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.