AS you see it

Abbreviations were invented to make life simpler and shorter, especially for medicos who, being short of time and heavy on things to memorise, bandy with them frequently and freely. So you have GIT for Gastro-Intestinal System, GUT for the Genito-Urinary System, c/o for ‘…complaints of’, o/i for ‘on inquiry’ and f/u for ‘follow up’ and so on and so forth. (And the fact that there is an abbreviation for something as ubiquitous as ‘Cough, Cold and Fever’ in the form of CCF is something I recently learnt and it is a wonder that I didn’t go into Congestive Cardiac Failure when I first heard of it!) Then there are abbreviations with twin implications; dual personalities, something akin to my sun sign, such as MI for Myocardial Infarct/Mitral Incompetence and IBD for Inflammatory/Ischaemic Bowel disease depending on whether it is a MD or a MS you are dealing with. But, despite being aware of the pitfalls of abbreviations, it is still disquieting to land into a trap by one as I learnt a few days ago.

Final year being here, wherein the search for ‘interesting cases’ has been replaced with the search for ‘exam cases’, the ‘post-emerge’ day found me looking through the Admission book for cases worth taking. With a pen and paper in hand, I cursorily glanced through, ‘for dialysis’, ‘AWMI’, ‘CRFs’, jotted down a few ‘Lt MCAs’ and a CAP, when my eyes finally espied two AS (Aortic Stenosis -the standard abbreviation known to all Under-Graduates) one below the other. My heart gave a leap at this sudden windfall as the sight of two such cases in the same ward on the same day. The first one was an old man whose murmur, on auscultation, sadly turned out to be unconvincing and not ‘classical’. [Unlike (yet) another case of AS which I had taken a few days ago!]. So I went back to note the name of the second ‘AS wala patient’ who turned out to be a resident doctor.

Still in a quandary whether to take the liberty of taking his case or not, a batchmate N finally summoned the courage to ask the Houseman where this doctor-cum-patient with AS was.
“Sir, there is a doc with AS here?”
“Yes”
“Sir, where is he? We want to see him…”
In the meantime the AS-doc came behind us and said gruffly,
“I am here. What do you want?”
Uh-ohh I thought mentally while N confidently went ahead. “Sir if you don’t mind, we would like to auscultate you, Sir please.”
“But, why…” he began confusedly when N overwhelmed him with his requests and finally we headed towards the side room. Now it often happens that there are small things which you sometimes see and register but the implications of which don’t strike you till much later. The same happened here. While tailing the doc, I noticed with a small frown that he was limping painfully and stiffly. But dismissing this, I entered the side room after N.
The Doc graciously cleared the bed, sat heavily on it while N started making small talk with him. He then borrowed my stetho and proceeded to auscultate him while I sifted through the file. Then it happened almost simultaneously.
N, with the stetho placing it all around on the chest and back and muttering, “Arre normal aahe. Murmur kuthe aahe? Ananya Murmur sunai nahin de raha hai….” while I reading through the history of the patient finally came upon diagnosis at the bottom.
The Doc in the meantime piped up, “Arre majha CVS normal aahe. How will I have a murmur?”
N in perplexity blurted out, “Sir, what do you have? It is written in the Register that you are a case of AS!”
“Ho AS aahe,” came his reply with me providing the shame-facedly-amused chorus “AS mhanje ANKYLOSING SPONDYLITIS”