Day 17

Celine's alarm went off around 6:20 today which was a blessing in disguise. I planned to run but I know the way I was feeling I would not have woken up. I forced myself out of bed to go and start moving my legs. It was a challenge today. Probably the one day where I wished so many people weren't waving and screaming hello to me as I ran because I could barely muffle out a "hey" with all the panting I was doing. I tried waving and smiling which most likely just made me look manic since I was breathing so hard. Yet at the end, as always I was glad I did it. It was the best way to jump start my day. Today I was in the OR in the morning again! Hallelujah!

I grabbed a few mangos for breakfast and was good to go. The man who had the cyst removal to his neck that Alex and I did yesterday came back for a wound check and dressing. We removed the drain and maintained hemostasis with pressure for a few minutes after. Then I put in 2 sutures where the drain came out, re-dressed his wound and told him to come back Saturday so I can monitor the healing process. It looked fabulous thus far.

The first surgery today I was first assistant to Brant for a sebaceous cyst removal right in the middle of the gentleman's forehead. It was very small so the incision had to be precise in order to not leave a scar. It went opposite of yesterday. Not much bleeding at all! This guy must have been eating his vitamin K which was nice. I got to close the wound with 5.0 silk, the thinnest thread we have so he would have little to no scarring. Future Plastic surgeon? Maybe. I do like facial surgeries. And it's quite an art trying to make the wound edges line up perfectly so it heals perfectly.

As soon as we wet done with that surgery, another was getting set up with Brigitte. An older man with a lipoma on his posterior neck, and Dr. Schuster asked me to be the surgeon for the case!! Yesssssss!! My first surgery! I was beyond thrilled! And I've seen so many thus far, each time paying close attention to the process so I was confident I could do it. Funny thing is, I wasn't nervous at all. Even with the first incision I felt as calm as a cucumber. I did love anatomy lab, so maybe that isn't surprising. Or maybe its because I'm so overly conscious and concerned that the patient is alright and comfortable that i don't have time to be nervous. After Brigitte numbed the area by injection of lidocaine with epi I tested the area to make sure he was completely numb before proceeding. I made an elliptical incision around the area of the lipoma, where the skin just filleted open beautifully. Then I used blunt and sharp dissection with the iris scissors, carefully dissecting out the lipoma, pulling back to reflect the skin the the hemostats. It was exhilarating! I loved every minute and it couldn't have gone better. I put in subcutaneous sutures to bring the wound together and let Brigitte close. It was a work of art and I really have the greatest team from which I learned from. Best day ever.

After lunch Brigitte and I went with Dr. Schuster to the DOT center in Sorsogon to meet with one of the directors of the clinic. The DOT center is responsible to seeing and treating those patients with TB since it is such N endemic in the Philippines. We are trying to do research to determine how they treat and process those patients with TB, how they diagnose and how and if they keep a database of all their information to say the least. We are going to conduct research on how TB is regulated and taken care of by these government and WHO regulated DOT centers with hopes of supporting and helping aid the system with our own interventions. First we bed the research on how they run as a clinic before we can make changes. The lady we met with was very pleasant and we have to go through a few more steps and meet with some others before proceeding. We'll probably get started next week. After our meeting we went into Sorsogon to pick up some more medications from the pharmacy with Dr. Schuster. While we waited Brigitte and I shopped around at some of the open markets and bought ourselves a pair of sweet Ray Ban sunglasses for the equivalent of about $2 American dollars. We got back to the clinic and dropped of the meds right at the end of the day, and helped the others finish up whatever needed to be done. It was a slow day most likely because there was the threat of a possible scheduled brown out. Yes, the region has days where they shut off the electricity to conserve energy and we've already had a few on the trip. It's not that bad, we actually make the most of it. 

Back at the dorms I worked out with Dan, then showered and had dinner before we packed ourselves into club Jeepney and head to Sorogon city for the night. We all caught up with our Internet needs and emails to attend to (my computer broke remember so it was a little limited) before trying to find a good place to go for the night. It was a bit of a fail in finding a place but we all still had a fantastic time riding around, blasting music and laughing at all the ridiculous things that were going on. We got back to the dorms and chilled for a little bit on the porch before deciding it was a good idea to head down to the dock. It is such an amazingly beautiful place and the moon tonight was exquisite as it reflected over the glassy water. I'll leave it at that for now because things got a little weird as the night went on. for example the part where we were almost kidnapped on a boat who's deck man wanted to take us to international waters. I use kidnap loosely as we were willing participants for this boat ride. Well maybe not me, because dark water for a non swimmer seems just like a horrible, even if Sidney Croaby asked me to come aboard, I think I'd say no. Ok now I'm really just going to leave it be and let you use your imaginations. Pirates of the Philippines much?

 We're taking a day off tomorrow to let the ENT surgeons tour the area and enjoy some of the Philippines. They will be leaving us on Saturday, so we're holding clinic then. Should be fun after all the events we have planned for all day tomorrow....and even more fun if there is more OR in my future. 

My dad hates when I use the word awesome, but I can't explain it any better then by saying today was an AWESOME day.

Day 16

Well after going to bed super late I woke up at 6:30 regardless, my body just being used to this now. I still wasn't in the mood for a run so I chilled out and wrote a little bit before picking myself up to get breakfast. My trip is now half over and it has flown! I'm definitely going to miss it. I already want to come back. I was scheduled to float from wound care to Dr. Ashik's room so my day started with cleaning the wound from an incision and drainage done yesterday to a woman's perianal abscess and redressing the wound. That was a nice way to start the morning! I went to Dr. Ashik's room after and saw one patient with destructive gout in his hands that was pretty impressive. I went to find hand sanitizer after touching the patient and head into the OR. Alex was getting ready to do his first surgery on a man with a sebaceous cyst that needed to be removed from the back of his neck. Dr. Schuster grabbed me and asked if I wanted to be first assistant with Alex for the surgery. Ummm of course!!! Dan was supposed to be there but they couldn't find him and by the time he came in he just offered it to me. I was pretty psyched! It was awesome getting to do the surgery with Alex with just Dr. Schuster mentoring. However as the incision to deeper and we started to dissect out the cyst, we ran into some venous bleeding. The man must have never had a leafy vegetable in his life. Either that or was a hemophiliac. His blood was SOOOOOO thin!!! Like pools of blood!! And it was unavoidable. He had to have some of the bleeders sutured to continue, one of which squirted in my direction just barely missing my face. My hands were covered in blood and we probably went through a half dozen packages of gauze. Alex and I were able to get the wound sutured up. I love suturing for the hundred thousandth time. Dr. Schuster assisted to help establish hemostasis by putting in som subcutaneous stitches and a drain for the wound before we closed it. It was incredible but we worked as a great team despite the complications. It took all morning, and we asked the patient to stick around to recheck the wound after lunch. Hopefully a hematoma won't develop and the wound will heal beautifully. The sutures I must say were on point.

At lunch they had fried bananas!! MY FAVORITE! And I had mangos at breakfast so this was just a great food day. For the afternoon session I worked with Ashik and floated around where I was needed. I was assigned to do a presentation at dinner for everyone on salivary gland tumors so I left clinic a little early to do my research. And by early I mean like 4:30. It was busy so I was reluctant to leave.

 While at clinic we saw a young boy who had gotten stung by a jellyfish and had an allergic reaction to it. It looked like Dr. Octopus from spider man wrapped around him and shocked him with his tentacles. That's my best reference. I felt so bad for the poor child, he was so uncomfortable. We also saw a 12 year old boy with VSD and pretty much heart failure. He looked emaciated and terrified. It was heartbreaking knowing that his condition was so poor and most likely untreatable. It's hard turning down those that we know we can't help. For instance we bad a lady that presented with classic symptoms of colon cancer and had an ultrasound that showed a colonic mass. She needs a colonoscopy to confirm but then what? She doesn't have the money to treat the cancer and we can't fund it. So unfortunately we provided her with all we could knowing that she needs more. We see very sick patients. A lot of diseases which I may never see again in the states and I want to help them all, but it's not possible. It makes me wonder what all the millionaires and billionaires do with all their money. Imagine if they put it toward helping others. It would save a lot of lives.

I forgot to mention one of my favorite patients. She is a 16 year old Filipina, who came in because of lumps she found in her breasts. She spoke English so I talked with her for a while when she first came in last week. I set up her neb treatment since she had asthma and sat with her and she told me all of her fears about having cancer. She was terrified. I listened to her story of her uncle who had died of cancer young and how she helps support her family, only coming to the clinic on her way back from school. The physician who saw her was vey concerned by the presentation that this could be cancer. She came in again Monday to get money for the ultrasound and I gave her a hug and wished her luck with comforting words. I was rooting for her. Well she came back yesterday with the results and it was benign!! The lumps were fibroids, there was lymph node involvement and nothing that suggested cancer. She handed me the results, and as my smile got bigger and bigger as I read it she stopped and gave me the biggest hug. This is just another reason I love medicine. You form relationships with your patients that are unlike any other. 

Well after clinic I finished my presentation which I'll jump ahead to saying went well at dinner.after finishing the research I worked out and went to the dock to finish stretching. I attracted some Filipino onlookers who were probably wondering why I was contorting my body into 50 different positions. What a weirdo. Dinner had fried bananas again. And pineapple! All my favorite fruits today. We had fresh coconut milk out of the coconut after that is just out of this world. The nights always end with sitting on the porch with everyone laughing and having the best of times. I can't believe it's half over! I don't want it to end.

Day 15

So my computer decided to die like I already said from who knows what. Maybe it caught a computer bug...literally. Like Japanese encephalitis or something. Anyway I'll update from my phone which should be fun and filled with autocorrections. 

So yesterday, after waking up frustrated by my computer I decided to run off my anxiety in the morning. Now I was pretty upset (my whole med school career is on this computer) so I had to fake a few smiles and happiness as I made my way through the small town. Even so it was hard to really do that. The people are so genuine that they actually made me feel better, and again they put life in a little more perspective. I mean I was the one upset over a computer problem. I'm not perfect by any means though. After the run I ate breakfast and headed to clinic. It was going to be on hell of a day given the number of people already lined up as I passed on my way back to the dorms. I was put in the student room today with Daniella and Dave. Woohoo!! Represent FAU! Dave is a fourth year from Tulane who watched over us. I haven't been paired with him thus far till today. Dave arrived to the Philippines with the most impressive mustache I have ever seen. He is also a member of the med frat at Tulane. We have 5 of their 13 members on our trip, all of which are equally entertaining. Daniella and I switched off on who did the H&P and who scribed and a good amount of our cases were quite complicated. We had a back pain come in first that bad multiple other complaints that were possibly due to a cancer or uterine cysts/fibroids, who we prescribes medications for and recommended come back if they didn't help her pain. Best case scenario being a muscle strain alleviated by the medications. Our other patient this morning was my absolute favorite. She came in with the complaint of rectal bleeding which we did a full H&P on, including Daniella getting the honors of performing her first rectal exam. Most likely cause was hemorrhoids, with a possibility of cancer, ulcerative colitis or diverticulosis. She was my favorite however because of how sweet she was. She sat there in such awe and amazement of us, telling us that we were so beautiful and it made her the happiest person just because she got to meet us. She said we looked like the movie stars on TV and just flattered us constantly. When she left her appreciation for the time we spent with her was evident as she embraced us both in the biggest bug with kisses on the cheek. That lady made my day. 

After lunch we cranked through more patients. Some basic coughs and colds, a fungal infection, and a cyst that needed surgical removal to name a few. Dave was a fantastic mentor. He gave great tips along the way and i felt like I really learned a lot working with him. We hit a record for how many people came today. It was a zoo. Clearly the word is out and people are flooding to our clinic. I definitely would love to do this again and come back at the next chance I can get. One of the ENT surgeons, Dr. Nachlas was removing a pre-auricular cyst that was amazing to see. Facial surgery is incredible. Another patient came in with swelling of this right leg that looked almost like elephantitis.  He wasn't my patient however so I didn't get to see how his case went. Daniella and I killed it in the student room. We were a pretty great team. Clinic ran late and it was nice to finally head back to the dorms after an exhausting day....not like every day isn't exhausting. But so worth it.

I did my inanity workout with a timer and list of exercises. It was less then exciting without Sean T yelling at me but it has to be done. Computer or not, no excuses. Dinner was phenomenal, and we had the ENT's give a talk on their experiences and surgeries. They were saying how medicine here is so wildly different. The OR's are questionably sterile, as the staff soaks and keeps tools and gauze in cleaned out peanut butter jars and mason jars. The patients aren't told not to eat so they have to reschedule, or by the time they come in they are knocked out so the ENT doesn't even have time to consult them. The windows are cracked as cars fly by outside, and the room is boiling hot. Gives you an appreciation for healthcare in the US. In an ENT office in the US, you can go in, get a CT in the office and have it read with a diagnosis in 15 minutes. Here CT's are barely available for the people. Everyone complains so much about it but it could be so much worse. Poverty is a whole other thing. In the US poverty still means you have a cell phone and TV in most cases with food stamps. If you show up sick to an ER, you are still cared for and treated. In the Philippines poverty means you have nothing. Food is scarce and if you can't pay up front at the hospital when you're sick, you are left to die. It's a whole different world.

Anyway, we all hung out for a while after dinner laughing and being silly as per usual. We got ice cream tonight which was the greatest thing ever and which we all thoroughly enjoyed. One of the ENT's daughters, Courtney came on the trip. She's a journalism major going into her second year at UF, and is doing an article for the magazine she works for, Blindfold, on our clinic. Ill be interviewed tomorrow. 

I didn't get to bed until 11 which is just crazy. No morning run tomorrow for me.

Day 14

I woke up around 6:30 today and decided for whatever reason it would be a good idea to go on run. I think it’s more because I just wanted to listen to my ipod and clear my mind for a while. It’s very relaxing and plus it was a beautiful morning. The clinic was already getting packed with people waiting. Clearly Mondays are crazy regardless of where you are in the world.  I was working with Daniella and Dr. Ashik today. There was no water all morning so that dehydration headache kicked in super fast. By the time lunchtime came I thought my head was going to explode. The first patient we saw was a man with uncontrolled diabetes, who had a pressure ulcer on his left great toe. I assisted Daniella in cleaning and debridement of the ulcer. Well Daniella did the debridement, as I watched. I don’t know what it is about feet but I could not be a podiatrist. The man had absolutely no feeling in his feet as she took a scalpel deep into the ulcer, cutting around the skin to approxiate the wound margins. It was like a physcian’s way of giving a pedicure, and he was very happy by the end of it. As Dave said when he came in to observe us, “This man is probably having the best day off! No work, laying in a cold air conditioned OR and two beautiful ladies tending to his feet.” That was the reality of it most likely. 

A lot of the pictures today are of some of the patients that came in. There was a high acuity in our clinic today. We saw a lady whose left leg was so infected and actively weeping that the skin was just sloughing off of it. It looked a lot like a scalded skin syndrome. Another child who came in, who was 7 years old but looked more like 2 presented with MASSIVE ascites, and caput medusa from some sort of portal hypertension from an unknown cause. Possibly a TB related problem, but he’ll need a further hospital workup which is where we sent him. It was incredibly impressive to see in such a young child. Later we saw a toddler who came in with a cleft palate, and a teenager with syndactyly (webbed fingers) that we worked up and will also require surgery. 

Lunch couldn’t have come soon enough, mostly for the water that I desperately needed. And it was such a cure! I felt so much better in the afternoon. It was like I transformed into Ironman, and Ashik and I just cranked out patient after patient. He’s a fantastic physician. Only 25 years old, with the knowledge of a walking medical textbook.

 So anyway, this afternoon I gave a lot of shots, one being an IV, for a hypertension lady, another being an IM shot in the buttocks for pain. I love how the experience is so hands on and that we have the chance to take what we have learned and apply it go real time medical situations. At this point it has become so comfortable, I don’t even think twice if someone asks me to give a shot, set up a line, or help suture a wound. I know I have so much to learn and quite a journey ahead of me, but one thing I know is how much I really love medicine, and doing what I am doing.

 

So switching lanes a little bit, what’s actually very interesting about the Philippines is how prevalent hypertension and diabetes is in this country. I mean, it is also very prevalent in America, but the Philippines doesn’t have the obesity problem our country does. I think the issue draws from their diet choices. They eat a lot of fruits, but vegetables are very limited in their diet. Meat is the largest staple, with a lot of pork and fish. However, the culprit most likely comes from the sauces that they use which are heavily salted. Delicious but heavily salted. I have the edema in my ankles to prove it, and Dan has a little bit of pre-hypertension.

 

When the day came to an end with yet another ulcer debridement, we walked back to the dorms in a state of exhaustion. Today is my rest day from insanity and I really needed it. The night was absolutely stunning. The night sky was so clear and there was a harvest moon that shined over Sorsogon bay. The power ended up going out with wasactually  a blessing as we all stayed out star gazing and enjoying the picturesque night view. I have to pinch myself sometimes to make sure that I’m not dreaming but actually living in one of the most amazing places on earth. Best summer ever. 

Day 13

We all woke up a litle desheveled this morning. Walking into the dining room was like walking into the Vegas apartment in the hangover….I was expecting to find a tiger. Only a monkey here though. The ENT surgeons arrived, one who brought his OR nurse and daughter along with him. I almost felt bad for the state of being we were in when they walked in. We all looked exhausted, and fixated on our coffee as we made our introductions. It’s just going to take a little time to pick ourselves up today. We decided to cure this with a nice run up some trecherous hills through the Filipino jungle in 90˚+ weather and 100% humidity. All of the kids on our grounds joined us for the run, and finally caught up with us as we were heading back. I carried Alana on my back for a while. She’s the sweetest little thing. Jack Jack came along with us which I loved. He’s so shy, but such a sweetheart. I let them play with my iphone (under close watch of course) as we headed back. I promised my parents I wouldn’t bring back and Filipino children. Darn it.

The lunch today was incredible with one of my favorite things, Lumpia. Plus we had mangos AND pineapple so I was thoroughly satisfied. I wish I was hungrier, but I never am right after a workout. After lunch we threw on our bikinis and head to a nearby cold springs, also filled with water that comes down from the nearby Volcano. It was a perfectly relaxaing afternoon, and the weather was beautiful. We spent most of the time in the pool, with some kareoke and billards played in between. Puspa killed the boys at billards, which was expected since hehas asked everyday to play with some of us. I personally like watching Rob and Dave kill it at Kareoke. It is probably one of the top 10 funniest things to watch. But I get a kick out of every time Rob speaks. The boys in our group are just wildly entertaining. At this point in the trip, we are quite the dysfunctional little family. I think we’ve had one of the boys claim the extra bed in our room every day the past few nights because our room smells much better and is clean. I can confirm that that fact is true. I know that I was getting burned no matter how much sunscreen was poured onto my body, and yes I mean poured! I swam in Banana Boat I think and it did nothing. As the medial students that we all were, upon leaving the cold springs we insisted upon going to Sorsogon before going home to pick up some Aloe Vera.

Appraently today is the first day of the summer solstice. Being away from internet, and not constantly being connected through technology to the outside world is actually quite nice. Not having the urge to look at my phone or check my email or getting right back to a text message is a great feeling. And maybe that’s why the people here are happier. They live in the present, and take the time to enjoy their surroundings enough to make it meaningful.

 So sorry Lali, whose comment I just got to read above. My time on a computer/phone to type this up is limited, and I don’t go back and re-read this. So errors are going to happen. And after writing this I have to wait until the day we take a 30 minute trip into the city, where I find a wifi connection at the local diner and wait until I connect to their slow internet connection (which by the way kicks me off every 5 minutes). So uploading everything, especially the pictures is a little more difficult since it takes over a hour or two. Grammar? Paragraph spacing?....first world problems.

Day 12

I didn’t sleep in at all like I expected. I woke up around 7am and decided to go for a run. Jack Jack who is 9 years old decided to go along with me on my run. He ran in filp flops, and I was thoroughly impressed. I ran a bit ahead of him and then back just to finish it up, and collected about a dozen other kids on the way. They all walked back with Jack Jack and I for quite sometime. Once we got back to clinic Jack Jack still stuck it out and followed me to the dock. I slipped down the stupid rocks a bit and scraped my forearm, as Jack Jack gracefully got himself to the bottom. I stretched for a bit and did a ab workout. It was absolutely beautiful and peaceful. I love running, and running through the jungle of the Phillipines is just surreal. I’m not sure my DC runs will compare anymore. As soon as I was finished I showered and threw on my bikini because we all were getting ready to take the fishing canoes out. It took 2 boats to carry our group and we stopped in the middle of Sorsogon bay. What an incredible view! The mountains looked as if they were painted around the water. We jumped in for a swim, and it was pretty deep, well deep enough so that I couldn’t see or touch the bottom. AND I was so proud of myself, as I swam from one boat to the other with ease! My swimming skills are less then superb as some may know, so this was quite an accomplishment. We dove and flipped off the boat into the water and had just an absolute blast before heading back for lunch. I was one of the fortunate ones who didn’t get stung by a jellyfish. So far I’ve been dodgeing some bullets this trip….just awaiting my time.

 

After lunch we packed ourselves in the Jeepney to head to a white sand beach about 30 minutes away. Crank up the Call Me Maybe once again! It was overcast for the afternoon which was unfortunte but didn’t stop us from having an aboslute blast. The water there was warm and so calm. We had a small cabin to hang out in and the afternoon turned into just another party. They had some vendors at the beach that craft the local shells into beautiful jewelry, sculptures, keychains and hanging decorations. I haggled for 2 keychains I can take back as memories from this unbelievable trip. There will be more souvenir shopping later for sure.

 

By the time we got back dinner was out and ready. We had a long night ahead of us, as Momma Tess (Dr. Schuster’s wife) planned and set up a disco on the grounds. Momma Tess is absolutely amazing, and the master behind the amazing dishes we are so fortunate to eat.

 

We had strobe lights and neon lights illuminateing our back porch with music blasting from the stereos that transformed our entire dorm into Club Bicol. Filipino familes and children from the local area also came out and we danced the night away with all of the children. Let me tell you they are AMAZING dancers. The kids are out of this world. I had so much fun dancing and playing and singing with all of them. It was truly one of the best nights. I aboslutely adore the kids. They started a game with me where they’d run around and tickle me trying to get me to chase after them. It lasted quite a while but their energy level is much greater then my own. The little boys were obsessed with Zach who is 6’8 and was throwing them into the air like a basketball. They couldn’t get enough of that. I think this is the first time I even mentioned Zach’s height. Well he is very tall to say the least, and since the Filipino’s are generally very short stature, he stands out quite a bit. I’m sure in the near future the boys will be challenging the Filipino’s to a basketball game at the school nearby, and I can’t even imagine the look on their faces when Zach hits the court. Anyway back to the Disco. The song of the night had to be PSY’s Gentleman song, and the kids taught me the dance to this song. They also taught us a few other dances characteristic to their culture, so get excited when I bring back those moves America. We danced the night away and I didn’get get to bed until about 2am. The ENT surgeons and Brigitte, a second year from FIU will be joining us tomorrow. Hopefully we’ll be put together by their time of arrival.

  

The boys attempt to dance