Final Week

This week I was on rotation in rheumatology, neurology, and geriatrics. The first day in the wards, we saw a rheumatology patient. He hadn't been diagnosed yet, so the students were able to perform an examination on him to determine what the problem was. The exam was checking for rheumatism and tendinitis, and they came to the conclusion, based on his painful and swollen joints, that he had both osteoarthritis and rheumatoid arthritis. This was the patient that they selected for this week's case presentation.  That same day, we also saw two neurology patients. The first suffered from a spinal lesion and we learned how to properly do a neurological examination to determine where exactly the lesion was located, which ended up being C7. The next patient also had a spinal lesion and it was determined by her scans that the lesion was C2, which was the result from being stabbed in the neck. The next day, we returned to the rheumatology ward in order to collect a history for the presentation on Friday. Because they had performed the rheumatology exam the previous day, this time it was a general exam to see if there were any additional problems. We then saw another neurology patient who had been diagnosed with myopathy. She could not walk or lift her arms. We learned how to do proper reflex tests and what each test tells us, and we also learned how to test muscles for tone and power to determine the severity of the myopathy. The following day, we spent the morning performing a comprehensive geriatric assessment, that tested vision, balance/coordination, cognition, and various other skills. We then discussed with the geriatrician what each test was assessing and what the results mean. The last morning, we began the day by listening to doctors from each department present an interesting patient that they had recently encountered. The cardiologist showed us an echocardiogram and an electrocardiogram of a patient that had been diagnosed with cardiomyopathy. The neurologist had a patient with an extremely rare neurological disorder called opsoclonus myoclonus ataxia, which has a very low occurrence, only affecting about 1 in ten million people per year. The patient had extremely unusual eye movements as well as an abnormal gait, as seen in the video of the patient that the doctor showed us. The pulmonologist presented a patient that was diagnosed with superior vena cava syndrome, which is caused by an obstruction of the superior vena cava. After the doctors' presentations, each rotation group had their own presentations, and then we returned to the hospital to perform a hand examination on an arthritic patient.

Classes this week were also quite interesting. On Monday we had endocrinology and we discussed hypo and hypercalcemia, the roles of calcium and calcitonin in the body, components of the adrenal gland, Addison's disease, and the effects of aldosterone, cortisol, and androgens. We also had cardiology where we learned about the anatomy of the mitral valve and its diseases, such as mitral valve stenosis and mitral regurgitation. Tuesday we had radiology in which we learned about the protocol for performing and interpreting a chest x-ray. We also had a lecture on pediatrics that I really enjoyed. We talked about what pediatrics is and how it differs from adult medicine in terms of communication difficulties, technical challenges, embryology, growth, development, preventative medicine, and the mother-child bond. The lecturer told us all about how to approach children and what to do and what not to do when examining a child. We also learned about child nutrition, physical growth, and growth standards. On Wednesday, we had a surgery lecture that covered vascular diseases such as arterial insufficiency, peripheral arterial disease, acute ischemia, gangrene, aneurysm, and varicose veins. We also learned about disease of the stomach and duodenum, peptic ulcer disease, the effects of NSAIDs and gastrointestinal bleeding. On Thursday we had a lecture about fetal monitoring and distress and then a lecture on the ophthalmic examination, which included visual acuity, visual field testing, color vision, and ocular motility. Friday's lecture consisted of learning the basis of quality in health care delivery, and what quality actually means in terms of treating patients. Our afternoon lecture was quite short, but we covered thoracic trauma which involves the lungs, heart, and esophagus. The injuries that we talked about were tension pneumothorax, pulmonary contusion, hemothorax, and cardiac tamponade. Class was dismissed early and a few of us went out to spend our last night here at a wine tasting where we got a chance to try a wide array of local wines, which I think was a very pleasant way to end our trip.

In a few hours, we'll be headed home, which is quite bittersweet. These last few weeks have been so incredible and I'm really thankful that I was able to come on this trip. Even though a lot of the information that we covered both in class and on rotation went over my head, sitting in on these lectures has made me so excited to be in medical school and actually learn all of this for myself. The hospital rotations were also great because it gave me a chance to see first-hand some of the conditions that I've only ever read about and never actually witnessed. While it is a little disappointing that I didn't see any new trauma patients, despite being on call a few times, it was probably a good thing that people weren't getting that badly injured. I'm also very thankful for the people that I've met here because everyone has been so friendly and welcoming and although I am ready to be home, I'm sad about leaving. Overall this trip was a little disorganized and we did get off to a rocky start, but once we actually got into the medical side of things, everything ended up working out. I look forward to the day when I can come back to South Africa because it really was an amazing experience.