Homework :(

So today was lame. We arrived at the clinic and both Dr. Jim and Erik held a meeting and told us that we have two projects to complete before we leave. The first is to give a presentation to the doctors about "something medical" and the other is to transfer written data from their surgical logs to computers. Both will be mind-numbing but its the least we can do for the time and patience that the physicians have given us here. My presentation will be over Spondylolthesis. The Chinese medical students arrived and now we are crowded. In fact, I think Jim gave us this task to get us out of the OR for the day. Also, I had my first stomach rumbles last night, yay..... I hope it subsides by tomorrow. Again I can't wait for Angkor Wat! Thursday!

Termites yum!!

Again it feels soo good to sleep in. I am sure I will miss this when school starts. I had a skype interview for a spot in the "med frat" this morning. Its a house with 10 medical students ranging in years from 1st to 4th, its in Montlake (my sought after spot), and will cost me $350 a month including utilities!!! It would be a dream. I hope I get accepted.



For most of the day we just lounged around the hostel. About midday some of the local workers called me over to their table to sample some "palm wine" which was being distributed from an old motor oil jug. It was whitish and smell terrible and the taste was akin to watered down bread mix. We toasted, and toasted again, and again.... Soon enough someone joined our table with what at first appeared to be rice and some sort of herbal concoction but as I inquired they explained that it was a bowl of termites, larva, and their eggs. Being slightly inebriated and always up for an adventure I took a spoon full and placed it in my mouth. I had a brief moment which could only be described as that feeling you have midair after leaping into what you know will be freezing cold water. I chewed.. and chewed some more. Salty yet oddly delectable the texture was interesting and I found myself in desperate need of comparison so I took another spoon full of termite soup and sampled it. Yum. We later went to the other hostel owned by the same people and it was much nicer with a swimming pool and cheaper rates. I'm moving there after Angkor Wat. We capped off the day with a tour through the royal palace that was rudely interrupted by a drenching tropical storm. Lori, Brent, and I found ourselves sitting on an oriental rug with one of the giant elaborate Wats to ourselves just watching the rain fall over the royal courtyard. It was remarkably peaceful and we let the warm moist air rush over us engulfing us with the sense of joy at relaxing in a royal palace somewhere in SE Asia. Finally they kicked us out and we (soaked to the bone) took a tuk tuk back to our place. Thats it for today. I've got clinic tomorrow and can't wait. Pictures should be added (to all entries) tomorrow too. Cheers!

Shadow puppets

I know I said I love being here but with the weekends for down time I have seen everything that Phnom Phen has to offer. Luckily next weekend we are planning on seeing Angkor Wat! Today I woke up late and walk from one end of the city to the other (~3 hours). Not much more to see. I ate at some great noodle stands and made my way all the way back to the Russian market. BE ON THE LOOK OUT for postcards. They cost me a small fortune to send but will be well worth it. Brent and Lori moved back into the hostel because their place wasn't what it was advertised as; it had ants, no
hot water, and wasn't in town. It worked out because now I have someone to hang out with. Tonight we went to go see a shadow puppet theater and it was fun. The shadow puppets are made of super thin leather and the show was funny (even though not in English). That was all for today. I will post a short clip of the puppet show on Monday. Tomorrow we plan on eating fried tarantulas and Brent found a "special" drink that he wants me to test.

The end of a great week..

Sorry I missed yesterday this is a double entry...

Thursday:
Today we went out to see the acid burn clinic. It was one of the most depressing places I have seen here. In Cambodia if you are caught cheating on your significant other than they may take battery acid and splash you in the face with it. If you are lucky enough to survive such an attack than you are horrifically scarred and debilitated for life. Not to mention the stereotyping that comes with being a burn victim. Although many attacks are unrelated to infidelity; there is a lovely woman we met who is scarred beyond belief and it was because she reported to the police that her brother-in-law sold her daughter into the sex trade and so he found out and dowsed her with acid. She is blind and her limbs do not have very good range of motion. Even worse is that people think she is an adulterer.. Their stories are heart wrenching and their physical appearance is gut wrenching (not trying to be insensitive but I would not take pictures out of respect but I need to explain how terrible this is). I would have been miserable all day but one of the workers outside of the acid burn clinic has been tirelessly building an aquaponics system and some of his (Carlos) ideas are revolutionary. Carlos and I set to chatting right away to the great dismay of Brent and Lori who could care less about aquaponics and more about getting out of the heat. I will not dive into that subject though because I could talk forever. Anyways when we returned Jim extended a dinner invitation to us for the evening.

Jim's house is HUGE. He has at least 4 servants and did I mention that his house is HUGE. He had an open bar and a few other guests so we helped ourselves unabated. We were joined by two traveling doctors, Viet the director of the acid burn clinic, and Javier a new media specialist. Again, Jim is an interesting character. We had a good dinner and great conversation (not really including Jim) and then out of the blue he cordially kicked us all out... I was full, toasted, and in Cambodia. Life is great.


Friday:
This has been one of the most rewarding trips I have ever been on! I have participated in at least 6 surgeries a day! Well, except for Fridays are slow but today I started out with the removal of a baseball sized tumor from a man's chest. We fought it for a good hour at least, but it finally gave in. Of course, it took nearly all of pectoralis major with it. Then I followed up with a few more hydroceles where I am "perfecting" my "buried suture". I have seen enough of these to do one myself and I probably could if I asked but I am not sure that would be such a good idea. For lunch today I sat with a group of women (well they all sat with me) and we laughed together as we tried to communicate. I have learned over the years that only a few key words are need to unlock the world: You are beautiful, delicious!, thank you, and hello. Between these three I can get a smile out of anyone. This afternoon I scrubbed in as second surgeon on a burn contracture of a hand. This young woman's fingers had been burned together in an almost fist like position. We initially set out to free two fingers but 3.5 hours later we only managed to get one freed. It was my longest surgery to date. The surgeon was amazing, but discovered during the operation that she had a congenital malformation as well, which severely hindered his ability to correct her hand. But we did manage to use skin from her hip to graft her new pinky finger.

After that I went to Brent and Lori's new place and it was very nice. Is anyone reading these? Leave a comment if so!!

My first sutures!!!!!

Today started off, for lack of a better word, shitty. I have a cold, fever, and was wallowing in bed this morning debating whether or not I should go to the clinic. I muscled up some courage and dragged myself to meet up with the married ones. Being that I had to blow my nose every 3 seconds I opted out of scrubbing-in for the first few surgeries. Brent got lucky this morning with an osteochondritis (sp?) which involved chiseling away giant bone formations off of some poor guy's knee. Loads of blood and lots of action, I was able to get some great shots of Brent helping out and became extremely jealous when the surgeon asked him to suture. It was a continuous suture and Brent missed that part of our suture clinic back in Anchorage so he had a bit of a hard time but I must give him credit for attempting his first sutures on a live person!

Eventually I scrubbed in for a hydrocele and Mona, the cute English medical student, walked me through the operation, the clinical diagnosis, and was just amazing. She was attempting the surgery for the first time alone (with me). I could tell she was nervous because she kept apologizing and I had to explain that I could not tell the difference between the world's best or worst surgeon. I did get to see a gyser of fluid erupt from the boy's scrotum, first cool thing of the day. Again, I am living my own dream working here, though 2 hours of surgery with a runny nose that you can't scratch or even touch is about as challenging as it gets for me. Lunch was good and the ladies are enjoying my Kamer. OH! Dr. Jim finally showed up.... He is...a character. He blows through the OR like a barefooted hurricane barking at any and everyone in his path. He was scheduled for a surgery in the afternoon and when it came time ALL of the surgeons were no where to be found. I think they were hiding and playing rock, paper, scissors to see who had to work with Dr. Jim. I have to give just some highlights of him in the OR:

1. Blowing in to the OR = "ALRIGHT LETS GET THIS SHOW ON THE ROAD. WHERE IS THE SURGEON?! WHERE ARE ANY OF THE GOD DAMN SURGEONS!?!? WHAT?! THEY'RE ALL OUTSIDE OF THE OR!?! TELL THEM TO GET THEIR ASSES IN HERE!!"
2. Spilled blood on the floor = "YOU! CLEAN THIS UP..NO NO NOW! NO! NOT WITH THAT! A MOP! M-O-P MOP! DO YOU KNOW WHAT THAT MEANS?!"
3. Start of a surgery talking to the surgeon who has not scrubbed in yet = "JUST CUT! OH FOR FUCK'S SAKE (slapping the surgeon's hands) YOU DON'T NEED TO WASH ITS JUST A QUICK CUT!"
I have never met anyone quite like him before.

Anyways, it was one of the last surgeries and I opted to scrub-in. Our patient was a severely scarred (old burns) 10 year-old boy who was there for a burn contracture (loosening of scarred skin) which required a skin graft. Mona, myself, and the surgeon started and fortunately I was told that I could sit for the operation because the surgeon is only about 4'5" (in the morning) and leaning over to match his and Mona's level would have killed my back. Mona had a cold as well and scrubbed out 10 minutes into the surgery. This left just the surgeon and myself. He is my favorite so far because he has descent English, he explains EVERYTHING and has a great sense of humor. He let me cut, cauterize, retract, separate facia, and..... suture!!! Yep! (giant grin on my face as I type) I helped suture a 10 year-old's armpit back together 6 stitches! I will admit that I am slow (he stitched 45 in the same amount of time), but I did it! The second time I ever stitched was on a human! I helped "skin" the patient's thigh (I will never look at slicing cheese the same again) and stitch the skin onto his neck. It was a rush, Lori got some great pictures and I hope to put them up tomorrow. Wish me luck, everyday here gets better and better!

My true calling...

Today was great! I woke up later than 3 am for the first time since arriving and went out to my favorite Pho spot. I have been practicing my Kamer "Cambodian" with hostel staff and gave it a go this morning. Fortunately it was met by a few laughs and smiles from the shy ladies who cook my food. I met up with Brent and Lori and we got a tuk tuk to the clinic. Sadly it was another slow day with only 4 scheduled surgeries but I was able to assist in 2 of them. I am becoming more proficient at scrubbing-in as well as gowning up without touching non-sterile objects. [You'd think it would be easy but after finally succeeding without a re-scrub the staff looked like they wanted to give me a medal]. The first surgery was to remove this poor gentleman's sixth toes. That's right, I said sixth toes (plural)! He had one extra big toe per foot! Only myself and one other surgeon operated on this poor man who was awake for the entire procedure! He had received a spinal block so he didn't feel a thing but I could tell he was freezing in the air-conditioned OR because he shook violently. He was brought warm blankets and stopped shivering which only revealed my own trembling hands to the surgeon (I was nervous). I helped cut, hold, lift, and wrap, it was AWESOME! At the end of the surgery we took pictures of his severed toes and discussed therapy with him (most of which I didn't understand because it was all in Kamer). The doctors here are extremely patient and always ready to explain things in their broken English. Our last surgery wasn't until the afternoon so I took another long lunch. Today I ate snail soup with fried whole fish. I can't say that I care too much for snail but it was a unique experience. After that, I teased some kids and made funny faces for the patients in recovery and they got a kick out of that. It feels good to see them smile. Finally, it came time to start the last surgery. This gentleman had a very badly misaligned foot that was a result of having polio when he was young. The surgery was incredible and I was right in the thick of it with three other surgeons. They cut his Achilles tendon as well as two others to relieve tension, sutured some together, and finally drilled a hole clear through the middle of his foot and drew a tendon from his calf over the top of his foot (under the skin) and using fishing wire pulled it partially into the hole. The idea is when the bone heals it will grow around the tendon and hold it there permanently. We were able to return his foot to a natural position and cast it. Even though the physicians and I spoke different languages we still all understood each other and worked well as a team. Its hard to describe the feeling of doing these surgeries.. I want to do this forever it is my calling. This hands-on helping people and making a real difference in their lives is why I wanted get into medicine in the first place. Tomorrow there are already 11 surgeries scheduled!! I can't wait! I may even get to suture for the first time! This may have surpassed the Peace Corps as one of the most amazing experiences I have ever had! Sorry this was soo long but it was an incredible day! I am working on getting some pictures online so bare with me..

Wanna shoot a cow with a bazooka?

We've had what seems to be endless downtime. Since midday Friday we have seen every sight in Phnom Phen and still have all of tomorrow off. Today was another interesting adventure, still battling jet lag I was up and rearing to go at around 3am so I forced myself to sleep at least another 3 hours. It felt funny after coming straight out of medical school being accustomed to having very little time for sleep and here being inundated with it. After my ritual walk/breakfast I met up with Brent and Lori and we were being persuaded by our host to spend $500 to go shoot a cow with a bazooka ($100 for the rocket, $300 for the cow, and $100 in AK-47 rounds to finish the job if we missed). Although VERY tempting, we passed and decided to check out the Russian Market. It was great! Everything and anything you could possibly want for cheap (if anyone needs anything for cheap just ask [16g USBs $20, iPhones, etc])! We stopped for some food in the hottest part of the market and after lunch I decided that I wanted a haircut, 1 hour and 3 women later I was finished, soaked to the bone in sweat and a crowd had gathered to watch what I assume would be called the "three little women cut hairy giant's head" show. After a quick siesta back at the hostel we set out to eat at the Banana Boat. It was a quaint restaurant but we somehow managed to "sit" at the only table that had no seats (Arab style). We think the waiters smiled/laughed at us every time they passed because we looked so awkward. The food was raw but good. Next, we roamed the streets of Phnom Phen at night and discovered that the city comes alive at night. The whole city was lit up like Christmas, and there were large groups of people dancing together everywhere. It looked, at first, like they were doing group aerobics but as we drew nearer you could hear the music. The rest of the night was spent sitting on the lawn in front of the royal palace and people watching. It was a good day..

My first surgery..

I really dig this hostel. The owners here are chill and have the most unique names; Tony Montana, Rooster, Tiger, etc. This morning I woke up early and went for a walk to see the sights before going to the clinic. Its dirtier here than anywhere else I have been but the people are super friendly and always ready to lend a helping hand. Breakfast took place at a little street side booth that served mystery meat soup and tea, which was amazing. I really missed having everyone stare and laugh at me while I ate but it took me back to the last time I traveled through this area. I met up with Brent and Lori and we headed off to the clinic in a tuk tuk. The clinic is exactly as I imagined it. There is one OR with 3 active surgeries taking place at the same time. We try to maintain sterility but everything we use is machine washed right outside of the OR and the instruments are hand washed (I think they have an autoclave somewhere..). They have a portable X-ray machine from the 1990's incase in a plywood "room" with a tech that has never worn shielding. Their recovery ward consists of 12 beds which each hold 2 people and if there is a third (caretaker) they sleep under the bed. I should have brought scrubs because most of the ones here are WAY too small, though the Cambodian nurses still whistle at me when I pass so it isn't all bad. We hit the ground running and Brent and I scrubbed in on my first surgery which was cleft palate repair. I "assisted" the surgeon by cutting the sutures, handing him instruments (some of which were the right ones), suctioning, etc. It was awesome! Dr. Lang was extremely patient with me and showed me everything he was doing. This past week was a holiday so we only had 4 surgeries and were relieved at noon. Brent, Lori, and I then spent the rest of the afternoon walking around the city visiting museums, the market, and sampling some local foods. The strangest thing I saw today were dogs roasting on a spit. Brent and Lori thought they were calves but base of the direction of the knees there is no way they were cow. I am looking forward to sampling the K9 meat sometime soon. Thats it for now, more to come soon......

Cambodia, let the good times begin!

Greetings readers! Well, it was a challenging 1st year of medical school but I finished! That's right, I am 1/4 of the way done towards my MD. I had a blast up in Anchorage with my WWAMIly (which was the first class in a long time to have EVERYONE pass all their classes). Sorry I didn't blog too much on the subject but its content would only have included waking up, school, study, gym, sleep, and repeat. With some added super stressful exams here or there. But, currently I am writing to you from Phenom Phen the capital of Cambodia! I just arrived after a grueling 18 hour flight. I have to give a shout out to Korean Air, which is THEE BEST and continues to be the best airlines I have ever used. I arrived late but fortunately Brent (a fellow med school student) and his wife met me at the airport and brought me to this quaint little hostel. I am too excited to get my hands dirty at the clinic tomorrow.. OH! and I will tell all about my exciting Seattle trip too but for now... Must sleep.. Stay tuned!