My last day in ID

In 2012 as a fresh-faced House Officer, I encountered a young man with necrotizing fasciitis (a severe infection of the skin and soft tissue). It was a horrific encounter of a young man who deteriorated rapidly before my eyes, whose care was escalated quickly to the intensive care unit within 12 hours of admission. He eventually demised from an overwhelming infection. I remember sneaking into the ICU to spy on his progress. His fingers and toes were literally dropping off from gangrene. It turned out that he had acquired an infection in his blood stream caused by vibrio vulnificus, a bacteria found in uncooked seafood or infected waters. I ruminated over the case for several days, wondering if there was anything I could have done better. I then saved his case under a newly created patient list of “Interesting Patients”.

 Fast forward to 2014, and no other patient ever made in onto this list that I had created. As of 30 June 2014, I had a grand total of 1 patient on that list. (Well, I can think of 1 patient that I wound have like to have saved but didn’t have the chance to) Then I started ID. Off the top of my head, the most memorable patients that I encountered were a patient with vibrio sennensis bacteremia, ANCA-associated vasculitis that manifested in the form of pyrexia of unknown origin (later became full blown pulmonary haemorrhage), cryptococcal meningitis in a non-immunocompromised host, Lemierre's syndrome from a Klebsiella infection, rhinocerebral mucormycosis, fungal endopathalmitis, NTM prosthetic joint infection, PML (yay!), recurrent HSV requiring chronic suppressive therapy, primary CNS lymphoma with no mass, syphilitic gumma, and a handful of HIV infections. I had been warned to anticipate the weird and the wonderful prior to starting ID, nothing less indeed!

 Many other thoughts as I end this 3 months. Have encountered so many inspiring clinicians and beyond that educators, missionaries, public health advocates. And to top it off, I had to answer the questions posed blank into my unanticipating face, "what do you want to do with your life?" Tough question to answer, because the truth is I am sinful and selfish beyond what I can bear to admit.

Time to forge ahead. Dreadful CVM :(

 PS: Oh oh! First hand encounter with lues maligna!

Perspectives

Had a chat with R this morning as we were waiting for the blue letters to come in. She told me about how she ended up where she was today, circuitous route from being house officer to medical officer, doing more MO postings where she thought she might have enjoyed but turned out she didn't; turning down offers to do PhD and moving to Oxford; having 3 children along the find, finding out later on that there was an opening for her to do dual accreditation which turned out to be what she really wanted to do. Incredible. It might seen long and circuitous by Singaporean standards, but at this point in her life, finishing up specialist training, watching her first born turn 9 this year (!!) and enjoying every bit of it, it really doesn't seem like a loss at all!