One of my favorite parts of clinic is seeing patients longitudinally. This is really hard, considering that we students go one or twice per month, the patient may be coming in only every few months or so, and it's by sheer luck which patient you get assigned to see that day. I've had the pleasure of seeing some patients more than once, and tracking their progress.
One of my patients today commented on how much I had improved since the last time we had met (which was almost 7 months ago if I remember correctly). The patient remarked that I seemed more confident and calm...and then apologized if I thought this was insulting. Which was sweet. I wasn't. It's so great to get that feedback and realize that you are learning a lot, even if you feel like you know nothing - which is the sentiment of pretty much every MS1.
It's the little things.
Sunday, April 27, 2014
Tuesday, April 15, 2014
Honduras trip
aka How I spent my Spring Break aka "Remember that time we almost died in Honduras?"
Spring break was a few weeks ago and I spent it doing a medical mission trip in Honduras. How I got involved was totally accidental, too. I recall receiving a mass email from the organization heading the trip, but didn't give it much thought. There would be some lunchtime presentation discussing it sometime during the middle of Block 1 so we'd probably get some reminder. But, it had completely slipped my mind until anatomy partner K brought it up. We went to the talk together and I was hooked.
I had never done something like this before and that was a huge factor in me wanting to go. Some friends had gone during undergrad, but it hadn't interested me much before. Now, I felt like I would actually be part of a team since I have an entire (!) few months of medical school under my belt. It would be an amazing opportunity to travel to Central America (haven't been!) and also get to know my fellow classmates better. If there is one thing I learned while on my senior class trip to Armenia, it's that trips like that tend to bring people closer together (or the opposite, but let's think positively!).
So I signed up. And then I learned Honduras has the #1 highest murder rate in the world. Oh joy. Well, there was no backing out now. I convinced myself that being in a group setting is not the same as being some random tourist and I also made sure to neglect to tell my mother that statistic. Ha! (As to the second "aka" above, that was a running joke between one of my roommates and me during our bus rides to the various clinic sites. Speed + steep mountains = palpitations for yours truly.)
Our team was composed of physicians, dentists, nurses, pharmacists, us MS1s, a couple of MS4s, and two undergrads. We had had biweekly gatherings prior to the trip to prepare and get to know each other better. And in Honduras, we met up with Honduran physicians and dentists, along with some translators too, to round out the group. Here we go!
DAY 1
We literally left the first day of Spring Break, in the wee hours of the morning, and returned in the wee hours of the morning on the last day. This year we would be traveling to Santa Barbara, a new location from previous years that is about a 4 hour bus ride from the capital of Tegucigalpa. And we couldn't even fly out of Sacramento. So we took a 2 hour bus ride to San Francisco, 5 hour flight to El Salvador, 30 minute flight to Tegucigalpa, and...spent the night there to avoid having an even longer travel day. To our delight, there was WiFi in the hotel.
DAY 2
Bus ride to Santa Barbara. With a pit stop at Wendy's for lunch. Seriously.
DAY 3
Today was our first day in clinic and we set up in a school in the Santa Rita area. I was assigned to Lentes for the day - doing eye exams and providing prescription glasses. I was a little glad I wasn't in Medicine on the first day so I could brush up on my Spanish before tackling patient histories. I can't believe how much I've forgotten in just a few years. I need to try and practice more often. We ended up seeing a little under 300 patients today, which is fewer than the average day, but also pretty decent for a first day.
DAY 4
Pharmacy day in Guacamaya! Drugs, drugs, and more drugs. Most of my day was spent counting pills, writing instructions in Spanish, and deciphering the hieroglyphics that is some prescriptions. I vow to write as legibly as possible when I'm grown up and an MD.
DAY 5
Free day! The original plan was to go see the Mayan ruins at Copan, but when people heard it was a 4 hour bus ride (meaning 8 hours in the bus roundtrip), they weren't so enthused anymore. I really really really wanted to see them and I'm so glad our team leaders were able to work things out so that whoever wanted to see the ruins could go while the rest could take a free day to shop or relax or whatever. I mean, c'mon, these are architectural goldmines. Could even be a once-in-a-lifetime experience. No competition.
DAY 6
My Medicine day in Sapote! I was pretty excited to work with our team leader, and kind of got a little shock when he said, "Well, you're the doctor, I'm just here to translate if need be or if you have any questions." Oh dear, I wasn't prepared for that. Glad A and I tag-teamed on a few patients so that between the two of us we could gather a more or less decent history. And then we had to come up with diagnoses and treatment plans so it was kind of cool pretending to know what we were doing. Fake it till you make it, right? Highlight of my day: diagnosing a UTI from an interview I did (alone! in Spanish!) and knowing to prescribe TMP-SMX! It helped that we had had Quiz 5 which covered all of this right before the trip. ;)
DAY 7
Don't remember the town but we passed by Lake Yojoa on the way. Was supposed to finish up Medicine today but due to some team members falling sick, I covered Pharmacy. Which wasn't so bad since I had some more responsibilities so I felt less like a human counter and more like I actually know why I'm giving certain meds to people. We saw a record number of nearly 500 patients today, bringing our weeklong total to over 1600 patients! We also broke the record for number of patients seen for this trip ever and had four clinic days only instead of the usual five. Yay team!
DAY 8
Time to go back to Tegucigalpa. We stopped midway in Siguatepeque to shop shop shop. I managed to buy a few souvenirs and would have liked to buy some more, but I ran out of cash and chickened out on using my card. I really wanted to save that for absolute emergencies and not risk falling victim to identity theft. I had let the bank know exactly when I would be out of the country but was still wary about using my card. But oh well, still got some nice canvas painting for my parents, some small woven baskets and wooden jewelry boxes, and a very interesting gift for the brother. ;)
DAY 9
Back to the USA! I was ready to leave, but also reluctant. It was nice living in a bubble and being with my classmates practically 24/7 - every night we played Banangrams and Mafia. We bonded and our team really meshed well together. I really miss our adventures already. From geckos in our bathroom to tortillas, refried beans, and plantains at every meal, this was such a wonderful experience, especially since it involved global health. What I'm really surprised about is that I didn't get sick at all. Usually when I travel, I'm the one in my family who gets sick while everyone else is just super. Just plain old good luck I guess. And finally to round out our adventures, as soon as we took off from El Salvador, the oxygen masks dropped in the row in front of us. Funny! But really, it was an unforgettable trip and I'm so thankful for our fundraising efforts - almost every single member of our team was able to cover all their costs. Amazing!
Spring break was a few weeks ago and I spent it doing a medical mission trip in Honduras. How I got involved was totally accidental, too. I recall receiving a mass email from the organization heading the trip, but didn't give it much thought. There would be some lunchtime presentation discussing it sometime during the middle of Block 1 so we'd probably get some reminder. But, it had completely slipped my mind until anatomy partner K brought it up. We went to the talk together and I was hooked.
I had never done something like this before and that was a huge factor in me wanting to go. Some friends had gone during undergrad, but it hadn't interested me much before. Now, I felt like I would actually be part of a team since I have an entire (!) few months of medical school under my belt. It would be an amazing opportunity to travel to Central America (haven't been!) and also get to know my fellow classmates better. If there is one thing I learned while on my senior class trip to Armenia, it's that trips like that tend to bring people closer together (or the opposite, but let's think positively!).
So I signed up. And then I learned Honduras has the #1 highest murder rate in the world. Oh joy. Well, there was no backing out now. I convinced myself that being in a group setting is not the same as being some random tourist and I also made sure to neglect to tell my mother that statistic. Ha! (As to the second "aka" above, that was a running joke between one of my roommates and me during our bus rides to the various clinic sites. Speed + steep mountains = palpitations for yours truly.)
Our team was composed of physicians, dentists, nurses, pharmacists, us MS1s, a couple of MS4s, and two undergrads. We had had biweekly gatherings prior to the trip to prepare and get to know each other better. And in Honduras, we met up with Honduran physicians and dentists, along with some translators too, to round out the group. Here we go!
DAY 1
We literally left the first day of Spring Break, in the wee hours of the morning, and returned in the wee hours of the morning on the last day. This year we would be traveling to Santa Barbara, a new location from previous years that is about a 4 hour bus ride from the capital of Tegucigalpa. And we couldn't even fly out of Sacramento. So we took a 2 hour bus ride to San Francisco, 5 hour flight to El Salvador, 30 minute flight to Tegucigalpa, and...spent the night there to avoid having an even longer travel day. To our delight, there was WiFi in the hotel.
 |
| We finally made it to Honduras! Photo credit: A |
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| View from our hotel room in Tegucigalpa. |
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| View from hotel balcony. |
DAY 2
Bus ride to Santa Barbara. With a pit stop at Wendy's for lunch. Seriously.
 |
| Leaving Tegucigalpa for Santa Barbara. |
 |
| Homes damaged by a mudslide. |
 |
| The streets of Siguatepeque. Photo credit: Z |
Today was our first day in clinic and we set up in a school in the Santa Rita area. I was assigned to Lentes for the day - doing eye exams and providing prescription glasses. I was a little glad I wasn't in Medicine on the first day so I could brush up on my Spanish before tackling patient histories. I can't believe how much I've forgotten in just a few years. I need to try and practice more often. We ended up seeing a little under 300 patients today, which is fewer than the average day, but also pretty decent for a first day.
 |
| The Lentes team! Photo credit: Z |
 |
| What I learned while in Central America. |
Pharmacy day in Guacamaya! Drugs, drugs, and more drugs. Most of my day was spent counting pills, writing instructions in Spanish, and deciphering the hieroglyphics that is some prescriptions. I vow to write as legibly as possible when I'm grown up and an MD.
DAY 5
Free day! The original plan was to go see the Mayan ruins at Copan, but when people heard it was a 4 hour bus ride (meaning 8 hours in the bus roundtrip), they weren't so enthused anymore. I really really really wanted to see them and I'm so glad our team leaders were able to work things out so that whoever wanted to see the ruins could go while the rest could take a free day to shop or relax or whatever. I mean, c'mon, these are architectural goldmines. Could even be a once-in-a-lifetime experience. No competition.
 |
| Traffic. |
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| Photo credit: Z |
 |
| U-C-L-A. Bruins at the ruins ;) |
DAY 6
My Medicine day in Sapote! I was pretty excited to work with our team leader, and kind of got a little shock when he said, "Well, you're the doctor, I'm just here to translate if need be or if you have any questions." Oh dear, I wasn't prepared for that. Glad A and I tag-teamed on a few patients so that between the two of us we could gather a more or less decent history. And then we had to come up with diagnoses and treatment plans so it was kind of cool pretending to know what we were doing. Fake it till you make it, right? Highlight of my day: diagnosing a UTI from an interview I did (alone! in Spanish!) and knowing to prescribe TMP-SMX! It helped that we had had Quiz 5 which covered all of this right before the trip. ;)
DAY 7
Don't remember the town but we passed by Lake Yojoa on the way. Was supposed to finish up Medicine today but due to some team members falling sick, I covered Pharmacy. Which wasn't so bad since I had some more responsibilities so I felt less like a human counter and more like I actually know why I'm giving certain meds to people. We saw a record number of nearly 500 patients today, bringing our weeklong total to over 1600 patients! We also broke the record for number of patients seen for this trip ever and had four clinic days only instead of the usual five. Yay team!
DAY 8
Time to go back to Tegucigalpa. We stopped midway in Siguatepeque to shop shop shop. I managed to buy a few souvenirs and would have liked to buy some more, but I ran out of cash and chickened out on using my card. I really wanted to save that for absolute emergencies and not risk falling victim to identity theft. I had let the bank know exactly when I would be out of the country but was still wary about using my card. But oh well, still got some nice canvas painting for my parents, some small woven baskets and wooden jewelry boxes, and a very interesting gift for the brother. ;)
 |
| Laka Yojoa. Photo credit: Z |
 |
| Painting of Lake Yojoa for my parents. Any resemblance? |
 |
| More goodies. |
Back to the USA! I was ready to leave, but also reluctant. It was nice living in a bubble and being with my classmates practically 24/7 - every night we played Banangrams and Mafia. We bonded and our team really meshed well together. I really miss our adventures already. From geckos in our bathroom to tortillas, refried beans, and plantains at every meal, this was such a wonderful experience, especially since it involved global health. What I'm really surprised about is that I didn't get sick at all. Usually when I travel, I'm the one in my family who gets sick while everyone else is just super. Just plain old good luck I guess. And finally to round out our adventures, as soon as we took off from El Salvador, the oxygen masks dropped in the row in front of us. Funny! But really, it was an unforgettable trip and I'm so thankful for our fundraising efforts - almost every single member of our team was able to cover all their costs. Amazing!
 |
| Pupusas during our layover in El Salvador. |
Saturday, April 12, 2014
The other side
This week we had Rheumatology case presentations for our Immunology class. We were divided into small groups and each member was supposed to act out a part of the patient care team. My group was assigned Systemic Lupus Erythematosus (yes, sometimes it IS lupus!) and I happened to play the part of the patient.
So many times we provide diagnoses and treatment plans to patients - in Doctoring, in clinic, etc. - and may not think too much about them. We come to the conclusion based on the history, the physical exam, lab tests and values, and clinical judgement. It makes sense to us and we explain that as best as we can to the patient. But while I was pretending to the be the patient, I realized just what it's like to be on the other side. This wasn't just a regular PCP appointment, "Hey, you're fine! See you next year." kind of deal. SLE is pretty much a lifetime diagnosis. Yes, it can be managed, but I felt overwhelmed taking that in, especially when you are trying to make sense of these lab values even though you don't have any idea what they mean. You go to see your doctor, concerned about certain symptoms, and then are dealt this huge diagnosis as the cause.
Something to think about.
So many times we provide diagnoses and treatment plans to patients - in Doctoring, in clinic, etc. - and may not think too much about them. We come to the conclusion based on the history, the physical exam, lab tests and values, and clinical judgement. It makes sense to us and we explain that as best as we can to the patient. But while I was pretending to the be the patient, I realized just what it's like to be on the other side. This wasn't just a regular PCP appointment, "Hey, you're fine! See you next year." kind of deal. SLE is pretty much a lifetime diagnosis. Yes, it can be managed, but I felt overwhelmed taking that in, especially when you are trying to make sense of these lab values even though you don't have any idea what they mean. You go to see your doctor, concerned about certain symptoms, and then are dealt this huge diagnosis as the cause.
Something to think about.
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