Match Day

Today I learned that I am going to McKayDee Hospital in Ogden, UT for residency in Family Practice. This is a great day. While in Peru, I realized that I need my support of family and friends. I also that I needed my recreation of mountains and southern Utah. I realized that it isn't that great when you are the only one that doesn't drink at a party. I have been praying that I would stay in Utah for these factors and I am happy that I am. This is great news and excited for the future. I am also with 2 other good friends from the University of Utah. Good times for the future

Peru Saga: Sunday:a day for guns and alcohol

I was on call last night and am a little hung over...from sleep deprevation. 3 gunshot wounds, a 23 yo with gun shot to the head on life support, a 18 yo with a broken femur and another shot in his foot that we dug out with local anesthesia, and another guy who passed away. I was watching the news today and his family was on there telling the story. One of the guys that went to surgery was shooting at police and as he went in the police said to the doc Just let the SOB die. And the doc said jokingly I will do my very best. The guy is doing just fine. One of the crazy things about this hospital is there is not a lot of linens so yesterday I had to mummy wrap two kids to suture their heads and got sheets bloody...nevertheless the ladies in charge of the linens were pretty angry because they didnt know if there were going to be enough sheets for the patients. Most of the gurneys don{t have any sheets at all on them. They are pretty gross to because they don{t get cleaned after every patient and will have dried blood clots on them. Another guy came in with infected wounds from a car accident the day before. he broke his femur into 5 peices and his tibia in two. His wounds smelled horrible. Another guy got into a motorcycle accident and I had to suture up his face. Before he was leaving I commented to the intern taking care of him that he had lost consciousness after the accident and was thinking that we should get a CT scan because of his trauma. He didnt show any huge signs of bleeding in the brain, so right after we talked about the warning signs of mass effect on the brain such as vomiting, seizures, somnelance...As we were talking he started to seize. And we got a CT scan. The problem is that if you dont have the $100 for the CT scan they wont attend you and the center said that the there was no doc until 8am the next day (which was not true) Anyways it has been pretty frustrating and even though our system costs a lot of money I am happy for materials, sheets, and being able to get diagnostic testing for patientsLast night I went in on a appendectomy and was also surprised to see that they don{t put the patient under general anesthetic and intubate. The patient woke up during the procedure and was thrashing his arms. Crazy.As for other things, I went to the institute dance and had a blast. I am pretty shy when it comes to asking girls to dance, but I felt like the world was my oyster here and I had a great time. Also other news, I just got an email telling me that I have matched and that I will find out where my residency is on Thurs.Thanks again Melis for picking me up and we will see you guys on WedScott

Peru Saga: tonight I celebrate with goat

Another crazy day at the ER. Two kids who were run over. Another guy who cut off his finger. A kid who split open his head. A guy who cut his finger with a knife. A guy who was working and part of the machine split open his leg and his hand that I had suture. Two gun shot wounds. One of the guys whose family didn´t want to show up and help him so sat there with an open wound for 5 hours before I got to work. I cleaned him up and put some extra gause on his wounds and bandaged him up. He was still pretty drunk. I cleaned up the burn victims from the day before and the guys who were beat up. I don´t remember the other patients but I do remember that I haven´t sat down all day and my feet are throbbing. This is pretty typical of 12 hours with no sitting and no lunch. But tonight on my way home from work I sat down and a fancy restaurant ($7) and ate cabrito a famous dish here made from goat meat. It was pretty good. Last night, I had awesome ribs for $3 at a fancier restaurant. The restaurant is right by my house and calls my name every night. It was so good. They serve big peices of corn called choclo and salad. I also had fresh squeezed O J. I am going to the beach tomorrow after my institute dance tonight.Partying up my last couple of days in Peru. Thanks Melis for picking me up. My flight gets in at 1245pm from Atlanta. I am flying Delta and they say that it is flight 150. However it only has my flight from Lima on the itinerary so the number might be off.

Peru Saga: Family does serve a purpose

I was sick this morning but I went to work at noon and ended at 8pm. 2 guys with bullet wounds. One was 16 and was shot once through the back and died. The other guy was 32 and shot 3 times and lived. It isn´t known if it was the police that shot them or if it was another gang. The 16 yearold mother came about 2 hours later looking for her son. When the intern told her that her son had passed away she was frantic. Screaming, crying and wouldn´t let go of the doctor telling him to tell her that it wasn´t true. Another 13 year old girl was hit by a taxi. She came in very confused and in and out of consciousness. She was frantic and kept trying to get off her gurney while we held her down. When I said her name for some reason she came back to reality for a second and was calm and then would go crazy again. It was eerie. She didn´t break any bones but definitely had a concusion. Another guy cut off the tip of his finger and I had to sew his finger together. I had to put the needle through the finger nail which was a pain because there was no skin to put it back together. Another guy had an electrical burn from work, and was in so much pain. We had to check his heart and his bladder for injury because electric burns cause damage throughout. Pain is one thing that they undertreat here and that we overtreat in the US. I think I would want my pain to over treated though.Another 6 year old boy cut his head open on the swingset. It was down to the bone. I had to sew two layers. he was pretty frantic. I first had him count to two hundred for me as I sewed him up. Then we played the animal guessing game like mason likes to play. I don´t know too many animals in Spanish as he would try to have me guess animals like walrus. It was quite a challenge. Then I asked him about his birthday and he told me about his friends and the food. Then he wanted to play the guessing game with food. It took about 30 minutes to sew him up given his wound size and my inexperience. I put in about 12 stitches (6 in each layer) so it was great to at least have something to distract him. Another day in ER paradise. Tomorrow church dance Wahoo!Scott

Peru Saga: I was lost but now I am found

These last couple of days have been more of the same. Sad story today. A lady 25 years old came in with serious brain injury after her minibus was hit (this is pretty common as these volkswagon buses don´t have seat belts) It turns out she is 3 months pregnant. They are going to try to keep her alive as long as possible but most likely she and the baby will pass away. Another 50 year old guy was playing soccer and broke his leg. Two other motor vehicle accidents today with broken femurs. An 90 year old lady with a broken hip. Three kids with sliced open lip, head, and fingers that I sutured as they screamed at me from their burrito blanket restraint. Another sad story, a baby with multiple injuries most likely from child abuse. However, there is no child protective services so they don´t do anything about it. Lots more cases that I don´t rememberLast night I got off work around 7 and thought about going to institute and looked it up on the internet. I couldn´t figure it out so I thought that I would go to the movie theater instead. I saw one close to my house as I was walking home from the hospital. Nevertheless I went on the wrong street and was lost and ran into the institute building 2 blocks from my house. I met some of the members and classes had already started so I just peaked in. They have 5 different classrooms with schedule from early morning to 730 at night. I ended up going tonight and the teacher loved to pick on me. All of the classes were full and they had to bring chairs in. It was really great to see. I went with a couple of the members to eat afterwards. I ended up going to the movie theater last night to watch Wolf Man and was surprised that my ticket was less than $2 so I got popcorn and a drink for $3. It was great..the first time I have had refreshments at a movie theater. Living it up in PeruScott

Peru Saga: it was good the old man was drunk

Today was actually slow and ironically a group of students from florida came to see what an ER in peru was like and there were no patients. I laughed as hours before the place was full of gun shot wounds. I sutured up a man in his 50´s that was drunk and was hit by a car and again was flung on to a metal fence. (They are human shishkabobs here). He broke 5 ribs and had a deep wound the size of my toe nail clippers and about 1.5 inches deep. We were worried he had punctered his lung but he was alright. I had to sew three layers of sutures from his facia to his skin. It took me a long time so his anesthesia wore off but luckily he was still feeling his self medicated anesthesia. I decided that if I ever get in an accident I want to be drunk or drugged up. Other cases today included an old woman who broke her arm. A guy whose motor cycle taxi fell on his foot and had a compound fracture aka his bone was sticking out of his foot. Another guy who broke his nose a woman who fell on a fence and had air in her abdomen but no signs of damage to her intestines or diapragm and some other people that I don´t remember.today I actually had lunch and had a good time talking to the interns. it was also so good to speak english again with the students from florida. they actually thought I knew what I was doing . Scary thought.I am going to try to go to find instute

Peru Saga: alcohol and church

So don´t worry I had two dinners yesterday and I am not losing weight but I bought some apples to start getting at least some vitamins. Last night I got ready to go clubbing...however, I went to my friends house who invited me and she was shocked by what I was wearing (tshirt and jeans) She said that I needed a collared shirt and slacks so I dug my pants out of my pack and they were pretty wrinkled and then put on my polo type shirt that I used for work. It turns out that we weren´t going clubbing and that we were going to a party for her cousin that was graduating from nursing school. I thought that this was going to be alright with my dress. It turns out that the party was all of the graduating class and their parents and they were wearing suits and ties and that nobody else was meeting with us. So already sticking out as a white guy, I walked into the party being very underdressed. There were 400 eyes staring at me as we walked in.They also brought us dinner at 1100pm ( I had eaten right after I wrote the email last night) But I ate the pork and mash potatoes. Also then there was a toast, which I thought was going to be lemonade that wasn´t. It burned as I sipped it and made me feel a little funny. I instantly recognized my mistake and then asked the girl who invited me to drink it. It was a drink called Pisco Sour that had 40% alcohol. We ended up having a great time. It was like LDSBC prom but latin style and we danced until 3 am. At 2am there was something called La hora loca when a bunch of clowns came with balloon animals and masks to the dance. It was a little different. The greatest part was that all of the parents were also dancing with the 20 year olds at 3 am when we left. I told them how I didn´t even think my brothers and sisters would have made it that long never the less my parentsI also made a mistake and opened my mouth about the funny differences between our cultures. As latins are more passionate and show their emotions a lot more than we do (even more than mom). And how adults have stuffed animals on their beds and in their taxis with them is almost pathologic for borderline personalities in our culture. It is funny that I have culture shock after visiting all the places and cultures that I have seen. I don´t know if that sip of alcohol helped disinhibit me or if i just have diarrhea of the mouth but I realized after that they probably didn´t need to hear that.Luckily we had such a good time that was not the most memorable part of the night. I woke up this morning at 9 when my doc called me to see if I wanted to come to breakfast with his family. Afterwards he mentioned that their was an LDS church close by and I went to see if there was a meeting at 11 or at 1 so I could go home and change. It turns out that their meetings start at 8 and 10 and so I went to church in my t shirt and jeans from the suggestion of the elders. I met a bunch of young single adults and found out that the institute building is by my house and am going to go to class in the next week ( they have classes all day long and full time staff) and to their party on Friday. It turns out that there are 7 stakes here and a million people. Funny how that is a lot of mormons and I still haven´t met one in the hospital.After church I went home to find out there was no power and my room was baking so I took my book and went to the beach and fell asleep from feeling the effects from the night before. So I am a little baked right now. I am about to call home but I thought that I would write this stuff down before. I am disappointed that I only have a week and a half left as I am just overcoming my culture shock, feeling comfortable at the hospital, and getting to know the members.Such is lifeScott

Peruvian ER Report

March 6,One amputated finger of 13 boy (machete accident), 3 pedestrian accidents, one lady who fell on a fence shishkabob style, two guys with tar burns which meant scrubbing their skin almost off, 2 yo who cut his chin open, one old lady who cut her ankle open, and that is what I can remember. Half a coke for breakfast half a coke for lunch, 12 hours with no time to even sit and now some crackers for dinner and off to go clubbing with the interns. until tomorrow

Another crazy in day in a peruvian ER

Please let me know if you don´t want updates. It doesn´t hurt my feelings to take you off the list. Also I forgot to warn you that these emails are rated R for violence. The following is a little more of the sameI am starting to feel more and more comfortable with what I am doing. Today I worked hard for 12 hours. I started the day rounding on patients and writing all of the perscriptions for every patient in the trauma ward. They have to buy all of their supplies so this means along with medications I have to write how many syringes, IV bags, needles etc each patient needs. I feel like I am actually helping and part of the team...which is good since there are only two interns with little supervision to take care of the entire ER. Today I sutured a man who fell 2 stories, put braces on 3 people who were run over, cleaned wounds of people who were attacked by rotweilers (sp?) one of them was 2 year old boy. I also put some pampers on a guy who was encephalopathic from elevated ammonia levels from chronic cirrhosis of the liver.Also today another man died while I was giving him CPR. He came in blue with no heart rate. Some guy had shot him in the head. I took over doing chest compressions for the doctor and it almost looked like his heart was coming back from the monitor. We paused and took an EKG and there was no electric activity. It is a crazy feeling as you hear the ribs crushing underneath your hands every now and again. Reality hurts to when your hopes are dashed as you think that this guy might make it from what the monitor tells you. In the ER there is nothing to separate the patients so everyone sees everything. It was pretty traumatizing for the guy I just had sutured his head. The patient´s family was devastated and was wailing outside. The ER is so busy that you don´t have time to pause and realize that someone died as another patient asks for your help or comes in runover by a car. You would think that something like this would affect me but it didn´t at least not the way I thought it would.I came home and got a $2 haircut and some peruvian chinese food which is like nothing I have ever had before and now I am going to bed. Tomorrow is another day and I am going to party with some of the interns after work. BTW I have to keep track of my patients for school and felt like this is the easiest way. Sorry for the graphic details

Week one in Peru

A week has passed and it has been a whirl wind of an experience. We operated on a kid that was in the earthquake in Chile because he didn´t of insurance in Chile he came to Peru to be operated on. He sliced his foot open and unfortunately didn´t have adequate attention or antibiotics. he came to the ER and we opened his foot and it was filled with pus and necrosed tissue. It smelled horrible and we washed it out. We are waiting for the plastic surgeons to see if there is any saving of his foot. he is oonly 13 years old. His little toe is completely dead and most of the sole of his foot.Yesterday I also had to stitch up a man who is an epileptic and had been drinking. He had a seizure and was brought in. He then had a seizure and fell off his gurney. He split his head open and that is why I had to stitch him up. He then had another seizure as I was trying to put his stitches in. After 20 minutes he was finally stitched up.Also another guy cut his leg with a peice of glass and his calf muscle was sticking out of the wound. As I helped stitch him up, the doc was washing the wound and washed off the blood clot on a major vein. He bleed like crazy about a liter and we finally stitched him up and gave him a compression bandage. We were just happy that it wasn´t an artery.Another surgery was on a 4 yearold kid who thought he was superman and jumped out the window and sliced all of the tendons in his hand. Crazy kidsI was a human ventilator for a man that was run over by a car. Unfortunately the man passed away. It was the first time one of the patients that I cared for passed away and it was a pretty humbling experience as I had to question that if he would have died if he were in the U.S. or a hospital here that had more technology or at least more staff.On a happier note, I went to the movies with a bunch of the med students here. it was some romantic comedy that had the same actors from My Big Fat Greek Wedding. It was funny how some humor just doesn´t translate as I would laugh and they would have no clue and at parts that were so dumb in my book were so funny to them. It was funny because of the girls had lived in Philidelphia for a year and talked about how she didn´t hang out with people her age because they were so imature and then we went to the arcade to play video games while we waited for our movie to start. Also another funny thing about the culture is how adults love stuffed animals here and cartoon characters. Pretty funny.Hope everyone is happy at home. I took the day off today because I have been working 13 hour days and got sick from food.

Gun Shots, traffic accidents= good times

Hello Family,This has been a crazy couple of days here in Peru. Yesterday was my first night on call in ER here. The ER is mostly staffed by medical students who do most of the work because they do their internship during medical school. Any ways so I have been working mostly with them while in the ER. Every hour especially on the weekend people come in with gun shot wounds. I had to sew up and clean out a couple of these wounds. One of the guys I had to sew up was a drunk guy that was stabbed in the butt. I had to clean out his wound pretty well with iodine which made it bleed. After I sewed him up he started to develop a hematoma luckily we put pressure on it and it went down. The thing is he got up to fast after being on the table for too long and he then went down and fainted. We got him back up and everything was fine. I also had to sew up a couple of sliced feet and traffic accident people. I have lots of good supervision and help here. It is just sad to see how many people get shot here everyday. (These are in neighborhoods that are not close to where I am at. I am in a very safe place as a side note). It was a busy night and I am still recuperating. The most frustrating thing about this experience is that the people have to buy all of their supplies at an outside pharmacy after they are evaluated before we fix them. Because this is the hospital that serves the poor about 70% of the population, they can´t supply sterile gloves, iodine, gause, or suture. People are only charged $3 for hospital services. The doctor that I am working with is a really interesting guy who want to show me the best of peru. He takes me out to eat everyday at different restaurants and pays for me and the other medical students. Everyone here is shocked that I am LDS as they have never met an LDS person before and they are surprised that I don´t drink. I was pretty bored and then they all complained to me the next day about their hangovers and how they wished they hadn´t drank. I wanted to say that I wish that they hadn´t either because it was 5 hours of my life that I can´t get back.Anyways everything is good here. I hadn´t realized how horrible the earthquake was in Chile until the doc that I am working with bought me a news paper. Hope everyone is alright at homeScott