Chronicles of a Student-Doctor #3

CHAPTER 3: ANESTHESIOLOGY POSTING.

Welcome to the Anesthesiology Unit.
In my opinion, this unit is where the real fun in the medical field lies. It’s one of the aspects of Medicine that literally leaves non-medical personnel mesmerized (Pun intended).

Yes, the Anesthesiology team is in charge of all the beeping machines you see in the Operating Theatre and the Recovery room.

(Photo-credit: WEB)

Anesthesiologists are awesome. They give special effects to the drama that takes place in the operating room. I see them as the behind-the-scene characters that make surgical “productions” a reality.

I can understand if you’ve never heard of them before. Anesthesiologists aren’t the most popular among Doctors. I became aware of that field of medicine about 4 years ago, when my mom had to undergo a major surgery. I was in the room with her when a doctor came in and introduced himself as her Anesthesiologist. He explained what he was going to do during the procedure and so forth, and I casually took in the information. I obtained more knowledge about what the Anesthesiologists really do on starting my clinical rotations.

(Photo-credit: WEB)

Whereas the Surgeons are admired for their courage and skillfulness in handling both the scalpel and knife, the Anesthesiologists are really the ones technically in charge of the unconscious patient lying on the operating table. Hence, I think they deserve more credit as well. 
I had a memorable time in that posting. I saw and learnt a lot too. I had the opportunity to observe a wide range of lots of procedures across several specialities. My Preceptor, Dr. Mandel was a nice, elderly gentleman who preferred the more traditional approach to Medicine. He sometimes painted scenarios of what to do in a place where standard medical facilities are not available. A good grasp of Physiology and Pharmacology was required from we his students.  There were two other doctors and two Nurse-Anesthetists on the team as well. 

ANESTHESIOLOGY DAY 1: Selfie…

I especially liked the flexibility of our schedule (morning or afternoon shifts on alternate days, or as specified); since we had to stay in the Operating Theatre all day.

Let me briefly show you how we roll on a typical day.
It’s the day of your surgery, preferably an Elective Procedure (maybe an Epigastric Hernia repair, nothing really serious) and you would need a General Anesthesia. 
You’ve been wheeled through the doors of the operating theatre and you are lying on the operating table. We now await the scrub nurses and their assistants as they setup for the procedure. The Surgeon and his Assistant are ready to scrub in as well.

The first thing we do as the Anesthesiology team is to chat with you. We want you to feel as comfortable as possible and attend to any concerns you have about your procedure.

***

“Ms. K, how do you feel today?”


“It’s okay to feel a bit nervous but we would like you to try and relax.”


“Hope you haven’t had anything to eat or drink since night?”


“Good.”

***

As we chat with you, we go through your medical chart. We want to ensure that you have no comorbidites (especially Hypertension or Diabetes Mellitus) that may put you at increased risk of complications during the surgical procedure.

If you are over 40 years of age, we want to see that you have the results of your Complete Blood Count (CBC), kidney function test (UCE), Chest X-ray and Electrocardiogram (EKG).

In addition, we need to ensure that you have an intravenous line running, we can’t always predict hemorrhage, so we also have to make sure a request has been sent to the Blood bank for a cross and match (in case a blood transfusion is required).

We start by placing EKG leads on your chest and connecting those to a monitor. We also put a pulse oximetry machine on one of your digits, as well as the Blood Pressure cuff on your arm. All these are done so that we can monitor your vitals (Blood Pressure, Heart rate, SP02, Heart tracing etc) as the procedure progresses.

Now that the nurses are set and the surgeon has scrubbed in. It’s time for you to go to sleep.

First we inject you with an anesthetic agent that makes you drowsy (PROPOFOL a milk-like suspension, is the most widely used); followed by a neuromuscular blocking agent (like SUCCINYLCHOLINE) to help facilitate the intubation process. After that, we cover your nose with an oxygen mask and ask you to take in some nice and gentle breaths.

In a little less than 2 minutes, you’re well sedated and unconscious. The next step is to do a Tracheal Intubation. This involves the placement of a flexible long tube through the back of your throat into your lungs to facilitate adequate ventilation during the surgery procedure.  

(Photo-credit: WEB)

Image: Tracheal Intubation

As soon as we are done, the surgeons can proceed. On our part, we continue to monitor your vitals and ensure you have an adequate anesthetic depth. We also give you Analgesics to ensure you don’t experience critical pain following your surgery, and Antibiotics as prophylaxis against Nosocomial Infections. 

(Photo-credit: WEB)

Once the surgery is over, we give another drug to reverse the effect of the anesthetic agent. We then extubate, ensure you’re awake and breathing adequately before transferring you to the recovery room. There you are monitored for a few hours to see that you’re in stable condition before you’re returned to the WARD or discharged home. 

For more information, here’s a link to what Anesthesiologists do.

Random selfie…
Random Selfie…

So would I love to practice as an Anesthesiologist? To be sincere, I’d rather not. I think the  long (often unpredictable) hours of standing would be way too demanding on my body. Anyway, cheers to all who choose to go through this dynamic path.
                                               ***
GLOSSARY:-

ANALGESIC: A drug primarily used to provide relief from pain.

GENERAL ANESTHESIA: A medically induced coma and loss of protective reflexes resulting from the administration of one or more anesthetic agents; with the aim of ensuring unconsciousness, amnesia, relaxation of skeletal muscles and loss of control of the autonomic nervous system (WIKI).

NOSOCOMIAL INFECTIONS: Also known as Infections acquired in the Hospital or other Healthcare facilities. 
Thank you for reading! 

~requ1ne~

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Chronicles of a Student-Doctor #2

CHAPTER 2: ENT (EAR, NOSE & THROAT) POSTING

Welcome to Otolaryngology (also called Otorhinolaryngology) department.

More than anyone else, we are concerned about what happens to your Ear, Nose and Throat. This is because we understand how those relatively unimportant parts of the human body can cause such great discomfort whenever something is out of place. You can count on us to do all we can to help you get better.

(Image-credit: WEB)

I resumed to ENT clinic with little or no knowledge about what it actually involved, asides Ear infections. Well, I had an unfortunate episode of Otitis Externa (Outer Ear Infection) few months after I got into medical school. Initially, I thought it was no big deal and I could manage by myself until the pain became so unbearable that I couldn’t even attend classes. I had no choice but to see a Doctor. Of course, the relief I got after some days of treatment (with antibiotics and corticosteroids) was priceless. I’ve never since taken my ears for granted.

My experience in ENT was great. Not only did I learn more about that specialty of medicine, I was also able to pick up some valuable life-lessons as well.

We had outpatient clinic on Tuesdays and Surgery on Thursdays. My amiable Preceptor, Dr. Thomas, had a private practice as well, and we went there every other day in the week.

 

(Photo-credit: WEB)

 

After my first few days, I got the hang of using an OTOSCOPE and stating my differentials based on what I saw inside a patient’s ears.

 

(Photo-credit: WEB)

 

I also learnt how to perform the Weber and Rinne tests (to check for conductive or sensorineural hearing loss) with the aid of a tuning fork.

Youtube link. (All Access Medicine)
Most of the patients were student-friendly, so I clerked a good number of them.

 

(Photo-credit: WEB)

 

In the clinic, a typical day is spent examining, listening to, reassuring, prescribing medications and giving patients bits of advice about their health. The Doctor would always caution the patients against using Q-tips (cotton buds) in removing excess wax from their ear canals; but advised them to make use of drops of olive oil (or hydrogen peroxide), to soften the hardened wax, thereby facilitating its removal by the Doctor himself. (Yeah, we saw lots of wax-impacted ears and it was unbelievably gross). Impacted earwax can be superimposed with bacterial infection, so if you have an ear discharge that gives off an offensive smell or your ear itches you repeatedly, please see a doctor. 

 

(Image-credit: WEB)

 

Soon enough, all the forms of Otitis (Externa, Media and Interna), Tinnitus, Allergic Rhinitis, Acute Bronchitis, Vertigo, Nystagmus, Hyper/Hypothyroidism, GERD, Sinusitis etc, became common terms and relatively easy diagnoses for me to make.
Some surgical procedures I saw were: Tonsillectomy,  Turbinate reduction, Bilateral Antral Wash-out (BAWO), Lingual frenectomy, Thyroidectomy and Tracheostomy.

 

TEAM ENT (Preceptor flanked by some Ortho Students)

 

The Ortho folks in X-ray protective Gears.
On a particular clinic day, I got to watch the Audiometric technicians at work. It was an insightful experience.

Audiometry is the science of measuring hearing acuity, with the help of an audiometer. Results of audiometric tests are used to diagnose hearing loss or certain diseases of the ear” (WIKI).

 

(Photo-credit: WEB)

 

While most of the cases were mild, I remember a devastating case in particular, a patient presented with advanced-stage Oropharyngeal cancer. What really struck me however was my Preceptor’s display of Empathy; Despite the strong offensive odor coming from the patient’s mouth, which we all (including the nursing staff) found repulsive, the Doctor actually went ahead to touch the patient and speak words of comfort to him, without as much as a nose-mask. He taught us an important life-lesson that day, everyone needs someone to show them some care, no matter how hopeless the situation seems.


Another highlight for me, was when we had the opportunity to accompany our preceptor to give a lecture in one of the other medical schools on the island. That was my first time there and I had a great experience. I also had the opportunity of seeing some parts of the island I wasn’t familiar with.
Towards the end of my posting, the Preceptor also took us to an all-expense paid lunch in one of Vincy’s finest restaurants. And we had so much fun that I wish we didn’t have to leave.

 

(Photo-credit: http://www.panoramio.com)

Image: Cobblestone Inn, Kingstown, SVG (free advert, lol).
Then the icing on the cake for me was when he shared with us that in considering a choice of specialty, each of us should ask ourselves these basic questions:

1. What area of medicine do I like? (Interest)


2. What area of medicine am I good at? (Strength)


3. What area of medicine is needed in my immediate environment? (Need)

I have since kept these thoughts and pondered over them. I know they would come handy sometime in the near future.

***
So would I like to specialize in ENT? Your guess is as good as mine, I’d rather not. Maybe it’s because of the thought of doing surgeries…hehe, no thank you!

By the way, please note that these commonly used drugs can be toxic to your ears. Always consult your Physician for concerns about side-effects of the medications you use.
Thank you for reading!

:::Requ1ne:::


Chronicles of a Student-Doctor #1

  
CHAPTER 1: PEDIATRIC POSTING

  
Welcome to Pediatric Ward.

      

A ward of crying babies and wailing toddlers.

There you find concerned Mothers and sometimes, Fathers (or other care-givers) seated all-night nursing their sick children back to health. 

I could imagine some of them counting the days, hours, minutes and perhaps seconds, until the Doctors declare them free to take their children/wards home. 

Having a sick child is worrisome enough, but having to stay in the hospital for a couple of days or weeks, is nothing but a nightmare.
On my first day, I presented to the Neonatal unit/Newborn Nursery (attached to the Maternity ward). I saw lots of day-old babies in the Nursery, undergoing a form of newborn screening. 

 

A Neonatal Unit (Photo-credit: WEB)
 
The scenario painted appeared to be both cute and cruel. Babies whimpering at the prick of needles; wondering in their little minds why they had been separated from the warmth and comfort of their mothers’ breasts. There and then I learnt how to put on a clean latex glove, and allow a crying baby to suck on my finger in order to be temporarily pacified.
Nothing beats the innocence of new life, cuddly little beings in all their dependence and vulnerability; bringing smiles to the faces and hearts of their loved ones. Never mind the fact that the adventure is just about to begin, from the basic challenges of constantly nursing, and changing soiled diapers, to the hospital visits for well-child exams and all the routine immunizations that must be completed. Then the financial, physical, spiritual, social and psychological implications of parenting a child; and providing basic needs like food, shelter, security, education and the rest. My submission is that child-rearing is a full-time job and future parents should carefully consider that before applying.
The purpose of the newborn screening is to rule out any infection that might have been transmitted in-utero or during delivery from the mother to the baby, and other potentially fatal metabolic disorders not apparent at birth. The detection of pathologic Jaundice is considered a priority (especially in premies), to prevent the sequela of kernicterus. Fortunately, most of the babies I saw did well and were soon discharged home with their mothers.
The Neonatal unit was also responsible for receiving babies born via caesarean sections. I got to see newly delivered babies assessed at the resuscitation bay, and they were afterwards transferred to the Nursery or the NICU as the case demanded.
After sometime, I was taken to the main Pediatric ward. The Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU) were also attached to it. The Pediatric ward is the most beautiful ward in the medical facility I’m currently at. It is comparatively large, accommodating, colorful and very child-friendly. 

  

Sick kids and their care-givers have the opportunity to walk into an adjacent courtyard to enjoy the scenery of the outdoors. Often times, children who are healthy enough to play, are seen running about or entertaining each other with all sorts of games. I always find it a heart-warming scenario. 
Each day on the ward began with a pre-round with the medical intern and registrar, followed by the general round with the consultant. After the rounds, the consultant would usually have teaching sessions with the medical students. Sometimes we are given topics to present and we ask our Preceptor questions as needed. After that, we go back to the ward to clerk patients or to assist the medical intern in carrying out the tasks for the day.

On the ward, I had the opportunity to talk to parents or guardians of a number of patients, and I learnt that to get maximal information, I had to ask the right kind of questions. Everything mattered from whether the child was born prematurely or at term, to the living conditions in the home, education of the child, and the kind of food the child ate. I also learnt the basics of the physical examination and assessment of the general wellbeing of a child.

During my first week, due to the lengthy Ward rounds, I thought I would collapse because my feet were sore. As the days passed however, I developed enough stamina. I guess I caught the flu too at the earlier part of my posting, but thankfully it soon passed.

  
 
(Random-selfie: With my sweetheart, Asholly. She blogs here).
Most of the cases I saw were relatively benign conditions, like: upper respiratory tract infections, Asthma, Sickle cell disease, Pneumonia, Diabetic Mellitus, Seizures, Urinary Tract Infections and Gastroenteritis. We also had some unusual cases like Chronic renal disease, Failure to thrive, Malnutrition among others.
One major highlight of my pediatric posting was the story I wrote about this little girl in: A LESSON FROM THE WARD.
Thankfully, many of the patients I saw during that period got well and were discharged home as appropriate. Sadly, we lost a few patients too. I remember one young teen in particular that died of some sort of cancer. It was a very emotional experience because I interacted with him in person, and I still have vivid memories about it till date.
At our weekly outpatient clinics, we did lots of well-child exams for children who were born prematurely. It was always interesting to hear mothers gladly talk about their kids’ developmental milestones.

 

During the posting, I also had the opportunity to attend a sickle-cell symposium funded by the Centre for Global Health, Medical University of South Carolina organized in conjunction with The SVG sickle cell Association. And it was quite an enlightening experience.

Finally, I had one of the best Consultants in M.C.M.H as my Preceptor- Dr. R. Boyle. A diligent, approachable and motherly figure. I really admired our cute and proper intern too, Dr. Joseph. 

The Pediatric Nurses and other staff were helpful as well. My colleagues were also nice and each of them contributed to making the posting a remarkable one.

Above all I’m thankful to God, for all I learnt and the experiences I had during that period.

In considering a specialty however, I don’t think Pediatrics would be one of my top choices. I honestly believe that whoever chooses to work with really young kids (5 years and under) as a healthcare provider or daycare attendant or classroom teacher must have a remarkable level of patience. I’ve had occasions to baby-sit before, and no matter how enjoyable it seems at first, it always turned out to be hardwork. 

Don’t get me wrong, babies and toddlers are fun to be with, but my level of tolerance with nonsensical tantrums is quite low. And more often than not, in dealing with kids I come off as being very strict. I’m always like “Sit down there” “Don’t touch that” and so on. With time, I was able to understand that most kids are just naturally playful and restless, and the calm ones (like I was, as confirmed by my parents…lol) are the exception. I think it’s still safe for me to conclude that I won’t cope as a Pediatrician. Ehm, as for Motherhood, I know I will enjoy the experience! 

(Photo-credit: WEB)

*** *** ***

Glossary
:


SVG
: Saint Vincent and the Grenadines.



In utero
: during Pregnancy.



Kernicterus
: Severe jaundice in a newborn with damage to the brain leading to cerebral palsy, mental retardation, vision problems or hearing loss.



Premies
: Babies born prematurely (i.e. less than 37 weeks).



Ward rounds
: a regular (often daily) visit to patients on admission to the hospital war by medical staff, for the purpose of assessing and making relevant decisions based on each patient’s health.

Thank you for reading!

:::requ1ne:::

A DAY IN MY LIFE.

TUESDAY, 29th of March, 2016.



4:30 am
I’m awake…

But I didn’t hear my alarm ring, which is quite unusual (or did it?).

Its default setting is 4:25 am for weekdays. (I’m an early riser, just like the Proverbs 31 Woman..lol)

  

Oh and I love my alarm tone, by the way…it’s a favorite song “OVERFLOWING GREATNESS” by Lekan Oyekanmi. Y’all should listen to it here

I especially love the part that says “my future is calling me, I arise“. It gives me a reason to actually get out of bed.

For my Quiet time, today was one of the days I was wide awake enough to transport myself from my bed to the couch. Hallelujah! Relocation is one of the tools I use to wage WAR against laziness especially with regards to Prayers and Studying! 
So here’s the passage I read from:

  

My devotional focused on how we all tend to focus so much on safety that it has become an idol. Instead of stepping out of our Comfort Zone into the unknown like Peter did, many of us prefer to sit back in the boat like the remaining disciples and miss out on a once-in-a-lifetime adventure.

The message of the cross isn’t safety first, infact Jesus says “Whosoever will save his life will lose it…” (Matthew 10:39). For God to be able to do some things through us, we must be willing to trade what we know for what we don’t know. So my question is this: how safe is too safe? Think about it.

And because I’m not quite done with Easter yet, I worshipped with this songHallelujah, Jesus is Alive.

(I’m a big fan of Ron Kenoly’s music. He used to be famous in our house when I was growing up, and I still get sentimental whenever I listen to some of my old favorites).

 But really, perhaps you and I can take some time to reflect on the lyrics:
Hallelujah, Jesus is alive,

death has lost its victory,

and the grave has been denied, 

Jesus lives forever, 

He’s alive!”

After my devotion, my morning went thus, in a nutshell:

I took my bath (which lasted about 10 minutes or so. I like to time myself while in the bathroom, by playing a favorite song. That way I know if I’ve stayed too long or not. This morning, my choice was OCEANS, where feet may fail. You can listen to it here).

Bathroom

(Don’t you just love your bathroom? Well, I love mine. Most of the time. It’s top priority. I take real efforts to ensure it stays relatively neat and odour-free. My ideal bathroom would be so awesome that I should be able to have a cup of tea in there…lol.

PS: I find the picture frames a little amusing. It seemed a little out of place at first though).

Got dressed

Dresser

(Ehm, I know it’s not all that impressive but I’ll get there someday! Hehe.. I’ve always loved calendars with daily inspiration quotes and that’s one right there.)

Studied a bit, along with a quick Breakfast (A piece of Bread with a mixture of corned beef, mayo, butter, onions, mustard, etcetera; AND ol’plain WATER! I’m not a fan of Morning Tea).

half-eaten breakfast..lol

(Yes, I’m a very light eater).

And I was out of the house like a breeze! 

6:38 am

Selfie time..

So, I beat my own record by leaving the house that early (6:45 am being my daily target).

And I also had to take out the TRASH, wastes are collected on Tuesdays in the area where I live. I once wrote a related piece here.  

(But no trash pictures…lol).

BUS STOP

(I enjoy the morning walk from my house to the Bus stop. It helps to burn some calories from breakfast, and helps with building my physical stamina too. I’m currently off my workout regime. Let’s talk about this later).

7:09 am.
I arrived at the hospital.

 

(MCMH, Saint Vincent & The Grenadines)
 

The Ward was almost empty surprisingly, I guess most patients didn’t want to spend the Easter weekend in the hospital. I wouldn’t want to either, emergency or not, lol. 

Maternity Ward

So we had a very brief wardround followed by a presentation by one of the medical interns. The topic was Placenta Previa, a very important obstetric indication for Cesarean sections. I won’t bore you with the details, but here’s a link you can read from if you’re interested. 

A couple of medical students, starting their O&G posting joined us today. Of the 5 students in our group, I’m now the most senior, since it’s my final week.
 

Another selfie…
 
(Yes, I love to POUT ☺️😉).
The day went pretty fast, as we busied ourselves. I got to clerk just one patient, then the Senior Registrar told me I could go home and STUDY! (Yeah, my end-of-posting exam is in 48 hours and it was a privilege to get off early).

H & P note

(Writing, the part of medicine I clearly enjoy the most, next to conversing with a patient…lol)

12:39 pm

I left the hospital.

I was home within 30 minutes. The first thing I did was to put up the curtains, I like to have a well-lit room, a habit I learnt from my mum. 

Let in some Sunshine..

I then went to relax on the sofa a bit, and happily munched the patties I had bought, as I browsed through my phone to see if I had messages pending via email or social media. 

Soon enough, I went to bed.

 

Hello Teddy…
 
(Yes, mum got me this Teddy. I’ve always loved teddies. One of my dreams is to have at least 3 different teddies behind the backseat of my car. Cool, isn’t it?)

3:27 pm

I’m back from La La land.

My siesta was quite refreshing and I was prepared to face the evening. Oh yes! My Roomie was back and I could appreciate the aroma from the plantain she was frying. What to have for lunch, I asked myself?

     
   

I eventually decided: Some Potato Pie with grilled Turkey breast, and some chilled Sprite to go with it.

    

I know right, I  promise not to taste any food till tomorrow morning. It seems I’ve been eating a lot more these days, perhaps it’s the after-effect of the Easter festivities. At this rate I hope I don’t end up adding a pound or more.

(PS: I’m still watching my weight o, abeg…like I tell anyone who cares to listen, my brideprice never complete, so I can’t shout. Pun intended. By the way I’ve been off my Workout regime for over a month now, I’ve not been serious. I plan to resume SOON, it can be as SOON as next week. I hereby call on all the forces of SELF-MOTIVATION and DISCIPLINE to aid my cause..lol).

5:51 pm
Studying has since commenced. The travails of a medical student. Nobody told me the road would be easy, so I can’t give up now.

  

  

(PS: That fine handwriting doesn’t belong to me o. It’s a friend’s. My writing is BAE abeg…hehe).

Shortly after, I needed some motivation to study, so I decided to chat with my wonderful friend and we ended up having this long conversation, of more interesting stuffs than just books. 

7:14 pm
My Roomie and I had our evening devotion where we sang, and shared what we had studied during our quite time respectively. After that I led the prayer and we shared the grace. It all lasted less than 20 minutes.

Not too long after, I went to iron my scrubs in readiness for tomorrow. It’s O&G surgery day! And it’s going to be my last one for this posting. 
 

MY SCRUBS (with my school logo)
 


8:38 pm

Still booking. And yes, I’ve transferred to the couch. Chewing some gum (thanks to my Flatie) as we speak, cos the book must enter by FIRE!!! Lol..

 

Still booking…
 

10:11 pm

Took off some time to visit Facebook and attend to Whatsapp messages, and resumed “booking”…lol. I’ve now switched to solving practice questions. Maybe we can do this together, hehe…if you’re medically-oriented, can you kindly answer the question below?

 

(cc: PRETEST)
 

10:57 pm

Yippee! Done with the books for tonight, glory to God. I’ve since performed most of my bedtime rituals: Clearing the dishes and cleaning up, brushing my teeth and washing my face. 

11:00 pm

 

Diary love 😘
 

it’s diary time, which will be followed by reading the scriptures! No better way to end the day than with God’s word. (I’m currently on the 13th Chapter of The Acts, and it’s been an interesting read so far).
 

I love my BIBLE too.
 

11:09 pm

And guess who just messaged me? It’s none other than  Ma Mère one and only super AMAZING Momma of life. Here’s a snapshot of our convo (trust me, it’s only a tip of the iceberg).

My mum of life!
 

12:02 am

I know right, I’ve entered another day already. Ok, I’m done. My mum has asked me to go to bed and I have a long day ahead. 
12:11 am

Finally in bed, it’s lights out. Sweet dreams, everyone. 

  
*** ***

Thanks for staying tuned people and I hope you found it enjoyable. Till I come your way again sometime in the near future, I remain yours sincerely,

requ1ne.

Cheers! 

***

abeg– please.

booking- studying.

bride price- a sum of money or quantity of goods given to the bride’s family by that of the groom, especially in tribal societies.