Chronicles of a Student-Doctor #6

CHAPTER 6: INFECTIOUS DSEASE POSTING.
Welcome to the Infectious Disease Clinic. 

This is where you hear all kinds of stories that touch; from infidelity issues between partners, to sad cases of children born immunocompromised as a result of poor parental choices.


(Photo-credit: WEB)
Infectious disease is a medical specialty dealing with the diagnosis, control and treatment of infections. The department typically serves to manage complex infections, especially those that pose a public health risk e.g. HIV/AIDS, Tuberculosis on a long-term basis. 


(Photo-credit: WEB)

The focus of the care provided is to improve the quality of life in the patients, even when their medical conditions are incurable.

Infectious disease is one of the most emotionally-demanding specialties in Medicine. Dealing with HIV/AIDS infected patients especially requires a lot of courage as well as empathy. 

During the posting, I saw patients from different walks of life coming in for treatment. Every typical person from your next-door neighbor to the colleague at work and that random guy on the street showed up at the clinic. While a few of these patients appeared emaciated, most of them looked healthy enough. Like my Nigerian folks would say “Aids no dey show for face.”


(Photo-credit: WEB)

My Preceptor, Dr. J. Davy was on point. A classy doctor who knew her stuff and gave no room to be intimidated by the patients in her care. She always emphasized the need for safe sexual practices and reprimanded patients who were non-compliant with their medications.
As per HIV and other STIs, the message remains:
– ABSTAIN,

– BE FAITHFUL,

– Use a CONDOM.


(Photo-credit: WEB)

Discretion on the ward was important and the status of most of our patients was coded. We had a few poor outcomes though and I recall how we lost a patient whose prognosis was really poor on our watch. As expected it evoked an emotional response, especially for the students. But we also had lots of patients who had been on antiretroviral medications for years and were doing fantastically.
Social issues were a main concern, as we had to deal with problems related to stigmatization, unemployment and substance use from time to time. Our patients got referred to the Psychologist or Social worker as the need arose.

As for patients who could not afford their antiretroviral medications, the government of Saint Vincent and the Grenadines was kind enough to provide their basic treatment free of charge. Infected nursing mothers also received Baby formulas from time to time. Breastfeeding poses a risk of mother to child HIV transmission and it is recommended that such mothers should not breastfeed.
My Infectous disease posting was quite interesting and enlightening in every way. There was a lot to learn as regards related medical conditions and several management options. I had the opportunity to attend a health lecture (or better put as Symposium) for nurses/midwives, where lots of current practices were discussed.

If as an aspiring physician you are passionate about preventive medicine and public health issues, Infectious disease may be a good choice for you. But be warned, you’ll see lots of end-of-life cases with so many emotional strings attached. 


(Photo-credit: WEB)

To everyone, stay safe & cheers!
Thanks for reading.

:::requ1ne:::

Advertisements

Chronicles of a Student-Doctor #5

CHAPTER 5: GENERAL SURGERY POSTING.
“How shall I begin my tale?
Of Mastectomies,
And Thyroidectomies,
Of Lumpectomies,
And Amputations,
Of Herniorrhaphies,
And Cholecystectomies,
Of Appendectomies,
And many MORE;
I hail thee great Surgeons!
Men and Women of Courage,
Standing tall among Giants,
Daring risks & defying the impossible,
Saving lives against all odds,
Giving your best for the good of all.”
-REQUINE.

SURGEONS (Photo-credit: WEB)
Welcome to the General Surgery department, where lives are saved with the aid of knives.
If you are a fan of surgical caps and masks, surgical scrubs and gowns, scrub shoes and shoe-covers;
If the thought of a serene air-conditioned room with machines beeping in the background is of any appeal to you;
If you can stand the gross sight of blood, the smell of burning flesh, the sawing of limbs, the suturing of skin, the cutting of ligaments and tendons, and many of such intense details, then you’re welcome to join us at the operating theatre.
An operating theatre simply put is a place in the hospital where surgical operations are carried out in a sterile environment.
ULTRAMODERN OPERATING THEATRE (Photo-credit: Wiki image)
The Operating theatre (OT) team typically consists of: The chief surgeon and assistant(s), the Anesthesiology team, the scrub nurses, the circulating nurses and in some cases surgical technicians.

I’m particularly impressed by the way surgical sets are arranged. The scrub nurses do a great job of keeping the sets in order throughout the surgical procedure.

(Photo-credit: WEB)

 I also like the general concept of sterility in the OT, although it seems overrated sometimes. But when it comes to the risk of a patient contracting nosocomial or iatrogenic infections, one is better safe than sorry.

Depending on the type of procedure, we spend anything from under an hour to over 3 hours in the operating theatre. All members of the team work systematically to achieve a common goal: get the patient off the surgery table and into the recovery room in stable condition. Thankfully, that is usually the case.
From the time the patient gets draped and the surgical site is prepared with an antiseptic solution, to the first incision the surgeon makes, every action is a hit from back-to-back (pun-intended).


As each procedure draws to an end, and the surgeon puts in closing stitches, he thanks every member of the team. No surgeon can successfully perform such technical procedures without the help of experienced OT staff.
During the course of most procedures, medical students are at the mercy of the surgeon(s) as we are often called upon to identify a nerve or blood vessel, or state the likely complication(s) of a procedure and so forth. It is usually mentally challenging but worth it in the long run. There are days when a member of the team says something funny and we all get a good laugh. OT humor is the best of its kind.
Monday was the delegated day for all elective cases in my team. Emergency surgeries came up as required. On surgery days, we had to be in the hospital as early as 7:00 a.m. and we’d go from the ward to the OT till late afternoon or early evening, depending on the number of cases we had.
Our outpatient clinic was on Tuesdays, where we saw new referrals and followed-up on previous patients. I found the outpatient clinics really challenging. We always seemed to have more than enough patients and standing for some 4 hours or more wasn’t exactly fun. But I was there to learn, so I learnt a lot. 

We had ward reviews from Wednesdays to Fridays, often followed by discussions, lab work, bedside procedures or other errands to run on the ward.

Surgery rounds were the best. There was ample opportunity to get involved with the management of the patients. And I had a great rapport with a number of them. I even had favorites. I usually felt pumped each morning as I stepped into the ward. I felt no pressure, sense of intimidation or dread, nor did I feel the need to impress any of my superiors. I was able to learn at my own pace and I did pretty well.


Then I related quite well with my colleagues on the team as well. The 12 weeks allotted for the posting was barely enough. 

An after wardround pose…
Library-selfie…#TeamNatural
Inside the OT…

My Preceptor, an elderly gentleman, Dr. Samuel Hazell, was quite the philosopher. His numerous stories about life and the practice of medicine were a highlight of my posting. 

Here are a few I recall:
[THE WORDS OF DR. SAMUEL HAZELL]
-Men should not only walk, they should also lead.
-A man should not just use his head to wear a hat, he should also use it to think.
-The Patient is more than a number (or case), the Patient is a Person (Flesh & Blood, Spirit & Soul), just like the doctors that treat him. Dignity should be accorded to every patient at all times.
-Doctors always profit from the misfortune of their Patients. There is no doctor without a Patient.
-God uses Doctors when he wants to remain anonymous.

(All emphasis mine).

***

Surgery posting is definitely one to look forward to. It can get a bit messy or malodorous sometimes with things like wound debridement. In the end, you have that sense of fulfillment that you’re making a positive difference in your patient’s healthcare.

I don’t think I can conceive the idea of practicing as a surgeon though. My stamina would probably not carry me for the first hour of a procedure…lol.


  

Yes….GLORY TO GOD!

Shout out to all the SURGEONS (both practicing and aspiring) in the house. Thank you for loving what you do and doing what you love. God bless you all! 

GLOSSARY:
Nosocomial Infections- Hospital-acquired infections caused by viral, bacterial or fungal pathogens.
Iatrogenic Infections– Disease induced by medical treatment or diagnostic procedure.

Thanks for reading.

:::requ1ne:::



 

LIVING & LOVING THE LIFE…

Hi guys!

So I decided to take a break from my Medical School Journal series and do this random post. I’m aware that a good number of folks (including myself) enjoy reading blogposts about day to day events. I’ve had an exciting MAY so far, and I will be sharing some of the things I’ve done/learnt with y’all.

15 funfacts about the month of MAY:

1. The WORD for the month- Ecclesiastes 3:12. Sweet!

2. The SONG for the month- You Make Me Brave (Amanda Cook & Bethel Music). It’s such a sensational song.

3. Listened to the podcast series 7 ways to increase your happiness by Joyce Meyer. I was mightily blessed.

4. Currently reading these two books:

i. AWAKEN THE GIANT WITHIN (Anthony Robbins). Since starting the book, I’ve been getting NEW ideas and rekindling some old ones. It’s a book that will definitely add PASSION to your dreams. I recommend it.

ii.  CHASING SUPERWOMAN (Susan  M. DiMickele). I loooove this book. It addresses issues like combining motherhood with spirituality and career. And I love the honesty with which the author writes about her personal experiences. I recommend it too.

5. Also reading this devotional for Ladies and Mothers by the very amazing Eziaha, one of my favorite bloggers. You can download it for free here.

6. I have also been studying the book of GENESIS and now on the 7th chapter, the famous story of NOAH AND THE ARK. I’ve enjoyed it so far.

7.  Just completed my 3rd week of psychiatry posting. The experience has been an adventurous one. You will be able to read about it later as featured in my Medical School Journal Series.

#TeamPsych
8.

Last Sunday’s Sermon- SEASONS OF MY LIFE was both epic and timely. My Pastor is such a blessing. You can download the PDF version here.

9. On Sunday evening, a friend from church took us on a ride to the countryside and we had soooooooo much fun. I’ll let the PHOTOS speak! 




10. On Monday which was work-free, I was home with friends watching the second season of Funke Akindele’s JENIFA’S DIARY, an unusual combination of comedy and common sense. You can watch the movie trailer here.

11. That evening, I and my wonderful friend Ede, went on a date to mark her birthday (which was belated). She is one woman of substance and value I admire, she blogs here.

12. Tuesday, Wednesday and Thursday flew quickly and aside work-related matters, were quite uneventful. However, I still had some FUN.

13. On Friday eveningmy friends and I had a Biblestudy on ANGER. I was thankful for the teaching because I’ve had struggles in that area in recent times. One of the passages we went through was the story of Jonah (Chapter 4) which we found quite hilarious. The main character, Prophet Jonah seemed to be seriously vexing at GOD, like some of us do sometimes. But God is always JUST and in this account, he patiently showed Jonah the errors of his thinking. 


One of my friends pointed out that ANGER is of 3 major components: the SOURCE, the FUEL and the DIRECTION. Pride fuels anger while Prayer dissipates it. I’m trusting God to breakdown every STRONGHOLD of anger that is limiting me in anyway. Phew

14. On Saturday, I attended this program organized by a group of young Christian ladies tagged “THE WOMAN IN ME” and it was such a BLESSING. The speakers were A-W-E-S-O-M-E! In particular, the teaching on communication was on point. One major take-home lesson for me was this: I’m not only responsible for what I say, I’m also responsible (to an extent) for what my hearer understands. I discovered a lot of negligence on my part and with God’s help I’m determined to do better.


Selfie with the Lady-Poet!
Selfie with my WORDED Sister!

15. So today is Mother’s Day, and I join millions of folks to celebrate all present and potential Mothers across the globe. I know womanhood and especially motherhood, is a huge responsibility. I’m passionate about women becoming all of what God has called us to be. This VIRTOUS Woman is who I aspire to become:



I look forward to enjoying every single day the rest of this month. I hope you do too. 

Thank you for reading..🙂

:::requ1ne:::

Chronicles of a Student-Doctor #4

CHAPTER 4: ACCIDENT & EMERGENCY POSTING.

Welcome to the Accident and Emergency Department, also called the Casualty unit.

It’s a good place to observe all kinds of drama. Each day brings you a different episode, I promise.

So what happens in an Emergency department?

Meet our Patient:

Mr. X, a 21-year-old man who just sustained a gunshot wound to his left leg. The story according to an eyewitness was that the victim had a heated argument with some guys at a local pub and after being dismissed by the patron of the pub, one of the guys allegedly shot him in a nearby alley. The gunman with his fellow conspirators immediately absconded, leaving Mr. X in a pool of blood.
A random stranger was kind enough to contact the services of the Emergency department.

The Emergency Medical dispatch team is quickly mobilized and off they go.

15 minutes later, the sound of the siren is heard as the Ambulance arrives.

(Photo-credit: WEB)
The scuffling of feet as nurses and orderlies rush to bring in the semiconscious patient on a stretcher.

The alertness of the Doctor-in-charge and every other member of the team as the Patient is brought into the resuscitation room.

Like in any Emergency setting, the ABC rule is applied:

A- Secure the Patient’s Airway

B- Check for adequate Breathing

C- Monitor the Circulation status

(Photo-credit: WEB)
All hands are on deck, and every second counts. Based on the suspected amount of blood loss from the patient, it’s only a thin line between life and death. Will the patient survive or not?

*** *** ***

I happened to resume in the department on no other day than my birthday, the 15th of December. I had mixed feelings that morning because I didn’t really know what to expect. Thankfully the day went well and I was able to have a nice time with a couple of friends later that evening.

A and E room selfie…
My first lesson in A&E: Every case in the Emergency room is a matter of TRIAGE. We had different color-coded Admission cards to put patients into groups based on the apparent priority of their presenting complaints.

RED CARDS: Emergent life/limb threatening conditions such as Major Trauma (MVA, Gunshot wounds etc), Myocardial Infarction, Significant Burn Injuries, Severe Respiratory Distress etc

BLUE CARDS: Urgent but relatively non-life threatening conditions such as Abdominal pain, Lacerations, Acute Asthma attacks etc

YELLOW CARDS: Non-life threatening conditions such as Chronic headache, cold symptoms, minor cuts etc

I can understand the frustration of some patients who complain that they do not get attended to at the Emergency unit on time. The Emergency unit where I worked has a written policy that all non-emergent cases would only be attended to after 4 p.m. on weekdays at the discretion of the Emergency unit staff. Some patients actually leave in anger after waiting endlessly.

(Photo-credit: WEB)
Many factors come to mind; the department somewhat doesn’t seem to have sufficient hands, so it takes a considerable amount of time for a nurse to be available to assess a patient, and much more for the doctor to examine such.

Each patient is attended to in the unit as the case demands. Some patients require intensive work-up including labs, X-rays, EKG or even emergency surgical consult. Other patients only require the doctor’s reassurance and can follow-up in the outpatient setting. A number of patients are transferred to other departments (e.g. Surgical Ward) for inpatient management while others are treated and discharged accordingly.

That said, not much happened during the early part of the day at the Emergency department where I worked. Most of the trauma cases presented from late afternoon till evening, so I missed out on some interesting cases.
Nevertheless, we had a good number of stab injuries, asthma exacerbations, some trauma cases, burn injuries, and lots of acute pain presentations.
I recall the funny incident of a patient who came with “fish-bone” stuck to her throat. She was a pleasant-looking elderly woman and just wanted to get the bone out of the way. It took the Doctor attending to her some effort but she succeeded, and the woman was so relieved. She kept thanking and blessing us with her prayers.
It was in A and E unit I began to get a good hang of the History taking and Physical examination, as well as the attempt to draw blood samples from patients.
I really did more of watching and learning from the variety of Doctors that worked in the unit.

A & E room Selfie (New year’s eve).

PS: New Year’s Eve was unexpectedly calm. No one seemed to want to spend the last day of the year in the casualty unit.

My Preceptor, Dr. Adams, a humorous but goal-oriented personality, taught us the importance of inspiring confidence in each patient that presents. He also emphasized on the need for efficiency as the unit demanded being kept on one’s toes. He was the first doctor to actually drill my presentation skills. He expected his students to be apt and concise at all times.

MILTON CATO MEMORIAL HOSPITAL.
In conclusion, the Emergency unit is a WORLD of its own. Anyone willing to work there must have an inner sense of peace despite the craziness and uncertainty each case might bring. As for me, I wouldn’t even dare.

Here’s to all the brave ER doctors and staff, keep doing what you know how to do best…xoxo!

Thank you for reading!
~requ1ne~