Saturday, March 28, 2009

M.D. = Make Decisions

When I was a fourth year med student doing my Emergency Medicine rotation, one of the ER docs told me, "M.D. means Make Decisions."  I've always been pretty wishy-washy.  I have a hard time making decisions about the most trivial things.  Take my iPhone for example.  I spent about an hour in the AT&T store trying to decide if I wanted 8GB or 16GB, black or white (I ended up getting 16GB in black, in case you're wondering... after switching between white and black several times).  But now I'm a doctor and I'm supposed to make decisions everyday - sometimes tough or tricky decisions.  This is one of the key components of being a good doctor, and I've observed this in some of my favorite attendings.  The ability to make a decision and commit to it.

It doesn't come naturally to me (obviously, since I spend hours deciding on things like phone colors).  But every time a decision is placed in front of me as a doctor, I consciously remind myself, "Make a decision, Linda, and stick to it."

Yesterday I sent two kids to the PICU.  The first one was a 12 month old girl who had pneumonia and was working hard to breathe.  I did my assessment and decided I wasn't quite comfortable with her staying on the floor.  She's doing fine and her labs were reassuring... but she ended up on continuous nebs which is a reason to go to the PICU.  So maybe I made the right decision by chance.  Then in the middle of the night I got called for a 2 year old boy who was having difficulty breathing after being extubated (he was under general anesthesia for a small procedure).  When I got there he looked bad.  He was sucking his chest down to his spine and had a barking cough.  I told the Anesthesia guys, "Yes, he needs to go to the PICU" and together we came up with interventions for this little guy's upper airway problems.  He started looking a lot better and by the time he got to the PICU he looked 100% better.  I felt a little silly bringing a comfortable, crying baby to the PICU, but considering what he looked like when I first saw him, I felt very justified in my decision.  And I committed to it.  It was a good feeling.

I'm in a transition period now where I'm getting towards the end of my second year.  In July I will begin my third and final year of residency.  I will be expected to make decisions all the time.  I will be the senior resident on call and I'll have first and second year residents looking to me for answers.  It's a little scary, but I think I'm ready.  Or at least, I hope so.  We'll see!

Sunday, March 15, 2009

Honduras

Wow, I am really bad at this blogging thing.  Good thing I don't have many readers, haha.  It's been over a month since I returned from Honduras.  I've been meaning to blog about it because it was such an amazing experience, but I just haven't gotten around to it until now.

We left on a Thursday at the end of January.  We flew into Tegucigalpa, the second most dangerous place for an airplane to land in the world (so I've heard... not sure what the first most dangerous place is).  The reason is because the runway is super short so the pilots have to time the landing just right.  Ours wasn't too bad at all.  I was surprised at how quickly we got there - it was a short 2 hour flight from Houston.  It was a beautiful sunny day when we landed.  We were greeted by some of the NCO's from JTF Bravo.  They drove us to the base where we met up with the rest of our team.  That night we packed up our supplies and learned how to perform maintenance checks on the HUMVEE's.  We went over the itinerary for the trip, and then rested up for the mission.

The next day we headed to Marcala, where we would conduct our 3-day household survey.  This is a project our residency program has been doing in conjunction with the Honduras Ministry of Health over the last several years.  We collect data on randomly selected children to assess for nutritional deficiencies and anemia.  Marcala is in the La Paz region of Honduras, near the El Salvador border.  It is a rural area where some of the poorest people of Honduras live.  We stayed in a local hotel called La Casona Inn.  The people who worked there were so friendly and down-to-earth, and they cooked the BEST food for us!  The first night there we organized all of our equipment in preparation for our surveys.  My friend Raman and I were assigned as the logistics officers so we spent HOURS going through all of the supplies and organizing them.  We were quite proud of our work.

We woke up EARLY for the surveys.  I woke up around 5:00 to inspect my HUMVEE.  Then we would eat breakfast around 6:00 (my favorite part was the plantains - yummy!!).  After that we'd gather our rucksacks and load them into the vehicles with plenty of water and MRE's.  The Honduran guards joined us around 7:00 and then we headed out!  We divided our group into five teams, Alpha through Echo (I was in team Echo).  Each team got an interpreter, one of the NCO's from JTF Bravo.  Ours was named Joanna, and she was very helpful and laid-back.  Driving to the houses was interesting.  The roads were ROUGH.  Some of them were just barely wide enough for our HUMVEE's, and most of them were rocky and unsteady.  Often we'd have a ditch on one side and a cliff on the other.  It was seriously dangerous!  In fact, I almost died one day (This is another story in itself, but basically I got my HUMVEE stuck in a piece of road that gave out under the tire; it could've flipped over and fallen off the cliff but fortunately the other tire remained on solid road.  We jumped out as soon as we got stuck, and another HUMVEE came and towed our vehicle out.  Craziness!!).  Sometimes we would drive up to 2 hours to get to our rally point.  From there we would hike an additional distance to the randomized households.  Some hikes were short (our first day the houses were literally down the street from the rally point), but some were painfully long.  Once we got to the house, our interpreter would greet the mother of the household, explain what we were doing, and start his/her questionnaire.  Meanwhile the medical personnel got ready to collect the data.  We weighed the kids, measured them using "Shore boards" and measured mid-arm circumferences.  Then we stuck them and gathered a drop of blood to check their hemoglobin level.  If they were anemic we gave them iron.  And we left every house with soap, toothbrushes, and dewormers.  A lot of the kids had round bellies that were probably filled with worms.

The best part about the household surveys was that we were outside.  It gets old being cooped up in the hospital all the time... It was nice to be able to enjoy the sunshine and the fresh air.  And the kids were so cute.  The second day of our surveys, my team met an incredibly nice family.  Not all of the people we surveyed were very receptive to what we were doing there.  But this family was so sweet and appreciative.  There were these two little boys who sat down next to me and started talking to me in Spanish (which unfortunately I don't understand since I took French in high school!).  I made do with body language and the 2 or 3 phrases of Spanish I know and we managed to communicate fairly well.  I showed them how to use my camera and they had a lot of fun with that.  The 2-year old boy we surveyed at that house was hilarious.  He was such a trooper.  He didn't even wince when we stuck him for his hemoglobin check - in fact, he laughed!  It was so funny.

The third day of our surveys was one of the most memorable ones, not necessarily in a good way!  This was the day of our infamous hike to San Francisco, a little town located way down in the valley.  We were told our HUMVEE's could not go past a certain point, so we ended up hiking all the way down into this valley - it took about 2 hours one way, and we were literally going down a 30-40 degree incline.  I thought my knees were going to give out, and when we stopped for a rest my thighs were shaking.  Of course since we were all a bunch of out-of-shape doctors, it was painful and everybody whined about it.  I have to say, though, the view was incredible.  And again, I was just happy to be outside.  The most frustrating part about that day was that when we got to where our household was supposed to be, nobody was home!  We tried to make the most of it and started handing out soap and dewormers to everyone we came across.  The hike back was exhausting.  Needless to say, I slept like a baby that night.

After our household surveys were done, we did a couple days of clinic.  The first day was for follow-ups from the previous mission.  There weren't very many patients that day.  The second day of clinic was our MEDRETE, an all-comers day that we announced to everyone in the local area.  We set up shop at a school, where we used their buildings for three stations - Preventive Medicine, Nutritional Surveys, and Clinic.  The residents worked the clinic.  I think there were over 300 patients there that day.  The clinic was pretty easy - mostly colds and rashes and stuff.  Nothing too crazy.  After our clinic day, we packed up our HUMVEE's and headed out for our hospital tour.  The first tour was at the regional La Paz hospital.  The second tour was at Hospital Escuela, one of the biggest hospitals in Honduras (located in Tegucigalpa).  We stayed at the Clarion hotel in Tegucigalpa our last two nights in Honduras - it was so nice!  Especially after "roughing" it for a week in Marcala and JTF Bravo.  One of our last nights there a bunch of us went out to a local bar.  It was so much fun!  There was a live band and they played all kinds of fun Latin music.  We all had a few drinks and danced it up in front of the stage (and ON the stage, haha).  The pictures from that night are hilarious.  Let's just say I have some good blackmail material for several of my co-workers...

I was sad to leave Honduras.  I loved being in a new country and doing something exciting and meaningful.  And it was nice to be away from the residency program for a little while.  I get tired of all the politics and demands of being a resident.  The trip came at the perfect time and I must say I came back feeling renewed and excited to be a doctor.  I wonder how long that will last... haha.

Now it's back to the grind!  More stories to come.  :)