Subaqua Sternal Rubs

My lab group had our first of two to three times weekly rotations at the Milton Cato Memorial Hospital this afternoon. We were originally assigned to the Medical service, but our precepting physician was off the island so we were re-assigned to General Surgery. After finding the "Operating Theatres," we were led into the Doctor's Locker Room , and proceeded to change into our recently sterilized scrubs, bonnets and shoe covers. However, it turned out that our precepting Surgeon had just finished her case and she requested that we change back into our long pants, shirts, ties and white coats to complete a history and physical on a patient awaiting surgery.

After introducing the patient, our preceptor left us to complete our assigned task alone. It was kind of cool to be able to do the H&P without anyone standing over you, and use some of the skills learned last term in Advanced Clinical Skills… The group member closest to the patient (who had 3 years experience in a podiatry residency) started of the interview. His first question?

"Do you have any medical problems or have you ever been admitted to the hospital before?"

My neck almost snapped doing a double-take. I don't know what they teach in Podiatry school, but I think it makes more sense to ask what brought the patient to the hospital this time around (i.e. the chief complaint) and the course of the current problem (history of present illness), so you can have some context to put the past medical history into…

Anyways, we managed to get all the questions we needed answered, even if it wasn't really in a coherent order. Our patient was a 45-year-old pleasantly obese female with right upper quadrant/epigastric abdominal pain that started 2 months ago. After presenting our findings to our preceptor, she asked us what we thought for a differential diagnosis. Our patient's HPI was classical for gallstones (fat, forty, fertile, and female), but it turns out an ultrasound showed a cystic mass in the head of her pancreas. Fearing the mass might be malignant, her surgeon scheduled a Whipple procedure to remove the mass.

The Whipple is not a super-common procedure (Christina from Grey's Anatomy was fighting for it in one episode, and one hasn't been done in St. Vincent in 10 years), but the surgeon was nice enough to give us her personal cell phone number so we could call to see when the surgery would happen and observe. (Luckily for the patient, the surgeon is a Vincentian trained at Georgetown who has done numerous Whipples previously.) So that's something to look forward to, even if we don't see anything interesting on our next Surgery rotation on Wednesday.

And to update everyone on the ongoing extortion: I got an estimate from a body shop today to repair the damages to the car caused from my little accident. They wanted 550EC (around $200US) just to repair the bumper, and they said they couldn't give a price on the rims, which has been the point of contention all along. A lot of good that did. So we still have to see if I can bargain down from the 1000EC that they guy is still harassing me for…

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