Moving on! February 2, 2009Posted by jaotte in Medicine.
Ok, new blog over at
I’m leaving this blog up “as is” so that the content can be accessed without any broken links or complications, for those who still use it as a resource.
I don’t expect to be writing any more Himalayan content in the near future, but I’ll be sure to cross-post if I do. I hope you will enjoy the content of my new space as it begins to emerge. Thanks for reading.
short update February 2, 2009Posted by jaotte in Medicine.
Tags: Medicine, Travel
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well, this blog is sorely neglected. I need to figure out a way to archive it or something so that it is still accessible but doesn’t totally occupy this wordpress space.
also into Twitter these days, so I’ll try to hook that up to this page as well.
Changes might be slow as I’m off to Montreal/Ottawa/Toronto/Hamilton over the next 2 weeks for residency (http://www.carms.ca) interviews, then studying for a big practical exam when I get back, followed by 4 weeks of Reconstructive Plastic Surgery in Cambodia and two weeks of urban/trauma ER in Vietnam. Phew!
In May, I get my MD. Nearly there!
ch ch ch changes September 20, 2008Posted by jaotte in Healthcare, Medical School, Medicine, Travel, Volunteering.
Much has changed since I started this blog. Nepal has a democratically elected government, and things are starting to improve in the healthcare sector and for human rights in general. My International Health endeavours were put on hold during my third year clerkship, in which I found myself working up to 100 hours a week at times, rotating through the various fields, and learning far more than I ever imagined possible. While it was exhausting and a bit soul-sucking, but the clinical experience was welcomed after years of didactic education. I liked most aspects of everything I tried; the procedural aspect of surgery, the puzzle solving of Internal Medicine, the adrenaline of ER/Anesthesia, the patient connections in Psychiatry, etc. are all things I hope will one day be a part of my practice.
Seeking variety in the work, the patient population, the location of the work, and the hours, I think I’ve found my match. I’ve decided to become a Family Doctor (with dabblings in Emergency Medicine, Surgical Assists, Public Health, International Health, and possibly more…). It really seems the most flexible for a person like me who likes a bit of everything, and most importantly, enjoys balance in life.
Now I’m in my fourth and final year, doing electives of my own choosing (1 month each of Anesthesia, ER, and then Family Practice) before some refresher classes in December. Simultaneously, I’m filling out applications for residency, praying that the program of my choice will take me, and that I will make the right choices along the way.
I also have the opportunity to do another International Elective in March 2009. It would only be 1 month long. I have not yet decided where or in which field I would like to do this. Haiti might be a good fit for me, as the need is strong and my medical French is under development, but it might be too dangerous right now. French-speaking Africa also appeals, but a month seems too short to find a niche and also to justify the cost. A return to Nepal or Northern India will be in my future, but I definitely want to commit a much greater time there as well. I have considered work with the Maori in New Zealand as there are strong parallels Canada’s own aboriginal population. There are lots of great options, but again, I struggle to find an ethical, sustainable program that will facilitate the maximum contribution from me, given my level of training.
Time is short.
Washing My Hands April 30, 2008Posted by jaotte in Humour, Medicine.
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ok, so I know I haven’t updated this in about, well, forever, but that’s because life as a clinical clerk is kind of busy. Ok, really busy. A lot of weird and wonderful things in the realm of medicine have happened both around the world and in my personal experience.
I’m still into International Health. In fact, I’m going to a conference this weekend about student-directed, interdisciplinary healthcare projects and I’m hoping it will help me generate some ideas for a publication I’m working on.
Nepal finally had an election, and the Communist majority winners are now relaxing their stance and embracing aspects of capitalism.
I’m planning another international stint for next spring, but I haven’t decided what or where yet. It’ll likely be in primary care, as my interests are bending towards family practice and emergency medicine more and more.
I might open a new blog that is more general i.e. my take on life as a clerk/intern/resident, but that would depend on me having a surplus of time – and we all know how likely that is.
Anyway, here’s something for good practice that every doctor should watch:
Journal 9 – Nine: Clinic and Palm Reading July 26, 2007Posted by jaotte in Medicine.
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(just a reminder: these posts are copies of entries from my paper journal, written Summer 2006)
Up early again. Too early. Have a nice warm bath. Well, actually, it’s more like wiping my face with a damp cloth, dipped in a bucket of warm water. Refreshing, and a nice relief after waiting in line for the “shower tent” listening to someone puke and then clean themselves up afterwards. It’s a sunny morning and we’ve got another gourmet breakfast thanks to Anooj’s culinary prowess. It’s pancakes! I fell a little homesick without the maple syrup, but I’ve got some authentic chai to keep me toasty.
We walk to the Tangste PHC. It’s quite well equipped with a dispensary, dental suite, gyne room, x-ray machine, and more. Today I’m posted in the pharmacy with another student and our Indian pharmacy expert. It’s pretty slow and we manage to take the time to explain dosing to the patients in our best version of the local dialect – which is terrible. The pharmacist is also a palm reader. He tells me about myself and my life, promising:
- life long happiness
- intelligence and wisdom
- I should be careful when driving
- I’ll have two children and ‘some’ relationships
- strong influence will bring me success
- I can do any career within Medicine but probably not Surgery. Wait, it’s probably okay too.
- I’ve had a troubled childhood
Well, it’s pretty complementary and hopefully accurate. The last point is totally off the mark, but I think he assumed it because I had a wild colour of hair and an eyebrow piercing.
I started to gt sick with hunger. Patients still trickle in. The last one doesn’t have a ‘script but a baby with a gash on his nose needs our attention. My whiz kid partner, with her inner-city ER experience cleans him up with saline and neosporin.
Finally we walk back for lunch and it is good. Back too soon to the clinic to finish up the day. We wait around impatienty for the last few prescriptions and we’ve already packed away many of the boxes.
Back to the tents. A nap cures my headache and revitalizes me for a cricket rematch. We lose horribly, but I am happy to have had a go at pitching and that I managed to score two runs. One our our suave lab technicians from Shimla wants a chat. I think he’s in love with all the Western girls around him and wants to impress us. He comes to look at my camera and I show him pictures from all the museums in London, much to his delight. All the children gather around and are trying to get a good view of the tiny 1″ LCD screen. “Dinner!”
Garlic naan, mushroom and pea coconut curry, and spring rolls. The kitchen masterminds have really outdone themselves again. Here, I thought I’d lose weight from the tough work and hiking in the Himalayas – no, certainly not with this lush diet and no one letting us lift a finger at camp. The only exercise I can get in is an evening hike, some cricket, or hauling boxes at the clinic.
The group that had gone earlier that day to treat the nomads showed us pictures of the settlement. There were fresh goats-heads hung under a bridge and a rare horse amongst the photos. The clinical work didn’t sound much different than that in Tangste, so I’m no longer jealous that I didn’t win a spot in the lottery to go.
Our head honcho delivers a talk about Leprosy. For an illness that is very well managed on the global scale, there are still some unexplained events. Despite controlling most cases and the low communicability of the bacteria, new cases keep popping up. Could it be a zoonosis? No one knows.
To the fire. Everyone throws on sticks and builds it into a huge, warm blaze. I drink from a cup being passed around the circle; it’s an awful Indian rum which proves later to be an excellent sleep aid. My tent-mate was already asleep but I stayed up singing cheezy Canadian camp songs, Disney tunes, hits from the 80s, and learning a few new melodies from the American contingent. Baby Got Back (by the funniest teammate on the trip) and Bohemian Rhapsody were the highlights. Two of the students from Queens were former camp councillors and naturally awesome singers. A guest from one of the recent Anthropology trips pitched in her soulful voice. The music is a relief after being without my iPod for many days now. I wonder if the altitude-induced crash of its hard drive will be fatal. Only once we descend, will I know.
Teeth brushed, bladder emptied, it is bed time.
My Afternoon in the ER: A DNR gets R’d April 21, 2007Posted by jaotte in Ethics, Medical School, Medicine.
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I spent Wednesday afternoon in the ER for the second week; I was observing, taking histories, performing physical exams, establishing differentials, recommending lab workup and possible treatments, learning about medical politics, and saying “I don’t know” a lot. It felt good to be in the hospital for once. Starting in September, that’s what it’ll be all about for me. For now, it was just an afternoon.
I’m probably breaching confidentiality somewhere, but I’ve removed/changed as much identifying information as possible; I think it’s an important illustration of how theory and practice don’t always look the same in Ethics. Here, the DNR is the case in point.
It’s the end of my shift. My supervising doctor says “Jessica wants to stay around and see this.” I do? The more experienced doctor taking over the shift was happy to have me. He began, in a painfully slow voice, to impart his wisdom upon me. Something about enjoying your job, not being bored, and then I lost track of his point.
I didn’t know what ‘this’ was. I was just following the sheet of paper that said to report to the ER on a Wednesday afternoon. People were scurrying around, moving equipment, repositioning beds, and clearing the path. For what? I heard something about ‘resuscitation’.’ Meekly, I asked the wise old man what was going on. “There’s a DNR resuscitation coming in.”
I couldn’t figure out all the fuss. Why would an ambulance hurry a dead person to the hospital if there was no intention of reviving them. So, I waited. I tried not to get in the way, which was hard to do when there were about 15 quick-moving bodies including RNs, RPNs, clerks, and orderlies doing there jobs. The grey-haired man just stood with me outside his office and continued to share his ideas, none of which had anything to do with the present situation. Well, I wasn’t listening anyway. I still didn’t understand what all the fuss was about.
Oh. We glove up. The paramedics roll in and we get the quick story; the woman fell, the neighbours called the ambulance, she was resuscitated for 20 minutes at which point the grandson remembered she was DNR. There were some language issues as the Asian grandfather was also present and had his own DNR. The son found the papers, but the family wanted to rescind the order since their grandmother’s quality of life was good. The original DNR didn’t expect her to collapse for another few years, when her dementia would be progressively worse.
I am hearing this as I watch them suction her, put a backboard under her, climb on the table, and attack her sternum with the heels of their fists. The paramedic squeezed the manual ventilation bag every once and a while. There is no pattern like I learned in my CPR course. They’ve pushed adrenaline, they’ve defib’d her. This has been going on for an hour. Even though she had a DNR? Even though she had a DNR.
There really wasn’t much going on. The resuscitation would stop as we lined-up to take an ultrasound of her heart. The valves were still.
I was waited in the sea of calm for the moment I might be useful. Someone asked if I wanted to ‘get in’ on the CPR. I was partly too startled and thinking exactly what I said: “well, he’s gonna call it in a minute anyway.” Was that cruel? A woman who had been asystolic for an hour? The family, from their wait-room imprisonment agreed to cease and desist. The wise man told us their decision.
The time is read out. The little curtained room clears, save for a few lingering bodies. The tiny woman lays on the table, still intubated, lifeless, 82. Not two hours earlier, the coroner was in here looking at a man who hung himself in the same way I am looking at her.
This was unusually glamorous medicine. And yet, so crude.
Journal 8 – Eight: Pangong Tse April 2, 2007Posted by jaotte in Culture, Healthcare, Himalayas, Humour, India, Medicine, Travel.
(just a reminder: these posts are copies of entries from my paper journal, written Summer 2006)
Wake up early to do some Yoga breathing exercises, while we pirch on large rocks in the field around our teacher. Breakfast at to 7 and we pile into the jeeps, ready for a short trip to Pangong Lake – the closest I’ll get to Tibet on this journey. Tonnes of animals in the valleys as we pass. A himalayan marmot, many donkies, horses, goats, and one hare (brown with white ears) look a bit insignificant against the tall mountain backdrop.
I understand why SUVs were invented, and thank their makers as we crawl over rocks and plow through streams that have washed the roads away. It’s not smooth, but the fact that we even get through is pleasing enough for me.
At the lake, as beautiful as the photos I’ve seen. Breathtaking to know I could just dip my toe in, and I’ll have touched Tibet. So many of our patients, with their warm smiles and hearty laughs, have come from that land at some point. Their presence shapes the Ladakhi culture and makes the province a whole different experience than the rest of India; it’s horrible to think that they aren’t in India by choice.
We walk closer to the lake and there is talk of going into the water. I’m shivering with many fleecy layers, mittens, and my trusty toque, but a few brave souls put caution to the roaring wind and hop in. Other, slower participants take their time changing their clothing to swimsuits behind the shelter of a 3-foot metal shield. This is much to the amusement of nearby soldiers who recognize the metal barrier as their urinal.
Epic feelings were crushed by all the “Restricted Area” signs and razor-wire coils forming a disincentive to walking around the lake to Tibet. I took childish joy in photographing the “Restricted Area: No Photography” sign as well as the soldier’s socks, hanging outside the bunker to dry.
We re0fuelled the cards and headed out. Got to chat with a colleague I didn’t know well yet, and rode in the comfiest jeep but discovered its shocks weren’t so great when we returned over the spilled boulders.
We had lunch at home base and did an afternoon clinic at the same location as the previous day. I was meant to do general med but felt sorry for the student distributing eye glasses, so I went and helped hi,. That was a difficult job. Lots of patients just needing sunglasses or a weak prescription which we had run out of.
One girl really liked a fashionalbe pair of +1.25s. We thought it was just because they were nice, so we had her try on the same prescription but in a pair of ugly-framed glasses. She said the latter ones made her dizzy (“zim zim”).
We accused her of just wanting the nice frames but then we then realized the ugly ones were in fact a stronger prescription (the handwriting made +1.75 look like +1.25) and would indeed make her dizzy.
I felt horrible. I just didn’t want to give her a pair of glasses that would make her dizzy or not correct her vision adequately, but we had been rude. I asked the translator to apologize and explain that we didn’t want to give her the wrong glasses because they might make her dizzy and nauseous. I apologized, and my partner said in his loudest, “I am speaking to an ESL student” accent said: “Me soooo sorry!” I nearly burst out laughing at the patronizing tone. Saying it louder, slower, and annunciating more clearly will not make her understand English. Nice try, though! Hahahaha!
We shut down the station early which was a relief, because I had developed a headache from the kerosene burner the dentists were using to sterilize their equipment.
I thoroughly enjoyed the idea of the toilet shack up on a nearby hill. No fourth wall/door but instead a view of the dunes above. Upon exiting, a nice view of he valley and gompa below.
Tonight was cricket in the most competitive way. Balls being lost in the stream, people tripping over stones in the fields, jumping into the water to retrieve the ball, etc.
Our Indian Pharmacist/trip organizer does a victory/”you’re a cheater” dance by swivelling his hips and shaking his hands above his head. I tried to take a video but was laughing too hard so I missed most of it! Alternate this with his rival since boyhood (currently on the other Cricket team) coughing his lungs out like the smoker he is. Lots of fun into the sunset.
An American dinner: Indian versions of pizza, spaghetti, fries, and an apple pie that was not quite as good as it looked. A short talk on Rheumatic Heard Disease. We disperse. Earlier, we’d played a little group game called Assassin/Mafia but in the darkness, there is only fire and song.
My tent-mate and friend is ill, so I head to bed early after the usual hold-flashlight-and-hold-breath trip to the toilets (outhouse-style). Vengaboys and wind, along with two male voices carry as we drift off. My nose is plugged. I bet we all snore like chain-saws at this altitude.
How Great is Wikipedia? March 7, 2007Posted by jaotte in Healthcare, Medical School, Medicine.
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There was a recent article on nature.com that addressed the use of public-contribution-based sites, like Wikipedia, in sharing medical knowledge.
The Hospital Librarian of the Year, fellow blogger and UBC library committee member, Dean Giustini weighed in on the issue. With vast experience with evidenced-base medicine, professional medical databases, and Google Scholar, it’s not surprising that he takes a cautious view.
From the article:
“The Wikipedia model is simplistic for medicine,” says Dean Giustini, a University of British Columbia medical librarian. “There’s something to be said for the wisdom of the crowd, but that doesn’t supplant the wisdom of the expert.”
Journal 7 – Seven: Slow March 5, 2007Posted by jaotte in Medicine.
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Luxury breakfast with pancakes and “eggy bread.” The latter is like French toast, without the syrup, and the UK members of our team seem quite familiar with this. We’ve been fed so well that it is hard to really miss any dish, but pancakes just aren’t pancakes without syrup. Who am I to crave this whilst in the middle of a health brigade to treat people who can’t afford a toothbrush or basic pain meds? We are spoiled.
I’m feeling dirty but a bar of soap and a splash in the grey washing tent really help. My congestion and runny nose (as well as the dirt under my nails) should prompt me to wash my hands a lot today, but the alcohol evap stuff is going to have to do since warm buckets of water are scarce; who knows if I’ve got a little head cold or if it’s just the altitude and cool mornings that are jamming up my nose, anyway.
We drive to an elementary school where clinic was scheduled for tomorrow. We aren’t allowed to start early because of some ‘scheduling conflict.’ The team snaps photos of the kids, has a brief lesson in pinworm diagnosis and treatment, and we take the jeeps further, to the next school and monastery. We hold clinic here but I’m stuck on triage. Blood pressure, heart rate, respiratory rate, and temperature. Well, the first three consistently anyway; the thermometer is on the fritz. Triage is slow as there are no emergency or particularly unusual cases. The down time gives me a chance to reflect on how this experience has been so far, compared with my expectations. I feel like I could do so much more, even if it were just grunt labour, learning more of the language, or otherwise making myself useful.
I’ve brought some stickers for the kids; good thing they are small and plentiful, as screaming hands reach for the colourful treats from all directions. Almost every Presenting Complaint says: “eyes.” Yes… but we are running out of glasses and hardly any of the frames would fit children; next time, I think we should bring and endless supply of sunglasses to help protect their eyes against the sun and blowing sand.
[[The journal stops here; rain and routine pre-empt my writing.]]