Wednesday, December 2, 2009

First illness

Ugh. I am home sick today. One of the little tykes decided I needed the viral gastroenteritis. Well I didn't. I haven't called in yet and I am upset that today was the day. I was hoping to make it at least a year. But the idea of puking on a little kid was disturbing, so I am home today. Dang it.

Sunday, November 22, 2009


My new recent pet peeve in the hospital is examining a patients throat. Especially adults. I have my little light turned on. I ask the patient to open their mouth. Then I ask them to stick out their tongue. And then usually their big fat tongue is blocking their pharynx so I have to ask them to say "ahhhhh", which will raise their uvula and pushes down their tongue bringing their pharynx (back of the throat) into clear view. Do you know how many times I have to ask before the patient actually does it? It usually takes three.

This sort of perplexes me because they followed all the other directions prior to that on the first command. They will even roll onto their side with ease for the rectal exam without a hesitation. But there is something about saying "ahhh" that people just do not want to do. So I ask them to say it multiple times. I'm even doing it when I ask it. And generally without a response. Until I explain why I am asking them to say it. Then I finally get an "ah" but not an "ahhhhhh."

With kids they don't understand the "say ahhhh" command. Which is why I have to gag them with the tongue blade. And then they cough onto my open mouth and I get mycoplasma pneumonia. But they are kids, and are cute, so I quickly forgive them.

But I am fed up with resistant adults. So adults beware. I know we all have flashbacks to our pediatricians using a device to see our throat. I'm pulling out the tongue blade. Thats right. Without me asking you to say "ahhhhh" first.

Saturday, November 14, 2009


Today marks my final day of OB---a two week stint of up at 415 in the morning, pounding on women's bellies that had just delivered a baby and asking if it still hurt, about 200 pelvic exams, 15 babies delivered by yours truly and three sad cases of babies that did not make it.

It was a whirl wind.

I remember my third year rotation where I heavily considered the field of OB/GYN. Delivering babies was fun and those residents work their tail off. But after these two weeks I realize that I am in the right field, which is one of the most reassuring things I have felt since I started residency.

I may still have the opportunity deliver more babies in the Emergency Department. Which to me is the most exciting idea---you just never know what will walk through those sliding glass doors on the first floor of the hospital. And thanks to the amazing ladies of the OB program I feel more prepared.

Tuesday, October 13, 2009

going to hell

My last call was particularly difficult. I know I've semi discussed ethics in previous posts but I honestly didn't think it would be such a huge part of my life as a resident. I am quickly learning that this isn't the case.

Around 130am I got a page about a pt on the floor who was not doing well. He was a 90 year old man who has recently been in and out of the hospital for pneumonia. He was actually getting better when that evening he aspirated an entire bottle of ensure. He then started breathing really fast (tachypnea) and required more and more oxygen (hypoxic)and started running a fever. So we transferred him up to the ICU and started to get ready to intubate.

But then we all paused.

He was a full code. He wanted CPR, intubation, cardiac life saving drugs.

And yet we paused. He was 90 years old. The likelihood he will be able to come of the ventilator is small. We tried to explain that to him and he responded with "I dont want to talk about that right now. I dont know what to do." Thats when everything changed.

To go up the chain of command in terms of power of attorney (POA) it usually starts with the patients spouse (but only if they are straight---dont even get me started with that), then their kids, then their parents/family, and then maybe friends? It all gets muddled.

So we called his son because that was the only number we had in the books. He comes into the hospital and we have a 2 hour conversation about to intubate or not to intubate. Meanwhile Mr. H's respiratory rate is slowly declining. After this discussion we realize its his wife who has the medical POA. So then we call her, who says to do everything.

So we set up the intubation again. And I start tearing up. If this man was 20 years or even 50 years old I wouldn't think twice. But with all his other diseases there is a very high chance he will not survive this. I am about to intubate someone who probably will never come of the vent. I am supposed to be doing this to save people. I am exhausted because it is now 4 am. So I start tearing up but try to hide it by pretending I am excited to "do a procedure".

When my pulmonary fellow comes in that morning I start with "I may be going to hell because of this one....."

Monday, October 5, 2009

this is what i've come to....

This when I feel like the singleness is just pouring out of me.....

I recently got a message from one of my pediatric attendings--one who I am fairly close with socially--asking me if I was interested in going on a blind date with a friend of a friend.

That was all it said. So of course my next question is "who is this guy? any more details??"

The response made it all a bit more embarrassing. Apparently another peds attending that I worked with last month "loved" me and wants to set me up with his nephew so he asked around the attendings to find out if I was single.

My attendings are working harder on my social life than I am.


Thursday, September 24, 2009

The thin line

I am currently on my first medicine ICU or MICU month of residency. And not only that, but it is at the VA where all the patients are already knocking on deaths door, and just waiting for the final say so to move on. Yeah, its pretty intense.

We had our first almost code situation today. And I say almost not because it was a close call---he did pass away---but it was almost called a "code."

He was a 60 something year old man who had perfed his bowel and required extensive surgery to remove the damaged small intestine and then got an infection in his blood which then gave him a really bad infection in his lungs and he started to down spiral around 3pm today. He was actually on the surgery team, we were just the medical help out. His blood pressure dropped and then his oxygen saturation dropped to the 60s (we want most patients above 90) and the highest we ever got it back was the mid 70s even after turning up his ventilator all the way. When his pressures dropped again, we were about to flip on the code button--which announces to all the pagers that someone is in a "code blue" situation and everyone comes running. Thats when someone decided to call his wife and verify his "code status."

We were told we were not to do chest compressions. So we turned off the code blue announcements and continued with increasing his pressures and such. Then there was a discussion what exactly his status was: increase pressures? start drips? chest compressions? withdraw all care? withdraw only some care? give shocks? only do CPR? It has gotten so specific of all the different choices a person has that it got me thinking about the thin line of what each person wants and how it can make such a difference---I needed to know how this whole DNR stuff actually started.

In a basic search on the internet it appears that the history of a person being able to decide what forms of resus they wanted started in 1976 with the case of Karen Ann Quinlan v New Jersey in which a 21 year old woman was found comatose after taking tranquilizers and ETOH. Her family wanted to withdraw life support but the medical team just flat out refused and the case was brought to supreme court where they ruled in favor of the family ruling "Karen's "right of privacy" included a right to refuse medical treatment and that her father, under the circumstances, could assume this right in her stead."

It wasn't until 1991 when the Patient-self Determination Act that mandated hospitals honor a patients desire in their healthcare. And now today's occurrence is so common place across the US.

In the middle of us giving a stronger pressure medication we were told to stop doing what we were doing. What does that mean? Stop the medication? Turn off the vent? The surgeon was running back and forth from where the family remained asking each specific question. Finally an understandable conclusion was given: Stop the pressure medication all together. Then 5 minutes later: turn of the ventilator.

He passed within minutes, hopefully at peace with the decision his wife made for him.

Monday, September 21, 2009

being a (good) teenager....

I recently saw a 16 year old boy who was super awesome. He was a talker. I mean I asked him how school was going, and I think I got a 10 minute response. Straight. Without pauses. Loved it! It sorta reminded me of myself when I realized someone was listening. Now I dont even need people to listen...

Anyway, after kicking mom out to do the genital exam and HEADDSSS exam (Home--are they safe?, ETOH use, Activities besides watching the tube, Drugs,Depression, Suicide, Sex, Smoking) he said, "yeah they asked me if I wanted a female or a male doctor. And I was like, come on! I am 16 year old boy. My hormones are screaming 'Female! Female! Female!' But I'm more mature than that, so I told them either one is fine. Because it is."

Then he immediately followed it with "are we gonna talk about sex now??" I said, "Well that is one of the topics I'd like to cover." When asked if he was having sex his response was "I dont really think of it as having sex. Its called making love for a reason. And I am not in love. So not really making it either."


Tuesday, August 25, 2009


I was extremely excited to be on vacation. And then it suddenly hit me that no one else was going to be on vacation at the same time as me. The amazingness of medical school was we could all go on a trip together. All these new interns I have desperately tried to connect to are still slaving away in the hospital, while I get to roam free. But who wants to roam all by their lonesome? I have recruited my hound on a trip, which he'll have a blast, but he's not much of a conversationalist. But the truth of the matter is my next vacation is in 8 months so I best enjoy this one!!

Sunday, August 2, 2009

Listening skills

A conversation between a nurse and a patient in the Emergency Department....

Patient: "Excuse me nurse? Are my testicles black?"

Nurse lifts up the patient's gown and takes a peek, "No they look normal."

Patient: "What are you doing? I asked if my test results were back!"

Gotta love the communication that goes on in the ED....

Tuesday, July 28, 2009


This is one of my favorite televisions shows. This is also my constant emotion these days. I haven't felt so, well, LOST since the beginning of medical school where I was convinced that everyone was constantly studying and I was incisively behind. I eventually just did stuff on my own pace and my own way and things went fine.

But doing things my own didn't really affect anyone else. My actions did not influence patient care. Now I can't really hold off on reading that chapter on hyperbilirubinemia because that kiddo is in the ED NOW.

I know I don't need to and can't possibly know all the answers now (why would I be doing residency if i did??), but I feel like I've got nothing in terms of knowledge. I am just roaming the island trying to figure out how to get back to what I know.

Friday, July 17, 2009

Did you goose it???*

The first trauma red came in around 1030 am yesterday. Being an intern and not having done trauma or ATLS (adv. trauma life support) it means I cannot sign up for the trauma patient. But it being 1030 in the morning, and nothing else to do, I asked my third year resident if I could tag along.

The pt was running from the police, up a hill, and fell, severely dislocating his right knee. After a few xrays and a quick physical exam, the residents and attendings quickly realized that the leg was pulseless below the knee and that compartment syndrome was setting in...and fast.

It felt almost like a Greys Anatomy episode (except no one was sleeping together)-- the decision was made to intubate in the ED and I quickly jumped in and asked my third year if I could do it. He paused for about fifteen seconds. When he finally said yes, I did a double take--wait did I really want to try this?

I got my stuff all set up. And we discussed which drugs we were gonna use. My attending pushed the drugs and said, "Ok, you ready?" I had a quick "OH MY GOD YOU ARE NOT READY!!" But I picked up the laryngoscope and started opening the mouth. The patient was in C-spine so I couldn't open the mouth too widely for fear of hurting his possibly fractured neck. I used a CMAC (we have an awesome airway man attending who tries out all the new airway stuff before it even goes to other hospitals)--it is a video laryngoscope but allows the intubator to also use it as direct, meaning you look into the patients mouth while intubating, and not at the video screen. Which is what I did---I didn't even realize it was video until my attending said "Go in a bit deeper."

I wasn't used to seeing the mouth with saliva. I was used to the plastic dummys so when I saw all the bubbles, I quickly yelled "I need suction!" but then I got a glimpse of the vocal cords (hahahaha! see previous blog) I yelled "Need the tube!" and I quickly jammed that thing down there. Then I reminded myself DO NOT LET GO OF THE TUBE. We use a color indicator to help us make sure we are in the correct spot (if the color looks like urine, then "ur in!") The stress and excitement quickly came rushing at me and I had some uncontrollable shaking. I left the trauma bay to try and pick up where I left off with my other 3 patients.

I was on a high the entire shift.

*Apparently this means did you stick the tube down the esophagus into the stomach. I of course screamed a yes! when asked this the first time. I quickly realized this is not a good thing. and luckily I did not do this.

Tuesday, June 30, 2009

watching it convert

I know I have said this before, but I loved my trip to Nepal. It was absolutely amazing and I would never say it wasn't worth it.

It may have not been worth it.

Today I spent several hours at my hospital being reminded of washing my hands after every patient (even after just entering the room), who the lawyers are to call when I get in a bind, and the number for the pharmacists for when I have no idea what the dosage is.

Then we got our ppd skin test. I had an inclining (ok I thought it was definitely going to happen) that I might sero-convert. This occurs when you are in contact with a patient of TB. You can either sero-convert and not get the disease, or you get the disease and sero-convert. It depends on the length of contact with the patient, the health status of the person who is exposed, the type of TB the patient had.

I had contact in Nepal almost everyday.

So this evening, while I baked cup cakes for my birthday tomorrow, I watched as the ppd test slowly enlarged over time. (dang it!!)

The next steps entail: a chest xray to prove I do not actually have active TB currently and then 9months of Isoniazid (INH) therapy. This drug does not come without heavy side effects. It can cause serious liver damage; especially if you drink while taking it.

What does that mean for me? I will be sober for a solid 9 months and I wont even get a baby out of it.

Thank you Nepal.
(I'd go back in a heartbeat!!!!!!!!!!!!!)

Sunday, June 28, 2009


A year ago I spent my birthday in one of my favorite vacation spots in the US: Lake Tahoe. I was surrounded by a group of fabulous ladies and it was possibly the best birthday of my life. I ran an amazing 10 mile trail race (although I got lost and added an extra mile to it) two days before my birthday. I went kayaking. We laid out on the lake shore. AMAZING is all I can really say.

This year, I turn 27 and I have to say the birthday will be completely opposite of last. My birthday marks the first day of residency (well, for most programs) and thus I will spend 12 hours of it in the hospital (doing more orientation) and I will attempt to round up ANYONE who would be willing to grab a beer. And although it won't be a bad night--I love birthdays and I dont believe they could ever truly be "bad"--it will be different. Instead of being surrounded by people I know, for the majority I will be surrounded by people I am desperately trying to get to know.

I am to have a birthday party filled with those I met about a week ago.

So I guess this goes back to a previous post---I LOVE YOU AND MISS YOU GUYS!!!!!!!!

Wednesday, June 24, 2009

Pop Up Thoughts

Over the past two weeks and for the next couple of weeks, I have been and will be certified in several life saving courses. They include Basic Life Support (BLS) twice, Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Program (NRP), Advanced Pediatric Life Support (APLS--this is basically the same as PALS), and Advanced Trauma Life Support (ATLS).

By the second course it all starts to sound very similar. ABC--Airway, breathing and circulation, then do other stuff. That other stuff varies based on age and what the monitor says.

One of the "exciting" things in all of these courses is the idea of getting to do some procedures that I've wanted to get my hands on for awhile now. Putting in advanced lines, and intubating a patient. I know this will sound a bit off color, but I've decided that the human vocal chords really look like a very small vagina. I know I know, its bizarre. But here's a picture

And once this idea got into my mind I couldn't stop thinking about it each time I intubated. And now I think this might just be what I think of each time I intubate in the future. And maybe its not a bad thing because codes are a bit hectic, so to have a moment of lightness could be actually helpful.....

So if you see a flash of a grin while I intubate it may because this pop up thought has appeared. Or it may be because I still cannot believe I am intubating someone; that I have actually graduated from medical school and in residency.

Wednesday, June 3, 2009


As things change rapidly around me, and we are warped closer to the start of residency, there is a large melancholy feeling about everyone "moving on."

Most of my closest friends have left the state to pursue amazing residencies elsewhere. And while I am so excited and proud of them, I am also sad when I realize many of them I may not see again. When will I have time to travel in residency? When will they? And of course I will make new friends, as will they. But I started this medical journey with them, and it would be nice to continue it and complete it together.

So while my own excitedness for my residency start date grows, so does emptiness of missing my friends, my classmates, my colleagues. I love you guys!!

Sunday, May 17, 2009


Well it is official---I am now an MD!! Patients beware--especially starting July 1st--I would suggest you visit a non-teaching hospital, at least for the month of July. But then please come all you want, I gotta learn somehow! :)

Graduation weekend was a lot of fun, but it seemed a bit anti-climatic at the same time. I've been trying to remind myself that I am actually done with medical school. Although I believe we learn throughout life, I am no longer an actual "student" anymore. I have spent 20 years of my life as a student. Weird.

The house drama continues---I think we might actually close next week!---but I am (trying to be) kinda glad---being an MD and house owner all in the same week is a bit overwhelming!

So do I change the name of the blog and just keep on telling my tale? Or do I just put this to rest (already!)?? hmmmm....

Saturday, May 9, 2009


Its been a pretty awful week. I am sure some will be upset with this blog, but I have to write it. I guess this makes me selfish in some way, but that is how it goes at times.

We, as a class, were informed that one of our classmates a week from graduation committed suicide. Although we hadn't spoken in a little over 2 years, I knew her well.

Our first year of medical school we became study partners. Unlike me, she was a true genius. Her photographic memory helped with her with graduating high school and college in 6 years total. It made studying really difficult since I was super slow compared to her. But we still made it as fun as possible.

As I got to know her, she began to tell me how hard life really was for her. She was extremely depressed---everyday. She once described it as being unable to hear the birds sing, or kids laugh. She was amazing and could hide it with her wonderful smile when she needed to. But I was deeply worried. Eventually I went to our school counselors about my fears, and was reassured that she was receiving treatment--both therapy and medications. Unfortunately it was these medications she used for her first attempt.

It was the day after spring break. I was pretty sick and took some NyQuil to go to sleep. She called me around 945 pm. NyQuil had done its job--I didn't even hear the phone ring. She didnt come to school the next day. I called her about three times in between classes throughout the day. I got a phone call from the police department at 5pm that evening. She was picked up for a DUI and needed a ride home. I was shocked--she didn't even drink. I went down there and she was a mess--I was told she took her prescription meds and she should not be operating a vehicle. I got her in the car and she confessed she took all the meds at once. I immediately took her to the ED, called her psychiatrist at home, and our closest friends. They met me at the hospital. While she was evaluated, we lied to her and got her parents phone number to tell them what had happened. I am pretty sure that she figured that one out, but she never let on if she was upset. She was admitted to the psych ward for a few days. During that time she blamed me for not answering the phone that night. She wouldn't have taken the pills, if I had just answered. The blame even came from her parents. It was so difficult to have a friend try to end her life, but to get the blame for it was unbearable. I started seeing a psychiatrist at that time.

She called me again at night after she was released. I freaked out. She called just to say hello. No big deal. But I stopped sleeping. I found myself checking my phone throughout the night. I would wander my apartment late at night. I was in a constant worry about how to keep her alive. I was not doing well.

At the time I did what I needed to. I was trying to save myself. I eventually had to sit her down and tell her that if she ever called me late at night again, I would just send a police officer to her apartment because I was so worried she would hurt herself. She laughed at me. But I was very serious. When the blame continued after that conversation, I left the friendship.

Over the next couple of years I worried about how she was doing. But the space between us was too great---I had created a canyon to protect myself and left her (with psychiatry help) alone.

Now that she is dead the guilt has hit again. I know that this is not in any way my fault. But what I feel is completely different--I feel that blaming me makes perfect sense. My feelings and my knowledge are in disagreement. I am devastated by the circumstances. It is entirely possible that if we had remained friends she still would have died--that is not what I feel guilty about. I feel guilty about leaving a friend when I knew that she was not okay. That she was not, by any means, stable. And when I left I was/felt relieved. How sick am I? Would I do it this way again? How angry did I make her then? Before she died?

How do I say I am sorry?

Thursday, May 7, 2009


I like to travel. Roadtrip, long flight, bus--no problem. I like getting all my things situated into the car, plane, bus and then listening to music, reading, sleeping. Just enjoying the ride.

I do not like airports. Its a holding situation for me. I can't really get situated yet because I'm not going anywhere, and as soon as I try to get comfortable, they're gonna call my seat number to board and I'll have to gather everything up. So I sit in this semi-anxious situation, just waiting for them to call me so I can really get comfortable and get a move on to where ever I am going.

I have the same feelings towards buying a house. The inspection process is just like me sitting in the airport. I am so ready to get moved in, get situated, put my towels in the linen closet. But that readiness/anxious feeling may mean that I am over looking serious issues that are going on with the road ahead.

I found out today that the house may need a new roof. The pipes are pretty old as well. The two things I really didn't want to deal with when buying a house. We're talking a huge cost at some point. Or maybe not.

So do I just jump in with the first classers even though I know I will be pushed into economy and possibly out of the plane just because I wanna get on the road so badly? Or should I really stand by, and see if another house will come my way.....

Saturday, May 2, 2009

Growing Up

When you're ready to purchase your first house people have a lot of advice on how to go about it. Truthfully, I've appreciated all of it, because I honestly have no idea what I'm doing. I have a fabulous realtor and, still, no clue on what I'm doing.

The first offer I made on a house was an embarrassing outcome. The way it works is you make up some price you are willing to pay for the property. This is generally less than the asking price. Then they can accept, reject or counter. So I got countered, but it was no where near what I had hoped to pay. So I increased my offer and re-countered. And then it was the big fat REJECTION!

Within 1 day of being rejected, I put another offer on a different house.

Its hard getting rejected when you're used to doing pretty well. I dont want to sound arrogant, but I've worked hard and you begin to feel a bit invincible (until residency starts) once you are matched. This has definitely brought me down.

One part of advice that has been absolutely impossible for me to follow is "do not get attached to the house." The only reason I can come up with is its not really yours til about a month into the process and therefore it can be taken away at ANY moment. I am about to spend a LOT of money (at least in my book) on something---I better well like it, be excited about it, and want it----how the hell do I stay aloof about it?? (maybe some males can respond to this.. ok ok...that was just mean)

So today I await for the counter on the second offer. I have been waiting for 4 days. Literally sitting on my couch. Waiting.

This has been one of the hardest weeks of my life.

Tuesday, April 28, 2009

More Nepal

My last week of living in Nepal, I sort of had a freak out that I would forget what it was like there, what I felt, what I saw, so I wrote several Nepali things down, of which I will share!

*It is always tea time. And it is the best tea in my life---especially when its super cold and there isn't any power to turn on a heater. Oh wait! There aren't heaters either.

* Lunch is served at 10:30 am, but that is because all Nepali's wake up at 5am. (gotta milk the goat, go to the temple and pray, sweep the floors) Dinner is not until 8 or 9---but there usually is a supper or snack in between there somewhere.

*Rice is eaten at EVERY meal

*If a car honks at you it either means "I'm coming!!!" or "Move over--I'm coming!!!" so its best just to move over.

*Nepali men tell the doctor when its their wife who has the complaint---even if it is vaginal discharge. If the husband does not know a particular answer to a question, he'll just make it up. Its very difficult to kick him out, but it is a must.

*All Nepali music sounds the same---the exact same---I absolutely LOVE it. My mom, on the other hand, hates it.

*The large trucks that transport garbage are decorated nicely. They have green or gold tassel, xmas lights on at night, crazy horns that are probably some sort of Nepali theme song. At least it has become that way to me. Move over--I'm coming!!

* When the power comes on at night--and a light turns on---all people touch their head and then their chest and repeat---its a thank you to god for the power. If you are in a bar when this occurs it is a UNIFYING to see---I have been known to participate as well---it has become a reflex. Because the days are hard, and the evenings are long without power---everyone must be grateful at some point for something.

*I LOVE IT HERE. I told Harka that I would love to be an elephant trainer. Because, lets me honest, I was born to ride. Harka said he would teach me Nepali. I'd just have to pick up elephant poop (no problem) and climb trees to get the food (problem). If I ever come back--and I hope I do---I will definitely visit that man.

(this written earlier): In 5 days I find out where my life will be for either 5 years or 3 years and for the first I am not consumed with what that will be or where else people might go or about feeling alone/single/unwanted---I feel free.
After being asked a million times if I was married, and/or how long it will be before that occurs---I am happy to announce I am single! I made my rank list based on what I wanted! And I can go to Nepal for 7 weeks and I don't worry about some silly boy ruining my time!

What a trip

Saturday, April 25, 2009

hello again

Its been several months since my last entry. My final time spent in Nepal was amazing--I have grown to completely love the insanity of that country. And I cannot wait to go back.

I came back to US craziness--the Match day. Lets just say I am very happy (exstatic!) where I matched and I, still to this day, cannot believe it.

I then did a quick turn around and headed to Honduras where I was in a friends wedding---it was an amazing trip and wedding.

Now I am in limbo land---I have not yet graduated, but I am not on any rotations. I guess this is where 4th year is supposed to be amazing, but I have to say its not my favorite time this year. Firstly, I dont like to be bored, and when deadlines are like 3 weeks away, its hard to motivate to get things done. So I am in this sorta bored but have lots to do situation. Secondly, I am attempting to purchase my first home. This is harder than it sounds. And I think it sounds awful. It has been a super hectic week in this department. And still the search continues. The good news is the banks are crazy enough to think I am a good lender with student loans up to my neck already----suckers!!! I fooled them! :)

I wrote down several Nepal stories/ways of life while I was gone, ready to share with who ever happens to read this. Those are to come this week while I continue to wrap up my med school career.

Friday, February 27, 2009

Greetings from Nepal!!

I know it has been awhile (ok so only two weeks--but time feels differently here) but I hope you have not forgotten me and my Nepal stories--because here come more to jostle your mind! (read: its a long one---again grab a beer, panni (water), coffee, chiya (tea) and be prepared!) I was in a little town called Ghorahi in the county of Dang which is western Nepal. :)

I am back in Kathmandu--after a crazy 19 hour trip was only supposed to take 12 hours--but there was a road strike (of course--just my luck) so we had to go the extra 6 hours around to get to Kathmandu. I got in around midnight---slightly freaked out if I was going to be able to grab a taxi and get me to the hotel. Plus i had no idea if the hotel was expecting me. So I befriended the only slightly english speaking Nepali and won him over---he lent me his cell phone to call the hotel---they were lights on and waiting for me once I got home! (wow i just called it home here in kathmandu---pretty crazy)

My experience in Dang was absolutely crazy. I lived in the hospital which added to the craziness---the Dog gang outside of the hotel was worse than in Kathmandu--one night I finally got a peak and saw the dogs running happily down the street while happily barking away --free from passing tractors, cars, motorbikes, bikes, cows, goats, etc etc etc. It is definitely their turf at night. :)

I ate dhal bhat and sag every day, two times a day. It is rice, and lentil curry and bitter BITTER boiled cabbage. It got old. REAL fast. But what was I to do? It was free and all Nepalis would be grateful to get that much food everyday---so with a happy smile I scarfed it down like it was the best food I'd ever tasted. Every day. Twice a day. for two weeks. you get my drift. BUT the morning coffee was still the best I've ever had---starbucks has something to learn! I have also eaten cooked fish---the whole fish with the eye staring at me---they are lightly fried....its pretty awful actually. the bones are nasty and I spend the rest of the evening worrying I am going to perforate my intestines (yes i am paranoid at times). Sadly my peanut butter jar is finally finished---it has lasted me a month (I"VE BEEN HERE A MONTH!?!?) so it did its part. So that is the update on the food....My mom is getting in this evening (WHOHOO!!!) so I am ready to eat some good stuff with her---some of the curries are amazing so I am hoping to stick to that for a few nights....

The cases. Not much OB. Mainly gyn stuff so that was good. But I also worked a ton in the general clinic and emergency. I saw two cases of Miliary TB----the chest xray was text book---it was so sad though---the prognosis can be bad. Luckily for that DOTS program I was telling you all about (gov't requires ppl to come in daily for the meds) people actually live good lives through TB. I saw many cases of typhoid---high fevers, headaches, and usually constipation although diarrhea can be can be quite serious because they can perforate as well. I saw a lot of PID---pelvic inflammatory disease---but surprisingly it is not usually from sexually transmitted diseases---hygiene is just so poor that B. Facillis is usually the case (although it was never cultured so who knows...)

I debrided a burn wound that took up half a 72 year olds man's thigh---it happened 15 days before he came to the hospital and was VERY infected. He smelled awful---I am pretty sure it was pseudomonas. The burn was from a candle---since he lived in a village and had no power. I had a 7 year old with a type three supracondylar fracture (its basically an elbow fracture for the non medical readers) with vascular compromise---her hand was cold, without a pulse and decreased sensation to her hand. She needed surgery. I tried to reduce was actually a really good reduction but still no pulse---so we sent her to nearest surgical hospital. It was a three hour drive.

I helped with a bad case of COPD and cor pulmonale (right heart failure) of an amazing 60 year old lady---she had pitting edema (swelling) up to her sacrum. All the woman get COPD here---not because of smoking, but because they cook with a wood fire. She was the hospital first charity case. She didn't have money for even food. (the hospital does not provide to the inpatients!) I bought her a pair of shoes---she couldn't afford any and wouldn't walk because her feet were so swollen. I loved her and was sad to see her leave---no money left and was O2 dependent. So she went to her village and will probably die in a couple of weeks.

And I had two TERRIBLE awful sad hearbreaking deaths. They were one day after another of less than one year old baby boys. It was awful. The situation in both cases was just so sad--i dont think i can comment any further right now.

Every day we rounded twice in our 10 bed inpatient hospital-once in the morning, once at night. The labs we were able to do: HIV, malaria, TB, urea, creatine, CBC, ESR, and urine. THAT WAS IT. So for the severely dehydrated patients we had no idea what their electrolytes were. We just just look for renal failure. We had no culture capabilities. So we treated empirically for everything. Luckily resistance for like pneumonia isn't bad, so we could use basic antibiotics--which is good since we didn't have anything else anyway. The only IV pain killer we had was something like pethidine ? I have no idea what it was truthfully, but I dont think it worked so well. Dr. Sanjeev was the only doctor (does it sound familiar Pancho??) so he worked 24 hours 7 days a week. Overnight the paramedics (think of an 8month training after tenth grade---they really knew nothing) would see the patients and then call him if anything happened so he could come in. But there was a brittish doc there as well---Dr. Jessica (no one goes by their last name) and she was just great!! We immediately became great friends and she taught me a lot. She would work with Kumar--one of the paramedics--at night because he had the best english, so that gave Sanjeev a break.

I had to get used to people staring at me. I guess seeing a white girl is pretty rare---I am thinking most people out there have never seen one in person. I had people (random people) ask me if they could take my picture with them. It was so bizarre. I would be just walking to buy some bananas or something, and someone would walk up to me holding a mobile phone and ask to take a picture (in broken English). Better watch out---I am famous now! Hahahaha

I ran a few times in Dang---it was goregous scenery with rolling hills and a river. It was amazing. This really surprised the people---to see a white girl running by. It even surprised them more when I would pant “Namaste!” to each of them or “Good morning” their eyes would jump out of their sockets and then they would smile and yell “Hello!” or “Namaste” back---it was awesome. The security guard was named Shreedhar (Shre-dar) but I called him Shredder--like the Rat from the Ninja Turtles—because I felt like he was my personal protector and I am pretty sure he could do some Ninja moves if necessary (I might have just imagined him doing these…). I loved him--he didn't speak any english so we spoke with my 30 word nepali vocab and lots of hand motions...he was an ex police man so was into running and exercising with me--it was just great.

My main contribution to the hospital was putting together the emergency bag. After their first code (i missed that one--it was a week before I got there) Jessica said it went so poorly that something was to be done. So we bought a computer case type bag and I put it together. It consisted of two ambu bags---one pediatric and one adult (we only had two fask masks---so we cleaned them with spirit which is ethanol drenched cotton---definitely not US standards) and two laryngoscopes--one peds one adult, but we didn't have batteries for the adult and we didn't have pediatric ET tubes (the tube that goes down the trachea to help people breath when we intubate) so we really couldn't intubate anyone....I also put IV cannulas, NG tubes, fluids, and then made a drug box of adrenaline, atropine, dextrose, diazepam, etc (all meds necessary for a code arrest or seizure). I also made saline flushes since those don't exist here. Hopefully it will be a big help the next time a true emergency comes in. Because the way it worked before---we would need to put an IV in a patient, but first the family would need to buy one, so they would go to the pharmacy (which is attached to the hospital) and buy an IV cannula and then come back with it---this could take up to 5 minutes and really delayed the treatment of the emergency. This also goes for medications, fluids, oxygen, etc etc etc. At least some of the real saving stuff is ready available and then the family can just pay to replace it in the bag. Does that make sense???

well that is the best update i can give right now--more after my travels!!

Saturday, February 14, 2009

Subha prabhat!

Oh my dear friends!

There is a gang that takes over at night. At first I was sleeping through the night (mostly) without a problem, but around 2 or 3 in the morning I can hear them strutting their stuff on the streets, letting their presence be known!!! Yes, I am talking about the stray dogs. Howling in the night. at first I loved the stray dogs---I even saved some breakfast to feed one (french toast)...he turned his nose up and walked away from it! That was the last attempt, trust me....Anyway, so I have started using my ear plugs at night to sleep, which means I sleep through the watch alarm...but you all know its no big deal since it is absolutely impossible for me to sleep in. :)

update: i leave for Dang tomorrow! WHOHOO!!!

So back at the hospital I must explain the confusion I've had recently. Apparently to the Hindus the year is 2065. The date today is 28-10-2065! Whatever that means. SO the ladies NEVER know when their last menstural period was...and when they do know, I have no idea what that means since I go by the the 12 month calendar that we all depend on (MATCH DAY IS TOO SOON!!). And I found out that next year they will be deleting their last month because the stars and their calendar are just not matching up...... Imagine that.... Then imagine if you were told that we're just gonna delete December this year.......

Now imagine you are a woman patient to see me and the lovely doctor (I LOVE HER!) enter a small door into a small room that has one white desk and three chairs---the doctor sits in one, I sit in the other, and the patient sits in the third. Then there are about 10 nursing trainees who loom a half circle behind you, listening to any menstraution problems or discharge, while your husband tries to listen outside, or sometimes comes IN and chimes IN! Then three white sheets are strung up behind you were you are told to lay down on a sheeted half bed and put your feet up (no stirrups). Then via flashlight (more on power outtages below) you are examined with the 10 trainee nurses all tryingto get a peak (the sanitary issues for the speculum and such will not be described---they do their best here, but it is NOT up to standard by any means). Then during one of the breaks--we see from 4 patients to 24 patients in a 2 hour span---so some times there are breaks---one of the trainees plops herself down and tells the doc about her anal puritis. I am shocked---there are not many people I would share this little issue with! But she is not embarrassed (my guess was pinworms) and gets the treatment without a blush.

Oh and on the outpatient side---we check anemia by looking under the eyes of the people. If they are pale, we assume anemia and we immediately treat for hookworm since that is the most common cause of anemia here. No tests necessary.

In my attempts to recreate some sort of normal lifestyle, I have found an amazing coffee shop! It is very clean and they have free wifi and american music playing. So I go there when I am absolutely freezing in my room to warm up and studyNepali. I have to say---its coming along alright. I learn a phrase or two a day. But it is very difficult and I finally realized why. When I first got here I was so upset because it seemed like the doctors would talk to the patient for like 5 minutes and then would turn to me and just say "he has fever for 5 days." I would always be like...yes? and what else did you discuss?? but it is possible that was it! For exampl;e to say "you're right" you say "ta-pai Le thik bhah-nu bho-yo." damn. i guess if you're gonna tell someone that they're right---you will better mean it!! Anyway, after they played the Aikon song "I'm so lonely" TWICE---I had to was hitting a bit close to the heart, ya know?

Oh! and don't think America is the only one with Pharm reps! I've had two sightings on my short stay here! They come VERY nicely dressed---you can definitely pick them out---and have little signs on each of the drugs, giving a sales pitch---when you think calcium think pearl-one!

Today I did Tot Shots Nepali!! Tuesday is shot day and we give polio---two drops of a liquid into the kiddos mouth and then one shot of HepB, DTap, and something else. I did well until--like my lidocaine accident when I was numb for a hour when it exploded in my face---I exploded the polio bottle in some unexpecting 2 month kiddo's mouth. He is well protected. :) Also they put eyeliner on these 2 month kiddo's eyes! Its supposed to be ramro--or beautiful. So its so interesting to watch the very nicely eyeliner eyes go from happy staring at me, to sobbing as I inject health into their little plump leg.

I cannot seem to get the power situation correct here. Just when I think I've got it--its all been changed. Right now we get power from noon to four pm. Then power comes back on at midnight to 7am. The gov't realized that giving power during the day is absurd because we use it! So instead they do it at night when we are supposed to all be inside and sleeping anyway. I am not too sure how long they will last. But the good news is---they may or may not be increasing the
power times! we find out next week--all very exciting.

Thursday, February 12, 2009


Hello folks! Well I have officially been out of the country for 2 weeks now! Its pretty crazy....I dont have much time to write a full post, so I will instead put an email down that I sent out from my first week....its been INTENSE, but good....missing everyone!!

Namaste! and subha sandhya! (good evening!)

this is to be the longest email ever! so please...grab a cup of coffee, beer, a glass of panni (water), and then come back to read this!!

Firstly I would like to thank everyone who has written me an email---you know you who you are. They mean a lot---I feel like I am actually having a conversation sometimes. :) and it has been great talking to some of you over phone! So I start this email there---I may sound sad and upset and possibly cry over phone. but please know---i am doing good....really good. I just get a bit sad over the phone because I dont have "normal" conversations here and so it comes out over phone. SO know that I am good--unless i say so, of course---and that I can't wait to hear about you! even if i make the phone call all about me, because to be honest, i dont speak that much around here. :) (EXCEPT FOR MY JOURNAL---court---i write in that at least twice a day!!)

ok about nepal. I am living in Kathmandu---in the Thamel area---a very touristy area very busy, someone is always trying to sell me tiger balm, or a shirt orm out from 8am til about 9pm (tonight is the exception but you will see why below) because there is little power (sometimes none) and so that is that. Today marks my one week experience here and I have to say at the end of th week--i am so glad i have come.

My first 24 hours i desparately missed my cellphone---i longed to make a quick phone call to say hello, chat about whatever, etc etc. I also realized how dependent on my ipod i was---when i didn't have power to charge it and it was completely dead. Luckily i am able to charge it from 6pm -8pm so i can listen to my music before bed (you know how i am). it took a good 48 hours for me to let go of these, now seemingly silly, necessities. i have gotten over that, although finding a place that only charges 5 cents per minute to call, means i can call more frequently (although this has come to an end---keep reading) and proabably have this week. (Thanks to those who have answered!!!)

I'll start with my daily life this week (And please know this comes mostly from my journal): I wake up around 645 or 7am...i wake up to crows or dogs barking usually. or the luggeee (sp?) man who lives somewhere near by---it wasn't long before I became the luggee woman---the dust and pollution help create some good ones!!! SO i get out of bed and begin doing my "workout" this consists of wall sits, push ups, situps, pike ups, etc etc etc. i cannot run here due to smoke, dust, pollution so my work out is inside...without a gym. I then sometimes take a shower (nicola and court--you should be proud---its been 3 days!!!) but the hot water is solar power so really it would be better for me to do it in the afternoon but i just dont. then i will write, read, or pack up my stuff, etc. I head to breakfast usually around 845 even though they ask me to come later everday. I drink milk coffee which costs about 70 cents for a small point--and this is possibly the best coffee i've had in my entire life. in addition i have french toast, or toast (depending on the belly). Ratna, the man who drives me to work everyday, is always punctuional (i am constantly suprised when he is there) and takes me the scariest 25 minute drive to Chabahill---the name of the area of where the helpnig hands hospital is. I have gotten used to the roads, although the first few days were awful. The pot holes are as big as I am, there are people walking every where, motorbikes, other cars, somehow we have not hit anything (knock on wood). I honestly don't know how he does it, but I love him for it.
I arrive usually around 10am but the doc arrives around 1030 or so. I work in the outpatient clinic in the mornings---I have seen typhoid, hepatitis (type unknown--they dont bother figuring it out unless it lasts for a long time), many many many pnas and chronic coughs. Which brings me to the TB situation. The people here pretty much have TB. Young, old, etc it doesn't matter. And the people refused to take the medication---even when it was basically given to them. SO the gov't (more on that below) has instituted DOTS---a system that requires people to come to the hospital everyday---they sit, take their medications under a person's supervision and then they can leave. in return they get something reduced (rent or something). its crazy to see the line of people everyday. to see the outpatient doc--it costs 60 ruppees or about 85 cents. to see the OB/GYn--its a bit more expenisive---150 rupeees or about $1.75. crazy eh? to get a CBC its about a dollar. it is costly to the people, but not just low enough that they will pay. they come from all over teh country---one family took 10 hours trip to get there. the clinic has been open 4 months and they ahve seen already 20thousand patients. pretty good i think.
there is no ICU, but they have an inpatient of about 12 beds. there is one OR and one post op room that holds about 8 beds. I have lunch in a office---i eat dumplings basically everyday. i now HATE dumplings. :) In the afternoon I finally get to do OB/GYN.
I love the OB docs. I also love the OB nurses...well one is a sorta nurse, and the rest are just training. but they are super friendly and have taught me most of the nepali I know (I can now ask if the pt has a fever, a cough, pain anywhere, and for how long...the ob stuff is much more complicated to learn, but i'll get it!). The OB stuff is great---they definitely estimate fetal age based on physical exam---how big the uterus is, etc etc. We listen to the fetal heart tones by stethoscope!! I have never seen this in the US, but it works well. I have also seen so many prolapsed bladders, and many many many cystoceles, rectoceles, etc etc. Menopause is late here---woman start around age 54 or so. So it is common to see a woman on her 7th pregnancy at age 45 and still baring a child. abortion is completely legal here, and surprisingly it has become more of a birth control method than anything else---i bet the prolifers would love to hear that. Woman refuse to use OCPs so they get pregnant, and the docs take care of it. pretty crazy. They dont run many tests here----so if they see discharge---they decide what kind it is (yeast, bacterial, etc) based on appearance and then they treat for it. No wet prep test, etc. today my last patient---had suspected choriocarcinoma. I actually felt her uterus enlarged and another mass. They'll take it out next week.

So after work, i get home and read. I read by head lamp when the power is out. The power goes out random hours. I never know when it will be there or not. But it sucks when it is out and i'm in the middle of something---the joke is my room probably looks like watergate from my head lamp. I fall asleep around 9pm and then I get up and repeat. I have finished two books so far---first one was a bunch of short stories about nepal called royal ghosts (about when the royal prince killed his entire family and then himself---pretty intersting) and a jodi piccoult book. I tried reading about the history of tibet, but the book was SO dry that I sold it. I am now on book two of the twilight series.

so my big news. last night i met with the founder of the helping hands organiztion. i went to a dinner at his friends house. it was a very nice house---even by US standards--of course I couldn't see much of it because the power was out when we first got there, and i felt ridiculous getting my head lamp out, so we pretty much sat in the dark for the first 30 min. then the lights came on at 8pm and I saw we were sitting in a large living room that had four couches. I was on one of them and then there were about 8 nepali men on the rest, and the woman sat on the floor. i almost jumped up then to sit with them. I was given a homemade alcoholic drink--to which i took one or two sips of---(i was so worried about offending people) and then a large bowl of hot water with a lemon in it was brought to me and the founder. i was told to wash my hands. I copied the founder. Then a large plate was brought to me---one side had hard seeds, sausage on another and fried meat on the other. I first tried the seeds but they were so HARD that I couldn't even chew. I left those alone. So I tried the sausage, but it had the weirdest spice that I gave up on that. I was about to try the fried meat when the founder told me it was goat intestine. My stomach flipped. So I said I would try it. Lets just say I did and there was no second bite. then other things were brought---a doughy type thing, a couple of chips sorta things, carrots ( I ate all of those) cold vggies in a strange sauce. and then another fried meat. I was ready to eat it although my stomach WAS NOT HAPPY at this point. they told me it was fried goat lung. a fine nepali delicatesee. SICK. I took one bite and knew I was done for. I tried to figure out where the bathroom was , just in case. This whole process was but 1.5 hours. During this time I was told my trip out east was canceled, and instead I was leaving in 3 or 4 days (no one knew) for the west where I will remain until my mom comes. I was shocked and a bit pissed no one told me before hand. So I started saying that I was Full---no more fried meats for me. And this entire time the people kept speaking Nepali to each other--so to busy myself I acted like JD from scrubs (something I now do regularly) and drift into my own head...this time i pretended they were plotting ways to kill me---i envisioned how i would escape everytime---from posioning to beating me up===I would dodge it all with my trusty 25 spray pepper spray that is always in my pocket. I was finally brought fried potatoes and asked repeatively if iw as on a diet. I was then told this was just the start---the real dinner was to come. My stomach flipped. again. So I ate the potatoes and hope I misunderstood.
I didn't.
the real dinner was bout 30 minutes later---in the dining room---rice, goat meat, curry, lentilss and truthfully it wasn't bad. but my stomach not being happy already could only eat a bit---more jokes about dieting ensued.

SO I leave monday or tuesday for the west. i am promised to have internet and phone booths but i am guessing they are mucn more expensive so I will not be writing or calling as much. I am told I will be the only OB doc...for which I replied that I was not qualified for that. and I am told I may be living in teh hospital...for which I hope is a joke, but guess it is probably not. I am told the Maoists are at peace here (although a year ago it was not the case) I go there with the founder and so if any problems arise, I come back with the founder. I am excited to leave kathmandu---this is a busy polluted city...i would love fresh air!! But I feel very safe here--probably because I go to bed early and dont go looking for trouble, but also---the people here are SO friendly. The nurses==who live on less than a dollar a day---bought me tea today to say goodbye. I was so moved I almost cried.

And if you felt the earth move this morning---i had my first dance party in my room tonight. picture this: me listening to Counting Crows hanging around here and dancing like no-one-could-see-me in my room. I am happy here. BUT I MISS ALL OF YOU!!!

Friday, January 23, 2009


I know, I know....its been forever. I have tried to sit down and write--several times---but I had so many different things to say and they would have been so many different blog entries. So instead I'm compiling everything into one huge cluster. Its not so different as my life! :)

Interviews: I am done with interviewing! I actually finished a few weeks ago. It was exhausting, but pieces of it was really fun. Here are some memories from that experience:
*I flew 5 different airlines, set foot in 12 different cities in a period of 2 months--all while doing an anatomy and an ED rotation (ok the schedule was flexible---but it still was a rotation!)
* Interviewing with up to 6 different people for fifteen to twenty minutes at a time---which felt more like speed dating than anything.
* Meeting the biggest gunner of each interview, and just hoping their number one didn't match mine.
* Having a residency director respond to my comment that I like classical music (I listen to it when I study) that he doesn't because it makes him feel depressed. And then he mentioned that he is probably just someone who is more apt to feel depressed anyway.
* Being asked where I am going next year aka what is my number one pick---ILLEGAL QUESTION---at several of my interviews and me just smiling away with a big "I dunno response."
* Being asked about 150 times if I had any other questions about the program.

Working in the Peds Ed for the past month has been interesting as well:
* A father knew the first day of his 16yr old daughters last menstrual period.
* The same 16 yr old girl replied to my question about being sexually active (I kicked the dad out by this point) as "Oh, Its been ages since I did that." When? I asked. 3 weeks prior to her dysuria. I didn't realize teenagers had such awful dry spells.
* I walked into the room of a 20something mom bringing her 2 year old son in because of an abscess. He was sucking on a starburst. Only she hadn't unwrapped it for him so he was also chewing on the paper.
*After waiting for 45 minutes to be seen, taking the history and doing the physical of a kiddo with asthma, the mom tells me she really doesn't want to be in the ED anymore. She'd rather just take her kiddo home.
* I have seen more "viral syndrome" URIs (aka colds) than I thought possible while working in the ED.

I've also been working on the yearbook for my medical school class. Its been sorta tiring, but fun to revisit everything we've been through and all the fun times we had. Motivating medical students to do something, though, its a challenge that I didn't appreciate until this task....

I am heading international next week. I will be gone for 6 weeks! I am doing an OB rotation in Nepal---its going to be amazing but I would be lying if I said that I wasn't a bit nervous as well. I hope to write at least one entry while I'm there, but we will see what sort of access to Internet I will have!!

Which means I have to make my rank list. It is due Feb25th. AGHH!