Swimming In Deep Water

A favorite saying of mine when I was a personal trainer is that "no growth of a human being takes place inside their comfort zone."  In medicine that is called having an attending doctor with you aka your safety net.  Well Wednesdays at el Centro de Salud they take that net away.  Not only do they take it away they pour gasoline on it, set it ablaze and then point at you and laugh.  Okay maybe not that extreme but pretty close; they don't actually point.  

Wednesday is when we students run the clinic.  Last week it came as a surprise to me but now it's something I have come to expect.  The first time we were in charge I was left completely drained by the end of the day having seen patients nonstop with the other two medical students from 8am to 4pm without a break for lunch.  Also, even though I'm pretty fluent in Spanish, having to keep one side of your brain working at full speed to speak clearly and then the other half being used to differentiate possible diagnoses and come up with treatment plans can be pretty exhausting.  Fortunately this week we three brought our A game and it definitely showed.

"No growth of a human being takes place inside their comfort zone." I repeat this phrase because there is so much meaning to it.  In medical school you are constantly pushed and placed just outside that zone.  It's easy for some to want to stay inside its warm boundaries and say "well I know how to take care of the common cold so I'll just treat those patients".  But then in walks a febrile young female patient who you soon diagnosis with pyelonephritis (infection of the kidney) and you thank God that you paid attention during that nephrology lecture.  

True story by the way.  

It felt really good to know that I had worked hard enough on other rotations so that with clinical accuracy we were able to ask the important questions, rule out other serious pathology, and get her a treatment plan, which I must say surprised me more than her diagnosis.  Normally for pyelonephritis in the United States you are admitted to the hospital on IV antibiotics.  After consulting the clinic director we put her on Nitrofurantoin pills and ibuprofen..... Not the big guns I had been hoping for.  Bienvenidos a public health in Ecuador.  Sometimes you just don't have what you need.  Maybe that should be our slogan....

Wednesdays in Ecuador are when I swim, the alternative being to sink.  They are the days when my clinical skills are put to the test and I have to deal with a strong reality: mistakes can cause harm.  It adds a pressure to how I treat patients but it is also what will make me a better doctor.  

Wednesdays here at el Centro de Salud you leave your comfort zone behind and you go to work.