The Moment of Truth

So my week hematology/oncology (heme/onc) is done.  I said goodbye to the sand and sun of Texas and hello to the mountains and snow of Colorado.  I had a lot of fun on heme/onc.  The doctors were amazing and the patients were so inspiring.  I loved to witness the relations that were built and to meet children in all stages of cancer treatment.  I even got to follow one child through his initial diagnosis and see all the steps that are taken to start treatment.  It was incredible.                                                                                                                             Monday morning started with table rounds.  All the PA's, nurses, and doctors discussed what had happened with all the patients during the weekend over cups of coffee.  I discovered that a heme/onc office does a lot more than a normal doctor's office.  They have counselors and learning specialists on staff to help out.  They talk to the kid's schools and explain what the family is going through and what support can be given.  There's also this position called Child  Life Specialist.  They are all over the hospital, not just on heme/onc.  Honestly, I might have chosen this profession if I knew about it before I started my pursuit of medicine.  All they do is play with the kids.  They plan parties and outings and gatherings.  They have a closet full of toys and arts and crafts.  I mean who wouldn't want that job?  But alas, I feel like I've come too far now to just switch careers.  (You can breathe now mom and dad; I'm not planning on dropping out of med school anytime soon).  Wednesday morning rounds are dedicated just to emotional wellness and coping skills.  The team discusses how each family is handling the illness and what can be done to help them.  At that meeting a plan was hatched to schedule these two teenagers appointments at the same time so they could meet.  It was thought that they could would be a good support person for each other.   

I was fortunate to work with all three attending hematologist/oncologist, two ladies and a guy.  They see patients as a group meaning patients are shared.  This helps them be familiar with all the patients and their treatment plan which makes being on call slightly easier.  The attending's time is split between making rounds on the hospital floor and being in clinic.  The clinic is always busy.  Some chemo treatments require daily infusions so these kids are constantly in the office.  There is a teen lounge and a kids playroom for them to hang out.  Lumbar punctures and bone marrow biopsies are also done in the office.  I got to witness several of these and actually perform some myself.  One bone marrow biopsy I completed I followed down to pathology to read the specimen with the pathologist.  They had this really cool microscope in the lab where 6 separate eye pieces hooked up to look at one specimen together.  The pathologist was able to point out several teaching points to me and we could even throw it up on a big screen TV so more people could see as well.  

Overall, my last week in Texas was my favorite.  The experience was awesome and I am glad I got to go.  I met several fabulous medical students from other schools.  I'm definitely going to miss them.  But unfortunately, I'm in a pickle.  Instead of clarifying everything and showing me my destined path, my week of heme/onc has only left me more confused on what I want.  I absolutely loved my time with the kids and learned so much from the doctors but I found myself missing the operating room (OR).  I find myself torn between peds heme/onc and ob/gyn.  They are both such awesome specialties with their own pros and cons.  I'm starting an actual list and have added 'soul searching' on my to-do list.  Luckily this decision doesn't have to be made for a few more months.  I actually set up another pediatric rotation back home.  So get ready Sebastopol!  I will be home for the month of January!  And I am counting down the days until Christmas break.  Nothing is quite like a mom and dad hug :-)          

Life in a Children's Hospital

Somewhere in Texas

Finally the rotation I've been waiting for!  Pediatrics!  I'm doing my pediatric rotation in Driscoll Children's Hospital in Corpus Christi, Texas.  Rocky Vista sends two students down at a time and another classmate was heading to San Antonio so we decided to car pool...all 18 hours.  But it was fun seeing New Mexico and Texas.  The hospital provides students with housing and there are several students rotating through at a time.  So I moved into a house with 4 other lovely ladies that is located across the street from the hospital.  Most of the other students are natives to Texas so they've been showing me around and teaching me all about Texas.

Dr. Tooth Fairy

The first week was spent on inpatient at the hospital.  This was my first time working in a teaching hospital with a residency program.  It is very different from the other rotations I've been on.  Also the most routine I've had in my days.  Every morning starts with Morning Report at 7am.  All the residents and medical students are there.  This is where those on call through the night report the patients they admitted.  The teaching attendings are there also and they elaborate on the cases when need be.  Then a teaching topic is presented by one of the interns.  At 8am you head to the floors.  For my first week, I was on the floor that had all the renal and neuro patients.  My second week I was on the cardio and heme/onc floor.  I would follow a resident around while they rounded on their patients.  Then I'd try to get all my notes in the computer before the attendings came and we'd all round again and present the patients to them.  This would take until lunch time.  Lunch was eaten while in Noon Conference.  A research presentation or Journal article were presented during this time.  Then back to the floor where we discharged or admitted patients all afternoon.  Check out occurred at 4:30pm.  The head resident would present all the patients on the floor to the head resident that was on call for the night.  This could be really short or take forever depending on how full the floors are.  Halloween occurred during my first week.  The hospital goes full out.  I went as the Tooth Fairy.  We were all encouraged to dress up and participate in the Pumpkin Parade.  All the children got to parade to every floor of the hospital and were given goodie bags that were full of everything but candy.

During my first weekend, we took full advantage of our time off.  Corpus Christi is right on the gulf coast and the weather makes it feel like summer.  So of course we went to the beach.  I tried surfing for the first time.  It is really hard!  People make it look so easy but I had the hardest time maintaining my balance.  But in the end I got a good photo op and a salt water sinus rinse :-)  We ended the perfect day by the water with some delicious fish and chips while watching the sunset.  It was a great day.  On Sunday it was time for brunch.  To continue with my Texas education I had chicken and waffles.  Interesting combination that actually tastes really good together.  Some other fun things we did as a med school family was take the Ghost Roll Sushi Challenge.  It was a mistake!  After one piece each we were all in tears!  I actually think I burned away some of my stomach lining.  Even after that, none of us can think back on that night without laughing.

Week 2 began with me back on the floors and then onto the PICU (pediatric intensive care unit).  This week was a little more frustrating for me.  I had some difficult patients that really made me ask some serious questions about medicine in general.  One infant had minimal brain function and was on a respirator.  This child has no quality of life and yet everything medically is being done to keep this child alive.  He has been through multiple surgeries and will definitely have more in his future.  When is enough enough?  When does mercy step in and medicine step back?  I admit that I am coming into the picture late and I never had the privilege of seeing this child really alive and thriving.  I am not a mother and so cannot speak with the opinion of one.  I never held him in my arms, have never seen him open his eyes.  Maybe with the hope of having that child back is what keeps this family fighting... I honestly don't know.  I have only seen him sick and what looks like suffering to me and it breaks my heart.  In a situation like this there are no right or wrong answers but it really makes me think.

Another difficult situation I came across was a teenager post kidney transplant.  This child had been given an incredible gift several years ago.  They were given a second chance.  Why were they in the hospital you ask?  Because they were in kidney failure due to rejection and all because they didn't take their anti-rejection meds.  Again, I can't speak from experience and I can image having to take drugs twice daily for the rest of your life can be annoying but really isn't that better than being back in kidney failure?  I was shocked to learn that noncompliance with anti-rejection meds is a huge problem in the teenage population.  Statistics show the highest risk for organ failure due to noncompliance is having an 18th birthday within 3 years of your transplant.  Some physicians are arguing to make teenagers be on dialysis, just to show them how much it sucks, before receiving a new kidney in the hopes of raising compliance rates.  If that isn't a big enough ethical question for you, then how about this.  Do patients who go into organ failure due to noncompliance get the same priority for a second transplant as those on the list for the first time?  Do they get a third chance?  I don't have the answers and I do not envy any member on the ethics committee.

           
 In the PICU I got to care for a lot of congenital heart disease.  There are so many different defects that a heart can be born with and the surgeries to repair them all are pretty amazing.  It's awesome seeing a baby looking really sick before surgery and within 12 hours post surgery they are awake, being held, eating, and smiling.  I was really surprised at how fast these kids recover.  And the babies are all so cute!  They are also a puzzle.  You can't ask a baby what's wrong and how are they feeling.  You have to discover it all for yourself by using clues and your observational skills.  It's a mystery waiting to be solved by me.  It's fun and exciting most of the times.  Sometimes it's frustrating.  Like knowing when a baby is just fussy or fussy because they're in pain.

I have one week left here in Corpus.  And I spend it doing heme/onc.  It's the moment of truth.  As some of you may know I've been telling people since I was 6 years old that I was going to be a pediatric oncologist.  Now we will find out if it's everything I think it is.  Wish me luck!  

  

The Month of Vajayjays....

My name is Danelle Wilson and I have a problem.  I like all specialties!  How am I going to decide?  I always saw myself as a pediatrician, but then I was wooed by general surgery.  And now I'm thinking "I totally want to be an Ob/Gyn."  It's going to be very hard to choose a residency if I end up liking every specialty.  I guess next month on my Peds rotation will be the moment of truth.  Maybe I like Ob/Gyn so much because of the baby part.

Even though Ob/Gyn focuses on a small area, the specialty is so vast.  You get to make patient connections and see women of all ages throughout their lives.  You follow a pregnancy and then get to be the first hands to welcome that life into the world.  You get to perform surgeries and can actually make problems better.  You're not just treating symptoms which is very satisfying.  I have learned so much during this rotation.  It was a great combination of patient care and surgery, clinic time and hospital time.  I really like the diversity.

My attending was a super cool guy!  He is from Argentina and completed medical school there before moving to Chicago to complete an American Residency program.  It's real interesting the difference between the two countries.  In Argentina, you don't go to college.  At 18 you start medical school.  The first two years are in classroom and then the next three are in hospital.  And then you're an attending.  There is no residency.  So at age 23 he was a full fledged doctor.  And the best part?  It's all free!  You don't pay for medical school in Argentina.  I'm very jealous of that fact.  Anyways, he was really funny and joked around a lot.  He said he could get away with it because of his accent.

Delivering the babies, when things went right, was awesome.  But when things went wrong, they went really wrong really fast.  Unfortunately I saw miscarriages, fetal demise, and birth defects.  I had one day being on call that was just awful.  I went from a miscarriage to an emergency C-section for a 29 week old fetus of a teenager who already had 3 kids not in her custody.  This poor baby did not have a very good chance of survival and was immediately airlifted to Children's Hospital in Denver.  After the C-section we delivered a baby who immediately went through withdrawal since mom did heroin during the pregnancy.  The inconsolable cry of a baby was just heart breaking.  The worst part of the call shift though was an inter-uterine demise (IUD).  This means that for reasons we don't know, the baby's heart just stops beating.  At 38 weeks a lady came to the ER saying she hadn't felt her baby move all day.  She was declared IUD and an induction of labor was begun.  It was the hardest labor I've been a part of.  This woman, who had done everything right, had a healthy baby one minute and lost it the next.  She then had to give birth knowing she wasn't going home with a baby.  I was really proud of myself for not crying during the process but boy did I lose it later that night.  It was a really bad day and extremely difficult to get through.  That day was full of so much sadness.  I was just hit with it back to back to back.

Luckily that day wasn't the norm.  And the good definitely outweighed the bad.  One of my favorite surgeries was placing a bladder sling.  This woman was having a problem with incontinence for years and it was really making her miserable.  Using a super long, curved needle attached to a mesh ribbon, you thread it under the pubic bone and up through the abdomen.  The woman came for her follow up the next week and she cried because she was so happy with the fix.  I also had some pretty interesting...finds...  You'd be surprised what people stick up there.  I thought about starting a diary.  I would begin with Dear Diary, today I pulled a bag of cocaine out of a woman's vajayjay.  Another entry would be 'today I pulled a Polly Pocket out of a little girl's "secret hole"'  Her mom threatened to take it away if she didn't behave so she hid it.  Another treasure found was cloves of garlic.  The lady read on the internet that it would cure what ailed her.  FYI - it won't.  Don't Do It!  Other gems were carrots and sex toys.  All in all very interesting.  It appears there is a need for a list titled "Things that Don't Belong in Your Vagina".

Anyway...I loved this past month and am super excited for the next!                                  

The Hip Bones Connected to the...

It's hard to believe that another month has come and gone.  I spent it on an Orthopedic Surgery Rotation.  It was very interesting and so much fun.  Bones are so cool!  And joint replacements are just amazing!  The precision and technology that goes into each surgery is incredible.  Each cut is made after several measurements and a blade guide is set up.  I saw several knee replacements, a few hips, and even a complete shoulder.  It is really incredible that the next day these people are putting weight on and actually using their new joints.  The biggest risk with a joint replacement is infection.  Every precaution against infection is put into place.  My attending would even send all his patients to the dentist before the surgery.  For some reason that science doesn't know yet, bacteria in the mouth loves to travel to metal in the body.  This is why people with joint replacements must take antibiotics before any dental work.  Another precaution is the room set up.  Everyone in the room is in a special suit and hood that has positive pressure air being blown down the front of the face towards the floor.  This is like an air trap that germs can't get across.  There is also air blown from the ceiling and out towards the sides of the room at floor level.  These suits are nice for the patient, but a pain for the doctor.  They get very hot.  And its hard to hear one another speaking.  Also, if your scrub pants aren't tired tight enough, the battery weight pulls them down.  One assistant had to have the circulatory nurse pull up their pants and re-tire them.  I was just super happy it wasn't me!

One of my favorite surgeries was piecing together a shattered clavicle or collar bone.  It was just like doing a jig saw puzzle!  We had to be very careful placing the screws because the subclavian artery and vein lie right below the bone.  Knick one of those and the patient can bleed out in seconds.  Another favorite was pinning a broken femur.  Through the smallest incision at the hip, you drill a pin down the center of the bone.  That pin is used as a guide wire for all the drilling.  Xrays are taken throughout to check placement.  This means that everyone in the room wears lead throughout the entire surgery.  Again, really hot and heavy!  A reamer is then used to drill a big hole through the middle of the bone.  A metal bar is threaded down the pin, the pin is removed and the bar is held in place with two more screws.  There is something very satisfying about drilling into bone.  What is amazing is that the patient is weight bearing the next day!  There is no cast or anything like that.  Pretty cool if you ask me.
      
My attending is a younger doctor who is trained in some of the newer procedures and is very up to date on all the latest and greatest.  He was a lot of fun to work with.  Ortho is most definitely a boys world with 91% of all orthopedic surgeons being male.  Luckily my dad and brother trained me well and I can carry my weight with the boys.  After a few jokes and showing some knowledge of golf and firearms, I was in the club.  I was even invited to participate in a golf tournament.  Now I haven't golfed since I was 13 and my grandpa taught me one summer.  But I did well enough I guess since I was invited back.  I was shown that business is still conducted on the golf course.  I was introduced to many business people and doctors from the area.  I also realized that I enjoy golfing.  There is nothing quite like hitting a little ball as hard as you can and watching it soar down the drive.  All in all, Ortho was fun but not for me for the long term.  If I had to choose between General Surgery and Ortho, General would definitely win.  But now it's time to move onto OB/GYN.  Hello babies!

Eat When You Can, Sleep When You Can, And Don't Poke The Pancreas

After a month of General Surgery my rotation is done.  I had so much fun!  The human body is amazing and I loved being able to observe it up close and hands on everyday.  It's incredible watching a heart beat inside the chest, feeling the aorta pound with blood right under your fingers, poking the ureters and watching them shrink in response, feeling the small intestines telescope in and out of each other.  Everyday I was just in wonder and awe at God's ultimate design.

While fun was had, I have also never worked so hard in my life.  But it actually felt like my work made a difference.  It was great meeting with the patients a few days after their surgery and hearing how much better they felt, how their pain was gone, and how thankful they were.  Surgery was very satisfying, it has instant results.  Sick gallbladder?  I take it out.  Hernia?  I fix it.  Collapsed lung?  I put in a chest tube.  Necrotizing fasciitis?  I cut it out.  There were solutions to all these problems.  I understand that not everything always goes according to plan and the outcome is not always so wonderful.  I was very lucky to never lose a patient during the month which I'm sure helps to glorify my outlook.  But even so I was never sitting back and waiting...surgery is all about doing something which made me feel better, like I was taking action.

My attending is an incredible teacher.  He spent a lot of time with me and showed so much patience.  He treats me like a colleague and has all the staff treat me like a full fledged doctor already.  (It's very exciting to have people address me as 'Doctor' and ask me what I would like done with the patient.)  I consider myself the bottom of the totem pole at the hospital but he says no.  He expects me to play the part of doctor rather than student.  When I offer to gown myself or remove a Foley or change a dressing he tells me to stop.  He reminds me that my job is surgery and I need to stick to my job.  I don't have time to perform these other tasks when there is someone else qualified to do them.  I understand now how surgeons get a bad rep for being stuck up and non-caring about patients.  But that's really not the case at all.  They just don't have the time to do all the things that are required of them.  This is why we have specialists in healthcare.  No one can do it all.  And also, it's the doctor's license and reputation on the line.  No one sues hospital staff these days...when something goes wrong everyone blames the doctor.  So it makes sense that a surgeon gets frustrated when their orders are not followed out to a tee or when time is wasted or when a mistake is made in the OR by support staff.  I will no longer be mad when my own doctor is late for my appointment.  I understand all the things that need to get done behind the scene and how emergencies can just pop up.  Just imagine if you were the emergency.  You wouldn't want your doctor to tell you to wait so they could stay on time with their office visits.  But I'm stepping down from my soap box now...        

Back to my experience in the OR...  One time my attending just walked out of the room towards the end of the surgery and left me to close.  I just stared at his back walking out the door while screaming in my head "NO!  Don't leave me!  I have fooled you all.  I really have no idea what I'm doing."  My panic died down when the scrub nurse looked at me and asked "Doctor, what do you want to close with?"  And I knew.  I knew what sutures to use and what knots to tie.  After finishing my last suture, I looked up to find my attending watching through the observation window.  So he didn't really leave me alone, which was comforting to realize.  I will really miss him.  Not only was he a great attending, he went out of his way to include me in his family outings and take care of me outside of the hospital.  He took me wake boarding on the reservoir, had me over to his house for dinner, and treated me to may lunches and dinners out.  He even drove me home at 4:30 in the morning after an emergency surgery where I almost passed out in the OR.  After a long 16 hour day at the hospital, I got home at 10 pm, finished my assigned reading and went to bed at midnight.  I was awoken by my phone at 1:10 am.  Turns out our patient had turned septic and we had to operate now.  I walked into the OR at 2:00 am not even realizing I hadn't had anything to eat or drink
since 5 pm the evening before.  We were closing the patient up a few hours later when I started to feel really hot and my vision tunneled a little.  According to my attending I turned sheet white.  He had me step back from the table and sit down right there on the floor where I stayed while he finished up.  He then personally got me breakfast and drove me home promising to pick me up later that morning so he could control when I went back to the hospital.  During the ride home he shared with me the golden rule of surgery: eat when you can, sleep when you can, and don't poke the pancreas.  Well, lesson learned.

With the Da Vinci - you can see my vagina
 repair on the screen in the background

On Friday, my last day with my attending, he told me he had a surprise for me as a reward for all my hard work.  He led me into the last OR room down the hall, one I hadn't been in yet.  Inside was the Da Vinci Robot.  This robot can do the work of several doctors at once.  The trocars (little portals used for laparoscopic surgery to get the instruments in the body) are placed in the pt and the robot arms are threaded through them.  The doctor then controls the robot from a station with a viewing window that reflects the camera inside away from the patient.  Everything the doctor does with their hands and wrists the robot does inside the patient.  Foot pedals are also used.  The robot arms can rotate 360 degrees in the patient.  This is the only one in all of Pueblo and only a few doctors are certified to use it.  My attending is in the last bit of his training and will perform his first surgery with it next month.  Well, I was in awe looking at this robot.  He demonstrated all it can do and set up a manikin and then told me it was my turn.  He let me run the 1.7 million dollar robot!  It is really amazing how sensitive it is to my touch and all the things it can do.  I had so much fun.  Anyway, I'm sure you're all tired of me droning on.  Last thing I want to share is a list of the most important things I learned this past month.  Next week, on to orthopedic surgery!              

At the control station of the Da Vinci

Things I've learned during my surgery rotation:
1.  Tie your scrub pants tight - it's tragic when they come loose while running to a trauma
2.  Always have a granola bar in your pocket.  Or two...two is better
3.  Hand lotion is your best friend - my hands have aged years with the 100+ times I wash them everyday
4.  Fruit chapstick under your nose or inside your mask takes care of most smells
5.  Have multiple pens in multiple pockets
6.  There is a fine balance between staying hydrated and having to pee in the middle of a 5 hour surgery
7.  Scrub caps are a great way to hide that you didn't have time to wash your hair
8.  It's amazing how little laundry you have when wearing scrubs everyday
9.  A good pair of shoes makes standing 12+ hours a day possible
10. Sleep and eat when you can, where you can...you never know when you'll be called in for a 2 am surgery      

Adventures in Surgery

Who knows?  Maybe I want to be a surgeon!  I am having so much fun on my surgery rotation!  Pardon me if somethings appear vague from here on out but I am trying to be very aware of HIPAA laws.  My first week with surgery was very intense.  My attending certainly kept me busy.  The very first day he had me as first assist in surgery with him.  Gallbladders, hernia repairs, and small bowel resections filled my day.  My first day was actually the easiest.  My attending never left my side, which was a drastic change the rest of the week went he sent me to accomplish tasks by myself.  I left the hospital at 8pm with two chapters of reading to complete and three surgeries to prepare for in the morning.

The rest of the that first week was crazy!  I logged 95 hours at the hospital.  My days became routine: I would get up around 5 am and get to the hospital by 5:30 to round on 8-12 patients by myself.  Rounding involves looking up all patient info for the past 24 hours.  You check the labs that were run that morning, any imaging or pathology reports that are in.  You check the vitals and the intake and output.  You talk to the nurses to see what kind of night the patient had.  Then you actually see the patient and do your exam.  The exam always includes looking at the incision for signs of infection.  I had one patient accuse me of just admiring my handy work (which I was while checking  for infection).  You answer their questions and tell them you will pass on everything they tell you on to your attending.  Then you get on the computer to right your note about your encounter with the patient.  All this is done with each patient before 8am.  At 8, I would meet up with my attending for our first surgery.  I absolutely love surgery!  Guts are just so cool!  And my attending lets me suture and cut and cauterize and staple.  

In between surgeries you talk to family members and write orders and chart the procedure.  You also run up to the floors to round for a second time with your attending.  He then reviews the notes I hopefully got done that morning and signs off on them.  Then back to the OR for the next surgery.  There are no breaks; I've learned to eat when I can as quick as I can.  My attending is also a machine who doesn't need sleep.  I think he personally enjoys going into a surgery at 9pm.  Then after stumbling out of the hospital at midnight, I go home to fall into bed only to get up 4-5 hours later to do it all over again.  

It's busy, but I wouldn't change it all!  My attending was actually out of town this past week so I worked with other surgeons.  I got to join ortho for a day.  They let me drill into the bone.  It was awesome!  And I spent a day with anesthesiology where I got to intubate patients!  Last night I was on call and got an appendectomy at 9pm.  Well the attending let me start and finish the procedure since we weren't on any time limit.  It was so amazing!  Anyway, I am having a lot of fun and working hard.  I'll try to update you all again soon :)             

Last day in Guatemala

three neighboring volcanoes

The morning started at 6am with a group of us taking off to hike a local volcano, Volcan de Pacaya.  This is actually an active volcano that last erupted in May 2010.  What made the hike so challenging was the very steep incline.  There are actually people who follow you up with horses hoping you'll give up and ride the rest of the way.  I almost gave in a few times, but eventually we made it to the top. 

Our final destination

The closer to the top we got, the more the trees thinned out and the ground became more sand like.  I felt so accomplished once I reached the top.  We got to walk about and explore all the nooks and crannies.  There were hidden hot spots with little green plants trying to grow around them.  Other than that it was just black lava rock everywhere.  Our guide showed us how to roast marshmallows over one of the hot spots.  That was really cool! 

 We started to head down a different way than we came up but halfway on this other path a sign stopped us saying it was too dangerous.  After some backtracking and walking around the dangerous part, we finally found the right trail to lead us down.  It was a very tiring and sweaty morning, but definitely worth it!

After the hike we got to go to a local coffee plantation.  The farmer himself met us and walked us around the land.  We learned about the different kinds of coffee beans and how they have to be planted with trees since they like shade.  Next we were taken to the farmer's home where we met his wife and learned about how the beans are processed.  First the husk is removed using a bicycle powered machine.  Then they are left to dry out for days and are surprisingly a pretty yellow color.  Once they are dry they are sorted.  Beans with imperfections are removed to be used for energy drinks while those that pass inspection become coffee.

We next got to roast our own beans.  The strength of the coffee all depends on how long you roast them.  Strong coffee is roasted for a longer time.  The beans are put over an open flame in a hot and smokey room.  They have to be kept moving so that they roast evenly.  Then we got to grind them by hand.  It was hard work and I did not do very well at all.  In the end we made wonderful cups of coffee!  It was a fun afternoon.     

After all that hard work our group wanted nothing more than a shower and clean clothes.  I also had one last trip to the market to make.  I am my mother's daughter and therefore get a high striking a bargin.  It's all about bartering at the market and I loved it!  The secret is to walk away.  Pretty soon my friends were having me barter for them. 

Back at the hotel one of our hikers had gotten a little too dehydrated.  Luckily we are a group of med students all eager to help with a bunch of medical supplies.  So it was decided that we would use an IV of saline solution to help our buddy feel better soon.  And I was the lucky winner allowed to put in the IV!  I was more nervous than the patient.  Good news though is that it went great!  He was feeling better in no time.  With the doctoring done, it was dinner time. 
 

 Our last night in Guatemala was spent hanging out on the rooftop of our hotel.  It was nice to see the city all lit up from up there.  The next morning after one last cup of coffee we loaded the bus to head to the airport.  Of course there was a group sing-a-long on the way. 

Overall I had an amazing experience in Guatemala.  I got to see and do and learn so many things.  I strengthened relationships with my classmates and met many new amazing people who became my teachers.  My passion for medicine and mission work is bigger than ever.  I can't wait for me next adventure.  Unfortunately it is now time to crack down and study for boards.  But in a few months I'll be in the hospital daily learning and working with patients.  That is what is keeping me motivated. 

From Ziplines to Chocolate

 

Friday was a day for fun and travel.  We started the day off with a Tuk Tuk ride, the local taxi, to a neighboring bay to go zip lining.  It felt like a clown car when we all got it.  The zip line was a series of 7 different lines with 3 of them taking over a minute to complete.  Once we were all geared up and had been taught how to break, we had a 30 minute hike up the mountain to the starting point.  Along the way we saw monkeys and some other animals I can't name.  We passed waterfalls, crossed swinging bridges, and saw beautiful views looking out over the lake.  It was a very tiring, but rewarding hike. 

So I really don't like heights all the much but I do enjoy the feeling of getting a little freaked out beforehand and then overcoming the fear.  It's exhilarating!  What a fantastic experience!  And it was a great way to see the sites.  Panajachel looked beautiful down below. 

After our adventure we had a little less than two hours before we had to be on the bus for Antigua.  Well of course I used that time to finally do some shopping in Panajachel.  On the way back to Antigua, we stopped on the side of the road in order to get a picture of the cemetery.  So the cemeteries here are really colorful little structures.  They sit above the ground like in Louisiana but are painted bright colors. 

Once back in Antigua we had more time to explore.  A few of us went to the chocolate museum and learned all about the history of chocolate.  The we did some taste testing and made our own concoction of hot chocolate.  It was really good.  We also stopped by McDonalds.  The McDonalds here are fancy.  They have a separate section called McCafe that looks more like a Starbucks.  It was really weird.  There was even a fountain in an outdoor garden eating area.  The night was causal for all with dinner and relaxing games.  I went to bed early since the next day began with a 6am bus ride to hike a volcano.   

Last Day of Clinic

Thursday brought us back to the town of Solola, but this time in a firehouse.  It was my favorite day, for we just saw children only.  I was in pediatric heaven.  We saw a lot of kids complaining of stomach pain.  Turns out the majority of them had parasites or worms.  Also a lot of cavities again.  We handed out multivitamins, toothbrushes, soap, lotion, shampoo, and lots and lots of stickers.











It was our fourth day of surprise lunch.  The generosity in this country is amazing.  In the middle of the afternoon we were visited by the office of the First Lady of Guatemala.  We were all given a certificate of appreciation to thank us for our service.  Dr. Bentley has been taking groups to Guatemala for 13 years and she says that this is the first time anything like that has happened.  It's also the first time that lunch has been provided. 

After an amazing four days it was nice ending with the kids.  I learned so much, not only in medicine but in mission work in general.  I definitely want to do another one in the future.  I would go back in a heart beat.  There is so much work that can still needs to be done. 

That night we had a group dinner with everyone.  It was really nice and a delicious meal.  Afterwards we went out for some drinks, games, and dancing.  It was so much fun!  I always am up for dancing.      

 

Day on the Water

 Wednesday we said goodbye to Panajachel via boat.  We were off to the town of San Antonio.  Before we left though, I had the most amazing banana pancakes for breakfast.  The veterans would not stop talking about them since the beginning of the trip so I had to try them.  The boat ride across the lake gave me a different perspective of how the towns are situated.  Panajachel is appeared to be the only one that had some flat land.  All the rest we passed, San Antonio especially, are built vertically up the mountain from the shore of the lake.  Walking up those hills to the center of town was difficult, especially for those hauling the medical supply bags.

San Antonio

That day I worked with Dr. Kesden who is in primary care in Florida.  He makes this trip every year.  I learned so much working with him.  He let me take charge and run the show.  They were my patients and he was there for support and to answer my questions.  Once again children and women dominated the clinic.  The big winners were cataracts, joint pain, and cough.  No wonder they all have joint pain.  I would too climbing all those hills with a child strapped onto my back and everything else on top of my head.  Also, the chronic cough is from having an open fire to cook with in the home without proper ventilation.  It's incredible how much these women endure in their everyday life.  Just add to the list of things I take for granted.

I did become a pro at checking eyes and using my ophthalmoscope.  It was another day where we were gifted with lunch, once again unexpected but greatly appreciated.  I feel like I really got to try some truly authentic food.  This time it was a spicy chicken soup and tamales.  Also hibiscus tea, which is a specialty drink there and also a natural diuretic.  After all our work was down, we once again had time to explore.  San Antonio is known for it's Palopo Pottery.  It is really beautiful.  I made sure to gift myself with a coffee mug or two.  The boat ride back to Panajachel was uneventful.  It was another early night with most of us turning in shortly after dinner.   

 

 

Day of Surprises

Monday night Panajachel called bedtime with a power outage.  Now we were warned that this could happen but usually only lasted a few hours or so.  Therefore I went to bed without thinking too much about it.  Tuesday morning dawned with, surprise! no power.  Which meant no water and no shower for Danelle.  I felt worse for those who had to work with me that day but at least we were all in the same boat.  Luckily, the saving grace that morning was the fact that there was still coffee due to a gas stove.  After my first cup, my dirty hair didn't seem like such a big deal. 

  


The bus that day was taking us to the town of Conception in the mountains.  We were to work in a school.  On the way, our bus driver suddenly pulls over on the side of the road.  Looking out the window, I realize we are right next to a beautiful three tiered waterfall.  We all got out and some of us even climbed up part way.  We could see all the volcanoes surrounding Lake Atitlan. 


The school at Conception was really fun to work in.  The walls were all decorated with the kid's artwork.  We worked at miniature table and chairs.  We had many curious visitors peeking in on us.  They were fun to interact with.  They loved having their picture taken and then shown to them on the camera.  Such a simple thing that I take for granted all the time brought so many kids joy that day. 

My job for the day was to run the pharmacy.  I learned how to properly dose patients, especially children who need a special calculation.  I sorted medications and filled orders.  I learned even more Spanish explaining to the patients how to properly take the medications or when to apply the cream.  Luckily everything was written out on labels so I could try to explain in my butchered Spanish and then point to the label I stickered on.  Hopefully one of those ways made sense.  The big medical winners of the day were scabies, GI worms, and rashes.  Once again we were surprised with a lunch of black beans, rice, and corn tortillas from the local women.  During lunch break, I played some soccer with the kids.  Now I haven't played soccer in years and am completely horrible.  These kids definitely schooled me but it was a lot of fun.   

After all our work was completed, we got some time to explore the town.  The church in the center of town is simply beautiful.  It is in it's final stages of being repainted so is this bright white beacon up on the hill.  Another spontaneous soccer game broke out in the streets.  It was amazing.  As soon as the soccer ball was placed on the ground, several children came out of the woodwork to play.  On our way out of town, we got stuck behind a funeral ceremony.  A whole bunch of people were gathered around this small fire in the center of the road.  The coffin was then carried down the road while the crowd followed.  Though I understood very little of what was going on, it was interesting to watch. 







Later back in Panajachel, we stopped at this special shop that the trip veterans knew about.  Turns out every year they order a tres leche cake from the same woman.  She makes it special for our group.  It was the best tres leche I have ever had!  We all enjoyed our appetizer that evening. 

Afterwards we watched the sunset behind the volcanoes across the lake.  We were blessed with electricity when we got back so my shower did happen that day.  It was still fairly early so we all went to the hotel pool.  After working (really playing) off our cake we grabbed dinner.  I had the best guacamole I've ever had.  The night ended with a specialty rum from the area and more card games.  Overall a very fun day.