Photo Credit: Photo by Piron Guillaume on Unsplash
I´ve been completely missing in action from my blog and the neglect shows. Not for a lack of desire to write, but because the learning curve while studying abroad has been steep...very steep. My time studying abroad has been amazing and is quickly nearing a close at the end of 2019 and I am looking forward to returning to the U.S.
This semester, we selected our rotation sites in Mexican hospitals. During my 2nd semester, I was constantly bombarded with, "Select the Green Cross! You really want to go there. You get the most action there." Needless to say, the Green Cross did not disappoint.
What Are the Green Cross Hospitals in GDL?
The Green Cross are government run trauma centers in GDL. They were established to provide services within Mexico´s Universal Healthcare System to the broader population of Mexicans and Indigenous peoples. Healthcare students throughout all levels of care are taught at these hospitals and when Mexican medical students enter their "service years" (residency but it is unpaid), they often round out their training at such hospitals.
We arrived by shuttle at our assigned location and were thirty-minutes into the hospital tour when the attending on duty screamed at us, "Obtenga sus culos aquí. Alinearse para la compresión del pecho!". Myself and another white uniform clad student quickly looked at each other and ran to catch up with the attending. The acrid smell of fresh blood, piss, and shit clawed into all of my senses. I rounded the corner to see an unconscious elderly woman bleeding profusely from her head. A nurse was cutting away her underwear...a National student was engaging in violent chest compression...the scene was one of controlled chaos.
It was at that moment that time seemed to rapidly slow down. The sounds of the ER faded and I was simply a body in motion reacting instinctively to my limited training. I yanked off my white coat eyeing where I needed to insert myself. A resident was having trouble intubating the woman. The next thing I realized, I had taken over and he was assisting me, holding the light while I slowly guided the curved blade of the Macintosh down the back of her throat until I could see the epiglottis. I followed with the breathing tube and attached the breathing bag and took over breathing for the woman at a six count. The experience was meditative and cathartic as the frenetic buzz of the room shifted into a symphonic rhythm. Doctors, residents, and students hummed or whistled while attending to life saving measures for Jane Doe whose brain was hemorrhaging and blood was oozing from her scalp and right ear. Someone´s grandmother had been hit by a car crossing the street.
I continued to breath for the woman for the next 45 minutes. I held her hand and talked to her as we wheeled her to MRI. I made sure her blankets were tucked as I would if she were my own family as we finally connected her to a ventilator and prepped her for final transport.
As the EMT team arrived to transport her to another hospital for additional surgical intervention and I looked at the carnage left in the corner once inhabited by her gurney, it was then I realized that trauma smells like blood, piss, and shit. It smells like humanity in its rawest form. I rose to the occasion but still longed for the isolated comforted of lab samples, petri dishes, and infectious agents.
We hadn´t even walked in yet as the ambulance pulled in bearing the aura of dead cargo. John Doe was a riding a motorcycle and was hit by a bus. Mexican buses are nothing to fuck around with as they do not stop. They barely stop at red lights and they do not stop for cyclists or pedestrians. By the time we squeezed past the sweaty hordes of patients in line for X-ray readings, colds, flus, broken bones and through the ER doors we were already being screamed to hurry our asses along.
His head was still in the helmet being held to his body by only his spinal column. Unlike the frenzied action of the day prior, we knew this young man´s fate.
While my colleagues spoke to his family, I held his hand as nurses injected massive amounts of morphine into his veins. Dunno...I feel that taking the time to offer comfort even if I cannot perceive them feeling it is important. Maybe, I am doing it as a salve to my own soul. Maybe it is what I would hope someone would take the time to do for me if I were ever in the same life or death (dying) situation.
"Do you know how to insert a catheter?". The question was posed to me on a rare slow day that consisted mostly of helping the nurses lift frail elderly men from one bed to another who were insistent on showing me their ancient testicles with pride. "No", I said as I flicked the sheet back over the elderly man´s skinny legs who was snickering and winking at me with a toothless grin. Mr. Longballs was having the time of his life seeing his first Black woman and calling me, "Bella Negrita",whilst blowing kisses at me and showing me balls that hung as long and low as truck nuts.
I followed the National student over to an elderly woman who was visibly wincing in pain. She was tiny--a mere skeletal figure under a thin sheet. Here granddaughter greeted us with a weak smile and concerned eyes. "¡Señora!", the student was yelling as the woman was hard of hearing. "Soy doctor________ y este es doctor_______. Tenemos que insertar un catéter para que pueda orinar cómodamente." This exercise was mostly to benefit the daughter. We opened the woman´s frail legs and she groaned in pain. Her frame was that of a 12 year-old. Currently, my Spanish speaking skills are in an awkward place: I understand a lot of Spanish medical terms, I understand Spanish spoken "at me" in a medical setting. I speak enough to do laundry, order food, and give "struggle" directions to an Uber driver around town, but I have limited capacity to speak back. The fellow medical student instructed me to clean and catheterize the elderly patient in Spanish. I took a deep breath and did as I was told, step-by-step.
As I rapidly slid the catheter into her ureter as instructed, she screamed and cried. It was a cry of resignation...of something once again being done to her body without her consent and being too weak to fight. As the catheter went in, the most purulent green mucus oozed then gushed out. We cleaned her up, push a bit of pain meds into her IV, reassured her granddaughter, and walked away to get ourselves cleaned up.
I returned to the nurse´s station to continue reviewing my neuro notes. I looked casually around the ER marveling at how humans are able to survive--no, how I was surviving--the ER without catching some super bug whose virulence factors could make it weapon of bioterrorism.
On this day, it seemed the Universe was in a jovial mood and I would spend the day MANUALLY de-impacting the constipated colons of elderly men...for five hours. The events of that evening left me with a lot of shit on my mind.
An elderly woman arrived in our ER with an acute myocardial infarction. This was a serendipitous case to have being that the very next day was our exam in cardiology. Alright, go team, GO! As everyone worked in their respective roles, I was assigned to teach a fellow student who always froze like a deer in headlights and cried any time major traumas was brought in how to catheterize this Jane Doe.
My gut told me this was not going to go well...my gut was right.
We removed the adult diaper to begin cleaning up the area for catheterization. The frozen and bewildered student was moving at the speed of molasses as fear and shock held a firm grip on her psyche. The sight of a diaper full of adult feces seemed to have been her "nope" for the evening. Meanwhile, I am trying to get her to engage with the task at hand instead of staring at the woman´s vagina while the attending is screaming at me to make her do it. I´m tired...I´m being pulled by a nurse to take a blood sample from the femoral. I can´t focus as I find myself increasingly frustrated with the tears welling up in the student´s frozen eyes. She had seen enough for the week but all my mind shrieked in reply was, "WTF are you here?!" I wanted to scream but let out a sigh...I think even my ancestors were tired of her too in that moment. Everyone has stopped what they were doing and were trying to instruct her how to catheterize the patient while she stood there--frozen.
Then...the unthinkable happened.
We both were stunned with the total release of bodily fluids and excrement onto our scrubs.
I silently finished my blood draws and handed them to the nurse. I urgently needed a cigarette and I didn´t even smoke (I do not smoke--EVER--by the way). I cleaned off what I could, changed into back up scrubs with the scent still clinging to my skin. I wanted tacos.
It is said that within the laughter of a child is the grace of God and in their tears the life force of the Universe. Or...I just made that up.
My patient was a two-year-old little girl who had secondary pneumonia with one little thing: She had a splinter in her finger.
I had never seen a child smile so wide as to when I painlessly removed it from her finger without her even noticing. The tears in her sparkling jewel black eyes coupled with the grin that rapidly engulfed the child´s mouth melted my tired heart.
There is beauty in the world of emergency medical training. That beauty is to be found in the sum of all our very human parts.