Code in the E.R.

Sorry this post is so long. Hopefully its worth reading, at least the first part.

The clinic today was pretty boring; a typical average day in the clinic with average cases. However, thanks to the ER, today was one of those days that I’ll never forget. It was about 10 am and I guess Dr. Lazo had forgotten about our previous conversation the day before because Dr. Gomero’s office was still empty and I wasn’t seeing any patients on my own. He was nice enough to ask me if I wanted to pull a urinary catheter out of this old dude though. Well, thank you so much Dr. Lazo, this will surely be a really important step in my quest to become a great physician. I did it if course; deflated the balloon and pulled, whoop-dee-doo! Well, around this time the ER called and doctor Lazo said, “Okay” and started rushing for the door. He usually doesn’t tell me where he’s going even though I’ve tried to show my interest a zillion times. He was heading to the ER as I knew though, so I followed him. In the ER was a 4-month-old infant who was pale, lethargic, floppy, and had a history of vomiting and diarrhea from the day before. I knew he looked really bad, but I wasn’t immediately aware of how perilous the situation was. I ran and got Dr. Sierra the pediatrician to come help. He showed up as the nurse was trying to put in an IV. We had a kid before us who was obviously dehydrated judging from his look and history, very dehydrated. His eyes were rolling around and his breathing was quite labored. In dehydration such as this the treatment is obvious and simple; give the patient fluids. It doesn’t even really matter what kind of fluids as long he/she gets something. The problem with dehydration is that if it is severe enough it can be life threatening. As the normal fluid of the body is dissipated through vomitus and loose stool, more and more fluid is taken by the body from the tissue outside of the vessels into the vessels to keep the blood pressure up and to keep precious oxygenated red blood cells flowing through vital organs like the brain, heart, kidneys, etc. If the dehydration gets severe enough no more fluid can flow into the vessels. As a result blood pressure drops, the blood becomes like sludge and the brain and heart start to lose oxygen. As the heart loses oxygen, the heart rate falls lower and lower until it stops, the brain has no blood flow, and the patient dies. This precipitous drop in blood pressure and heart rate is caused hypovolemic shock and our patient was suffering from it.

Up to this point, I’ve been impressed with the health care here at La Loma Luz. They don’t have much, but they make good use out of what they do have and things run pretty smooth; the physicians seem to really know what they are doing. I was overall unimpressed with how things ran in this life and death situation though. I’m not here dog on the staff here or anything, because I realize they aren’t used to such situations like this, but things were just chaotic. Like I said, the treatment is simple, but unfortunately we couldn’t gain access to this little guy’s vasculature system. Putting an IV in a baby is hard enough, but putting one in someone who is so dehydrated is darn near impossible. The nurses and doctor probably tried over 10 times in every area they could think of with no luck. The scene was chaotic with nurses running all over, two physicians working, and a screaming, crying mother by the baby’s side. I was just staying out of the way, observing, hoping that someone could get a vein. I had never put an IV in an infant and felt helpless to just watch. Dr. Sierra had them put a nasogastric tube in and start some oral rehydration fluid. I think everyone knew it was futile, but we didn’t have any other options at the time. Dr. Sierra grabbed a 16 gauge needle and stabbed it into the kid’s leg. I asked him if they didn’t have an intraosseus needle and he said they didn’t. All they could use was this huge needle, but it wasn’t working either. An intraosseus needle is a way to get fluids and medications into someone in an emergency situation by stabbing right through the bone and injecting into the bone marrow. It’s fast and easy, but wasn’t happing here. They tried to stick an IV into the neck, but couldn’t get the large vein there either. At this point, I was pretty worried, but didn’t know how close to death this baby was. What added to my frustration was that everything going on was in Spanish. Sure the official language is English, but among themselves everybody speaks in Spanish, so I couldn’t follow what was going on or what people were thinking.


At this point, I was sitting and thinking how unimpressed I was with how things were going. Granted they were addressing the issue of getting fluids into this kid, but there were no monitors on. Nobody was following the oxygen saturation, nobody was checking a blood pressure or pulse and the monitor was right there. Nobody was clearing the room. Nobody was trying to calm mom down and get her out of the room because she was not helping things. It was just was chaos. Maybe Dr. Sierra was too worried about just getting a line in this kid to think about anything else, but I couldn’t understand why they weren’t monitoring this kids vitals. Anyway, I think everyone felt helpless and frustrated.


I was wondering about a central line, but I wasn’t sure if they had the stuff to do that here. That was the last resort though, so Dr. Lazo, being the most experienced, attempted a last ditch try to surgically place a central line into the jugular vein. They created as sterile of a field as best they could and he made his initial incision. In order to create a sterile field they put a drape over the baby and there was one of the lab workers at the baby’s head holding his hand. The fan was blowing the drape around so I squeezed myself in a bit to try and hold the drape down. The procedure was slow and I’m sure very stressful to Dr. Lazo. It was hot, humid, crowded, and a life or death situation. As the procedure was continuing the lady at the baby’s face was stroking his hand and talking to him. Every once and a while somebody would ask her how the baby was doing and she would say he’s okay. Dr. Sierra even checked under the drape a few times. For one reason or another I was hesitant to do much at this point (I hadn’t had hardly any experience with such a situation either!), but tried to help where I thought I could. It was so crowded that I didn’t want to get in the way even though I wasn’t too impressed with how things were going. At one point though I didn’t see the baby moving at all and thought, “what if this baby dies and I just sat here holding this drape,” so I checked under the drape. The lady said the baby was doing okay, but that chest was not moving!!! I grabbed my stethoscope and placed it on the baby’s chest: no breath sounds and a very weak, nearly inaudible pulse were present. I told Dr. Sierra what my findings were and said we better intubate. He grabbed the ambu bag and put it over the baby’s mouth and I began chest compressions. I was going crazy at this point. This baby was as close to dead as he could be, we were doing CPR, and we couldn’t get any fluids in him. I could do CPR till the cows came home, but if we couldn’t get a line in there was no hope. All hope lay in the hands of Dr. Lazo at that point. I was also frustrated with the response to this baby’s cardiopulmonary arrest. Dr. Sierra had handed the bag to one of the staff members and I’m not sure where he had gone. I was compressing the chest and trying to explain to the person how to get air into the lungs. The mouth piece was upside down, there was no seal around the mouth so the air wasn’t even getting into the lungs, and we couldn’t get a good airway. Didn’t anyone there know how to properly bag somebody in a code!! Where were the nurses who were supposed to know these things to help?! They were all just watching! Why wasn’t anyone checking vitals and turning on the monitor like in a normal code! Why did I have to stop my chest compressions to check if the kid’s heart rate had improved! Didn’t anyone think the situation was as perilous as I did! No breathing + no heart beat = death!!!!!! Well, I kept trying to tell the person bagging how to do it so we could get some air into the lungs and we were finally doing okay. The whole time I’m doing chest compressions and Dr. Lazo is trying to put a tiny tube into a vein about the width of the head of a needle and mom is sobbing behind us. At this point, I was 100% sure this kid was dead. Such a simple treatment and we were helpless.


I was wondering where Dr. Sierra was and come to find out he was getting a bolus of epinephrine ready and injecting it, which was a smart thing to do. He came over and took over bagging as I continued chest compressions, but what was the point, this kid was dead. Well, I stopped and placed my stethoscope on his chest. Wait a second! I could actually hear a heart beat a little better. It was still below 60, but definitely better. I looked up at the IV bag. It was running!! I looked at Dr. Lazo’s incision. He had managed to place the line into that tiny vein and was working on securing it and stitching things up. We continued CPR and a few minutes later I checked the pulse again. Heart rate was in the 80’s! Yee ha!!! We continued and a few minutes later the heart rate was greater than 100. I stopped compressions as Dr. Sierra continued bagging the patient. After some time the baby began breathing on his own and Dr. Sierra stopped giving him breaths. I still think he should have been intubated and assisted because he was still struggling, but at least he was alive and stable. To add more stress to the situation though, Dr. Lazo couldn’t stop the bleeding from the wound he had made. They had nearly stitched everything up, but it continued to bleed quite a bit. Dr. Godoy, a surgeon from San Ignacio, had been called and showed up. Luckily, he was able to adjust a few things and stop the bleeding. The baby had lost quite a bit of blood, but was doing okay. The nurses prepared him for transfer and they sent him to Belize City to the pediatric intensive care unit.
When it was all over everyone was chatting in Spanish, but everyone kept saying “Gracias a Dios.” They are a really religious group obviously being an Adventist hospital. They all were grateful the baby was alive and gave all the praise to God which is pretty awesome. Dr. Sierra was sitting there praying at different moments during the whole situation which was very interesting to me. I talked to Dr. Lazo after and told him good job, as I was obviously impressed, but he just gave all the praise to God. I really like how they involve God with everything and I think it really helps considering the mostly good outcomes they have with limited resources.
I can’t be sure the baby will survive. I don’t know how long its brain was unoxygenated and what permanent damage might have occurred. He was stable when he left so hopefully everything will turn out okay. It was a crazy experience as I had never been in such an emergent situation like that (most of my ER experience has been pretty mild and I haven’t done an official ER rotation yet), but it was a great learning experience. I was disappointed with myself that I didn’t help more initially and I spent the evening second guessing my actions, wondering if I had done everything I could, regretting not being more vocal, and regretting some of the little details I didn’t think of during the high stress moment. That’s how I am though. I will analyze every little detail and replay the situation in my mind so I can think of every place where I need to improve. I know as a physician that may stress me out and will drive my wife crazy, but the way I look at it, at least I will always continue to improve and hopefully some day, be a great physician. Then I won’t have to think so much about my actions. While there are some regrets, at least the little guy is alive and he has Dr. Lazo to thank for that. In my mind, I have been a bit critical of Dr. Lazo for a few of the things he’s done while I’ve been working with him. He’s a pretty good physician, but I just don’t understand some of the things he does. Today he was a hero in my eyes. I asked him if he had ever done that before and he said only on adults. Being in such a high stress situation with such a difficult task I was more than impressed with how he kept his cool and was able to deliver. On the other hand, I was not impressed by the nurses and think they need a refresher course in emergency situations.

What’s great about the hospitals in America is that after a situation like that there would be a log of everything that happened, someone would review to check for mistakes, and then there would be quality improvement, retraining, etc. Here they didn’t record one thing and I imagine they aren’t going to see what areas they can improve on for next time. It’s odd because they don’t have any kind of continuing education or anything to ensure that the staff is continually learning and reviewing skills. Once you’re done with school you don’t have to do any continuing education to be sure you can do your job. Crazy!

This situation also made me think of how grateful I am for healthcare in America. Sure, it’s expensive, but it sure is good. The proper equipment for whatever situation is usually always available. Things run much smoother and usually everyone knows their place and what they’re doing. In addition, the training is much better and in general, hospital personnel are much more prepared. Be grateful to live in America and get the care you need when you need it. Sure it’s expensive, but I’m willing to pay the extra cost for the best healthcare in the world.

The rest of the day was slow and boring. The only other thing I can remember is that I had the x-ray dude do a chest x-ray of me. I’ve been feeling short of breath lately, coughing a lot, and not getting over my “cold”. I didn’t think it was anything serious, but I thought I would do a chest x-ray – It’s like $15 bucks here. It was normal so that is good. I’m worried I may have a mycoplasma pneumonia or bronchitis. It could also just be a really bad cold that is closing off my airway a bit and that is actually what it kind of feels like. If I don’t get over it soon I’ll start self medicating.

This evening I headed to San Ignacio to find a Tikal tour. Didn’t take long and I found a tour going on Saturday. It’s an all day trip, 7:30 am to 5 pm over the Guatemalan border about 70 miles away. It includes all the travel, border fees, entrance fees, lunch, and a knowledgeable guide of the area for a good price so I’m excited to go see the most popular Myan ruin in the world! Should be pretty fun. I practically ran the 45 minute walk home to get back to see The Office. They have NBC here! I was ticked when it wasn’t on. I thought it was on Wednesday night at 8 pm, but maybe it was Thursday. Hopefully it wasn’t Tuesday! I guess I’ll find out tomorrow. What a wild and great day. I can’t wait to see what tomorrow brings.

The little one I delivered a couple weeks ago.

Steak dinner from Eva's - $7.50!

Tuesday

Not much to write about today. I sat and watched Dr. Lazo work all day and asked him questions in between to show my interest. At one point I asked him if I could see some patients by myself and take call in the ER a couple nights a week and he said he’d think about it. Did he already forget about the last 2 weeks where I was already taking call, seeing patients, delivering a baby, and managing hospital patients? Does he have no idea what the last couple weeks were like? I guess so. I don’t understand what his problem is. I’m thinking he’ll come around, but he sure is resistant to the idea. I think he’s a bit of a control freak so he likes to do everything. Who knows? I would just go with Dr. Gamero, but guess what? He quit. Yea, over the weekend he just decided he didn’t want to work here anymore; not even a two weeks notice. He didn’t even make it 3 weeks working here. He said to Dr. Lazo over the phone that it was due to lack of time, but who knows? So, my plan of working with him just went out the window. I could just go with Dr. Sierra, but I don’t really want to be doing pediatrics. I already did a lot of that this year and while there’s always stuff to learn I would really like to get more experience in OB/Gyn and Lazo is the OB/Gyn. So, I decided I would stay with him this week and ask lots of questions and learn all I can regardless of what he lets me do and next week I’ll go with Sierra so I can have some independence. And after that I’m all done with my Belize experience!

Independence Day

September 21st – Belize’s 28th birthday was today. What a privilege to happen to be here for their independence day. Essentially, the commercial sector of the country shuts down to take off the holiday. Luckily, the buses were still running so I could get back to Santa Elena okay. I woke up to a huge storm this morning. It was raining like crazy! It didn’t look like there was any end in sight to all the rain so it kind of ruined my plans for today – no kayaking. I decided to just leave as soon as I could. I considered heading into Belize City downtown to see what was going on for the Independence Day. I decided not to though because I was worried about getting a bus back to the hospital. I’m glad I didn’t because I heard on the radio that they had canceled the parade. The rain was just too bad. It was flooding some of the streets as I was walking to the bus station and I had to slosh through 6 inch deep water at times.
The bus ride took forever like usual; 2 ½ hours to go about 60 miles. I was lucky to come back when I did though because I got to see the big parade in San Ignacio. I got home and headed right into to town to get a bite to eat. About half way there people started lining up and down the street. It was looking like a pretty big event. Once the floats started coming I decided to stop to watch the parade, which lasted for about an hour. Wow, Belizeans really know how to throw a party! The parade was really up beat with lots of island style music and dancing. About each float would be pulled by a truck that had a huge stack of speakers on it blasting music. Everyone was having a really good time and it was really cool to see this aspect of their culture. They really have a lot of pride in their country and their slogan for the parade was “Diverse Origins, Common Aspiration, Together We Celebrate as Belizeans.” I got a lot of pictures and video of the parade too, but unfortunately I can’t video on here.
After the parade I headed to Eva’s for dinner. I love that place. I ordered the most expensive thing on the menu – the steak dinner. It cost a whopping $7.50! Then I was able to lounge as long as I wanted and use their wireless internet. I love Eva’s. Tomorrow I start another week of work. Hopefully, this week will be as good as last week, but I don’t have my hopes up. Later.

Sabbath on the Caye

Today was the most boring day I’ve had yet in Belize and it was great. I woke up early and caught the boat to San Pedro. I was looking around for the church on that island and luckily I met a local named Jose. He knew every nook and cranny of the place. He said he thought he knew where the church was so I followed him. I thought he was wrong because it was totally not near the address that was on the church website. He was right though and led me to the 3rd floor of this random building. There were no signs on the outside of the building or anything, but to my surprise on the 3rd floor there was the chapel. There is no way I would have found the church without Jose. I tried to invite him in for church, but he didn’t want to, but at least I tried some missionary work.
Church was good and everyone was really friendly. They had me say the closing prayer of their sacrament meeting. I was surprised when the meeting was only two hours long. After church I had some time to kill before the water taxi was heading back to Caye Caulker, so I just walked around and got some lunch. San Pedro is pretty and everything, but I like Caye Cualker much more. San Pedro is much bigger and more fast paced so I was ready to get back to Caye Caulker soon.
Back on Caye Caulker I had planned on going sea kayaking, but the weather turned pretty bad. The wind was blowing pretty hard and the waves were white capping so I thought it wouldn’t be a good idea. Plus I was having a good time just lounging around on a Sunday afternoon. I sat around, MSN chatted with Jessica and Marcello for a while, watched some TV, and took a nap. It was a nice day. Dinner was at a takeout Italian place just down the road. The guy was a native Italian from Bologna, right close to Ferrara, a city I served on my mission. He was nice guy and made a pretty good batch of Pasta.
So, that’s it. My day was super boring and probably even more boring to read about, but I had fun. Tomorrow I head back to the hospital after a morning of sea kayaking, if the weather is good. I was talking to the Italian guy and he said he was pretty sure the buses weren’t running tomorrow because it is a holiday. Man, it would really stink if that is true. If it is I guess I’ll be stuck in Belize City for a day, but I’m okay with that. :)

At the church

Caye Caulker

I made it to Caye Caulker, an island paradise. I woke up early hoping to catch a bus travelling by the hospital. I wasn’t sure on the schedule, but wanted to make sure I was there by 7 am. The bus came right at 7 am and it was headed to Belize City. Belize City is only about 60-70 miles away, but it took 2 ½ hours to get there. The buses here stop wherever there are people that want to get on. We stopped over and over so our average speed was pretty slow. The bus was crammed and hot. People had to stand in the aisles it was so packed. I walked directly to the marine terminal after I arrived and took a taxi out to Caye caulker. It’s like 15 miles away from Belize City.
Stepping out of the boat onto the dock I knew I had arrived in paradise. Just like any tropical island there were palm trees, beaches, and crystal clear water. There was a sand street lining the entire beach up and down the shore and the only vehicles here are golf carts. In fact, all the streets on the island are sand and since this is such a small place the whole ambiance is just great. It is a place to chill and relax.
My place I had reserved was not too far down the shore road. This place looked great from the outside. It was right on the shore with its own dock. One good thing about Belize is that for the most part things are cheap. Also, because it’s slow season and there has been a recent swine flu outbreak keeping tourists at bay the clerk gave me any room of my choice for the price of their cheapest cabana. He mentioned the 3rd floor suite with a sea facing view so I went for that one. It wasn’t really much of a suite though even if the view was amazing. It didn’t have a TV or A/C, which I can live with, but when the toilet stopped working I had to put my foot down. They let me go to a different room in back without the view, but with a TV, A/C, and most important a toilet that would flush. Am I not such a pretty boy? I can deal with a lot, but I must at least have a place to go to the bathroom, so I thought I was justified in asking for a new room.
I felt like I was the only tourist on the island until the evening. I was trying to go on a snorkel tour, but not one tour guide had other people going. It’s impossible to get a tour guide to take a boat out for only one person so I was in a tough situation. I didn’t want to go tomorrow because I have plans for the Sabbath and I wasn’t sure if I would have time on Monday since I have to head back to Santa Elena. The guy finally offered to take me for the price of two people. It would have been nice if I could have just rented the equipment and gone by myself, but the coral reef is like a mile from the island. I finally caved in. It was only like 40 bucks to have my own personal guide, the boat ride, equipment, and all the water I could drink. I’m glad I went because it was sweet!!!
First, we headed to sting ray ally. I was a little hesitant to jump in the water as all I could think of was the crock hunter meeting his death by getting stabbed in the chest by a sting ray. It was a sting ray, right? The guide said they were safe as long as I didn’t step on one. What happens if I step on one, I thought? Do they eat me for lunch or spear me to death? Another reason I was stalling is because I have an irrational fear of open water. I think my fear mainly stems from being terrified of sharks, but being underwater and looking out into an unknown abyss is kind of unsettling. Even if I know things are safe I just have a problem with that, like I said, “irrational fear”. I think I watched too much Jaws as a kid too, because sharks scare the bajeebees out of me. If I saw a shark in the water while snorkeling I would probably just die right there from the shock. I couldn’t let Mario think I was a wimp though so I finally jumped in. Once I got comfortable it was great and lots of fun. There were quite a few sting rays and they would swim all around me. I could reach out and touch them. I also saw a barracuda and a few other fish. We then headed to two more places on the reef where the coral is. This was a blast. I saw so many diverse kinds of fish and luckily I had an underwater camera so I got some good pics. At one point I came across this huge school of fish that were hiding behind a rock. I scared them out and about 200 fish came zooming out. I also saw a humungous fish about the size of my upper body. Mario said it was a Parrot fish. Unfortunately I had used all my film by then so I couldn’t get a pic. Overall, it was way cool seeing all the fish and fun to have a personal guide although he didn’t really do much. He told me the names of like three fish and he didn’t even get in the water at the last place. Sheesh!
Dinner was great and I love how cheap food is here in Belize. This dude on the street guided me to a restaurant that had an outdoor barbeque. They had a fresh catch of fish, lobster, and shrimp that they were grilling up. The menu is according to what they were able to catch that day. Unfortunately, I don’t really like sea food, but I do enjoy shrimp so I got the shrimp kabob. I got a side of spaghetti, cole slaw, watermelon and this big kabob for $7.50. In the US, I’m sure it would have costed at least $20. It was soooo good and the restaurant was right on the street so I could watch all the locals pass. I had a great time, but I kept thinking I wish I had someone here with me. I mainly wish Jessica was here obviously, but any company would be nice. I meet a few of the locals when I go places, but it can get pretty lonely when there’s no one around I know. Oh well, I’m trying to have as much fun as I can even though I’m wishing Jess was here all the time.
So that was my pretty cool unexciting day. Tomorrow I’m going to Ambergis Caye to go to church and explore that island a bit. I don’t think they have any Sunday activities here, but I think I may rent a sea kayak and explore a bit. I did that once in Italy and had a great time. Until next time. . .

View from my hotel

On the dock Snorkeling. . .obviously

Caracol

My first day off was today and it was a great day. I left at 8 am and headed up to Mountain Pine Ridge. Kib picked me up at the hospital in a Susuki Samurai. It was a total piece of junk, open in the back, and had 0 shocks, but it made the trip fun. First off, I have to just say that the roads in Belize are horrible. I’ve never been on such a bad road for such a long stretch of road. The ride was about 2 ½ hours. All of those hours were on a way bumpy road up and back in a vehicle without much for shocks. I literally was about to puke when we finally reached the western highway. Thank goodness the trip wasn’t a few minutes longer. It didn’t help that Kib is a pretty crazy driver. I don’t know what he was thinking, but he would go barreling down the road not even trying to veer away from pot holes. A few times I would have flown out of the car if I hadn’t had my seatbelt on and I was shocked we didn’t pop a tire.
Well, after a bumpy, but beautiful drive over Mountain Pine Ridge and through the deep Belizean jungle we arrived at Caracol, the largest Mayan ruins in Belize. Archeologists are discovering that Caracol was likely a bigger kingdom than Tikal in the Mayan world, and they have proof that Caracol defeated Tikal during a war. We were the only tourists to go to Caracol all day so we had it all to ourselves. Since it is the middle of the rainy season, not tourist season, and it was raining throughout the day I guess no other people wanted to brave the road to Caracol. As I walked on the jungle road and then suddenly saw the first temple rising up high through the rain forest I literally gasped. All I can say is it was amazing! I absolutely cannot believe that the Mayans were able to build such astounding edifices in the middle of the thick jungle. Just seeing the thick forest around, it is astounding that anyone could even live around here so long ago let alone build such an amazing city. The temple is 43 meters high, so about 130 ft. I climbed to the top and had a great view of the landscape around the city. What is also amazing to me is when I looked off the back end of the temple there was just jungle. The front side is completely excavated from top to bottom, but the back literally has jungle all the way up to the top. I noticed that in the back there is a layer of dirt covering the temple maybe a few feet deep and the jungle has totally overgrown it, complete with very tall trees. It basically looks like a big hill from the backside. It’s no wonder this site is only partially excavated and that they are still finding other Mayan ruins with probably many others undiscovered. It would be easy for one to pass right by such ruins with all the overgrowth and never know they are there. This temple I was standing on is actually the main and largest temple in Caracol and it is called the Caana. It is a large pyramid with a flat top. On the top of this plaza there are three mini temples on three different sides of the temple. The central temple on top had a few rooms with staircases that went down into the darkness below. I didn’t have a light and wasn’t too keen on heading down there and meeting up with some critter so I didn’t bother exploring. On top of this temple I also saw some humongous spiders, much bigger than any spiders I’ve seen in the States. They weren’t as big as say a tarantula, but they were awfully close.
We took walk throughout all of the ruins of Caracol. They were all pretty cool, but none as massive or impressive as the first temple. There were about 3 different ball courts, where the Mayans played some sort of game. I’m not sure how the game was played, but I Kib was telling me he couldn’t remember if it was the winner or the loser, but one of them was sacrificed to the Mayan gods. I guess I need to watch “Apocalypto” and maybe that would tell me.
When I came down off of the Caana Temple Kib was sitting on the bench with some creature crawling on his shoulder. I couldn’t quite make it out till I got close and to my surprise there was a monkey crawling around on him! He said he was sitting there and it just appeared and jumped on him. It had its tale wrapped around his neck. As we were leaving the plaza a worker got our attention and explained that it was his monkey. I guess as a baby it fell high out of tree to the ground below and was stranded so he had nursed it to health and it had basically become tame. It ran around the grounds during the day, but always followed them back to the worker’s quarters and would sleep there at night. He explained she is a Black Howler Monkey. I need to read more about them, but I think I remember reading somewhere that they are native to Belize and a protected species here. It was fun to get an up close experience with her, but after a while she got a bit annoying. She wouldn’t get off of Kib all morning and just clinged to him. I tried to get her to crawl on me, but she refused. When it was time to go Kib couldn’t really get her off of him although he wasn’t being too aggressive. He got in the car and pulled out hoping she would jump off, but she never did. I told him he better get more aggressive or she was going to become his new pet. He grabbed her forcefully and tried to throw her down outside the car and she freaked out! She was squealing and trying to bite him, in fact, she actually did get a few bites in but didn’t break skin. After he eased off, she stopped freaking out and crawled back to his shoulder and sat there calmly. Then he tears her off his shoulder and tries to give her to me telling me I needed to throw her out my window. I’m thinking, “Get that filthy thing away from me!”, but I tried to get a hold of her and she tried biting my finger off! I was luckily too quick for her. We were in a bit of a dilemma with this ravenous monkey trying to bite us! Of course, if we didn’t try to get her out of the car she was as calm as could be. Finally, Kib grabbed her hard and held her out the window. I think this is where he got the bite, but he threw her on the ground and carefully drove off trying to not run over her. The whole time she’s trying to scratch her why up into the vehicle. When we finally got past her and on the road she was running fast trying to catch us. Luckily we were a little faster, and this was my last memory of Caracol: The beautiful grounds in the distance and a crazy howler monkey running with all her might trying to catch us. You couldn’t write this stuff!
We made our way back up the bumpy road and stopped at a few places along the way. The first was Rio Frio Cave, which is basically a massive tunnel that was carved through the mountain by the Frio River. This thing was humongous and a bit creepy. I went a ways in until I could see both ends of the cave. I didn’t have a light so I didn’t feel comfortable going any further, especially since Kib told me there was a deep ravine somewhere around and to be careful. There is actually one place in the cave where there is a sandy beach along the side of the river. I could tell from all the tracks that people go in there to swim and hang out. Swimming in a cave river doesn’t seem very enticing to me, but Kib told me it was a pretty popular thing for the locals. The whole area around the cave reminded me of the movies Rambo 2, Missing in Action, and Uncommon Valor. Actually, there are a number of 80s movies I used to watch as kid that were about the Vietnam War that the area reminds me of. Belize in general reminds me of those movies, but in this area we were out in the middle of nowhere and in the jungle so I kept thinking of scenes in those movies when they’re trekking through the jungle. The rain forest is crazy. It is soooo thick with foliage and wild life. There are so many insects around. I think I saw like 6 different species of ants scurrying around the jungle floor. The spiders are absolutely freaky and I’m sure they would scare the pants off of Jessica. She always got scared by the dinky spiders in Missouri and these ones you can’t just wipe up with some toilet paper and flush down the toilet. They may clog the toilet. I remember I had to get in the crawl space under our house in Missouri a few times for different things. If our house had been in the rain forest I don’t think there is any way I could have got myself under there. By the way, when I say rain forest it’s not technically considered a rain forest here, but it is pretty darn close!
After the cave we headed down the road some more to Rio on Pools. This is an area where the river crosses over an expanse of huge granite boulders and forms a number of waterfalls and pools. It is a very popular swimming spot for locals and tourists. I had brought my swimming suit, but didn’t really feel like swimming. The water is normally crystal clear, but was totally murky today. I guess this is due to all the rain they’ve been getting. It was also pouring at this point; not a really good day for a swim. It was fun to see though because it is an absolutely beautiful area and right around the area of pines on Mountain Pine Ridge.
We basically were done at this point and headed off the Mountain Pine Ridge. The area is pretty crazy, because there is a rapid change from jungle to pine forest then back to jungle. It’s not like an American pine forest, but there is a lot less foliage than the jungle and scattered tropical pine trees. The drive was actually one great part of the trip because of all the beautiful scenery although like I said, I bit bumpy.
When we got back to town I tried to give Kib money for gas, but he wouldn’t take it so I offered to buy him dinner. We went to an Italian place he knew of and I was totally fine with that obviously! The restaurant was run by Fabio and his wife who are from a small village close to Venice. The food was pretty good, but not the best Italian food I’ve had. It was right downtown though and actually cool to see San Ignacio in the light for once.
I better get to bed. I’m hitching a bus ride to Belize City early in the morning to head out to the cayes. Hopefully I’ll get there okay, since it’s quite a trek getting out there without my own transportation. I’m staying at Popeye’s in a cabana that is right close to the sea. Should be quite an adventure.

Caracol from the top of the temple Plaza A at Caracol Rio on Pools at Mountain Pine Ridge Me, Kib, and Jakie the Black Howler

Kib must have not known when it was going to take the picture!

Videos to come if I can get them on here.

Thursday

Today was a fairly slow day in the hospital, but I stayed busy. This morning as I was getting ready the nurse called because my patient with the burns wasn’t doing very well. He was spiking fevers all night, was tachycardic, and his blood pressure was 65/40! I’m wondering why they don’t call Dr. Gamero, since he’s the physician. Anyway, I was wondering what’s going on with him. He’s got to be septic, but his white count is normal and his urine is clean. I thought maybe I wasn’t giving him enough fluids, but I’ve been giving him a lot lately. Anyway, I did some labs, bolused him some more fluid, and increased his maintenance fluid. The labs were all normal except one. Only his protein was a bit low which is another reason his pressure could be low and him having swelling in his legs, but it wasn’t that low so I doubt it. I consulted with Dr. Manzanero, who is the internist who sees patients in the hospital when the doctors need him. He didn’t really change much except an antibiotic, and he’s getting a chest x-ray tomorrow. I hope we can get this figured out because I’m really worried about this kid.
I worked with Dr. Sierra, the pediatrician, all morning. The funny thing is he sees all ages of patients because the doctors here have to. He was pretty busy this morning so he just handed me a bunch of charts and I took Dr. Lazo’s office and saw them. He’s great because he gives me a lot of freedom. It got a little wild was when Dr. Sierra left. He was only working a half day this morning so he left at noon. Dr. Gamero had to leave yesterday, even though he was on call, and I covered the ER for him even though nobody really came in. He was supposed to return at noon, but never showed up. It’s kind of crazy that a doctor can just not show up who is supposed to see patients and be on call. He got held up for some reason. Well, I just started seeing all the afternoon patients out of necessity. They were all pretty simple cases. Things went well and I also had an ER patient that had smashed his hand and broke the end of his finger. Finally, Dr. Gamero shows up at 5:30 pm after all the work had been done. After I checked on the burn victim I decided to call it a day. Tomorrow I’m taking the day off and heading to the Caracol ruins and taking the whole weekend for that matter. I’ve been working a lot lately so I’m more than excited to finally be able to get out and see some things. Dr. Lazo got back tonight anyway, so my fun days doing a lot in the hospital are probably over, since he and his wife seem to be anti-student. I’m going to try and just stay with Sierra and Gamero for my last two weeks so it’s not totally lame as I finish up my experience here.
One crazy case was this Mennonite girl who came in during the morning and saw Dr. Sierra. She had aplastic anemia which had been initially diagnosed and treated in Guatemala. She was feeling fatigued and looked as pale as a ghost. Dr. Sierra did a CBC and her hemoglobin was like 4!! Normal is 12 and you should transfuse blood at 7 or 8. Even worse, her platelet count was 5! Normal is >200. Platelets clot your blood and sever bleeding usually will occur at <20!>5. Dr. Sierra admitted her of course. She needed platelets very badly so I asked Dr. Sierra about it. He said they didn’t have platelets. I wondered why don’t transfer her to a hospital in Belize that had platelets. He tells me there isn’t one! I said, “You got to be kidding me, there isn’t one hospital in Belize that has platelets?” Nope. I still can’t believe that, maybe there was a miscommunication, but they told me she would need to go to Guatemala for platelets. That should tell you how behind the times Belize is with their medical care. It is a small country, but come on. This girl is on steroids which will hopefully increase her platelet count.