It's been a long time - Ebola woes

So yes, it's been quite some time. I wanted to mention how things are being progressively blown out of proportion for Ebola. There are several reasons why Northern America will survive this thing, especially being that the problem in Liberia etc. is that they just do not have the capabilities to treat infectious diseases like we do.


This case exemplifies why they have the issues they do - a family whose father is severely ill, sent to a local hospital, and in the course of the night he dies. The hospital is unable to tell them whether the patient died from ebola or not, because they don't know where the test results are.

This is typical of a developing-country healthcare system.

The issue that occurred in Dallas was essentially that administrators, being part of a for-profit system, do not take proactive measures unless there are dollars in jeopardy. This is not the case until people start either dying or suing.

We should therefore expect in the coming weeks that someone high up in the hospital or government will get fired.

We should also expect there to be a few more cases (one if we're lucky) around 25 OCT- 05 NOV 2014 (Halloween!) due to new infections and/or new influx from western Africa.

Hopefully this will all blow over soon.

Miami heat

So I've sucessfully moved to Miami in this cozy little room upstairs in an Argentinian couple's house. They rent out the place to medical students all the time and things have been full of work, except for the fact that I have suddenly been super dizzy (for my medical peeps, I've been trained to NEVER use the word dizzy and instead use more accurate terms, in this case vertigo).

I had intended to write more on this blog, since I've been here since July 9th (which was also another deal). However this thing has knocked me OUT.

I've been unable to go to work at the hospital on random days, especially since it's randomly impossible to sleep since I feel like the world is spinning and I'm on a constant free-fall.

Unbelievable.

I've since been diagnosed with Vestibular Neuritis - which is essentially and as far as we know an infection of the inner part of your ear that's responsible for balance, by a virus.

Virus = no medications for it.

So essentially I'm stuck like this for 2-4 weeks. Which is fine, since there's no permanent damage, but it really sucks since I'm feeling like what we call in the navy a skiver - someone who gets away with not doing work - and I also have not really been feeling well enough to go out and discover Miami.

I'm just in a rut in my bed with randomly doing questions from the online tests to prepare for the boards part 2, watching netflix, and just reading. When I don't feel like I'm in orbit.

Hoping this thing passes soon, and I an live life again.

Evacuate

So these six months are pretty much the worst I've ever had to go through in anything. Seriously things are so terrible that I've just wanted to quit and go home and I've asked for a transfer out of this hospital but no dice- the municipal government is in charge of all this and they won't let any switching of horses mid-race.
So here's what's so bad.
There's a specialist who comes and sees the patients like any other hospital system. But in Mexico the attending specialist is not a part of the hospital staff- they are a total free agent and the hospital acts like a health hotel more than anything. And since the attending has no ties or responsibility to anyone but their patient, they leave little to no notes with repercussions.
You can imagine what a liability nightmare this is for hospitals, so how do they get around this?
Enter fifth-year interns.
Since there's an extra year of training not done anywhere else, it's a fifth year's job to read the specialists' mind and write out or copy the progress notes that an attending wrote/ did not write. Coupled with that we also do a full clinical history, and then proceed to re do the entire history again in a different format called an intake form. Same info, different form.
All this leads to a hell of a lot of paperwork that just ends up in litigation standby just in case someone sues the hospital, and is not read by anyone except the boss, who is in charge of correcting spelling, grammar and syntax. Every day.
We also are on call every third day to essentially do said paperwork any time of the day.
This leads to a schedule where we get anything resembling over 24 hours off only every three weeks.
And we were just told that we have to attend mandatory classes on Saturday, even if this lands on that sweetest of times when you get more than 24 full hours off.
All this for $60 dollars every two weeks of work.
And this is one of
the -good- jobs in this country.
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Had a fantastic resident tonight who gave me the confidence to write out full charts. I can't believe how terrible most doctors are when it comes to teaching and managing subordinates and tonight just drove that point home; the resident was kind honest and superhelpful in ways that should have been as soon ad I arrived and was working. I guess the difference is that great places of excellence are able to recruit individuals who have the ability to inspire confidence and know that's what they're looking for- the bad ones just recruit randoms or easies. So as always the most important factor is to figure out what you need and then setting up a framework where everything you do points to that.


If your need is to own a fancy car and be able to park it in a handicap spot - like the guy above - then you have your work cut out for you.

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I am a big fan of doing whatever you can where you are and taking full advantage of social engineering to further your goals ESPECIALLY educational. It comes from a petty officer I worked with in the navy, PO Gardner who always was asking "what else can we do?" and always had an answer. I definitely was inspired by that method of thinking and it's always served me well.

This last day of mine I was able to schedule a ride along with paramedics. This is a wicked opportunity to learn just how the sickest and the most hurt are found on the scene and how they're initially treated and taken to the hospital by the EMS staff. The crazy thing is though that this is run out of the fire department! So I'm at a fire station!


- and a kinda fancy one at that. After two hours on the public transit system (by the way foothill transit is now most comfortable public transit system in the world from what I've seen) I made it to the fancy part of a city way east of LA.



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I'm going to miss these walks in the dark through east LA. It's interesting how time is a factor usually forgotten when it comes to judgement- at first two shadowy figures are walking towards you and ou feel apprehension but then they walk by and it's not a problem. Same people and two different reactions that you have against them.

So why when it comes to how people act towards us we judge someone and then label and treat them accordingly? Shouldn't there be some reevaluation that takes place?

The resident that I was working under I felt was very hard to read the entire time I worked with her. I wasn't really sure if I was doing a terrible job or a great or even ok one- there were times when I felt like I wasn't making her standard so I would pull back from making written documentation and she would tell me "no it was great;" similarly I can come up with plenty of situations in the opposite direction.

When all was said and done and my time with her had finished she said that I had been one of the most improved ever - she had thought that I would be such drag and she would have to make up for my failures -which she did at first- but by he end of it all she was quite prepared to trust me in taking full control of a patient.

Usually you learn the most from the ones who you find most annoying - they're most different. If you judge them as awful then that just places you further away from being able to learn from them.


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Burn the bridge of your choosing.

Well things have been fairly peaceful- the patients I've seen are really complex usually but atraumatic. This is good for the patients and the workers here sine there's less stress for all parties but it sucks for me since that means that I'm spending most of my time with people that really should be with either their family physician or are heavily in internal medicine - and the way the system is setup in Mexico we haven't actually done rounds in internal medicine so we are at an incredible disadvantage when it comes to that.

However

That does mean that I can take the time to catch up so to speak. I also have a resident who is particularly anal about charting too which means once again I feel like an idiot since I'm so behind in the knowledge factor and she gets fairly annoyed at my ineptitude early on- but that's what it takes: you will always burn your first bridge, be it for the step, for any test or any skill. The trick is that if you know you're going to burn your first anything, to make sure that that is the first purpose.

When you start to learn how to play guitar you don't pick up a thousand dollar model. Your first car shouldn't be a mazzeratti (sp? I know nothing about cars, natch!). And your first rotation in a specialty or your first shift of any job will be incredibly inefficient while you learn where everything is at.

including the "drink ice chips" box.

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