Blogging is a lot of work! I didn’t realize what I had gotten myself into but writing these things takes way more time and effort than I imagined. Even though I know I could make my blog posts much, much shorter, every time I start blogging about something I feel like there’s just so much to say and next thing you know there’s three pages of verbiage about my week… So I’m not turning out blog posts as quickly as I thought I was going to be able to. But it’s fun nonetheless and it gives me a way to remember everything. Thanks for sticking with me through my long wordy posts to those that read these!
So moving in chronological order, after the family rotation I had a rotation in Hematology/Oncology with the nicest doctor imaginable. The first time I met him I knew he was going to be nice before he even spoke. He just had the eyes of a nice person, if that makes any sense. They looked like the eyes of someone who smiled a lot and for some reason that stood out to me. Anyways, I think it’s a requirement to have an extremely gentle and compassionate personality to do the kind of work this doctor does- it’s very emotionally draining. Hematology deals with diseases of the blood and is often closely linked to oncology. A lot of the diseases are genetic which usually means they can be debilitating or life long and although there are treatments for some things, there aren’t a lot of cures. We saw patients with all sorts of blood problems, some very serious and others not so serious. The day started out with rounds on the hematology floor of the Hospital Eugenio Espejo. Patients whose main problem falls under hematology are hospitalized in this area, so most of the patients we saw on this floor had leukemia. After rounds on the hematology floor we went to the other floors of the hospital where patients were hospitalized in other wards but also had hematology disorders. Most of these patients had some sort of anemia or blood clotting issue. There were about 40 patients to consult with so the process took all morning. We worked our way down the 10 floors of the hospital and went around to patients in internal medicine, pediatrics, ICU, emergency, surgery, and maternity (which was located at the Maternity Hospital across the street). It was pretty interesting to see such a variety of patients, some who seemed like they would make a nice recovery and some who were obviously not going last for much longer. It was a little emotionally draining to see so many patients who had problems that couldn’t be fixed. The hardest case I saw was a patient in the ICU who had cerebral hemorrhaging, which basically means her brain was bleeding internally and creating too much inward pressure, which is a very serious problem. The doctor said the only thing they could do at that point was give minimal life support. It was a sobering experience and everyone was visibly upset by it. I guess I’ve been fortunate to have so far been isolated from the “ugly” side of medicine in that most of the patients I’ve seen in my rotations up until hematology have had fixable problems. I asked one of the residents how he felt about hematology and he said he could never do it as a career because it’s too disheartening to send patients home knowing they will just be back in a few weeks or months. I think I would feel the same way.
On Tuesdays and Thursdays the doctor we were shadowing does external consultations. Patients from all over the country come to see him for prescription checks and refills and for routine labs and/or treatments in the hospital. These patients all have some sort of blood problem but don’t need to be hospitalized. We saw a lot of anemia, some hemophilia, thalasemmia, and a lot of other things I didn’t understand to be honest… The doctor was great about trying to explain things to us when he could but it was super hectic. They had 30+ patients to get through in a few hours and there were two doctors crammed into a tiny consult room. Two patients would come into the room at a time and at one point there was even a resident seeing patients so everyone was talking at the same time and there was so much going on that it was hard to keep up. If there’s one thing I’ve learned here it’s that patient privacy does not exist in Ecuador. Can you imagine cramming into the same consult room with two other patients who are talking to other two other doctors at the same time? Heads would fly if that happened in the U.S.! Same thing goes for the hospital rooms since most of them don’t have privacy curtains and if they do, they are rarely used. It is also common practice for patients to knock on the door of the exam room while the doctor is with another patient and then just barge in because it isn’t expected that they should have to wait to ask their question (at least the patients and doctors seem to have this similar expectation for the most part). It’s a very strange concept compared to the U.S. where the whole medical system is set up to honor patient privacy to an extreme. I’m not sure what the laws are like in Ecuador officially but they definitely seem more lax in practice than what I’ve experienced at home. I guess it probably boils down to resources and efficiency. In the U.S. we aim for efficiency but we also have the resources to have separate consult rooms for each doctor or to build hospitals with enough space for only one patient per room. Here space is an issue and need outweighs resource availability. The newer public hospitals have some surprisingly updated equipment but they are still seeing patients at maximum capacity. It also makes a difference that healthcare, at least in the public sector, is free in Ecuador. This is a relatively new law and I’m not sure what things were like previously but I have a feeling that since healthcare became free many of the hospitals have become more strained to keep up with patient demand. Ecuadorians who don’t have social security (which is provided with most full time jobs) are able to go to any public health center or public hospital with a referral and seek treatment for free or relatively low cost. Those with social security get to go to the social security hospitals, which have shorter wait times and better equipment. Those with a disposable income (which seems to be the minority of the population) can pay to go to private hospitals, which have the shortest wait times and the best services and resources. It’s an interesting strategy to attempt to deliver healthcare to the population although I’m not sure how the government is paying for it (I’m obviously no expert on Ecuadorian politics) and some people are critical of the plan since they envision Ecuador spiraling into even more debt. It seems like those who are able to pay for their own healthcare are critical of the plan but those who benefit the most from it are very supportive of it, so there are a lot of mixed feelings about it. All of the hospitals and clinics that I’ve been working in have been public institutions so I haven’t really had the opportunity to compare the public vs. private institutions, but that’s fine because the public hospitals serve the majority of the population.
There were a few other things that I learned during this rotation, one of them being that I can’t watch bone marrow aspirations. There’s something about the huge needle and watching the doctor twist the needle into the hip and knowing that the patient is in pain despite the lidocaine injection… just really gets to me. I tried to watch two bone marrow aspirations and both times I got really dizzy and had to leave the room to go sit down. I was really bothered with myself that that was my response to this particular procedure but I’m hoping it’s not something that will be an issue in the future. I’m comforted by the fact that I’ve been able to watch every single surgery with no problem, so I know it’s not blood and gore that bothers me.
The other thing I learned was that the teaching doctor makes a huge impact on the learning experience. This doctor went way out of his way to explain things to us, answer our questions, show us patient X-rays, lab results, and exams, and even put us to work in the external clinic filling out patients’ names and birthdates on paperwork and prescriptions so that we could feel useful and involved. Even small gestures like asking us to stamp his paperwork for him made me feel like he appreciated our presence. There have been some doctors that were obviously not very pleased to have students shadowing them and it makes for a very hostile and intimidating environment. It’s already hard enough to formulate the questions I want to ask intelligently in Spanish and it’s even worse when the doctor is trying their best to ignore your existence. So being able to shadow a doctor that is excited about your questions and goes out of their way to include you in their day-to-day routine makes a huge difference in whether the rotation is a experience or not. I feel really lucky to have been able to shadow this particular doctor because it definitely made this rotation interesting and enjoyable to go to while in other circumstances it might not have been due to the difficulty of the subject.