Sincelejo Diaries, part 2

Posted on April 5, 2014 by K Eckland

Tuesday – We drove back from Cartagena this morning before heading to surgery in the afternoon for a bypass grafting case. For the first half of the way, I sat in the back and enjoyed looking out the window. It’s amazing how dry parts of Bolivar are.

The drought has been responsible for the deaths of over 20,000 farm animals here in Colombia. The small lakes are disappearing, from my first trip to Sincelejo to my most recent visit just a few weeks later. The trees and bushes besides the roadways are completely coated with layers of dust from passing vehicles. It gets greener as we pass into Sucre, but it’s a sad reminder of the devastating effects of climate change.

After stopping for breakfast along the way, where we met up with Dr. Melano, Iris went with Dr. Melano and I stayed with Dr. Barbosa. We talked about music mostly. At one point, a former patient from several years ago called, just to say hello. The patient had recently heard that Dr. Barbosa now had a surgery program in Sucre. (The patient had previously traveled to Cartagena from a small town in Sucre for surgery.)

Once we got to Sincelejo, we headed to the hospital to see our patient before surgery and go over any last-minute questions or concerns.

(Of course) I was worried about finding vein but we easily found good quality conduit. Dr. Salgua has been very nice about helping me with the saphenectomies. The team teases me because I have a difficult time pronouncing her name. We have a kind of system: While I finish closing the leg, she moves up the table to assist the surgeon in starting the grafts. Then when I finish wrapping the leg, I stay at the back of the table with the instrumentadora, learning the Spanish names for all the instruments. Once the chest is closed, she does a layer of fascia and I close the skin incision.

It’s a little crowded sometimes with the new instrumentadora learning the essentials of cardiac surgery, but the atmosphere at the back of the table is a lot different from the climate at the top. (Dr. B is always calm, pleasant and entertaining – but Dr. Salgua is almost completely silent the whole time). I am a lot quieter than my “out of OR self” when I am across the table from the surgeon too..

Wednesday – Another coronary case, on a fragile-ish patient (multiple co-morbidities including chronic kidney disease etc). It was a long case and I was a little worried the whole time but the patient did well. (I always worry about the frail patients).

I did okay too – performing a saphenectomy with Dr. Barbosa. The patient had a vein stripping procedure previously (on one leg only) so I wanted to be sure to get a good segment of vein on the remaining vein. I think Dr. Barbosa was worried about the quality of the conduit (because he kind of hovered – and didn’t relax until we started harvesting it.)

Skip harvesting

I wish I would have more opportunities to perform a traditional saphenectomy (one very long incision). I assisted on one several years ago – and I think if I had a chance to do a couple more, I would feel more comfortable skip harvesting. Of course, a headlamp would also help. (It’s kind of dark looking down the skip ‘tunnels’). Then once I’ve mastered skip harvesting, I think it’s just another small jump to endo-harvesting with a scope. I know a lot of people never bother learn to skip harvest, but I feel more comfortable building on the principles of open procedures first. I might need them in an emergency case which is kind of why I wished I had more open saphenectomy experience.

Thursday – Saw three patients in the clinic today. However, on reviewing the patient records and an intra-office echocardiogram, one of the patients definitely doesn’t need surgery at this point. (Asymptomatic with only moderate valvular disease). We were happy to let him know he didn’t need surgery even if that means fewer cases.

Two surgeries today. The first case was a bypass case for a patient with severe coronary disease and unstable angina. Dr. Salgua and I did the harvest. I think Dr. Barbosa is a little nervous about handing over the reins to me for harvest because he keeps a pretty close eye on me while I am doing it. But then again, it might be because I am a little overly cautious and hesitant at this point. If I didn’t have Dr. Salgua to look over my shoulder and encourage me onward, I’d put clips on everything and proceed at a snail’s pace to make sure I do it right. But since it’s still my first week, maybe I shouldn’t be so hard on myself.

On the other hand, he must think my suturing is pretty good, because he just trusts me to do it correctly.

The second case was a patient from last week, who developed a large (symptomatic) pleural effusion and cardiac effusion (no tamponade or hemodynamic instability) which is a pretty common surgical complication. The case proceeded well – I placed the chest tube, with Dr. Barbosa supervising. Dr. Barbosa performed the cardiac window portion of the procedure.

Sadly, one of our patients from last week died today. It was a fragile patient to begin with, and even though surgery proceeded well, the patient could never tolerate extubation and had to be re-intubated twice after initially doing well. From there, the patient continued to deteriorate.

Friday

Today we had a beautiful aortic valve surgery. This has always been one of my favorite cardiac procedures. Somehow its elegant in the way the new valve slides down the carefully coördinated sutures. (I don’t have pictures from this case – since I was first assisting – but I will post some from a previous case – so you can see what I mean).

Dr. Salgua worked an overnight shift, so I was at the top of the table – (and yes, noticeably quieter than normal.) I was surprised at how fast it seemed to go – but maybe that’s because everything went so smoothly. Or maybe because we’ve done a lot of coronaries lately, which is a much more tedious and time-consuming process.

Iris and I are working on a patient education process – as a way to improve the continuum of care for patients (particularly after discharge). I really enjoy working with Iris because I feel like we are always on the same page when it comes to patient care.

While it’s been a tiring week for the crew – I am, as always! exhilarated and happy to be here in Sincelejo. Just knowing it’s the end of another week (and I am that much closer to going home) has me feeling a little sad. But I guess I can’t stay forever, and I sure don’t want to take advantage of all the kindnesses that have been extended to me.

That being said:

At the end of every surgery, every day and every week in Sincelejo – I am grateful. Grateful to Dr. Barbosa for being such a willing and patient teacher – grateful to the operating room crew (especially Iris Castro and Dr. Salgua) and particularly grateful to all the kind and generous patients I have met and helped take care of*.

The medical mission

This week I had another inquiry about ‘medical missions’. I know people mean well when they ask about medical missions, or when they participate in these types of activities but…

Long time readers know my philosophy on this – don’t go overseas so you can pat yourself on the back over the ‘great deeds’ you performed ‘helping the poor’. It’s patronizing to the destination country and its inhabitants – and generally not very useful anyway. An awful lot of volunteers with real skills and talents go to waste on these so-called mission trips when their skills might be better served (in less exciting or glamorous ways) in free clinics in our own country.

But it does give everyone involved a chance to brag about how selfless and noble they have been; traveling thousands of miles, sleeping somewhere without 24/7 wi-fi (and who knows what other hardships).

Instead, change your orientation – and maybe challenge that assumption that everything you’ve learned about medicine, health care and taking care of people is better and superior. Open your eyes and be willing to learn what others have to teach you instead.

* I always opt for full disclosure and transparency with the patients. I introduce myself and explain that I am a studying with Dr. Barbosa, what my credentials and experience is to give them the opportunity to ‘opt out’.

Iris & Ximena

Posted on March 31, 2014 by K Eckland

Here in Cartagena, I have been fortunate enough to have two great roommates; Iris and Ximena.

Dr. Barbosa made all the arrangements for me, and I was a little nervous about bunking down with another nurse (we can be temperamental and territorial at times) but living with Iris has been absolutely wonderful.

I was kind of worried I’d be living with some young, possibly flighty nurse who might resent having a middle-age woman in her home, cramping her style. Instead, it’s like having an instant best friend and I love it.

For starters – we have a lot in common: we are both academically and professionally inclined. Iris is the perfusionist for Dr. Barbosa’s cardiac surgery service and is extremely knowledgeable.

Part of the machinery that makes up Iriis’ professional life: the heart-lung machine

(In Colombia, Perfusion is an advanced nursing degree. Iris obtained her master’s degrees in both critical care (National University) and Perfusion at (CES.). She is widely acknowledged as one of the best perfusionists (if not the best) in all of Colombia. Her peers frequently consult her seeking advice for a variety of surgical circumstances.

She is the only nurse to collaborate (and be listed on the cover) of a comprehensive Colombian textbook on Cardiology. Her name is listed along side such esteemed Colombian physicians as Pablo Guerra, Nestor Sandoval and Sergio Franco.

She also serves as a reviewing editor of several Colombian medical journals. Research articles are sent to Iris to review the methodology/ study design and overall quality. Articles she rejects will not be accepted for publication.

In her free time, it’s not unusual to find her reading the latest journal articles on cardiac surgery or working on presentations for the latest meeting or international conference on perfusion. In fact, she recently returned from the annual Colombian conference on cardiology and cardiac surgery in Medellin. She is equally enthusiastic about all aspects of nursing and the position and rights of women (nurses) in Colombia and in medical society in general.

She is particularly outspoken against much of the machismo that dominates life here. She is the one person I have learned to expect to never ask me the unpleasantly intrusive questions that seem to pass for almost introductory conversation here such as “Why don’t you have children? Don’t you want them? What does your husband think of that? Your husband permits you to be here [in Colombia] without him?”*

Even when we don’t agree on all issues, she never judges my opinions or thoughts. She endeavors to understand my reasoning instead. It’s refreshing.

This combination of intellect, insight and experience makes for a lot of interesting and engaging discussions in the evenings as we relax and enjoy the fragrant breezes that bring daily relief to the sweltering city.

A strong woman in a culture of machismo

Iris is also extremely forthright and independent (traits that also resonate with me.) She takes no ‘guff’ from anyone and lives how she pleases in a society that has a lot of difficulty accepting that (unmarried, no kids with Ximena as a part-time roommate.)

Even my professor, as charming and intelligent as he is, defaults into this kind of ‘macho’ thinking. He tells me he worries about Iris, as “she is all alone” without a man to protect her. He worries she is missing out on true happiness and is destined to be sad, alone. Nothing could be further from the truth.

Rather, Iris has chosen to defy tradition, and live life on her terms. She has friends, family and romantic attachments like anyone else. She just maintains both her privacy and her independence despite that, sort of like Elizabeth I of England.

It is sometimes hard as an outsider to understand why this attracts some much attention – a single woman living quietly in her own apartment. But then I think back to some of the comments I get from friends, acquaintances, co-workers and even strangers regarding locums life, and I realize, that as female professionals; whether the United States or Colombia, we still have a long way to go.

It’s just that as an American, I think I have fallen for the illusion of the possibility of female equality in way that women in other countries never have. (The irony is that at this moment in my home country, women’s rights; to reproductive, financial and professional freedom are being eroded more that any other time in recent history. Hard won battles of the 60’s and 70’s are being erased with nary an outcry.)

Here ‘paternalism’ rules the day – and no one pretends any different.

But there is more to Iris that a forthright, intelligent, independent individual. She is also a nurturer, a caregiver, a nurse in the very sense of the word.

What could be more nurturing that offering up her home to an unknown stranger from another land?

“Ximena”

Iris and the other members of her apartment complex have adopted a white and orange stray cat that answers to a variety of affectionate terms. One of these is “Nena”. One my first day here, I confused “Nena” as a shortened version of Ximena, so Ximena she is.

This straggly looking, mangy little ball of fluff is adored by the residents of the small apartment building. Typical of most cats, she is “owned” by none, but owns each neighbor in turn. But it was Iris who took up donations to get Ximena surgery she needed and routine veterinary care. All the residents share in the feeding and care of the street cat – including applying a cream to her healing surgical scar, but it is Iris whom Ximena usually seeks.

While most of the residents leave their doors open during the afternoons to invite Ximena in, Ximena is most often found either inside our apartment, or bellowing outside the door (on the rare occasions that is is closed.) She wanders in with the grace and arrogance that only a cat possesses.

She carries herself with a dignity that belies her ‘homeless’ state as to say she isn’t a vagabond but a seasoned traveler as she visits each apartment in turn – but always comes back to Iris to stay all afternoon and overnight.

Some of the neighbors our jealous of Ximena’s attention, but with our weekly journeys to Sincelejo, they always have an apportunity to host ‘Nena as their favored guest.

Iris loves to cook – and does so easily, deliciously. She embraces a healthy lifestyle filled with daily exercise and fresh fruit and vegetables.

salad made of exotic fruits

We talk about my love of Colombian food – and together one day in the kitchen, we make brevas. She tells me with a smile that she has never made them, but used to watch her grandmother cook them for a sweet tweet.

Boiling brevas: Photo by Camila

We savor the sugary treat, one breva at a time over the next several days.

In addition to learning how to perform saphenectomies from Dr. Barbosa, Iris is teaching me how to crochet. My first project will be one of the small bags that is in a style typical for Colombia. I think it is ironic that it seems easier to suture that it is to crochet.

But Iris is endlessly patient with me – and slowly, slowly as I unravel my mistakes and start again, I am making progress. She has a blogspot where she showcases her latest creations. She recently received national accreditation as a ‘native artist’ to participate in festivals and art fairs that specialize in traditional Colombia crafts.

Today, as we sit on the sofa, crocheting, we talk about plans for the Semana Santa (Easter Week). The secretarial staff in Sincelejo has vacation plans and wants to keep the office closed all week so she can visit a boyfriend in Medellin – but Iris and I think it should remain open for the patients. We plan to offer to staff the office, so that patients won’t have to wait a week to be seen. We will have to navigate and negotiate carefully and diplomatically to prevent causing any hard feelings but as Iris points out, it’s the right thing to do for the patients – and the doctors, and that’s what matters. (My motives are admittedly more self-serving: more clinic = more surgery.)

*This type of questioning is fairly pervasive throughout Colombia, and is often performed as part of introductory conversation. Once a taxi driver in Bogotá directed me to the nearest fertility clinic when I responded “No” to the question about children. He wasn’t rude, on the contrary, he thought he was being helpful.

** Iris prefers not to have her picture taken.

The Sincelejo Diaries

Posted on March 30, 2014 by K Eckland

Sincelejo from the balcony

Since I have very limited wi-fi while in Sincelejo, I have been keeping a diary of my time on the cardiac surgery service of Dr. Cristian Barbosa. But then again, maybe I should explain why I am here.

I came to Colombia to learn how to perform skip harvesting saphenectomies with Dr. Barbosa. As I mentioned previously, we’ve kept in contact since we first met, and he was gracious enough to offer to teach me.

Before I ever left Virginia, it took a lot of paperwork and diplomacy, but we were able to secure administrative permissions for me to study sapheneous vein harvesting with Dr. Barbosa at the hospital in Sincelejo. While this isn’t medical tourism, I thought my readers might enjoy hearing about daily life as part of Dr. Barbosa’s cardiac surgery service.

Cardiac Surgery in Sucre, Colombia

outside the operating room

While the cardiac surgery program is located in Hospital Santa Maria, Dr. Barbosa and his team often travel to nearby hospitals and clinics to see new consultations. This program is the only program in the state of Sucre and patients come from all parts of the state.

Many of the patients come from tiny pueblos of a few hundred (or thousand people). Many others come from impoverished backgrounds. (Colombia has a tiered health care system with a national health care plan for people from lower socio-economic classes, kind of similar to the Medicaid concept.)

We arrive in Sincelejo on Monday, March 24^th in the evening. We have a busy day tomorrow and the doctor wants to get started early (without facing the 3 hour drive in the morning.)

En Familia

In Sincelejo, we live en familia, in a large airy apartment with big windows that overlook much of Sincelejo. There are four of us here, the surgeon, the anesthesiologist (who is Director of the program), the perfusionist and myself. Iris and I share a large room with a private balcony. Meals are shared and we usually travel as a group to the hospital and on errands.

After our arrival Monday evening, the doctor, the perfusionist and I head to the largest grocery store and shopping center in town. We shop as a family, picking out fruit, arepa corn flour, coffee and other essentials. We then head to the food court. (They are treating me to Corral, due to my proclaimed love of Corral’s famed hamburgers).

It sounds like it could be uncomfortable – this domestic scene with my boss and the cardiac surgery team, but surprisingly it isn’t. Iris, the perfusionist (and my roommate both here and in Cartagena) always says they are a “cardiac surgery family,” and it feels that way – in a comforting, cozy way.

I joke and call Dr. Barbosa, “Papa” as he is the natural father figure of the group, and somehow it feels appropriate.

‘Papa’ of our cardiac surgery team

25 March 2014 – Tuesday

Today we travelled to Corozal to see two consultations in the intensive care unit. Then we returned to Sincelejo to see another patient at another hospital, Maria Reina. We eat lunch at the apartment, en familia . Afterwards, we go back to the office to see patients before heading off to surgery. (We had to delay surgery for several hours because the patient decided to eat breakfast. I guess s/he was hungry too).

Finally after this delay (to prevent anesthesia complications), we head to the operating room. There are the typical delays while the patient is being prepped and prepared. This gives me a chance to get to know the rest of the crew, Anita (the instrumentador or surgical tech) who runs the operating room table, Raquel, an experienced instrumentador who is training to work in the cardiac suite, and the two circulating nurses, Patricia and Estebes.

Raquel (right) and Anita, the instrumentadors

The circulating nurses are responsible for taking care of all the duties that fall outside of the sterile field, like fetching additional supplies, medications or instruments. They also control the environment by regulating the temperature, and adjust the electronic machinery (like the electrocautery unit, or the sternal saw) according to the surgeon’s immediate needs and specifications.

Patricia and Estebes, circulating nurses

Dr. Salgua is the medical doctor who works in the office, seeing patients and assessing their medical (nonsurgical needs.) For the last year, she has also worked as Dr. Barbosa’s First Assistant in Surgery. If there is any chance for friction in the operating room, most likely it will come from her. I am cautiously nice but optimistic when I realize she is fairly quiet, and not overly aggressive. (I relax, but just a bit. I am still nervous about how the team will take to me, even though the common Oops! “accidental” needle stick scenario seems unlikely here.

Dr. Salgua

Everyone is very friendly and welcoming and even before starting the actual surgery, I am breathing easier and starting to think that maybe I could belong here, with this group.

The surgery went well (valve replacement and annuloplasty). After the surgery, we transport the patient to the intensive care unit and give report to the doctors and nursing waiting to assume care of the patient.

Note: patient did well and went home on POD # 3 on 3/28/2014.

26 March 2014 – Wednesday

More surgery today, but still no coronaries (and thus no saphenectomies). It was a great day in the operating room – I closed the sternal incision.. (BTW, surgery went beautifully). I am already starting to feel more at home with the operating room staff, and I feel like they don’t mind having me around. Dr. Salgua has been very kind in assisting me during procedures, which is a relief. She still stays pretty quiet during the cases, but I think maybe sometimes she is a bit nervous too.

with the team

After transferring the patient to the ICU, our second visit to the patient from yesterday finds her over in the general surgery ward. (This morning she had been sitting up in a chair in the ICU when we arrived.) She looks good and states she is sore, but otherwise fine.

The cardiac catheterization lab calls; there are four cath films they want us to review, and patients to discuss regarding surgery. The patients themselves are resting in the recovery area after the cath procedure, so our administrative assistant, Paola makes appointments for each of them and instructs them to bring their families, medications and any questions.

The most interesting part of the cath lab is who is doing the caths. It’s a nurse, while the cardiologist sits behind the protective radiation shielded glass enclosure viewing the films and calling out for additional views. I wonder if the nurse knows that in the United States, a similar position would pay over 100,000 dollars. But this is one of the things that I see a lot of her in Colombia and in Mexico. Well trained nurses being essentially nurse practitioners (making diagnoses, treating disease, performing invasive procedures) but without the status or the compensation.

My roommate and I talk about this disparity sometimes. She’s a master’s trained nurse herself, so it makes for some very interesting discourse and insights. (She doesn’t like to have her picture taken, so I haven’t.)

We finish seeing patients and head home. The doctors head off for a siesta. Dr. Barbosa has been up since before five for his daily exercise before surgery.

As for me – after some scouting of the immediate areas around the hospital and the apartment, I went on my motorcycle tour. It was great fun but I got an important reminder of the perils of motorcycles just a few days later.

Note: After and uneventful surgery (defect repair), patient recuperated quickly, and was discharged 3/29/2014.

27 March 2014 – Thurday

The week is really flying by. I’ve been having fun with the operating room team. They are a great group. Everyone has been extremely nice and welcoming. (You can never be sure how your presence is going to be tolerated or change the existing dynamic.) Dr. Melano and I have a couple of animated discussions over current practices, literature and recent meta-analyses. It’s an enjoyable discourse even though my vocabulary often fails me. I hear myself making grammatic mistakes and repeated errors in Spanish but it seems with some much going on (reviewing my anatomy, practicing my suture ties, assisting in the operating room and trying to keep up on my writing )- I just can’t seem to remember as much as I should in Spanish. I inwardly cringe when I substitute ‘conocer’ for ‘saber’ yet again, but the word is out of my mouth in reply to a question before I can corect myself.

Dr. Salgua assists Dr. Barbosa

I sit out this surgery (still no coronaries) and spend some time taking pictures to document my experiences here. I got a couple of shots that I really like, including one of Dr. Barbosa, Dr. Salgua and Raquel.

one of my favorite pictures from that day

Note: Patient discharged home 3/29/2014.

28 March 2014 Friday (and coronaries!)

Today is my big day – and I am excited and a little scared too. I got up at five this morning and went with Dr. Barbosa to the exercise park, so I would have a place to walk while he played tennis. It helped me get ready for the day, and I got to see where Dr. Barbosa uses up all of his pent-up aggression. He turns it into a power slam. (I don’t know tennis terms, but whatever swing he was doing – it must be responsible for his tranquil overall demeanor.)

After breakfast, we head to the hospital. We check on our hospitalized patients before going to see today’s surgical patient in pre-op.

Our patient is a bit fragile-looking so (of course!) I worry about her and how she will do with surgery. I also worry that I might not sew straight, now that it’s time for me to get to work.

Some of my previous OR “lessons” have been brutal, including several at a troubled facility that sent me running away from cardiac surgery (of all kinds) for several months*. This is what fuels my anxiety. (I am not anxious by nature).

But here in Sucre, in this OR, this experience is nothing of the sort – Dr. Barbosa is an excellent teacher. I don’t know why it’s a surprise. He’s always been a bit of a Clark Kent of the operating room; pleasant, calm and methodical.** This is just the same. In his soft burring voice he goes over the procedure with Dr. Salgua and I. The he oversees our attempts, gently encouraging and coaxing. It is yet again, a comfortable experience, instead of a traumatizing, horrible one.

a pretty great teacher

I don’t have any pictures which would show my twinkling eyes which are the main indication of my happy grin beneath my mask as I finished closing the last leg incision.

We wrap the leg when we finish and move up to the ‘top’ of the operating room table. (I’ve learned that the top and the bottom of the operating room table are two very different places.)

I close the chest incision – surgery is over. We transfer the patient to the ICU. She remains a little fragile but has no immediate problems.

After making sure the patient is stable, the team heads over to Clinica Maria Reina. We have received a call that a trauma patient is being placed on ECMO (to support his lungs) after developing a fat embolism. We are standing by to help, as needed.

As I look around, and talk to the staff, I find that there are three patients in the small ICU, all young men in their twenties, all intubated with critical injuries, all due to motorcycle accidents. One patient, just barely an adult has lost a limb as well. He is awake and hitting the siderails with his remaining hand to capture the nurse’s attention. She holds his hand and speaks soft to him and he calms down. Watching this, along with the patient struggling to survive as doctors rush to connect ECMO is a sobering reminder of how devastating my joyride could have been.

The patient is connected to ECMO without incident. As a weary unit, all four of us return home.

The view from my private dance floor..

Everyone is exhausted – but I am exhilarated! I just want to dance – so I do, by myself, on the balcony with my phone blaring out some music. Later that evening, we go out for dinner to celebrate a successful week. I am still in a joyous dancing mood which probably drives my companions a little crazy but it’s been such a great day.. so when we return home, I dance some more.

March 29th, 2014 – Saturday

In the morning after my dancing spree – Dr. Barbosa and I walk down to the hospital. Our fragile patient from yesterday is doing okay, and our other two patients are ready to go home. I review discharge instructions with each patient, and hope that I am not mangling my Spanish too badly. But they seem to understand me, so maybe I am doing alright. The doctor is nearby, writing prescriptions, to clarify anything I have trouble explaining.

One patient asks about getting out of a chair without using his arms (and stressing the sternal incision) so I demonstrate my favorite technique, and together we practice.

After we finish, we head back to the apartment to eat breakfast, finish packing and head back to Cartagena. Dr. Melano is staying behind (along with Dr. Salgua, who lives in Sincelejo) to check on our remaining patient.

The ride back is pleasant, but I start to feel some of the fatigue from all of the excitement of the week. I also feel a little sad to be leaving our little cardiac ‘family’ for a few days, which is probably crazy considering how much time we’ve all spent together. I guess it’s because I know it’s just temporary.

Iris and I head back to ‘our’ Cartagena apartment where the neighborhood cat, Ximena is waiting for us.

Now we will relax, write and get ready for the return trip on Tuesday.

* A deliberate elbow to the face was just the beginning of a series of humiliations at a previous facility.

**Pulling on his superman cape when needed.

Memories of Mexicali

Posted on September 10, 2012 by K Eckland

As I get ready to leave Mexicali, I am posting several old postcards of the city. Today’s post is more reflective of the many changes going on now – but we’ll be back to our usual topics soon..

this one is just a few years old

I’m sure that my regular readers can tell that parting is ‘such bittersweet sorrow’.. How could it not be – when I have met such wonderful people, learned so much and made some great friends?

Mexicali – Av..Revolucion – circa 1960’s

At the same time, I am excited about moving forward – school, studying in Bogotá, and working on my research.

Governmental Palace (now part of UABC) circa 1960’s

Hard to leave the hospital in particular. I went back there yesterday and got to see some of the people who were so welcoming, starting on my very first day. (When I was still struggling – particularly with the regional accent here – which differs from the Spanish I was used to hearing.)

Av. Lopez Mateos

It was great to be back in the operating room with Dr. Ochoa. With classes in Nashville, and my homework assignments, I hadn’t seen him for a couple of weeks.

I know I will miss him most of all even if I am embarrassed to admit it. He will always rank up there as one of the world’s great “bosses”; he was great to be around; day after day after day- which is not something you can say about most people. I know I’ve talked about what a good (and patient!) professor he has been, but this last month, when we’ve been collaborating on the book, has changed the dynamic a bit. He’ll still always be ‘my professor’ and a surgical colleague – but now that we have worked together in a different capacity – he is more of a friend too. (I’ve actually called him by his first name a couple of times, which is a hard thing for me to do..)

I think, too, that is was a little-bit eye-opening for him to be more involved on the writing (and researching) side of things. I hope he enjoyed it as much as I have. (He should – he did all the research on Mexicali’s nightlife.. )

and Joanna – who has become one of my best friends.. (Not just my best friend in Mexicali – but someone I consider a really close friend – anytime, anywhere..) It just seems like we connect and communicate on that level that only really close friends ever do.. Despite different backgrounds, I feel like I’ve known her my whole life.. So it’s hard to say “see you later” to Joanna.. (“See you later” is so much better than goodbye, don’t you think?)

So of course, as you can imagine – I spent my last day at the hospital – in the place I love the most: the operating room.

Dr. Rivera (left) and Dr. Ochoa

I’m going to miss my ‘movie star’ surgeon too – Dr. Rivera has been great about being in all my pictures and film clips.. He’s a nice young resident – (still grounded) and I think he’s be a great surgeon when he finishes his training.. He’s interested in surgical oncology – so we might be writing about him again in a few years..

Meet Lupita Dominguez, surgical nurse

Posted on July 5, 2012 by K Eckland

Had an amazing day yesterday – one of those days that reminds you how much we can do in medicine when we all work together. I am hoping to write it up as a case study – if not – I will tell you more about it here. (The patient was exceedingly gracious when I asked permission.)

But this morning, I was back in the operating room with Dr. Cuauhtemoc Vasquez. (If he is tired of me – he sure doesn’t let on..)

I finally had the opportunity to get some of the pictures I’ve been trying to get on every visit to his OR – to show readers the heart, and the pulse of cardiac surgery..

There’s a running joke in Mexicali – if you need help in the operating room, any operating room, in any of the hospitals in the city; just holler for Lupita because she’s always there.

Introducing Lupita Dominguez, surgical nurse

All kidding aside on the popularity of the name “Lupita” among operating room personnel, there is just one Lupita that I would like to talk about today, Lupita Dominguez, who is Dr. Vasquez’s surgical nurse. In the months, and the numerous occasions that I have been a guest in Dr. Vasquez’s operating room, I’ve had the opportunity to observe and appreciate the hard-working Lupita.

Lupita Dominguez with Dr. Vasquez

Teacher, Coordinator and Mind-Reader

Most people don’t know it – but Lupita has the hardest job in the operating room, and probably (in Mexico) the most poorly paid. They say a good scrub nurse has the instrument in the surgeon’s hand before he knows he needs it – and from what I’ve seen, that’s Lupita. She’s here an hour earlier than the rest of the surgical team, getting everything ready, and she’ll be here after everyone else escorts the patient to the intensive care unit.

Here she is, a blur of motion as she takes care of everyone at the operating room table

As I watch again today, she is ‘running the table’ and anticipating the needs of not just one demanding cardiac surgeon, and an additional surgeon, but also one surgical intern, and another student. With all of these people crowded at the table, she still has to follow the surgery, anticipate everyone’s needs and keep track of all the instruments and supplies in use. In the midst of this maelström, the scrub nurse has to ensure that everyone else maintains sterility while preventing surgical instruments from being knocked to the floor, or otherwise misplaced (a difficult task at times).

Here she is demonstrating how to correctly load the needle, and pass sharp instruments

She’s forever in motion which has made taking the few photos of her a difficult endeavor; She’s shaving ice for cardioplegia, while listening to the circulator, adjusting the OR lights, and gently guiding the apprentices. She’s so gentle in her teaching methods that the student doesn’t even realize she’s being led, and relaxes enough to learn. This is no easy task, particularly since it’s just the beginning of the July, and while bright-eyed, pleasant and enthusiastic, the new surgical resident is inexperienced. Her own student nurse, is two parts shy, but helpful enough that near the end of the case, (and the first time since I’ve known her), Lupita actually stops for a moment and flashes me a wave when she sees the camera faced in her direction. I’m surprised, but I manage to capture it.

a very rare moment – Lupita takes a millisecond to say hello

She is endlessly busy, but ever uncomplaining – even when a scheduled surgery takes an unexpected turn and extends to twelve or even fourteen hours. Bladder straining perhaps, baby-sitter calling, but Lupita never complains. She’s not unique in that – scrub nurses around the world endure long hours, tired feet and legs, hungry bellies, full bladders, and aching backs as they complete their days in the operating room. But she does it with good nature and grace.

Lupita assisting Dr. Vasquez during surgery

The surgical nurse

In the United States, this important job has been lost to nursing, a casualty of the ongoing shortage. Positions such as scrub nurse and others like it have been frequently replaced with technicians who require less training and thus, less compensation that nurses. Maybe the nursing profession doesn’t mourn the loss; but I do.

as you can see – here she is, ‘behind the scenes’ so to speak..

But in Mexico, and many other locations, this position remains the exclusive domain of the nurse. Nurses such as Lupita, spend three years studying general nursing in college, before completing an (optional) additional year of training for a specialty such as the operating room. After completing this training, these nurses spend yet another year in public service.

The idea of the public service requirement is honorable yet almost ironic (to me) at times, since the majority of nurses in Mexico will spent their careers in public facilities, and by definition (in my mind at least), nursing is an occupation almost entirely devoted to the service and care of others.

Working conditions vary but some constants

Depending on the country, the culture, and the facility; conditions may vary; nurses may get short breaks, or be relieved during particularly long cases. The only constant is the cold, and the hard floors, and rickety stepstools[1]. While the nurses here tell me that the workday is only seven hours long – I’ve been in the operating room with these ladies before, and watched a supposed ‘seven-hour’ day stretch to fifteen. But it is just part of being a nurse.

[Usually I tell people when I am writing about them – but on this instance – there was never an opportunity.. but she (and all the nurses in the OR with Dr. Vasquez) certainly deserve mention.]

[1] Temperatures are set lower in cardiac surgery rooms. Why the stepstools always seem rickety, I have no idea.

Wrapping up and saying “Thanks!”

Posted on July 1, 2012 by K Eckland

It’s a busy Sunday in Mexicali – presidential elections are today, so I am going to try to get some pictures of the nearest polling station later.. In the meantime, I am spending the day catching up on my writing..

a polling station in Mexicali

Lots to write about – just haven’t had the time.. Friday morning was the intern graduation which marks the end of their intern year – as they advance in their residencies.. Didn’t get a lot of pictures since I was at the back of the room, and frankly, unwilling to butt ahead of proud parents to get good pics.. This was their day, not mine and I was pleased that I was invited.

I did get a couple of good pictures of my ‘hermanito’ Lalo and Gloria after the event. (I’ve adopted Lalo as my ‘kid’ brother.. Not sure how he feels about – but he’s pretty easy-going so he probably just thinks it’s a silly gringa thing, and probably it is..)

Dr. ‘Lalo” Gutierrez with his parents

Lalo’s parents were sitting in the row ahead of me, so of course, I introduced myself and said hello.. (They were probably a little bewildered by this middle-aged gringa talking about their son in atrocious Spanish) but I figured they might be curious about the same gringa that posts pictures of Lalo on the internet.. I also feel that it’s important to take time and tell people the ‘good things’ in life. (Like what a great person their son has turned out to be..)

Same thing for Gloria.. She is such a hard-worker, and yet, always willing to help out.. “Gloria can you help me walk this patient?” It’s not even her patient, (and a lot of people would say – it’s not our jobs to walk patients) but the patient needs to get out of bed – I am here, and I need some help (with IV poles, pleurovacs, etc.) and Gloria never hesitates.. that to me – is the hallmark of an excellent provider, that the patient comes first .. She still has several years to go, but I have confidence in her.

She throws herself into her rotations.. When she was on thoracics, she wanted to learn.. and she didn’t mind learning from a nurse (which is HUGE here, in my experience.)

Dr. Gloria Ayala (right) and her mother

She wasn’t sure that her mom would be able to be there – (she works long hours as a cook for a baseball team) but luckily she made it!

Met a pediatric cardiologist and his wife, a pediatrician.. Amazing because the first thing they said is, “We want nurse practitioners in our NICU,” so maybe NPs in Mexico will become a reality.. Heard there is an NP from San Francisco over at Hospital Hispano Americano but haven’t had the pleasure of meeting her. (I’d love to exchange notes with her.)

I spent the remainder of the day in the operating room of Dr. Ernesto Romero Fonseca, an orthopedic surgeon specializing in trauma. I don’t know what it is about Orthopedics, but the docs are always so “laid back”, and just so darn pleasant to be around. Dr. Romero and his resident are no exception.

[“Laid back” is probably the wrong term – there is nothing casual about his approach to surgery but I haven’t had my second cup of coffee yet, so my vocabulary is a bit limited.. ] Once I finish editing ‘patient bits’ I’ll post a photo..

Then it was off to clinic with the Professor.

Saturday, I spent the day in the operating room with Dr. Vasquez at Hospital de la Familia. He teased me about the colors of the surgical drapes,(green at Hospital de la Familia), so I guess he liked my article about the impact of color on medical photography. (Though, truthfully, I take photos of surgeons, not operations..)

Since the NYT article* came out a few days ago – things have changed here in Mexicali. People don’t seem to think the book is such a far-fetched idea anymore. I’m hopeful this means I’ll get more response from some of the doctors. (Right now, for every 15 I contact – I might get two replies, and one interview..)

Planning for my last day with the Professor – makes me sad because I’ve had such a great time, (and learned a tremendous amount) but it has been wonderful. Besides, I will be starting classes soon – and will be moving to my next location (and another great professor.)

Professor Ochoa and Dr. Vasquez

But I do have to say – that he has been a great professor, and I think, a good friend. He let me steer my education at times (hey – can I learn more about X..) but always kept me studying, reading and writing. He took time away from his regular life, and his other duties as a professor of other students (residents, interns etc.) to read my assignments, make suggestions and corrections when necessary. and lastly, he tolerated a lot with good grace and humor. Atrocious Spanish, (probably) some outlandish ideas and attitudes about patient care (I am a nurse, after all), a lot of chatter (one of my patient care things), endless questions… especially, “donde estas?” when I was lost – again.

So as I wrap up my studies to spend the last few weeks concentrating on the book, and getting the last interviews, I want to thank Dr. Carlos Ochoa for his endless patience, and for giving me this opportunity. I also want to thank all the interns (now residents) for welcoming me on rounds, the great doctors at Hospital General.. Thanks to Dr. Ivan for always welcoming me to the ER, and Dr. Joanna for welcoming me to her hospital. All these people didn’t have to be so nice – but they were, and I appreciate it.

* Not my article [ I wish it were – since I have a lot to say on the topic].

Spending the weekend with Dr. Vasquez, and medical photography

Posted on June 10, 2012 by K Eckland

For internet searches for medical photography – all of my images are free for your use, but please give proper credit for my work, ie. “Photo by K. Eckland”. For commercial uses, contact me, (so that I can contact the subjects of my work).

Please note that patient privacy is protected – and patient permission is obtained prior to photographs. For the most part – I photograph surgeons – not patients, or surgery.

Spent much of the weekend in the operating room with Dr. C. Vasquez, cardiac surgeon at two different facilities, and the differences couldn’t be more apparent – and perhaps not what one might expect. Much of it comes from perspective; as a person behind the lens, I see the scene differently than others might.

harvesting the radial artery

In fact, this prompted me to write an article on the subject of medical photography, complete with a slide show to illustrate the effects of color on surgical photographs. I’ve also re-posted much of the article here (see below). Once you see the photos from today, you’ll understand the article.

the beige operating room

The case today went beautifully, with the patient extubated in the operating room.

Dr. Vasquez, and Lupita, scrub nurse

While we were there – had an unexpected surprise! Dr. Gutierrez ‘Lalo’ showed up. I have been trying to get him into the cardiac OR since he confessed his interest in cardiac surgery. It was great to see him – and I like encouraging him in his educational goals. (I kind of miss being a mentor, and preceptor to students..)

Lalo peeks over the curtain..

Dr. Gutierrez (Lalo) in the cardiac OR

Medical Photography

Medical photography is many ways is more art, and luck that skill – at least for people like me who never set out to be medical photographers in the first place. It was a natural development prompted by dire necessity during the early days of interviewing surgeons and medical writing. I am still learning, and hopefully improving.

But as I said before, much of it is luck, and timing, particularly in this field, where the subjects are always in motion and a slight movement of the hand tying the suture knot can result in either a breath-taking shot or an utter failure to capture the moment.

The most dramatic and vivid photographs often come at mundane moments, or unexpected situations. In medical photography, where the subject matter combines with a dramatic interplay of color, light and shadow to illustrate some of life’s most pivotal moments such as birth, death and life-saving operations – it is surprising how important the background elements are.

Here in Mexicali, I have been taking photographs of different surgeons for several weeks at different facilities across the city. But, almost unanimously, all of the photographs, regardless of subject at Hospital Almater are lackluster and uninspiring. Contrast this with the glorious photos from the public facilities such as Hospital General de Mexicali, and Issstecali.

The culprit is immediately apparent, and it demonstrates how such carefully planned such as aesthetics and interior design can have unintended consequences. The very studied, casual beigeness used to communicate upscale living in the more public parts of the hospital are destroying the esthetics of the operating room services they are selling. Whereas, the older facilities, which have continued the use of traditional colored drapes and materials do not have the problem.

Historically, surgical drapes were green for a very specific reason. As the complementary color to red, it was believed to be a method of combating eye fatigue for surgeons looking at the red, bloody surgical fields for hours at a time. Over the years, operating room apparel and drapes evolved away from this soft green to a more vivid blue, know as ‘ceil’. The reasons for this change are probably more related to manufacturing that medicine, and since that evolution, surgical drapes now come in a variety of colors – hence the color matching here, of the paint, the tile, the patients, the operating room and the surgeons itself. Somewhere, an interior decorator is filled with gleeful satisfaction – but I can only muster up a groan; knowing I will be here again and that most of my photos will be unusable.

While the consequences of poor medical photographs may seem trivial to anyone but myself (and my interviewees) at this junction – it runs far deeper than that. With the advent of the internet, and the complicated legalities of getty and other corporate images, small, independent photographers such as myself are gaining wider exposure than ever before. Alas! – much of it is uncredited, but several of my more popular images are downloaded thousands of times per week, to grace slideshows, powerpoint presentations and other illustrations for discussions of anything from medicine and surgery to travel, technology and even risk assessment. In an era of branding, and logo recognition, places like Hospital Almater are certainly missing out.

In other news/ happenings: Upcoming elections!**

Finally found someone to talk to and explain some of the issues in Mexican politics – but he hates Quadri, and doesn’t really explain any of it except to say ‘He’s corrupt..” (From my understanding, ‘corrupt’ is an understatement, and that all of the parties are corrupt – and it’s pretty well understood by everyone involved – so of course, if I hear something like that – please explain.. explain..) It’s not like I am capable of voting anyway, but I’d sure like to hear perspectives..

It looks like I’m not the only one who is a little leary of pretty boy pena’s party’s dubious history. His numbers have fallen in recent polls in advance of tonight’s televised debates. (Let’s hope these debates are better than the last.)

My personal “favorite”, Quadri is still trailing in the dust, but it looks like Lopez has a chance to take the election from Pena (much like it was ‘taken’ from him in 2006 with his narrow defeat.. Lopez is a socialist which is hard for Americans like me to understand – but then again, it’s not my country, and the levels of inequity here are certainly wider than at home – so maybe someone like Lopez can bring some much needed support to the lower classes.

I mean, a lot of what we take for granted in the USA doesn’t exist here, like a decent free public school education. (Okay – I know critics will argue about the value of an inner city education – but we still provide a free elementary & secondary school education to all our citizens.) So socialism for the purpose of providing basic services in all areas of Mexico seems pretty reasonable. (It would help if I could read some primary source stuff – without using translation software, so I would have a better idea of the specifics of AMLO’s ideas.)

I did ask my friend about the student demonstrations for Yo Soy 132. I guess as an American growing up after the 1960’s – we tend to not too make much of a big deal over student demonstrators – after all – we have the ‘Occupy’ movements going on right now in our own/ other countries – but he was telling me that this is pretty uncommon in Mexico.

** No, I’m not really into politics but I feel like it’s important to try and understand as much as possible about the places (countries) where I am residing.

Mexico on my mind….and the city by the fence

Posted on May 26, 2012 by K Eckland

Actually, it is on my mind quite a bit these days, as you can imagine. But that’s also the title of the new website where I will be contributing to articles about life, and health care in Mexicali. It’s a website designed for Americans and other extranjeros living in Mexico, so I thought it was the perfect place for some of my articles on medical emergencies and medical services.

I think that if you are an ex-pat living in a different country/ culture/ etc. even if you’ve been here for a while – if you become ill, it’s a little more frightening and confusing than it might be in your old hometown. So, hopefully the addition of a fellow gringa to help navigate the system, so to speak, is more comforting and helpful to readers..

Of course, many of the readers of the site are living in different areas of the country, so this is also a chance for me to speak up and promote Mexicali – and after being here for a couple of months – I really think that Mexicali is often judged harshly.

Sure, I don’t want it to become the next Cabo San Lucas – where Spanish is drowned out by drunken teenagers hollering, puking and carrying on in English, and Mexican culture has been submerged beneath a sea of tacky shops, Starbucks, and the homogenous effect of chain restaurants and fast food. But I also think that when people skip over Mexicali, they are missing a chance to see an interesting side of Mexico – a side that is often downplayed to tourists unless you are heading to Mexico City.

But first – let’s be sure to say what Mexicali isn’t. It isn’t a quaint seaside resort, or charming village. It also isn’t a crime-infested border city, as we’ve talked about before.

If you are looking for cute, charming and rural – this isn’t the place for you.

But that’s not to say that Mexicali is without its own considerable charms. It is first and foremost – a city of industry. While this contributes to wide areas of industrial blight (factories and their by-products aren’t particularly attractive) – it also means that there is a significant sector of skilled labor and a higher overall standard of living. Some of this industry is medical, but much of it is more traditional – factories and companies who came here to take advantage of NAFTA. Frito-Lay is here, Modelo brewing is here, as well as several juice distributors and machineries. But there is also Intuitive Surgical – the makers of the DaVinci Robot, a two million dollar piece of extremely sophisticated medical technology.

street art in Mexicali

It is also the capital of Baja California, so there is a large contingent of government offices here too, along with the Universities and educational facilities of higher learning.

But most importantly, it is a city of people. These people are the true heart of ‘Mexican culture’, in a very real sense. I am fortunate that as a student, in my daily activities – I get to encounter these people on a day-to-day basis – and the people of Mexicali have proven to be as friendly and welcoming as any city I’ve ever lived. Despite the close proximity to the border, this is the real Mexico – and it hasn’t been diluted. Spanish remains predominant, and real working class citizens populate the streets and buildings as opposed to the more touristy destinations where everything has been ‘Americanized’ for our comfort.

Want to learn Spanish? Then come here. You will get to practice every day. People will help you, correct your grammar, offer you the occasional missing word – and they do it with patience and a smile, but they will expect you to speak Spanish all the same.

The charm is here – on the quiet, upscale streets in the different barrios of the city, in the music emanating from well-kept homes, in the kitchens of mom and pop restaurants serving native dishes, and in the way that residents still welcome outsiders like myself.

They have pride in their city, their way of life and take pains to encourage me to sample it – pieces of their culture, whether as part of traditional festivities for a national holiday, or a bite of food from a street vendor or even just directions to the best [blank] in town.

an art museum in Mexicali

It also has its own identity, distinct from larger Mexico. Some of this comes from dealing with the heat – 120 degree days in the summer are not uncommon – on these dry, sun-baked and parched streets.. Some of it comes from the unique make-up of this city – which boasts a shared heritage with a large Chinese community who fled the states after building the railroads. So, yeah – they probably have the best Chinese food in Mexico too.

So hopefully, as I write about the doctors, and hospitals of Mexicali, visitors to the city will see the other charms that make me appreciate this place a little more every day.

You’ve come a long way, baby!

Posted on May 23, 2012 by K Eckland

Wow.. a long couple of days – but I am sure not complaining! Still having a blast – and as they teased me in the operating room, “Cristina, Cristina, Cristina!” I felt more like I belonged – instead of as a student, often lost/ confused. Even more so – when I found myself irritated on rounds – irritated when the answers were obvious!! Obvious – that’s certainly making progress.. (Irritated is such an improvement over clueless, I must say..) But the interns are a good bunch, even if they don’t love surgery like I do!

Residents at Mexicali General

The good doc gave me some homework – as we work on a ‘mystery diagnosis’ which I am enjoying. Of course, it won’t be a mystery as soon as the pathology comes back, but I am surely enjoying the intellectual challenge (and kind of hoping that my preliminary leaps aren’t completely off-base..) Of course – the doc is so smart – he probably already has it all figured out, and is just checking on the faculties of his student. (He is secretly brilliant, and just hides it behind his braces and freckles.. Kind of scares me sometimes..)

Deceptively normal looking..

Bumped into Dr. Ramirez and Dr. Perez (the anesthesiologist) this morning, which reminds me that I still need to write about my visits to his operating room last week. So I haven’t forgotten – expect it in just a couple of days..

It’s nice too when we run into people I know as we round at different hospitals around the city.. But then – as I glance at the calendar and realize that time is passing – I get a little sad. Just as I am starting to understand things (Spanish, the hospital systems etc..) and I am enjoying it here so much, learning so much, yet time is flying, and before you know it – I will be returning home again (wherever that is!)

Gabriel Quadri de la Torre, will you marry me?

Posted on May 20, 2012 by K Eckland

[I have used images obtained on the internet to illustrate this post – and have tried to give proper attribution to sources.]

Just kidding about the marriage proposal – but it seemed like a nice headline for today’s post, as I muse about Mexican politics.. I’m no political pundit, just a little gringa temporarily living in Mexico.

So I am spending today at home, trying to get a better understanding of Mexican politics in advance of the presidential elections this July but it’s a daunting task!

As I read and read, different articles about the candidates and the issues** – it becomes very clear that this is one of those things that makes you truly appreciate how complex a lot of the things we often take for granted are – such as a working knowledge of your ‘home’ political systems, and its domestic and foreign policy issues.

Of course, the basics are easy enough to understand – Presidents are elected for a one time only six-year term – (no re-elections here) and there are more than two major political parties. But the intricacies of this process, the sentiments surrounding it – and the true impact, and importance of the issues facing this nation are certainly too deep for a short-time resident like myself to really understand and comprehend on a deeper level.

I know who the candidates are – I watched the televised debate a few weeks ago, (and understood much of it) but of course, I couldn’t catch the nuances, or comprehend much of the deeper meaning, the context or the history behind their statements.

At this point, as an outsider looking in – I think that Enrique Pena Nieto of the PRI party will win. Probably not for the reasons that residents vote for him – but because even to a foreigner like myself, he presents a nice, polished picture of what we expect politicians to look like. (Not always a good thing in my opinion – but people can look at him, his 1960’s gelled look and picture him as president – in a John Kennedy-esque way – he is young, well-groomed and certainly handsome. He seems smooth enough in his speech the other night, though a recent article (in English) leaves me doubtful as to his actual capabilities to govern this troubled but beautiful country**. I also have some misgivings about his party – they ran Mexico for a long time – (70 years) and I’m not convinced they did such a great job of it.

Despite being as ignorant as I am – I have my own favorite, Gabriel Quadri de la Torre of the New Alliance party – which just goes to show that you don’t really have to understand anything to hold an opinion. So, Mexicans take note, and be glad that they don’t let ignorant gringas like me vote..

But – as an outsider looking in, Gabriel Quadri de la Torre (from my very limited perceptions) seems a little less like a career politician and a little more like a college professor. Many people would argue that this is a handicap since it means he would be less effective, and less knowledgeable about actually navigating the system so to speak, but to a ‘southerner’ like myself – who is quite disgusted with the Ted Kennedys, the Robert Byrds, and all these other dynasty senators – it’s refreshing.. (I know that both of those American politicians are now deceased – but the mold of being able to be in politics just because you’ve been there, getting re-elected over and over and over still exists – just ask California politician, Jerry Brown.)

Photo by NTX – obtained from Vertigo Politico website.

I like Gabriel Quadri de la Torre because he seems to be a man of science, a man of reason – not some oratory firecracker who just likes to stir people up – but then again – that’s probably why he’s trailing so badly in the polls. His platforms on alternative energy are forward thinking (but then – I grew up on a windfarm outside of Tracy, California – so of course, I would think so.) I was also interested in his position on Pemex, but frankly didn’t know enough about the situation to understand it – even after I asked several people here in Mexicali.. (I’m not sure they understood it either – they are in health care too – not analysts, not economists..) So I decided to ask one.

I asked an outside financial analyst & economist who specializes on oil and alternative energy resources for more input/ insight on the Pemex issue from both a national (Mexican) and international perspective. I also specifically asked –Is privatization the best thing for Mexico or does it just benefit outside investors? How does it impact the rest of the world?

This was his response [edited for length only]:

“Pemex is an incredibly poorly run state-run oil company (think of the postal service but drilling for oil)

Privatizing it would be the best thing for Mexico. It wouldn’t make a big difference to people in my field [economics/ finance] but Mexico would find more oil which would be good for the whole world (especially Mexico).“

The other reason I like Gabriel Quadri so much – is that he seems like someone who is smart enough to know that all of these issues are more complicated than they first appear – and he doesn’t offer any quick easy fixes.. I like that – even if other people have told me it makes him look indecisive. He also took the time in the debates to explain his positions instead of wasting time attacking his fellow candidates..

We all heard about Pena’s ex-mistress whining on facebook – can we move on to the real issues that affect the 100+ million people who live here? Mr. Quadri seemed to be the only one who was really able to do that..

But then, like I said – I’m not sure if someone like me can even really understand the issues..

Take crime for example -we all heard about the headless bodies on the side of the highway – and we all know that the escalating homicide rate, and rampant violence among drug gangs is a big issue in the coming election. But can a foreigner like myself, (particularly one living in the relatively sheltered environment of Mexicali) really understand the impact of this runaway train of grisly murders that has gripped this nation during the course of President Calderon’s term? Of what it’s like to live in an area where people ‘go missing’?

Is it possible for me to grasp the intricacies of the candidates plans to address this issue – particularly in light of the history of corruption among Mexican police forces? What about political corruption?

And that’s just the tip of the iceberg as far as issues are concerned. Just the idea of trying to govern a place like Mexico City (D.F) would send me into a panic – and that’s not even getting into the Pemex investment issues, endemic poverty and social security issues, or trying to bring the rest of Mexico into a technological age to make it more competitive with the rest of Latin America, and the rest of the World. With so many foreign trade opportunities, Mexico can and should carve out a better place for itself in the world – but how? (Maybe they will figure it out at the G-20 next month, who knows?)

My gringa criticisms of the other candidates are probably equally unfair, as they hinge on such limited (okay, absent) insight.

Josefina Vasquez Mota – National Action Party. I guess my main issue with her – is I find her a bit too Hilary Clinton and not enough Geraldine Ferraro. Plus her views on some of the issues are a little too conservative for me – particularly if she’s using the ‘woman power’ platform.. I am an old-school type feminist, which means I want equality, not special preference – so you can’t get my support by saying, “I am a woman, so if you are a woman, you should support me.” You can’t have it both ways – equality means an equal chance to fail.

If I want to be the best at something – I want to be the best person at it – not the best woman.. It’s kind of like all of those world records, and Amelia Earhart – she got a lot of ‘first woman’ but not a lot of first person.. That’s really second place. I guess in the 1930’s it was a big deal for a woman to do any of it, and maybe that’s the case in Mexican politics today (and the USA, for that matter) – but I still don’t think she should trade on her ‘womanhood’ to try to win an election.

Just be the best candidate. She certainly seems smart enough without all of that – but then again, maybe it’s inescapable. After all – I don’t hear people speculating that the other candidates have an eating disorder..

As for Andrés Manuel López Obrador (party of the democratic revolution, or something like that) – well – I guess he’s my second choice.. Since it’s impossible for Quadri to win, I guess I’d feel a bit more comfortable if Lopez was at the helm, because he seems to really care about the Mexican people (from what I’ve read about his previous work but I guess he also has a bit of a shady past..The whole ‘Legitimate Presidency’ thing kind of reminds me of the hanging chads episode down in Florida.)

** Of course, another significant issue for English speakers like myself – is always the use of language, and translational biases. It really hits home once you try to function in another culture and another language how strong semantics really are – and how easy it is to make a mistaken impression through incorrect word choice. So when I read these English language articles, I have to question how much of the information was slanted simply by the words the writers chose to use – even when translating quotes and candidate statements. Also some of the sources themselves for English language information are a bit sketchy..Kind of like if you read this blog for your Mexican election info..

In the operating room with Dr. Cuauhtemoc Vasquez, Cardiac Surgeon

Posted on April 28, 2012 by K Eckland

Had a great day in the operating room with Dr. Cuauhtemoc Vasquez, MD the promising young heart surgeon I told you about several months ago. I have some absolutely breathtaking photos of the case – but I want to double-check with the patient before posting anything potentially revealing in such a public forum.

Todays’ surgery was at one of the public hospitals in Mexicali – and while technology was sometimes in short supply – talent sure wasn’t. I was frankly surprised at the level of skill and finesse Dr. Vasquez displayed given the fact that he is so early in his career.

Dr. Cuauhtemoc Vasquez, Cardiac surgeon

He’s also just an all-around pleasant and charming person. I know from previous encounters that he’s well-spoken, interesting, engaging and an excellent conversationalist – We didn’t talk at length on this occasion – because honestly, I really don’t like to be distracting during cases – especially since much of the discussion was in an English-heavy Spanglish.. (He is fluent in English but we both tend to slip in and out of Spanish. I mainly slip out when I start thinking in English and come across a concept that I am not sure about explaining or asking about in Spanish.**

But don’t worry – I am planning on seeing him next week – where I can hopefully lure him to lunch/ coffee or something so we have a more lengthy discussion – so I can give you all the details in a more formal fashion in a future post.

As a crazy side note – finally got that ‘great’ picture of the good doctor.. Oh, the irony – not during a thoracic case but while he was assisting Dr. Vasquez – (the good doctor is board-certified cardiothoracic surgeon, after all..) I didn’t post it here because there are some ‘patient bits’ in the photo..

**I know this can be frustrating from my experiences with my professor – but it’s also frustrating when: a. a question gets misinterpreted as a statement (because of my poor grammar) or b. misconstrued completely – which still happens pretty frequently. Luckily, people around here are awfully nice, and tend to give me the benefit of a doubt.

Also – I need to post this photo of one of my favorite operating room nurses – Lupita. (Lupita along with Carmen and Marisol) have been an absolute delight to be around even of those very first anxious days..

Lupita, operating room nurse.. Doesn’t hurt that she’s as cute as a button, eh?

Great day in thoracic surgery and oops!

Posted on April 21, 2012 by K Eckland

Oops! probably shouldn’t be part of any blog about thoracic surgery – but I say – “Oops!” because as I look over some of my writing – I see that I have definitely fallen into old habits (of writing reviews). But I won’t fight my natural tendencies – and just maybe, when we get done – there will be another ‘Hidden Gem’ for my loyal fans..

Long, wonderful day in thoracic surgery – which started at the Hospital de la Familia, a private facility on the outskirts of Mexicali by the ‘new’ border crossing.. It’s way out on Avenue Maduro (after it changes names a couple of times) in an industrial area. But – like most of the private facilities I’ve seen so far in Mexicali – its sparkling, and gleaming with marble floors, and plenty of privacy for the patients.. Don’t worry – I’ll be writing more about this, and the other private hospitals in Mexicali soon..

Hospital de la Familia

While I was there – I got to see Dr. Octavio Campa again. He’s an anesthesiologist – and a pretty darn good one (and if you’ve read the previous books, you know I won’t hesitate to mention when anesthesia isn’t up to par, either.) This picture* should show you exactly why I am so fond of him – as you’ll note, he pays very close attention to his patients, and their hemodynamic status.

Dr. Campa – Anesthesiologist

This is my second time in the operating room with Dr. Campa – and both times he has consistently shown excellence in his care of the patient. (He’s pretty skilled with a double lumen tube, which helps.)

Dr. Octavio Campa Mendoza MD

Anesthesiologist

(if you want to contact him to schedule anesthesia for your surgery – email me.)

Dr. Campa was born and raised in San Luis, Mexico. In fact, along with Dr. Gabriel Ramos – he’s known Dr. Ochoa for most of his life. After completing his medical education, he did a three-year residency in Anaesthesia, and has been practicing for seven years.

Prior to starting the case, he started a thoracic epidural for post-operative pain control – using a nice combination of Fentanyl and bipivicaine, so this should be fairly comfortable for the patient when (s)he wakes up. A lot of anesthesiologists don’t like performing thoracic epidurals (it’s an extra hassle, and takes more skill than a standard lumbar epidural) but I am sure the patient will appreciate the extra effort.

He was attentive during the case – and the patient’s vital signs stayed within acceptable ranges during the entire case – good oxygenation, no tachycardia, and no hypotension at all during the case. He didn’t delegate any of his responsibilities to anyone else – he administered all the drugs, and stayed by the patient’s side during the entire case. (Like, I said before – if you’ve read the books, you know that this is not always the situation.)

Recommended.

Dr. Vasquez, the cardiac surgeon joined us in the operating room today. It was nice to see him. I posted a picture of him in his surgical regalia so everyone will be able to recognize him when I interview him next week.

Dr. Vasquez (left) and Dr. Ochoa at the end of another successful case.

I can’t (and won’t) tell you much about the individual cases but I did get some great photos to share today.. (It’s too bad – because I always meet the most interesting people – disguised as ‘patients.’ But it wouldn’t be fair to them.)

* I don’t believe in ‘staged’ operating room photos – what you see is what you get – sometimes the photos aren’t perfect, because I take them while people are working – but I don’t want to add any artificiality to the scene. Of course – the casual, between cases photos are a little different.

a more casual photo now that the case is over.. Dr. Vasquez, Dr. Campa and Dr. Ochoa

I promised everyone more photos – so don’t worry – I still have a lot more to share. This is one of my favorite ones of Dr. Ochoa – he’s notoriously hard to get ‘good’ photos of – because he’s always in action, so to speak – so a lot of the operating room photos don’t always capture him well.

Dr. Ochoa, writing orders

After the first case – we headed over to Mexicali General – where I was able to get some more pictures of my friends.. However, this photo below – is probably my favorite that I’ve taken in Mexicali so far.. (Which is surprising because: a. it’s not a surgery photo and b. I had to set aside some of my ego to even post it.)

But then again – no one is going to look good in a photo next to Carmen – she’s a stunningly beautiful woman – even after an evening in the operating room. Carmen is one of the circulating room nurses at Mexicali General – and she’s pretty awesome – in addition to having these amazing expressive eyes that peep out from behind the surgical mask. I really enjoy talking to Carmen – because at the end of the day – whether I am taking on the role of medical writer, photographer or student – I am a nurse, and I always enjoy talking to other nurses and hearing about their work, and lives. (I know there is a great book there – a compilation of nursing stories from around the world – but try getting a nurse to slow down for five minutes for an interview..)

with Carmen, a circulating nurse at Mexicali General

Of course, I couldn’t end my post without more pictures of my two favorite people; Lalo and Jose Luis..

I like standing next to Jose Luis – besides being a fabulous guy – doesn’t it make me look thin??

For the last photo today – I’ve got a great, dramatic action photo of Lalo.. You can’t really see – but he’s throwing sutures in this picture – and I just think it will be a great photo for him to have when he’s a practicing cardiac surgeon someday.

Dr. Gutierrez, throwing sutures during a VATS case

The staff at Mexicali General

Posted on April 20, 2012 by K Eckland

Mexicali General Hospital

I thought it was about time that I post some pictures of all the great people I see at Mexicali General.. I still need to get some more pictures, of course – so everyone can hear more about all the people I meet and talk to every day.

First, there’s Lalo, who is probably one of the world’s nicest residents.. (After all, he rounds with me everyday – and hasn’t run away screaming..) No, seriously, he’s just really kind – and patient with me, particularly when I have questions about cases (usually translation). I haven’t convinced him that thoracic surgery is his passion yet – but he does have a thing for cardiac surgery, so he’s not entirely hopeless..

Lalo

Then – there’s Jose Luis – who is just about the nicest, friendliest guy an extranjera like myself could ever hope to meet.. Actually, everyone in the respiratory therapy department has been pretty awesome (and their use of slang has certainly advanced my education!) I talk to Jose Luis about all my ideas about pre-surgical clinics and such – he never laughs.. Maybe he doesn’t completely understand me, (especially when I get excited and talk really fast in my horrible gringa spanish) but he never laughs at me, or does that shoulder shrug thing that people do when they aren’t real enthusiastic about your plans..

Dr. Ochoa is second from the left, Jose Luis is in the center (in blue)

Of course, there’s Dr. Ochoa – who certainly got more than he bargained for when I first contacted him for an interview (back in November 2011). I don’t suspect he ever thought he’d end up with a gringa student (but then neither did I, at the time).

But he’s always gracious and good-natured – and I always feel like I am learning a tremendous amount, even when it’s not all surgical. He certainly handles a lot more pulmonary medicine than I ever expected.

There are so many other cool people who I cross paths with – like Ariel (Raul Ariel del Prado Rivas.) I don’t have his photo (yet!) but Ariel is the nurse in charge of emergency & disaster response for the hospital – for everything from natural disasters like earthquakes (which are pretty frequent here), mass casuality events, to biohazard / environmental spills, and bioterrorism.. If that wasn’t enough for any one person – he also teaches.. In fact, I’m planning to take his ACLS class next month..

Hopefully, knowing about all these nice folks who are always looking out for me will ease the fears of any of my friends and family at home..

Bronchiectasis, Tuberculosis and Spontaneous Pneumothorax

Posted on April 5, 2012 by K Eckland

Fun day yesterday – saw several patients with the doctor in the general thoracic clinic over at Mexicali General, as well as a patient over at his private clinic office.

Dr. Gutierrez, a surgical intern joined us for the clinic, which I enjoyed. He’s nice, and doesn’t seem to mind my halting, grammatic train wreck Spanish.. I took his picture earlier this week – (his first intra-operative photo!) during one of the cases –

Dr. Gutierrez, surgical intern

Went with Dr. Ochoa over to a new private hospital across town – (had to use GPS to find it) called Arco Quinones Hospital. It’s on Rio Tamazula Sur y Calle 4ta # 2600. You have to drive thru the industrial section of Mexicali to get there – but it seemed like a cute little place. It’ so new – there were only 3 patients in-house.

Dr. Luis Carlo Maldonado Martinez was kind enough to give us the full tour: there are two patients floors – one ICU bed with ventilator and cardiac monitoring equipment, one labor and delivery suite – a very small neonatal area, and 2 operating rooms. There’s a small one-suite lab (about the size of my kitchen here but suitable for the more basic lab studies) and a radiography suite for x-rays and ultrasounds. They also have a small ER (but probably more suitable for a ‘urgent care’) with two beds. The place is brand-spanking new, with gleaming floors and smiling staff. (Not a bad place for a nip / tuck sort of thing – but too tiny for any ‘real’ surgery or serious illnesses.)

The good doctor performed a small procedure over there in one of the operating rooms on a very nice patient – letting us try out the facility a bit. Everything went very smoothly – and then it was off to another hospital to see another patient!

I take patient privacy very seriously – so I don’t publish any details about patients, or photographs without their express permission in their native language.

More homework today – he liked the English version of our patient education (for pre-surgical optimization to prevent post-operative complications) brochure so now I am working on creating a Spanish translation.

Love, Life and Surgery in Latin America is now Colombian Culture & Cuisine

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