Our Very Own Hospital Escapade: Part 2, A Turn for the Worse

We waited in the hospital room with our eyes glued to the clock.  Finally, 3:30PM rolled around and I was transported down to surgery.  We were told that the appendectomy would take 30-60 minutes, but the nurse told us that oftentimes, it took as little as 15-20 minutes once they got started.  K and I prayed, he kissed me, and followed the nurse to the waiting room.  I don't remember a thing after that, just waking up in my hospital room with my husband sitting next to the bed.  I was pretty groggy, but I felt good.  My surgeon let me know that they weren't able to take out the entire appendix as it looked as though it had perforated (burst) in the past and walled itself off, attaching to my colon and causing that inflammation.  He thought that it had probably burst again recently, causing my pain. 

My awesome nurse got me up and walking around the hallways early the next morning.  I still didn't have an appetite and my diet was limited to clear liquids (think Jello and Italian Ices.)

My folks came to visit that morning and we enjoyed chatting with them for a few hours. Later that evening, I began to feel awful. My nurse was especially adept and after checking my vitals, called the internal medicine team about my condition.  She also contacted the surgery team.  My temperature was 103.4, heart rate was high in the130s, blood pressure was low (85/50), my white blood cell count (WBC) was elevated (this is a marker of infection which they assumed was from my appendix and colon)  In other words, I was septic.  Sepsis requires a number of criteria to be met:

RN.com

My surgeon came in, examined me, and told me that they needed to go back in and likely take out part of my colon and small intestines.  I was in so much pain that I honestly didn't care, I just wanted to feel better.  They scheduled my surgery for the afternoon, but I continued to decline and they bumped me up to the morning.  I remember talking with K, knowing that I was really sick.  I kissed him and we said our goodbyes, just in case. They had to place a new IV as my first one had occluded (clotted off) and then they gave me the anesthetic.  I woke up around 4:00PM and promptly fell back asleep until 9:00PM.  I felt pretty awful at that point and just wanted to sleep.

Of the next three days, I remember very little.  My abdomen hurt and I was continually nauseated.  I had two more different IVs which also clotted due to the "vesicant" medication I was receiving, (vesicant: damaging to the vessels) namely: potassium and phenergan. 

Me getting a CT scan, the fluid hanging in the IV bag on the right is potassium.

The PICC nurse was called to place a PICC line (peripherally inserted central catheter) and I was so grateful!  It meant that my blood draws could be done through the PICC line and that hopefully, it wouldn't clot off because of where the line dripped the medications into my larger vessels.

AHRQ PSnet

My surgeon came in every day to check on me and examine my belly.  At some point, I asked him about B12 supplementation (why did I do that, my med school friends? 😉) but he said that he only took out six inches of my terminal ileum and eight inches of my cecum.  So I'm no longer the proud owner of an appendix or of fourteen inches of small intestine and colon.

More to come, including my experience with an upper extremity DVT (blood clot in my arm) and how it feels to heal in a hospital.

For His Glory,
KCE

Our Very Own Hospital Escapade: Part 1

This January, we learned that you never know what's around the corner.

Over two years ago, I had some vague right lower quadrant(RLQ) pain while we were in Dominica.

Socratic.org

I visited our school's on-campus clinic and they scheduled an ultrasound for 9/18/17, the day Hurricane Maria hit.  So in the hubbub of the aftermath, I didn't get follow-up back in the states.  Later that year, I had more pain, but our insurance wasn't great and I figured if it got worse, I'd go to the Emergency Dept (ED.) Luckily, it seemed to subside and we continued on with school and life.

At the beginning of this last December, I was busy studying for the COMP exam.  I was under a lot of pressure and my pain returned.  Both K and I figured it was likely due to the increased stress from studying. 

Then, on 1/2/19, I began feeling awful.  K sent me to bed around 7:00 PM and that night, I couldn't even turn over in bed without excruciating pain in my belly.  The next day, we drove to K's folks' home and dropped E off before heading to the hospital.  We went into the ED and I told the physician's assistant (PA) about my pain.  They were worried about a couple of different things; they performed some physical exams and then decided that I probably needed a CT scan of my abdomen.  The CT scan came back and showed "a lot of inflammation" around my appendix and in my small and large intestines.  The doctor came in and told me I needed to be admitted to the hospital.  Scared, but relieved, we waited to go upstairs to my room.  The internal medicine resident came by while we were still in the ED and told us that I'd probably be seen/examined by both the gastroenterology doctor (GI) and the surgeon.  We were blessed to have a single room (I didn't share the room with another patient) and got settled in for the night.

The next day, I was seen by the internal medicine team and the GI doctor.  They were concerned about Crohn's disease and told me I needed a colonoscopy.  As a younger person, I thought the day I'd need a colonoscopy was far off in the future, but when they brought in the GoLytely drink, I laughed and started drinking.

Mooremedical.com

My nurse was sweet and offered to flavor the rather salty GoLytely with Crystal Light.  It tasted like a savory lemonade.  I made it through the first four or so glasses before I had to slow down.  My initial goal was just to drink it and get it over with as fast as possible, but that much liquid in my stomach made me nauseated and I vomited up quite a bit of it.  Still, it did what it was supposed to do.  I hadn't had much of an appetite for the last two days, so luckily I think it took less GoLytely than it might of had I had a normal diet.

I slept pretty well that night (for being in a hospital) and woke the next morning to the phlebotomist coming to draw my blood.  My procedure was scheduled for 8AM and they rolled me down to the colonoscopy suite.  The GI physician and anesthesiologist were already in the room and the nurses who did my prep were so kind. The anesthesiologist started giving me the propofol and I stared at the bar holding up the TV; I was out in less than two seconds.

I woke up after the procedure and the GI doctor explained his findings.  He told me that he was pretty sure I didn't have Crohn's just based on the gross appearance (gross meaning what he could see with his eyes, not the microscope.)  Still, they took biopsies, which they let me look at before sending them to the pathologist.  It's a strange feeling to look at pieces of your intestines.  Then, they showed me pictures of inside my small intestine and colon which were awesome!  He told me he'd consult with surgery as he wasn't worried about Crohn's and definitely thought it was my appendix causing all this trouble.  My surgeon came in a little later and told me that he'd scheduled a laparoscopic appendectomy for later that afternoon.  I was nervous for the surgery, but so grateful that I didn't have Crohn's disease.

Stay tuned for the next part of our hospital adventure!

For His Glory,
KCE

Your First Semester at Ross

Studying during the Basic Sciences:

Medical school is hard.  Information flies at you 10 miles/min and at the end of the day, you’re swamped by how much you learned and yet how much you still have to learn that day. I know I cried a lot of tears throughout my first five semesters due to just feeling overwhelmed.

  

First Semester:

Time management is crucial in making it through first semester especially.  You’ll have lectures in the mornings and lab times a few afternoons per week.  This means you need to get yourself a study schedule and stick to it.  I would look at my schedule and make a table of all my lectures so I could check them off one-by-one as I watched them; I’d also make a column for the second time to watch each lecture as well as each time I wanted to complete the practice questions.

Some people attend class so as not to fall behind.  If you need this accountability, go for it!  During my first semester, my baby was four months old, so this mama wasn’t sleeping through the night, at all.  Because of this, I found myself drifting off to sleep during lecture (sorry professors, I promise it wasn’t you, it was me.)  So I decided to use Panapto and it changed my life.  Panapto is the recording service RUSM uses to tape our lectures so you can watch the lecture at your own pace.  I would get up and go to school, hunker down in my cubicle and watch the lectures at 1.5x speed.  If I missed something, I’d rewind it.  If I needed to pause to think about something, I could.  If I didn’t understand something and needed to pull up a different resource, I could.  Yes, lectures took me a little longer to get through, but I felt like I understood so much more at the end of them than I would have had I sat in class. If you suffer from ADHD and get all sorts of distracted, this might not be the method for you, or you’ll be working till midnight every night to finish things.

When you finish your lectures, do not forsake the professor’s practice questions.  These give you good insight into what they think is important and how they might ask questions on the exam.  When I started doing the practice questions, I saw my exam scores go way up!  Do them right after lecture to see what you missed and then give them a week or so after you’ve reviewed the lecture and try them again (if you haven’t memorized the question) and see if you remember the material.

Using Panapto also allowed me to get ahead for lab.  Because I didn’t go to class in the morning, I’d review for anatomy so that I’d be prepared for lab.  I was blessed with two really good lab partners (we were still dissecting cadavers, which I believe will be done digitally now in Barbados) and one, who honestly slacked the entire time, rushing through things and working in a sloppy manner.  On this note, I’d like to say that medicine is a team-sport, you have to bring your A-game because you’re responsible for how your teammates perform too.  If you work hard before lab, all of a sudden, lab becomes a lot more useful to you and not the time-suck people can sometimes see it as. 

                Outside Resources for Firsties:

1. I’d like to say first that Boards & Beyond Review Series is beyond amazing.  I wish I would have known about it in first because I *suffered* through biochemistry.  Honestly, biochem and immunology were so difficult for me.  They throw a lot of immunology at you in first and it isn’t a discipline (one of the things you absolutely need to pass to get through 1^st, the disciples in first are gross anatomy, microanatomy, and biochem) so immunology gets pushed to the side.  BUT IMMUNOLOGY IS SO IMPORTANT.  (I know you read that as “immunology is so important,” but I mean IMMUNOLOGY IS SO IMPORTANT.)  So much of my remaining semesters would have gone more smoothly had I not had to look up simple things week after week because I didn’t understand it in the first semester.  Here’s where Dr. Ryan (Boards & Beyond) works his magic.  After I watched the immunology videos and biochem videos, I felt like I understood it.  Medical school has a lot of information you can memorize your way through, but not really understand.  When I watch B&B, I get it.  I want you to “get it” too.  It’s $19 for a week trial (I’m not paid, I just love it) and if you are struggling with biochem, try it.  Some of the stuff might be a little advanced for first semester, but honestly, those videos are worth their weight in gold.
2. Second, anatomy challenges you, even if you feel prepared.  You have to learn nerves and muscles, and veins, and the brachial plexus.  I loved kenhub.com for their anatomy quizzes and videos.  https://act.downstate.edu/courseware/haonline/quiz.htm has cadaveric pictures you can use to quiz yourself, which proved immensely helpful for the anatomy practicals.  Other people like Netter’s flashcards.
3. Finally, I’d like to say, in first semester, learn what RUSM professors are trying to teach you.  I’ve seen a lot of great students who just couldn’t make it through first because they tried to do too much.  You have plenty of time to get involved, so give yourself the first semester to settle in and grind it out.

You just have to survive first semester.  You’ll find a rhythm that works for you.  It might be different than what everyone else is doing, but if it works for you, do it.

I wish you the best of luck!

Family Update 12/29

Hello everyone!  It’s been a marathon around our house for the last few months.  

Fall 2018 marked the last semester of my basic sciences curriculum.  With my university moving to Barbados in January 2019, it was extra motivation to study hard and get through the material!  All the glory be to God, I took our final on 11/30 and found out I passed the week afterwards.

 

The two weeks between our final and the COMP were intense.  K’s folks were kind enough to come down to our home to watch E while K and I went to a gala celebrating the completion of our basic sciences curriculum.  It was wonderful to celebrate with my friends and just enjoy ourselves for a bit.

That Monday, it was back to the grind. For two weeks, I studied from 6 AM to 5 PM.  I would come home for a few hours for dinner and to see my family, then head back to school around 8 PM to study until midnight or 1 AM.  I reviewed cardiology, renal, hematology, GI, reproductive, and pharmacology.  Things that I had recently seen: neuro/respiratory/endocrine I didn’t specifically study.  I watched a review series called Boards and Beyond and did a bunch of practice questions.

Then, came the CBSE or COMP exam.  COMP is a 4-hour, 200 question comprehensive exam covering anything and everything from the first two years of medical school. I was scheduled to take it on 12/14 and showed up with about 45 other students (most of whom are part of the accelerated program, whereas I am curriculum.)  It was nice to see a few faces whom I knew as we settled into the exam. 

Boy, I didn’t feel great after that test.  As on all our exams, there is an option to “mark” questions and come back to them.  I use the marking system as a way to track which questions I’m not sure about.  So if I know I know the answer, I answer it and move on.  If I’m unsure, I mark it and come back to it at the end of the block of questions.  If I knew I didn’t know it, I’d make a mark on my scratch paper and wouldn’t mark it (no use wasting time on something I knew I wouldn’t be able to figure out.)  When it was over, I had marked 48 questions and knew I didn’t know 12 others.  If I got every other question correct, that would give me the score I needed to pass: 70% (140/200.)  Praise God, I not only passed but exceeded the necessary score!

Now, I’m on an approved absence from school (as are all my classmates) as we study for our first real board exam, the USMLE Step 1, which I’m planning on taking this spring.

K is crushing it, as usual.  I cannot describe how supportive he has been while I’ve been in “go” mode.  Not once did he complain about doing essentially *everything* for two weeks.  Over Christmas break, I actually got to spend time with my husband (we even went on a date! Thanks Mom and Dad!)  I miss him and E so much when I study all day, but I recognize that we are in a wonderful stage right now because I’m home and can see them at lunch and at dinner and for bedtime and I know it won’t always been this way, so I’m trying to treasure the moment and just enjoy it. 

Anyway, back to K.  He starts the last semester of his master’s program in about 2 weeks.  He will graduate with a master’s degree in Theology come May and we are so excited to watch him walk across that stage!  I’ve joked that he’s earned this degree with E on his knee, but I’m only half joking.  He’s written countless papers and read I don’t know how many books while holding E.  In fact, when I proofread his papers, I can always tell where he’s gotten up to help E because they’ll be the same train of thought written into the subsequent paragraph, almost like his brain just kept going. 

We are so proud of him and all his hard.  It’s no easy feat to stay home with a baby or toddler and to earn a master’s degree on top of that just blows me away. 

E is happy as a clam.  He seems to grow inches overnight!  He enjoyed seeing his grandparents over Christmas and got spoiled rotten.  He’s really into the Octonauts series on Netflix right now (for a kid’s show, it’s definitely watchable for adults.)  He got some Octonauts themed toys and has enjoyed playing with them. 

We wish you the best in the New Year.

For His Glory,

KCE

Under Pressure

Psalms 94:19 “When anxiety was great within me, your consolation brought me joy.”

I’m pretty sure David was facing a more intense pressure than we are. I really appreciate how God comforts us in times of anxiety.  I’m there now, for sure.

We have entered what is my last semester of the basic science curriculum.  I have three “mini” exams, a practical skills exam, and a final this semester.  When I’ve run that gauntlet, I’ll have two weeks to study for the Comprehensive Basic Sciences Exam, or more informally “COMP,” exam.  COMP tests on everything we’ve learned in the first two years of medical school.  It’s the gateway exam I have to take (and pass) in order to sit for my first actual board exam: USMLE Step 1.  (USMLE= United States Medical Licensing Examination) 

I’m feeling a lot of internal pressure for some of the following reasons:

-I want to finish this semester strong because grades matter more since I’m considered an “international” medical student. 

-I want to pass because I don’t want my family to have to move, again, internationally. 

-I need to pass COMP so I can sit for Step and pass it before March.  I can’t start my clinical training until I pass Step and I want to be able to start my clinical years next July so I can graduate on time (otherwise, I’ll actually “match” into a residency a year later than I had planned and that equals a year of lost income for us.) 

-In order to increase my chances of obtaining a residency, I have to not only pass Step, but crush it.

I know that God has brought us this far.  He has never left us, even in the middle of a hurricane we are safe in our Father’s arms.  I believe that his hand is on us and He has a plan for our family.  As we face this period of intensity, would you please pray for us?  That God’s presence and plan would be abundantly clear, that we would press on in our desire to serve Him, and that He would comfort us in times of anxiety. 

We love you all and are so thankful for you.

For His Glory,

KCE

My Love

My husband, y’all. 

I’m sitting here, trying to review cardiac pathology, but I keep getting distracted because my amazing husband is playing outside with our son.  So instead, I’m going to take a moment and brag on him because he’d never do it himself. 

When we first started dating, K knew that I was planning on attending medical school.  I’m sure he didn’t know all that would entail, but he was happy that I was happy going into medicine.  When it turned out that we would end up moving internationally for medical school, he was supportive and excited for a new adventure.  Sure, it was difficult to leave his family, church, and jobs.  He left the only place he’d ever called home to start a master’s program and full-time daddy duty.  It was quite an adjustment for all three of us.  Dominica is beautiful, but it comes with a unique set of challenges for many single students, challenges compounded for those with families, especially a baby.  But my husband is a trooper.  I can’t tell you how many pages he has read or typed holding E in his arms.  He’d get E to lay down on his lap, then pull out his books and highlighters until the little fella woke up and required all of daddy’s attention.  He was responsible for feeding him throughout the day (keeping up with washing bottles and their accessories is not fun.)  He’d bring him up to school every day (a long walk in sweltering heat,) so we could eat lunch together, then walk him back up home to nap. 

The night of the hurricane, he was steadfast.  We made a plan and pulled our mattress into the living room so we could lay next to the only concrete wall not surrounded by windows.  We packed up our most important items and laid down to wait out the storm.  I remember looking at him as E slept between us, blissfully unaware.  He reassured me that we would be okay.  The next day, we left our little home, deciding to shelter at the student center on campus.  He made three trips back to our house that day to collect different items that we needed (not knowing how long we would be there,) and then to pack up our remaining baby items to give to our neighbor, who had recently given birth. 

That week is a whirlwind in my mind.  Initially, we didn’t know how long we would have to stay prior to being evacuated.  We were told to ration our food and water.  Luckily, we had filled a few gallon jugs before the storm and had those with us, but we knew that we’d need some of the water for E’s formula and that I’d need to drink because I was still nursing him.  K made sure that I was drinking and eating and that we’d have enough before taking any for himself. He helped rearrange the furniture in the little room we were staying in to make it more hospitable for us and for the family with whom we shared the space.

As we were evacuating, he made sure that we were safe and comfortable.  He grabbed a chair for me to sit in with E, but in order to let more ladies sit, he sat on the floor of the boat, for twelve hours, with his back against the wall.  We had been told that the ride would be about 4 hours, so I inquired at hour five how much longer it would be?  I was told about six to seven hours longer and I broke down in tears.  Because we had been told only 4 hours, many people hadn’t brought food.  We had brought snacks for ourselves and for E, but K generous offer to share what we had was taken up by many of the ladies around us. 

Even now, as we are so grateful to be back in the United States, K does the majority of work around our home.  As I am in my last semester of basic sciences (please, Lord!) I’ve been studying with friends more frequently, which means that K has morning duty until I can get home.  He makes most of our meals and does 90% of the housework.  He makes sure that E is fed, dressed, and clean.

They play outside every morning, drawing the alphabet (in both Hebrew and English) and chasing each other all over the yard.  As I write this, I can see him racing E down the driveway, and now he’s using E’s overalls to lift him up and I can hear our little boy laughing with delight.

The other night, I sat on the couch and cried because I felt so overwhelmed.  K sat down with me and held me until I felt better, then gave me a twenty minute pep talk about how I can do it.  He gave me another inspiring speech the other day as we played outside with E.

I am incredibly blessed to be his wife.  Our son has a father who loves him and delights in spending time with him.  Thank you, Lord, for this wonderful chapter in our lives. 

Life in the USA!

Hello Everyone,

We haven’t forgotten you, we promise.  The last few months have been hectic, but we’ve had an enjoyable break where we visited our families and spent time at the children’s museum, zoo, and libraries. It really is a treat to be able to take E places like this, as we were pretty limited in Dominica as far as age-appropriate trips were concerned. We feel renewed for the upcoming semester.  K is taking two classes this fall, one in Biblical Hebrew and the other in Biblical History.  (I looked through his Biblical Hebrew textbook…..I know he’s up for the challenge.) I can’t imagine how many book pages and papers he has typed with E on his lap or playing with toys at his feet.  He’ll graduate with his master’s degree next April and we can’t wait to celebrate!  (I kind of feel like he should be able to walk during commencement with E in his arms since he’s essentially earned his degree that way.)

Glory to God!  I’ve made it through my fourth semester out of the five which comprise the basic sciences portion of our curriculum.  After this fifth and final semester, I’ll study for and then sit for my first national board exam, otherwise known as STEP 1.  After that, we’ll spend some time at another campus while I learn to do a few more types of exams and get familiar with the hospital setting, then we’ll be off to my clinical rotations for two years.  (After clinical rotations, I’ll take the second set of licensing exams which test clinical knowledge and clinical skills.  After that, I’ll graduate with my M.D.)  I am so grateful for the support of K and E and our families as I’ve studied.  They’ve sacrificed time with me so I can keep on working and I am forever grateful for the notes of encouragement and pep talks I’ve received. 

We appreciate your prayers and love.

For His Glory,
KCE