What do those eyes belong to?

I walk with some friends at 5 am. Both of my friends I walk with live on the other side of the suspension bridge. So I have to walk to the other side of the bridge by myself. I have a system. There is a light at the beginning of the bridge, so I open the gate, get on the bridge, close the gate behind me, then I shine my flashlight all the way down the bridge to make sure there aren't any animals (snakes, tarantulas, monkeys...) waiting for me. Well, the other day, I was in a hurry so I closed the gate and began walking down the bridge while I got my flashlight ready to shine down the bridge. I shined the flashlight and at the other end of the bridge were 2 eyes looking at me. So I stopped, (I was probably about 20 feet from the gate at this point) my heart started beating a little faster, I continued to shine my light on it, trying to figure out what it was, then it began running toward me. I turned around and took off running toward the gate. Of course when I got to the gate, I could not open it. I was pulling instead of pushing, my heart was racing. I could only imagine what was running at me. So I got out of the gate, closed it, turned around and shined my flashlight to see what it was. And I quickly learned I was running from a little Kitten.

Second snake sighting

Well, so far so good. I have seen my second snake, and it too was dead. This is a coral snake (I only know that because someone told me) and unlike my first snake sighting, this one is poisonous. It was found outside the back door of the house behind me. The lady who found it was in her car (a big van to be exact) and saw it standing up. She ran it over 2 times with her car and it was still standing up in strike position. The neighbor came over and chopped its head off with a machete. I know it looks like a baby, but from what I have been told, it has enough venom to hurt you really badly.

Beryl Koch (Nov 18, 1919 - March 6, 2008)

Beryl was an angel sent by God to participate in the lives of so many people. She was always helping, always serving, always showing God's love to those around her. Some of my fondest memories of Beryl are the way she told stories of Jesus using a pan of rice when I was in preschool and kindergarten, making fuzzy lambs in VBS, her winning the watermelon seed spitting contest at a church picnic in the Szoke's backyard (this little tiny lady and she could outspit big boys), having high school youth group at her house when she didn't have any children or grandchildren in the youth group and making us homemade donuts (and lots of them because there were lots of big boys in our youth group). I remember she always brought fresh flowers from her garden to decorate the church sanctuary and Sarah Szoke and I always got to take them home. Some of these things may seem so trivial or just normal daily activities, but they made an impression on me and we will never know how many other people these trivial things made an impression on as well. I have surely learned many lessons from Beryl's life, one big one is when serving the Lord, no matter how trivial or mundane the act may seem, someone may be eternally touched. I am thankful to the Lord that I was able to share my life with Beryl. I will truly miss her but I know I will see her again some day and what a day of rejoicing that will be.

First trip to the jungle

On February 27, I was informed that I would be going to the jungle the next day. I had fears. Fear #1: the plane. As you can see from the photo, the planes we fly on are not big. They fit up to 6 people, but only 800 lbs of weight not counting the pilot, so this is a very small plane. Plus, it is a nonpressurized cabin. My only experience, up to now, with a nonpressurized cabin had been in a helicopter and I did not like that at all. I could only imagine that this would be worse, we would be higher and flying over vast areas of nothingness where if something did happen (a crash for example), no one would find us for days.
Fear #2: The jungle. I have never been to the jungle, have only seen it in movies (and we all know everything in movies is reality). I did not know what bugs to expect, what to expect from the people, would they feed us, and if so, what would it be? I have heard many stories about the food in the jungle, boiled grubs, cold piranha soup. Our plans were to just go for the day, but if the weather didn't cooperate with us, we would have to stay overnight. Where would we sleep, there is no electricity, so what bugs, or other critters, would climb into bed with me while I was sleeping?
Fear #3: being the doctor. What illnesses would they have that I have never seen before, will I know how treat them? If someone is really sick and needs to be flown out to the hospital, will I recognize that patient? What if they don't speak spanish (which they didn't, but I had a translator), how will I know what is wrong with them?
28. The ride in the plane was fine, it was very smooth and I was not afraid aSo with all these fears, I set out for one day in the jungle on Febt all. The community was very welcoming, it was a very small community of about 15 people, we were able to see everyone and treat all their ailments, which were very mild. No one was really sick, no one had anything that I didn't know how to treat. There was a storm in the afternoon, but it cleared in time for us to leave that day. We didn't eat anything while we were there. I didn't see any scary creatures, only some beautiful birds.
Overall, it was a great experience. In and of itself, it was not a very productive trip, but for me it was. I am now over my fear of the jungle, so when I have to go for 3 days, sleep there, bathe in the river, eat the food, I won't be so afraid. I now have had a taste of what to expect, and I enjoyed myself.

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?