Week 2 at Victoria Hospital

June 17, 2013

I just finished my second week in Internal Medicine at Victoria Hospital.  I spent a lot of my first week learning about the flow of the hospital, the roles of the physicians, and getting to know the staff, but after my second week, I really settled into my role at the hospital and got the chance to get even more involved in patient care. 

The pace at Victoria is extremely fast as the hospital is currently overflowing with patients.  The emergency department is constantly at capacity and rarely are there many open beds in the wards.  At one point, the ED could not possibly fit in any more beds and patients were being admitted and forced to sit shoulder-to-shoulder on chairs along the walls.  On Tuesday, I spent the day in the ED with my preceptor examining patients that were bound for the Internal Medicine ward once beds opened up, and it was one of the best learning experiences of the week.  We had a lot of patients to see in a very short amount of time and I was forced to think and examine patients quickly and learn procedures on the fly.  The day was challenging and a bit stressful at times, but my diagnostic and my blood drawing skills had improved dramatically by the end of the day!

There were so many highlights this week, but there was one experience that really stuck out.  This week I learned how to draw blood from the femoral and radial artery and run an arterial blood gas, I learned how to do a blood culture using sterile procedure, and I correctly diagnosed a heart murmur, but the real highlight of the week was learning to read ECHO’s with Dr. Anthony Lachman. 

Dr. Lachman is a world renowned cardiologist from Cape Town.  He spent 28 years in Connecticut working for the NIH and teaching for Yale Medical School.  Also, he and his colleague Dr. Barlow were the first in the world to diagnose and publish an article about mitral valve prolapse.  Dr. Lachman is an extraordinary physician, and after 28 years in the States, he decided to leave the fame and the fortune behind and return to Cape Town to help the people of his hometown.  The most amazing case that I saw while working with Dr. Lachman was a 7 year old girl with Tetralogy of Fallot.  Tetralogy of Fallot is a condition that we actually learn a lot about in medical school because it ties in a lot of physiology and anatomy, but it is a condition that I figured I would never actually see in my life as a student or physician.  There are different forms of the disease, but in this girl’s particular case, she had a hole in the wall between her two atria and her two ventricles (an ASD and a VSD).  She was also missing the connection from the right side of her heart to her lungs and because of this she had her vena cava (the large vein that returns blood from the body to the heart) surgically attached directly to her lungs because the right side of her heart was essentially non-functional.  It was a truly unbelievable, but very unfortunate and sad case.  I hope to get the opportunity to spend some more time with Dr. Lachman before I leave.  I learned so much from him in such a short amount of time, and he guaranteed that I would get to see some more cases that I would probably never encounter again in my life!!