Rhett’s Blog

In the ER and more

It is Friday and my first week in Belize is almost over. This has been a pretty exciting week. The first few days were pretty slow going in the hospital. I mainly just observed and followed a few different physicians around. I observed a few surgeries too. Well, there was a little chaos with staffing the doctors for Thursday through the weekend. Dr. Lazo was going out of town on vacation leaving Thursday and all next week with his wife, who is the other OB/Gyn. Dr. Gamero was planning on covering, but he got called away on a family emergency. There is only one other physician here that works nearly full time – Dr. Sierra the pediatrician, although he normally doesn’t take call. On Wednesday I had had a talk with Dr. Lazo that I would like more responsibility and to be more involved in procedures. He seemed really resistant to having me do anything, which was very frustrating. When I found out all the difficulty with staffing I mentioned to him that I would be willing to help in any way I could. In the end, Dr. Lazo decided to let me be the primary on-call physician for the ER with Dr. Sierra as my supervisor for Thursday afternoon until next Tuesday. It has been a pretty crazy experience so far. Last night I had a couple cases of influenza and a dengue fever. Later in the evening a little boy came in with a trampoline injury. I think he dislocated his elbow, but the x-ray was pretty bad so it was difficult to tell. We splinted him and sent him to follow up with an orthopedist.

This morning was when things got a bit crazy. I was called in the morning to come in for an abdominal pain case, which ended up being a typical case of cholecystitis, but only mild. In the middle of taking the history a nurse rushes in and tells me I needed to come right away. I asked what going on. She says a patient had just come in labor and she was delivering right now. They had been trying to call Dr. Sierra, but he wasn’t answering his phone. Medical school hasn’t been too scary so far because regardless of what I was doing I always knew there was an attending nearby to help me out. In this situation, as I was running down the hallway of the hospital, I was scared to death because I knew I was the only one that could respond. What if there was some major complication? Was I ready to make the right decisions in such an intense situation? I wasn’t sure about that, but at that point I had no choice. When I entered the patients room there wasn’t much time to do anything, I didn’t have time to ask her any pregnancy history nor even how far along she was (We had actually seen the patient earlier this week so I knew she was around 37 weeks, and I knew some of her history). They didn’t even have time to get her to the delivery room so she was in a regular bed. Once I got my gloves on the baby’s head was right there. It took only one push and she came right out. As I suctioned and clamped I was praying that everything would be okay. Luckily, the little thing let out a few squeeks and then a good cry. I gave her to the nurses to take care of while I turned my attention back to mom. Things seemed to be in control; not too much bleeding, uterus was contracting well, and mom looked good; there was no IV running or any monitors going. I sent the nurse to get something in case she wouldn’t stop bleeding and something for pain. The placenta delivered without problem and was complete. I was worried about tearing due to the rapidity of the delivery. She had a 2^nd degree tear of the perineum, but the cervix looked okay. I had never really sewed up a tear like those, only had seen a few, but since I was the only one there I had to do it. When all was said and done, it looked pretty good and the nurse was impressed. Halfway through the suturing Dr. Sierra showed up and basically took over. Overall, it was a pretty nerve racking experience, but looking back, I’m not sure why. Everything was routine and besides happening real fast the delivery went really well like a text book.

I’m sure this weekend is going to be a great learning experience managing the ER. I was planning to head out and see some Myan ruins, but this works too. I came to Belize for some great medical experiences and so far I’m getting those. The first few days I didn’t think I would get to do much, but I think the staff is finally getting used to me and hopefully, starting to have some trust in me. Until next time. . .