I know I promised to write more, and here I am with mostly regular internet access and I am doing worse at writing than I did when I had only weekly access! Sorry! I'll make up for it with two posts this time.
Let me begin by saying that Siem Reap (the city in which popular tourist destination Angkor Wat is located) has a totally different atmosphere both from the villages where I have worked in the past and from Phnom Penh, Cambodia's capital and largest city. It is very Western because of all the tourists, plus it is a popular landing site for expats and a central place for NGOs. It is chock-full of restaurants selling Khmer and Western food (meaning you see traditional dishes like Amok, things like morning glory in oyster sauce and fried noodles, on menus alongside things like pizza and cheese burgers, plus you may or may not see Thai, Korean, Indian, or Chinese food as well, or even some sketchy Mexican and Khmer places), and I can't walk more than 50 feet without someone calling out, hello! Tuk-tuk miss? (tuk-tuks are motor bikes attached to fancier carts), and when I politely decline, asking tomorrow? See Angkor Wat? It makes me smile, really. The upside is that many speak a passable degree of English, so I could do things like borrow a pen from the waitstaff at the restaurant I have been frequenting, and manage to be understood. I do miss the simplicity of being in the villages though, and the constant interaction with fascinated villagers. I miss the vieilles and their toothless smiles, the children calling out, hello!, being surrounded by Khmer and forced to practice.
A day starts for me around 6, which is when my body has, without exception, decided it will wake up. (This is now two and a half weeks in, and still 6am...no matter when I go to bed.) Recently at least, I can almost go back to sleep by the time I get up, at 7. I get ready and come downstairs for breakfast at the guesthouse. My current favorite dishes are banana-chocolate pancakes (with banana in the pancake and chocolate on top) and bread with vegetables and cheese (because I have a penchant for melted cheese and the mini baguettes are quite toasty!). I get to the hospital around 8:30, usually walking with the one or two premedical students who are also doing this program, and my translator (who is a nearly finished Khmer medical student) meets us there. Rounds start whenever the doctors arrive from their morning meeting (which I surmise is a bit like Grand Rounds where a case or disease is discussed, but I am not entirely sure). Rounds may or may not go quickly, depending on the complexity of the cases, how many operations are scheduled for the morning, and whether one or both of the surgeons is present. One surgeon is a younger, quieter man, though when I worked with him for most of a morning, I was surprised at how much English he spoke and how much he too seemed to enjoy teaching me. The other is far more effusive--he has a constant twinkle in his eye and loves to laugh and joke with the nurses and patients. He is the one with whom I work the most frequently and he really seems to love his work. He is also a great teacher, prone to asking "pimping" (basically, the questions the attendings love to ask students) questions in French, English, or Khmer depending on his mood and the complexity of the question. He also loves to look at an interesting patient and tell my translator and I to discuss, leading us on a brief history/physical and discussion between us as to what labs to order. Sometimes I have to stop myself and remember an ANA or dengue titer is not available for the vast majority of Cambodian citizens. After rounds, we'll go to the OR (I'll post about this soon) and watch as many surgeries as the morning will have, then we will sit outside for a bit and discuss a tropical disease like dengue, typhoid, or for tomorrow, leptospirosis.
The afternoons are usually quiet here. The doctors need to work in private clinic as well as public to make sufficient money (or more than sufficient money...) for their families, so the hospital pretty much goes silent in the afternoon (the moral of the story is if you're a patient, you do NOT want to have a crisis in the afternoon, where there are primarily nurses around and there is also a doctor on call). The doctors go to their respective clinics after lunch. Most days, I come back, have lunch, write, sometimes I talk with people, sometimes read. Lately, the animated surgeon has been telling me if he or someone else is on call and has an afternoon surgery, and I'll go and watch. In the evenings, usually I meet with the two premedical students and we get dinner. Our favorite place is Father's Restaurant, whose prices don't exceed $3.50 or $4 for anything on the menu. They have lovely Khmer food (tonight I had a soup like egg drop soup), coconut water from a coconut, excellent fruit shakes, and so much more, plus the staff is really sweet--and they recognize us by now :)
I really am having a good experience! I don't always feel I am doing a lot of good, but I am learning a LOT about medicine in Cambodia and learning how things are done, getting ready for my own rotations at Georgetown that begin in just two weeks....
Thanks for listening :) I will try and give you a glimpse into surgery in the very near future!
Sunday, June 24, 2012
Tuesday, June 5, 2012
Second Year of Medical School
Second year of medical school....rumored by some to be the most intense year of medical school and indisputably a challenging, busy year. That perhaps explains, while not entirely excusing, my lengthy blog silence. Still, I have to say--I (mostly) loved second year, and I am tremendously excited to begin clinicals in July.
Second year falls in a steady rhythm: four weeks of consistent class and studying with the ability to take a night off here and there, to visit friends in the area, followed by two weeks of class and more intense studying and slightly rising blood pressure, and finally, two weeks of nine-plus hour study days and four exams, where the light of day is barely seen (with a few pauses when sanity is needed). Then, the cycle begins again. Really, I prefer it to the first year schedule of exams every two weeks. Sure, there are about three weeks that are way more insane than any time in first year, but the stress ebbs and flows. There is recovery time, less guilt when an afternoon is taken off for ice cream or a walk or to hang out with friends. If first year told you everything about how the body works and where all its parts are located, second year told you everything that could go wrong and how to treat it. The analogy of flinging mud at walls hoping some sticks is fairly accurate, but I did love the material. It felt much more clinically relevant and tangible. I do remember some of it too; for instance, I can probably tell you how to treat hypertension, recognize bipolar disorder, take a much better health history, and tell you what to expect with heart failure. Most pharmacology no longer sounds like a foreign language, and Microsoft Word has even learned how to speak it :)
What are some of the lessons of second year?
(1) Boards are omnipresent and awful. Sorry to begin the list with a downer, but anyone who has been to medical school knows that Step 1 of the medical boards is kind of an obsession throughout second year. Professors are known to indicate parts of lectures that are "often on the boards." Bits of information are added specifically for that purpose. Talk scatters about "q-banks" (series of questions and explanations), "First Aid" (tells you almost everything you need to know for boards), "DIT" (one of the online prep classes). Having studied for them since October and taken them nearly two weeks ago now, I can say it is seven hours of brain drain for which I paid nearly $1200, but finishing is definitely an accomplishment, my span of knowledge is more, and I just keep my fingers crossed for a good score.
(2) Many patients really do respect you as a physician. During fourth quarter physical diagnosis, which took me and a partner to a hospital in the area, we had the wife of a patient shoo a visitor away for a few minutes because, "the doctors are here right now." Even with the short white coats and stethoscopes and reflex hammers that feel much more awkward than natural in our hands, with a mouth that stammers out history questions and fingers that furiously scribble answers for fear of forgetting anything, minds that search desperately to remember what to ask if the patient has had a stroke or diabetes and frequently forgets to ask about medication allergies, we are viewed as authorities. It's certainly terrifying to know and humbling, but empowering too. It is like a flash vision of the future, where we really will be doctors, exuding confidence and actually knowing some of the answers. I had a moment in ambulatory care in the first semester, where we go and shadow a primary care physician in the area, when I was able to follow up with a patient. She'd been someone I expected to be difficult when I met her, with several physical and psychological problems, but she and I ended up connecting. I talked with her for a half an hour, gathering relevant history and advising for weight loss. I left with an encouraging smile, and was blown away when three weeks later, she came in again and remembered my name. When I saw her with my preceptor, she acknowledged to have followed some of my diet advice, and she hadn't gained any weight in the time in between. I was blown away. A patient actually followed my advice? It made my month.
(3) Coffee really does work. This is not to say I am addicted--I am working really hard to keep my consumption to a minimum. And no, I still don't like the taste of coffee--I have to have cafe au lait or a latte or anything that is at least half milk. I have discovered, however, that on days where I have not gotten nearly enough sleep and I find my eyes getting heavy or my mind stalling over the same five words, the caffeine in coffee does bring me that needed burst of energy and helps me to focus more. Whether the effect is psychological or not, I haven't tested, but it does work. That being said, I can't do more than a medium, ever. Sometimes even with that, if I am not sufficiently sleepy, I can feel the caffeine in my blood like tiny bubbles, and it feels as though everything is going on warp speed. It's all a matter of spacing and planning :)
(4) There's something for everyone. Well, mostly at least. My favorite module of the year was viruses. That something essentially non-living to be so destructive and so elusive of nearly all medications just blows my mind. I have quite a bit of respect for these little particles as pathogens! My friend meanwhile far preferred bacteria to viruses. Others loved cardiology, neurology. It will be interesting to see how all my classmates and I like our rotations next year and what we all end up going into.
(5) Medicine is truly a calling and privilege. Though or patient interaction was mostly minimal this year, every one reminded me why I love medicine and why plugging through these didactic years is SO worth it. Just being able to hear fragments of people's stories and to sit in a room with them and figure out how to connect with them on a very human level is powerful. I admire the strength I see in most of the patients, how one can be a 49-year-old former addict and now diabetic with ulcers on 20 medications and still light up when she talked about her grandchildren, or how one can be depressed with multiple ailments and exhaustion written on her face yet find the energy to joke with us. There truly is nothing else I would want to do with my life.
For those who stuck with this very long entry, thanks :) I will try and be much, much better with writing this year. I leave tonight for Cambodia, where I will spend three weeks working in a hospital in Siem Reap (where the temples of Angkor Wat are) doing what is essentially a rotation. It was time to try something more clinical for me. When I come back, rotations start and I will begin with OB/gyn at Washington Hospital Center for six weeks. Blessings and love to all!
Second year falls in a steady rhythm: four weeks of consistent class and studying with the ability to take a night off here and there, to visit friends in the area, followed by two weeks of class and more intense studying and slightly rising blood pressure, and finally, two weeks of nine-plus hour study days and four exams, where the light of day is barely seen (with a few pauses when sanity is needed). Then, the cycle begins again. Really, I prefer it to the first year schedule of exams every two weeks. Sure, there are about three weeks that are way more insane than any time in first year, but the stress ebbs and flows. There is recovery time, less guilt when an afternoon is taken off for ice cream or a walk or to hang out with friends. If first year told you everything about how the body works and where all its parts are located, second year told you everything that could go wrong and how to treat it. The analogy of flinging mud at walls hoping some sticks is fairly accurate, but I did love the material. It felt much more clinically relevant and tangible. I do remember some of it too; for instance, I can probably tell you how to treat hypertension, recognize bipolar disorder, take a much better health history, and tell you what to expect with heart failure. Most pharmacology no longer sounds like a foreign language, and Microsoft Word has even learned how to speak it :)
What are some of the lessons of second year?
(1) Boards are omnipresent and awful. Sorry to begin the list with a downer, but anyone who has been to medical school knows that Step 1 of the medical boards is kind of an obsession throughout second year. Professors are known to indicate parts of lectures that are "often on the boards." Bits of information are added specifically for that purpose. Talk scatters about "q-banks" (series of questions and explanations), "First Aid" (tells you almost everything you need to know for boards), "DIT" (one of the online prep classes). Having studied for them since October and taken them nearly two weeks ago now, I can say it is seven hours of brain drain for which I paid nearly $1200, but finishing is definitely an accomplishment, my span of knowledge is more, and I just keep my fingers crossed for a good score.
(2) Many patients really do respect you as a physician. During fourth quarter physical diagnosis, which took me and a partner to a hospital in the area, we had the wife of a patient shoo a visitor away for a few minutes because, "the doctors are here right now." Even with the short white coats and stethoscopes and reflex hammers that feel much more awkward than natural in our hands, with a mouth that stammers out history questions and fingers that furiously scribble answers for fear of forgetting anything, minds that search desperately to remember what to ask if the patient has had a stroke or diabetes and frequently forgets to ask about medication allergies, we are viewed as authorities. It's certainly terrifying to know and humbling, but empowering too. It is like a flash vision of the future, where we really will be doctors, exuding confidence and actually knowing some of the answers. I had a moment in ambulatory care in the first semester, where we go and shadow a primary care physician in the area, when I was able to follow up with a patient. She'd been someone I expected to be difficult when I met her, with several physical and psychological problems, but she and I ended up connecting. I talked with her for a half an hour, gathering relevant history and advising for weight loss. I left with an encouraging smile, and was blown away when three weeks later, she came in again and remembered my name. When I saw her with my preceptor, she acknowledged to have followed some of my diet advice, and she hadn't gained any weight in the time in between. I was blown away. A patient actually followed my advice? It made my month.
(3) Coffee really does work. This is not to say I am addicted--I am working really hard to keep my consumption to a minimum. And no, I still don't like the taste of coffee--I have to have cafe au lait or a latte or anything that is at least half milk. I have discovered, however, that on days where I have not gotten nearly enough sleep and I find my eyes getting heavy or my mind stalling over the same five words, the caffeine in coffee does bring me that needed burst of energy and helps me to focus more. Whether the effect is psychological or not, I haven't tested, but it does work. That being said, I can't do more than a medium, ever. Sometimes even with that, if I am not sufficiently sleepy, I can feel the caffeine in my blood like tiny bubbles, and it feels as though everything is going on warp speed. It's all a matter of spacing and planning :)
(4) There's something for everyone. Well, mostly at least. My favorite module of the year was viruses. That something essentially non-living to be so destructive and so elusive of nearly all medications just blows my mind. I have quite a bit of respect for these little particles as pathogens! My friend meanwhile far preferred bacteria to viruses. Others loved cardiology, neurology. It will be interesting to see how all my classmates and I like our rotations next year and what we all end up going into.
(5) Medicine is truly a calling and privilege. Though or patient interaction was mostly minimal this year, every one reminded me why I love medicine and why plugging through these didactic years is SO worth it. Just being able to hear fragments of people's stories and to sit in a room with them and figure out how to connect with them on a very human level is powerful. I admire the strength I see in most of the patients, how one can be a 49-year-old former addict and now diabetic with ulcers on 20 medications and still light up when she talked about her grandchildren, or how one can be depressed with multiple ailments and exhaustion written on her face yet find the energy to joke with us. There truly is nothing else I would want to do with my life.
For those who stuck with this very long entry, thanks :) I will try and be much, much better with writing this year. I leave tonight for Cambodia, where I will spend three weeks working in a hospital in Siem Reap (where the temples of Angkor Wat are) doing what is essentially a rotation. It was time to try something more clinical for me. When I come back, rotations start and I will begin with OB/gyn at Washington Hospital Center for six weeks. Blessings and love to all!
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