it's been a week since i started my dermatology ssc at hope hospital (or salford royal as they now call it) and i have to say, although i wasn't really looking forward prior to it, i'm actually liking it very much. not particularly loving and being passionate about dermatology but simply loving the fact that i'm in a different hospital and in a whole new environment altogether. i even enjoy commuting from manchester city centre all the way to salford each day, as crowded as the trams/buses are! the hospital is HUGE, it makes royal preston seem like a mouse hole. i envy the students based here because they have a newly-built education centre (opened by the mayo clinic i may add) which has 5 storeys and is very high-tech! i never really liked preston all this while but suddenly i am greatly resenting the fact that i was placed there. but it's something i cannot change and i have to make do, and at least i get to get out of it for awhile and experience being somewhere else for a change. besides, things back in preston were getting a bit... hmm... hostile. best i stay away for awhile. :p
i think it's unfair that many people don't regard dermatologists as doctors. just because they don't really deal with internal medicine (actually they do, especially those who work on the wards) doesn't mean they are not important in the field. i think we've been taking skin diseases for granted all this while; after all they're almost always the same old boring stuff like psoriasis, eczema and acne, but once you've seen the worst skin conditions you can ever imagine, your heart just goes out to the patients the same way it goes out to every other patient who's suffering from other diseases.
yesterday i met an inpatient who had erythrodermic eczema (called erythrodermic when more than 90% of the body is eczematous), and i immediately just wanted to shed tears for him. his whole body was literally red, perhaps a few spots of clear skin on his face but that was about it. he could only lie still on his bed because his whole body was itchy and painful, and just a little bit of friction would cause him to be in so much discomfort. his bed sheets were stained with fluids which were constantly leaking out from his tissues, and no matter how often he took a bath, he still smelled really bad. he was very depressed (who wouldn't be?) and clearly very embarrassed of his condition.
i also attended a 'clinical meeting' among dermatologists, where they gathered various odd cases from all over the region which conditions could not be diagnosed/treated. it was quite interesting - each patient was placed in a room and the consultants and registrars took turns to enter each room to talk to the patients one by one. i tagged along with a registrar and i felt as though we were all doing OSCE! must've been a bitch for the patients though, having to repeat their stories about 20 times to each doctor. :P after that the dermatologists gathered to discuss what they thought of each case and where to go from there. the differentials were all so weird and i was really lost, but it was an eye-opener to realise that there are people out there who are suffering from a whole new spectrum of diseases - those that we as NORMAL medical students/doctors would never ever think about.
the patients were from all age groups: children to the very elderly, and each of them are intensely affected by what they suffer from in so many different ways. there was a 14-year-old boy whose whole face was erythematous FOR 4 WHOLE YEARS. there were vesicles all over his face which never went away. at first they thought it was SLE because it did look a bit like a malar rash but they tested for it and it turned out negative. he has been all around the UK trying to get his problem solved but nobody seemed to know what it was. when we talked to him we found that he had so little confidence, very bad eye contact and seemed as though he was going to give up. i just felt so sad for him. he's 14. supposed to be enjoying school and life in general. but instead he has to shield himself from the world because he can't bring himself to face anyone with his condition.
and to think that we freak out when we have a random zit popping up on our faces once in awhile. or when we think we look "ugly" in pictures and beg our friends not to post them up on facebook. these people... the only pictures they're willing to take are those by medical photographers for research purposes.
other cases we had: a 16-year-old girl who had hirsutism which was more or less successfully treated by laser therapy, but then came with patches of hyperpigmentation all around her face and neck. they were NOT pleasant at all. she seemed very upset because, come on, she's 16! the age when we are exceptionally conscious of our looks. there was a middle-aged smart-looking lady who came in with a big indentation in her forehead which seemed to be growing (and by growing i mean getting deeper). just a random indentation! no trauma whatsoever. it was like she had a nail screwed deep into her skin and into her skull. can you imagine a hole right in the middle of your forehead? how weird is that? another middle-aged lady - a very sweet indian woman - came in with every single allergy possible. i swear. she's allergic to latex, flour, makeup, hair-dye, laundry detergent, seafood, dust... and i know, most of us are somewhat allergic to dust, but for HER, all she needs is to inhale a tiny speck of dust and she will start to wheeze and her whole body straightaway feels unwell.
there were many other strange cases that we saw but i will spare you the details. my point is that most of the time we think of skin diseases and simply assume they're all fungal infections or the common allergic reactions which could very easily be treated with antifungals or steroids, and that those who seek help for their skin problems aren't "as important" as those who walk into other clinics for, say, vomitting and diarrhoea. while i admit that most of the time skin conditions are hardly anything near deadly, a lot of them are chronic and cause a lot of distress to the people who suffer from them. they are affected physically, mentally, emotionally... it's just so draining to live life like that. i mean it's not like having heart problems where you can still walk around town without anyone knowing. if you have lesions all over your face and body, you step out of your own house only to worry about how people will think of you. it's just not nice!
i'm not saying that skin diseases are equivalent to the big killers like cancer and heart diseases and all that, but i just hope that people will gain a little more perspective into how serious some of the conditions can be. and by serious it doesn't just mean high rates of mortality (because mortality is obviously quite rare in dermatology), but also how it affects the quality of people's lives.
to be honest, i initially wasn't at all pleased to find out that i was going to do dermatology for my ssc project (5th choice somemore!), but i guess i should count myself lucky to be able to do it in one of the largest dermatology centres in the UK (28 consultant dermatologists, how is that not big enough?). i've learned quite a lot just this week itself, and i have 3 weeks to go. that said, i don't think i'm actually interested to pursue a career in dermatology - i'll leave that for those who are explicitly passionate about the skin :P, but it's good to learn a little bit about something totally different from what we're used to and at least know that there are so many people out there who are affected by these kind of diseases.
