This one is actually from today.
Unless you are watching Gray’s Anatomy, doctors on TV are presented as calm, cool, and collected. They don’t have outbursts. They discuss issues with their patients quietly behind closed doors. They mask their emotions. But they are just doctors on TV.
At the end of last quarter our ICM small group leader, a real doctor, told us a very funny story about how after much time, she finally let a problem patient have it saying, “I can’t stand you!” While she was saying it, she couldn’t believe she was doing so but, amazingly enough, it was all for the good—it put her in a better position to negotiate with the problem patient who continued to come to see her after all that.
Today I had my first outburst. The clinic in general was a little crazy. Dr. Salvatierra seemed moody and was sending Rosa (the nurse) off for things he could easily do himself. Rosa was mad at Dr. Salvatierra because he told her she couldn’t go to a staff meeting (because there was no replacement for her) so she was slamming doors. They had an argument in front of a patient. Etcetera, etcera…
And after all that, as I was walking to the lab to see if there was anything interesting to see, I started hearing catcalls. “Hola guapa.” I looked over and saw a boy with his arm folded up at the elbow (he had just had blood drawn apparently), smiling, and I wondered if I knew him because surely that must’ve been a joke. There was nothing to see at the lab except the completely overwhelmed lab tech who was left behind while the other 2 were at the meeting so I went back down to Dr. Salvatierra’s office. “Ey guapa,” I heard again, but this time from a different boy, sitting next to the original catcaller, arm folded at the elbow and smiling as well.
I was still processing the fact that I was getting catcalls. At the clinic. While wearing my white coat that identified me as a medical student and, therefore, someone who was obviously at the clinic for educational or work purposes. And I decided that that just was not okay. So I went back out and asked the boys if I knew them. Their jaws dropped. “Oh, you didn’t know that I speak Spanish?” I asked and then went on to tell them, “Well do me the favor of treating me with a little respect while I am working. It is one thing to deal with catcalls while I am walking down the street but to have to deal with that while I’m at work?! It’s people like you who make Peru look bad.”
After my little diatribe and the boys’ immediate apologies, I looked over at the sex workers who I had just examined sitting a little ways down. They looked a little in awe at the unexpected outburst and seeing them made me wonder whether I should’ve asked the boys into the office and let them have without the other patients being present. But then I decided that that is the nice thing about my still being a young and naïve medical student—maybe it was wrong to lose my cool, maybe a bit unprofessional, but it felt damn good.
Tuesday, July 17, 2007
What I can give
Monday, July 9, 2007
Another entry from my journal. This one is from July 6th. And the experience I wrote about just made me reflect on how nice it is that across cultures we have some commonalities that allow us to do small acts of kindness. In this case, as a woman, I was able to put myself in my patient's shoes...
Today Hollie and I were taking care of the vaginal fluid specimens again. The doctor, slightly distracted, was in and out of the room and Rosita, the nurse, supervised and instructed us. During one of my turns doing taking vaginal fluid samples, I began to look around the patient’s labia and anal sphincter for any lesions, warts, or ulcers as I do with every exam. Although I’ve seen several ulcers and warts already, for the most part they are usually under control. However on this patient, I found warts on her vaginal walls, one huge one on her labia as well as several other smaller ones, and some around her anus. I showed them to the doctor and then began inserting speculum, which (of course) hurt since the patient was a community person who was not used to these exams and so was not relaxed and because the lubricant-less speculum was rubbing against her warts.
I completed my exam as delicately as possible and as I was withdrawing the speculum, the nurse and I noticed that the patient had some bleeding around her labia. We decided to call the doctor to make sure it wasn’t an ulcer, but the doctor was nowhere to be found. So for several minutes my patient waited, laying on an examining table, with her legs in stirrups, and her body exposed to Hollie, the nurse, and myself who kept coming in and out of the curtained area. At one point I looked over at the patient and she looked as though she was going to cry and I felt for her. I pictured myself in her shoes, just being told I have an STI I know nothing about, laying in an uncomfortable position exposed to everyone who walks past, and I desperately wished that we used drapes at Barton. In the absence of that, I closed the curtain more and asked Hollie to come out from the curtained area. Then I decided to tell the patient that she could sit up until the doctor returned if she wished to.
The doctor was finally found and he determined that the bleeding was from abrasion to one of the warts, not an ulcer, and the patient was sent on her way. And I was left with a lot to reflect on. On the one hand, I had the initial excitement today of feeling like a medical professional. I saw a patient, I diagnosed her, and I gave her treatment (I put ointment on her warts). But on the other hand, I think the best service I did to that young woman today was just putting myself in her place and helping her to be comfortable.In my travels before and now I have always been very aware that I will be taking much much more from my experience than what I am able to give. But today it felt really nice to be able to give through such a simple act.
Another entry from my journal. This one is from July 6th. And the experience I wrote about just made me reflect on how nice it is that across cultures we have some commonalities that allow us to do small acts of kindness. In this case, as a woman, I was able to put myself in my patient's shoes...
Today Hollie and I were taking care of the vaginal fluid specimens again. The doctor, slightly distracted, was in and out of the room and Rosita, the nurse, supervised and instructed us. During one of my turns doing taking vaginal fluid samples, I began to look around the patient’s labia and anal sphincter for any lesions, warts, or ulcers as I do with every exam. Although I’ve seen several ulcers and warts already, for the most part they are usually under control. However on this patient, I found warts on her vaginal walls, one huge one on her labia as well as several other smaller ones, and some around her anus. I showed them to the doctor and then began inserting speculum, which (of course) hurt since the patient was a community person who was not used to these exams and so was not relaxed and because the lubricant-less speculum was rubbing against her warts.
I completed my exam as delicately as possible and as I was withdrawing the speculum, the nurse and I noticed that the patient had some bleeding around her labia. We decided to call the doctor to make sure it wasn’t an ulcer, but the doctor was nowhere to be found. So for several minutes my patient waited, laying on an examining table, with her legs in stirrups, and her body exposed to Hollie, the nurse, and myself who kept coming in and out of the curtained area. At one point I looked over at the patient and she looked as though she was going to cry and I felt for her. I pictured myself in her shoes, just being told I have an STI I know nothing about, laying in an uncomfortable position exposed to everyone who walks past, and I desperately wished that we used drapes at Barton. In the absence of that, I closed the curtain more and asked Hollie to come out from the curtained area. Then I decided to tell the patient that she could sit up until the doctor returned if she wished to.
The doctor was finally found and he determined that the bleeding was from abrasion to one of the warts, not an ulcer, and the patient was sent on her way. And I was left with a lot to reflect on. On the one hand, I had the initial excitement today of feeling like a medical professional. I saw a patient, I diagnosed her, and I gave her treatment (I put ointment on her warts). But on the other hand, I think the best service I did to that young woman today was just putting myself in her place and helping her to be comfortable.In my travels before and now I have always been very aware that I will be taking much much more from my experience than what I am able to give. But today it felt really nice to be able to give through such a simple act.
About a little old woman
Monday, June 25, 2007
The following is the most recent of my required journal entries for IHOP:
On Friday, we packed our bags, sadly said goodbye to Iquitos, and boarded a plane to Lima or the big dirty city as I like to call it. In Lima, we had arranged to rent an apartment in the Miraflores area, considered to be one of the safest areas in Lima and therefore recommended to us foreigners. Normally I don’t get to wound up about what the US Embassy and other expats recommend as far as safety but this time I decided that since I need to have my computer with me and since it’s my summer, I might as well live it up in the opulence of Miraflores.
Our apartment is small but beautiful by anyone’s standards. It is on the main avenue of Miraflores, a couple of blocks from the supermarket and from a gym that rivals many gyms in the US and where we will be exercising during the week. All these newfound comforts suddenly hit me yesterday in a taxi after a long day of walking and shopping (because “it’s so cheap!” as we often exclaim) when I was mentally calculating how much I’ve spent in the last few weeks and how much that same money might mean to some of the patients that we saw back in Iquitos. One patient that continues returning to my mind was an elderly woman that we saw at the hospital who had a melanoma that was gradually taking over her nose. “You need to go to Lima,” the doctor told her, while explaining to us that there are no oncologists in Iquitos. “You need to go to Lima to get care,” he repeated several times.
A cheap roundtrip to Lima can cost as little as 116 US dollars. The care the woman needed, who knows? Regardless, anyone who looked at this woman would be able to tell that she did not have 116 dollars to spend on a trip to Lima. I had 116 dollars. Much more than that in fact. And I’ve used it to buy shoes, clothes, earrings, phone cards, and other things that I suddenly want, but not much I actually need.Being in Peru puts me in a same state of mind as being in Bangladesh often put me. It makes me very aware of the hundreds of privileges I have that the majority of the world does not have. And this is an uncomfortable realization because even if I did give all my privileges up, how much of a dent does it actually make? If I paid the woman’s trip to Lima, can she afford hospital care? If I pay for that too, can the next woman who comes in with a melanoma afford care? Do I pay for her too? I know that it makes much more sense to try to work on what is at the root of the problem—lack of access to healthcare, poverty, unemployment, lack of education, etcetera, but what do we do in the meantime?
The following is the most recent of my required journal entries for IHOP:
On Friday, we packed our bags, sadly said goodbye to Iquitos, and boarded a plane to Lima or the big dirty city as I like to call it. In Lima, we had arranged to rent an apartment in the Miraflores area, considered to be one of the safest areas in Lima and therefore recommended to us foreigners. Normally I don’t get to wound up about what the US Embassy and other expats recommend as far as safety but this time I decided that since I need to have my computer with me and since it’s my summer, I might as well live it up in the opulence of Miraflores.
Our apartment is small but beautiful by anyone’s standards. It is on the main avenue of Miraflores, a couple of blocks from the supermarket and from a gym that rivals many gyms in the US and where we will be exercising during the week. All these newfound comforts suddenly hit me yesterday in a taxi after a long day of walking and shopping (because “it’s so cheap!” as we often exclaim) when I was mentally calculating how much I’ve spent in the last few weeks and how much that same money might mean to some of the patients that we saw back in Iquitos. One patient that continues returning to my mind was an elderly woman that we saw at the hospital who had a melanoma that was gradually taking over her nose. “You need to go to Lima,” the doctor told her, while explaining to us that there are no oncologists in Iquitos. “You need to go to Lima to get care,” he repeated several times.
A cheap roundtrip to Lima can cost as little as 116 US dollars. The care the woman needed, who knows? Regardless, anyone who looked at this woman would be able to tell that she did not have 116 dollars to spend on a trip to Lima. I had 116 dollars. Much more than that in fact. And I’ve used it to buy shoes, clothes, earrings, phone cards, and other things that I suddenly want, but not much I actually need.Being in Peru puts me in a same state of mind as being in Bangladesh often put me. It makes me very aware of the hundreds of privileges I have that the majority of the world does not have. And this is an uncomfortable realization because even if I did give all my privileges up, how much of a dent does it actually make? If I paid the woman’s trip to Lima, can she afford hospital care? If I pay for that too, can the next woman who comes in with a melanoma afford care? Do I pay for her too? I know that it makes much more sense to try to work on what is at the root of the problem—lack of access to healthcare, poverty, unemployment, lack of education, etcetera, but what do we do in the meantime?
Welcome to the Jungle
Saturday, June 9, 2007
Today, Hollie and I climbed aboard a little plane with bags full of yummy fish and fried chinese food and proceeded to fall promptly asleep. When I next woke up, we were in the air, 1/4 of the way to our destination of Iquitos, Peru. We made it to Iquitos and managed to wake up, get our bags, and go outside where our driver Don Marcial was wating for us with a sign that was not quite as big as Omar's sign (our taxi driver in Lima), but we'll forgive him. As we travelled through central Iquitos to the house where we will be staying, Don Marcial serenaded me with verses from "En Mi Viejo San Juan"-- Javier Solis joined me as a little girl growing up in Puerto Rico to Don Marcial, a driver in Iquitos who has never left his city.
Don Marcial also recited verses of poetry praising the Amazon as he pointed it out at the distance, obscured in the evening darkness. "Wow, that's beautiful!" I exclaimed, thinking about how being this close to the Amazons might be the best part of the trip to Iquitos (sorry Van Voorhis!).
But the best suprise came later, when Hollie and I met our housemate who gave us the key... to the wireless internet... We have the internet? Awesome! We came close to surviving ten whole hours without it...
Today, Hollie and I climbed aboard a little plane with bags full of yummy fish and fried chinese food and proceeded to fall promptly asleep. When I next woke up, we were in the air, 1/4 of the way to our destination of Iquitos, Peru. We made it to Iquitos and managed to wake up, get our bags, and go outside where our driver Don Marcial was wating for us with a sign that was not quite as big as Omar's sign (our taxi driver in Lima), but we'll forgive him. As we travelled through central Iquitos to the house where we will be staying, Don Marcial serenaded me with verses from "En Mi Viejo San Juan"-- Javier Solis joined me as a little girl growing up in Puerto Rico to Don Marcial, a driver in Iquitos who has never left his city.
Don Marcial also recited verses of poetry praising the Amazon as he pointed it out at the distance, obscured in the evening darkness. "Wow, that's beautiful!" I exclaimed, thinking about how being this close to the Amazons might be the best part of the trip to Iquitos (sorry Van Voorhis!).
But the best suprise came later, when Hollie and I met our housemate who gave us the key... to the wireless internet... We have the internet? Awesome! We came close to surviving ten whole hours without it...
An explanation & Arriving in Lima
I've decided to transfer all the blogging I've done in my group blog to my regular blog so that everyone can see what I've been up to, so althought these will appear to be written on the same date, they are from different dates.
Thursday, June 7, 2007
I am the big spoon... For anyone who has met my "amiguito" that probably conjures up a funny image-- 5'1" me wrapped around a 6'1" body. But I am the big spoon and it works for us.
Last night, after arriving my hostel in the big, dirty city of Lima at around 1 a.m. (so actually, this morning). I tried to wrap myself around a little stuffed mycobacterium (www.giantmicrobes.com if you need a reference), I tried to wrap myself around myself, I tried to wrap myself up in the sheets, but it wasn't working. For the longest time I lay awake in bed hearing the random cars drive by. When I finally drifted off to sleep it was a fitful sleep, I'd wake up every so often, switch sides and go back to sleep again, until the knock on our door at 9 in the morning that meant breakfast was here.It's morning now, not much brighter in the southern hemisphere winter time, but I'm a little more excited. In a few minutes Omar will pick us up so that we can go meet Silvia, our local contact person here and we can figure out what we will be doing over the next few weeks. So far the few people I've met have been nice and helpful and at least I speak the language this time around. So, maybe tonight I will try wrapping myself around a pillow, who knows... I'm sure I'll figure it out.
Thursday, June 7, 2007
I am the big spoon... For anyone who has met my "amiguito" that probably conjures up a funny image-- 5'1" me wrapped around a 6'1" body. But I am the big spoon and it works for us.
Last night, after arriving my hostel in the big, dirty city of Lima at around 1 a.m. (so actually, this morning). I tried to wrap myself around a little stuffed mycobacterium (www.giantmicrobes.com if you need a reference), I tried to wrap myself around myself, I tried to wrap myself up in the sheets, but it wasn't working. For the longest time I lay awake in bed hearing the random cars drive by. When I finally drifted off to sleep it was a fitful sleep, I'd wake up every so often, switch sides and go back to sleep again, until the knock on our door at 9 in the morning that meant breakfast was here.It's morning now, not much brighter in the southern hemisphere winter time, but I'm a little more excited. In a few minutes Omar will pick us up so that we can go meet Silvia, our local contact person here and we can figure out what we will be doing over the next few weeks. So far the few people I've met have been nice and helpful and at least I speak the language this time around. So, maybe tonight I will try wrapping myself around a pillow, who knows... I'm sure I'll figure it out.
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