For this week, and more than likely next week I be will shadowing a group of residents. Meaning they've completed medical school are doing rotations in all of the wards of the hospital, to better improve their knowledge and also work towards choosing a specialty. Residents are assigned to an attending, which is a more seasoned and experienced doctor. This group's attending is Dr. Bina, the pediatric neurologist I referred to in an earlier post- who reminded me of my Aunt Betty. That makes shadowing the residents all the more interesting and enjoyable, because Dr. Bina is an AMAZING doctor. Yesterday, we attended the morning session where the group of resident's, who had been on duty the previous night, reviewed the new cases with all of the doctors in the hospital. Then they went on rounds, going more in depth with the charts and treatment plans with the another attending/head honcho guy, of whom I still need to get a name. Meaning it was a very busy and fast-paced day for them, so we didn't do much, but listen and walk quickly from ward to ward. However, one of the residents did have us go examine a patient, and try to infer what we thought the problem was. The patient had severe edema/swelling on the right side of the body, that had been there since birth. We ruled out allergy and injury and predicted that it was something genetic. Once the resident made his way over to the patient he told us that it was something genetic, probably a syndrome of some kind, that he would have to do more reading and research on to find out exactly what it was, since it was rare. Today however, was a more "typical" day for the residents. We went the morning session again, where a new group of doctors/residents reviewed the cases from the previous night, when they had been on duty. Then the residents we're shadowing reviewed cases that had already been admitted for a few days with Dr. Bina. They went patient to patient, ward to ward, going over charts and treatment plans, while Dr. Bina approved and did some teaching along the way. At one point she went on a bit of a rant, which she did in English surprisingly, and her words were incredible. She reminded the doctors that hard work and discipline were both important parts of medicine, along with taking a humanistic approach. Additionally she added that intelligence is important but more important she thought was their attitude and enthusiasm. She also mentioned that the therapeutic part of care is extremely important in medicine, especially in Pediatrics. Finally, one of the coolest things she said was, "your eyes can't see what your mind doesn't know". Meaning you could miss a diagnosis if you haven't learned about it, which is why it's so important to make list of possible diagnoses, and then refer to the literature and start ruling things out, or adding possibilities. Basically, she wanted them to be continuously learning. Like I said, she's an incredible doctor, and teacher.
So in addition to their follow-ups with Dr. Bina, the residents also performed two procedures today, which we got to watch and "assist" with. The first one was a lumbar puncture (spinal tap) on a boy, probably 10 or 11, who had minimal capabilities to move his body, and couldn't speak. This procedure is when a needle is inserted into the spine of lower back, lumbar region, and fluid is collected. This fluid is the cerebrospinal fluid, CSF, which is the fluid that surrounds the brain. This fluid is then evaluated in the lab, the results could help lead to a neurological diagnosis. This particular procedure can be extremely painful, and this boy was under no sedative and since his family wasn't in the room, he held my hand for the entire procedure. It was so rewarding to not only watch this procedure but to be able to hold the patients hand, and assure him (the best I could) that the pain wouldn't last long, and it was all going to be okay.
The second procedure we observed was a bone marrow aspiration. This was on a much younger patient, and since it was a much more painful procedure sedative was used. In this procedure a needle was again inserted in to the lower back, to remove bone marrow, which is the spongy tissue found inside bones (containing cells that produce red and white blood cells and platelets). The sample is then spread on to slides to be examined. In this particular case, they suspected that the patient had leukemia, so they were testing for that. This case was extremely interesting to observe, but much less rewarding emotionally for me.
That's probably my favorite part about medicine. The interaction with patients. Because you have to be there for them. They are putting their lives in your hands and you have to make them feel like even if they're scared, they're making the right decision to trust you. I've always had a passion for helping people, and medicine is where my interests led me. But today, when I gave my hands to someone else to hold, to assure them that it was going to be okay, I felt in my heart and knew in my mind, that I was right where I was supposed to be.
Each day that I'm here in Nepal and each day I spend in the hospital, I'm reminded of how truly blessed I am. It helps to put a much more humbling perspective on things, and allows me to think and feel in a ways that I never thought possible. I guess that's what happen when you're thrown into something completely new and completely different. Something that forces you out of your comfort zone. Something that challenges you emotionally, physically and spiritually. But when you take on, and eventually survive, that something, you realize that you couldn't imagine your life without it.
Nepal, is one of those somethings.