Nerd problems...

Yesterday I was all packed up and ready to leave Chiang Mai. The experience had been great, I had said my goodbyes to the friends I made, and I caught a tuk tuk to the train station, backpack on my back, ticket in hand.

I got on the train, and discovered that I was in a strange layout compartment, with a bed that was much more comfy than any of the other trains I'd been on before - fantastic! I reached into my bag to look for something, and discovered that I had forgotten one of the two most important things on this trip...

1. My Passport (I had this one with me)
2. My Retainer (This one was not).

I can't go a night without it unless I want my teeth to shift, and a lot more painful braces when I return home, so I grabbed everything, ran with a 20kg backpack on my back, and ran out of the train station. I got a cab home as quickly as possible (did I mention I now hate every car on the road in Chiang Mai?) and got to the house, and started pounding on the door... but nobody was home, and I had left my key inside when leaving.

I paid the taxi, sat down in front of the door, drank iced tea, ate snickers, and laughed at myself for being so dumb (it's the only thing you can do).

It all worked out for the best though, as it so often does when you're traveling. I've now got a flight tonight that gets in at the same time as Michelle Sparling's and Lindsay Todd's flight, and I've got a hostel right next to theirs - so I'm super excited for this.

I'm planning on going to the airport 4 hours early this time, in case I forget anything again...

I've posted this many times before, but I'd like as many people to see it as possible, it's actually really beautiful. Check it out! Oh, and it's my birthday, I'm 21 now... weird how time never slows down, right?

The rest of my week in the Operating Room

What's up bloggers? I've got a few stories from yesterday in the OR:

Thursday

So I had my second last day of Surgery today and it was absolutely amazing. The day started off very slow, as my alarm didn’t go off, and all my laundry was dirty, but after running to the hospital and changing into my scrubs, everything seemed to get better from there. We started off the day just observing a series of minor procedures through the OR doors, as none of us really wanted to go in. We then got the chance to check out a thyroidectomy, a partial excision of an enlarged thyroid and lymph nodes, and a femur fracture.

The femur fracture was by far the most fun, while the neck lump excision was the most intense. Because of the location of the tumors in the patient’s neck, you could see many things like the carotid artery, and the patient’s left sternocleidomastoids, which I was pretty impressed by. There was an incredible amount of bleeding, sometimes to the point where the surgeon would swear in English. With the fracture, I was super close to the table, and at one point I had to leave the OR. I was watching very closesly, and loving all of it. I could see the dissection close up hand, and eventually we got through the muscle and down to the bone, where it was a clean fracture. The doctor used clamps to place both bones back together before getting the metal plate; unfortunately I left because there was blood squirting everywhere, and I had not been provided with safety glasses. One of the nurse informed me that they were for scrub staff only, so I decided to just avoid that OR and check out another one.

Later on in the day I watched my favorite surgery so far. We were strolling around, checking the board, and discovered that there was a procedure in OR 4 that was not listed on the board. We asked around, and discovered that it was an emergency surgery. After being invited in, the neurosurgeon came over and explained the case to us, which was incredibly nice. It was a male patient who had a motorcycle accident – he had a subarachnoid bleed, and they took scans / thought nothing of it two weeks ago. He came in today with headaches, blurred vision and nausea, so they took another scan, and discovered that his ventricles were huge. Because of the subarachnoid bleed, the blood had clotted the flow of CSF, and the choroid plexus kept producing more and more, increasing his CSFP. They needed to drill into his skull and install a shunt to drain the excess CSF into his abdomen.

I was super excited, because I’ve read about these surgeries, but have not yet experienced one first hand. It was fantastic. First they opened his abdomen and his skull at the same time, as the neurosurgeon used the drill to get through his skull. Once he was in there, he drained some of the CSF, and he invited me close so I could see it squirting out through the tube with a lot of pressure, pulsing to his heart rate. He then made a subcutaneous incision along the skull, and got a large metal rod from a sterile package (about a meter in length). He then took the rod, and put it in the patient’s skull, and fed it (under the patient’s skin) through his head, neck, thorax, and down into his abdomen. This would be the guidewire to bring the tube, but it was the coolest thing I’ve seen. After trying to get the tube through once, and the proline snapping, the tried again with great success. They installed a subarachnoid pump mechanism (a one way valve / pump that can be operated by pushing on the patient’s skull) and hooked it up to the abdomen draining tube before closing him up.

I asked when they would take it out, and was informed that it was there for life. Awesome stuff, best surgery so far. 

Can anyone guess what this is?

More updates soon - I promise. Including a Christmas one when I get my elephant pictures back!

Life in the OR

Well today was my first day at McCormick hospitals, accompanied by my first time in surgery, and it’s an incredible feeling – there are no words to describe it. We got to the hospital in the early morning, and I met my other interns from GapMedics; Jess and Bennita, who were also as excited as I was. After we all changed into scrubs (and crocks) we were immediately thrown into the OR, even before knowing what was going on. The head nurse who was incharge of us is known as Pi No Nah, so she kept us pretty busy for the day.

The first surgery was a repair of fractured Tibia. From the X-ray I could tell that he also fractured his fibula, but it would take a few days of traction before we could also fix that. The bone was shattered, and I saw them pulling pieces out with forceps, which was super cool. They pieced it back together like a jigsaw puzzle, and then started drilling holes, screwing screws, and attaching metal plates to allow the bone to grow back together. As they checked the placement of the bone with the fluoroscope, the three of us huddled behind the radiation shield because there weren’t enough lead coats for all of us. After that, they closed, and we were rushed into the next surgery.

The next surgery we got to watch was a C-Section, which I thought was on the fence between really awesome, and really gross. It was awesome because a little boy was welcomed into the world, screaming (of course) and I could see on the monitor the seconds he had been alive, which really puts a lot of things into perspective. It was really gross though because the baby had not yet learned to have control of his bowels (which I should have really expected, but whatever) and it got everywhere, especially inside the mother… I wouldn’t think it would be a problem though, since it can’t be infectious, just illicit an immune response for being in an abnormal place / from somebody else. I don’t want to think about it anymore; in laymans terms, it was cool.

We breaked for lunch, and when we came back, we got to observe a transurethral resection of a man with benign prosthetic hyperplasia, which was super cool. They went in through a urethralscope through the guy’s junk, and used the cautery to excise prosthetic tissue that was intruding onto the ureter… the surgeon basically just scraped out what was in the way… but jeeze, the amount of blood mixed saline that was flowing out once the scope was removed was enough to fill a bathtub twice…

Oh, I forgot to mention the smell of surgery… body cavities don’t really smell good on their own, but add to them the burning flesh smell, and you’ve got to have your stomach tied down.

The last two surgerys we observed of the day were an appendectomy on a kid, and ureterlithotomy (if that’s even a word). The first surgery was done under general anesthetic, while the rest of them weren’t. They seem to prefer spinal anesthetic, which I would never elect to get, due to the fact that you A) have to be awake the whole time and B) have to deal with the spinal needle without lidocane. Anyways, the kid was put under GA, so that was pretty cool. His appendix was excised, and it was all very routine. We then went to the ureterlithotomy, which is a removal of a stone between the bladder and the kidneys. It was done on a woman, so once again there was the scope snaking up her urethra, but that’s the least invasive way to do it. The stone was broken up, and all of the pieces were collected, but at one point one of the pieces tried to go into the ureter further up, and it was like watching a suspense movie on the screen – crazy fun.

Overall the first day was amazing, and it’s starting to hit me that this is just a regular job for some people. I’m definitely excited for what Wednesday brings!

My Last (Full) Weekend in Chiang Mai

After finishing up at Maharaj hospital, I was excited to get a move on to McCormick – but I was also dead tired. I spent Saturday catching up on a lot of things, and just having a day in; which sometimes is much needed to get away from the hustle and bustle of Chiang Mai.

Sunday was different though – I wanted to do something that I could only do in Chiang Mai, so I decided to head out with the rest of my orientation group, and check out the Palace and Doi Sutthep on top of the mountain (I probably didn’t spell it correctly).

It was about a 1 hour red-cab ride up winding roads that never ended. The air got very cold, and very thin – so much that we noticed it in our breaths… not to mention our ears popping like crazy, and hanging on to the bars of the cab as it sped dangerously around corners. After having good life chats in the back of the cab for a little while, we arrived first at the Palace.

I don’t actually remember seeing the palace, nor do I think that I took pictures of it, mainly because the building itself wasn’t too impressive or noticeable, it was just a series of white two story houses. The grounds on the other hand were very impressive. There were flowers everywhere, a jumping fountain basin which took 10 minutes to walk around, huge bamboo trees, and a beautiful area that overlooked the rest of the mountain and Chiang Mai. We spent about an hour here walking around and seeing what there was to see; it was pretty awesome.

We then went on to our final destination of the mountain, which would be the heart of Chaing Mai. This temple had been recommended to us by so many people, and even old stories. There was an elephant that they sent up the Chiang Mai mountain, and every time it stopped, a temple was built on the grounds. At the very top of the mountain, it turned around 3 times, and trumpeted 3 times, so they decided to build the great temple up there… and boy is it great. It’s stunningly beautiful, and overlooks the city with a crazy view (see my pictures). It was here that Sanne also informed me of a lot of things about Buddhist Culture, including the fact that it is not a religion, but a philosophy. People aren’t praying to Buddha, they are just showing their respect, and he is not a god, but simply a man who found enlightenment. It’s a little confusing, but definitely something I want to look into more.

After spending forever at the temple, we headed back home, but not before stopping off at the movie theatre to watch Life of Pi – which is really good, though I wish I read the book first. Oh well! McCormick Hospital tomorrow – super excited!

More pictures below!

- See Ya!

Last day with Maharaj - Family Medicine

I came down with some sort of mysterious flu on Thursday, so I found that my next day at Maharaj was going to be my last. I arrived in the morning as per usual and met with Dr. Peerasak who I was assigned to for the day. He informed me that (like Monday) we would be doing Home Ward Rounds. I jumped in a van with him, a driver, a nurse and a medical student, and we drove across Chiang Mai to the first patient’s house.

Unlike the patient I had previously seen on Monday, the first one we visited today was in a very nice house. We arrived at the front of the gated property, and let ourselves in. When we got into the house we found the patient right in front of us, lying on a hard wooden bed near the kitchen. I was informed that the patient had advanced cervical cancer, for which she had already received chemo and radiation therapy. Because of the advanced stage of the cervical cancer, her urethra was being compressed, leading to back up of urine in her bladder, leading to hydronephrosis. She also had high blood pressure, and demonstrated considerable edema in her legs – so much that you could still see finger marks after grasping her legs 10 seconds later.

Most of the time both the doctors, nurse and patient spoke in Thai, but through my limited Thai knowledge I was able to catch some of the conversation; her saying that because of the swelling, when she had gone to the bathroom the other day, she had slipped, fell, and was now experiencing back pain.

After doing some more general checks (blood pressure, pulse, asking more questions, etc) we reviewed her chart, and left to go onto the next patient.

***

Our next patient we found in a traditional Thai home. He suffered from a stroke 10 years ago, and though he was able to walk with the assistance of a cane, he did not leave the house. His wife had retired and was now taking care of him. He seemed in very good spirits, and bilateral motion was very good – enough that I didn’t catch on that he had suffered from a stroke until they told me… though I should have known when they started asking him to do things like smile, raise both arms, etc. We identified his main problem to be his blood pressure, but he identified his primary concern to be the pain he was experiencing. After doing basic checks and reviewing his medications, we went back to the hospital to discuss both patients, and update their charts.

One thing I kept getting told by all the family medicine staff is that Canada apparently has a very strong Family Medicine field. I wasn’t aware of ours being a particular worldwide leader, but apparently we are, so I’m kind of proud of that.

***

Once we had completed all our charting, it was time to head over to the seminar about a new ACE inhibiter for controlling BP in hypertensive patients. Though the presentation was in Thai, the powerpoint was in English, and I could understand a lot of the Thai being spoken. I actually had a good time sitting through the one hour presentation, CHSC 2P27 actually taught me something useful, as I was able to follow a lot of the graphs, and look for bias errors (none of which I found though, which is good). There was free iced coffee, and free drug-swag from the drug company. Everything in the room was decked out with the new drug – presumably because they want you to prescribe it. I walked away with a folder, two note pads, a pen, a boxed lunch, two iced coffees, and a box of tissues… not too shabby.

After the presentation, I was whisked away into another room with the medical students and their instructor. One of the students was doing a journal article presentation on a NEJM article about vitamin A as treatment for something… can’t remember at this exact time, but the article is upstairs. Anyways, despite speaking Thai again, I was able to follow the conversation – especially the parts where they switched to English – and was even able to provide an opinion regarding the article, which was pretty cool. It was actually pretty fun to have the board discussion on the validity of the article, and the significance of the results… once again, CHSC 2P27 apparently taught me well… who’da thunk it?

At the end, I was asked about something I learned regarding the article, and to reflect off of it. I mentioned the fact that the placebo being used in patients… Oh, just remembered, the article was about NAFLD and a drug treatment vs a vitamin treatment vs a placebo. Anyways, I had wondered why placebo patients showed a 30% increase in better symptoms (decrease in fibrosis, steatohepatitis, etc) while drug patients showed 50%. The doctor explained to me that even though the placebo patients are not receiving the active agent, they’re not being denied care, and were presumably removed from the harmful stimulus, or had some sort of other treatment that would be ethically obligatory.

***

After the conference was finished, I was invited to take my last look at the department of Family medicine… but not before being invited back to a party there this Friday… pumped, there’s karaoke. Dr. Boonsong took me across campus to where a hospital-wide game was going on. There was a big field with lots of cheering teams of different colours, dancing, etc. The teams were tying about 20 people’s legs together, and making them race across the field seeing who could do it the fastest. Though I didn’t participate, it was a fun way to end off the week there at Maharaj.

Though not initially wanting to be in family medicine, and being reluctant to like it at first, I really do feel like I learned a lot, and am happy I got the experience to broaden my knowledge of Thai, international and family medicine.