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.)

Is there a doctor on board?

So this is my first post from Peru, but I actually had a blog that I didn't finish that I'm going to post first as it seems fitting.

Flying back from Alaska after Thanksgiving break, I was enjoying some solo time on board the airplane. Flying for me is not hours wasted in boredom, but a beautiful reprieve from duty, conversation and the pursuit of recreation, all good things, but all good things to take a break from as well.

Shattering my solace and simultaneously revving up and relocating my heart to somewhere around my stomach, a voice came on the PA: "Is there a doctor on board? One of our passengers at the front of the aircraft is unconscious and needs assistance." Banish the thoughts of heroics that you see on TV and now imagine a medieval page training with a wooden sword and shield being sent off to face the dragon.

Naturally, I instinctively ducked my head, peering around the seat to see... no one in the aisle. I braced myself for a few seconds, praying that I was not the most qualified person on board and then unbuckled and started to walk up the aisle.

"Are you a doctor?" the flight attendant inquired, fittingly so as I was in "Alaska mode," a.k.a. unshaven and in comfortable clothes.

"No, but I am a 4th year medical student," I replied. I'm not sure how I missed it, perhaps the whole hiding incident, but she pointed out to me that a REAL doctor was already with the would-be patient. At this point I was committed, however, and still crept up to peer over his shoulder. All I could see of the patient was an arm, which was moving in a very non-seizuresque fashion. My ABCs ran through my head (Airway, Breathing and Circulation) and I realized that if any of those were missing, that arm would not be moving. Whew.

I offered my assistance to the doctor, who tacitly ignored me. I returned to my seat relieved. I may not have saved the day, but I DID later score a free cheeseburger from the grateful flight attendant.

(The patient turned out okay too)

Healing

Late summer in Alaska means that it starts getting dark-ish and the air cools off substantially in the evenings. That's why I was shivering as my friend and I prayed together down by the Kenai River that night in 2006. I was getting ready to start medical school and he was blessing me before I started. Now before I go on, realize that I had spent months and years leading up to a fairly new-to-me belief in the supernatural, stemming from examples of regular people doing incredible things through the name of Christ all throughout history even up to some events that summer that I had seen for myself. I know it's a stretch for those that don't believe in miracles, but I was preparing myself for a lifetime of seeing and being a part of the divine and miraculous.

My friend had the gift of seeing and speaking truth, so when he told me that night that I would not have the gift of healing, I was more than a bit disappointed. However, he quickly added that spiritual healing would be mine to share with those around me. What that meant at the time, I didn't really know. As I have come to understand medicine, however, it makes sense. Doctors really just remove obstacles so that the body can heal itself. The actual healing takes place over hours to days to months to years as the slow, intricate process restores normality. Spiritual healing, on the other hand, is both an active and passive process involving confrontation of lies believed, encouragement of truth known deeply and faith in the redeemability of any circumstance.

Today was a day I recommitted to experiencing Christ in my life. Something I've done somewhere between 100 and 10,000 times, probably closer to 10,000. Seems I can't ever stay on track, but I keep going for it anyway... So when I saw my patient's husband reading her the Bible this morning, I offered to pray with them. As I said, "Amen," he looked at me and said something to the effect of the following:

"You are an answer to prayer. We have people all over the country praying for her," and went on to describe miraculous healing that he had been a part of and continued, "God wants to use your hands to heal people, but more than that, he wants to use you for spiritual healing. He wants to pour out these things through you if you are willing and have the boldness to follow."

He didn't know my story. He didn't know that I would be using my hands in surgery or that years ago, my friend had spoken very similar words to me. I ascribe glory to God for looking at me and seeing that even with my tendency to veer off in all kinds of directions, He would make use of such a broken and fallible tool.

To top things off, just last Sunday I had whispered a prayer that I almost had forgotten, "God, please send some one to show me that I am still walking your path."

P.S. I apologize to those of you who didn't know I put faith in such weird stuff. You don't know because I'm scared to share some of the things I believe in, but this is me and I'm in love with God.

I love crazy people

I have lots of good blog-worthy material saved up from my excellent moose hunting/camping trip to my Chicago-South Dakota-Texas roadtrip with Daniel to the emotional rollercoaster that is living in Seattle, but what inspires me tonight are the crazy people of Harborview.

It's been kind of rough working in the ER... long hours, difficult patients... a lot of unrewarding medicine interspersed with some really great chances to help people. So two nights ago I was hanging out in ED Green (read: the least sick patients in the ED) when somehow, a slew of crazy patients ended up in there all at once.

The most consistent of them wasn't actually crazy, but a teenager who had ingested a few too many 'shrooms and no matter how persistent we were, would not believe that he was still alive. I say consistent because every 3 seconds or so, he would loudly question: "AM I DEAD?!?!?!?" Which we answered in the negative the first few times, but after around number 50, we just let it go. Some one may have even tried convincing him that he WAS indeed dead, but that didn't pacify him either.

Next to him was a good old boy (if you've ever seen Strange Brew, think Dave Thomas's character) who just randomly shouted funny things. I can't remember most of them, but a lot of them made me laugh... none so much as a simply shouted, "ONE TIME! I SURVIVED FOR A WHOLE MONTH ON NOTHING BUT APPLE JUICE!" He was definitely my favorite because he was funny and completely harmless, and only piped up every so often.

And next to HIM, was a guy who was MAD. He stayed quiet mostly, but every once in a while he would get riled up and start cussing at anyone he could: the kid shouting about being dead, the pleasantly crazy guy next door, his nurse walking by, the doctors hanging around... And man, this guy could swear. He was practiced, no doubt and even had my ears burning a little.

The last guy was across the room from the others, but it didn't seem to bother him. He let loose with the eeriest, crazy laughter at the strangest times and would kind of mumble to himself and occasionally yell at nurses. But mostly, he contributed the creepy laugh. He actually was in the ED two nights in a row and was my patient the 2nd night... Pretty entertaining guy.

So it may not sound that funny from the outside, I dunno, maybe it does... but after working for 11 hours and having all 4 of them piping up at once:
Young Guy: "AM I DEAD??!! AM I F***ING DEAD?!?! SOME ONE ANSWER ME! AM I DEAD??"
Happy Guy: "Sometimes tomatoes are PURPLE!"
Mad Guy: "SHUT THE $%@!* UP YOU PIECE OF $%$#@ing *#%@!!!!"
Laughing Guy: "EEEEEEEEHAAHAHHHAHHAAHAAAA!!!!!"
Young Guy: "AM I DEAD?!?!!!"

You get the point. I couldn't fill out charts. I just sat there at my desk and laughed. Good ol' Harborview...