The weather continued to cause problems overnight as the snow continued to fall. The next morning I woke up to news reports of closed highways and 4 inches of snow and more to come. After discussing with my fellow travel buddies we all concurred it was one not safe to drive to Charlotte then two we could not even get out of Winston. We were able to rearrange our flights to depart and on Friday evening and all was well. I have to say I breathed a sigh of relief because I used the snow day extra time to pack, clean, spend time with friends and even complete some discharge summaries.
I have to admit, working on an inpatient specialty service (Renal) before planning to travel abroad for four weeks can be a bit stressful. I was perhaps scrambling trying to finish discharge summaries, finding time to pack, and ensuring everything was in order before I left the country. If that wasn't enough North Carolina had a record breaking snow storm roll through. The storm hit on Wed about noon with a few flurries which was the day before my scheduled flight. This then rapidly escalated to heavy accumulating snow causing grid lock on all the roads around the hospital. I ended up having to park my car in the nearby grocery store parking lot after I could not make it home due to the slick roads. Thankfully I had wonderful friends available with a four wheel drive truck to bail me out. The down side was that I was suppose to take a final shopping trip for the last few items to pack including a camera connector cord and new camera. I was able to get the essential items at Wal-greens but the rest I had to do without. Even if I could have driven to the stores the stores all closed early due to the snow.
The weather continued to cause problems overnight as the snow continued to fall. The next morning I woke up to news reports of closed highways and 4 inches of snow and more to come. After discussing with my fellow travel buddies we all concurred it was one not safe to drive to Charlotte then two we could not even get out of Winston. We were able to rearrange our flights to depart and on Friday evening and all was well. I have to say I breathed a sigh of relief because I used the snow day extra time to pack, clean, spend time with friends and even complete some discharge summaries.
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I want to share my experiences from a recent trip to Falmouth, Jamaica. I went with 3 fellow medical students and 1 physician from MU to this small island town. We met up with a larger group from Joplin, MO to work at the town's health care clinic known as the Methodist Clinic. We were there for two weeks and it was challenging, rewarding but most of met several incredible people. Below is the reflection paper I wrote when I returned (sorry it's really long) Enjoy, Meg
Jamaica is an island known for its magnificent beaches, fantastic hotels, and ‘no worries’ attitude. But beyond the beaches, hotels, and tourist shops lies the heart and soul of Jamaica, where taxes are high, incomes are low, and Jamaicans struggle to provide for their basic needs. On the rare chance that health care is accessible, little money is left to pay for it. This paper reflects my first hand account of the sights I saw, the people I met, and the emotions I felt while spending two weeks with a medical mission team in the Jamaican town of Falmouth. One of the first things I noticed before even speaking or treating a single patient is the attire the Jamaicans where when they are going to the doctor. The women are wearing their Sunday’s best, in dresses or skirts with their hair pulled back while the men are wearing their nice slack and Sunday shoes. On several accounts there would be patients waiting all day to see the doctor out in the stifling waiting room dressed in their suits with a simple hanky to dab he sweat off their brow. This simple decision of what outfit to wear to the doctor’s visit reflects the respect Jamaicans show towards healthcare professionals, especially those from America. They are grateful for the opportunity to be seen and treated even if the only treatment you can offer are vitamins. They are appreciative of the time you took to listen to them and care for them. The attitude is the polar opposite compared to some patients I have see in the U.S. If you don’t have the newest medicine to give them or they may have had to wait 30 minutes in the waiting room they are angry and confrontational. One memorable patient was a woman who came in for a fungal infection of her fingernail. Over the previous few months she slowly watched her fingernail become discolored and finally it started to thicken, lifting up from her nail bed. The patient knew there was some kind of infection in the nail but her chief concern was the cosmetic appearance. She hated the way the nail looked and wanted the discoloration fixed. The only solution we had to “fixing” the nail was to remove it, which is a painful process and medically not indicated. However, after explaining to the patient that nail bed would be left exposed and it would be painful when doing such chores as hand washing her clothes didn’t sway her decision. The woman understood the potential risks but was persistent that she wanted the nail removed. After discussing the risk and benefits with the patient we went ahead and removed the nail for this patient. After the nail was removed I explained to the patient how to take care of the exposed nail bed. She nodded in agreement with the instructions and repeated them back to me. However, since there were several instructions I decided to write them down for her on a piece of paper. I did this then had her read the paper back to me. This is when I realized that what I thought I had written as simple instructions the patient didn’t have enough education to read. She could not read the word “exposed” or the word “bandage” to name a few. For me these are words we use all the time and I thought even a lay person would know them. This was an awakening to me on how easy it is to be surrounded by highly educated people who all speak the same language then apply that same level of education to my patients who are hesitant to speak up when they don’t understand. On a rural clinic day I saw an elderly woman in her late 80’s came to the clinic accompanied by her daughter. The woman lives up in the hills with her adult son who is mentally retarded who she cares for. The elderly woman still cooks, cleans, and washes the clothes. Her daughter checks on her daily but the patient is still completely independent. On physical exam she had poor breath sounds with a possible pneumonia so we treated her with antibiotics. We thought it was necessary to err on the side of caution. If the woman did have pneumonia it could easily progress and kill her. In addition we gave antibiotics to her daughter because they are regularly in contact and did not want the daughter to re-infect her mother. This was a situation where the standard of care in the United States or evidence based medicine management for this patient could not be obtained. The circumstances surrounding her illness including the lack of follow-up and limited resources required us to give the patient antibiotics. We didn’t have the luxury to follow up and see if she got better or worse. We didn’t have the luxury to obtain a chest x-ray. Despite these limitations I strongly believe that we gave her the best standard of care we were capable of at the time. There were several challenges faced when trying to treat patients in Jamaica. One commonly encountered issue was in the management of patients with hypertension. The patients would come to the clinic with their medication (most of the time) and tell you they came to have their pressures checked. They would be able to give you a history of when they last saw the doctors and some would even go to the extent of telling you they know their pressure is really high because they develop severe headaches. However, most of these patients would then go on to tell you that they didn’t take their medicine this morning because they wanted you to see that their pressures where high. This makes it extremely difficult to know if their current medication regimen is working or not. Adjustments are almost out of the question unless you saw them during the first week and can have them follow up the next week. Perhaps they don’t take their medication because they are afraid they won’t receive refills on their medications or perhaps they don’t think the doctor will believe them if the numbers don’t reflect high pressures. I don’t know the exact reason for this commonly occurring hurdle to treating hypertension in Jamaica. What I do know is that an important part of successfully treating these patients was educating them on their disease and explaining how important it is to continue taking their medication before seeing the doctor. Educating the patient may not have impacted the treatment provided by our medical team but hopefully when the patient sees future teams they will be able to make medication adjustments. When people ask what we did in Jamaican I tell them we worked at a free clinic and set up mobile clinics into the hills. Yet this isn’t exactly the entire truth. The Jamaican patients are actually charged a fee to be seen in the clinic by the American doctors. Even though the foreign medical staff is volunteering, there were always at least two Jamaican nurses who were working the intake station. Their job was to pull the patient’s chart, help record their visit and on multiple occasions give background information and relevant medical history when the patient couldn’t remember. These women were community members so they know the people and process of the community. They are an invaluable asset when walking into a clinic and seeing a patient for the first time. These nurses are paid by the Jamaican government, which comes from a small fee paid by each patient to be seen in the clinic. In my opinion the fee required by each patient provides multiple assets to the clinic. One it employs the Jamaican nurses helping currency circulate in the economy. Two it makes the patient’s invested in their clinic visit. This decreases the number of patients who are simply there to just see the doctor or for some very minor complaint. Which then also allows patients who are more acutely or chronically ill to see the physicians because the clinic can only see a certain number of patients each day. There were a couple occasions where information was learned during the second week that would have been helpful to know the first week of clinic. One tid-bit of knowledge was that limited lab tests were available to the population at the local hospital free of charge. These labs included a CBC, CMP, lipid panel, and T3/T4 levels. This would have perhaps changed the medication options provided to the patient or in some cases even diagnosed their primary disease such as hypothyroidism more quickly. On the other hand even if we were aware those tests were available multiple factors played in to being able to utilize them, such as did the patient have the transportation means to get to the hospital and once they are complete will the results of the test be provided to the physician in time before they leave? One method we used to overcome these challenges was to first ask the patient if they had access to the hospital and second we told the patients that they needed to physically get a copy of the lab result themselves and bring it to their follow up appointment. There was one cluster of patients that were frequent in the clinic, those who needed refills or needed medications. These patients would complete their medical history and when you asked for what medications they were on they would provide you with a list of medications on a prescription note from the local doctor. They had seen the local doctor who had diagnosed him and given them a prescription for treatment. Yet the patients didn’t have the money to buy the medicines. They simply had to wait until the next US team came to provide medications. In this instance there is access to health care services but there isn’t adequate access to medications due to cost barriers. Instead the Jamaicans are reliant on the free medications from the foreign missionaries who do not come on a regular basis and when they do come there is no guarantee that they will have the same medications that the patient has been taking or was prescribed. There is a part of me that wonders if the free medications being provided for the past 20 years has created a dependence of the Jamaican people on the foreign missionaries. My thoughts include that why would the Jamaican government step in to change the current system if they can rely on the Americans to keep coming down month after month and provide them for free? During the two weeks in Falmouth, Jamaica I expanded my medical knowledge but more importantly I made lasting relationships and was exposed to a culture different from my own. I would recommend this trip any student who wants to push them self. However, I would also offer them the following advice.Be prepared for unexpected challenges. This includes new diseases and diagnoses. This includes workspace limitations. This includes drug and supply limitations. This includes improvising when schedules change. This includes dealing with the heat. No one area is excluded from challenges. In regards to people, the Jamaican’s are very friendly and this is their chance to see a physician while a team is in town. They respect the doctors highly in the community and will watch out for you while you are there. However, this being said it also perhaps provides a false send of safety and security. I never once felt threatened, scared, or endangered. Perhaps this was due to certain Jamaicans watching our backs and knowing that if the doctors feel things are dangerous they will quit coming to the community. Those drug dealers or gang members know the money making ways of the street but those shady characters also know who their ill mother goes to receive her health care. If the medical teams feel the area is dangerous they will not return. Faith, vitamins, and water are three very important treatment options for the patients you will see while in Jamaica. There are illnesses when you are limited in the fancy evidence based, stand of care treatment options and a simple prayer with the patient to give them strength and hope can do wonders. Also reminding the patients that when working out in the fields all day in the extreme heat and they become lightheaded that it is important to drink water while working is more often than not presented. Manual labor is a way of life and a method of survival. There are patients who have terrible excruciating arthritis but continue to work in the fields swinging a machete. The simple obvious answer is to quite performing the movement that is causing you pain. On the other hand, if your entire family is counting on the income from the repetitive movement causing you pain more times than not the patient will continue to swing that machete, they don’t have a choice. The volunteers who help run the clinic are not always medically trained. You learn to work with those who have never been involved in medical treatment except their routine doctor visits. But don’t discount their value in making the clinic run. It doesn’t take an MD to be able to count 30 pills; it doesn’t take an RN to be able to perform urine dipsticks. Each team member is important and it is crucial to respect and accept his or her level of medical knowledge. That being said I am sure that any student going on the trip will be able to find several ways to make the clinic run more efficiently, However the clinic has been established for over 20 years so just because you see better ways to run thing make sure to approach it in a respectful manner and not in a critical one. Most importantly be willing and open to admit when you don’t know a diagnosis or treatment. The trip is one learning experience after another. Especially when it comes to skin rashes in dark skinned populations, guess what their routine textbook pictures in white skinned people present completely differently in dark skinned individuals. Don’t worry too much there is a book in the clinic that gives pictures of diseases in dark skinned patients. It is very helpful. All of the physicians are more than open to answer questions and discuss treatments. Other tips…the helpers in the hostel will do your laundry daily so there is no need to pack very much. The hostel is actually very nice, it isn’t a five-start hotel but there are clean sheets, clean modern toilets, showers with hot water (most of the time), and electricity. There is never a shortage of food especially if you like carbs and jello. If you enjoy veggies be prepared you intake will drop substantially while on this trip. Don’t worry though you can simply ask Ruth, the Jamaican cook, to go to the market and purchase some vegetables for your personal stash. Before writing this paper I looked over the goals I had prior written prior to departure and realized I met them all and many more over the course of the two weeks in Jamaica. I learned about the use of alternative treatment plans since what we term the ‘gold standards’ of treatment in the U.S. are not always available in a developing country. I was able to integrate my knowledge of public health and primary care to help treat the Jamaican patients I saw. I learned about the culture, beliefs, and attitudes towards medicine and health the population holds. I learned how socio-economical factors such as access, cost, and educational levels affect healthcare in a third world country. Treating patients can and should be an opportunity to improve their health, whether they are in the land of opportunity or one of the impoverished sections of the world. Committing to that standard will make me a better physician wherever I end up and this trip taught me valuable skills that no doubt I will use in my future practice of medicine in the states and abroad. As I embark on my next great adventure I realized that I haven't officially blogged in what looks like over a year. In reality I have been writing monthly blogs as Word documents on my computer which are saved under the folder on my desktop "blogs". Yet, somewhere along the way I developed a fear of posting them without taking the time to edit and review what I have written. As you can see I have slacked off on reviewing what I have written making it worthy enough to post here. Despite how this fear developed I need to get over it and starting right now. Tomorrow morning at 2 am I am leaving from Kansas City to go to Falmouth Jamaica for a medical mission trip. I don't know really what to expect, making me excited and nervous. There is extreme poverty in Jamaica which adds another complexity to the treatment of patients. I look forward to this challenge and doing what we can with limited resources. I anticipate it will be much more of a learning experience that I can imagine sitting here now and will try to keep you updated when ever I get internet. For now I am headed to bed for a couple hours before I have to aw
I have finally gotten over the fear of feeling trapped awhile on my inpatient psych rotation; always having to key my way through 2 doors before I can even get to the unit where I need to be. Then I get my new assignment to the child psych ward. For those of you who know me I sometimes get a little bit nervous when I am around 5 or more children, especially if they are all running around shouting and all hyped up. I really get panicked that I can’t control them all at once so I was not really looking forward to the child psych ward where there are many uncontrollable children. However, I convinced myself that I could for sure handle it after spending 4 weeks on the inpatient adult service, adults are a lot more scary than children right….wrong!! I was slightly creeped out when I met face to face with one pre-adolescent child as I wheeled the chart rack back to the nurses’ station, no big deal simply said good morning and walked around the kid. However, I had that sinking feeling in the bottom of my gut. I got over it and went on with my day, lecture, lunch, seeing pts, and then all hell broke loose. The boy I met earlier in the morning that was up in my face got upset, then angry. I am still not sure what it was about but the kids started to knock over the entire chair, tip the table, cuss, spit, yell and finally wedged his body into a corner. The staff did what they were trained to do, try talking him down, figure out what is upsetting him and help him deal with it. Well that wasn’t working so they called in the reinforcements. When the boy started to get violent again, kicking the staff they had had enough, talking wasn’t working they moved to the next step of physically restraining him. This next step includes one staff member to each limb and even one to the abdomen if he is bucking about. They held him there for 5 minutes trying to get him to calm down but he was not having it. He began to spit, yell, be inappropriate, and that landed him with the spit mask and the staff tying him down to a backboard type transportation bed that was soft. This allowed the staff to carry him in a safe manner to the seclusion room where he was put in four point restraints on the bed (that means both hands tied down and both legs tied down). He would stay that way until he could calm down and quite being a threat to himself and others. This is where I left the disturbance and went to write my notes. When I can back to the floor later on in the afternoon the same boy way playing as if nothing had happened.
There are several tragic points to this story, one that the child could get completely out of control that it came to this point and two that one of the other newly admitted patient’s mother saw this episode go down. What parent in their right mind would want to leave their child in a place where there was an uncontrollable male child with their sick young daughter? That set off a whole new string of problems. To me witnessing this for the first time was disturbing, here you have a 10 year old kid being held down by five adults and still fighting, part of me wanted to cry another part of me wanted to go free the kid. I can’t really explain it, it was simply barbaric from the outside looking in but the reality of the situation it was necessary to protect the child, the other children on the unit, and the staff. Everything was done in the safest most controlled manner possible. I left thinking what a way to start off your first day. Hopefully it will go better tomorrow, Meg This post has been a long time in the making; many moments of “I should write about this” and “I will make sure to blog this weekend” yet I never seemed to get it done. Finally I am forcing myself to sit down and catch up what has happened over the past few months, giving a short overview of my first couple rotations. In July I started off with my Surgery rotation, which is 8 weeks of time spent in the operating room with several different types of specialties. My first 4 weeks were with the Acute Care/Trauma Team consisting of a team of physicians who deal with some of the worst injuries imaginable every day. They are constantly confronted with dealing with unexpected situations and determining the unknown. I highly respect these doctors and respect that this is one profession that I could not do for the rest of my career. To me the operating room is a fascinating place where I was privileged to spend two months. On the second half of my rotation I was able to work with various subspecialties including the cardiothoracic surgeons. There are the individuals who are responsible for cracking open a person’s chest, exposing the patients beating heart and repairing the damages. I wish I could explain in words the marvel and magnificence of seeing a beating heart then watching as it is slowly stopped, cooled, drained of all its blood, repaired, the re-warmed as the blood return and finally watching as the final shock brings the patient’s heart beat back to life. To me this is remarkable and I still am astounded by the advancements of modern medicine. Another aspect of surgery that blew me away was watching a skilled surgeon operate on the tiniest of people, babies only a few days old. At times the parents saddened me but overtime I was more overwhelmed with how much the children were cared for whether by their parents, nurses, doctors, or anyone coming into contact with them. In one surgery I watched the oxygen saturation of a 4-month-old child drop to 18% (it is suppose to be close to 100%) while the anesthesiologist was trying to intubate her for a surgery. Inside I was panicking along with everyone else in the operating room, however, if you would have walked in at that moment you never would have know, the team kept their composure and did what they had to do to obtain the airway, the room was calm (actually more calm than usual) because everyone realized that freaking out and making a scene would only make the situation worse. More to come about my second rotation; Internal Medicine…Meg (I was recently cleaning off my desktop and found this post from September 3rd that I never posted so here it is.)
As I sit here in bed I hear the rumble of the attic fan and feel the cool breeze over my skin. I have had an amazing past couple of days hanging out with my family at table rock. It has been awhile since the entire family has been down here together, really I can’t even remember when it last happened, maybe 2 or 3 yrs ago. Yes that long. When I look back 3 years ago I could hardly image I would be in the place I am now. It was the beginning of my first year of medical school, new people, an overwhelming amount of material, and giving up the free time I once called my own. I had boyfriend then and now I find myself dating someone new who I have know since I first moved to Columbia to start college. The way the world works is unpredictable a concept that I struggle with because I am constantly planning, making a list, and checking things off. However, life isn’t like that, even when you think you have everything figured out a curve ball comes your way and changes your life. Right now I struggle to find where I fit in, what stage of my life I am in, and what direction I want to take it in. I am scared I have sacrificed several precious years of my life to doing something I didn’t particularly like doing (aka sitting in windowless basement rooms studying). I think to myself did I make the right decision, I just don’t know. I feel lost and overwhelmed at times, craving for direction of any kind. Then I take a moment to pause and reflect on my days spent on the wards or in clinics, the times when I am interacting with the patients. Those interactions make everything worth it to me and I realize I made a difference; even if is just a small one. The patients also give me direction in my life; I see patients one day and find myself wondering how they are doing weeks later. To me this is a sign that I want to work in specialty where I will have long lasting relationship with my patients. I want to grow up and work somewhere where I don’t have to spend a half hour reading up on the patient before I see them. I simply want a quick refresher and walk into the room knowing their history already because I have treated them for years. The day will come, all too soon, where I have to make my final decision on what exactly I want to spend the rest of my life doing. For me I think the decision will rest in what makes me happy and makes me wake up looking forward to going to work each day. After a truly relaxing and enjoyable weekend I have returned the Lab D to begin the daily routine of studying. It is hard to explain the feeling I have about starting to study all over again. There is a part of me that feels relieved because we completed our second year of medical school. The last round of tests were finished on Friday and I spent the last weekend outside planting flowers, mowing the lawn, going out to breakfast, and visiting family.
Then there is this other part of me, which is a ball of nerves worried about if I will be prepared enough for Step 1 of the USMLE. The Step 1 is the first of 3 exams that are required to get your US medical license and the score received of the Step 1 is what goes on your application to residency programs. A poor score can really close doors to which programs you apply to and even what specialties you consider. That is why I feel anxious about the test. In spite of this pressure, it is important that I not overwhelm myself with the “what if”s. I am going to take each day one at a time and simply do my best. Then hope and pray my best is good enough on June 3rd when I take the test. Yesterday I had the opportunity to run the GO! St. Louis Half Marathon in downtown with Stac. It was a race that I have spent the last 10 weeks training for and have run in the past. This year I even beat my time from last year so I knew I was capable of finishing. However, as we began to climb the last set of hills making up miles 11.5 to the finish, I began to have doubts that I would finish and just wanted to be done. I was really hot, thirsty, my legs felt like jello, my arm was numb and I had a side cramp I couldn’t shake off (all probably a mixture of my lack of quality training and the warm weather). What kept me going was Stac cheering me on, the crowd cheering me on, and the people running the race along side of me. It is encouraging when a fellow runner sees you struggling and gives you that extra “you can do it” or “almost there.” Thank you to all those people who I knew and those who I didn’t for supporting the racers.
More importantly it is inspiring to see those people who are running the race for a variety of reason. One group was running it to raise money for cancer awareness in honor of their friend whose mom recently died of lung cancer. There were others running in honor of those Missing in Action and a group of church members running to provide clean water to those who lack it. (Ummm I started this blog in lecture and now can’t remember where I was going with this paragraph) For me the 24 hours I spent in St. Louis before, during, and after the race was much needed time away from school. I didn’t see it this way before the race; instead it was going to be time away from studying. On the drive to the St. Louis I decided that I was going to enjoy the time away, a mini vacation perhaps. By making this decision something else happened, I was able to regain some perspective that I have lost in the past 3 months. There was time for laughter, to meet new people outside the field of health care, and experience new places, basically realizing that there is more than just school. Right now school may consume my life but it doesn’t need to define who I am. Meg As I sip my coffee and soak up the sun shining through the windows I can’t help but admire the knitting group in the corner. I’m not sure why I find them so fascinating, I have no interest in knitting, have no clue about half of the things they are talking about, and have never met any of them. Yet I find myself diverting from studying to observe them or some may say ease drop on them. It isn’t hard since they aren’t whispering and when excitement about a topic or story is present you can hear the crescendo of their voices and laughter. I can’t hold back my smile, as I look over all I can see is the small white caps of their hair peaking above the high back chairs…they are so cute!
Then I begin to wonder if there will be a time when I too will be able to meet up with my white haired girlfriends and spend the morning chatting. Quite honestly thinking about the future scares me because I have not idea about where I will be. I can’t even guess what state I will be living in two years from now. In the end I have faith that everything will fall into place and have to remember to “not worry about tomorrow; for tomorrow will care for itself. Each day has enough trouble in its own.” Recently I did find out some exciting news, my placement for the rural track rotations. I will be completing my Family Medicine, Pediatrics, and OB/GYN rotations in Joplin, MO. However, this means that I will be living in Joplin from January 2011 until the end of May. Joplin was not my top choice of places to go especially since it is 4 hours from both Columbia and Wash MO. Yet I am looking as another experience where I am venturing out of my comfort zone. Some of the best experiences in my life have been during the times where I stepped out on my own, going to a new place, meeting new people, and ultimately learning more about who I am. Last week I saw a patient who I will call Pat. I will remember Pat because he/she was the first HIV positive person I have seen as a patient. Don’t get me wrong I have met many HIV positive people, probably more than I will ever realize, so what makes this special. I was acting in the role of student doctor and simply taking the history of this patient was fascinating to me.
Pat was first found to be positive 18 years ago when patients expected only to live a few years. Now 18 years later Pat hardly believes they are still alive. I find it remarkable how far medicine has come in such a short time. For some the discovery of effective HIV medication wasn’t soon enough but for many it has given them the chance to see their children grow up and to see their children’s children. Pat never expected to see his/her own children reach adolescence and now Pat is watching his/her grandson approach adolescence. There was and still is a stigma attached to HIV. It is perhaps not as negative as it once was but it is there. I think the natural reaction is to be scared or precautious around someone who is infected. I found my first reaction to the patient surprising. The patient was being seen for an illness unrelated to HIV, HIV was simply another chronic illness such as diabetes the previous patient had. When taking the history Pat simply mentioned he/she was positive and unconsciously I had a moment where I was apprehensive about seeing this patient. The feeling was a mix of feeling fearful and cautious around this patient. However, it only took a split second before my rational brain took over. You can’t contract HIV from talking to the patient, being in the room with them, or even doing a physical exam. There needs to be direct contact with body fluids in order for transmission to occur. It then dawned on me how I was probably a bigger threat to her since she was immunocompromised. This means that a simple infection a normal person’s immune system can fight off an immunocompromised person can’t. This patient’s CD4 count was about 250 and was on a corticosteroid further increasing the risk of infection. Pat should have been apprehensive about me touching him/her. Pat showed me how wrong first impressions can be and how fear can really obstruct your thoughts if you let it. This patient also excites me for what the future of medicine may brings and I look forward to being a part of it. |
AuthorMy name is Meg and I am currently a Geriatrics and Palliative Care Fellow at Mount Sinai Hospital in New York City. I started this blog several years ago as a way to remember and talk about what I experienced while studying abroad in Rwanda during the summer of 2009. Archives
January 2016
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