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. :)

Best Day at Ross Thus Far!

So I admit...I'm officially the worst blogger ever...I just end up not finding the time that I would like to write about all of my experiences here. However, I couldn't pass up the chance to write about this past Thursday.

In fourth semester, students spend two full days at the hospital...and Thursday was my first day. I got up early, ate breakfast and popped my Dramamine for the hour roller coaster of a car ride to Princess Margaret Hospital in Rosseau, the capital of Dominica. I was a little anxious. I felt confident in all I had learned to prepare myself for the day, but being the first time...I had tiny butterflies :) We arrived at the hospital around 9 that morning and were given our assignments for the morning. There were different specialties that were sent to observe, including family medicine, OB-GYN, pathology, geriatrics, ENT (ear, nose, throat), anesthesiology, primary surgery, and post surgical rounds. I sat there anxiously awaiting my assignment...my first preference would be surgery...no luck...then anesthesiology...no luck there either...pathology?...nope...I began to worry about how much I would enjoy the day but tried to remind myself just to be grateful that I was going to follow around a physician that morning instead of sitting in class. I leaned over to my friend Diana and joked that we probably got stuck with OB-GYN (no offense to anyone that has that profession...just not really what I want to do all day). I ended up with ENT...but poor Diana got OB-GYN (she said she learned a good bit by the end of the morning shift...but she never wanted to see a vagina again). I wasn't pumped about the ENT assignment, but awaited instructions anyway. Then, a guy in my group that had been assigned primary surgery asked to switch to something they had an open spot in, so immediately I asked for his place in surgery and I GOT IT!!! I was SO excited!

We headed over to the OR, which was an experience in itself (note to all reading...hospitals at home can be annoying and frustrating...but we should all be grateful for he luxuries we have by where we live). I went to the ladies dressing room and changed from my "professional" attire and into what I think are some of the most comfortable clothes ever invented...SCRUBS. We were given hair nets, face masks, and booties...a quick overview of the patients we would see that day, and that was it...time to start!

The first surgery we saw was absolutely my favorite and it would be a shame not to explain it fully. The man having the operation had a bad fall previously and broken his femur (longest bone in your body...from the hip to the knee). At the time of the break, he had surgery to reset the bone and inserted a large steel rod to allow the femur to heal. Luckily for this man, his leg had healed very well, however, that meant that he needed another surgery to remove the rod. The surgeon made a 4 inch or so incision in the right hip, and then proceeded to jab back and forth with surgical scissors until the end of the rod was exposed. Once it was exposed, he used fancy pliers to pull on the rod to loosen it a bit. Once he finished with the pliers (with the rod visible from within the mans hip), the surgeon began putting his tools together. The long rod that was placed in the mans leg had a small hole in the end of it. The surgeon put a T-shaped handle onto a long steel bar with a hook on the end. He jabbed this into the leg a few times until he was able to get the hook of his tool into the hole in the rod in the mans leg. From there, it was a tug of war between the surgeon and this man's leg. Eventually, with probably 3 giant pulls, the rod quickly slid out of the mans leg....I know this seems kinda harsh for people that are squirmy...but i ABSOLUTELY LOVED IT!!!...I've often wondered if I would like Orthopedic Surgery...so it was definitely awesome for me to witness one. It's amazing to me how brutal the surgeon was...made me think about how much pain people are in when they wake up...wondering how much of that is from the surgery and how much is from the surgeons method...?

I also saw a prostatectomy, removal of a foot nodule, removal of an epigastric hernia, and catherization of a man that had not urinated since Sunday (keep in mind that I went to the hospital on Thursday). Those surgeries were also exciting, but nothing like the femur rod removal...and that was just my morning.

After lunch we were sent to interview a patient and do a full physical exam. I was sent to the womens ward and met Octavia, a lovely 33 year old mother of 4. She was born with only one kidney and about 5 years ago, her kidney started to fail. She was a wonderful patient. We laughed and she told me all about life in Dominica...and amazingly, then asked me where I was from. When I told her South Carolina she said, "Greeenville, right?" which absolutely blew me away. She said she has a good friend that is going to Bob Jones University right now...small world huh? :)

Well, I better get in bed because it's one in the morning here and I need rest...but I couldn't resist getting this up while I had a few minutes....hopefully more awesome stories will come again soon.

P.S. Aunt Linda: I hope my descriptions don't churn your stomach, but I wanted you especially to know how my hospital day went. Also, I still had that pack of PB crackers you gave me...I took them with me and ended up giving them to Diana when she was feeling sick...so on behalf of her, Thank you for those!!! :) love ya!!!