Clerkship - A Frightening Experience in the Ophthalmology Clinic

The title says a frightening experience; actually it wasn't that terrifying, but it left a deep impression, so I conveniently jotted it down.

In the ophthalmology clinic, besides eye problems, it's still eye problems (isn't that obvious?): inability to see, blurry vision, photophobia, strabismus in children, glaucoma, and so on. After sitting on the sidelines in the clinic for a long time as a useless Clerk, you really hope the busy attending physician will talk to you a bit more, or that you can get up and take a new patient to help ask about their chief complaint and medical history, alleviating some of the time pressure on the attending physician.

Occasionally, you encounter a few physicians more enthusiastic about teaching. They might specifically turn on the slit lamp camera to explain the Findings to you on the screen, or after finishing the examination, specifically tell the patient that a medical student would like to practice looking through the ophthalmoscope. Then you can jump right up and go outside to find the patient to practice with the ophthalmoscope. Although it's still not easy to see anything, at least you get some practice. But honestly... if you don't plan to go into ophthalmology in the future, the repetitive Cases over time will really get boring. You just have to repeatedly hypnotize yourself that at least you can learn doctor-patient communication.

The story took place on an ordinary afternoon that should have passed just like this.

Conscious Disturbance

A roughly 60-year-old man, unaccompanied by family, walked into the clinic and almost fell. With the support of the clinic nurse, he sat down. Initially, he could somewhat answer the attending physician's questions, but after the physician finished examining his eyes using the slit lamp and explained his condition, he became increasingly unable to respond, eventually reduced to mere mumbles. Seeing that the situation was wrong, and knowing his underlying condition included diabetes, the clinic staff suspected hypoglycemia and first gave him a piece of candy. Then they let him lie down on the bed in the examination room.

As a result, because this elderly man was weak all over and couldn't stand up on his own, the Clerk who originally only sat on the sidelines being useless hurried to roll up his sleeves, exerting effort together with the senior resident (學長) to move him onto the bed. By this time, the patient was almost unresponsive to external voices.

The clinic nurse was also instructed at this time to contact the emergency contact number recorded in the medical chart, hoping a family member could come over.

Calling: "Do... do... do..."

"Hello?"

"Hello, may I ask if this is Mr. XXX's family?"

"Yes."

"While Mr. XXX was being examined at National Cheng Kung University Hospital just now, he may have fainted due to hypoglycemia. Is there anyone who can come to the hospital?"

"Ah? But I'm still working, I don't have time."

"......"

(Omitting the cursing by the on-site staff here)

Alright, temporarily without family support, and with a bunch of patients still waiting in the clinic, the attending physician was quite troubled. At this time, the wise senior resident who came to assist checked his arm.

"He has a hemodialysis access; we cannot rule out an electrolyte imbalance!"

Emergency Room

After discussing with the attending physician, the senior resident decided to register him for the emergency room for observation. So the on-site staff divided the work: the nurse called for a wheelchair, and the senior resident called the emergency room to hand over the case. While making the call, he glanced at me.

Huh? Strange, why am I starting to break out in a cold sweat all over?

"Junior (學弟), since the patient is unaccompanied by family, please help escort the patient to the emergency room in a moment."

What!!!

Just as I nodded, before my shock had recovered, the senior turned back and continued his handover to the ER:

"A diabetic patient, on dialysis, just had Conscious Disturbance in the ophthalmology clinic. We'll send a student to escort him over; he has basic knowledge and can monitor him on the way."

Wait wait wait, what is basic knowledge ahhh, could it be ACLS and stuff? I haven't even passed the certification yet ahhh. How could you safely hand the patient over to me like this ahhhh? Are you sure looking at an infinitely panicked Clerk with a calm "I believe in you" expression is right right right?!!!

"Okay, senior, is there anything I need to hand over when I go to the ER later?" ----> Pretending to be calm in serious contradiction to the internal monologue above.

"Oh, his family just managed to contact his wife, she will rush over later. He has already finished the ophthalmology part today, so please hand over the appointment slip for his next follow-up visit to the emergency department."

Moving the patient down from the bed and onto the wheelchair, followed by the "we're counting on you" from the attending physician and the senior resident, I escorted the patient to the emergency room with my head held high.

Returning to the Clinic and Afterword

Fortunately, nothing major happened on the way. The patient was safely escorted to the emergency room. After simply cooperating with the ER for a triage interview and confirming he was pushed into the emergency ward, I returned to the ophthalmology clinic on my own. The attending physician was very happy to see me back, expressing that ophthalmology would give me extra points (YA~ scattering flowers~~), but I felt rather ashamed, as apart from exerting physical effort, I didn't actually help much throughout the whole process.

An hour or two later, as I was leaving the clinic and getting ready to go home, I heard the ophthalmology clinic staff ask the physician:

"That patient sent to the ER earlier has regained consciousness. It was because his blood sugar was too low. When he woke up, he clamored that he wanted to come back to us to continue his appointment."

"Ah, we already finished seeing him and handed his appointment slip for the next visit to him! He was unconscious at the time and won't remember anything we told him."

I smiled knowingly and went home with an inexplicable good mood.

A reminder to everyone: When seeing a doctor, if there is a concern that your own illness might cause an emergency situation, or if the anticipated tests will affect your mobility—such as the mydriatic examination in ophthalmology, which affects vision—it is best to be accompanied by family or friends.