rashid elhawli

The Power of Observation

Our story starts with folk hero and investigative genius, Sherlock Holmes. After walking in for our customary weekly tutorials with the Intensive Care Unit (ICU) registrar, we were surprised when we heard we were going down to the ICU. Not privy yet to the details of what would happen next, we wait anxiously to see what is in store.

It is a well-known fact that medical students have very little, to no business in the ICU. It is a complex environment that operates on thin lines of balanced give and take from the various machines, to which the ICU staff carefully attend to and calibrate.

Upon arrival, we gather near a row of patient beds, the whole 10 of us. He first asks if any of us knew the author of Sherlock Holmes, much to his disappointment none of us had any idea. Proceeds further to quiz us on the profession of the author, I say to myself he must have been a doctor of sorts and sure enough, he happened to be a surgeon.

I await with intrigue where he is leading us and then comes the order of the day, ‘there is an unconscious patient in this room, you are to walk in there and work out what is going on with her, by merely inspecting her and the room’. We collectively look at each other puzzled, but we enter nonetheless to see what we can make of the task at hand.

At first sight, we begin to comprehend two things; the power of observation and a picture telling more than a thousand words. None of us spoke a word for a good 5 minutes, before we were all called to gather and share one thing observed that could not be repeated by someone else. We eventually were able to get it all out and summarise the clinical picture of the woman in front of us.

In brief, she was a young lady who had been involved in some sort of accident. She had bruising and scratches all over her body, but worst of all was the severe trauma to her head. How did we know this? Well, she had to have part of her brain removed, partial craniectomy, which would have been an urgent procedure to reduce the ever rising pressure inside the skull.

Moreover, it seemed that all her body functions were being operated by machinery. Her body temperature, her breathing, her nutrition were all externally supplied. Moving over to the monitors, there was a close watch on particular measures that would give the doctors an idea of the pressure in her brain and how well blood was reaching parts of the body. There was even the slight, but ever important detail of the bed being completely on about a 30 degree incline to allow gravity to lessen the load on the head.

Once we had been through all of that, we were all in awe of the power of observation and its implications for our careers. We rounded the session with a few cases in which we took a few rather arbitrary figures and tried to paint a clinical scenario. From there we could proceed to putting into practice what had been drilled into us through our course so far. For a different, but equally intriguing teaching experience, stay tuned for my most enjoyable teaching experience to date.

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