Honors Students away from campus for study abroad, co-ops, or internships are encouraged to write about their experiences to share them with the Honors community. In the post below, Parker Bamback ’20 describes how his medical clerkship in Nepal helped him better understand a career in medicine.
– By Parker Bamback
My name is Parker Bamback and I’m a senior Biology student with hopes of going to medical school. This past summer, I had the privilege of spending almost two months in Nepal participating in various medical activities.
I’ve had numerous interesting and exciting experiences in medicine through past volunteering and job-shadowing, but my experiences in Nepal exposed me to the most difficult parts of what being in medicine entails. Many who want to become doctors, like me, imagine a career of helping people and improving quality of life. We envision ourselves as the hero in the stories of our patients. We don’t want to ponder the part of being a doctor that involves dealing with suffering, or possibly even death. During a four week medical clerkship at Model Hospital in Kathmandu, I was faced with having to experience what is truly involved in being a doctor.
I began my first day of the program in Internal Medicine. I woke up feeling both nervous and excited, and couldn’t wait to meet the doctors I would be spending the next two weeks with. They exceeded my expectations: they were friendly, nice, funny, and best of all they could speak English! After morning coffee, it was time to start rounds on all the patients and the first stop was the ICU. The second patient we observed had been unresponsive for a couple of days and today was the day the doctors felt comfortable giving him the diagnosis of vegetative state. The doctor called in the patient’s daughter, a young woman who worked as a nurse at the hospital, and explained to her that although her father’s pneumonia had been cured, it had entered his brain and he was now trapped in a permanent vegetative state. It was painful to watch all hope drain from this woman’s face. I asked one of the doctors to explain the treatment options for this man and was told: “she either takes him off life support so he dies, or we wait for him to die on his own.”
The situation with the next patient in the ICU was not much easier as she was hysterical and I had to assist in restraining her for a test. She was in the ICU due to a pulmonary embolism and the test was to see if her thirty-two-week pregnancy was still viable—she hadn’t felt the baby move for several weeks. The test concluded that the pregnancy was no longer viable. The day did not get much better from there, and ended with me holding the hand of a young girl while doctors performed a painful bone marrow aspiration on her. In the U.S., an aspiration is normally a quick procedure performed under general anesthesia; however, the doctors here did not use anesthesia, nor did they have the proper equipment for the procedure. They had to use a knife to chip down the outer layer of the syringe to get it to fit with the needle. It was not a perfect fit so they had to keep trying to use their fingers to form suction between the syringe and the needle. It took them over thirty minutes, using both the girl’s hipbones, for them to get enough marrow. During this time, the girl was dry heaving from the pain, crying, and begging us to stop. It was excruciating to watch. This was not how I pictured my first of my clerkship. I tried to reassure myself that there are some bad days in medicine, and that surely tomorrow would be better.
Day two was worse. I arrived at the hospital to see new faces in the ICU. I was very happy, thinking that some people got discharged, but was quickly informed that they had all died during the night. Later, while doing our rounds in the ER to see if any patients needed to be admitted, a man came in unresponsive and I watched as the doctors tried vigorously to revive him. They were not successful and walked away, leaving the man lying on the bed uncovered and alone. I walked out of the ER and saw the family of the patient waiting in the hallway, unaware that he was no longer alive. That was the first time I witnessed someone die. It was hard, but I tried to take comfort in the fact that everything was done to try and save him.
I can’t say that about a patient later in the week. I had been in internal medicine for about five days at this point, all of them just as grim. In fact, I had, gone from being excited every morning to being distressed over what pain I would witnesses that day. On this particular day, a forty-five-year-old man was going to be the first patient to leave the ICU alive since I had started. Unfortunately, he was leaving because his sons were taking him home to die. From the look of him, no one would know he was dying: he was happy, joking around, and full of color. This was because he was on medication to combat his liver disease. Without the medication, he would die within a week or two. His sons were removing him from the hospital because they had run out of money and had already used what little savings they had to pay for the $50 a day stay in the ICU. They would also have to discontinue their father’s medication which cost $5 a day (a daily foot-long sandwich at Subway costs more than it would to keep this man alive). It was so disheartening. The only person to leave the ICU alive was the pregnant woman who came in on my first day. Although I was sad that this woman had lost her baby, the fact that she was leaving the ICU was the highlight of my first week. At least someone was getting out of this place alive and healthy. It made me happy to think about it.
My second week in Internal Medicine was much more optimistic: only one patient died and many were sent home. It was during this week that I was exposed to just how different the practice is of U.S. medicine versus that of Nepalese medicine. A man had just been diagnosed with terminal pancreatic cancer, and I was preparing myself for the miserable conversation between the doctor and patient regarding the diagnosis and prognosis. But, it never happened. The doctors took the wife aside and told her the diagnosis and prognosis. She was devastated and weeping, but when she calmed down she instructed the doctors not to tell her husband and the doctors agreed. I was shocked when the doctors went to the patient and told him that he just had a bad stomach ache that would eventually go away. The patient was then discharged. I discovered that in Nepal, patients have very few rights. In this culture, the family of the patient makes all decisions. It juxtaposes the individualistic culture in the U.S. In Nepal, a patient’s family gets to decide what the patient is allowed to know, and they are the ones who must consent to any tests or treatments. Only one doctor I spoke with, a pediatric surgeon, felt that patients should have the right to know their diagnosis and prognosis. Everyone else believed it to be an acceptable practice.
I am so grateful for all my experiences during this clerkship—the good and the bad. I learned so much about medicine in general and it was invaluable to have the opportunity to observe doctors working in a poor, undeveloped country. I am most appreciative of my rotation in Internal Medicine. Although they were probably the hardest two weeks of my life, they forced me to experience the harsh realities of being a doctor; the messy and depressing parts I hadn’t really wanted to think about. Initially, it made me question whether or not I could handle it every day—accepting that people will die and that I won’t be able to stop it—but because of these experiences, I know it is all worth it just to watch that one patient go from being so sick they need a feeding tube, to being healthy enough to walk out of the hospital. Smiling! This is the memory that will motivate me every day. It is the memory that makes me know for certain that I want to be a doctor.