I’m a final-year medical student, and in just under two weeks, I will begin my final clinical training at one of the largest hospitals in the world. I will spend 8 weeks at one of the most busiest trauma centers in the world. It’s a place known for managing a staggering number of patients with injury mechanisms you just do not see that often in western medicine. The place is known for offering an intense immersion into emergency medicine. This has been a dream of mine for many years, and when the opportunity finally came up, I didn’t hesitate. And thanks to N for giving me the initiation to really apply…I am not sure if I would have done that without you 😉
Through this blog, you’ll have the chance to follow my journey. I’m starting this almost two weeks before my departure, so you’ll get a few unfiltered impressions beforehand.
Thoughts before departure
There are a lot of questions running through my mind: What about safety? What about the risk of HIV? Could I experience post-traumatic stress? Will I be able to manage emotionally in an environment that’s harsh and unpredictable? What about the language? How will it feel to be far from home, surrounded by strangers?
And yet, there are other thoughts, too – thoughts that really drive me: I believe this experience will shape me into the doctor I want to become. I hope it will teach me how to stay calm in chaos, expand my horizon by pushing me far out of my comfort zone, and help me grow both personally and professionally. This is probably the final chance to get hugely influenced, before starting working as a doctor where routine will set in after a while. I’m curious to see how another health system operates and whether this will influence the way I will practice medicine in the future.
There’s so much I want to learn. First and foremost, I want to improve my ability to remain calm in the storm. I believe the only real way to develop this is through exposure to high-stress situations. I’ve already done this to some extent through emergency medical services and my work in hospitals, but I expect this elective to be a very different experience.
Fundamentals like the ABCDE assessment I know by heart. I’ve developed a strong skill set in inserting IV lines and can suture basic wounds independently. But more advanced procedures like complex wound closure, thoracic drainage for tension pneumothorax, central venous access and wound care (burn injuries, open fractures and many more) are areas I hope to focus on. I want to be a part of the team and help managing through busy shifts.
Beyond technical skills, I also want to improve my clinical judgment: How urgent is something? How do I improvise with limited equipment? And perhaps most importantly: Where is my own limit? Knowing when to call for help is one of the most critical and underrated skills in medicine – and one I hope to improve even further.
I applied for this elective almost two years ago, and it took nearly a year for the application to be processed. I’ve read dozens of blog entries by others who went before me, many of which include warnings like, “You really need to be sure about your decision. This is going to be tough.” Still almost everyone came to the conclusion that this was one of the best medical experience in their life, I read exactly one article stating that the author regretted the decision to go there.
I started preparing early: I got a new passport, got an international driver’s license, and began saving money – because this elective is far from cheap. I booked travel insurance and professional liability insurance. I also purchased some equipment: a compact pulse oximeter for patients without monitoring, a headlamp for suturing in case of power outages, trauma shears, and much more. (Don’t forget your travel adapter – that almost happened to me.) I booked my flight four months in advance and secured accommodation. Even getting a credit card was a process – it’s not easy as a student without a regular income.
Next to a lot of organization I got myself a full set of HIV post exposition prophylaxis. Initially I decided to not get one, because you can get it there quite easily. But I do not want to take any risks regarding HIV, and I know how small transmission probabilities even without PEP are. My thought process was quite simple: Everyone told me to use common sense and listen to your gut, regarding safety. And my “gut” told me to be 120% safe. Additionally I got myself some vomex, loperamid and antibiotics to be prepared for the “if” case.
For professional preparation, I ordered the latest ATLS manual and began reading it weeks ago. I supplemented this with a detailed PDF guide prepared by local attending physicians at the hospital I’m going to. It covers key injuries I’m likely to encounter – gunshot wounds, stab wounds, burns, motor vehicle accidents, falls from height – and it includes local protocols and practical advice. I hope this gives me a solid foundation. My prior experience in EMS and anesthesiology will hopefully help, too.
Still, I’d be lying if I said I wasn’t nervous. The closer my departure gets, the more anxious I become. But giving in to that anxiety isn’t an option. In twenty years, I want to look back knowing I took this chance. I’ve been drawn to this experience ever since my first steps in medicine, and I believe that deliberately seeking challenge, and adapting to it, is a character trait that will serve me well in the medical field for the rest of my life.
Let the journey begin.
My elective as a medical student in South Africa 