The Future is...

I could really use another year right now.

Another year to study, another year to learn, another year to figure out what in the world I'm supposed to be doing.

How did this all happen so quickly? How is it almost over?

I'm so close to having a nervous breakdown these days that it's not even funny. People start talking about electives, or even worse residency and my heart goes into my throat and I feel sick.

I haven't taken the step yet, I do plan to. This summer hopefully, but that will be too late for almost every medical elective in the US during the fall. On top of that most hospitals only take US students anyway. I called no less that twenty hospitals yesterday and only ONE said they could take me, and even then they don't have spaces until February. The state of Pennsylvania (where most of my family lives) apparently won't let any international students do electives at their hospitals. Go figure.

So what happens with that is if I don't get it sorted within the next few weeks is that I can't do electives this Fall. That doesn't sound so bad when I put it like that, but let me clear up the consequences of all of this. No elective = no recommendation from a US doctor = fat chance of getting a residency.

Which means I'll have to take a year off, and during that year I'll have to figure out how to pay my excessive amounts of loans, AND figure out how to get a residency the next year even though my chances will be even more slim a year out from graduating than they already will be immediately after I graduate.

Basically, my future sucks. I should have just become a ski bum.

Best Day Ever!!!

Wanna know what I got to do today? Do ya? Well tough luck 'cause I'm gonna tell you anyway!!!

Day three of surgery and they let me scrub in for the (it was my first time!) to help with repairing an abdominal aneurysm on a convict! There were two massive guards with him at all times, they even stood right outside of the operating room (because there was a massive chance he was going to become violent while his abdomen was sliced clean open...*sarcasm*).

Technically I only held traction, but I was the best traction holder person in the place. I didn't get smacked in the face by the surgeon as he flailed is elbows around, I stood in a backbend position for almost two hours so the main guy had room to work and I didn't even break a sweat (it probably helps that those drugs for my back have finally started to make some progress), and best of all not once did I break the sterile field!
At the end the doctor let me help suture him up. It's the first time I've ever sutured (EVER as in l've never even seen it done before unless on TV counts).

Then I came home, I got on my computer and guess what- I passed my pediatrics shelf exam!!!

I have to go study for my next test which is in two weeks, but I have so much motivation to study now it's not even funny!

March

I had a really good day today, and this is the first time that I can say that and truly mean it. Never in my wildest dreams did I think I was going to even remotely enjoy surgery, but here we are at day 2 and so far I love it. It's funny how life surprises us sometimes.

I haven't written much on a while so I'm not really sure where to start this post off at. I've gone through a few rotations since the last post, namely geriatrics and pulmonology. In both I felt like I was just waking up each day, going to class, and coming home, never did I feel a spark. I wish I had. Right now I'm prepping for my internal med final which is in just two weeks!!! I have so much to do!

This past weekend I went to the pediatric hospital with some friends and helped hand out bears to all of the kids. It was so much fun! I now know what being Santa Claus must feel like because when we went to our last ward (otolaryngology) we essentially got attacked. I've never seen so many excited little faces in my life. It was so cute and I got that warm fuzzy feeling by being a part of it.

A little girl was even nice enough to draw us a picture. She got a giant elephant I picked out at toys-R-us! I'm glad she got it, we usually pick the kids who get the biggest bears based on who we think will appreciate it the most. I think it's fair to say that she appreciated it. It was really nice of her.  Last year we had a massive unicorn like the one in the movie Despicable Me, we searched the hospital high and low to find the perfect little girl to give it to.

As for everything else in my life right now it's so-so. I've managed to hurt my back pretty good so that involved searching for a doctor in this place that #1. Isn't in any way associated with the family med doctors our school sends us to (they're pretty bad- not that I'm any expert or anything) and #2. I can afford. In the end I found a really nice walk in clinic where they were able to take x-rays and everything and it only cost me $60 out of pocket TOTAL without insurance. Which makes me wonder why in the world did it cost $600 for the chest x-ray I needed in the U.S. last winter??? Does x-ray film cost more in the U.S. or something?

Anyway, the doctor was really nice and even though there wasn't anything wrong with my x-ray she thinks I have a damaged nerve and prescribed me some stuff for the pain (because repeating the experience of sitting 45 minutes on a tram platform unable to move and crying isn't something I'm really keen on repeating). So far it's only helping a little, I hope it'll kick in sometime in the next few days otherwise I'm going to have a problem.

One of the hospitals we have class at- yes I was impressed too.

First Aid and the Time I Almost Died

So I'm working on getting my BLS/ACLS certification right now. My school doesn't offer any certification for either so it's all online. We do however have two very pointless classes that we have to take in our first and second years that are very loosely based around "what to do in an emergency" with CPR and the Heimlich both included. But, despite the fact that they teach us what to do, how to do it, yell at us, and call us stupid, there's no certificate at the end. So now I have to essentially do the whole thing over again, makes sense right? Well yeah kind of, because apparently even if they teach it to us, it doesn't mean we actually know what to do in a real scenario, we need all the practice we can get, and I can prove it!

Some call them shish kebab I call them death sticks.

This brings me to story time. My friend and I had just finished our "first aid" course maybe two months before the end of our first year and to celebrate we decided that we were going to grill up some shish kebabs. It was the first time I'd had steak in a while and it was delicious!

And then I got a really fatty one, and I chewed, and chewed, and chewed some more. And finally I decided it was minced enough and I could swallow. You can obviously see where this is going... I realized my airway was obstructed pretty quick. At first I wasn't at all worried, I was trying to be logical about all of it, there was no way it could be that stuck. Well it was.

After about 15 seconds I really started to panic and stood up. Still trying to be logical I took a huge drink of soda thinking it would force it down- no deal. There was no where for the soda to go except out, and it spewed from my mouth all down my front. At this point my friend realized something was wrong and she stood to avoid the "waterworks."

After that failure I started beating on my lower chest hoping to dislodge the thing myself. Obviously that wasn't going to work so in the middle of doing that I threw myself in front of my friend thinking she would do the Heimlich and save my life, because she must have realized I was choking. I was pretty out of air at this point and still trying to get the thing out of my throat, any longer and I'd be in a Polish morgue over a piece of steak.

So as I position myself in front of my friend ready for her to squeeze the hell out of me, what's my friend do? She pushes me and jumps out of my way. So much for that first aid course.

Eventually, after what seemed like an eternity but was probably more like five seconds my airway gave one final spasm and a half chewed, saliva filled piece of meat flew across the room and lands smack on my friends plate. I spent the next 5 minutes coughing and gasping for air before turning to my friend to apologize profusely for the soda and pieces of food now decorating her living room.

Of course I also asked why she didn't save me!?! Apparently, I missed the essential part of choking 101. You know, the universal sign for choking. Yep, in all my logic and even in my panic I forgot to place my hands over my throat to signal I was choking. In addition to that with all the other hustle and bustle my friend thought I was being violently ill, because choking people don't normally spew coke allover the place. Makes sense. I probably would have done the same.

What's the point of my story? 
#1. If you're choking don't put liquids in your mouth.
#2. Don't forget the international sign for choking, it's apparently kind of important.
#3. Don't EVER trust a first year medical student with your life no matter how trivial the procedure might be.

Oh, as for the ending of my woeful tale: By the end of the day I was back to full health with no long lasting damage or what not. Though I didn't eat anymore shish kebab after that. And we both learned a valuable lesson. I learned to ask for help instead of being stubborn and insisting I can do everything myself. My friend learned that just because a person is spraying their drink all over the room it doesn't always mean they're vomiting.

More Adventures in Internal Med

Classes have been going pretty good lately. Over the past two weeks we've had a few different classes all part of internal med. Namely: rheumatology, family med, and diabetology (yes, apparently that is a real specialty-I'd never heard of it before either).

Of all of them the rheumatology and family medicine rotation were probably the best of the three. The doctors in rheumatology spoke amazing English and were very helpful. And family med was good just because we were actually allowed to do things for a change. I got to give my first shot, we took blood glucose levels for all the patients who needed it, did physical exams, and all that sort of fun stuff. It was nice to be trusted and taught actual skills.

Even though we got to do a lot, the patients for the most part seemed like a bunch of (forgive this adjective) wimps. There were a few people who were legitimately ill, but for the most part it was "I woke up with a stuffy nose this morning and need a note for work." Seriously!?!? I've come to class with bronchitis both in med school and in undergrad because I'm not allowed to miss classes, not even one even with an excuse. And they're telling me they can't go work a cash register with a stuffy nose?

Okay, I get it some people just can't handle being sick. But, it seemed like ALL of them were looking for a way to get out of work. We even had one woman who was faking serious abdominal pain to get out of work- we only caught it because I said to the teacher in English that hermanski's sign was positive and while she was talking to her she checked and despite the fact the woman almost jumped out of her skin when I did it, she didn't even notice when the doctor did it. And most ALL of the injections I gave were narcotics.

I guess this explains why the doctor we were with pretty much thought every patient was faking it- most of them were. But, when patients were legitimately ill they got no sympathy. I guess once you see this sort of stuff so many times, you just stop caring about the patients as a whole. I dunno...but what I do know is I don't ever want to be the sort of doctor that brushes people off. I've had experiences with that, and when you are really sick it's very disheartening.

They see patients with it like this. 

Another interesting thing was the aesthetic quality of the clinic. It was messy, I don't mean just dirty, it was that too; I never saw anyone wash their hands, or clean the equipment not once in the entire week. It was messy, there was junk everywhere. The desks were covered in books and pamphlets, the walls didn't look like they'd ever seen paint, it was very "ghetto" and small, very small. And they saw patients in these conditions, better yet patients came to see them with these conditions. Back home if an office looked like this place it would have been condemned and there's certainly no way patients would actually elect to visit it. I understand money in clinics like this aren't the same here, but that is no excuse for the mess.

One of the best parts was when the drug salesmen would come in and pitch their drugs. The doctor wouldn't even pretend to pay attention, so my group was pretty much the only audience. One of my friends made it a point to convince them to give us free pens and notebooks. SCORE!

The only good part about diabetology, or at least the most interesting part was that we had class in a church, well next to it. The hospital had an extravagant chapel we had to go through to get to our classroom. Before we were about to take our final for the rotation our teacher jokingly pointed out that their was a reason we had to go through the church to get to the classroom. When I was getting ready to take a picture of it the first time, I quickly realized there was a priest hanging out, so I quickly hid my phone and took the picture later. I'm not sure how keen they are of people taking pictures of hospital chapels here.

I think we only have another two or three weeks of internal med before we start surgery or psych - I'm not sure which. I've enjoyed internal med, but I'm really ready for it to be done. If I felt like I were getting anything useful out of it the majority of the time I'd be alright, but I feel like I'm just going through the motions lately.

On another note, last Thursday was Donut Day! A.K.A Fat Thursday. Needless to say I'm still coming down from my sugar high. 

Teddy Bear Hospital 2014

Once again Teddy Bear Hospital was an awesome success!!! 

Like last year I had one heck of a time trying to get out of class even with my deans office excuse  which we applied for almost three weeks prior to this. Basically, I was missing three hours of a rotation that doesn't even exist in the US and they wanted me to pay 600 zl to make up the class. But the real kicker is that they didn't tell me or anyone else this until the day before we were supposed to go. Needless to say those of us who were going were not having it. In the end we sorted it out with the head of the department so it wouldn't be a problem, but not without some serious anxiety first.

The whole group of us (about 8) all met at a local grocery store and cabbed it to the other side of town. The international school we affiliate with for this is not exactly close so it takes a good amount of time just to get there. Once we were there we got everything all set up and ready to go for the kids. Basically (if you don't remember from last years post about this) there are three stations and kids bring their bear to each station to try them out.

The first station is just basic sort of doctor stuff. The kids tell us what's wrong with their bears and we fill out a little piece of paper with the bears vitals and then we have the kids listen to the bears heart, take its blood pressure, check reflexes, give shots, and stuff like that. The funniest thing in the world is to play pretend with a five year old. "Why don't you listen to the heart? Can you hear it?" "Oh YES I CAN HEAR IT." (I must need my hearing checked).

The next station is "imaging." My friend and I made an x-ray out of a box and collected some old x-rays to show the kids (so that we wouldn't have to tell them that the ribs were an arm again).The kids would put their bear inside, we'd shake the box around, and then we'd pull out an x-ray showing the body part the bear was complaining about. Getting x-rays when most places use computers is a little tricky so we had a few print out versions.

The third and final station was the operating room. We had a big table covered in a sheet for this and some fake scalpels and bandaids. We also brought gloves and masks along for the kids so they could get more into the role. I remembered to bring my sewing kit this year because last year kids brought bears that were legitimately in need of some stitching. I got to sew up one dalmatian- though I don't think the kid really cared.

The kids we had this time around were younger than the ones from last time around ages four to six. And for many of them it was their first year of speaking English so trying to understand them or even get them to talk sometimes proved a bit difficult.

Near the end of our time there some of the kids were really riled up. So instead of releasing them to the teachers as wild hooligans we had everyone get in a big circle and we taught them how to do the "Hokey Pokey" because that's what cool doctors do.

Overall, we really had a blast and I think the kids did as well. If anything though it's taught me pediatrics probably isn't really my thing. I just can't relate with kids well and quite frankly I think they hate me.

The Woman in the Black Reeboks

http://wrzesnia.powiat.pl/pub/uploadimages/popup/nowa_przychodnia2.jpg

The old woman was hysterical. She had come to the doctor for a simple stomach ache and the diagnosis ended with atrial fibrillation. She dabbed her face with a tissue as the nurse tried to calm her down. She was in her eighties, but this was her first major medical problem. "My son, I have to call my son. Where's my cell phone?" she cried over and over.

My classmates and I stood in the corner helplessly, not able to say anything to comfort her. Barely even able to ask her how she was doing. For the moment, I wanted nothing more than to be able to speak Polish.

The nurse let her lay on the ECG bed and the doctor instructed anti-anxiety medications to be administered. Almost twenty minutes later the woman was still shaking. Crocodile tears covered her wrinkly face and the doctor ordered the ailing woman back to the waiting room to wait 30 minutes before she would have another ECG. "We need the room, we have other patients," she said.

The nurse not at all pleased by the doctors decision half carried the anxious woman back to the small waiting room which was nothing more than a converted hallway where seven other patients sat.
Some time later the nurse and I half carried the woman back to the ECG bed. She had calmed down, but only a little- tears still filled her blue eyes. I helped lift her feet up onto the bed and noticed her black Reebok sneakers. The same type of sneakers my own grandmother wears on a daily basis.

The ECG was performed again and confirmed the diagnosis. The woman's son arrived half way through the test, and the look of relief on her face was enormous. Like any good son he was very concerned about his mother, checking to see if she needed anything, asking what was wrong. The woman was never told the diagnosis, the son was taken to the hallway to explain the situation and she was referred to a cardiologist.

Before the woman left to go the doctor performed an abdominal exam- Hermanski's sign was positive, she had guarding in her abdomen. The main doctor came in and conferred with the one who had done the exam. They spoke in Polish, so I still don't know what they decided the cause of the pain was.

While the woman was buttoning up her shirt the main doctor turned and said to us. "So there are some problems, but I think she is faking it. She is doing this for attention."


And that is the attitude towards most patients in almost all of the departments I have visited. But, it's fair to say it was the worst in family medicine.