I was raised by my grandfather since I was
a young child. He fed me, played with me and even changed my diapers. I was his
joy and we were inseparable. Lately since highschool I’ve been studying in
Australia, and he lived in Taiwan. We hardly get a chance to see each other.
During the 2014 mid semester break in July, I’ve decided to fly back to Taiwan
for the week and spend some time with my beloved grandfather.
He’s an elderly gentleman with silver grey
hair with still hints of black in the middle. His receding hairline and patches
on his face accentuate his age. He has light blue rings around his pupils and also skinny arms and legs with a prominent belly. When he walks, he shuffles in a slow gait. While he is82 and has a history of hypertension, hypertrophic prostate, stent in his left carotid and also diabetes. He is my grandfather I love so much.
Recently during clinical days, we've learnt how to perform a cardiac examination. This procedure gives us the set of skill to discover signs of heart problems simply through observation, touch and listening. It was strongly emphasised that such skill will definitely be examined by the end of the year, and I know that with these skills only practice makes perfect.
On our first clinical day, the head of school told us the importance of family and friends during med school. They will serve a crucial role in your education he said, for what are friends and family for other than for you to practice on? This lesson sank deep into my head, and from that day on, my girlfriend became my guinea pig.
Once I arrived in Taiwan, I went to live with my grandfather. I treasured the opportunity to see him, and we had a heart-to-heart talk that lasted late into the night. He was proud that I was now a med student, and I was content to be able to spend time with him.
And as you may have guessed dear reader, during my time there, I gave my grandfather a cardiac exam. What better opportunity than this? Not only did I get to practice my new taught skills, I also got to know my grandfather on a whole new level.
I donned on my stethoscope and put on the whole show for him. I got him to lie down on the bed, and began the ritual.
I began with examining the hands, inspecting the knuckles, joints and fingernails for any abnormal formations, lesions and signs. I notices vertical lines that ran down some of his nails. I got him to press two opposing nails together and noticed an absence of clubbing. I observed that his hands were warm and fingers were dexterous.
Then I moved up the hand and measured his pulse. I had done this numerous times with friends and colleagues, and now know to expect a ... thud... thud... thud. However, the moment I located his radial pulse, I felt something abnormal. The rhythm was irregular and also the strength of each beat was alternating between firm and weak. I felt excited to palpate an 'abnormal' condition, after all 'normal' get's boring after the 100th time.
I measured his blood pressure and found it to be 120/80. I was astonished as I knew he had hypertension. His medications must have been working very well, as his value was even more closing to perfect than my own.
I moved up the arm and onto the face and continued with the examination. I grabbed my cheap pen torch and started to look for signs in his eyes. I knew my grandfather had blue eyes. This always had fascinated me as the rest of our family had brown irises. I learnt that blue eyes are due to a lack of melanin, a colouring pigment that gives our skin it's colour. Blue eyes are blue because of a lack in this pigment and thus present their colour the same way the sky is blue (how? I forgot). I was certainly surprised when I shone the light into this eyes and found the brown iris that I always thought was absent. To more accurately describe my grandfather's eyes, he had a brown iris with a ring of whitish blue surrounding it. The term arcus senilis immediately popped into my mind. The week before, our clinical tutor kept on mentioning the term, and I thought to myself this was going to be a sign that I wouldn't see in a patient until way down the line when I'm actually with real patients. By then I'd probably forget what it's called. But here I was, looking in his eyes, the the white ring stared back at me. I don't think I'll ever forget arcus senilis again.
Moving down, I examined his mouth, teeth and palpated his carotid and looked for any elevated jugular vein pressure. So far, I've not yet seen an elevated JVP, so I just stared awkwardly at his neck, hoping to see any movement. After 20s of staring, I gave up and moved on. (maybe another day)
My grandfather's chest had a scar around his right nipple. I never noticed it and found out that he had a tumor which was removed a long time ago. I then located his 5th intercostal groove and proceeded to palpate his apex beat. This one again proved unfruitful and so I moved on.
Auscultating (fancy word for listening) to my grandfather's heart beat was a highlight for me. As aforementioned, I knew his pulse felt abnormal, and his heartsounds certainly reflected the same way. While I expected an irregular rhythm instead of the usual LUB dub... LUB dub... LUB dub..., I heard LUB dub... LUB dub... bop......... LUB dub... LUB dub... bop......... Two beats sounded normal, but on the third beat, it was consistently missing S2 and sounded abnormal. What does this mean? I don't know.
Listening to his lungs, I also heard a dull rumbling when he exhaled. It wasn't crackling for sure, but a low frequency rumble. What does THIS mean? I don't know.
Moving further down his legs, I examined for any oedema, and found nothing in return.
By then I had finished the physical examination ritual. I had felt and heard some interesting signs on my grandfather, but I had no idea what they meant. What I know is that I had examined his body from head to toe and come away with deeper understanding of my grandfather than I previously knew.
A few days later before I left Taiwan, I examined him again to feel for that mysterious beat one last time. I donned the ritual and got him to lie down. When I felt his pulse, all I felt was a uniform and regular thud, and the mysterious heart sounds also disappeared. What does this mean?? .... I don't know.
Recently during clinical days, we've learnt how to perform a cardiac examination. This procedure gives us the set of skill to discover signs of heart problems simply through observation, touch and listening. It was strongly emphasised that such skill will definitely be examined by the end of the year, and I know that with these skills only practice makes perfect.
On our first clinical day, the head of school told us the importance of family and friends during med school. They will serve a crucial role in your education he said, for what are friends and family for other than for you to practice on? This lesson sank deep into my head, and from that day on, my girlfriend became my guinea pig.
Once I arrived in Taiwan, I went to live with my grandfather. I treasured the opportunity to see him, and we had a heart-to-heart talk that lasted late into the night. He was proud that I was now a med student, and I was content to be able to spend time with him.
And as you may have guessed dear reader, during my time there, I gave my grandfather a cardiac exam. What better opportunity than this? Not only did I get to practice my new taught skills, I also got to know my grandfather on a whole new level.
I donned on my stethoscope and put on the whole show for him. I got him to lie down on the bed, and began the ritual.
I began with examining the hands, inspecting the knuckles, joints and fingernails for any abnormal formations, lesions and signs. I notices vertical lines that ran down some of his nails. I got him to press two opposing nails together and noticed an absence of clubbing. I observed that his hands were warm and fingers were dexterous.
Then I moved up the hand and measured his pulse. I had done this numerous times with friends and colleagues, and now know to expect a ... thud... thud... thud. However, the moment I located his radial pulse, I felt something abnormal. The rhythm was irregular and also the strength of each beat was alternating between firm and weak. I felt excited to palpate an 'abnormal' condition, after all 'normal' get's boring after the 100th time.
I measured his blood pressure and found it to be 120/80. I was astonished as I knew he had hypertension. His medications must have been working very well, as his value was even more closing to perfect than my own.
I moved up the arm and onto the face and continued with the examination. I grabbed my cheap pen torch and started to look for signs in his eyes. I knew my grandfather had blue eyes. This always had fascinated me as the rest of our family had brown irises. I learnt that blue eyes are due to a lack of melanin, a colouring pigment that gives our skin it's colour. Blue eyes are blue because of a lack in this pigment and thus present their colour the same way the sky is blue (how? I forgot). I was certainly surprised when I shone the light into this eyes and found the brown iris that I always thought was absent. To more accurately describe my grandfather's eyes, he had a brown iris with a ring of whitish blue surrounding it. The term arcus senilis immediately popped into my mind. The week before, our clinical tutor kept on mentioning the term, and I thought to myself this was going to be a sign that I wouldn't see in a patient until way down the line when I'm actually with real patients. By then I'd probably forget what it's called. But here I was, looking in his eyes, the the white ring stared back at me. I don't think I'll ever forget arcus senilis again.
Moving down, I examined his mouth, teeth and palpated his carotid and looked for any elevated jugular vein pressure. So far, I've not yet seen an elevated JVP, so I just stared awkwardly at his neck, hoping to see any movement. After 20s of staring, I gave up and moved on. (maybe another day)
My grandfather's chest had a scar around his right nipple. I never noticed it and found out that he had a tumor which was removed a long time ago. I then located his 5th intercostal groove and proceeded to palpate his apex beat. This one again proved unfruitful and so I moved on.
Auscultating (fancy word for listening) to my grandfather's heart beat was a highlight for me. As aforementioned, I knew his pulse felt abnormal, and his heartsounds certainly reflected the same way. While I expected an irregular rhythm instead of the usual LUB dub... LUB dub... LUB dub..., I heard LUB dub... LUB dub... bop......... LUB dub... LUB dub... bop......... Two beats sounded normal, but on the third beat, it was consistently missing S2 and sounded abnormal. What does this mean? I don't know.
Listening to his lungs, I also heard a dull rumbling when he exhaled. It wasn't crackling for sure, but a low frequency rumble. What does THIS mean? I don't know.
Moving further down his legs, I examined for any oedema, and found nothing in return.
By then I had finished the physical examination ritual. I had felt and heard some interesting signs on my grandfather, but I had no idea what they meant. What I know is that I had examined his body from head to toe and come away with deeper understanding of my grandfather than I previously knew.
*****
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