I came down with some sort of mysterious flu on Thursday, so
I found that my next day at Maharaj was going to be my last. I arrived in the
morning as per usual and met with Dr. Peerasak who I was assigned to for the
day. He informed me that (like Monday) we would be doing Home Ward Rounds. I
jumped in a van with him, a driver, a nurse and a medical student, and we drove
across Chiang Mai to the first patient’s house.
Unlike the patient I had previously seen on Monday, the
first one we visited today was in a very nice house. We arrived at the front of
the gated property, and let ourselves in. When we got into the house we found
the patient right in front of us, lying on a hard wooden bed near the kitchen.
I was informed that the patient had advanced cervical cancer, for which she had
already received chemo and radiation therapy. Because of the advanced stage of
the cervical cancer, her urethra was being compressed, leading to back up of
urine in her bladder, leading to hydronephrosis. She also had high blood
pressure, and demonstrated considerable edema in her legs – so much that you
could still see finger marks after grasping her legs 10 seconds later.
Most of the time both the doctors, nurse and patient spoke
in Thai, but through my limited Thai knowledge I was able to catch some of the
conversation; her saying that because of the swelling, when she had gone to the
bathroom the other day, she had slipped, fell, and was now experiencing back
After doing some more general checks (blood pressure, pulse,
asking more questions, etc) we reviewed her chart, and left to go onto the next
Our next patient we found in a traditional Thai home. He
suffered from a stroke 10 years ago, and though he was able to walk with the
assistance of a cane, he did not leave the house. His wife had retired and was
now taking care of him. He seemed in very good spirits, and bilateral motion
was very good – enough that I didn’t catch on that he had suffered from a stroke
until they told me… though I should have known when they started asking him to
do things like smile, raise both arms, etc. We identified his main problem to
be his blood pressure, but he identified his primary concern to be the pain he
was experiencing. After doing basic checks and reviewing his medications, we
went back to the hospital to discuss both patients, and update their charts.
One thing I kept getting told by all the family medicine
staff is that Canada apparently has a very strong Family Medicine field. I wasn’t
aware of ours being a particular worldwide leader, but apparently we are, so I’m
kind of proud of that.
Once we had completed all our charting, it was time to head
over to the seminar about a new ACE inhibiter for controlling BP in
hypertensive patients. Though the presentation was in Thai, the powerpoint was
in English, and I could understand a lot of the Thai being spoken. I actually
had a good time sitting through the one hour presentation, CHSC 2P27 actually
taught me something useful, as I was able to follow a lot of the graphs, and
look for bias errors (none of which I found though, which is good). There was
free iced coffee, and free drug-swag from the drug company. Everything in the
room was decked out with the new drug – presumably because they want you to prescribe
it. I walked away with a folder, two note pads, a pen, a boxed lunch, two iced
coffees, and a box of tissues… not too shabby.
After the presentation, I was whisked away into another room
with the medical students and their instructor. One of the students was doing a
journal article presentation on a NEJM article about vitamin A as treatment for
something… can’t remember at this exact time, but the article is upstairs.
Anyways, despite speaking Thai again, I was able to follow the conversation –
especially the parts where they switched to English – and was even able to
provide an opinion regarding the article, which was pretty cool. It was
actually pretty fun to have the board discussion on the validity of the
article, and the significance of the results… once again, CHSC 2P27 apparently
taught me well… who’da thunk it?
At the end, I was asked about something I learned regarding
the article, and to reflect off of it. I mentioned the fact that the placebo
being used in patients… Oh, just remembered, the article was about NAFLD and a
drug treatment vs a vitamin treatment vs a placebo. Anyways, I had wondered why
placebo patients showed a 30% increase in better symptoms (decrease in
fibrosis, steatohepatitis, etc) while drug patients showed 50%. The doctor
explained to me that even though the placebo patients are not receiving the
active agent, they’re not being denied care, and were presumably removed from
the harmful stimulus, or had some sort of other treatment that would be
After the conference was finished, I was invited to take my
last look at the department of Family medicine… but not before being invited
back to a party there this Friday… pumped, there’s karaoke. Dr. Boonsong took
me across campus to where a hospital-wide game was going on. There was a big
field with lots of cheering teams of different colours, dancing, etc. The teams
were tying about 20 people’s legs together, and making them race across the
field seeing who could do it the fastest. Though I didn’t participate, it was a
fun way to end off the week there at Maharaj.
Though not initially wanting to be in family medicine, and
being reluctant to like it at first, I really do feel like I learned a lot, and
am happy I got the experience to broaden my knowledge of Thai, international
and family medicine.