Third Year of Residency

I guess it's time to post again - it's only been eight months! I am now a third year resident which means I should know all there is about family medicine, right?  Hah! What it really means is that I now realize that I will NEVER know it all and will spend the rest of my life learning and depending on God to help me help my patients!

Marion Historical Museum

Marion Hospital

Right now I am writing to you from Marion, Kansas, where I am "moonlighting" - working as a small town doc in the emergency room of a rural hospital. I'm here from 6 PM Friday to 6 AM Monday to take care of anything that walks (or rolls) in the door. So far I have seen three patients, none of them truly urgent - a sports concussion, a foot injury and poison ivy. I do have to be prepared to stabilize very sick or injured patients, so it's a lot of responsibility (and a bit scary still). Mostly, I enjoy meeting the folks in the community, putting my medical knowledge and skills to the test, and gaining confidence.

In June, my father and I took a group to Bolivia for our annual mission trip. We saw over 250 patients during the week, worked at the girls' orphanage and helped to build a special education and rehabilitation center that will also serve as a daycare center for health workers' children.  My patients were mostly adults with diabetes, but I did see some interesting - and sad -cases. One man had just had a heart attack and needed a cardiac catheterization. However, the cost is really prohibitive in Bolivia, and I am not sure about the outcome. He was on medical management, but I am sure even the recommended medications are very expensive for the average Bolivian.  Another patient was in remission for ovarian cancer. She had to travel to Santa Cruz every 6 months for tests - CT scans, bone scans, blood work. You can imagine how expensive all of that is. She had already spent all of her money and taken out loans to pay for her initial surgery and chemotherapy. I wish I could have helped them more, but I was able to pray for them. I did diagnose one woman with diabetes. She was very upset initially. However, I gave her a lot of education and encouragement regarding diet and exercise, and she attended a diabetes education class while I was there. Hopefully, it was caught early enough that she can make some lifestyle changes to avoid some of the long-term complications of diabetes. Unfortunately, there are limited medications available to treat the disease in Bolivia. Insulin is very expensive and somewhat dangerous to use without good glucose monitoring. And almost noone has a personal glucometer; test strips must be outrageously costly there. How could you know how much insulin to use without frequent testing?

On September 22, I will be heading to  the Middle East for a one-month rotation at a small hospital and residency program. It will be a unique opportunity to learn about Muslim culture, the health issues and medical system in this part of the world, in particular women's health.  I will also get a first-hand glimpse of what it's like to run a residency training program and teach residents. Please pray for safety, a great learning experience, and clear direction about whether or not this is something I want to do long-term. I'll be blogging while I'm there, so stay tuned....