Another day on the streets

Before hitting the streets, I was confronted by the daughter of one of the foundation's employees.  She had injured her toe doing some extreme sports, but luckily it was not too bad.  It was not deep and did not look like it needed any serious attention, so we patched her up with no problems.  

Our first stop was in the most unlikely of places, Arkadia.  You may remember my last posts about visiting one of the famous night clubs in this region, ITAKA.  Today we were there on strict business - to find a homeless family known to frequent the area.  We walked down the tourist-filled road until it cleared out.  Down the road, we veered left and walked off the main road into the shrubbery.  We were told that there was a homeless family that lived in the catacombs there.  The catacombs are dangerous and people are frequently getting lost in them.  They are largely unchartered, so when people get lost inside, they are often not found until they are dead and gone.  There was a story not long ago about a girl who got lost in the catacombs - her mummified body was found two years after she went missing.  The catacombs are a very interesting part of the history of Odessa.  You can read more about it here.  I took a guided tour of the catacombs with Claudia in 2010 so you can read about my impression on my old blog, My Trans-Siberian Journey        

Arkadia

Not a bad place to spend the afternoon volunteering

Walking to the Catacombs

Unfortunately, no one was home so we were unable to see the catacombs and I didn't want to ask if we could have a peak inside.  We then made our way back to our old hot spot in the roundabout.  Today, our friends were more willing to let us help me.  I bet the gifts of Coca-Cola, chocolate and water we gave them warmed them up to our company.  They even let us take photos of us working with them.  One girl had fresh self-mutilation cuts on her arm.  I didn't even have to ask her if she needed help.  She asked me if I would help clean her cuts.  They were luckily not that deep, so they were easy to patch up.  I have treated more self-mutilation injuries her in Odessa than I ever did in my two years as a psychiatric technician.     

Back at the roundabout

Self mutilation is a huge problem here

Applying the ointment

After care questions

Then one of the boys told me he had problems with his feet.  He asked me if I could help him so I gloved up.  Looks like he had some bad blisters that had popped.  The dirt was so impacted on his foot that it was difficult to even clean it off.  I used an antiseptic towelette and then proceeded to clean it with alcohol.  Next up, you guessed it, Neosporen.  I tried my best to prevent the injuries from getting infected by putting bandaids over them.     

BSI - Body Substance Isolation

check out these cuts

Interesting callous

Start off with an antiseptic wash

After cleaning with alcohol and applying Neosporen, patch up with bandaids

More bandaids

Happy to have been helped

All in all, we had a great day.  We did not go back to see the family in the underground - the folks with the guttate psoriasis - so I gave the cream, Q-tips, some chocolates and a bottle of nail polish to the street patrol worker.  He will give it all to them next time he stops by their place.  Back at the center, we were greeted by one of the little girls who had gotten a physical the day before.  She was happy to see us.

little kindergardener joined our photo

On our way to the Opera

While we were getting ready to head to the opera, my dad was approached by one of our fellow hostel mates.  He had been running up some concrete stairs in Odessa the previous nights and had slipped.  He cut his face badly in a few places, so he needed to have stitches.  After being turned away by one emergency doctor, he was finally seen and given the care he needed.  Our hostel friend wanted to get my dad's opinion on his injuries.  After examining him, my dad noticed that the stitches were way too tight so he decided to loosen them.  When stitches are too tight, they get engulfed by the surrounding skin and cause what is known as railroad tracks.  So, we went through my little black bag and got to work!  I sterilized a needle I had brought to sew clothing with a lighter and used the forceps I had brought.  

 My dad taught me that injuries swell, so stitches should be looser than expected to accommodate for such swelling.  He then showed me how to safely loosen stitches.  It was interesting to see him get to work in the most random of places.  Proving medicine does not have to be confined to a clinic! 

Forehead stitches

Loosening some more stitches

Only in Ukraine

After this impromptu post-surgical after care, we made our way to the opera.  We had purchased tickets to Tchaikovsky's Iolanta earlier that day, which was an adventure in and of itself.  The lady didn't speak any English, so when other tourists heard me speaking Russian they all crowded around me and asked me if I could help them.  I did all I could for them then we headed off to do more exploring around the city.  The opera was beautiful, but the opera house was stunning.  It was built by an architect from St. Petersburg in the neo-baroque (Vienna baroque) style in 1810.  It is guilded in gold, making it extra beautiful.

Admiring the opera house

Ready for the show

Beautiful mirror!

Papa

artistic shot

I am so glad I finally got to go to the opera in Odessa.  It was totally worth the $17 for two tickets!

Ring-ectomy

Today was a fantastic day for me.  I got to do some serious hands on clinical work at work today and loved every minute of it!  It all started when I noticed something a little funny about one of my patient's fingers...

There I was, sitting at the nurse's station surveying the scene.  I was feeling a little uneasy about how my day was going to turn out, since earlier a patient had flipped out on me and yelled at me because I kindly asked him not to sit on our desk.  He said I was disrespecting me and asked me if I thought I was the president or his mom.  Clearly not, or he would have been speaking to me with a much better tone.  Anyways, at about 1PM one of our out patient's came up to me and asked me if he could have a cigarette.  It was then that I noticed something funny about his finger.  I asked him if I could take a look at it, but at first he adamantly refused.  He stating he was treating it with medicine, as he furiously doused his hands with hand sanitizer and rubbed it all over.  He finally relented, and what I saw shocked me.  His hand was so swollen that his ring was cutting off some circulation to his fingers.  This is not even the worse part!  His fleshy tissue was actually bulging out of the grooves in his ring, and cutting into the dermis at the both ends of the ring.

You may have heard the story about the patient I worked with while I was doing my clinical rotations at the emergency department.  Well, his hand got smashed in an accident, and his ring was also cutting of his circulation, but at a much faster rate.  We struggled for 3 hours trying to get it off, when finally someone took my advice and called in the big guns: the fire department.  They came with bolt cutters so large, they would make you cringe.

Luckily, this "ring-ectomy" was much easier.  I helped stabilize while my coworker used the bolt cutters I found in the back of our hand guy's truck.  I did wash them with hot soap and water, and flamed them before use in attempt to sterilize.  When working psych, I have learned that improvisation and creativity is key.

Removed ring

We had to cut the ring in about 4 different pieces so we could pull it off without hurting our patient's delicate skin.  He kept insisting it felt fine and that it didn't hurt.  He was sad to see his $3 ring get cut off, but he understood that it needed to be done.  He kept trying to take the ring off himself, but we had to tell him to let us do it ourselves.  It's a good thing he did not try to muscle it off since it would have definitely torn a piece of flesh off.

Next we cleaned the finger with an antiseptic towelette.  We debated how to further clean it, and decided iodine would be the best route to take.  I did not realize that hydrogen peroxide is now contraindicated unless you are trying to do some serious microbe or dirt removal from a wound. This is because it actually kills skin cells and causes the healing process to take longer.  Supposedly lots has changed since my days of getting scrapped knees as a kid.  We were also aware that alcohol would hurt  way too much.  So we settled with iodine.  Iodine is commonly used to antiseptically clean areas before surgery. According to my microbiology class, iodine will disrupt bacteria's protein synthesis and plasma membranes, thus preventing them from carrying out normal functions such as replication. 

After we cleaned up, we wrapped him up with a loose gauze.  We wanted to keep the pathogens and dirt out, but also allow the wound to breath and heal.  I explained to him the importance of keeping the site clean.  "Use warm water and soap when washing your hands, and avoid getting your hands dirty," was my initial advice.  I also had to look him straight in the eyes and tell him the importance of calling us or seeing a doctor if his finger started to change colors, smell, feel tingly or anything unusual.  Although, for a schizophrenic, reality is often unusual.  Many schizophrenics are disorganized and struggle with personal hygienic practices.  I am a little worried that he will not properly care for his wound, so I will ask his study coordinator to call him next week to follow up and ask him how it's healing.

post ring-ectomy ring piece

I am so proud of myself for noticing such a serious, yet small and easily overlooked, condition.  His finger definitely had already started to smell a little bit, but if he had gone a little longer, he could have gotten an even more serious infection.  He could have gotten infected by Clostridium perfringens, or Staphylococcus aureus causing him to get gangrene or necrotizing fasciitis respectively.  He could have lost his finger, or worse.  We also noticed a ring on his other hand was causing a similar swelling to take place so we cut it off before it also got infected and cut into his flesh.

It's times like this that I really wonder about the marketing of "unbreakable" rings.  Serious, why would you want a ring that couldn't be come off?  One last random note to make about rings - I learned in my EMT class, if you ever come across a burn victim, the first thing you do after your quick initial exam is to take all rings and jewelry off the patient.  Hands will literally swell around rings and will cause circulation to be cut off.    

Where'd you go?

I've been working as much as possible in order to rack up those clinical hours for PA school applications, and of course studying Microbiology.  Sometimes I go to work from 7-3PM, then head almost immediately to my class from 4-7:30PM, work for my parents online and go to bed exhausted.  I have been keeping up and excelling in my class, so all in all life is good.

Big news - a coworker at my psych clinic told me that her woman's groups wants to support my efforts in Ukraine!  I was very touched by her offer, so I have a renewed vigor to sort out the nitty gritty details.  I have about 5 large boxes full of needles, vacutainers, and blood draw tubes - still not sure what to do about getting them to Ukraine.  I did call a contact today who I believe used to work at the Ukrainian embassy, so maybe he can shed some light onto the situation.  I contacted a few local nonprofits to see if they would take the donation, if I cannot feasibly take them to Ukraine.  

I am also somewhat in contact with someone at The Way Home - we have been been communicating via Facebook in Russian.  I love how my computer has an easy way to switch to international keyboards!  I definitely have some brushing up to do.

I found out today that the physician assistant application portal will be available April 17th, so I am excited to get all my information into the system and apply this summer!

I am currently working an overnight shift at my psych clinic.  Besides driving home at 7AM in a daze and trying to fall asleep when the sun is up, it's not bad.  I mean, I have done a lot of homework, wedding research and plan on spending about an hour or so reading up on fun places to visit while in Hong Kong.  Oh yea, and I am going to Hong Kong this Thursday with my fiance to visit my sister, her husband, and one of my best friends from college.  I cannot wait for that!

Here are a few photos I have compiled over the past month.

Just a small example of what I have lying around my apartment

Gram-positive streptococcus bacteria found after preparing a slide with cultures from my mouth in Micro lab

Trash and Cash - a gift from one of my psych patients

Sand volley ball did not end well for this friend's toenail

It will probably just fall off and grow back.  Not much I could have done besides suggest cleaning it and applying a bandaid to protect it from infection

Fire ants!

After returning from my Costa Rican tropical vacation, I was hit hard by some nasty virus.  I was coughing, sneezing, had mucus in my chest and had a head ache.  I missed out on a week of work, but still managed to made it to the first week of Microbiology.  I was sneezing ever 3 minutes, so I think that I got one of my classmates sick, because she got sick and did not show up to the next class.  I felt bad about that one.  I am feeling 100% recovered now, so I have been able to catch up with class, life and the tasks at hand.

As of last week, I booked my MD dad a flight to Ukraine and booked him a bed in the dorm room I am staying at!  I have a real live doctor coming to help me in Ukraine.  How cool is that?  I am thinking about all the amazing things we can do.  I have a feeling that microbiology will inspire me and teach me how to run tests that may come in handy out there.  Needless to say, I am excited that one of my key supporters in life will be coming with me.

Now, back to the medical photos you and I all love.  While we were on vacation, our apartment got infested by fire ants.  They swarmed my desk, occasionally made their way onto our couch and even found themselves in our shower.  Last week, I found a huge hole in our wall where they were coming in.  So, I decided to do my best to plug the hole up!  I frantically searched for the hot glue gun, because I thought that would be a good idea... but settled on blue putty that I use to hang photos.  I fought a losing battle as I sprayed them with water, circled them with chalk and saw them continue to pour out.  Without thinking, I started using my hands to plug the hole with the putty.  I managed to close the hole, but they got a few good retaliation strikes in.  The following photos are the aftermath.

5 minutes after

The next morning, I woke up at 4AM because my hand started throbbing.  I got up and grabbed and ice pack from the fridge, but my hand just kept getting more red and swollen.  I took a Benadryl at work that morning, even though I knew it would make me drowsy!  I was really starting to worry because it started oozing something fierce.  I used whatever I had lying around my apartment to treat myself.  I found old hydrocortisone cream that would help with the allergic reaction and itch, and I had a packet of antibiotic ointment that came in a first aid kit that Nat's mom gave us for Christmas.

18 hours

My hand got so swollen I had to take my engagement ring off, lest it get stuck there and need to be cut off.  Getting rings stuck on my hand is one of my top fears.  When I was doing my EMT clinical rotations, I watched the Emergency Department try unsuccessfully for 2.5 hours to get a titanium ring off a kid who had a smashed had.  The Fire Department had to come with bolt cutters the length of my arm to get that ring off.

48 hours

48 hours - post hydrocortisone

My dad wrote me a prescription to get some antibiotics, but by the time I was about to get it, the swelling was finally retreating.  I did not want to kill of my normal gut flora over this fire ant attack, so I waited it out.

72 hours

I am happy to report that a week later, beside a little round discolored scar on my pinkie, you can't even tell I got into a fire ant altercation.     

"It's just a flesh wound"

There are some perks to hanging around people who aren't studying exactly what you are studying.  In my case, whenever something goes medically wrong, or whenever something is bleeding, I get a call.  In my friend's case, when he split his finger open, he didn't have to go to the emergency room.

Last semester, I got a call at about 1PM on a Friday.  It went something like this:

Friend: "Hey, Erika... um... I cut my finger with a kitchen knife and I don't know if I should go to the ER."

Erika: "Oh no, how long has it been bleeding?"

Friend: "About half an hour..."

Erika: "I'll be right over."

I grabbed what was left of my EMT supplies and rushed over.  When I arrive, he explained that his room mate, also a law student, was too disturbed with the sight of blood to help him.  

Minor Finger Laceration

Upon examination, I realize that it was "just a flesh wound" and stitches would not be warranted.  I had learned at an early age when a cut or scrap was serious from my MD father.  I would often run to him crying when I had cut my toe running on asphalt.  He would look at it, give me a hug, and tell me it's just a flesh wound.  "Band-aids won't help," he'd explain, "We will just put some hydrogen peroxide and alcohol on it and it will heal up just fine."  I could see that the superficial skin layer, the epidermis, had been damaged, but the deeper layer of the dermis was not.  So, I told my friend it was just a flesh wound and gave him roughly the same treatment my dad would have given me.  I cleaned his injury with alcohol, hydrogen peroxide and some Neosporin.  Although, unlike my dad, I believe in the powers of band-aids, especially when flaps of skin are involved.  So, I tightly wrapped a band-aid around his finger to make sure the skin flap healed properly.  

This was early in my career as a personal on-call EMT, so unfortunately I didn't have the proper personal protective equipment (PPE) at the time.  I washed my hands thoroughly with soap and water both before and after treating the site.  Since then, I have increased my stock of medical supplies and am proud to say I now stash a box of gloves in my apartment.  Just in case my medical services are ever unexpectedly needed again!

Healed Finger

This is a picture taken months after the incident.  Glad to know he didn't have to waste his time at the emergency department over such a minor laceration. 

Let Bygones be Bygones

Bygone - a thing dating from an earlier time

I bet you didn't know that phrase had a real meaning!  Well, now you know.  Today I took the GRE, and although I still can't get a grip on if I should be ecstatic about my score, I find that it really does not matter.  I am extremely proud of myself, and how well I did compared to what I was prepared to get, given my dismal history with standardized tests.  I guess the hiatus I took from life to study everyday for 8-10 hours a day paid off! 

Now, back to the good stuff - graphic picture I have accumulated during my path to PA school!

A few weeks back, after fulfilling my duties as DD and driving everyone back to my friend's house, we decided to hang out into the wee hours of the night.  It seems that after 4AM, all filters fly out the window and candidness takes its place.  Somehow, everyone's sordid medical history became the center of conversation.  Even though we had just been introduced less than an hour ago, one guy started telling us all about his cerecum impaction.  Of course, he had a picture of this excised ball of ear wax on his phone.  I insisted that he show me the picture, but at first he didn't take me seriously.  After a bit of coaxing, he relented and gave me permission to post it here on my blog.

Cerumen Impaction

Ceruminous glands are found in the external auditory canal (ear canal).  Their main function is to produce the wax (cerecum) that waterproofs this sensitive area and simultaneously kills bacteria and traps particles.  

A cerecum impaction can occur after an individual uses Q-tips or bobby pins to clean his or her ear.  This is because doing so inadvertently pushes wax too far into the ear canal.  The external auditory canal is rather remarkable at cleaning itself.  So unless you want to fish one of these suckers out of your ear during your next visit to the doctor, you might want to think twice the next time you decide to "clean" your ears! 

What's on your mind?

Since December 2011, I have been working at a psychiatric research clinic as a patient care technician.  It all started with a conversation I had last semester with my Biology lab partner.  His explanation of the facility and all characters he encounters got me thinking that maybe I could get some valuable experience by signing myself up.  My experiences at this clinic have really opened my eyes to the work of psychiatry!  

Today, I started my day by learning more about the Central Nervous System in Biology.  The brain is incredible and should be treated with the utmost deference.  It's ability to integrate sensory information in mili-seconds is just astonishing!  With a plethora of neurons and receptors, however, you better believe that something is bound to go wrong from time to time.  When this happens, cognitive dissonance often occurs and the doors of psychiatry are flung open.  After examining a sheep brain in lab, I made my way to the psych clinic.

This job has been great, not only because I am getting valuable work experience that will serve me well when it comes time to apply to graduate school, but also because I have been lucky enough to shadow the Physician Assistant (PA).  The last two days shadowing have corroborated my thoughts of possibly becoming a PA at a psychiatric facility someday.  I know it may be a depressing and often  hopeless field to work in, but the thought of helping someone fight the demons, angels, government spies or torpor that plague their mind fills me with zeal.