YAY! Going to Malawi spring of next year!

Yeah! I recently found out that I will be going back to Africa during my 4th year of medical school! I applied for the international 4th year clerkship abroad program at our school. I requested that I go to Malawi (my first choice), Ghana, or Uganda for 5-6weeks in the spring of 4th year. I was just informed that I will get to do the clerkship in Malawi. Malawi is was my first trip to Africa in 2004 (during my undergrad years). Malawi is one of the 10 poorest countries in the world and has a higher HIV prevalence rate than Uganda. I think I will be going to an area in the more southern region of the country (possibly Mangochi district). I am sure it will be a great experience. It will be fun as I make preparations and try to brush up on some Chichewa (the official language of Malawi, which is in the same Bantu language family as Swahili). I try to give more updates as more information about my Malawi trip becomes available.

Despite having lived in Africa, My PPD turned positive in med school. BUT I DON'T HAVE TB! Whew.

Recently I had my annual PPD test placed. The area became red and irritated, as always occurs for me, but then something truly horrible happened - it became raised. Not much, but there was a definite bump under my skin. I went in to have it read and to my utter horror it was read as positive. I was justly upset at the possibility of having tuberculosis and had much to ponder as I waited for my chest xray. It just seemed so ironic to me that despite having lived for a total of a year in Africa, that my PPD test would turn positive during the third year of medical school! I had not 1, but 2, negative PPD tests since returning from last adventure in Africa, so it would have to mean that got infected during med school. Still fuming at my bad luck, I went with much indignation to my TB treatment program visit. There I was offered a blood test to confirm that I actually did have TB before I had to take 9 months of a slightly nasty drug called INH (isoniazid). I got the quantiferon TB test, and it turned out to be negative. Today I got the bill for the test: $102.84. I wonder if that goes in the miscellaneous column of my medical education expenses.



A map of TB prevalence by country. Notice that the East African countries I have worked in have a MUCH higher rate of TB prevalence than the US. Good times.



A positive PPD test. This is not a picture of my arm (image from google image search), but the raised area is similar to what I experienced.

Temporary tattoos and teddy bears named 'teddy bear'

On my pediatrics rotation I got to take care of some of the cutest kids. When I say cute, I mean cute. Some of these kids were so adorable, they put the Welches Grapefruit juice commercial kids to shame. One three year old girl had bright eyes, thick black hair and cute dimples when she smiled. When I went in to listen to her lungs, I found her carefully clutching a little Teddy Bear. She seemed shy, but also happy to interact despite being on oxygen. I tried to strike up a conversation by asking, "That's a nice Teddy Bear you have there. What is his name?" My 3 year old patient responded with a look that clearly indicated she thought I was a little bit stupid and said, "Teddy Bear." The little girl's mom smiled and said, "Yeah, we are going through a real creative period right now."

A couple days later I came in to check on this same patient. I asked my three year old patient, "How are you today?" She responded in very cute high squeaky voice: "Bedder." She was so cute I tried to go through the process of getting a picture taken with her to share (this involves a signed consent from mom as well as some other paperwork), but my patient improved so much that she was discharged the same day so I didn't get a chance to do the photo shoot.

A few weeks later I had a 4 year old patient who was very sick and hated being examined, taking her medications and getting nebulizer treatments. However, this patient absolutely loved temporary tattoos. So her parents had a very sizable selection of temporary girly tattoos (pink flowers, stars, happy animals, etc) that she could pick from after cooperating with a medical exam or treatment. It worked really well. After a couple days, I guess she started to like me because after I examined her in the morning, she asked her dad to show her the tattoo collection and picked one out just for me. (If you are wonder, yes, this was a highlight of my pediatrics rotation). I walked around the rest of the day as the proud owner of a pink flowers and stars temporary tattoo. The tattoo was cute on the peds floor, but it got some strange looks outside the hospital!

This is just a sampling of some of the cute-kid interactions I had.

The upside of having a family that is a festering cesspool of viral illness

I always get sick when I go home and visit my family. Always! In the past I have found it very irritating. You have a free weekend a couple weeks before finals and go up to see the fam. You arrive and an adoring sister with copious nasal discharge gives you a huge hug and proceeds to use your jacket as a make-shift kleenex for her nose. 3 days later you go back to your house in Seattle, develop a sore throat, runny nose and a fever and you realize you have killer viral illness #8 of the season. 10 days later you feel better, but not before giving said killer viral illness to several classmates, undoubtedly resulting in the loss of a couple friendships. A couple months later, all is forgotten and you go home to visit the family again, only to have the process repeated.

HOWEVER, on my peds rotation it came in handy. And when I say handy, I mean really handy. The other medical student on my pediatrics rotation fell seriously ill, not once but twice. He developed a high fever resulting in the inability to get out of bed for several days, and actual hallucinations. During this time I also developed a little bit of a scratchy throat for a day or two which quickly resolved. It seemed like my body was fighting off a lesser version of something awful it had encountered before. (I don't mean to imply that I have a killer immune system or that I never get sick. I actually get sick a lot, it is just that pediatrics clinic can't hold a candle to the immune challenge you get from hangin' with a family that has 13 kids).

Apparently, it is very common for medical students to fall very ill during their pediatrics rotation. We were warned about this, and staff commented that the acquiring of severe illness from peds clinic seems to occur more often with people who are only children growing up or had fairly clean living environments. Well, not a problem here! :)
Here my (fun and terrific) family has been labeled by name. However, perhaps the could also each be labeled as "Immune challenge #1," "Immune challenge #2," etc.

Pocatello, Idaho, a place that makes Curling seem exiciting

I am now in Pocatello Idaho for my pediatrics rotation. I am super excited about it because Pocatello is supposed to be one of the better rural areas to do your peds rotation. You get to see a wide variety of clinic patients, round on children in the hospital every day and also round on NICU patients. My old roommate, Melissa, did her Peds rotation here and had a very good experience (although she did warn me that they work you very hard here).

Despite being an ideal location for a pediatrics experience, Pocatello itself is perhaps not the most exciting town in the country. Many people have asked me how Pocatello is and what it is like. I have struggled with a way to describe it. Perhaps the best way to explain it is that Pocatello is a place that even makes the sport of curling seem exciting. Allow me to explain. The Olympics are now in full swing and there is a news channel that seems intent to play every minute of the curling competition despite it being perhaps one of the most boring sports played in the winter Olympics. In other locations I have been at during the winter Olympics, it seems to be a widely accepted fact that when curling comes on, the channel should be changed. Curling is perhaps even below commercials in interest-holding-ability.

However, in Pocatello it is a different story. In several patient rooms, parents sit holding their sick child watching curling in rapt attention. In the physician's lounge in the Pocatello hospital, curling has been playing on the big screen TV every day. It is even a item of discussion in the elevator (i.e. "Hey, Jim Bob [<-- made up name], How about Canada's Curling team? Aren't they something?"). Perhaps the scariest event of all occurred when I went home Friday evening after a very long week and found myself watching curling in a near mindless state. It was an almost out-of-body experience. How low had my life sunk? What had happened to me that I was actually exposing my brain to the neuron-atrophying affects of curling? Then I realized it could all be explained in one word: Pocatello. Indeed, Pocatello, Idaho is place so boring that it makes the sport of curling seem exciting. I have included a few pictures of the area of Pocatello, surrounding my apartment to aid in the illustration of what Pocatello is like.

This is the parking lot in front of the apartments the medical students life in. As you can see, it is jam-packed and parking spots are hard to come by (note sarcastic tone of this sentence). Did I mention I received an angry note after accidentally parking in another tenant's spot after coming come in the middle of the night after call. As you can see, he or she was right to be upset, as there was obviously no where else to park.

Here is the view out of my apartment window. Did I mention that the apartments are "in town."
Here is the prettiest picture I have of Pocatello. It did have its moments of beauty/charm.

Here is a picture of the road in front of my apartment after the snow had melted.
Now think back to the pictures posted above. Look at this picture of an Olympian throwing a curling stone (or whatever they are called). Doesn't it now put off an air of mystery and perhaps even excitement? Do you see how curling could captivate you if you lived in a place such as Pocatello for an extended period of time?

Peds in Pocatello, Idaho.

First let me apologize to my blog readers about being so bad about updating my blog. I was so happy to be back in Seattle with friends and family after being in Alaska for 6 weeks that I didn't publish any of my blog posts that I started during my psychiatry rotation. I have now made a few edits and back published some of my tardy blog Jan and Feb blog entries. Just as a heads up: The date at the top of the blog entry is the date when I save the first draft of that entry, not when it is finally published to the blog. Thanks to Aunt Bev for reminding me that people still read my blog and that she missed my updates!

Now, for an update. I have now finished my psychiatry rotation. I made the 12 hour drive from Seattle to Pocatello, Idaho where I starting off my 6 week pediatrics rotation. I am very excited about the rotation. I love kids and am considering pediatrics as one of my specialty choices. Pocatello is supposed to be one of the best places to do the pediatrics rotation because you see a wide variety of pediatric problems in clinic, in the hospital and in the NICU. There are 10 different physicians we will be working with during the 6 week rotation.

Opportunities for personal enrichment outside of the hospital/clinic may be a little less varied. I did some research prior to departing for Pocatello, I did some research on things to do in Pocatello and I found the following website:
http://www.tripadvisor.com/Attractions-g35572-Activities-Pocatello_Idaho.html
Apparently the top things to do in Pocatello are:
1) Visit a museum
2) Visit a Fort Hall Replica
3) Visit Old Town
4) Visit an old church
5) Visit a mansion

"I wanted to clean out my bowels, so I ate soap."

As part of the psychiatry rotation, you spend several weekend and weekday nights 'on call' with the resident until 11:00pm or so. You split your time between seeing patients in the psychiatric emergency room and answering questions about ward psychiatry patients from nurses. On one afternoon with the resident we got a question from a nurse about a patient on the wards who was complaining of "bowel distension" and some mild abdominal pain. I recognized the name of the patient as one of the patient's my team was following so I offered to go upstairs and talk to the patient first. The resident said he thought this was a great idea and said he would be arriving about 10 minutes after me. Here is a summary of our conversation (at least as good as I can remember):

Me: "Can you tell me about your abdominal issues?"
Patient: "Well, I know my abdomen is very distended, and I am really constipated."
Me: "Tell me more. When was your last bowel movement?"
Pt: "I have had two bowel movements today and they were both pretty loose and I had two bowel movements yesterday too, but I know I am constipated. Look how big my abdomen is."
Me: "Some people might think that if you have 4 loose bowel movements in the last 2 days, that you probably aren't constipated. Can you tell me if you have changed anything about your routine or what you have been eating recently?"
Pt: "Well, I really wanted to clean out my bowels, so I ate soap."
Me (confused, and trying to keep a straight face): "Uh, allow me to clarify. You ate soap?"
Pt: "Yeah, soap. You know, it comes in a bar."

Hmmm... I wonder what the source of her loose stools and abdominal distention/pain was?

When you think about on a very basic level, it sort-of makes sense. If you want to clean your hands, you use soap. If you want to clean your dishes, you use soap. If you want to clean out your bowels, wouldn't you also want to use soap?

Oh so good. Soap. Deliciousness in a bar. Maybe those food scented soap bars really have a market.

A couple people I have spoken to had their mouths washed out with soap when they were younger after saying some bad words. They say that it actually doesn't taste that bad. I wouldn't know.

Voices.

In psychiatry you learn that a surprising number of people hear voices. Many people can successfully go through day to day life hearing voices (aka auditory hallucinations) and frequently without other people finding out. When we talk to patients who have auditory hallucinations sometimes they like the voices. It may be the voice of their mother telling them comforting things. Sometimes it is their own voice which is telling them positive self talk saying things like, 'don't be sacred' or 'you can do it,' etc. However, perhaps even more frequently, the voices are degrading and cruel. They may say things to the patient over and over again such as, "You are worthless. You are worthless. You are ugly." One patient said the voices said to her, "Eat, eat, eat, and die." Others have voices that say, "Kill yourself." Over and over again. Perhaps the most horrific, are the voices are those that state that if the patient does not kill him or herself that something terrible will happen to the rest of the world (the world be destroyed, all the children in the world will die, etc). Usually the patient has some sort of understanding (however small) that voices do not indicate reality and that if the person does not kill him or herself that the world will not come to an end. However, this led me to the question: What if the patient actually believed that if he or she didn't kill him or herself that many other people will die?

In Biblical philosophy it is said that there is no greater love than to lay down one's life for one's friend. Likewise, it is also considered by many to sacrifice yourself in service to your country. In some religions it is considered a sin to commit suicide which may even result in the person committing suicide going to hell. But what if the patient truly believed that if they didn't kill him or herself then many other people would die? In that situation, although it is of course a terrible tragedy that the individual has tried to end his or her life, is it not also an incredibly selfless act? Although their reasoning is flawed as they have been given incorrect data, they are acting along one of the most noble of moral codes of our culture. Just food for thought.

Reading notes every morning - better than a best-selling mystery/adenture novel!

I am now in the depths of my psychiatry rotation in Seattle. It is a great and truly memorable experience! Medical students are divided into teams that round on patients in the hospital fr psychiatric reasons. For the most part, patients are being held against their will for their own safety (either for suicidal thoughts/plans or psychosis or something similar). The teams usually consist of an attending psychiatrist, either a psychiatry resident (psychiatrist in training) or a psychiatry physician's assistant, 1 or 2 medical students, a social worker, a pharmacist, and occasionally a pharmacy student. The teams are generally a lot of fun and are very dedicated to helping patients.

In the morning, the students get there a little before the other members of the team and look up labs, medications and read nursing and other notes from the team's patients from the team before. Then before rounding the medical students can update the team on what is going on with the patients before team interviews the patients each morning. This is a very similar pattern to what happens on other rotations in the third year of medical school. However, what is different about psych is WHAT is written in the notes. On other rotations, the notes usually have the patients blood pressure, heart rate, how much fluid they consumed and how much the urinated, how they slept, how much pain they are in, etc. In summary, overnight notes in other third year rotations are just a touch boring. Occasionally something exciting happens (your patient worsened and might have to be sent to the intensive care unit or something else sad or upsetting), but generally not the most exciting part of your day. Psych notes have a lot of this medical information too, but they also have descriptions of what the patient said or did the previous afternoon and night. By almost every definition, psych notes are almost never boring. In fact, opening up psych notes in the morning was one of the my favorite parts of the day. It was even better than opening up a best selling adventure or thriller book because you never knew what patient might have done over-night.


My pictorial version of psychiatry notes - they are better than an adventure/thriller book or movie. Even more exciting and unexpected.

I loved OB, now I am on my psych rotation!

I had a blast on my OB rotation in Anchorage. It was a lot of fun. I got to see lots of deliveries, numerous surgeries, and work with some very cool people. I had such a good time on ob, I actually started considering at a specialty choice. (We will see what the rest of third year has in store for me surrounding my life decision making plans). OB had some wonderful moments. Mom's and babies are lots of fun.

Despite our enjoyment of OB, at the end of our stay in Anchorage, the cold weather and the very short number of daylight hours made us pretty happy to get on the plane and come back to Washington State.



Here is a picture of the OB students I was with in Anchorage. From left to right they are Jonathan, Lindsey, Kristin, and me. This was taken after our final exam on the very few hours of day light. By the time we were about to leave a large portion of our conversations focused the fairly depressing topic of astounding lack of daylight hours. Here are just a few of our sample conversations:

Jonathan at 1:30pm, "Hey, guys look at the beautiful sunset outside." We looked outside, and indeed there was a brilliant red sunset behind the snow covered mountains. It was indeed beautiful, it perhaps would have been even more touching if it was occurring at 5 or 6pm instead of 1:30.

Lindsey, at around 11am a couple days later (just a couple days before the shortest day of the year), "Hey, guys, look! It is another beautiful sunset." Me, "That is beautiful, but it is before noon, so that would make it a sunrise." Lindsey, "Uh, that looks just like the sunset a couple days ago. Are you sure it is not a sunset?" Allow be to explain this conversation. Towards our last days in December, the days became so sort that the sun essentially rose as a sliver of light from behind the mountains in the south (around 10am), and set as sliver of light a few hours later as a sliver of light coming behind the mountains from the south. Thus, other than the time of day, the sunset would be difficult to differentiate from a sunrise.

After a brief, but well needed break for Christmas, I am now on my 6 week psychiatry rotation in Seattle. I am looking forward to some unique experiences and catching up with people in Washington.

Enough with spam comments on my blog!

I curse you internet junk-mail spammers!!!!!! (earthquakes, thunder and lightening sound). No more spam comments on my blog! No, I don't want comments trying to sell Viagra on my blog posts about learning Swahili in Tanzania. Anonymous comment posting has been eliminated due to abuse by spammers. You must now have a Google account to make a comment.