Chapter 5

ISSSTE, or Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, is the middle-level hospital in Oaxaca. It’s a step up from Hospital Civil, and serves only state workers, including public school teachers. On the first Monday of my two-week rotation to ISSSTE, I was placed in internal medicine. I found this interesting, as I listed the following as my medical interests to the medical director:

1. Emergency Medicine
2. Surgery
3. Pediatrics (But I only like kids over 2, so if your pediatrics units include babies, I’m out.)

While at least I wasn’t forced to change or touch a baby, for which I’m very thankful, I decided that internal medicine is not for me. As it turns out, it meant a 6 hour shift of wandering around every patient room, reading their chart, and realizing that once again, I (or any Mexican physician) wouldn’t be able to help the patient with anything tangible, and instead just give drug after drug in hopes to squander whatever ailment the patient had. Further, I realized that since I don’t understand many diseases in English, I was mostly a waste of space in a Mexican hospital, where rumor has it that they say everything in Spanish, making learning diseases that much more difficult.

On that day, I saw a very cute small Mexican boy with malaria, as well as an elderly man with tuberculosis. Other than that, I clumped the rest of the patients together as “ill,” as I had no idea what was bothering them. Due to my obvious ignorance of internal medical illnesses, I decided to never return to ISSSTE after that first day. I took this time to do the following every day for the succeeding two weeks: first, I would wake up around 11 am. I would then eat the food that had been left out for me at 7 (my normal wake up time), which had lost all evidence of heat by the time I encountered it. This was followed by a quick shower, and then a trip to my school to use the wireless internet. This lasted until about 2:30, at which point I would walk back to my house, eat, and then either sleep until the early evening or attend class, if class was in session. I then would eat dinner and drink with either my Mexican friends or the other students from my program (which is now comprised of a completely new group of interns), go to bed, and repeat the process every day. I look at this point of my life as the hiatus I took to make my medical internship more of a non-medical vacation. There was even a weekend that we went again to the beach.

Huatulco is one of the two most popular beaches in the state of Oaxaca, filled, like Puerto Escondido, with bright blue waters and gorgeous beaches. It’s seven hours away from where we live by bus, and because some of the students in my program are not gifted with intelligence (such as myself), we decided to not only take a redeye bus to Hualtulco at 11 pm, but we also decided that to make the bus trip more enjoyable, we would have a few drinks before our late departure. The problems with such a decision were numerous. First, I forgot that I recently had completed a course of intensive, amoeba-killing antibiotics that left my liver in a state of dilapidation and malaise, and, as far as my liver was concerned, there would be no hydrolysis of the alcohol entering my bloodstream for at least a week. Needless to say, I was uncomfortably intoxicated after a small number of drinks, which made for a messy bus ride. First, pictures have surfaced of me from that night hugging many from a group of children’s characters. Men (and possibly women) were dressed in large costumes including Spongebob Squarepants (named Bob Esponja in Spanish), Mike & Sully from Monsters, Inc., and many other characters meant mostly to entertain young children on the streets of downtown Oaxaca. Another photo has surfaced in which I can be seen lecturing an Asian cartoon character, and I’m told that I had refused to hug her and was not afraid to tell her so, although the silly yarn-haired character had never even offered an embrace in the first place. Further, I’m told that I was upset with the bus company for acting too much like an airline, with the same ridiculous security procedures I’m always “randomly chosen” for in American airports. Another intern informed me that at one point, I jokingly yelled to the bus driver to “please stop slamming on the brakes of the aircraft,” though I neither recall nor agree that it ever happened. If I had, though, it’s fairly unlikely that I said it in Spanish or that he understands English, so all is well.

The night begins to come back in fuzzy recall when at one point I decided to use the bathroom at the back of the bus. Nearly sober, I felt my pants to be wet, and assumed the worst. When I smelled the liquid to be Ocean Mist and very slippery, I reached in my pocket and pulled out a full pump-bottle of Ocean Mist hand soap, and scrawled across it in black Sharpie read, “No me robas PLEASE” (Do not steal me PLEASE). I promptly fell into the dry toilet fully clothed, the bathroom light turned off automatically because it no longer sensed my movement, and I decided that I never again would drink before traveling, especially with antibiotics.

(Also, upon asking the other interns why a full bottle of soap was in my pocket, they informed me that I had taken it from a bar in Oaxaca, laughing to the point of inebriated tears that the bar owner had tried to appeal to both English- and Spanish-speaking audiences with his plea to not steal his hand soap. If you’re reading this, dear bar owner, I’m truly sorry and will be supplying your disgusting bathroom with more hand soap soon.)

After coping with one of the worst accidental hangovers I had ever occurred in my entire life, the beach delivered all it promised, with a very fancy hotel ($20/day for breakfast) and a private beach with an amazing pool.

After my clinical hiatus, I began this week at Cruz Roja Mexicana, or Mexican Red Cross, the main emergency-responding ambulance service and urgent care clinic in Mexico. The first day, I noticed the difference between American and Mexican emergency response systems. In Mexico, the ambulances are outfitted with only medical oxygen instead of airway management devices, drugs, and other medical tools. Further, the “paramedics,” though I believe they don’t actually deserve the title, are volunteers with no medical training further than taking vital signs, which doesn’t do much unless you can interpret the vital signs and give an appropriate intervention. I also noticed differences in in-hospital care. The ambulance brought in a 65-year-old man who had been stabbed by a family member four times in the chest. The stabbing had occurred the previous evening, and the man was left bleeding on the ground until the following morning when a passerby stumbled across the man covered in blood and called the Red Cross for collection. The stabs resulted in a pneumothorax, in which air in the chest cavity causes the collapse of a lung. In such cases, the stab wounds can sometimes be considered “sucking chest wounds,” meaning that the collapsing or collapsed lung is inhaling and/or exhaling through the holes in the chest, usually looking like a small bubbling volcano of blood. Small bubbling volcanoes of blood are fine by me, and in the states, emergency medical technicians are trained to apply an occlusive dressing on the wound to prevent in/exhalation through the chest cavity. In Mexico, they would rather conserve the dressing, and instead, use their fingers to cover the holes. Not accustomed to a rather crude method of emergency medical care, I promptly began getting dizzy and nauseous when I was asked to put my finger in the man’s chest, and through my tremors, allowed a small burst of blood to squirt out onto the floor near me.

Later, I was talking with the medical students who run the emergency medicine clinic at the Red Cross as their clinic time during medical school. We all got along very well and spent most of the day talking and joking, when some miscommunication occurred. I had thought that the cute medical student had asked whether I liked the dinners in Oaxaca, to which I responded in Spanish, “yes, the dinner is pleasing to me.” They all laughed and after a bit of language mishaps occurred with my developing Spanish and their developing English, I realized that they were inviting me to dinner. I promptly declined, though, saying I have class until very late and would not be able to make it, much too scared to imagine myself sitting at a table of Mexican medical students and trying to understand something, anything, as they spoke Spanish at a rate faster than the speed of light.

The next day at the Cruz Roja, yesterday, left me with two patients in the entire five hours, both of whom were elderly Oaxacans having taken a spill on the street, leaving me to pick out tiny bits of gravel from elderly scraped knees for all of thirty minutes, and reading my book the rest of the time.

At least, though, it wasn’t Bob Esponjawho had taken the fall, for that probably would have been too hard for me to handle, especially considering our past.