So I am currently sitting in the London airport killing time once again which means that my trip is over. I just wanted to fill you all in and reflect a bit on the trip as a whole.
The last day or so of Pediatrics was great. The attendings there really taught more than any other department I was in. I saw some very interesting/hilarious patients. There was one kid who drank a bottle of insecticides. Insecticides are composed of organophosphates which are highly poisonous so we was given the antidote which is atropine. Well one of the phrases every medical student has memorized when studying for their Pharmacology test is in regards to the side effects of atropine: "Hot as a hare, dry as a bone, mad as a hatter...". So on first entering the wards in the morning I see this child (about 11yrs old) flailing in his bed, his mother slapping him because she is freaked out and wants him to stop, he is ripping himself free of the restraints and screaming that "they are coming". Nothing could calm this kid down, that is until he saw the 3 foreigners watching him. As soon as he saw us he became very still and stared a hole right through me as he whispered something to the nurses and staff restraining him. They all burst out laughing and told me that he wanted to know why the cat person was there (ie me and the other 2 foreigners). He carried on for a good 45minutes before the residents finally decided that they would give him haloperidol (an anti-psychotic). The Indian medical system continues to confuse me because the doctor wrote the prescription/order for a haloperidol injection and handed it to the father. The parents were going to have to go down to the pharmacy and purchase the injection for it to be given to the patient. This posed a slight problem as the parents (along with security) were needed to help restrain the child. I have no idea where the logic is in going about giving a medication in this way, nor do I know how it ended as we continued rounding on other patients. Some of the other patients that really made an impression on me were two little babies and a 9yr old girl. The first baby was around 1yr of age and had 'septic dengue'. He looked so sick and was so edematous that it was really sad. The team talked with the parents and they all agreed to sign a DNR (do not resuscitate) order, so sad. The 9yr old girl had meningitis (suspected to be TB) and I have never seen such pronounced and 'by the book symptoms'. I first noticed this girl when she was eating breakfast because she was leaning back on her mom sitting perfectly straight as her mom fed her, kind of odd. Once we came to her on rounds I discovered why. She had absolutely positive Brudzinski and Kernig signs; if you moved her neck at all she just screamed in pain. It was really incredible. The last baby was a failure to thrive patient meaning he wasn't eating and growing like a baby should. It turns out that this was because the mom was not breast feeding for some unknown reason. This patient was memorable to me not because of the diagnosis but the response of the medical team caring for him. The attending actually yelled at the mother and told her that if she did not want to kill her baby she needed to start breast feeding or find a wet nurse. I have never seen a doctor be so blunt and to the point in the US. He did not try to sugar coat anything or listen to her explanations as to why she was not breast feeding he simply told her the cold hard fact that her baby would die if she did not feed him. Very true, but quite harsh.
I cannot believe that my month in India has ended. I really was not sure what to expect when starting out on the trip but it was so much more than I could have imagined. I loved learning about the cultures and religion that are such a prominent part of the Indian identity and daily life. I was amazed at how big of an affect it has on their outlook towards medicine and life in general. I was shocked by the doctor patient relationship and how patients will just walk right into a doctor's room and ask to be seen and how a doctor will often yell at the patient if they are not following orders and can be a bit harsh with them (I should clarify that they came across as harsh to me, an outsider, but that this was viewed as very normal by everyone else). I had been warned that Indians are rude and yet I found them to be the most welcoming and accepting people who always gave more than they actually had to give. I was intrigued by how hard daily life is for many of them and how 'simple' medical problems have much larger effects for them here (having diabetes and a cut on the foot is much more serious when you do not own shoes and walk barefoot through trash all day every day). While there are many programs in place to help those who cannot afford regular medical care to get doctor's appointments and needed medications the system is not perfect and seems to focus on getting paid over helping the patient sometimes (such as the boy above). India seems to be full of these sorts of contradictions yet the people as a whole are so happy and content with their lives. I do not believe that any other country in the world could live with such a huge population without their being constant battles for space and property; while the Indians handle it with minimal upset. I am beyond thrilled with the experience I had in India. I feel that one month was barely enough time to feel as if I gained a basic understanding of the culture and how to get around and live in India. I would have loved to stay longer and really hope that I can return someday.
I hope that this was not too boring for all of you or two chaotic (I know I am a terrible writer and tend to just write as I am thinking versus thinking about what I am writing). I also hope that I was able to get across to you all how incredible and experience this was and that I highly suggest making a trip to India if you are ever given the chance. It is different from any other country you will ever travel to (both a good and bad thing) and if you can accept that you will gain more from the people and the culture than you ever thought possible.
Jacq
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