Blood and Guts

So thinking for the last few minutes about the sheer profundity of the last few weeks of my Guatemalan adventure, I’ve been anxiously wondering (musing on my rooftop patio on a shockingly clear morning – the three volcanoes that tower over looking so close it seems as though they’re either ready to topple their monstrous weight over on top of me, or skitter away in a light breeze, flimsy cardboard cutouts that they surely are) how best to ensnare my audience’s intrigue. I know I’m already jostling for attention with so many sensationalist distractions in the burdened American daily life. And you know it’d be cheating to rely solely on the fact that my friends and family must have a perfunctory interest in my goings-on. So… what then to catch them with? Not sex, American culture is so desensitized, and there hasn’t been much to speak of as of late anyway. Not drugs, not really my bag and I haven’t much accurate experience from which to pull. Violence…? Well, not violence per se, but blood, definitely. I’ve seen a lot of blood recently. Blood, organs, pain, but also compassion, genuine care, and a lot of well-placed expertise. There, I hope that’s got you for at least a minute longer, and I think I’m not being overly theatrical – this is the intensive life of a rural hospital attending to the medical needs of 50,000 t’zutuhil mayans in Santiago Atitlan, Guatemala. And I’ve been thrust right in the center of it all.

I’ve dedicated the last 10 days and the coming three weeks to volunteering for the Hospitalito Atitlan (puebloapueblo.org), located just out of Santiago on the southern shore of Lake Atitlan. It’s a city set on a beautiful bay ringed by volcanoes and virgin forest, and the only camera-laden, sunscreen-dobbed, sun-hat-donning gringos to be found come for two hours on Sundays to peruse the spectacularly embroidered textiles that Santiago is famous for. The small enclave of resident foreigners, mostly connected with the Hospitalito, attract interested and friendly glances from the locals during late afternoon trips to the market for fruit, vegetables, tortillas, or pancake mix. I live now in The Milpas, an incredible residence that was once a backpacker’s hostel and now has been rented exclusively to Pueblo a Pueblo, and the entire property is one of the most beautiful gardens I’ve yet seen in the country, interspersed with quaint thatched roof cabanas. My room is a beautiful wooden loft, two windows to each wall, which perches atop the house, with a full view of the fields of corn, cabbage and beets running down to the tourquoise waterside before being thrown aside by the slopes of the volcano across the bay. My four housemates, all medical volunteers for the Hospitalito (Tanner, 28 and Will, 23, east coast med students, Kate, 28, ER resident from the UK, and Reenie, 32 OB nurse from New Mexico) cook all our meals together in our fantastic kitchen – the boys get sent to town for shopping, the girls inspire incredibly gourmet and healthy meals. We sit with candles out on our veranda, talking, laughing, me learning invaluable amounts about the medical profession and med school and share a bottle of wine. The living here is superb (and I pay $100 a month for this paradise).

Now, allow me to tell you about work. Many of you know I got my EMT certification last winter, mostly in hopes that I’d be able to get involved with some volunteer opportunity in a medical capacity during my travels. It’s one of the lowest medical certifications (up from CPR), but has enabled me to work with the mostly Guatemalan nursing staff at the Hospitalito. I’ve hopped right on with their schedule, day shift, night shift, then a day and a half free, and I primarily help out the doctor and med students on call in the ER (two beds) and manage care for our in-patients (up to five, plus two delivery beds, which are nearly always occupied by young mothers-to-be). I’m still getting my bearings of where supplies are located and the procedures for running a shift but it’s been shocking how involved I’ve been able to be. The first real day I was working, a man came in to the ER, drunk as they nearly always are, pants tied in front with a plastic straw, with a severe posterior septum hemorrhage (substantial nose bleed way in the back of his nose). He was bleeding out his right nares and also down his esophagus and would periodically vomit out semi-coagulated blood. Our attempts at putting a foley catheter to pack his hemorrhage were frustrated until after we had recovered 600ml of lost blood and he had soaked his clothes, the ER bed, and most of the personnel involved. We were able to stabilize him, but it was an incredible experience to start of my month here. I was right in the middle of things, holding his head steady, putting pressure on his nose, coordinating efforts with the ER resident on call, administering O2. So exciting!

I’ve since been involved with other ER traumas, and also with in patient care, which is just as rewarding, as I’m able to interact with the patients, learn a little about them, and make them feel a little more comfortable around the primarily English-speaking doctors, many of whom utilize me for translation (so glad I just had that month studying in Xela). In truth, it’s usually the doctor speaking to me in English, me speaking to one of the nurses in Spanish, and the nurse speaking to the patient in T’zutuhil. You wonder how much really gets through this game of telephone. I’ve helped out with deliveries – I’ll never forget watching this 3-minute old baby, still wet and bloody, crying and clawing the air suddenly quiet, eyes wide, and stare about the room in wonder at the new world in which she was just beginning life. It was truly magical to see, especially so at 2:30am.

It’s been such a privilege to be involved. And, quite frankly, I’ve been able to do and see things here that would take a medical school degree and three years of residency to do (and then would be fighting other residents for the privilege). Last week a surgical jornada came for three packed days of operations and consultations. I was assigned to be a circulante in the Operating Room. Our first operation of the day was the repair of a veseco vaginal fistula, essentially a passage torn between the bladder and the vagina in danger of infection. I spent the first while translating, and learning from the anesthesiologist how he sedated the patient, maintained her vitals while providing for the surgeons. After an hour, the two surgeons said they needed another pair of hands, would someone please scrub in. I volunteered (realizing that the first time I had even worn scrubs was a week ago), washed my hands and forearms and then slipped into the sterile gown and gloves. It was incredible to be right there next to this open-abdominal surgery, I was responsible for suction and holding whatever clamp or malleable the doctors needed. (Two hours into the three hour surgery, the gynecologist looks at me and confirms that I was an ENT – ear, nose and throat – resident, right? I laughed, and said no, I haven’t even finished undergraduate yet, I’m an EMT! He stops and says, what the hell are you doing in the OR? I say simply with a shrug, it’s Guatemala! We laugh, and go right on with the surgery.) she gave us a scare for a minute when she shifted her hips and bore down on her abdomen, spilling a portion of her small intestines out of her incision; the anesthesiologist jumped up and gave her a direct IV injection. I learned then: anesthesiology is 90% boredom, 10% terror, according to the stats he gave me.

Last Friday I learned how to insert an IV line (well outside of my legal scope of practice in the US), and yesterday applied three, the last one perfectly, not spilling one drop of blood. I was so proud and bragged about it to all the volunteers. It’s wild how many different medical problems I’ve already seen after my first week, probable GI ulcers, scalp lacerations, potential sepsis in a 3 week old, removal of benign foot growths, diabetic ulcers, fevers, colds, coughs. This is the medical world (though I’m constantly impressed by the other volunteers that this is nothing like medical practice in the states). Still, I’m learning so much, getting such great experience, and really starting to wonder if the medical field might be a calling for me. I’d take after my mom and dad, I guess, maybe it’s in my blood. It’s been so fun, also, to learn (from the other med students and nurses, and also from the work) and really appreciate the work that they both dedicated their lives to.

Just a couple more things to communicate, update-wise. Playing a lot of soccer, the doctors just played in a three day tournament, Hospitalito vs. the carpenters, machinists and teachers of Santiago. Such a blast! Climbed volcan san Pedro, and started off paddling the local canoes across the bay (at least 70% of the time Tanner and I couldn’t get it to go in any kind of a straight direction), followed by a 4 hour hike STRAIGHT up the mountain. I’ve also been recruited to train the local bomberos of Santiago, whose only expertise are in tossing a little bit of water on any medical victims, and then driving their ambulances really really fast to the Hospitalito. It’s been frustrating to try to teach them CPR and spinal immobilization, especially in another language, and a little intimidating, me being some punk kid standing in front of 20 attentive Guatemalan men. Hopefully Tuesday will go a little better. I’ve also been offered a job here at the Hospitalito, a paid position, to take over the volunteer coordinator who leaves in a week. I was flattered, of course, and while it would be incredibly rich to really stay and get to know this town and become a local, I seem a little adverse to accepting. Firstly, it’s an administrative position, so while I’d be able to continue working with the nurses, my priority would have to be sitting in front of a computer. It’s a needed position to be filled, and I was repeatedly told I’d be a great candidate, but it would dramatically change my plans for the rest of my trip; no more traveling. I’ve gotta come up with a decision in the next few hours.

So that’s my life right now. I live in paradise and get an adrenaline fix every day. I’m learning a ton, making great friends, and potentially working on building a future career. How perfect is that?

I have posted some pictures on my photo gallery, of my house, some friends, and even a few (of me!) in the operating room, which are really wild. Dad, it took you 13 years of postgraduate study to get into the OR, I’m doing surgery on a year break from undergraduate! Note, for some reason my most recent pictures are posting in the MIDDLE of my photo gallery, so leaf through the pages until you see shots you haven’t seen (it’ll be clear which are the medical ones, look for a lot of people in scrubs and medical supplies everywhere).

Hope you all are living life as if you’ll die next week (which you might!). Live with not a drop of fear, go after your dreams like you were born to! So much boundless and energetic love, Ty