My Caribbean Medical School Experience: Hospital visit, School Updates, and just some fun stuff

I hopped off the bus from Roseau with my hands full. I tried to steady my hands with two pizzas, a white coat, a 1 liter water bottle and a backpack. As I began to ascend the hill to my apartment, I contemplated my days’ visit to the hospital and put another check in the mental column knowing that I chose the right profession. Here's a recap of my day.

I awoke this morning at 7am, rubbed the sleep from my eyes, and attempted to get dressed in the dark. Today was hospital day. I had to look like a doctor, for real live patients for the second and final time this semester. I arrived at the library with my classmates before taking the shuttle to Roseau. The ride took a little over an hour up the winding hills and valleys to the Dominican capital. We arrived at Princess Margaret Hospital and placed our things in our designated room, and tackled (to some) the most important task of the day, figuring out the orders for Pizza Hut. I can say with honesty that some people dreaded hospital day. At one point, I was one of them. This is the day that we can test our skills and look like a stud, or try and fail and look like a dud. I’m pretty determined to avoid looking like a dud. Many of my friends attended the hospital the weeks prior to my visit, and as always, they shared their experiences. The common consensus was that if you get the geriatric rotation (old folks) for the day, prepare for the doctor from hell. My friends warned me of the doctor’s demeanor and be prepared to know your stuff, or expect a tongue lashing. My goal as you’d expect was to avoid that rotation if I could, but we don’t get the choice. As the stars aligned and they read off the names for geriatrics, my name was right at the top. I couldn’t help but think like Charlie Brown.

I swallowed my pride and prepared for what was certain to be a crappy day. Because the rotation for geriatrics isn’t at the hospital, we had to take a short bus ride to what they call the “infirmary.” When I heard what they called it, I thought I was going to the dungeons beneath Westeros. To say the least, I was in for a few surprises.

This is the Infirmary.

When we arrived, I instantly tossed out my preconceptions, but still prepared for the hellish doctor that would be overseeing my visit. We were greeted by two doctors, both pleasant and kind. And my six classmates divided into two groups and each saw our first patient.

Our patient was an elderly Dominican man, who greeted us with the widest smile one can have with only a few teeth. He was a very pleasant person, and he couldn’t wait to figure out what was wrong with him. He was like a child with huge secret that he couldn’t wait to blurt out. ( His secret was his condition.) Typically, we would interview the patient and gather history before doing a physical exam, but this case we had to use our Sherlock skills and deduce the problem by observing. To avoid getting in trouble with HIPAA and all that patient confidentiality business, I’ll avoid the boring stuff and simply say, that after doing all the necessary tests, my group figured out the problem in a matter of minutes (at least I did.) It was a “by the books,” “textbook,” “play by play” perfect example of an old stroke. (If a patient has a stroke in the right side brain, it affects the left side, and vice versa.) Medical jargon aside, it was fun seeing everything I would expect to see for a patient with that condition, and it felt good to know it. When we spoke to the patient about his “secret” he was happy to know that we got it right, then he strutted his way over to go and chat up the pretty ladies down the hall. He was a joy to work with, and interestingly, so was the doctor. (were my friends wrong about the mean doc?) After this patient we rejoined our groups and received a tour of the infirmary. And I have to stop here and make a huge statement.

Shame on us.

What? What do you mean shame on us? Who am I even talking about? You, your friends, your family and the entire United States and myself.
What was that all about? Are you offended for not knowing why? Let me explain.
I’m learning about medicine in a country that is ridden with poverty. A country where clean water is rare even from the tap. A country that doesn’t have the capabilities of medicine that we take for granted in the USA. Where patients have to fly to a nearby island to get complicated surgeries or even simple ones. With all this being said, they still treat their elderly with more respect and dignity than they ever do in the states, all with a tiny budget.

To paint a picture in your mind, the infirmary is a perfect square, three of the sides are wards for patients, and the last is the “administrative” part, the kitchen, and the “chapel.” The doctor explained that each patient is taken outside to enjoy the fresh air every day. This rarely happens back home, even in the nice weather. Each person enjoys a complete bath from a nurse and has their hair braided (mostly the women) every single day. In the US, nursing home patients are lucky to get a bath once every 3 days. Their beds and quarters were spotless, despite the building being old (likely built in 1940’s.) The physician said that the floors were so clean, that she would eat off of them (though I wouldn’t suggest doing that anywhere.) Their meals were prepared from scratch, made with local spices and veggies and spelled AMAZING. The patients in this building never got bed sores. not a single person. In the states, patients are often stuck in bed for days or even weeks, collecting bed sores like they are going out of style. As I walked around the patio where the patients sat, many of them smiled and waved and said “Good morning doctors!” Hearing those words, brightened my already chipper day, and made me feel guilty all at the same time. (The feeling of guilt was from the realization of how different the Dominican and the US cultures differ in their values toward their elderly.) We continued our rounds, pointing out visible clinical signs of old strokes and cerebral palsy. For lunch my group traveled to one of the few fast food restaurants on the island called KFC. (maybe you’ve heard of it?) After lunch we returned to the infirmary to conduct our patient interview and clinical exam on a new patient.

Our new patient was an elderly woman with no current complaints, but a laundry list of medical problems. As the patient entered the exam room in her wheelchair, I was able to use a few skills I learned as a nursing assistant to help her into the bed (you never know when old skills will surface again). This patient tested our group’s ability to remain professional while guiding the patient back to the interview after each 5 minute story of her life. (We only had 30 minutes to do the interview, and she told a version of the same story 3 times, hence cutting our time quite a bit) Nonetheless, we managed obtaining enough information to continue on to the physical exam. This is where my team got to shine. I was in charge of doing the cardiac exam, and my classmates did the general survey and abdominal exam. As a team we were able to determine a previously undiagnosed condition that the staff had not yet known about. (avoiding details to keep patients identity safe.) We thanked the patient for her time, and afterward we had to do the hardest part of our day. Dictate our findings of the patient to a doctor as if we were a doctor talking to the attending physician. (This is much harder than it sounds, because we have to abandon normal speech, flip a switch and speak a language called doctor.) In doctor language, we describe every aspect of every finding based on anatomical placement, hyper this, hypo that, jaundice, erythema, conjunctiva, pallor, bilateral, unilateral and the list goes on. (for my medical friends, I know this is simple stuff, but to some, it’s tough.) Your sentences sound like “On examination, there was a erythematous papule of 2 cm diameter on the left lower extremity” or “On examination there is hyperpigmentation of the epidermis of the right hand’s proximal interphalangeal joint on the 2^nd digit of the right hand.” A few of these sentences come out of your mouth and a patient nearby stares blankly as if you are speaking dolphin. In plain terms, the person has a freckle on their finger. After many verbal corrections from our doctor (who turned out to actually be an angel) on how to present a case, I now feel more comfortable with doing this task in the future.

We returned to the hospital to collect our belongings and returned home with a feeling of fulfillment and satisfaction.

About a week ago I was tested on my ability to conduct an interview and educate a patient about a topic that is usually tough for patients to talk about. (Such as alcoholism, child or spousal abuse). The reason I am writing about this particular exam is because I walked out of the exam on top of the world, thinking that I had aced it. I failed, and it was one of the better things that could have happened to me on the island. I’ll explain. When I received my results, by default I entered into something called the “Stages of Grief.”

Stage 1: Denial

My first thoughts were that they made a mistake. I felt amazing during that exam! I knocked it out of the park! (They didn’t make a mistake)

Stage 2: Anger
I was furious. I was upset with my grader, myself and the world.
Stage 3: Bargaining
They must have gotten my exam mixed up with someone else! Maybe THEY made a mistake. I talked my exam through with my friends to confirm my suspicions and boost my ego.
Stage 4: Depression
It ruined my whole day. I was so upset that I couldn’t even study.
Stage 5: Acceptance
I got down off my ego driven high horse and considered the possibility that I made a mistake. Maybe I missed something important. Maybe I made a critical error. ( I did)

After meeting with a professor, it turns out that I did well in 4 out of 5 sections, and failed the last one by a single point. But if I hadn’t failed, I NEVER would have learned from the many tiny mistakes that I did make. If I passed, I would have pat myself on the back and moved on and been a mediocre doctor with a lot to learn. Instead, I was lucky enough to fail and was able to fix many of the problems that I was unaware I had. To me, that was something I am thankful for. The professor was confident I would have no trouble passing the second time around and I am retaking the exam in a few weeks. (Don’t worry, I’m still getting along fine.) I am a firm believer that the best way to learn is to make a mistake, and did I ever learn something here.

Just some small highlights and scattered thoughts:

For the first time in my med school career, I received my first B+ on an written exam. It may not seem like much, but that was my equivalent to climbing a mountain slightly smaller than Everest. (Heck, I can’t climb the whole mountain unless I get an A right?) It was a proud moment worth mentioning, but I’ll move on.

From the very moment I chose to come to Ross, I wanted to complete my fifth semester in Saginaw, Michigan. It’s close to home, my family is there and my life is there. I got accepted to go to Saginaw for my fifth semester, and I have to turn it down. With my current timeline of events, completing my 4^th semester at the end of April only gives me 1 month to study for the test that determines every part of my future as a doctor. It isn’t to be taken lightly. So after talking long and hard with Sarah, I’ve decided to postpone my 5^th semester for a few months so that I can prepare for this exam. This means that I will continue my 5^th semester in Miami Florida in September of this year before moving on to my clinical rotations early in January 2015.

I feel that some people go through life wearing a set of horse blinders that shields them from enjoying the little things. Every day that I walk the sidewalk to or from class, I always turn to look at the flower bushes growing along the way. If a person doesn’t stop and look hard enough, you’d miss one of the things the island is known for: it’s nature. Aside from the colorful flowers and fruitful trees, I’ll often see a plethora of hummingbirds zipping and diving around the bushes. I even stop in my tracks to watch them as people walk into me like I’m an idiot for having my brake lights out. Sorry. Even on a recent run of mine through open trails deeper into the mainland (away from the water) I saw some of the famed parrots that the Dominicans proudly display on their flag. It was one of my more memorable moments on the island.