when it rains it pours

There's something about the rain here.  First of all, it's inevitable.  It rains nearly every day.  It's just something you can count on.  And because most of our patients come by foot, or by bus, usually when it's raining, things slow down a bit in the ER.  Unfortunately, the rain just lasts a short while... today it rained hard...and longer than usual... and things got really really quiet in the ER.  I even went home and took a quick nap.  Then it stopped raining.

Within a matter of 2 minutes after the last rain drop, the patients started pouring in the door.  "Doctorita, me puede atender?", "Doctorita, mi hija...", "Doctorita, doctorita, doctorita"... An emergency Cesarean section among them, several "non-emergent" emergencies, then a 14-yr-old boy with a snake bite.  Crazy.  When it rains, it pours.  Then after it rains...wow.

I've posted some long overdue photos of my trip to see monkey orphans... it's 2 guys who've rescued 22 monkeys whose mom's were killed (apparently monkey is a delicacy).

"eres gringa?"

Today in clinic a little girl looked up at me with curious eyes and asked "Eres gringa?"  (translation:  Are you a gringa?).  For those of you who have not traveled in Latin America, gringo is a term used for North American, pale with a camera around the neck, I'm going to bring a sombrero home with me type people... but somehow, in her sweet curiosity, it was very endearing.  I love how kids ask questions and say what's on their mind.

Another thing that I love-- the greetings here in Ecuador.  Everyone greets everyone else when they arrive, when they leave, even sometimes when they walk out of the room for a second.  In fact, one of the residents had a nanny here for her daughter, and the woman would say "Buen Provecho" (translation: bon apetit, enjoy, chow down) everytime she walked in and out of the kitchen during lunch... and that was at least 12 times per lunch.  That was kind of awkward.  But otherwise, I really like the greetings.  

I wonder why we don't have a cultural kiss in the US.  We just coldly, distantly shake hands, or give a head nod, or go about our business and don't greet each other.  Here it's the good ol classic one cheek kiss for everyone in the room to say "Good morning, goodbye, Thank you, See you tomorrow"... I've just grown to enjoy the affectionate customs of the culture here.  Watch out, I may kiss you on the cheek to say hi when I get back.  But seriously, I don't know if I'll ever be completely comfortable with my attending kissing me on the cheek to say, "Good work, clinic's done... now go home and read about polymyalgia rheumatica and VDRL titers and bronchodilators."  Still kind of weird to me.

discerning "yah" & the rule of 2's

Today was my first day to operate with the regular surgeon at the hospital.  I had been assisting Dr. Hammill, a visiting surgeon from San Diego, who was here for 3 weeks.  He was an incredible teacher, a genuinely kind person... he will definitely be missed here.  He was stepping in for Dr. Eckehart Wolff, the "orthopedic/trauma/whatever comes my way that needs an operation" surgeon, who's been here for 18 years.  Dr. Wolff is quick, and in the words of the Ecuadorian interns, is "very German".  I learned within the first few minutes that "Yah" meant cut, release, hold this retractor, move your hand, watch what I'm doing, and we'll have this operation wrapped up in no time.  The hard part was figuring out which one he meant.  

We started at 8am and had 6 surgeries done by 3:30!  Whew.  And they weren't simple either.  (A resection of a congenital pseudoarthrosis-- I'll post more about this later, a hysterectomy/oopherectomy, a giant incisional hernia, an inguinal hernia, and an osteomyelitis case, then after all of that, an emergency ruptured appendix turned generalized peritonitis with an incidental Meckel's diverticulum resection!)  It was a fun day.

hairy legs!

no lazy sundays in Ecuador!

So much for my "lazy" Sunday...  the past 36 hours has been CRAZY!  

1) Baby delivery total came to 3 with one more born in the wee hours this morning.  I took a quick nap today to catch up on my sleep bank that's been dipping far into the red and soon after I awoke, my post call adventure began...

2) My phone rang with an urgent call from "Alas de Socorro"-- Wings of Rescue, to let me know there was an emergency flight into the deep jungle to pick up 2 patients... did I want to go?  Of course!  I hopped in the tiny Cessna plane, room enough for the pilot, me, one seat behind, and a space for a patient to lay down behind the passenger seat.  WOW!  We flew about 40 minutes out from Shell to Makuma.  Pictures definitely don't do it justice... the sun streaming through to highlight shades of green and gray of the rolling rainforest blanketed hills and mountains jumping up from the deep green, the horizon of glimpses of jagged mountains peaking out between the clouds.  Think of "honey I shrunk the kid" flying closely over the top of a giant broccoli-- strange description, I know, and now I'm going to have to go to the fresh veggie market this week to satisfy my broccoli craving after 40 minutes of thinking of broccoli out and back!  It really was beautiful and relaxing with the hum of the engine, the warm sun, and not much civilization in sight.

When the plane started flying lower, I knew we were nearing Makuma, but there was NO runway in sight!!!  Just green green green with a few thatched huts in clearings here and there.  We circled around and I saw the "runway" finally, a dirt path carved out in a narrow clearing in the trees.  Rocks were placed at fixed intervals in the landing strip to slow the plane.  Surprisingly, it was a relatively smooth flight and landing!  

We stopped just long enough for the brightly clad Indians to come running out of the trees carrying one 60-year-old man who had fallen (I believe from a tree) and been impaled.  His abdomen was tightly wrapped beneath his shirt, so I wasn't able to see the extent of the damage... I was told that "his guts were hanging out" (sorry to be graphic), so he must have been a tough tough man to endure the flight sitting up if it was true.  The other patient was a young woman who had miscarried and was bleeding profusely.

Missionary Aviation Fellowship (the ministry that runs Alas) is a "good samaritan" organization, so we didn't attend to the patients during the flight (besides the fact that there wasn't room or equipment on board).  Just room enough to pick up the patients and transport them quickly to the hospital.  I think it's an incredible ministry!  What better way to use the skill of flying than to pick up gravely ill patients who would otherwise die in the jungle... most of the sites they fly to are at least a few days walk from help.

3) My first tarantula sighting!  On the side of my neighbor's house.  Take into account that because of the background, it's hard to tell the magnitude of this eight-legged creature.  But trust me, I wouldn't want it in my bed, or inside at all, or really anywhere near me.  It was at least the size of my entire palm, and I might even be underestimating.  Picture to come...

4)  While we were taking glamour shots of the fuzzy and intimidating arachnid, sirens sounded in the distance, and Dr. Brice's cell phone started ringing... a few teenage boys had been hit by a car while walking on the road and were just seconds away from the hospital.  I wasn't on call, but this is the kind of place that most medical workers in the area drop what they're doing and head for the ER when they hear sirens.  I saw one of the patients, sent him off for XRay, and finally made it home to relax, make some oatmeal raisin chocolate chip cookies, and post this much-needed update!  Whew!  What a day!

ready for tomorrow

Talk about a full day!  By 3pm, I had already delivered 2 babies, sutured up a machete-wounded hand, seen a handful of other patients.  Sigh.  It's good to have a break to sit down for a few minutes.  I have to admit, I'm getting worn out.  It will be nice to be post-call tomorrow and have a "lazy" Sunday.  A good nap, a run, reading (my latest book is "Freedom of Simplicity" by Richard Foster)... I think I'll borrow my neighbor's hammock for the afternoon.

early bird

It seems like every night on call has its own little thing to help get you through the night.  On Tuesday night, I was hoping it would be sweet sleep and dreams of good ol' Tennessee.... but instead it was sweet little Milena, all 3036 grams of her, born at 3:45am!  Her mom must have yelled at least 15 times "Cut me in half, get this baby out of me now!"  But in the end, all of her pain and effort was worth it for her beautiful little girl.  

I don't think the birth of a child will ever cease to seem a miracle to me.  To go from one minute with a woman lying in front of me, screaming in pain, with a gigantic convexity protruding from her abdomen, to the next minute with a slimy, but beautiful nonetheless, baby crying in my arms.  Miracle.  There's no other word for it.