Panama Planning Trip

During my family practice rotation I went to Panama for a couple of days to plan the future of VIDA in that country. We met with the chiefs of a community, Irgandi, where they have no access to doctors for 3 months of the year. They have problems with infant and maternal mortality rates during this time, diarrheal illnesses, malaria, dengue, and a list of other diseases. We are working with the health department to help teach the people simple things that they can do to help prevent illness along with building gardens to help with their nutrition. While there, we marched in the island breast cancer awareness campaign. It was a great trip and we got a lot of things planned. I also read A thousand years of Solitude, something not medical.

Cardiothoracic Surgery Rotation

What an awesome two weeks! Not only did I get to see and do some pretty cool things in heart surgeries, but the docs were so great to take the time to teach. I would have never have thought that surgeons would be more laid back than internists! I had such a great time with this group. I was able to help out with valve replacements and bypass grafts and removing tumors. I was able to learn how to cut and how to sow on patients with supervision. I pulled drains and chest tubes. One chest tube I didn't have the patient hold his breath and I heard air go back in, which could collapse his lung and prolong his hospital stay 3 more days...luckily he was fine on xray and not symptomatic. I had a hard time sleeping that night because I was worried about him. But now on to family medicine.

Internal Medicine rotation

Internal Medicine rotation was rough. During most of the rotation, my stomach was so tense that I would have diarrhea and want to vomit. Mostly because I felt that the attending physicians were going to attack me for something I didn't know. On my third day of the rotation, my attending asked me a question about diabetes management that he had mentioned in a noon lecture series that I couldn't remember what he said because I was eating lunch and it was the first time I heard about diabetes management. When I asked him what the answer was, he wouldn't tell me and told me to find it out for myself. I looked for four hours for the paper he was talking about and asked other students, residents and interns and couldn't find the answer. I finally found the answer and he never asked me the question again. I finally felt that I got the hang of internal medicine after two weeks and then I switched to cardiology where the whole game of learning what the attending wanted started again. This time it was more complicated because my attending didn't like guidelines. It was a pretty traumatic two weeks and then I got the hang of it. It was interesting when my attending told me that patients feel that doctors are like gods. I thought that the god complex was just a myth....

Lone Peak

I went hiking with my roommate Benj, his sister Katherine, and friend Wendy Lee. It was a pretty crazy hike. We started at the Draper side although it was supposed to be the prettier and less of an incline... The problem was that there was a huge fire there a couple of weeks before and had burned the mountain side and it was still steep but had 2 extra miles of flat. It did have an awesome view of the valley as you could see both the Great Salt Lake and Utah Lake (two of the most beautiful lakes in the entire world!) We also could see IKEA which the girls ended up getting a picture of. We came across wild raspberries and elderberries and ate enough to almost get diarrhea but we didn't. Along the trail there was a cabin that some brothers had made and had actually saved a couple of people from freezing to death when they were caught in a blizzard last year. It smelled like urine but it was pretty cool that they had taken the time to build it.

Lone peak had a incredible view and it was kind of freaky having to balance on rocks with sheer cliffs of a couple of hundred feet on both sides of you. But it was worth the climb. On the way back, I led us down the wrong canyon (as there are many trails to get to Lone Peak) and luckily Benj had his GPS. We ended up having to do a little rock climbing. It was quite the adventure. We finally made it back to our cars after 16 miles and 12 hrs of hiking. It is a good hike and not for the weak hearted but it is one I would recommend for the view and the experience.

My pediatric rotation

I just finished my pediatric rotation and thought that I should write a little about my experience.

Pediatrics was great. It was so cool to go to deliveries and see how the babies turn from blue to pink and to be able to warm them up. It was sad to see babies going to bad situations and feeling helpless. Watching circumcisions was a little traumatic though. Out patient peds was fun besides having malaria at the time. I think that it would be pretty cool to see kids grow up. A lot of the visits were healthy kids and making sure they were alright which was good. I spent a couple of days with oncology and got to do some lumbar punctures which was pretty fun also. I was nervous but I think that procedures could be good to do. I really liked inpatient pediatrics and following families day after day and seeing the progression of their health.

Embarrassing moments:
My attending physician has a reputation for being strict and giving poor evaluations to both students and residents. I actually really enjoyed his teaching. When I went in for my evaluation I tried to convey this. I said "I really like that you tell us what we did wrong after every presentation....you are not like those nice doctors that say you did a good job." He immediately replied asking me if I thought that he didn't give any positive feed back. I told him that we were all happy with him. Never the less, the next day he brought a bowl full of candy for us.

Our last day, because our attending only wears bow ties, we all dressed up with bow ties. It was pretty funny and quite a sight to see us following him around dressed like him and we received plenty of comments.

Irony of malaria

After a week of well baby nursery and starting out patient clinic during my pediatric rotation, I noticed that I had a high fever. My first thoughts were that I had gotten a virus from one of the kids or that I had malaria from my trip to Africa this summer. The next night, however, the truth came out as I woke up with my bedsheets and clothes were soaked to the skin. I had to change everything so that I could go back to sleep. At that point I knew I had malaria because I didn't think that I had cancer or tuberculosis which can also give you night sweats.

Because the fevers would spike and then I would feel alright, I went to the clinic to talk to the pediatricians about what I had. I followed one of the interns for a while until I was shivering so bad that he told me that I needed to go a doctor. I drove with my windows up on a hot July day so that I wouldn't feel so cold. I went to the student health center because of my horrible health insurance deductible of $2500. They took my blood and cleaned up my vomit and told me they would contact me when my results were in.

I figured that they would want to treat me and that it was better to be near a hospital than at my home alone if something went wrong, so I went to class. I had to leave because I had another fever spike. I went to Dr.Hale's office, my research mentor and infectious disease doctor, who was in Ghana. I laid down on the floor as his secretary got his PA to come see me. She had to call the lab twice to get my results because they weren't going to read them for two days. From my experience in Africa and studies on malaria I knew the dangers of cerebral malaria and was shocked that I wasn't going to get treatment. Luckily, I got some Malarone pills from someone who didn't need them and under Terry, Dr. Hale's PA , I took them. I threw up the first dose (which each dose costs $32 and there were a total of 3, and I had to get another dose). I only took one because I felt that I had absorbed some...not good. Then after my medication finished and I had another episode of night sweats I self treated with expired doxycycline (my prophlyaxis from a year previous.) I called the pharmacists and she said that by doing that I made my medication 40% less effective (she also told my mom about how stupid that was when she picked up my meds for me and got her worried.) I got one more dose.

And after a week of symptoms I felt better. I was pretty scared through the whole thing though because I was peeing blood and could feel my spleen and liver were enlarged. Dr. Hale returned from Africa they day I felt better and said that I should have been hospitalized. I had P. falciporum the most deadly species, but only 1% parasitemia.

The people at the public health department laughed at me because I was supposed to be studying about malaria prevention and ended up getting it. My excuse was that my deet in my backpack ate through my medication on the way home from Africa and I took the risk because I was already home. I lost, but now I have a funny story to tell. The health department did contact me and said there are mosquitoes in Utah that can carry malaria. I went camping in the windrivers right after getting home. I feel that if there is an outbreak of malaria in Wyoming it is my revenge for that stupid speeding ticket!

Wind Rivers and Rainbows

Two days after getting home from Africa, Brent and I went to the wind rivers to explore the vast wilderness of Wyoming. On my way there, I recieved my first speeding ticket which was awesome. We found out at a diner from a weird gray haired waitress that had the blank stare of a serial killer that the "Rainbows" were having their convention up where we were going to be. Driving up there, we saw a couple of people hitch hiking and when we got into the mountains we discovered the school buses turned homes, pirate flags, and naked people. It was pretty great. We ended up getting up to Big Sandy at 10 at night to be pretty much the only group at the lake. We put our food in the bear box and slept to the sounds of the river rushing a hundred yards away...beautiful. I woke up and played my harmonica waiting for Brent to wake up which he did at 900 and then we went and hiked the cirque of the towers. The hike was through snow up to our thighs at sometimes. It was quite an adrenaline rush as we walked on the frozen snow through the boulder field because you never knew if the next step you would stay on top of the frozen snow or a fall to an unknown depth. When we got to the cirque and had lunch, there was a marmot that was watching us. I was stupid and gave it part of my bagel. We tried to take a nap but the marmot would get on the different boulders that we would be sleeping on and steal things. We would throw rocks and try to scare him, but he had a short memory and would keep coming back. I finally hit him twice in the face and he left us alone. (It was from lots of good practice from throwing rocks at Paul and Spencer on hikes. I knew those skills would come in handy one day.) The cirque was pretty cool. The next day, we went and hiked to the top of East Temple Peak. The hike was intense as it consisted of hiking through a river and ice on top of the river, snow that you couldn't stay on top of, and the edges of frozen lakes (which sometimes broke.) We were beat already when we got to the steep boulder fields of the peak. I thought that I was going to throw up. We finally got to the top and rested and saw an incredible view. We then came down the mountain part of which consisted up sliding on our butts down one of the steep slopes that we had to climb up. Coming down was much better than going up and I finally didn't care about getting my feet wet so I walked through the river on the way down. We were beat that night and I burned off my shoe laces trying to dry them by our fire. We got down the next day when 3 huge groups were going up. They probably waited for Monday because they went to church. I figured I prayed so much more hiking to East Temple Peak that I would survive than I normally do that I was justified in hiking on the Sabbath. On the way home, because of Brent's beard and my neck beard people thought we were Rainbows and would be pretty angry when we wouldn't pick them up when they were hitch hiking. I felt a little guilty especially because I have always wanted to hitchhike for the experience and never dared to. Especially because I don't really feel hippies are dangerous. I just had a bunch of clothes that David had given me for rotations in the back seat and wanted to get home in a hurry. I am not the hippie that I would like to be, but at least I survived and felt the efforts of my hiking in the wind rivers for the next week.