A mole is a swelling

First day of Plastic Surgery today. We're stationed at Dept 28 for this coming two weeks. The resident came at 11 plus asking "Should we start the class now?" but class was scheduled at 12 and there were only me, Ara, Nisa (wow the original crew, haha) plus Chip in the class.

"We should start at 12. More are coming."

"How many are you?"

"33," Chip the class chief answered. The resident had a surprised face and gave a thumb up.

I turned to Ara. "We Malaysians aren't that good, it's just the Egyptians are bad (at attending class). We're just better relatively."

"Yeah. Unfortunately that makes us never want to improve."

So at 12 the class filled in and the resident brought in the patient. "He has a swelling on the left side. Take a history and then the doctor will come and discuss the case."

Chip asked who wants to volunteer for the first day, and I felt his eyes on me which made me remember my first day of fifth year Surgery, haha. As expected, nobody wanted to take the history. This was getting old. I didn't say anything and just took out my notebook. Eyed the patient and noticed an ulcer on his right temporal, but where's the swelling? Ara stood up and I took a chair and positioned it in front of the patient. Greeted the patient.

She noticed my notebook was out and so she asked, "You wanna present?"

"Don't mind." I glanced again at his left temporal and couldn't find the swelling the resident said there was.

"Okay then you're presenting."

And so we began. It surprised me when the patient said he is 62 because he didn't look that old to me. I would have guessed he was in his 50's. Usually Egyptians look older than their claimed age because of the tough life in Egypt. Mr. Khaled was 39 but he looked late 40's to me.

"What made you come to the hospital, sir?"

He gave a long account on his journey that I didn't understand, but I got that he came because of the wound on his right temporal that didn't heal for the past two years. We analysed that and Ara asked him, "You have any lump anywhere?"

"No I don't."

So where is the alleged swelling?

---

Dr. Hamid came and I presented the case. "... He complains of a non-healing wound since two years."

"This is perfect. In his own words."

I had a dispute with the partner over this wording!! See me do the penguin dance ~(^^,)~ Pardon the bragging. I actually nearly rubbed my head here and then on a job well-done.

"What about the swelling?"

Again with this mysterious swelling. "The patient denied any swelling, and I didn't see any either."

"There, on the left side."

"Where?" I came near the patient.

"There, that."

The doctor pointed to his mole. A one by one by half centimeter at his left temporal over the frontal ridge. And I laughed.

Apparently in Plastic Surgery, a mole is a swelling and must be treated accordingly. So then we discussed the presentations of basal cell carcinoma.

---

"You had the wound for two years, so why did you come to the hospital now?"

The patient repeated the account that I couldn't understand in the beginning. The doctor translated him to us. "He said he came to Cairo to visit his sister and when he was walking in the street, a doctor stopped him and said the wound was suspicious and he should get it checked. And that's why he is in Kasr el Ainy."

That was one amazing doctor. To point out a problem people are oblivious of, on the street, and directing them to where they would get help. And to be that trustworthy that the patient became compliant.