A Family Doctor's Tale - EAR NOSE THROAT DEPARTMENT

THE ENT DEPARTMENT


The Ear Nose Throat  (ENT) Department of Singapore General Hospital is one of the smallest department with 4 consultant ENT Surgeons, 2 medical officers and 1 houseman.


It is however one of the most essential department of the hospital as 80% of cases are generally  the ear nose and throat conditions.


However 90% of the cases can be seen as outpatients or by experienced Accident and Emergency Doctors and General Practitioners.


Our job is to handle those ENT conditions which the Accident and Emergency Doctors could not handle.


Typical conditions are:


1.Foreign bodies in the ear and nose such as small marbles, small parts of toys, cotton buds in the nose of children, which can be removed with a nasal forceps or sucked out with suction tubes


2. Fish bones or chicken bones stuck  in the throat which can be removed by crocodile forceps. 
If further down the throat an endoscope may be required to remove the bones sometimes under general anesthesia.


3.Severe infections of the ear with pussy discharge which require drainage of the pus.


4.Severe blockage of the ear by wax which my required syringing of the ear with warm water to remove the wax.


5.Peritonsillar  abscess or quinsy ( A Simple Guide to Tonsillitis)which is an abscess or bag of pus surrounding the tonsil causing blockage to food, swallowing and even breathing. 
A cut just above the tonsil will usually drain the pus and relieve the blockage. However the patient will normally have to stay in hospital for one or two days to make sure the bleeding stop and he or she is able to swallow and breathe properly. 
He or she is then scheduled for a future operation to remove his tonsils.


6.Bleeding from the nose(A Simple Guide to Epistaxis)  is an emergency which has to be attended quickly because of the danger of loss of blood.
Most mild bleeding of the nose comes from bursting of blood vessel of the septum and can be stopped easily by coagulating the blood vessel with silver nitrate or cautery (electrical burning) under local anesthesia.
In severe cases packing the nose with gauze packs anteriorly from the front or posteriorly from the back to plug the bleeding can be done with great discomfort to the patient.


7.Vertigo (A Simple Guide to Vertigo) or severe dizziness may be treated with an injection of stemetil with temporary relief. Recurrence especially in cases of Meniere's Disease (A Simple Guide to Meniere's Disease)  is quite common.


8.The cancer patients of the nose and throat are particular in danger of bleeding of the nose, breathing difficulty and spread of the cancer to the rest of the body. The most common cancer seen here is Nasopharyngeal Cancer (A Simple Guide to Nasopharygngal Cancer).
Other cancers are Cancer of the Larynx, Tongue, Salivary glands.
These will be talked about in the next blog.

A Family Doctor's Tale - THE NEW DOCTOR

THE NEW DOCTOR
It was the first day of my life as a doctor.

It was exhilarating. It was exciting. 

It was quickly brought down to earth or hospital ward.
The head of Ear Nose Throat Department of Singapore
General Hospital spent little time to introduce his
consultants  and medical officers to me
(the only houseman and the most junior doctor
around to do all the ward work).

We then make a ward round of all the inpatients
to update the latest information on their medical
conditions and also which patient will be fit for
discharge on that day. 

The houseman (me) was of course supposed to do
these (so called red tape) as well as to take blood
tests and fill out all the information on new
patients admitted to the ward.

After the ward round I got around to do all the
paper work and blood tests.
It was a small department which was why only 1
houseman was attached to it. 

The patients were generally post-surgical recovery
cases who of course may need pain killers and
constant monitoring for post operation complications. 

Of course there were also the odd nasopharyngeal cancer
(A Simple Guide to Nasopharyngeal Cancer) patient
who were on chemotherapy because their cancer was
fairly advanced.

So it was work and work and work again as new cases
come and old cases had the usual pain and bleeding
after operations. 

I had never like the word "cases" because it was so
impersonal. 

I would try to know my patient's name, what sort of
work they were in. 

I also believe in helping the nurses and nursing aides
in their work as I do not consider myself superior to
them.
After all I had just started on my medical journey while
they had so much more experience in their many years
in nursing.

One of the many disadvantage of being a doctor was the
long hours we are expected to work.
When there is a night duty, a doctor has to work from
8am in the morning up to 1pm the next day.
Of course the main work was from 8am to 5pm.
From 5.01pm onwards we have to attend to the
new cases admitted to the ward as well as the
inpatients in the wards who has complications
like bleeding postoperatively or had severe pain
or unable to sleep. 


Because the Ear Nose Throat Department has less
emergencies, life at night was not too bad and
usually there was some time to sleep. 

However because there were fewer medical officers and
houseman in the ENT dept, night duty happened about
every 3 days including Sundays and public holidays.
Meals such as dinner and breakfast were served by the
ward assistants.

For me , I was allowed to see some outpatients when
I had finished my ward work. 

In addition I was allowed to assist in some operations.
I was lucky enough to be able to do  a tonsillectomy
operation (A Simple Guide to Tonsillitis) with

a trainee medical officer guiding me with instructions.

A Family Doctor's Tale

IN THE BEGINNING
I have never planned on becoming a doctor.

I was looking forward to a career in mathematics or chemistry. Those were my favorite subjects. I like solving mathematical problems and I look forward to experiment with the chemicals bought from the drugstore.

Then one day I came upon a Reader Digest condensed novel ” Not as a stranger”.
It was all about a poor medical student who became an assistant to a Family Doctor and eventually took over the family doctor’s practice.
It was inspirational.

Then came medical TV serials such as Marcus Welby M.D
Ben Casey, Dr Kildare , Doctor in the House.
I resolve that I would try to be a good family Doctor.

My mother whose older brother was a doctor in China encouraged me to take up medicine.


So it was at the tender age of 18 years, I entered the medical faculty of the university of Singapore.

The first day was a nightmare. Entering the dept of Anatomy, I was presented with a large hall of corpses and the strong smell of formaldehyde.
Suddenly the dream of being a doctor became a nightmare of looking at & cutting up of a dry preserved corpse for the next 18 months.


In the meantime there were the endless lectures of anatomy, physiology and biochemistry.
Life became rather rushed. Unlike other undergraduates, we were studying through out the whole year with 4 semesters instead of the 3 semesters in the Arts and Science faculty and 2 weeks break in between.

There were daily taking notes of complaints of patients and examinations of patients. There were also procedures like drawing blood from patients, watching surgical procedure done by eminent surgeons, doing minor surgical procedures like removing small lumps and bumps, stitching of cuts and cleaning of wounds.

The most important assignment was the “catching” of 20 babies at the Kandang Kerbau Maternity Hospital (the biggest baby factory in the world in the 1970’s) or the delivery of 20 babies in the hospital by natural birth.

So it was after 5 years of tutorial and practical medicine that I finally graduated as a medical doctor. 
Even then I had only 1 month rest before being called up for
my housemanship - a compulsory year of working in the hospital before becoming a fully registered doctor.