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Ebola, Global Health, Infectious Disease, Patient Care, SMS Unplugged

The hand-sanitizer dilemma: My experiences treating patients in Uganda

The hand-sanitizer dilemma: My experiences treating patients in Uganda

Ugandan hospital - smallSMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A thick green glob landed on my scrub top at the same time that the first drop of sweat rolled down the small of my back. I tried not to grimace and discretely walked over to the hand-sanitizer dispenser. But like every other hand sanitizer I had tried, this one was empty. Yesterday I had also discovered that the only bathroom in the hospital had no toilet paper. It was 7 AM, and I would be using my pocket toilet-paper stash to clean off sputum from the hacking patient that apparently all the doctors knew to avoid standing in front of. The day was off to a good start.

How, I wondered as we continued rounding, did doctors respond to this dilemma – having to care for patients without being able to fully protect themselves – when they were in health centers treating Ebola. I tried not to think about what I would tell my parents if I developed rare infectious symptoms in a few days. We were in Uganda, countries away from the Ebola outbreak, but there were still plenty of infectious agents we could and probably were exposing ourselves to.

Just as I was wracking my brain for the names of the bacteria and viruses that might be deadly, I noticed one of the doctors rest his hand on a patient’s shoulder. And it dawned on me that the real dilemma was not about what I, who had access to the best medical care, might pick up, but rather about what I might pass from patient to patient.

It’s ironic that in the U.S., patients have to remind doctors to reach out and touch their shoulder or hand at an appropriate time – to make patients feel that the doctor connects with them on a human level. Yet here in Uganda, the  doctors know when to reach out to their patients, they know how to talk to the patient’s family. My clinical-skills professors would love to see this.

But if the hand-sanitizer dispenser was empty for me, it was empty for the  Ugandan doctors as well. We were told as first-year medical students that we would fail our “Practice of Medicine” final if we forgot to sanitize our  hands upon entering our standardized patient’s room. So what were we to do when we had more than twenty patients in one room, each with at least two family members, and no hand sanitizer for anyone? How many of these dozens  of people were walking around with my hacking patient’s sputum on them as  well?

The doctors certainly could be spreading infectious agents. But given the proximity of patients on the wards, those very same infectious agents had likely already been spread between the patients overnight – before we even arrived that morning. I couldn’t help but wonder which was more important to the patients who had a 50 percent chance of survival: to feel that their doctor was treating them as a human being or to increase their chance of survival by a negligible margin? How big or small would the margin introduced by the doctor’s touch have to be to tip the scale one way or another?

Before I could finish thinking through my ethical dilemma, we left the ward to scrub in for surgery. There I found the only working hand-sanitizer dispenser.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo of Ugandan hospital by Natalia Birgisson

SMS Unplugged

How to get a student-friendly room for under $100

How to get a student-friendly room for under $100

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Natalia in her roomTo all the incoming med students wanting ideas on how to set up their rooms with the staggering debt of higher education, here’s what I suggest:

  • $13.38 for 32 sq feet of “Thrifty White Hardboard Panel Board,” but we can call it your new best friend. Home Depot
  • $10 for screwdriver and screws. Home Depot
  • $10.79 for dry erase markers, eraser, and spray. Office Depot
  • $4.99 for a 3 pack of scented candles in glass holders. Ikea
  • $2.98 for 300 pack of matches. Home Depot
  • $8.99 for a plastic storage box that fits under most beds – reserve that for the pile of discarded clothes, papers, and notes that you don’t have time to clean up until after finals. Ikea
  • $14.99 for a basic night stand. Let’s be real, you’re going to study late into the night on your bed and fall asleep. Set yourself up with a nightstand so you don’t have to drool on the laptop you were using. Ikea
  • $6.99 for a table lamp to go on your night stand. Ikea
  • $9.99 for curtains – color so it feels like home. Ikea
  • $7.96 for curtain rod set. Ikea
  • $4.99 for the Swedish meatballs. Ikea

Total: $91.06 with room for tax

You’re welcome.

Natalia Birgisson will soon start her second year at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo courtesy of Natalia Birgisson

Chronic Disease, Patient Care, SMS Unplugged

High yield: Lessons from a 4-year-old

High yield: Lessons from a 4-year-old

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

AlanIn two days, we take our last exam as first-year medical students. Sitting in the same library that I used to as a pre-medical student, I think about what it is, exactly, that has changed this year. For me, the point of transition from pre-med to med student really happened over Thanksgiving break a few months ago.

I had come home from my first term of medical school more ready for my mom’s hugs and homemade banana bread than ever. People say that the first few terms of medical school are like trying to drink out of a fire hose, because there’s so much information we are expected to learn and retain. On an average week, for example, we have 40 hours of class, not to mention the time we need to study.

Luckily, one of the hardest classes this term had its final the day before Thanksgiving break, so we could go home with some amount of stress alleviated. Biochemistry had been the hardest, least intuitive class for me, and I was relieved it was done – and I was happy to be with my family.

* * *

“So what have you learned in medical school?” my beloved step-dad, Dan, asks excitedly. We’re having our traditional family brunch, with my grandparents, parents and sister, and all the cousins that are around. I look down at my plate, thinking. I’ve learned that the vitamin B12 bottle I can see on our kitchen counter next to the leftover pie contains a unique vitamin because it’s only helpful to two enzymes. I’ve learned how the fatty food that we’re eating kills us, and what that food looks like in dead bodies.

“Diabetes,” I answer, smiling at Dan. “I’ve learned how the two types of diabetes happen.”

“Ah, sí?” my grandmother asks in Spanish. “Debemos invitarle a Bea para que nos enseñes.”

My little 7-year-old cousin, Aida, was diagnosed with type 1 diabetes two years ago. It’s caused quite a stir in my Hispanic family that we can’t feed her quesillo, bread or even fruit without worrying. Her mom, my Aunt Bea, has been plagued with guilt that she did something wrong ever since the diagnosis.

In every family there is that one cute little kid – usually the youngest – whose misbehavior makes all the other kids look like angels. Punishment doesn’t work because they don’t mind being yelled at, discipline doesn’t work because they’re stubborn, and praise doesn’t work because they’re so cute they get attention all the time anyway. If my siblings read this, they’ll nod their heads remembering me as a child. When I hear this description, though, I think of my 4-year-old cousin, Aida’s little brother. He is the most beautiful little child, with big brown eyes, tan skin and dark rusty red hair.

Alan was born when I was already away in college, so I don’t get to see him or his adorable older sisters very much. But here I am now, with Alan and the rest of my family, who gather on the couch after brunch and wait for me to explain to them what’s going on with Aida. I talk with Aida and Bibi, the two little girls, about clean-up cells that got the wrong message in Aida’s body.

I’m asking Aida and Bibi to explain to me what they understood from what I had said when I look over at my aunt to make sure she’s okay. It’s then that I realize that Alan is quiet. It’s the only time that I’ve ever seen him sit quietly, and I see his attention is on me, as well. There’s no way he understood what I was talking about with beta cells and the immune system, but he understands that this is important, and because everyone in his family is focused on it, so is he. In the dynamics of his family, diabetes trumps all other cards.

***

In that moment, my 4-year-old cousin taught me the two most important lessons that I’ve learned so far in medical school. First, that diseases – whether common and rather boring to learn about, or rare and still not understood – affect everyone in the patient’s family. Every family has someone with something, my own included. And, second, everyone whose life is influenced by such diseases looks to doctors more often for support, affirmation and solidarity than anything else. This moment on the couch with my precocious cousin listening to me, this was medicine. And I was becoming a doctor.

Natalia Birgisson is a first-year medical student at Stanford. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.  

Photo of Alan Higuery by Beatriz Royo Higuerey

SMS Unplugged

Introduction to the ICU: My grandfather’s passing gift

Introduction to the ICU: My grandfather’s passing gift

ICU - big

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

This week, I began to think of death as a friend. My grandfather was hospitalized on Mother’s Day, and by the time my parents called me on Monday morning they couldn’t tell me anything more than, “He’s in the ICU with multiple seizures. They’re taking him off ventilation tomorrow.” Reaching for the knowledge I’ve spent all year chipping away at textbooks to acquire, I asked about neurologic exams, autonomic drugs and heart conditions I knew he was at risk for.

“I don’t know, Little Doctor,” my mother kept saying, reminding me that none of these words were a part of the conversation for family. A day later, sitting with my family in the hospital room, I realized the real conversation was about peace, humor and love. My family wasn’t fighting death because they could see it already in Poppa. Poppa’s ribs were broken from CPR earlier that week, his breath came in hard-earned gasps and his blood pressure hovered around 80/44.

Alternately fascinated with the activity of his accessory respiratory muscles and heartbroken at the image of my stepdad standing at the side of Poppa’s bed, resting his hand protectively on his father’s forehead, I thought about how death has a presence. There wasn’t a single one of us in that room who wasn’t certain Poppa was going to leave us in a matter of moments.

I sat quietly in the back of the room watching our broken old man who looked so little like the jolly Poppa I had gotten to know over the past 10 years. If this is what patients look like in the ICU – barely human anymore – I wondered how I would have tried to relate to them on my rotation if I hadn’t first been to the ICU with my own loved one.

The answer came the next day, at our open-casket wake. Poppa looked like himself again. This is how I will remember him, resting peacefully, almost ready to sit up and tell us another joke. I still can’t believe how the coroners re-infused my grandfather’s body with his personality after it had been stripped away during his medical emergencies.

Aside from the memories and family that Poppa gave me, I’m so thankful that his parting gift to me was helping me understand how dehumanizing the ICU can be. I hope that when I go to clinics in a year, I’ll remember the difference between the man I knew and the man I saw on a hospital bed.

Natalia Birgisson is a first-year medical student at Stanford. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out. 

Image by Niels Olson

Medical Education, SMS Unplugged

Visitor in the OR: How I became pre-med

Visitor in the OR: How I became pre-med

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Natalia badge - small“Why do you go to medical school?” My little sister frowned, angry that I was leaving again after just a week.

“Why don’t you come with me?” I responded, and ran towards her with my arms outstretched. With a squeal she turned to run up the stairs. So began our last game of chase until I see her again in six months.

My sister’s question followed me on the plane ride back to California. For the last four years, my decisions have been based on the desire to help people through medicine. Every step of the way I’ve become more sure that this is for me.

It all started with shadowing a neurologist. I was a freshman in college and was trying to decide whether to pursue my interest in psychology or medicine. Little did I know that this neurologist monitors peripheral nerves during neurosurgery, and I soon found myself clad in green scrubs, cap and mask, entering the OR for the first time.

The words craniectomy for microvascular decompression floated my way. When I looked them up later, I learned that this means an artery had come too close to a nerve and every time the heart beat, the artery expanded, hitting the nerve and causing the patient great pain.

Watching the neurosurgeon and his resident move an artery inside the patient’s brain, a sense of belonging washed over me. I felt that I was finally in the right place. The thrill of scrubbing into the OR, the intellectual fascination of seeing the neurosurgeon cut open the patient’s brain and the sense that this person’s life was in his hands tipped the scale on my decision to pursue medicine. It’s the moment I look back on when I need to reassure myself that I chose the right path.

Now toward the end of my first year as a med student, I know what things like craniectomy for microvascular decompression mean without having to look them up. And I just got my badge to shadow in the neurosurgery OR again.

I wonder how I’ll feel shadowing neurosurgery this time. Part of me really hopes that it’s nothing exceptional so that I can gravitate toward a specialty where I get to see my little sister more than twice a year. Part of me really hopes that I get the feeling again that I’ve found my calling. And I stall a little bit, wondering which one I’d prefer.

Natalia Birgisson is a first-year medical student at Stanford. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

SMS Unplugged

New Girl: Living the sitcom in medical school

New Girl: Living the sitcom in medical school

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Natalia and housemates“The question is how would the fantasy suite episode go if you were the bachelor?” My roommate Will brought the conversation back to where it started one evening. My other roommate, Dan, immediately shoveled a heaping forkful of dinner in his mouth and looked away. The first episode of this season’s “The Bachelor” had just aired, to Will’s delight. He found every opportunity to bring it up, from connecting my Venezuelan heritage to Juan Pablo’s, to discussing the scandalous elements of the show with us as we cook. Naturally, a lively conversation between the three of us followed Will’s question about the overnight dates episode, and I was still laughing when I sat down to work.

So what’s it like to live with two guys?

The question has come up numerous times amongst my classmates, friends and family. And when it does, I make a joke about the show “New Girl.” Or I tell people that it’s great as long as I clean my own bathroom. Then I change the topic of conversation because my real answer to that question goes deeper than a passing hallway conversation merits.

In the past four months, we sure have had our moments. There was the day I couldn’t choose which sundress to wear, and Dan liked them all. Or so he said when I showed them to him while he ate breakfast.

There was the day we decided to deep-clean the house. A few minutes later I turned around to find Will shirtless and mopping the floors with undiluted floor polish.

There was the day I came home and snapped at them to turn the TV off because ESPN was echoing in our living room yet again. Dan and Will surreptitiously turned the TV to mute every time I came into the living room after that.

But there were other moments, too, ones we don’t tell other people as a joke. There was the night I came home sobbing after breaking up with my boyfriend. And it was Dan, not any of my girlfriends, who got me a cup of tea and held me as I cried.

There was the time that Will broke his leg, and the following weeks when we pretended that we were going up the stairs anyway so why not let us take his bag for him.

There was the day I came home and saw Dan lying on the couch with his eyes closed, looking as aged as my grandfather after a long day.

We have no secrets in this house. We know when one of us is struggling in a class and how to bring it up. We’ve all heard each other receive distressing calls from home. We know when to give Dan alone time and when to drag Will out on a Friday night. I know when Dan has a crush and when Will gets a Snapchat from his girlfriend. They pretend not to notice when I’m eating inordinate amounts of chocolate.

These are all moments I don’t share with people when they ask what it’s like to live with two guys. This home we share is perhaps the only part of my life in medical school that doesn’t regularly push me to my limit. Rather, this is the place and they are the people I can count on to help me let my guard down. Because the truth is that living with them isn’t a gender issue. It’s about living with two classmates who have become my best friends, my confidants, and my brothers.

Natalia Birgisson is a first-year medical student at Stanford. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Medical Education, SMS Unplugged

Basement floods, ski lifts, and Christmas cookies: Life lessons from winter break

Basement floods, ski lifts, and Christmas cookies: Life lessons from winter break

Natalia at Hot SpringSMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Going home for the holidays means trekking to a small town in northern Iceland for Christmas, and then to the suburb of Miami known as Little Cuba for the New Year. As with so many 21st-century families, my parents are happily divorced and remarried. I have every kind of sibling known to the English language – full, half, step, and ex-foster siblings total eight loved ones I pray for before bed.

Every December, I land in Iceland having slept little, eaten less, and inevitably forgotten my winter coat. But I land at home. This is a place where scathing water bubbles to the surface of the land so hot it is piped into houses at 194 degrees Fahrenheit. Here like nowhere else can you take an endlessly long, hot shower without feeling guilty.

In fact, the Christmas that we installed a hot tub in our backyard, my stepmom joked that we could fill it with hot water from the hose since the plumber hadn’t arrived. I was out cross-country skiing to my grandparents’ for cookies and tea when my dad made good on her joke.

A while later, when I was back home and showering after my excursion, my sister Tatiana forced the lock on the bathroom door open. She pulled me out of the shower, threw a towel at me and barreled past with a bucket of dirty water. As she dumped the water into the shower, she shouted at me to get dressed. Dad had flooded the basement.

I walked out in my towel and joined the assembly line that my family had formed. My dad stood at the front, passing up buckets of water as he sloshed through the basement in his fishing boots. Petra, my stepsister, flashed jokes that had us laughing as we spent the afternoon clearing the basement.

This year’s Christmas adventure was learning to snowboard. Dad woke us up every morning as soon as the lights on the ski slopes turned on. Luckily, my sister Helga is still only seven, so she doesn’t last more than a few hours.

The second day, Petra and I almost crushed Helga when we all fell off the ski lift. We came home for lunch and my little brother, Birgir, regaled my dad and stepmom with stories of how we survived. After lunch I walked through the basement to put the helmets away and passed the buckets we’d used to clear the basement flood. I touched the jacket I’d worn when Dad and I biked through the highlands and the game of Trivial Pursuit that my stepbrother, Asgeir, always wins. I smiled thinking how this home is filled with memories of childhood and love.

And it dawned on me that I have been so busy with medical school, I forgot about my dreams outside of medicine. For I dream that I will become a gifted surgeon, able to help heal those in need. I dream that I will work in developing countries and leave my mark upon the world. And while I have those dreams, I also dream that some day my own basement will flood and my children will laugh as they run around in the mess. I dream that someday my children’s children will visit me on their own for tea and cookies.

Returning for winter quarter, I’m thankful my family continues to ground me amidst the whirlwind of Stanford medical school. I’m thankful they remind me every time I come home that the greatest accomplishment of my life will be to raise a family of my own whose laughter rings in the memories that fill our home.

Natalia Birgisson is a first-year medical student at Stanford. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo by Peter Espe

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