a day at the va spa

my attending went away for the weekend and so the chief of ID at the Ann Arbor VA covered for her yesterday. the chief of id is my kinda pseudo-advisor and i had some email conversations with her while i was still on my fogarty in Thailand and then later talked to her in person at the VA. she is hugely famous and is one of the world's most foremost experts on fungal and yeast infections. for medical people out there, let's just say that when i went to read about a patient i had with Candida parapsilosis, Dr. K. was the author of the Up-to-Date article "Overview of yeast infections." i was trying to explain how crazy that is to Chris, to have your attending be the primary author on numerous Up-To-Date articles in the field that you're hopefully going to go into. anyway, she's a big deal, but really down-to-earth and into teaching and giving good advice. basically, she would be a woman version of a nice dr. cox (on scrubs) but dr. kelso's age. i just got the feeling that that was a terrible analogy, but im free-writing, so i'm going to keep it anyway.

in any case, yesterday was pretty slow. i got one consult for a patient who had Bacteroides fragilis growing out of his blood cultures but E. coli in his urine, and we were asked about the source of his infection and on recommendations for treatment. i learned a lot with my senior resident (who was also interested) and hopefully made a good impression. i was surprised that i i didnt feel as intimidated as i thought i would and also was psyched to learn a few things on rounds, which always includes a trip to the microbiology lab, where i smelled some S. mutans on a plate. There was a vote on whether the S.mutans smelled like butterscotch or butter popcorn and I voted for popcorn (it ended up being a tie). who knew micro lab could be so fun?

later, we went to change a dressing on a wound. i went to help get supplies and had tape to keep the dressing in place (which i can never tear). dr. k. watched me struggle with the tape briefly and then took it from me and ripped a piece off without a problem. her advice to me: "you have to be bold!" the patient's wife (who was learning how to do the dressing) interjected that she always had a problem with the sticky tape so i didn't feel so bad. granted, i still am decades younger than either party though. note to self: practice tape-ripping skills for further ID work.

after rounds, i went to work on my note. during that time, i got excited since i received an email from an administrator at Johns Hopkins saying that the Fogarty International Center funds from their center would pay for me to go back and spend a month at Dr. Cynthia's clinic in Mae Sot, on the Thai-Burmese border. this means that i will return to Thailand twice this year, once as a OC Hubert/CDC Foundation scholar and once with Fogarty. I'll be spending about a month in Thailand each time and be based in two different places (Nonthaburi, outside Bangkok, for the CDC, and Mae Sot/Chiang Mai for the Fogarty). Maybe fourth year will turn out to be more like my "year off" than I originally thought. :)

in any case, this email got me really excited. when i went to leave for the day, i stopped by Dr. K's office and told her about it and the projects i was going to be working on in thailand. we talked about how medical education was changing at michigan (some medico-legal officer doesnt think student notes should be allowed in the medical record anymore?!) & the differences between thailand and the us. i brought up that the Fogarty Center had solicited a piece about "the need for patient education and health literacy in the health care system, drawing from your experiences in Northern Thailand" after reading my article in The New Physician. i was kinda offended although i'm not totally sure why, but i feel defensive about people just being like "can you comment on the plight of the poor?" or the sentiment of "please draw from your exotic experience and perspective as a first-world person working in the third world." it's not like people in the US don't need health literacy too, although i don't think the woman who emailed me was implying that they didn't.

i ended up writing the article, which i posted on my friend's health-care related blog, cure this!. it will also be published in the July issue of Global Health Matters (the Fogarty newsletter), but decided to compare my experiences in the US and Thai health care systems instead of just focusing on Thailand's shortcomings. Dr. K. and I talked about this for awhile, and i was really struck by a comment she made when I noted that my close friend (and ID fellow) would see a ton of patients in clinic and not really have a ton of time to talk to them or write the best ever notes in the chart, but she was still providing good medical care. Dr. K corrected me - "excellent medical care" and noted that Thailand's health care system may not be perfect, but the docs over there were truly saving lives.

as i prepared to leave, she said that she was excited for me to return to Thailand and advised me to take malaria prophylaxis, adding, "You should go back - it's a privilege to be in a place where you can really practice medicine."

i sometimes wonder if mentors know how much students look up to them, and how a little comment can really go a long way.