American University of the Caribbean 2014

Medical, Nepal Pokhara

If you wait long enough for the double doors to slide open in one hospital in NYC, stop a couple minutes for the smiling security guard to write down your name and ask you why you’re there, climb two flights of stairs to the 2nd floor, and walk through the long, white hallways.

In one room would be a student; wearing a short white coat like all the others students; a stethoscope slung around his neck and a tragically underutilized green book tucked away in his front pocket. You would want to leave after a brief glance, not seeing much to catch your attention or hold your gaze, but then just as soon as you began to turn away you would suddenly stop short.

Against the black and white papers pinned up against the wall of night float schedules, infection control guidelines, and this week’s cafeteria specials something different would dance across the computer screen. Pictures of wide blue lakes and lush green jungles; colorful clothing hung out to dry and  sunsets over temples coated in gold with statues of ever watchful animals. Promises of cliff jumping, soaring through skies, and a chance to practice medicine with people who actually needed it floated across the student’s eyes.

On arriving into Pokhara, you couldn’t help but feel that you were in the presence of something far more powerful than yourself

In case anyone missed a beat that student was me (surprise!), and it would be about 6 months later when I eventually boarded my Emirates flight and took the long 18 hour trip from The Big Apple over to Southeast Asia.

On arriving into Pokhara, you couldn’t help but feel that you were in the presence of something far more powerful than yourself. It didn’t take long to realize exactly what that was; looking up from literally anywhere in the city you could see the silhouette of the Himalayas kissing the horizon; it was a stunning visual, one that had to be seen to be believed.

This is the moment I’ve been waiting for. I walk in through the main entrance and glance at the guards, they smile in response to the tentativeness my body language seems to be exuding. Instead of walking up 2 flights of stairs I walk straight and take a sharp left. Through the long, dark corridors I go all the way until I reach a padlocked room; the doctor’s room.

I enter it and look around; a bed, a chair, and papers pinned up against the wall with words written in Nepali, most likely the doctor’s workday schedule. After I put on my short white coat, just like the other nursing students (they function like the interns in the U.S), I walk out onto the ED floor and stop in front of the first bed. An elderly man with diarrhea for 1 day duration; I pick up his charts and see Ciprofloxacin written under the treatment plan. In the next bed is a woman wrapped in colorful cloths, CHF exacerbation; put her on Lasix.

The patients with TB get RIPE treatment. The ones that are HIV+ are on some variation of HAART. Asthma patients leave with albuterol pumps and the ones that need a little more help get prescribed longer acting beta agonists. The patients that are vomiting get abdominal exams, and more than 50% of the time you are looking at their face, checking for any signs of pain.

The funny thing about going abroad, is you expect something different; seeing the same treatment plans you would as if you were back home shatters that illusion.

You always wash your hands with either soap and water or sanitizer afterwards. Presenting to attendings involves a combination of fear and excitement. Gaining the trust of the interns only comes after showing them you’re willing to work. If you are, they’ll like you, if you don’t, you’ll be ignored.

Sometimes heart sounds are difficult to hear, especially if the patients are bigger. Other times you’ll hear something and have no idea what to think. It’s usually unlikely you’ll ever give one patient all the time you wish you could. The ones that come in because they aren’t complying with medication are tough to manage. Harder still are the patients that go back to difficult home situations; you’ll always wish you could do more.

Going home at the end of the day feels great. Surprising yourself with something you didn’t think you knew or thought you could do feels ever better.

I read somewhere a couple years ago that people change everything around them, to see what stays the same within them, and that’s exactly who they are. Traveling thousands of miles away to a place that was different in every conceivable way served to highlight this point. When nothing is recognizable, your deficiencies and strengths as a medical student and person, qualities you carry with you no matter where you ago, are made even more visible.

The choice of which direction you choose to go in is yours.

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