THE GODDESS' KRYPTONITE

CHAPTER 43: Wrongly Aroused

"For a male patient presenting with right lower quadrant abdominal pain, what can be your differential diagnosis?" Adam asked the three medical interns who were rotated in his department. The four of them were about to enter a cubicle to assess a twenty two year old man who has a history of low grade fever for the past two days, right lower quadrant abdominal pain and vomiting.

"Inflammatory bowel disease?"

The first medical intern responded with a questioned like tone.

"Are you giving me an answer or are you asking me?" Adam asked her back. As his eyes met the medical intern's eyes, the poor intern was speechless.

"Okay...inflammatory bowel disease. What else?" Nang mapansin ni Adam na hindi na ito makasagot, he nodded and accept her answer.

"Typhylitis." Sumagot naman ang isa pang babae. She's more confident than the first one. Muling tumango si Adam.

"Pyelonephritis." Sagot naman ng isa pa. Muli siyang tumango saka ibinaling ang tingin sa pinakaunang medical intern.

"It can also be epiploic appendagitis, perforated bowel, hernia, urinary tract infection, diverticulitis, testicular torsion and-"

"Good, that is the answer I want. You have to be confident, my dear." Adam winked at her as he cut her off.

As a fellow, before he designate each intern to residents, he make sure to assess each one of them. Sometimes, its annoying to have female interns. They tend to lose their focus because of him. Tulad ng pinkaunang intern kanina na para bang natulala nang titigan niya ito. He cannot blame them, who would not be speechless if you're professor or senior is drop dead gorgeous. Minsan nga pati pasyenteng babae ay tulala na rin.

Pumasok si Adam at ang tatlong babae na medical intern sa loob ng cubicle. He showed how proper assessment is done. From introducing himself first down to having rapport and communicating to patient. History taking is one of the tool to do differential diagnosis. Pagkatapos niyang tanungin ang pasyente tungkol sa mga sintomas, ipinaalam niya dito na kailangan niyang magsagawa ng mga ilang pisikal na pagsusuri. Mabuti na lang ay hindi ito maselan, pumayag siyang gawin ito ni Adam kahit pa may tatlong medical intern sa loob.

"Can you lie on your back?" Tanong ni Adam sa pasyenteng nakatagilid at naka-fetal position. Hawak hawak nito ang ibabang bahagi ng kanang tiyan niya. Guarding behavior on his right lower abdomen is obvious. Huminga siya ng malalim saka tumango sa doktor.

"I'm gonna apply pressure on the left side...okay?" Paalam ni Adam sa pasyente.

"You...come here on my side." Adam called the first female medical intern.

She immediately walk towards him and follow Adam. He's on her back when Adam held her hand. Ramdam niya ang nerbiyos. Not in assessing the patient, but because Adam's hand is touching hers.

"Press slowly and gently into the left lower quadrant of the abdomen, then gradually release the pressure. If the patient feels sudden pain in the right lower quadrant of the abdomen, it is indicative of what?" Paliwanag at tanong ni Adam sa medical intern kasabay ng pag-alalay nito pababa ng kamay sa kaliwa at ibabang bahagi ng tiyan ng pasyente.

"Mmmm!" The patient grunted as they slowly took the pressure off.

"A positive Rovsing's sign." Mahinang bulong ng medical intern.

"Good...next...you, how do you perform the maneuver to show if its a positive Obturator sign." Adam asked the most confident of the three.

Without any hesitation, she asked the patient for permission. Adam noticed how smart and confident this medical intern the moment she enter the ER. It reminded him how Franchesca was on her first day of residency. The fierce and her assertiveness. Even the tone of her voice and the way she say the patient's name shows how good she was.