السلام عليكم و رحمة الله و بركاته
الحمد لله و الصلاة و السلام على سيدنا رسول الله و على آله و صحبه و سلم

1. It's been 5 days since the last lecture of Dr. Hussein Khairy. We only got apologies from him eversince last Tuesday, for not be able to come and continue his lecture and clinical rounds as usual. Nobody dares to ask why.

2. He is seemingly busy. It is not a surprise at all, as it should be expected from the very beginning. After all, he is the dean of the faculty. What should surprise us, is to the fact that he can attend to the faculty as early as 7 am to give lecture, and then continue with clinical round before entering his office for administrative work. This goes on 5 days a week (except Friday and Saturday). and on Saturday, he has his schedule in the operating theatre. He has been practising this routine since more than 10 years, except for the 'deanship' part.

3. As regards Dr. Hussein Khairy, he keeps stressing one important concept. The concept of consolidating things. The art of learning and studying bit-by-bit. The art of doing things consistently albeit by little.

4. He also insisted us to have our own logbook for us to write down everything we see and do in clinical rounds. "You can even publish it after a good few years", he once said. Of course, at the end of the day, there are only few of us who keep documenting everything. Others are already fed up, and I'm unfortunately, among that 'others'. Just happy enough to observe and listen like a boss :)

5. It is really inspiring while reviewing my notes. Unconsciously, we have had at least 140 sessions (both lecture and clinical rounds). And we have seen more than a hundred of clinical cases, some of them are rare ones, and almost all of them are fascinating.

6. We have seen at least 3 cases of short distance firearm injuries, with abundant of clinical findings. We have seen cases as benign as lipidema and lipoma, to cases as bad as burst abdomen and infected amputation stump. We've seen almost all kinds of skin graft and tissue flap. Also many surgical procedures and post-operative management apparatus that we can easily read in books.

7. Yes, we can actually read it quite easily in text books. In addition to Dr. Google and Prof. Wikipedia. But it makes a lot of difference by seeing with your own eyes and feeling by your own hands. It CONSOLIDATES easily.

8. Alhamdulillah, I really appreciate the value of seeing things with my own eyes and the power of consolidation. I'm really looking forward to having my notes well documented, for my own good and of course for others. InsyaAllah. May Allah make it easy for me. And whatever the cause is, may Allah ease Dr. Hussein Khairy from being too busy.

والحمد لله ربّ العالمين

السلام عليكم ورحمة الله
الحمد لله رب العالمين و الصلاة و السلام على سيدنا محمد و على آله و صحبه و سلم

1. Lastweek, I got the chance to take history from one of a patient in one of the General Surgery Department. She was a 67 year old widow from Masr El-Qadeem, came complaining of painful legs.

2. At a glance, it was obvious that she is obese with several co-morbidities. She was an uncontrolled diabetic. She was sitting on wheelchair and looked stressed with the pain. I could see some obvious clinical findings even before I started asking her questions, yet I ignored it.

3. It seemed that her most distressing symptom was painful leg, so I decided to take her as "painful lower limb" case. I started assessing the complain, the present history, and excluding the possible differentials.

4. It couldn't be a case of limb ischaemia as the condition started acutely after she fell on the floor by inability to walk on her lower limbs, and before the minor trauma, she had no claudication pain at all. It couldn't be caused by any other common local causes. No signs of DVT, the skin was clean from any ulcer or pigmentation, no swelling, no redness, temperature was normal, no nothing.

5. She said something that sounds like 'fracture' in Arabic, but I thought it was irrelevant, or the patient was just misinterpreting (or exeggerating) her painful limbs.

6. Just after analysing the history of present illness (which I took it as painful lower limb case), Doctor Shareef came in. 10 minutes suppose to be sufficient enough to put a provisional diagnosis, yet I stucked still at the history of present illness.

7. To cut it short, Dr. Shareef asked few questions and.... "voila"! That was it. Unbelievably, the patient actually has recurrence of breast cancer in her right breast and bone metastasis.

8. Yup, the painful legs was due to pathological fractures of few bones of her left lower limb, and bone metastasis in her lumbar vertebra, compressing the sciatic nerve. Good job to myself! I've ignored obvious hirsutism that the patient had on her face. And the patient had done radical mastectomy for her left breast 4 years before. And the hirsutism could be due to the chemotherapy or hormonal therapy (tamoxifen). I was too slow in my history taking.

9. I know that nobody's perfect. But it's all about practice. Practice makes perfect. Good history taking needs sufficient basic knowledge and effective communication. I haven't read enough literature, and I haven't communicate well. Effective communication is a skill that needs practice.

10. Few things that I've learnt from this patient are;

- Patient doesn't come to you with label, "examine my left leg" for example. You have to figure out the problem.
- The most distressing complain of the patient is not necessarily the worst underlying problem he/she has. The underlying cause might be fatal, while the complain might well be benign.
- Communication skill is crucial, especially when dealing with foreigners, in my case, Egyptian.

11. May Allah guide us in the journey to becoming professional competent doctors. We have 4 months and a half till final exam. May Allah ease.

والحمد لله رب العالمين