First Snake Sighting

Yesterday I was walking with a friend past another friend's house. And I spotted my first snake in Shell. It was about 3 feet long, thick like a quarter, and the best part, it was already dead. My friend's cat, Tiger, was playing with it. Apparently he catches snakes on a regular basis, plays with them for a while then kills them and eats them. I think it was actually still alive when we walked up because I saw the head move, but it was dead within seconds of us spotting it. Then I watched as the cat ate some of the skin and part of the tail. I talked with my friend this morning, she said he ate the head and part of the tail and that is all. She told me now that she has a cat that eats snakes, she has realized how many snakes there really are here in Shell. She recommended I get myself a shovel for when I encounter a live one. I plan to get right on that.

First night on call

Ok, here is the story of my first call. Things to keep in mind, this is my first call here, I have to do everything in spanish, I am now the attending, which means it is all my responsibility (I have been the attending for OB patients before, but not for medicine patients). So I have several obstacles to overcome.
Call starts at 8 am. Nothing happened until 10 am. This guy comes in to the ER (we are the ER, there are no ER docs) sweating, dizzy, weak, hasn't eaten much in 2 days and his blood sugar is 22. Now, last week, he had a heart attack and was sent to our hospital in Quito for treatment. They told him he needs bypass surgery for his heart, but he has no money. So he is essentially a ticking time bomb, and now he is in my ER. So we treat his blood sugar, and get him under control. He is doing better. Then I get a 26 day old with fever, this one is straight forward, run some tests, give antibiotics, wait for the results. So, now it is lunch time and I decide to go out with a couple other ladies to a cafe 5 min walk from the hospital. I didn't take an umbrella with me for the first time since I got here. We just finished lunch and my friend gets a call on her cell phone looking for me at the exact time we hear the helicopter and it starts down pouring. So there are 2 patients in the helicopter, a guy with a snake bite and a lady in labor who they tell me has placenta previa and is bleeding (placenta previa is something that requires a c-section and if the pt is in labor, it becomes an emergency). So I get a plastic bag to put on my head and take off running to the hospital. When I get there, I find out she does not have placenta previa, but she is indeed in labor. This is her 6th child so it should not take that long, she is already 7 cm. So we start taking care of the snake bite guy. Snake bites is something I know nothing about so one of the other docs stayed and helped me (that was super nice of him). We thought this guy might have compartment syndrome (that is pressure in a specific part of an arm or leg that puts pressure on the blood vessels and nerves, after that you can have permanent damage to the extremity), if he indeed had compartment syndrome, he needed surgery but 2 problems, 1) the surgeon was in the OR doing surgery on someone else, 2) he got bit by a poisonous snake that causes your blood not to clot so if we cut him open, he could bleed to death. So I go in the OR, talk to the surgeon, we get his pain under control with morphine and I go to check the OB patient. She is fine, moving slowly, but now she is 8 cm. Then I get called to the ER again for a kid with burns all over him. I call in the surgeon and go look at the kid. Apparently the dad was putting a mixture of gasoline and diesel into a diesel lamp and it exploded yesterday. They had taken the kid to the free clinic and got some bandages, but nothing else. So now this kid is very dehydrated. The anesthesiologist came in and sedated him so we could clean him up. He had burns all over his face, his front, his back, his arms. This was the first time during this call that I almost started crying. We got him all taken care of and I went to check on the OB patient again. She is not doing anything, her contractions stink and she is stuck at 7 cm. While I am evaluating her, the nurse walks in the room and has a smile on her face. She tells me that MAF just called (those are the pilots that bring sick people in from the jungle), they have a child in serious condition. The nurse starts laughing because she knows that has been the day from hell so far. She says it sounds like pneumonia and many times when the pilots say something is serious, it is not. So, ok, she sent the ambulance to the air strip to get the child. I decide to start medicine on the pregnant lady to get her moving along. I go back to the ER as the ambulance arrives with the very sick kid. They were right, he was very serious. He was breathing about 75 times a minute, his oxygen saturation (which should be >93%) was 60%. It was very possible this kid was going to stop breathing. This was the 2nd time during this call that I almost started crying. So we called in the people to do an x-ray and the anesthesiologist (in case we needed to intubate him), gave him oxygen, medicine for his lungs, antibiotics for the pneumonia he had, steroids to help him breathe better. After an hour, the anesthesiologist still had not come, so I called him myself (then I found out they had never called him). Then I go to check the pregnant lady. The resident had just checked her 20 min prior and she was 7 cm. So I was going to check her again to see if she was doing anything, otherwise, we were going to do a c-section. I asked her how she was doing, she said she was the same, She got a contraction so I said I would check her after the contraction. She held her breath, so I decided to look under the sheet and there was the baby. Of course, this was my first delivery here, I don't know where anything is, and I am in the room alone with the door closed. So I finish delivering the baby, with one glove on, of course, then I open the door and yell for help. Everything turned out ok, and I learned another lesson, women here don't make any noise when they have babies, and they know they can do it without my help, so if I am not in the room, they don't care. We finished up with her and went back to the kid who was not breathing well. The anesthesiologist came in, got the ventilator ready in case, but we all decided he was doing a bit better and we would wait longer before intubating him. At this point it was only 8:30 pm. I could only imagine this keeping up all night long. But right now the ER was empty so I went home to eat, shower and relax some. I called the hospital at 10:30 pm, still nothing, so I went to bed. I slept all night (except the 4 or 5 times I woke up thinking I had slept through my phone) and got called at 7 am this morning for another delivery.

So even though the call sucked big time, I did sleep all night and everyone was still alive this morning. And the kid with pneumonia is still very sick, but is doing better. They have promised me that all my calls won't be like this one and it can only get better from here.

being a tourist in Banos

Tuesday, February 12 was a holiday in Shell so we didn't have office hours. I had the day off and went to Banos to be a tourist. I went with a doctor from Miami who is visiting Shell for 2 weeks. The first thing we did was go to the zoo. It was interesting. The majority of animals they have are animals that can be found in Ecuador. Some of the cages are small, but not too bad. And there were some animals that were loose (like the Tapirs). As you can see from this picture, you can get really close to the animals. This monkey kept coming by the bars like he wanted to be fed or petted. So I stretched my hand toward him to scratch his back and he put his hand out. I was slightly frightened, but he was very gentle, he just held his hand there and let us touch it, he didn't do anything.
The other monkey had a really strong tail. He put his tail out the fence and pulled Lilly's leg toward him, it looked like he was trying to get her purse. In the picture, you can see his tail on her leg.
After the zoo, we went horseback riding. It was a 3 hour tour that only took about 2 hours and 20 minutes. We walked, trotted, and cantered (that is my favorite part). We went to a water fall. After that we crossed a skinny bridge on the horses. On the other side of the bridge, we walked a little, then the guide said we had to get off. We got off and she told me to start walking up the mountain. She brought the horse up behind me then told me to get back on. We then walked up the side of a mountain on horseback. That is slightly scary, but very fun. I loved every minute of it. There was one point when the horse in front of me was sliding down in the mud and next to us was the edge of the mountain. I had visions of one of us falling and going down very far. But it was still fun. We made it to the top and went back a different way, thankfully. This picture is Lilly on the side of the mountain. Pretty cool, huh?

Eww...What is that?

The grossest thing yet happened to me this am. I was in the shower, all I had left to do was rinse my hair when I lost all water pressure and then the water got really hot. So I turned on the cold full blast and it came out forcefully. I finished rinsing my hair and turned the water off. I looked down because I always have to move my hair away from the drain for the water to drain, and there was brown stuff on the tub floor. I assumed it was from my foot scrub so I pushed it toward the drain. I quickly realized it was a different consistency, then I saw that it was all over my arm and my leg. It had the consistency of ear wax (you might not appreciate the consistency of ear wax if you are not a doctor, but you might be able to imagine). Then I realized it must have come from the shower head or the pipes when I turned the cold on full blast. I had to shower all over again. I have decided I will be getting a new shower head and very soon. I talked with another missionary who has been here for a while. She told me that was the sludge that collects in the pipes because the water here is not that clean. Is it even worth taking a shower if that is what is in the water???

First days in Shell

On Tuesday morning, I got on a plane to fly to Quito. After about 15 minutes in the plane, on the ground, the pilot got on and said there was something wrong with the computer and we would have to wait only a couple minutes. 45 min or so later, we took off. I arrived in Quito no problems. Then Wednesday morning, I was getting ready to leave and I got a call from another missionary here telling me that the Volcano, Tungurahua, had erupted over night and the road to Shell was closed. So the family I was driving with, made some phone calls and found out the road on the other side of the valley was open so we decided to go that way. It only took us about 45 minutes longer than normal, and the road was not too bad. It was a narrow road, cobble stone in parts, dirt in parts,and paved in parts. There were parts that were very close to the edge as well. But we made it to Shell.

When I got to my apartment, I asked a bunch of questions about cleaning since they had just replaced all the walls. I wanted to know of the cabinets and dishes had been cleaned. I was told, "we think, but you might want to do it again". So I went to the military store in town to buy supplies to begin cleaning. I got there, did all my shopping (about 20 min worth), I went to the front and they told me the computer was down and they didn't know how long it would be. I could wait if I wanted to. So I left without my stuff and went to another smaller store in town and got the essentials (toilet paper, vinegar to clean with, cereal, dish soap...). I began cleaning. There was, and still is, mortor (because they put up cinder block walls) all over the floor, tub, tiles in the bathroom, the kitchen sink. The cabinets have dust and left over termite mess in them.

Two of the ladies bought me some groceries to get me started. Everything was in closed packages, so I left it on the counter overnight because I don't want to put anything away until I cleaned the cabinets. MISTAKE!!

When I woke up Wednesday morning, there were hundreds of small sugar ants in my kitchen. I quickly learned about Terro (Ant Killer). I put this on the counter and was told that I may find hundreds of dead ants over the next couple days. So far so good, the live ones are gone, and no dead ones yet.

So Wednesday morning I returned to the military store to do my shopping again. This time I asked ahead of time if the computer was working. All was good. I got what I still needed and set on home. I began cleaning again. I did laundry and got my closet cleaned so I could put my clothes away. Then I began the cabinets and the dishes. I think this is going to be a couple days work.

Cangrejos for dinner

For Carnaval, my family decided we were going to eat Crab. She went out in the morning and bought 36 live crabs and brought them home to clean them. I got out of bed just in time to watch a part of the cleaning. It was amusing. There was a bucket of already cleaned crabs crawling on each other. Then there were those in the water waiting to be cleaned. Trying to escape from all directions, and they were fast. She explained to me that she removed the stomachs with the poop in them so that when it was time to eat, you could eat every part because it was all cleaned.

When we got ready to eat, I asked how we do this. The table was covered with newspaper, everyone was given a wooden cutting board and a wooden mallet. But for the most part we just used out teeth to break the shell. And the mom actually ate part of the shell too. They didn't crack to many legs open, they just broke them at the joints and sucked the meat and juice out. I had a hard time with that part. I ate 2 crabs (just the legs because I had a hard time with the head too), others in the family ate 8. It was an eventful meal.