Home again home again

And now I'm back. . and everyone speaks english. . and my dreams are all messed up. . I keep thinking that there are babies to be delivered and I keep constructing sentences in Spanish. . .

I'm off to the woods now. . about 6 hours later than I planned, but, hey, what can you do. .
Thanks for reading thus far

I am going to try and continue to post, so keep checking if you want!

God Bless TSA

I bought tequila at the duty free in Mexico for my dad - that meant they gave it to me when I got on the airplane. . I attached it to my back pack and forgot it about it. My flight from Mexico was almost an hour late so when I got into Customs I was rushing like crazy. I missed my flight, of course, so slightly pissed off, but mostly amused (because there was another flight I could catch), I rechecked my bags.

I meandered up the stairs to the security check point so that I could go back into the airport and wait.

TSA: Do you have any liquids with you?
Me: No.
TSA: What's this?
Me: Oh. . well, that's liquid I guess, good point. But it's Duty Free, I got it after I got on the airplane.
TSA: Nope, you have to check it.
Me: Well I can't, my bags are already gone.
TSA: Well, you could check the bag on your back.
Me: But I already checked 2 bags.
TSA: Ohhh. . that'll be like 80 bucks.
Me: There's no way I can. . .I mean, I got it Duty Free.
TSA: Nope.
Me: But. .
TSA: Nope. You can run down and see if your bags are still there.


Which I did, and they were gone of course. Really. . you really think that between customs and the security check point, during which time I had no chance to exit the building or go through my things, I dumped the tequila out and made a bomb. . seriously???

Big breath. . .about 3 of them. . and then I just laughed. Gave the tequila to one of the people who had missed their flight and was being forced to stay in Houston, and went on home.

Sorry dad. . it was probably shitty tequila anyways.

Don Galleta's Wild Ride

I am lucky to make it out of Mexico alive.
Every taxi ride I have ever been on is safe compared to the ride I had with Don Galleta (Mr. Cookie). That's actually not his real name, I have no idea what is real name is. He has been working for the school for years and years and even the older doctors refer to him as Don Galleta. I don't think he likes the name very much, because no one calls him that to his face. He is one of the night guards and maitenance men at the place where I lived (the parking lot for the medical school). He was never very happy when we got in late.

So Dr. Munoz (our host) organized a ride for me to the airport - great, I get to save 20 bucks, I never mind that. If I had known how absolutely nuts Don Galleta is, I would have paid the 20 bucks. He drove a 12 person van like it was a sports car. Speed up, break really fast, speed up, break really fast. We had to make a stop in a parking lot and he forced a lady who was almost to her parking spot to back up all the way back onto the road, making angry gestures at her the whole time. It was so crazy that other people in the parking lot where telling him Tranquila, Tranquila (chill out).

Then we get on the open road and he sees a boy ahead of us throw some trash into the street from their car. . he chased them down! In a 12 person van he chased these guys down. It took him like 5 minutes, but he did it. I think we hit 90 mph and I really thought that I was going to die.

But I did make it to the airport on time.

Small World

On Monday I was in the birthing room and this patient called me over. . .

Her: Estas hablando ingles?
Me: Si
Her: Are you from the states?
Me: Yes. . how do you know English. .you speak perfectly?
Her: I moved there when I was 5, I've been back here for 8 years.
Me: Really. . wow. . where did you live in the states?
Her: Southern Idaho.

Disney was right.

Baby Thriller

A night to remember, a night to end all nights, bouncing babies everywhere.
My last guardia did not going to go gently into that good night. It was pesada. . it was heavy. . it was hard. . it was busy.
We'd deliver one and another woman would come in to replace her - the room was always full of 5 women ready to give birth, sometimes more.
3 deliveries, 3 c-sections, 1 tubal ligation and an explosiva (a birth in the bed, not in the delivery room).

Normally there are 3 interns on during a guardia - 2 for births and 1 to take care of the little ones that pop out - and one student who is usually as competent as an intern - they usually fill in where needed and attend births, check cervixes, or assist in surgeries. On my last Guardia night, there was 1 intern for births/surgeries and 1 intern for the babes and no student and me. Thus, I was actually a playing member of the team. No longer was I jolly little miss-tag along, aimlessly wandering from intern to intern, patient to patient- smiling and nodding my head without understanding a damn thing that I was supposed to say or do. (like in the beginning when the patients would ask me questions, I'd have no fucking clue what they said, so I would put my most sympathetic face on and nod - I can understand them now and it turns out they have been saying things like -Doctor, I have to go the bathroom and Doctor why do I hurt so much or Doctor, Is something wrong? - and I've just been nodding and smiling, great, just great). No, suddenly I had become a useful, needed, depended upon member of the team; unfortunately this transformation was not due to any increase in my knowledge or ability, it was just the consequence of desperation.

But I did it. . mostly on my own, occasionally someone would pop their head in just to check on things. I was lucky, because pretty much every woman I worked with was multiparous, which means that the baby comes out easy, no episiotomy is needed, and usually there is no tearing. My one premiparous (that word may be made up) did tear pretty badly - a Grade II or III, and there weren't any other births at the time, so the intern Marta repaired it.

I went from birth to a tubal to 3 c-sections right in a row (including one that was a friend of a doctor - the asshole took me away from 3 almost complete women while Marta was still in delivery, leaving no one to watch the women and Marta with her hands very full. . and then he did a transverse incision instead of a vertical incision - prettier - I'm all about the cosmetic thing, but I wasn't very impressed that the only time he would do it is as a favor. . ).

My last birth was the crown jewel of the night. Martha was finishing up with a birth and I was watching the room - 2 premiparous completely dilated (10) and 1 new admit who was multiparous with 7. I walked back and forth, coaching the fully dilated women, and then the hour came to recheck, so I went to check the multiparous. She was at about an 8. . ok. . cool. . .we got a bit of time, no problem. The premis were all still very high, so I attended the multi for a bit - her water hadn't been broken, so I did that for her. . Uh oh. . Meconium. Meconium means baby stress which means listen to the heart beat, but I couldn't find a Pinnard. Ok. . I'll use one of the plug-in dopplers, but there were so many women in the room that she was in a bed off to the side and she wasn't next to an outlet. Great, I think. . I'll roll the bed towards an outlet (not an easy task). So I'm trying to roll the bed and the woman starts screaming.

Me: What's wrong?
Her: My baby, it's coming, I can tell, it's coming.
Me: No, really. . this can't be happening this fast. . from an 8 to birth in 3 minutes? (that was a thought)

I guess, it can happen that fast, because I had her spread her legs and there was the head full of hair peaking out. Hello baby head!

Me: Some swear words in English.
Her: Ohhhhhhhh
Me: Paciente a sala (Patient to room. . what you say when you want a patient moved to the birthing room and everyone to jump into birth-prep mode)

Apparently no one heard me. The interns claim that no one understood me, but what the fuck else was I going to shout out? I think no one wanted to hear me, and everyone ignored me. I looked down again and saw that this baby was not waiting.

Me: Fuck, fuck, fuck fuck.
Her: Ohhhhhh
Me: Fuck. . .ok. . .

I only had one glove on (Michael Jackson style), but I didn't really have a choice, so I guide the baby out using both hands, and hold it. No aspirator, no way to clamp the cord, no way to cut the cord.

Me: Paceinta a sala AHORA!!!

After what felt like 3 minutes or more, people finally came. . at a slow gait. The pediatrician woke up, the nurse sauntered in to give me a birthing kit, I aspirated, I cut, and I handed the baby off.

Then she was wheeled to the birthing room, I stitched her up, and that was that. . my last birth. .

Well, almost my last birth. . on Monday I delivered one last baby and it went just fine. .

Push Fatty, Push

There's one doctor who I really don't like and he really doesn't like us (or really any other of the students, or any of the patients. . I'm actually not sure why he is a doctor). He works for about 5 hours in the evening/night and he seems to just hate being at the hospital - He reminds me of one of those bitter, bitter doctors who is miserable with his life and deeply regrets the choice he made to go into medicine (you know, the ones who try to talk you out of pursuing medicine as a career). Grinches.

Anyways, when he is watching a birth and using all of his weight to shove his elbows and fists into the stomach of the patient in an effort to get the baby out faster, he says. .

Empuje Gordita, Empuje. (Push fatty, push)
Gordita. . necesitas empujar. . mas, mas gordita.
Gordita. . quieres que tu bebe vive? Si Gordita. . No gritas gordita. . No gritas. . solamente empuje.

Great, that's exactly what I want when I'm giving birth. . I want my doctor to call me Fatty and tell me not to scream. You do that and I'll deck you.

Push fatty, push. . .jesus.

Leeching

I am a leech. An energy sucking, experience abusing, knowledge lacking giant leech. Most of the time I have no fucking clue about what is going on. There are occasions when I begin a task filled with confidence, but about half way through uncertainty replaces my assurance and, with my tail between my legs, I sheepishly seek out those who know and ask for help.

I am not used to feeling so inept and I am not used to feeling so incapable. I feel better when I at least have the illusion of contributing and giving back as much (more) than I am taking. In truth, probably the most difficult thing about this experience has been making the adjustment to being so useless all of the time (I'll credit Erin with that statement). Like all things hard and difficult, I know that being in such a frustrating position is good for me - it forces me to relinquish control (at least a little) and it is humbling to be clueless all the time. Still, I haven't been the best at embracing this unfamiliar role - my emotional response has mostly been guilt.

There's the ridiculous, totally unjustified, outrageous guilt. The guilt for not knowing things that I haven't learned yet in school. Guilt for not knowing how to do things I have never done before. Guilt for dozing for an hour while the interns and the students are working so hard during the Guardias. Guilt for not speaking better Spanish. Guilt for chosing sleep and comfort over experiencing Mexico and partying with the students (it's Mexico, I should enjoy it and experience it. . but it's my bed and it's really not that nice or comfortable but I am so tired. .ahh sleep. . I guess I'm old).

Then there's the guilt that's slightly more founded. Like guilt for getting so much personal attention from the doctors, personal attention that the other students aren't receiving. There is the guilt for taking up learning time from the other students - for example, attending a birth that should be attended by a student. Guilt for getting all of the privelages of practicing medicine without having done the work of learning the information in class. The guilt of knowing that I will probably never be able to repay the kindness of the students, interns, and doctors here. Since these are all inherent components of the program, there's not really much I can do to change it, except choose to not participate, and then I would have to feel guilty about that.

And then there's the guilt that is born from participating in activities that conflict with medical ethics in the states, ethics of education, and my own personal ethics. For example, the cold truth is that we are studying in Mexico because, here, education of the student trumps the welfare of the patient (another Erin observation). Both Erin and I are untrained and unskilled in the art of delivering babies, and yet we have little to no oversight during the births we are attending. I am essentially trusted as a 'doctor' skilled in delivery. And for this I can feel some legitimate guilt. Early on in the month, I made a choice to go with the flow, to trust the judgement of those around me even if their choices were not consistent with my knowledge level, my comfort level, or my ethics.

Down here, you are called doctor once you enter medical school. Indeed, after Dr. Pacheco overheard me introduce myself as a student to one of his patients, he took me aside and told me that I need to embrace the role of doctor; I need to instill confidence in patients and introduce myself as a doctor, not as a student. Working with patients who think that I have the knowledge and experience to qualify me as doctor and doing nothing to dispell that misconception is seen as dishonest trickery in the moral code of medical schools in United States. It is almost equivalent to running an experiment on human subjects without their consent. Although it may not have the same tragic outcome as Tuskegee, it is understood as equally morally reprehensible.

Then there is the larger issue of patient rights and, at times, human rights. Doctors here treat their patients differently than doctors in the states treat their patients. The doctor-patient relationship is reminiscent of the more traditional doctor as omniscent patriach model that we have worked so hard to do away with in the states. At Materno-Infantil, doctors are all-knowing, and they refer to their patients as Queen, sweetie, child, little mama, even fatty. There is minimal attention paid to patient consent and patient agency in decision making is almost non-existent (information is routinely withheld from patients). Unnecessary, treatable pain is not immediately alleviated.

These things do not mesh with the way I strive to treat patients and people. I understand that most of this is either a cultural thing or a resources thing. It is clear that, except for one or two doctors, most of the people working in Materno-Infantil truly care about the patients and are passionate about providing excellent care to the poorest sector of Mexico. Of course remembering cultural differences helps to dissipate the horror at what I see as lack of respect, condescencion, and even cruelty to pateints. But cultural relativity can only carry me so far - at what point is something just simply not consistant with human rights? While I have yet to see something that grievous, it is an important question to ask, especially when I am expected to participate. Do I be in Rome and do as the Romans do, or do I do what I believe is right? Although I am loathe to admit it, my response has been somewhat inbetween. I have found myself treating the patients here slightly differently than I would treat the patients in the states. While no excuses should be made, a likely explanation is because I don't speak enough Spanish or know enough medicine to circumvent the established doctor-patient relationship.

There is a serious moral problem with us being down here. There is an element of this experience that feels unsettilingly colonial - as though the rich white girls from the United States are down here to learn (experiment, practice, improve themselves) on poor Mexicans since the poor Mexican patients don't matter as much as the rich white patients in the United States. Of That is a somewhat simplified way of looking at the situation. Erin and I are down here on an Intercambio, an exchange. An exchange (of ideas, of people, of experiences) implies that both parties have something worthwhile to offer and something to gain (and this is one reason I really like the philosophy behind an exchange - it's a true sharing of ideas that legitimizes both participants as educators and learners). And the doctors in the hospital are exceedingly proud of the technology they have, the wealth of knowledge and experience working at the hospital, the education they are giving to their students, and the excellent care they give to their patients. And they want to share this with us. They gave Erin three or more tours of the new wing of the hospital and took her picture with the governor of the state of Guanajuato. Erin and I were featured in the Mexican newspaper in an article explaining why we have come down here to learn (what Mexico has to offer that the United States doesn't). There seem to be motives behind so much of what we have done here. For example, I believe that the time we spent in Ultrasound was just to show us how advanced they are in the hospital. This is problematic as well - why is there a need to prove their achievements to two undereducated medical students? (Because we are from the United States).

Although we may not embrace this role, Erin and I are ambassadors (of a sort) from the United States. We are representatives of our home and we carry all of the baggage of the highly charged relationship between the USA and Mexico (and the rest of the world). Because of this, the third statement I make when I meet someone new is often anti-bush, anti-wall, and anti-Iraq war. Perhaps one positive element of our ignorance in all things baby is that it helps to even out the imbalance inherent in this troubled relationship of power. I think there is some amount of surprise when the doctors and students realize how little we know and pride and satisfaction at getting to educate the 'big doctors' from America.

Of course, the reality is that this experience is much more complicated than any one statement I've made. It's a mix of all of the above, plus a little and minus a little. There is so much history and experience that is woven into the roles we (Mexicans and Americans) are playing down here, that it is impossible to tease out any true meaning.

And with that, I relinquish my soap box.