letter home...

I was hoping to be able to keep up with personal correspondence as well as send an occasional blog entry out to you guys. I am finding that for whatever reason, I am not doing so well. This is a letter I wrote last week. My desire to keep everyone informed has overcome my fear of being completely redundant…and my mom read the note and asked me to publish it…there is no better reason than that…Thanks for reading along…

Hey gang…it has been too long and I was feeling like I needed to get in touch…though to be truthful, I don’t have a specific story or message to share…I hope this doesn’t get scattered…with that intro, how can it not…

I just found this from a letter that I started a few weeks ago, but never finished…I guess I can blame the heat…

“…I might come dangerously close to belaboring this point…but it is still hot…really hot…hanging out at 105ish…humid…our poor cat is pregnant, really pregnant…she seems like she groans when she waddles around the yard…even the birds and rats play nearby, knowing she is way too encumbered to exert any authority…the people I work with and the patients are complaining about the heat…I guess it is hot from anyone’s standpoint…dogs in the street are pissed…snakes are even biting more often…everyone is frustrated…come on down!!...”

I am glad to say the rains have started coming more regularly now…our cat had kittens (I’d include a photo, but risk complete ostracization) and the food chain has been re-established in our yard…it is incredible when the rain falls…water to drink and showers to be had…it puts things in perspective…on the less positive side, the puddles have given rise to an angry mosquito horde as well as some pretty impressive mud…the mosquitoes have really cut down on my microscope time…i can’t sit anywhere for a prolonged period without getting eaten alive…I thought my body would acclimate or something…not yet…still waiting

speaking of bug bites…the last time I wrote a really quick tease of a message promising a night off and internet…we had just wrapped up a course for the advanced promoters…I spent the last hour talking about jaundice and Rh isoimmunization…I couldn’t believe it went as well as it did…I was terrified...after getting back to Flores and doing some grocery shopping, things spiraled downward…pretty quickly I started feeling lousy...I went to bed early thinking I was tired…I woke up and immediately knew all was not right….I got the 5 am bus back to our clinic, and was sent to bed on arrival…although there were people keeping a close eye on me, the fevers came late that night…as that was a clinical change, I dragged myself out of bed, shuffled across the yard to the clinic, through an amazing rainstorm (I am not making this up…I swear), I poked myself and took some slides of my blood, and started treatment for malaria. I couldn’t think of anything else that fit my symptoms and for which we had therapy…due to my delirium the slides didn’t turn out very professional(ly?) nor polished, but they were enough, in combination with my slow improvement with treatment to suggest malaria as the diagnosis (although I had been taking prophylaxis…just like my concussion-causing face-plant despite my cranio-protective helmet)… I started to have a glimmer of hope after 3 days of chloroquine, by 5 days out I felt pretty much back to normal…although a colleague found some rum raisin ice cream on day 3 as well, so I am holding out for that as the amazing cure-all…god it was good.

On the plus side, I had 3 days where I didn’t have strength for anything but reading…initially I couldn’t focus on much besides trashy crime novels, but as I started feeling better I read more and more challenging books. I just finished Confessions of an Economic Hit Man by John Perkins. I thought my work abroad would teach me about medicine, Spanish and local culture. I should have been more aware, but wasn’t, that this would include an education in US foreign policy, as it relates to Latin America. Although the bulk of this book took place in the 60s-80s, it is completely pertinent to the situation and the present culture here. It puts some recent current events in a different light (referring more to the present coup in Honduras, and less to Michael Jackson’s demise).

After a five-year hiatus, I just restarted Gabriel Garcia Marquez’s Love in the Time of Cholera. I don’t know if it is the Colombian setting, the story or the style, but I am hooked. What I remembered as a dreary story about a man suffering from unrequited love is still about that, but I am laughing more and enjoying the wording and the characterization much more. There is an expression in Spanish “me cae bien”. (I hope I am not repeating myself…I looked in some older notes to see if I have described it before, but I didn’t find anything…)…it means “to fall well”. medicines, people, events can all “cea” bien o mal (poorly)…a medicine that works and the person gets better “falls well”, whereas a medicine that causes an upset stomach or doesn’t make the person better doesn’t “fall well”. this is a huge reason people stop treatments here. this can happen minutes after the dose, regardless of the medicine and hereafter will always happen…it sort of removes any blame…My point is that for some reason the book seems to be falling much better this time than it did the last time. I guess it is the way I am looking at it...or, alternatively, maybe it is because this edition has Oprah’s approval on the cover. Oh god.

quick question…does anyone know what I am supposed to do about ants in sterile fields?...The other day in clinic I had anesthetized, cleaned and prepared an area around a cut and was focusing on closing a wound (and trying not to drip sweat onto the work space)…slowly, approaching from the corner of my vision…an ant ambled from the picnic table up onto the patients arm, onto the drape and into the wound…he or she was completely immune to my efforts to blow him away or at least off-course…there was an admirable determination there…Flies I can understand, sure…but an ant seemed more intrusive somehow… I grabbed it with a pincer and chucked them both…can anyone send me any evidence-based thoughts or strategies??

we still get sick visitors at all hours…the easy ones are sick…you can see them coming from the gate…it is bad but you get started immediately trying to make things less scary…the more difficult ones for me are the ones who want to be seen, but aren’t really too sick…whether we see them or not isn’t really too defined and depends on lots of factors…how long has the problem been going on…where the family lives…if there is blood, impaired consciousness or a pregnancy involved…nothing like high standards…the other challenge are the patients that feel like they are gravely ill, and are trying to be taken seriously, but everything checks out ok…I try to relax and joke a bit to improve the anxious mood…normally when middle-aged men come in after hours, it is usually pretty urgent…a guy came a few nights ago just as we put dinner on the table…he was screaming and writhing around outside the clinic door…I couldn’t find anything wrong…his history, exam, tests weren’t concerning…from his actions he was pretty convincing, but slowly I began to get the impression he was hoping for more attention…I didn’t need to hear more than…”this is the pig flu! I know it…”…”its not? how about HIV? do I have that??” I think that’s when his wife lost her conviction as well…I decided to drag a cot out of the salon, elevate his feet and give him 15 minutes to see what happened…in the mean-time the Christian church next door started kicking…and it is right next door…it has microphones, huge speakers and not one person that sings on-key…this used to be funny, but it is nearly every night…it is difficult to have phone conversations and sometimes I need to wait for a break to hear breaths sounds…anyway…the church got going, as I crossed the yard from the kitchen to the clinic…the patient promptly rolled over and vomited…”that music gets me pretty sick too” I mentioned, with a smile…my Guatemalan colleague laughed as unbeknownst to me, the husband and wife had just divulged that they had recently and proudly joined the fore-mentioned church…yep, can’t put a price on valuable international ties I am developing here…smooth…

I was finally able to talk with my sister tonight…I was asking about current events… she mentioned she saw that the Utah bars are now public access…I remember before leaving that people were planning pub-crawls and parties…ahhh…I hope you guys had fun…I feel really far away sometimes…it is funny the unpredictability of things that bring that feeling on…though friends on a main st. jaunt definitely would…or maybe it was just the heat…

brian