Island Med Student

Check out my post on Medscape about my new journey.

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Okay, so if I were actually faced with a real life code, I’d probably pee my pants and run screaming in the opposite direction for a doctor. But, hypo-the-tically I can actually run a code as a team leader. Over the past two days, I’ve had my Advanced Cardiac Life Support (ACLS) training. I know everything about identifying various heart rhythm abnormalities like atrial flutter, ventricular fibrillation, and supra-ventricular tachycardia. I know how to use a defibrillator, and when to give shocks and at how many joules. I know which drugs to give like epinephrine, atropine, etc, and I know the dosages and maximum quantities you can give. I also can place advanced various airways like combitubes and endotracheal intubation.

We practiced a million times, and eventually I memorized all the algorithms, and got over my fear to the point where I could manage anything they threw at me, including a dummy that was in asystole for like 10 minutes!

So, I’m now officially certified, and ready to be thrown into the mix at US hospitals. After the training, I took some more pics of Princess Margaret Hospital, and shot some video footage that I’ll be posting soon.

This is it. I’ve done everything I need to do. Only 4 days, 19 hours, 25 minutes, and 16 seconds until I leave Dominica!

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I spent the day at Princess Margaret Hospital taking a Basic Life Support (BLS) course for healthcare providers. I was certified in the past, but my certification had expired so I had to take the class today. Basically, I spent the day doing chest compressions, giving respirations, and using an automated external defibrillator (AED) on a variety of non-alive patients of various colors and sizes.

I’m kicking myself in the butt for not bringing my camera with me. Since I had no camera, I got creative and used my laptop to snap some pics and a short video, but they’re of low quality. Thursday and Friday I have my Advanced Cardiac Life Support (ACLS) class, and then I’m audi TT! Next time I will be bringing my real camera!

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Many people have written me asking about whether or not they should do their 5th semester here in Dominica at Princess Margaret Hospital. My personal opinion? YES! I thought it was an absolutely fabulous experience, and I think it’s better than going to Miami. I’m sure some people disagree, but this is my own opinion. Here are a list of positives and negatives with regard to staying:

Positives:

1) I think that the experience at PMH is much more hands on. I think a combination of the laws in Dominica and the doctors who teach at PMH makes the learning more interactive. I saw many patients. I was allowed to perform many procedures like starting lines, putting in catheters, doing digital rectal exams, and intubating. From what I’ve heard from students in Miami, you just don’t get that much hands on experience there.

2) You get to see more stuff. Again, from what I know from Miami students, here at PMH you see more stuff. I saw many operations, procedures, histories taken, etc. The exposure is awesome. Not only is there more exposure, but I think you see a broader range of pathologies. I saw someone with tertiary syphilis. You probably won’t get to see this in the States.

3) There are less students here. Less students seems to mean that the doctors have more time to teach. You’re not competing with hundreds of other students for the doctors’ time.

4) You have more time to study here. Again, this is compared to what I know from Miami students. They seem to have more required classroom time, which means less time to study. I can promise you that I had more than enough time to study for 5th semester classes AND plenty of time to study for the Step.

5) It’s cheaper here and there is less traveling involved. This is self explanatory. Not moving means less money spent. It’s cheaper to live here than in Miami. Moving sucks. Not going to Miami means one less move. (You still might move to Roseau, but this is a lot easier than moving to Miami.)

Negatives:

1) You’re in Dominica. Some people simply don’t like living here. If you can’t stand living here for 12 more weeks, I guess you should go to Miami.

2) They have official Step Review courses available in Miami. I’m not sure how they work, but I know they exist. They have review classes here given by Ross professors, but it’s not the same. If you think you absolutely need the courses, you might want to consider Miami. I personally prefer studying without the courses, but that’s just me.

3) PMH is less equipped than the hospital in Miami. There is no MRI at PMH and the CT scanner breaks sometimes. So, you won’t have as much exposure to some technologies. Some people think this is bad, I actually think it’s good. You have to rely more on your history and physical exam skills here. I think it’s a good opportunity to brush up on your important skills. You have the rest of your medical career to learn how to interpret MRIs.

That’s all I can think of for now. I’ll add more to the list later if anything comes up. Let me know if you have any questions!

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It’s true. I’ve lived on this island for 589 days. Now, I only have 16 more to go before I return to the land of excess milk and honey, processed food, pollution, big cars, and bad health. I have very mixed feelings about the whole thing. Anyway, today I have my very last practical exam ever!! It’s going to be the most difficult one to date, but by now, I kind of feel like a pro at them. Thursday is my last written exam of the semester. I can almost taste the sushi!

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Friday I did my psych rotation at PMH. The cool news? It was my very last day of rotations! All I have left is one practical exam on Monday, one written exam on Thursday, and 3 days of BCLS and ACLS training the next week. I can’t believe how quickly 5th semester has gone by! Today or tomorrow I’m going to post about my overall experience at PMH. Many people have asked me how I liked it and whether or not I’d recommend staying in Dominica for 5th semester. The short answer is yes, STAY!! But I’ll post an official post soon with details.

The psych rotation was awesome. Even though I didn’t get to see too many patients, it was still quite interesting. I think on some level I expected psych patients to be different here in Dominica. Well, for the most part, I was wrong. I met a few patients with schizophrenia and a few who had manic-depression. For the most part, they were strikingly similar to patients I’ve seen in the States. Listening to their stories and getting to know them really reminded me of how much I love psych. Mental health issues can affect peoples’ lives much differently than a physical health complaint. Living with schizophrenia, or having a friend or relative with schizophrenia is an incredibly challenging undertaking. It would be an understatement to say that it’s very difficult and frustrating at times.

After seeing the patients, we spoke with the psychiatrist for a while. He was absolutely amazing and very intelligent. He spoke to us about issues relevant to mental health in Dominica. I was shocked to hear him say that there are very, very few attacks on staff by psych patients in the hospital. I was used to being attacked verbally and physically almost every day at my old job in a psych hospital in the States. When I asked him what he thought the difference was due to, he said that it’s probably because of respect. The patients in Dominica tend to trust and respect medical professionals very much. In fact, I’m always surprised to hear the patients respond “yes, doctor” to me almost every day. They trust what you say to them and respect your knowledge. I guess it’s very different in the States. There is a general suspicion of doctors. And when it comes to mental health patients, there is a lot of mistrust and even downright hatred. Take, for example, a patient with paranoid schizophrenia. They are the epitome of distrustful. Yet here in Dominica, they still tend to trust the doctors and nurses (at least to some degree). This is absolutely amazing to me. I’d like to write a much longer article on this topic, but I don’t have the time right now.

So, more to come soon!

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Check out my post on Medscape about how the beat goes on…

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I forgot to write this post on Friday, so here goes:

1) Soaking gauze with adrenalin is a good way to create hemostasis.

2) Surgery on someone with a heart murmur can be an indication for prophylactic antibiotics.

3) When performing surgery on the nasal sinuses, it’s a good idea to pack the throat with gauze to prevent blood from accumulating.

4) When extubating someone who has a lot of blood or secretions near their airway, you should try to put them on their side.

5) Forced expiration against a closed epiglottis can cause acute pulmonary edema.

6) Acute pulmonary edema is a life threatening emergency. Also, I had learned about pink frothy foam in class, but seeing it in real life was a totally memorable experience.

7) STAT furosomide works well for acute pulmonary edema. Discontinuing IV fluids is also important.

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My head is throbbing right now, so I’ll keep this post short and try to elaborate later. The gist? I spent the day in the ICU at the hospital today. What a stressful place! There was a patient with a suspected brain tumor who was comatose. PMH doesn’t have an MRI or neurosurgeon, so unless he gets flown to another island, his prognosis is poor. There was another man with HIV who was not responding to antibiotics and is in bad shape. The patient we spent the most time with today was a 10-year old boy with sickle cell disease. He was in so much pain, that it killed me to look at him. He was extremely anemic, so the decision was made to put in a femoral line and give him a blood transfusion. I held his hand for a while and tried to keep him awake. I was absolutely amazed by how quickly he improved after the transfusion. He went from almost completely unresponsive to awake and talking to me. I wanted to stay and comfort him all day, but alas, I was too tired. I also visited my friend Rennady on the Winston Ward (more to come on that later).

The pic above is Kristina and I a few weeks ago getting ready to head into the operating theatre.

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Today was another fun day at the hospital. I got to intubate my first patient. I missed the first time, and went into the esophagus, but the second time around I got it into the trachea. Because my surgery days are on Mondays, Wednesdays and Fridays, I’ve seen tons of Ob/Gyn surgeries. Mostly, I’ve seen myomectomies (removal of uterine fibroids) and hysterectomies. I pretty much think I could do one now (with close supervision, of course). When you spend hours upon hours in the OR without eating, you find yourself absolutely starving by the end of the day. It’s a strange juxtaposition to be fantasizing about eating sushi and burritos when you’re staring at the intestines and other internal organs of another living being. But such is life, and such is the life of a med student.

The pic above is the welcome sign at PMH. In the coming days, I’ll try and get some more shots of the hospital for your viewing pleasure.

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