Oy

Well it was my first full day in the clinic and I am so tired… so I am resulting to lists…….

this morning:

got up, ate breakfast, had a devotion with the whole staff on forgiveness, cleaned out the clothles closet all morning

had lunch

this afernoon: saw a patient with Trichomonas, saw a patient with Acathanosis Nigrasis (sp…I will fix later), saw a patient with strange unexplainable neuropathy that has been worked up by doctor in Europe it seemed, saw a URI in a college student, went and helped run the kids club for two hours.

this evening

went out for chinise with our supervisors who we cannot decide if they like us or if we drive them a little nuttY! We are hoping for the former. The guy is very, very solf spoken even Emily has trouble hearing him. SO I of course have trouble hearing him. And its hard in clinic some times but I think it will get better in time. I want to earn their trust.

We had a long talk which I want to write more about tomorrow about residency in Romania and the health care system in general ending with a discussion of Roma (gypsy culture)…. praz that tomorrow I will be more awake!!!

Pa!

Back in Bucharesti….

I am so oddly content to be back in Romania. It is an odd sort of homecoming considering I don’t speak the language or even know the culture all that well. Nevertheless I am at home with being in Eastern Europe and doing service work. I was sort of amazed as we flew over and such how easy it all was. I suppose after 4 yearsof going abroad for a summer ( or for a month last summer) I have become strangely accustomed to international travel.

Last night we went to the new mall which is a lot like the central mall except even larger. I was shocked by its size and diversity of stores. Romania is certainly on the rise at least to some degree. We had Pizza Hut (I caved beacause I knew Emily would eat it) and then went grocery shoppng. We then headed home. The clinic where we are working has a second floor with a library, seating room, kicthen and call room. We are living in the call room. But after hours we have the whole floor to ourselves. So its like our own flat…for free. Quite nice.

We have been spending an hour or so each night doing language study which is going well. My grammar is non-existant but my vocabulary is growing all the time.

Today we slept in but we got up in time for lunch and one of the doctors’ birthday. In Romania it is tradition that you bring your co-workers or classmates cake on your birthday. So there was much chocolate cake and celebrating. The clinic has a prayer time after lunch and then I saw three patients. THere is a resident who has been working with the Hansons (Drs) for several months but he is nearly done. He did a good job teaching me, I did not get too much hands’ on experience but I think they were mostly feeling me out today to see what I knew and what I could do. We are having a meeting tomorrow to discuss what our duties will be each day. I am still working out the logistics but hopefully we will go the orphanage/do research twice a week and then work here three days a week.

Patient wise I saw a mole excision procedure on a Romanian 12 yr old, a 22 yr. mormon researcher/former misssionary to Romania with a hernia and a 30 yr old (who oddly works for the IMB (Southern Baptist Mission Borad) with an enlarged Thyroid. We discussed religious freedom post-communism with the Mormon and the high pervalence of thyroid problems in certain regions of Romania with the Thyroid case. My attending does a good job with patient education which is a forgien concept here. Its really interesting to see how he incorperates public health and education into his practice.

I am so tired…that night of no sleep flying over here is still being paid off (maybe I am not such a vetran at this after all. ) But there is lots to say that I will blog tomorrow (first jaunt out into the city, more impressions of the clinic, long covnersation with young social worker, etc)

Pa!

Leaving on a jet plane…

well its all packed…by some miracle all of the donations fit in the two extra suitcases and all my doctor stuff fit in my carry on….

I am sitting on my bed looking out over the mt. Virginia is so  green this time of year. Despite the fact I only lived in this house for 2.5 years before heading down to Wake, it is more home than anywhere else even DC where I lived the longest. It is a wonderful place to retreat to when I am tired of traveling and schooling.

but for now…off I go!!!!!!!!!!!!!!!!!!!!!!!!

Eastern Europe Calls

-the smells of homemade bread, wine, honeysuckle, fish

-the taste of black coffee, pastry, bread, dried fish, European chocolate, of tea, of cabbage and potato soup, of cherries
-the feel of the weight of a toddler in my arms, a hand with chapped skin, a rubber ball in my hand, a kerchief on my head, of dust on my hands from the road and the wheelchair, of the grimy poles on the buses and the sensation of nearly falling as I hold on for dear life

-the sounds: of barking dogs, of music in the courtyard, of grandmothers sitting on the bench in the park, of children yelling, of horns honking

-the sight of: the People’s Palace, cherry trees, trees with white paint on them, rows and and rows and rows of grey apartment blocks, rows of cribs, tiny hands reaching up, swings and scrapped knees

I am so ready to be immersed in  all of it again.

yet also so anxious..

Despite all the craziness of this week with Raena moving out and Karen and me trying to rearrange everything we own and me trying to frantically pack and prepare for every possibility and still be awake enough the next day to keep up in clinic I am excited and I can’t believe its really happening

I am so excited yet so anxious. I am not anxious about leaving home (although I am sad about not seeing Ren or my med school girls for a while but I am used to long distance relationships by now). I am not anxious about flying across the world. I am not anxious about living in the developing world or working in a place where I don’t speak but a little of the language. I am not worried about going. I am worried about retracing my steps and coming back.

I am taken back to my last visit to Dupont. It was 24 hrs. after arriving at Regan from Bucharest. I was exhausted, jet-lagged and my senses were overwhelmed by the cleanliness, brightness and friendliness of America. All of the sudden as I walked into the brand new orthopedic care center waiting room I am paralyzed by what I see. I don’t know rather to cry or scream. There are children everywhere, children just like me. And I realize I just came from a place full of people like me but where there are not smiling, laughing children zooming around in wheelchairs, bouncing on crutches, signing a story, working on homework. Instead there are endless rooms with cribs and cots of frail, clammy, grimy children with death grips and haunting glances that ask you a single haunting question why not me? Why not me? Why not take me home? Why not care for me? Why not treat my diseases? Why not teach me? Why not give me a chance?

I resisted sitting among them. I felt so removed from them yet I knew in my saner parts that I belonged here. Finally my knees could not take the indecision. I sat down in one of those colorful waiting room chairs and rejoined the world of the living. I just broke inside as I did it, it was just so unfair. Why not me? Why was I here and not there? Why was I on my way to med school and not in a bed somewhere or even dead? I managed to get through the appt and then fled home.

This time home is medical school. Home is the very thing that nearly led me to a state of hysterics. I can’t run and I can’t hide. It will be all around me, everyday, all day.

My research PI splits his time between working as a peds ID at Wake and as the head of two pediatric AIDS program one in India and one in Africa. How does he do it? How does he jump between worlds? How does he sleep at night? How does he not start smuggling children in his suitcase?  Maybe he pulls it off because he has seen so much he is numb. Maybe he pulls it off because he can remove himself from his patients. Does he never ask Why not me?

A little bit of practice….

I love being in clinic. Seriously its so much fun. I hope I still love it in 10 years… I even didn’t mind being in a family med clinic, although I did get very excited when we saw kids…

Chronic Pain Clinic

I saw three or four patients who had pain contracts with my attending. One patient had a form of Elher-Dalhoe’s (kind of distantly like Kniest) even. Despite my constant attempt to suppress the little judge that lives just south of my spleen, he was very persistent. I couldn’t help but compare their situations to my own and I couldn’t help but look at their decision to take neurotics as a negative one. I tried so hard to remain neutral and impartial but it was so difficult. I felt a little sad each time a patient would leave with more drugs and would not hear of any alternative to them. My attending who himself has a chronic health issue (very different than mine) told me that my response was completely normal and that I had a right to an opinion on the topic. He said I would become more impartial as time wore on although no less secure in my own standards. I hope he is right.

Kids, kids, kids!!!!!!!!!!!!!!!!!!!!!!!!!

Every time a kid would come in, I would get so excited. We did a handful of well child checks in which my attending would allow me to participate more and more in as the 2 weeks went on. I realized as time went on that I had never really attempted to examine a kid and for all my talk about peds had no clue what I was doing in the beginning. On my last day there we had 2 kids come with URIs, he handed me their chart and told me he was going to take care of the elderly woman in the next room. It was 2 brothers a 3 yr old and a 5 mon old. I walked into the room and tried to act like I knew what was going on. I got a decent history from the Mom/ 3 yr old. Then came the PE part. Now my PE skills have improved dramatically and I have a half decent shot of doing things well on an adult. But as much as I love kids, its hard to get them positioned and cooperating for a good PE. I was totally blessed with the world’s most cooperative 3 yr old. He was completely ok with having his ears, mouth, heart and lungs examined. I didn’t even have to put him in his Mom’s lap. Then came the 5 month old. He was not as easy but after some play with my stethoscope and sitting with Mom, I got at least a glimpse  of everything I needed to see. I presented the cases to my attending and was throughly pleased with myself. I had not done a perfect job but in 2 wks I went from having never laid hands to examine a child to doing a full URI work up on a pre-schooler and a infant on my own. And I generally enjoyed the extra effort and creativity it took to get the kids to cooperate.

I had one kid from the class I teach at church show up in the clinic. And it was really neat to see him another setting and be a part of his care.
Heart Sounds, Blood Pressure and UTIs (Urinary Tract Infections)
Med school is at times a very, very FUTILE endeavor! I know that I don’t know that much about anything yet but there were times where I was still very frustrated with how little I knew. My attending asked me, “What is the most common cause of UTIs?” And I admit, I have no clue despite the fact I have already had micro. He says, “Ok let me give you a hint, gram negative, lactose fermenting rod.” And I think in my head E-coli…but NO it can’t be e-coli that causes various forms of GI distress. So I come up with some alternate answer… the answer is of course e-coli. I go home at lunch and I look up my e-coli lecture. There are 30 slides on EHEC, ETEC, EPEC….(traveler’s diarrhea in various varieties of severity), there is one sentence about E-coli being the most common causes of UTIs… UGH! How frustrating. The UTI fact is much more important relevant yet that fact was not on my exam.

I knew my heart sounds knowledge was weak. We have not done cardiac phys  yet and I really had only heard normal heart sounds. So I  was somewhat ashamed at my igorance when my attending started asking me what part of the cycle murmurs were from. But by the end of 2 weeks my skills had again improved dramatically and I was getting at least OK at differentiating systolic and diastolic murmurs.

My worst part of PE coming into my clinic experience was taking Blood Pressures. There is simply too much to do. I can’t hold on to everything and listen all at the same time. But I finally figured out that if I have the patient hold the bell of the stethoscope, I could actually  quite accurately get the BP. I am so grateful that this problem has finally been cleared up.

Procedures: Pap Smears, Heamatomas, Stitches and More

I have the world’s coolest attending who for some insane reason let’s me a mere first year get all kinds of hands on experience. I can talk to people all day long. I can take histories and listen to people’s stories till the cows come home but put a needle in my hand and I panic. To some degree I have a complex, I have had folks telling me since I decided to go into medicine that my hands will make procedures difficult and thus I believe they will. But the truth is I am not half bad at procedures, in fact with practice I am half decent.  I managed to tie my first suture, do a pap smear, 3 blood draws and drain the biggest hematoma I have ever seen…. Ok picture this, 25 yr old big atheletic guy gets his leg pinned to a wall by the tailpipe of a car. The guy is fine except for the fact his leg is three times bigger than the other. After a ultrasound, we discover he has a massive (like 1.5 ft by .5ft) hematoma. A week after the accident the leg had still not gone down so we decided to try to drain a little off. My attending sticks an 18 gauge needle in and nothing happens. He takes it out and all of the sudden blood spurts across the room, after quickly finding a basin, our patient proceeded to “leak” 500 ml of fluid. We stopped the bleeding at that point. 2 days later 500 more and 3 days after that, my attending handed me a 16 gauge needle and said GO. Scary…I know, me with a 16 gauge needle in my hand….

Surprise, surprise, surprise…

I was shocked how much I enjoyed taking care of elderly patients. I enjoyed listening to them and taking their histories. Not because they were complicated and usually had a variety of medical problems but because a good portion of their therapy seemed to be talking to someone about it all. Even the ones we could do next to nothing for seemed to leave genuinely pleased that we had taken time to at least listen to their problem and acknowledge their situations.

I quickly realized that continuity of care and variety are both important to me. I really thought prior to this that neither of these two aspects were all that important to me. But I really enjoyed building relationships with patients. One of my favorite patients turned out to be the guy with the hematoma because he was there every 2 days so I had a chance to get to know him and his family. The other than I really loved about family med was the variety. Take one hr of last Wed morning: 9 mon old well child check, STD check on 22 yr old Gay college student, med check on a 80 yr old, Pap smear and check up on a 40 yr old.  I loved the randomness of the primary care setting. I thought I would get bored in a primary care setting and there were mornings where I had 3 Back Pain cases in a row or 4 URI (colds).

The Thursday before I started clinic I shadowed a pediatric genetics specialist and although I enjoyed that too. I enjoyed family med so much more. I really think I will either end up in general peds or family med. It will be interesting to see how much I still love family med after 8 weeks of it in a foregein  language.