Catching Up & Counting Down

Geez, it's been more than a month since I posted anything...so I'll {quickly} play catch up.

I had recently started Ob/Gyn last time I posted.  Well that rotation is over.  It was a really good clerkship experience.  I had lots of Gynae emergency clinic exposure, antenatal clinic patients, C-section & vaginal delivery assistance, and at the end, I actually got to deliver a baby solo!  That was a great way to end the rotation.



On the road again...
One weekend during Ob/Gyn the usual suspects took off to visit Morocco.  We stopped in Marrakech, Casablanca, and Chefchaouen.  In Marrakech we visited the Djemaa El-Fna (Big Square), shopped & got lost in the souks, rode camels, toured the Marrakech Museum, enjoyed the fresh mint tea and ate lots of good food--tajines, cous cous  and the best fresh squeezed orange juice for $0.40 a cup from the square! and visited the stunningly beautiful gardens of Yves Saint Laurent.  Marrakech is definitely a place worth returning to!!!
























We drove a little more than 4 hours to Casablanca and stayed one night.  We roamed and drove around the city a little bit, relaxed in a fancy hotel lobby bumming wifi, and visited the Hasan II Mosque.  It was breathtaking!  The mosque that sits on the coast with the sea on three sides is one of the largest in the world.  We didn't have time to wait to go inside for a visit but the outside complex was lovely. 









The next leg of 7+ hours driving took us along paved and unpaved roads, through small communities and larger cities, until we reached Chefchaouen--the blue city in the Rif mountains.  Another beautiful place to visit.  Its crisp and clean and many buildings are painted blue.  They're known for their delicious goat cheese (i can vouch) and yummy olives.  We stopped at a family style restaurant here and the food was so good that we all ate 2 meals!













During our trip we stayed in 2 Riad's and a hotel. A Riad is definitely worth experiencing.  It was so peaceful and a quiet place to wind down after the hustle and bustle of Moroccan excitement outside the walls, with great service and good mint tea!


A Touch of Home...
As much as I've been missing home, I was so excited to see some familiar faces!!! Little sis from the island came to do a few rotations in London at the same hospital and Uncle Zahmu came to visit his daughter who's been doing it big in London for a few months herself!  We all went for Afternoon Tea!  It was a super chill, laughter filled afternoon.  I was soo glad to see some more folks from "home".








Another new start...
My Pediatrics rotation began 3 weeks ago.  I've already spent time in the Peds Clinic, In-Patient, Peds Emergency and NICU. Seeing the little ones in NICU can be tough but they are little fighters.  I start every rotation only knowing what we read in the books, but seeing the various diseases and illnesses in real life, in front of your face puts everything into perspective.  Learning to trust your clinical judgement along with what you read in the books is a process that I'm building each and every day.  I've spent time with some really good Consultants & Registrars and that makes a world of difference in the learning process.  They challenge you, force you to stretch yourself and your thinking, which sometimes reminds you how much you really just don't have a clue...but they also provide bedside teaching and experiences that you can only get by chance.  Like that knee cap reduction I did on a kid who's leg appeared to be flexed almost 90º in the wrong direction because his kneecap was dislocated, yikes! 

Love abounds... Making good use of the weekends, I was able to go back to the City of Love again with Mi Amor for a few days!  Twice in 4 months and I'm honestly looking forward to going back again.  I LOVE PARIS!

Another weekend my cousin got married and I was able to attend...thanks FaceTime!  Can't wait to see the happy couple in person.




Beware of the Coffee Shops...
Two of my housemates and I visited Amsterdam recently.  That was a cool city as well.  It's known for the Red Lights and the open Cannabis smoking (neither of which I took part in!!).  But it's also known for Tulips, and Bikes, Waffles, Canals and some really happy friendly people.  I highly recommend visiting.  That's another place I'd go back to without thinking twice.  I think i've said this about every place!  Guess I better save my coins for some return trips.





Sheesh! I think, i'm all caught up now!

I have 3 more weeks in Peds before a few of my friends come to visit and get in on the European travel scene!  I'll write about that once they get here.  They are going to make a few stops without me while I prepare for my Peds Shelf Exam and pack up my life once again...because I'm coming home in 25 DAYS!!! I can't wait! Seriously! I haven't seen my family in nearly 9 months.  This is the longest stretch I've been away EVER!  I'm ready for a hug from my momma!

But until May 26th rolls around I'll be here, being a good student, and daydreaming about the next adventure.

Until next time....

Ob/Gyn...Oh my!

Hello good people...I'm currently in my Obstetrics & Gynecology rotation.  You know...women's health related stuff, lol.  So many guys are probably squirming already.  

It's my 4th week already.  I had no idea how many women at any given time in the Essex area were on the verge of having babies, just had babies, unfortunately some have lost babies due to miscarriages, and others are trying to start or expand families with IVF.   Not only are we focused on the obstetrics aspect of things but also women health concerns like HPV, cervical and ovarian cancer, benign tumors, fibroids, STI's, family planning and the like.  It's all going on here every day.  

It's a super busy rotation!  Busy is good.  Busy means my knowledge base is increasing exponentially!  Every night I'm praying that I'm retaining as much as possible.  What I learn during the day, I have to review during breaks or at night.  I'm constantly jotting down acronyms and other phrases I hear people using to go and find out exactly what they're talking about.  

My vocabulary must increase by 500+ words during each rotation.  Things I've never considered or realized I didn't know, I'm learning.  My mind is stretching.  My experiences are being enriched.  Im really learning to be a doctor....Every time I stop to think about that, I have to pinch myself because I'm really here...doing what I've wanted to do forever...and it's AWESOME!

Over here, midwives deliver babies in birth centers (or at home) if the moms have low risk pregnancies.  Totally different than what we're used to in the US, where the Doctors or Nurse Practitioners handle just about all of the prenatal care and deliveries. 

My current Consultant is a BOSS!  I love working with her.  She makes sure I'm involved, front and center....IN EVERYTHING!  She is an Obstetrics Consultant...caring for the pregnant mom's to be.  During clinic, she encourages me to see patients and present them to her...ask then questions and learn to perform examinations, high level ultrasounds, and fetal doppler scans while she's present.  During ward rounds, I'm there, interviewing and examining patients, and having the occasional rapid fire questions being thrown my way.  During deliveries I'm there.  If there's a C-section I'm scrubbed and assisting.  I'm learning it all and doing it all!  

For the high risk deliveries, Consultants are present on the Labor Ward if needed.  In case of an emergency or the midwives have concerns about mom or baby, they ring an emergency alarm.  The first time I witnessed one, I had no clue what to expect.  Everyone available on the Labor Ward rushes to the room where the alarm goes off, ready to spring into whatever action is needed.  My first call, I tried really hard to stay in the background, far out of the way of the folks who knew what they were doing!  Then, I was working a shift with my Consultant...the Boss!  The emergency alarm rings, I go to the call with everyone else, I attempt to stand near the back out of the way...I mean this woman is actively bleeding...and it looks like a fair amount of blood to the untrained eye.  

What happens next???? The midwife explains to the Consultant that the patient has a PPH--a Post Partum Hemorrhage...she recently delivered and has lost more blood than expected...and still bleeding...looks like she has a vaginal tear and her uterus hasn't quite contracted enough to stop blood flow after delivery.  Ok, the Consultant gets the details, surveys the situation, then calls me over.....whaaaaaaaa????...."D, come over and see this...let me show you what's going on...this is why the woman is still bleeding...this is how we know what type of tear is present...we'll check for uterine contraction like this...this isn't a life threatening situation...these meds need to be given to help uterine contraction...this is what needs to be done about the tear and who can handle it...All I could think was wow!  There are probably 15 people in this room who are all great at their jobs, ready to handle an emergency situation if warranted, and my Consultant took the time out for a moment of teaching!...while everyone looked on and waited to find out what they should do next.  Complete and total awesomeness!!!! 

The Gynae emergency clinic is just as busy.  I've partnered with one of the senior house officers there for many clinic shifts.  I'm taking histories, doing examinations, generating differentials and suggesting care plans...learning when people need to be admitted immediately and who we can send home...who needs an Ultrasound scan right away and who needs them scheduled later down the line...what types of miscarriages have occurred and how do we manage them--expectantly, medically, or surgically?  

In the clinic this past week, after taking a patient's history, doing and abdominal and VE, discussing my findings with my mentor who had been there by my side the entire time, determining what I thought may be going on and what we should do...it was time to have the discussion with the patient.  I explained to her what her options were and the most unexpected thing happened....She asked me what I thought she should do....Me?!?  She felt comfortable enough and trusted me and my judgement enough to guide her to do what would be best for her.  And guess what?  I did!  

This is what my patients are going to expect from me as their Doctor...trusting me to help guide them to better health and well-being.  

I still sometimes can't believe it's all happening.  I'm in the thick of it all...Up close and personal...getting my hands dirty and feet wet...forming relationships...helping patients decide what's best...And I'm loving every minute of it!

And all you people think I do is travel the world...ha!!!!!!

Until next time...

City Break & So Long to Surgery!

Can you believe I've already been here 6 months?!?! It's crazy.  Feels like I just got here.  But I'm 2/3 of the way finished my London stint!  What an experience it's been so far.  I know plenty of you think all we do over here is sightsee and travel all over Europe!  Don't be fooled: We really work hard!  This is a whole different type of learning environment.  It's real OJT--On the job training. It's good because things you learn actually stick.  You can associate disease presentations, treatments, & complications to actual patients.  You don't forget the patients. 

The patients are our teachers every day along with the Consultants, Registrars, and Junior Doctors we work with.  The way the patients progress teaches us how we should manage and treat the various illnesses and what we should watch out for to let us know if things are going in the wrong or right direction.  I prefer this type of learning over strictly lecture style teaching any day.  The concepts, lab values, clinical signs and symptoms actually mean something.  I can't ignore the patient right in front of me.  Between their history, observations, complaints, usually the patients end up telling us everything we need to know to work through their problems and they don't even realize it.  Learning to be a Doctor is ridiculously awesome!

Some days absolutely suck because there's so much I still don't know.  But those days are usually the most useful and productive overall because I actually learn new things or learn more in depth information about a particular disease process.  That's what I come home and read about at night so my learning is more focused and relevant.

Friday marked the last day of my Surgery rotation--way to close out surgery with an adult circumcision, parathyroidectomy, and a hip replacement!  Over the last 3 months, I met and worked with some super intelligent people with great personalities and willingness to teach.  I think the best part of being exposed to such a variety of healthcare professionals, is being able to take the things they do very well and incorporate those skills into what my ultimate  "doctoring style" will be and for that, I'll be forever grateful.  

Now for the other interesting stuff...A few weekends ago, a group of AUC folks met up for a full day coach tour to see more of the UK.  We went to Windsor Castle, Stonehenge, and Bath.  We had a fun day & it was nice to see people I haven't seen since last April when I left the Island =)

Windsor Castle: 

This is where the Queen hangs out and relaxes when she has free time or if she's entertaining guests.  The art collection at the castle was worth somewhere in the Billions of Pounds Sterling! The staterooms are opulent and many have been refinished in the same style as the original rooms.  Queen Mary's Dollhouse is also located at Windsor Castle.  It's the largest dollhouse in the world, which on a tiny 1:12 scale is fully functional--real silver, working electricity and water, wine in the wine cellar, and lift (elevator). 

Check out pics from Windsor Castle...

Queen Mary's Dollhouse

 All of Us!

Stonhenge:

Most people have heard of Stonehenge before.  While historians think they know what the purpose of some of the stones were at various times, the full history behind the stones still remains a mystery.  Stones first started appearing at the site 5,000 years ago and they were rearranged many times over the course of a few hundred years until we were left with what stands today (restored by the Heritage Society as closely as possible to the final arrangement).

Bath:

The City and the Roman Baths.  There are four main features at the Roman Baths: the Sacred Spring, the Roman Temple, the Roman Bath House and the Museum holding artifacts and treasures from Roman Baths that were operational for more than 300 years. Falling rain water is heated deep in the Earth's crust and then rises up through fissures and faults in the limestone and fills the baths.  

Clean water for you to sample...it was hot and tasted like sulphur.  Pass!

Separate from the Windsor, Stonehenge, & Bath Tour, before I came to the UK I got free tickets to witness the Ceremony of The Keys.  Its a 700 year old ceremony that takes place at the same time every night (9:52pm) to lock the Tower of London and ensure the safety of the crown jewels.  

The ceremony is timed to the minute and the words are exactly the same every single night.  The only time the ceremony was ever late was once when a bomb from WWII hit nearby and stunned the guards for a few minutes.  Once they recovered they continued with the ceremony, but sent a note of apology to the Monarch who was not happy with the delay.  

I must admit, I had no idea what we were going to see, but it was actually really interesting.  Can you imagine doing something at the exact same time every single day for 700 years? That takes serious dedication! 

Note: If you want to see the Ceremony of the Keys you must book WELLLLLL in advance! I got tickets 5 months in advance.  The next available slots are in Sept 2016!  If you know you'll be here, go online and order your free tickets (£1 processing fee) now!  order a few so you can take others along because last minute isn't an option.  Photography isn't allowed inside during any part of the Ceremony visit so I don't have any inside pics to share.  Just go check it out for yourself.  It's worth it.  

(http://www.hrp.org.uk/tower-of-london/whats-on/ceremony-of-the-keys/)

Outside the Tower of London 

While out we saw a local artist Sneakbo, who has more than 50 Million Youtube hits, that was shooting a music video.  Even better, the song was pretty good!

And I got to see THIS guy again!!!!