Sunday, October 7, 2007

Medicine on Tinian

I wasn't certain what kind of medicine I would be practicing on Tinian. I knew that I had to be prepared to treat whatever walked in the door, and I knew I would have to do a lot of "clinical" diagnosis; i.e., using the physical exam to determine a diagnosis without relying on a lot of testing. But would I see just sore throats, diabetes, hypertension, and physicals or would I see more exotic illness such as dengue fever, TB, and tropic disease?

I have now worked 14 days . . . 12 of those days in a row. I take call every weeknight and then every other weekend, so I work 12 days in a row followed by two days off. No complaint here! I'm practicing medicine, and what medicine I am practicing.

In the 12 clinic days, I have seen 278 patients. I do see a lot of sore throats, runny noses, and congestion. I had a run of pink eye this week. It was a pure epidemiological study. You see, almost everyone on this island is related. One person went to Saipan the week before last and then there was a family party over the weekend. In the next two days, I had 4 cases of pink eye then 4 cases the next day, then 3 cases with all the cases being relations. On the fourth day, classmates and community acquaintances started arriving. We ended the week with about 25 cases of pink eye.

I see a LOT of gout and staph aureus skin infections here. As far as the staph, it is all still quite sensitive to Bacitracin and Keflex, so I'm grateful for that. But because of the constant humidity here, these sores really become very large wounds very quickly. They seem to come in groups as well as I saw 3 patients with culture-confirmed staph in just 2 days.

We do have diabetes and hypertension and weight issues. I have seen 4 perforated eardrums. I keep thinking that this would be a great place to be a student because you see so much here. We don't have dengue fever or even any "tropical diseases" per se. I do a lot of TB testing because we have a lot of foreign workers living here but I have yet to see an active case.

As I said, I'm always on call and so I've had to get used to answering the phone many times a night, listening to my nurses' presentation of the cases, and then making the decision as to whether just treat over the phone or to go in. At first I had a difficult time with that decision but I think I have a formula for the decision now. I pretty much jump forward to what is the worst outcome that could present itself and decide if a nurse should handle it. If not, I'm out of bed and walking to the hospital. I'm only a short 5-minute walk and it's beautiful here at night. The walk gives me time to clear my head and make decisions before I get to the hospital.

I was called about a hypertensive patient with a blood pressure of 190/120. Out of bed I sprang and I actually jogged into the hospital. Treatment with a calcium channel blocker and vitals every 15 minutes, and 90 minutes later we were out of the woods and I was back in bed.

Of the big cases I've had there's been a large bowel obstruction, which turned out to be volvulus (the large intestine twisted on itself), the hypertensive urgency, a possible stroke, gangrenous toe, and chest pain.

Medicine? I practice a wide variety of medicine here and I love it. I have even had a few "what the heck is this?" cases. These cases are keeping my journal searching abilities fresh.

I walk to work, home for lunch and back to work again, and then home in the evening. On each of these walks while I'm either looking forward to the day and what will present or reflecting upon the day I've had, I am grateful to be here. I can't imagine being anywhere else. This is the medicine I've always wanted to practice. It's Mayberry here . . . as I walk down the street every driver that passes waves and people call out to say "Hi Doc." Yes, they know I'm a PA and I tell them over and over again, but this is a term of endearment and not an acknowledgement of a medical degree. I'm grateful that I'm here and that I have had the exceptional training necessary to appropriately treat my community. I can't imagine being anywhere else.

2 comments:

Deece said...

Hi! I'm a Saipan blogger checking out your blog - I love it! I'm so glad that you and your husband decided to make the move. You're definately a blessing to Tinian and the CNMI.

Anonymous said...

Thanks Deece. Welcome and visit often. Kevan and I absolutely love it here and plan on staying for quite some time. Glad to hear from you.