Feeling Comfortable with Being Uncomfortable 

So many COVID patients in ER

Wow, this week has been quite a rollercoaster! 

Laurel and I started the week with ER which was really interesting! I had never shadowed nurses and doctors in the ER department, so this was a really unique and incredible experience. 

We saw patients, mainly older-aged patients, that had come to the ER due to breathing problems in response to which the nurses told us that many patients were becoming hospitalized due to COVID. One of the nurses, Pablo, took me to the waiting room outside of the radiology department where an older-aged patient was having breathing issues and pain in her chest and abdominal region. After placing her in a wheelchair, I drove her to the ER where we sat her in the triage area. We took her blood pressure and asked her to wait there. Soon one of the ER receptionist came and began asking her questions regarding her name, phone number, etc. It was quite obvious that the patient was in pain and was not able to breathe such that when she began saying her phone number, she could not even complete saying all the numbers. Upon seeing this, the nurse asked the receptionist to leave. Talking to the nurse afterwards, I learned that the receptionist had come to the patient to ask her if someone related to her could pay for her treatment before she received it. As they were processing the information, the patient sat sleepily in the triage area with a brown paper bag in one hand, often asking us for a sip of water. 

As we walked around the hallways, Laurel and I could glance inside the rooms from afar and see patients mainly with oxygen supply through a nasal cannula. It was really sad to see almost all of the older-aged patients with the identical sad and dull look on their faces as they stared up at the ceiling gasping for air while trembling. 

My First General-Surgery Experience! 

On Tuesday, I got to experience my very first general-surgery, which was both exciting and scary at the same time! A patient that was my age had a toenail injury requiring her to remove her entire toenail. While I was interested to look at the injury site, I had a very difficult time detaching myself from the painful emotions that I assumed the patient was going through. Witnessing a situation where the patient, who was my age and was in deep pain and extremely nervous, was quite intense. Observing the doctor, I was quite surprised at the doctor’s humor and his ability to alleviate the intensity of the atmosphere. As soon he had come into the room and looked at the patient’s bleeding toe, he said “Muy Bien” and proceeded to ask everyone in the room how they were haha! This situation along with just being in the ER  gave me the opportunity to experience something really unique. 

Having to see patients who were battling all sorts of health issues was quite scary but observing them and the staff constantly for the entire week allowed me to see the value of growth and knowledge in being in an environment that forced me to step outside my comfort zone. 

It finally clicks! 

Up until this point, seeing different specialities finally allowed me to put together how they were interconnected. Patients typically arrive at the ER (payment would be handled at this point depending on the circumstance) from which they would be directed to radiology if needed. If blood analysis or other treatments like PCR were obtained, then their reports would be sent to the microbiology and hematology department. From there the patient would either be kept in care or provided prescriptions and then discharged. In terms of discharge, the patients would go to the receptionist while the pharmacists would gather their medications. Being able to understand and observe patient flow reflected the organization and structure of hospitals. From experience, just sitting in the waiting room and observing patient flow is an underrated role as part of clinical needs finding: there is so much that you can learn about the hospital and healthcare professional and patient interaction. 

Advocate for yourself!

Something important that I learned during my time in ER was being able to advocate for yourself. Having been assigned ER, I was quite excited to begin my rotations there this week. Before starting, I had pictured myself observing a doctor who would be treating different patients. However, to my surprise, when I stepped into ER, I saw how there were so many nurses that were all busy charting medical records or attending to their patient’s needs. After introducing myself to the nurse that we had been directed to go to, Laurel and I were left standing there. Hoping that a nurse would direct us and take us to observe her, I waited in the reception area for two-plus hours. While there is so much you can observe just by sitting in the reception desk and watching nurses and physicians perform their routine, being able to see up-close how healthcare staff interact with patients is also very valuable. In this way, Laurel and I made the decision to continue walking around as well as ask patients if we could observe them as they did their treatment. At first, it felt awkward and uncomfortable asking patients, but seeing how much we learned just by witnessing a process up close made me glad that I had asked. 

On Wednesday, after having spent two hours in the ER, Laurel and I eagerly wanted to observe other departments as well. Therefore, we went up to the maternity and OR departments and asked if we could observe patients there. After being told that we were not allowed to, we asked them again if we could observe the processes there. This time, we were told yes and we then walked through the hallways to observe the staff and the general processes that occurred in the inpatient area. While we were not able to see the patient interaction up close, it was still really interesting and cool being able to see the hospital staff perform their daily routines. After having shadowed different specialties, it was quite amazing being able to finally see the interaction between different specialties (from ER to radiology, to pharmacy, etc.) finally come together: from patient arrival to their discharge. 

After shadowing inpatient briefly, Laurel and I headed back to ER to continue shadowing there. Rather than sitting in one spot, we did a few rounds by sitting in the waiting rooms and then observing the triage area as well as the reception desk. Rotating within ER in this way helped us to understand the general ER procedure and staff as well as perform clinical needs finding. In this way, I learned being able to learn from the hospital requires confidence and courage to be able to ask staff what you want to see. Everyone is busy with their day-to-day activities, and if you want something to be done you need to take action and advocate for yourself. There is no need to feel ashamed for doing so. At the same time, it is important that you respect others and their space and are cognizant that your actions are not causing harm or discomfort to others. 

On the Other Side of Things

Birthday Fun! 

Before the start of the week, everyone came together to celebrate my birthday! I don’t typically celebrate my birthday, so this was really special to me and I am so thankful for the cohort for making my birthday feel so fun and special! On Saturday, we had a fun relaxing day where we watched a movie and then went to the Escazu mall where we all met up. After walking around the clothes store, we went to El Mestizo for dinner and then ordered dessert. I ordered a Falafel pita wrap which was really good, and the dessert was hands down one of the best desserts I had in quite a while 🙂

Sunday was a really productive day! After finishing our writing class assignment, we all met up to get Gelato and then headed to Lolita where we played card games. Then we headed to Amor de Barrio for dinner! 

Today, all of us in Selina spent the day quarantined in our room so we had a very fun and relaxing movie day.

We then went to get snacks for dinner 🙂 I am really sad that my time here in Costa Rica is almost coming to an end. It’s quite surprising that Thursday was my last day in Hospital Clinica Biblica and today was my last full day in Costa Rica as I will be returning to Houston tomorrow morning. Whether it was being in ER for this week or being in Costa Rica for the past two months, being in an environment that I did not feel comfortable in at the beginning made me realize that it was this discomfort that allowed me to grow so much both emotionally and mentally. 

While I won’t be in Costa Rica next week, I will still be working remotely on the clinical needs finding that I conducted this week in ER and will also be meeting doctors virtually! Stay tuned for my last week of internship next week 🙂