Note: Due to limited wireless Internet access, this blog will be updated semi-frequently. Stay tuned for my subsequent "post boluses..." :-)

Sunday, May 2, 2010

Day Eleven: Micro Wonders



 
I have to say...it feels so great to have M as my current preceptor! It turns out he is not technically an “Infectious Disease Fellow” per se, having just assumed the title so he could pursue some independent projects in Cambodia and Thailand. He actually has some background in pulmonary medicine and palliative care. Just the past couple of days that I’ve had M with me on rounds, I feel like I’ve definitely learned more than all the days I’ve spent here combined. Definitely makes me appreciate the value of a good clinical mentor!

That said, my rotation here is quickly becoming centered on microbiology and infectious disease. In a way, I guess it’s a logical progression. After all, most of the pathology here is caused by acute or chronic infection!

So today, it was back to basics. I spent some of the morning helping M clean up some of his fever study databases. Afterwards, we methodically reviewed all the positive culture results with the microbiology techs. These “Microbiology Rounds” actually occur on a daily basis, and is actually a great way to double-check if a given patient is on the correct antibiotics.

The patients on the ward are growing some interesting (and frightening) stuff. Indeed, I’m now starting to associate the term “Gram Negative Rod” with “Oh crap...” More often than naught, these organisms turn out to be resistant to the broad spectrum antibiotics that are generally used to cover pneumonias and other infections (otherwise known as “Extended Spectrum Beta-Lactamases”). AHC is starting to experience a dramatic rise in these types of infections, which is problematic since the only other option for treatment here is giving a very powerful antibiotic (e.g., Imipenem).

To my delight, S, the lab tech, was more than willing to take me under her wing and show me how to do some gram stains and other techniques. Keep in mind that I haven’t done a single gram stain since 1st year of med school, so I was most definitely rusty. Thankfully, S was very patient. I got to do several stains (as well as a Ziehl-Neelsen stain for Tuberculosis), and then spent the next hour or so looking at slides with lots of bacteria.

It is fascinating to watch S go about her business, staining slides at the flick of a wrist. To me, a lab newbie, I found myself entranced by her sheer skill. Whereas the same task would probably take me eons, she looked as if she were perfectly within her element. I watched her enviously as she flitted around, peering at slides and preparing multiple lab cultures at the same time. I on the other hand, was taking forever trying to find a visible cluster of bacteria on my gram stain.

What a humbling experience. I came away from the lab definitely happy that there are people who are much better qualified to do these things than I!

So to top off my day, B, an ID fellow from Brown Med, has just arrived in Siem Riep. I was very happy to see him. In all honesty, it’s been nice being alone for a time so I could have the freedom to do what I want to. It’s definitely made me more of a self-directed learner. That said, I’m thrilled to be having people who can show me the ropes. It’s amazing to me how hungry I’ve become for good teaching in the span of a week!

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