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.

Shame and Salvation - Miercoles

Wednesday was a rough day and a great night. During the day, I delivered a baby and when I went to repair the tear, I fucked up. Dr. Pacheco was called away and two very capable students were left to help me. And it was going fine, until suddenly I wasn't understanding their directions and it seemed like I had totally misapproximated the edges of the tear (truth was, I was fine, I just needed to do another layer of stitches to, I just didn't get what they were seeing). Then I made a really bad stitch, so everything had to get cut out. This was when the tears of frustration and mortification and guilt and dissapointment started welling up in my eyes. Dr. Pacheco gave me a pep talk (don't think you can't, if at first you don't succeed, you need to hide any uncertainty from the patients, don't shatter that patient illusion of doctor as infallable, I am very proud of you, etc., etc., etc.) and he finished up the stitching. And then I made a half hour lunch break into a two hour lunch break, because I'm one of the strange, somewhat spoiled, very oblivious foreigners.



I'm 26 and I still deal with my stress by crying - sigh. . not so professional and oh so inconvenient. It has so many undesirable effects. . like the poor students felt so guilty, and Dr. Pacheco felt guilty. I just want to remain composed, but the more I try, the more the flood gates open. . I'm just a hopeless cause.

But a shitty day turned into a great, get back on the horse kind of night. I had Guardia with David, Mario (Peds), and Liliana. David and Liliana were the interns responsible for births. Liliana went to c-section and stayed there all night - through all 9 of them. . all 9 of them with only a 10 to 15 minute break in between. That's a new definition of hardcore. I stuck with David in the Partos part of the ward. Things were pretty mellow for a good portion of the night - just a few births that David did since the attending really couldn't stand my presence. David even had two tears so bad that the doctors stepped in to help repair (of course I felt bad for David, but secretly this made me feel a little better - even the surgeons to be need help with stitching sometime - but that's just secretly). I spent the bulk of the night tactoing (yes that's a made up Spanglish word) cervixes and dopplering baby heart beats (the new wing has dopplers for those of us with poorly trained ears).

The baby (shit) storm hit around 1 or 2, I don't really remember. David had just finished with one birth when another woman (Gravida 6) went from about 0 dilation to 10 in 10 minutes. That's really fucking fast. It was beyond an easy birth (I mean, she barely had to push). The doctor helped a lot, but I did some stitching, which was really the horse I needed to ride again.

Then all of the doctors disappeared. I don't know where they went, but they were gone. That was when woman one went up, woman two started to crown, and woman 3 followed shortly after. David handled woman 1, I coached woman 2, and I think the Dr. or David or someone else, I don't know attended woman 3. My woman actually took a while. . it took a lot of pushing and a lot of pain and a lot of exhaustion before her baby came down. She was pissed at me by the time I finally got her into the stirrups. So I was alone and trying to breathe deep, thinking, I can do this, I can do this, I can do this. It was a mantra of desperation. David came in when he was done with woman 1 and I had a flicker of hope, but then he got called to attend woman 3 - all hope was shattered. The problem was that the baby was just not lowering. . .nothing was happening. (And even if there had been someone around to call for, I don't know how to politely call for help in Spanish). The Doctor eventually showed up, stuck his hands inside the woman's vaginal and did some head rotation, told me where to put the episiotomy, and pushed with all of his might on her belly. Pop!

And then I successfully sewed up the episiotomy - without anyone watching over my shoulder or really telling me where to stitch (not saying that I liked this sitution, but it was that do or do thing). The worst part was that she was in so much pain. I gave her lots of topical anesthetic, and I asked for them to push more anesthetic into her doppler or IV, but no one was around to do it, and I had to proceed. At the end she said, 'I'm never going to forget this.' Ugh. . I felt awful. Still, despite the pain, I think it was successful. . I hope it was successful. . people said it was, but it's a sort of unsettling feeling being all on your own and responsible n' shit. Welcome to doctoring, eh?

Guardias Uno, Dos, Y Tres

So Monday night was my third guardia. I am now half way through. I am tired and am in total awe at the ability of these interns to pull 36 hour shifts every 4 days and be functional and highly successful in all of their responsibilities. Tuesday was actually the first day in my life that I have ever fallen asleep while standing up (in my defense, I was in the ultrasound room and it is dark and cool and their are these machines with soothing images on them, and the doctor that runs the ultrasound room is more or less an asshole, so I was trying to go to my happy place). I was giving an ultrasound to a patient and I kept falling asleep while I was moving the rolly thing across her belly. I think it was just for a second, but what if it was for a minute or more? I'm sure the patient knew or was scared shitless.

My first guardia was a night of watching. Occasionally I felt around for a cervix (which I always failed to feel) and stuck the little heart beat magnifier thing to the big belly for about 10 minutes while not hearing anything. I was exhuasted by my uselessness.

Guardia numero dos was a bit better. Partially beacuase 2 of the interns on that night spoke pretty damn good english, so if there was ever something I was really not getting, they could explain it to me in English. This meant that I spent much of the night speaking English. Plus, by then I had sat in the hot seat twice under the eyes of Pacheco, so I had a slightly higher level of confidence. My Spanish was rolling a little more and I was getting more comfortable with the interns and students. I even delivered one myself with the kind tuttelage of Totti. Things were all calm and happy until the end of the shift (I mean like 15 minutes until the end) when one of the interns was in surgery, Totti was delivering a baby, and another woman was crowning in her bed. He looked at me and said. . go get ready. I must have looked terror striken because he finished birthing baby number 1, re-gloved himself, and delivered baby number 2. Then he took off and left me to stitch up with another intern watching over my shoulder. It took me like an hour to make 6 or 7 stitches.

Ahhh. . stitching up. . .so the first time I ever put a needle into human skin was last Wednesday when I stitched up my first episiotomy. Episiotomies are not easy things to repair- they aren't surgical incisions into durable skin. They are more or less tears in uncooperative mucosal tissue that continues to tear and ooze blood if you don't make the right kind of stitches. All this to say that I am not really as good as I'd like to be at the whole stitching up process (In confession, I'm not sure all of the vaginas I have repaired look like they are supposed to). I don't know what I am doing, and I don't always understand the guidance that everyone gives me, plus the guidance changes drastically depending on which student, intern, or doctor is giving it. And it's not like the repairs made by the students, interns and even some doctors are works of art. Really, as I mentioned before, I'd be pretty pissed if my vagina was subjected to the 'repairs' performed by some of the less diligent students and the lazier doctors. But, the whole idea of us practicing sans any experience or strict observation is emblematic of the fairly large ethical dilemma both Erin and I are facing down here, but I'll get to that later.

Guardia numero tres. . Monday night was intense. It was relentless. The new (absolutely gorgeous) hospital wing opened on Monday, so we were in the much larger, air conditioned space (which was the nice thing about the night). Usually there were 5 to 7 patients at any given time in labor (everytime one patient gave birth, another one stepped up to take her place). And it seemed like the births came at least once an hour, if not two an hour, so there was no rest for the weary. And to make everything harder, there were only 2 interns on Monday night. That makes: 1 attending for partos, 1 attending for surgeries, 1 attending for peds, 1 intern for partos and surgeries, 1 intern for peds, and me. Plus a very capable pre-intern who showed up at around 10 or so. I was thrown into a c-section as the only assistant of a doctor who was not so pleased that his assistant didn't have a fucking clue about what to do and couldn't speak any Spanish. Thank god for the nurse - the surgical nurses here are so incredibly patient and gentle. The beginning of the night was spent with an attending who doesn't believe in automatically doing episiotamies. . I like him. I delivered three babies with help, but mostly I checked cervixes. I touched lots and lots of vagina.

I want a shirt that says, 'I touched lots of vaginas in Leon, Mexico.'

Salsa

So we found this restaurant where this woman comes to your table with a big mortar and pestal and a whole bunch of bowls with really yummy looking ingredients in them. She then asks us what we want in our salsa.

Oh yes. . fresh, made to order, ground at the table salsa.
It's ok to be jealous.

Spot the Foreigner

The other fun thing at the party was that this girl walked in and right away I said to Erin, she is not from here (and no, it wasn't the white thing. . .there are a lot of very white Mexicans). Turns out she is from France - she is hear teaching French for a year.

I always love meeting people from other countries when neither of you speak each other's language and so the only option is to speak a common non-native language.

We stick out like sore thumbs.

Jokes

Oh. . and the great big fucking joke that we discovered on Friday night? All of the interns and students speak Spanish. . or at least can understand Spanish. Apparently all it took was a few beers to get them to let down their guard and speak another language.

It's nice that they have been letting me speak Spanish, it's somewhat of a relief to know that if Ireally don't understand something I can ask them/say it in English, and it's somewhat embarrassing to feel like their English may be better than myS panish and they have been letting me butcher the language . . . sigh.

Universal Fridays

Fridays are the same everywhere. Everyone loves Friday.
Erin mentioned that Friday's are her favorite day, even better than Saturdays. And I think I agree

The mood is relaxed and there is still so much excitement and possibility surrounding the coming freedom- the weekend feels endless (by Saturday you realize that Sunday is the next day and you have to be productive).

Last Friday at the clinic was great fun - just a whole bunch of students hanging out and joking in the ER with Dr Pacheco. It even felt like the babies decided to take a break, since Urgencias was not crowded at all. After my whine fest before, the students have become so incredibly friendly and generous and welcoming and inclusive. It just took a little ice breaking, I guess.

One girl, Yessyca (That's my name in Spanish) is especially wonderful. She is in her 4th year (a pre-intern) and she is very, very good at what she does. She is friendly, enthusiastic, a great teacher, beautiful. . she has been so good to us. She and her boyfriend (who is an intern - they make the perfect couple) took us to Lagos de Mariselles or something like that. It was a nice 20 minute drive outside of the city. We met some other equally nice (and perfect) medical students and had yummy seafood for lunch. It was oh so yummy.

(I made one of those horrific cultural/language errors and got called on it. Someone was talking about metrosexuals and I said I was surprised to hear that word in Spanish. When they asked why, I stumbled around and said it was fairly new - the sweetest girl Adriana called me on it - you offend us Jessie, what do you mean new, as though we are so far behind. Oops. . I'm not even sure what I meant - stupid gringo.)

After dinner we went to the 26th birthday party of one of the interns, Mario. It was a drunk fest. It was at this gorgeous house/property (their country house) - it looked like the house that the rich kid in high school had all of the parties at. Actually, the whole scene was very high school like (which makes sense, they are oh so young). It was pretty fun and funny. . there were the guys talking with the guys while their girlfriends patiently waited and conversed with each other. There was the overly enthusiastic female flirting with everyone and controlling all conversations, there were the agressive men, and there was the serious deep boy (who I ended up talking to about abortions, politics, and other light hearted topics. . in a mix between english and spanish, since his english was almost perfect). There was even the father and uncle and the little kid running around excited to be up past his bed time, but sort of bored with the whole affair. It was an awesome scene. It was good to bond with the students in a way outside of the stress of the hospital.

Buttons

This is another Pacheco story. . .

So we are doing rounds on Friday when Pacheco pulls out his palm pilot and starts playing music. He sticks it back in his pocket and we continue doing rounds listening to Queen, J-Lo, Shakira, and some other poppy stuff that I have no idea what it was.

Then he starts playing this song by The Pussy Cat Dolls and turns to me and says (in Spanish):

P: What does this mean?
Me: What, the lyrics?
P: Yes, the lyrics.
Me: (Listening) I'm not sure I can figure out what they are saying in English. (This is sort of a lie since I have realized that the lyrics are very sexual and I am trying to avoid having to translate sexual lyrics into Spanish to my attending physician).
P: Here

At which point he pulls up a copy of the lyrics and points to the chorus.

P: Just this
Me: Oh.

So this is what I see:

'I'm tellin' you to loosen up my buttons babe (Uh huh)
But you keep frontin' (Uh)
Sayin' what you gon' do to me (Uh huh)
But I ain't seen nothin' (Uh)'

In an attempt to avoid the inevitable discomfort that is going to arise when I try and explain this song's pathetic attempt at trying to create a new slang phrase for foreplay, I pull out my little notebook and start to write a literal translation. I read it to Pacheco in between patients.

Dr. Pacheco looks at me in a funny way and says,

P: But what does it really mean?

At this point I start laughing hysterically. The absurdity of the situation overcame me.

P: Don't be embarrassed.

So I compose myself.

Me: (Thinking I don't even know how to fucking say foreplay in Spanish). It's like before sex, when a man prepares a woman (yes, I did use the word prepare).
P: Like excites?
Me: Yes! Excites. . exactly. .. it's about that. But the girls are saying that their man isn't really doing that. He's just pretending (how do you explain frontin' in Spanish?). You're telling me what you will do to me, but I haven't seen you do anything yet. (at least that's what I think I said)
P: Oh.

A Bit More About Dr. Pacheco

There are some people who are just born to be good teachers. Dr. Pacheco is one of them. He is passionate about OB/GYN, he absolutely loves teaching, he is wonderful with his patients, he is a thorough, skilled clinician, he is compassionate towards his students, has an excellent, open repoire (boy I can't spell that word) with them, his students trust him and have fun during their time with him. He makes his patients comfortable through laughter. He is efficient without being careless or brusque to the patient.

An example of his greatness. . last Thursday, the mean doctor Erin was working with (who I am now working with - Dr. Juan Carlos) screamed at two students for not knowing some miniscule information and then kicked them off of his ultrasound service (a 2 week rotation). What drama and what an asshole. Of course Dr. Pacheco accepted them and counseled them and joked with them about it - and now he is teaching them about ultrasound and encouraging them to make sure they don't lose their human touch.

He has been so wonderful with me - really taken me under his wing and I am learning a lot from him. And he has been so patient with my inability to do things (like measure cervixes - although last night during my guardia I did it so many times. . woo hoo!).

I've also had great conversations with him about health care in Mexico. One of the things he is trying to battle is myths that are spread by doctors at public Health Centers throughout Mexico. For example, on Friday a 24 year-old woman came in for a check-up. She was on her 5th pregnancy, so Dr. Pacheco quickly brought up family planning and the idea of recieving a tubal ligation (they are very popular here - I think the Catholic church sees it as an ok method of contraception since conception never occurs, but that's speculation, not fact). At first she refused, but Dr. Pacheco pushed further to figure out what her reasons were. Her reasons were all based on misinformation she had received from her doctor at her health center (like you can't have sex). Although it was the end of the day and hot, Pacheco reassured her, reeducated her, and strongly encouraged her to consider the ligation (you are 24 and have 5 kids - do you really need more?). He also encouraged her to counter bad rumors about ligations when she hears about them.

Afterwords we talked about how important patient education is and how it is such a crucial part of a physician's job. When I asked him what he thought she would end up deciding, he seemed doubtful that she would decide on a ligation, but he remphasized that what was most important was the reducation and the hopeful spread of information.

Firsts

On Wednesday June 6th of 2007 I got to wash up, suit up in the purple sterile outfit, and sit in the stool in front of the baby exit for the first time. Dr. Pacheco, was there to guide my hands, tell me what to do, and basically birth the baby, since I didn't know what the fuck I was doing. But he is such an awesome teacher that he did everything while still making me feel like I was doing it (plus, he was wearing a harley davidson head cover and had his scrub sleeves rolled up like a muscle tee - really, what more can you ask for?). I helped bring 2 babies into the world on Wednesday and it was a pretty incredible, shockingly fast, and now somewhat normalized experience. Quite sadly, I have no idea what the name of the mom was, what the baby weighed, or whether it was a boy or a girl. This emphasizes the factory nature of the whole process here- the goal is to make each birth the same in it's procedure and outcome. For the first time in my life, I got to be the first person that holds the baby after it leaves the womb. And at the end of both births I stitched up the episiotamies - it was my first time stitching in human skin.

Here are some things I learned:

1) Babies are slippery little buggers, so hold on tight.
2) Babies have gumby's powers of flexibility and can withstand a lot of tugging.
3) When you cut the cord, look away, they squirt.
4) Birthing is very, very messy.
5) It really doesn't bug me as much as I thought it would to get birthing blood all over my feet, legs, and upper body.
6) Every single teacher - attending, intern, student - has their own highly successful method for birthing babies, removing the placenta, cutting episiotamies, and stitching episiotamies. Who ever is looking over your shoulder has the best method, and they are always right.
7) My adrenaline didn't kick in until the end of the second birth, which was when my hands started to shake.

Early on Thursday morning, during my Guardia shift, I delivered another baby, this one almost by myself, although, again, with some help (I haven't really figured out how to do this whole thing with only 2 hands, but I am learning).


I was very, very nervous about the whole thing, but once I was sitting in the seat, it just became a do or do situation. There was no other option, which is a huge relief, since up until I actually did it, I was somewhat convinced that I would freeze and have to come to terms with the fact that maybe medicine isn't for me. And while I still don't know what I am doing, and I am still not as competent or confident as I would like to be, I am learning (slowly) and I am getting more comfortable making decisions about what to do next. And when I actually understand what people are saying to me and why they are telling me to do certain things, I may actually be able to make the right decisions about what to do next.

Smells Like Teen Spirit and Other Mexican Variations of American Songs

Classic rock, Eighties butt rock, and American pop are all very popular among the folks I have met in Mexico (although the rock lovers avoid the pop like the plague). Which makes sense, class ic rock is good, eighties butt rock will never lose it's appeal to the cheese in all of us and, as my sister puts it, pop is like bubble gum, almost everyone secretely likes the taste of bubblegum once in a while (although no one would ever want to chew it all of the time). They hand out fliers for death metal nights at clubs here in Leon.



There was an older man in Guanajuato who wore a beret-type hat and had a warm face with a huge smile. He sang songs for money. His repretoire included the best of Tom Petty, Elton John, The Rolling Stones, and all of the other best of classic rock songs that you listened to over and over again when you were young ad didn't know about music that wasn't on the radio. The funny thing was that he sang the words as though he had memorized the way that they sound without knowing any English (like the way an American Opera singer sounds when she sings an aria in Italian, or Britney Spears when she decides to start appealing to a larger audience by singing in Spanish, a language she can't speak). Thus, although he had the appropriate tonal quality and even mood to match the songs (something I am guessing he learned from listening to the original), his phrasing was not always right, and, consequently, the emotion imbued into the song was often slightly off. It was (here's that word again) surreal. This was compounded by the fact that he varied locations and never had consistent scheduled appearances, so I would hear him early in the morning and late at night, or in the middle of the day as I walked home from class. Sometimes it felt like he was following me, playing my own personal Guanajuato soundtrack. Think The Life Aquatic and the Brazillian David Bowie.



Speaking of opera, in Reanimation Class on Tuesday, someone in the hospital started blasting opera so loudly that I swear it was over the intercom system. Think Shawshank Redemption for this one. It lasted for several hours and was a pretty awesome backdrop to reanimating the babies.



But best of all is that in Leon we live right next to a cover band that practices several days a week for several hours at a time. They are loud and, well, they are not very good. But not for lack of trying - they are so dedicated. And they are rock to the core. They are classic rock (the hard kind, not the wimpy hippy kind), eighties rock, grunge rock, and even a little bit of indy rock (I swear I heard a White Stripes song in there my first weekend here). Last week I heard a song played over and over again. The singer was doing the mimic sounds thing I talked about above and, although it was familiar, I couldn't place it.



Finally it clicked. . it was Smells Like Teen Spirit by Nirvana. . off key and out of rhythym (which may actually be a great theme song for my time here, but I will refrain from forced, bad metaphors).

The Baby Factory - Part 2

It's a small room, longer than it is wide. It's lit up by flourescent lights overhead and there are no windows to the outside, so there is no natural light. 7 metal beds, each containing a mother-to-be in labor are lined up on one of the long walls, between them is enough space to walk through. An eighth bed, empty, is pushed up against the opposite wall. Two fetal heart monitors are hooked up to the patients on either end, the volume is turned up so that there is a constant background noise of scratchy fetal heartbeats. On the far end of the room is a desk with 2 typewriters and a laptop computer on it. Scattered around the room are students, interns, nurses, and attendings (it is difficult to tell who is who), most of whom are sitting and staring absently at the women moaning and writhing on the beds. The air is stale, moist, and hot - the atmosphere is stifiling.

This is surreal redefined (I know, I know, I have overused that word. . but really, there is no otherway to describe this). This is the oddest thing I have ever seen. The disconnect between the pain the patients are experiencing and the detachment of the doctors and nurses is unsettling. I am disturbed by the absence of patient privacy and the general atmosphere of inconvenience expressed by all of the health care officials. No one knows the patients' names. No one comforts the patients through their contractions. No hands are held or brows blotted. The patients are only touched every hour when the students and interns listen to the fetal heart rate and check the cervical dilation.

This is how it works (this is somewhat graphic, so don't read if you are squemish)

1) The woman comes to the emergency room and it is determined that she is close to giving birth (this is determined by 3 cm dilation, contractions that are close together, when the water broke, etc.) For more on this, see The Baby Factory, Part 1

2) In the Emergency Room, she is told to remove all of her clothes, put on a gown, and empty her bladder. She is given an enema and then walked to the entrance of Partos (The Birth Room), where she is told to sit. When more than one woman is sitting and/or when a bed becomes available, an ER nurse pulls back the curtain to the Partos and yells for another nurse to come get the patients.

3) The patients are escorted into the room I described above, told to get into the bed, and situated so that their gown is easily lifted up. They are given an IV and told to relax (hah).

4) Once situated, a student, intern, or attending physician looks at their chart, checks their cervix, and asks if they are in pain and if they want any pain medication ( an epidural). The intern on pediatrics rotation goes through a series of questions with them. After about 20 minutes, they are left in peace.

5) Every hour, or half hour if they are close, their cervix is checked and the fetal heart rate monitored. If they are close, they are watched carefully: contractions are counted and they are told to push, push, push. Some of the more compassionate (or bored) interns sit with the patients and coach them, and coax them along, comforting them with words (although I saw none of this sort of patient care until my second night in the ER).

6) Once they have reached ten centimeters AND the head is visible, someone shouts 'Pasa en Sala' (Pass to the other room) and an orderly comes running, grabs the bed, wheels it into a connecting room, and tells the patient to quickly get onto one of two birthing beds. The other bed has stirrups that woman drapes her legs over and little handles for her to grab onto to help her push.

7) While the patient is moved to the birthing room, the student or intern quickly washes up and puts on a purple sterile gown and gloves, and then prepares a sterile field: washes the patients legs and puts on purple sterile drapes over the legs and stomach of the patient. Then the student or intern sits on the stool in front of the woman's vagina and waits.

8) Push when you have pain. Don't cry, it will hurt your baby. Don't cry, it will exhaust you. Rest when you don't have pain. Stop crying. Push harder, push, push, push. That's the dialogue. Sometimes if it's taking too long, another doctor gets up by the patient's head and pushes with all of his or her strength on the belly. Sometimes forceps are used if the baby is stuck. Episiotomies are made on every patient, as long as there is enough time (sometimes they wait so long to move the patient that they don't have enough time to cut an episiotomy. . sometimes they wait so long, or more than 2 woman are crowning at the same time, that they have to give birth in the non-birthing beds). The idea of letting birth proceed naturally is not very popular here. It is forced into a rapid event.

9) The baby is born, the cord is cut, the baby is handed off to the pediatrics intern. The placenta is birthed, and the uterus is checked for left over placenta. This is a barbaric procedure during which the doctor essentially shoves his or her entire hand into the uterus and repeat as necessary. The women groan and scream in pain. In truth, some doctors are much more gentle than others, but my first night, I was appalled by the procedure every time I saw it.

10) Finally, the episotomy is sewn up. Most of these students are not very good at sewing up the vagina and, if anyone ever put that many stitches with that little concern in my nether-regions, I'd be pretty damn upset. But I guess it's gotta get done, and I guess they have to learn. Human rights, let alone patient rights, aren't really the most important thing in this hospital at 3:00 in the morning. Really, most of the overworked, absolutely exhausted interns are just hoping that they can get through a birth without complications and without making any serious mistakes. The stitching up takes about 45 minutes and the woman is exhausted. She is allowed to briefly see her baby (The doctor holds the baby up and says in a very monotone voice, 'This is your baby boy/girl. Give him/her a little kiss. You will see him/her soon after you are finished here and have been given some time to rest. Congratulations.') Upon finishing, the doctor washes the woman off, lowers her gown, stretches her legs out, and leaves her to be retrieved by the orderly (which sometimes takes 20 or 30 minutes. . depending on when a bed is available).

11) If there is room, the patients are moved to the main floor where they stay for 8 hours. If there is no room (which is more common), they are moved to a room inbetween the birthing room and the OR.

And that's the baby factory. . .something like 40 births a day. . on my first night I witnessed at least 7 or 8, not including the c sections that occured through out the night - but I will cover that later.

Reanimating Babies, Companero

Trial by fire, thrown into the deep end, cross your fingers and hope for the best.

It was crazy. If I thought that before was crazy or surreal, I was wrong, so very, very wrong. Monday was my first Guardia - my first overnight shift (8 in the morning until 3 the next day - that's oh so many hours). It was baby-mania, it was doppler machines beeping, it was women screaming, it was hot, it was flourescent lights, it was so completely foreign.

But I get ahead of myself. The funniest (and sometimes most frustrating) thing about this experience has been the total confusion Erin and I have been in regarding our schedule. No one seems to know when we are supposed to be doing what. So I am all suited up to follow Dr. Pacheco into surgery when Dr. Allyson (the Director of Education) comes running into the 'OR' to tell me that I have to go to class. (The following was in Spanish, although really it's more like have Spanish/half English. Because Dr. Allyson is to most confusing person to understand. . she speaks fast and then when we don't understand her, she decides to speak in English, which we really don't understand).

Dr. Allyson: 'You have to go to class. Why aren't you in class right now?'
Me: 'What class? What do you mean class? I didn't know that there was a class for me to go to.' (That was what I tried to say, it probably sounded more like. . Class me what go for why?)
Dr. Allyson: 'Baby Reanimation.'
Me: 'Baby what?'
Dr. Allyson: 'Reanimation Neonatal. . .it's important.'
Me: Oh, of course.

And so I went to the class where the babies are reanimated. Or, as we call it in the states, Neonatal Advanced Life Support, which is a much clunkier, much less descriptive name. And at first I was thinking, why I am I here, how am I going to understand a damn thing that will be taught in this class. But actually, it was the most peaceful, relaxing, ego-boosting time I've had since I have gotten here. I could understand most everything the teacher said, I could read the powerpoints, Erin and I took the tests in Spanish together and passed all but 2 of them (which is more than 70%), we successfully completed the practicals. We were in a situation where the people we were with knew as little as we did. One of the medical students was so nervous that when he was going through one of the practicals and asking for assistance, he looked at the teacher and said, 'Companero, por favor, ayudame.' That's equivalent to saying, 'Partner (Friend, Coworker), Please help me.' That may not seem that funny to you, but it was pretty hilarious at the time. It was so great to feel so relaxed again and so in control.

But that was short lived.

3:00 came and I changed into my Scrubs, bid Erin farewell, and slowly walked towards Partos, the room where Guardia is served, the room of the births. . . the heart of the baby factory

Dinner with a Doc

The doctor I am following around (Dr. Pacheko) invited me to dinner at his house (of course I said yes, what was I going to say. . I have other plans. .like what Jessie, well, like hitting my head against a wall).

This might classify as the most surreal thing I have done here so far.
Going to anyone's house anywhere is always a fascinating experience because you see this very personal side of them that they may or may not mean to show you. It's even more revealing when you see the rest of their family. I think this is amplified when you go to someone's house in another country.

So he and his wife Nancy (who is a pediatrician) and their adorable 6 year old son Eric all live in this strange, strange gated community composed of pre-fab condos painted white, tan, and a muted yellow. It's suburbia in Mexico. . except it feels like Little America. Little postage stamp sized back yards, well trimmed front yards, children roller skating down the street, incomplete fences dividing property lines. The inside of their house is pristine. White furniture covered in plastic, lots of ceramic and crystal statuetes of deer, elk, angels, and ballerinas (for those of you who know, think Grandma Betty), a painting of Davinci's The Last Supper on the wall, the t.v on in the kitchen.


Nancy cooks (of course), although Dr. Pacheko does set the table and futz with the salt shakers. The food is delicious (chicken with a picante sauce, rice, beans, desert is blackberry and cheese icecream). We talked about medicine and families. . we take small talk to a new level. We talked briefly about why I wanted to go into medicine (especially after studying history and literature. . I am not very good at explaining our system of education in the states. . the system here is so very different). I talked about change and wanting to change things, and he gave me a look of, oh you silly naive thing, saying that trying to change anything is frustrating, especially when your superiors are so stupid. We then talked about Bush and the wall on the border. Every once in a while their son would come downstairs and come over to me and say (in English), 'I am ice cream' (he is in a bilingual school) or 'I am cookie'. . (translation. . I want some ice cream, I want a cookie). So awesome.

After dinner he brought down photos of his family vacations (at this point I really do feel like I am in Middle America, except everyone is speaking Spanish - again, a B line surreal movie). And then he proceeds to ask me about the cost of everything in America. How much does a car cost? How much does a taxi cost? Does everyone in New York take taxis? Is it cheaper to live in New Jersey? How much does it cost to fly from San Francisco to Washington DC? What about to London? How long of a drive is it from Seattle to San Francisco? How much does it cost for kids to go to the camp that you will work at? How much does it cost to go to medical school?

And on, and on, and on. What is so heartbreaking is that they both work a lot (he works M-F, she works three nights a week in Guanajuato at night) and yet, they both clearly feel like they are not doing all of the things they want to do, that they are not making enough money to be living this new Mexican (American) Dream. The American Dream of Suburbia has filtered down across the border into Mexico, but in a rather distorted way (it reminds me of those wavy mirrors at the carnival). It's the classic case of Keeping up with the Jones's (although it's not clear if the Jones's are actually still Jones's or if they are Rivera's or Munoz's). Why is it always the shit of our country that gets exported? Coke, processed food, fast food, suburbia, plastic, pollution, bad tv shows, etc (the list is long). We do have wonderful things in the USA, but we don't do a very good job of sharing them with the rest of the world.

The Baby Factory (Part 1)

I am currently working in a baby factory, not a hospital.
It's amazing, I've never seen so many pregnant women in one place in my life.

They don't even come to this hospital (El Materno-Infantil) until about 2 or 3 weeks before their estimated due date (4 if something might be complicated). All of their OB checkups are done at other smaller hospitals (Centros de Salud).

My first day I worked in the emergency part of the hospital. This is sort of like the distribution center of the factory. The appointments are quick (5 to 10 minutes, after waiting for many hours), there are 3 or 4 women in the same room with their legs spread and cervixes being examined. They are told to come to emergency if they think their baby has stopped moving, if they have severe pain anywhere, if they are experiencing contractions, if their water has broken, etc.

The two questions to answer are: are they ready to give birth or not? Is there an emergency or not? If their cervix is dilated to 4 or 5cm, they are sent to the birthing area of the hospital (I have yet to be inducted into this area). Sometimes they are scheduled for a c-section, if it's felt that it may be an emergency situation. If they are less than 4 or 5 cm dilated, they are classified as non-emergency and they are sent to walk for a few hours, less than 2, they are sent home. It's fast paced, get the job done, no nonsense.

My second day, we first did rounds on many of the patients that we had sent to the birthing center. They now had babies with them and had that exhausted tranquility that surrounds a brand new mother. They get sent home after 8 hours (if there are no problems).

We rounded on one patient who had had a C-section in April, but had returned with a bad infection. Although I'm not completely sure if this is what happened (that whole language thing again), I think that a gauze pad was left inside of her during the surgery. Good to know that it happens here as well as in the states.

On a side note, the future doctors here are so young. . 18, 19, 20. . .crazy.

The rest of my second day was spent doing external consulations. This was similar to the ER, but the appointments were longer, and patients were coming in for a 38+ week check up or because they were having some sort of problem. For most it was just reassurance, for a few it was a referral, and for one it was an immediate C-section - she was not very happy.

And that's the baby factory. . or what I know of it so far.

Hardness

I think I am currently immersed in the hardest thing I have ever done.

It may be slightly premature to say that, because I do start clinical rotations in a year, and I may find surgery, neurology, or internal medicine more daunting and demoralizing, but those will be in in English, and right now, I'd take neurosurgery in English over birthing babies in Spanish.

I thought I was at that level in Spanish where I could pretty much undestand everything that was said to and around me. Really, I'm not, it's just that people have been speaking slowly to me and using simple words. When I'm truly on, I'm getting about 75 to 80% of what is said about a patient. As the day goes on and I get more tired, that number decreases rapidly in an inverse exponential curve, or something mathematical like that. Plus it's medical Spanish, and I don't even know what the English equivalent means, plus all of the abbreviations. The most humiliating part of it all is that I can usually follow conversations around me, but the minute that someone says something directly to me, or asks me a question, my brain turns to porridge and I can't understand what they said to me and answering the question is damn near impossible. Any grammar that I learned in Guanajuato has fled from my Spanish repretoire. . it's total surrvival mode now. Sentences like. . I go here, I from USA, Tomorrow I (she) went fishing, no, eating. I've regressed to a 2 year old, and even 2 year olds speak better than I do.

Humbling, that's what this experience is. In so many million ways. For example, I have never been so underprepared (unprepared) for an experience in my life. I barely know what a cervix is, I certainly can't find one, and I'm still not sure if what I am feeling in a mom-to-be's belly is a head or an ass. Meanwhile there are 20 y/o students taking the lead on complicated births. I have lots of reading to do this weekend.

On a cool note, I have learned how to find a baby's heartbeat with a thing that looks like hourglass and basically functions like a cup against a wall - dopplers be damned.

They do 36 hour shifts every few days here. I am not capable of that. I might be able to pull a 36 hour shift in English, maybe once a week (ok, maybe twice). But in Spanish, every few days, I think I might die. My brain has to work 3 times as hard when it's thinking in another language such that, by the time I come home, I just lie on my bed and cry (dramatic, I know) - mainly because I think that's the only thing my brain has any energy left to do. They had me scheduled for a 36 hour shift on Monday and then on Wednesday, and my advisor came in and said, no, no, no, that's just too much for you. . you Americans just aren't trained for that like we are here. As much as I'd like to prove to him that I'm not soft and wimpy and whiny like other Americans, I wasn't about to argue with him.

And although I finally got what I wanted - to be in a city with absolutely no tourists - I am finding myself desperate to speak English again. I know that it's just a product of the loneliness one feels when they are in a new place (any new place) and all alone. I will meet people and I will make friends, that just takes a little bit of time. I'm actually surprised at how unfriendly/unwelcoming many of the medical students have been, but I guess just like medical students all over the world, they are selfish with what little time they have, which in Mexico appears to be even less than in other places. Besides, I have too much studying to do to be all social n' shit.

On the plus side, the doctor I am following is incredibly patient with me and great with his patients. He is passionate about teaching and I think he finds me entertaining. I have felt and measured correctly a few cervixes, measured bellies, felt a fetal head, foot, and butt, and heard the fetal heartbeat several times. On Monday, it's c-section time. . .and then it's on to birthing bouncing babies.

Thanks for attending my pity party.
Here's hoping that this is probably the low point of my time here. The opposite of the honeymoon phase.

A Nada Entry

So I know it has been several days since I have written, but nothing truly unique and exciting has happened. Or a lot of really cool stuff has happened, but sometimes it gets hard to say anything when there is so much to say (imagine that from me).

This is a nothing entry because I really have nothing to say. I am off to Leon tonight. . I start my internship tomorrow morning. I am titilating (that word is so incredibly mispelled that I can't even blame the keyboard) with excitement and nervousness. . .so nervous. I swear my Spanish is worse today than it was when I entered the country. It's like now I am aware of all of the mistakes that I am making. .before I just made them cluelessly. Sigh. . I just keep reminding myself that fluency is a journey rather than a destination. . I'm not really sure what it means, but it's poetic in a cheesy way and it makes me feel better. Now instead of just stringing together several random words in random tenses, I stop and start my sentances over and over again, repeat a verb in 5 different tenses (preterite, imperfect, wait, no, conditional, or maybe this is where I use the subjuntive), stutter through long words and then hit my head against the table in a feeble attempt to convey that I know what I said was about as intelligable as the squeaks of a dolphin. Trying to learn another language is truly a form of masichism. And then yesterday in walks a Czech girl living in the states who is fluent in English, Czech, and can understand about 6 other languages. And her Spanish is far superior to mine and she has only been studying it since January. . .she takes the occasional class, listens to the radio, and reads. Some people just have the gift. . and yes, I am jealous of them.

I have people that I have to go say Adios to. It's amazing how you run in to the most incredible people when you travel, but more on that later.

Comentario (Chapter 4)

So that was my night on the town. It was a blast - so much activity and excitement. Still, I'm just not sure I am cut out to do it every night, or really any more than once in a while, and I am pretty sure that means that I am old. But I am ok with that, because I like daylight.

That said, I think I'd be up for it at least once more before I leave this town.

Another totally unrelated comment on the nature of tourist towns. The interaction between tourists and locals is fascinating. Locals become excellent at remaining detatched while making each tourist feel unique and special, as though they are the only tourist that they have ever talked with, danced with, felt like this about, hooked up with. The more naive tourists become excellent in snowing themselves - they convince themselves that we are unique, they are different than the tourists that were here a week ago, they are forming some sort of deep relationship. For the most part, no one really steps out of their roles. Some completely disengage and observe cynically from the side. Others (probably like myself) only half engage, casually participating without wanting (or expecting) any follow through, occasionally stepping away to observe cynically, but still reluctant to completely walk away from a possibility (sort of like agnostisim)

Both sides use each other - it is a thinly veiled contract. And yet, it amazes me (is wonderful) how many people really, truly believe that their situation is different. And, to be fair, ccasionally meaningful relationships are formed, but the reality is that is difficult to do in a town that people are constantly filtering through It's a lot of hope, I guess.

En Finalamente (Chapter 3)

But no, our night was not over. . .from here we went to another bar (La Dama de Las Camelias) and my companions had more beers, I ordered water (by this time I had stopped. . actually I had stopped a while ago. . apparently I am a lightweight now a days. . .interestingly, one of my teachers told me that the difference between an average party night and a special party night is 20 and 40 beers. . that's a lot of beer, either way).

This bar (an afterbar) had a Cuban feel and the music was a little slower and the dancing a little less intimidating. Unfortunately, we were pretty much done with the dancing. We just talked and joked and watched one of our companions (Esme) sink into a fairly drunken stupor. By the way, the cast of characters is: Rolando, Luis, Esme, Sarah, Me, Laura, and Meme (the latter two left earlier).

It was great. By the end of the night strangers were engaging in other stranger's conversations and no one could really say anything straight. I couldn't understand a damn conversation I was evesdropping on, but I'm pretty sure it was not due to my Spanish comprehension level. I overheard one conversation that went like this:

Hable?
Hables. .
Habla?
Hables, hables. .
Si. . Hables?
Hables, hables, hables, hables.

I'm not joking. It was awesome.

The most surreal part of the night was when a gringo our age dressed in hip-hop type clothing (big baseball hat, big, low-riding pants, jersey) kneeled down to our level (by this time we were all sitting/squatting on the floor) and started begging a ciggarete off of Esme and Luis, in excellent Spanish. And then he started talking to Sarah and apparently they are both from the same town in Colorado. . and he's been here for three years. That was when I started looking for the video cameras, because it was so strange, so very very strange.

Just Like The Wind (Chapter 2)

Oh those who can dance, how I envy you. You move your high heels to the rhythym, your hands always know where to go. Your arms, nothing like the wet spaghetti so dreaded by Patrick Swayze. You spin, again, again, again, and eight more times, never once stumbling from diziness. You relinquish control of decision making, and yet, you are not a passive lump of clay. You are active, engaged, filled with passion and expression.

Okay. . I'll put that out of it's misery. . forgive my attempt at being poetic. . while it's not early, I went to bed late.

Point being, there are some people here in this town who can dance, Mexicans and gringas and Japanese alike. The grinding and booty shaking that people do all over the world, that's not as hard as I once thought it was. Ballroom dancing, salsa. . that's a challenge.

We had some great conversations at the Cuba Mia (the Salsa Bar) last night. . mostly in Spanish, occasionally in English. We talked politics, we talked about how to tell people from different countries apart, we talked beer. And then some of our other teachers came into the bar and we went to join them. This is when the music got loud, the talking stopped, and the dancing started. So we all danced a little, but mostly we watched the almost professionals. There were about 6 or 7 people who I was just enamored with. They all kept switching around with each other (I think several of them teach salsa at this place). It was awesome too, since the guys even danced with the guys. . which were probably the best dances of the night. They were imaginative yet controlled. I really did feel like I was watching Dirty Dancing.

And speaking of Dirty Dancing, at one point during the night, I made eyes with one of the 'professionals' (as I like to call them). We exchanged smiles and, just as my group was getting ready to leave (at like, oh 3:30), he came up and asked me to dance. We danced. . well, he danced and I stumbled. But he was a good teacher, good at controling my direction, good at helping me feel the music, good at not letting me leave to join my group, and by our third dance, I think I was feeling it a little more. He was not modest, he knew he was amazing. I felt like this lump of clay that he was molding. . . I felt like his project. This was all augmented by his not so subtle attempts to charm me: he would not speak to me in Spanish, he tried to figure out how long I was in town, he tried to make me feel special (just like I'm sure he did to the girl who was here last week). It was not important that he was almost certainly gay. It was a harmless game and I was loving it. So after two and a half glorious dances, my friends finally came up to get me and I was reluctantly pulled out of my eighties fantasy. Just call me Baby.

Roma (Chapter 1)

So last night I did the whole when in Rome thing. Or, as they say here, 'Al lugar donde vayas, hay lo que veas.' For those of you that know about my tendency to hear the stroke of midnight and say, 'wow, I am up so, so, so late,' be proud, be very proud. I stayed up until 5:30 last night. Or 5:30 in the morning, whichever you prefer or whichever sounds more impressive. That's the thing to do here. Stay up really late, drink a lot, dance a lot, stumble home a lot. It pretty much happens every night of the week. Before coming here, I thought I knew what a party town was. I didn't. I now know that a party town is a town where there is no distinction between the type of party that one finds on Monday and the type of party that one finds on Saturday. Every night is packed with activity, every night is a rager, every night is fun, fun, fun.



I find this slightly disconcerting, being from the old school way of thinking of Friday, Saturday, and if you're really crazy, Wednesday or Thursday are party days (each with a slightly different feel). How does one tell the difference between days? What does one look forward to? When do you ever have the chance to rest? How do you tell if someone is a real party animal, totally wild and crazy, or just a poser? I asked this of my fellow party-goers last night (I'll get to them in a second) and, apparently, there is a slight increase in the intensity of partying on Thursday because many students go home on Friday for the Weekend. For some reason, I find this very comforting. . .I think it's a sign that I am getting old (more on that later too).

Today several of my teachers don't have to work. In their contract, they get holidays off and a while back they didn't get Semana Santa off, so they took a make-up day today. We students benefited greatly from this decision. Our teachers decided to party last night as though they did not have work today, and they were kind enough to invite us along. First we went to a bar, then we went to another bar, and then we went to a Salsa bar. It was here that I realized that I am actually very inept at dancing (I had previously thought that I could sort of hold my own on a dance floor. . I was a fool).

Plans that don't always work

My stomach has been acting up since I got here. . .perhaps even before I got here.
It was pissing me off, and I was getting tired of having a low grade ickiness underlying everthing I do. Granted, having to deal with stomach stuff is the burden every traveller must bear. In truth, it is a small price to pay.

But still, two days ago, I decided that I was going to beat my stomach into submission. The plan was this. . I would eat street food, I would eat meat, I would have juice. . all of the things that a careful, health conscious traveller is not supposed to do, but all of the things that make being in another country worthwhile.

Perhaps this was a mistake.

For a day and a half, things were going splendidly. But then, my stomach fought back with a vengance. I will spare you the details, but it's been a while since I have eaten. I had a little this morning, but I have retreated back to rice cakes, peanut butter, and water. So my stomach has bested me this round. But I am not defeated. I will return twice as strong (and twice as stupid). I will survive to, once again, eat all of the street food that I desire. Ice cream, juice, ceviche. . .it will all be mine, I will live to tell the day.

But for now, I shy away from the light and crawl back into the darkness of my room.

Besame, mime, besame

So on top of all of the other things going on in this city, for the last two nights there has been a mime performing in front of the steps of the Teatro Juarez. All the children gather on the step and giggle uncontrollably at the antics of the mime. The adults gather behind the mime and giggle a little more controllably at the antics of the mime.

I was one of those adults and one of the only gringas around and apparently the mime noticed me because as I ventured off for home he started to walk beside me. He held out his hand, so like a good prop, I put my hand in his. He walked with me for a little bit while the children shouted 'Besale, Besale' (Kiss her). So he pulled me toward him and leaned into to kiss me. I thought, I'll be clever and give him my cheek, which he kissed. Then he turned and asked for a kiss back. So I obliged and he turned his head and our lips met. . . everyone laughed and laughed.

I fell for the oldest trick in the book, and like a tourist, I was kissed by my very first mime (sorry, terrible, terrible reference).

Mayo

May is a great month to be in Guanajuato. The entire month is dedicated to the celebration of the Basilica Colegiata de Nuestra Senora de Guanajuato, the very large Churrigueresque style church built in 1693. There are parades and demonstrations practically every night. Tonight right outside my home away from home a massive procession passed by. First there were about seventy-six trombones, 110 clarinets right behind, they were followed by rows and rows of the finest virtuos. Oh wait, wrong parade. Sorry. .. and that's a joke that probably three of you got.

Back to the parade. . .there really were rows and rows of people playing drums and blowing horns - every single arm of the military was represented. The cutest part was that each group had little toddlers playing little drums and little horns. They were followed by dancing, whip-cracking children dressed up as cows and cowboys and señoras and evil men. It's part of a torredor celebration, which I still haven't really learned about (no one really seemed to know why it is performed). Behind them were people dressed in what appeared to be traditional indigenous clothing - feather headresses and beaded tunics - they were performing these beautiful dances to very rhythmic drumming. After them followed children dressed as angels carrying candles (the cutest thing here was one kid who had fallen asleep and was being carried by his mom). After that, a huge float of flowers and the Virgin Mary being carried on the shoulders of over a dozen men. A very long electrical cord provided the light for the float. And they were followed by a Mariachi band.

Not too bad for a Sunday night in May.

And tonight. . Monday night. . . a huge parade of taxis. Oh yes, over a hundred green and white taxis with balloons and Religious figures on the roofs. . .the taxis are filled with what I would assume is the family of the taxi driver and children lined up on the streets to catch the candy that they are throwing out of the windows.

Wow. . .will the amazements never cease??

Ups and Downs

This town is filled with winding streets (callejoneadas) that take you far above the city. They are mostly made of stone and at times there are stairs. They narrow and the buildings crowd above you. And then they widen and you can see an expanisve view of the city below and the brightly colored buildings crawling up the opposite side of the valley. And just as you start to think, well, I guess I'd better turn around cause I don't know where the hell I am, the callejoneada runs into a major street, or it takes a sharp turn downhill, and suddenly you are oriented. They are wonderful for absent-minded wandering and for a moment of peace; walk up a side street for 50 feet and, compared to the craziness of el centro, you have entered a ghost town. And if you get lost? Just go downhill.

Boom Crash Bach

There are certain types of weather that go with certain types of music. For example, Reggae calls for a hot summer day. Bluegrass reminds me of early spring mornings. Classic rock begs for driving during a brisk, windy fall day. And organ music? Well, organ music needs lightining and thunder and rain.

So here's the setting. A big cathedralesque church called Templo de Campañia. It was built in 1765 by the Jesuits, the exterior is Churrigueresque and the interior has a simple beauty to it. It's one of the sites of the annual Guillermo Pinto Reyes international week+ long festival that occurs here. Mass ends, pews are moved, darkness falls, lights are dimmed, and out walks a man with white, shoulder-length hair. He bends over the balcony in a low bow (the organ is on the upper floor, we watch him play via a projection onto a screen). He's dressed in black, which is undoubtedly the most appropriate color for a man with white long hair who plays the organ. He gives off an air of mild insanity, which, again, is the most appropriate state of being for a man dressed in black with white long hair, who plays the organ. The organ itself is a sort-of mad man instrument. The chords and blurred sound and sheer size of the instrument conjur this image of a tortured soul hunched over the keyboard in the dark of night in an echoing church.

His name was José Suárez. He was quite good. Or at least I think he was quite good, he is very accomplished, so others seem to think that he is very good as well. In truth, this was my first organ concert ever and really the only other person I knew who played the organ was my Grandma Betty and I don't think she was very good.

But the concert was so much more than his playing. About halfway through his 4th piece, a low, rolling thunder could be heard. An occasional flash could be seen through the windows. It gathered in a slow crescendo, only to climax during his last piece, which was, by far his best (Fantasía y fuga en la menor BWV 561 by Bach). It was quite a spectacular finale and I'm not sure I will ever be able to attend another organ concert unless it is accompanied by lightining and thunder.

Backstreet Boys at the Rodeo

This was fun.
Last night I went out with my teacher to a concert. We had to take a taxi to get there, it was far away. A bit further than I thought it was going to be since I thought it was going to be within walking distance. It was so far away that I thought, 'Where the fuck are we going?' (btw. . I apologize if swearing offends you, it's just I never really got over the novelty of swear words and, well, I use them when I talk, so I'll use them when I write. . if it really bugs you, you can email me with the reasons why and I'll consider no longer using them). It was so far that I started to get a little nervous, which is probably an appropriate feeling for me to have, being a girl in a strange land with a somewhat strange man. Plus, he didn't know where we were going, the taxi driver didn't know where we were going, and I certainly didn't know where we were going. There was a bit of confusion for a while.

But after stopping to ask for directions, we pulled into a big outdoor concert place. I think it might have been where they have rodeos and such, I'm not sure. It was a dirt floor, there was lots of wind, and there were lots of bright, colorful lights. We were some of the first people there, but the first band was already playing. They separated girls from boys, women from men, inspected our things, and let us in.

The teacher I was with (I´ll call him Rolando, since that's his name) told me that it was a poppy twist on traditional Mexican beats and songs. I asked him if he liked it and he said 'No, well, sort of, it's ok. . it's fun to dance to.' And he was right, it didn't move me deep down in my soul, but it was fun, catchy, and very dancable in that 'Shit I don't really know how to dance to this' kind of way. There were several bands. . one band even played 'In the Summertime' in Spanish. It's much better in Spanish.

The bands on stage danced and had great voices and there was a lot of synthesizer, fog machines were everywhere, several drum machines, lots of cowboy hats, a very short skirt and a pair of shiny green leather pants. And they have this brilliant idea of having two stages on opposite ends of the concert arena so that, when the openers are done, the main band doesn't have to spend all of this time setting up, the audience just turns around.

It was great people watching. It was exactly like a middle school dance or going to the amusment park in middle school, or what a backstreet boys concert would be like, although I never went to one (I swear). Lots of screaming and swooning for the band (especially this one band dressed in matching white suits), lots of flirting, lots of whispering and boys asking girls to dance and then the dance and then each gender running to their friends to giggle and whisper more. Ahh. . young love. . .I definitely felt a little old, although later on in the evening older couples started coming, and that made me feel less old.

When the band dressed in white played, they invited all of the ladies to come up, and all of the ladies came up and filed through, first giving the singer, then the guitarist, then the keyboardist a kiss, sometimes on the cheek, sometimes on the mouth. And the band didn't miss a beat. I was very impressed.

The main band wasn't playing until like 2 or 3 and the third band was a sleeper, and I'm old, so we went home. And that's the end of this story. No great revelations or anything, but it was a good time.

The Obligatory Introductory Blog Entry

Yup, I'm here.
And now you are reading about me being here.
'Where is here?,' you ask. Here is Gunajuato, Mexico for 2 weeks (to frantically improve my Spanish), and then here will be Leon, Mexico for 4 weeks (where I will use that frantically improved Spanish to frantically do a clinical internship through the medical school here).

So first off, just so I get this out of the way, I apologize for any typos, mis-use of punctuation, misspellings, and, what the hell, poor grammar. Surprise, surprise, I am using a Spanish keyboard and, lucky for me, I get to blame it for every mistake I make while typing this blog.

This is my second ever attempt at a travel blog, except this time I am using a new format - a blog blog instead of a travel blog. The travel blog was sort of a blog with training wheels - it helped me figure out titles, provided me with maps, and held my hand in case I decided to upload pictures. Now, although I have no new qualifications to merit this, I have graduated myself. This is partly because, in my dream world, I imagine myself transforming this travel blog into a blog blog. I like to imagine that in the coming years, I will write very witty, insightful things that will change the world (slowly at first, of course, but eventually, they will lead to a massive revolution the result of which will cause world peace, eliminate poverty, and make the skies turn a nice shade of purple). But right now I'm just hoping that I will be able to do things like upload purty pictures and provide you with links to maps of places without any assistance.

Because my attention span hates it when people have really long blog entries, I am going to try and keep them short. Now, those of you that know me (which is probably all of you) know that my definition of short is slightly different than the dictionary definition (in that I see myself as tall and I tend to write incredibly brief emails, and, for the most part, I don´t talk very much). So, in order to conform to other people's standards of short, I sometimes may sporadically cut a story off only to continue it in the next entry. It may be a little confusing because blog entries are listed with the most recent one first, but I think it will be fun, like little chapters of a story. And if you don't like it, well, consider it tough love. Or you could just stop reading.

I will try and proofread.

And with that, time for a new entry.