Like a lamb led to the slaughter house, I opened not my mouth in self defence of the criticisms. Like a sheep before its shearer I was submissive. I tried to the best of my abilities to answer the questions in quantum, at a slower pace within the limit of my adaptability so as not to attract more undue questions. A point of nemesis came when a fellow Register wanted to throw me off balance with a question regarding the tumour staging. The question caught the attention of the moderator who asked him in return to explain his reasons behind the staging of the tumor. He seemed to have brought himself to the hot seat and in a moment was made an object of ridicule.

It was in deed the longest clinical presentation. The hottest, irksome and herculean bedside presentation I've ever done. A case, I was physically and emotionally drained. The fact that I came out alive that very day was nothing but a mystery. 

SON OF THE KINGDOM STORY.....