Nephrology Rotation

Yesterday I started my new rotation in Nephrology. I am with another girl, Sophie, and together we decided that our doctor, Dra. Bocangel, cannot teach. She is a really busy woman with a permanent expression of pursed lips that imply disapproval – reminds me a lot of my first Russian music teacher in America that never failed to make me cry at least once during the 1-hour long lesson. Yesterday, we were in consultorio with her, mostly seeing kids who had UTI’s for some reason or another – none were serious. I did learn that chronic constipation can lead to UTI’s, I think because chronic constipation begins to push on the bladder, somehow leading to insufficient emptying of the bladder. I would have asked her to explain further, but she never has a free moment, so it’s difficult to get her attention. At 11am, there was an academic talk by an American professor that we met first thing in the morning, where he questioned us what medical school we attended and whether it was a good school, by his standards. Northwestern was “okay” and “not bad”. He is a neotologist at Phildelphia’s Childrens Hospital and he talked about the interesting and therefore sad cases that he encountered at his hospital. Apparently, he did Peace Corps in Bolivia many years ago and has since then been coming to Bolivia to interact with the doctors in the Children’s Hospital in La Paz. He usually brings his family as well, so we got to meet his daughter, who is 16, and has already traveled much more around Bolivia than I ever have. He gave his speech in Spanish, which wasn’t very fluent but it’s not as if I really could have done better. Switching between English and Spanish all day really doesn’t help with learning Spanish – but oh well, that’s not the main reason I came here. The auditorium was freezing!! I had a shirt and a sweater under my white coat, and still, at the end, I couldn’t concentrate on the lecture because I spent all my energy trying to stay warm. Today, we had grand rounds where medical students and/or residents present interesting cases. They finally started heating the auditorium, but the waiting rooms where patients wait to be seen by a doctor are still freezing. Very little sun comes through the windows and all the patients are bundled up in their coats. I kind of envy them because at least they are wearing their coats. One of the cases in grand rounds was of a little boy who got basically mutilated in a car accident. Both of his legs were completely gone below the knees and somehow, the groin area was also brutally damaged. Later on in the day, we actually got to go to the ICU and see him. He didn’t respond to anyone – not even the nurses or the doctors. Instead, he just blankly stared at the television. In grand rounds, someone mentioned that hopefully his parents won’t abandon him now. There are no pedestrian lights here and cars don’t stop for passengers when turning so I wonder how often this type of accident happens. The ICU was small – just one large room that probably held around 14 beds. I asked if they ever had too many patients for the beds, and the doctor said “all the time, many of them end up dying because we don’t have room”. It’s weird that from a distance, there doesn’t seem to be many falta of resources until you start hearing the stories of people who never got the treatment they needed because there was no space or no medication available. Is it fairer to have the medication but not allow everyone access to it, or to not have the medication available at all?

Right now, I am at home, in my room, writing this blog while a little dog named “Estrella” (“star”) is sleeping on the bed right next to me. I miss having a pet. I skipped Spanish class today because I think I am getting the flu. Being around sickly kids all day kind of has that effect. I think my immune system finally realized that I have settled in in La Paz, and so now would be a great time to get sick. Going out and trying cinnamon and milk ice cream tonight didn’t really help either. Oh well, I think I will have plenty of time to recuperate next week because there is supposed to be a huge transportation strike on Monday and then the Aymara New Year on June 21st, and then another hold that Thursday. If I can hold out until after this Saturday’s Gran Poder Fiesta, I think I will be alright.