Over the Andes into Chile

The tunnel at the top was really long

I took the opportunity to go to the bathroom in the back of the bus

we came out on the Chilean side just as I was walking back to my seat

no problem at customs, besides some raisins that I had

I decided to eat them all rather than throw them out

luckily I have intestines of iron after a summer of traveling

400grams of raisins does nothing

then 27 switchbacks down a very steep boulder field

super impressive that there used to be a railroad here

cool remnants of a covered track

though nowadays it doesn´t seem like it snows as much

the final 3 hours of the drive were a struggle to stay awake

warm afternoon sun and picturesque vinards in the Chilean central valley

the air gradually getting more humid as we approached the coast

smell more and more like San Diego

though temperatures like San Francisco

Viña del Mar reminds me of the Spanish coastline near Barcelona

I´ve decided to run a different direction for each of my four days here

On Thursday I´ll go to Santiago for my last two nights before returning to North America.

 

Last Week in the Hospital

For lack of memory about what I was going to post about
I´ll outline my day

0640 up to make and eat oatmeal
0725 out the door to catch the ¨trolley¨ which is an electrified bus. Runs on tires but has those antenae to pull down electricity from overhead wires.
I only have a 2 min walk to the bus stop, and the bus comes at the same time each day.
0735 get on the trolley but ask anyway to make sure it´s going to the hospital today. I once got on a clearly labelled bus without asking and it took me to a different place. I thought it was strange that the driver reached over to switch the sign not long after I got on.
0745 Arrive near the hospital, walk the final 200m up the hill while enjoying the predawn glow of east behind me.
0800 The meeting starts promptly to review difficult cases with all the residents and attendings.
0900 On some days there are different activities at 0900. On Wednesdays are generally M&M conferences and today´s was particularly interesting. It started with an overview of the case, clinical history, and pertinent lab values. Then there was a comprehensive review of the clinical decision making process. Finally, a resident from pathology presented the autopsy findings. Then everybody discussed the choices they made, and what they might do differently in the future.
1100 Mediamañana which means food and mate. Today was one of the attending´s birthday so there was cake for all.
1130 Rounds started, later than normal, so they went on past 1300. There is some of the quizing and challenging that you see on tv but not as much as I expected, or was lead to believe on my first day.
1330 Wonderful hospital lunch. You know how much I like these...
1430 collected my things and cought the bus back to the center to do two hours of Spanish hw.
1700 hour of internet to write this and finish up the honor board orientation powerpoint that I´ll help to present in less than two weeks.
1830 jog over to the big park to join the running club for a workout.
2100 home for dinner, more Spanish, then sleep before 2300

Interview Questions

Preguntas para médicos y enfermeros

Función:
Edad:

Pacient (iniciales):
Diagnóstico:

1. ¿Estaría dispuesto a compartir sus ideas sobre las decisiones clínicas en este caso?
2. ¿Hubo más de una alternativa de tratamiento en este caso? ¿Cuales?
3. ¿Qué rol tuvo en esta elección? ¿Qué grado de participación tuvo en la elección?

4. ¿Cómo se siente con respecto a la forma en que se tomó la decisión?
5. ¿Cómo ha afectado el costo de medicamentos y de exámenes complementaros la elección que hizo?
6. ¿Los resultados de la decisión terapéutica fueron satisfactorias tanto para la familia, el pacientes y los médicos? ¿Fué satisfactoria para alguno de estos en mayor medida?

Preguntas para pacientes y sus familias

Iniciales:
Edad:
Relación con el paciente:
1. ¿Estaría dispuesto a compartir sus experiencias sobre la relación con los médicos del hospital?
2. ¿Piensa que habían otras opciones de tratamiento? ¿Los médicos le informaron sobre otras opciones?
3. ¿Cuánta participación tuvo en la elección de tratamiento?
4. ¿Como se siente acerca de la forma en que se tomó la elección?
5. ¿Cómo ha afectado el costo de medicamentos y exámenes complementaros la elección que hizo?
6. ¿Esta satisfecho con el tratamiento realizado?

Tupungato and Uspallata

The last two weekends have involved social events on Saturdays, and solo bike adventures on Sundays.

The trip to Tupungato was poorly planned. Slept in late, ran, ate, then around noon decided to go.

Messed up the busses, and by the time I was on the rental bike, free on the road, the sun was setting beyond the vinyards over the Andes. Still got in 50km though and found some delicious raisins (since i didn´t have the ganas to drink or carry wine).

Uspallata however went much more smoothly. Caught the 0800 bus, rental bike headed up into the valley by 1100. Perfect sunshine, dark blue altitude sky, inca rock carvings, bouldering in another location, nap on top of a mountain. 11 miles downhill to end the day. I´ve got to figure out how to get this pictures off of my virus infected camera...

Olympiada

Last weekend, no, two weekends ago, I was invited by some 5th year medical students (they have six years here after HS) to attend their end of year camping trip. Since it is winter, it was going to be in a camp with cabins.

While it is impossible to describe the experience in detail without forgoing other equally valuable experiences, I wanted to share the essence of spirit that I understood.

A powerful generosity, willingness to share, patience to listen, and sense of community as this group of students so fluidly accepted me into their midst.

1600 they finished their exams for the semester, and we piled onto the minibuses (traficos)

1730 arrival

1830 tea

1930 fire

2030 icebreaker games

2130 wine and fernet

2230 start cooking asado

2330 dinner

0030 some students have a rock band

0230 hook up computer to start playing dance music

0500 I fold and go to bed while most continue dancing

1100 up and breakfast

1200 mountain hike

1700 parting words

what a weekend

Spanish Lessons

well it appears that during my month in Bolivia, I managed to claw my way back to where I should have been at the end of Spanish 101 at Haverford. My classes started this week and I´ve been labeled as B1 or ``threshold``. Certainly feels like a threshold. The threshold of being able to speak. But it´s good, i´m getting to the point where I can explain my way around any language barriers, and ask for clarification in spanish as needed. I have 90 minute lessons 5 days a week in the afternoons. Quite challenging as my natural inclination after lunch is to sleep. still not used to the 6 hour sleep nights. After class, I come home to run before homework before dinner before bed. But today, skipped the run to type some stuff up for my project and now I´m going over to a medstudent apartment for mexican tacos. I a group of 5 students who were rotating through the clinic in their last week before winter break. Now they are on winter vacation for two weeks, but like medstudents everywhere, vacation = studying for the next big exam.

Today started with the weekly literature review, which is like PBL without a timer. Presentations are supposed to be short but drag on and on without visual aids. My attention drifts after about 3 minutes. I´m scheduled to do a presentation on the 26th of July. Trying to decide between IUDs or 

Then rounds with one of the teams. One poor woman had metastasized breast cancer that had invaded her liver. Amazing to actually see the distended veins on her abdomen as the blood found a collateral route back to the heart. She is on a morphine drip with her husband at her side. Thankful that he was asked to leave the room while we examined her on rounds. There is no hope for life, but our team will strive for ultimate comfort and quality during her last days in our hospital. 

While listening to the lungs of a longtime smoker, I heard crackles for the first time in real life. Hard to remember the dire consequencees of pulmonary edema as the excitement about actually hearing a sign rushed through me. Also greatful that my repaired stethescope works well. The diaphragm is somewhere in the Buenos Aires airport as when my bag was searched, they didn´t close the pocket that had my disassembled stethescope. After searching in vain for a replacement here (they only have litman parts), I cut out the bottom of a yogurt container and attached it with a rubber band. I should take a picture. Everyone said ``look, an american, functional but without style``.

Okay, well 25 minutes after the time I was invited, i should probably think about leaving. It took me a while to get used to this alternate sense of time, but now that I´m used to it, it´s kind of nice. there is extra time built in everywhere for whatever you want, like updating your blog for instance. should have done spanish hw instead i´m afraid

vehicles

i´m collecting pictures

but never seem to have my camera cord when i get to a computer

i´ve really enjoyed observing the vehicles here

many familiar brands

but with small diesel engines

german buses 

and french sports cars

also some really nice motorcycles as july seems to be the only really cold month

tried to take the same bus home yesterday that I take to the hospital in the mornings, only to find myself in a neighboring town.

I had dosed off and the bus had changed numbers somewhere along the way!

I guess i´ll go back to asking about everything instead of trusting what I read

oh well, the upside was that I found a railroad along which I can potentially run out on the flat side of town

okay, back to spanish studies

should write a post about my project also

okay, all that and more coming soon