Diagnosing (Ashleigh) in Dominica

The last few weeks I've finished each of my posts worried that I wouldn't have anything "new" to write about for the next weekly installment of my blog. I mean how many times can I write about "embracing the environment I'm in," taking advantage of everything this opportunity has to offer, how my classes are going, what my friends are like, and the things I miss about home? Granted, all of those things are extremely important aspects of why I wanted to start this blog, but they can only be discussed so many times before they become repetitive. Up until this week, I'd reach my weekly "day to write," and somehow something just came to mind for me to write about. Whether it was a thought or revelation that I had, or a unique experience that had occurred, I had something. Yesterday arrived; however, and I honestly had nothing. Not that nothing had happened, but the majority of my time since last Thursday had been spent on campus in a space called the Large Learning Lab (LLL) with a few other classmates reviewing lectures, discussing questions we had come across, and really just focusing on our studies to ensure we continue to progress through the semester as well as we would like. I took a few breaks to watch a couple episodes of Grey's Anatomy and NY Med, exercise, and walk along the ocean, but for the most part it was a fairly uneventful span of days. Definitely nothing to write home about. I knew I wouldn't necessarily stick to a strict "every Monday" writing rule, but I was afraid that my not writing yesterday would turn into not writing for another week, which would turn into two weeks, three weeks, etc. I'm sure you catch my drift. Well, I think somebody, somewhere sensed this onset of fear, and decided to give me something to write about. Whether you want to look at it as fortunate or unfortunate is completely up to you, but I'm choosing to view it as both (as well as a bit ironic).

Last night I was in my "usual spot" in the LLL with one of my friends going over the Anatomy of the Anterior Abdomen lecture we had been given earlier in the day. We had just gotten back from a brief trip next door to the Pic 'n Go coffee shop, where they now know me by name, and greet me with "Hello, my dear," every time I enter, for our last jolt of java before they closed. As I moved my chair out to sit down and get back to work, I noticed that my right foot and ankle were significantly larger than my left due to what appeared to be inflammation. Now, at this point, let me just say, being "doctors in training," studying lecture material for the rest of the night was not going to happen. We had entered full-blown investigation mode.

Between the two of us, we began palpating different aspects of my foot to determine what the problem was. Ruling out possible infection due to a lack of heat radiating from either my foot or ankle, we moved on to investigating possible sprains, fractures, and other soft tissue or skeletal related problems. She went through the standard patient interview protocol that we learned a few weeks ago, and I recalled that throughout the 6-7 weeks we've been in class, my foot has been a little sore on both the bottom and top surfaces, but nothing that had caused significant discomfort or excess fluid build-up. I assumed it was a result of poor footwear, a weak plantar aponeuorosis (a fibrous tissue overlaying the bottom of my foot), and weak arches. I've always had minor problems with sore feet when I don't wear the right shoes. I didn't think anything else of it this time. As I continued to think back throughout the last 8 weeks of being "on island;" however, I remembered that the weekend before classes started I stepped in a muddy patch along the road leading to my apartment and fell. Since my foot was literally stuck in the mud, I ended up twisting slightly as I fell. Now we were on to something! She and I both continued searching for possible causes of "localized pain and tenderness along the dorsal (top) surface of my foot and oriented more laterally." Consulting WebMD as a "symptom checker," we ruled out several things, and finally reached something that aligned pretty well with my presentation. Lisfranc Fracture Dislocation. (The Lisfranc joint is another name for the junction between your tarsal and metatarsal bones, or the border between your midfoot and forefoot.) We were sure of it! Well, actually, knowing that we don't really know anything, we accepted the high probability that we were completely wrong. That being said, I continued to research it, and prepared myself to be in a non-weight bearing cast for 6 weeks followed by a supportive boot for an additional 6 weeks. I went to bed last night with my foot elevated and an ice pack wrapped around my foot/ ankle.

As soon as I could this morning, I went to the clinic on campus (although I still just wanted to "wait until I got home" to see my regular physician), and consulted the Dominican physician on staff. Based on my presentation and history, he wasn't exactly sure what it might be, and wanted to get further confirmation from x-ray. He placed a phone call to the Portsmouth Hospital to see if their x-ray machine was "up and running" today, filled out an order for the x-ray, I hopped into one of the Campus Security trucks, and arrived at the hospital about 10 minutes later. Knowing I would not be walking into the kind of hospital I am used to, I wasn't exactly sure what to expect. Honestly, I would equate it to a large clinic in the United States. One floor, each respective department pretty much running itself, and 30-40 patients sitting on benches just waiting. Signs encouraging early detection of HIV and diabetes lined the wall, and posters urging children and families to begin healthy teeth-brushing habits early were impossible to miss. We found the Radiology department (luckily I had the security guard with me) and knocked on the office door for the technician. He took the imaging order from my doctor and led me into the radiology room. 2 different views of my foot were taken. Ten minutes later both films were developed, I was assured "it's okay," and was on my way back to campus to follow up with the physician. He deemed it a soft-tissue injury, gave me medication for the fluid build-up and pain (basically a stronger version of Tylenol), encouraged me to wear sandals or "non-limiting" shoes so as not to place additional pressure on my foot with the fluid accumulation, and sent me on my way. Extremely different than the United States in terms of the details of my medical encounter; however, at the end of the day, incredibly similar.

Am I happy my foot isn't broken? Absolutely. On the other hand, I still really have no idea what's wrong, and the not knowing is driving me crazy. Guess I'll have to wait it out for eight more weeks, and follow-up with my MD at home. Who knows, maybe I'll never find out what the actual problem is/ was.

At the end of the day, our diagnosis was wrong, but it was a "real-life" opportunity for us to apply what we're learning in class, and we loved it.

Moral of the story: NEVER doubt that there will be something to write about.

Now, for your viewing pleasure, the bones of my right foot.   

Believe

“I am an idealist. I am an optimist. I am hopeful. I believe the best in people and situations.” These nineteen words were the first snippets of a document that I started early last week in an attempt to clear my ever- wandering mind as I prepared for exams early this week.

As of Tuesday afternoon I am about one third of the way through this first semester in medical school, and I must say, so far things are going quite well. I’ve made friends, I’m progressing and learning how best to approach the most important, academic, part of it, and have found ways to embrace the environment I’m in. Since arriving in Dominica, I think the span between my last post and this one is the longest yet; however, it feels like the shortest. Each time I’ve sat down to this point, it seems I’ve had a purpose- a specific topic or train of thought to carry out. In some ways, it even seems like they all run together and follow a common theme. Maybe that’s a good thing- maybe not; I’ll leave that for you to decide. What I do know is that for the last week and half, I’ve had a Microsoft Word document open on my desktop simply for collecting quotes and sayings I’ve come across, events that have happened, thoughts that have crossed my mind, ideas for what to call this next blog, and even (shamelessly) the results for an online “Which Disney Princess Are You?” quiz I completed while taking a much needed study break over the weekend. The result being Jasmine: “stubborn, energetic, and compassionate. You want to see the world and be allowed to make your own choices,” just in case you’re curious.

As I mentioned last week, writing is a great stress reliever for me. Unfortunately, I’m not one to sit down and write little bits at a time- it’s either all or nothing- hence why I’m taking this current period of insomnia to write. Therefore, I started the aforementioned Word document as a way to at least get some of the things swirling around in my brain out. What I did not necessarily expect; however, was the insight it provided with regard to where my brain tends to go when my studying mind begins to wander. Although it was a completely trivial and meaningless thing to do while I felt like my brain was going to physically burst, the results of said character “quiz” were actually quite accurate. Anybody who knows me in any way would probably also agree. Despite my best efforts to conform at times and “go with the flow,” I’ve always been one to “do it selfie.” Case in point, when I was barely in second grade, I packed my hardcover Webster’s Children’s Dictionary (roughly 500 pages, mind you) in my backpack for a family vacation because I wanted to be a “big kid” with my own backpack and my own books. Needless to say, despite my best efforts, I finally had to give it up and let my Dad carry it for me. If you asked me now, I’d give anything just to have that Esmeralda backpack filled with just a notebook. :) Don’t get me wrong, I’m not necessarily one to break the mold (or the rules, for that matter) just for the hell of it, but I also have never been one who settles for something because “everybody else is doing it,” or it’s the thing I’m supposed to be doing because “that’s where I’m at in life.”

Secondly, one of my favorite questions to ask people is, "If you were to win the lottery tomorrow, what would you do?" (Feel free to answer if you'd like). In asking this question, I feel like a lot can be learned in a relatively short amount of time about a person and the values he or she holds in highest regard. I honestly don't care how you would spend your money- whatever decisions you make are completely yours, and that's all I want to know. Who are you? What makes you answer this question the way that you do? What experiences have you had that helped shape your outlook and perspectives about life? I'm simply curious about people, and love to ask meaningful questions. For me, there are several things I would do, but traveling and “seeing the world” would be top on the list. Thanks in great part to my family, and the opportunities they provided my younger brother and me when we were growing up, a love and respect for traveling has been fostered in me for as long as I can remember. Granted, I know I’m not the only person who was fortunate enough to travel around the world as both a child and a young adult, but I also know that I never treated it as a right or something that I deserved. Honestly, some of the best memories I have of traveling as a kid involve NOT making it on a flight. Every single time we traveled, it was an adventure. Whether I sat by myself or talked my Dad’s ear off for the entire Trans- Atlantic flight, I appreciated every single minute of it. I believe it is from these experiences, and the attitude that all four of us had toward every single chance we were given to learn about a new place, that my desire to explore and see different cultures, meet new people, and embrace other societies stems. Do I have great stories about all the places we visited? I could probably talk your ear off. On the contrary, do I have stories that might make somebody else never want to travel again? Honestly, probably more than not. That being said, I STILL would probably chose to fly on a pass over buying a guaranteed ticket.

Along that same vein, one of my favorite places to go when I need time and space to myself in Minneapolis is a parking lot in front of the airport. Without a clue as to where the planes are going or who is on them, the entirety of the experience from the smell of aviation fuel to the powerful, yet humbling, roar of the engines, is soothing. At one point, I thought I wanted to be an airline pilot. Up until I was twelve, the airport was my second home, and to this day, there are very few places that I feel more comfortable in than airports. I know it may sound strange, but it doesn’t matter where in the world I am, being in an airport feels like home. What I began to realize; however, is that becoming a pilot might take away that feeling. Instead of the simultaneous thrill and comfort I felt while being surrounded by airplanes and endless possibilities of where to go and what to see, it struck me that those choices of what to do and who to see would already be made for me. I was afraid it would become a chore, and realized that the freedom that comes with closing my eyes and sensing, feeling those precious, fleeting moments of contact with the ground between when the nose gear and the main gear, respectively, leave the runway, is something too intrinsic for me to place in somebody else's control.

Who knows what the culmination of my various interests will be down the road, but for right now, I’m choosing to return to those nineteen words that I wrote last week, and believe that they will hold true no matter where the future takes me.

The Power of Words

If I’m being perfectly honest, I am writing this right now for several reasons, one of which is to distract myself from the amount of stress I currently feel. Our next exam is a week from today followed by an Anatomy Lab Practical on Tuesday, and despite knowing that I walked myself into this situation fully understanding that my limits would be stretched in every single way possible, this knowledge doesn’t take away from the pressure and weight I feel at this moment. If there is one thing this blog has shown me over the last several months, it is that writing always makes me feel better. Ergo, here I sit with a fresh cup of coffee and a cup of Chicken Wild Rice Soup.

In thinking back upon the first 25 years of my life, it had never really crossed my mind to question or evaluate how I best coped with stress. Somehow, on a level that I didn’t even understand, I just knew how and I did it. While looking through files on my computer over the last few weeks, it struck me how many times I had taken 15, 20, 30 minutes when I was stressed to just sit down and write. Write about the weather. Write about my classes. Write about relationships, buildings, experiences, anything. I just wrote. More often than not, whatever it was that I would end up penning (or typing) had absolutely nothing to do with where I started. It would generally start on one topic, and end in a completely unrelated realm of my life. As I was taking a study break earlier this afternoon, I stumbled upon the blog of one of the most eloquent, mature, beautiful (inside and out), and truly genuine young women I have ever met; my brother’s girlfriend, Jackie. Six and half years ago they started dating, and I never imagined that she’d still be around. Wait, don’t take that the wrong way. By that I mean, he was seventeen and she was sixteen, and I don’t know about you, but thinking back to when I was sixteen? I could barely decide on what shirt I wanted to wear to school, let alone think about starting to date somebody who would be around for what would turn out to be: two more years of high school, eight combined years of college, a parents’ divorce, several study abroad and internship experiences, and, most recently, emergence into the “real world.” To me, they are both amazing, and despite our ups and downs, she is the sister I never had.

As I was reading through some of her posts, it struck me how completely raw they were. Not in the sense that I felt like I was reading something I shouldn’t be, but in the simple fact that they relate completely to the human experience. To things that so many people are afraid to talk about or simply experience because of social, cultural, familial, educational (whatever else you may call it) norms and expectations. How did we get here? How did we reach a point where talking about our highest highs and conversely our lowest lows is not only undervalued, but discouraged? Shouldn’t we be open to facing those human experiences together? Words, whether their usage (or lack thereof) is well thought out beforehand or not, have an immense power that I believe has become underutilized and in some cases abused. In one of her posts, she says, “If I had one wish, it would be that people embraced with aliveness and with reverence the power and sacredness of words and wordlessness.” In reflecting on this, not only in how I experience my personal friendships and relationships, but also how it impacts me professionally, I am brought to a lecture we had a couple weeks ago about the importance of the patient interview and how we go about obtaining a patient’s history. So much of the measure of success in this experience is the way in which we, as physicians, use our words, and subsequently how we interpret and accept the words (or wordlessness) of our patients. As we were told in this lecture, 85% of the information we need to make a diagnosis when a patient enters our office is obtained during the patient history. Why wouldn’t we use this tool to the utmost extent to ensure we are giving our patients the best care and experience they could possibly have?

On that note, I now digress to where my mind was upon beginning this post. In looking back over the last few weeks, my posts have mostly been written on Mondays, so today being Monday, I began thinking this morning about what I wanted to write. In what became a failed attempt at straying away from an introspective, philosophical post, I began thinking about rain. As I was falling asleep last night, raindrops the size of skittles (yes, I just referenced Skittles, and perhaps their ad slogan “Taste the Rainbow” came to mind as I wrote it) began slowly tapping my window. Now, I don’t know about you, but the sound of rain on my window is one of the most relaxing, peaceful sounds that I can think of. Maybe it has more to do with growing up in Minnesota and getting cozy in a full armchair on a rainy (or snowy) day with a book and a wonderful cup of tea, but the crisp and refreshing smell of rain on what is normally a hot and sticky island was extremely welcome. When I woke up this morning, the rain was still falling. At that point; however, instead of thinking about how peaceful it was, I began thinking about having to walk to school in it. Remembering how three weeks ago I had left my apartment equipped with my umbrella “just in case” only to arrive 10 minutes later on campus with the bottom half of my pants dripping with water, and the notes in my backpack running ink, I was not excited to even think about experiencing that again. I was determined it wasn’t going to happen. Not this time.  Not today. I loaded my backpack, wrapped it in the waterproof cover that I bought, grabbed my rain jacket and umbrella, and set out for class. As I walked out onto my balcony expecting to be hit with a wave of humidity, I was instead faced with a refreshing breeze, and again, that peaceful, soothing sound of rain. Not wanting to lose this moment, I pulled out my phone and took a couple pictures. Granted, the Caribbean is not visible when it rains, but I realized how incredibly beautiful this place can be, even when it’s raining. 

Last Friday I received an email from the postal department alerting me that I had a package to pick up between 10am and 1pm today while the customs office was open. Along with at least 10 other people, I wandered over to the office this morning to pick up my first big piece of mail since arriving on the island. I knew it was coming, but it still didn’t take away from the excitement I had to be receiving something from home. When I approached the window to obtain my "package slip," I was surprised to find out that I had also received two additional pieces of mail! One from an old friend in Minneapolis, and another from my Grandparents. As it had when I walked outside my apartment to venture onto campus earlier this morning, it struck me how the littlest things can often make the biggest difference.

With that, I now must return to studying, and will leave you with a couple pictures of my first “care package,” as well as some of the “decorating” I did this past weekend in my apartment to keep the inspiration and motivation flowing.  

Note: Mug did not arrive with coffee (although I wish it had)

Until next time and with love,

Ashleigh