Work, work

After a weekend full of excitement, it's been a busy week in the hospital. I set a new record for number of surgeries in one day one Monday with 8, then subsequently one-upped myself on Wednesday with 9. These were no more than 12 hour shifts too, I might add.

It's a little different here than the states, needless to say, and I've found myself a little frustrated with some of the differences and a little relieved at some of the others. I've come across some interesting cases here including a fluke inhabiting the bile duct, a set of triplets today, a horrible necrotic reaction to an NSAID injection and a horrible case of necrotizing fasciitis following a hematoma caused by a fairly innocuous fall against a table. (my apologies to the non-medical folks)

I was expecting to be doing a little more hands-on work, but there are a good number of other students and residents around in this hospital. Occasionally I'll get to first-assist in a surgery, but there's a lot of watching, cutting sutures and retracting while some one else is doing the real work. All in good time I suppose. The other students are really nice and pleasant to work with. I usually take a little time to help them with dressing changes on the wards, but don't really have a whole lot to offer.

I spent Wednesday and Thursday with the pediatric surgeon and saw a few good cases. The most common stuff here in kids includes hernias, ankyloglossia, cryptorchidism and hydatid cysts from parasites. We operated on the former three and saw the latter a few times as a consult. It was a nice change of pace seeing kids in clinic. The pediatric surgeon gets teased for being not only a surgeon who operates on children, but a surgeon close to the size of his patients, but he takes it well and is overall a really great guy. One of the most important qualities for an attending is a willingness to teach and he excels at this.

I met up with an American kid last night whom I had met last weekend at the discoteca. I didn't know much about him, but it turns out he's a seriously committed Christian but has a much different path than mine. He had a pretty great story of coming to Christ and encouraged me in a lot of ways. We share a lot of similar beliefs and both have a desire/calling to do our small part to bring a little more love into the world, particularly the developing world. It was kind of funny because earlier in the day I had spoken with a good friend who mentioned he was praying that I would find community.

I'm currently waiting for a call from a group of expats who are here volunteering at an orphanage. We're planning to probably go out dancing tonight and then head out to the jungle town of San Ramon for the weekend. More on the later.

Fin de semana #2 - Huancayo & Inginio

After 4 days back at work, it was time for a little R&R. My friend Mario came in from Lima (as a reminder, a Peruvian neurologist I met in Seattle) and we decided to hit the town. We met up with two Peruvian gals, the daughter of my landlord and her cousin and commenced with the revelry. This included karaoke (I bust out a mean Bon Jovi), live music and dancing until the wee hours of the morning. Come to find out, the cousin is actually a dance instructor! Major bonus... not to mention that she was "Miss Huancayo" for two years running. Some ridiculous luck I have.

We managed to get up in time to finish breakfast by noon at Mario's family's restaurant a few miles from my place. Restaurant may be a slight misnomer as it's more of an outdoor cafe, but the food was great if not your typical breakfast: sopa verde and cau cau (a kind of potato soup and a dish with cow stomach, potatoes and rice). That afternoon we had a nice walk around his old neighborhood, made friends with a little girl who showed us how to get past the gate down the river and generally goofed around along the Rio Mantaro. Later that day I fell asleep on the riverbank of another river close to town where people were bringing in a huge carrot harvest. We closed out Saturday by heading to La Cabana for dinner and internet.

Sunday was amazing. Mario and I had heard about a good place to visit in the mountains on Saturday from a guy by the river, so we headed out to see if we could find "Arco Iris." We took a shared-ride taxi out to Juaja (hoo-huh) and then hired a taxi to take us to a little more remote area. We ended up outside Inginio, a fairly touristy spot for expats and locals alike. Green mountains, a clear stream and lots of parks tucked in the valley. We arrived next to a park with a family playing volleyball and asked if we could join. They ended up inviting us for lunch too: pan-fried truche (true-cha) with red chili fired in a pan over a camp fire. IT WAS DELICIOUS. Supposedly truche is a small, imported salmon, but whatever it is, it was amazing. The family was celebrating one of the girls' birthdays, so Mario and I made sure to sing Happy Birthday in English. Her little brother was hilarious, a 3 year old named "Peidrito." We also took a few moments for a hike up a valley before being turned back by the approaching rain.

Instead of paying our way back to Huancayo, we snagged a ride with the family and treated them to ice cream from a local creamery (fresh milk!) on the way home. Back in Huancayo, we got caught in a "chaperon," a fierce, but brief, downpour. As it broke, we left our shelter on the side of the street and passed through the Sunday market. I snagged an alpaca sweater for 10 bucks... not bad, not bad.

We rounded out the day with a church service with Mario's mom followed by another trip to La Cabana for good food, wine and an incredibly uplifting conversation with Mario's mom. She exudes a sense of warmth and joy and was able to speak some really powerful truth to me about trusting in God and how ridiculous it is to doubt Him.

After this weekend, I can't say a word to disagree with her.

A lost stethoscope saves the day!

Not that today was bad, it was pretty enjoyable actually, but there were no surgeries scheduled and I spent most of the day seeing post-op patients with one of the other surgeons and hanging out with people... not a lot going on. I was about to head out early for the day when I realized I had left my stethoscope in the locker room the day before. I went to the OR locker room, and it was nowhere to be seen.

Now losing a stethoscope shouldn't be that big a deal, except that mine was given to me the summer before med school by my cousin who is a pediatrician and taught me during my 3rd year. It has sentimental value. And it's a nice stethoscope.

So I inquired to multiple people including surgeons, cleaners and nurses and finally they told me to talk to the chief of surgery. Within a minute or two, he had one of the cleaners bring it from the lost and found, a huge relief. I thanked the surgeon who referred me to the chief and as we were talking, he asked if I was busy. Well, not really, no. I was about to go home actually. He invited me into watch a pediatric surgery and I hastily accepted.

It was a 13 year old girl with fluid in her chest from tuberculosis. I ended up as the first assistant rather than a spectator and actually got to help quite a bit. They even let me help close. I tried pretty hard to skin the skin closure done well as this girl will have a pretty sizable scar on her back/side for the rest of her life. It was pretty sad to see someone so young so sick, but the nice thing about kids is they get better pretty fast.

On another note, I was praying about residency last night, wanting to make the best choice and was asking for wisdom. The idea to read Jeremiah 27, which I don't really know much about, popped into my head and so I did. It discusses the Israelites being sent away from their home, the places they loved and the land they were connected to, to live in Babylon. For them, it was a strange foreign city and they had set their hope on an imminent return. However, Jeremiah told them to invest in that city and work for its good, that their fates were tied to the city they were sent to and that they could prosper there, even away from home, if they chose.

I thought it a pretty awesome answer to prayer. Not that I'm 100% sure of where I'll end up (I think I know), but that God is working to bless wherever I go for residency and I can choose to be a part of that.

A new rotation begins

For the non-medical students in the audience, clinical rotations go something like this: Enter a new place with new people and new systems, awkwardly stumble through the first week, gradually gain more grace and feel like your at the top of your game and actually learning medicine by about week 3-4. Rinse, wash, repeat every 4-6 weeks.

So, here I go again, except this rendition has a twist, as it's in a foreign language. Que bueno.

I met Dr. Montano outside my humble abode at 8 in the morning and he ferried me to the hospital where I proceeded to sit and watch for the rest of the day. Actually, it wasn't that bad, but he did tell me I'd have to watch for a while.

-WARNING, DORKINESS FOLLOWS, IF NOT MEDICALLY INCLINED, FEEL FREE TO SKIP-

Such cool consults to start the day: a lady with sepsis who needed a laparotomy, classic appendicitis and cholecystitis (positive Murphey's sign and McBurney's point with Rovsing's sign and rebound) and to top it off, a strangulated hernia. Neato mosquito. Of course, my attending did all of these surgeries with another doctor while I watched, but he did all of them OPEN, which I never see in the U.S. So cool. I actually skipped the hernia repair to do a couple chest tubes on the medicine ward (I butchered both of them, but got the job done). Super great first day, medically speaking.

-DORKINESS ENDS, KIND OF-

My attending is a classic surgeon. Serious and professional when necessary, a little crude and hilarious when in the right atmosphere. I wish that I could understand Spanish a little better because he is quite entertaining from the little that I do gather. He is also a great teacher and will take time to explain things to me that he deems important, as slow as the process is with my comprehension. One thing that stuck with me from my first day was his interest in the etymology (Sp?) of the word for surgery. It comes from a Greek word for hands, which translates to doing something with your hands. I didn't quite get the finer points of his monologue, but I got a sense that he feels a great deal of respect for work with the hands.

After work I met up with Mario and hit up La Cabaña, the author's recommendation in Lonely Planet - Peru. Great food, great music, great atmosphere. We had a great conversation and enjoyed telling stories and laughing, alternating in English and Spanish. The tone become more serious as he told me of the sudden, unexplained death of his 18 year old brother. I want to respect his privacy and won't go into detail, but it was an emotional conversation for both of us. It made me realize how much I have and how grateful I should be to have such a wonderful family and group of friends. I truly love all of you more than I express, or can express.

As a kind of preview, I am gathering a list of things that I find amusing or odd about Peruvian culture which I will publish at a later date. Stay tuned!

And because I'm not sure if I'll write about it later, I spent today with an anesthesiologist (a Christian) and went 1 for 3 on intubations. He and a couple other surgeons took me out for a steak dinner tonight which was AMAZING. Three bottles of wine later, we were all friends and I was invited to spend the weekend with one of the surgeons maybe doing a little fishing (I had to decline numerous attempts to refill my glass - moderation my friends, moderation). We'll see. I also ran into a few expats at dinner who I will try to meet up with later. Good times in Peru!! Peace!

Huancayo

Before diving into my first day at the hospital, I have to reflect briefly on my trip to San Andres with Mario, Guillermo, Claudia and Dr. Montano (the sister of the surgeon I am working with). Talk about accomplished! She has worn more hats than that one guy in the children´s book that wore a lot of hats, including being the Minister of Health and the director of the Peruvian police. To boot, she owns one rockin´ house in a remote oasis, about 2 hours south of Lima.

We piled into her car and commenced a weekend of eating homemade pizza, steaks, chorizo and whatever else we could get our hands on, lazing around the pool, playing games and checking out the local trees and horses. Suffice it to say, it was wonderful.

After being thoroughly burned despite prodigious application of sunscreen, we left and almost immediately hopped a midnight bus to Huancayo. It was a luxury cruiser of a bus, definitely no chickens attached. I slept for most of the 7 hour ride and only woke to see the bus going further and further up, peaking at over 16,000 feet before descending into the San Mandero valley and Huancayo.

We headed to my host home which I´ll write about later to rest briefly before hitting the hospital. We were treated to a circus of an entrance, having to traverse the outside of the hospital several times before ending up where we started and meeting the hospital director. I won´t emphasize this a lot, but I could if I wanted to: the man can talk.

I´m getting kicked out of the internet cafe, so I´ll finish this later... Peace!

First days

One of my longtime goals has been to dance like a Latino. Now, genetically speaking, I have some built-in limitations that I have been furiously working to overcome the last 3 nights. Miraflores is a upscale district in Lima that has an alley called La Calle de los Pizzas (Pizza Street) where the Pizza isn't so great according to Mario. The dancing, on the other hand, is superb. It is the young Peruano (Peruvian) crowd and music ranging from salsa to electronic to meringue, reggaton, cumbia, musica negra and 80s ballads. They even mixed in a little "Greased Lightning" last night.

It is typical to hago horas (hang out) in Pisco bars before hitting the clubs. Pisco is a grape-based liquor that is popular in Peru and is pretty similar to vodka. Mario has lots of friends and it's been great to pick up some Spanish and then proceed to work on my dances moves until late into the night. We also went to a district called Barranca which Mario and company frequent. We spent part of a night in a classy pub there listening to a live singer and his guitar.

Yesterday, I met up with Helanie, a friend from Alaska that I had met in Portland. She is here working with orphans that she supports year-round but only can visit occasionally. Her main mission this trip was to find her "Lost Girl," who had run away from the orphanage to check on her family and had been sexually abused on the road. She found her at a detention center and said the meeting was incredibly emotional, a more tragic version of the story of the prodigal son is what I pictured. The reunion was nothing if not filled with mutual love.

Today (Saturday), Mario and I are going to help Helanie's group feed orphans and then get ready to go to San Andres for a party on Sunday. Mario's attending/boss, a preeminent neurologist and former Minister of Health in Peru has invited him and the other residents to her house there as kind of a retreat. I finagled an invitation and it should be a good time.

She also took us on a tour of his hospital a couple days ago. It is 310 years old officially and began with a miracle known as the "Pobre Cristo." The story goes that a priest stopped to help a beggar at this location, a former trash heap, and the beggar turned out to be Christ, who admonished the priest to care for others like he had cared for him. So they started a combination convent/hospital in the 1600s. Pretty cool stuff. Also, it was a great honor to learn this from such an important woman. The hospital has an entire room full of human brains with different disease processes visible which was pretty creepy but impressive all the same. Apparently it wasn't illegal to return a body to the family missing a few important, but non-visible pieces back in the day. (my apologies to the feint-of-stomach)

All that is not to mention walking on the beach, seeing cathedrals, palaces and other important buildings, hanging out with Mario's dad, eating good food, going for long walks through the city in search of electronics and taking taxis and buses all over the place. It has been a very full 3 days.

I also started my residency match list today. If you're the praying type, I could definitely use a little help there. Love you all!

On to Peru!!

By way of introduction, this blog is now serving as the official receptacle for all thoughts and ponderings of my voyage to Peru for the purpose of learning general surgery from a physician in Huancayo, Peru. Huancayo is a town of about 300,000 at 10,700 feet in the Andes Mountains east of Lima. I arrived here in Lima last night.

After an uneventful flight and passage through customs,
(How long will you stay? -47 days.- *stamp* Welcome to Peru. -Gracias.-)
(I'm not sure if I was supposed to get my luggage searched, but no one stopped me)
I was greeted by Omar, a friendly taxi driver who has somehow arranged to pick up all the medical students that visit Lima through my contact here. We had a great conversation, by which I mean I spoke slowly and awkwardly and he filled in the gaps, and took a drive down the coast to Hostale Pukara.

It looks like most of the houses here, but had a lobby, warm shower, clean beds, free internet and complimentary breakfast. After partaking in all three, I am now sitting in said lobby awaiting my friend Mario who I met on my neurology rotation at Harborview. He is (thanks God!) from Huancayo and is vacationing from neurology residency. I think we may travel together this week.

So I'm excited, getting back into international travel mode and ready to take on all that God has to offer here in Peru (hoping for a little less adventure than my last trip). I should be writing quite a bit more frequently now, so stay tuned! Love all you guys!

(also, check out my last post, as I just put that one up this morning too. I'll try to take a break and reflect on the interview trail at some point here too.)