Subaqua Sternal Rubs

Half in a haze of unconsciousness, I hear it again:

and again:

It was my landlord knocking on my ground-floor window, letting me know that he was going to the airport to pick up someone from Grenada who just called him last night to show them the place for possible rental next term.

His excuse? "I didn't realize you were sound asleep."

Yeah, I guess it is really weird to be asleep at 6:45AM…

The smell of acrid smoke just hung in the air for hours. Despite repeated exposure, the noxious odor of burning flesh is something I never really can get used to. So maybe this surgery thing really isn't for me, and I should stick to Emergency Medicine. Well, that and I was having real difficulty (pain) with my back after standing for 4 hours straight. (Chronic issue after lifting too many obese patients on the ambulance/in the hospital.) Oh well, it was worth it because we got to see 3 surgeries instead of just one.

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This afternoon it was back to the Male Surgical Ward for Part II of our Urology rotation. Lo and behold, the same patient who we gleaned a history from last week was still on the ward, albeit in a different bed. This time, we were instructed to preform a complete, yet quick (1o minutes) physical exam. (Being newbies, we are a little slower, trying to make sure we don't miss anything, but managing to anyways.) Of note was a large, smooth, palpable mass that moved with respiration and spanned the entire left side of his abdomen. Evidently, a CT scan showed a possible renal clear cell carcinoma (kidney cancer), that may have invaded the Inferior Vena Cava (the major blood vessel collecting blood from the lower part of the body and returning it to the heart). Unfortunately, the type of cancer and spread to other sites in this patient carries a very poor prognosis. The urologist estimated that mean survival would be about 6 months, possibly a year.

However, this patient could die a lot sooner than that from a rather common complication. Since the tumor is invading the IVC, it results in an irregular surface on the inside of the vessel wall which promotes clot (thrombus) formation. If this thrombus were to break off and become an embolus traveling through the circulation, it would eventually reach the lungs. At this point, if it were sufficiently large enough, it would cause a pulmonary embolus, ischemia of lung tissue, and rapid death. For this reason, the urologist has scheduled surgery to excise (cut out) the tumor from the IVC, and hopefully prevent this complication. Our group has been invited to watch the surgery on Friday, which should be interesting, as it would be our first surgery in St. Vincent, despite having completed 3 surgery rotations already. (Our rotations are scheduled in the afternoon, and most surgeries are scheduled for the morning.) I just wish it could be more curative for the patient…

Being back in Grenada for the weekend was a surreal experience; seeing all the people and places I thought I wouldn't see for a while, if ever again. Actually, it wasn't too bad, mostly because I knew I was just visiting and would be leaving again. And best of all, it was all free. The trip started out on Thursday evening when I boarded a Dash-8 turboprop at the E.T. Joshua Airport in St. Vincent. The 25-minute flight ended up being over an hour, since we had to circle the Point Salines International Airport repeatedly while we waited for some rain to clear up. My first thought was, "Rain? At least it's not snow, why don't they just land already?" When we finally did land, I understood the pilots wise decision to delay touching down, since even with the rain abating the plane ended up slightly off the center line and skidding. When I tried to get off the plane, it was another half an hour of waiting while the flight attendant passed out rain ponchos and everyone had to put them on one-by-one. Really people, you won't melt from a little bit of water. I doubt Grenada has enough polluting industries to cause significant amounts of acid rain.

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So last night, after coming back from a long day (including hospital rotations and OSHA training), the guys whose rims/tires I damaged with that nasty pothole stopped by, along with my landlord to mediate. He said that this has been going on too long (almost 2 weeks now), and he just wanted to settle it. Of course, by "settling it," he meant that I should just give in to his demands for 1,000EC (~$400US). My landlord actually stood up for me, saying that this guy was being completely unreasonable, and just trying to take advantage of the situation, since if he submitted the claim to his insurance he would be getting 1 used MAG rim, value depreciated. We finally agreed on a number that was pretty much half-way between what I thought was fair, and what he was demanding. While it was a little more than I wanted to spend, it was definitely worth it. I really can't deal with the guy coming over every night to argue for hours when I am trying to study. I just hope it was enough so that he doesn't try and rob the place while we are not here. (Not that he would get that much anyways, as I always carry all valuables (including my computer) on my person, at all times.) I'm just glad it's over though.

In other news, my landlord took the opportunity to change out the vehicle we were renting from him. Since the whole pothole incident, he gave us his personal vehicle (a 2-door Toyota RAV4) to drive around, while he procured us another vehicle. He bought us a 4-door Nissan Bluebird (aka Altima in the US). With the exception of the steering wheel being on the opposite side, it's pretty much identical to the car that I have been driving at home since High School. I think this car will work out better for us that the SUV for a number of reasons - 1) we have 4 people sharing it, and it has 4 doors (getting in and out of the RAV 4 was a pain), 2) it has a truck with a vertical wall, so that our groceries do not fall out the back when we open the trunk on our steep driveway, and 3) it's cheaper to rent, and should be better on gas mileage too.

And for a final bit of news, I will be leaving St. Vincent at 5:55PM this evening (if the plane is on time, yeah right) to head back to Grenada for a free vacation to teach/lecture/coordinate CPR to the new 1st termers for the weekend. My SVG cell phone should work there, but in case it doesn't I will put my Grenada SIM card back in, so try me at the old number if the new one doesn't work. Good thing is that all I do this weekend is 1 lecture and then I just get to sit around "coordinating," which means I will have plenty of time to get caught up on the studying, and I should be able to earn enough money to make back what I just spent on my new rim/tires.

On the schedule for yesterday's hospital rotation was Surgery/Urology. After meeting our precepting physician at the Operating Theatres we were led to the Male Surgical Ward to conduct a history and physical on a pleasant 57 year old male complaining of painful and dribbling urination, as well as frank hematuria (blood in the urine) for the past 4 days. We spent an inordinate amount of time on, and delved deep into the man's history of present illness, past illnesses, social history, etc. in a vain attempt to find a surgical reason for his problems. Despite our precepting physician's initial glimmer of hope that the gentleman may need a minor, 15-minute surgical procedure, unfortunately once again we did not get to scrub in for any surgery. Instead, he was diagnosed with clot retention, and his management would consist of foley catheter placement. The cause of the clot was thought to be a bleeding prostate, which formed a blood clot, causing urine in the bladder to back up, as well as the blood in the urine.

After our hospital rotation, it was back to campus for an evening lecture: OSHA Blood-Borne Pathogens. I'm even in a foreign country, and I still can't escape the grasp of OSHA. Kinda sucked though, since I am certified to teach the class, and two of the people I am sharing a car with had current certifications and we could have skipped the class, except the 4th person sharing the car had never been through the class, so we all had to stay. Oh well, it gave me a good opportunity to register to take the USMLE I, and rid myself of a nice chunk of change ($695 to be exact.) Now that I've registered, I guess that means I should start studying for it…