First Day at Hospitalito

I show up, as directed, for morning report at 7:30 am.  The "morning report room" is actually an open air patio overlooking Lake Atitlan, with plastic chairs around a beat-up wooden table and a roof made of plant matter.

We are operating in "tiempo latino", so no one else shows up until 7:45.  Eventually 6 of us are gathered around the table, and I get my first experience of trying to follow sign-out in Spanish.  There are 4 hospitalized patients, and I follow along just fine (probably because the person giving report is speaking with an American accent).  I am feeling quite proud of myself for following along until the obstetrician from Spain starts speaking.  Now, please understand, most Guatemalans speak Spanish as a second language (like me!) and therefore speak relatively slowly, carefully, and without a lot of slang.  So I had been following most conversations pretty well.  Our Spanish obstetrician, on the other hand, speaks a very fast lispy native tongue, and I catch about 25% of his words and comprehend only the rare complete sentence.  I had been hoping to learn a lot from this guy, so this does not bode well.

Now for an hour of orientation, which is good, aside from the schedule (I get 24 hr in-house calls on Wednesday and Saturdays, and most other non-post-call days in clinic), and the confirmation that I will indeed be the only MD in house when I'm on call overnight and on weekends.  I'm used to having an attending physician in house with me at all times, and to being encouraged to run questions by them if I have even the slightest doubt about the best thing to do for a patient.  This will be a whole new kinda fun, I can tell.

Then I thought it was time to get to work, but instead I'm encouraged to go eat breakfast.  (Um, I did that before I came to work, but thanks.)   Oh, and change my clothes.  Apparently my clinic clothes are not appropriate attire, I'm supposed to wear scrubs, including in clinic.  OK, can do.

Eventually I start actually seeing patients, and realize that very few of them speak Spanish.  They all seem to speak the local native Mayan language.  So I need a translator to get to Spanish.  Of course, I'm still thinking in English, so my head is kinda spinning with the three languages between us.  I keep having to cross out English words in my clinic notes.  All my abbreviations (SOB, CP, PERRL, AFOS, CTAB, RRR no m, no c/c/e, no N/V/D) are based on English and presumably therefore no good.  I have no idea what the equivalent abbreviations in Spanish are.  So I'm writing everything out, and using my dictionary to do so.  I have decent experience talking to patients in Spanish (LA county hospital, thank you), but documenting in Spanish is new.  How do you say wheeze?  crackles?  My dictionary doesn't know.  C.O.P.D.?  E.P.O.C., apparently.

Reassuringly, I knew what to do for almost all my patients today.  (And the one I didn't know how to help stymied the other docs too.)  My knowledge of the system infrastructure here is quite lacking, and my Spanish could be better, but at least my medical knowledge seems adequate.  This is good.

Next, we have a C-section.  Yay!  I get to assist!  Breech primagravida, healthy mom and baby.

Apparently, one of the family docs here from the states does the spinal anesthesia, because there is no anesthesiologist.  So he gives me a rundown on the how-to basics, which is cool.  Not much different than an LP, but of course one has to watch the blood pressure and the respirations carefully.  He preps his meds from a cheat sheet.

The OR has an out-of-use fireplace in the corner.  That chimney is the only ventilation system, as the windows and doors are (happily) closed during the case.  The bovie doesn't work.  The tools are a little more basic than we have at home, but overall I find the set-up fairly familiar.

Now, I'm operating with our Spanish Obstetrician.  Problem is, I don't understand a damn thing he's saying the whole time.  So I'm across the table from him, with an open belly between us, and I'm cutting, retracting, exposing, sewing, etc, and he's jabbering away with what is presumably useful information.  Thank heavens I've assisted on this particular surgery many times in the past, and therefore have some clue what to do.  When the tone of his voice suggests displeasure, I try randomly changing my technique a little to see if his tone becomes happier.  Mostly, he sounds fairly happy during the case.   When I feel I really must understand what he wants from me, I ask and keep asking until I understand his reply.  He is kind about our language barrier, but doesn't seem capable of slowing down his lispy speech.
Eventually we have a baby.  It's too blue and floppy for my tastes, but comes around eventually with a little positive pressure ventilation (from the family doc who had done the spinal earlier).  Apgars of 1 and 8.  Phew.

Lunchtime.  Surprise!  Happy birthday to one person today and another tomorrow!  Someone made soup for everyone, and now it's a party!  Soup is kinda tasty, although I don't recognize all the ingredients.  At 2:15, I realize I am late to be upstairs in clinic, which I had been told starts at 2 pm.  So I excuse myself from the table, and head up stairs, only to find it completely dark and deserted.  I must wait for the receptionist and nurse, who apparently are still downstairs eating soup. Around 3:30 I finally have patients to see.  I proceed to find a bit of a stride, and I do not feel the need to ask any medical questions of the other doctors for the 4 people I see this afternoon, only "do we have x here" questions directed at the pharmacist.  I find this encouraging.  It helps that the obstetrician is elsewhere.

We wrap up the day at 4:45, and I walk the 10 minutes home to my aunt and children.  They've had a good first day as well, having procured milk, a brighter light-bulb for the kitchen, and a clothes-line.  Of course, these were bought in town, which one has to get to via harrowing tuk-tuk transport, but that's another story.