Yo estoy una hoja.

For a hospital that is administered on 100% paper the IMSS never seems to have any paper.

Charts are handwritten. If any official evolution form is not available then you write your evolution note on any random piece of paper you can find and stick it in the chart, or even just put your note in an open spot on a sheet that is already in the chart. One day one of the interns actually went to the office to ask if we could have some sheets of paper. He returned rather upset and holding a grand total of 2 sheets of paper that they had given him. 2!!! About a 1/2 hour later he burst into the intern room giggling and clutching about 1/2 a ream of paper. We didn't ask where he'd gotten it from; we just hid it in one of the cupboards. The sheets ended up being the wrong size of paper, but that's easily fixed; you just tear off the end of the sheet and voila!

There is one ancient computer in the intern room with an even older printer. It is used to type and print discharge reports. Couple problems with that...say 5 discharges are ordered at the same time, if you're in charge of the last report ordered you've got to wait to have access to the computer, and your patient has to wait even longer. Plus you still have the problem of paper...can't really print a report on air. It wasn't long and I joined the rest of the interns and students and started bringing my own sheets of paper from home.

Not done talking about paper yet! The bathrooms. Yup, even the bathrooms. If I need to go I run around to the sinks in the ER scrounging for some paper towels before I even head there. Patients lined up bed after bed in the ER will have a bag of their personal belongings beside them and more often than not you'll find a role of tp in that bag

It's amazing how a place run on paper can be more paperless than a US hospital run on computers.

We have one EKG machine in the ER. It's of an ancient design with little suction cups you adhere to the patient. It must somehow know or understand that it absolutely can not give up or stop working because it's all they've got. So many times over these weeks I've thought it was at it's end, but somehow it would surprise me each time. Once it wasn't working, so we tried everything even changed outlets, it still refused to turn on, that is until we started smelling something burning and switched it back to the original outlet. Then for some reason it worked!!! We had a line of patients waiting for their EKGs so we didn't turn it off after that, but still by the time the next patient was ready to go the machine had died again. The intern I was working with suggested we try burning it again as that had worked last time. We eventually figured out that even though on the screen we couldn't see anything the machine was still actually working and we just had to from memory push the right buttons in the right order and at the right time and then pray until you got those three things all right and a little slip of paper started printing off. That was the status of the EKG machine for a while until of course we ran out of EKG paper. Sigh! However, the last time I used the EKG machine not only was there paper but the screen was also working. Like I said, it's a machine full of surprises.

Hasta!