Over the past few weeks, I have become fluent en Espanol (pronounced: es-PAN-owl). This is because Kelly, Clodagh, Ronnie and I are heading to Peru and Bolivia in the morning! Having completed physiology and my second Community Week in Boone, North Carolina, the four of us are going trekking in the Amazon for Spring Break 2010. Originally we were dead set on climbing Machu Picchu, but unfortunately incessant mudslides and flooding have kept us from our dream, as the trail is closed through April 7th. Luckily, however, thanks to the quick work of Gregor (my BFF from GlobalBasecamps), we were swiftly switched to a luxury tour of the Amazon Rainforest within days after the closing. (P.S. - This is why you go with an American company for foreign travel bookings. Slightly more expensive, but you save tremendous amounts of hassle, and, when natural disasters get in your way, you have no worries, and you get full refunds and compensation for your troubles.). So, tomorrow morning at 4 am, the four of us will head out and add another 2 entries into Robby's list of "Countries Where I've Drank a White Russian."This past week, before the packing and road trip back to DC, I spent my second Community Week in the mountains. It is amazing the things I've learned after just a few short months. Anatomy and Physiology have given me a much better appreciation for why physicians do what they do during office visits, and why they order tests. Those two classes have shed some light on the process of developing a differential diagnosis (note that Histology has been absolutely zero help so far in medical school). Words like, hydronephrosis and biliary atresia, actually mean something now. There is a rhyme and reason as to why a physician checks a patient's reflexes by tapping just under the knee cap (patella). I now know why that reflex response occurs (detection of changes in tension by the golgi tendon organ), and what the absence of that reflex could mean (perhaps receptor damage, cerebellar lesions, or peripheral nerve disease, with possible involvement of the dorsal sensory column of the spinal cord). With every detail I learn, I realize just how much more information there really is out there. My preceptor in Boone has been a Pediatrician for decades, and even though he keeps up with the current literature, it's his rote knowledge and intuition that is so impressive. It's daunting how much work I will have in the years to come.
And I still need to figure out how to make a sturdier airplane out of tongue-depressors.
If you were to ask me right now, "Robby, what specialty will you choose?" I would probably say Emergency Medicine. But I love kids. I can totally see myself picking a 4 year EM residency program where I can specialize in ER Peds. I don't know if I could work in a private practice like my preceptor; I enjoy the hustle and bustle of the emergency department. But children are so innocent and just flat out adorable. One nine month old patient (let's call her Rachel), was absolutely perfect. She giggled when I let her hold my stethoscope and "found birdies" in her ears. She laughed when I tickled her and checked her reflexes and strength. I stayed in the room so long, taking a full history and performing an extended physical exam, that my preceptor had already finished with his last patient and barged in before I was finished (that's a rarity, let me tell you). Rachel's mother later called the office to tell the staff how wonderful I was with her child. If that doesn't get you ICM bonus points, I don't know what will. It was a hell of a morning; every kid we saw was cuter than the last, and not one of them cried. I think the afternoon made up for it though.
I have been known to knock, walk in the room, and have the kid take one look at me before bursting into tears. In these cases, I let my preceptor do the physical; somehow, apparently, I've already made the kid mad enough to cry.
I know there's a long way to go, but I'm glad we have these opportunities to get into the community. Between these weeks and EMS, I'm excited about medicine again. It puts all that studying into better perspective.
Peru, Bolivia, Five Star Nerve, Vegas, and Microbiology/Immunology, then off on a Scandinavian Cruise! My first year will be over before you know it...
Hasta luego!
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