Island Med Student

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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Thursday I had a clinical skills exam. Basically, I had to do a head to toe physical exam in less than 45 minutes while two doctors watched and evaluated me. We had to do almost every exam possible (each cranial nerve, cardio, respiratory, etc.), so I was super nervous. But I practiced a bunch (thank you Micah!), so I felt pretty prepared.

At the end of the exam, I heard one of the best comments that I think I’ve received since beginning med school. One of the physicians (who happens to be one that I respect very much and think is amazing) said that before he went through the grading process, he wanted to let me know one thing. He said, “I can tell by watching you that you are going to make an exceptional physican some day. You care about your patient and it shows. You enjoy what you’re doing and it shows. You’re paying attention to the details and it shows.”

I couldn’t have asked for a better compliment. Med students are so very low on the totem pole. We work our butts off for years only to get yelled at by our attendings, residents, and even patients. But on Thursday, I felt like my almost 2 years of hard work had finally paid off. And I earned the respect of a respected physician. It makes all the hard work seem worthwhile.

Note: The pic has nothing much to do with the post. I just happened to find it when going through some random shots. It’s another one in the “pictures of my hair with flowers taken with a cell phone” series.

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Today was a good day. Dr. Chu, the Dean of Clinical Sciences at Ross came to talk to us today about our upcoming clinical rotations. I got lots of good information, and answers to all of my questions. It looks like my goal of doing all my rotations in the DC/Baltimore area may be fulfilled. In addition to that, they added another “special rotation,” which is a rotation that you can start before you get your Step 1 scores back. The rotation is psychiatry at St. Elizabeth’s hospital, in DC. I spoke with my clinical advisor, and as long as I get the required paperwork in soon, I think I’ll get the spot. The rotation is 6 weeks beginning June 16th, which is perfect timing, since I plan on taking the Step on June 1st.

I also had a great day at the hospital. Today I rotated in the ICU, and learned all kinds of stuff about taking care of critically ill patients. It was also nice to see how well the ICU runs at PMH, even with limited resources.

I can’t believe I’ll be starting my first clinical rotation in a little over 3 months!

Note: The pic above is me and my very good friend Harold. He is a lovely man, who always brings joy to my day.

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Check out my post on Medscape my silly desire to save the world.

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Today I started my anesthesiology rotation. Of course, that means that I spend all my time in the OR, which I love. Today was AMAZING! I got to see so many awesome things. Here’s an incomplete list of the stuff learned:

1) How to remove fibroids using a special corkscrew device. Oh my god, this is the coolest thing ever!

2) How to surgically fix both an epigastric and umbilical hernia.

3) Commonly used anesthetic drugs, and their indications/contraindications/side effects, etc.

4) Holding the anesthesia mask on an unconscious patient is WAY harder than it looks. My hands were aching and tired after about 10 minutes

5) How to put in an IV line.

6) How to inject an intrathecal anesthetic. Here’s the longer version:

The coolest part of the day involved a young patient who had fractured his patella playing soccer. He needed surgery to remove the broken fragment and re-connect his ligaments. They opted to use an intrathecal rather than a general anesthetic. The injection was given, and he was completely numb from the waist down. A sheet was placed in front of him, so he couldn’t see what was going on. The surgery was totally awesome. It was my first orthopedic surgery, and I was amazed by all the drilling and poking. During the surgery, my friend and I were talking to the patient. Eventually, he wanted to see what was going on with his knee, so my friend would take a picture with her cell phone, and then show it to him. He was amazed and having a great time. He totally gets the best patient award. Thank you Mr. Patient, for allowing me to post these pics!

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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.”

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