Ohhh it’s NaLa not NaNa…

I should've known right then and there that me hearing "Nah-nah" as the name of the house dog was reaffirmation in choosing Ob/Gyn. I guess it can also mean I'm twisted and sick. Nonetheless, today I fell in love all over again.

Unbeknownst to Scott and I, we were not participating in the gastrectomy (praise Jesus!) today. Instead, Dr. Cabrera handed us over to our areas of interest. Scott to Neurology/Neurosurgeon and I in Labor & Delivery! As soon as I entered the ward, my eyes lit up and I was ready to rock-n-roll. Within 20 minutes we were rolling a mama at 30 wga (weeks gestational age) into Cuarto del expulsión No. 3. Here the women in labor are placed in this elongated hallway titled Trabajo de Parte (fancy for “Labor”). It resembles the hallways found in emergency rooms where patients are placed when all the rooms are taken. Once they are ready to empuje, they are rolled into a cuarto del expulsion. These are located in a huge room on the other side of the ward which are divided into 4 sections. So, multiple vaginal deliveries can be going on at once. Then there was a tube tying called an esterilización, then a cone biopsy of the cervix, and then I got to first assist a c-section! Love it.

One of the attending asked if I was gonna do turnos aka night-shift. I’m gonna opt for no gracias. I will definitely bring that term to the states come June and dub “night-shift” or being on call – TORturnos.

Today, the country has one of the world's highest homicide rates...

Archbishop Romero

This was the first picture I took in El Salvador - it's a banner that is seen as soon as you exit the airport. I didn't know what compelled me to take the picture. I hadn't had the chance to look at it let alone try to translate the words. But, each day I like to google "El Salvador news" and someone else's blog came up posting an article in the Washington Post about a former military captain, Alvara Saravia who has decided to provide details after all these years.

I didn't realize that Scott and I arrived her just a week after the anniversary of Archbishop Romero's assassination which was the beginning of El Salvador's 15 year civil war. Jackie gave us a briefing on the history before we left about the conservative party and the leftist guerillas...

...but gotta go to the hospital. Click on the link to read the very interesting article!

Gimps y Yo on a mission...

Scott and I got back from the hospital today with enough time to take a stroll through the main street in El Congo. We were on a mission to get beer and wine. Surprisingly, we were not hassled to buy anything from any of the vendors. Just some looks wondering what this gringo in a cast was doing hobbling along in their town.

To our dismay, a 6-pack of Pilsener was out of budget and there was no boxed wine (Scott was really disappointed about that). We picked up a bag of chips and were appalled at the calories per serving. A bag, roughly the size of those $0.99 dorito bags at wawa, held about SIX servings at almost 300 calories per serving. Put that bag down! Scott is convinced that there will be a huge need for Statins in this area very soon. Everyone here is well-fed!

On the walk back, I realized what the street reminded me of – Market Street! Random stores playing loud hip hop music, selling DVDs, TVs, and hubcaps. I debated on buying a set and shoving it in my suitcase. Maybe if I have extra bisto. In addition to the small shops, and even medical clinics, there was a store that was selling tile for the kitchen or bathroom, one selling toilets, and even a cell phone store. I had to pull Scott along as he stopped in front of the fried chicken place (equivalent to Crown Fried Chicken for those of you familiar with that establishment) mesmerized by the intoxicating aroma of fried chicken. We had to get back to put the two botellas of vodka in the freezer.

There is no Nighthawk in Santa Ana

We took LM to get the standard chest x-ray after central line placement, which was down the hall. Instead of ordering a portable CXR, the patient is the portable entity. No one was wearing protective shields and the tech had his 3 year old daughter washing her hands in the sink next to the machine. Mario was called in to read the XR. We followed him in and I noticed a familiar aroma. I was taken back to my last semester at Loyola - hours spent in the photo lab processing film and developing prints. Wow they develop their own X-rays right then and there. Scott was right, ”I am assuming this film isn’t coming up on the computer.” The line was in its place and no signs of pneumothorax.

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.

Primer Noche

I must've brought the rain. It's rained twice since we got here, but it does have a nice cooling effect. After almuerzo (aka lunch), I took a long nap. Between being tired, full, and the heat/humidity I had a nice slumber.

When I woke, Scott and I joined the main household to chat- mostly to soak in all the Spanish we can. We met Mario's sister-in-law who said Jackie and I looked alike. We do get mistaken for sisters often. (Side note: at customs, the hombre was confused because my last name is "Suarez" yet I had an American passport. He kept questioning, "Latina? Latina?" Nope, Filipina. Scott interjected with "She's American" and the poor guy was confused. "American with the last name Suarez" Yes, I know. Hard to believe. Where is that imnotmexican.com site when I need it).

Mama Chave is Jackie's abuela who gave us some pupusas for dinner- which are akin to corn tortillas, soft and filled with cheese and or beans. I knew Mama Chave was mayor of El Congo, but tonight we learned she was mayor- or Alcadesa- for FIFTEEN YEARS! Elections are every 3 years. I think it's amazing she was elected 5 times. When she started, the country was undergoing a civil war at the time. Mario said she was running for office while he was in medical school and remembers fondly of his classmates chanting "Ma-ma Cha-ve, Ma-ma Cha-ve" to him.

Tomorrow is Easter Sunday. I promised Helen I'd go to mass. And I promise to take pics so I can post them. We start work on Tuesday and I'm itching to get back into the O.R. as crazy as that may seem!

Found a use for this blog after all...

This blog was originally inspired by Laurence Ross who always has the ability to share in life's... well I guess just life. Good and bad. We were both bitching about our lives, as per usual, and it was suggested to him that he go to a junkyard and throw glass bottles (see first of 3 entries- hah!). Sometimes I sign for things due to my obsessive compulsiveness and end up with things like a latent blog. But, it's back up because I have an excuse to write- on the plane ride to El Salvador, I was thinking I wanted to keep a blog of my month here. So, instead of creating a new one, I figured I'd awaken this bad boy up.

Before I started medical school, I randomly found myself in Costa Rica with Joe. Mike DeShields extended a casual invite to "come visit whenever". So, that's what we did. We bought plane tickets and flew down to Central America. No plans and not even an address. Just directions, in Spanish, to his place.

4 years later I find myself back in Central America. I took a shot in the dark and asked Jackie if her uncle, a surgeon, would mind Scott and I to come down for a month and complete an elective. Thanks to Jackie and her uncle, Mario, Scott and I are spending a month in El Salvador to end our final month as medical students.

Mario picked us up from San Salvador and when we got "home" we were greeted by the sweetest family - Mama Chave, Mario, Sr., and Nancy. Almuerzo was just what I needed and Jackie called to check in on us. Feeling at home already.

Stay tuned for pics...