Today was my first visit/clinical round at Princess Margaret Hospital, in Roseau. The theme of my first clinical round? Can you tell by the color of this font?
Where do I begin?
Given the fact that my entire "study day" was dissolved by this full-day, hospital visit I have to make this post short. However, I will highlight some of the more memorable details of my first clinical round as a 2nd year medical student.
We arrived at the hospital at 9 a.m. this morning with a bag full of all the examination equipment we own, literally, wearing pristine White Coats, ID badges, and in my case plenty of nerves and excitement. This would be our first, real clinical round as 2nd year medical students!
I realized before getting on the bus that I had neglected to bring scrubs with me, which was a big problem because these are required if you are chosen for a pathology, surgery, or anesthesiology rotation. I made sure my friend would allow me to borrow hers if I was chosen and she wasn't.
At 9: 30 a.m. I waited expectantly to hear what I'd be assigned to; "Please let it be path or surgery or obgyn!"
Then they called my name and assigned me to Pathology! Score! I blew a kiss to my friend as they called her name for Internal Med and took her scrubs. I was so thrilled to see if this field, the one I have always been intrigued about and tested well in**, was for me!
Things didn't start out too promising as we soon found out our "preceptor"/attending MD was Cuban and didn't speak much English...at all. Me and the other student on the rotation informed her that we both speak/understand Spanish, which made things a bit easier halfway through.
Today I got to watch and learn from an autopsy of at 72 year old Dominican woman, who died of an intestinal obstruction, with a secondary pulmonary hemorrhage. Well technically, the final cause of death was pulmonary failure, but this was due to the obstruction of the mesenteric artery, supplying the small intestine. Anyways...
The first thought that crossed my mind when the technicians began the Y-incision was, "wow the human body is so fragile...a few deep cuts with a sharp scalpel and your internal organs are exposed in under a minute". The second though was, "oh dear God that smells terrible!"
I'm not sure why the body smelled so terrible (the lady had died fairly recently, either the night before or that morning)..but I suspect the loads of blood from the pulmonary hemorrhaging combined with the necrotic bowel had something to do with it.
I had a flash back to the scene in "Silence of the Lambs" when the medical examiner offers Jody Foster some Vicks vapor rub to stave off the smell. I really wanted some Vicks vapor rub at that moment.
This wasn't anatomy lab, with the pre-cleaned, preserved, Formaldehyde-soaked cadavers. This was a woman who less than 48 hrs ago had been living, breathing, in her hospital bed. A mother, whose daughter and son-in-law had some to ID her right before the autopsy.
After about 10 mins I sorta got used to the smell, and knew just how far away to stand with out looking like a wimp, while still getting to marvel over the entire dissection process.
The most interesting, fulfilling part came next, when Dr. Milagros began to examine each internal organ, slicing and sectioning so that we could see which ones contained what specific type of pathology. So cool! I finally got see so many of the pathological findings we are taught in class with image slides.
Purulent fluid! Hemorrhaging! Atherosclerotic plaques! Ventricular wall hypertrophy! Etc! How cool is that?!
After much teaching and much observation we were given a 30 minute lecture in Spanish (by the time the autopsy began Dr. Milagros had already switched into Spanish, for our benefit, so we could actually learn something) about the virtues of the Cuban health care system, versus the U.S. system, versus all the problems with the Dominican system. AND THERE ARE MANY.
It turns out we were supposed to observe 2 autopsies today: the elderly lady and an infant, but the infant's parents still hadn't shown up to ID the baby so this autopsy was cancelled. It probably sounds very morbid, but I was really looking forward to the infant autopsy because I wanted to see how it would be handled, if the techniques would be different, and what pathology had occurred.
After removing our booties, caps, face masks, we returned to our main quarters.
Everyone ordered pizza from Pizza Hut (a bonus to visiting Roseau) and one hour later we were off again to conduct a patient interview and full physical exam ALONE.
I was partnered with two other students and interviewed a hemophilia patient. The grim part of the exam, apart from the obvious fatigue and blindness, was the fact that he had been admitted to the hospital last weekend for a collapsed lung, and was through out the interview and physical exam coughing up blood and sputum. Like a lot of blood. And yes, some splattered onto my shoe/foot. (I went OCD after the interview and basically cleaned my entire foot and shoe with soap).
The interview and exam went well although the task was very intimidating at first. After all, this was my first interaction with a hospital patient as a medical student who is expected to know what to do and how to do it with max efficiency. But we were lucky and our patient was very compliant and kind to us.
After our interview we presented our patient to the other Cuban doctor we were assigned to, he lectured us on differential diagnoses for lung collapse, etc. and we were done. I popped a Dramamine for the ride home, passed out in the bus, and went home to take a long, hot shower.
I'm beat but I'm also still processing the days events. I feel fortunate to see how patients are take care of in a developing nation--the wards and nurses' uniforms haven't been updated since the 1920s--and am glad that I have at least some of the skills and knowledge to get the most of these experiences now.
Will I end up in Pathology? I dunno, but at least I can cross that off my list of experiences and store today's experience in my memory. I think if I can get over the smell I would really take to this specialty. I truly do enjoy the coursework component, and the practical component just reinforces this knowledge. But I still have many, many rotations to do in the years to come, so we shall see then.
It's already late and I have a full, 8 hours of lecture tomorrow. Time to get back to the studious-side of my life as a medical student.
Cheers!
Where do I begin?
.jpg) |
| Super Nerd M.D.--how I look after rolling out of bed at 7 a.m. and donning my "doctor wear". |
Given the fact that my entire "study day" was dissolved by this full-day, hospital visit I have to make this post short. However, I will highlight some of the more memorable details of my first clinical round as a 2nd year medical student.
We arrived at the hospital at 9 a.m. this morning with a bag full of all the examination equipment we own, literally, wearing pristine White Coats, ID badges, and in my case plenty of nerves and excitement. This would be our first, real clinical round as 2nd year medical students!
I realized before getting on the bus that I had neglected to bring scrubs with me, which was a big problem because these are required if you are chosen for a pathology, surgery, or anesthesiology rotation. I made sure my friend would allow me to borrow hers if I was chosen and she wasn't.
At 9: 30 a.m. I waited expectantly to hear what I'd be assigned to; "Please let it be path or surgery or obgyn!"
Then they called my name and assigned me to Pathology! Score! I blew a kiss to my friend as they called her name for Internal Med and took her scrubs. I was so thrilled to see if this field, the one I have always been intrigued about and tested well in**, was for me!
Things didn't start out too promising as we soon found out our "preceptor"/attending MD was Cuban and didn't speak much English...at all. Me and the other student on the rotation informed her that we both speak/understand Spanish, which made things a bit easier halfway through.
Today I got to watch and learn from an autopsy of at 72 year old Dominican woman, who died of an intestinal obstruction, with a secondary pulmonary hemorrhage. Well technically, the final cause of death was pulmonary failure, but this was due to the obstruction of the mesenteric artery, supplying the small intestine. Anyways...
The first thought that crossed my mind when the technicians began the Y-incision was, "wow the human body is so fragile...a few deep cuts with a sharp scalpel and your internal organs are exposed in under a minute". The second though was, "oh dear God that smells terrible!"
I'm not sure why the body smelled so terrible (the lady had died fairly recently, either the night before or that morning)..but I suspect the loads of blood from the pulmonary hemorrhaging combined with the necrotic bowel had something to do with it.
I had a flash back to the scene in "Silence of the Lambs" when the medical examiner offers Jody Foster some Vicks vapor rub to stave off the smell. I really wanted some Vicks vapor rub at that moment.
This wasn't anatomy lab, with the pre-cleaned, preserved, Formaldehyde-soaked cadavers. This was a woman who less than 48 hrs ago had been living, breathing, in her hospital bed. A mother, whose daughter and son-in-law had some to ID her right before the autopsy.
After about 10 mins I sorta got used to the smell, and knew just how far away to stand with out looking like a wimp, while still getting to marvel over the entire dissection process.
The most interesting, fulfilling part came next, when Dr. Milagros began to examine each internal organ, slicing and sectioning so that we could see which ones contained what specific type of pathology. So cool! I finally got see so many of the pathological findings we are taught in class with image slides.
Purulent fluid! Hemorrhaging! Atherosclerotic plaques! Ventricular wall hypertrophy! Etc! How cool is that?!
After much teaching and much observation we were given a 30 minute lecture in Spanish (by the time the autopsy began Dr. Milagros had already switched into Spanish, for our benefit, so we could actually learn something) about the virtues of the Cuban health care system, versus the U.S. system, versus all the problems with the Dominican system. AND THERE ARE MANY.
It turns out we were supposed to observe 2 autopsies today: the elderly lady and an infant, but the infant's parents still hadn't shown up to ID the baby so this autopsy was cancelled. It probably sounds very morbid, but I was really looking forward to the infant autopsy because I wanted to see how it would be handled, if the techniques would be different, and what pathology had occurred.
After removing our booties, caps, face masks, we returned to our main quarters.
Everyone ordered pizza from Pizza Hut (a bonus to visiting Roseau) and one hour later we were off again to conduct a patient interview and full physical exam ALONE.
I was partnered with two other students and interviewed a hemophilia patient. The grim part of the exam, apart from the obvious fatigue and blindness, was the fact that he had been admitted to the hospital last weekend for a collapsed lung, and was through out the interview and physical exam coughing up blood and sputum. Like a lot of blood. And yes, some splattered onto my shoe/foot. (I went OCD after the interview and basically cleaned my entire foot and shoe with soap).
The interview and exam went well although the task was very intimidating at first. After all, this was my first interaction with a hospital patient as a medical student who is expected to know what to do and how to do it with max efficiency. But we were lucky and our patient was very compliant and kind to us.
After our interview we presented our patient to the other Cuban doctor we were assigned to, he lectured us on differential diagnoses for lung collapse, etc. and we were done. I popped a Dramamine for the ride home, passed out in the bus, and went home to take a long, hot shower.
I'm beat but I'm also still processing the days events. I feel fortunate to see how patients are take care of in a developing nation--the wards and nurses' uniforms haven't been updated since the 1920s--and am glad that I have at least some of the skills and knowledge to get the most of these experiences now.
Will I end up in Pathology? I dunno, but at least I can cross that off my list of experiences and store today's experience in my memory. I think if I can get over the smell I would really take to this specialty. I truly do enjoy the coursework component, and the practical component just reinforces this knowledge. But I still have many, many rotations to do in the years to come, so we shall see then.
It's already late and I have a full, 8 hours of lecture tomorrow. Time to get back to the studious-side of my life as a medical student.
Cheers!
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