Living the Dream, a Resident's tale. : August 2010

This was a two week rotation that commenced the week after I returned home from South Africa. For those who have never heard of Physical Medicine and Rehabilitation(PM &R), I will attempt to shed some light on my chosen field and highlight my experience on the rotation.

Physiatrists(PM &R), as explained by the AAPM &R website, are experts at diagnosing and treating pain, Restoring maximum function lost through injury, illness or disabling conditions, Treat the whole person, not just the problem area, Lead a team of medical professionals, Provide non-surgical treatments, Explain your medical problems and treatment plan, and Work not only on treatment but also prevention. Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R). Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.

So there is a quick blurb on what a Physiatrist is and does. I spent two weeks with Dr. Mike in Mansfield Ohio, around 1 1/2 hours north of Columbus. I drove 30 minutes to his house, and then rode another hour with Dr. Mike every morning to get to his office. I enjoyed the first week riding with him as I learned firsthand of the lifestyle of a physiatrist, and all the positives and negatives about the specialty, but there are some things you learn about people that you never wanted to learn about them when riding in the car! :) The hours were not that bad if you take out the 3 hour round trip commute every day...and the constant boasting of Dr. Mike with his "6 board certifications and 181 certified IQ". Here are some of my impressions:

1. I liked how I could spend more time with patients then in family medicine. Also, there is a broad scope of diseases in PM & R but I at least know the neighborhood of where the diseases are coming from whereas in FP, you never know what will walk in the door.
2. I liked both musculoskeletal medicine and the neurological portion of the rotation. I wouldn't mind getting involved in Prosthetics and Orthodics.
3. I love how the goal of a physiatrist is to keep people from having surgery by using other means to restore health.
4. I used my Osteopathic Manual Medicine during this rotation which was fun to do!
5. I like the procedures and how you get a flavor of anesthesia, and radiology when doing injections.
6. It would be a fairly good lifestyle.
7. I could help people with impairments like my own.
8. I attended a couple of BOTOX parties...not sure if I want to get into that, but I would be trained to administer it during a PM & R residency. I turned down some beer at the party and they all thought I was crazy. haha.

For now, this is what I want to do. I head on a three month tour of PM &R starting next week in San Antonio, Texas. I will then do a month at the University of Utah, and lastly at Mayo clinic. I have to turn in my residency application on Sept. 1st and PM &R is my aim. If for some reason I absolutely hate the rotations coming up, I will likely switch to family medicine. Wish me all luck as I go through the crazy residency application process!

I also just finished the Step 2 COMLEX licensing Board exam last Wednesday. I took step 1 last summer and will take step 3 next year, and once I pass that I will officially be a licensed physician. So step 2 was another 8 hour, 400 question exam. Why I continue to pay 500 dollars for these exams and put myself through such craziness is beyond me. I never thought I would spend so many Friday and Saturday nights preparing for an exam either. But overall I was glad for the opportunity to study more about the treatment algorithms and pick up things that I missed during the rotations. Thank you Makenna for putting up with me and providing me with food and support so I could continue studying! Her last few weekends were pretty lame since she had a study crazed husband. Hopefully it will pay off someday.

Yes, I have heard those horns in real life. You know, the horns you heard on TV while watching the World Cup. And they were every bit as loud as they sounded on TV! :) I was very privileged to spend a month among the good people of South Africa from April 17th to May 14th, 2010. The opportunity came through the Des Moines University Global Health department, with this being one of many destinations available worldwide. They even paid 1700 of the 3000 dollars it cost to fund the entire trip...it was a deal and an experience of a lifetime too good to pass up! I had over 400 pictures from the trip and had a hard time choosing which ones to post. It took me a while to decide and then to figure out how to post a fraction of them(not to mention i've been a little bit busy with life), but I figured out how to use picasa so here we go. I'm still working on how to post more than four collages on a post, so forgive me for having a few different posts.

I started at Port Columbus International at 3 pm on Saturday, flew to Atlanta and caught a direct 16 hour flight to Johannesburg that arrived Sunday at 5 pm South African Standard(SAS) time, (which is six hours ahead of Eastern time and almost literally on the other side of the world). We spent the first night in J-burg. My two travel buddies and collegues for the trip were Mike Bowers who was also my former roomate in med school and Liliane Idylle- a 4th year med student who grew up in France but was actually Vietnamese. You'll see a few pictures of them. Everywhere you turned in J-burg you saw businesses and homes alike protected by huge cement walls. Crime is out of control there and you almost felt like you walked into a war zone. But once inside the walls of the Sunrock Guesthouse compound we stayed in, we felt very safe. We flew to our final destination the next morning, three hours north, to Polokwane(formerly Pietersburg-the name changed to a more African name after Apartheid fell). It felt much safer than Johannesburg. I would consider the size of Polokwane in terms of city borders to be that of Ogden, UT. The population was roughly 500,000. Lisa from Blessman ministries greeted us at the airport and gave us a South African survival crash course in the car as we headed to the Blessman Game Ranch. We learned there were 11 official languages with english being required of everyone to learn, though some do not. I'll never forget her describe how so many times she had been in the same room with an Africaan(white) and a black South African who, even though they both understood english, would not talk to each other and would use Lisa to relay the message to each other if they needed to communicate. Such were some of the feelings still lingering from Apartheid, though this was not the norm that I witnessed. I feel like they've come a long way in 20 years in getting rid of those differences and imaginery bounderies of race. We were also counseled to never go out after dark and be wise when choosing what water to drink. Sounds great eh? So Lisa took us on a mini Safari that evening before dusk and we saw Wildebeest, Impala, Warthogs, Girrafes, and Baboons. Our accomadations were amazing and we had hot running water with internet and I was beginning to think how comfortable it was to be in South Africa. The feeling didn't last long. We were taken to the hospital the next morning and were shown our permanent quarters for the month. You'll see the pictures. They could rival almost any horror story of accomadations from any returned missionary(at least from my mission:)). We were given our own dorm rooms in the nursing school dorms, with community bathrooms. There was a sink in the dorm room, and brown rusty water came rushing out the first time I turned it on. The heater didn't work(it was winter time in SA), and we had no refridgerator to store food. The toilets in the bathroom didn't have seats, you had to supply your own toilet paper, and had to pass by women and men in bathrobes(even I with the medical background had a hard time with this occasionally) on their way to shower. My shower had no curtain, only a sheet of plywood I moved back and forth to cover the entrance and I was grateful I had flip flops to protect my feet. We had hot water 80-90% of the time which was pretty good I admit. The were no lights in the bathrooms at night which made for some interesting night trips to the lou. All in all, it could have been worse.

Well, I will spare you with our day to day dealings and try to give the overall picture of the month and let the pictures do the rest of the talking. My first week I worked in the Casualties department at the hospital which was the equivalent of our Emergency department. Sounds like a pessimistic name I know, but I was actually impressed with the quality of physicians. They were constantly running out of supplies(Government run hospital...is this in our future?), and had to ration when to use X-ray/CT/MRI, but most could rival and surpass almost any American physician when having to diagnose a patient relying only on the history and physical alone. I quickly wished with my hearing that I had subtitles for some of the harsh SA Accents, as they were hard to understand. Toward the end of the trip I was picking things up pretty well. One of my favorite stories from the Casualties Department was on our first day. There was a patient who we suspected had meningitis(which is so, so common down there along with TB and HIV), and us american students concluded we needed a lumbar puncture. We told this to the doctor in charge and he said "sure go ahead, you can do it." Between us, we had witnessed a couple of lumbar punctures and I was shocked this doctor was willing to let a couple of students on their first day with the service just "go ahead" and do it without knowing if we were capable. I then thought about protecting him from any law suits if something went awry asked him if we needed to get informed consent from the patient to do the procedure. He stated "we don't worry about the legal system here, so no need to get it." Wow. From a physician point of view that sounded awesome! To be able to go through my career as a doctor and not worry about malpractice would be sweet. But it was a little scary from the patient point of view. My other favorite experience was when a drunk man came in after getting hit in the head with a beer bottle, and the doctor asked me if I knew how to suture. I said a little bit, so he got me a pan and filled it with water and soap, handed me a big suturing needle and needle driver that was normally used to sew up abdomens. He then left me alone in the room with this man who was bleeding profusely, to stop the bleeding and put in scalp stitches. I had sewed a couple of arm lacerations and pigs feet in med school, but never a bleeding scalp! The man survived and I put in the sutures...but it was a crazy experience!

The next week I spent in the HIV clinic. I essentially listened to the doctors deciding what regimen HIV patients should be on for as many people they could see in a day. It is a sad story there because 1/3 of SA population is infected by HIV, and it wasn't until 2006 that the president acknowledged HIV led to AIDS. They have a whole generation of people dying of HIV.

The third week I worked at a family practice clinic with Dr. Raza. He was an amazing Pakistanian who fled to South Africa with his family after the Taliban tried to take his life for doing some of his medical training in America. Here I saw a wide variety of conditions, although most were related to TB or HIV compications. No patients had appointments, it was a first come first serve type of deal. So the patients would all arrive at 7 am in the morning and likely would wait hours, even until 5, 6 pm or midnight to be seen. I hope it wasn't a foreshadowing of where America's health care is heading.

The last week I spent with Orthodics and Prosthetics and saw how people who had lost limbs were able to walk again. It was really cool and I hope to perhaps be involved in something similar one day. I also got to cast on my own literally dozens of little children with club feet...an experience I would've never found in the states. It was very rewarding!

We spent our weekends experiencing the rich culture and tourism of South Africa. Our first weekend we stayed close to home and went to the Protea Lion Ranch Hotel. Here they had raised an entire pride of lions from infancy and allowed us to go into the compound and actually touch the lions! It was so nerve racking but oh so cool! On Sunday we walked 45 minutes to get to church(I really felt like a pioneer in a foreign land), but it was so cool to see the faith of these african saints. We were blessed after church to be fed by the senior couple missionaries who provided a wonderful and much needed break from the hospital food we had been eating three times a day for weeks.

Our second weekend we flew across the country to the most southern tip of africa, Cape Town. This city felt more like California than Africa. It was so beautiful, the weather was perfect and we even dipped our hands on the other side of the Atlantic ocean! Not many people can say they've been to both sides of the Atlantic. We saw the huge World cup soccer stadium, drove the coastline and saw majestic cliffs and beaches, and even saw african penguins on one of the beaches! We climbed Table mountain(actually rode in a cable car to the top), and saw the very tip of the african continent. We also went on a township tour and saw how dirt poor some of those people really are, and walked through a museum dedicated to remembering Apartheid...it was very eye opening. We stayed in a hostel and got to experience first hand how comfortable european women are changing in front of complete strangers...ackward!

And for our last weekend, we went to Kruger National park and went on three safari's. This was my favorite as I've been dreaming to go on a Safari for as long as I can remember. You know you are in a different world when the gatekeeper at the parks entrance instructs you to not get out of your car for any reason and go directly to your campsite. I asked why(i'm sure its all obvious to you, but I had to ask) and she said "you're not at the zoo, there are wild animals that will eat you!" That was enough for me to stay in the car. We went on one Safari in the evening, and two in the early morning with one being a hike and the other driving. We actually saw more animals when driving around on our own in our rental car though. Funny how that works. We saw elephants(they were everywhere, almost like squirrels), impala, water buck, water buffalo, girrafe, hippo, owls, cranes, alligators, hyena, rabbit, deer, kudu, zebra, wildebeest, baboons,vervet monkeys and hundreds of colorfully rich birds all in their natural habitat. On the way there, I got pulled over for speeding and contrary to what i've heard about police in foreign countries, these cops did not accept bribes. ;) On the way home we drove to Gods window, which is like a green grand canyon and witnessed the beautiful majesty as the sun went down. We drove through several towns on our way home and saw rural South Africa. I was impressed with how diverse the SA landscape was and the beautifulness of God's earth no matter where you are. The people are good and I hope their country will continue to get better and better! I would like to go there again someday and do all the things we were unable to do in three short weekends. I missed Makenna terribly and that was the worst part of the trip, but we were able to Skype nearly every night and that made it more bearable. Next time I will have her with me. Well, I could talk in more detail about everything, but I've already spent way too long on this post(don't ask how long), so this is where the text ends and the pictures begin. Thank you for letting me share with you one of the most amazing months of my life to date!