Redeeming a bad Monday (2/2)

Fresh out of the hospital after an unspeakably frustrating morning, I took a long walk home to chill out a little. I spent some time relaxing at the house before calling up a friend to meet up in the park (the Jesus-lovin' gal I met at the discoteca). There was a crowd at the park watching a heated volleyball match and when I asked, it was a team of "maricones" that was dominating. Now there are about a billion words for homosexual in Peru, but maricon (merry-CONE) is the most widely accepted.

My friend and I went for a walk and talked for a while at a juice stand where they basically blend up whatever fresh fruit you want and dump it in a glass. Delish. She had some wise things to say that helped redirect my angst and we discussed our life goals and stuff. Good times. She had to cruise to class that evening and I headed back to the park to try my hand at volleyball.

I watched the conclusion of a match where the maricones again kicked some major butt. It seemed that the winner of the match kept the court and took on challengers. So I hopped down onto the court to see if I could join the next group of challengers. However, as soon as I stepped up, the whole crowd started cheering. Apparently, gringos don't show up to play volleyball a whole lot. As our team slowly formed, one of the reigning champs told me to join their team, as they were one down. If I thought the cheering was loud when I walked on, it was doubled when I stepped onto the other side of the court.

We ended up playing a pretty close match and some really good volleyball. Man, those guys can play. There were definitely a few pretty hilarious moments like when one guy set the ball for me to hit and simultaneously called out "Mi amor!" I'm used to getting teased about the girls here liking me, so it really wasn't that much different and everyone was just out to have fun and joke around. We ended up winning, and apparently there was some money on the game because I came away 1 sol richer. I wasn't a standout player and made my share of mistakes, but also got a few nice spikes in. They invited me back at least...

Afterward I met up with my gringo crew at a pizza joint downtown for some good times and okay pizza. My friend finished her classes and took me to a bar with live Peruvian music and colchitas (kind of like spiced rum) for a nightcap before I tucked in for the night.

It was a long day and the stark contrast between my morning and my afternoon still surprises me a bit, but I'm thankful that the pain of my lesson in humility from that morning was far outshone by the richness and the fullness of engaging in the lives of the beautiful diversity of people that God has made.

Lessons in Humility strike again (1/2)

Ever have those days when you know what you're supposed to learn from the hard things you're facing, but you just don't care and you want it to be made right??

Welcome to Monday. Having been here for 3 weeks, I assumed I would be given a bit more liberty in the OR and much to my delight, I was offered the opportunity to assist on thoracic cases... on Monday.

Up to this point, I've gotten to assist only a couple times, with the majority of my time being spent watching and leaning over the surgeon to help retract. Reminiscent of shadowing a physician during my 1st year of med school. In contrast, during my surgery rotations this year, I've done a below-the-knee amputation myself and assisted on neck dissections, opening the chest for heart surgery and multiple thoracic surgeries, not to mention doing a fair amount suturing upon closure for most cases. Coming to Peru, I was hoping to get even more hands-on experience while learning about endemic diseases.

So I showed up, on Monday, ready to get my hands a little dirty, but when I walked into the OR, the patient wasn't in the room. When I check again, they still were there... 30 minutes... 45 minutes... an hour... hour and a half and no patient. In fact, the surgeon that I'd met and was planning to operate with was nowhere to be seen either. I finally got up and sought out the anesthesiologists. They essentially told me that all of the thoracic cases were canceled for the day. Upon further inquiry, they informed me that thoracic cases are complex and they should have two real surgeons operating for all of them.

I wanted to scream in their faces that I have assisted on thoracic cases at the Oregon Health Sciences University Hospital and if I was good enough there, I should be good enough in Huancayo, Peru.

I managed to keep cool for the most part, but when one of the interns graciously offered to let me watch another laparoscopic gallbladder surgery, I should have said thank you and scrubbed for the surgery. But I told him, instead, that at this point, I don't have the humility to stay and watch anymore. He understood the situation. I left.

In speaking with my attending about the situation later, he explained that allowing me to assist is not necessarily illegal, but is borderline, and he believes that there was some concern about litigation. Still. It stung.

Fin de semana #4 - R&R vs R&B

I had planned to stay in Huancayo anyway, but when fever struck Thursday night, thoughts of fleeing the city for the weekend vanished. I was bummed to call in sick on Friday because a pancreas specialist was visiting for the weekend, events to include a dinner on Friday, rounds on Saturday and some teaching on the subject. So instead, I spent Friday sleeping/watching movies/sleeping and trying to pretend like I wasn't there. My host family finally discovered me late in the day and did their best to coddle me, which I resisted only half-heartedly.

Saturday saw much improvement and having reassured myself that I didn't have anything scary like TB or malaria, I headed over to my attending's house for lunch... or so I thought. As it turns out, he's somewhat of a gourmet and I arrived to find pork glazed in honey smoking in a homemade contraption in the back yard. His house is beautiful, with a garden in front and back with all kinds of interesting, edible plants that I can't begin to remember the names of.

However, for him, being at home on Saturday does not necessarily mean not working. Across his back lawn is the back entrance to a clinic that he shares with his wife, a dermatologist. Throughout the afternoon, patients would drop by for appointments or check-ups and he would duck out for a few minutes. Later in the day, he told me to come with him and we wound up in a private clinic doing a hernia operation on Saturday afternoon.

As I was watching, it gave me room for pause. My ideal career consists of working really hard some times and playing really hard at others, hopefully helping people along the way. His life is nigh consumed by surgery and patients, even in his free time. When I questioned how he manages this, he replied that he does what is necessary to support his family both here and in Cuba. It was quite sobering.

Saturday evening, I headed over to a gathering of a bunch of expats at the house of my friends from the jungle trip. It was a great night of hanging out, drinking wine (Romanian pinot?), eating lasagna made by my British rockstar friend (to be fair, he hasn't made it yet, but his music is fantastic) and hearing stories from all over the world. We had folks from France, Bermuda, England, Ireland, the U.S. and Peru all converging over dinner. Excellent.

Nighttime found us trying out a new discoteca, La Noche, which was a flop so we moved on to familiar haunts, a discoteca they frequent frequently and I'd been to once, Taj Mahal. In addition to a great night of dancing, later on, I was recruited to meet a couple of Peruvian gals with my British buddy. As is prone to happen, the girl I danced with asked why I was single, but when I started talking about my faith, instead of a blank stare, her eyes lit up. We ended up talking quite a bit and we have pretty similar stories and love for God.

Not that such coincidences are unheard of, but it is rare to meet some one in Peru that loves God but can still go out dancing and have a glass of wine or two. Anyway, it was super great to meet some one had a genuine love for God and was excited to talk about it! God must have known that my Monday was going to be really frustrating and I'd need some encouragement. More on that later.

Sunday I slept in and then headed back over to Dr. Montano's house for a lesson in making ceviche, a Peruvian delicacy. We hit up the market to buy supplies and that was an experience itself. He had fewer patients on Sunday and I slipped out a little early to spend time with the expat crowd. They'd had a barbeque that was winding down when I got there, but the music was winding up. I was treated to live performances by my British friend, the gal from Bermuda who sings some mean blues without accompaniment and the local on guitar and wooden flute, which is in a lot of Peruvian music.

I winded down the night with a walk to the central plaza. Snagged a burger and fries and sat down to eat and think and pray. Got accosted by a group of Peruvian gals on vacation who all wanted pictures with a gringo. Back to prayer & meditation. Reenergized. Back to the casa for a conference call with my college roommates over Skype to finish off the night and me.

The Daily Grind

The alarm clock is set for 7 a.m. (which means I roll out of bed at about 7:20) and breakfast is waiting downstairs. The initial offerings included fruit, eggs and avocado, but the family I'm staying with has since realized that I really only eat a piece of bread and drink a cup of coffee (instant coffee, sugar, milk & hot water). If I'm feeling ravenous, I'll stack on some jelly or a piece of cheese. I'm out the door at 7:45 and walk less than a block to the main road through Tambo. Huancayo proper is actually a bit to the south of my place. It usually takes a couple minutes to spot a legit taxi looking for a fare. The price to the hospital is 3 soles, which equates to about a dollar.

Five minutes later I'm at the entrance to the hospital, greeting the security guards at the gate, walking through the courtyard and I head to my daily work. Since obtaining my white coat from Dr. Montano, none of the guards have really questioned my right to be there and give me confused looks when they ask my last name, but let me by.

Mondays, Wednesdays and Fridays I'm in the OR all day with the general surgeons. Occasionally I'll check out other surgeries. This week I stepped in on an emergency GYN surgery for a ruptured ectopic pregnancy (lots of internal bleeding) and a revision of a nasty tibia fracture. I don't do anything, just watch. Wednesdays I scrub in with the pediatric surgeons and usually get to help out a bit. This week we removed a 10 pound ovarian tumor from a 13 year old. It was ugly.

I suppose it was the arrogant American in me that assumed I would walk in and get to operate or have a pretty active role in the OR, but there are usually two surgeons on all general surgeries and they work 12 hour days doing nothing but operating. I share 2nd assist duties with the interns here. On simple surgeries, I sometimes first assist and actually got to head up removing a fatty tumor from a guy this week. It has tested my patience to sit and watch surgeries that I've seen a lot of already, but I will be there soon enough.

Tuesdays and Thursdays I generally tag along for morning rounds with the surgeon of the day and the intern covering the surgery floor. After rounds I help with dressing changes, wound care and sometimes head down to the ER to hang out with a doc down there. Dr. Carlos is a medicine doc that is pretty proficient in English and enjoys the chance to practice, so I've been hanging out with him in the ER when he's on. I actually learn quite a bit of medical Spanish from him as well.

I'm usually out the door before 5 on non-OR days and today I came home for a nap, which wiped me out for the rest of the day. I walked downtown to see if I could catch a movie at the mall, but the one I wanted to see was in Spanish rather than in English with subtitles. Sometimes I just need a break from stumbling through Spanish.

So instead, I ate dinner at the mall food court and then headed to the central plaza/park and just hung out. This may sound kinda corny, but tonight was kind of a date with God. I haven't been doing so hot on spending time with Him lately and tonight was a great chance to just relax and enjoy the presence of my Creator.

This weekend is looking like it will be full even though I'm probably staying in Huancayo. I'm okay with that, especially considering that I have a potential grand adventure in the works...

Fin de semana #3 - Welcome to the Jungle

La Merced was the destination. The group consisted of 3 girls I'd run into in a restaurant while out with the doctory type, a Huancayino and an English rockstar. The girls were from Maryland, N. Carolina and France/England and are here volunteering at an orphanage. After a quiet Friday night at home for me, we met up at the bus terminal on Saturday a.m. to commence our journey.

The rest of the crew was wiped out from dancing until 4:30 in the morning, but somehow managed to rally for an 8 a.m. bus ride. I was so proud. So we talked briefly before most of the crew passed out on the bus. I enjoyed the beautiful scenery between Huancayo and La Merced and tried to sleep when the turns got a little too twisty.



Upon arrival in La Merced, we snacked (a popular pastime with this group), they slept, I visited a local hospital and we embarked on a beautiful hike through the jungle to a waterfall. We made it back that night in time to eat and experience a small amount of the city life before tucking in for the night.



We arranged for a guided tour on Sunday, which I will admit I was not a huge fan of, but I was following the crowd. It turned out pretty great. We learned about local history, agriculture, native groups and such. We even visited an "authentic native village" where we were greeted with traditional clothing, a story, dancing and exotic animals. Afterward, we were expected to buy souvenirs and stuff, but I didn't. I did pay 50 cents to have my picture taken with an exotic rodent (pacarana) eating an ice cream though.



Finally, we got down to business and headed way out of town to hike up to another waterfall that was pretty spectacular. We went swimming despite the coolish temperatures and I got a great massage from the cascading water. I also managed to take a fall off a boulder that I was climbing, but our guide, Jesus (hey-SOOSE), was there to catch me and I wasn't hurt a bit. Anyone care to comment on this irony???



There was tons more that happened over the weekend, but it was little stuff, like getting yelled at about nutritional supplements on the bus, riding on the back of a moto taxi, trying to make animal-shaped balloons in the pub, countless jokes with new friends about American vs British culture, eating giant rodents, finding obscure bands in common with people from across the pond, driving through a river on a cliff and hoping the bus wouldn't slip and planning our next escapade. Believe me, it's in the works, and it very well may involve snacking.

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.