Yo estoy escuchando.

ello & appy Friday!

Dermatology is going well. In short, it's easy. Although by the end of these 4 weeks I wonder if I'll be able to say Head and Shoulder correctly, or if Ead and Choulder will have replaced it completely.

After my averted attempt at turning in my FM3 paperwork last Monday, it took just 3 more trips to the main campus for them to accept everything. I can't complain about 4 total trips, it's normal and expected. But there's always a small hope lingering that it'll just take one trip that inevitably gets smashed every year. Oh well, at least being in Derm, I had the time to make all the trips with no damage done.

I am thankful it's rainy season in GDL now. Things are much cooled down due to the daily downpours. Normally the rain happens late evening or during the night. But for some reason last night it decided to wait to rain until this morning. In anticipation of all the backed up traffic from the flooded streets I left early for the hospital, and still got there late. (Still beat the doctora there though, so no problems!) I was thankful there were parking spots available on the block of the hospital, and after my typical awkard attempt at a parallel park I opened my door, umbrella in hand, to find myself in the middle of a river. oooeeeeee! I jumped from my car with minimal splashing and then tried finding an ideal place to get from the middle of the street to the sidewalk with no success. But deciding the middle of the street not to be the best place for me I hiked up my white pant legs and braved the river. I walked into the hospital this morning going 'squish, thump, squish, thump, squish..." Que attractive, no?

Coming back from my weeks in the States I've noticed some new billboards that have gone up in my absence. They are advertising McDonald's. I have to admit, once in a great while I enjoy some McDonald's myself. About a year or two ago they started their McTrio del dia. (McTrio of the day). A Medium fry, drink, and sandwhich for a cheap price. Last semester they started offering the Grande option with their McTrios. Not good in my opinion, but inevitable considering it is afterall, McDonald's. But now these billboards are advertising the McTrio Plus. Everytime I see one such billboard I have a sudden desire to grab a shot-gun and obliterate the thing. Good Grief McDonald's!!!!! Mexico needs no help getting fatter, they're doing a fantastic job of that all on their own!

Last but not least for this blog. I miss my old apartment. I did not realize how spoiled I was by having so much space. But even more so, I miss my windows. I had windows that looked outside in my old apartment. The window in my room opens into the well that descends through our house from the roof to the bottom floor and is covered on top by yellow plastic. In my old place I'd have the windows open 24/7 and was able to enjoy the thunderstorms. Here having my windows open doesn't actually matter, as I still don't get air movement through them, and the rain falling on plastic is borderline obnoxious! I know I'll get used to it, and even if I don't I'll get over it. :)

Hasta!

Yo estoy reunida con mi equipaje.

My alarm woke me up this morning at the time I had set it for. Only problem was that I had first forgotten to switch the time from Boston to GDL. Didn't realize I was an hour early until I was in my car and saw the green digits laughing at me. It didn't take much for my housemates to convince me to take a nap.

Today was a typical first day in Mexico. Went to HAL first and got paperwork taken care of there. Then was off to a hospital in Tlaquepaque (probably was once a suburb of GDL, but has since gotten engulfed by the growing city). I was scheduled for 4 weeks of Neurology, however when I got there they told me that they don't have a Neurology service at that particular IMSS. So I'm doing Dermatology instead, and then will have to transfer to another hospital to do Neurology. Driving home today I was finally able to turn on the radio in my car and relax a little bit. I wasn't stressed before, but I had tried the radio and ended up snapping it right back off prefering to drive in the quiet.

I also made a trip to the main campus to get the process started on my FM3 renewal/address change. I walked in the building, turned the corner to head towards the International office, and froze. The office was packed with starting first semesters. It must be their orientation week. I paused a moment more, then turned on my heel and headed back the way I'd come. There was no way I was going to enter that room then. I'll have to try again tomorrow, hopefully at an earlier time.

My suitcase was delivered today. As no one was home this morning we arranged for our neighbor to receive it for me. Same neighbors that let me park me car in their parking spot all summer while I was gone. This means that I have all my cords back, a.k.a. here's some pictures!!!

Museum of Fine Arts. Chihuly blown glass exhibit.

Jamaica Pond: kind of like the jewel hanging from the Emerald Necklace (a 7 mile long path/park through Boston)



My last day at Children's Hospital Boston.



For our last day in Boston, Amy & I made plans to go downtown to the New England Aquarium. Delayed a bit by a sudden downpour, but we made it. Joining us are Luke (the son of the lady I stayed with), and Pablo.



Then Amy & I headed out to the ocean. Far past all of the small islands, the one below was my favorite, out until nothing but ocean is seen, and then....



....the water suddenly breaks and power rises out, and unless you were already looking in its direction, disappears before you know it leaving behind a splash any cannonball would be jealous of. The whales that we happened across were in the midst of a feeding frenzy so it was amazing as they were being very active. It the end the naturalist aboard the boat with us guessed that we had seen about 20 different whales on our trip.


I'll leave you with a video. CHB had the most fun musical stairs ever. It took a lot of self restraint to not play on them everyday. Thankfully Amy was willing to enjoy the novelty with me.


Hasta!

Yo estoy adaptando.

Breaking News: Culprit of recent blog highjacks has been caught and charged accordingly. Prosecution is pressing for 5 years hard blogging. ;)

I made it back to GDL today in a timely manner. I was able to make-up for a sleepless night by catching a few winks on my flights. Unfortunately, my suitcase did not have such a pleasant trip as I. It's currently lost somewhere in between Boston and Guadalajara. It had to happen eventually I guess. I'm somehow confident that it'll make it back to me...just like Little Bo Peep's sheep. "Leave them alone, and they will come home, wagging their tails behind them." I did go ahead a buy a new toothbrush and tooth paste though. Figured a cute little sheep tail wasn't enough to make up for overgrown oral flora.

This also means that pictures are on hold a day or so longer as my bag of cords was haphazardly stuffed into my suitcase at 2:00am this morning rendering me camera cordless in addition to computer cordless and phone cordless.


Hasta!

"For Christ is the end of the law for righteousness to every one that believeth." Romans 10:4

Yo estoy hijackando

Hola everybody!

As Christy continues to work diligently at Boston’s Children’s Hospital and spends her evenings goofing off with me, I thought I would do her a favor and hijack her blog! Who is this awesomely mysterious hijack blogger, you ask? Amy! Her old roommate, Boston-visiting friend!

Christy and I started our week long adventure with a visit from her sister and brother-in-law, Carrie and Troy. The four of us hit many of Boston’s most famous sights: Freedom Trail, Swan Boats, Cheers Bar, Duck Tour, Boston Commons, Frog Pond, MiT campus and museum, and Ye Old Oyster House. The food was wicked and the hills killed my legs!

The rest of the week Christy and I found amazingly cheap ways to entertain ourselves. We semi-crashed a backyard barbeque graduation party. We viewed a pre-cut movie as part of a research study by the production team. I can’t tell you the name of it or anything about it unless I want to get sued (or maybe Christy would. Muahaha!), but I can say that it had some big A-list names in it and at one point the characters talked about Normal IL (no joke!). We saw the beautiful Chihuly glass exhibit at the Art Museum, played on the musical stairs at the Children’s Hospital, and got “mooned” by some Boston firefighters (long story).

Sadly, we only have a few days left in Boston, but we have some great plans (going to a lake and the Aquarium)! Plus, who knows where the cobble stones roads will lead us! I also have a surprise planned for Christy on Saturday evening. Shhh! Don’t tell! :)

Stay tuned for Christy’s point of view, some pictures, and a video!

Hasta Pasta!

Amy

Yo estoy yendo de paseo turístico

This past weekend was an absolute blast! Amy Hohulin has come and is staying the week with me. In addition, Carrie and Troy were in Boston for the weekend. We were non-stop tourists all weekend long and only made a dent in what Boston has to offer. A great big hug to Carrie and Troy for making the quick trip!!
Here's just a few moments from the sites we saw, the adventures we had and the miles we walked.


Aboard a Swan boat enjoying a leisurely row around the Public Garden lagoon.


Make Way for Ducklings!!!! …and then some.


Lunch at Ye Olde Union Oyster House. Oldest restaurant in the US.


Visit to the Massachusetts Institute of Technology.


Old State House. The Declaration of Independence was read from that balcony I believe July 18, 1776. The intersection in front of it was the site of the Boston Massacre March 5, 1770.

Hasta!

Yo estoy esperando.

It's really not ideal to be up at 3:00 am on a Saturday morning. But when you're waiting for a visitor to arrive it is completely normal and acceptable. Amy Hohulin's plane has arrived and she's on her way right here! right now! (I'm sure you all wanted to be updated to that extent ;) We'll meet Carrie and Troy tomorrow morning downtown and start a fun weekend filled with lots and lots of touristy things!!! I've been sitting here making a rudimentary list of all of our options, what to choose? what to choose?

In the meantime I wanted to post the following picture of my cousin Danielle and I last Sunday evening. She lives in Tennessee and was passing through Boston on her way to Maine for a vacation. What a random opportunity that we could just not pass up!! I should have thought enough ahead to take a picture while there was more daylight so the Boston Common background would have been visible, but I didn't. I'm sorry. But you can consol yourself knowing that it was a particularly unexciting corner of the Common we were in, so you're not missing much.



Hasta!

Yo estoy dependiente.

Back in GDL, UAG has resumed. This means that many of my classmates yesterday were posting as their Facebook status something to the excitatory effect of a “new semester”. And although technically I am two weeks ahead of them (having started my 7th semester two weeks ago), I now feel two weeks behind. Or to be more exact, two weeks and one day behind all of them. I’m scheduled to start in my assigned hospital on the 25th in GDL, however, because of the inefficiency we all know and love as Mexico’s own system of organized chaos, the 25th I will instead be running all over the city in between offices and hospitals just trying to get documents where they need to be. I roll my eyes at this, because I already know what is most likely to happen. I will return to GDL on the 24th, spend hours trying to get myself organized and my plan of attack all laid out for Monday, all to find out come Monday that everything they told me in June (right before I left) has now changed and I actually need to do this, this and that instead. I may have to plan on going to the gym for a boxing class that night....

Anyways, back to the here and now, I’ve finally come to a point in my learning here in Boston where I’ve come upon some down time. If I had the choice, I’d rather not have the down time, but at the same time, I can actually take it as a good sign. I’m getting my work done in much, much, much less time and much more independently than before. I did learn a lesson yesterday though, that I shouldn’t let myself be too independent:
- One of my patients is an adorable baby boy, unfortunately he has a messed-up heart (technical term ;). But because having a messed-up heart isn’t enough, they saw signs of an intestinal infection so took precautions to avoid it, one such precaution is not letting the baby eat. So I started him on a PN prescription. Many problems later and a long story made short, he ended up being way behind on his PN. Monday I came in, assessed his status and then put in the order for an advance in his PN. One of the dieticians then reviews the case, notices the patient has a high blood sugar that morning and freaks out because I had increased the dextrose of his PN. I called the nurse to confirm that the reading had been contaminated, and she agrees to get a heel stick reading as soon as possible. In the meantime, this dietician continues to freak out. She tries talking to the attending team in charge of the baby to get them to just flat out change the PN order, but they refused her saying he needs the increased calories. (They’d already told me that when I’d asked them about the situation.) This now had succeeded in making her mad. She calls our attending and vents to him, but he just told her to wait until the heel stick results. In the end, her rampage was all for nothing. The heel stick proved that the high reading had been a contaminant, and the PN was advanced just as I had originally recommended. If we had been in Mexico I would have told her to “toma una pastilla de CHILL!” Either way, lesson learned, and now I make sure I go to or at least call the particular dietician I’m in consult with to get their stamp of approval before I actually put in recommendations.

This morning I attended a breakfast conference with the fellows. The topic was constipation. (Constipation for breakfast!! Yum!!) The doctor giving the topic was not shy to admit that she LOVES constipation. I actually appreciated that she said that because it made me excited to hear her talk. Whenever someone loves what they are talking about, it shows, and almost always makes for an interesting talk no matter what the subject is. And of course, it ended up being an excellent conference. At one point she was talking about a certain study and made a joke about how they do the study in Mexico, which everybody laughed at. I, on the other hand, got defensive. Just because Mexico does not have all the nifty resources available CHB does, doesn’t mean they should get made fun of. Instead they should be recognized for their creativity in developing a method of completing the exact same study with the few resources they do have. But all jokes or nonjokes aside, I learned a lot about constipation from her..…who knew?!?!
Hasta!

Yo estoy calculando.

This past week was more intense as I added on average a patient a day to my workload. I know that doesn't sound bad, but from my perspective I was being asked to magically know how to recommend individualized parenteral nutrition perscriptions for these patients when a dietician gets years of practice before actually being put on the spot like that. So in other words I was doing a lot of calculating both in and then for hours out of the hospital too. So now at the end of the week I've ended up with pages and pages of scribbled calculations and lots of crossing out followed by rescribblings.

And yes, the actual work is fuzzy in the above picture. You can think HIPAA for that ;) I haven't done this much math since I was last in a math class, probably over 4 years ago now.

Something else I'm experiencing here that is quite unique is specialization. I can say that so-and-so is my patient, which would be true, but at the same time I am just 1 of about 14 doctors that is able to say that. I have yet to form an opinion on what I think about this as there are quite obvious pros and cons to this form of medicine. Say it's a baby in the cardiac ICU, who now has an intestinal infection rendering him NPO (nothing by mouth), that's where I come into play --- cue the parenteral nutrition *trumpet fanfare*!!! But I'm just one more doctor being added to the already long list of neonatologists, cardiologists, gastroenterologists, and of course all of the fellows, residents, interns, and students that go along with each of those areas. Pro- this baby is getting the best attention possible because it's got specialists for each different area. Con - this makes it so easy to turn communication into miscommunication. You figure out your recommendations, figure out who you need to communicate them to, then actually communicate your recommendations, and finally you have to remember check up on them later to make sure that said recommendations were communicated correctly. By taking a step back and just observing this mechanism at work, I see that it really isn't that bad as long as those involved in the relay are well practiced in the art of communication. On my part, I've definitely improved this week, but probably still a few kinks to work out before I can run smoothly with the rest of Children's.

One more picture to share with you. I discovered the use of my Webcam, which then proceeded to provide me with a few minutes of delightful entertainment!


Hasta!

Yo estoy orgullosa.

View of the Charles River from Harvard Bridge looking in the direction of the Longfellow Bridge taken sometime Monday evening before the sun disappeared.



This is me and Pablo, a fellow UAG med student, enjoying Boston's 4th of July festivities. (Note: His Boston Red Sox cap had been given to him about 4 years ago before he even knew where Boston was or what the Red Sox were. Life's circumstances sometimes are just too perfect to be just circumstance.) :)

Monday was indeed a very long day, but Pablo introduced me to his housemates and I made many new friends. They were all international, mostly from Germany and France, so being the only American amongst our group for a very American holiday was quite a unique experience.
It was brought to my attention that our particular holiday celebration was seen as odd because of the fireworks. When I responded that Mexico has fireworks at their independence celebration it was explained. Mexico has 'el grito' as their big celebration and fireworks accompany 'el grito'. But in America we have fireworks and then occasionally a concert (as in Boston's case) or music to accompany the fireworks. Here the celebration IS the fireworks. I understood the point being made and confessed I'd never thought about it before. The discussion kind of ended there. Sometimes I have to think awhile, and after mulling this particular topic over for a day I've come to a more dramatic conclusion than the one I made yesterday. And that is that we celebrate our fireworks because, they aren't just fireworks to an American. Listen to our National Anthem and it will tell you that:
"And the rockets’ red glare, the bombs bursting in air,
Gave proof through the night that our flag was still there;"
When Sandi Patti's rendition of the Star-Spangled Banner swells at the end of the fireworks display to que the grand finale these crowds of people aren't shouting and cheering for a mere bit of gunpowder and fire, but they are shouting in recognition of a great nation that has fought, and bleed, and by the grace of God exists today yet strong, and in that moment they are free, they are united and they are proud.

God Bless America!

Yo estoy libre!

I am attending church today at the local Starbuck's close by Children's here in Boston. The slow internet signal where I am staying prevents the live feed from actually transmitting, so I'm here, at Starbuck's. Listened to Dave Zehr this morning sipping a coffee, watching life traverse by on Longwood Ave and with coffee shop soundtrack in the background. It feels really good to be free this weekend.

I was thrilled to be told I wasn't expected at Children's on Monday. It ends up I'll probably be celebrating the 4th of July by myself this year, but I do plan on going down to the Esplanade. So in reality, I won't be by myself, but rather 1 of a million enjoying the holiday festivities. As the Boston Pops 4th of July Celebration is considered the premier 4th of July Celebration in the nation I am thrilled to have this opportunity to get to experience it first hand. I have been reading information online about the event, and am sad to realize I'm missing the weekend long events. Such as the reenactment yesterday that started in Boston Harbor ending on the Boston Commons or today's Chowderfest! But I'd decided to stay in my area and study instead. By studying as much as I can these first three weeks, I won't feel guilty about not studying my last week when I have visitors!!!! Yay! I love visitors! However, tomorrow is going to be a longer day than I was expecting. Apparently, to enjoy the celebration from the Esplanade itself you have to have a wristand attainable at any of the three entrances to the area, and furthermore they typically run out of wrist bands by about 2:00pm. Sooooooo, it's going to be a long day! If you guys want to watch the fireworks with me they'll be on CBS!!!!!

HAPPY 4th of JULY!!!!!!