Rotations at the St. Maarten Medical Center

Borrowed this from Benji's Blog

You finally get your first little taste of clinical medicine during 5th semester. The ICM department requires all fifth semester students to sign up for two rotations of your choosing and they can either be at the St. Maarten Medical Center in Philipsburg or the Mullet Bay Clinic right by school. There are one-hour rotations and four-hour rotations and the specialities available are as follows: Pediatrics, Family Medicine, Surgery, Anesthesiology, Emergency Medicine, Radiology, Dermatology. There may be a few more, but I can't remember them as of now. I ended up doing a one-hour rotation in pediatrics way back in early June and I just had my last rotation, a four-hour emergency medicine stint two weeks ago. Seeing that I am required to write a reflection of each of my experiences, I figured why not just make a new blog post out of it. The alternative would have been writing a poem, singing a song or doing an interpretive dance... And you think I'm kidding.

Pediatrics

I ended up rotating with one of my good friends and two other AUC students for this one. The four of us plus a team of nursing students pretty much ran around with Dr. O for an hour going from room to room learning about each of the patients inside. We started off in the neonatal intensive care unit and saw a some really tiny, tiny babies. They were premature and needed to be put in incubators since they didn't have enough body fat to keep themselves warm. We then looked at another baby and Dr. O asked us what was different about him. After a few minutes we determined that he had Down's Syndrome. It can be tough diagnosing it at such an early age, but there are some tell-tale signs physicians can look for like the "sandal gap deformity" where there is a wide gap between the big toe and the rest of the toes. You can also see excess nuchal skin of the neck (also seen in Turner's Syndrome), Brushfield spots in the eyes (little white deposits of connective tissue in the iris arranged in a concentric ring). Not always, but sometimes the infants can have the "typical" facial features of Down's syndrome like the flat nasal bridge, and upslanting of the palpebral fissures. And usually a lot of these newborns are hypotonic, requiring a lot more support from examiners to hold up their head and shoulders, while the arms just flop back with gravity.   

Nuchal Skin Fold

Sandal Gap deformity

Brushfield Spots

After leaving the neonates we then went and saw some of the older children with their parents. I can't remember much of what we saw during this time, but I do remember two children in particular. One was a little boy who was diagnosed with asthma. I just remember seeing him sitting outside in the tripod position with his labored breathing. Dr. O pointed out the movement of the child's chest while he was breathing. It was just going in and out very rapidly, which is typical to see when someone is having an asthma attack.  The last patient I remember distinctly was a young teenage girl who had Sickle Cell disease. This also happened to be my first real pimping experience and I failed miserably. Dr. O asked me how someone gets Sickle Cell Anemia and I nervously and not-coherently started getting into the genetics about the glutamate to valine mutation and the recessiveness of the disease and all this other stuff when he cut me short and said he was only looking for "it comes from the parents". That was my "oh" moment and I felt a little silly. I'm not sure how I'm going to handle pimping during rotations when I can barely form a cohesive sentence to a simple question like that. Dr. O then asked what kind of medication you give to Sickle patients and the answer was hydroxyurea. It's funny he asked that because literally two hours later during pharm, our professor taught us about hydroxyurea in class. It's used because it increases fetal hemoglobin production in Sickle Cell patients, thereby reducing the dependence on HbS. The same question also appeared on our final exam, and I knew it without thinking thanks to Dr. O. It's funny how much easier learning material is when you can actually see it in a clinical setting. I think that was my main take away point from my peds rotation. Actually seeing patients with certain conditions just stays with you; Reading it from a book.... not so much. Seeing it and then going home to read about it and reinforce it-- even better. I can't help but get excited for clinicals for this very reason.    

Emergency Medicine

I heard that this rotation was hit or miss in terms of how many cases you would see. It was definitely a miss for me, but it was no fault of anyone, just the luck of the draw. Maybe part of the problem is that I went to the emergency department for four hours on a very sleepy Sunday afternoon... I probably shouldn't have expected much. I was the only AUC student for this rotation and basically just followed Dr. B around as she saw a couple cut and dry situations. One guy was brought in by his wife because he fell on his shoulder while playing soccer. Treatment? Sling and a pain killer. Another lady came in because she fell down and sprained her ankle. Treatment? Pain killer. There was an older girl who came in for a terrible migraine. Treatment? Turn the lights off, comfort her, and let her rest. There was an Italian couple that wandered in with a pushy third friend who served as our translator. The woman was on Warfarin but had been having vaginal bleeds for the last week so they were looking for an INR to measure her coagulation. 

The most interesting event of the day ended up being my last case of the rotation and it was when a 6 year old boy was brought in by his grandmother because of a cut on his head. Apparently he had been cut by glass and he required stitches. I had never seen anyone get stitches before and I didn't want to be in the way so I stood a good 10 feet from the table watching in horror as Dr. B sewed the little boy's head up while he squirmed around. The cut was superficial and only needed 4 stitches, but I'm just not used to seeing blood. My recurring thought was what if she sticks him accidentally in the skull? I was standing so far away one of the nurses physically grabbed me by the arm and pulled me right up to the table and was like you need to watch this! And I'm glad he did because after I got over my initial fear of seeing a needle go into someone's head, it was actually pretty cool watching Dr. B at work. After seeing that relatively simple procedure, I think I may actually be able to stitch someone up myself now. Any takers?

Related Articles:
Benji ended up doing Surgery and Emergency Medicine during his 5th semester. To read his experiences click below!
My Day in the O.R. (caribbeanmedstudent.com)
My First Taste of Emergency Medicine (caribbeanmedstudent.com)