Let the Adventure Begin

I'm typing this post with hands that smell like dead people. I've washed my hands 5 times now but the scent of formalin (the preservative) still permeates my skin. Alas, the joys of medical school.

The last few weeks have flown by, the longest day of the year is past, and June is almost over. This means two things. First of all it means that I have my Course 4 final examination on Thursday (peripatetic - 20%) and Friday (MCQ - 80%). Course 4 has been all about the kidneys and hormones. We've covered some really common (and a bit boring) things like Type 2 Diabetes -exercise, lose weight, control your diet, stop smoking and your risks of Type 2 Diabetes go down - it is a very good thing if your risk of T2D is down because T2D is bad (retinopathy, nephropathy, neuropathy, hypertension, CAD, etc). Then we also have other exciting topics like obesity, osteoporosis, vitamin D deficiency, thyroid disorders, and so forth. Some of our professors have used the analogy that most medicine is like horses - common, everywhere, unsurprising - but every so often you run into a zebra which is rare and presents you with something new and interesting. At this level of medicine we are learning all about the 'horses' although the 'zebras' (rare diseases) seem a bit more interesting and you certainly haveto be aware of.

However, the day when we get to focus on zebras will come soon enough, if we specialize. So for now, we are learning the bread and butter of family medicine.

Endocrinology has been pretty interesting because it has some fabulous 'zebra' disorders, as well as some pretty neat 'horse' disorders. An example is acromegaly - this is a disorder where you have too much growth hormone. Growth Hormone is what is responsible for making you grow as a child and teenager. However, when you get too much Growth Hormone (GH) it is bad, especially in an adult. It tells your bones to grow, but because your growth plates are fused when you end puberty your long bones (legs especially) can't grow any longer. The result is that you get bone growth in places like your face, hands, and feet. You also get some soft tissue changes - your tongue becomes massive, your lips get big, your neck gets larger, and you sweat a lot with a characteristically bad odour. This is a disorder that the trained eye (aka an Endocrinologist - a hormone doctor) can spot walking down the street, on the train, in an audience - so disorders like that are certainly interesting to learn about.

At present though the horses and zebras have been galloping through my eyes and into my brain (hopefully) at a great speed because I'm in full on cramming mode. I seem to function well this way, leaving a lot of my studying until just before the exam. It makes for a fairly stressful week or so prior to the exam but my life is quite relaxed other than that...and it has worked so far. Tonight I spent several hours in the anatomy lab with some of my friends going through the cadavers to learn the anatomy relevant to the renal and endocrine systems - thus the smelly hands. We also looked at pathology specimens - these are essentially body parts in jars which exhibit a certain disease (pathology). For example, tonight we looked at five different types of kidney tumours, prostate cancer, enlarged prostates, bladder stones, and kidneys of someone with severe hypertension (high blood pressure) so my mind is still full of nerves, vessels, and masses.

I like medicine and I'm enjoying medical school - at least that is what I tell myself after a full day of studying. Several weekends ago I spent a day in High River learning some new skills and reinforcing some other new skills. The day was designed to encourage us to consider 'rural' medicine as a career option and it was pretty exciting. The first reason was that I successfully inserted an IV for the first time. For some people (such as nurses) this is a bit of a non-event and they do it all the time, in fact, a lot of practicing physicians have very few reasons to put an IV in. However, for me as a student it is one of those things that makes me feel a bit more like I'm on the way to becoming a 'real' doctor. The other exciting thing was the three hour long sessions about labour and delivery. I don't think I want to be an obstetrician (care for pregnant women/deliver babies) but it was pretty interesting to learn about. I'm excited to deliver a baby (hopefully I'm still excited after it happens), and perhaps I'll get to watch/assist in a delivery in Ghana.

Speaking of Ghana - that is the second impending event. I depart for Accra, Ghana on June 26th, 2010 at 8:15am - that is this coming Saturday! I fly via the US traveling from Calgary to Denver, then Washington Dulles, and then on to Accra. I'll arrive about 12:30pm on Sunday and Leah Campbell, one of my friends from Calgary who is currently visiting Ghana will be picking me up at the airport. She has arranged for me to stay near or with one of the Ghanaian families that she knows for my first night which will be fabulous. On Monday I plan to meet up with the Elective Coordinator Sefa and likely head out to Donkorkrom.

This past week I spoke with the student from Class above me who went to the same hospital last year. He was able to fill me in on some of the details of my elective which were quite lacking prior to our conversation. There are still a lot of unknowns but it is going to be a grand adventure! Donkorkrom is the administrative centre for the Afram Plains District of Ghana which is one of the poorer regions in the country. To get to Donkorkrom will be about a 7 hour adventure in itself - or so I understand. First I'll be catching a bus from Accra to a smaller centre, then from there a tro-tro (minibus/van/truck) kind of transport to a ferry crossing the western arm of Lake Volta. After the ferry crossing it is about a 2 hour tro-tro trip on dirt/gravel roads. The student who went last year said that they got stuck during this segment of the trip and they all had to get out and push to get the tro-tro out of the pothole as it is rainy in Ghana at this time of year. I have no idea what my experience will be but I'm going to try to keep you updated

Once I arrive in Donkorkrom I'll likely be staying at a guest house a 10 minute walk from the hospital itself. It doesn't sound like much of a town from the guidebook and what the other student said but there are supposedly two internet cafes in Donkorkrom so I'll be able to update you on the exciting events of my elective.

The hospital has 74 beds and runs a busy outpatient clinic. On staff are two doctors, some nurses, some health care assistants, and various others. This means that the doctors are very busy but the fellow who went last year said they are excellent teachers which I'm quite excited for. If the style of elective is the same I'll likely spend mornings and some afternoons in the outpatient clinic dealing with patients with any number of complaints but malaria and typhoid are very common. In the other afternoons I'm hoping to assist with surgeries, work in the emergency room (casualty), or the maternity ward. However, I'll just have to wait and see how it goes.

Because I'm time restricted and only have six weeks (of which I'm supposed to work approximately 6) I'm hoping to travel on the weekends. If everything goes well I'll get to a national park where you can see elephants, perhaps some hippos, and other African wild life. I'm sure that I'll also enjoy the African life right in town as well.

I know that the next six weeks are going to be an incredible experience - I'm going to gain new perspective on life, medicine, and the world, but for now I need to catch some zzzz's so that I can pass my Course 4 exam and not have to rewrite it in February.