Healthcare in the Himalayas Part 2

Yeah, we left at 9:10am on Tuesday. I remember looking at the clock and being like, okay, what's gonna be my door to door? So, yeah, I didn't know it was about to happen. Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. Yay.

Okay, we want to hear more about your India trip.

Yeah. So last week, I left you guys on a cliffhanger. Cliffhanger. That's kind of foreshadowing for the story about my travel back to the States. So if you didn't listen to last week's. Listen to me talk about all my positive experiences on the trip, because now I'm just gonna explain some issues that went. That went.

It's about to get real.

It's about to get real. And I think most of the time when people talk about travel stories and stuff, I don't like, oh, my flight got delayed. And then it's just like, I'm like.

Okay, I know those are not the most interesting stories, like, everybody's had a.

Flight delay, but, yeah, so. But I do think that this just shows, you know, risks of traveling to a developing country, you know, kind of just issues that can come on these global health trips and stuff that I have never experienced before.

Yeah.

Just to kind of preface if you didn't listen, last week I went on this global health trip to India, and I was with doctors and residents and other med students, and we were having clinics in these towns in the Himalayan region. And so we were really out there, like 12, 000ft in these tiny towns, you know, spotty cell service. I remember sitting there and just kind of looking out into the mountains and being like, wow, I'm so far away from home right now. You know, like, we were miles and miles away from any sort of airport, from any main road. It just was like, oh, wow, I'm in. I'm really in the middle of nowhere, which is something that I've. I. I haven't experienced before. I mean, I grew up traveling. You took us places and stuff, so I feel pretty well traveled. But this was like nothing I ever experienced. But when people. So when people are saying, like, wow, you're going to the Himalayas, you're going to rural India, like, that's scary. Are you afraid? And I'm like, I'm kind of more on the notion of. I just think it's kind of like a fallacy, I guess, to have fear of the unknown just because you don't know something doesn't mean that it's scary.

Yeah, well, and a lot of times people are afraid of like foreign lands. Right? Like, they would be fine camping in outdoors in the United States, kind of in the middle of the nowhere. But when you talk about going to a different country, they're like, oh, I don't know, you know, things are just so different there. And so sometimes I feel like that's a little bit. I was kind of like a small mind idea, however. Yeah.

So I'm trying to do it. Yeah, exactly. Like I'm definitely on the opposite side of the spectrum where. But this experience definitely made me realize, okay, there's definitely some truth into being on foreign land so far away. So let's see. We went. So again, we're at 12,000ft up in the Himalayan region. And then we start our descent down. So we have, our international flights are on Tuesday and on Sunday we start driving down the mountain to another town that's at about 4,4000ft. So we're traveling from 12,000 to 4,000. And the purpose of us doing that on Sunday, two days before our international flight was to try to avoid landslides. They kept talking about landslides, especially when we were doing drives, we would be doing These up to 10 hours one day drives through the Himalayan region. And they told us they're like, you need to wear closed toed shoes in case we need to climb over a landslide.

Wait, now, is it landslide or mudslide or boat?

Landslide or bow? But yeah, but I mean, I don't know. What's the difference?

I don't know. I just remember you guys talking about when you were talking before, I was hearing mudslide. But I don't know, maybe that's just, I mean, was it like water coming down there or it's just like all of a sudden, okay, falling rocks, a.

Lot of falling rocks, especially when you're high up, there's not, there's not even any dirt. It's just rocks. There's no dirt, there's no greenery. It's just rock. So that's more landslides. But then when you get lower to kind of where we ended up at the 4,000ft level, then rain can, can induce these mudslides.

So.

Yeah, and then that's more like mud and that's more when rain happens. Okay. Rather than the rocks. But similar thing, it causes these blockages in the road. And when you're really out there, there's only one road to get where you need to be. And I. Road is, is a really strong term for what we were driving on.

Path.

Yeah, yeah, just a path. But so anyway, we get down to Manali, which was. It's a bigger town, more of a traveler town. And the purpose of we drive there on Sunday and we were spending two nights there so that on Tuesday that we could drive down to Chandigarh, get on our domestic flight from Chandigarh to Delhi. And then Tuesday night we were flying from Delhi back to the US So we needed to get to Chandigarh in order to make that flight so that we can make our international flights. So we have this whole like goodbye ceremony on Tuesday morning. Again, we're still in Manali and Chandigarh is about three hours away. So our flights are that night at like 7pm we leave at like 9am yeah, we left at 9:10am on Tuesday. I remember looking at the clock and being like, okay, what's going to be my door to door? So yeah, I didn't know it was about to happen. So we get in the car and we're driving. So we have this three hour drive and we're not too concerned about making our flights because again, we left plenty of time and there was one car that. So my group, again it's med students, residents, there's about 30 people in the group. So one car left a little bit before my group did. And they're driving and then they text in the group chat and they say, okay, there's a landslide here and blocking the big main road. You know, they're trying to move it, but we don't know how long we're going to be sitting here. So again it's like 10am at this point. So we're like, okay, we'll just go and wait and see if they can clear it because it was more a more populated area. So they did have equipment able to be able to clear this stuff, but it just takes a long time. So you're just sitting in this long line waiting to see if they're going to clear it or not. So we, we were like, okay, let's just keep going. And then we get there and then we're, we're sitting just in a line and at this point we kind of realized that there's more landslides happening throughout the area because that there was, because there was rain the night before. So that caused all of this movement to happen. So we kind of start getting word that okay, even if they clear this one, there could be another one that's going to happen. So now we're like, okay. We don't really know what to do. Our drivers don't speak great English either. So when we're trying to communicate with them to figure out what they're thinking, it's hard because they're just like, oh, no, no, no, no, it's okay. Like, so that was also just difficult. So we're worried about making our. Our Chandigarh flight at this point, but we're still waiting it out. Then the car that was in front of us, we see them turning around and coming back towards us. And we're like, well, what happened? What are you guys doing? And they're like, well, a landslide just fell right in front of us.

Oh, my God.

So we decided this is not safe to go down this road, which was the main road. We need to turn around and take back roads.

Okay, that sounds safer.

Yeah. So we're. They're like, okay, we're not going to get through. We need to try another way. So then we're like, okay. And now we're scared because now we understand that there was, you know, there's landslides happening currently. So we're driving again through the mountains, and now we're going through these back roads and we're all trying to look at our phones and pull up Chandigarh Airport. How long is it going to take? And all of our maps are saying it's going to take 10 hours. It's going to take, you know, 12 hours. And I'm like, okay, do you need to.

It was supposed to be like, three hours, right? Yeah.

Yeah.

Okay.

But now that we're taking this, these back roadways, we're trying to reroute it and. And it's just not adding up, but the drivers are still going. And again, our flight's at 7pm that night. It's noon at this point. If it's going to take 10 hours, we're not going to make our flight. So we're all just like, do the drivers know something that Google Maps doesn't? You know, there? And that's what people were. That was. The discourse was like, oh, they know a different way. It's like, okay, well, I'm looking at the map and there's only one road and I'm mapping it via that road. So I'm skeptical at this point. And then we're like, okay, we need to book a later flight. So then we all book a 9pm flight from Chandigarh. So we're like, okay, well, maybe like, if we don't make the 7pm flight, then we'll book a 9pm flight. And luckily at this point the flights were pretty cheap. It was like 30 bucks. So we were just like, okay, we'll just book another flight. And then there was also an 11pm flight that night too. So we're like, okay, like, we'll be okay. We'll at least make the 11pm if something happens. But yeah, then we're, we're driving through these back roads and luckily it's not, it's not raining or storming or anything. It had just stormed the night before. But it's, it's, it's just getting sketchy and the drivers are just driving, driving, driving. They're trying to get us to make our flights. And then someone text in the group chat about like stopping for lunch. And we were like, we were like, well, they're like, okay, well we can stop for lunch if you guys want, but if we do that, you guys are probably not going to make your flights.

And we're like, no, I don't need lunch.

We don't, we're like, no, we don't need lunch. Let's go, go, go. But like, the drivers also aren't getting lunch either. So they're just driving, driving, driving. And you know, at this point, it's later in the evening, it's like the, it's getting dark and I, I still have no idea. My Google Maps is still taking, say, saying it's going to take eight hours. You know, the time's just going up as we're going through these back roads, just kind of aimlessly driving. And then we kind of get word that, okay, we have 2km left until we hit the main road. And then once we hit the main road, then we'll be fine. And then like, we'll be safe and they'll be able to speed and get us to our flights or whatever. I don't know what this quote unquote main road looked like, but, you know, it apparently was better than the roads that we were driving on. So at this point it's like, it's the, I don't know, maybe 4pm or so, four or five. We've probably been driving for like five hours and we're 2km away. And then we hit another landslide. We didn't see it come down, but then they're driving and then there's just a huge road blockage and we're also in just rural nowhere. So there's no one here to come and clear this or anything. Like that was just, it was there. We were like, okay, we're not getting through. And it's getting dark at this point. And now we're like, okay, we're not making it to the airport. We cannot get to an airport. We kind of were holding onto hope, holding on to hope. And then we're like, okay, we're not gonna make it. We get out of the car, and we end up talking to the car that was in front of us that was. That saw the landslide fall and figured out that that actually killed some people. So that was. God, I kind of didn't really understand exactly what was happening, but then when I heard, that was like, oh, I just want to get out of this situation. Like, I am not like, you know, now it's not about me making my flight. It's about safety. So they're like, we just need to get to higher ground right now. And everyone needs to move their international flights because you guys are not making it back to the States anytime soon. So now we need to drive. They say that we're going to go to Blasper, which is at Higher Grounds. And this is the town that we stayed in at the beginning of the trip, which we all just. We weren't supposed to stay in that town originally, and we ended up staying there because there was flooding and we just did not like the town. We were just like, blasphemer is the worst. Which, sorry, Blaspher. But it was just. There was nothing there. It's so hot. The hotel that we were staying at was just. It just was not ideal. So we were really upset that we were going back to Blaspher, but.

Okay, but aren't you, like, thinking, like, okay, I want to just get somewhere safe. Like, you know, as the mom, I'm like, I don't care if it's hot and, like, unappealing. I just want you somewhere safe.

Yeah, but anywhere but blasphemy. Any other town, anywhere else. Can we just, like, not go to Blasphemer?

So you're saying there was another safe town that was somewhere different?

Yes.

Okay.

But again, I don't know anything. And this is also just kind of like pros and cons of traveling with a big group versus traveling on your own. You know, on one hand, I don't have all the information. I'm not able to make these decisions. But at the same time, it's like, okay, now it's. Especially since I have independently traveled and planned whole trips for our family and stuff. And then it's like, okay, now I'm in this position where I don't I don't have any choice of what I'm doing.

And control freak with no control.

Yeah, it's hot. I mean, it was just hard. And like, again, someone else is making these decisions for the whole group, which is stressful on them too. But anyway, we end up driving for, like. Like eight more hours or something. Again, the drivers are just driving, driving, driving. I mean, we're not rushing at this point, so we got to, like, stop for a snack and stuff. But it's like, we're still kind of on a rush because we don't want a storm to come in. We don't want something to happen. So we're. And we're just trying to get to the hotel. So they ended up driving for 14 hours straight, which is, you know, that was just ridiculous. And, you know, after we figured out that we had to move our international flights, then we're all on the phone with the airlines trying to switch. We have spotty service. So, like, I was calling you to try to help me. And, you know, people booked through different ways. So a lot of people who booked with cash just had to eat the money and buy a new flight because it was too late to switch it because it was only a couple hours from when our flight was supposed to take off. So they're calling on the phone with airlines just being like, please, can I have travel credit? Can I have something? And they're like, no, not the policy. You know, whatever. So it's like. So yeah, some people who. Especially people who just bought with cash their flights had to eat, like $1,500.

So that's like, that is so much money in your. At your age. But we had used points, so was able to book you a new flight with points. And now I've got to use up the points that are stuck in Air France. So I'm going to have to take a trip to Paris.

So. So really, you got a trip to Paris out of all of this?

Yes, yes. I'm gonna have to sacrifice and do that.

No, but I'm so grateful for you for helping me through that too, because, yeah, if I didn't have anyone, I feel like I was, like, talking to headquarters, trying to figure everything out as I'm in the fields, just. Yeah, yeah. Anyway, then we finally get to the blaspher and this didn't happen to me. It happened to my friend Maddie. But we know it's 11:00pm at this point. We get in, we get to our hotel room. We're all also sick, too, where this is when my My sickness kind of started to hit me. I had been sick a couple days before, but then it just. It was getting worse. So we get to the hotel and Maddie walks into her hotel and there is just rat poop on her bed. After this long day.

It'S not funny, but it's kind of fun. Yeah.

Oh, man. So we spend the night, we get up the next day, and we drive another three hours and just hoping that nothing bad happens and that we make it to Chandigarh. We get on a flight and we get to Delhi. We actually got pulled over on our way to Chandigarh by the cops. Don't really so unclear what that was.

About, but anyway, just said it was all okay.

Yeah. He was like, oh, it's fine. I was like, okay. Finally make it to Delhi. Had a weird situation in the Delhi airport where I ended up getting stuck in this place, in this purgatory was what I was calling it for five hours. Because once they let you into the Delhi airport, they don't let you out. And then you can't go through security until at least four hours before your flight. And we got there early, and I didn't really understand, so I walked into the airport, you know, just being like, okay, well, I'll just walk in, see what's up, and then walk out if I want to. But that was not an option. So I was stuck in this confined area for about five hours that day. Then finally get on the flight, fly to New York, connect, fly to Houston. Luckily, there's no delays or issues with that. But total door to door travel time was a little bit over 63 hours.

God.

Yeah.

That's a long time.

Mm.

I mean, it's one thing, and lots of people have travel horror stories, and even though, you know, I mean, being stuck in that purgatory, part of the airport was less than ideal. But whatever. You were safe.

Yeah. I did not care.

You know, that's. That's fine. You were in Delhi. I just wanted you in Delhi at that point. But the stuff about driving around in the mountains and having landslides and mudslides, like, right in front of you and turning around and trying to go somewhere else, that just like. That gives me heart palpitations.

No. Yeah. And that's like. It's like, okay, you miss a flight, I. It's definitely gonna. It's giving me a different perspective about, you know, missing flights, getting delays, whatever. If I'm in an airport and I'm safe, that is just. Yeah, very grateful for that. Cuz, you know, we couldn't even get to an airport. And I was not safe. Then I ended up on my flight. This lady next to me was just complete Karen complaining the entire time they ran out of chicken meal. And she threw a whole fit because she didn't want the vegetarian. And she's, like, turning to me, trying to get me to be like, oh, yeah, this is. She was just saying that it was ridiculous. She was having a terrible time. And I was like, lady, you don't know what I went through.

You are asking for sympathy from the wrong person.

Yeah. I'm like, I don't care. Like, I am so happy to be on a plane going to the United States right now. Like, I don't care about your chicken meal.

It's really true on that. On that perspective stuff. It is important to, like, think about that whenever you have those delays now it's, you know, when you do get delayed and you miss part of your trip, that is a pain. But, yeah, this is. This is a whole different level.

Yeah, I'm happy that I'm safe and that I'm home. But then when I got home, I woke up on. I got home on Thursday, woke up on Friday, super sick, went to the health center, told me I had Covid. So that was a bummer. And then also had to do this. Had to do a stool sample test, which I had never done before. That is demoralizing. It's demoralizing having to poop in a bucket and then scoop my poop and then go take it to somebody like that.

We make patients do that all the time.

Yeah, demoralizing. Hated it. Yeah. And that's when I got the campylobacter diagnosis.

So you had Covid. Campy. Well, but how are you now?

I feel a lot better. Yeah, I. I think it took me. It took me a while to recover from that. Honestly, even then I started. Was starting classes on Monday, got back into school, and then. Yeah, even so that was last week. And it was rough trying to get back into things.

I know when you make plans, I mean, you know that stuff can go wrong and you know that you're going to be tired when you get back, but kind of is good. I mean, again, you didn't have any control over the schedule. That was all decided for you. But it is nicer if you can plan for some downtime after returning home before you right away start classes. But I understand that just. That wasn't an option.

Well, I was supposed to have another day, but I didn't have that.

You did not have Another day. Yeah. Well, okay, so. But wrapping it all together, what is your advice to other people who are looking at doing trips like this?

I feel like I can't really necessarily speak to other trips, I guess definitely, like, vet whatever institution or organization you're going with. This was a organization that my school sent, so I was like, okay, it's vetted, and I'm glad that it was. And what made me feel better about it was that they. It's a. They've been doing this for 25 years and they keep going back to the same places. I think a lot of other programs try to do it and they're newer and they might end up, you know, they try to make it an ongoing thing and it doesn't work out. So that can be more harmful than beneficial to places if you're just going and just seeing people and then leaving and not coming back. So I think, like, that's important. And also just other people's experiences. Like, obviously, you know, there's every. Things can go wrong no matter how reputable the organization is. But I think just having people that have a plan, because, you know, now they're going to make changes for next year and make sure that they stay closer to the airport on the last day. But I mean, the year before that there was flooding at the campsite, so they made changes because of that. And, you know, like, stuff happens and they make changes. So. Yeah. You know what I'm saying.

Well, the point is, in these areas, there's just a whole lot of stuff that you can't control.

Yeah.

Are there options for people to do programs like this in the United States? Go into more needed, underserved areas or not that you really know of.

Yeah, but it's not the same. I mean, you can go do a rural health clinic somewhere, but.

Yeah, just not the same level.

It's not the same level because. Yeah, there's not. Also. It's just different in the States. There's not a ton of tiny towns in a large mountainous region that don't have access to health care.

Yeah, that's true. There's a lot better roads.

Yeah, yeah. It's just different. I mean, we're a developed country and stuff.

Yeah, yeah.

That's not that there's not needs here, but it's just. It's different types of needs. Not, you know, like, there's a lot of needs even in an urban setting, you know.

Yeah.

Like the. The health care access in the United States is just like, there's different problems there rather than access in different parts of the world.

Right? So, yeah, there's plenty of different ways to volunteer and. But it's. It is. It's a different. It's a different experience. I'm just so glad you made it home safe and sound.

Me too.

Story from mom's side. I'm like, just kind of sleeping, and I still got my earplugs in. And dad comes in saying, mudslides, blah, blah, blah. And I'm like, wait, what? What. What are you talking about? What's going on? Stephanie can't get back. There's landslides, mudslides. And I'm like, wait, is she stuck in a sleep fly? What's going on? Like, no, no, she's okay. She's just. They're. They're maybe gonna miss their flight. And I was just all discombobulated and.

I told him not to wake you up. I specifically said, don't wake mom up.

Because I was waking up. In his defense, I was like, it was. It was morning time. It was time to get up anyway. It's just. I waited.

I texted you guys and I said, let me know when you're awake because there wasn't any purpose in me calling you guys and waking you all up.

Yeah, well. But, you know, I was glad to be able to help rebook the flight. So that was. I was glad I could do that and be somewhere where there was good wifi and had computer access and could sit there and check all of these different things, looking for the different flights. And I had, like, a bunch of windows open on various computers, like, okay, here's this over here. And just, you know, trying to call the credit card company to transfer my points. And I was just like, it was, you know, it was real high, high stakes, exciting stuff. Watching me, like, type on my computer, I actually didn't realize that it was, you know, it seemed, like, inconvenient. But I didn't realize really until you got back that. That, you know, that that slide was happening, like, right in front of you and all of that. That's.

Yeah, I tried to not. Like, there wasn't any purpose in just making you worried.

So you're withholding information?

Well, yeah. Oh, no, I didn't need. You didn't need to know that information at that point. I was just going to stress you out and there wasn't any.

Well, I needed to focus on my mission.

Exactly.

Booking flights.

Yeah. But I think in general, just with the trip overall, and in addition to just my summer, I did a preceptorship before that and then did this. And I just got so much clinical experience. A reason why people are hesitant about global health trips and stuff is because two students talk about how much they get to do. But it's not like I was doing anything that I wouldn't be allowed to do here. I was just seeing a lot more patients and I was seeing patients independently, but the attending still had to sign off on everything. I still had to present to them just as I would here. But there was just more opportunity for me to do that. So I think the clinical experience that I was able to get was, was so good in a niche way of just getting to like, practicality. I feel like it really just got down to what do we need to do? Like, what's, what's the best plan here? Like, bam, bam, bam. Done. I see that now. Just looking at, we have these PBL cases, problem based learning. And we have this case and it, we talk about it for two hours and we get different parts and different information. People like, okay, you need to do this imaging, you need to get all of these labs and do all of this. And I even noticed myself being like, we have a sick kid who came in. We need to give them broad spectrum antibiotics and like, let's go. Like, it's kind of just. I'm like, I get the point is to talk through it, but I'm, I can see myself now just having more practical knowledge, I guess, of how to like apply what we're learning and stuff.

Be a little more solutions based rather than, you know, that's really nice to kind of look at all the different things that could be. And it's important to keep all that in mind. But it's also important to get the patient feeling better. And sometimes the patient gets better. And then you don't have to do like a hundred thousand dollar workup because they're, because they're better now. Then if they get worse again, you're like, okay, now let's go back and see these different possibilities. Well, that's partly the difference between academic medicine and real world medicine.

Real world medicine versus academic medicine.

Yeah, yeah. Just, I mean, sometimes I see these things people are doing. I'm like, okay, they're like, well, we got to get this and this. I'm like, but that's not going to change your management.

Yeah.

Why are you getting that test?

That's exactly actually really how I am feeling in this PBL cases when it's like, okay, we need to test stool. Well, we need to test, do this red blood cell Test in the stool and do. I'm like. And they're like, okay, do you think we need to order this? And I'm like, just ask the patient if there's blood in the stool, and if they don't know, then we can do this. But I'm like, what? Like, why are we. And like, at that point, we already have the diagno. Like, if we're gonna do all that, then we might as well just send it for the cultures. Like, why are we doing. You know what I'm saying?

Like, yeah, yeah.

I don't understand. I get your point. You want. The point is, is you want us to be like, oh, if there's blood in the stool, then it's probably a bacterial infection. But like, yeah. I'm like, let's think practical here, you know?

Yeah, yeah. And I know. I just. I see that all the time with, you know, an elderly patient goes into the hospital, they have stroke, and then they're like, okay, well, we've got to check their carotid arteries to see if there's plaque there. And I'm like, well, what are you going to do if there's a big stenosis in their carotid arteries? Are they a candidate for an endarterectomy or some procedure? Well, no. Well, then why are we even checking? Yeah, it's not going to change anything of what we do, so let's just not order extra tests. I also. I don't know. I remember one time a resident said to me, she's like, you deserve the results of the tests you order. And it's important to remember that, too. Of like, don't order something if you really. If it's. If it's not going to change management. And you're kind of like, okay, I don't really want to know that that person has a 99% stenosis in their neck if there's nothing we can do about it. That doesn't help me. It kind of just stresses me out if I tell the patient, that kind of stresses them out. And so let's just. Let's just do what we need to do. But you have to kind of look back. You do have to look at what the different solutions are and kind of work backwards. Like, okay, do we really need to do that test? And I think that's something that. I don't know, sometimes you either get it or you don't.

Well, I think, like, also that's why this experience was so unique because, you know, I am in a huge academic center, and that's what we're doing, and that's what you do in med school, is talk through all these things and whatever. But then in this setting, we really did have to work backwards. We're like, we have this amount of supply, we have these antibiotics, we have this, these management tools. Like, what are we gonna. Then working back from that, what can we do for this patient?

I think that's good. That actually is really helpful because I swear I work with some interns that, I don't know. I think they never figured it out. Yeah, maybe in practice they finally did.

But I mean, obviously that doesn't apply for everything in this situation.

We.

That's kind of what we had to do because one, we couldn't make a definitive diagnosis because we didn't have the tools to do that. We didn't have labs, we didn't have anything to do. And then two, it was like, okay, if it's this type of viral infection or this type of viral infection, how is this going to change management? And then it's like, okay, well, it's not. So it was also kind of refreshing just having attendings who understood that a little bit or just like, was kind of teaching in that way, because it was. I think sometimes I've gotten frustrated with the exact thing that you're saying of. I, I ask, you know, if I'm shadowing somebody or in the clinic and I see them then going and wanting to like, biopsy this thing and talking through the patient and, and, you know, giving them the options, being like, do you want a biopsy? Do you want it not? And then I asked them and I'm like, well, why would you biopsy that? If this is an 87 year old and they're not going to do chemotherapy or anything, why does it matter? And I still. And I never got, I've got. I haven't. Sometimes it's like, okay, well, this person is actually a chemotherapy whatever. But some, A lot of times I don't get a clear answer on that.

Yeah, they probably don't love being called out on those things either.

Well, I, I'm learning. I'm a learner. That's what I'm like.

I'm like, why?

Because I do ask why. I'm like, why are you talking to. Why are you giving them these options? Because I'm there to learn. And I want to know, like, why.

Yeah, And I think sometimes they really. They don't really know themselves or they don't. Again, they don't take that next step to be like, oh, okay, what, what are we going to do with that information? So. Yeah, well, I can't wait till you are on your internal medicine rotation rounds. That's going to be fun. The, you know, I mean, dad, I mean, dad's internal medicine, family medicine, we're a little more practical. There' there's tons of overlap between the two. But that internal medicine round, so they're like, oh, wow. Well, this is very interesting. I can't remember this patient had dementia or something. And they said, well, we need to get an eeg. And then we were like, well, why are we getting the eeg? And they said, well, to rule out Jakob Creutzfeld's disease. And I was like, well, I don't know. I haven't looked up if there's been any new treatments for Jakob Creutzfeld, but at the time there was absolutely no treatment. It was like, I'm like, why would we want to tell somebody that they have Jakob Creutzfeld's disease when there's absolutely nothing we can do about it? It's also the incidence. It was just like, it was super rare. And I remember the attending at the time because I think maybe we consulted neurology and they recommended that or I don't know, somebody recommended it and he was like, oh, oh, Jakob Creutzfeld. I had not thought of that in the differential. Very interesting. Yes, we definitely need to get the EEG for that. And I was just, same thing. I mean, I'm a third year med student. I'm like, what, what are we doing?

I mean that I do see, I like, I do like parts of the internal medicine thing of figuring out the diagnosis. I do like the problem solving. And I realized that this summer too. I liked it. But I think it's also like, if you have the time and resources to be able to do that versus when you don't. I like. And I think also, you know, being in a big academic institution, it's great to learn about yak, whatever.

Yeah.

But like, and so I do think, like, there's. I do appreciate learning opportunities. But then it's like, okay, we don't have the time or resources to do this and this is not helpful. Then it's like, okay, so, you know, I can see the benefit for diving deeper into something. Like there was. There was actually a patient at the preceptor that I was doing and this was a post op patient. So they just had like an elective surgery and. But they kept getting these infections and I was interested in this because then and I was going back and I was looking and I was like, I think it's some sort of autoimmune something. And. But none of those doctors cared. They're like, yeah, he's in the hospital for three days. Like, like, okay, like, we're gonna give him antibiotics. Like, what do you mean? And I thought I was like, well, but maybe he has, like, if we just add on like an igg, then maybe we can figure out, like, if we. So that is. So I do have, like, you know, there's is I'm still interested in.

Yeah. You want to know what's wrong with patient again, especially if there's something that you can do about it, something you can treat, but. Right. That's the total other end of the spectrum of. And that's kind of like part of ER medicine or hospitalist medicine, where it's like, I don't care what's wrong with the patient. I just need them discharged. Yeah, it's. And then like, okay, go follow up with your primary care doctor is always the answer. And then it comes back to me, which is fine. Then I can do that workup on. But, you know, on a different timeline, because exactly when you're in the hospital, I mean, time is money, and so there's no reason for them to be sitting around waiting for tests if it can be done as an outpatient. But exactly.

Yeah.

Yeah, for sure.

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