Subaqua Sternal Rubs

Today's rotation was Ears, Nose and Throat, and was held in a Doctor's private clinic (not the hospital) in the capital. As it was afternoon "office hours" we were treated to a stream of patients to see and interview, rather than the traditional one. This also meant that our interviews had to be a lot faster, and lots of the extraneous material was cut out. I was glad to finally not have to ask a patient about their sex life, when all they had was a simple ear problem.

My colleagues interviewed patients with Benign Positional Paroxsymal Vertigo, deviated nasal septum, and kids with wax plugs in their ears. My patient came to the ENT specialist with right lower quadrant abdominal pain that radiated to the groin. WTF?? How did he get here? Anyways, after a history and brief physical that was completely unremarkable, the pt. was diagnosed with psoas muscle spasm.

The most interesting case of the day was a 3yo boy that had a branchial fistula. (Image) And all this time I thought they were just making this stuff up to torture us in Embryo, as I had never seen anything taught in that class in my 7+ years of working in the ED/EMS. (Ok, maybe a couple things, but definitely no fistulas.)

So it ends for now. The damage this time? 400EC for two brand new tires. (~$150US, or about $37US per person) It could have been worse, but it could have been better. Hopefully our landlord, whom we rent the car from, will assume some of the cost, as he is getting brand new tires back instead of the bald tires that the car came with. Unfortunately, he is in Trinidad and unreachable, so we had to replace the tires and hope for some sort of reimbursement.

In the never ending car saga, it seems we managed to put holes in two tires. Starting a couple days ago, the passenger side rear tire has had a slow leak, so that we've had to put air into it multiple times. Last night as we were trying to go to dinner, one of my roommates and I noticed that the front tire was completely flat. We managed to get the spare "donut" on, but that wasn't much better, as it too was pretty much flat. As our car was OOS, my parents, who were concluding their visit, had to take a taxi to the airport this morning. I wish them a safe trip home, but I won't actually know if they made it on the plane or not, since they still live in the Stone Age and don't have cell phones.

We managed to get the car to a tire repair place (well, really more of a shed on the side of the road). The proprietor was very nice, and managed to find a nail in the rear tire, so maybe it punctured the front one, and after falling out, punctured the rear one. Anyways, the guy didn't have any other tires in the size we needed, so he "double-patched" our original tires with some rubber cement and told us they were "for temporary use only." Which means we will have to go into town tomorrow to get some replacement tires. That's the one thing about living on an island with limited imports: You usually have to make multiple trips to get anything done, as we will have to search tomorrow to see if there are any shops on the entire island with the right size tires in stock. The good thing is that today's patching only cost $8US, and new tires should only be $35US each, with used tires less than that. The bad thing is all the wasted time, as it still took over an hour to do the patching today, because even on a Sunday there were always 3 or 4 cars lined up for tire repair at the shop. The roads in St. Vincent must hate everyone else too, and not just me…

Today's opthalmology rotation lead us in to the Operating Theatre, where we saw 2 and 1/2 cataract removal surgeries. (It would have been 3, but we have to learn to factor in the morning Vincentian "rush hour," and stop leisurely strolling it at 8:30am.) The operations we saw were a variation of Extracapsular Cataract Extraction, in which a smaller-than-usual incision is made into the eye, a "tunnel" is created, the lens is manually pulled out and replaced with an artificial lens. The cool thing is the small incision does not require stitches in the eye, and after a recovery time of a week or less, the patient has 20/20 vision, as it is possible to correct refractive visual deficits with the new artificial lens. (Note: SVG does have a phacoemulsification machine, the newest method of cataract removal, but at a cost of $90,000US per surgery, it doesn't see much use.)

And the best part? We managed to make it to the hospital and back without any car accidents (though one of my roommates did manage to give us one of his patented daily near-death experiences).

After attending a lecture on the next two years of my life (clinical rotations), I spent the weekend in Bequia with my parents, who are down to visit. It went pretty well, with the exception of my father getting his snorkel fins stolen, and the restaurant trying to overcharge $45US for dinner. My parents are staying on Bequia to do some scuba diving without me, as I had to make it back to St. Vincent in time for my first OB/GYN rotation, oh joy! (And the fact that I can't dive for a few more months yet.) The rotation wasn't that bad… a 20yo female who was 16 weeks pregnant, and presenting with vaginal bleeding. A quick history, physical that was limited to the abdomen (thankfully no pelvic exams for us yet), discussion of the case and we were out of there in an hour.

The title says it all. Yes, I was in another automobile accident tonight. No, no one got hurt, and no, it was not my fault. A taxi driver was too far over, and we clipped mirrors. His car suffered no damage, and only the glass of the driver's side-view mirror was cracked on my car (but the housing and everything else is fine.) He tried to claim that I crossed over into his lane because some glass shards from the mirror were found on his side of the road. Two problems with that theory: 1) There is no such thing as a "lane" in St. Vincent, because there are no lines on the road (actually, technically it was a "highway"), and 2) when the mirrors hit, they both swung in towards the car, causing the glass to bounce off the side of the car, and land far on the opposite side of the road. But since it will only cost about $10 US to fix, I really didn't feel like explaining forces, vectors and collision physics to the Vincentian.

Now I have a headache, so it's time to take some acetaminophen and go to bed.

… I still have a huge phobia of having objects put in various body parts where they have no business being. Case in point was today's opthalmology rotation. Even though I am in my mid-20's, I can't stand putting my finger or any other object in my eye, hence I still wear glasses. I guess this was a major clue for our precepting physician who volunteered me for a few demonstrations. The first was relatively easy and benign - the standard eye chart. I didn't make out too bad — I could read the big "E" (yes, the very 1st line), which corresponds to vision of 20/200 vision without my glasses.

The next exam was this high-tech handheld camera-like device (actually it looked pretty close to a thermal imager that Fire Departments use). I was a little apprehensive at first, but it was over in a few seconds, and it was also completely non-invasive. It also gave me this cool little print-out with my refractive errors. (4.25R, 4.0L in case you are interested.)

Next up the doctor asked me to tilt my head back, and started instilling drops in my right eye. I immediately thought "this can't be good." (Though the drops were pretty benign, only a local anesthetic that didn't dilate my pupil or otherwise mess with my vision.) At this point, the doctor turns on an ocular ultrasound machine in order to measure the length of the eyeball (which is longer in near-sighted, shorter in far-sighted). I tried to tell our preceptor of my intense "no stuff in eyes phobia," and he did attempt three times, but eventually he was no match for the reflex action of my orbicularis oculi. I mean what did he expect when he tries to push a pen like device that is glowing red like a laser onto my eyeball? Anyways, the doctor did finally manage to get a reading from one of my colleagues who also wears glasses.

During our visit we also interviewed a patient (gasp!, how surprising) who had a resolved case of bacterial conjunctivitis, after a week's worth of antibiotics. After a thorough review of opthalmological pathophysiolgy, our preceptor invited us to see glaucoma surgery in the Operating Theatre next week… It should be interesting to see how they cut through the eyeball to open up a hole in the Canal of Schlemm, which will allow for greater drainage of the aqueous humor, theoretically relieving the glaucoma symptoms.