Tag Archives: ER

“UPED” is also a 4-letter word…

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I have a confession to make: I have no desire whatsoever to blog.

I feel so at home here in Tuxtla that it’s easy to forget I’m supposed to be a traveller. The truth is, I’m not travelling anymore – I have my home here, a job to go to every day, friends I can make plans with, public transit I’m comfortable taking, new cellphone chargers to buy when mine dies. It’s only when I consider blogging that I remember my time here is temporary, and as a result, I have been avoiding this blog like the plague.

However, with the month drawing to a close, it is becoming difficult to ignore the fact that I have another life in Canada, and when I return to that life, I know I’ll want these blog posts to remind me of my home in Mexico!

Centro medico

Let’s backtrack a minute to A Day in the Life of el Estudiante Sarita, and to that fateful comment posted by a faithful reader: “Your new position doesn’t make for as harrowing a blog post but it sounds much better for you – way to go on suggesting a switch.”

Now, let’s fast-forward to a week after I had comfortably settled into my routine in Pediatria. On Friday afternoon, after my regular debriefing with la Doctora, I kissed her good-bye and told her I’d see her on Monday, to which she responded, “Oh, I won’t be here on Monday – I’m leaving for holidays for the next 2 weeks!”

… say what?

I bemusedly contacted Lizeth, my exchange coordinator, informing her that my placement would need to change yet again, and somehow she worked rapid magic and found me a placement for the next week.

Remember my comment from my first week, about how I had little interest in Emergency and even less in Pediatrics? Well, the fates decided that I was giving up on both too soon, and I was to report the next work day to …
*drumroll please*

Las Urgencias Pediatricas Emergency Department (UPED).

Urgencias
Note the makeshifts tent set up along the gates, where people sleep while waiting for news about their family members
Tents

Upon arrival, I was introduced to Miguel, an incredibly kind if incredibly fast-talking interno (Year 5 of 6 in Mexican medical education). Our introductions were suddenly interrupted by shouting behind us, as the doctor doing rounds engaged in a heated debate with a nurse and a resident regarding a discrepancy in patient care. I have never heard so many creative variations of groserías as I heard coming from that doctor’s mouth. As his tirade was winding down, Miguel nudged me. “Go introduce yourself to that loco,” he whispered. “That’s your supervising doctor.”

Hesitantly, I approached the doctor, who was, self-admittedly, completely loco and not one to mince words when he felt his staff was slacking off. But he was also an amazing doctor, devoted to his patients and passionate about improving their level of care and his staff’s skill level. He warmly greeted me, and instructed Miguel to provide me with every possible opportunity to learn during my time in UPED.

UPED

Miguel took this to heart and took me under his wing, immediately walking me through the process of how to take a patient history for new entries, how to fill out a lab req, and where to drop off blood samples (Quick reminder: This is all in Spanish. Oy vey, my ears were bleeding from trying so hard to listen and absorb everything!) However, as Miguel and I were taking down the patient history of a 6-year old with a ruptured appendix, there was another flurry of activity as the surgeon came striding into the ER – there was a 3-year old with a perforated intestine requiring even more emergent surgery, and I was informed that I was to accompany them into surgery.

I do not know how much more clearly I could have stated, “I HAVE NO CLINICAL EXPERIENCE IN SURGERY. I HAVE NEVER SEEN A SURGERY BEFORE.” Before I knew it, I was on the surgical ward, changing into Miguel’s borrowed surgical scrubs and frantically trying to listen to how I was to scrub my hands and what to do with the surgical booties and where to stand so I wouldn’t contaminate everything. The surgical resident was extremely personable if extremely brusque, and as he was unpacking the sterile trays, he showed me each instrument and told me its name. I tried to absorb as much as possible, but since he was only showing me everything once and since I was very clear that it was the first time in my life I had ever seen these things – in English OR Spanish – I was assuming this experience was more of a bonus teaching session.

Assume nothing. Behind us was the operating table with the tiny patient already anesthethized, and within minutes, the surgeon was on one side of the table, the resident on the other, and I, the first-year exchange student, was beside the resident as the instrumentist for the surgery.

Pardon my Spanish, but ¡¿QC?!

Long story short: They quickly realised I meant it when I said I had no surgical experience, and another resident was called in to act as instrumentist. Once the resident took over as instrumentist and I was able to simply observe the surgery (which was all I wanted to do in the first place!), I was in awe. This was (as I have mentioned many times!), the first surgery I have ever seen, and it was beautiful. Watching the surgeon delicately slice through each layer of tissue, cauterizing the edges of the cut to control the bleeding, that distinctive smell in the air, the metres of intestines that literally came ballooning out of the body once they were freed from their confined space… The human body is incredible, amazing, miraculous, and powerful, and to see it exposed so carefully was a true gift.

(Speaking of gifts, the surgery occurred on my sister’s birthday, and I kept wondering what her reaction would be if she were in the room :P)

Once the perforation was corrected by resectioning 20 cm of intestine (which were handed to me with the instructions, “Guardalo.”) and a stoma made in the side of the patient, the pinch-hitter resident and the surgeon left me and the original resident alone to sew up the incisions. And I kid you not – completely scrubbed up with only our eyes visible, standing on opposite sides of a draped patient with a gaping open abdomen, with my finger acting as an anchor for the stitches holding the abdominal wall together – the resident casually started to flirt with me. Oh, los Mexicanos!!

Once the incision was closed and cleaned, the resident left to chart and the nurse handed me a plastic bottle containing the 20 cm of intestine, and asked me to go prepare it in formaldehyde. I wandered into the hall, clutching my intestine bottle, and eventually found some very nice healthcare aides who took me to a jug of formaldehye sitting in the hallway and helped me syringe in enough to cover the sample. At this point, the resident had me fill out a Pathology report, then instructed me to go change. In the change room, juggling my borrowed scrubs, the Path report, the intestine, and a can of Coke the resident insisted on buying for me, I had a brief out-of-body experience and wanted to break into uncontrollable laughter.

Instead, I changed and met the resident in the ICU, where he proceeded to hand the intestine bottle to the patient’s mother, informed her that here was what had caused the problem, and pointed her to her daughter’s bed. He then turned to me and said, “Well, quieres una otra Coka?”

El tor de Chiapas

That was my first day in las Urgencias Pediatrias. And though I frantically reviewed and quizzed myself on all surgical instruments that night, I did not go back into the OR. Instead, the rest of my time in the hospital was spent finally being useful. I was comfortable enough with the layout of the hospital and in my lanugage skills to actually be able to type up patient charts, collect lab results, fill out reqs, and drop off samples at the lab, even understanding when there was an issue with one of the reqs and being able to correct it myself without having to bother an intern. The UPED staff were incredible to work with – so patient with my language skills and constantly finding things they could teach me how to do so I could do them myself. Los internos invited me to stay on for la guardia (night shift) one night, and it was very satisfying to be further included as a part of their team.

Friday was my last day in the hospital, and when one of the doctors found out, he started giving the interns a hard time, “Where’s her cake? It’s la canadiense’s last day, of course we need a cake!” I laughed it off as a joke, but sure enough, later in the day, Miguel came running in with a bakery box, and soon the entire UPED staff was gathered in the break room, toasting me as I cut the cake.

Gracias por el pastel, Dr. Keeven!

Los estimados doctores del UPED
UPED doctores

La buena gente del UPED 🙂
Internos de UPED

To make it a truly authentic Urgencias fiesta, after about 10 minutes of relaxing together, another doctor came running in, shouting, “There’s a head injury outside, the patient is seizuring!” With this, everyone shoved the last bite of cake in their mouth and bolted outside.

My time in Mexico has taught me too many things to count. But possibly the most surprising, and the most potentially life-changing, is that as much as I cannot believe I am about to admit this…

I love Peds. and I love Emerg.

And I have no idea where I will end up next!

Outside the hospital

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“Plan” is a 4-letter word

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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.

P1120202

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.

Ready for anything… except perhaps what came next.
First Day!

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 ☺

Hospital Chiapas Nos Une