If my time in Mexico has taught me anything in the first week, it is to accept that initial plans ultimately look nothing like reality.
When I first received my exchange placement, it was in the department of Neurology, which had been one of my chosen fields. When I was given the name of the doctor I would be shadowing for the month, I saw that my department was now Pediatric Neurology – different, but still within the realm of what I was anticipating. When I arrived at the hospital on Monday morning, crisp and shiny in the requisite all-white uniform, I was told to report to Pediatric Neurology consults from 3-5PM; but in the morning, to report to Las Urgencias — aka the ER.
Within ten minutes, I was at the bedside of an unconscious patient in the Shock room. “Hiciste un chest tube antes, si?” asked the ER resident (You’ve put in a chest tube before, right?) I think I literally laughed in his face, as I assured him most emphatically, “Uh… non!” I watched with shock and awe as the resident took an endotracheal tube and began sawing off a portion with his scalpel. “We don’t have the resources here to buy chest tubes, so we have to make do with what we have,” he explained as he made notches in one end and tied off the balloon valves. “It’s not the best chest tube, but the most important thing is to save the patient’s life.”
He counted ribs, numbed the area with Lidocaine, and made his cut. “Venaquí,” he instructed me, holding out a sterile glove for me to slip on. “You can feel where to insert it?” Suspended in disbelief, I watched myself wiggle my finger in between the patient’s ribs, trying to find the space to insert the life-saving tube that would drain the fluid and blood from around his lungs. The resident deftly placed stitches, clamped the tube, inserted it through the cut – and immediately, a gush of frothing pink fluid poured out. This patient had a massive hemothorax (immediate evacuation of over 1L of blood after insertion of tube thoracostomy), requiring urgent surgery.
And thus began my introduction to Mexican medicine. Las Urgencias is a chaotic series of hallways lined with stretcher beds, with la Sala de Choque (the Shock room) as a separate salita with four beds for patients in shock. In Choque, urgent minor surgeries (like our thoracostomy) and CPR are performed, comatose patients are held, and in the middle of it all, a bespectacled senior doctor sits on a stool, ceaselessly churning out reports on a typewriter.
In the next few days in Las Urgencias, I attempted to take blood from a patient using a rubber glove as a tourniquet while transferring the blood into a test tube because vacuum tubes are not available; did an assessment on a comatose patient we were later told was pronounced brain dead; and correctly diagnosed a man with COPD from a distance (and only finding out later that the “EPOC” written on his chart was Spanish for COPD!)
I also spent many, many hours straining to just hear the doctor’s report. Not only is the noise level in Urgencias quite deafening at times, but I could not quite get used to the affect of the ER doctors… They would be lecturing a patient or delivering notes to their resident, when suddenly, with zero change in tone and definitely not even the slightest indication of eye contact (literally, they can have their back to you), they would be asking me a question on what process was contributing to the patient’s renal failure. I could not decide what was most challenging: knowing the answer to the medical question, understanding their rapidfire Spanish, or just frickin’ knowing when they were even talking to me!
For those reasons, I approached the exchange program about changing my placement. I loved the variety of cases I was seeing in Las Urgencias, but I had to admit that the atmosphere was not the most conducive to my learning. A senior Neuro student advised me to try and procure a placement with a Doctora in Pediatrics who was apparently “muy amable y tiene mucha pacienca con los estudiantes,” which was exactly what I needed!
Thus, from Neurology (in which I was interested but had no experience)
to Emergency (in which I had a glimpse of experience but little interest)
to Pediatrics (in which I have neither experience nor interest)…
Who knows where I’ll end up next!
But I’ll keep you posted ☺