Stories from medical school - A day in the dermatology clinic
It’s the hottest week of the year-summer 2019.
Where am I you ask? In Bali surely. Or on a beach somewhere…right?
I find myself in the deepest realms of hell, perhaps because subconsciously I knew I’d be heading there. And the form of torture the devil has decided for me? Shadowing a dermatology clinic.
This specialty, fondly named “dermaholiday,” is turning out to be far from enjoyable or relaxing. I sit next to the registrar (Doctor J), in a room which, like much of the UK, is poorly equipped for tackling 40-degree heat without a fan or air-conditioning. I can see the sweat patches on his scrubs, which he opted to wear for its cooler lighter fabric. Although now on second thought, maybe those are the dry patches - it’s hard to tell anymore.
There’s a knock on the door and a lady in her 60s walks in, and immediately proceeds to dump a rag on the dermatologist’s desk. The patient has thoughtfully been collecting dead bits of her scabby skin for us to examine. She begins to shake the rag, scattering dry, raisin-like bits of keratinised skin all over the desk (and I’m sure a little bit even got wedged in between her patient notes). Impressively, Doctor J is nonchalant and calmly asks the patient to pick up her dead bits of skin and refers her for surgical excision of her lesion, as he is worried the cause might be cancer. Weird skin lesions and ulcers are a normal sighting in the dermatology clinic but what’s not normal is to be greeted with organic human skin confetti; patients do the strangest things and medical school does not prepare you enough.
At this point, I’ve been in clinic for what feels like an entire day; I glance at my watch and it is barely midday. I am hot and sticky, covered in all the secretions my sweat glands could possibly come up with to keep me cool. I am fed up with spending my summer doing clinical remediation, to the point where I am tempted to fake heat stroke and go home to a cold shower and ice-cream. But before I can get in character to showcase my parasite-level-quadruple- oscar-winning-performance, the next patient enters the room.
I guess I can hold off pulling a sickie and observe this last patient.
The next patient, a large middle-aged man, walks in with his wife and proceeds to sit in front of us and, right off the bat, something seems odd. It’s hotter than Tenerife in the UK right now, why and HOW is he wearing a jumper, jacket, jeans and worker boots?
“It’s his feet and his hands doctor, I can’t stand ‘em,” His wife says.
“Uh, what about his hands and feet?” Asks Doctor J.
Oh no. Please don’t tell me it’s what I think it is. Not today. Please.
“They’re so sweaty, and they smell so strong! I can’t stand it. He soaks through all his socks, ruins his shoes. Our boys ‘av got the same problem," She tells us.
“It’s true. Things slip out of my hands because they’re so sweaty. I even have to wear really thick wooly socks to soak up the sweat. Look.” He adds. Before Doctor J can respond, he whips off his big boots and socks.
His socks squelch and thud as they hit the ground and the intense aroma of stagnant pond water and sweat fills the room.
Doctor J winces, but quickly regains his composure.
The patient’s foot is yellowed and wrinkled as if it had been in the bath for too long. Inspecting the soles of his feet, they are pitted with small holes.
What a stroke of luck! Running into pitted keratolysis with hyperhidrosis on one of the hottest days the UK has ever seen. I can only imagine how difficult it must have been for the patient to deal with this on a day to day basis, especially on a day like today.
For clarity, Hyperhidrosis is a skin disorder which causes abnormally excessive sweating independent of any of the usual causes of sweating, this sometimes creates the perfect conditions for bacteria to grow. This is pitted keratolysis, a bacterial infection that is a common complication of hyperhidrosis, usually affecting the soles of the feet and hands causing crater like pits, and smelly feet.
As gross as dermatology was to study, it was my guilty pleasure to see and smell something that would raise the bar for my tolerance levels of gross. But in scenarios like this, I am reminded about how debilitating some of these conditions can be. When we first meet someone, one of the first things we do is look at and smell them. In our increasingly superficial world, I see how, specifically dermatological conditions, can affect how a person is perceived and thus affecting their personal and intimate relationships.
As much as I dramatize and poke fun at this scenario, I hope people remember we are all human. The doctors are human. The patients are human. Each with their own struggles. Much like the patient discussed, there are patients living with conditions that affect their everyday lives, but equally, there are doctors who are willing to help carry this burden every day of their lives. And on days where you may come across odd patients on the irritatingly hottest day of the year, I hope you would be like Doctor J.
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