"ORGANIZE YOUR THOUGHTS... THINK SYSTEMATICALLY."
Week 2. Right now, I’m typing this entry on the our hour-long ride back to Portsmouth. I usually spend my morning ride looking over some board material, while on my way back I usually end up falling asleep after a long day at the hospital... thus, risking my head falling over and plopping on top of one of my friends shoulders. However, I got some stuff on my mind, so I decided to take the time out to pre-blog.
On my mind this week are our rotations in Anesthesiology. Right now, the job seems to be exactly as I had painted in my head: come in during the beginning of a surgery, do some needle poking, talk to a few nurses, check that the patient is responsive to the treatment, and then head out the door to perform the treatment on another set of patients… Perhaps its just the Dominican way of doing things?
Remember that picture I painted of Princess Margaret Hospital last time? Little did I know that beginning my work in the Operating Room department would be so completely… different. The operating room facility is located in the same building where we have our fifth semester lectures, but on the second floor. Outside, it’s a giant cold-looking white colored building, with a tin-sheetmetal roof. To get to the operating room, we need to enter two glass doors, with their glass panes painted over in white. However, after entering, it literally is a different world. The décor features modern pastels, modular plastic cabinets, a standard glistening white floor, and most importantly updated and modern equipment. According to the poster located in the hallway to the three different operating rooms, the site was remodeled in 2001 (in fact the ICU I visited last week was in the old set of operating rooms).
Anyway, back to what I was thinking. Our rotation group was standing in our scrubs, gowns and caps in front of a patient about to undergo an obturator nerve block in preparation for removal of his medial meniscus ligament in the knee (The Dominican's looove their Cricket). Our attending Doctor looked me directly in the eye and asked me, "Tell me everything you know about Propofol." So I started saying, "Well its quick acting, and used to initiate anesthesia, and its better than Thiopental..." and he stops me saying:
"That's right, but ORGANIZE YOUR THOUGHTS... THINK SYSTEMATICALLY."
Remember that childhoold song, Dry Bones, which goes: "The toebone is connected to the anklebone..." and so on and so forth? I remember singing - and annoying the hell out of my classmates -with that song all the time. Well, medicine - even the hardest stuff - can be thought of in that manner. A good example in Anesthesiology goes like... "The Haloflurane goes with the Succinylcholine to make 'Malignant Hyperthermia' which results in Metabolic Acidosis, Accelerated Muscle Contraction, Tachycardia & Hyperthermia."
(Now try to sing it to the tune of the aforementioned song!)
Okay, medical blabber to some of you, but to me it makes complete sense because the logic is there! The point is Everything in medicine links together. I believe that's one of the best parts of medicine, its a never-ending web, but the essence of it can actually be captured by categorized, systematic thinking... Organized thought makes going through the "files and files" of thoughts in your head easily accessible in one sweep. Imagine disorganized thinking: it's like trying to find a needle in the haystack... Well, I still need to get acquainted with this way of thinking, but I see this as the reason why your doctor can just look at you and tell you what's wrong with you with the snap of two fingers.
Now don't be amazed if I shoot medical thought blabber at you next time I see you... you can always shoot the lyrics to Dry Bones in return back at me... We'll call it even.
1.29.2009
1.25.2009
Luck & Skill
"ARE YOU trying to make me more sicker?"
I alluded to what we actually do as fifth semesters as medical students here in Dominica in my last entry. Four out of five days of the week, we come out to Princess Margaret Hospital (PMH), which is the core hospital of Dominica, located right outside the capital city of Roseau. From now on, completely disregard what you think hospitals are like based on what you see in the states. Airconditioned, multi-floored buildings, well-sanitized with just about everything glistening in white... One of the most defining scenes is as you enter in after the giant painted-on "Welcome to Princess Margaret Hospital" sign... its a big diamond window where I see shelves of patient files stored. Some of the files are falling over into the gap behind the shelving and the window. Talk about care for patient records and ultimately, privacy. Nope, there's no huge cafeteria... Just a simple kitchen that's across from our teaching facility called The Canteen. You grab a seat in a plastic patio chair, pop open a glass-bottle of coke, and enjoy burgers and some other fried Dominican dishes. However, in the end, with what they have, I know the Dominicans make the best of it... and 50 medical students - including myself - are placed into the midst of it all.
Fifth semester for my program at Ross University - the name of my school - involves 12 intense weeks of observation and training in various Hospital wards. My first ward rotation took place in the ICU. We were about to observe a patient admitted for Heart Failure, after experiencing symptoms on one of the cruise ships that come into Dominica. The only doctor in care of the ICU told us, "The department's [and the patient's] yours." And there we went for it, asking for the patient's history (a download of how they ended up at the hospital) and started physically examining his/her body. Well, go figure, our patient started grumbling and he/she said to us the statement that started this entry...
I'll admit we're still new to this clinical deal. However, we were doing things by the book with what we had, our stethoscopes, our hands, and our knowledge. By the way our patient was asking, I figured he/she didn't like his/her time at the hospital. After all, the patient was crowded into a single isolation room without a window, the equipment cramped up much free space in the room. However, I had to think... "Our patient's lucky." No, no, no... not lucky that we're in a hospital that doesn't have all the resources... This guy/gal is lucky to be not only in good hands, but anyone's hands. Some people in the world can't even take care of their sickness because they don't have the money to get sent to a hospital, much less just see a physician.
See, at the end of our findings, it seemed that our patient was stabilizing... No signs were there to show progression of any decline of the patient's status. I believe if it wasn't for the dedication and knowledge of the sole ICU doctor in Dominica, then the lack of resources would have been a bigger issue. Instead, from what we observed, our observing doctor made the best of what he had, and that, my friends, is true skill. No matter where you go, its not just the technology that will define your bill of health when you leave the hospital... it is still the knowledge, flexibility and industriousness of the doctor that will make the difference. And it is these three qualities I aim to acquire as I move forward in my medical education.
Oh yeah, did I tell you? Jo's Chicken Surprise was absolutely amazing. She should start competing against The Canteen.
I alluded to what we actually do as fifth semesters as medical students here in Dominica in my last entry. Four out of five days of the week, we come out to Princess Margaret Hospital (PMH), which is the core hospital of Dominica, located right outside the capital city of Roseau. From now on, completely disregard what you think hospitals are like based on what you see in the states. Airconditioned, multi-floored buildings, well-sanitized with just about everything glistening in white... One of the most defining scenes is as you enter in after the giant painted-on "Welcome to Princess Margaret Hospital" sign... its a big diamond window where I see shelves of patient files stored. Some of the files are falling over into the gap behind the shelving and the window. Talk about care for patient records and ultimately, privacy. Nope, there's no huge cafeteria... Just a simple kitchen that's across from our teaching facility called The Canteen. You grab a seat in a plastic patio chair, pop open a glass-bottle of coke, and enjoy burgers and some other fried Dominican dishes. However, in the end, with what they have, I know the Dominicans make the best of it... and 50 medical students - including myself - are placed into the midst of it all.
Fifth semester for my program at Ross University - the name of my school - involves 12 intense weeks of observation and training in various Hospital wards. My first ward rotation took place in the ICU. We were about to observe a patient admitted for Heart Failure, after experiencing symptoms on one of the cruise ships that come into Dominica. The only doctor in care of the ICU told us, "The department's [and the patient's] yours." And there we went for it, asking for the patient's history (a download of how they ended up at the hospital) and started physically examining his/her body. Well, go figure, our patient started grumbling and he/she said to us the statement that started this entry...
I'll admit we're still new to this clinical deal. However, we were doing things by the book with what we had, our stethoscopes, our hands, and our knowledge. By the way our patient was asking, I figured he/she didn't like his/her time at the hospital. After all, the patient was crowded into a single isolation room without a window, the equipment cramped up much free space in the room. However, I had to think... "Our patient's lucky." No, no, no... not lucky that we're in a hospital that doesn't have all the resources... This guy/gal is lucky to be not only in good hands, but anyone's hands. Some people in the world can't even take care of their sickness because they don't have the money to get sent to a hospital, much less just see a physician.
See, at the end of our findings, it seemed that our patient was stabilizing... No signs were there to show progression of any decline of the patient's status. I believe if it wasn't for the dedication and knowledge of the sole ICU doctor in Dominica, then the lack of resources would have been a bigger issue. Instead, from what we observed, our observing doctor made the best of what he had, and that, my friends, is true skill. No matter where you go, its not just the technology that will define your bill of health when you leave the hospital... it is still the knowledge, flexibility and industriousness of the doctor that will make the difference. And it is these three qualities I aim to acquire as I move forward in my medical education.
Oh yeah, did I tell you? Jo's Chicken Surprise was absolutely amazing. She should start competing against The Canteen.
1.22.2009
First Night
AND IT STARTS WITH THE CHICKEN DINNER...
My great friend Jo just sent me a tupperware container full of her "special recipe" chicken, white rice and carrots. I'll be honest, after five semesters of living in Dominica, I don't know how us med students get by without each other. But we'll get to the chicken - and my background - in a later entry.
Here's where I start my blog. The night before the big exam - the COMP. 200 questions over 4 semesters worth of material. You might be wondering... Why is he starting this blog in the middle of med school? Okay, or even asking, Why is he writing in a blog right before one of the most important exams in medical school? With avoiding the technical med school lingo... This semester - my fifth - begins an experience of people. That's right. It's bye bye books - the last four semesters - and "Hello!" real-life experiences.
(Oh yeah, and did I mention that cramming 4 semesters of material would be a miracle to pull off in 12 hours? :D)
So, what's going to go in this blog? Everything from my goals and lessons... worthwhile stories about co-workers and patients... amazing places I've been and places I plan to be... and even stuff that's unexpected at this moment of time. So, grab a seat, and hold on to that handle bar right next to you (actually, isn't one there... just use your imagination)... It's going to be quite a ride!
... you know, speaking about unexpected, I'll let you know how my chicken surprise turns out next time.
My great friend Jo just sent me a tupperware container full of her "special recipe" chicken, white rice and carrots. I'll be honest, after five semesters of living in Dominica, I don't know how us med students get by without each other. But we'll get to the chicken - and my background - in a later entry.
Here's where I start my blog. The night before the big exam - the COMP. 200 questions over 4 semesters worth of material. You might be wondering... Why is he starting this blog in the middle of med school? Okay, or even asking, Why is he writing in a blog right before one of the most important exams in medical school? With avoiding the technical med school lingo... This semester - my fifth - begins an experience of people. That's right. It's bye bye books - the last four semesters - and "Hello!" real-life experiences.
(Oh yeah, and did I mention that cramming 4 semesters of material would be a miracle to pull off in 12 hours? :D)
So, what's going to go in this blog? Everything from my goals and lessons... worthwhile stories about co-workers and patients... amazing places I've been and places I plan to be... and even stuff that's unexpected at this moment of time. So, grab a seat, and hold on to that handle bar right next to you (actually, isn't one there... just use your imagination)... It's going to be quite a ride!
... you know, speaking about unexpected, I'll let you know how my chicken surprise turns out next time.
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