El dolor de estomago

Today, I finally had that moment we've all known was coming where I realized how much I've actually learned this past year.  There was no big "ah, ha"; medicine just seemed natural.  Claire and I were at clinic today, watching the UAG medical students fumble through a patient history.  The patient was a 22 year old female coming in with stomach pain.  As she's describing her symptoms, I'm trying to pick up as much of the language as possible.  Finally, I watch her move her hands from the center of her abdomen to her right side as she describes how the pain has moved since it first began.  Immediately, I knew it was an appendicitis.

We followed her into the doctor's office and listened to the patient answer more questions.  Upon physical exam, the doctor touched an area of her abdomen referred to as McBurney's point.  The patient cried out in pain.  The doctor then bent the patient's right leg, and the diagnosis was confirmed.  She had an appendicitis and needed to immediately go to the hospital.

After the patient left, the doctor asked us for a differential diagnosis.  What else could have been wrong with this patient?  As we stumbled through our differential in Spanish, I didn't care that we were failing miserably.  What mattered was that I finally realized and appreciated how much I've learned this past year.  I know how to take a history, I know how to do a physical exam, I can present patients to doctors, and I can synthesize symptoms into a classical diagnosis.  Amazing.

There is more to this stomach ache story.  Some would consider it a sin, but I have been in Mexico one week and had not eaten tacos.  So, what was I going to do?  Skip the provided lunch with the host family and find me some tacos.  Now, none of us actually got a stomach ache, but upon eating 6 tacos each, the potential for stomach aches was there.  Deliciously fresh tortillas, several different meats (chorizo, carnaza, pastor, asada y lengua), onions, cilantro, a few salsas, and an ice cold manzanita later, I was a happy girl.

 ...clearly, we all were.