I was actually rather looking forward to today - now that I'm a fourth semester, we're moving out of the academic and into the practical, in this endless medical pilgrimage. Today was the first day I was scheduled to go to the hospital, and I made very sure to have all my i's dotted and t's crossed - I'd read and re-read the syllabus, gotten all of my instrument together, and even went so far as to buy an iron so I could finally melt on my Ross patch. I'd heard stories from other students - one sat in on an autopsy in their pathology rotation, and another watched a third-world hospital gunshot-wound debridement. How was I to know that my day would be wasted?
We stood around for about 10 minutes in front of the library before being crammed onto one of the nicer Dominica buses. These aren't like American charter buses - or even like American school buses. They're like really big vans, and this was one of the nicer ones. Each row of chairs has these little folding seats and, since my name was the last called, I got stuck with one. There was no way to sleep - the top of the seat hit somewhere around my 12th thoracic vertebrae. Luckily, I'd brought a pathology review book, and managed to read through blood vessel disorders. I generally have no problems reading in moving vehicles - that's partly how I kept my sanity on cross-country bus trips between Georgia and Michigan, and then again from Connecticut, to Georgia, to Texas. Those were American roads, though - quite unlike the Dominican....paved trails, I'm going to call them. Somehow, they're all winding and curvy, and they all feel like cobblestones. The mountainous terrain forces them up and down, up and down... I'm not only lucky that I actually managed to get some reading done, but that I'd scored some Dramamine from Nicole over a pancake and egg breakfast this morning.
After a hour's drive to the capital city Roseau (ROW-zoh), we got to Princess Margaret Hospital, affectionately called PMH (because it's not medicine if there aren't abbreviations. CXR, D&C and a DNR, anyone?) We were broken up into groups - everyone was supposed to bring scrubs, just in case they started out with surgery or path, but some folks forgot theirs, and so there was some switching going on. I wanted to switch -especially when I found out that I'd been assigned to OB-GYN (that's Karma), but I figured it'd be unprofessional to try to switch out of something just because I wasn't interested in it. Another guy did, though - and looking back, I think I should have also. Two other students and I were quickly lead to where we'd meet our doctor.
There was a lot of waiting around today - it was sort of life class, only without the sitting. We stood in the postnatal unit (ahem....hallway) while two interns chatted away, finally recognizing us at a break in their conversation. The doctor was busy doing something at her office, so one of them would show us some stuff. She led us to the prenatal area, and performed a physical exam on this woman who was something like 34 weeks pregnant. That was it - just a little strategic "laying on of the hands", and that was that. We retired to the little desk/nurse's station in the post-natal hallway to chat about pregnancy and such.
Finally the doctor came, and continued asking us questions about more pregnancy. She gave us something to think about (rather, asked us a questions and told us to think of the answer) while she went to do something, and then came back for more talking. Boring as hell. The girl in our group, who's actually interested in this stuff, politely asked the intern (prior to the arrival of the doctor) what she'd be doing on a normal day. Unfortunately, this was the day before surgery day, and there just wasn't a whole lot going on. I will say, though, that this one intern had a peculiar talent, which I've only seen in one other person (an incredibly intelligent college roommate of mine) - the ability to, when asked any question, vault into a lengthy, meandering digression full of truly impressive tangentiality, only to not forget the question, and somehow answer it in such a way that the rambling makes sense. Very Dickensian, I suppose.
The doctor led us down to the gynecological ward (room, I mean), and we were actually allowed to palpate and percuss the belly of a women in possession of massive uterine firbroids. They treat those with surgery. That was that.
After that, we hopped in a cab and drove to some restaurant (whose name escapes me) that had a sign like a Starbucks, and seating like a Starbucks, but faced a massive cruise ship, moored like a dingy in the massive Caribbean sea. I had a nice chicken panini something or other and a coffee-flavored slushy-thing . Because of the timing, we actually ended up having about an hour and a half. Nice not to be rushed.
We returned to PMH and were broken up into new groups - I was placed into surgery. I was looking forward to this part too - I know that it was going to be post-op, but I'd at least hoped it'd be cool. Firstly, unless any of you have ever spent time in a third-world country, you cannot know what I mean when I say that this hospital was downright spartan. There were no individual patient rooms, merely neat rows of beds partitioned off by brightly colored curtains. Everything looked like it was from the 70's, or 60's, perhaps. We were given an hour to do as much of we could of the H&P (history and physical).
The gentleman we'd been assigned to had been smashed in the back of his head with a rock by a 16 year-old kid two Sundays ago, was knocked unconscious, and brought to the hospital via ambulance. They sewed in 10 stitches, took some x-rays, drew blood, and discharged him on Tuesday. That Friday, he came back, complaining of terrible headaches. When we saw him, he was still waiting for his CT scan. The thing we're worried about when it comes to head trauma is neurological injury, but this guy was fine - with one exception. He followed motor commands, had no problems with his memory, was oriented to time and place, and, otherwise, was found to be healthy as a horse -but, since the accident, he'd lost his sense of smell. That's called anosmia, and is generally due to a fracture of the cribiform plate of the ethmoid bone; trauma is just about the only way it can happen. I said he was healthy otherwise, and he was - his cardiovascular, respiratory, and abdominal exams (most of which I performed) were perfectly normal.
After presenting the case to the attending and listening to other cases, we hopped on the bus back to campus, and I regretted not bringing any more Dramamine with me. It was lightly drizzling when we got back, but I was dropped off close to where I live, so I didn't have to trudge through it. I then went and poked around in the prevertebral region of one of the cadavers for half an hour, because no one showed up for my TA session.
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