That time when... med school kicked my butt

Second year of med school has been a blur so far. I arrived back from my trip to Africa on the day my classes started, literally dropped my bags at home and went straight to class. I do not advise doing that and will not be doing it again.

My brain was not ready to jump from Chad straight to classes. So while I tried to adapt to being back, I started running behind class materials and felt like I was playing catch up. The entire semester. My stress levels went to record highs, and I even had insomnia, something that, with rare exceptions, I had never had. I passed all of my classes, but my class ranking suffered a bit and I'll have to work extra hard to recover.

The result is that I finished the semester utterly exhausted. But since I'm an overachiever at heart, instead of taking advantage of winter break to recuperate before second semester, I went ahead and signed up for an elective. Because I'm insane. I did escape for a week to go to the beach, because I felt that I could simply not start 2nd semester without recharging my batteries at least a little bit. I'll talk about that on the next blog post, suffice to say, it worked! A week in paradise was just what the doctor ordered. :)

However, I realized that I need to cut myself some slack, and not be so hard on myself. This semester was pretty tough, but I passed. Beating myself up because of class rank is stupid, and I know I can do better next semester, when I won't start out stressed and already playing catch up. Plus, we start out with Neuro and I love neuro!! So it should be fun.

So the two lessons to take home are: 1- don't come back from a stressful trip to Africa (or elsewhere) the same day your classes start. Give yourself some time to arrive and adapt before classes start. 2- do your best and don't beat yourself up if the results are not exactly what you expected. After all, it was just 1 semester and I passed!!

Mentors

Even before I started med school, I knew that I would need a good support system. And I knew that was going to be a little complicated, because I was moving to a country where I knew nobody at all. I have good friends, but the closest to me geographically, are still in the next country. It's 4hrs away, so it turned out ok and I get to see them on a somewhat regular basis (money and time being short and all.)

I also knew I'd need mentors. I had never actually had a mentor, so I didn't know where/how to find one.

Then I went to Africa and worked with Dr. Scott. Before I went, I had no idea if we'd get along, I was even a little aprehensive. But we got along great, he taught me a lot, trusted me, and told me to come back any time. So I went back, and learned even more. I know he'll be there for me if I need help or encouragement, and I'm lucky to have him.

Last year, I had also contacted a Neurosurgeon from the US about an article he wrote, and to my greatest surprise, he wrote me back, gave me his phone number and told me if I ever had any questions, to feel free to contact him. I am planning on working with him in the near future, so we've emailed a few times, and even though we haven't met yet, I feel like he's also becoming a mentor, and I'm grateful for that.

To finish, I recently went to a neurosurgery congress and met another great neurosurgeon. It was a small congress, and I ended up talking one-on-one with him on numerous occasions, about medicine, but also about philosophy, injustice and traveling. He gave me some great advice and also invited me to do a rotation with him when the time comes (I'm still an MS2).

I can't believe how lucky I am, that without even trying to, I have found myself 3 mentors. Three great surgeons and great human beings, to look up to, ask advice from, and generally have "in my corner," should I ever need help or get discouraged.

To all of you pre-med, med students and residents out there, find a mentor. At least one. Someone you can trust and who can help keep you motivated, inspired and give you a little push once in a while. We all need it. :) 

Neurosurgery

I'm on cloud 9 right this moment. Sorry it's been a while since I wrote, but I got back from Chad on the day my classes started, had a friend come visit, then my mom, and between studying and trying to get my life organized, time got away from me.

But I just got home after being out of the house for 15hrs, and had such a fantastic day that I had to come and share. Let me explain: today was my 1st ever medical congress, and it happened to be a Neurosurgery Congress.

I am a lowly 2nd year medical student, and even though I've done and experienced a lot more than your average 2nd year, none of it was in my country and my university doesn't know anything about it. I get no brownie points for going to Africa and assisting in surgery, or doing internships in hospitals in Germany. Therefore, I am really, just a lowly 2nd year med student. Who happens to be fluent in French.

The guest of honor and main speaker for this congress, was a heavy weight French neurosurgeon. I had obviously googled him prior to the congress. This morning when I got there, imagine what isn't my surprise, when the 1st person I see, standing alone close to the door of the auditorium, is The Man Himself! So I smiled and said "Bonjour" to which he replied "Vous parlez Français?" To which I replied in French and we somehow immediately fell into conversation. It was just 30 seconds, but it was enough.

A little later, we had a coffee break. This is a small congress, so most people already knew each other and I was the only med student, lost in the crowd, nursing my cup of coffee. The Neurosurgeon guy comes, all by himself, talk to me. We end up talking for about 10 minutes, I tell him a little about myself, ask for advice, and walk away with his card and **an invitation** to come do a rotation with him, once I get into the clinical years! YES!!!!!!!! I am over the moon!!!!

As if all of that wasn't enough, I later met a team of Neurosurgeon/Neuroradiologist/Radiotherapist from Brazil (and I also speak Portuguese!) and one of them said casually that if I wanted to come do a rotation, I'd be more than welcome. I didn't let that pass and immediately got their contact info and even went so far as to suggest a possible date (winter break, I have 3 weeks off!).

You'd think the day's riches had been exhausted, but they weren't. The French Neurosurgeon *comes back* to talk to me, and we start talking about travel, philosophy, and of course, Neurosurgery. The guy is simply awesome. Not only is he a great surgeon, but his holistic philosophy of care and his emphasis in Quality of Life above Overall Survival is something I had always thought about.

Just to sum it all up:
- I befriended a world renowned Neurosurgeon and got an invitation to do a clinical rotation with him in France.
- I befriended an entire Neuro-onc team and also got an invitation to do a rotation with them in Brazil.
- I learned A TON about the latest treatment options and diagnostic imaging for brain tumors + made a list of things I don't know/didn't understand so I can read up and catch up.

Today was a really, really good day. The only thing I didn't do was make any local friends in Neurosurgery, which is kind of a downer because they're the ones who can let me into surgeries here and now. But hey, there's still tomorrow!! :)

Back home

Sorry guys, I got busy and sad and then in a whirlwind I was back in Berlin for 4 days, in Paris for 14hrs, then flying home. I arrived Monday at 11am, went home, ate, showered and *went to class*!!

I am exhausted. It's Thursday evening, I got back from class a little while ago and all I want to do is sleep. But I have to study. And my mom is still here. So I'm procrastinating and writing a blog post. Mom leaves tonight.

I only had 4 days of class, but I feel like I'm so ridiculously behind already. One of the profs definitely loves the Socratic method, and is pimping us hard. I also met the 1st gunner and wow, she's annoying.

I guess I better get my act together, or this semester is going to kick my butt!!!

I'll write more about Chad later, there are still many stories to tell. :) 

Leaving Chad

I'm sitting at the brand new, air-conditioned airport, remembering the 1st time I left Chad. The airport was little more than a hot and humid warehouse, with bad lighting and lots of mosquitoes. They had a turnstile gate-like thing, that you had to push and be pushed, to show your passport, pull your luggage and attempt not to lose a limb in the process. It was crazy.

Now it's organized, squeaky clean, with air conditioning which actually works. Today was 45°C and I was dying. Now I'm almost cold. *Almost.*

I'm sad to be leaving. Last time, I knew I was coming back, and even then, it was hard to leave. Now I know that I will probably *not* be coming back, or at the very least, not to Moundou. You see, Dr. Scott is leaving at the end of the month, moving to Sierra Leone. The hospital will be managed by a Chadian family practice doctor and a nurse/surgeon who will do the operations. No more western doctors or volunteers. If I do come back to Tchad, it will be to Bere, our sister hospital. But I'll feel like a guest there. It's not my hospital. It's not my African home.

Weird, I know. But I have too many memories at this hospital. Good and bad. Tragic and funny. Profound and silly.

I'm gonna miss Tchad, the hospital, the patients, and the people I worked with. I leave you with a few pictures of random moments.

Life in Chad.

The OR crew

Tite, our dressing changes expert!

We did a first-aid refresher course

Surgery w/ Dr. Scott

Suturing

Cute patients learning 

how to walk again

Riding a donkey

Football/soccer game

Hanging out under the mango trees

Patients with cute kids 1

Patients with cute kids 2

Amputations

Puzzle with peds patients

Lesson of the day: Brush your teeth!!

This was originally supposed to be a funny post. We've had several people come in with dental abscesses, and I always joke with the OR nurses and ask them "What have you learned today?" To which the answer is "Always brush your teeth!"

The 1st time I ever performed CPR on a live person (not the dummies we practice on) was a guy who came in for a dental abscess and stopped breathing on the table. Luckily, it was only for a few seconds and we got him back.

Then we had a lady who had a track of pus going all the way up her cheek and to her skull above her ear. We opened it up and pus just kept coming. Her aponeurosis was necrosed and we had to dissect it out. This is a dental abscess, and here I am, looking at her cranium!! She's an elderly lady, and I was actually afraid she wasn't going to be able to kick the infection. Amazingly, she's doing well.

However, yesterday we had another dental abscess. Young, otherwise healthy female. Huge amount of pus. She aspirated. She desatted, and try as we may, she just kept going south. We were trying to suction the pus out of her lungs, and giving her O2, but nothing seemed to help. After about 15 minutes of having O2 sat between 60-70% and a heart rate above 150bpm, she arrested. I jumped on the table and started doing compressions. I looked at her eyes and her pupils were fixed and dilated. I knew her brain had been without oxygen for too long. She died.

(Here is Dr. Scott's blog about what happened, in case you want more details: https://gardners2koza.wordpress.com/2016/02/25/death-in-the-or/ )

So what was going to be a funny post about the importance of good dental hygiene, became a tragic post about the 1st patient who I've seen die on the table. Because of a stupid dental abscess. It seemed totally surreal. I'll never forget the look on her mother's face.

So if you're reading this, thank your lucky stars that you have access to a dentist, a toothbrush, and toothpaste. Make sure you use it. It may quite literally save your life.

(The pictures below are from the 2nd case described, the elderly lady with pus tracks going up to her skull.)

During the procedure

During dressing change

Call me surgeon!!

I think there comes a moment in every med student's life, when they feel like their dreams are coming true, that they're in the right path, that all the effort (past, present and future) is worth it.

My moment happened when I performed my first surgical procedure (minor!) on my own, from beginning to end. I was supervised, of course, but I did everything. Local anesthesia, incision, disecting the lipoma out, suturing. It was removing a lipoma from someone's thigh, so nothing transcendental, but it was awesome. And it was a pretty big lipoma too!!

I feel like a surgeon. Of course, I have *many* years of hard work ahead before I am really a surgeon, but I'm getting there.

Here's a picture of me, grinning from ear to ear, with the lipoma I just removed!