El Hospital Nacional en Mazate

Remember my friend Ruth? The one who I got so lost trying to find at church several weeks ago? Well, after passing a long period without contact, I was lucky enough to bump into her in Santo Tomas the other day. I’d tried calling several times, but got strange messages about the line not working, and then lost track of the idea of touching bases with her. When we first met, I’d been very excited to be friends with her for a couple of reasons. First of all, it was just nice to have a Guatemalan friend – meeting and connecting with people is one of the reasons I’m here, after all, and I’d been having a hard time doing that. However, we are clearly compatible as amigas, which is a relief after feeling a bit out of place in a school environment. As I believe I’ve made pretty clear, being a teacher just isn’t my thing. Medicine, however, is, and Ruth works as a registered nurse at the national hospital in Mazatenango.

When I saw here by chance on Monday, she told me that she’d been transferred temporarily to emergency room duty. She invited me to accompany her on shift, which luckily happens to be early mornings. That fits great with me, and so on both Wednesday and Thursday of this week I went with her to Mazate. So far, it has been an incredible, enjoyable and eye-opening experience. I’ve taken to introducing myself as a medical student, because our education system is significantly different from those of the rest of the world, and anywhere else my background would be equivalent to the first three years of medical school. With that, everyone’s been more than eager to give me full access to everything that’s going on. I even had a long, jovial conversation with the hospital director, who I think may now consider me a fast friend.

My first day, a man came in who’d been working on a construction site. He’d fallen and impaled himself on a rebar pole, essentially in a sitting position. An HIV+ man who’d been in a car accident was wheeled in shortly after I arrived. I watched with horror – before knowing that he was HIV+ - as he was catheterized and examined by half a dozen un-gloved hands. When a nurse from another department walked by and recognized him as an HIV patient, I felt sick realizing that I’d been thinking about protective equipment all along and hadn’t said a thing. Having just gotten there, not even yet introduced to most of the staff, I felt out of place correcting them. Lesson learned. I spent much of the morning with an internist who enjoyed the novelty of a) a student to teach and b) its being a gringa. I did rounds in the internal ICU with him, examining patients with everything from pancreatitis to hernias.

The next day, I spent much more time in the emergency room, and was given above and beyond unlimited access. Doctors love to teach, and they were more than happy to give me opportunities which are appropriate for a medical student. That means I was doing a lot more than giving shots. I stitched up the head of a 17 year old car accident victim, pulling his ear back together and closing up a variety of slices across his scalp. I extracted a leatherworking awl which a 15 year old boy had accidentally jammed it into his hand, and took over the ambu bag for an anesthesiologist when he got tired of providing respirations for an unconscious victim of severe cranial trauma.

The national hospital is fascinating because it’s exhaustively overworked and undersupplied. No one knew what to do with our cranial trauma victim once he’d been stabilized, since the hospital’s only ventilator was currently occupied. The doctor had to use suture material which was several sizes too small when re-attach the heel meat of a girl whose foot had slipped into the engine when the motorcycle she’d been riding on crashed. The supply of urinary catheter bags dwindled to nonexistence early on Thursday, so plastic bags taped to the catheter’s end are being employed for now. Lincoln City Animal Clinic has a far nicer x-ray machine than this hospital, and the generally stark and decrepit appearance of the facilities is initially shocking.

That being said, the doctors and nurses are fantastic. They were incredibly nice, and everyone was clearly very focused on their work and in-tune with whatever the current emergency happened to be.

Because it’s a national facility, all of the poor patients who can’t afford a better, private hospital arrive there. Since Guatemala’s a pretty impoverished country (aside from the upper echelons of society tucked behind bodyguards and razor-wire topped fences in the city) that means pretty much everyone with a problem. Among other interesting cases, I saw a 7 month pregnant woman whose uterus had ruptured through a previous cesarean scar. The baby was stillborn, but apparently the mom’s doing alright. A few minutes before, I’d watched a lady with a breach birth being rushed to the operating room, only to have her bed taken over by a tiny bright yellow baby. With fluorescent eyes and skin the color of a Golden Delicious apple, it didn’t take a rocket scientist to figure out she had hepatitis. Um. Not that a rocket scientist should know anything about that anyways, but you get the idea. Ruth’s brother actually came in, too, after having an air compressor explode somehow while he was working on it. Despite a cut across his thumb and blunt trauma severe enough to swell one hand to twice the normal size, he was lucky enough to have relatively little damage.

I think that the most shocking moment for me happened not long after we’d gotten there. I was standing next to the doctor over a patient complaining of abdominal pain, when I glanced up to see the door swinging open. In sauntered an EMT whose expression I couldn’t distinguish between bored and dazed. “Buenos dias..” he drawled while surveying the room, evidently looking for direction. In his arms, limp, wild-haired and covered in blood, was the tiny body of a young girl. The moment was remarkably reminiscent of the famous Oklahoma City bombing photo of a firefighter carrying a bloodied preschooler out of the debris. This child’s face had been slashed open at the upper lip, forming a gory sort of grin which exposed her bright red mouth and unnaturally jutting teeth. This artificial facial expression stood out perversely, drawing attention from her listless empty eyes and dangling limbs.

Estefanie, as I later learned to be her name, had been in a car accident. She was actually just in shock, and after a thorough exam it was determined that the cut on her face was pretty much the worst of her problems. However, the initial shock of seeing her distorted and unresponsive face being brought into the emergency room is an image that will stick with me for a while. Why on earth the EMTs hadn’t put her on a backboard I have no idea, but I feel like a more conventional presentation would have softened the impact of first seeing her.

Sadly, Ruth will be rotating out of emergency pretty soon. First she’ll head to a turn in Women’s Surgery, which will be neat, and then it’s on to her usual post in geriatrics. Luckily, I’ve already had several doctors offer (unprompted!) to let me work with them once she moves on. I’ve been more happy the past two mornings than I’ve been in the whole combined time that I’ve spent at the school – you can be sure I’ll take them up on the offer!