6-5-08 – Esmeraldas, Ecuador
This morning I clocked out after 24.5 hours at Delfina Torres Hospital. During the shift I saw patients with weak muscles, clogged lungs, dengue fever, kidney failure, liver failure, and heart attacks. There were also machete-slit wrists, burns, broken bones, bullets – and to balance it all, both a baby brought into the world and a baby taken out. These heavy things I’m getting used to, and as the shock-value wears off, I shift from debilitating empathy to levelheadedness. I’m not sure if this is good or bad. Of course nobody wants to lose their sensitivity, but having inner peace and clarity of thought in the middle of craziness is kind of nice. Some might argue that the two are not opposed – that gaining in one does not come at the expense of losing the other. It sounds good to me in theory, but boy I’m telling you things are moving too quickly for me to make sure that the change understands the flexibility that it has. Or perhaps its not that I’m losing empathy, because I still feel for patients – but rather that I’m developing control over how that empathy gets expressed.
The saddest case, obviously, was the three-month old boy with head trauma who could not breath… at all. Right off bat I’ll tell you that he didn’t make it. The mother said she took him to see an acupuncturist whose needles instigated the problems. Whatever the cause, he had a cerebral hemorrhage that was steadily increasing the pressure in his skull. A CT scan, a Neonatal Intensive Care Unit, and a neurosurgeon would have been useful, but the hospital does not have any of these. We put him on a counter next to the sink and ventilated him manually for two hours. My only job was to watch his chest rise and fall every time I squeezed the bag. I was still watching his chest when he died - the post-mortem gasping from muscle spasms gave me a great false hope that a miracle was in progress. But it wasn’t. In the end we handed his little body over to his grandmother because his mother had already gone home.
Speaking of mothers who went home, the HIV+ mother that I mentioned a few days ago snuck her baby out without permission. The kid was not ready to be discharged, the mother was not educated and the situation is now a mess - the hospital has to send someone to go find her because she does not have his medication or his formula.
And one more baby story. As it seems to always be the case, I was temporarily left alone to take care of a room by myself – this time it was OB-GYN consultation. There was one mother on a table, big belly, waiting to give birth but nothing was happening. Another came in with a much smaller tummy – she said she was ready. I apparently missed the urgency in her voice. A bunch of things happened really fast, and before I knew it the janitor and I were hauling ass down the corridors to the birthing room. All he had to do was push the gurney – I was pulling, back-pedaling, steering and opening all the doors. Bear in mind I didn’t know where I was going. We kept telling her not to push even though the baby’s head was already out, and he kept telling me which way to turn. We got there alright, but there was no time to move her into stirrups - the baby was born on the gurney. After catching my breath, I walked out of the birthing room and into the waiting room, which is kind of like a runway for expecting mothers – half a dozen heads poked up, hoping I was not coming for their deliveries.
Normally in the early morning hours when the ER quiets down, doctors retire to their bedrooms and the others wipe off gurneys to catch some sleep. Last night, though, around three in the morning Safadi brought out a ghetto dry-erase board, gathered everyone around, and started teaching about the American Heart Association’s BLS protocol. He is a fascinating individual – young and suave with soft brown eyes and stylish black hair that is gelled in the front – the kind of guy who would have been homecoming king and valedictorian with a full-ride to Michigan. He’s a bit of a schmoozer, but he wants good things - like education, for example. Continuing Ed is not mandatory in Ecuador to maintain a medical license, and it is not subsidized either – but he is putting out half a month’s pay at the end of June to take an Advanced Trauma Life Support class – and when he comes back, he will teach the staff who are interested. I like working with him because he is a good teacher – he uses me to get information from patients, then asks my opinion. At the end he puts it all together so that I understand how to think when I see different combinations of symptoms. Outside of work, he also helped me find a cheaper place to live.
The new place is in the heart of the city, so I can’t leave after dusk – but I’m usually either tired enough to go to bed early, or I stay up reading, reviewing notes, and committing Spanish phrases to memory. Sounds lame, but I kind of like it – the time to think, be quiet, and rest. The room is small, but it’s got everything I need – a bed, a fan, a bathroom and a hook on a wall to hang some clothes. I buy water in 5-Liter bottles, powdered milk and snack on granola I brought from home – won’t last forever, but for now it’s nice. And the day before yesterday I bought a brush and some soap, so now I scrub down my hospital pants in the shower, then hang them up to dry over night.
Before the month is up I hope to take more pictures, but it is not easy or safe to do. It is not safe because the streets are dangerous. I’m told the kids are smart and know how to use razors to slice through pockets or cut straps off shoulders. The older ones just pull knives. Of course not everyone is like this, but it happens enough that even the Ecuadorians at the hospital take taxis at night if they have to go six blocks. There is no safe place to keep personal belongings in the hospital either. Theft by both patients and staff is so common that the Emergency Department’s only basic life support kit is stored in a lock box, and there is only one key and it stays with the doctor. Blood pressure cuffs also have a tendency to walk away and be sold outside to medical supply stores – which is why there is only two in the ER. And not to beat a dead horse, but we have to bring our own cups and silverware to eat in the cafeteria; during the day I hide mine in a crooked wooden cabinet in the back of the Minor Surgery room – I only take it out when no one is looking. Sounds paranoid, but that is the way it is.
Take care,
-BH-
This morning I clocked out after 24.5 hours at Delfina Torres Hospital. During the shift I saw patients with weak muscles, clogged lungs, dengue fever, kidney failure, liver failure, and heart attacks. There were also machete-slit wrists, burns, broken bones, bullets – and to balance it all, both a baby brought into the world and a baby taken out. These heavy things I’m getting used to, and as the shock-value wears off, I shift from debilitating empathy to levelheadedness. I’m not sure if this is good or bad. Of course nobody wants to lose their sensitivity, but having inner peace and clarity of thought in the middle of craziness is kind of nice. Some might argue that the two are not opposed – that gaining in one does not come at the expense of losing the other. It sounds good to me in theory, but boy I’m telling you things are moving too quickly for me to make sure that the change understands the flexibility that it has. Or perhaps its not that I’m losing empathy, because I still feel for patients – but rather that I’m developing control over how that empathy gets expressed.
The saddest case, obviously, was the three-month old boy with head trauma who could not breath… at all. Right off bat I’ll tell you that he didn’t make it. The mother said she took him to see an acupuncturist whose needles instigated the problems. Whatever the cause, he had a cerebral hemorrhage that was steadily increasing the pressure in his skull. A CT scan, a Neonatal Intensive Care Unit, and a neurosurgeon would have been useful, but the hospital does not have any of these. We put him on a counter next to the sink and ventilated him manually for two hours. My only job was to watch his chest rise and fall every time I squeezed the bag. I was still watching his chest when he died - the post-mortem gasping from muscle spasms gave me a great false hope that a miracle was in progress. But it wasn’t. In the end we handed his little body over to his grandmother because his mother had already gone home.Speaking of mothers who went home, the HIV+ mother that I mentioned a few days ago snuck her baby out without permission. The kid was not ready to be discharged, the mother was not educated and the situation is now a mess - the hospital has to send someone to go find her because she does not have his medication or his formula.
And one more baby story. As it seems to always be the case, I was temporarily left alone to take care of a room by myself – this time it was OB-GYN consultation. There was one mother on a table, big belly, waiting to give birth but nothing was happening. Another came in with a much smaller tummy – she said she was ready. I apparently missed the urgency in her voice. A bunch of things happened really fast, and before I knew it the janitor and I were hauling ass down the corridors to the birthing room. All he had to do was push the gurney – I was pulling, back-pedaling, steering and opening all the doors. Bear in mind I didn’t know where I was going. We kept telling her not to push even though the baby’s head was already out, and he kept telling me which way to turn. We got there alright, but there was no time to move her into stirrups - the baby was born on the gurney. After catching my breath, I walked out of the birthing room and into the waiting room, which is kind of like a runway for expecting mothers – half a dozen heads poked up, hoping I was not coming for their deliveries.
Normally in the early morning hours when the ER quiets down, doctors retire to their bedrooms and the others wipe off gurneys to catch some sleep. Last night, though, around three in the morning Safadi brought out a ghetto dry-erase board, gathered everyone around, and started teaching about the American Heart Association’s BLS protocol. He is a fascinating individual – young and suave with soft brown eyes and stylish black hair that is gelled in the front – the kind of guy who would have been homecoming king and valedictorian with a full-ride to Michigan. He’s a bit of a schmoozer, but he wants good things - like education, for example. Continuing Ed is not mandatory in Ecuador to maintain a medical license, and it is not subsidized either – but he is putting out half a month’s pay at the end of June to take an Advanced Trauma Life Support class – and when he comes back, he will teach the staff who are interested. I like working with him because he is a good teacher – he uses me to get information from patients, then asks my opinion. At the end he puts it all together so that I understand how to think when I see different combinations of symptoms. Outside of work, he also helped me find a cheaper place to live.The new place is in the heart of the city, so I can’t leave after dusk – but I’m usually either tired enough to go to bed early, or I stay up reading, reviewing notes, and committing Spanish phrases to memory. Sounds lame, but I kind of like it – the time to think, be quiet, and rest. The room is small, but it’s got everything I need – a bed, a fan, a bathroom and a hook on a wall to hang some clothes. I buy water in 5-Liter bottles, powdered milk and snack on granola I brought from home – won’t last forever, but for now it’s nice. And the day before yesterday I bought a brush and some soap, so now I scrub down my hospital pants in the shower, then hang them up to dry over night.
Before the month is up I hope to take more pictures, but it is not easy or safe to do. It is not safe because the streets are dangerous. I’m told the kids are smart and know how to use razors to slice through pockets or cut straps off shoulders. The older ones just pull knives. Of course not everyone is like this, but it happens enough that even the Ecuadorians at the hospital take taxis at night if they have to go six blocks. There is no safe place to keep personal belongings in the hospital either. Theft by both patients and staff is so common that the Emergency Department’s only basic life support kit is stored in a lock box, and there is only one key and it stays with the doctor. Blood pressure cuffs also have a tendency to walk away and be sold outside to medical supply stores – which is why there is only two in the ER. And not to beat a dead horse, but we have to bring our own cups and silverware to eat in the cafeteria; during the day I hide mine in a crooked wooden cabinet in the back of the Minor Surgery room – I only take it out when no one is looking. Sounds paranoid, but that is the way it is.
Take care,
-BH-
1 comment:
hey ben, great blog on ecuador, found it by accident today. looking forward to reading more, the medical work sounds challenging to say the least! --scott (manayunker@gmail.com)
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