Island Med Student

• Anatomy on the Beach
  (tags: blog)
• Swedes Ponder Whether Killer Can Be a Doctor – New York Times
  (tags: news)
• Wired News – AP News
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• Medical schools prepare for “silver tsunami” – Yahoo! News
  (tags: news)

I just completed my HIPAA awareness training via an online application. The training involved reading a bunch of text, and then taking and passing (with a 70% or higher) a final quiz. We were told that it would only take 2-3 hours to complete. It took me about 20 minutes. These sort of training applications always crack me up. I used to have to take these kinds of quizzes at my old job at the AAMC. I’m convinced that a monkey could probably pass it with a 70%, and even if you don’t pass on the first try, you get as many attempts as you need. And I’m pretty sure that they use the same questions on the re-take (and you have access to the answers as you take it). I realize the importance of “compliance” and “adequate training” on various laws and policies such as HIPAA, but it all just seems so dumb downed, and it makes me wonder how much is really learned. Anyway, I passed, so I can now rotate at US hospitals with the confidence that I’ll never violate any confidentiality laws. Ummm, yeah.

Please do check out this article on Wired’s blog about Mike Huckabee’s endorsement of GodTube, a Christian version of YouTube. I really didn’t think much of it until I watched one of the videos (below), which pretty much made me want to vomit. Here’s a recommendation though, don’t watch this video first thing in the morning like I did. It might just ruin your day.

PS: I could write a lengthy rant about why this video disturbs me, but I have too much studying to do today. In summary, I’ll say this: I am certainly not “against” any religion. In fact, I think religion serves an important purpose in many peoples’ lives. I am, however, against scare tactics in general. And especially scare tactics used to get people to believe in a certain religion, or anything else, for that matter. Using fear to make people believe in your cause is a form of propaganda. Naziism anyone?

“Propaganda is the deliberate, systematic attempt to shape perceptions, manipulate cognitions, and direct behavior to achieve a response that furthers the desired intent of the propagandist.”

““ Garth S. Jowett and Victoria O’Donnell, Propaganda And Persuasion

“By the skillful and sustained use of propaganda, one can make a people see even heaven as hell or an extremely wretched life as paradise.”

- Adolf Hitler

Everyone is familiar with the stories of people getting queasy at the sight of blood, and even passing out. Even if it’s never happened to you, I’m sure you’ve heard of someone who has. I’ve always considered myself to be fairly comfortable with blood and needles. I like to watch when getting my own blood drawn, and I don’t even mind getting poked with needles. When I worked and volunteered at hospitals, I saw blood all the time, and even carried it around the hospital. In anatomy lab, I was the first person to cut into our body, and I never got grossed out by any of the dissections (granted, there isn’t much actual blood left in the bodies). I’ve cut open live rats while working in a neuroscience lab, and I’ve even gotten to watch a few surgeries on humans. So, I assumed that I had a pretty strong stomach when it came to blood, needles, and medical procedures. But a few days ago, I found out that it might not be so strong after all.

I was rounding with a physician and she decided to take us to the dialysis unit to see a patient. By this point, it was about 12:30 in the afternoon, and I had not eaten anything all day. We stepped inside the clinic and met a lady who was being dialyzed. I watched the blood running through all the tubes and was fascinated, since this was the first dialysis machine I’d ever seen in use. But as the physician started describing how the machine works, I realized that I was starting to drip with sweat. I could feel the blood draining from my face, and then the world became a little fuzzy. As the doctor pulled back the blanket to reveal the arteriovenous fistula on the patient’s arm, I felt my knees becoming weak. The sweat was dripping down my back, and I could barely see. Luckily, at the last moment, I gathered all my strength and ran out of the unit into the outside corridor.

After I made it outside, I looked around for a place to sit. There was a bench nearby, so I stumbled towards it and collapsed. As I sat there, waiting for my blood to return, I realized that there were patients all around me, staring intently. I guess I must have looked like a mess, covered with sweat, with an absolutely white face that matched my white coat. I sat on the bench for several minutes before I could stand again. I knew I desperately needed sugar, but I didn’t have any change on me, so I just bravely stepped back inside the unit. I was pleased to realize that the other students in my group had covered for me, and I hadn’t made as big of a scene as I had originally thought.

The whole incident really got me thinking, though. If something as innocuous as a lady on dialysis is enough to send me to the floor, how will I deal with a spurting artery? Or a severed limb? Or one of a million bloody scenarios to come? I guess I’m really nervous that I picked the wrong profession. What if I can never overcome the vasovagal response to the sight of blood, or someone being poked with needles? I’m wondering if there are other people like me out there. Did you ever figure out a way to prevent passing out at the sight of blood? Does it eventually just go away after working in medicine long enough? Or is it something that you always have to battle?

Click Here To View the Original Post on Medscape

I spent the morning devising a super-duper-take-over-the-world study schedule plan for the USLME Step 1. I’ll be taking it around June 15th, so I have about 20 weeks to prepare. Part of my plan involves watching Kaplan videos on every subject. I started watching them this morning, and fell asleep about 30 minutes in. I had some disgusting bookstore espresso, and then gave it another shot. I got about 25 minutes in and fell asleep. I’m starting to think that my plan may need some adjusting. The man giving the anatomy lectures (in the pic) has a very monotonous voice, and I just can’t seem to stay awake when he’s talking. It doesn’t help that all this information is review for me.

I took this second pic just a few minutes ago from my balcony and sent it to John, an awesome guy who found me through my website and sends me great emails, but whom I’ve never met. The coconut trees happen to be way more exciting than the Kaplan videos. I can stare at them for hours without falling asleep. Maybe I should have gone into dendrology instead of medicine.

• nosugrefneb
  (tags: blog)

Okay, so I always say, “this is my new favorite thing.” But seriously, this is awesome. I just found the perfect combination of stuff.

Here is the recipe:

Take a 5.5 mile run beside the Caribbean Sea.

After cooled down, combine these ingredients in bowl:

1 1/2 cup cottage cheese
2 spoonfulls Matouk’s Guava Jam
1 banana, sliced

Take bowl onto balcony, mix ingredients and eat while watching the sun set over the Caribbean Sea.

Repeat every evening.

So, I came up with the idea of trying to post entries every hospital day when I get home. Here’s an incomplete list of the stuff I’ve learned thus far at PMH.

1) If I don’t eat all day long, and then see a large amount of blood, I almost hit the floor. (Actually, I already knew this, but rediscovered it….longer post about this to come.)

2) Many patients at PMH can’t pay for many of the diagnostic procedures, hence they rarely get them done.

3) If and when they can get the procedures done, it’s usually too late to help.

4) When performing a lumbar puncture, patient positioning is super important, otherwise you might not be able to get any CSF.

5) IV diazepam works very well for grand mal seizures.

6) Mixing some lidocaine with the lubrication when putting in a urinary catheter is a really nice way to make the procedure less painful for the patient.

7) I feel like an idiot when a family member calls me “doctor” and asks me to help their relative, because I am not a doctor, and I probably don’t know/can’t help their relative. All I can do is get the real doctor.

8 ) It’s important to get on the ward early and go over all the patients’ charts before the attending comes in. That way, you won’t go “umm….I’m not sure” when he/she starts drilling you on the patient’s details.

9) Electronic PDAs are awesome ways to store medical information, and are good for impressing your attending.

10) Don’t be afraid to ask any question (e.g. “Why is that patient on propanolol? Isn’t that contraindicated for patients with COPD?). You might be surprised by the things you notice that your higher-ups have missed. It’s better to risk saying something stupid, and help a patient, than to remain quiet and potentially do harm.

I can officially say that I am completely happy with my decision to stay in Dominica and do my fifth semester at Princess Margaret Hospital in Roseau. The semester involves a lot of patient interaction, and I really feel like I’m in an immersion program. I have so many stories to tell, but to keep it brief for now (and since I’m terribly tired because of my new schedule), I’ll just say a few things. I met a patient who had obvious signs of a stroke, but couldn’t afford the 500 EC bill to have a CT scan. That’s just one example of the sad stories that unfold every day at this hospital. Many of the patients are very ill because they can’t afford healthcare, and end up in the hospital when they get to the point where they can’t function anymore. The hospital itself is so very different from what I’m used to. There is no neurosurgeon at the hospital, so patients needing neurosurgery must either travel to Martinique (obviously very infrequently feasible), or wait for the neurosurgeon to travel to Dominica. Everything just runs so differently, that I’m in a constant state of amazement. It’s been an incredible learning experience thus far, and I can’t wait to see how the rest of my semester unfolds.

The pic above was taken outside of the hospital today. I still have many more pics to take, and only wish I could take more pics of inside the hospital, but don’t want to violate any HIPAA laws.

• Dominica Mom and Med student
  (tags: blog)