Wednesday, July 18, 2012

Interview Questions

Preguntas para médicos y enfermeros

Función:
Edad:

Pacient (iniciales):
Diagnóstico:

1. ¿Estaría dispuesto a compartir sus ideas sobre las decisiones clínicas en este caso?
2. ¿Hubo más de una alternativa de tratamiento en este caso? ¿Cuales?
3. ¿Qué rol tuvo en esta elección? ¿Qué grado de participación tuvo en la elección?
4. ¿Cómo se siente con respecto a la forma en que se tomó la decisión?
5. ¿Cómo ha afectado el costo de medicamentos y de exámenes complementaros la elección que hizo?
6. ¿Los resultados de la decisión terapéutica fueron satisfactorias tanto para la familia, el pacientes y los médicos? ¿Fué satisfactoria para alguno de estos en mayor medida?

Preguntas para pacientes y sus familias

Iniciales:
Edad:
Relación con el paciente:
1. ¿Estaría dispuesto a compartir sus experiencias sobre la relación con los médicos del hospital?
2. ¿Piensa que habían otras opciones de tratamiento? ¿Los médicos le informaron sobre otras opciones?
3. ¿Cuánta participación tuvo en la elección de tratamiento?
4. ¿Como se siente acerca de la forma en que se tomó la elección?
5. ¿Cómo ha afectado el costo de medicamentos y exámenes complementaros la elección que hizo?
6. ¿Esta satisfecho con el tratamiento realizado?


Tupungato and Uspallata

The last two weekends have involved social events on Saturdays, and solo bike adventures on Sundays.

The trip to Tupungato was poorly planned. Slept in late, ran, ate, then around noon decided to go.
Messed up the busses, and by the time I was on the rental bike, free on the road, the sun was setting beyond the vinyards over the Andes. Still got in 50km though and found some delicious raisins (since i didn´t have the ganas to drink or carry wine).

Uspallata however went much more smoothly. Caught the 0800 bus, rental bike headed up into the valley by 1100. Perfect sunshine, dark blue altitude sky, inca rock carvings, bouldering in another location, nap on top of a mountain. 11 miles downhill to end the day. I´ve got to figure out how to get this pictures off of my virus infected camera...



Olympiada

Last weekend, no, two weekends ago, I was invited by some 5th year medical students (they have six years here after HS) to attend their end of year camping trip. Since it is winter, it was going to be in a camp with cabins.

While it is impossible to describe the experience in detail without forgoing other equally valuable experiences, I wanted to share the essence of spirit that I understood.

A powerful generosity, willingness to share, patience to listen, and sense of community as this group of students so fluidly accepted me into their midst.

1600 they finished their exams for the semester, and we piled onto the minibuses (traficos)
1730 arrival
1830 tea
1930 fire
2030 icebreaker games
2130 wine and fernet
2230 start cooking asado
2330 dinner
0030 some students have a rock band
0230 hook up computer to start playing dance music
0500 I fold and go to bed while most continue dancing
1100 up and breakfast
1200 mountain hike
1700 parting words


what a weekend

Thursday, July 12, 2012

Spanish Lessons

well it appears that during my month in Bolivia, I managed to claw my way back to where I should have been at the end of Spanish 101 at Haverford. My classes started this week and I´ve been labeled as B1 or ``threshold``. Certainly feels like a threshold. The threshold of being able to speak. But it´s good, i´m getting to the point where I can explain my way around any language barriers, and ask for clarification in spanish as needed. I have 90 minute lessons 5 days a week in the afternoons. Quite challenging as my natural inclination after lunch is to sleep. still not used to the 6 hour sleep nights. After class, I come home to run before homework before dinner before bed. But today, skipped the run to type some stuff up for my project and now I´m going over to a medstudent apartment for mexican tacos. I a group of 5 students who were rotating through the clinic in their last week before winter break. Now they are on winter vacation for two weeks, but like medstudents everywhere, vacation = studying for the next big exam.

Today started with the weekly literature review, which is like PBL without a timer. Presentations are supposed to be short but drag on and on without visual aids. My attention drifts after about 3 minutes. I´m scheduled to do a presentation on the 26th of July. Trying to decide between IUDs or 

Then rounds with one of the teams. One poor woman had metastasized breast cancer that had invaded her liver. Amazing to actually see the distended veins on her abdomen as the blood found a collateral route back to the heart. She is on a morphine drip with her husband at her side. Thankful that he was asked to leave the room while we examined her on rounds. There is no hope for life, but our team will strive for ultimate comfort and quality during her last days in our hospital. 

While listening to the lungs of a longtime smoker, I heard crackles for the first time in real life. Hard to remember the dire consequencees of pulmonary edema as the excitement about actually hearing a sign rushed through me. Also greatful that my repaired stethescope works well. The diaphragm is somewhere in the Buenos Aires airport as when my bag was searched, they didn´t close the pocket that had my disassembled stethescope. After searching in vain for a replacement here (they only have litman parts), I cut out the bottom of a yogurt container and attached it with a rubber band. I should take a picture. Everyone said ``look, an american, functional but without style``.

Okay, well 25 minutes after the time I was invited, i should probably think about leaving. It took me a while to get used to this alternate sense of time, but now that I´m used to it, it´s kind of nice. there is extra time built in everywhere for whatever you want, like updating your blog for instance. should have done spanish hw instead i´m afraid

Thursday, July 5, 2012

vehicles

i´m collecting pictures
but never seem to have my camera cord when i get to a computer
i´ve really enjoyed observing the vehicles here
many familiar brands
but with small diesel engines
german buses 
and french sports cars

also some really nice motorcycles as july seems to be the only really cold month

tried to take the same bus home yesterday that I take to the hospital in the mornings, only to find myself in a neighboring town.
I had dosed off and the bus had changed numbers somewhere along the way!
I guess i´ll go back to asking about everything instead of trusting what I read
oh well, the upside was that I found a railroad along which I can potentially run out on the flat side of town

okay, back to spanish studies
should write a post about my project also
okay, all that and more coming soon


the best hospital food ever

literally
each morning I see the truck back in
piled high with farm products
carrots, potatoes, chickens
then about 7 hours later
when I go with the residents to eat lunch
amazing

baked chicken with carrot sauce and a side of polenta
roast beef with brocoli and a side of cheese ravioli
so many others but i´m getting hungry again just writing about it
obviously i´ve suspended my vegetarianism while eating as a guest

the food schedule has taken some adjustment
i have to eat breakfast before 0700 to catch my bus
lunch is at 1400 at the earliest
then dinner is not till 2200 or later
this means i´m not hungry for breakfast because i´m still digesting dinner
i feel full during my run in the evening
and then i´m nearly starving again by the time we finish making dinner after ten
all completely worth it though
this has got to be the best i´ve eaten since leaving Ukraine
I think i´ll quickly recover the weight that I lost during my week of diarrhea in Bolivia


Tuesday, July 3, 2012

other things i´ve seen that i´m trying to embed into my medical knowledge

A person with hemiparalysis caused by chagas disease. Chagas is a protazoa spread by the kissing bug. Memory key is Tom Cruise likes kissing = trypanosoma cruzi. Tom Cruise also has a fat neck = megaesophagus and talks a lot of poop (megacolon). Lesions are normally in the heart but this person had them in her brain. Immunosuppression caused by HIV was a contributing factor. She presented with delayed gastric emptying and gastritis.
Megaloblastic anemia case in an alcoholic where perniscious anemia was suspected but the labs were unavailable to confirm. The residents seemed to relish the challenge as they sat down to solve the case with the history and clinical signs that they had available while they waited for the blood work (autoantibodies to intrinsic factor and folic acid levels) to come back from the lab in a different hospital. The other suspect was chronic folic acid deficiency as a result of alcoholism.
Cobalamine = B12, necessary for DNA synthesis and many other reactions.
Sjogren´s syndrome is an autoimmune disease that attacks exocrine glands that make tears and saliva. Memory aid is stoic sweeds who never cry and have dry vaginas.
Arthritis associated with Crohn disease. I don´t really understand why this happens. More antigens get into the body, and somehow this makes the body more likely to react agaist itself...? How does this fit with the hygene hypothesis? Mr. Gears?
Lots of lupus. Inflammatory disease with antinuclear antibodies. That´s about all I know so far.

Pneumococcal vaccination adverse event in an adult. I refrained from mentioning at that moment that the vaccine had been developed at the University of Rochester.
Also interesting, a cellulitis rapidly diagnosed and for which were prescribed antibiotics. What is this mixed up with sometimes?

Mendoza morning rounds

vacation part of the summer over
project started yesterday
pretty intense, preview of third year
Spanish way over my head, but improving rapidly
hospital before 8 in time for morning rounds, where I seem to get a lot of questions becuase I don´t blend in well
seem to get a lot of them wrong or look stupid because I mix up my words when answering the question
like the three characteristics of graves disease which was tossed to the medical students this morning
I remembered hyperthyroidism, but got really tripped up trying to explain that the antibodies acted as receptor agonists on the TSH receptors. The other two are goiter and orbitopathy (Retroorbital fibroblasts secrete GAG in response to cytokines such as interferon gamma and TNF alpha secreted by TH1 cells). Yes, they use UptoDate...which I hop on in the residents lounge to answer the lists of questions that pile up in my notebook.
Ít ended up well though, next patient had an ulcer and I answered a question thrown out about how often antibiotics should be applied to the wound (only if infected because they kill healing skin cells) and the attending was impressed.
so yeah, super fun, great review, and the residents are really helpful and awesome
they said they´ll help me get my project done no problem
but that first I should come out dancing with them this weekend
so yeah, guess I should update my blog
but even more awesome
I saw my first natural birth yesterday
seeing the first breath of life and the baby go from blue to pink was amazing
I got goosebumps allover
couldn´t think at all when asked what APGAR stands for (appearance(color), pulse, grimmace (reflex), activity, respiration) 
or whether to suction mouth first or nose first (mouth).
Lots to learn, but it is all very relevant. Back to feeling like there are not enough hours in the day, not rushed or stressed, but pushing the pace nicely.
More to come later. Off to go find a modista or costurera to add some more pockets onto this white coat I bought down here.
besos