Kitty Holbrooke: Medicine, Week Two

This week went by like a whirlwind and I cannot believe I am already here writing my second blog post!
Tuesday was our first office day, meaning we worked in Dr. Moorman’s clinic instead of the hospital OR. Dr. Moorman and his family had been off-island for five weeks before we arrived, and as a result, this day was jam-packed with 40 patients, doubling the norm. Luckily we had the help of two new PA students, Kahley and Elise, as well as Tyler and Megan.
Tuesdays are consulting days, as opposed to Wednesday and Thursday procedure days, so we spent our hours meeting with patients and hearing their concerns, or addressing follow-ups. Our job, both Alexis and I as high school interns, and the PA students, was to introduce ourselves to the patients, receive information on their past medical history, family medical history, allergies, and preventative procedures (mammograms, colonoscopy), and to find out what issue they were here with today. We then reported all the necessary information to Dr. Moorman, and then went back into the room with him to see his diagnosis. We would go in pairs of two, Alexis or me, and one of the PA’s, and I learned a lot about patient-medical professional interaction.
What surprised me the most was the wide array of cases and how the vast majority of them I never would have associated with plastics. We saw anything from an amputated index fingers, to keloids on the ear, to an inch long horn-like protruding mass on the forehead, to stretched out earring holes. We also consulted potential breast reduction, abdominoplasty, or hernia patients. The majority of our cases, however, were irregular skin lesions or bumps that were potentially cancerous. These are issues that I have always associated with dermatology, yet here on the small island of St. Croix, still fall under the care of Dr. Moorman.
One of the PA’s taught us the ABCDE of skin lesions suspicious of cancer: Asymmetry, Borders, Color, Diameter, and Evolving size/shape/color.
After a busy day at the office we headed to the hospital to discharge the Panniculectomy patient from the day before who had spent the night due to excessive nausea. We got to see a new wing of the hospital and witness the hard life of an invalid as well as the dedication of the nurses and other medical staff.
Wednesday and Thursday were both very similar. They were procedure days with 15 to 25 patients where we did a variety of procedures as well as a few follow-ups. The follow-ups were primarily to change the dressings/bandages on our patients who had been operated on the week before. Dr. Moorman removed quite a few cysts, lipomas, and skin lesions, as well as took punch biopsies. Every excision is bottled and sent to pathology where they test it for cancer. It was our job to bottle and label the samples as well as fill out the paperwork. If there’s one thing I’ve learned so far, it’s that there is an abundance of paperwork and forms to be filled out in the medical field.
Dr. Moorman also had us, as well as the PA’s fill out his SOAP notes; Subjective, Objective, Assessment, Plan. Every single meeting with a patient requires one of these and is saved to the online database.
Some of the more interesting cases of Wednesday and Thursday were removing a foreign body from the arm (a bougainvillea thorn), a breast reduction gone wrong from another doctor, an excision of a massive lipoma on the back, and a foot fungus that reached the knees. In addition, Lexi and I both had the opportunity to remove stitches from two different patients which was actually incredibly exciting.
Friday we were back in the OR early in the morning for another breast reduction. This was our first big procedure with the six students so it was quite a full room, much to the vexation of some of the nurses. Dr. Moorman continued to be a great teacher and each of us got a chance to scrub in and be a part of it all. Friday’s patient was a petite woman so we removed significantly less breast tissue than the previous reductions, yet we still took out over three pounds worth. It was our quickest yet (quicker had Dr. Moorman stitched himself) and we had the majority of the afternoon to relax back at the house.
The weekend has been absolutely incredible. Saturday was a slow day spent around the house, where we played hours upon hours of cards with our host siblings, watched fragments of movies, and spent the entire afternoon in the pool. The day ended with a mesmerizing campfire and the gorging of s’mores.
Sunday we went to Buck Island, a National Park and marine reserve that is a 30 minute catamaran sail from St. Croix. The beach was voted one of the top ten prettiest beaches in the world by National Geographic and that definitely rang true in my opinion. We snorkeled, Stand-Up-Paddleboarded, jumped off the boat, and just had an all around great day. As always, I am endlessly excited for our next week in paradise.