Kirstin’s Blog

last set of pics b4 quito and home…

my last week!

I can’t believe its Friday already and I am getting ready to leave for Quito. I am waiting for the taxi to come pick me up. It was supposed to be here at 8 am, but due to it being Good Friday there is a ton of traffic and processions and apparently he is stuck in a long line of cars. So I won’t be leaving for Quito until at least 10 am. The bad part of that is that I will have much less time to sightsee, but I am still hopeful that I will at least get to Mitad del Mundo- where the equator line is. This week went so fast, but there was a lot going on.

Monday was a somewhat hectic precall day. We had several admissions, mostly for elective surgeries like cholecystectomies (removal of gallbladder) and cyst removals. On top of that I was busy trying to get my presentation together for Wednesday.

Tuesday I was on call for my last time here. It was busy all day long in the ER. We did get a short break in the afternoon however to rest. That break ended very quickly when there was an announcement over the loud speaker calling on call doctors to the ER. I had never had that happen before but knew that it definitely couldn’t be good as they normall call on the phone if there is a patient. So off we went running from the resident’s house to the ER. There was a young woman who had attempted to commit suicide semi-unconscious on the hospital bed. She had taken 4 grams of tylenol, many sleeping pills an possibly some other medications as well as having cut her wrist. Thankfully the cut on her wrist was not bleeding profusely, it was not big enough or deep enough to cause a real problem. We had to get a tube into her stomach though in order to try to empty it and then wash it with charcoal to try to remove the effects of the medications she had taken. She was just conscious enough to fight the nasogastric tube and make it extremely difficult to place. She was also fighting any attempt to place an IV or draw blood. Finally we had everything done that needed to be and were able to give the medicines necessary to cancel the effects of the tylenol as well. She remained semi-conscious for a while and we admitted her. We had several other patients in the process and that night but around 11:30 the last one was taken care of and we were able to go rest. After midnight the woman who had been admitted decided that she wanted to leave. She pulled out all of the tubes and lines and got her husband to sign the form. Apparently here you can’t force anyone to stay, even if they just tried to commit suicide.

Wednesday I had to give my presentation and I was extremely nervous. I am not a fan of public speaking at all, and this had to be in Spanish to a roomful of physicians and residents, more than half of whom have Spanish as their first language. I had put a lot of work into the presentation, so I knew the information and that it had everything in it, it was just the delivery of the information that had me worried. I fumbled a bit due to nerves, but it went ok. they had some really good questions at the end, which I somehow found it easier to answer than reading the slides, haha. I was definitely glad that it was over though. The residents were going to a pool that afternoon, so I was invited to that. It was gorgeous- with a jacuzzi, large outdoor pool, sauna room and steam room. We spent the afternoon chatting and playing some form of a game that was kind of a mixture of basketball/polo/soccer. It was a nice relaxing day, even though it wasnt extremely sunny or warm. It was actually raining for part of it. But we had a good time anyway.

Thursday I had my last morning report at the hospital before I left for Banos with the Martins. They had decided that I needed to have a day off and travel. So we went to one of the very touristy towns about an hour away- they have a car and so they drove. It was beautiful. surrounded by mountains, with all kinds of shops and parks and natural springs and a gorgeous catholic church. We drove by several waterfalls along the way as well. One of which was involved in a large landslide that killed at least 5 people back in February- it had been 1 waterfall prior to the landslide and was now split into 2. There was still a roof of a house between the 2. It was a reminder that although the mountains are beautiful, the amount of rain each year makes them a dangerous place. In Banos we went to a Swiss restaurant and share cheese fondue. I would have to compare Banos to Woodstock, NY a little. According to the Martins a lot of Europeans and “ex-hippies” have moved there. It is a very eclectic interesting place. There are all kinds of adventure trips that go from there including trips down the river and bike rides. I hope that someday I get to come back and experience some of these more touristy things. I was really excited to go to a store there that sells good Ecuadorian coffee and spices, since most coffee from here is exported and therefore it is hard to get good coffee here. It was closed though, so I am hoping that I will have enough time in Quito to maybe find coffee there. I did get some other souvenirs though.

So now I just wait to head to Quito and hope that I get to do some sight seeing. Thank you so much for all of your help with this trip! I have appreciated the support from everyone- through prayers, financial support and reading and commenting on this blog! It means a lot to me that everyone I love has been so excited about this trip with me, and I look forward to seeing everyone again and sharing any pictures that I have not had the chance to put on here.Thanks again, and I will officially be back in NY around 10 pm Saturday night!

Rio Verde pics

Ecoparque pics (the ones I have, waiting to get the rest from Cristian)

Puyo pics

Hola Vida hike and Waterfall

lack of sleep…

So in the last few days I have had some crazy stuff happening. On Thurs I was once again “kidnapped” by the residents an we went to Ecoparque which is sort of a nature reserve about 15 min from Shell. We went on a sort of obstacle course which was up in the air on wires. We were strapped into a harness and had to climb across all kinds of different wire setups. It was so much fun, I was having a blast and even though it was difficult at times I didn’t have much trouble at all, the residents however were freaking out about the height an having difficulty. They were in shock that I was just fine. A couple of them actually fell at the hardest part of it, at which point everyone was laughing hysterically. They started calling me a monkey, haha. We then came back to Shell for dinner- we got plantains with cheese made by the version of the Philly grease trucks here- people just cooking along side the road. It was really good. Then we went to charaoke in Puyo, and when it was about 10 or 11 at night and I thought the night was over we left charaoke (at which I did sing- Shakira’s Underneath your clothes and then with Evelin Britney’s Baby one more time- I can’t believe it either, but I’m here and it was fun, lol) we went to a dance place. We danced until about 2 am. It was so much fun but I was already dreading my on call day after not so much sleep that night.

On call on Fri turned out to be worse than I could have imagined patient load wise. We had several traumas over night, the worst being a man who had been driving drunk and hit a bus, thank God that no one else but him was injured. He had broken his femur into 3 oddly shaped pieces (the femur is the bone in the thigh). This is a bad bone to break- it’s so hard to fix and requires basically a metal plate for life and cast for a long time. The trauma surgeon was called, and decided to operate that night. It was already 11:30 when he was called, an he was in surgery elsewhere still. There was a woman who was ready to give birth, so I got to help deliver the baby at 12:15 Sat morning. That was fun, and the baby girl was just a healthy cute little thing. Of course since I helped with the delivery I got to do the paperwork for her admission, which meant even though Isabel was going into the surgery for the guy I still couldnt sleep in order to get the admission done and switch out with her later if the surgery took as long as we thought it would. We had had a steady stream of patients in the ER all morning and afternoon, mostly nothing too crazy, but just no time to sleep or rest, with 20 min breaks for lunch and dinner. I did manage to get 1 hr of sleep before switching out with Isabel at 3 am. We finished the surgery around 5ish, had the pt stable and back in his room at 5:30. I was able to go back and get another hr of sleep before we had to see more pts in the morning and finish up any other paperwork before the next group started their on call day. It was definitely great for learning, but I was so tired and my brain didn’t want to work in Spanish at points, haha.

By the time we had finished sign out and everything it was about 10 am on Saturday, which gave me 2 hrs to sleep before I had to get ready to go with Daniela, and several others to a hike to a different waterfall. I was still tired, but didn’t want to miss out on the trip and I am so glad I made that choice! The trip out there was rough on the bus- there were no seats so we were standing trying to hold on and not fall over around all the twists and turns at a higher speed than they probly should have been. The hike was beautiful, the way to the waterfall was all downhill, down many slopes and steps, the view was gorgeous the whole way. We were just having a great time all joking and chatting the whole way. At one point there was a bridge to cross (5 people at a time) to get an amazing view of the waterfall. There was another area that for $1 you could climb up to be right next to or even behind the waterfall! That was awesome. One of my favorite parts of the hike was that there were all these signs about throwing trash in the bins, preserving nature, but one sign in particular was just so surprising and cool that I had to take a picture of it- “Esta preparado para una sorpresa- Dios existe!!!” (Be prepared for a surprise- God exists!!!) This one was on the way up the climb to the waterfall itself! I loved that. I got some great pictures and made the climb all the way up to behind the waterfall which was extremely difficult through this kinda carved out area of rock- I had to crawls through parts practically! I was almost completely soaked and dirty, but it was so worth it. Then we climbed back down to the regular path, back up the mountain and went to a restaurant where we got some snacks- yuca fries, nachos with guacamole and guava juice. the ride back on the bus we were able to sit down too. I am so glad I went.

So I will be finally putting up the ridiculous number of pictures that I have to post today, slept extremely well last night after the climb back up the mountain from the waterfall. Today I am going to attempt to make pancakes from scratch for dinner with Daniela and Marlin and possibly a few others. I found a seemingly easy recipe online for strawberry vanilla pancakes as well as an easy maple syrup substitute recipe, so I am hoping that this all goes well, haha. I have really enjoyed getting to know some of the people here though, and will miss them when I leave the end of this week. I can’t believe it is already my last week here. It has gone so fast, but I have had a great time and learned so much in this short time!

Shoe box handouts!

Operation Christmas Child is a Samaritan’s Purse charity in which people place toys, essentials and nonperishable items in shoe boxes around Thanksgiving time in the US in order for those things to reach children in need and who would normally not receive a Christmas present. I have filled one of these shoe boxes almost every year that I can remember, and never realized how much of an impact they really make. I also never knew that sometimes Samaritan’s Purse holds onto them until a later time in the year when they might be more needed. I had the absolutely amazing opportunity tonight to help hand those shoe boxes out at the local Nazarene church. They had a party with music, singing, popcorn and soda for the kids. They had even put together a puppet show to demonstrate God’s love and why He forgives us. It was such a fun night, and at the end of it we handed out the shoe boxes to the children. They were so pleased to get the little toys, crayons, pencils, brushes and books. It was really cool to get to see something that I have participated in from afar in action. I forgot to bring my camera, but may be able to get pictures from Dan and Christina since they had theirs tonight.

Today at the hospital was calmer (for me who was not on call), with many patients being seen in the clinic area.  I have also chosen a topic for my presentation that I have to do next Wed- Neonatal fevers and sepsis. So now I am starting to research and put my presentation together. I am still in shock of how fast my time has gone her, but feel like I have learned a lot, and been able to participate in so many things that I could not have imagined I would. I will be really sad to leave here in a week and a half.

crazy call

I’m extremely tired and my nose and ears are all stuffed up today. I’m tired from the insane night on call last night, but I have no idea why my nose and ears are all weird. I was fine until after my nap this afternoon. So last night just was nuts. We had so many patients, 3 who needed surgery, 2 of which I scrubbed in on. One was an appendicitis, the other was an abscess that needed to be drained. The other surgery was a trauma from an accident with a large lawnmower blade in which a man’s right foot was sliced open. The tendons, muscle and several bones were cut completely. In between these surgeries we had several children with diarrhea and vomiting that had to be admitted and many other patients that we treated in the ER. One patient in particular was an extremely difficult case. A 13 yr old girl was brought to the ER by her parents with a large amount of vaginal bleeding after her first sexual intercourse. This was really difficult for all involve due to her being so young and scared. I still wonder if there were extreme circumstances surrounding this experience, but she denied it. She was torn in a similar way to a woman who has given birth, in a lot of pain and traumatized. In order to stitch up her wounds the dr had to give her some anesthesia. This was very hard on her mother, but I was able to tell her mother that she would not remember the pain of being stitched, and that things will get better.

After all the paperwork was done and the patients taken care of it was after 2 am. I was able to sleep until 6, and even took a 2 hr nap from 3-5 today. Then we (the residents, Christina, Dan and myself) had bible study at the Benedick’s tonight which was really good. We watched a NOOMA video about God’s mercy, being grateful and finding our corner (that we can give to others). The discussion afterwards was really awesome as some of the questions were difficult, but we all were open to sharing and really looking for what God is doing in our lives, especially with this special time here in Shell. Finding the time and energy to do anything extra seems to be an issue for all of us, but it was good to talk about how He gives us so much mercy and grace with which to do what He has for us to do. We talked about how simple it can be to share that mercy and grace with a patient, even just through a smile or a kind word. Not every patient will need us to pray with them or spent a ton of time with them, but taking that extra moment is sometimes all that is required to help them or make them feel better.

I am probably going to sleep earlier tonight than usual, but hope that I wake up rested and not stuffy so that I can be the most useful tomorrow at the hospital as I can be. I still have pictures that need to be added from this weekend, and will hopefully get to that tomorrow.

my 2nd week

I can’t believe that half of my month here is already over! It has gone so fast. I have spent most of my time so far in the hospital seeing patients in the ER and in “consulto” or the clinic with the drs. I have so far not been involved in any surgeries, but they say that the surgery calendar has been slow. We have ha such a variety of cases, ranging from the every day cold to asthma attacks, to traumas. We have seen several accidents involving a child on a bike or walking being hit by a car. We have also had some adult traumas involving car accidents and one woman who fell off the back of a truck while it was driving. So far we have been able to stabilize and treat all of these people, thank God. Even a man who came in with high blood pressure and chest pain who we determined by xray to be having an aortic dissection and had to fly to Quito for an immediate surgery by a cardiothoracic surgeon survived against the odds. These situations can be so difficult to deal with, but it has been awesome to be in a place where praying with the family is almost expected. It makes it easier to know that the family also knows that God is in charge of whats happening, not the doctors, and that He is so much better and more capable than we are anyway. Medicine here is quite different than in the states in general. We use slightly different antibiotics, people can walk into a pharmacy here and buy antibiotics without a prescription which causes some issues with resistance, and people still believe that the dr has what is best for them in mind here. They listen to what we have to say, and the majority of the time follow it as best they can. This has been a nice change. I am getting used to the names of medications, the differences in the way things are treated, an the specific resources that we have available to us here. I believe that we actually have a very good amount available to us, even within a short drive. The CT scanner is only 20 minutes away. We have an ultrasound machine, x-ray machine and a portable x-ray machine here. I have been really impressed with the family medicine residents from Quito as well. I am learning so much and being able to help with many procedures and patients. It has flown by so far though.

I have had such an awesome opportunity here to be involved with bible studies in groups that exist here as well as my own reading. I was also able to attend the local Nazarene church today. It was hard to understand parts of the sermon, but I think I understand more than half of what was being said. Overall I am thrilled at how much time I have been able to spend studying and getting closer to God over the past 2 weeks.

Yesterday I went on a hike to Hola Vida, a waterfall about an hr busride from Shell. It was gorgeous, and I took all kinds of pictures. There was a pool of water to wade in at the waterfall, but it was freezing! It ha rained all morning and had barely stopped by the time we were almost to the hiking area. Thankfully I didn’t see any big spiders or snakes, but there were some gorgeous butterflies and dragonflies. Overall it was just an awesome thing.

Today after church the Dan, Christina, their kids, Dianne, Steve and I went to Puyo for lunch. We had a dish created in Puyo made from chifles (plantain chips), tuna, and chochobeans, named bucanero (i think is the spelling). It was created for the garbage collectors years ago by a woman who did not have food prepared to feed the workers and therefore threw together whatever she had. It is surprisingly good though random.

It is pretty insane that so much has happened in 2 weeks… I hope the next 2 weeks seem to last longer, but I will be making more trips and working more so I will keep updating this as often as I can!