"All my backs are packed; I'm ready to go"... Saying goodbye to my wife was probably the hardest thing to do in my last year of medical school. As I am departing for my international medicine rotation in Thailand, I reminisced back to my childhood days of growing up in the streets of Bangkok, Thailand's capital. The constant sound of speeding motorcycle, colorful street vendors, bells from Buddhist temples all rings in my mind along with the smell of grilled chicken, spicy lime-papaya salad, ripen sweet mango, fresh coconut milk, and steaming red curry. But with this trip, a new sound of gunshots, burning buses and political agenda blasting from the microphone of the protesters were added to my memory.
Despite the isolated chaos in the streets, I found peace in the hospital. Modern Thai Medicine is modeled after our western medical practices in content. Notes were written in english mixed with Thai conjunctions and articles. This is similar to the way Thai doctors discussed the cases, English medical terms connected with Thai verbs...similar to the way I talked to my parents. All the textbooks and exams were in English, the same one that I used in medical school (Robbins, Netters, etc). The Thai medical students had an extra job of learning the English language in addition to Medicine. However, the medical education is 6 years in length, initiated right after high school. I spent my time with the department of Anesthesiology, working mainly in the SICU with quick stunts in the OR. Due to my fluency of the Thai language, I was able to assimilate well with the medical students, residents, attendings, nurses and patients.
I began my week in the SICU, following an ICU attending from the department of Anesthesiology. The main SICU, located in the General Surgery Building. The unit held about fifteen beds. The technology is about five years older than ours, but the medical knowledge of the team members are all up to date. Many types of equipment are designed to be reused, for example the O2 mask in the OR are made from hard black rubber. There was also limited number of medications, especially the newer meds. I saw a ranged of Liver Transplants, Whipples, various GI-malignancy resections, Triple A's, Motor vehicle traumas, Respiratory difficulty POST-OP from myasthenia gravis, etc. The patients were often older, sicker, and often with co-morbities .
I was also able to attend several Palliative care lectures given by the Department of Anesthesiology. Palliative Care and Pain Medicine are not currently board certified medical specialities in Thailand. One unique observation was the spirituality in the end of life care. In the U.S. hospitals, pastors and nuns often provide spirituality consultations. However, this is not the case in Thailand, a country of mainly Buddhists. There were no such official consults in the hospital. Death was seen more as a cyclic process of nature when compared to Western beliefs. Aggressive treatments and "hope for a miracle" were not as often sought after by patients and family members. The patients were more accepting, tolerant to pain, and truly give their doctors all of their utmost trust and respect. Patients often required less pain medications. The faculty admitted that they were having a hard time addressing spirituality and pain with the dying Thai patients. Another interesting observation was that family member's input strongly influences the patient's wishes in the end of life care decisions.
Beside taking care of patients in the ICU and the OR, I also ran a code in the interventional radiology suite, did some fiber optic intubations, saw some really interesting tropical parasites in the Department of Parasitology, and share my experiences with the younger medical students. My trip ended early due to violent protests by a group of anti-government party in various areas of bangkok. I left when things were getting really heated. The roads and shopping malls around my dormitory were closed, army tanks and personnel filled the street marching toward critical points about 1.5 miles north of where I am. I felt safe but a bit uneasy about the situation. The country seemed to be split into two fractions: the rich (yellow shirts) vs. the poor (red shirts). My uncle had to navigate around the areas of the protesters as we make our dash to the Airport.
My flight left for Seoul where I would be transfered to Chicago. Half awake midway to Seoul, the pilot said on the intercom "is there a doctor or nurse on board? We have a medical emergency! Please contact a flight attendant!" I raised my hand, told them I'm a U.S. medical student who just finished all of his training. To my surprise, I was the only the medical provider on the plane of 200+ passengers. Here I am with my last patient encounter in medical school, 40000 feet in the air, 2.5 hours away from destination, and noAEDs. My BLS/ACLS card will be expiring soon. She was a 50 yo Korean female who doesn't speak English. OK. ABC, check! Good. I thought to myself, my best friend who matched ER would probably give me crap about this later. It was nerve wrecking. I was surrounded by flight attendants. They were trying to translate for the patient. Based on history and physical examination, I narrowed it down to acute food poisoning, gastroenteritis, acute hep A, but can't rule out bowel obstruction or other crazy life threatening zebras that my mind was racing through (ie AB Pain = MI in DM). All I could do were supportive measures. Thankfully, she was stable for the whole flight and was rushed to the hospital when the plane landed. I let out a sigh as I exited the plane, the flight attendant thanked me and handed me a free food voucher to any restaurant at the airport. I found my connecting gate and laid myself across a row of seats. I drifted off to a half-sleep state as I waited for my next flight that was leaving in 8 hours! Atleast the airport got free wifi. Time for a dose of southpark.
