Ahh med school

I know it has been awhile since my last entry but I have been busy. This year is a little less stressful than last year because I am working to stay ahead of the game. In fact, this last midterm I had I earned a high score of 95%! It felt good to do well in my Urinary Systems class. Seattle is great! I am training for the half-marathon in November as part of my goal to run a full-marathon before I turn 30. Speaking of which, today I learned that I am the oldest person living in my house. I have never been the oldest anything anywhere. I know I am not that old but my life has been such an amazing adventure that I am sad to see time slipping away from me. But what can you do? I have always had everything I've needed and nearly all that I've wanted so I really can't complain. Thats all for now, short and sweet..

What a week it has been! First I arrived with my parents to help settle me in to Seattle. That was a blast. The house was a bit more like a fraternity than I had imagined and twice as messy. We went to and fro buying up all the necessities. THANK YOU MOM AND DAD!!! Once they left I began, what seemed to be, the impossible task of cleaning up the house. Though messy, though only 2 bathrooms between 10 people, the location and scenery are incredible! I am only a 5 minute walk to class and I we are surrounded by the lake on three sides.

Orientation was much more fun than I had imagined. We kicked off with a sports competition with the whole class and my team won! It was awesome. We continued with some normal lectures and just wrapped up yesterday.

Today I parked cars on our front lawn and made $600 (I got to keep 10%). This is how the house makes money. Then I went to my first Husky game and it was spectacular! I love going to a school with a football team. I hope you enjoy the video and the pictures!! Stay tuned....

Hiking up Deer Mt. and camping at the top was so much fun! I went with one of my best friends, Tara Miller. We each packed way too much up the trail and it was easy going for most of the way up. Tara packed an astounding 50 lbs up that mountain and once we reached the top it was a bitter cold rain storm and some hiking through snow. But we eventually made it to the little cabin at the top and to our surprise there was a little oil heating stove which dried us out and kept us warm for the night. Newt loved the hike and was exhausted when we returned home. I could barely feel my legs and back the next morning because they were so stiff. Then a quick float plane trip back to Met for work!

Monday was another great day at the clinic. Spencer is no longer here so it is just me. I have found that going in and interviewing patients without someone to fill in the blanks is harder than I thought. I find myself asking all the questions without direction. It is a little terrifying because I am constantly reminded that I have no idea what I am doing. Luckily the staff here is amazing and when I come out with only a line or two of information to share they take the time to evaluate my performance and give me great feedback Dr. Crosby is gone and a new doctor Dr. Ratlif is here. I have met her before and she is great. Currently I am following Dr. Henry around and he has been great as well. I think the nursing staff is warming up to me because the nurse director stopped by my house and dropped off a few jars of kippered sockeye salmon and twenty pounds of fresh caught King salmon from her husband’s boat. I was also invited to watch the native dancers practice dancing in the long house in preparation for this weekend (Founder’s Day in Met). They invited me onto the floor and they showed me some of the traditional moves and I got to dance with them on the main floor. It was AMAZING! I took call with Michele and we only had one call in the afternoon (Yay!). She is the one that calls pretending to be the patient and I have to triage her. I can’t help but feel this growing terror of becoming a physician; there is so much to know, so much responsibility, and such disastrous consequences. I have been chatting with Dr. Henry (a young doctor from New Mexico) about residency and he has been sharing some horror stories.

The time has arrived to hit my project hard and fast. I have decided on and been approved for a community garden project. Today I spent most of the morning in a meeting with a master gardener interested in the project. She gave me a list of some “heavy hitters” in the community to call and invite to a meeting. I call them all and most said they would be thrilled to hear us out. The plan is to put together a proposal which would include funding, staffing, mission, and general organization as well as literature backed research demonstrating the positive effects of gardening on childhood obesity and adult diabetes. If these community leaders agree to the project then we will write it up this weekend and they will present it to their groups next week. Everyone is excited about this project and after looking over the grant I am in for a long weekend of grant writing (which is the part I committed to doing). I hope this all works out. I can’t wait for this weekend because the clinic director’s daughter is getting married (HUGE DEAL), a potlatch, and Founder’s day!

Weddings, Potlatch, and Catheters

What a week! So the clinic days have flown by. One day in particular sticks out because I was able to put in my first urinary catheter (under great supervision of course) but it was all me and I have decided to avoid getting one myself at all costs. We had few interesting emergencies and some great cases as well but this weekend was the best I have ever had in Met.

Mike and Michiel's wedding.

Michiel is the daughter of one of my FAVORITE people in Met. She is the clinic director and is like the godmother of Met in my opinion. She is well respected and has done great things in the community, so when it came to her daughter's wedding it was referred to as "the wedding" rivaling the royal wedding in notoriety. It was a glorious celebration set against an unbelievable mountain/ocean back drop with a perfect fusion of tradition and modern protocol.The bride was stunning and her husband-to-be was a tall and stern looking native man. As a couple they looked amazing. After the wedding we all went to a sit down reception and listened to many praises from both sides of the family and were all invited to the wedding potlatch to take place the following day.

The Potlatch

Never in my life have I seen such a celebration. For those of you who do not know what a potlatch is; it is a celebrations for the whole community with traditional food,

native dancing, and ceremonial gift exchanges, speeches, and thanks are given. As Michiel (a PhD candidate in native culture studies) explained, the main purpose of a potlatch is the redistribution and reciprocity of wealth (gift giving). When I arrived there were a few presentations from the newly weds then the feast. And what a feast it was! Long rows of tables were set out for all of the guests, hundreds of seats.

Then servers (who were all relatives in some way or another to the newly weds) came out with plates stacked high with dungeness crab (the best crab in SE Alaska in my opinion), traditionally smoked salmon that knocked my

socks off, fried uligan fish (This was the first time I tasted them after hearing from several locals that it was an "acquired taste", I loved them), deer soup, salmon eggs and seaweed over rice, and herring eggs that came on a hemlock branch. Such an eclectic array of tastes and textures as I have never experienced before.

I was eating wildly and laughing with the

elders sitting near me as they were amazed to watch me devour any and all extra crab/fish/anything put before me. What a feast! Then we cleared the tables and awaited eagerly for the dancing.

When I say that "I have never seen such a celebration before" I m

eant it, during the "opening ceremony" all of the dance groups came all at the same time. This meant that all of the drummers were drumming which shook the building to its foundations and filled the hall with a thunderous noise that would put jumbo jet engines to shame. The only thing that vied with the mammoth sound came from the dancers themselves. Both men and women chanting and singing deafeningly loud, the men with their deep and fierce roars and the women overtop with their majestic and bold tones.

Now I must admit that I assumed that potlatches lasted only a few hours, "you get in, you eat, you watch some dances, you leave how long could it take?" Little did I know that potlatches are long events. We started at 1pm and didn't finish until 3am! I am proud to say that my family stayed the whole time. We received some spruce tip syrup, native art, and much more. All in all it was one incredible party!They came in a line and slowly filled the hall until every inch of the dance floor was covered. It was truly a sight to behold (see video http://www.youtube.com/watch?v=FoZeoxj_zbU, though it doesn't do it justice). Throughout the ceremony there were several dance groups that came out to perform and they were each spectacular! A few times I even got up to dance and I have to say it was interesting being the only "white guy" dancing but the community members were great and showed me what to do (while laughing at/with me the whole time). My most memorable moment of the evening was when they called all of the single men up to dance and some of the female dancers I was sitting with encouraged me to go up. So there I found myself with 4 other impassioned and strong looking male dancers feeling very out of place and nervous as ever because I have no idea what to do.

One of the dancers came out and showed us what we were to do which was looked like a turkey dance to impress and seduce the women. Once we started the whole hall erupted with laughter at the sight of these young men "shaking their tail feathers" on the dance floor (see video http://www.youtube.com/watch?v=EQ-3ULonE0o). It was a riot! My mother at one point was called up to receive a gift (a hand-painted native drum!) for giving up her house and leaving her son "out in the cold" for the wedding party. She was blown away. It was a magnificent drum. Finally the night ended around 3am.

The next morning was Founder's day for the island and I ran the "marathon" which was only about 4 miles. I cam in near last (boy do I need to get out more). There were booths and food for the community members and that night I went out to see the fireworks. It was a funny experience because in Met they didn't have all of the fireworks ready like other cities, they had to bring them out to the shooting zone in loads so we would watch 5 mins of fire display then have to wait 15mins for them to go get/set up more all the while the locals were shooting off their own impressive collections. What a trip!

Met week 3

Hiking up Deer Mt. and camping at the top was so much fun! I went with one of my best friends, Tara Miller. We each packed way too much up the trail and it was easy going for most of the way up. Tara packed an astounding 50 lbs up that mountain and on

ce we reached the top it was a bitter cold rain storm and some hiking through snow. But we eventually made it to the little cabin at the top and to our surprise there was a little oil heating stove which dried us out and kept us warm for the night. Newt loved the hike and was exhausted when we returned home. I could barely feel my legs and back the next morning because they were so stiff. Then a quick float plane trip back to Met for work!

Monday was another great day at the clinic. Spencer is no longer here so it is just me. I have found that going in and interviewing patients without someone t

o fill in the blanks is harder than I thought. I find myself asking all the questions without direction. It is a little terrifying because I am constantly reminded that I have no idea what I am doing. Luckily the staff here is amazing and when I come out with only a line or two of information to share they take the time to

evaluate my performance and give me great feedback Dr. Crosby is gone and a new doctor Dr. Ratlif is here. I have met her before and she is great. Currently I am following Dr. Henry around and he has been great as well. I think the nursing staff is warming up to me because the nurse director stopped by my house and dropped off a few jars of kippered sockeye salmon and twenty pounds of fresh caught King salmon from her husband’s boat. I was also invited to watch the native dancers practice dancing in the long house in preparation for this weekend (Founder’s Day in Met). They invited me onto the floor and they showed me some of the traditional moves and I got to dance with them on the main floor. It was AMAZING! I took call with Michele and we only had one call in the afternoon (Yay!). She is the one that calls pretending to be the patient and I have to triage her. I can’t help but feel this growing terror of becoming a physician; there is so much to know, so much responsibility, and such disastrous consequences. I have been chatting with Dr. Henry (a young doctor from New Mexico) about residency and he has been sharing some horror stories.

The time has arrived to hit my project hard and fast. I have decided on and been approved for a community garden project. Today I spent most of the morning in a meeting with a master gardener interested in the project. She gave me a list of some “heavy hitters” in the community to call and invite to a meeting. I call them all and most said they would be thrilled to hear us out. The plan is to put together a proposal which would include funding, staffing, mission, and general organization as well as literature backed research

demonstrating the positive effects of gardening on childhood obesity and adult diabetes. If these community leaders agree to the project then we will write it up this weekend and they will present it to their groups next week. Everyone is excited about this project and after looking over the grant I am in for a long weekend of grant writing (which is the part I committed to doing). I hope this all works out. I can’t wait for this weekend because the clinic director’s daughter is getting married (HUGE DEAL), a potlatch, and Founder’s day!

2nd week in Met

This has been another interesting week. I volunteered to be on-call everyday, which in hindsight might be a mistake. During the day I am seeing patients with Spencer, the other medical student, he is showing me the ropes and is great because he understands my level of knowledge and really goes out of his way to explain things. We go in, interview the patient then present to the physician. Next we all go in together and treat the patient. Afterwards I have an opportunity to “debrief” with the physician, which entails asking any questions or making any comments on how everything preceded. Last night I was on-call for the first time and discovered that my “black cloud” has followed me from Boston because we had a call about once every hour or two. I saw a gambit of patients. I got to put in an IV and monitor various patients (supervised of course!).

Tonight I am on-call again but this time the on-call supervisor is going to triage the patients then call me as if she were them (regardless of the complaint ie: “my kids are being too loud what do I do?”) and I have to respond as if I were the on-call doctor and would have to triage them myself. I have already had my first call and it was funny because she only gave me the information she received which was not much and did not make sense. This patient I decided that they should stay home and not come in and she agreed and had already told the patient the same thing. Did I mention that I love it here?

Metlakatla

I arrived in Metlakatla (Met). Well, perhaps I should describe how I did this. I flew, via jet, in to Ketchikan’s airport on an island across the channel from the main city. After taking a ferry across I walked down a few blocks towards Taquan Airways, all-the-while float planes were buzzing around like mosquitoes, bald eagles were perched everywhere watching vigilantly, and whales had been spotted coming down the channel. I reached Taquan and clambered into a small four-seated beaver (that's a type of float-plane for those non-Alaskans) loaded down with US post. We taxied out on to the water and waited for the “traffic” to clear before the roaring engine took us into the air. Soaring high over the channel I saw the whales and before I knew it we were touching down in Met. Met is a small community with just over a thousand residents and it shows. As I walked towards the clinic everyone passing in their cars gave me a friendly smile and a wave. I reached the clinic and was immediately thrown into mix. In fact, a nurse came over gave me an oral report, handed me the patient’s chart, and walked away. I chased after her and explained how it was my first day and I would love to treat the patient with someone in the room with me. She smiled and assigned me to one of the health care providers and I followed Michele for the rest of the day. Michele is a PA and she was AWESOME! She explained her thought process as we proceeded and answered every one of my questions. It was a fun experience.

The next day I shadowed Dr. Crosby, an elderly gentleman from S. Carolina with an accent to prove it. He is the type of physician I strive to be. His patients love him, his co-workers admire him, and he is insanely smart. There is another 4^th year medical student here, Spencer, from Harvard and he is teaching me a TON! We go in together to see each patient and I get to do the interview and any questions I forget, he asks. Then we do the physical exam and present to the physician. It is the perfect set up. But today I only saw 2 patients before we had an emergency. An elderly gentleman came in with symptoms of a stroke. I almost got to put in an IV and everyone was running around like crazy. It turned out to be a game of “hurry up and wait” because the patient had to be transported to Ketchikan via boat and the boat was not ready. After 40mins of waiting we wrapped up the patient and took the 30min ride to Ketchikan and handed him over to their staff. The rest of the day we wondered around town and waited for them to fuel up and get some other business out of the way. I am hoping that someone will take me fishing while I am in Met because the weather is unbelievable. Stay tuned for more and photos!!

Oh Canada..

So I arrived in Canada a few days ago and I am slowly falling in love with this city (Vancouver). I am staying with Lidia at her host family's house and they as super nice. They are a Philipino family and they are falling head of heels to cook me traditional food (I may have mentioned that I love lumpia, shanghi, and more). Our first day out Lidia and I explored downtown Vancouver. This town is built for pedestrians. We walked for hours ducking into the various retail stores because they are all having mega sales 70% or more off of many items. I took advantage and bought a few things but then later found out that there is a 12% tax here!!! Damn. We are eating like kings and just having the time of our lives. The International Jazz festival is going on while I am here so we've been chasing jazz venues for the past couple of days. I am helping Lidia with her English and she is excited to start classes next Monday. Our first day ended with us having front row seats to a jazz concert splitting a bottle a decent wine. Jazz, wine, and good company does life get any better?

Day two we set out towards the waterfront, Gastown, and Granville Island. The waterfront was nothing too spectacular although Lidia enjoyed seeing all of the float planes and ships in the harbor. We walked through Gastown and saw the giant steam-powered clock. I love Gastown and hope that we return there at night. It is a cute little street with fashionable stores, pubs, and more. There was another jazz concert there that we sat and watched for a while before heading off to the island. So far my favorite place in Vancouver is Granville Island. It reminds me of the market in Boston Fanull Hall (sp?). There are all sorts of foods, artisans, and more there. We just had a ball walking around and sampling some of everything. We took the aquabus to get there and I think we may return tomorrow. After Granville Island we left for Vanier Park where we thought there was a Shakespeare festival but it turned out to be just a theater. We relaxed in the park before our long trek back to her host family's house (across town, 30min subway trip, 15min bus trip). Rain or shine we have been walking machines and it is a good thing too because Lidia's host mom constantly bombards us with food. 'You too thin. Eat! Eat!'. 'That is not enough make it a dozen or better a baker's dozen'!

And.. We're back

Sooo sorry that I have been out of the loop for the past few days but I have had an incredible time. A brief continuation from my last blog, I was sitting at the bar in my hostel all alone as Brent and Lori had abandoned me for greener pastures when who of all people should walk in but the girl (Chan pronounced 'Jan') I met on the bus up to Chiang Mai! She was excited to run into me when I got back and wanted to know if I wanted to go dancing with her and some of her friends. I had nothing better to do so I got dressed and went. It was a blast! Her friends were other foreigners from NGOs French, English, Australian, and of course Cambodians. We all partied and danced and swapped traveling/working stories and I didn't get home till 4am. I was up and running for surgery 4 hours later. I knew that it was going to be a slow day because we had 4 WWAMI students, 5 Hong Kong students, 2 UK students, and now 6 French surgeons. While everyone sat in frustration in the OR fighting for space I went out and visited with my "patients". My Kamer has really gotten impressive and I can hold and very brief conversation and tell a joke or two. The mood has completely changed for me with regards to the clinic. Dr. Jim is back and he alone has transformed the clinic into a dreadful experience. He barks at everyone, pushes people around, and is a general **shole. Plus there is no way to get near the table with all of these people here and the Cambodian docters/nurses feel bad because I have really built great relationships with all of them and there is nothing any of us can do. So I have cut my days in half and spent the afternoons and nights with Chan. She and I drive around on her scooter (I suck at it) and visit all of Phnom Phen as she introduces me to everyone. We eat at GREAT places, drink the best coffee, and our nights are filled with dancing and more people. She seems to know everyone in this city. She helps me with my Kamer and we discuss Cambodian culture as we sample "Apeen" or fried tarantula. She works for the a national magazine and through her connections with various businesses we continue to eat and drink some of the best Cambodia has to offer. Everyone at the clinic was very sad to see me go on my last day and I hope to come back for a 4th rotation here because this experience has been so incredible.

Saturday Chan and one of her close friends took me out to a rural village were some of her friend's relatives lived. It was Peace Corps all over again. They lived in an extremely poor area but were still SUPER kind and I had an opportunity to sit and chat with two very nice translators. We all laughed and I sampled every home-made...thing that was offered to me. I even got to use the first-aid kit in the car to clean some wounds from a worker who had cut himself out in the field. We all laughed at my attempts to speak Kamer and they all wished me safe travels when I left. I really like the two handed bow here. It is a simple gesture that provokes deep respect. The whole experience was surreal. Tonight was my last night, Chan took me out to get Kabobs and take care of some last minute shopping. We managed to get me to the airport with ALL of my luggage on her scooter which I have to say, she is a CRAZY driver and I am thanking my lucky stars that I will leave Cambodia in tacked. There was a tearful good-bye and I know Chan will be a friend of mine for years to come. So here I sit in the Cambodian International Airport waiting to take my 48 hour trip back to the US. What a BLAST! I have to keep asking myself; can life get any better? I can't wait to see you all and share more of my experiences with you. See you soon!

Return to Phnom Phen

Well I can say beyond a doubt that our trip back, via plane, was much less eventful/stressful. The total time it took us to get back was less than one of our delays via train/bus. Brent and Lori were happy. I must say that I miss my travel buddies, Ben and Matt because they would find the joy and adventure in the process rather than the inconvenience. But we weren't totally without incident. On our way back we arrived in PP and took a tuk tuk to the hostel. It was rush hour and never in my life have I witnessed such chaos. Stop lights here are merely suggestions and right of way in an estranged concept. Anyways, we were going up this hill and our tuk tuk didn't look like it was going to make it. We were laughing about our weight when the torque of the motor scooter acted against it and flipped the driver up into the roof of the front of the tuk tuk and we started a free fall backwards down the hill into on coming traffic. Lori and Brent jumped out and tried to slow the run-away tuk tuk while the driver and I were stuck inside. Luckily we careened into a wall and no one was hurt but we could not stop laughing. This and while we were watching a movie in Chiang Mai the projector wasn't switched over in the middle so the screen went black and we could here the tap-tap-tap of the film in free spin for 5 minutes. It were at those moments when we were reminded to that this is no-where close to the US. Now I am all alone at the hostel. Brent and Lori can afford to stay somewhere nice and so we said good bye and here I am... Stay tuned!

Night Bazaars Jungle Canopies

Last night I went out and came across a HUGE market. Supposedly it was the famous Chiang Mai Weekend night bazaar, there were at least two miles of booths/stands selling all sorts of unique items. There was a stand for eatable bugs, paintings, nicknack's, and much more. I am REALLY low on funds so I only bought one thing all night; it was a hand drawn self portrait. I liked it quiet a bit and it was ridiculously cheap. I had so much fun weaving in and around hordes of people haggling loudly in the street. The air seemed electric with excitement over all of the new and wondrous things from all over the country. I walked for 5 hours and still did not see all of the bazaar.

This morning was a rough wake up. My legs ached a bit from walking all night. We were picked up at our place and driven to the Flight of the Jungle site. It was a very long, and very windy road which had we gone much further I would have lost my breakfast. The canopy course was incredible. I hope the videos come out. The course had 34 platforms 22 ziplines, and 4 drops. The longest zip was 300m and nearly 150m high. It was a thrill. They scariest part was the 40m straight down drop they let us free fall for most of it. It was awesome. Great day!

Elephants and Whitewater rafting

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Well, today was just another amazing day. I awoke from my food coma as the result of last night's amazing feast that we prepared. I made red curry with curry paste that I crushed myself, coconut soup, chicken Pad Thai, and fried banana spring rolls dipped in sweetened condensed milk. It was a blast cooking. Our teacher had the most hilarious laugh. He sounded like and evil cartoon character. Thanks to my mom's cooking genes I did very well and was especially proud of the rose that I made from a tomato as a garnish.

Anyways back to today, I woke up and went to my favorite little spot near our hostel for some Thai tea and more Pad Thai (I am either addicted to it or they spike it with MSG). I love the mornings here because they are quiet and provide excellent time to ponder life and its wonders. Again, I find myself smiling as I reflect back on my life, which has been (so far) and incredible adventure. I had We had to split up today because Lori didn't want to go rafting being pregnant and all, which is understandable so she left to train elephants. Brent and I, on the other hand, REALLY wanted to go rafting. The tour picked us up and two hours later we were riding elephants through the jungle towards our rafts. I was taught how to operate an elephant and led our little train through the jungle. Before, I thought that riding a horse was an ultimate power trip but a 1.5 ton elephant trumps that any day. I sat on his neck and controlled him using my feet on his ears. So cool! Next we reached our rafts and went through the brief instructions. Our boat was the "American" boat with Brent, Brian (a lawyer from Philly), myself, and the guide. We ripped through rapids, careened over waterfalls, dove in and swam through some of the rapids and down the river; all the while splashing and dunking the other boats' patrons. By the end of the trip we were soaked, muddy, exhausted, and grinning ear to ear. Life. Is. Good.

And a very special shout out to my dad! HAPPY FATHER'S DAY! Thank you for always pushing me to be/do my best. Thank you for all of those wet and freezing nights cheering me on along the sidelines of my soccer games, thanks for sitting through the sweltering heat timing at my swim meets, thanks for all those late nights helping me with my homework and most of all thanks for always being there. I love you very much and hope you have a great Father's Day!

Tigers and Thai Cooking [Take 2]

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What a day! This is hard not to repeat the same stories that I had from last time I went on this adventure but it was a blast. We got a Tuk tuk to the Tiger Kingdom. It was an incredibly funny feeling as I faced the prices $80 to see all of the cats again because I found myself saying. "Well, I will never get another chance to... wait.. this is the second time I will get to do this. It was in that moment that I again found myself in deep appreciation of my family. My mom and dad for giving me all the opportunities in the world. This may sound simple but after living in El Salvador for 3 years I have found the only thing that separates me from any of my poorer farming friends were the opportunities provided to me. Mom, Dad if you are reading this I owe you everything and I just wanted to say thank you from the bottom of my heart. I also wouldn't have a clue which direction to go without my trail-blazing sister. Rach you are so amazing and inspiring. Thanks for all of your current and continuing support. And where would I be without my moral compass? Ben I hope to grow someday into the man you currently are. I am truly blessed with the life and family I have.

Anyways back to the Tiger Kingdom. We got tickets to see all of the tigers including the newly born <1 month olds. They were all great! The babies were so cute they were the size of full grown house cats at 1 month and medium dogs at 2-3 months. We saw tigers from babies to small, medium, large, and HUGE. I rubbed their bellies, and laid on top of them. It was a rush. Then we went to a snake farm which was less than fun. They had a snake show which was very impressive and terrifying. They would hurl the snakes out of their boxes and then snag them inches from striking audience members. I had an 80 lbs boa wrapped around my shoulders.

After we got back from Tiger Kingdom we went straight to our Thai cooking class. This one was very nicely set up. I made spicy red curry, coconut soup, pad thai, and banana spring rolls. I am a master Thai chef, even my garnishing flowers came out beautiful! I have loads of pictures and I wish I could write more but I am exhausted and we have elephant riding and whitewater rafting tomorrow. Wish me luck!

Trains, busses, and Shrapnel

Sorry I haven't been writing but we have been traveling for what seems like days. But before we left we had one more day at the clinic. I had already promised the Chinese students that I would give them the OR for the day so I stayed out and helped diagnose patients. Again, I am torn between medicine and surgery. We saw all sorts of illnesses and conditions; cleft palates, broken bones, skin conditions, and more. The most memorable for me was this gentleman who came in asking if we could take out a piece of shrapnel from his tricep. I asked him were he got it and he explained that it came from one of the US bombs dropped in 1973. He preceded to explain what had happened and how he'd lost several close friends in the explosion. He was not angry towards me, which surprised me. He explained that they were political bombs and also that he had witnessed the US apologize for “acting foolishly”. We continued with the examination and once we scheduled him for surgery he started asking if we could remove all of the other shrapnel too. He had 15 pieces in total throughout his body! I felt embarrassed and angry towards my country's foreign policies which were compounded by by some of the books I have picked up recently. Don't get me wrong, I understand why we do/did what we do/did but it still sucks. The worst part of this current line of thinking is that there are few if any solutions... I need to get new material to read.

So we began our trek towards Ching Mai via bus. Last night we drove to Siem Reap, it was a long 6 hours on a very bumpy road but we made it and stayed at Siem Reap Guesthouse which is one of our favorites. Though I met a very cute Cambodian girl on the bus and we chatted most of the way and she promised to show me around Phnom Phen when I get back. She emailed me today and asked if I wanted to be her date to a traditional Cambodian wedding too! I am excited to see Cambodia through a local's eyes. This morning we got up early to be picked up to be brought to the bus. We waited 1.5 hours for the bus (#1 stop/wait), then 1 hour later we stopped at restaurant (#2), then we hit the border were it was hot, humid, and filled with confusingly long lines. We made it through reasonably unscathed and waited on the other side to be picked up 2 hours (#3). Finally, they came to pick us up but it was a sh***y van to take us to the “bus”. But instead it took us to another restaurant for an hour (#4). We had now officially been waiting longer than traveling on a bus. Ugh..

On our last bus I met a gorgeous Brazilian woman traveling with her husband and we chatted most of the way to Bangkok, they gave me some great places to visit when I go to Brazil. I think I may try to get down there for the World Cup or Olympics!

As we passed through the streets of Bangkok I was in awe by how much the city has grown in one year. There are skyscrapers popping up all over like flowers during springtime. The infrastructure here is starkly different from that of Cambodia, the streets are cleaner, the prices are higher, and things are organized. We finally exited that cursed “bus” and took an overpriced taxi to the train station. It was busy and we purchased 1^st class tickets on the next overnight train to Ching Mia (on which I am writing to you now). The 1^st class train is nice, we may even get some sleep tonight. I can't wait to be petting tigers, whitewater rafting, and riding elephants again.

Well, our train was 4 hours late arriving into Ching Mai but that was fine because our beds were very comfortable. It wasn't too hot either so we just relaxed and planned our next week! Pictures soon!

Humbled..

Today was a fantastic day in the clinic. we got there early and I made the rounds saying "good morning" and "how are you" to all of my patients and the staff. Everyone is really warming up to me. We only had 5 surgeries scheduled but I ended up working on the two longest and most challenging. But before that I started with my favorite anesthesiologist I had been 3 for 3 on IVs and today my batting average was shot to hell. I must admit I was feeling cocky and asked to put an IV in a 1.5-year-old. Don't worry! They were asleep when I tried. I missed and but got it on the second try, then I attempted to place another in a man with "shifty" veins. I would insert the needle directly over the vein and then it would roll off to the side. I poked him 4 times before someone else tried. Then, I told the doctor that I wanted to intubate again, he brought me over to a 3-year-old and I could not for the life of me find her vocal cords (its that damn tongue that I can't seem to get out of my way). After an unsuccessful attempt he let me try on an adult. I could not get the tube in and felt terrible until he himself couldn't. All of the morning surgeries went off without a hitch and I was scheduled to scrub in with the chief of surgery in the afternoon.

Over lunch one of the Chinese medical students asked if I wanted to help her teach some of the kids, in the pediatric ward, origami. I leaped at the chance and we strode in and had a blast with the kids. The one in this picture still has my first sutures! We gave him a neck and it looks great! Soon the all of the other family members were standing around and laughing with all of the kids as they threw their new paper airplanes (the only origami I know) at me in a collaborative attack.

This afternoon was one of the scariest I can remember. We started with a humorus repair that got ugly because this patient had had 3 surgeries in the same location prior. Though the chief was always in good spirits and kept asking us (the Chinese medical student and I) if we agreed with what he was doing. The surgery was fascinating and time flew by (2 hours). Once the pins were set he began suturing the muscle and asking us if we knew how to suture. I said that I have done the skin quite a bit and the other med student hadn't done any so far. Once he finished the muscle and started the subcutaneous layer he asked if I had seen that type of suture before, which I had. "Ok! You finish now. One here, here, and here (indicating only 5 more until i could close the skin)". Then he stood up took of his gloves and gown and left! Only the nurse, an anesthesiologist, a young Chinese med student, and I were left in the OR. Of course as soon as he left I drew a blank as to how to do a continuous subcutaneous suture, so suture a layer of simple broken ones. But I didn't draw the skin close enough so I added another line of subcutaneous stitches, still no success. By this time the anesthesiologist told me I had 20 mins before the patient would wake up and all of the other Chinese medical students had wondered into the OR and were all watching me like sports announcers. On the third try I stitched more superficially and FINALLY the top layer came roughly together. Because the base stitches were terrible the skin was not perfectly lined up like I was used to so this made my "easy" skin sutures tumultuous. They looked God awful and I was in shaky panic mode the whole time but I finished. Sure it was 4 minutes before the patient woke up, 3 minutes before the chief walked back in wondering where I was, two minutes before the nurse was about to take over, and minute before I passed out from panic. As the title suggested, I was/am humbled. But what a day!