The One About Pop Wuj

Two weeks down, two weeks to go in Xela, so I guess it’s about time that I talk about my school here!

I chose this school relatively arbitrarily off of a list of programs my medical school already supported, and I’m so, so glad I did. My school, Pop Wuj, has been fantastic and exactly what I needed to learn medicine and Spanish simultaneously.

My afternoons are jam-packed with Spanish. Each day from 2-6 PM, I receive one-on-one language tutoring, which is fantastic, because my learning is tailored to my specific needs. Typically, we spend an hour on grammar, an hour on medical vocabulary, and the remaining time either reading Spanish stories aloud or conversing. I’m probably a really difficult student, because I tend to be pretty shy at baseline, so when you add in the constant struggle of a foreign language, I’m not super talkative. Regardless, I’ve been learning a ton and I can barely imagine where my Spanish will be in two more weeks!

My mornings, however, are way more fun. On Mondays and Thursdays, we have medical lectures on tropical disease, nutrition, or other common problems in Guatemala, while the other mornings are dedicated to clinic.

On Tuesdays and Fridays, we run clinic at our school. It’s a free clinic, and patients line up even before 7 AM to secure an appointment with the doctors. The clinic is set up and runs similarly to those in the US, but operates on donated medicines from an American NGO, so when the medicines run out, it’s time for Plan B. Students are responsible for triage (taking vital signs and getting a basic history) and consults (the actual patient visit) with the help of two Guatemalan physicians who are actually around the same age as me! I have to apologize for not having pictures of the school clinic yet… it’s a busy place!

This Wednesday, I traveled to mobile clinic in “Alaska.” Okay, so obviously, I didn’t really hop on a microbus to Alaska (would I even be there yet?), but that is the nickname of a small community called Xeabaj that was forced to rebuild its entire community after a hurricane several years ago:
DSCN1275

Again, the poverty was palpable; we traveled down bumpy, dusty, motion-sickness-inducing roads to the middle of nowhere and held our clinic in a one-room concrete building:

...I'm not really sure why we left ONE chair in the middle of the room.

…I’m not really sure why we left ONE chair in the middle of the room.

Here, we’re limited in medications (we were forced to prescribe an antibiotic that doesn’t cover skin bacteria super well for an abscess!) and privacy (lacking the ability to perform a pelvic exam, we had to treat a woman for both urinary tract infection and vaginitis). Working at a safety net hospital in the US sometimes feels like working with few resources, but this experience has been an incredible reminder that much can be accomplished with even less!

All in all, I was really proud of myself this week: I was able to get through all of my visits (along with my pediatric resident partner) with our intermediate Spanish levels. I’m confident by the end of my time here, I will feel confident enough to carry out a full visit on my own in Spanish. Mission (hopefully) accomplished!
Until then,
K
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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 Accent

This morning, I attended an anesthesia resident lecture, led by one of the chief residents with input from a well-respected and extremely knowledgable attending.

And it’s a great educational opportunity and I’m grateful for the opportunity to work with this man… but I’ve spent the first few days of my surgical subspecialty trying to place why his voice sounds so familiar.

And then it hit me. He sounds exactly like:

 And now I have to spend the remaining 1.5 weeks trying not to giggle at the image of Puss in Boots as an attending.

…life as a fourth year is SO hard.

The One With the Appropriate Gift

During my first year of medical school, a textbook author named Barbara Fadem played a huge role in my education. An expert on behavioral health, Barbara guided us in how to address defense mechanisms, recognize substance abuse, and approach complex ethical issues.

For whatever reason, one particular line from her textbook has always stood out in my mind:

From Fadem, Barbara. Behavioral Science in Medicine. 2007: 26: 493.

From Fadem, Barbara. Behavioral Science in Medicine. 2007: 26: 493.

This concept has always made me chuckle at its seeming absurdity, because who in an urban environment even raises chickens, let alone thinks to package their eggs up for their doctor’s appointment?

But this week, my jaw dropped as I walked into a patient room.

Because there, on the counter, with “Mindy’s Farm” scribbled on top, was this:

“Mindy,” I began, giggling. “You have no idea how appropriate this gift is.”

———–

Also, I’m taking this opportunity to wish a very happy Father’s Day to the man who always read me countless stories and taught me to ride my bike and to drive, who still washes my car and changes my oil, answers my frantic 6 AM phone calls when my car door freezes shut, and supports me no matter what. Love you, Dad!

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.

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.

Have a Good One!

This morning, an elderly couple approached me in the hallway.

“Honey, can you help us find this?” the woman inquired, reaching out a tremulous hand with her instructions for reporting to her endoscopy appointment.

I smiled and waved them on, taking a few steps down the hall to point them to the Endoscopy suite.

“Thank you so much,” she nodded, retrieving her paper from my hand.

“Anytime,” I responded. “Have a good one!”

…it took me an entire flight of stairs to realize what I’d just said.

Oops…

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