A final blog post about la fuente

This is my LAST WEEK OF MEDICAL SCHOOL!!!

I am working three days this week at the clinic and then we fly out of Cusco on Thursday morning.

When I walk out of the clinic tomorrow, it will be my very last time wearing a short white coat. Also, at least for the foreseeable future, it will be my last time seeing an adult patient.

I have loved medical school, as it has been the culmination of a lifetime of dreaming. Ever since elementary school I have wanted to be a doctor…at times my obsession was self-serving (I wanted to do something impressive and make money) and at other times the dream felt impossible (when I started off college with mediocre grades). The Lord was gracious to change my heart and to help me get accepted to Tulane. Now that this much anticipated chapter of my life is going to end, it feels surreal. It’s not that I don’t want it to end (believe me, I won’t mind not receiving another grade for the rest of my life), but I do kind of get emotional realizing the thing I wanted so badly, for so long…it will be over in 11 days. Or should I say, just beginning.

There have been many highlights along the way, but for sure my 2 month Family Medicine rotation here at La Fuente stands out as the single best learning experience of the past 4 years. The doctors here are true examples of what it means to serve/love your patients and I hope that I can adopt their compassionate approach to patient care.

Here is an excerpt of the things I listed at "the strengths" for my feedback evaulation for my Intl Family  Medicine rotation

-The number one strength was the dedication to compassionate care the physicans exemplified. I was literally in awe of the capacity to serve, listen, care for and be patient that the doctors showed.

-The doctors LOVE teaching and it’s a charity-based clinic, so there is no rush to see patients to make more money. When there wasn’t a line out the door, the doctors loved taking time to discuss differentials for basic complaints like  “abdominal pain” or “headache”. I felt very challenged to be thinking critically with every patient

-I got to see active cases of Leishmaniasis, Tuberculosis, yellow fever, acute altitude sickness, a host of rare parasites, and life-threatening diarrhea (all diseases I never got to see in New Orleans).

-I got to see the differences between the American hospital system and the Peruvian system. I left feeling that despite the brokenness of the US system, it could be a lot worse and we have a lot to be thankful for.

-I was forced to use my Spanish for hours, every day, a challenge that I eventually found to be fun.

-You really feel like you are a part of something special, from the nurses to the cleaning lady to the doctors. Everyone who works at the clinic believes in the mission of serving the poor in Peru.

a few nurses and a dentist during one of our staff devotion (we met for 15 mins of bible reading and prayer every AM)

Dr. Derick Brubraker (my precepting Doctor)

Dr. Wilson on the Right (my favorite pediatrician!) Working with a 3rd yr peruvian medical student

Nurse Nancy....working at her triage desk

a view of the clinic

another view of the school...dentistry and pharmacy to the Right

Blog post about the craziest patient ever

As one of my other recent posts noted, I am in my last week of medical school. And fate had it that the single most fascinating/wild patient encounter of my 4 years of medical school occurred this week!

A 20 yo girl came in today to discuss her 1 month of “stomach pain” after drinking soda (which she drinks 5 days/wk, despite realizing the connection between these drinks and her pain). We talked about this subject, as well as her shortness of breath, induced with exercise for the past few years. As I do with all patients, I followed our conversation with a physical exam. Everything seemed normal (lungs were clear/ eyes reacted to light/ heart beat was normal), until I had her lay down for the abdominal exam. At first glance, her abdomen just seemed really large to me (out of proportion to the rest of her body). I started pressing on her protuberant abdomen and felt something similar to a mass in the lower-half of her abdomen. At this point of the visit…I panicked, left the room, and told her I’d return with the real doctor!

In my mind I thought, either she was a really strange sort of FAT or she was PREGNANT! I started replaying our conversation in my mind, I had asked her about her periods and she stated they were normal (5 days of blood) and regular (came every month), and her LMP was on the 25^th of April.

I left the room and said to my precepting doctor, “she looks and feels super pregnant”, but she has normal periods and didn’t mention anything about being pregnant. I should have asked her more questions after my exam findings, but I was too embarrassed (as I didn’t want to imply she was pregnant if she was simply overweight). While discussing the patient, we had the nurse obtain a urine analysis looking for an infection, and a urinary pregnancy test (the main reason for the urine analysis was to have something to tell the patient as we asked her for the urine sample).

The urine pregnancy test came back POSITIVE, as this point we didn’t know “if she knew, and was simply assuming we knew” or “if we had some big news for her”. I went back into the room with my supervising doctor, and started with a bunch of repeat questions. Asking specifically about her period in January, February and March confirming she had her normal cycle for the past few months. We also asked her if she had a male partner or boyfriend, her response to this question included an alleged “I have never had sex before”.

Normal periods for the past few months and a virgin--the news that she was pregnant was obviously not going to be expected. So much so, that she even denied its possibility after we showed her the pregnancy test results. We then got out the Doppler ultrasound machine and were able to auscultate the baby’s pulse (which was around 140 beats/min, compared to her pulse of 70 beats/min). We asked her to listen to the noise and she still maintained that it must be her pulse making that rapid noise. We measured her fundal height, which in centimeters roughly correlates to weeks-gestation: 26 weeks pregnant!

That’s 6.5 months pregnant, if she delivered today, the baby is old enough to survive…and yet she had no clue she was pregnant. On so many levels this case amazed me.

In talking with the doctors at the clinic, this was the first time any of them had heard of a pregnancy being diagnosed via “physical exam”. Most (all) people find out they are pregnant many, many months before a doctor would be able to touch their abdomen and palpate an occupied uterus.

Maybe she was lying about her periods and her history of no sexual activity (and she suspected the pregnancy), but if this was the case, she was an incredible liar. I honestly believed she is in complete denial and really believed that being pregnant was impossible. Whatever the case: Immaculate Conception? Honest obliviousness? Lying? It was a really good reminder to me why I must always do a physical exam on every single patient! 

she thought that the baby's heart beat was her own pulse

A blog post about a dream coming true

I had a lot of expectations about Peru before we left in January, and most of them have been met or exceeded. However, I had one specific dream before coming here that had yet to be fulfilled in the past 4 months: I wanted to play a legit game of soccer with Peruvians.

This past Sunday, a group of Peruvian medical students invited me to play in a mini-tournament of 6 medical student teams. I immediately said yes, and even went out and bought brand new soccer cleats.

I arrived 20 minutes early and started stretching, my anticipation was high as my dream was finally coming true. My team arrived a few minutes later, but 70 minutes later…we were still waiting for our game to start (bad sign #1). Then we started playing and I was the lone player they had sit on the bench to start the game (bad sign #2). Then half-time passed with me still on the bench (bad sign # 3). With 10 minutes left in the game, they subbed me in and I got to play…I made one mistake and basically didn’t get near the ball again before the game ended. After the game, the captain told me I’d get to start in the other game they were playing that day. We waited another hour until our second game, only to find out the other team wasn’t around and had to forfeit…hence no game #2 (bad sign #4).

At this point, I had been at the soccer field for about 3 hours, had my new shoes on, but hadn’t really gotten to fulfill my dream. A few players on our team packed up their stuff and started walking off. I was trying to laugh about the situation, but the comical randomness of the situation was not making me feel much better.

Finally, somebody suggested we go play a pick-up game on our own. We set up for 5 on 5, with smaller goals and started playing soccer. We played for the next 90 minutes without taking a break and I had a ton of fun! My team won 10-7, and I scored 3 goals. Although I was nowhere near as good as some of the guys, I felt like I held my own (or at least didn’t suck that much, which would have been pretty bad considering my new cleats are neon green and call a lot of attention to myself).

Anyways, it was a great day and it rekindled my love for team sports (hoping to find some time to join an adult soccer league once we move to Tacoma). 

our team! captain was the goalie. I missed the memo on the MAN U jerseys. Also, notice my lime green shoes