Eat When You Can, Sleep When You Can, And Don't Poke The Pancreas

After a month of General Surgery my rotation is done.  I had so much fun!  The human body is amazing and I loved being able to observe it up close and hands on everyday.  It's incredible watching a heart beat inside the chest, feeling the aorta pound with blood right under your fingers, poking the ureters and watching them shrink in response, feeling the small intestines telescope in and out of each other.  Everyday I was just in wonder and awe at God's ultimate design.

While fun was had, I have also never worked so hard in my life.  But it actually felt like my work made a difference.  It was great meeting with the patients a few days after their surgery and hearing how much better they felt, how their pain was gone, and how thankful they were.  Surgery was very satisfying, it has instant results.  Sick gallbladder?  I take it out.  Hernia?  I fix it.  Collapsed lung?  I put in a chest tube.  Necrotizing fasciitis?  I cut it out.  There were solutions to all these problems.  I understand that not everything always goes according to plan and the outcome is not always so wonderful.  I was very lucky to never lose a patient during the month which I'm sure helps to glorify my outlook.  But even so I was never sitting back and waiting...surgery is all about doing something which made me feel better, like I was taking action.

My attending is an incredible teacher.  He spent a lot of time with me and showed so much patience.  He treats me like a colleague and has all the staff treat me like a full fledged doctor already.  (It's very exciting to have people address me as 'Doctor' and ask me what I would like done with the patient.)  I consider myself the bottom of the totem pole at the hospital but he says no.  He expects me to play the part of doctor rather than student.  When I offer to gown myself or remove a Foley or change a dressing he tells me to stop.  He reminds me that my job is surgery and I need to stick to my job.  I don't have time to perform these other tasks when there is someone else qualified to do them.  I understand now how surgeons get a bad rep for being stuck up and non-caring about patients.  But that's really not the case at all.  They just don't have the time to do all the things that are required of them.  This is why we have specialists in healthcare.  No one can do it all.  And also, it's the doctor's license and reputation on the line.  No one sues hospital staff these days...when something goes wrong everyone blames the doctor.  So it makes sense that a surgeon gets frustrated when their orders are not followed out to a tee or when time is wasted or when a mistake is made in the OR by support staff.  I will no longer be mad when my own doctor is late for my appointment.  I understand all the things that need to get done behind the scene and how emergencies can just pop up.  Just imagine if you were the emergency.  You wouldn't want your doctor to tell you to wait so they could stay on time with their office visits.  But I'm stepping down from my soap box now...        

Back to my experience in the OR...  One time my attending just walked out of the room towards the end of the surgery and left me to close.  I just stared at his back walking out the door while screaming in my head "NO!  Don't leave me!  I have fooled you all.  I really have no idea what I'm doing."  My panic died down when the scrub nurse looked at me and asked "Doctor, what do you want to close with?"  And I knew.  I knew what sutures to use and what knots to tie.  After finishing my last suture, I looked up to find my attending watching through the observation window.  So he didn't really leave me alone, which was comforting to realize.  I will really miss him.  Not only was he a great attending, he went out of his way to include me in his family outings and take care of me outside of the hospital.  He took me wake boarding on the reservoir, had me over to his house for dinner, and treated me to may lunches and dinners out.  He even drove me home at 4:30 in the morning after an emergency surgery where I almost passed out in the OR.  After a long 16 hour day at the hospital, I got home at 10 pm, finished my assigned reading and went to bed at midnight.  I was awoken by my phone at 1:10 am.  Turns out our patient had turned septic and we had to operate now.  I walked into the OR at 2:00 am not even realizing I hadn't had anything to eat or drink
since 5 pm the evening before.  We were closing the patient up a few hours later when I started to feel really hot and my vision tunneled a little.  According to my attending I turned sheet white.  He had me step back from the table and sit down right there on the floor where I stayed while he finished up.  He then personally got me breakfast and drove me home promising to pick me up later that morning so he could control when I went back to the hospital.  During the ride home he shared with me the golden rule of surgery: eat when you can, sleep when you can, and don't poke the pancreas.  Well, lesson learned.

With the Da Vinci - you can see my vagina
 repair on the screen in the background

On Friday, my last day with my attending, he told me he had a surprise for me as a reward for all my hard work.  He led me into the last OR room down the hall, one I hadn't been in yet.  Inside was the Da Vinci Robot.  This robot can do the work of several doctors at once.  The trocars (little portals used for laparoscopic surgery to get the instruments in the body) are placed in the pt and the robot arms are threaded through them.  The doctor then controls the robot from a station with a viewing window that reflects the camera inside away from the patient.  Everything the doctor does with their hands and wrists the robot does inside the patient.  Foot pedals are also used.  The robot arms can rotate 360 degrees in the patient.  This is the only one in all of Pueblo and only a few doctors are certified to use it.  My attending is in the last bit of his training and will perform his first surgery with it next month.  Well, I was in awe looking at this robot.  He demonstrated all it can do and set up a manikin and then told me it was my turn.  He let me run the 1.7 million dollar robot!  It is really amazing how sensitive it is to my touch and all the things it can do.  I had so much fun.  Anyway, I'm sure you're all tired of me droning on.  Last thing I want to share is a list of the most important things I learned this past month.  Next week, on to orthopedic surgery!              

At the control station of the Da Vinci

Things I've learned during my surgery rotation:
1.  Tie your scrub pants tight - it's tragic when they come loose while running to a trauma
2.  Always have a granola bar in your pocket.  Or two...two is better
3.  Hand lotion is your best friend - my hands have aged years with the 100+ times I wash them everyday
4.  Fruit chapstick under your nose or inside your mask takes care of most smells
5.  Have multiple pens in multiple pockets
6.  There is a fine balance between staying hydrated and having to pee in the middle of a 5 hour surgery
7.  Scrub caps are a great way to hide that you didn't have time to wash your hair
8.  It's amazing how little laundry you have when wearing scrubs everyday
9.  A good pair of shoes makes standing 12+ hours a day possible
10. Sleep and eat when you can, where you can...you never know when you'll be called in for a 2 am surgery      

Adventures in Surgery

Who knows?  Maybe I want to be a surgeon!  I am having so much fun on my surgery rotation!  Pardon me if somethings appear vague from here on out but I am trying to be very aware of HIPAA laws.  My first week with surgery was very intense.  My attending certainly kept me busy.  The very first day he had me as first assist in surgery with him.  Gallbladders, hernia repairs, and small bowel resections filled my day.  My first day was actually the easiest.  My attending never left my side, which was a drastic change the rest of the week went he sent me to accomplish tasks by myself.  I left the hospital at 8pm with two chapters of reading to complete and three surgeries to prepare for in the morning.

The rest of the that first week was crazy!  I logged 95 hours at the hospital.  My days became routine: I would get up around 5 am and get to the hospital by 5:30 to round on 8-12 patients by myself.  Rounding involves looking up all patient info for the past 24 hours.  You check the labs that were run that morning, any imaging or pathology reports that are in.  You check the vitals and the intake and output.  You talk to the nurses to see what kind of night the patient had.  Then you actually see the patient and do your exam.  The exam always includes looking at the incision for signs of infection.  I had one patient accuse me of just admiring my handy work (which I was while checking  for infection).  You answer their questions and tell them you will pass on everything they tell you on to your attending.  Then you get on the computer to right your note about your encounter with the patient.  All this is done with each patient before 8am.  At 8, I would meet up with my attending for our first surgery.  I absolutely love surgery!  Guts are just so cool!  And my attending lets me suture and cut and cauterize and staple.  

In between surgeries you talk to family members and write orders and chart the procedure.  You also run up to the floors to round for a second time with your attending.  He then reviews the notes I hopefully got done that morning and signs off on them.  Then back to the OR for the next surgery.  There are no breaks; I've learned to eat when I can as quick as I can.  My attending is also a machine who doesn't need sleep.  I think he personally enjoys going into a surgery at 9pm.  Then after stumbling out of the hospital at midnight, I go home to fall into bed only to get up 4-5 hours later to do it all over again.  

It's busy, but I wouldn't change it all!  My attending was actually out of town this past week so I worked with other surgeons.  I got to join ortho for a day.  They let me drill into the bone.  It was awesome!  And I spent a day with anesthesiology where I got to intubate patients!  Last night I was on call and got an appendectomy at 9pm.  Well the attending let me start and finish the procedure since we weren't on any time limit.  It was so amazing!  Anyway, I am having a lot of fun and working hard.  I'll try to update you all again soon :)             

Last day in Guatemala

three neighboring volcanoes

The morning started at 6am with a group of us taking off to hike a local volcano, Volcan de Pacaya.  This is actually an active volcano that last erupted in May 2010.  What made the hike so challenging was the very steep incline.  There are actually people who follow you up with horses hoping you'll give up and ride the rest of the way.  I almost gave in a few times, but eventually we made it to the top. 

Our final destination

The closer to the top we got, the more the trees thinned out and the ground became more sand like.  I felt so accomplished once I reached the top.  We got to walk about and explore all the nooks and crannies.  There were hidden hot spots with little green plants trying to grow around them.  Other than that it was just black lava rock everywhere.  Our guide showed us how to roast marshmallows over one of the hot spots.  That was really cool! 

 We started to head down a different way than we came up but halfway on this other path a sign stopped us saying it was too dangerous.  After some backtracking and walking around the dangerous part, we finally found the right trail to lead us down.  It was a very tiring and sweaty morning, but definitely worth it!

After the hike we got to go to a local coffee plantation.  The farmer himself met us and walked us around the land.  We learned about the different kinds of coffee beans and how they have to be planted with trees since they like shade.  Next we were taken to the farmer's home where we met his wife and learned about how the beans are processed.  First the husk is removed using a bicycle powered machine.  Then they are left to dry out for days and are surprisingly a pretty yellow color.  Once they are dry they are sorted.  Beans with imperfections are removed to be used for energy drinks while those that pass inspection become coffee.

We next got to roast our own beans.  The strength of the coffee all depends on how long you roast them.  Strong coffee is roasted for a longer time.  The beans are put over an open flame in a hot and smokey room.  They have to be kept moving so that they roast evenly.  Then we got to grind them by hand.  It was hard work and I did not do very well at all.  In the end we made wonderful cups of coffee!  It was a fun afternoon.     

After all that hard work our group wanted nothing more than a shower and clean clothes.  I also had one last trip to the market to make.  I am my mother's daughter and therefore get a high striking a bargin.  It's all about bartering at the market and I loved it!  The secret is to walk away.  Pretty soon my friends were having me barter for them. 

Back at the hotel one of our hikers had gotten a little too dehydrated.  Luckily we are a group of med students all eager to help with a bunch of medical supplies.  So it was decided that we would use an IV of saline solution to help our buddy feel better soon.  And I was the lucky winner allowed to put in the IV!  I was more nervous than the patient.  Good news though is that it went great!  He was feeling better in no time.  With the doctoring done, it was dinner time. 
 

 Our last night in Guatemala was spent hanging out on the rooftop of our hotel.  It was nice to see the city all lit up from up there.  The next morning after one last cup of coffee we loaded the bus to head to the airport.  Of course there was a group sing-a-long on the way. 

Overall I had an amazing experience in Guatemala.  I got to see and do and learn so many things.  I strengthened relationships with my classmates and met many new amazing people who became my teachers.  My passion for medicine and mission work is bigger than ever.  I can't wait for me next adventure.  Unfortunately it is now time to crack down and study for boards.  But in a few months I'll be in the hospital daily learning and working with patients.  That is what is keeping me motivated. 

From Ziplines to Chocolate

 

Friday was a day for fun and travel.  We started the day off with a Tuk Tuk ride, the local taxi, to a neighboring bay to go zip lining.  It felt like a clown car when we all got it.  The zip line was a series of 7 different lines with 3 of them taking over a minute to complete.  Once we were all geared up and had been taught how to break, we had a 30 minute hike up the mountain to the starting point.  Along the way we saw monkeys and some other animals I can't name.  We passed waterfalls, crossed swinging bridges, and saw beautiful views looking out over the lake.  It was a very tiring, but rewarding hike. 

So I really don't like heights all the much but I do enjoy the feeling of getting a little freaked out beforehand and then overcoming the fear.  It's exhilarating!  What a fantastic experience!  And it was a great way to see the sites.  Panajachel looked beautiful down below. 

After our adventure we had a little less than two hours before we had to be on the bus for Antigua.  Well of course I used that time to finally do some shopping in Panajachel.  On the way back to Antigua, we stopped on the side of the road in order to get a picture of the cemetery.  So the cemeteries here are really colorful little structures.  They sit above the ground like in Louisiana but are painted bright colors. 

Once back in Antigua we had more time to explore.  A few of us went to the chocolate museum and learned all about the history of chocolate.  The we did some taste testing and made our own concoction of hot chocolate.  It was really good.  We also stopped by McDonalds.  The McDonalds here are fancy.  They have a separate section called McCafe that looks more like a Starbucks.  It was really weird.  There was even a fountain in an outdoor garden eating area.  The night was causal for all with dinner and relaxing games.  I went to bed early since the next day began with a 6am bus ride to hike a volcano.   

Last Day of Clinic

Thursday brought us back to the town of Solola, but this time in a firehouse.  It was my favorite day, for we just saw children only.  I was in pediatric heaven.  We saw a lot of kids complaining of stomach pain.  Turns out the majority of them had parasites or worms.  Also a lot of cavities again.  We handed out multivitamins, toothbrushes, soap, lotion, shampoo, and lots and lots of stickers.











It was our fourth day of surprise lunch.  The generosity in this country is amazing.  In the middle of the afternoon we were visited by the office of the First Lady of Guatemala.  We were all given a certificate of appreciation to thank us for our service.  Dr. Bentley has been taking groups to Guatemala for 13 years and she says that this is the first time anything like that has happened.  It's also the first time that lunch has been provided. 

After an amazing four days it was nice ending with the kids.  I learned so much, not only in medicine but in mission work in general.  I definitely want to do another one in the future.  I would go back in a heart beat.  There is so much work that can still needs to be done. 

That night we had a group dinner with everyone.  It was really nice and a delicious meal.  Afterwards we went out for some drinks, games, and dancing.  It was so much fun!  I always am up for dancing.      

 

Day on the Water

 Wednesday we said goodbye to Panajachel via boat.  We were off to the town of San Antonio.  Before we left though, I had the most amazing banana pancakes for breakfast.  The veterans would not stop talking about them since the beginning of the trip so I had to try them.  The boat ride across the lake gave me a different perspective of how the towns are situated.  Panajachel is appeared to be the only one that had some flat land.  All the rest we passed, San Antonio especially, are built vertically up the mountain from the shore of the lake.  Walking up those hills to the center of town was difficult, especially for those hauling the medical supply bags.

San Antonio

That day I worked with Dr. Kesden who is in primary care in Florida.  He makes this trip every year.  I learned so much working with him.  He let me take charge and run the show.  They were my patients and he was there for support and to answer my questions.  Once again children and women dominated the clinic.  The big winners were cataracts, joint pain, and cough.  No wonder they all have joint pain.  I would too climbing all those hills with a child strapped onto my back and everything else on top of my head.  Also, the chronic cough is from having an open fire to cook with in the home without proper ventilation.  It's incredible how much these women endure in their everyday life.  Just add to the list of things I take for granted.

I did become a pro at checking eyes and using my ophthalmoscope.  It was another day where we were gifted with lunch, once again unexpected but greatly appreciated.  I feel like I really got to try some truly authentic food.  This time it was a spicy chicken soup and tamales.  Also hibiscus tea, which is a specialty drink there and also a natural diuretic.  After all our work was down, we once again had time to explore.  San Antonio is known for it's Palopo Pottery.  It is really beautiful.  I made sure to gift myself with a coffee mug or two.  The boat ride back to Panajachel was uneventful.  It was another early night with most of us turning in shortly after dinner.   

 

 

Day of Surprises

Monday night Panajachel called bedtime with a power outage.  Now we were warned that this could happen but usually only lasted a few hours or so.  Therefore I went to bed without thinking too much about it.  Tuesday morning dawned with, surprise! no power.  Which meant no water and no shower for Danelle.  I felt worse for those who had to work with me that day but at least we were all in the same boat.  Luckily, the saving grace that morning was the fact that there was still coffee due to a gas stove.  After my first cup, my dirty hair didn't seem like such a big deal. 

  


The bus that day was taking us to the town of Conception in the mountains.  We were to work in a school.  On the way, our bus driver suddenly pulls over on the side of the road.  Looking out the window, I realize we are right next to a beautiful three tiered waterfall.  We all got out and some of us even climbed up part way.  We could see all the volcanoes surrounding Lake Atitlan. 


The school at Conception was really fun to work in.  The walls were all decorated with the kid's artwork.  We worked at miniature table and chairs.  We had many curious visitors peeking in on us.  They were fun to interact with.  They loved having their picture taken and then shown to them on the camera.  Such a simple thing that I take for granted all the time brought so many kids joy that day. 

My job for the day was to run the pharmacy.  I learned how to properly dose patients, especially children who need a special calculation.  I sorted medications and filled orders.  I learned even more Spanish explaining to the patients how to properly take the medications or when to apply the cream.  Luckily everything was written out on labels so I could try to explain in my butchered Spanish and then point to the label I stickered on.  Hopefully one of those ways made sense.  The big medical winners of the day were scabies, GI worms, and rashes.  Once again we were surprised with a lunch of black beans, rice, and corn tortillas from the local women.  During lunch break, I played some soccer with the kids.  Now I haven't played soccer in years and am completely horrible.  These kids definitely schooled me but it was a lot of fun.   

After all our work was completed, we got some time to explore the town.  The church in the center of town is simply beautiful.  It is in it's final stages of being repainted so is this bright white beacon up on the hill.  Another spontaneous soccer game broke out in the streets.  It was amazing.  As soon as the soccer ball was placed on the ground, several children came out of the woodwork to play.  On our way out of town, we got stuck behind a funeral ceremony.  A whole bunch of people were gathered around this small fire in the center of the road.  The coffin was then carried down the road while the crowd followed.  Though I understood very little of what was going on, it was interesting to watch. 







Later back in Panajachel, we stopped at this special shop that the trip veterans knew about.  Turns out every year they order a tres leche cake from the same woman.  She makes it special for our group.  It was the best tres leche I have ever had!  We all enjoyed our appetizer that evening. 

Afterwards we watched the sunset behind the volcanoes across the lake.  We were blessed with electricity when we got back so my shower did happen that day.  It was still fairly early so we all went to the hotel pool.  After working (really playing) off our cake we grabbed dinner.  I had the best guacamole I've ever had.  The night ended with a specialty rum from the area and more card games.  Overall a very fun day.