OPD Reflection:

Rayan Mroué, Group C

When I arrived in the Dermatology Unit at 8 am for my OPD rotation I must admit I was

feeling quite nervous. The idea of shadowing a patient as they consulted a doctor seemed a bit

invasive to me, especially in the Dermatology Unit which would most likely require patients to

show parts of their bodies, so I was worried about how the patients would feel about my presence

or if I would be bothering them. Nonetheless when I arrived and introduced myself to the woman

working at the desk, she told me that I should sit in the waiting area and that they would start at

9. While I was waiting, I looked at the patients starting to come in and saw the patients that I

would soon shadow.

It was a young-looking man who walked in with an older woman, his mother, they

checked in at the front desk and came to sit near me. As they sat, the woman looked at me and

asked with a smile how come some of the chairs had tape on them, then she quickly realized it

was to enforce social distancing and laughed a bit. I smiled at her and acquiesced, and I

remember hoping that she and her son would be the patients I would shadow as she seemed

really nice and friendly. I could see that the son had very dry skin around his hands and back of

the neck, which I assumed was maybe from a bad case of eczema. As the clock approached 9

they were called back to the front desk to give some information. As I listened, I found out they

had come all the way from Tripoli for this appointment and that they also did not have any ID, as

a result the woman at the desk asked them to write their names on a piece of paper, to which the

woman and son answered that they couldn’t as they did not know how to read or write. This in
addition to their accents made it clear they were most likely refugees. Shortly after that they were

allowed in to see the resident and I was told I could go shadow them.

When I joined them in the office the resident introduced me to them and asked if it would

be okay for me to be present during the consultation, the mother enthusiastically said yes, I

thanked her and immediately felt a lot more at ease. The resident asked why they had come, and

so the mother explained that her son was born with a genetic disease that caused his skin to

essentially peel off and die, and that it would always get worse whenever the weather would

change as it is doing now as we enter winter. The resident asked the son to sit on the bed and

undress so she could examine him. As he undressed I realized his condition was far worse than a

bad case of eczema, his entire skin on his chest, arms and legs was dying and peeling, he had

very few patches of “normal” skin, most of his bodies was dark, flaky or scarred skin with some

open wounds appearing as well. The resident examined him shortly and then left to bring the

doctor. I was left alone with the patient and mother, and so took the time to explain my presence

again and why I was here, and then proceeded to ask her and her son about the condition. The

mother, again, was really nice and talkative, she explained to me that he’s had this condition his

entire life and that during the change in season it gets much worse, with many more open

wounds appearing and that these would become quite painful for him. However, there was a

whole other aspect to this as well, due to his skin constantly shedding into his clothes and bed

sheets they would get ruined very quickly as they would get to a point where washing them

would not be enough, in addition all the dying tissue would often create an unpleasant smell

which she described to be similar to raw meat. It made his life impossible to live normally, he

needs to cover his entire body with lotion, takes several showers a day and will often need to

replace his clothes and bedsheets. The son was also very open about it and allowed me to look at
his skin on his body particularly in areas where it was quite bad. I was frankly shocked at how

strong the mother was being, under any circumstance having such a lifestyle must be incredibly

difficult, but even more so in this case, since it seemed quite clear their financial situation was

less than ideal as refugees, and as the mother told me she had several children to take care of.

The financial strain of having to buy new clothes and sheets often plus the lotion and hospital

visits must have been insanely difficult to live with. And yet both the mother and son kept a

strong and positive attitude and seemed hopeful for things to get easier which was really

inspiring.

However, when the doctor finally came I was surprised to see how he acted, he came in

with a few other people, either residents or med 4s I am not sure, greeted the patient and mother

and they started examining him. While examining him they talked to and asked each other

questions in English, then promptly left the room again, I imagine the patient must not have felt

very comfortable since there was almost 0 communication with him and just a bunch of people in

white gowns staring at him while talking in a language he could not understand, almost like he

was just a kind of exhibit. As a matter of fact, the mother proceeded to tell me she couldn’t

understand anything they were saying as it was all in English, I only told her that she should ask

the resident to explain to her in Arabic when she comes back, as I did not feel it was my place to

explain it myself. But I was shocked the doctor would just come in to look at the patient while

barely saying anything to him or the mother, I had expected him to try and explain to them the

situation, and was interested to see how he would explain it to them in simple but effective

terms, but he didn’t do that. When the resident came back, she explained briefly and prescribed

some medication as well as scheduled a checkup in a few months. I found it also interesting that

she made it a distinct point to tell the mother that none of this is a cure to the disorder but only
ways to make life a bit easier, I can guess that is not an easy thing to have to say to patients in

cases like these but it is also very important that they know and understand this.

I only saw one other patient following this, however it was cut short as she was veiled

and needed to remove her veil for her examination, so I had to leave the room. Though the

experience I had with the mother and son was by itself a very good experience for me, I think. It

was such a rare condition and impacting people who do not come from an easy background, it

was very insightful and inspiring to see how they were coping with it. And it was interesting to

see how they were being accommodated in the hospital setting.

Of course, if there is one thing that could be improved it is the wait time, as I had to wait

until 9 for the rotation to start and then in between patients I needed to wait as well, though I

don’t really know a solution for this. Apart from that, all went smoothly, I’m glad the residents

knew why I was there, and they were very nice and understanding.