• The alarm goes off at 6:15AM. Normally, I do not hear the alarm at first because it is set to the soothing sounds of birds chirping, but since there are nightingales that chirp all night outside my window, this is not very helpful. I should probably change my alarm.
• Go into the bathroom to try and coax the shower to (a) get at least quasi-warm and (b) provide at least a trickle of flow. If this is not possible, I can always wash my hair in the sink.
• Dress in my all-white uniform that I have actually come to quite like wearing, for several reasons:
1. Although it seemed insane to me to wear pants and a long jacket in +39C weather, you would be so hot no matter what you wore that at least in long pants, you’re not sticking to yourself (/the 19 Mexicans crammed into the bus next to you) with sweat.
2. Scrubs material is way cooler than dress pants.
3. I never have to think about what to wear in the morning, hallelujah!!!
4. From Day 1, I have never felt out of place in the hospital, even though I’m a different race, a different culture, and speak a different language. When I walk down the street, all anyone sees is yet another medical student dressed all in white.
• Go downstairs for breakfast, which normally consists of a literal (yes, Phil Cook) heap of local fruit: mango, papaya, bananas, and cantalope. Once, for a special treat, they gave me imported apples 😛 Other breakfast essentials include coffee (from a local coffee finca) and tortillas. This morning, I tried to be helpful and prepare everything myself, but apparently committed a gross error: the minute Ubel walked into the room, he looked at my plate, aghast, “Sara, you didn’t warm up your tortilla?” When Magali walked into the room, he turned to her immediately, “Sarita is eating tortillas that were not warmed up.” “Sarita, ¿por qué?” she gasped, horrified.
Canadians, please take note: YOU ALWAYS WARM UP THE TORTILLAS.
• Get driven to the hospital by Ubel, where we talk about Canadian politics (all of Mexico will be well aware of my views on Mr. Harper by the time I leave!), compare prices between our countries (“Un coche es barato o caro? Guayaba es barato o caro?”), and learn English swears (please take note that it was not I who initiated the latter!)
• Report to la Pediatria for rounds at 8AM. Unlike las Urgencias, la hospitalización pediátrica contains about 20 beds, with only 2 patients in a room – and the rooms have doors that close! Of the 20 patients we saw, nearly half had severe fevers that were in the process of being diagnosed as either Dengue or Chikungunya, two mosquito-borne viruses that are endemic in this area. On the other side of the ward is a single large ward for los Lactantes (nursing babies), with 15 cribs arranged in a large circle around a central nursing desk. Dengue and Chikungunya are also problems in these infants, as is malnutirition, food-borne illnesses such as Salmonella, hydrocephalus (increased fluid in the brain), and encephalitis (inflammation of the brain usually due to a virus).
• Rounds are finished by about 11AM, at which point I either talk to other students about differences between our medical schools, discuss differences in healthcare policy between our countries with la Doctora, or spend some time researching the topic I’ll be asked to discuss during the afternoon Neuro consults.
• At noon, I leave for lunch. Sometimes, Ubel packs me a little lunch, which is always exciting because it has the potential to be absolutely anything. Once it was leftover pancakes folded around leftover salad, and once it was a hotdog and mayonnaise sandwich (and honestly, both were delicious!) Otherwise, I either walk to the cafeteria outside the Walmart across the street for gringas or quesadillas, or I walk to the OXXO and buy a yummy but bizarre sandwich that always insists on hiding some kind of pickled veggie. I usually eat in the hospital lunch room with Lizeth, one of the student SCOPE coordinators in Tuxtla, who has been my tour guide/translator/lunch buddy/general lifesaver!
Family-run booths selling everything from tamales to Jell-O outside the hospital
Unas gringa para una gringa!
• Between 3-5PM, I join the neuropediatrician for external consults. Each consult is about 30 minutes long, during which time I try to follow along as the neuropediatrician takes a detailed birth history and history of presenting illness (that 95% of the time is some kind of seizure) and then be alert to the very subtle look given by the neuropediatrician that is my cue to take the patient to the other room and perform the neuro exam.
I am now conducting the neuro exams on all the patients, which is alternately amusing, educational, and bien pinche dificile. Performing neuro exams on kids in general is hard (they think you testing their reflexes is hilarious, and therefore refuse to go limp because they’re too busy giggling); performing neuro exams on kids with severe disabilities is very hard (when a child cannot respond to their name, it is hard to communicate that you would like them to follow the movements of a little bell using only their eyes and nothing else); and performing neuro exams on severely disabled kids IN SPANISH? Let’s just say I am sharply honing every single non-verbal communication skill I possess!
I both greatly respect, am severely intimidated by, and don’t always agree with the neuropediatrician whom I am fortunate enough to work with for the month. While I often think that in Canada, we don’t expect enough of kids, I think there must be a happy medium between our two worlds. Here, I’ve seen suspicion of neurological damage when a 13-year old boy was asked what season it was and he responded (very appropriately, I thought!), “Summer.” The doctor paused, looked at him gravely, and then intoned, “What day is solstice, young man? Solstice occurs on June 21. Therefore, we still have three days of spring.”
So perhaps I too have neurological damage. 😛
However, whatever I may think about this doctor’s bedside manner, I am in awe of the patience and generosity of time he shows to me. At the end of the first day, it was already 5PM and I was ready to thank him and leave, when he asked, “Oh – do you need to leave immediately?” I turned to find him setting up his laptop where he had a presentation on hipertensión endocraneal ready to go, and launched into a mini-lecture. Every day after that, he has given me a subject to research for the next day (anything from classification of seizures to pathological reflexes to UMN lesions), and once consults are done for the day, he asks me to present what I’ve found while he adds in any missing information. He is intimidating enough that I would never dare slack off and not do the research, but there is also something very endearing about how much he wants to teach me that puts me at ease with him. I’ve also made him laugh twice, which I consider a supreme accomplishment!
• Around 5:30PM, I walk back outside into the blinding heat and catch my combi just across the street. Comfortably inconspicuous in my white uniform (which miraculously, even in rainy season and even with riding a crammed combi, somehow isn’t black by the end of the day!), I wedge myself between a nursing mother and an impeccably suited gentleman, and pass my 6 pesos up to the driver. I know I’ll barely have my foot in the door at home before Magali will be insisting I eat something and Valeria will be telling me where we’re going out that night, so I savour my half hour of solitude (well, as alone as you can be when you’re in the back of a truck with 19* other Mexicans) and look forward to whatever the evening will bring!
Evening view from my front door
*I didn’t want to publish false information in this blog, so I made a point to count the gente in the combi with me today.