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gellybearwrites · 5 years

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The fiery depths

I recall the last time I yelled at a patient.

She was in labor, waiting to be admitted at the ER. It was 2:00 in the morning, in the bleak atmosphere, my eyes kept on shutting - my body was weak, my consciousness drifting away every 30 seconds. I wanted to sleep, like the resident who was only a few inches away from me. I wanted a little bit of rest, for the day had been long and exhausting.

I had to stay up and examine her since it was part of my job.

She looked decent and was probably in her late 30s. I was expecting that nothing would go wrong.

But at the beginning of the interview, she acted like she was deaf. I had to repeat every question twice or thrice before she answered. The questions were simple and I could not understand why her hearing was poor.

I was trying my best to stay awake, to attend to her, but I got so irritated during the interview. Every time I repeated each question, I felt like a balloon continuously filling up with water, with not much space left. Unsurprisingly that balloon burst.

I ticked, I cracked, I burst. I yelled at her, asking if she was deaf. Both of us felt every fury in every word I laid down. I saw the terror in her eyes as she saw me transform from an innocent little kitten into a raging lioness, ready for an ambush. I couldn’t stop myself asking her why I had to repeat every question.

Then the resident woke up.

All the rage began to shatter. He took over the interview as I waited for his admitting orders.

As I made an intravenous access and took blood samples, I couldn’t bear the shame and guilt I had in me. As the nurse took her to the delivery room, I did not even utter an apology.

After that duty, all I thought of was the backlash I gave to that patient. I only felt guilt, because I was not able to dig up a little compassion beneath the drowsiness. I lost myself just because of lost sleep.

In retrospect, I still have a lot of memories where I get furious with patients. I’m not quite sure if it’s the system, or the culture the led me here.

All I know is that I pray every night for kindness and compassion, which lacks all throughout the healthcare system in this country.

I try, I strive, in the hopes of not letting rage happen again.

#medicine #healthcare #md #philippines #horror #medicalintern #medicalinternship #wheninob

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summerlivingtolove · 9 years

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Medical Internship Summary!

My first 2 weeks here I spent interning at Thammasat University Hospital. Before this trip, I felt like I hadn’t had sufficient experience in the medical field to know 100% that I wanted to be a doctor, but the past 2 weeks definitely confirmed it. Upon reflection the past few years, I have come to find that I would like to use my life to help others find an optimal quality of life through health and fitness because it is my belief that the body is the basic foundation of obtaining skills and knowledge to positively impact society. But whether or not I could do that through a career as I doctor, I wanted to discover on my own. The past 2 weeks have been a great experience to see the various ways a medical career helps impact the lives of many, which has solidified my desire to pursue medical school.

In my time at the hospital, I was able to observe in 4 departments: surgery, pediatrics, biochemistry, and medical diagnostics.

[warning: the next few paragraphs will contain a lot of scientific/medical jargon that could be tedious/boring to read, feel free to skim over if it’s not your interest]

Biochemistry

In biochemistry, we visited a few labs and got to see the connection between medicine and research. Most of the projects we saw were investigating the molecular significance of traditional Thai herbs and how they attributed to their medicinal properties. Thanks to the UT FRI program (Freshman Research Initiative), I was able to gain research experience, read scientific papers, and understand basic biology and biochemistry techniques, which made the day I spent there enriching and intriguing. The biochemistry lab we visited first used a lot of techniques I had learned about in my introductory classes like Western blotting, and it was exciting to see its application beyond the textbook descriptions. One of the graduate students was investigating a Thai herb’s effect on leukemia cells. She allowed us to look at the differences between normal cells and leukemia cells through a microscope, which was amazing. We also spent time talking to another researcher who did neuroscience research on the effects of another traditional Thai herb on schizophrenia in rats and because I have a neuroscience background, I was incredibly excited!!! She showed us slides of the rat brains and how schizophrenia caused certain parts of the brain to deteriorate and went into detail about how she used a variety of tests like prepulse inhibition, maze studies, etc. in order to make conclusions about the herb, which was exciting to me because I had studied all of these techniques but had never been able to experience the techniques’ applications. All of the knowledge I had obtained over the years suddenly seemed to have a purpose beyond a test or exam, and I was very grateful I had learned all that I did prior to coming here. I felt like my knowledge gave me full grasp of the research and its importance to the medical field. I spent my time in the biochemistry department in awe of all the potentially life-changing research going on throughout the world. It was so EXCITING. Though I do not want to pursue research in the future, I gained an appreciation for the strong role it plays in advancing medicine.

[lab coat official!]

Pediatrics – Gastrointestinal Tract specialty

We spent one afternoon observing a GI tract pediatrician see her patients. It’s a little different in Thai hospitals with regards to appointments; some departments still need appointments, like surgery and procedural departments, but for specialty or general doctor appointments, you just have to show up and wait for a doctor to see you. The GI tract doctor had a long line of patients that waited patiently until it was their turn to be seen. There was no predetermined time to arrive, it was more of a first-come first serve basis. The attitude of patients towards their doctors is slightly different than in America also: Thai people greatly respect their doctors and are very thankful for their time and consult. There were a few medical residents who were also observing as well, and the patients were patiently waiting as the doctor explained to us the medical history and condition of the patient; whereas I think it would not be the same in America with regards to patience and respect. The doctor was sweet and motherly towards the children that came in and provided a warm aura that kept the kids calm for the most part. Most of the kids had esophageal sphincter irritation, constipation, or anal fissures, which are all painful GI problems, but the doctor made them feel at ease. She explained to use the signs of various common afflictions children have with the GI tract and it was interesting to me to learn how the diagnosis and treatment process. There is a lot of problem solving that comes with being in the medical practice, something I had never considered before! I have also always been interested in pediatrics because I believe that a child’s health foundation is crucial to their lives and thus enjoyed my afternoon seeing the kids come in!

[the hospital was gorgeous with lush vegetation everywhere!]

Surgery – Transgender Transition

Before seeing this surgery, I already had a preconceived notion that I would not want to pursue surgery, but the morning I spent in the OR confirmed my thoughts entirely. We watched the complete rewiring of a former male’s genitalia to that of a female’s. The doctor explained to us the pre-operation procedure: in Thailand, before this procedure is performed, a patient has to undergo a long procedure of psychiatric confirmation of a gender disorder, physical operations like breast and hip implants, etc. in order to confirm the patient’s necessity and desire to change their gender. Though surgery does not frighten me out visually, I was uninterested in the physical interaction and mechanisms of surgery. I appreciated the experience because it was a rare chance to see this type of operation, but it did not peak my interest. I’ve come to realize that I enjoyed observing patient-doctor interactions much more because I enjoy forming bonds with patients, which to me is much more rewarding and enjoyable.

[first time ever in scrubs!]

Medical Diagnosis

We spent the majority of our 2 weeks in the Medical Diagnostics, and it was by far my favorite of the four departments! The staff was so welcoming and were eager to maximize my time there by teaching me about all the various tests used to detect physiological dysfunction as well as allowing me to try it myself. Within this department as well, I saw a significant use of the scientific method problem solving process applied to the diagnosis and treatment of patients. We first got to observe nerve conduction studies to detect neuromuscular problems and also got to experience them firsthand. A stimulus is applied, which causes an involuntary muscle twitch, which made me laugh so hard [which is wrong because you need to be relaxed for adequate measurements]. We did arm, facial, and leg conduction tests and learned how to interpret the results. The conduction speeds and latency could show nerve dysfunction or injury. It was super interesting to me because of my neuroscience and anatomy background. It is always exciting to me to see the application of the physical mechanisms on the function of the body. The external nerve conduction studies could be performed by technicians; however, invasive procedures have to be performed by doctors and thus for the EMG (electromyography), a doctor came in and evaluated the patient. The doctors explained to us how to interpret EMG results to detect denervation and recovery in the nerves. One doctor in particular, after explaining her problem solving process on how to find the nerve damage in a paralysis patient, encouraged us by sharing the rewarding parts of being a doctor. She said that though it is disheartening to see no improvement or atrophy in a patient’s neuromuscular system, the days that she saw partial or full recovery made her job worth it. This was incredibly encouraging and motivating to hear because that is my hope as a pre-medical student and to have that hope confirmed as a fundamental joy of being a doctor was reassuring. Within the department we also got to experience electroencephalography (observation for abnormal brain waves), carotid duplex ultrasonography (examination of arteries and veins for plaque and atherosclerosis), transcranial Doppler (examination of cerebral blood flow and identification of stenosis or stroke), visual evoked potential (detection of abnormalities in the optical tract), and pulmonary function test (detection of pulmonary obstruction or asthma and similar dysfunctions in respiratory function). I thoroughly enjoyed experiencing and interpreting the diagrams and results of all the tests; it was incredible being able to fuse my knowledge that I had learned in neuroscience and exercise science in a clinical setting with regards to my own body or others. I was also allowed to help with small things, and it was fun to get a little hands on experience. For example, I got to help put on EEG electrodes onto the head of an elderly stroke patient and learn of about all the locations. The patient had the biggest, most joyous smile that melted my heart. She was so sweet and despite the language barrier, I could experience her joy through her smile. It is cliché to say that a smile is the same in all languages, but over the course of this trip, it has proved so true. She told us good luck on our studies and I could feel the sincerity behind her good wishes because of her smile. It was also amazing to me how someone who had Alzheimer’s and had recently had a stroke could be so fully of joy. It was a wonderful reminder that your happiness is in your hands and your perception of your life will influence your happiness or lack thereof.

[TCD analysis on my cerebral blood flow -- i’m normal!!!]

[nerve conduction study -- facial nerves twitching all over the place]

Overall thoughts

I enjoyed my two weeks at Thammasat so much. I learned so much with regards to patient care, diagnosis, treatment, and recovery, but even moreso, I reaffirmed my passion to pursue medicine. Getting to see and interact with a diverse group of patients made my heart so happy; I can’t wait to see what the future holds as I pursue this path!!!

#summerlivingtolove #summer2015 #friendsforasia #medicalinternship

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