Dehradun Clinicals - week 2

Namaste!

So I am still getting caught up on my blogging, sorry to be so far behind, but finding reliable Internet here is a tricky business...

Anyways, last week in Dehradun Katie and I shadowed Dr. Gandhi again because our clinical doc for the week was out of town for some kind of emergency?! so we were back at City Heart Center with Dr. Gandhi Monday through Wednesday. Again this rotation was a lot of cardiology and so we listened to a ton of hearts and lungs, but we did get to see an emergency where an old woman with Parkinson's disease was in ventricular tachycardia where her ventricles in her heart were beating super fast and thus there was no relaxation in her heart, which is needed. This is because the heart fills upon relaxation, so the heart was not getting the blood supply needed and thus not getting the oxygen it needed. Dr.Gandhi told us "This is classic V Tach., you see it, you shock it..." At one point I saw her heart rate at 230! Dr. Gandhi defibrillated her once and the jump looked PAINFUL! She immediately went back into V Tach. and Dr. Gandhi had to defibrillate her again, and again, looked super painful... she did recover after this procedure but the next day Dr.Gandhi told us that she went back into V Tach. overnight and they could not defibrillate her out of it... which lead to an MI (heart attack), and after that there was nothing they could do... :(

On Thursday and Friday morning Katie and I did get to shadow Dr.Joshi at Doon Hospital which is a government hospital and is as crazy as a train station at rush hour... The way on receives medical treatment here is almost beyond explaining in words. Dr. Joshi is another cardiologist so we saw a lot of patients with hypertension, recent, old, and acute MIs (heart attacks), mummers, prosthetic valves, and many children with VSD (ventricular septal defect) (these were clinically cool because you could feel it on the chest if you put your hand over the heart). I did pin point a systolic murmur on one patient and Dr.Joshi called me a budding cardiologist, well I have no idea what I'm budding into! We looked at a ton of EKGs, which Katie and I could only guess how to read because Dr. Joshi is a very busy man and didn't have too much time to explain things. When he did have time to explain things, he was an extremely good teacher and went into a lot of detail, he also would ask us questions and test us some, this was difficult sometimes because of the noise and the accent, plus some medical terms are different here in India, when they meant he same thing. The crazy thing about Dr. Joshi's office was that patients line up and crowd his office, people wait "patiently" for his medical attention, and many people shove to get next on the stool, plus everyone is looking over his shoulder while he treats his patients, oh and did I mention, there is almost no patient privacy?! It was quite the experience.

In the evenings Katie and I would go to our next clinical rotation at an OB/GYN. Dr. Nesha Gera did not get many patients in the evenings because the monsoon came in the evenings last week, and people just don't venture out when it rains that hard (wading through small rivers on the roads is not very pleasant plus you get soaked from the down pour). Dr.Gera is very nice and would serve us tea every night with cookies and raisins. We did get to see some interesting cases, and oh yes... a lot of pregnant women! Katie and I were pumped to see ultrasounds when we could see the fetal heart beat, spine, eyes, and movement. We were allowed to listen to the fetal heart and on one woman we got to feel the position of the baby's head! We also got to see a uterus biopsy. We did have one very interesting case where a woman's cervix was "falling out" of her vagina. This is called a prolapsed uterus and Nesha told us to fix it you had to have a hysterectomy (removal of woman's reproductive organs). Every time this woman would stand up the cervix would "fall out" and it looked painful and very uncomfortable. Unfortunately we didn't get to see any births at this rotation, but Katie and I were hopeful for one in Mussoorie (hint hint we saw one today!). We also found out about abortions, they are very legal here in India and can be done up to 20 weeks... Dr. Gera does not perform them unless totally necessary, like if there is a problem with the fetus or it will harm the mother or there is any kind of foreseen complication like eclampsia. Also when performing an ultrasound in India it is illegal to tell the sex of the baby because most families will abort if it is not a boy, another sad fact I found about the sex of the baby is that often once a woman gives birth to a girl they will sometimes "through it away" like into a river... very sad.

Well that's it for clinical stuff from week 2 of Dehradun and week 3 of the program. I hope to post more about the fun things I did in Dehradun last week tomorrow!

Until then...

Namaste