In the past week, I have learned so much about medicine, compassion, culture, and myself.I spent the past week in both the Oncology ward and in Surgery.
Monday, Tuesday, and Wednesday I spent only in Oncology. There was so much to learn about the different types of cancer and associated treatments. I did some research myself over the weekend before to try to familiarize myself beforehand. There were about nine children in total over the few days I spent there.
Most of them had Leukemia, so I learned a lot about the course and treatment of that cancer. One had a tumor in the upper portion of his right cheek, although the scans revealed that it penetrated far back into his head. There was one boy with Leukemia in grave condition due to the presence of another infection, Sepsis.
All of the children had one parent by their bedside.
There was one moment that was hard, and that was when the mom of the boy with the facial tumor saw the scans and just how large the tumor was. She cried pretty hard for a while and it was difficult to stand and observe.
One of the saddest things about the oncology ward was the constant blood tests and other painful examines these kids were subjected to every day. They didn't have many modern blood draw supplies, it was mostly just sticking a needle into the vein and trying to get it right to get blood to drip from the needle into a vial.
There was one moment when a girl, just a few years old, saw the doctor coming over with the tray and started crying immediately. The hardest part is that they're not like other kids who resist or try to avoid the needle. All she did was reach over for a small towel that she put in her mouth to bite down on to help with the pain. With her other hand she held her dads hand while he whispered happy things in her ear. So heartbreaking.
In Hospital de los Niños, all of the kids are being treated with chemotherapy. They don't have radiation therapy as an option. They also don't have any research in the country, so research drugs and methods are unavailable to these patients. In addition, they don't even have access to online databases of journals or articles to stay up to date on modern treatments! I logged on to my university account to help the head doctor look through articles on modern treatments of solid tumors.
Although the oncology ward was full of interesting cases, I actually didn't feel like I was learning or doing much. The residents who were stationed there the week I was there were really unfriendly and didn't show me much. I always tried to ask what I could to help them and always just got "nothing." Whenever I asked them questions about certain cases or treatments they gave me really short and complicated answers. It was a huge contrast from the residents in Infectology who were always happy to show me any case and explain to me what I didn't understand. The head doctor was really great and always taught me whenever I was with her, the problem was that she was really busy and couldn't spend much time in the sala.
On Thursday morning they were going to perform a surgery on the boy with the tumor in his face to get a same for a biopsy. I asked if I could join the surgical team and observe. They told me of course (Dra Cruz is a maxilla-facial surgeon in te hospital and she is incredibly nice and helpful).
I got to the hospital early and, after some confusion, learned that I had to put on sterile clothes and leave all of my clothes in a changing room in the entrance to surgery.
After that fiasco, I was in the operating room. There were two rooms side by side with big open windows on all sides which was great because while I was in on one surgery I could still watch another.
The biopsy ended up being a Neurosurgery because it was the only way to extract a sufficient sample!!!!
It was INCREDIBLE to watch the neurosurgeon and Dra Cruz work together to drill through the skull and remove the sample.I ended up spending my entire morning in surgery and watched some bone marrow withdrawals, and another biopsy.
After an entire morning in surgery I went back to Oncology to check on the progression of the patients.
I got to watch them cut under the tongue of one patient to improve its motion and therefore improve the patients speech.
I watched the removal of warts from the inside of a girls mouth.
And then I watched ANOTHER intensive neurosurgery. They had to carve out two holes in an 11 month old boy's head to insert a tube and then re-stitch it all up. It was so fascinating.
Then I watched them operate on a boy who's testicles had not descended after the time they should have. They manually withdrew them into the scrotum by making an incision in the scrotum and working through there.
After this surgery I changed and went back to oncology to help the Dra. research recent articles on the treatment of solid tumors. I used by MDConsult provided by cfhi!
After this I went around and said goodbye and thank you to all of the doctors an residents I had worked with over the past two weeks.
I'll miss the busy pace and interesting cases in Hospital de los Niños! I'll probably visit again before I leave La Paz.
After my two weeks there, I'm by no means decided on a specialty that interests me most, but I could definitely see myself working in a hospital setting. I love the fast paced and heavy work load environment, and the challenge it provides in maintaining an optimistic and friendly personality that creates an aura of comfort and confidence when speaking with patients and parents.
I also love the accessibility of inter-consulting and immediate referrals. Being able to work with the doctors you are sending your patients to provides a level trust and security in the doctors mind that might not be rivaled in private practice. Having brilliant minds come together from different specialties to work on a difficult case is also an incredible luxury that only a hospital setting provides!
Overall, I've learned an incredible amount in my time at Hospital de los Niños and am excited for the contrast my future experiences will provide!
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