“My Calling Is Clear!”

August 30, 2012

 “For I know the plans I have for you,” declares the Lord, ” plans to prosper you and not to harm you, plans to give you hope and a future.”  Jeremiah 29:11

As I stepped out of the elevators and entered the double doors, I heard the familiar sounds of crying, objects clashing, and running feet. I looked around and saw the bright and colorful surroundings that felt like a reprieve from the rest of world. It was then that I knew I was “home.”

This “home” I refer to is the Pediatrics ward.  I have found my calling.  My interest in Pediatrics goes as far back as middle school.  I always knew this is what I wanted.  Furthermore, to confirm my desires, I interned in Florida Hospital’s Pediatrics and NICU ward for a semester during my senior year of high school.  I never stopped smiling!

However, when I started my eventual career in medicine and started learning about all the “cool” and interesting cases medicine has to offer, I started rethinking my path.  Maybe I should be an Internist, so that I would witness and diagnose these “cool” cases that mostly affect adults.  Suddenly, Pediatrics seemed a bit boring.  Aren’t most children relatively healthy?  Would I be bored with checkups, immunizations, school physicals, and the other mundane tasks of a pediatrician?  What about the paranoid, know-it-all, helicopter parents?  I would have to deal with them as well.  And babies?? They can’t tell you what’s wrong with them.  Will their incessant crying and irritability reduce me to a pile of frustration, as their parents look to me to tell them what’s wrong with their child? And let’s not forget the dark side of Pediatrics, which includes child abuse, depression, and other mental illnesses.  How will I keep my composure when I witness these unfairly treated adolescents and the consequences it brings?

I rotated in Internal Medicine from January to April.  I was sure that I would probably seek a residency in IM, due to the vast number of sub-specialties I could go into afterwards.  However, I couldn’t shake the boredom I felt most days of the week.  Surely it is interesting, however, it wasn’t for me.  My surgical rotation was quite interesting, and I will always be fascinated when one opens the body while the patient is asleep, repairs something inside, closes it up and the patient is better.  However, my interest in surgery is from afar.  But as soon as I started Pediatrics, the familiar smile that never left my lips in high school during my internship returned, even on my first day of rotations.  It was evident: I love kids!  And I can’t imagine a career without them.

As it turned out, Pediatrics ISN’T boring after all.  Children are so dynamic as they grow older, that many things change, including differential diagnoses and drug dosage, even with children only months apart.  Also, most attractive to me in Peds, is the fast turnover of the kids, with new kids on the ward everyday, unlike the adult ward, where a patient can be in there for months. Kids tend to get better faster, which increases a sense of accomplishment (important factor for me) and decreases boredom (also important)!

I found myself staying on the ward for longer hours, coming back to interview patients in the evenings (long after I settled in at home and had dinner) and just hanging out with the kids and their parents.  I realized that I could never do so willingly in Internal Medicine or Surgery.  Sure, I did a few overnight and weekend calls in Internal Medicine, but I was always aware of the hours passing by.

The most proud moment for me in Pediatrics, was when I spent some time with a mother and her 11 year old son who has Type 1 Diabetes that was poorly controlled.  It was common knowledge among the doctors and nurses, that due to a slight language and culture barrier, the mother seemed to not understand the importance of supporting her son in his tight blood glucose control to prevent the sequelae of a chronically high blood glucose, and would undermine the efforts of the doctors by feeding her son way too much sending his blood glucose spiraling upwards.  I spent the morning educating, in laymen terms, about diabetes to the mother.  The light seemed to emerge in her eyes, as she finally seemed to understand the pathophysiology of what was happening to her son.  She became tearful and was very grateful.

I presented the 11-year old patient to Grand Rounds, and later, during morning rounds, the patient’s mother kept saying to her doctor: “Natacha told me…”  I was a bit embarrassed that she kept mentioning my name, afraid that I may have said the wrong thing. I held my breath after each declaration.

The doctor followed with: “Natacha? The medical student, Natacha? You know she’s only a medical student. There is a difference.”

To which the mother replied, “I know, but I figured she studied about diabetes and knows something about it.”

Fortunately for both the both of us, the information I gave was correct, and the doctor subsequently praised my efforts.  It was at that moment that I, paradoxically, felt like a real physician.

“I can do this,” I thought.  “I CAN be a Pediatrician.”


What You Don’t Know…

March 20, 2012

James 1:5
“If any of you lacks wisdom, he should ask God, who gives generously to all without finding fault, and it will be given to him.”NIV

It has been a while since I’ve posted a blog.  My apologies for the absence.  Since my last post, a ton has been going on.

It has been both overwhelming, exciting, and of course, a blessing.

An update is due:

I have taken and passed STEP 1, by God’s grace, around the holidays.   At the end of January, I moved across the pond to the U.K to commence my 3rd year clinical rotations.  I will be completing all my cores in England, and then heading to America for my 4th year electives.  Well, most of them anyway.  Plans are underway to do up to 8 weeks of electives in Africa (more on that in another post).

So, as I sit here today, I have nearly completed two months of my first rotation, Internal Medicine, in England.  It seems surreal that time can actually go by so fast.

Almost everyday in the clinical setting has given me ideas for blog posts, so that you may get a glimpse of what clinical rotation is like, compared to basic sciences.  It has been a wild ride, thus far.  I will definitely post memorable anecdotes during this clinical year.

However, as in introduction to my future clinically-oriented posts, I would like to briefly give you an overview of what clinical rotations has been like!

This is the third time in the last five years that I’ve moved to another country to start a new adventure.  This always combines certain emotions together.  Starting anything new is stressful.  Starting something new in a new country brings its own unique stressors.  Compound that with the major time difference, and well, you get the picture.

Coming to England to “study abroad” has always been a dream of mine.  Unfortunately, majoring in Biology at Oakwood didn’t leave much room to study abroad.  I am fortunate that being a foreign medical student afforded me the opportunity to follow this dream at last.  Choosing to come to the U.K was an absolute NO BRAINER!

And I don’t regret it for one second.

Upon my arrival, I got oriented and comfortable in my accommodation a few steps from the hospital.  The weather in England was a stark contrast to the weather I left in West Palm Beach.  This didn’t help the jet-lag situation, but since sleep is my best friend, I didn’t mind the extra zzz’s.

Internal Medicine (IM) is housed under “General Medicine” because you “know a little about a lot” in regards to adult medicine.  However, within Internal Medicine, there are many subspecialties.  These include: Infectious Diseases, Allergy & Immunology, Cardiology, Endocrinology, Pulmonary, Rheumatology, Hematology, Gastroenterology, Neurology, and Nephrology.  If you are interested in any of these specific fields, IM is an excellent specialty to go into, so that you may sub-specialize later in your career.

Before I continue, I would like to mention some brief differences between the titles of doctors in the U.S and U.K.  In the U.S, new doctors in their first year of residency are called “Interns.”  In the U.K, they are called “F1” for Foundation Year 1.  Thereafter, residents in the U.S are just called residents, and then they can become Chief Residents.  After that, they are Attendings.  In the UK, the second year is F2.  After further training, they are considered Registrars.  It takes many years of training to become a Consultant in the U.K (which is synonymous to Attending).  Also, doctors are called by their first names in the U.K and they don’t wear a white coat, for sanitary reasons.  Only Consultants are called doctors, and surgeons are called Mr./Mrs.

I started my IM rotation with Infectious Diseases.  Starting with Infectious Diseases (ID) left my heart with a gleam and wide open to the possibility of specializing in this unique field, due to my interest in Global Health.  My hospital is located in a very diverse populace of immigrants from India, the Middle East and Africa.  With this, comes the introduction of many diseases not seen frequently in the West, but studied while in Basic Sciences.  For example, I am well versed in Tuberculosis in its many forms due to the astounding cases of TB at my hospital.  This would not have been the case had I been in the U.S.  This is true of several other illnesses and interesting infections I’ve seen during my 3 weeks with ID.

So far in my training, I have been given lots of opportunity for hands on learning.  You just have to ask!!  I have learned how to draw blood, do Arterial Blood Gases (ABGs), take blood cultures, put in IV cannulas, assisted in Lumbar Puncture, take several patient histories and physical examination (“clerking” a patient).  I even assisted in a cardiac arrest by doing chest compressions during my voluntary weekend call.  I attended and witnessed Catherization Labs (“cath lab”), Colonoscopy labs (and I will get to do a colonscopy soon).  I even get to do the not so glamorous necessities, such as rectal exams (called PR in the UK).   There are several other “skills” I want to make sure I attempt or at least observe before I finish IM in 4 weeks: urinary catheter, central line, LP, ascites drain, etc.   Phew!

However, one theme that constantly bombards me while in the wards is how much I don’t know or have forgotten since Basic Sciences.  I look in awe at all the physicians and their apparent ease in navigating this art that is medicine.  It’s only when a humble enough junior doctor assures me that they felt the exact same way that I breathe a sigh of relief.  Therefore, feeling inadequate in medical acumen in the wards is far from a unique feeling, even amongst practicing physicians!  And it is this awareness of gaps in knowledge that keeps us on our toes to continue to research, study, and keep up to date with medicine.

Unfortunately, the medical field has a way of making us feel that inadequacy is unacceptable, and therefore, at times many of us have faked understanding.  This can be deadly for the patient!

So, my theme in the wards has been to ask questions! Asking a question may make me seem/feel inadequate for a few moments, but not asking will certainly make me feel inadequate for a lifetime.  I am a student; therefore I am here to learn.  If I knew it all, I wouldn’t need to pay thousands of dollars in tuition fees.

This feeling of “not knowing” will follow me into residency, as is evidenced by friends’ and colleagues’ testimonies of how they feel in their first year of training.  In my opinion, not knowing is NOT the crime.  Not asking is!

I am very fortunate to be here, a student of medicine.  I love every second of it, and I wouldn’t change this path that I’m on for anything else.  This year is turning out to be one of the best years of my life.  On top of which, I’m in Europe!

This means, I also get to indulge my other passion: traveling!

I just came from Spain and in a few days I’m headed to Switzerland.  Several other trips are under way, as well.

I am excited to chronicle what medical school is like when my head isn’t buried in the books!  Please join me on this amazing journey.

Are there any specific topics you’d like to see discussed in regards to clinical rotations? Let me know in the comments and I’ll be sure to include them in future postings.