Subaqua Sternal Rubs

Remember last term when I cut my finger on an underwater wreck and got a Tetanus booster "just-in-case?" Well, evidently the University clinic in Grenada never charted that fact (yes, the same clinic that told me to go home and take acetaminophen for Decompression Sickness). Well, today, I had the joy of another Td update all over again. (And the sore shoulder to go with it.) Evidently a documented tetanus shot is required before they set us loose in clinical rotations. (Or is it that they set the patients loose on us?) I guess I couldn't use my post as proof I got it.

Upon checking my campus PO box this afternoon, I found two envelopes: one from the school that basically stated that the Stafford funds had been dispersed (whew, I can now rest easy knowing SGU was paid a month ago! Yes, that's how long it takes mail to get down here), as well as another envelope whose ominous return address was, "Department of Pathology, St. George's University, Grenada, West Indies."

Were they writing to tell me that due to some just-recently-discovered huge Scantron error, I had actually failed Pathology, and would have to go back to Grenada to retake the course. As these thoughts of doom were running through my head, I gingerly opened the envelope. The enclosed letter read:

RE: CPC 5 Submission - 25 November 2005.

Dear Carsten,
I write to congratulate you on your excellent analysis and write-up of the Clinico-Pathological Conference #5. Your submission demonstrates your ability to scientifically and logically analyze the difficult clinical problem provided. Incidentally, your submission is one of the ten best analyses.

Do keep up the good efforts.

Signed,
Pathology Course Director

Wow, I don't even remember what CPC #5 was. My submission couldn't have been that good however, as I spent the previous week in the decompression chamber in Barbados, and I tended to be succinct with these submissions, using bullet form and not even real sentences. Oh well, the letter is appreciated, and in my permanent record for inclusion when I apply to residencies. Don't know what kind of weight is given to something like that in the Dean's Letter, but I guess every little bit helps.

Tis better to be thought a fool, then to open your mouth and remove all doubt.

Unfortunately, I seemed to forget this wise old adage during today's radiology rotation. When called up to identify an unknown lesion on a plain abdominal x-ray, I examined the abnormal area closely with a magnifying glass. All of a sudden, without thinking, I blurted out, "blastocyst." I mean, it was in the area of the ovary/fallopian tube, and it really did look like a little embryo, so I was thinking possibly an undiagnosed ectopic pregnancy (where the embryo implants somewhere along the fallopian tube, rather than in the uterus, where it should go.) Turns out I was way off — evidently I was looking at a tooth, a molar to be precise (not to mention the fact that a blastocyst is nowhere near an embryo where you can start to recognize a shape). The fact that there were other lesions that looked like incisors should have clued me in that my first inclination was way off. (A multi-gestational, i.e. triplets, etc., ectopic pregnancy? Not very likely. Duh.) In case you were wondering, this patient had an ovarian teratoma — basically a growth of normal tissues from more than one germ cell layer in the wrong place. After looking at films to determine the difference between normal gas and obstruction, different stones, and various inflammatory diseases (i.e. Ulcerative Colitis, Chron's, etc.), it was back to campus for evening lectures. Oh, joy! Well, at least the lectures were on Emergency Medicine.

Dinner tonight was cooked by one of my roommates and consisted of: A couple of chicken breasts, fried in bacon grease, and topped with copious amounts of Ranch dressing, mixed with bacon grease, as well as bacon (though sans the grease).

Despite how it sounds, it was very good. However, it's something you can only have maybe once a year. More than that, and you're risking an instant heart attack.

And for some strange reason, I had yogurt for dessert. Must have been the "Burns More Fat" plastered all over the container. Hope there was some truth to that advertising

Well, it turns out ENT's do more than removing wax build up out of ears. (I am just kidding, but it does seem that most patients seem to get this service preformed.) After interviews were completed, the members of my group and I took turns examining patients. My patient today was a 13-yo female who was complaining of headaches and dizziness for a number of years. Her ear canals were completely clear, so she avoided that service, but my otoscopic technique elicited a laugh from our preceptor, as my 6′3″ self had to kneel on the ground to get anywhere near the patient's ears. The rest of the exam was normal, except we were able to elicit some nystagmus on lateral gaze. She was diagnosed with vertigo, given a prescription and told to come back in a week for further investigations if things didn't clear up. A logical approach, I think - I mean if it hasn't killed her in 5-10 years, then a week shouldn't matter. Much different from the US, where she would have gotten a CT/MRI immediately to search for zebras and attempt to avoid litigation. (There is a saying in medicine: When you hear hoof-beats, don't think zebras, i.e. what's common is, well, common.) There was also a patient who presented with a swelling on the left side of her face. She was recovering from surgery to remove a lipoma from near the parotid gland, and when asked what could be causing the swelling, I immediately thought blood (since I am that kind of blood and guts person), and said "hematoma." Well, unfortunately I was wrong, and it ended up being a large amount (~40cc) of saliva that was leaking from the parotid. The ENT scheduled her for surgery to place a catheter that would drain the saliva continuously through the Stetson's duct into the mouth. She got quite a deal — only 200EC (around $68US) for the second surgery, as the first surgery cost 1000EC (around $375US), which still isn't bad considering the cost of health care in the US…

When working at the hospital, I always wondered what they were looking for on a chest x-ray (CXR). Now I know. For our Radiology rotation yesterday, we stared at CXR's for two hours straight. The preceptor was excellent, and explained all the features we should be looking for in different pathologies (i.e. pneumonia, cardiomegaly, pneumothorax, pleural effusion, etc.), as well as asking many tangentially related questions on the etiology, pathogenesis and treatment of these pathologies. I still have a long way to go on my hazy infiltrates, but I think I learned something. Next week, the focus is on abdominal films.

More to come, but I just don't feel like writing at the moment.