I didn't know it was possible to be that hot....

Last Thursday, we had our first Stan session. I hate to say it, but we killed him. I think it was much harder than working with a real patient, but I also thought it was fun. Medical students are not allowed to do too much hands-on work and we can practice hands on skills on the Stan machines. I think part of our problem was that we were so worried about not killing Stan that we thought too much and didn't act enough. Another part of our problem might have been that the air conditioner was turned off in the Stan room and we couldn't turn on a fan--it was probably 90-100 degrees in there with no moving air!

Yesterday, we had our first "Mini" exam of the semester. Don't even get me started on the "minis!" Each mini consists of 1/3 of the information from the semester from each class on one BIG (not mini) exam, which we are given 2.5 hours to complete. It is a mini examination compared to the USMLE Step 1, but these Mini exams, my friends, are anything but mini. When I left, I felt like I did horrible, but then after I talked to some friends, I think I did okay.

Today, I had to go to PMH (the BIG hospital on the island). I got up, got dressed, had a small breakfast and a Dramamine then I hit the road at 8:00. We took the 23 mile (>60 minute) drive to Roseau, the capital. It was a bumpy ride and I'm glad that I took my Dramamine, but I was extremely sleepy from the medicine until about 10:00-10:30. We were broken down into multiple groups and randomly assigned to physicians. If I had my choice, I would have rounded with the hematologist/oncologist since that is what I'm interested in, but I got the post-surgical rounds, which was fine too. The professors that we showed are Cuban and the first one (about 50-60 years old) had an extremely heavy accent. He was a great teacher, but I really had to listen carefully to understand him--part of that was that I was still drowsy from the Dramamine. I did manage to say a few thoughtful things, so I at least looked like a medical student with somewhat of a brain. Next, we went to orthopedics with the second, younger Cuban professor. I made huge brownie points with the second professor because I knew that osteoporosis caused micro-fractures often in the spine (fractures that are so small that they cannot be seen by X-ray). He asked how I knew this exciting information and I had to reply that I either saw it on Discovery Health or on a commercial for an osteoporosis medicine...not exactly doctorly, but I did know the answer.

Next, well, it was the embarrassing part of the day. Six of us followed the first doctor to the woman's ward to palpate a cyst in a lovely lady's axilla (arm pit). She had an ultrasound and they said that it was an abscess (infection) probably because she is diabetic and they are more susceptible to infections. All six of the medical students palpated to mass, then the doctor got down to business. At PMH, they have open wards so we had the curtains pull around so she could have some privacy. Six medical students, two physicians, and two nurses surrounded her bed (all within 2 feet of the bed because of the curtains). The hospital has no air conditioning, there were no fans nearby, windows were opened but there was no breeze, and worst of all it was probably 80-85 degrees before we all slammed around the bed like sardines. Next, the physician injected the woman in the axilla with lidocaine (a local anesthetic). I was cringing just thinking about a needle going into this poor woman's arm pit--her face confirmed the horrific pain she was experiencing. We don't cover anesthetic until March so I'm not sure how long it takes for lidocaine to numb the area, but I don't think it was as quickly as this physician moved. Probably less than 30 seconds after injecting the lidocaine, he injected his needle to try and aspirate the abscess. Our patient was quite, but her face was screaming. I asked her if she wanted to hold my hand and she said yes, so I tried to comfort her best I could, but I don't think it did much. This went on with little success for probably five minutes, then I got really hot. I don't mean a little hot, I mean really hot. I noticed I was getting hot then 30-60 seconds later, I thought I better move toward the "hallway" (the area in the big-open-room ward that is in between the beds and curtains). I tried to find a chair, but I couldn't so I leaned against the wall. Then I remember shaking and being so, so hot. I knocked over two empty water bottles and I remember falling into one of my group member's arms. I didn't think I fainted because I remembered all of it, but the two gentleman who were holding me said that I was holding myself up for all but about 30-60 seconds--I guess I did pass out. I was assigned to my own bed. One of the doctors come over and checked up on me, but it was obvious that I was just overheated. Apparently, 1-3 students pass out per day because it is so hot. I was so embarrassed, but they are used it. I don't think anyone else passed out when we were there, but nine other people told me they thought they were going to pass out, but they found somewhere to sit down, which I could not. In fact, the guy that caught me left the oven (I mean the patient's bed) a minute or two before me because he was sweating so much and almost passed out. I'm lucky we both didn't pass out. Everyone was so nice, but I felt so stupid. I usually drink about 2 liters of water a day and I didn't do that today. I will make sure to drink more water before my next hospital day.

After the fun fainting on the wards, we all picked up a taxi and headed to lunch. The people I was with wanted to go to KFC, why, I don't know. So, KFC it was. Around the corner there is a little, cute, cozy coffee shop, so we got iced coffee. After our two hour lunch (why did we need two hours, I don't know), we headed back to the hospital. We were again divided into groups and I again had to go to the second level to the woman’s ward (I like to think of it as one large sauna with smaller, hotter pockets that are like ovens). We were supposed to have three students to one patient, but the second patient was discharged so we had six students to one patient. I was rather relived that upon returning to the oven to interview our patient, the other five people in my group performing the interview all had to leave to cool down. I really can’t believe how hot the woman’s ward was. I didn’t know I could be that hot without being sunbathing in the Sahara desert. Anyway, our patient was great and made our lives much easier by being so nice and easy to work with. If I didn't know our patient was a seamstress, I'd guess she was a teacher because she was so patient and caring. Then again, perhaps she was patient and caring because she is a Mom. I think that our interview and patient exam went very smoothly. Our attending professor was an amazing woman. She had been a practicing physician for 40 years! It always excites me to see women in non-traditional roles. Now, about 50% of medical students are women, but there is a lot of variety once physicians specialize (traditionally, women are more often pediatricians and obstetricians and less often surgeons). Forty years ago a woman in medical school was amazing feat, let alone a minority woman in medical school. I wish I could have spent more time learning from her: she is great.

We all loaded up on the bus to head back to school, but a group talked the bus driver into going to KFC (I don't know why they all love KFC so much). I really wanted to get back, but I didn't mind that we had this 40-60 minute delay as it takes that long for Dramamine to kick in. It is a good thing that I had the Dramamine for the ride back to school because I was stuck in the back, the ride was extra bumpy and the driver was going fast. I felt like I was on Mr. Toad's Wild Ride, but a Dominican version that could actually kill me!

Overall, it has been a exciting week. I am sad we killed Stan the stimulator, but I'm proud that we were good with our real, live patients. I hope the exam went well, as I studied and studied even after my head felt like it was going to fall off my shoulders. I'm starting to finally feel like I am on my way to becoming a physician; but most exciting of all, I think I'll make a great physician some day.