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.
Wednesday, August 27, 2008
Thursday, July 31, 2008
Tuesday, July 22, 2008
Chapter 3
I’ve completed two weeks of a ten-week internship, and though I wish I could say I’ve done it successfully, I’m not completely sure.
The second week of clinical rotations put me in a small, urban, one-woman clinic that decreed itself as general practice, but turned out to have most patients with obstetric/gynecological conditions with a small side of general malaise patients.
Upon monitoring my first PAP smear, I decided that I would never wish such a thing on anyone, but that was before I saw my first pustule abscess.
A fourteen-year-old female patient came into the clinic with her dad and brother, surely begging them upon leaving the house that they would leave her to walk by herself. Her abscess was on her coccyx, so in order to show the doctor and I, the girl had to pull down the rear of her pants and lay on her stomach so that the doctor could poke and prod at the visibly sore and irritated area and then present the tragic situation with two options: “we can either lance and drain it now and give you some antibiotics or we can do a round of antibiotics and hope it goes down.” After advising the terrified patient that the former would be the faster method with the highest probability of success, she consented, and a local anesthetic was applied.
The female doctor that I once thought was angelic and quaint then presented herself a card-carrying member of the dark side by pulling out a large razor blade from a sterile pack. Upon making a small incision to the side of the abscess, immediately a flood of light grey pus poured onto a pile of gauze pads waiting to catch the sinful heap. Soon thereafter, my stomach turned as I inhaled to experience what must be the scent of death. In an effort to keep myself from insulting the girl for having such a vile substance in her body, I held my breath through the rest of the simple procedure, which amounted to a woman popping a golf-ball sized pimple from the rear of a pride-damaged high school student. And that was only the first day.
I would like to say that it was an accident that I missed clinic that day, but I found myself toilet-bound for longer than one would normally desire due to the excessive amount of street hamburgers I’ve been eating. They’re less than two dollars for the most amazing thing that has ever entered my mouth (next to a Pizookie), they include jalepeños, pineapple, hot sauce, mayo, and baloney, and I rarely eat less than two a night. I feel that by repeating this process, my body will quit rejecting them as foreign and they’ll soon become a valued member of the team.
The next day I waited two hours for a bus to this same clinic, and when a woman asked me why I was waiting so long, I responded honestly: “I think my bus is late.”
“It’s not coming, honey.” I had assumed that maybe it had gotten stuck in traffic. I’ve heard of two hour traffic jams in Portland.
When walking to the clinic, the next day, I got lost and had to ask the doctor to leave her patients to pick me up. Things in the clinic, it seems, are going well so far. Right?
I had much more fun this weekend, when we left Oaxaca, Oaxaca to Puerto Escondido, Oaxaca. The small beach town averaged 80 degrees while we were there of the most humid air I have ever experienced. It was against all odds in the first place that we even arrived:
We signed up with an angry woman inside a small booth and paid $130 pesos (the equivalent of about $11.50 US) for a 7 hour trip via a large van with overhead compartments to the beach. We regretted not paying the $250 pesos for the first class bus when we looked out the window to see our imminent death: a 7 hour long one-way road in the foggiest mountains I have ever seen with a driver that had clearly no regard for our lives or his own. At one point, the suicidal man attempted to pass a large dairy truck around a curve and missed getting us killed by less than a fraction of an inch. My neighbor, César, complained of leg pains inflicted by my instinctual grabbing response for days.
Once we arrived, we hadn’t completely escaped death.
The next day was spent entirely at the beach. Being an avid fan of swimming and the newfound challenge of bodysurfing, I quickly ended up in the deep Pacific waters tirelessly treading water in hopes of an appropriately sized wave. A graduate of last year’s program, Serena, came along with us to the beach to see us along, and decided to tag along with me in the deep salty waters, until she lost control. She tried to stand on the unsteady ocean floor until a large wave knocked her over and took her tumbling many times and, after the damage had been done, she once again tried to stand up; her black, curly hair covering her gasping mouth, and she was promptly knocked over once more by the strong ocean current.
I witnessed the ocean abuse her time and time again until my laughter caused me to double over and wheeze, tears pouring from my eyes at the sight of her repetitious battle with the water. The lifeguard tapped me on the shoulder and told me in a hurried Spanish that if my friend (Serena) cannot swim, she needs to move into the more manageable portion of the beach.
Later, as my laughter died down, I sat on the hot sand and offered to take a picture of some students from my program, Amanda and César, as they stood on the sharp rocks protruding out of the water. Just as I was about to take the photo, we were once again interrupted by the high tide, which made its way all the way up to our blankets and bags, forcing me to take my eyes off of the two standing on the rocks many feet away. After the crisis of wet beach towels subsided, I looked back to the sharp rocks to find César, who was completely dry and wearing a shirt when I offered to take the picture just seconds ago. He was drenched, gasping for breath and on all fours in the shallow water, with Amanda completely out of sight. The water was drawn back into the warm ocean, and Amanda was revealed, also on all fours gasping for breath, reaching out for a rock to give her leverage.
Suddenly, the ocean washed over her body once more, knocking her back down underwater after what was clearly a shocking experience.
Finally, César got victimized once more by the angry ocean when we swam out and were met with a large drop, suddenly finding ourselves unable to wade into the waters.
“Fuck,” César said, as his body sunk into the water, leaving only his bottom lip dry. He quickly popped back up, and slowly rotated in place back to shore while his head bobbed up and down from his dog paddling. He was promptly drawn farther into the ocean, and I think it was his expression of great fear that made me instantly laugh as I was drawn in farther with him. We finally swam our way back in, but César swore off the ocean for the rest of the trip.
And, after 3 of the 6 in our group almost drowned, I decided not to tell them that I’ve worked as a lifeguard for years. “But I didn’t rescue you because I value my own life more,” I pictured myself saying.
More updates from the hospital to come, as today I found myself in a claustrophobic room with 5 medical students and a diabetes patient with the worst foot infection I had ever seen. You could practically see through the flesh that had been eaten away on either side of his skin, and a first year resident was picking at the dry, exposed flesh with forceps, preparing to suture the large gaping wound. Surgery is tomorrow, so hopefully I’m presented with the opportunity to witness something more upsetting and foul than I could have ever asked for. All in the name of medicine.
The second week of clinical rotations put me in a small, urban, one-woman clinic that decreed itself as general practice, but turned out to have most patients with obstetric/gynecological conditions with a small side of general malaise patients.
Upon monitoring my first PAP smear, I decided that I would never wish such a thing on anyone, but that was before I saw my first pustule abscess.
A fourteen-year-old female patient came into the clinic with her dad and brother, surely begging them upon leaving the house that they would leave her to walk by herself. Her abscess was on her coccyx, so in order to show the doctor and I, the girl had to pull down the rear of her pants and lay on her stomach so that the doctor could poke and prod at the visibly sore and irritated area and then present the tragic situation with two options: “we can either lance and drain it now and give you some antibiotics or we can do a round of antibiotics and hope it goes down.” After advising the terrified patient that the former would be the faster method with the highest probability of success, she consented, and a local anesthetic was applied.
The female doctor that I once thought was angelic and quaint then presented herself a card-carrying member of the dark side by pulling out a large razor blade from a sterile pack. Upon making a small incision to the side of the abscess, immediately a flood of light grey pus poured onto a pile of gauze pads waiting to catch the sinful heap. Soon thereafter, my stomach turned as I inhaled to experience what must be the scent of death. In an effort to keep myself from insulting the girl for having such a vile substance in her body, I held my breath through the rest of the simple procedure, which amounted to a woman popping a golf-ball sized pimple from the rear of a pride-damaged high school student. And that was only the first day.
I would like to say that it was an accident that I missed clinic that day, but I found myself toilet-bound for longer than one would normally desire due to the excessive amount of street hamburgers I’ve been eating. They’re less than two dollars for the most amazing thing that has ever entered my mouth (next to a Pizookie), they include jalepeños, pineapple, hot sauce, mayo, and baloney, and I rarely eat less than two a night. I feel that by repeating this process, my body will quit rejecting them as foreign and they’ll soon become a valued member of the team.
The next day I waited two hours for a bus to this same clinic, and when a woman asked me why I was waiting so long, I responded honestly: “I think my bus is late.”
“It’s not coming, honey.” I had assumed that maybe it had gotten stuck in traffic. I’ve heard of two hour traffic jams in Portland.
When walking to the clinic, the next day, I got lost and had to ask the doctor to leave her patients to pick me up. Things in the clinic, it seems, are going well so far. Right?
I had much more fun this weekend, when we left Oaxaca, Oaxaca to Puerto Escondido, Oaxaca. The small beach town averaged 80 degrees while we were there of the most humid air I have ever experienced. It was against all odds in the first place that we even arrived:
We signed up with an angry woman inside a small booth and paid $130 pesos (the equivalent of about $11.50 US) for a 7 hour trip via a large van with overhead compartments to the beach. We regretted not paying the $250 pesos for the first class bus when we looked out the window to see our imminent death: a 7 hour long one-way road in the foggiest mountains I have ever seen with a driver that had clearly no regard for our lives or his own. At one point, the suicidal man attempted to pass a large dairy truck around a curve and missed getting us killed by less than a fraction of an inch. My neighbor, César, complained of leg pains inflicted by my instinctual grabbing response for days.
Once we arrived, we hadn’t completely escaped death.
The next day was spent entirely at the beach. Being an avid fan of swimming and the newfound challenge of bodysurfing, I quickly ended up in the deep Pacific waters tirelessly treading water in hopes of an appropriately sized wave. A graduate of last year’s program, Serena, came along with us to the beach to see us along, and decided to tag along with me in the deep salty waters, until she lost control. She tried to stand on the unsteady ocean floor until a large wave knocked her over and took her tumbling many times and, after the damage had been done, she once again tried to stand up; her black, curly hair covering her gasping mouth, and she was promptly knocked over once more by the strong ocean current.
I witnessed the ocean abuse her time and time again until my laughter caused me to double over and wheeze, tears pouring from my eyes at the sight of her repetitious battle with the water. The lifeguard tapped me on the shoulder and told me in a hurried Spanish that if my friend (Serena) cannot swim, she needs to move into the more manageable portion of the beach.
Later, as my laughter died down, I sat on the hot sand and offered to take a picture of some students from my program, Amanda and César, as they stood on the sharp rocks protruding out of the water. Just as I was about to take the photo, we were once again interrupted by the high tide, which made its way all the way up to our blankets and bags, forcing me to take my eyes off of the two standing on the rocks many feet away. After the crisis of wet beach towels subsided, I looked back to the sharp rocks to find César, who was completely dry and wearing a shirt when I offered to take the picture just seconds ago. He was drenched, gasping for breath and on all fours in the shallow water, with Amanda completely out of sight. The water was drawn back into the warm ocean, and Amanda was revealed, also on all fours gasping for breath, reaching out for a rock to give her leverage.
Suddenly, the ocean washed over her body once more, knocking her back down underwater after what was clearly a shocking experience.
Finally, César got victimized once more by the angry ocean when we swam out and were met with a large drop, suddenly finding ourselves unable to wade into the waters.
“Fuck,” César said, as his body sunk into the water, leaving only his bottom lip dry. He quickly popped back up, and slowly rotated in place back to shore while his head bobbed up and down from his dog paddling. He was promptly drawn farther into the ocean, and I think it was his expression of great fear that made me instantly laugh as I was drawn in farther with him. We finally swam our way back in, but César swore off the ocean for the rest of the trip.
And, after 3 of the 6 in our group almost drowned, I decided not to tell them that I’ve worked as a lifeguard for years. “But I didn’t rescue you because I value my own life more,” I pictured myself saying.
More updates from the hospital to come, as today I found myself in a claustrophobic room with 5 medical students and a diabetes patient with the worst foot infection I had ever seen. You could practically see through the flesh that had been eaten away on either side of his skin, and a first year resident was picking at the dry, exposed flesh with forceps, preparing to suture the large gaping wound. Surgery is tomorrow, so hopefully I’m presented with the opportunity to witness something more upsetting and foul than I could have ever asked for. All in the name of medicine.
Wednesday, July 9, 2008
Chapter 2
On day three in Oaxaca, México, after spending all of our first day sitting through orientations and lectures about how to be safe in a colonial Catholic town, it was exciting to finally receive our cell phones, which meant I could finally give out my number to the world and have a viable connection to a native English speaker who wasn’t enduring a similar sort of culture shock as myself.
The director of the language school handed out small boxes with 1998 Nokia-style phones, and upon receiving mine I realized that my box not only looked cleaner and less beat-up than everyone else’s, but upon opening it, I found something truly eye-opening. It appeared as though God had separated the Oaxacan rain clouds and said, “Joel, for once, I’m going to let you win.” As I pulled out a shiny brand new flip phone the inner voice of my head reminded me of the truth: you don’t deserve this, it whispered in a sinister tone, everyone else has a gnarly pixelated phone; something has gone horribly wrong. You know that you usually don’t receive nice things for no reason. I tried my best to silence it, when Sarah, the second-year medical student from New York, interrupted my thoughts.
“Wow, you got a nice one,” she complimented.
“Oh, it’s really nothing,” I said, knowing fully that it truly was.
“No, wow, I’ve never seen them give out a flip phone before. They must like you,” said Serena, our local coordinator who has been through the program many times.
“Do you really think so?”
The next five minutes of Oaxacan introduction was what I refer to as “me time,” during which I pictured what Sanda and Marta, the directors of the language school, were thinking when they chose me for the prized gem. “That Joel Miller character,” they would say. “He’s really something, isn’t he?”
Naturally, though, after programming the phone with each of the cell phone numbers of what I personally referred to as the “cellular peasants,” I had to trade the cell phone in. After hours of trying to convince myself that “no red” means “congratulations on your new phone” rather than “no network,” my host sisters informed me that I had no other choice. I now can play Snake (or what is called Serpiente here) on my 1999 Nokia.
The next day we started our clinical rotations. Most locations last one week, while some of the larger hospitals last two. Our medical director, Dr. Tenorio, drove two from our group, César and Amanda (pre-medical students from Harvard and Princeton, respectively), to clinics at 7:30 in the morning and took the remainder, Sarah, Samuel and I (Samuel a pre-medical student from Oregon State) at 8:30. I often ask César and Amanda if I can have their autographs, and though they give me one every time (and are beginning to act as though it’s an old joke I’ve recycled too many times), I think that they find that all of the work they put in to admissions essays and applications in high school pays off a little more every time they’re asked to give an autograph.
I started my first week at a small, government-funded rural clinic called Centro de Salúd Xochimilco. Over thirty Centro de Salúds exist in the state of Oaxaca, and they give primary and family practice care to rural and urban patients. Of the few patients I did see, the most interesting one was a frail elderly woman who appeared from a Mexican soap opera.
“Doctor,” she said, exacerbated, leaning forward to my preceptor. “You have to help me. I have a lot of problems.”
After a list of pains and bumps that she showed to us, I decided that one of her first problems is that she didn’t know her age. She took a stab at 73, and said she had a birthday coming up in May. When the doctor informed her that it was currently June, she said half-heartedly, “oh. Maybe 74 then.”
Seventy-one was the correct answer, and was found after looking up her birth date in her chart. My favorite pain of hers was in her arm: “I squeeze lemons with this hand to make lemon water,” she said, which is a normal enough Mexican career. “And the other day, my bicep was so swollen that my nephew called me a luchador!”
A luchador is a Mexican wrestler, one who usually wears silly masks such that his identity not be leaked to the prying public. They attempt superhero status, though I’ve never been impressed and think of their wrestling more as a partner dance in a ring with other muscular men. The whole spectacle is sort of similar to watching a small dog mount a larger one. Sure, it may work, but it can’t be that fun for either involved, embarrassing even, and while we watch, though can’t determine why, we can’t stop. Nor can we stop the sinful deed of that ambitious canine.
Picturing the small woman as a luchador made me imagine her in the ring, thousands of fans wondering why they had purchased these tickets in the first place, staring down her 280 pound opponent down with her ever-present scowl. I imagine the image jumped across the doctor’s mind, too, as she was laughing for almost as long as I was.
It turned out that the woman did, in fact, have many problems, only one of which I had enough medical knowledge to vouch for. After smoking for fifty years, she said, “I’m seventy-four, and once in a while I want to have a cigarette, so I smoke, and I like it.” This was directly after the doctor’s offer to help her quit. I considered correcting her: remember, maim, that we determined today you are actually only seventy-one, so you can’t claim that your age is a reason for your bad habits. Before I had a chance to speak up, I was invited to listen to her lung sounds, which were markedly more diminished than any I’ve ever heard before.
And at the end of the day, I returned and tried to call home, but the buttons on the aged Nokia were stuck, and require a few hours before a new attempt.
The director of the language school handed out small boxes with 1998 Nokia-style phones, and upon receiving mine I realized that my box not only looked cleaner and less beat-up than everyone else’s, but upon opening it, I found something truly eye-opening. It appeared as though God had separated the Oaxacan rain clouds and said, “Joel, for once, I’m going to let you win.” As I pulled out a shiny brand new flip phone the inner voice of my head reminded me of the truth: you don’t deserve this, it whispered in a sinister tone, everyone else has a gnarly pixelated phone; something has gone horribly wrong. You know that you usually don’t receive nice things for no reason. I tried my best to silence it, when Sarah, the second-year medical student from New York, interrupted my thoughts.
“Wow, you got a nice one,” she complimented.
“Oh, it’s really nothing,” I said, knowing fully that it truly was.
“No, wow, I’ve never seen them give out a flip phone before. They must like you,” said Serena, our local coordinator who has been through the program many times.
“Do you really think so?”
The next five minutes of Oaxacan introduction was what I refer to as “me time,” during which I pictured what Sanda and Marta, the directors of the language school, were thinking when they chose me for the prized gem. “That Joel Miller character,” they would say. “He’s really something, isn’t he?”
Naturally, though, after programming the phone with each of the cell phone numbers of what I personally referred to as the “cellular peasants,” I had to trade the cell phone in. After hours of trying to convince myself that “no red” means “congratulations on your new phone” rather than “no network,” my host sisters informed me that I had no other choice. I now can play Snake (or what is called Serpiente here) on my 1999 Nokia.
The next day we started our clinical rotations. Most locations last one week, while some of the larger hospitals last two. Our medical director, Dr. Tenorio, drove two from our group, César and Amanda (pre-medical students from Harvard and Princeton, respectively), to clinics at 7:30 in the morning and took the remainder, Sarah, Samuel and I (Samuel a pre-medical student from Oregon State) at 8:30. I often ask César and Amanda if I can have their autographs, and though they give me one every time (and are beginning to act as though it’s an old joke I’ve recycled too many times), I think that they find that all of the work they put in to admissions essays and applications in high school pays off a little more every time they’re asked to give an autograph.
I started my first week at a small, government-funded rural clinic called Centro de Salúd Xochimilco. Over thirty Centro de Salúds exist in the state of Oaxaca, and they give primary and family practice care to rural and urban patients. Of the few patients I did see, the most interesting one was a frail elderly woman who appeared from a Mexican soap opera.
“Doctor,” she said, exacerbated, leaning forward to my preceptor. “You have to help me. I have a lot of problems.”
After a list of pains and bumps that she showed to us, I decided that one of her first problems is that she didn’t know her age. She took a stab at 73, and said she had a birthday coming up in May. When the doctor informed her that it was currently June, she said half-heartedly, “oh. Maybe 74 then.”
Seventy-one was the correct answer, and was found after looking up her birth date in her chart. My favorite pain of hers was in her arm: “I squeeze lemons with this hand to make lemon water,” she said, which is a normal enough Mexican career. “And the other day, my bicep was so swollen that my nephew called me a luchador!”
A luchador is a Mexican wrestler, one who usually wears silly masks such that his identity not be leaked to the prying public. They attempt superhero status, though I’ve never been impressed and think of their wrestling more as a partner dance in a ring with other muscular men. The whole spectacle is sort of similar to watching a small dog mount a larger one. Sure, it may work, but it can’t be that fun for either involved, embarrassing even, and while we watch, though can’t determine why, we can’t stop. Nor can we stop the sinful deed of that ambitious canine.
Picturing the small woman as a luchador made me imagine her in the ring, thousands of fans wondering why they had purchased these tickets in the first place, staring down her 280 pound opponent down with her ever-present scowl. I imagine the image jumped across the doctor’s mind, too, as she was laughing for almost as long as I was.
It turned out that the woman did, in fact, have many problems, only one of which I had enough medical knowledge to vouch for. After smoking for fifty years, she said, “I’m seventy-four, and once in a while I want to have a cigarette, so I smoke, and I like it.” This was directly after the doctor’s offer to help her quit. I considered correcting her: remember, maim, that we determined today you are actually only seventy-one, so you can’t claim that your age is a reason for your bad habits. Before I had a chance to speak up, I was invited to listen to her lung sounds, which were markedly more diminished than any I’ve ever heard before.
And at the end of the day, I returned and tried to call home, but the buttons on the aged Nokia were stuck, and require a few hours before a new attempt.
Saturday, July 5, 2008
Chapter 1
I awoke at 4 am packed, boxed, and ready to board an aircraft of any size, prepared to spend the next twelve hours sitting either alone in an airport on a computer ("Is that Joel Miller? He must be very busy and important--he's on a computer in the airport," I think they're saying), bumping elbows on a small aircraft with my neighbor ("Why are Joel Miller's limbs so unyieldingly long?") or being harassed by airport security. Again.
The rest of my series of flights went relatively unremarkably, until I arrived in Mexico City and was warned to adjust my watch to reflect the current time, which was two hours ahead of Portland. Having successfully pried my long ring fingernail into my Target watch dial, I entered into Mexico City International Airport to thousands of ads for duty free alcohol and cigarettes. Luckily, when I return, I’ll know that such places are available, but I thought it best to avoid public humiliation where more than language barriers are separating the people. As of right now, street smarts, general whereabouts knowledge, and how to get through customs are on the list of things I cannot currently claim to have mastered.
I wandered the airport for ten minutes before somehow stumbling upon customs, assuming that I’d have to leave the security checkpoint in order to gain my boarding pass for my final flight to Oaxaca. The line for customs took about 40 minutes, which I spent nodding and turning around to listen to an overweight Oregon man tell me about his last time in Oaxaca:
“Oh, a pre-medical internship? When we were in Oaxaca, we stayed with a couple of guys… I’m pretty sure they were a couple of flamers, and one of them got real sick and had to go to the hospital. I’m wondering if it’s not AIDS related, being that he was dating another guy and all.”
“Hard to say,” I conceded, and turned around again, hoping for a second he would cease his ramblings.
I got out of customs at 4:51 and my flight was scheduled to depart at 4:50, so I frantically ran up and down the corridors having no idea where I’d find a sign that said “If you just got to this county, and need a boarding pass, this is the place to be” in another language. Through my frantic search, what kept running through my head was the annoying fact that I once again relied on myself when I shouldn’t have, remembering that I didn’t write down any emergency contact phone numbers because I pictured a perfect trip. I finally found a check-in location for Mexicana airlines, only to be told in all-too-fast Spanish that I was at the incorrect check-in location, and that I’d need to go to the domestic check-in location. Luckily, one of the young cute customer service agents (who didn’t speak a word of English) felt sympathy for me and rushed me through countless corridors and curves, during which all I could say was, “gracias, gracias, gracias mucho.”
I finally arrived at the check-in counter, and told the man that I had missed my flight by ten minutes in a hurried Spanish. He slowly poked away at the keyboard and handed me a boarding pass as he directed me to the gate, saying, “It’s not time yet.” It was at this point that I realized my mistake: not buying a digital watch. I’ve never been able to read an analog clock, and I thought that purchasing wearing a small watch around my wrist would make me seem more worldly and knowledgeable.
“Look at that young man,” they’d say. “I bet that he can tell me the time should I inquire, seeing as he’s wearing a minature clock on his wrist at all.” I thought with this dignified demeanor I’d naturally pick up how read an analog clock.
I sat for fifty minutes at the gate waiting to board while remembering that I made that cute customer service agent rush me through the airport for nothing, not to mention being permitted to completely skip the declarations portion of customs. I was wondering why everyone looked so confused when I told him or her I was late for my flight.
My host mother, Claudia, and her daughter, Monica, greeted me at the airport and on the ride we discussed Oaxacan weather, traffic, and points of interest. Upon entering the house, I was greeted by my first cockroach (see photo), and met the rest of my host family. For the first four weeks, another student is staying in the house, a sixteen-year-old from Alabama that doesn’t speak a word of Spanish, which is rough because the host mother Claudia doesn’t speak a word of English. Much of the first night was spent translating house rules and food allergies.
Monica, 20, is a second-year medical student going on to her third year. Upon hearing this I immediately began considering ways I could gain access to a Mexican medical school, and when people asked why, I could say, “Oh, the states just seem too fast for me,” which would make me sound wise in my decision to do what a relaxed professional should do. Monica’s older sister Claudia is a therapist. We also live with their 14-year-old sister who is a student. I now see the problem with American society: parents should feed and house their children well into their children’s careers.
The second night in Oaxaca after I soberly and willfully ate fried pig skin and boiled pig intestine for lunch. (I remember thinking, it’s Mexico, why not? and then finding the skin tasted like Wheat Thins, while the intestine tasted more like heaven. Later when I went out to dinner I asked the waiter to hold the worm from my Tequila and the grasshopper from the Mexican BBQ chicken.). After lunch, the sixteen-year-old from Alabama and I met some of her friends from her program for a night on the town. I found this a wise decision because we, as college students, usually read emails with instructions like “please email your fellow program participants and arrange a time to meet on Sunday” and say, I’ll leave it in my inbox for now. I’ll just play a quick game of MarioKart and I’ll email everyone afterwords! We then find ourselves surprised when we find ourselves with no Internet in Oaxaca except at the language school, which we don’t attend until Monday and end up at a bar with high school students. This was after we sat through a two-hour movie in French with Spanish subtitles that involved a woman in love with atomic bombs and Hiroshima and an Asian man that slapped her. There may be more to the story, but I fell asleep by the time the second subtitle flashed upon the screen due to my inability to remain conscious when reading. Thus, I’m pretty sure it was horrible.
During the movie, one of the sixteen-year-old from Alabama’s friends thought only she was listening and looking at her when she said, “God I can’t believe you’re living with him.” Such a phrase can be taken two ways: either she hates me, thereby accenting the “God” or she loves me, and would accent the “can’t.” I gathered that she loves me, but still said “I’m right here,” which led to giggles and whispers throughout the night, soon followed by a forced partner salsa (contrary to popular belief, I’ve never salsa’d before in my life, and it was a humiliating excursion) at a loud bar that played Daddy Yankee. The only problem is my painful yearning to escape the techno and lighted flooring
In case you're wondering, my Mexican phone number is 011-52-1-951-150-6431. (You may have to dial 1 before all of that, but in my opinion, why include one more when you already have a country code, a wireless phone prefix, an area code, and a number? It all just seems a little excessive.)
I arrived at Portland International Airport at about 4:45 am for my 6:55 flight, childishly obeying the FAA's advice about arriving two hours early for international flights. After checking in (which took all of two minutes), I made my way to the security checkpoint, where I was greeted by an old man who immediately tagged me as a terrorist.
"Hello, sir, please place your belongings in the bins and step right this way. Sandals too."
I noted that he didn't direct me towards the metal detector. I followed him to an area secluded from the world by white plastic walls with red "DO NOT ENTER" signs and symbols plastered upon it.
"This is a machine that detects for explosive material, please stand with your feet on the mat inside."
Like an usher from hell, he motioned me into the machine that had red lights and glass doors, and it was about this point that I realized that I wasn't going to like this. I looked at him for a second hoping maybe he'd offer that he was actually kidding and that I could indeed proceed to the metal detector. His angry accusatory stare told me otherwise, and I stepped inside the box. Glass doors shut behind me and the room suddenly became very small. Out of any sci-fi movie, a robotic female voice chimed in.
"Air sensors activated." I then realized that he didn't tell me something he was supposed to, and the voice inside the box wouldn't offer me any answers. Seconds later, I was blasted on all sides by what felt like Nerf darts, each area of my body being shot within a fraction of a second of the other. With each blast, I naturally reacted by flinching in the area the shot originated, and since I was being shot from all angles, I appeared to be seizing in all directions, shirt and shorts blown up because of the incessant strength of the air darts. Within seconds the entire process was over and I pulled my shirt down from its perched position on my left shoulder. The red lights turned green, and the glass doors in front of me automatically opened.
Upon reflection, I have a complaint for the TSA. Instead of "air sensors activated," consider warning passengers with a quaint message such as the following: "hello valued customer. We appreciate your patience as we test your patriotism with air guns. You'll soon be shot from various angles with regular outdoor air, and please avoid humiliating yourself by flinching each time an air gun shoots you. Thank you." A calm reading by Sigourney Weaver may do the trick for me.
The TSA devil in front of me smiled. "Fun, isn't it?" He asked. After catching my breath, I shot him an angry glare, wondering how anyone could think that being shut in a tiny glass box and blasted with air numerous times within a few seconds would be fun. "Well, no... That is a machine from hell. That was horrible!" He cackled at what he took to be a joke and I made my way to the next harassment checkpoint without giving the evil man the satisfaction of realizing I may have needed defibrillation had my heart not soon slowed.
I was complete with the whole process by 4:52, and cursed the FAA's advice about arriving two hours early for international flights for all of those two hours while taking deep sweaty breaths to slow my heart rate after the TSA Torture had concluded.
The rest of my series of flights went relatively unremarkably, until I arrived in Mexico City and was warned to adjust my watch to reflect the current time, which was two hours ahead of Portland. Having successfully pried my long ring fingernail into my Target watch dial, I entered into Mexico City International Airport to thousands of ads for duty free alcohol and cigarettes. Luckily, when I return, I’ll know that such places are available, but I thought it best to avoid public humiliation where more than language barriers are separating the people. As of right now, street smarts, general whereabouts knowledge, and how to get through customs are on the list of things I cannot currently claim to have mastered.
I wandered the airport for ten minutes before somehow stumbling upon customs, assuming that I’d have to leave the security checkpoint in order to gain my boarding pass for my final flight to Oaxaca. The line for customs took about 40 minutes, which I spent nodding and turning around to listen to an overweight Oregon man tell me about his last time in Oaxaca:
“Oh, a pre-medical internship? When we were in Oaxaca, we stayed with a couple of guys… I’m pretty sure they were a couple of flamers, and one of them got real sick and had to go to the hospital. I’m wondering if it’s not AIDS related, being that he was dating another guy and all.”
“Hard to say,” I conceded, and turned around again, hoping for a second he would cease his ramblings.
I got out of customs at 4:51 and my flight was scheduled to depart at 4:50, so I frantically ran up and down the corridors having no idea where I’d find a sign that said “If you just got to this county, and need a boarding pass, this is the place to be” in another language. Through my frantic search, what kept running through my head was the annoying fact that I once again relied on myself when I shouldn’t have, remembering that I didn’t write down any emergency contact phone numbers because I pictured a perfect trip. I finally found a check-in location for Mexicana airlines, only to be told in all-too-fast Spanish that I was at the incorrect check-in location, and that I’d need to go to the domestic check-in location. Luckily, one of the young cute customer service agents (who didn’t speak a word of English) felt sympathy for me and rushed me through countless corridors and curves, during which all I could say was, “gracias, gracias, gracias mucho.”
I finally arrived at the check-in counter, and told the man that I had missed my flight by ten minutes in a hurried Spanish. He slowly poked away at the keyboard and handed me a boarding pass as he directed me to the gate, saying, “It’s not time yet.” It was at this point that I realized my mistake: not buying a digital watch. I’ve never been able to read an analog clock, and I thought that purchasing wearing a small watch around my wrist would make me seem more worldly and knowledgeable.
“Look at that young man,” they’d say. “I bet that he can tell me the time should I inquire, seeing as he’s wearing a minature clock on his wrist at all.” I thought with this dignified demeanor I’d naturally pick up how read an analog clock.
I sat for fifty minutes at the gate waiting to board while remembering that I made that cute customer service agent rush me through the airport for nothing, not to mention being permitted to completely skip the declarations portion of customs. I was wondering why everyone looked so confused when I told him or her I was late for my flight.
My host mother, Claudia, and her daughter, Monica, greeted me at the airport and on the ride we discussed Oaxacan weather, traffic, and points of interest. Upon entering the house, I was greeted by my first cockroach (see photo), and met the rest of my host family. For the first four weeks, another student is staying in the house, a sixteen-year-old from Alabama that doesn’t speak a word of Spanish, which is rough because the host mother Claudia doesn’t speak a word of English. Much of the first night was spent translating house rules and food allergies.
Monica, 20, is a second-year medical student going on to her third year. Upon hearing this I immediately began considering ways I could gain access to a Mexican medical school, and when people asked why, I could say, “Oh, the states just seem too fast for me,” which would make me sound wise in my decision to do what a relaxed professional should do. Monica’s older sister Claudia is a therapist. We also live with their 14-year-old sister who is a student. I now see the problem with American society: parents should feed and house their children well into their children’s careers.
The second night in Oaxaca after I soberly and willfully ate fried pig skin and boiled pig intestine for lunch. (I remember thinking, it’s Mexico, why not? and then finding the skin tasted like Wheat Thins, while the intestine tasted more like heaven. Later when I went out to dinner I asked the waiter to hold the worm from my Tequila and the grasshopper from the Mexican BBQ chicken.). After lunch, the sixteen-year-old from Alabama and I met some of her friends from her program for a night on the town. I found this a wise decision because we, as college students, usually read emails with instructions like “please email your fellow program participants and arrange a time to meet on Sunday” and say, I’ll leave it in my inbox for now. I’ll just play a quick game of MarioKart and I’ll email everyone afterwords! We then find ourselves surprised when we find ourselves with no Internet in Oaxaca except at the language school, which we don’t attend until Monday and end up at a bar with high school students. This was after we sat through a two-hour movie in French with Spanish subtitles that involved a woman in love with atomic bombs and Hiroshima and an Asian man that slapped her. There may be more to the story, but I fell asleep by the time the second subtitle flashed upon the screen due to my inability to remain conscious when reading. Thus, I’m pretty sure it was horrible.
During the movie, one of the sixteen-year-old from Alabama’s friends thought only she was listening and looking at her when she said, “God I can’t believe you’re living with him.” Such a phrase can be taken two ways: either she hates me, thereby accenting the “God” or she loves me, and would accent the “can’t.” I gathered that she loves me, but still said “I’m right here,” which led to giggles and whispers throughout the night, soon followed by a forced partner salsa (contrary to popular belief, I’ve never salsa’d before in my life, and it was a humiliating excursion) at a loud bar that played Daddy Yankee. The only problem is my painful yearning to escape the techno and lighted flooring
In case you're wondering, my Mexican phone number is 011-52-1-951-150-6431. (You may have to dial 1 before all of that, but in my opinion, why include one more when you already have a country code, a wireless phone prefix, an area code, and a number? It all just seems a little excessive.)
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