BSI. Scene Safe!

     Almost two Saturdays ago I took the Oregon EMT practical exam. My fellow candidates and I had to prove our ability to perform six skills in a competent manner. These skills were medical and trauma assessments (if you want to know what this looks like, here's an example of a Trauma Assessment), providing spinal immobilization for a supine patient (getting a patient onto a long spine board), providing CPR and using an AED (see my PSA below), ventilating a patient with a Bag-Valve Mask and inserting a supraglottic airway, and then a random skill that was either caring for a bleeding wound and shock (what everyone wanted to get because it takes 30 seconds to do) or splinting a long bone (the skill I ended up doing -an easy skill that's made difficult by the 5 minute time limit). Everyone had done the skills so often in class that we all knew how to do them, and do them well. However, nerves are tricky things, and there's a lot of waiting that goes on at the state exam so you have plenty of time to agonize over mistakes you think you've made or all the ways you could mess up the next skill. Plus, the proctors aren't allowed to give you any indication of how you've done, so you often leave a station convinced you'd done something wrong, and since you can't talk to anyone about the exam, you sit there and go over everything over and over in your head. Then you just try to figure out if it was a critical fail or not. Luckily for everyone in our class, we eventually realized that our instructor had held us to a much higher standard than the state exam and I think almost all of us passed. We went to a place down the street to celebrate, talk about how we'd done, and cheer each new victorious compatriot as they joined us. It was a great way to end the class.

Guess I'm going to need to get one of these. ; )

     The final step to becoming an EMT was to take the national exam, which I did last week. That exam is cognitive rather than psychomotor and thus tests you on your knowledge, and not on your ability to perform skills. Like the state exam though, this one also plays with your head. It's an adaptive test, so if you get a question right the next question will be harder, but easier if you get the question wrong. The computer keeps asking you questions on a particular topic until it's clear whether you should pass or not, and then it moves on to the next section. You can be doing really well, but still fail half the questions because you keep getting harder and harder questions, which is a bit unnerving. Also, the test doesn't tell you when it's switching to a new section, so you might get some easy questions all of a sudden and think you must be doing poorly, when really you're just starting a new section. Oy. Anywho, I got out in about an hour, but then had to wait four days to find out how I'd done when I received the official results in the mail because they forgot to email me my results the next day like they were supposed to. It doesn't matter though because I passed and come Jan. 1 I'll be a licensed EMT!!

How hypothermic was he when he was unfrozen? Question for the ages.

     Now that the class and whole process is over, I've certainly enjoyed having more time to focus on work and prepping for PA school interviews, but I'll admit that there are things I miss. I miss debates about whether or not Han Solo was profoundly or only mildly hypothermic when he was thawed from the block of carbonite (I hold to "mildly" since I don't think he was mentally altered). I miss hearing about real calls and how responding to a patient with ruptured esophageal varices is pretty much just sloshing through blood to check a pulse and confirm death (I would gladly explain what happens, but I don't think everyone would enjoy the details as much as I do, so look it up if you're interested). I miss quizzes where questions such as "what should you do with bystanders at the scene of a motor vehicle accident" have possible answers like "lay them in the road to act as human traffic cones" or "douse them with gasoline and tell them to light flares." I miss the bad jokes the other students would tell when we were loopy from sitting around for hours waiting to perform skills for our practical exam. All said though, I'm glad to move on to the next step and start using my new skills. First though, I have a couple Public Service Announcements.

You really should.

PSA 1: If you find yourself a bystander at the scene of an accident, here are three things you should not do: a) run up to the ambulance (running people are considered panicked/unstable and no one will exit the vehicle until you calm down), b) frantically wave us to where you think we should park/get angry if we don't park there (it's usually fairly obvious where the accident is and there are regulations about the best places to park to avoid hazards), and c) assume the EMT is an idiot. The last one may need some explaining. Often EMTs and paramedicswill do things that may seem stupid to bystanders, but only because the bystanders don't know the reasons behind the actions. For instance, my instructor was once at a motor vehicle accident where the driver was severely injured. When he first came up to the patient he asked them if they knew their name, where they were, what had happened, and if they hurt anywhere. One bystander became infuriated at this because it was obvious that the patient's leg, and pretty much everything else, was very broken and needed immediate care. What the bystander didn't understand was that the paramedic was collecting important clues that would determine care. From these questions he could determine if the patient was alert (altered mental status would increase the patient's priority), oriented (and to what degree), and whether there was any cause to suspect severe spinal cord injury (if the patient didn't feel pain, this would clearly be a problem). So, as in any area of life, don't assume that you know or understand all the reasons behind someone else's actions. 

This is all you need to do. Smiling not required.

PSA 2: CPR. It's important. Sadly, few people learn how to do it, and even fewer perform it when it's needed. I have two things to say about it. First of all: just do it! CPR cannot, by itself, restart someone's heart and save their life (that's why you need a defibrillator aka an AED), but it causes the blood and oxygen to circulate so that the other cells of the body are still alive when you restart the heart. CPR classes take just a few hours, and the skills you learn are vital. You can find a course here: AHA CPR Classes. Even if you have never taken a class, you can still perform CPR. Lay people are now taught "compressions only CPR" which just means that all you do is the compressions -the pounding on the chest, rib-breaking part. There's no need to count or give breaths. It's simple. Scary, but simple. Basically, the compressions are the most important part of CPR, so please just do them until EMS can arrive. This podcast includes a discussion of the effectiveness of CPR: PodMed. In class we watched a real video of a guy who had a heart attack in his office and it took FIVE MINUTES before anyone began CPR, even though his wife arrived just as his attack was beginning. This should not be. My second tidbit about CPR is a slight modification to the first: definitely do CPR, but make sure the patient actually needs CPR first. This means you shake them and shout in their face, then if they don't respond you check for breathing and a pulse. If they have no pulse start CPR immediately. If they aren't breathing but have a pulse, you need to breathe for them. If they are both breathing and have a pulse chill out. They probably just fainted. Call 9-1-1 but don't go breaking their ribs. Our instructor told us about an old man who fainted while waiting in line at the bank and then woke up when "Rescue Ricky" immediately began CPR and broke his ribs. "Ricky" thought he'd saved the guy's life when really he just caused him agonizing pain. Or there was the group of "rescuers" who told the paramedic that a surfer had collapsed when walking back from the beach on a hot day, but was resisting their efforts to perform CPR. The poor surfer was merely overheated, and these people were trying to hold his arms down so he would stop fighting them as they tried do CPR. Please do CPR when needed, but don't let these latter stories be you.

P.S. -The title of this post comes from all the skills we perform as EMTs. The first two things you have to do when performing any skill is state that you have taken appropriate precautions by using body substance isolation (gloves, glasses, anything that prevents contact with bodily fluids) and that you have determined the scene is safe. We said "BSI, scene safe" so often that it almost became a single word we spat out without even thinking. That's good, because if you forgot to say either of the two phrases, you automatically failed the skill, even if you did everything else correctly. 

We all started doing jazz hands whenever we said BSI to represent the imaginary gloves we had one. Then we started doing it without realizing it. Our instructor enjoyed mocking us for it.

Just Because I Love Christmas

     Today is going to be a bit of a break from the usual, due to the delightfulness of the season. While fall is certainly my favorite season, and winter probably only comes in at third place, Christmas is one of my favorite times of the year. So, in honor of this fleeting time, which really has a lasting impact on the rest of the year, I present to you a post of Christmas joy and a playlist of some of my favorite tunes this year. It was hard to select just a few songs, because there is such an abundance of Christmas music, and music is so closely tied to my memories of Christmas. Frankly, it's not Christmas at my house until the John Nilsen albums are brought out and someone mentions the dance my older sister once made up to Nilsen's version of Bring a Torch, Jeannette Isabella, or until we hear the cheesy tunes of Mitch Miller and the Gang. So, rather than post all the songs I love, I decided to go with the ones I've listened to the most this year.
     There's probably some clever way to actually have the music play, but I don't really feel like figuring that out, and I think it would really start to annoy people after a while. Instead, I've listed the title and the artist for each song so they're easy to find on iTunes. I've also posted links for some of the songs/albums because there is quite a bit of great Christmas music available for free. I really enjoy both Solid Rock Christmas albums. A couple songs, like Sing Emmanuel (an original composition by one of my friends) and the ones performed by Camerata Carolina aren't available commercially anywhere since they're performed by my friends or choirs I've sung with, but if you'd like them just let me know and I can arrange something. Enjoy!
      

Annika's Playlist for Christmas 2012  

I Wonder as I Wander -Josh White and the Solid Rock Band

The Holly and the Ivy -Wayfarer

O Holy Night -Josh Groban

What Child is This? -Sarah McLachlan

O Come, O Come Emmanuel -Josh White and the Solid Rock Band

Carol of the Bells/Sing We Now of Christmas -BarlowGirl

Ave Maria -Rachael Lampa

Dormi Jesu -Camerata Carolina

Sing Emmanuel -Julie and Lindsey 

Advent Song -Northern Conspiracy 

Midwinter -Camerata Carolina

Christmas Canon -Trans-Siberian Orchestra

All Creation Sing (Joy to the World) -Seth Condrey

White Christmas -Dogs on Tour
Baby, Please Come Home -Anberlin

Merry Christmas, Here's to Many More -Relient K

Let it Snow, Let it Snow, Let it Snow -Michael Bublé

Snowing in Seattle -Sherwood

Winter Night -Little & Ashley

Christmas This Year -TobyMac & Leigh Nash
Coventry Carol -Celtic Lore 

Jesu Joy -David Klinkenberg

Celtic Carol -Lindsey Stirling 
Is There a Place For Us? -Mychael Danna
Waltz of the Snowflakes -Peter Ilyich Tchaikovsky 

March of the Wooden Soldiers -Steven Pasero

Let All Mortal Flesh Keep Silence -John Nilsen (if anyone knows of a good choral recording of this, please let me know)

Christmas Eve (Sarajevo 12/24) -Trans-Siberian Orchestra

Carol of the Bells/God Rest Ye Merry Gentlemen -The Piano Guys

God Rest Ye Merry Gentlemen/Slieve Russell -Dan Cleary
Road to Lisdoonvarna/Swallowtail Jig/Irish Washerwoman -Tony Elman

The Wayfarer Christmas EP (as well as his album of hymns) can be downloaded  here:

http://noisetrade.com/wayfarer 

The two Christmas albums from Solid Rock can be downloaded here: http://www.ajesuschurch.org/music/ 
Two Christmas albums from Dogs on Tour can be downloaded here:
http://www.dogsontour.org/archives/tag/music-for-winter 

The Advent Song (as well as some other great songs) can be downloaded here:

http://marshill.com/music/albums/northern-conspiracy-live 

I'm very much in favor of stealing the idea of Weihnachtsmärkte (Christmas markets) from the Germans

Update: My awesome friend Anne got me a great choral version of Let All Mortal Flesh Keep Silence and it is gorgeous. I also discovered the band Zerbin and they have a pretty rockin' version of O Come, O Come Emmanuel. You can get it here: http://noisetrade.com/zerbin. 

The Answer is Always Airway... and Administer Insulin

     As encouraging as it is that I have a interviews at a couple PA programs, I know that many, if not most, people do not get admitted their first try.So, ever since September I've been taking an accelerated EMT program. So long as I finish the class and pass all my exams (a practical skills exam for Oregon and a written national exam), I will be a licensed Emergency Medical Technician by January. This will help me not only continue my medical education and get a job in a medical profession, but my hours as an EMT will count as medical experience hours. Such hours are required by almost every PA school, but are difficult to get because most schools want these hours to involve "hands on, direct patient care." Simply put, you have to somehow be responsible for a patient's care. This is why most volunteer positions in the U.S. will not count, and is one of the main reasons I spent a month at St. Joseph's hospital in Kenya last summer. 

If we did our lab skills with dolls...

     Before you begin to think though that I'm only taking the EMT classes to help fulfill a requirement and it's something I have to force myself to do, I should say one thing: EMT class is a blast. While I'll admit that the 8-hour days, which begin with a 5:15 am wake-up call, are sometimes long and tiring and I probably won't miss them after class ends next week, I have still really enjoyed the course. This is due in large part to my excellent instructor (who includes a Star Wars themed question on almost every quiz and tells us great stories from some of his paramedic calls) and great classmates (who always make me laugh). Of course, I also find the subject matter quite interesting, and it feels so good to finally be able to actually do something to help a person who needs medical attention, rather than simply learn about the molecular basis of their condition. 

A tasty way to combat hypoglycemia

     The class has affected my daily life as well. For one thing, my family is probably sick and tired of all the medical facts and stories I bring home. For another, I study for class and exams using daily occurrences, like the time I cut myself on one of those blasted thick plastic electronics cases (which I think are a bit excessive) and I found myself staring at my injury thinking, "well, it's deep, but the blood seems to just be coming out slowly and sort of oozing, so it's probably just a capillary bleed." This spills over to other people and I've begun to understand better the conditions of friends and family. This happens with strangers too. A few weeks ago a teenage boy came into the coffee shop where I work with his mentor. The man offered to buy the boy, who seemed a bit confused, anything he wanted, but the boy initially refused. Eventually he admitted that he probably should get something to eat since his "blood sugar was low." He ordered a drink and some food... and promptly forgot what he had ordered. The whole time I was watching his behavior and thinking "likely Type 1 diabetes mellitus, probably suffering from at least mild hypoglycemia." I was ready to fill up a spoon with caramel drizzle and just have him suck on it if he seemed to get any more disoriented (and before he became unconscious which would mean such actions would be contraindicated), but a sweet coffee beverage and sugary donut seemed to resolve any blood sugar blues quite nicely.

    I could do into far greater detail about all the things I've learned and the things I've taken away from the class, but I realize that not everyone will find it as fascinating as I do so instead I'll include a list of tidbits that I think people might find interesting/helpful as well as some quotes and phrases from the class that might give you all a better idea of what EMT class is like. One thing to note is that, even though our instructor is continually telling us to use our "big boy/girl words" (i.e. correct medical terminology), many of his phrases for the class sound like they fit in a kindergarten classroom.

Things You Should Know 

• If you're pregnant and your water just broke, you probably have time to get to the hospital without needing EMS (Emergency Medical Services). This is especially true if this is your first pregnancy because the first stage of labor (the contractions) lasts an average of 16 hours for the first pregnancy (labor for subsequent pregnancies is typically much shorter). Apparently a lot of people call 9-1-1 for "imminent delivery" and contractions have just started. Sometimes the patient isn't even pregnant. Sometimes they're not even female (don't ask me how this works). 
• Women who are having a heart attack often do not present with the stereotypical symptoms of crushing chest pain that often radiates to the left arm or leg. Sometimes women just feel like they're having stomachache or back pain. 
• When EMTs respond to diabetic emergencies, they often encounter bystanders or family members who plead with them to give the patient some insulin. In light of this fact, I think I should state that insulin is not a diabetic "cure-all." All insulin does is act as the key that unlocks the cells and allows them to absorb glucose (sugar) from the blood. If someone is suffering from low blood sugar (hypoglycemia), insulin will not help them. It will actually make the situation worse, and might even kill them. This is why EMTs and paramedics are never allowed to give anyone insulin, and even nurses typically are not allowed to administer insulin to a patient without another nurse there to verify that they are giving the correct dose. Our instructor really stressed this fact, so now it has become a standing joke to reply with "administer insulin!" whenever he asks how to treat different patients. 
•  If someone is suffering from hypothermia, DO NOT rub their cold limbs. If they're that cold, it means that parts of them, including the plasma (which is mostly water) in their blood is actually frozen. If you rub them, the ice crystals in their blood can potentially slice their blood vessels to pieces. Yeah... not good. Call 9-1-1 and follow the dispatcher's instructions until EMS arrives.
• People are more likely to get overheated on days that are hot and dry than days that are hot and humid. This is because the moist heat tires you out quickly and people realize that they should cool off, whereas on dry and hot days, people can feel fine and then suddenly experience heat exhaustion or even heat stroke. 

...but for some reason this is just fine.



This is too "invasive" for most states...

• Oregon is one of the most progressive states when it comes to what EMTs can do. For one thing, EMTs in other states can only give someone epinephrine if they have their own Epi-pen. Oregon realizes that not everyone carries their Epi-pen with them everywhere, so EMTs are allowed to give patients in anaphylactic shock epinephrine via an injection just under the skin. We're also allowed to check a patient's blood sugar. In other states, if a patient has a history of diabetes and an altered mental status, the protocol is to just give them glucose, even though the cause could be that the patient already has high blood sugar (hyperglycemia). The thinking is that a finger prick to check blood sugar is an "invasive procedure" and since most diabetic emergencies are due to low blood sugar (hypoglycemia), administering oral glucose should help, and giving glucose to someone who is hyperglycemic won't really hurt them (at least not in the short-term). While this is all true, Oregon still disagrees and says that EMTs should be able to just check the blood sugar so they know what the best course of action is and are also able to give accurate, detailed information to the hospital. Considering that we're allowed to deliver babies and insert supraglottic airways, pricking someone's finger or giving a small injection into the shoulder doesn't really seem like that big of a deal.

Quotes/Phrases from Class 

• Treat with diesel -getting someone to the hospital asap because there's nothing more you can do for them on scene
• Drive by Braille -I'm guessing most people can figure out what this means. It's really not how you want to be driving.
• Let's go get the stair chair -a code used to communicate that the scene is no longer safe (usually because you've just discovered that the patient or a bystander is crazy and/or dangerous). It works because you really only need one person to carry a stair chair, not everyone, but most people wouldn't know that so they don't become suspicious when all of the EMTs return to the ambulance.
• Blinkies and whoo-whoos -lights and sirens 
• No pumpy-pumpy, no livey-livey -our instructor's explanation for why the heart is important
• Talky, talky then touchy, touchy -how to assess a responsive medical patient
• Rappin' and cappin' vs. limpin' and pimpin' -our instructor's phrases to describe the responses produced by activation of, respectively, the parasympathetic vs. the autonomic nervous systems. Most people probably know these responses better as "fight or flight" vs. "rest and digest" 
• "Trauma is a naked sport." 
• "If you don't have an airway, you don' have a patient." -This is why you make sure everyone has a "patent" (clear) airway before treating anything else (even life-threatening bleeding) and why the answer to almost every test question is "airway."
• "I open the patient's mouth. What do I see?" "The mouth is full of secretions and vomitus." "Yes!" -Real soundbite from skills lab 
• "Screaming barfies" -also known as "hot aches," these result from warming extremities after you've gotten them so cold that you've reached the point of frost nip (precursor to frostbite). Basically, reheating them hurts so bad that you want to scream and barf at the same time.
• "Ding, ding, whoop, whoop. Here comes the hero wagon." -how firefighters arrive on scene 

Here's one final soundbite from class. This sort of thing where someone just threw out a random answer happened a lot. It was always good comic relief.

Instructor: "Fresh water or salt water drowning, which is worse?

Everyone: "Salt."

Instructor: "Right, everybody knew that. And why is salt water worse?"

That one guy: "Sharks!" 

Should you be interested in how cops sometimes view EMTs and firefighters, here's a cartoon we watched when we discussed "mechanism of injury:" Freeway Patrol: Episode 5

'Tis the Season to Be Thankful

A little Settlers of Catan after the feast

     As anyone in the U.S. knows, today is Thanksgiving, and I am certainly reminded that I have much for which to be thankful. For one thing, all my grandparents are still alive. I remember elementary school friends being surprised being to hear this, and more than a decade later, I am still reminded how blessed I am. On the note of family, it was great to spend Thanksgiving with the majority of my family this year, particularly as I may be elsewhere in the country if I get accepted to a PA program. I'll even get to see most of the family I missed today when I head up for a visit to Seattle soon. 

     I'm thankful to have a job. Anything helps in this economy and I'm incredibly blessed to be both a barista and an administrative intern. Even better is the fact that I work with some pretty great people. I'm also thankful to be three quarters of the way done with my EMT course. I've absolutely loved it, and I'll probably be posting soon about some of the things I've learned or some great quotes (there's quite a few) from the class, but I'll admit that it will be nice when I no longer have to spend 3-4 hours each week commuting to and from class, 16 hours in class, and another 6 or so doing homework. Not to mention that, once I pass the state and national exams, I could finally work as an EMT as well. 

     Really, there are too many things for me to list. I could go on and on about the beauty, freedoms and bounty of my country, or my friends far and wide, or even the simple joys of listening to music. Instead I will close with one last thing that occurred this week, and which is pertinent to this blog: I got invited to another interview for a PA program! I'm quite excited and, of course, very thankful. :)

Psalms 69:30

Best Belated Birthday Present Ever

     My birthday was a couple days ago. It was a good break in a sea of finals, mid-terms, assignments and job training, though over too soon. In fact, I spent the last few hours of it finishing a case study for genetics, rushing to finish it so I could wake up at 3:30am for barista training. Luckily for me, some of my presents have been a bit delayed so it's like the birthday isn't over yet. Today I received an email that topped all the other presents. While it may not have been intended as a birthday present, I like to think it was. 

     So to make a long story short, this morning I received my notification from a PA school telling me that I had been selected for an interview!! I almost cried I was so excited. The best part is, it's my one of my top choices. Now, obviously this doesn't mean that I'm in or that I'll be accepted because there's still a lot of people trying for just 75 spots, but it does mean that now I'm competing against approximately 260 other applicants instead of all 1500 who applied. It's a good, good day.

Waiting, Waiting, Waiting

Fall at home

     Life has been busy since I returned from Kenya. There have been lots of very good things, like the weddings of good friends, but also some less than fun things, like job hunting and finishing applications for PA schools. At the end of September I started taking an online Genetics course as a requirement for some of the PA programs I applied to, as well as an accelerated EMT course so I can gain more medical experience and, hopefully, a job. Add redecorating a bedroom, birthdays, and volunteering at the local hospital, and my life has been pretty full these last couple of months. This week is particularly busy since I have two finals (practical and written) for my EMT course, as well as a quiz and mid-term for Genetics. Whew. 

     Despite everything that is going on, I have to say that the most tiring thing might be all the waiting. I'm waiting to find out if I can shadow any PAs in the area. I'm waiting to hear if I got the job I recently interviewed for. I'm waiting for my birthday (ok, that's a fun one). Most importantly though, I'm waiting to hear back from PA schools. I applied to 8 this cycle and I've already received 3 rejections. However, it's been almost two months since my last rejection letter, so I'm hoping that means that the other schools are actually considering me. My top school is still in the running, so I'm hopeful. I know though that many PAs do not get accepted the first time they apply, and when there are 1500 applicants for 40 spots, it's easy to understand why. So here I am...waiting. Some days it's tough, but until I know anything for sure, I'm just going to keep preparing myself for every possibility, as well as enjoy the time I have at home with friends and family. After all, it's fall and that's simply one of the best times of the year.

Reflections on Kenya

Sunset back home

     I've been home for two weeks now, which hardly seems possible. In one sense, it seems like I was just in Kenya yesterday, but in another sense, it feels like my trip was ages ago, or even just a dream that didn't really happen. Of course, the 1,047 pictures and videos help deny that last idea, but they don't change the feeling of surreality. It probably doesn't help that I sort of hit the ground running. I definitely had a day or so of adjustment, but since then it's been a lot of unpacking, application finishing, arranging to shadow PAs, and going to weddings (the last bit was certainly the most fun).

     Now that I've been back for a bit I'd thought I'd write up just a few last reflections on Kenya, mostly ones I thought up on the long drive (7.5 hours) from Migori to the Kenyatta Airport in Nairobi. 

     First, some random tidbits:

La b and pharmacy waiting area

1. I never mentioned it before, but people were a bit obsessed with Obama over  there. It probably didn't help that Migori is not that far from the area Obama's family comes from. In fact, many random people in Migori claimed to Obama's brother, father, cousin, or other assorted family member. 
2. The patients in the hospital formed their own community. Often you'd enter a room and all the patients and their family members would just be chatting up a storm, or they wouldn't even be in room. Instead they would be outside relaxing in the sun, or washing their laundry or children.
3. I sort of fell in love with Kenyan soap operas. They were so, so bad. Everything about them, from the acting to the writing to the cinematography, was just atrocious. The thing is though, they were so bad, they were good. They were also constantly playing on the hospital tv by the lab so I could just sit at reception and listen to them. You didn't even have to see them to die of laughter.
4. I started to judge people based on their blood. This may seem absurd, and it is, but after a while you start to be able to tell some things about a patient just by looking at their blood. Most of the lab techs could just look at a tube and tell that the hemoglobin was low, and once the tubes were centrifuged, you could tell even more.

That's a chunk of fat and/or cholesterol

Fatty blood -probably drawn after a meal

Normal blood

Low hemoglobin... and everything else

Hemolysis

      Secondly, here are a few cases from the hospital, good and bad:

Two girls on the hospital swing set

1. The mother whose first two children had developed fevers shortly after birth and had died within 24 hours, but whose third baby survived and did well.
2. The 5-year-old girl who was hit by a pikipiki and responded to pain, but never actually woke up. Her family was finally able to come up with enough money to send her to Kisii for a CT scan, but by then she'd already been unconscious for over a week and we feared any damage detected would be irreparable.
3. The hemophiliac boy who had to come to the hospital after a tooth extraction. He ended up being just fine, but the dental students were pretty concerned.
4. Multiple cases of machete attacks. One man almost lost his nose, and a 20-year-old boy who had been stabbed in the back was the first person I ever gave an injection to. 
5. The three triplets who were born far too soon. Two died right away but we had so much hope for the third one, despite the defective incubator. He died on the second day. 
6. So many AIDS deaths. It seemed like the majority of the deaths in the hospital were attributed to AIDS, and those were always hard to see. It's incredibly frustrating to know that, no matter what you do, you will probably lose the battle for a patient's life, even to a simple illness, because their immune system is basically gone. 
7. Two cases of bee stings. We discovered that swarms of bees would occasionally appear and if you didn't get out of the way fast enough, there was a good chance you'd end up in the hospital. Luckily I never encountered such a swarm, and the two cases I saw did just fine.

     Third, I noticed three things on the trip to Nairobi that told me I'd been in rural Kenya for a while:

1. I was surprised to have a seat belt.
2. I was delighted to discover toilet paper in the bathroom of the restaurant where we stopped for lunch.
3. I was shocked to see so many Mzungus in the airport.

     There are definitely things I appreciate more being home. My family had Umpqua ice cream (quite possibly the best in the world) waiting for me when I arrived, and that is certainly a point in America's favor. I also appreciate having privacy again, since that can be kind of difficult when there's fifteen people in the house and the windows to every room are always open. There are also things I missed. The other day I went grocery shopping and was so excited to see so much variety but I was bitterly disappointed when I saw the mangoes. Now I remember why I never liked mangoes in the U.S. They're just not ripe or good-looking, and they will never be as good as the ones from the street vendors in Migori.    

This is a real mango

These just can never measure up.

 

     Now that I'm back from Kenya it feels like the real work for preparing for PA school is beginning. My first applications are due Sep. 1, so right now I'm running around trying to finish those, since it was quite tricky to take care of some things while I was abroad. This means getting in some last minute shadowing, polishing essays, updating my resume, making sure all my information is accurate, as well as preparing for the possibility that I won't be accepted this cycle. To prepare for that possibility, as well as help me get a job, I'll be taking an accelerated EMT course this fall, as well as a genetics course. Trying to organize those classes while in Kenya was ridiculously difficult and thankfully my wonderful parents were willing to call the school for me and help sort everything out because email was just not cutting it. 

     For anyone who is interested, I am going to keep this blog going to chronicle my entire journey to PA school, providing tips on what works, when to do what, things to avoid, and the like. I can't guarantee pictures of babies or wild animals, but hopefully it will be an interesting journey and will be helpful to anyone thinking about PA programs themselves.

Last Thoughts

As I prepare to leave tomorrow morning to begin my journey home, I have a few final thoughts on my time here.

Random Thoughts 

With Wesley, the baby whose delivery I watched
and helped with

• One of the other students hit the nail on the head when they said that driving in Kenya is like live-action Mario Kart. There are obstacles that come out of nowhere (cars, cows, children), people driver faster than they should, lanes don't really exist, and cars pretty much play chicken when they pass. I'd say it's a miracle people don't hit each other, but I saw too many motor and pikipiki accident cases in the hospitals to know that's not true.
• I realized on safari that the first day Geoffrey taught me Swahili, the first verbs he taught me were the most important ones (for me): kula (to eat), lala (to sleep), and soma (to read).
• There were so many great and interesting things that I saw at the hospital, but the natural birth was probably my favorite. I'd been waiting the entire trip to see one and I'm so glad I managed to see one on Friday. It was just the midwife, mother and I and it was awesome. I even got to wrap up the new baby boy and hold him up the mother was ready. :D 

With Geoffrey in the lab

Things I'll Miss 

• Being able to do all the medical things I can do here, but not in the U.S... yet.
• All my friends at the hospital, especially the guys in the lab and Bobby in the pharmacy. I have some of the greatest conversations with them just waiting for patients to show up.
• Being able to just buy a delicious mango from a street vendor for 40 cents and scoop it out with a spoon for dessert that night.
• Seeing so many different kinds of animals.
• My friends in the program, and not just the other students. I'm really going to miss Helen and Judy.
• So much sunshine.
• Kenyan soap operas -They were always on in the hospital waiting room, and even in the house sometimes, and they were just so completely ridiculous. The acting, writing, and plot were always atrocious, the kind that's so bad it's good. The best were the Spanish soap operas that were dubbed into English. You could just listen to them playing in the background and start laughing.
• Helen's donuts -we sometimes called them "crack donuts" because they sort of became addicting. They're not quite Marty's, but close when they're hot.
• Walking by all the street vendors, especially the ones selling fruits or fabrics.
• Mirror dancing -one of the best parts of going to the club was watching the Migori guys dance with themselves in the mirror. Absolutely hilarious. 
• The funny English typos we see on signs all the time.

Thing I Won't Miss  

Harry, our friend who lives in the house and eats insects

• Being stared, whistled, or yelled at every time I go out.
• All the relationship questions that are usually the first or second thing people ask me. E.g. "Are you married? Why aren't you married? When will you marry? How many kids do you have? Exactly how many children will you have? When will you have children?" And, of course, the inevitable, "do you want to marry/have kids with an African?"
• Pillows that are just an inch thick.
• Slow internet -this is especially a problem when one is trying to finish their CASPA application, like me.
• The almost daily power outages -considering our computer here is a desktop one that doesn't have battery power, these power outages often strike right in the middle of a long email or photo upload and you lose everything.
• Feeling like people just see me as a big money sign, forcing me to haggle for good prices and mistrust most people I meet.

Things I'm Looking Forward To

Christian, Judy, Andrew G. and I in Maasai Mara

• Being able to just pick up my phone and call friends and family, or, for that matter, just get in a car and see many of them face to face.
• Eating vegetables other than cooked cabbage and sukuma wiki.
• Chocolate! I really craved it the first week or so. There is chocolate here, but I've found most of the chocolate bars here to be too sweet even for my taste, so I had to settle for chocolate cookies. 
• Being able to call different schools and people because I had been trying to arrange for more shadowing hours and to take a class this fall, and it has been almost impossible to do via email. 
• The new Classic Crime cd -I was a backer for their Kickstarter project which means I get to download their new album 2 weeks early which is awesome, but that also means that every time I've checked my email this week I've been reminded that the download is ready, I just can't download and listen to it here because I didn't bring my laptop. 
• Being able to read or lay outside without ten or more children pouncing on me.
• Listening to music other than Hip-Hop, R&B, and Rap -I like songs and artists from all these genres, but for an entire month this is almost the only kind of music that has been played here and I'm ready for a break. 

Swahili Word of the Post

kwaheri -goodbye 

Inevitable -Life at St. Joseph's

The file room... yeah.

     I’ve been meaning to do a post on the hospital, and it seems like I better do it now since I’m leaving so soon. There have also been a lot of things that have come to feel like they’re inevitable over here, and since most of them relate to the hospital, it’s a 2 in 1 post! It’s also long, so be warned.

     It is inevitable that someone’s phone will go off in the hospital. I don’t just mean some patient is talking to their family in the hallway. No, the doctor will be in the middle of an examination and the patient will answer their phone, or the doctor will. Granted, if a doctor gets called in the middle of rounds they generally ignore the call or tell the caller to try again in 10 minutes, but still, it happens all the time. Even in the middle of the morning meeting, the phones never stop. Surgeries aren’t exempt either. If you’re not scrubbed in and the surgeon’s phone goes off, you get to answer it. It’s crazy. Also, it’s not like the phones are on vibrate or silent. Every time someone gets a call or a message, the music is blaring. Oy vey.

Gold star to anyone who can identify this test,
A+ if you also know the result of the bottom row.

     Whether or not it’s actually inevitable, I think most of us are pretty sure we’re going to come home with at least tuberculosis (TB), if not also malaria, typhoid or HIV. We see so many patients with each of these diseases each day. Every time I see a TB patient, I think of the special rooms we have for such patients in the U.S., rooms that only allow air to enter and purify any air before it leaves. At St. Joseph’s, TB patients are just in the big rooms with all the other patients, quite possibly passing on the disease to everyone else. If I come back with anything, I’m guessing it’ll be TB. However, we did have a recent HIV scare when one of the guys got blood into his eyes during a surgery (the patient was negative for HIV and hepatitis when we retested her blood, but my friend decided to start post-exposure prophylaxis just in case) and there was a student who went home with malaria a month ago.

Patients can pay with cows if they don't have the money.

     The reality though is that most of us students will go home without a serious illness. That doesn’t mean though that we’re not going to get sick. It’s sort of become a rule that everyone will get sick while they’re in Kenya; the only question is just how bad it’s going to be. So far I’ve been lucky and have only had to deal with allergies and a sinus infection (though the dusty safari trip seems to have made it a bit worse). It’s certainly not pleasant, but it’s better than the stomach bug other people have had. A girl who was here before me had to go to the hospital every night for an IV. Having to go to the hospital for treatment is possibly our greatest fear here. St. Joseph’s is leagues ahead of the other hospitals near us, but none of us want to be patients. Thanks to a recent Harry Potter craze in the house Alex came up with our new motto for St. Joseph’s: “you could get sick, or worse, admitted.”

Filling out discharges in pediatrics

     Speaking of jokes, sickness and St. Joseph’s, it became a joke amongst us students that it didn’t really matter what the symptoms were, a pediatric patient always had “complicated malaria.” Of course that wasn’t true, but we heard Dr. Atonga say it so often that it felt like it was.

Radio and fan -two things I'm pretty sure you
don't usually see in an American OR.

     Something else I heard often, albeit before I left home, was how shocking Third World countries are. Now that I’ve been here almost a month, I’m not sure if being shocked is inevitable (though perhaps I was just so prepared to be shocked that not much has shocked me yet). However, while being shocked may not be inevitable, I feel like becoming frustrated and angry is. This is especially true in the hospital. There have been quite a few times when we’ve wanted to order a CT scan or an MRI for a patient, only to remember that the nearest CT machine is an hour away and there is no MRI machine anywhere close. Other times we’re waiting on a test to diagnose a patient, only to be told that the reagents are out of stock. Other times, you just get angry. For example, an extremely ill little girl was brought in, but despite being dehydrated and anemic, no IV was started until the second day when two medical students from Poland and some of the Medics to Africa students started it themselves. The girl’s veins were so small by that point that it was almost impossible to get the necessary blood samples for testing. Another common source of anger is the Clinical Officers (CO) who work at night. A CO is sort of like a Kenyan PA in that they function as a doctor, but they have only three years of training. Most of the “doctors” at St. Joseph’s are actually COs and most of them, like Dr. Atonga, seem to be pretty good. The two female COs who give reports in the morning though seem to know very little. Despite never having attended medical school (though she plans to next year), Alice the anesthesiologist often puts these two to shame and calls them out whenever their methods of treatment seem wrong or inadequate, which happens more than I’d like. Once Alice questioned their treatment of a patient who died. The COs may not have necessarily caused the patient’s death (heart attack), but they treated it incorrectly, using the wrong dosages of medications. The COs never answered Alice’s questions. They just started laughing. I think a language barrier played a role since Alice was speaking English and the two COs never seem comfortable speaking it, but whatever the case, the response was pretty infuriating. 

Ready to give injections in Maternity

     The language barrier is another inevitable part of life at St. Joseph’s. Every Kenyan is bilingual, if not trilingual, by adulthood. People first learn their tribal language (Dhoulo is the one in Migori) and then Swahili, the trade language. Most also speak English, which is taught in school, but most is not everyone. The staff members at the hospital mostly speak English well, but many of the patients, including the patient whose wound I dressed everyday, speak almost no English. I’ve learned some Kiswahili (the Kenyan dialect of Swahili) since coming here, and that usually helps a bit. However, I think I’ve confused a few people because I can greet them in Kiswahili and ask them how their pain is, but if they try to say other things to me, I’m totally lost.

Fibroids removed from one woman's uterus

     Being lost is nothing special at St. Joseph’s. The last inevitable thing about being a student here is that at some point (actually at many points) you will be asked to do something and have no idea how to do it. Filling out discharge papers were particularly frustrating for me at first. The good thing is, if you ask for help, the people at the hospital are usually more than willing. Even in the middle of surgery, Dr. Agullo’s a pretty good teacher, and if you show effort on rounds, he’ll push you to learn more and do more than you expected. Really in almost any department of the hospital, if you show initiative and want to learn something, someone will be willing to teach you, whether it’s tests in the lab, how to give injections, or even how to feel the position of the baby in the womb. It’s something I’ll miss about St. Joseph’s, though working here has made me more excited to work in a U.S. hospital one day.