With a 2 hour time difference and having gone to bed 10pm El Salvadoran time, I woke up bright-eyed and bushy tailed at 5:45 this morning. Got into the shower and let me tell you the Castaneda bathroom is hooked up. Heated shower water is unheard of here, but we have it.

While Scott and I were reading out on the back porch Mario, Sr. comes out to tell us something. I was trying to make out “desayuno” (aka breakfast), but somehow Scott was able to decipher “hospital” from his message. I guess Fatty wanted her beans, right Greg?

Apparently, Mario got called into the hospital today because a patient of his was very sick. The 3 of us scarf down some eggs and beans and rush over to “Hospital Cader”- one of 3 hospitals/clinics Mario covers. Sorry, Ma didn’t make it to mass today.

We enter this baby blue painted building, pass through some hallways and arrive at LM’s bedside. He is a 72 year old male diagnosed with gastric carcinoma. He complained of severe abdominal pain in the middle of the night. All 45 kilos of him was writhing and moaning in pain. I noticed I could count each of his ribs and clearly distinguish the 3 parts of his sternum. Mario couldn’t get a blood pressure and we felt his pulse was faint. Outside the room was his family. Worried, upset, sobbing.

LM was moved into a different room where we could put in a line. The landmarks on his neck were so clear that the IJV (internal jugular vein) could not be missed. With his head turned to the right, his sternocleidomastoid was well defined, as if I had my Netter’s open. Just this time, a layer of skin was between me and seeing the muscle fibers. Mario handed me the guide wire and I immediately had flashbacks of when I placed my first central line. Don’t ever ever ever let go of the wire. Ever. I watched him prep LM and proceed, with precision, and gaining access on the first stick. No ultrasound guidance to ensure you are aiming for the vein and not the artery. No huge blue sterile sheet covering the patient and no huge blue sterile gown causing you to sweat and fog up your plastic face mask and rendering you blind. Just the basics. Sterilize the area with iodine, look at your landmarks, and just do it.

If you look carefully, those bottles on the right are Starbucks Frappucino Bottles.

Applying the Nike slogan to central line procedures in the U.S. probably wouldn’t fly well with the insurance companies, lawyers breathing down our necks, thick-necked patients, and germaphobic/antibiotic resistant Americans.