8.6.13

And the cherry on top of the shit sunday that has been Guadalajara:
Today I woke up at 2am with a cockroach on. my. face. It was terrible. I grabbed at whatever was on my face and got the leg off him and put it in my journal as a souvenir. Cockroaches are hairy.
Everyone has had a meltdown so far and last night I joined that club. It just pushed me over the edge. `i was in the hallway in a little ball hyperventilating and luckily the kids here came and calmed me down.
I give up Mexico. What else do you want from me?

On a positive note, the new girl has a Mac so I'll hopefully be able to use it some.

8.5.13

Over the weekend, someone left the door to our house open and my iPhone and Mac were robbed. So I won't be able to post here much. Sorry!

Today I sutured three people and I have to say I'm not as thrilled by it as I once was. The rest of the day Dec and I sat on our asses.

Then Dec's phone got pick-pocketed. It was my last life line to the real world and it is now gone.

8.1.13

I could not have asked for a more amazing summer. Here in Guadalajara I have "bagged" a patient, stitched up people, pumped a woman's stomach, and so much more. I love wearing scrubs and being called "Doctora". I have an insane amount of responsibility here. I have my own patients and consult with doctors only to get their signatures on the bottom of the charts. I write up prescriptions, order x-rays, and even get to wear a stethoscope around my neck! Today was our third at the North Green Cross Clinic. As the doctors begin to recognize us, we are given more and more responsibility. Today they tossed almost all of the stitches to Decs and me. Decs and I make a great team. We switch off doing the stitching, with the other person assisting getting non-sterile supplies and blotting off the blood.

As Decs and I have discovered all of the cases start to run together. Even when we sit down and try to remember the day we can’t pull apart the patients. The record we came up with for today was:

Finger 9 stitches

Back/butt 7 stitches (decs)

In between tow 5 stitches

Stomach pump 2l of fluid activated carbon

Drunk guy and boob grab

Forearm 6 stitches

Back of hand (decs)

The stomach pump, however, I do remember in great detail. One of the attending doctors called me over by saying Doctora Nina. I really want to correct him and say I'm not a doctor, I’m just a kid, but then he wouldn’t give me any cases. “Doctora Nina” he said, “there is a stomach pump case coming. Let one of the nurses finish putting the bandage on your stitches and get ready.” So, I put down the gauze and gave it to a nurse who was passing by. I went and stood by the doctor while the EMTs wheeled the girl in. The doctor pointed to her and said, “Go pump her stomach. She swallowed pills.” I mean I know my mom got her stomach pumped after she ate mushrooms in her backyard but that’s about all the context I had. Unfortunately, there were no Greys Anatomy episodes about stomach pumping. So I went over to the women and asked what she had swallowed. I got her to admit to taking about 30 pills of unknown origin. Then the doctor came back over and asked what I was doing, that we had to get going, that we didn’t have much time. Go to the cendis (the little supply room where a man sits and gives you everything you could ask for) and get the asdfghjklkjhgfdsa. Right away sir. I went over to the cendis and asked for the equipment to do a stomach pump. Thankfully the guy behind the counter was experienced and knew what I wanted. Then the doc asked me to open the bad with the tube in it but of course it was super strong plastic so I had to run and get scissors (I know, no running with scissors, but the doctor had gotten off his ass for the first time that day, so I figured it was important). Then he got surgilube and introduced this 3/4cm tube up into this woman’s nose and down her throat. She was not pleased. There was a lot of blood. It was actually quite violent. Then he left and I was in charge. I assumed pumping a stomach required a machine. I was incorrect. The nurse handed me a syringe and walked away. I walked after her and whispered to her, “what am I supposed to do with this?” She smiled and said, “I think you stick it in the end of the tube and pull out the contents of her stomach.” So that’s what I did. I pulled out the contents of her stomach with a 50ml syringe. The procedure was simple but insanely tedious. Introduce about a minute and half of water-ish stuff into her stomach, let it run out, suction out the rest, repeat. I went through 2L of solution over two hours. It took me a long time to get all of the pills out. You could see the bright green pill remnants going through the clear tubing so I did it until there were no more green pill spots. I squatted below her bed coaxing the stomach contents into a bucket for about an hour and a half. Then I put in about half a liter of activated charcoal solution to absorb any more bad stuffs still in her tummy. Then I took out the tube and had her sit up. She talked to the social worker about how upset she was in her life. Her husband didn’t sound like the best guy, but he never beat her or raped her or hurt the kids so that’s a plus. She was just sad and thought her husband was having an affair and just sad about life. I told her to wait there until the doctor saw her again and walked her to the bathroom and made her talk to me the whole time. Last thing I needed was to have spend 2 hours saving her for her to jump out the window or slit her wrists. That sounded insensitive. I didn’t want her to die. Dying’s bad. That’s rule numero uno in doctor-ing. I kept an eye on her as I did the rest of my stitching and she left with her father a little while later.

7.31.13

Our second day in the clinic was pretty even keeled compared to the day before. The big highlight of the day was a crazy diabetic patient that came in. She went into a diabetic coma when her blood sugar dropped but once we gave her glucose she started waking up. But, as she gained consciousness she became pretty violent. She kicked her bed away from the wall and was swinging her fits. She clocked me in the arm and then tried to take out her IV. I called Decs over to help me control her and from then on she wouldn’t talk to me at all. She would only talk to “the pretty doctor” aka Decs. He talked for her for about 20 minutes until she finished the IV bag and then he walked her to the door.  A couple minutes later the policeman stationed in the clinic walked up to Decs and gave him a pink sticky-note. On it was her number and a note that said “I would love to get to know you better” with a heart and her phone number. I got quite a kick out of it; finally I wasn’t the one with the stalker.

I also did my first two official stitches. I'm having trouble remembering them, but they were completely unsupervised on an unsuspecting guy. I'm pretty sure it was a guy. Ehh maybe not. I can’t remember. But they went in uneventfully.

There weren’t many emergencies so I shadowed the pediatrician a lot. She doesn’t acknowledge or let you talk but she does teach a lot, especially if you ask her questions point blank. The vast majority of the cases in the ER that day were kids.

It was also my Grandma's 80th birthday! I was able to get skype working and give her a call when I got back from the clinic. It was so nice to talk to her. Happy Birthday Gum :)

PS How could I have forgotten the purple finger! It was truly baffling. A guy came in with a bright purple finger! He said it was some type of medicine, but I've never seen such bright "medicine"

I did my best to scrub off the purple so when the flap of skin re-attached to his finger he wouldn't have a purple tattoo. Truly bizarre. 

7.30.13

I’m working at the Green Cross (mexico’s government hospital system) in the ER with another volunteer Decs from England. We’re working the afternoon We left the house at 1:00 and we got to the clinic at 1:45. We changed and walked into the small ER. We greeted a guy in a white coat and introduced ourselves as first year med students. So, the Dr. gave us a chart and said go! The patient ingested some sort of paint solution (probably paint thinner). He had vomited it up and drank a liter of milk, but he still had some pain on his lower left stomach. We had no idea waht we were doing so we started with the basics: heart sounds and heart rate, blood pressure, respiration rate, and a stomach exam. Then i went back to the Dr to ask what the hell we were supposed to be doing. He asked me what things to look for in someone who has swallowed something dangerous. I froze - I had no idea what to look for! So I said stomach perforation and subsequent infection? He said yeah and what else? I had no idea so he said that you also had to look for lung perforation, which you can hear when you listen to their lungs, esophageal perforation, which you would hear when they walked in cause they would struggle breathing. So we went back, discovered that one of the stethoscopes was shit (I’m just wearing it around my neck now so I look official). We went back to the nurses’ station, got a new stethoscope and listened to his lungs. They sounded fine to me, but I wasn’t really sure what I was supposed to be hearing. Once we finished that we went back to the Dr. and said that we thought he was fine but that he should double check our work.

Then, Dr. Jorge (aka pink shirt dr) grabbed us and took us to a little trauma/ICU room where there was a pretty beat up guy unconscious. They had intubated him when he came in this morning at 8:30 and they hadn’t been able to get the ventilator to work. So they had been taking turns bagging him. Then, they let me bag him! It was harder than I though it would be to squeeze it, but, thankfully, I was able to recall my extensive Grey’s Anatomy (no not the medical book, the TV drama) knowledge and I knew to count one-one-thousand, two-one-thousand, three-one-thousand etc. I even made a little song out of it after a while. I was able to get pretty close to staying at the optimal 27 or 28 breaths per minute rate. After a while Decs had a go at it and he did it until I recovered. He was going a little slow so I took over for a little while. Then he did it again and was juts starting to get the hang of it when the guy’s heart rate starting freaking out. First it shot up to 180, then 200 and then all the way up to 250. Poor Decs’ face went white and he got my attention and then I got the Dr’s attention. The doctor was un-phased but Decs was freaking out (understandably).  I took over and both the patient and Decs calmed down. I kept bagging and the Dr asked who wanted to accompany him to the other hospital where they had a ventilator. I raised my hand and off we went. I got to ride in the ambulance and kept bagging him. They turned on the sirens and everything. As I climbed down out of the ambulance bagging him, I felt this calm come over. I had seen this scene on TV a million times: arriving at a hospital, everyone flooding out of the ambulance, doctors from the hospital ready and waiting for us. Everything just felt supremely right.

The hospital was surprisingly nice. It almost looked like an American hospital. Not quite, but almost. That’s not meant to be racist or insensitive; the thing is that the hospitals here are crap. So to find one that wasn’t falling apart and even had automatic doors was surprising. There they changed to bad to one of their own and suctioned him out and finally got him on a vent. They I looked around for the Dr I came in with but I didn’t see him. So I went back to the ambulance and rode home to the hospital.

When I got back the Dr gave me another case and I asked the patient questions and then presented the case back to the doctor who prescribes medicine. I watched mostly because it was my first day but wow is it going to be a great month! They will let me do pretty much everything but because it was my first day I mostly just watched they offered to let me stitch a patient at the end of the day, but he looked rich and had injured himself playing tennis and the cut was on his face so I decided to let the other doctor do it. There was a pair of brothers who were painters and who had fallen off their scaffolding. While the one brother was fine, the other brother had dislocated his shoulder and fractured his lower left leg to oblivion. His tibia was split straight in half and his fibula was a mess. Decs and I tried to count the different fractures we saw but gave up after 7 because his patella and top of the fibula was just in pieces.

The majority of the other cases were minor cuts and bruises, but the level of independence that we got was simultaneously terrifying and exhilarating. It was a splendid first day.

7.29.13

Today Ariel was supposed to show all 5 of us new kids how to get to our hospitals and introduce us to the staff at 9:00am. He meandered in at 10:30am. When we asked why he was late he said, "I'm not late, this is Mexico" We proceeded to stumble from one clinic to another. I don't know who messed up what but no one knew who we were or where our CVs ended up. It took about 5 hours but eventually we went to both hospitals and got the official blessing from both hospitals. I start work tomorrow at 2:00pm at the Cruz Verde, the government hospital. Should be fun!

7.28.13

All of the kids in the house (7 today) ventured into the center of the city and went to the market.  I got some soccer jerseys to work out in, but mostly just took in the city. We walked about 30 minutes to get to the three story market. It was similar to a ginormous West Side Market, but much more disorganized and cramped. It was a mind-bending maze and we wandered for a while to try to find an exit. At one point in our quest we ended up in central courtyard filled with caged birds. We also found a Subway very close to the house and so we stopped there on the way back. Unfortunately, when we got back the house smelled like gas and the hot water heater was puffing out black smoke. I turned off the gas at the wall and it simmered down. No hot water for us. The internet has also been exceedingly spotty with only 2 hours of internet yesterday. Ariel (the program director) claims that it is because the city is doing work and intentionally shutting it off, but I'm fairly sure its just a crappy box. We'll see if it gets any better.