First Week of Rotations: Check

I've just wrapped up the first week of rotations here and it's been exhausting trying to get over jetlag while learning and thinking critically.  I still get tired in the early evening when it is about 3 am on the West Coast, but I'll figure it out eventually.

A lot of things here have different brand names so it sometimes gets confusing.  An example here:

Another common one I've seen is Tazocin (guess which that one is).  There are also a lot of drugs that are common here in Singapore that you'd hardly ever see in the US.  A lot of times when we start a patient on a chemotherapy regimen, we premedicate them to prevent nausea with granisetron (as opposed to ondansetron).  A lot of patients are also getting itraconazole as the initial antifungal of choice, though my preceptor wouldn't tell me why until next week. 

Over the past 2 days I've started making interventions on my team.  Being on an oncology service, the team is mostly focused on the chemotherapy regimen and managing complications from the regimen like neutropenia.  I've been able to pull from past acute care rotations to help treat patients more effectively.  Yesterday I had a septic patient who had an enterococcal UTI for 5 days before I saw her.  She was already on aztreonam because of a penicillin allergy and they had started her on clindamycin the day before and were just going to continue the regimen.  Of course these antibiotics don't cover enterococcus so I asked to change to vancomycin (it was sensitive) and metronidazole (since they wanted anaerobic coverage in case).  The physicians are very good at taking care of the cancer but this was a pretty important thing to overlook so I was glad I could contribute to patient care in only my first few days here.  Now if I can keep this up while learning a thing or two about oncology, we'll get the ball rolling.