Today was a bad day for me. I must say it was the weirdest day with few complicated/rare cases being admitted under my care. The day started off with a 15-year-old boy with Juvenile Idiopathic Arthritis , followed by an interesting case of PUO. A 55-year-old gentleman with 2 weeks history of intermittent fever(every 2 days) associated with chills and rigors. A very classical picture of something tropical: Malaria! Yes, the malarial screen was positive for Plasmodium Falciparum. Many feel that malaria has disappeared from our radar but no so. I just heard that a patient died in JB hospital a few days ago due to Malaria. A disease that we are still fighting for centuries. The worst part: I heard Quinine is running low in stock in government hospitals and the distributor is also out of stock. There are some newer drugs that are being used to treat Malaria like artesunate, artemether etc but it is still not widely used nor available.
Then came an interesting patient who took some chinese medicine for Gout and developed rashes after about 1 month (delayed hypersensitivity reaction). The rash was typical of photodermatitis: maculopapular rash with blister that appeared only on sun exposed area of face, neck, forearm and lower leg. I am very sure the chinese medicine contained Allopurinol, the commonest drug to cause allergic reaction including Steven Johnson’s syndrome.
While I was seeing these patients, came a case of Thyroid Crisis to our ER. 25-year-old lady who had defaulted anti-thyroid medications for 2 years presented with high-grade fever, agitation, restlessness, palpitation and shortness of breath. Her HR was 150/min with ECG showing sinus tachycardia. Her T4 level was > 100, beyond what our machine can measure. She was resuscitated and transferred to GH as they are unable to sustain the cost of ICU management.
At the same time, came another patient who had a simple fall at home and subsequently noted to have mild left-sided weakness. No loss of consciousness was noted. GCS was full with a power of 4+/5 over the left side and he was admitted as a case of stroke from ER. A CT scan later showed a RT subdural haemorrhage(2.4cm thick) with cerebral edema and slight midline shift of 0.4cm. I had to transfer him to GH neurosurgical unit for evacuation.
These cases really kept me busy today. I must say that since I joined private sector, I have seen many interesting and weird cases. Just last month I had 2 young patients( 28 and 31 years old) with severe hypertension (BP around 260/160!). One turn out to be bilateral renal artery stenosis and the other Conn’s syndrome!
Just last week I had a patient with advanced Systemic sclerosis with atonic dilated esophagus throughout the entire length. She was unable to swallow even fluid. I referred to my Gastroenterolgy friend who did the OGDS and found food particles in her throat! A barium swallow done at another centre showed the contrast entering/aspirated into the lung! We actually got a bronchogram!
What a day…………………….
Pagalavan's Avatar 
I’ve been waiting for this kind of post for ages..a bit boring reading too much about the politics et cetera for the moment..just wait for the election.haha.keep writing n sharing interesting cases u see everyday 😉
Fantastic! We should start our own medical tv dramas. I know where to start. No pun intended.
I wonder why do complicated cases end up seeking private hospitals first instead of public hospitals where there should be even more specialties to address the case variety.
Is it perhaps that the public is losing trust in the public system?
I think that complicated cases end up seeking private hospitals is not correct. There are far more complicated cases seen in the public hospital. I attended a symposium few years ago where a free paper research showed that 70% of community still prefer to go to public hospital for resuscitation.
I worked in private hospital as locum before. Conversation from the senior nurses showed that they seldom do resuscitation in the ER. For more ‘quiet’ private hospital, they saw < 10 cases in resuscitation in 10 years where a public ER doctor could easily saw 5-10 cases of resuscitation in a week.
Come to complication cases in private, they actually 'screen' it first and if they don't want it, the most common excuses given was 'NO ICU bed'. I came across a few suicidal attempts cases where the patients was brought to the private ER and they not even bother to insert a nasogastric tube (not cost so much $$) to the patient but keep asking pt to go to public hospital. By the time the patient reached public hospital emergency, it already pass 4 hours ingestion…..so no point to insert and do lavage already.
The worst example was an private ambulance went on site and saw the victim's right lower limb was total lost secondary to the bad accident. The private ambulance just turned back and drove away from the scene. By the time public ambulance arrived, the public ambulance got all the complaint for late coming where actually it arrived in 15 minutes.
Don't forget, private talk about money first before saving but public save first before talking about money.
I think it depends on how you define “complicated cases”. How do a patient know that his disease is complicated? Only when they land up in a hospital, the doctors diagnose the problem and tell the patient how serious the conditions are. There is no way the patient is going to know before that. They just go to whichever hospital which is the nearest. Most people come to private hospitals for comfort, easy access and faster diagnosis. I will talk more about why patients go to private hospitals later in my blog posting.
my weirdest case is referral from a KK-c/o got slapped by fish, pain at cheek+
o/e:inflamed cheek,tender. WTH! turned out that guy had just gone fishing and when he finally caught the fish, the fish was struggling and accidentally hit his face.when the pt came to see me. no more red cheek! Of course la, it’s normal for you to get red cheek when you just get slapped
Dr Paga, for ur info, Sabah is a state where u can see malaria cases everyday and we dont really use Quinine anymore. Artesunate is commonly use and is always availaible
Not in JB. According to our state ID physician, you need to buy it from a pharmacy outside!