Deep Thoughts from the Chicken Bus

The more I learned in medical school, the more I felt I didn't know. I've had very few moments when I thought to myself, Gee I know too much for my own good. Well, I had one of those moments this weekend while riding an overcrowded bus. These "chicken" buses, at least the ones I've been on, don't have cages of chicken on them. I guess they did before. They are actually yellow school buses that are painted in various bright colors. On the front they have their origin and destination, making them pretty easy to figure out. (Unlike the time Joe and I took a bus to Manuel Antonio in Costa Rica and kept our fingers crossed we would end up at said destination).

Anyways, so the moment. The bus continued to fill w/ more and more people crammed like sardines. People sitting in chairs, and people in the aisle on top of each other grasping for dear life. As I was standing there, on our way home from, the word froutterism, UNFORTUNATELY, popped into my head. I was cursing First Aid and how the example took place on a crowded place like a train or bus. I was praying to high heavens that this would not happen. Of all the things to remember... Luckily no harm no foul.

Other thoughts:

• Dear El Salvadoran women, how do you wear black eyeliner in this heat? I, MAYBE, put on eyeliner if I'm working in an air conditioned office. Maybe.

• Kind sir preaching about world famous leaders. Will you shut the hell up if I buy your book that features Buddha and Adolf Hitler on the same page? These people obviously are not listening and saying, las palabras de dios, may grab their attention, but they still don't want your book.

• Thank you muchacha for holding our bags in your lap while Scott and I are grasping for dear life on the bus. We do like your Guns 'n Roses tank. We wonder if you were at the same concert as the Doctor.

Snowstorm in El Salvador

This week I'm working w/ Wendy, a first year Ob/Gyn resident, in Patologías del Embarazo. Most of the patients we receive are women who complain of bleeding early in their pregnancy and end up having miscarriages. We occasionally get a patient with placenta previa. This week we had a 15 year old girl (G1P0 - for those of you who speak the same language as me) who was sent from a town called Sonsonate...

This was the ultrasound that accompanied her...

This ultrasound shows what we learned as "snowstorm" appearance, indicative of a molar pregnancy (hydatidiform mole).

Since the Hospital Nacional San Juan de Dios does not have the equipment to suction out this molar pregancy, we had to send her to the capital, San Salvador. There they will also determine if the molar pregnancy was complete or incomplete. So between yesterday and today, we got her beta-hCG quant and a chest x-ray (to make sure no metastasis occurred) before sending her on her way. Her quant was in the 400, 000 level. CXR was normal. After a phone call and a signature from the attending, our patient left for San Salvador.

Que lastima! No tengo mi camera!

So yesterday, I casually mentioned to Mario, Sr. that I needed to learn la palanca de velocidades (stick shift). I think Senor Gritz would be appalled by my lost ability to use (and conjugate) the conditional tense. Actually, all the other tenses other than the present and preterito.

Anyways, so Mario, Sr. started teaching me immediately... and I said, "No, otro vez! Manana?" Hahaha. Surprisingly, he remembered. And this evening I had my very own lesson in driving stickshift. In spanish. En el campo - the countryside.

THANK GOD I had a lesson of the basics w/ Joe a couple years ago. Luckily I didn't hit any El Salvadoran child or puppy.

Mario, Sr. decided to teach by letting me drive to the countryside to pick up Catalina (the sister of Mama Chave's first husband). We met her sister, Paz, who lives by the train tracks at a higher altitude than El Congo. It was quite a difference from the living conditions here at Casa de Mama Chave. The house resembled a wooden shed held up by some miracle of God. It smelled of camp fire and there were dogs chasing around roosters. Everyone always introduces me as "este Melissa. ella doctora (as I usually interject w/ No, no, en Mayo, Doctora) ... ella mejora amiga de Jackie". They are the sweetest.

On the ride back to El Congo, we took the scenic routes and Mario, Sr. and Catalina pointed out all the small churches. She also bought Scott and I pastillitos (sp?). I think they are my new favorite thing. They are fried dough w/ shredded lettuce (and not sure what else) inside. They reminded me of little tiny empanadas. The vendor puts about 6 of them in a small plastic bag filled w/a tomato sauce mix. HEAVEN.

The one time I don't have my camera on me... so much I wanted to capture. So, I told Mario, Sr. that I wanted to go back to see Paz and the churches, this time with my camera.

I may just start smoking...

... so everything I want to say anything, anything at all, I'll just suck in the nicotine.

Apparently, I'm wrong about everything so I've succumbed to being quite the mute these days. Or just a crybaby. Sometimes both. Overly sensitive, quite possibly. Misinterpretation of these minor jabs, sure. My saving grace is Labor and Delivery (doubt I'll be saying that in a few months) and the most welcoming and warm doctors at the hospital. 2 more weeks I will be back in my dirty city and I can be my chatty self and perhaps laugh again.

Until then, light me up. I guess I would probably have to buy a pack first.

coffee, beer, and ice cream

Fridays have become special days for Scott and I. Last week we ventured to El Lago. Today we decided to hit up some Mayan ruins in Chalchuapa. Welcome to Tazumal!

Ok. Having major problems (still) with uploading pictures onto blogger. Not sure if it's blogger or 3WC internet. Anyways, between Scott's Central America Book, Lonely Planet, and the Cabrera-Barahona family, we've been able to get around El Salvador with ease. We took the 202 from El Congo into Chalchuapa and walked a few meters to the ruins (you can see pics on FB, ugh so annoying). This was the first Mayan ruin I've ever been to so I was pretty excited. The entrance fee was $1 for natives and $3 for extranjeros. I swear if I didn't open my mouth (or if I was fluent in Spanish) I could probably pass for a native. Today at the market, while I was trying to bargain down a pretty sweet hat, the vendor asked if I was from here. To his dismay, I am not and had two guesses- Hawaiian/Chinese or Filipino. Ding!Ding!Ding! The funny thing was he pointed out how my eyes were different and proceeded to pull back the corners of his eyes and say "chinky". I'm pretty sure Joe would've loved to be there for that moment. I honestly don't even think I have asian eyes, but es muy bien.

Scott and I met this endearing American, Tyler, at Tazumal. He is a 26 year old from Portland, Oregon who spent almost a year teaching mathematics and sociology in Columbia. Once that gig was over, he decided he wanted to work his way up back home. He went to Panama, Peru, Costa Rica, Honduras, Nicaragua, and now finds himself in El Salvador. He will be meeting his parents in Guatemala next week. I give him a lot of credit. I can live vicariously through him, because I'm not sure I could be a lone traveler for that long.

He told me that when he gets really frustrated in his travels there are 3 things that make everything all better: coffee, beer, and ice cream.

I was thinking today about what my 3 things would be and I came up with: coffee (coffee is pretty fantastic), shopping, and a hug. I got all 3 today :) Coffee I've been able to have everyday. Finally, we got to go through a pretty cool market including a lunch that cost us $1.50 each. And when we parted ways w/ Tyler, he gave me a hug goodbye. I haven't had a hug since I left on April 3. I guess I didn't realize how much of a staple that has been in my everyday life. I'm hugging everyone when I get back!

Muy triste....

Yesterday, we received a mom in el parto (short for L&D). She came in with an X-Ray of her thorax. A doctor who sent her was thinking she was having twins because she was large for her gestational age. Nope, not quite.

Mama had polyhydramnios because her baby has what we call "Anencephaly". The Central Nervous System fails to develop completely (see the wiki link for more). In the States, women of reproductive age are encouraged to include folic acid in their diets. Folic acid has been shown to reduce the risk of Neural Tube Defects. The prenatal care down here is inconsistent. Sometimes the moms are able to get appropriate prenatal care, but in this case she wasn't so lucky. One of the residents told me that anencephaly is common down her, but not sure why.

Pretty sad day. I was thinking of how I couldn't begin to fathom how the mother felt. After carrying this baby for almost 9 months and to not bring her home. That is the rough part of this field. It can go from one extreme to another- the happiest of moments to the most heartbreaking.

We did it all by ourselves!

Scott and I decided to venture back to El Lago on Saturday. On our own. We were gonna walk there and catch the bus on the way back. I was kinda wary about walking there b/c we don't have a map and we had only been there once (being dropped off by Mario, Sr.).

So, we're walking. In town, the bus to the lake passes us by going the other way so we definitely knew the buses were running. Score. We continue beyond the main street and cross the overpass above the main highway. You sure we're going the right way, Scott? We were walking for about 20 minutes or so and the Coatepeque bus hadn't passed us.

Random moment: There was a bright orange hatchback that passed us and a guy leaning out of the window whistles and then says something in Spanish. Scott- What did he say? Me: I have no idea. Maybe $5 for a blow job, lady? But maybe he was commenting on my defined calf muscles. I did work out before we left for the lake.

Later when Scott asks me what I was thinking on the walk over, I tell him, "This guy has no F****** clue where we're going." Thankfully, the bus finally comes and drops us off lakeside. We stop at a small store, Scott wanted a cold dessert, and I needed some soda. The lady asked if I was native to El Salvador and I say no. She said I have similar skin tone to the people here but ojos diferentes. I imagine if Joe were here, he'd be sure to interpret that as, She just told you that you have chinky eyes.