My Brief Encounter with Dandy-Walker Syndrome

On my call a week ago, I found myself doing my best to read up as quickly as possible on Dandy-Walker Syndrome/Malformation as we were preparing to insert a central venous catheter into a patient with this condition.

The purpose of a central venous catheter can be categorized based on the reason. There are therapeutic needs such as the administration of fluids or blood and its products, multiple blood draws and the administration of drugs such as antibiotics. One of the more common diagnostic reasons for a central venous catheter is to monitor the central venous pressure amongst others.

To be honest, I underestimated the conditions that exist within the population here in The Bahamas and what I would be exposed to upon my return home for my clinical years. I've seen the clinical presentations of Scleroderma, SLE and numerous patients with Rheumatoid Arthritis and now my first encounter with Dandy-Walker. I NEVER would have imagined seeing any of these here because I ignorantly thought that I would only be exposed to self-induced ailments such as Hypertension and its complications, Diabetes and heart failure.

So briefly, Dandy-Walker Syndrome/Malformation affects the development of the cerebellum-the part of the brain that is responsible for coordination of movement and is also involved with cognition and behavior. The development of the 4th ventricle in the brain is also affected; this is the fluid-filled cavity between the brainstem and the cerebellum and the posterior fossa.

Persons with this condition tend to have problems with movement, coordination, intellect and mood as well as other neurological problems.

The cause of this condition is unknown and it is a rare occurrence. Feel free to read up about it either at the site listed in the picture or perform a Google search.

I've been amazed at the conditions I've been exposed to so far. Such exposure has lead to a greater curiosity of what exists in the population of The Bahamas and what I will see as my future in medicine evolves granted the newfound diversity.




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Barb to the Back

“We are *all* we are, and all in a sense we care to dream we are. And for that matter, anything outlandish, bizarre, is a godsend in this rather stodgy life. It is after all just what the old boy said – it's only the impossible that's credible; whatever credible may mean...” 
― Walter de la Mare, The Return

The world of medicine has allowed me to experience the world through various facets of life. ON a daily basis, I interact with the young in age and the young at heart; delinquents and the elite and then there are those who walk on the wild side of life.

On my last call, lying in the trauma bay was a man who had been "stabbed" by a stingray that he was trying to spear. In its attempts to escape the ray stabbed him in the back which led to part of its barb remaining lodged in the lower part of the man's back. Throughout the course of booking an operating theatre (OT) and clearing the necessary requirements, it wasn't until 2 a.m. that he was finally able to be wheeled in to the OT.

After assisting with the insertion of a chest tube in a gun shot wound victim, I ran to the OT trying to get ready to scrub in on the procedure of the removal of the barb. The surgical area was neat and clean and there was no one in sight. I took off my white coat, grabbed a hair net and surgical mask and looked frantically around the area to which I had access for the foot covers-there was NONE in site or in any of the dispensers.

I made my way to the doctor's lounge and changing rooms and knocked hoping someone would be able to assist me with locating 2 foot covers. Unfortunately no one answered. So, stupidly, I made my way to the OT. I passed two, and as I saw surgeons and scrub nurses all fixated on their procedure,  it automatically became clear why no one was able to assist me earlier.

I approached OT 3, waved my hand in front of the monitor and the doors opened. I signaled to one of the surgical nurses to assist me with finding foot covers and after doing so I finally realized the error of my ways. One by one, they each turned around and looked at me in disgust, disbelief and anger.

Away they all went. "Are those outside shoes you're wearing?" "Where are your foot covers?" "Why are you here without them?" "Oh my Lord! are you serious?" "You should have asked someone in front to find them for you? Why don't you just walk into the OT just as you are? You're already this far?"

The tongue lashing went on and on and no matter how hard I tried to tell them that no one was out front to assist and that I didn't have access to the changing area, they did not care to listen or help. I allowed the doors to close, said good-bye to probably my once in a lifetime experience to see such a surgery performed and "hauled tail" out of the OT.

This week was not my best week in Surgery. It did open my eyes a little bit to the double standards that exist as it relates to the proper practice of surgical attire-I'm sure you've been in a hospital and witnessed surgical staff walking throughout the hospital in foot covers and heading right back into the OT without even changing them.  Needless to say, I won't be stepping foot into an OT without proper attire and I'll definitely be stepping my game up as the rotation advances.

I Survived My First Week of My Surgery Rotation

With my second week of my Surgery rotation on the brink, I can say that the first week of surgery was not at all what I had expected it to be. Yes the stereotype holds true as far as Surgeons equated themselves with a god, however, not all of them are that way.

From the inception, regardless of the fact that our team is predominantly male (we're the only females on our Team), I have yet to experience a lack of respect. Each member does he part to ensure we are learning, actively engaged and participating in the management of the patients on the service as well as corrected when we are wrong or going down the proverbial rabbit hole.

All in all, I'm excited to learn in light of the amount of reading that I have to do on a daily basis and I am eager to take part in the intellectual discussion that occurs at the bedside during rounds. This week will be the start of our presentations on rounds-I can already sense it won't be what I've grown accustomed to during my Medicine rotation.

Here's to a new week.