"Tranquilo, mi amor"

This morning was only my second time in the hospital, and it was perhaps my most memorable experience yet here in Monte Cristi. Last week I toured the hospital on Tuesday with Coco, the next day with Dr. Garcia, and the next day I shadowed the diabetologist. On Friday I went to Dajabon, which I will blog about soon (that was quite an experience as well). So I came to the hospital today expecting to shadow the same diabetologist from last week. I went to the morning meeting of the doctors, and we went over the case of a pregnant woman, 29 weeks in (LMP), predicted to have a premature birth within the next week. Again I picked up bits and pieces, but my knowledge of embryology terms in Spanish is limited. So I sat in the back and quietly scrambled through my Spanish medical dictionary trying to keep up. It doesn't make it any easier when many of the doctors in the hospital are Cuban, speaking one of the most difficult dialects of Spanish. But it's certainly a good thing that I get to learn two new dialects at once, so I can't really complain.
Dr. Garcia, the doctor that I shadow in the afternoons in the bateys, had not shown up to the meeting in the morning, so I figured he decided to forgo the meeting to begin seeing patients. He walked me to the diabetologist's office the previous week, and so naturally I paid no attention to the number on her door (the doors just say Medicine Interna 1, 2, 3, etc.). So when the meeting got out at 9 a.m (I think the meetings are meant to last about an hour long, although they seem to end abruptly when the director of the hospital feels the residents have been hounded enough for the day), I started walking towards the area of the hospital where the diabetologist's office is when I realized that I had no idea which room to go into. I had a decision to make. Should I pick one of the doors and knock on it, risking the embarrassment of walking into the wrong room? Or wait in front of all 5 potential doors, and when one opens peek in to see whether la doctora is inside? This sounded pretty attractive, except for the fact that the lobby was full of Dominicans who had already noticed a goofy gringo in their presence and would wonder what I was doing pacing in front of the salas. I decided that best option was to just walk over to Dr. Garcia's room and ask him what number the room was. His office was just a few doors down anyways, and I hadn't seen him for a few days so I wanted to stop by and see how he was doing. Having seen a patient just walk into his office, I stood outside the door and waited to catch him between patients.
After waiting 5 minutes, a younger doctor walked up to me and says, "Ey doctor, we're about to do a hernia surgery, come with me" (verbatim in Spanish).
"OK!" I blurted out, and we walked up the ramp to the second floor to the surgery rooms. As we walked into the prep area outside the operating room, he ordered one of the residents to grab some scrubs for me. At that point I started to wonder whether he knew that I did not have any medical training. Did he call me doctor in a kidding sort of way? I had seen him in the meetings before. Maybe he knew I was just shadowing in the hospital. Before I had the chance to tell him my situation he left to scrub into surgery. Yikes. The resident brought me the clothes, and I changed in their locker room. It reminded me of the good old days in the Division of Surgical Research at Vanderbilt, where I'd scrub in for animal catheterizations 3 days a week. They made me wash my hands in the prep room, so I knew I'd be helping at the table in some capacity. I came into the operating room, and they had me put on a gown and surgical gloves. The entire time the only thing running through my head was the one time in high school when I watched a surgeon at Vanderbilt perform heart surgery on an infant. Standing on a stool to watch the surgery, I felt my face start tingling right around the time when they began cauterizing the vessels after the first incision. The smell was insufferable, and when I first registered that what I was smelling was burnt flesh I dropped to the floor, but only after taking down a couple of machines on my way. I was thoroughly humiliated. I've had a good amount clinical experience since then, and spent a lot of time in the animal OR, but I hadn't returned to the human OR since then.
After I put my gloves on I reluctantly walked up to the table. The nurses had administered spinal anesthesia, meaning the patient would be awake for the entire surgery, and free to moan and give a nice little flail of the arms when compelled. "Tranquilo, mi amor," (relax, dear) the nurse whispered to the nervous patient. The room felt like it was around 85 degrees, and I was in full panic mode. Then the doctor made the first incision, and turned to me and asked for the clamp, insinuating that I would be his surgical caddy for this operation. "Remember when you pass me the instruments, hold on to them tightly so you don't drop them," he told me with his Cuban accent. It was at that point, in the middle of the clamp exchange, when I looked down at the incision, and had that familiar sequence of feelings. Tingly face, seeing stars. If I held out any longer I'd be a goner.
"Would it be okay if I sat down?" I asked nervously.
"Of course", he said, and the nurses brought a stool over. I sat down and the nurse pulled down my mask and unbuttoned the top of my gown.
"Look at how pale he is!" another nurse cried, and burst out in laughter (The Irish don't get much sun, it's in my genes, I should have said). The other nurses followed suit. Luckily Dr. Valdez came to my rescue.
"It's quite normal. When I watched my first surgery I hit the floor. Don't worry about it," he reassured me. But this time I felt different about the experience. For one, I did not feel humiliated. I was somewhat embarrassed, but it was more funny than anything else, like any of my gringo moments here. I also didn't want to leave the room. After 5 minutes I was ready to keep watching, and I witnessed my first (human) surgical procedure in its entirety. Although it was a basic operation, I still found it fascinating. I know right now I am interested in endocrinology, but I have not been exposed to enough branches of medicine to say with certainty that I will be an endocrinologist. Surgery is certainly still on the table, no pun intended.

In thinking about the experience now, it shows a lot about how I've grown up since high school. Just like when I listen to a record I haven't heard in many years and it evokes vivid memories of a distant but specific time and place, my second experience in the operating room conjured up images of that first surgery years ago, yet the experience was much different this time around. Certainly my scientific knowledge is much broader these days. From animal surgeries and anatomy labs I knew quite well the geography of the abdomen. Partly because of this knowledge, and partly because I'm much more confident in general now, I wasn't afraid to ask the surgeon questions about the operation. But I think most importantly I wasn't discouraged by an embarrassing moment. In high school I sat in the nurses' lounge while the cardiologist finished the surgery, too scared to go back into the OR. This time around I waited a few minutes to regain control of my faculties, and returned to watch the rest of the operation. In the words of Vince Vaughn as Trent Walker from Swingers, "Our little boy's all grows up, cause you grows up, and you grows up, and you grows up, and you grows up!"





N.B.: I've gotten some complaints about the title of the blog, "I'm So Bored with the U.S.A.". Let me explain myself. It's a song by The Clash that I like. And it doesn't mean I hate America. It's just a joke. I might change it though, to prevent future readers from thinking I'm done with the U.S. of A. I'm just taking a break from a long tumultuous relationship.