GI and Ultrasound.

First week and I'm already behind on keeping track of my shadowing. This does not bode well.

Last Thursday I shadowed a nurse practitioner who works in gastroenterology. The morning was spent seeing patients in the clinic, which was pretty boring. All the NP did was order various tests and adjust meds. The afternoon was more interesting - I got to watch procedures in the GI lab upstairs. I first saw two upper GI endoscopies, which were fairly straightforward, and then I saw two colonoscopies, which were cool because the patients had various lesions which needed to be biopsied and further examined. At one point, the doctor performing the colonoscopy told me to walk around to the front of the patient (I was standing on the other side, where all the action was) and look at her belly. Lo and behold, there was a bright reddish light shining through the woman's abdomen! It was cool to be able to see exactly where the scope was positioned relative to more familiar external anatomy, then look at the video screen and note exactly what the bowel looked like in the position. Overall, it was a good afternoon and I found the GI docs and nurses quite amiable and knowledgable.

Friday we were back at school for class...nothing much to report there.

Today I shadowed the ultrasound techs. This time I was smart and carried around a little notepad so I could write down some of the events. Two highlights:

1) The first woman of the morning was a pregnant twenty-something, accompanied by her husband. She was having her 20-week prenatal exam. The sonographer went through the exam slowly for my benefit, pointing out the fetus's bladder, stomach, femurs, heart (the 4 chambers could clearly be seen) and cerebrum. It was quite fascinating, especially since the only fetal ultrasounds I've really been interested in were my mother's from when she was pregnant with me and my sister, and those are so blurry I really can't see too much. The technology has really improved in the past 20 years.

Something which I found rather disconcerting happened when the tech asked if the couple would like to know the gender of the fetus, and the mother said yes. When the tech announced that it was a girl, I sneaked a glance at of the father's face. He didn't look too thrilled. The mother was practically crying with happiness - "We're having another baby girl, honey!" - but the dad looked (dare I say it) disappointed. I had half a mind to walk across the room and shake him by the shoulders and say, "You're having a perfect, healthy baby! What the hell is wrong with you?" Naturally I didn't do that, but I was mildly disgusted. Who could seriously have the gall to be upset at news like that? I'm baffled.

2) The last patient of the day was another young woman having a pelvic ultrasound to rule out PID (Pelvic Inflammatory Disease) as the cause of her abdominal pain. The tech did a regular external ultrasound, paying careful attention to the placement and size of the ovaries and uterus. The patient then agreed to undergo a vaginal ultrasound, and wow, what a difference in the appearance of the uterus! While the ovaries were out of range of the probe, during the vaginal exam the endometrial lining of the uterus lit up like a light bulb and a small calcification inside the uterus which was not visible on the external ultrasound suddenly appeared. Afterward, the tech pulled me aside and said, "Even though the docs never order vaginal ultrasounds in addition to the external, we always do them because you just can't see everything externally."

Overall, it was a very educational day. I met a fourth year med student who is an alumna of my school and of the Scholars program, and she gave me tons of good advice for the rest of the semester and for next year. Hopefully I'll run into her again.