What a crazy morning! I was woken up around 7 am, by my on-call telephone. I’ve been getting to manage the ER since most of doctors skipped out this weekend and they were calling me for a patient. The patient had abdominal pain and it turned out to be a bad gall bladder. The crazy part was that while I was taking her history the nurse rushed in and told me I needed to come with her. She explains to me that a woman came in that was in labor and she is having the baby right now!! They had tried calling Dr. Sierra, but he wasn’t answering his phone. Holy smokes, I was nervous! I didn’t know anything about her history or complications. When I ran into the room she was crowning. She was going to have the baby any second. It was one of Dr. Lazo’s patients that I had seen with him a few days ago, so I knew a bit about her history. I knew she was close to term and that she hadn’t had any complications during her pregnancy. I slipped on a gown and gloves as fast as I could and as soon as I did the baby was coming. It didn’t take much and the baby was out. I caught it, suctioned, clamped the cord, cut it and handed the baby to the nurses. The placenta delivered nicely and all was well. Luckily, there weren’t really any complications and it was a pretty routine delivery. The only problem was that she tore a bit due to the fast delivery, 2nd degree. I had never really sewed that up by myself, I had seen a few, but honestly couldn’t remember the exact technique used. I didn’t really have a choice though, so I just started sewing and it actually turned out really good. The nurse was impressed. I’m definitely going to need more training in that though. Dr. Sierra finally showed up and kind of took over and I went and ate breakfast. Thinking back I can’t believe how scared I was. Up to this point, in whatever I’ve done, I’ve always known that I had the attending physician to fall back on. This time I didn’t and it scared the living daylights out of me. Luckily it was a routine delivery, but I knew pretty well what I was doing, so I shouldn’t have been too nervous, but I was. Being an intern is going to be one scary experience, I can’t even imagine.
There were only a few other ER patients today, but Dr. Sierra let me see a few of his patients in the clinic. All-in-all it was a pretty amazing day. Tomorrow is the Sabbath for the Adventists so all is closed down. I imagine there won’t be many ER patients, but you never know I guess. I’m actually surprised at how slow the ER has been so far. I would think that there would be more patients with all the people in the area, but I guess the hospital in San Ignacio is only a few miles away and it’s much bigger, so I’m sure most people would go there if they could. Things are so much different here with their medications. It gets pretty frustrating and probably makes me look like an idiot. For some reason, they hardly ever use narcotics. For most pain they only use ibuprofen or diclofenac (which is similar to ibuprofen). Today, the woman having the gall bladder pain was still in quite a bit of pain so I asked what they had for pain besides NSAIDs. She said codeine, Demerol, and some injectable morphine. That’s it. No lortab, oxycodone, Percocet, vicodin, dilaudid, etc. Weird. Well, I told the nurse to give her some Demerol, and then went and told the doctor what was going on. He was really nervous, like, “Oh. I wouldn’t give her Demerol.” So, I wondered why not and he just said it is way too strong, like it was dangerous or something. I’m thinking, Demerol is weak sauce compared to other narcotics. Well, instead he wanted to use something I had never heard of. In fact, about every medication we used on her today I had never heard of. They are these combinations of some kind of anti-fever/pain medication and anti-spasmodic. I couldn’t even find the drugs in my epocrates so I just said, whatever, and did what he said. Maybe we are just wimps in the U.S. They give a mom after delivering no more than ibuprofen and I’m doubting that they have the capabilities of an epidural. In the US she gets an epidural and plenty of lortab. Pretty interesting, I must say. Another interesting, somewhat unrelated tidbit, Ardis just stopped by to bring me dinner, as chatting with her, she said they don’t have any oncologists here in Belize! That’s crazy. She says if you get cancer here it is a death sentence, because they currently have no cancer center in the country. I guess they do have a pretty limited health care system. That makes sense considering they have a medical student managing their ER right now!
So, I’m wondering if the staff thinks I’m stupid being that I don’t know all their medications. It’s just a lot different and that makes it difficult. It doesn’t help that all the medications in the pharmacy are in Spanish either.
This evening was a pretty interesting experience. About 11 pm I got a call to come in to the ER. There was a 29 year old male with fever, sweating, diarrhea. When I got there and started interviewing the guy I thought he was just acting really weird, kind of lethargic. I asked his friend if he usually acted like this and he said yes. He was oriented, but just seemed really slow, but since I didn’t know him I wasn’t sure. He was drenched in sweat, he had a bit of a fever – but had previously been like 107 earlier that day, and he had had a couple bouts of diarrhea earlier that day, but just loose stools. I started giving him IV fluids and something for fever and nausea, but then I wasn’t too sure what to do. One of his friends with him was actually a doctor from England – he said he was acting really confused to him too, so we decided it would be best to admit him and keep him overnight, then run some tests in the morning. I had to wait till the morning because the lab was closed and they couldn’t get a hold of anybody. Isn’t that crazy! Nobody around to do labs, this is so different. Well, I didn’t really know their process for admitting patients so I tried to call Dr. Sierra. Well, he just didn’t answer his phone. I couldn’t believe he wouldn’t answer his phone, being that I’m only a student managing the ER. Well, anyway, I just wrote an admit note like we do in the US and told the nurses what I wanted. By the time I left that evening I checked on the patient and he was already doing much better. He was like a different person, talking normally to me, no more confusion or sweating. I guess he had just gotten dehydrated. Well, after I finally got some labs this morning (I’m actually writing this the next day) I found out that he had entaomeba histolytica in his stool, meaning he had amebic dysentery. He was doing so well this morning that I sent him home with some medications for the dysentery. It was pretty cool because I had never seen anyone with that problem before and I got to see him from start to finish throughout his stay. I feel pretty good about his course, but the only confusing this was that he had these raised rashes on his legs that looked really familiar to me. I looked at my tropical disease book and the rash looked like cutaneous larval migrans, which is a worm infection that gets in your skin. I had never seen it in real life though so I wasn’t sure. All of the tests I ran didn’t point to that diagnosis and his history didn’t really point to that, so I didn’t follow it any further, but it was kind of interesting. I wonder if he has a worm digging through his skin? Probably not. I guess if he comes back I’ll treat him for it.
I was able to spend a bit of time on the internet today. I applied to residency on Tuesday of this week to Family Practice, so I guess it’s final that I’m going to be doing that, specifically rural. I actually feel really good about it. I know there are going to be some drawbacks to the field, like low compensation, lack of prestige, being on call a lot, and it’s going to be really difficult to learn everything since rural FPs need to have such a broad knowledge, but I actually feel really good about my decision. I feel like this is where I’m supposed to be and that says a lot since I’ve never felt anything has clicked until now. I applied to 25 programs, definitely a lot for family practice, but I just didn’t want to leave anything to chance. I’ve already received 7 interviews so I’m very excited about that. The only problem is none of the interviews are in my top ten programs. They are Alaska, Cheyenne WY, Casper WY, Las Vegas NV, Montana, Yakima WA, and the University of Utah. I’ll probably go to the U of U interview just because its home, but honestly, I’m not too keen on going there for residency, at least at this point. They just don’t have a lot of the things I want in a residency and over the years the U of U medical department has just left a bad taste in my mouth. They’ve always been such a hassle for me to deal with for some reason. I was also looking for more of a community-type setting where I wouldn’t be competing with residents of other specialties. Even though I haven’t received interviews to my top programs yet getting so many that’s fast keeps me confident that I will be able to interview at my top places.
Well, I hope I’m not boring any one, but one of the main reasons I did this blog was to kind of keep a journal of my experiences instead of writing in my own personal journal. Then I am going to use one of those companies that convert your blog into an actual book. Also, this is mainly for Jess too, so I’m just kind of chatting about whatever is happening in my life right now.
Anyway, wish me luck. Until next time. . .
There were only a few other ER patients today, but Dr. Sierra let me see a few of his patients in the clinic. All-in-all it was a pretty amazing day. Tomorrow is the Sabbath for the Adventists so all is closed down. I imagine there won’t be many ER patients, but you never know I guess. I’m actually surprised at how slow the ER has been so far. I would think that there would be more patients with all the people in the area, but I guess the hospital in San Ignacio is only a few miles away and it’s much bigger, so I’m sure most people would go there if they could. Things are so much different here with their medications. It gets pretty frustrating and probably makes me look like an idiot. For some reason, they hardly ever use narcotics. For most pain they only use ibuprofen or diclofenac (which is similar to ibuprofen). Today, the woman having the gall bladder pain was still in quite a bit of pain so I asked what they had for pain besides NSAIDs. She said codeine, Demerol, and some injectable morphine. That’s it. No lortab, oxycodone, Percocet, vicodin, dilaudid, etc. Weird. Well, I told the nurse to give her some Demerol, and then went and told the doctor what was going on. He was really nervous, like, “Oh. I wouldn’t give her Demerol.” So, I wondered why not and he just said it is way too strong, like it was dangerous or something. I’m thinking, Demerol is weak sauce compared to other narcotics. Well, instead he wanted to use something I had never heard of. In fact, about every medication we used on her today I had never heard of. They are these combinations of some kind of anti-fever/pain medication and anti-spasmodic. I couldn’t even find the drugs in my epocrates so I just said, whatever, and did what he said. Maybe we are just wimps in the U.S. They give a mom after delivering no more than ibuprofen and I’m doubting that they have the capabilities of an epidural. In the US she gets an epidural and plenty of lortab. Pretty interesting, I must say. Another interesting, somewhat unrelated tidbit, Ardis just stopped by to bring me dinner, as chatting with her, she said they don’t have any oncologists here in Belize! That’s crazy. She says if you get cancer here it is a death sentence, because they currently have no cancer center in the country. I guess they do have a pretty limited health care system. That makes sense considering they have a medical student managing their ER right now!
So, I’m wondering if the staff thinks I’m stupid being that I don’t know all their medications. It’s just a lot different and that makes it difficult. It doesn’t help that all the medications in the pharmacy are in Spanish either.
This evening was a pretty interesting experience. About 11 pm I got a call to come in to the ER. There was a 29 year old male with fever, sweating, diarrhea. When I got there and started interviewing the guy I thought he was just acting really weird, kind of lethargic. I asked his friend if he usually acted like this and he said yes. He was oriented, but just seemed really slow, but since I didn’t know him I wasn’t sure. He was drenched in sweat, he had a bit of a fever – but had previously been like 107 earlier that day, and he had had a couple bouts of diarrhea earlier that day, but just loose stools. I started giving him IV fluids and something for fever and nausea, but then I wasn’t too sure what to do. One of his friends with him was actually a doctor from England – he said he was acting really confused to him too, so we decided it would be best to admit him and keep him overnight, then run some tests in the morning. I had to wait till the morning because the lab was closed and they couldn’t get a hold of anybody. Isn’t that crazy! Nobody around to do labs, this is so different. Well, I didn’t really know their process for admitting patients so I tried to call Dr. Sierra. Well, he just didn’t answer his phone. I couldn’t believe he wouldn’t answer his phone, being that I’m only a student managing the ER. Well, anyway, I just wrote an admit note like we do in the US and told the nurses what I wanted. By the time I left that evening I checked on the patient and he was already doing much better. He was like a different person, talking normally to me, no more confusion or sweating. I guess he had just gotten dehydrated. Well, after I finally got some labs this morning (I’m actually writing this the next day) I found out that he had entaomeba histolytica in his stool, meaning he had amebic dysentery. He was doing so well this morning that I sent him home with some medications for the dysentery. It was pretty cool because I had never seen anyone with that problem before and I got to see him from start to finish throughout his stay. I feel pretty good about his course, but the only confusing this was that he had these raised rashes on his legs that looked really familiar to me. I looked at my tropical disease book and the rash looked like cutaneous larval migrans, which is a worm infection that gets in your skin. I had never seen it in real life though so I wasn’t sure. All of the tests I ran didn’t point to that diagnosis and his history didn’t really point to that, so I didn’t follow it any further, but it was kind of interesting. I wonder if he has a worm digging through his skin? Probably not. I guess if he comes back I’ll treat him for it.
I was able to spend a bit of time on the internet today. I applied to residency on Tuesday of this week to Family Practice, so I guess it’s final that I’m going to be doing that, specifically rural. I actually feel really good about it. I know there are going to be some drawbacks to the field, like low compensation, lack of prestige, being on call a lot, and it’s going to be really difficult to learn everything since rural FPs need to have such a broad knowledge, but I actually feel really good about my decision. I feel like this is where I’m supposed to be and that says a lot since I’ve never felt anything has clicked until now. I applied to 25 programs, definitely a lot for family practice, but I just didn’t want to leave anything to chance. I’ve already received 7 interviews so I’m very excited about that. The only problem is none of the interviews are in my top ten programs. They are Alaska, Cheyenne WY, Casper WY, Las Vegas NV, Montana, Yakima WA, and the University of Utah. I’ll probably go to the U of U interview just because its home, but honestly, I’m not too keen on going there for residency, at least at this point. They just don’t have a lot of the things I want in a residency and over the years the U of U medical department has just left a bad taste in my mouth. They’ve always been such a hassle for me to deal with for some reason. I was also looking for more of a community-type setting where I wouldn’t be competing with residents of other specialties. Even though I haven’t received interviews to my top programs yet getting so many that’s fast keeps me confident that I will be able to interview at my top places.
Well, I hope I’m not boring any one, but one of the main reasons I did this blog was to kind of keep a journal of my experiences instead of writing in my own personal journal. Then I am going to use one of those companies that convert your blog into an actual book. Also, this is mainly for Jess too, so I’m just kind of chatting about whatever is happening in my life right now.
Anyway, wish me luck. Until next time. . .
Patricia and Blanca at the nurses station
I'm glad that Ardis is feeding you. And from the sounds of everything else, I don't think that guy will mind having worms in his leg. At least it's not cancer.
ReplyDeleteAnd yes. Americans are wimps if you ask me. Good job sewing her crotch up!