The One Where I Used a Machete

Yesterday, I had the opportunity to join my school on one of its social missions: to build safe stoves for the families of rural Guatemala. In many homes, families are cooking over open fires, which is problematic for a multitude of reasons. There’s the obvious fire hazard, along with the threat of respiratory disease due to smoke inhalation, and also the less obvious fact that an open fire doesn’t allow control of the heat, so much of it is lost, requiring more wood or other fuel to cook the same amount of food.

My school channels much of its tuition into buying the supplies for these stoves, and the students volunteer to provide the labor once per week.

The day began with my first chicken bus ride!

 

I have yet to take a good picture of a chicken bus myself, so here’s a stock photo!

Basically, a chicken bus is a school bus clad in colorful designs or cartoon characters jam-packed with native Guatemalans in local dress. I was kind of bummed because the one that we took was unfortunately just plain yellow, but I have to admit I never thought I’d be riding a school bus again!

As the bus headed farther and farther outside of the city, the change in socioeconomic status was visible. The scenery transformed from colorful storefronts and houses to dilapidated sheds without doors in fields of dust:DSCN1208 DSCN1209

Our group of four arrived at a small little home barely larger than my bedroom in the US, which was home to a couple and their three sons, ranging in age from 1-6 years old. There were stacks of concrete bricks, sand, and concrete mix waiting for us, but we almost immediately ran into a problem: the family did not have a water source in their home.

Upon venturing across the neighborhood a few times to refill buckets of water at a neighbor’s house, we got to work: soaking the bricks so they would adhere to the cement. Mixing cement. Stacking the bricks in a precisely measured and leveled rectangle.

And my favorite job: chopping apart concrete bricks with a machete.

My handiwork!

My handiwork!

In the end, we’d made this:

Our stage 1 stove! There are two more stages to be completed in weeks to come!

Our stage 1 stove! There are two more stages to be completed in weeks to come!

There’s no doubt that the extreme poverty of this family was striking, but what stood out even more is their generosity. While six year olds in America have no qualms asking for a laundry list of items for Christmas, the six year old in this house divided his single cookie into five parts: one for himself and each of four volunteers.

Why is it that people with nothing share so willingly, while people with everything hold on tight?

The One Lost in Translation

I can almost guarantee you this situation is happening in some hospital, somewhere, with some patient: the medical team walks in, asks a few simple questions in English, and gets the correct answers. The team then proceeds to explain the entire treatment plan in English, assuming that if the patient can respond to basic questions, they must have a grasp of the entire language.

My experiences this week have made me acutely aware of how dangerous this situation can actually be. When speaking to Guatemalans, I can demonstrate a reasonable grasp of Spanish, and often receive responses that are far more complex than I can fully understand. Sometimes, I just get the general gist of things. Other times, I make incorrect assumptions and miss the point altogether. Or worse, I may not have even the slightest idea what was said, but don’t feel comfortable enough (or can’t remember the words!) to ask them to slow down. But typically, I’m only trying to buy a bus ticket or understand my host brother’s new job, so a few words lost in translation are usually not a huge deal.

But when explaining a cancer diagnosis or the risks and benefits of a surgery, losing words in translation is not an option we can afford. I have no doubt there are patients for whom English is a struggle, but they may be too embarrassed or respectful to interrupt to remind us that they can only handle the basics. No wonder patients have difficulty complying with treatments, or even articulating what exactly their medical problems are.

Though I came to Guatemala to learn Spanish via cultural immersion, this trip is also a firsthand experience confirming the importance of using interpreters, avoiding assumptions, and checking to ensure patients are understanding their providers, regardless of language.

The One with the Belated Blogiversary

I am the worst blogger ever.

Yesterday, I spent the day overdramatically collapsed on my bed, exhausted after spending the prior two weekends travelling, and the days in between scrambling to finish oral presentations, studying for and completing Step 2 CS, and doing laundry. I was grateful for a day that demanded absolutely nothing of me, and I chose to indulge in absolute nothingness.

But the consequence of my indulgence? I’m now one day late on acknowledging my one year blogiversary! 

I can’t believe it’s been one year since I started this, intending to offer stories to family and friends during my third year, when I had few other opportunities to catch up with them. And despite my third year schedule leaving dozens of stories yet to be told, I’ve managed to keep in touch with family and discover a whole community of medical (and other) bloggers, mostly thanks to Medical Mondays.

Special thanks to all of my readers for all the support and encouragement. Looking forward to another awesome year with you!

<3, Kay

The One Where Fourth Year is Like Preschool

Today, I donned my bright blue raincoat and red rain boots and trekked out into a downpour on what would be my very last first-day of school. After 22 years of first-day jitters and picking out new outfits, my formal education is just one year away from its end, and I can’t even begin to believe it.


But this year, my fourth year of medical school seems to bear more resemblance to my first year of school, in preschool, than my most recent year of school, my third year, and here’s some examples of how:


Pre-school/Fourth Year:
Teacher / Clerkship Director: So I know that sitting still all morning is really tiring, so instead of going to noon conference, why don’t you play outside in the sun or take a nap for an hour?
Third Year:
Clerkship Director: All noon conferences are 100% mandatory, and we may or may not be taking attendance… you’ll never know.
PS/4th:
Allows you a leisurely wake-up at 8 AM, and maybe even a mid-day nap.
3rd:
Demands that you’re up before the crack of dawn and fully alert by 5 AM, and you sure as hell won’t be sleeping again until at minimum 10 PM.
PS/4th:
Who doesn’t love snack time?!
3rd:
Hmm… did you even eat lunch today?
PS/4th:
No exams, just simple projects to fill the time and allow you to fully explore your creativity.
3rd:
Oh yes, and on top of working 5 AM – 9 PM, we’d like you to study for an incredibly nit-picky 100 question national exam every 6 weeks. You’re welcome!
PS/4th:
Plenty of time to get to know your classmates, visit with family, and enjoy yourself with friends.
3rd:
What’s a friend?
————-
Happy Medical Mondays and happy June!


For my new visitors, I’m K, a brand-spanking-new fourth year medical student in the US, fresh out of my Step 2 boards-studying cave and still growing accustomed to the bright lights and free time on this side of third year. I’ve got plenty of new blog ideas and, now that Step 2’s over, plenty of time to put them together, so stay tuned. For now, take a look around (and maybe even subscribe or follow me on FB/Twitter), or hop on over to visit our lovely hostesses Emma and Jane to peruse some other fantastic medical blogs.

The One Where a Stranger Caught My Happy Dance

I interrupt my Internal Medicine Shelf exam / USMLE Step 2 studying to bring you a very important message:

…I just walked (okay, I’ll be honest, danced) out of the hospital for the LAST time as a third year.

More than a few people witnessed my triumphant hospital exit…

And the next time I don my white coat and enter the hospital, I’ll be a fourth year.

…I can’t even believe it.

Excuse me while I take a moment to squeal:

I did it! I did it! I did it! It’s over! I’m no longer the low man on the totem pole! I’m a fourth year! I did it! So happy, so happy, SO FREAKING HAPPY. 

Andddd back to work.

<3, K

Even More Ways to Know You’re a Medical Student…

41. As fourth year approaches, you tell your long-lost friends that you’re “putting in a standing order for potlucks qmonth.”

42. One of these long lost friends responds, “Phew, my insurance will cover that!”
43. Your favorite GI bug is Bacillus cereus because come on, let’s B. cereus!
44. You’ve perfected your cow drawings and puns to most creatively reserve your team’s COW (Computer on Wheels) for rounds.

Mooooove it along. This one is for Team 3.

45. You crave graham crackers and saltines when you’re exhausted.
46. When your patient tells you that there are invisible people cooking bugs in his house, your immediate reaction is to simply nod and ask, “And how long has this been going on?”
47. Your white coat weighs more than your backpack, and at any given moment you can produce a stethoscope, a reflex hammer, a penlight, 2-3 different texts, patient lists dating back two weeks, and no fewer than five different colored pens.

From A Cartoon Guide to Being a Doctor

48. A small child sees you in the hospital cafeteria and shouts, “LOOK, MOM! IT’S A DOCTOR.”
49. After informing this child that you’re a medical student, not yet a doctor, said preschooler scoffs and rolls her eyes.
50. Your impressive upper body strength earned via surgical retraction is quickly turned to mush by your six-days-per-week internal medicine rotation.
51. It’s not uncommon for someone at a bar to ask how you dealt with “chopping up a dead person and stuff.”
52. You make claims like, “Of course we all have a second stomach for dessert!” because you “learned that in medical school.”

So of COURSE you have room for this!

53. You plan next year’s vacation around the available options for international rotations, just so that the medical school will help fund your next big trip.
54. You spend your days informing patients of the importance of having a PCP and receiving all the right screening tests, but you haven’t actually gotten a physical since you started medical school.
55. You once brought a real human skull home for Thanksgiving, much to the disgust of your mother and father.
56. While spelunking in Budapest, you quickly mark yourself as a weirdo when you begin wondering aloud if the same fungal illnesses exist in American and European caves, because no one wants histoplasmosis.
57. The highlight of your week is when your resident tells you, “It’s Cinco de Mayo. Why don’t you head out and drink some margaritas for all of us?” at 1 PM on a Sunday.
58. Your friend casually mentions that her head hurts, and you immediately slam her with seven follow-up questions. (When did it start? What does it feel like? Have you felt anything like this before? Are you nauseous? Does your mom’s brother’s lawyer’s dog’s neighbor have a history of headaches like this?)
59. You are the only person on the team who is able to take the time to delve deeper into the patient’s history or to listen to their grievances, and you easily earn the patient’s trust and admiration. Sometimes, they’ll even tell you you’ve restored their faith in the medical system.
60. Your blog has been sadly ignored for several weeks while you juggle six day work weeks and upcoming board exams. (But there’s plenty of stories just waiting to be told, promise!)
————
Happy Medical Mondays! Can you believe it’s May already? And beyond that, can you believe I have just THREE more work days until I’m completely DONE with third year?! It feels like I just hit the wards for my very first day on Labor and Delivery, and now, somehow I’m gearing up to take my very last shelf examination.
For my new visitors, I’m K, an almost-fourth year medical student in the US just finishing up internal medicine and very much looking forward to having the time to get back to blogging and share all the stories I’ve collected with you. In the meantime, take a look around (and maybe even subscribe or follow me on FB/Twitter), or hop on over to visit our lovely hostesses Emma and Jane to peruse some other fantastic medical blogs.

Internal Medicine: Week 1 Recap

On Monday, it’s probably safe to say I was legitimately terrified.

Obviously, I didn’t get any sleep on Sunday night, and instead I just sat on my floor wrapped in my own hair.

I just finished radiology, a rotation known for it’s relaxed atmosphere and minimal hours of “work.”

And this week, I started Internal Medicine, an 8-week rotation known for longer hours, intense pimping (aka: q-and-a sessions in which medical students typically get to be embarrassed by just how much they’ve forgotten from the USMLE Step 1), and just an overall larger workload, especially when making the switch from “radi-holiday.”

…except I basically hit the medicine team lottery.

I’m one of four students spending the first four weeks at a community hospital about 35 mins outside of the city, and I’m learning that friendliness of hospital staff increases proportionally to distance outside of the city. I mean, here, people say things like:

“Listen, if your stress level hits even 1/10, that’s too much. You don’t have to know all of the answers and I want to know if you’re feeling uncomfortable.” -Dr. Hospitalist

“I know you have two patients. But do you want a third? Wait, really? You want one? Are you sure? Really? You’re sure?” – my intern, who apparently is really worried about overworking me.

And no one ever makes me feel bad for not knowing an answer. Which is good, because there’s a lot of answers I’ve forgotten in the months since I took boards.

The staff of this hospital.

I was assigned to the team responsible for the less acutely ill patients, so the management plans tend to be fairly straightforward and our patient turnover rates are pretty high. Multiple times this week, I picked up a new patient to follow in the morning, only to help with the discharge paperwork by noon. Admissions typically come in overnight, so usually once my notes are (hand)written, there’s not a whole lot going on in the afternoon.

…which means that I’ve been getting hours upon hours of both independent study time and one-on-one teaching with both my resident and my attending on any topic of my choosing… and I’ve STILL been getting out by 3:00 PM (my classmates stay until 5-6 PM at least…).

This is how you leave the hospital at 3 PM for the fourth day in a row…

Basically, I have radiology hours along with the opportunity to interact with patients.

So I’m pretty much living the dream. Minus the part where I’m spending my one and only day off battling a GI bug, but I guess you can’t have everything.