First Day of Hospital! Saturday, June 11th

Today was our first day of Electives. And it was awesome. I was in Child Health with Dr. Said (A pediatric endocrinologist (doctor of Hormones)) and his residents and some 5^th of 7 year medical students. Trevor was in Neurology with Abdullah al-Asmi and Claire was in Family Practice with another physician. I think I might let them blog about their experiences, because, I’m tired and fatigued from writing.

My experience was not unlike my experiences back at home, except that it made more sense now after my class “Principals of Disease” where we learned about bacteria, viruses and other infectious diseases. In my time with the children, we talked more about the diseases in that class than I could have imagined, remind me to thank Dr. Elder and Lopez when I get home. That class was difficult for me (to succeed or to enjoy) but it was so incredibly worth it. I met incredibly nice 5^th years, one, Kumait, has become our close friend and is in charge of the Social program for exchange students. He’s setting us up to do incredible things, undoubtedly. He’s supposed to call any minute and whisk us away to the old souk. We’ll see if that happens. He’s a mild know-it-all and brown-noser, but I say that kindly, because I see some of myself in him. J He also understands English Sarcasm, which I am so grateful for I could cry. I’m so sarcastic sometimes, but I can’t express it here because it doesn’t translate well. He’s also one I can poke fun at, so that’s fun. I followed Residents predominantly as they presented on patients, then sat in on classes of 5^th years. Omani women drive me crazy sometimes… they are so meek and quiet and mousy. Even the residents struggled to speak out loud to the doctor on their patients. I get being shy, or uncertain, but I’d love to smack some spunk or self-confidence into these girls. Anyways… these patients had EBV, HSV, Roseola (slapped face rash) Rheumatic Fever, a condition where one has dysfunctional sodium channels at the Dorsal root ganglia and has no sensation – heat, pain, touch, nothing. So had no toes, and scars everywhere. Also, they had meningitis, dismorphic features, some afebrile, others with temps in the 40’s. Lol, if you understood any of that – I deem you nerd. For those of you non-medical folk out there, they were sick with respiratory illnesses, bacteria or viruses in the fluid in their brain, fevers or not, rashes or not, and arthritis which moves from joint to joint and makes them hot to the touch. Dorsal root ganglia is just the main communication center of your body that tells your brain what it feels… if it’s sick, you have no feeling. Oh, and one baby didn’t go through development as an embryo right and so had low set ears, with the Ala (the big part of the ear) being flat and smooth, not roughened like normal. We then had lunch, went to an Acid Base Disorder lecture, and came home. PS. Dr. Putnam does it 1 million times better. Be grateful Boonshoft, be grateful. Know that graph and the flow chart, it’s so much easier. And now – three hours of blogging later… I’m done.

Trevor’s Day:

So Jessica is forcing me to write this, even though I would much rather tell it to her and have her put it into words since she is a much better writer than I am. Today began the “real” reason for why we came to Oman. (You know, obviously not the beaches, tourism, or fun). Although today turned out to be a very fun day in its own way. It began with one of SQU’s employees picking us up at the hotel and taking us to the university, which is about a five minute drive. The man didn’t talk much outside of saying “SQU?” when he came into the lobby to get us and “You’re welcome” when I thanked him for dropping us off. When we stopped, Salim came down and got us and took us to our destinations.

It kind of turned into a much longer affair than we or Salim, from the way he was doing most of his morning work on his cell phone, expected. First we stopped at the neurology wing of the hospital to meet Dr. Al Asmi, who is the doctor in neurology that I will be shadowing, but he was in a meeting. Salim was ready to barge into the meeting to get him until Jessica stopped him at the last second by suggesting we go ahead and get our ID badges. Good idea, because I’m not sure that Dr Al Asmi would have had the best first impression of me if our first meeting involved this crazy American man interrupting his morning meeting. So we got our ID badges after walking across campus in the already sweltering Omani heat. Then we went back to the hospital where we tried to drop Jessica off at the pediatric wing, which failed yet again, as Dr. Alexander was apparently on vacation leave. We went back to the neurology wing, where Dr. Al Asmi was out of his meeting and ready to meet me in 5 minutes time. Jessica, Claire, and Salim said goodbye and I waited in the seminar room, where I met a nurse from Malaysia who I chatted with.

Dr Al Asmi was a very friendly man who spoke very good English. He and I chatted for a while as we waited for his group of 5^th year medical students to arrive to start clinicals. We talked about the shortage of physicians in Oman, the challenges involved in implementing residency programs, as Oman just started their residency programs 5 years ago and still do not offer residencies in all specialties, and the difference between the structure of the American medical school curriculum and the Omani medical school curriculum. The students showed up, I was introduced to them, and we started rounds. Rounds were extremely interesting, as they combined ICM and the core science classes to effectively demonstrate what “real” medicine was like. I was surprised to learn that the Omani medical students seemed to not understand some of the practical aspects of clinical medicine as well as I did, as they did not know what some of the tests were and did not seem to have as refined interviewing skills. However, their knowledge of pathologies and diseases was much greater than mine. I saw a lot of very interesting cases though. One man had a TIA (transient ischemic attack) and I got to see an abnormal pronator drift with him. I got to see a case of myasthenia gravis and also a very interesting case called Progressive Supranuclear Palsy, which has Parkinson’s like syndromes, and involves an abnormal glabellar reflex.

After that, I was done rounding for the day so I went downstairs to eat lunch at the cafeteria, where I ran into Claire and Jessica, who were also both done for the day. The medical students Jessica had rounded with had invited her to a class on acid-base disorders, so Claire and I joined her for the class. I gotta say that I appreciate the way the information was presented in our class better, as we used flowcharts and a graph to make the information easier to understand, whereas this class just kind of threw a bunch of information at the students and expected them to memorize it. We will have to try to find them a copy of the graph and flowchart to show the students to make their learning a little easier. So anyway, that was my first day at Sultan Qaboos University. It was a very interesting experience and I look forward to what the rest of the week has in store for me. Oh, and Jessica sucks. J

Claire:

After leaving Trevor stranded in an empty classroom in the neurology department, Salim, Jessica, and I loaded into Salim’s car and drove the short distance to the family medicine “FAMCO” which caters to the primary care needs of SQU’s students, employees, faculty, and family. After a few minutes of standing in the intake hallway nervously while Salim disappeared to convince someone in FAMCO that I was indeed supposed to be there—Why is no one at SQU expecting us??—I left my friends and found myself sitting in an empty FAMCO exam room to contemplate my fate. Apparently, however, the Omani physicians and faculty are pretty laid back when it comes to foreign strangers showing up and demanding shadowing privileges. I can only imagine how this scenario would play out at BSOM. The physician who greeted me assessed my clinical skills (minimal) and academic knowledge (fair, if I do say so myself…) before promising to call Dr. Mustafa, my supposed supervisor and sort-of forcing me onto an unwilling 4^th year resident, Dr. Nafisa, in the middle of her clinic hours. I was unsure of how pleased she was to see me, so I tried to act my politest and most interested for the duration I was with her. We saw a patient with a wicked burn from falling out of bed onto a hot plate. Dr. Mustafa arrived soon. Unfortunately, I think he came in on his day off solely for my benefit! He added me to the 5^th year students’ clinical rotation, where they were practicing clinical exam skills, and !!!! preparing for an OSCE. This really worked in my favor. I took my OSCE last week so I didn’t look like a total fool. We dissected at length a patients’ presentation with acne, on with red eyes, and one with asthma. For the patient who complained of red eyes when he was exhausted, the doctors prescribed more rest. Haha. The doctor-patient relationship doesn’t seem so different here in Oman. After clinicals, Dr. Mustafa was gracious enough to give me an extensive tour of the hospital and medical school facilities, some of which were very, very impressive by US standards. (ICM rooms loaded with state of the art recording equipment and multiple cameras?) When we were finished he took me to lunch at the hospital cafeteria, where thankfully, I met with Jess and Trevor and even ran into Emma again. Lunch was quick, tasty, and Omani. Afterwards, Jess wanted to go to an acid-base lecture. I guess there’s no accounting for taste.

((Jess’s Side note: and this has been Trevor and Claire’s first (AND LAST) direct contribution to this blog. I cannot tolerate such harassment! –Dramatic Sigh- PS. Claire just told me that the ICM room’s cameras are set up so that as a student interviews a patient and does a Physical Exam, that the feed goes back to the lecture hall so ALL THE OTHER STUDENTS CAN WATCH AND CRITIQUE!!!! Uh, no thank you. I’m nervous enough with a Doctor directly in the room, makes me super self-conscious, that sounds miserable. But It’s cool to know their ICM rooms kick butt.

This night, after arriving home, Claire and Trevor slept and I wrote on this blog. My new found friend Kumait said he’d take us to the Souk and help us find good purchases, but by the time he arrived it was 7 pm and too late to go the market. So we went to a restaurant and Shisha bar. Shisha is Hookah, in the States. Smooth and full of water, it is flavored to add a different facet to smoking. I had done it once in the US, but I had too much flavoring and it burned my lungs. This time I tried the two types we got, and enjoyed them, honestly… as much as one can enjoy thick air that when breathed out tastes like Sweet Melon, or Strawberry-Grape in an apple pad. But my throat consistently hurts afterwards, and, though I don’t cough, I feel bad for my lungs. Supposedly, one Shisha is comparable to 19 cigarettes (depending on who you talk to, 40.) So. Not my fave…. It makes my argument for not trying one cigarette seem like foolishness, but I can’t justify the rat poison or tar or nicotine. But Trevor and Kumait did it, while Claire, Hamseh and I just ate amazing barbeque and really good Lime Mint juice. The conversation was pleasant and the evening simply wonderful. There was one other woman in the main center, but in general, you never see another girl. I found a sectioned off room today labeled “Women Only” and found 5 or so women inside smoking, writing on a computer, reading, etc. Segregation even in the Shisha house. We talked about little bit about Omani marriages. It seems since the weddings are so extravagant, sometimes lasting three days, that the men and the women pay for their celebrations separately. But, the man is responsible for finding the house, furnishing the house and providing all comfort for the wife. They believe in equal opportunity, but acknowledge that there is a difference between men and women and that we don’t think or process in the exact same way. They want it to be that a woman can work if she wants, but doesn’t have to. Their goal is just to treat her as a princess. Which doesn’t seem so bad to me J. Omani dating relationships are all on the DL. A person will approach another quietly and say that they like them and are interested in getting to know them better. Then they will date in secret, without even their parents knowing, perhaps only their best friends, until they decide to either get more serious in an engagement or to part ways. They do this it seemed to protect the honor of a woman. It isn’t a bad thing culturally if a man goes from relationship to relationship, but to maintain the chastity and purity of a woman, they don’t go telling who she has been with. I think I’m in love with this philosophy. Better than the Facebook relationship updates… why do we feel compelled to share our guts online? (MW, I hope you grinned) Do we do it for attention? To get sympathy when things end or positive regard/jealously when things go well? Are we too externalized? Can we operate within our own person or need another’s input to feel good about a situation? If we were to take everyone who is a hyperuser of Facebook/iPhone/xBox360/Skype (or the equivalent), how would they cope with a quiet room with no electronics? I have been in that situation, and have responded with mixed emotions: stressed because of the FoMo (Fear of Missing out) and distressed from the lack of my comfort blankie, and relieve that I know longer have to be a slave to my phone or spend hours staring at a screen. Yes, I see the irony in that I’m writing on this blog, even this is different. This self relfection in the face of severe cultural upheaval is quite therapeutic… even as it is frustratingly slow sometimes. Even though I love this blog, and believe in written vulnerability and sharing/documenting my thoughts, do I need to write everything on here? Every emotion, judgment, disagreement, joy? No, discernment is wisdom, and honestly there are some things that my soul is treasuring that cannot be put into black and white on a page. A lot is here, but I think there is wisdom in discretionary posting.

My doctor (the AWOL Dr. Alex) said that in Oman “You will learn to slow down, I think.” And I think he is right. The people hear speak slowly and clearly, they are even-keeled and soft, and walk with such grace, you’d think they had no hurry in the world and nothing but air gliding them forward. It’s really beautiful to watch. May I learn from them to speak with ease, walk with peace and learn to sip the Arabic Kahua. Perhaps I too could benefit from their lives of being fully present in the moment, fully studying, fully playing, fully resting. They are busy, but not pulled a million directions. I am in need of some strong centralizing momentum in my life. The image I have is of a hurricane, strong winds centralizing around a single cyclone in the center, pulling, pulling all things to this place. It is far reaching, and yes, it is a bit chaotic, but at the center, the eye of the storm, there is peace. Perhaps there is a great treasure at the center, a beautiful golden orb, or a fiercely glowing light, neither of which can be tarnished or extinguished. This is my center, this is my core, my true value and self. In this place of peace I find rest, caught in the palm of the Spirit of God, entranced by the dance and beauty of the storm around me. But I am unfazed by it ferocity. I am unafraid by its power. I am instead entranced by its beauty, propelled by its strength, and dance sweetly to its song. Goodnight, my sweet friends. I hope the nature of your music (instilled by the sweet gift of our Creator) cradles you softly in the knowledge of your own internal moxie, worth, gumption, courage, grace, and love. Dance on to the rhythm of the chaos, breath deep in the stillness of your core, be unafraid for you have not been given a spirit of fear, but one of power, love and of a sound mind.