Internship diaries – Thinking out of the box

The internship was such a beautiful journey, every case had something unique to teach. I had thoroughly enjoyed every case that I dealt with. My internship has many interesting stories and memories. I have penned down one of the stories for you. Stay tuned for more such stories.

I had done a clinical internship in a hospital that has multiple centres across the states. I was posted on emergency duty at one of the secondary centres. One fine evening, an old gentleman walked into our emergency department with severe pain and decreased vision. Seeing him I had many assumptions in mind. The patient was not giving any history clearly. After noting down all the history that I could, I tried to assess his visual acuity. The patient was giving variable answers just by guessing as he did not want to admit that he can’t see. So I turned off the computer visual acuity chart and asked him if he can still see. With no seniors around I was a bit confused about how to handle the case, then an idea struck me.  I took a long red colour pencil close to the patient and asked him to grab the pencil, then to my surprise, he could not do it, he kept wandering his hand in the air hoping to grab the pencil. He was able to appreciate hand movements and PL+ PR was accurate in the affected eye. Then moving on to the slit-lamp examination, I noted that the patient had a severe corneal ulcer, opacities overall.
Next time, When I had uncooperative patients, I first check their eyes with a torchlight or a quick sweep of slit lamp to understand the problem grossly. In this case, performing a torchlight or slit lamp examination at first would have been saved the chair time instead of expecting him to read the chart (since we already knew that corneal ulcer patients have severe photophobia and pain in the eye). Understanding the tentative diagnosis at the start of the examination would also help me in asking better-leading questions required for that particular case. This case taught me that everything is not written in books for us to learn, some things we learn with experience, some by just thinking out of the box.