Bacteria Staining and Blood Smearing

This week I started our second week of internship at Clinica Biblica Hospital. Monday through Wednesday, Laurel and I finished up our rotation in the Microbiology Lab shadowing Gabriel and Carla. One of the highlights of this week was our observation of the three different staining procedures in the hematology and pathology labs: Blood smear, Ziehl-Neelsen staining, and Gram staining. Blood smear is a procedure that allows a medical professional to examine various blood cells microscopically. We were able to see neutrophils, leukocytes, platelets, and plasma all of which can provide critical information about the patient’s health. One of the hematologists explained to us that when there is a distinct difference between the different types of cells as indicated by the cell counter device, it becomes really important for a doctor to then manually investigate the blood cells to detect any abnormality. In the pathology lab, we saw how both Ziehl-Neelson and Gram staining was done. Both of these procedures are considered bacteriological stains as they help to identify acid-fast microorganisms like mycobacteria as we saw in the lab. The difference between both of these procedures is that Ziehl-Neelson employs heat as we saw through a Bunsen burner type setup where the pathologist used heat as a way for the stain to penetrate through the cell wall of the bacteria for visualization. On the other hand, the gram staining procedure helps to classify bacteria as either gram positive or gram-negative based on the color of the bacteria observed under the microscope. Observing these procedures as well as personally talking to scientists and researchers in the lab helped us to see the mechanisms performed in the lab as well as reflect upon practices that could be made more efficient using engineered solutions. 

Radiology: It’s not what you think…

After the microbiology lab, we transitioned into our next specialty: radiology. I think Laurel and I can both say that this specialty has been quite surprising to us (in a good way!). Coming into radiology, I came with the mindset that radiologists simply spend hours looking at black and white images of x-ray. However, spending just a single day alone was enough to change this mindset. On our first day, we started off shadowing Dr. Jorge perform CT scans of multiple different patients. In the span of 2.5 hours, we saw 1 patient get a CT scan of their knee and 2 get CT scans of their cerebrum. We noticed that all of these patients were elderly and one of them was even bedridden. After performing the CT scan, which took about 10-12 minutes, the Dr. Jorge examined the reports by looking at the axial, sagittal, and the lateral perspectives of the area of interest and then saved the reports into a folder and into a flash drive. He would then place the flash drive into a folder before sending it back to the patient. In the process a radiologist technician would prepare the CT scan room for the next patient. After talking to Dr. Jorge, I learned that about 17-18 patients come in each day for a CT scan and that depending on the seriousness of the examination, the scans typically take anywhere from 10-25 minutes. After observing the CT scans, a radiologist technician, Pablo, gave a tour of the radiology department showing us the MRI area, mammography and sonography room, X-ray room, fluoroscopy room, and where and how the X-ray images are printed. Through our tour we learned that since MRI machine was not working properly at the moment and that since there was only one MRI machine between both the Clinica Biblica downtown and Santa Anna location, doctors had to refer patients requiring an MRI examination to a completely different hospital. After the tour, Laurel and I met radiologist Dr. Adriana Fonseca who gave a brief summary of her work schedule and background before inviting us to watch a fluoroscopy procedure she was performing at noon Before the procedure, Dr. Fonseca explained to us that a fluoroscopy procedure is a medical imaging technique that uses several pulses of an X-ray beam to showcase how a contrast agent moves through the internal structures and organs. I guess the best way to describe this is that the procedure essentially creates a movie of images taken at multiple pulses of the area of interest. The doctor further explained that patients typically require this procedure to get an understanding of how fluid or food is moving through their mouth and into the digestive tract or how urine is moving through the urinary tract. 

In this case, we saw a female pediatric patient (about 6 years old) who seemed to have swallowing and digestion issues and required the need for a fluoroscopy examination to identify the cause for those problems. To do this, Dr. Fonseca provided the patient with foods of varying granularity to chew and swallow. After each intake, she would examine the image of the food going into the mouth and the bolus traveling down the esophagus. After multiple iterations, she came to the conclusion that the intake of the food seemed normal. However, after waiting a few minutes she noticed that some of the food came back up the esophagus indicating that the patient had severe reflux issues which would require the need for surgery as previous medical treatments did not seem to work. I was amazed to see not only how Dr. Fonseca interacted with the patient who often seemed to reject the food she was given but also how closely she observed the patient’s actions from which she was able to take important clues about her diagnosis. Both Laurel and I were quite in awe as we saw the doctor quickly scroll through different images and quickly point out issues that seemed to require critical attention about the patient’s health. After watching this procedure, I am really eager to watch more fluoroscopy procedures on Monday. Stay tuned 🙂 

The Other Side of Things

Outside of my internship, I joined the GMI crew on a trip to the Jade Museum where we saw preservation of archaeological heritage of the pre-Columbian era organized into 6 exhibits across 5 different floors of the museum. From learning about the ecological and historical context of the beginning of the formation of jade societies and their economics to understanding their daily lifestyle and traditions (culture, like religion, burial rites, etc.) I was quite amazed at the differences and similarities Jade societies share with our society today. Here is us after our 2-3 tour of the museum; if you can’t tell, we were quite tired and hungry! Our next stop was Tortilleria.

The next day, Katy, Jhalak, and I decided to take a walk in the park. The weather was really nice and the walk seemed to help us relax and get a breath of fresh air after feeling quite exhausted from having spent the morning in our dim room (the lighting situation in the Selina hostel room has always been a mystery to me since we moved in haha). After our tragic discovery of our ice cream being stolen from the refrigerator the previous day, we were determined to get dessert and subsequently went ice cream hunting after our walk. 

After going through multiple different shops, we finally came to a conclusion that we would check out the Dos Pinos ice cream place in La Estacion and get ice cream from there. Here is a picture of what I got! (I am still drooling as I look at this!) 

We also started off the week with a pizza night!

Also this morning, I tried an Acai bowl for the very first time, and I have to say it has been my favorite breakfast item so far (even though all the Selina breakfast meals so far have been sooo delicous!!) Stay tuned for next week!