Island Med Student

I’ve learned so very much this week, that I know I can’t remember even 10% of it, but I’ll give it a try anyway:

1) How to take a peds history (don’t forget the milestones!).

2) When dealing with sick children all day, it’s a fabulous idea to keep candy in your white coat pocket. Bribery is good!

3) How to get a blood sample, urine sample (supra pubic aspiration), and CSF sample (lumbar puncture) from a neonate. It’s actually surprisingly easy.

4) How to recognize transmitted breath sounds.

5) The fact that there are no orphanages in Dominica (more to come on this topic).

6) How to recognize a seizure in a neonate.

7) How to create a Ballard Score for a neonate.

8 ) What a VSD in a young girl sounds like (and the fact that the closest place that it can be surgically corrected is Martinique).

9) What happens if a mother is in stage 2 of delivery for too long (namely, the baby becomes hypoxic and it can have long term repercussions).

10) How to perform an APGAR score, and all the other procedures involved with getting a baby from the OR into the nursery (suctioning, O2 if necessary, cutting the umbilical cord, etc).

11) And now, for the coolest thing learned all day, and actually all week, here is the story:

A woman is in the OR about to have a C-section performed. I’m standing in the room next door, peering in through the window (I can’t enter because I’m not in scrubs, and I’m with the pediatrician.)

The surgeon walks in wearing a full gown, gloves, mask, etc, and a pair of galoshes.

I turn to my friend, “I wonder why he’s wearing galoshes.”

After giving the epidural, the surgeon makes the incision, and puts his hands inside, apparently looking for the uterus.

Minutes later, I hear a tearing sound and a huge waterfall of blood tinged liquid spews out of the woman’s uterus, right towards the surgeon. He quickly takes a step back, with the uterus still in his hands. The liquid sprays all over his feet, and soaks the OR floor.

I turn to my friend, “Now I know why he’s wearing the galoshes.”

Monday was a very enlightening day for me. It was supposed to be my first day in pediatrics at PMH, but my doctor was assigned to the HIV clinic. So, instead of seeing little kids, we saw around 10 HIV positive patients. It was absolutely fascinating.

First of all, the patient population was not what I would have expected. It was mostly older men. Please keep in mind that with an N of 10, I’m not about to make any statements about the epidemiology of HIV in Dominica. But I was interested to see what kind of patients came in.

I learned a lot about the HAART regimen, and what kind of problems to expect based on CD4+ counts and viral loads. What was particularly surprising was that we saw a few patients who currently, or in the past, had very low CD4+ counts, and very high viral loads, yet remained virtually asymptomatic. This is the kind of stuff you don’t learn in the books.

The day ended very solemnly. I met a man who has a huge growth on his parotid gland. His tumor is benign, but it’s almost twice as large as his head. I could smell the necrotic tissue from two rooms away. He was incredibly emaciated, which I’m sure was related to the fact that he can barely eat. I plan on writing a more lengthy post about this man, so I won’t say much more for now. But what is the most important thing I learned that day? Take nothing for granted, especially your health.

This past week I have been rotating in the Accidents and Emergency (A&E) department at the local hospital. I think I’ve had more fun this week than I’ve had in all the other weeks combined. Our attending physician is absolutely amazing. The A&E department at this hospital is at times pretty chaotic. There are patients literally everywhere. The nurses (or sisters, as they are called here) are always trying to keep up, but there is always a constant flow of patients. Usually, there are only three med students following around the physician, but due to a scheduling conflict, they had to assign six students to this one physician. In the midst of all the chaos and confusion, our doctor remains completely calm and manages to teach us quite a bit in the process.

On the first day of my rotation, I was already writing notes in patients’ charts, writing orders, and even writing scripts (with his signature as well). Okay, so this might sound pretty lame to all of you, but this is the first time I’ve ever actually written a script! It was so much fun!

By the second day, we were interviewing all the patients and performing exams on them. The physician would leave us alone and return a little while later for our report. Then we’d tell him our proposed diagnosis, and usually we were right on. It made me think that I actually might know a thing or two.

The most interesting part of the second day was a 78-year old man with BPH. He was very friendly and smiled at all three of us med students as we filed in the room. The next thing I knew, our doctor was asking us all if we had performed a rectal exam yet. “Only on the model,” we all replied. “Well,” he said, “today is your lucky day!” I was so excited that I almost started shaking. I gloved up, applied the lube, and performed the exam. Afterwards, the other two students also took a shot. Luckily, our patient was more than willing to allow us the opportunity to learn (amazing!).

After we performed the rectal exam, it was time to change his urinary catheter. I guessed the right number, so the doctor gave me the responsibility. This was the first time I’d ever performed a procedure that required sterile gloves, and I stumbled a bit getting them on. I removed the old catheter, inserted the new one, and inflated the bladder, all with instructions from the doctor. After it was all over, I stepped back and admired my work! I was incredibly proud of this quite miniscule accomplishment.

Today was just as much fun as the first two days, and I have learned that I absolutely love A&E. I feel more like a doctor now than I ever have before. I can’t believe that I can actually diagnose patients correctly and come up with treatment plans. I’ve come a long way since my first days of med school. But there is one thing that hasn’t changed, and that’s my giddy excitement over learning the little things. Many people consider performing rectal exams to be scut work that’s given to med students as a sort of rite of passage. But I don’t mind performing them in the least. I’m actually thrilled and enthused to have the opportunity to perform one. Now, I know this might seem silly and ignorant to many of you seasoned med students and physicians out there, but I don’t care. I like getting excited about seemingly insignificant or boring tasks. It’s what makes life fun and interesting. People all too frequently lose the childlike excitement with their jobs and their lives, because they stop seeing the importance of things, and they just mindlessly float (half asleep) through life.

It reminds me of a sign I once read: “You don’t become old and stop playing in playgrounds. You become old BECAUSE you stop playing in playgrounds.” So, here’s to never getting tired of performing rectal exams!

Click Here To View the Original Post on Medscape

Yesterday, I took my fourth trip to Les Saintes, a collection of French islands very close to Dominica. We sailed there on the Passion, a catamaran sailboat. This time, I was actually part of the crew instead of just a passenger. Cathy, Micah and I all took care of making sure everyone had plenty of food and drinks on the way there and back. We had less time because we left late, so we didn’t rent scooters or go to the beach. Instead, we ate some awesome French food, drank French wine, and shopped at the little souvenir shops along the way. I found my new best friend, a blow up ducky, which I wore around my waist for the rest of the day. The trip, as always, was absolutely incredible, and I hope to go again at least one more time before I leave the Caribbean.

Click Here to See the Pics

• NPR: Old-Fashioned Play Builds Serious Skills
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This is my dinner tonight: a big spoonful of peanut butter, a bunch of chocolate chips sprinkled on top, microwaved for one minute until warm and gooey. Mix and eat with fingers. Mmmmmmmmmmm! It’s good to be old!

I just accidentally came upon some of my old blog entries. I’ve had more than one blog in my time on this planet, but closed them all down when I started this one. I still do miss the more creative writing style that I used to have with some of my older, more personal blogs. Anyway, I came upon this entry, and it made me smile, so I thought I’d share it with all of you. It was written over 3 years ago. Here’s to art!

Two weekends ago, my friend Circus Boy bussed from NYC to DC to visit my friend Katie, and they invited me to join them in their festivities. Friday night we started at a posh and trendy gay bar called Halo where I randomly ran into my banker, and we then migrated to another gay bar, Apex, to get in some much needed dancing. We ended up dancing on the Karaoke stage and began an avant-garde dance routine which involved tossing around a bar chair. Right at the pinnacle moment of our performance, Circus Boy tossed the chair in the air for me to catch it, but since I wasn’t quite ready, the chair flew to the floor, breaking a glass on its way down. We were promptly escorted out of Apex.
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• Miracle Workers? – New York Times
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• Psychology – Mimicry – Persuasion – How to Build Rapport – New York Times
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Today was by far one of the coolest days ever. I definitely feel more like a doctor right now than I ever have before. Today I rotated in the Accidents and Emergency (ER) department. My attending physician was super awesome. He let us students take the histories, do the physical exams, write the findings, come up with diagnoses and treatment plans, and even write orders and scripts. He literally left us alone with the patients, and just came in at the end for us to present them. Of course, all orders and scripts had to be signed by him as well, but I totally felt like a real doctor.

In addition to all that fun, I got to place my first urinary catheter, perform my first rectal exam, and help teach another student how to give an IM injection. And yes, I think rectal exams are kind of neat (I really think everything is neat).

We took blood, looked at barium enema x-rays, and all kinds of other fun stuff. Eventually, I’ll try to post all the stuff I learned in a post, but for now I have to study and prepare for tomorrow’s workshop.

I love my job.