I Can't Believe This Is My Life

So Friday was my first day of being on call for this rotation. Typically "on call" makes you think of people living their normal lives until their beeper or cell phone goes off. In OBGYN, you don't have that kind of time, so you stay at the hospital....for 24 hours...
I got to the hospital around 6:20 to make sure I was in the right place to meet my Doc at 7am. We reviewed the patients that were there from the night before with the doctor from the night before, and then we were off to see them. The patient list wasn't too bad, but there were some crazy cases...I'll tell you about my two favorites!
1) There was a very kind lady who was there to have her first child. She had come in the night before and was induced, but wasn't having much luck progressing. She ended up with some other complications, which led to her having a cessarian section. My doc told me to scrub in for the procedure...which meant that I would be pretty close to the action, but that was all I thought. Little did I know, I was about to be all in the action! I had never seen a C-section before, or a baby be born for that matter, so I was incredibly excited!!! Before I knew it, we were starting...with my doc on one side of her abdomen, me on the other, with one nurse beside me. Doc cut her abdomen, one layer at a time to avoid damage. I manned the suction. At one point, both the doc and I put two fingers in the abdomen on each side...and pulled! Seems kind of brutal, but we had to get a baby out of there! Next, doc pointed out the uterus and asked me if I could see what he was pointed at..."Is that the baby's hair!" I said...and I was right! I couldn't believe it! We were seconds away from bringing this baby into the world! I couple snips later, and the uterus was open. Doc asked me to put my hand on the mom's stomach, and then kindly reminded me that because of her spinal anesthesia, she couldn't push the baby out. So doc looks me dead in the eye and says..."ok, you're going to push this baby out....and you have to like, for real push!" Before I knew it, he was holding the baby's neck while I pushed her out! 3 big pushes later...our patient was a first time mommy to a beautiful baby girl!! The umbilical cord was clamped and I cut it. Not too long later, the placenta was delivered, and then it was time to suture this lady back together. The suturing took as long if not longer than the delivery. Then, doc put her outer skin layer back together as I placed staples across her abdomen....and that was it! I had helped deliver my first baby!
2) Baby number two for the evening came rather quickly. We knew that the mom was getting close, but being her first child, it would generally be a slow progression. I was in my call room on the 4th floor when my phone rang. It was doc...saying "Hey! Get down to L&D now!" which is on the second floor. There weren't steps near there, so I had to wait for the elevator. I got to the room right as doc was gowning and getting set to start. You could tell mom was ready to go. She was already saying had to push...she just had to get it out of her! :) Being my first vaginal delivery and not as much involvement as the c-section, I stood behind doc and watched this one. Mom and dad were super excited! The grin on dad's faced when he realized his baby was almost here was priceless. Labor is supposed to take a while when it is your first pregnacy...but this lady set a new standard for first time deliveries! Within 10 minutes, their baby girl was there, screaming, and ready for some loving! I must admit, I got a little teary-eyed with this one. Just seeing the look of first time parents, and seeing them cry got to me.

I think I was emotional after seeing the parents cry and hold their new baby girl for lots of reasons. Partly, I've just become a big softy, so them crying was enough. Partly, the idea of what the mom must have felt...carrying this baby for 9 months and in a matter of minutes, there she was, in her arms...it was just beautiful. Mostly though, I was amazed at the things God is allowing me to see and do in my life. I most definitely don't deserve any of the great and wonderful things He lets me be a part of, but I'm so thankful that he does!

Well, those were the high points of the on call night for me. I've seen a lot thus far, and that's just the first week!!!

Oh Baby!

So after a very long, but appreciated break, I'm back in the swing of things with school. I have finished all the classes and passed all the necessary exams....they're letting me bust into the hospital! I have 90 weeks of rotations ahead of me, but I like to look at it more in small chunks. My first "chunk" is OBGYN. I started Monday and so far everything is going wonderfully! i have been privileged to see quite a few in office procedures (pap smears, annual exams, STD screens, etc) but the real fun for me came today. The doctor I'm following has it set up as so: He shows me, then it's up to me. While I am not legally allowed to do everything I would like to do, I jump at the chance to do what I can. Today was the highlight of that chance for me so far. Until today, we had only seen gynecology patients (girl parts...ya know), but today we had a few OB patients. For the first one, he showed me how to use the doppler machine to detect the fetal heart beat. Therefore, since he showed me, the next one was up to me. The patient was super nice about everything! I assured her that if when I put the doppler on, if we didn't hear anything at first, it was no indication that her baby didn't have a heartbeat, but that instead it was my first time trying to locate one so it might take me a while. To my surprise, it only took me about 15 seconds. I was like a kid in a candy store. This huge...and I mean HUGE grin hit my face. There was life inside of her and I could hear it!!! I'm blown away by the way God created us...I think that is the biggest thing I am learning from all of this.

Tomorrow will be my real test: 24 hour shift at the hospital. I freak out at the idea of being late, so I will be there by 6:30, but My doctor is the on-call doctor for tomorrow at the hospital, which means I'm on call also! :) However, this is not the, we carry a pager and live our normal life until it goes off kind of on call. I will be at the hospital from 6:30 tomorrow morning until at least 7am Saturday morning. While I know that's going to be a long time...I'm pretty excited about it. He's the person in charge of the entire OBGYN unit...which means that most likely I will get to see my first child be born tomorrow!! Now you want to talk about miracles....can't wait to see one of God's most miraculous adventures known to man! More to come...... :)

Welcome to Life as a Doctor

So I spent last night from 8pm to 7am this morning in a local emergency room doing a rotation. It was by far the most exciting and educational evenings of my medical career so far...here's a summary of the patients I got to see:

1) 54 yo F presented with chest pain and HA
PMH (past medical history) of Hypercholesterol, HTN (high blood pressure), Asthma, CHF (congestive heart failure also incredibly stressed and worried about everything in Haiti...which we later found out was b/c she's from there and still has family there
ordered a CT chest w/ contrast...
--> cardiomegaly, CHF
admitted
she was my first pt....great pt...actually using her for my write up
interestingly....around 6 this morning we're called upstairs b/c she's losing it....we get up there and it was like she had ODed on opiods or something
they still hadn't figured it out when we left...but she was perfectly alert and oriented a few hours prior....maybe the husband gave her some of her regular meds before he went home and it messed her b/c she was already receiving lasix IV, tylenol, and nitropaste

2) 19yo female - can't swallow and throat hurts...DXed with strep throat monday...tongue had some erosion that almost looked like a Candida infxn but once you depressed the tonge, the tonsils were so swollen they were nearly occluding the entire throat....hence the dysphagia
3) 73yo M with rectal and penile bleeded...go pulled away from him though to go to a code blue for a
90 yo F found in asystole (flatline)...gave epinephrine and atropine, 3 rounds with chest compressions and bag ventilation throughout...
which is where stuff got awesome...CPR person got tired...Dr asked if we knew how, I said yes, he said "get your gloves on, let's go" so i gave compressions, then D gave some, and the woman after a while came out of asystole and got a rhythm back....so i'm feeling nothing in this womans femoral artery for the longest time and then finally she gets a bounding pulse with the last dose of atropine....absolutely insane!
4) 66 yo F attacked near her home, didn't let go of her purse so the criminal stabbed her with something in the arm...had to get an xray and sutures
5) 29 yo creole woman that didn't speak english...substernal pain, pain uder right breast, and pain in the pelvic region, especially after sex...ended up being nothing that they could figure out though
6) 67 yo M with severe backpain, PMH: HTN, pending prostate biopsy, nothing showed up on CT of abdomen, pelvis, or chest
7) 71yoF PMH: HTN, DM, Arthritis came in with SOB, chest tightness...had a CXR but didn't come back before we left
8) 36 yo F PMH: schizoaffective, reported listening to the spirits and voices and walking around for 3 days but she was at a bus stop and had fallen and hit her head...CT cervical spine w/o contrast, CT head or spine w/o contrast, CXR...ended up with C2 fracture (she broke her second vertebrae in 3 pieces...this is the same vertebrae that Christopher Reeves was affected by)...the freakin dens was broken in 3 pieces...it was crazy...so we needed her to lay still to preserve the spinal cord...but she had been on neuroleptics long enough that she had developed tardative dyskinesia (makes the patient twitch, almost like Tourettes) so it was hard for her to sit still...
9) 38 yo M PMH: schizophrenia, HTN, depression - having suicidal thoughts, missed his meds yesterday, girlfriend died 7 months ago...not sure what they did with him...he was still there when we left
10) 19 day old baby boy (adorable) running a fever...so protocol if they're under 30 days is to do a full septic work up, which includes a spinal tap...but it was amazing how much better it was for an infant...they don't have to use as big of a needle and the baby doesn't really feel as much of the pain

So that was what I got to do last night...first time seeing all this mumbo jumbo I have to learn really put into practice...and I LOVED EVERY SECOND OF IT!!!!

Medical School Prom

So as amazing as it is that it has come so quickly...I'm nearly 30 days away from finishing my time on the island. As a gift to the 4th semester class, the school pays for a huge banquet for everyone to attend, which was this past Saturday. The dinner was great, there were performances by members of the class, and dancing. The favorite part for me was it was held at Fort Shirley, a historic landmark here in Dominica (the first mass emancipation of the British Empire took place there). I was on the planning committee, which proved to be a lot of work, but to see everyone having a good time and random people thanking me for everything...it was well worth it.

I'm actually in lecture so I'm not going to draw this one out...but it was certainly an amazing evening full of friendship, laughs, and great pictures! It was nice to actually be able to enjoy the island without having to study for an evening :)

Godly Parents

So this week at NewSpring, my home church, we started a new series called "Don't Get Married Until..." for singles and engaged couples on preparation for marriage. Sunday was "Don't get married until you hear from God". There were so many great moments during the sermon, but one that really stuck out to me was when Perry (the pastor at NewSpring) addressed the parents. Here's a link to what I'm talking about... http://www.youtube.com/watch?v=L8q2o-y_hF0 I highly suggest checking it out if you have time.

Anyway, being a parent is something I have always looked forward to (one day a long time from now...haha). And there are many times I come across people and think "weren't you raised with more manners than that?" or something to that effect. Perry touched on this during the sermon. He gave the example of mom's that try to be "the cool mom" to their young daughters and dad's that don't teach their sons to respect their mother and other women. Without a second passing, I thought to myself...SO GLAD I HAD THE GODLY PARENTS HE'S DESCRIBING! Naturally there have been millions of times I'm sure that my parents have annoyed me, as I do them or we disagree, but regardless of all that, I cherish them so much and am so thankful they were the ones God chose to raise me.

My mom is a rock. I've seen her deal with a lot in her life and watched her handle every circumstance. I think she gets that from her mom, who raised 4 amazing children as well as my cousin as a single mother after the death of my grandfather. We aren't promised that times will always be easy, but you do the best you can with what you have, something my grandmother taught me when I was little. My mom has dealt with a lot in life, just like anyone else, but through it all, she stands. When my dad was diagnosed with two completely separate cancers and her mother was told she had a brain tumor...my mom, although I'm sure terrified like the rest of us, was there for the rest of us, always making sure my brother and I were alright. At the same time, growing up she was a mother to Jeremy and I...and that was priority number one. It's because of that mentality, and not trying to be the "cool mom" that has brought us to where we are not. At the age of 23, my mom is one of my best friends and someone I actually enjoy hanging out with, shopping with, having coffee and talking with...something I'm so grateful for!

As for my dad...I definitely grew up a "daddy's girl". My mom always tells us we are "two peas in a pod" and she's right on point. My dad and I have always "been on the same page" with a lot of things. My love of sports started with my dad. I remember growing up and going to Clemson football and basketball games as a family...especially football. Always stopping at KFC or something in Easley on our way to Clemson to grab lunch and parking near this giant tree on the campus. Unloading our picnic table and having lunch as a family and then Jeremy and I climbing in that giant tree...then throwing football around with dad for a while before heading over to the stadium to cheer on our tigers! From there it was baseball and basketball...with dad as my coach. He always knew exactly what to say to encourage me, motivate me, or piss me off just enough to make me a better athlete. :) Even when I got to high school and college and dad went from being my coach to on of my biggest fans, he still knew the right things to say...always helping me analyze the game. My mom memorable time was when dad told our family he had been diagnosed with cancer...to this day I'm not sure how he did that. It was as if it wasn't a big deal...I don't know how scared he was on the inside...tons I'm sure...but he never, not even for a second, wavered in his faith. He knew that God could take that cancer away at anytime and would if that's what was His plan. He prayed over our family and the doctors he was working with and that was all it took. His faith inspires me and taught me the type of dependence on Christ I wanted my future husband to have. One of the points Perry made in his sermon was about dad's "dating their daughters" and being the man that tells them they are beautiful so that when some guy comes along and tells them...they already know :) . This is something else I have cherished over the years. Both of my parents always compliment me..but something I remember from when I was little was dad bringing mom flowers and bringing me one as well. Flowers from daddy never gets old.

I feel like this blog was so scattered with random thoughts, but that's just what they were...random thoughts of gratefulness I had while watching the sermon...I'm so thankful for the Godly parents that I've been blessed with and I wouldn't trade them for anything! Also, if you want to see the entire sermon, you can watch it online at www.newspring.cc

A day in the life of Dr. G

So despite being constantly around medical knowledge and situations, I still enjoy watching medical based television shows like House and Life in the ER. Another show I enjoy watching when I have time is "Dr. G - Medical Examiner". If you've never seen the show, Dr. G is basically the best at autopsy examinations. I got the chance to step into her shoes this past week.

Twice during 4th semester at my school, students are required to go to the hospital for rounds. My second trip was last week. The schedule is the same for everyone, in the morning you follow a physician and do whatever they do, sometimes participating, sometimes just watching. There were three girls plus myself that went to the Pathology department. The physician we followed was from Cuba and did not speak English very well. So...thank you to all the teachers who taught me Spanish in high school and college because it got me through the day :) We went through a short presentation in her office and then it was off to work. We left her office and went outside to what looked like a shed or something that should be on a farm. While looking a little shady on the outside, the inside was a fully functional lab. The man was a 76 year old Dominica with a cause of death of CVA - Cerebral Vascular Accident. Just before we began, the mans wife and two other relatives came in to identify the body. That was definitely tough. To see the mans widow walk in, see him, start crying, and with tears streaming down her face told us that was her husband. After that, the relatives signed some papers and then left...and it was time to start the examination.

So this is the part that will gross you out if you're squeemish...so there's your WARNING!

So the autopsy began with cutting the deceased from his throat down to the bottom of the abdomen. The autopsy technicians cut through the fat and abdominal muscle wall to expose the abdomen. A saw was used to remove the center of the ribcage and expose the chest cavity. And this was the part that amazed me...so as you may or may not know, there are large arteries that come off the heart and then the large intestine connects to the rectum. These are the major areas that hold everything in place. These two areas were dissected through, a couple other things happened, and then in a few minutes, all internal organs from the chest and abdominal cavity were removed in one big mass and layed on the examination table. This is where the pathologist takes over. She has to inspect each organ for other signs that could have lead to his death. Everything is cut open, weighed, and sometimes samples are taken to be looked at under a microscope. However, since the cause of death that was suspected was the CVA, it made sense to look at the brain first. So we did...we had to first remove what's called the calvarium..basically the top of the skull so the brain could be removed. Once the brain was on the table the pathologist started working her way through it. It didn't take long to find the cause of death. There is a group of arteries that runs through the brain, so if you know where to look, your job is much easier. There is a one called the basilar artery. It had an "atherosclerotic plaque" in it. That's the same issue we all hear talked about with high cholesterol and eating too many cheeseburgers. The plaque closed off this artery and prevented the blood, which carries the oxygen from getting to the brain. So basically this man died because he couldn't get oxygen to his brain.

Once the pathologies was finished looking through all the organs, they were put back inside the man and he was sutured up, which was impressive in itself because the incisions that were made were barely seen.

And that was it...I had seen my first autopsy and confirmed the diagnosed cause of death....something that is so gross to many people, and was one of the highlighted days in my life on this island.

During the afternoon at the hospital I interviewed a post surgical ward patient and performed a full physical exam for him. However, it pales in comparison to the excitement of the morning...and my class has started, so that's all for now :) I can't believe I only have 43 more days here!!!

The little things in life....

There are a lot of rituals that occur after exams at my school...one of my favorites is cooking with my friend Michelle. It tends to be a post-exam ritual because that's the only time we have to do it. My favorite thing to make is egg salad because 1. it's amazing, and 2. I can make a lot of it and have sandwiches throughout the week. I didn't have any eggs, so I went to the grocery store to grab a dozen. Pending where you go here, they may or may not be refrigerated. At the place I went to on this day, they were. As I reached for the eggs, it was almost as if I were dreaming...I could swear that I saw pasteurized milk...but I thought...there's no way...I've lived here a year without "normal milk". If I've never told the story of milk here on the island, here's the short of it...the milk here comes in a box with a flip top, sits on the shelf...therefore NOT refrigerated...tastes absolutely NOTHING like what, as an American, I am used to...so basically I bought it just for cereal, to feed local cats and to occasionally put in my coffee. Anyway...I looked again, and sure enough, the store had pasteurized milk!!! I asked them how long they had it, to ensure that I hadn't missed it over the last year, but they said they had just started getting it. It is shipped in from Barbados (I believe). I payed 11EC (Eastern Caribbean dollars) for 1 liter (which is roughly $4 US), but it was COMPLETELY worth it. To top it off, I had just received a package in the mail from my parents the day before and they had sent me some oreos....needless to say, I had a night of oreos and ice cold milk!!!!! It's amazing the little things that can excite you once you've lived outside of your "normal"...makes me realize how much I take for granted living in the USA...even something as small as a glass of milk. :)