An example of cool people.

Another quick fun thing to share about why people are so nice and friendly here!


This afternoon, as I finished my jamon y queso tostado,  I was glancing at foodgawker.com (check it out!) and the waiter/manager/chef walked by and said "que rico" (how delicious). To which I responded, "Si, me gusta cocinar. Y esto ayuda encontrar..." "Yes, I like to cook and this helps me find recipes (which I didn't know the word for.)

We then discussed tamales and humitas and what the difference was.  Turns out that tamales are made with maiz and humitas with choclo, which is I think like saying that tamales are made with corn meal or the type of corn that goes in corn meal and humitas are made with a sweeter fresh, corn on the cob.

After this conversation and a bit more he invited me to come back, when I want to come.  Yup he invited me to the kitchen of his restaurant because I like to cook and because cooking is like medicine, it is very different to study it and read it, than it is to have someone show you.

Stitches and stuff.

I have been completely enjoying Cafayate. In all ways: food, atmosphere, weather, company, etc.  I am recovering from Dave's departure as well. Monday we had a fabulous lunch and I got some wicked tan lines (winter sure is rough here).  We had a tasty dinner too.  Then he left on a bus at 5:00am for Salta, and his subsequent return to the US. He is currently in Miami, in the middle of a 15hr layover.  Ugh.

Yesterday morning I went with Dr. Vargas to the hospital in San Carlos, a small town of a few thousand people, 22km north of here. It functions as a kind of walk-in clinic with a few beds for inpatient and one labor and delivery room. It is tiny. There was a single patient staying in the hospital.  She was there for significant stomach pain, and a classical Murphy's sign. (This indicates that she has an inflamed gallbladder and means that when you press on her stomach near her ribs on the right, she pauses during inhalation because it hurts when he diaphragm pushes her gallbladder to close to your hands.)  Otherwise, we saw about 10 patients there several post-op and a few others.

Today at the hospital in Cafayate, I did my first stitches.  I stitched closed the cuts for a laporoscopic surgery. (aka a total of about 8 stitches.) Of course I felt pretty good about this.  Also, the surgeon taught me how to gracefully make knots which I practiced for about 20min after using thread tied around the arm of a chair.  Everyone got a good laugh out me sitting there tying knot after knot, myself included, and now I am also much more graceful at knot tying.

Later on I assisted in a hemorrhoid surgery. (After doing the spinal block.) The assistance the surgeon needed was more simple that for some surgeries so the second surgeon did another small procedure while I helped the first.  It is interesting to get the perspective of the surgeon now, in addition to the anesthesiologist.

I also went to the consultario (clinic) after the surgeries and saw how several of the appointments go. The practice with my Spanish is constant and applying it really helps.  I even read a little of a textbook on OR nursing (in Spanish) and could pretty much understand it. 

When the appointments were over, I returned home and Skyped with some fam for a while which was lovely.  Then I dropped off my laundry, just finished a ham and cheese sandwich at Fabiola's and am going to go exercise.
 I made the mistake of starting "Game of Thrones" yesterday after the hospital since Dave had left and I was alone. I read about 1/4 of the book before bed.  Hopefully I can finish all of them before school starts again.  I have a feeling it wont be a problem.

Back at it.

(A rare winter cloudy sky Sunday, when we arrived in Cafayate.  Hasn't been a cloud since.)

We arrived happily in Cafayate Sunday evening and have been enjoying sleeping late and relaxing.  This is the start of a two week school winter vacation so Cafayate is buzzing with Argentinian tourists and others as well.

Feeling a bit back to normal today. After a few days of pure vacation and practice with castallano (more common here than espanol). I am back in the swing of things. I started this morning at the hospital in Cafayate, under the guidance of Dr. Carlos Vargas, general surgeon.

My walk to work at sunrise.

This morning when I arrived, Dr. Vargas was doing diagnostic ultrasound. Here, gallbladder problems are very common, so mostly, that is what he looks at. I saw two normal gallbladders before we continued to rounds. From about 8-9 all of the doctors (and I think head nurses) round on all the patients in the hospital. I would estimate that there are about 10 beds for children and 10 for adults with an additional 4 each for intensive care. There is also a labor and delivery area that is pretty small, but has space for about 8 newborns. During rounds I was introduced to everyone and especially to Norma, the head doctor (I think).

Next we went to the quirofano (OR) I had a little more chance to get to know the other doctor, intrumentador y enfermera (nurse) there. They all complimented my spanish, especially once they found out that I haven't taken classes before. I of course appreciated that and then continued to miss half of what they said. It was really good to be back to speaking spanish. And while some of the other doctors (on rounds) clearly speak some english, they know I want to learn spanish and the folks in the quirofano seem pretty limited to spanish. I am very happy about this.

There was a laporoscopic cholycystectomia first this morning (have I mentioned that they are very common). They were unable to simply pull the gallbladder out when it was detached because it was so full of stones. I knotw this because they needed to remove the stones. If I had to esimate I would say that there were a good 3 tablespoons of stones before they successfully removed it.

After the first surgery there was a little down time so Dr. Vargas gave me a tour of the rest of the hospital, did an ultrasound on an ER patient and introduced me to the director of the hospital. Everyone gave me warm welcomes and invited me to do whatever I want while I am here.

For the second surgery, I scrubbed in! (first time) (means I got totally washed and dressed in sterile garb, and got to help (kinda). The surgery was a hernia repair and they debated on whether it was an old direct hernia or a new one, but I didn't understand the resolution. I held a retractor and was able to feel the hernia before repair. It was great to be as close as I was because it was a lot easier to see how careful and deliberate every movement and cut was. They nicely explained all of the layers of fascia (connective tissue) and exactly what they were doing. Again, all in castallano.

That was it for the surgeries today. Tomorrow is c-section day.

I left the hospital and got a cab to La Estancia for a nice late lunch with Dave, however, power is out here so I am blogging and waiting to see if it comes back on.

My walk home.

Don't worry Dan, there is a place for visitors to play futbol while they wait (v. the neighborhood kids.)

Too much fun

As happened last time we were here, I/we started having too much fun and then our blog dropped off the face of the earth... more or less.

There is no way that I can possibly describe in appropriate detail all of the things that happened after last Sunday morning so here is a laundry list of what has passed:

Tilcara- went with Daniela, her niece and two daughters, bought veggies at a market, took lots of pictures of the drive.
Asado- Daniela's family and Rene's friend Dr.Carlos, and his family came up for an asado (giant BBQ) Sunday afternoon.
Salt Flats- Monday after leaving the house, we drove up to the salt flats which required crossing the Tropic of Capricorn (for those interested in latitude).
Jujuy- stopped at Daniela's family's home in Jujuy on our way back to Salta, had some more amazing food and celebrated Rene's bday- complete with birthday cake firework!
Made it back to Salta after 10 on Monday night.

Dave started his journey here about 5 hours later!  Made it seamlessly here for lunch on Wednesday.
We have been enjoying eating here together.

I finished up my classes in Espanol and continued in the OR.  Yesterday was my last day it was an interesting one too.  I successfully did an entire lumbar puncture by my self.  In fact I performed all of the anesthesia (supervised of course) for an indirect inguinal hernia surgery.

After the OR yesterday we went back to Juan's (La Cordobesa @ Leguizamon y Martin Conejo).  We shared a fabulous wine with Rene and a bit of food.  We spent the afternoon wandering around Salta a bit more.  Had some coffee, a fabulous burger (complete with corn, an egg and some awesome tomato, egg, mayo type sauce).

                                                          Rene (left) and Dr. Carlos

Then we got to do the coolest thing!  Rene's family, Dave and I were invited to join Dr.Carlos at a very special asado.  He has a friend who is a gastroenterologist but owns a farm about 20minutes south/southeast of the city. Once a year, for decades, his family slaughters pigs.  Then they have a massive asado.  Rene said that even for his family, it was a special event.  The food (pork) was amazing.  The people were so welcoming and friendly. The hosts kept pulling things off the fire and as they cut it, they specifically called out my name and gave me two pieces of whatever so that Dave and I would be sure to try it.  It was definitely a Spanish speaking event, and while I know I missed things, I was far from mute the evening.  Dave talked with one of the farmers about his tobacco crops and the difference in Argentine and Brazilian tobacco.  They talked quality, oils, burn and minerals.  They talked about the difference in shade tobacco in CT and what is grown here.  It was fabulous as well.

In an hour we will be packing up and heading to Cafayate!  I am so excited to continue this adventure.

Big Four Days

 

Well its been a big few days.  I am have been having too much fun so I haven’t been writing.  As it is I am sneaking in a quiet few minutes to start this post. Friday was a quiet morning at Clinica Guemes but that meant it was a good time to learn.  I have been pretty consistent in starting IVs which is awesome.  I also tried to do a lumbar puncture again, but needed help. The most exciting part was that I learned to intubate!  I mostly intubated two patients, with Rene’s close guidance. It makes so much more sense now…pretty cool. I have also finally figured out manual ventilation with a mask where I can manage the mask with one hand instead of two.

After class Friday afternoon I went to La Cordobesa, the almacen that Rene’s friend Juan owns (corner of Leguizamon and Martin Conejo).  I enjoyed a bunch of wine, some picada and some hot dogs.

Now (Sunday morning) I am in Purmamarca with Rene and his family.  He rented a house outside of town for the long holiday (Independencia, 9 de Julio) and his birthday (9 de Julio).  

I took the bus here, it was easier than I thought.  Platforma10 is the best website for looking at some major bus routes, like Salta to Jujuy.  Otherwise, the internet is not the way to go.  I took the bus to Jujuy (San Salvador de Jujuy) and at the bus terminal there, just walked around to the dozen or more bus companies that had signs indicating a bus to Purmamara. One had a bus leaving 2hours after I arrived, which would have been fine, I could have wandered Jujuy a bit, but I asked “hay un collective mas temprano”  “is there a bus earlier” and she directed me to Evelia.  They had a direct bus to Purmamarca leaving in about 10 minutes.  Perfect.

Purmamarca is (as described in Lonely Planet) more than anything, in the most beautiful location. It is clearly very touristy, but it is nice to get to be a tourist a little.  The place the Cadillo’s rented is 1-2km outside of town and it was a warm sunny afternoon, perfect for a walk. (Saturday)

It is incredible here.  Beautiful and empty.  There are many trucks that come by on their way from Chile to the rest of Argentina and to Bolivia.  Especially common are truckloads of used cars on their way to be sold in Bolivia. However, when the trucks are not passing, which is still pretty often, it is completely silent here. I haven’t been somewhere this quiet in a very long time.

Today, I am going to go with Daniela and anyone else to Tilcala. 

I was very lucky to be invited to join the Cadillo’s here for this trip. I do not know how to express my gratitude for their welcome.  Hopefully I can repay it someday.

(this is incomplete as I wrote it Sunday Morning and it is now Monday night, but I will edit this post later with more info)

Just a view from the bus window.

The center of Purmamarca

A shot from my walk up to the house. 

 Los ninos y los chanchitos.

 Just a view from the car.

 Yup.

 Oh and a picture of me!

 Some vicuna, wild on the side of the road.

Las Salinas (the salt flats)

cell phone in Argentina

I wanted to take a minute to describe how I easily and painlessly got a cell phone in Argentina for cheap. In general cell phones are expensive in Argentina so when I say cheap, I mean I use it infrequently, but easily.

I have a Droid2Global phone by Motorola.  It has a SIM card and is global ready.  It is possible to simply pay to use (Verizon or other) service in Argentina but it is insanely expensive (like $5/min).

Instead, I unlocked my phone and got a prepaid-SIM card from a local cell phone company.Here's how:

1.  First I called Verizon, before I left the states and I asked them to please tell me the unlock code.  It was not perfectly easy to get the right person on the phone, but it wasn't terrible.
For Verizon Call : Global Customer Support Team at (908) 559-4899.  I think I needed to speak with technical support. I said something to the effect of "I am travelling abroad where I will not be able to use Verizon service.  I would like the code to unlock my phone. I am prepared to aggree to the terms and conditions," (such as, I can't call Verizon for help when I have another SIM card in my phone, duh?!)

2. I showed up at the main Movistar branch in Salta (I expect that this would work at Personal or Claro as well)  I went to reception and asked for a prepago chip (aka a prepaid SIM card).   With a little bumbled spanish and english, but plenty of smiles, the woman got me a chip an a phone number. We put the chip in my phone, turned it on, it asked me for the unlock code (make sure you have your unlock code available) and I was all set.  It cost me nothing.

3. Next I went next door to the telefonico (or something close to that) and I handed her a piece of paper with my number on it and I said I wanted to recharge it (recarga).  It was possible to charge either 30pesos or 60pesos.  Be warned that the charge does expire after about a month.


So for about 30min of time or less, and 30pesos ($6.67USD) I have a cell phone that I can use to get in touch with people here.  Calling is still much more expensive, although I think it is free to receive calls, and texts are about 0.60pesos.

los colectivos (the bus in Salta)

In Argentina the buses are referred to as colectivos, not autobuses.

I must say, I love the buses in Salta.  (Once I had a bus card). 

There are a lot of bus routes in Salta, they are not perfect, but they are pretty darn good.  There are 8 general routes that the buses take, but most numbers have more than one route i.e. 7A, 7B, etc. The buses are most useful for exiting the center of Salta, such as going to Spanish class for me. 

The bus that I take every day to and from class picks me up 2 blocks from my house and half a block from Clinica Guemes, where I have been spending most of my clinic time.  I was nervous about learning how to get my stop the first time because I had no idea how to figure it out, but the city is laid out well so I knew I had to get off the bus at Tomayo, which I am pretty sure is not labled, but I also knew that the address I was going to is 2240.  It is a block over from the bus route, but the blocks are numbered the same, so I could just watch the numbers climb as we passed houses and businesses and when we hit 2100, I hit the button to stop and viola, I did it.

The bus comes frequently and is way more convenient than any subway system, even than DC. It works because traffic is never really bad in Salta, many people walk and take the bus system so a "slow ride home" might take 15-20minutes instead of 10-15 in good traffic.

Another thing I like about the bus system is the courtesy that continues from other parts of this country.  If a child or an elderly adult gets on the bus, immediately, a person in a seat gets up to give it to them.  Many times during rush hour the buses get very crowded so it is even more helpful, and more of a sacrifice, but this is the norm. It is also the norm in places like banks to let elderly adults and adults with young children or pregnant women to the front of the line. It makes perfect sense but never happens in the US outside of some public transport and I haven't noticed it in other countries.


Some tips for anyone who wants to ride the bus:

Another thing to know is that there are specific bus stops within "el centro" but after that a bus will pretty much stop on any corner, so if you want to take the bus back, just lift up your arm when you see it and it will stop for you.  Likewise, just press the button to stop at any block you want.

You must pay for the bus with coins in exact change but it is difficult to get a hold of coins here. So with a card, just like a metrocard at a major US city, you hold your card near the machine and it prints you a receipt so that if "an authority" comes on the bus, you can prove you paid.  There are signs at many kioscos "SAETA RECARGA" at any of these kiosks you can buy a card (6 pesos right now) and recharge it as needed.  These locations are more or less listed on the bus company website as well.

If you need to find a specific stop within the city, google: saeta nuevas paradas and the PDF you find has a map of the stops in the center. Easy.
 
www.saetasalta.com.ar/

a little about life

So it is high time that I wrote about more than medicine, although it has been consuming a lot of my time and thought...

The lifestyle in Argentina is similar to Spain (as I understand it). In general there is siesta every day and dinner is late at night.  There are often four meals a day.  The "fourth meal" is often called "tea" and is a light snack eaten around the hours that most people eat dinner in the US.  Dinner is usually started later than 9.  Also, no one shows up on time (almost no one)  For example, last night I was invited to dinner at the Cadillo's again and invited to come at 8.  I showed up at 8:30 and I still felt early (although totally welcome).

I want to mention that Rene and Daniela's children are completely adorable.  I love the sound of Antonella's laugh, a sweet constant giggle.  I love practicing my Spanish with Paula. Last night they were excited to find out that used to teach dance.

Last night for dinner we had picada y postre.
Picada is like antipasto, complete with:

 olives, homemade pork pate, pickles, and pickled onions and garlic.  Yum

and ham, mortadella and prosciutto (I had to look up the word because all I could come up with was jamon crudo.)

and homemade empanadas!!!  With diced beef, eggs and herbs; or cheese. In Salta empanadas are always baked, not fried.  Love them.

For dessert we had a strawberry and cream tart and a bunch of different types of cookies (most containing dulce de leche). 
Of course dinner was also served with agua mineral con gas and wine from the area.

Tonight I am invited out again to return to the almacen (where I went Saturday afternoon) to enjoy more wine, picada and conversation.  It is great practice for me to go out and I enjoy the company but my alarm certainly comes early every morning and siesta does not exist for medicine. (Surprise surprise)

otra cirugia (another surgery)

Today I returned to the Hospital Publico Maternal Infantil for another cardiovascular surgery.  This time the surgery was for a 13 year old girl who had an atrial-septal defect, that means a hole between two sides of her heart that serve as a kind of reservoir for blood. (Not the ventricles which do most of the pumping.) 

Unlike last week, this girl had a nearly fully grown heart.  I was blown away by what it looked like while it was moving.  When we are taught about the heart we are taught that the electrical impulses that cause contraction, move through the muscle in a particular pattern, but then when we talk about the heart pumping we almost describe it as a uniform stiff strong contraction.  For me this is not what it looked like at all.  For me her heart wiggled and danced with waves of motion that were so soft and elegantly coordinated.

The surgery required temporarily bypassing her heart using a blood pump.  As soon as the bypass was complete her heart almost looked deflated.  The heart is meant to be dynamic in size so it can effectively pump what ever blood comes its way.  With out blood flowing through her heart, it shrunk to less than half the size from before.

Next, in order to operate, they use a special "blood substitute" into the coronary arteries. This literally stopped her heart. They were then able to open her heart (by cutting into the right atrium) and sew closed the hole between the atria.  I was taking turns in the good viewing spot at the patient's head with the anesthesiologist.  At first when I saw them sewing the defect closed it looked like they were sewing up a valve.  I was not expecting the tissue to look like that, although it makes sense. (Sorry non-med people, you'll just have to trust me on this.)

The actual repair of the girls heart took, maybe, 5 minutes.  It was over so quickly I could barely comprehend.   After they finished and her blood was successfully returned to her own circulation, they continued to clean up and close up.  The thing that struck me during this process is that the free edge of her right lung kept moving in and out of the scene.  The way it moved reminded me of waves lapping at the shore.  It expanded into view and part way over the heart and then receded again with each breath. 


In case you haven't noticed I am trying to capture things that I find amazing and beautiful that I am sure I will loose sight of in in time.  The intimacy and trust in the OR and the view that it gives me of our bodies is something special. I am sure I will continue to appreciate this at some level, but I am also sure the novelty will wear off and I might forget how beautiful a heart beat is.

Parade!

Despite asking several people and googling a bit, I still do not understand why there was a MASSIVE "procesion" (relgious parade) yesterday.   There were at least two kilometers of roads in Salta filled with gauchos and their horses.  It was incredible.  Many others also marched the parade. All I know is that it had something to do with the Virgin Mary.  Other than that, your guess is as good as mine.  I was out in the morning yesterday (Sunday) for a bit, then I came home and was studying for a couple hours with the windows open and I could just hear loud projections of something over a city wide speaker system.  I decided to check out what all the noise was about (besides, I wanted to go out anyway to enjoy the sunshine and move some more).

 Typical gaucho clothing for the region.  I learned that the red is to represent blood and the black stripes to represent mourning.

 This is three lane road plus there a usually cars parked on both sides.

 The horses are on the shady side of the (four lane plus parking) street.  The horses continue past the second tall building in the photo.

 And they keep going!

 This is the crowed by the square where the main announcements were happening, however there is a speaker system throughout the city (V for vendetta style) so you could hear the announcements and singing everywhere.

 Many of the groups carried pictures of Mary with gorgeous floral arrangements.

"winter"

Have I mentioned that it is winter here...igual (equal) que 29 de Diciembre.  It is 8 at night and dark out.  I was just too warm walking a block in jeans, a t-shirt and a blazer.  In fact, it was warmer than many summer nights in Connecticut.  Mild winter.

Pediatric Surgeries

Ok, so where was I?   Tuesday night I went to dinner with some very cool people who own property in Cafayate. Wednesday morning I went to a pediatric cardiovascular surgery.  Wednesday night I went to dinner again with some of the same people and two Argentines.  Then yesterday morning I went back to the clinic 8-2 then class 2-6 and I completely crashed last night.  Dinner is a late affair and went from about 8:30-11:30 both nights.  The days have been long but action packed.  Now I am going to try to catch up on what I saw in the surgeries. 

Two days ago I went with Rene to a different hospital: Hospital Publico Maternal infantil. It is a massive new pediatric hospital that is really nice. We went there to do a cardiac surgery on an infant.  As far as I can understand, the surgical team (Rene as the anesthesiologist, and the two surgeons) contains the only people capable of doing this surgery in Salta, Cordoba and Mendoza  (provinces).  

The surgery was quite incredible and went perfectly smoothly.  The baby girl (37days old) was born with a decending aorta that was nearly occluded.  That means that the blood vessel off of her heart gave off branches to each arm and to her head but then the blood supply to the rest of her body, her abdomen and legs, was barely existent. The surgery required clamping the aorta closed after it gave off the supply to the right arm and head (brachiocephalic trunk for my med friends); cutting out the narrow part; and reconnecting the wide part from below to the aortic arch.  This had to be done in less than 20 minutes in order that the baby not be paraplegic. 

It was amazing to see how they did this surgery.  I was expecting that they would have to violently crack open her chest from the front, but that is not how they did it.  They layed the baby on her side and made a cut between two ribs.  Since our ribs are supposed to move up and down it was not difficult to gently move them apart (easy because they were no longer yoked together).  The opening for the surgery was only a couple inches tall and wide.  Then they collapsed the left lung (her right one is enough to do all the work) and they could access the blood vessels.  

The surgeons were great at explaining to me what they were doing and pointing out things like the recurrently laryngeal nerve and the ductus arteriosis. They spoke only in Spanish but slowly and most of the technical language is the same in English and Spanish.  They completed the detatchment/ reattachment in 15minutes seemingly without effort. 

The important aspect from the anesthesiological perspective is that blood pressure in the brain rises when the aorta is clamped off.  The heart slows in response to the pressure change and returns to normal.  However, this can be dangerous when the aorta is unclamped because the blood pressure can drop dramatically sending the baby into a sort of shock.  Therefore, right before the aorta is unclamped it is necessary to increase adrenaline and add blood plasma quickly.  This transition went quite smoothly. 

After the aorta was repaired there was another part of the surgery.  Because the baby’s blood was backed up, the lungs were getting too much blood.  This caused a change in the way her blood vessels to her lungs grew and needed to be corrected so that the pressure in the rest of her body and in her lungs would have the right balance. Until this point the surgery was completely outside of the cavity where her heart is. You could see the beat, but not the heart, only the lung and blood vessels.

It was amazing to see them open up the sack where her heart was (carefully avoiding the phrenic nerve).  Her heart was about the size of the tip of my thumb to the first knuckle.  It was unbelievable. 

The bottom line is, the surgery was amazing and the baby did very well.

The drawing that one of the surgeons, Juan, drew for me.  They had to clamp at C; cut out A; and reattach to the part near B.

Yesterday there was another infant surgery, this time at Clinica Guemes.  Normally they do not do infant surgeries there but the night before a woman had a c-section and her baby was born with some of her intestines outside her abdomen (basically it looked like there was a bundle of intestines sticking out of her belly button.)  This surgery also went very smoothly but Rene told me that these children often have to have more surgery later in life because their intestines do not develop quite right. 

We also talked a little bit about the payment system for surgeries. One problem that doctors face is that they are paid pretty similarly for each surgery, though not exactly the same.  So the insurance pays Rene a little more to do the pediatric cardiac surgery but it takes the entire morning (most of the time is prep and finishing).  At Clinica Guemes he might do six surgeries in the morning.  This is certainly a disincentive to do the complicated surgeries which I find interesting to contemplate, but he really loves to do the peds-CV so he does them anyway.  

Today in the clinic I successfully started my first IV. (!!) and with some assistance I did my first spinal tap.  Very cool, I think.   

There were no surgeries scheduled in the late morning so I left the clinic, dropped off my laundry, and I am at a café.  After I publish this I am going to pull out my Spanish notes and study until class starts. I was completely exhausted last night (veged out infront of the Spanish food network ElGourmet).  I am glad to have a day to catch up a little.  I was so tired for class yesterday that I could barely focus.

Have I mentioned that there is a rooster in my neighborhood? I hear it every morning and I keep forgetting to mention it.  Did you also see the picture out of my window, pretty much straight out (not the sunset, the other one).  I live in an urban neighborhood.

That is why I love Salta, a city with roosters.

pictures

 The convent on the plaza.

 The plaza on a quiet Sunday.  Ill get one on the week day when it floods with kids after school.

 The view straight north out of my apartment.

The view to the northwest of sunset!

I love my life.

That pretty much sums it up.

I feel so lucky to be doing this and to have such good people here.

I am still enjoying my spanish class enormously but it doesn't change much so there is not a lot to discuss.  We have covered present, future, ser/estar, comparisons, time, numbers, reflexive, questions, the basics.  Tomorrow we start past tense which I have seen before but only very briefly (2hours of the class I took in Farmington.)

Then I went to el Quirofano, the OR, for the afternoon.  There I saw a tonsilectomy, partially saw a prostate removal laporoscopically (with a camera and only three small cuts in the patients skin), a hemorrhoid surgery, and a cesarian-section!  The C-section was clearly the coolest!  It was kind of crazy but totally cool to see them pull the baby out.  He was super cute and healthy.
I also tried to start an IV but failed, not terribly though...better luck next time. 

I am starting to get to know everyone a little better in the department and they are clearly getting to know me better.  They are very patient with me and were helping me by speaking slowly and listening patiently while I formulated my answers.  They were also directing me to better spots for watching the surgeries and introducing me to people who don't know me yet.  I shared mate with them, tried bread with anise (yum) and I might even go dancing on Saturday.  They make me feel very welcome.

Just to top it off, the weather was very mild again today and it was lovely to walk home in the fresh but not chilly air.  I also discovered that if I move my seat closer to the window, I have a gorgeous view of the mountains aka the Andes.  Me gustan mucho.

Surgery is cool and I have a great teacher.

Friday morning started like the day before focusing on the anesthesia.  Except Rene was more determined to speak to me in Spanish only even though he loves speaking in English.  After a couple hours, he had some free time in his schedule (which is rare) so he went to run errands.  I elected to stay at the clinic and follow his partner around, Juan Lopez who is affectionately referred to as JLo :) Since the morning was "quiet" I ended up staying in the surgeries and watching.

It is pretty unbelievable what can be done to the body and it made me appreciate how the human body is much less fragile than I tend to think. We are designed to repair ourselves very well.  And when we need surgical help to do it, we can heal from that too.  

The coolest thing about watching the surgeries was how it made anatomy come to life.  I loved anatomy this year and to see it in action was awesome! 
I saw a tubal ligation (illegal unless there is a medical reason for the woman's saftey), a meniscus repair (in the knee joint), both done laporoscopically.  I also saw a knee repair where the gracilis tendon was irritated, swollen and weak and the man's knee had become dramatically knock-kneed, this was fixed.  There was also a "cyst" in a mans wrist that needed to be removed and yesterday (Saturday) I saw a laporoscopic gallbladder removal.

All in all I would say that Surgery is amazing. 


On another note, I would also like to say that Rene is a phenomenal teacher.  Perhaps because he has been in my shoes when he learned English, but I think there is more to it than that.  He is wonderful at explaining to me in Spanish what is going on.  He speaks slowly and uses limited vocabulary which I know or can figure out. When someone else says something that I do not understand, he re-says it, in Spanish, in a way that I can, often just by slowing down.  I can understand a lot of the medicine too, which he clearly wants to teach me.  He checks often to see if I am comfortable with what I am doing and repeatedly tells me to let him know if I need anything at all. I am very grateful for having him as a cornerstone of my experience here.

First day in the OR

Estoy muy cansada. En la manana, me fui a la Clinica Guemes donde Dr. Rene Cadillo esta trabajando esta semana. Es un anestesiologo... (mas en espanol un otro tiempo.)
  
(I am very tired. In the morning I went to the Clinica Guemes where Dr. Rene Cadillo is working this week.  He is an anesthesiologist.) We went back and forth between four OR's all morning.  I saw some of the surgeries but not much.  More later.  Today I tried to focus on using as little English as possible (although Rene speaks wonderful English).  And started to learn about anesthesia. The surgeries included a carpal tunnel surgery, one for large nodules on a mans hand caused by gout, a hysterectomy and more. 

**(NERD ALERT) The coolest thing was the way they do the nerve block (stop the nerve from transmitting anything) for the hand surgery.  Dr. Cadillo uses an insulated needle except the tip is exposed.  He puts it into the arm with some voltage and can tell when he is close to the nerve because the arm starts to move.  Depending on which muscles move he can tell which part of the brachial plexus (nerves to the arm) he is near!  I thought this was very cool.  Then he can block only the nerves that he needs too!**

All in all it was a great experience and it is clear there will be more to come. After the OR I figured out how to buy a bus card because otherwise you have to pay with peso coins and these are nearly impossible to find. I found a great lunch spot where I successfully ordered a Quiche like thing and a salad with beets, eggs, and carrots.  Yum!  I successfully rode the bus to class and made it home too.
 
I am off to clean up for dinner at Rene's house with his family!  And to figure out how to get a taxi there. Chau.

Day 1

This morning I hung around here, made breakfast, organized a little, then got some empanadas (YUM) for lunch and went to meet my teacher, Patricia.  We took a cab to her place where she has a great classroom set up.

Patricia is great. Native to Salta, her mom teaches English which is how she started to learn.  She used to work for a company in Buenos Aires that wanted a "branch" in Salta, but a few years ago she quit working for them and now does it on her own.  I can tell it is going to be great to hear her and to have to communicate in spanish.  She will tell me the words if I say them in English and then I am supposed to continue in Spanish as much as possible.

It is great to have a personal instructor because we started at the beginning with basics and I am able to move through them quickly, but fill in gaps that I've missed with my self study; and get correction when needed. (For example, we didn't have to spend much time on numbers today because I know them pretty well, but she taught me some exceptions like 700 and 900 are slightly different from the normal pattern.)  She also taught me how to ride the bus home. 

Turns out it is winter here (as of tomorrow technically) and it was chilly on my walk from the bus stop.  I am warming up a bit and deciding what I want to do for dinner...?

arribo

34 hours after leaving, I am here.  Unfortunately tomorrow is a holiday so it isn't time for a shower and bed, it is time to grocery shop! Gonna sleep like a baby tonight.

Almost time!

So, I am mostly packed...I think and about to head to sleep.  Very excited for my trip! 

Just gchatted with the Dr. I am working with and was thrilled to find out that the clinic where he is working now is two blocks from my apartment!  And on the way to the grocery store and the center of everything!  It was especially good to connect with him because we have not connected lately.  It helped my excitement.

I am all set with my apartment and my Spanish lessons.  Finally feels like it is all coming together!  I had a lovely last day here and now I can have some sweet dreams!