Mexican medical patient

I had my first brush w/the Mexican medical system as a patient this last week. Although this is somewhat personal, I’ll say that I was diagnosed with iron deficiency (microcytic/hypochromic) anemia a few months before I left for Mexico. The doctor I saw in Texas put me on iron pills, but it was pretty apparent that not much progress was being made by the time I left. This is something of concern, as men my age rarely have this kind of anemia. It can pretty much be one of two major causes before you start scratching your head and looking for the extremes: 1) malabsorption of iron and/or dietary deficiency or 2) a GI bleed somewhere. The former is not likely, since this is recent problem and my diet hasn’t changed. However, I don’t know for sure.

I met this doctor through someone at school who is a grad from UAG and teaches a few courses here. I know he can’t be that old just by looking at him, but many students in Mexico start med school at 17-18, so who knows. I made appointment to see him in his consultorio. After a bit of getting lost and searching around, I find his place. I had the description, address, color, etc. but I think I would have still missed it if I hadn’t seen him outside, because I would have mistaken it for a shack. I parked across the street, and entered a room covered only by a curtain (and a gate, but that was open) to the outside, no bigger than my bedroom. In this patient room was his desk, a patient table, a filing cabinet, and a small stand where some rudimentary medical tools, injections, etc. were stored. The bed and a few other things were draped in blue cloth.

Now when I was deciding whether or not I wanted to go to med school for real, I logged quite a bit of time with my friend and mentor who is a surgeon, both in the OR and in his office seeing pre/post-op patients. At least at that hospital, blue meant sterile (perhaps others use green). As a med-student larva circulating around the OR with the nurse, it was made very clear: don’t touch anything blue! I had a small flashback to that as I sat there, knowing very well that there was nothing sterile about the cloth on the bed or anywhere else.

He took my vitals, I made a joke about IPM (our pre-clinics course where we learn the basics of physical exams) as he was checking my ears, etc. knowing he had to do the exact same thing I was doing when he went to school. He reviewed my labs which I brought and basically told me what I already knew and that we needed to start with new, current labs. I agreed. He wrote out a script for the labwork, and he commented that here in Mexico, they don’t order “panels” like the US; rather, every specific test is spelled out explicitly. All in all, we spent 40 minutes or so talking, explaining things both about my situation and about medicine in Mexico in general. I won’t tell you what the bill was, but even taking into account that I know he was giving me a discount from being both a friend’s referral and knowing that I’m a student, it was so low I was embarassed not to give him more but I didn’t want to insult his generosity. I realized then what a different planet I’m on with respect to medicine here.

One could have easily been put off (I sure was!) by the ramshackled exterior of the building, the slummy neighborhood, the lack of polish and glitz that Americans almost make synonymous with physicians (doctor = money). Before I walked in, I was introduced to a friend of his who is also a doctor (who also teaches at UAG, because I’ve had her for IPM), and she was just sitting there on the street yacking it up with my doctor’s brother, who runs the pharmacy next door (also a closet-sized operation). It was 6:15 or so when I got there and almost 7:00 when I was getting ready to leave, and she was still there. It’s not that they are lazy or don’t want to make a buck or are so horrible that they don’t have business–it’s just a plain simple truth that life, even in medicine, is just slower here. A doctor here is almost like any other working stiff–highly specialized and respected, but there is no managed care to drive them to ever-increasing volume, no malignant, litigious environment to cause them to refer to 3 other doctors and run $1000s of dollars worth of tests just to cover their asses. It’s also why so many doctors do what these do and just teach for some steady money, seeing patients during off hours or working shifts at hospitals. It’s totally customary that if a doctor wants a few hours off, they don’t schedule anything and they go do what they want to do. This obviously wouldn’t work for a surgeon or for someone who is actively working a shift at the hospital, but for private, degree-on-shingle-type general doctors, they just make their own lives as best as they can. Only the most sought-after grads get jobs with the government hospitals because it’s a steady check, even if you have to work harder. It’s completely the opposite in the US. It’s neat and depressing all at the same time, because you think, “You can do more than this,” to which a lot of them would reply, “Why?” It’s just a fundamental clash of core values as to how one defines “success.” That difference in the value of time is also what allows doctors here to be truly counselors to their patients, not having to mill them at 5 minutes a consult. Their time may be worth less by comparison to US physicians, but the people here are the beneficiaries of it. The lack of electricity with Hurricane Katrina forced many physicians to delve back to their roots, diagnosing in its purest form, without the need for an MRI/CT/etc. to back up their assessments. Here, the kind of hands-on diagnosing is the norm, with specialized tests only given when necessary or when traditional methods fail.

As for me, I’m trying to figure out how I’m going to get my labs done, fasting, when I have to be at school at 8am every day and lots of labs don’t open until 7-8a. I went to one lab and they wanted $120USD for the tests, I told them I could get cheaper elsewhere, and I can. The problem is the university hospital is a ways away, but I’ll figure it out. Unless something radical changes, I’ll probably have a date with an endoscope in my near future. That will certainly deserve another post.

I’m goin’ back to Texas

I’m going to Texas for a business trip. Not really wanting to go because my family is nuts and they are going to aggravate the crap out of me.

I’m convinced some of my relatives are sociopaths. My husband knows them and he agrees. I gotta go take care of estate stuff for my deceased sister, meet with lawyers, maybe an accountant and a real estate agent. This stuff was supposed to be done by a relative, but of course, it has not been done. That has not stopped said relative from criticizing me behind my back for not doing what she should have been doing, but well, sociopaths are like that. Oy, Familia.

On a positive note I will get to:

• See the relatives I like
• Spend time with my abandoned fat cat Audrey
• Eat a Whataburger
• maybe eat Chinese food that has more ingredients than soy sauce and garlic
• stock up of foods that are not to be had here in Mexico and smuggle them in.

What kind of foods/items are not found here?

• Jif peanut butter (hubby’s favorite), in greater than 1 cup (for $3) size
• Kit Kat candy bar
• 3-way light bulbs
• coasters (cheap ones anyway)
• granular Splenda (way expensive here and no big bags either, just packets)
• Whole bean Decaf coffee
• Hershey’s chocolate (the unsweetened kind)

We are going to an American store (what I call it) that supposedly carries all types of products from the US later this afternoon. There are loads of other stuff I need to get but that is all I can remember right now. I am taking 2 big suitcases and packing them lightly. Need room for the return contraband.

Embryazepam

Embryology at 8:00AM every morning with a professor that barely speaks [strained] English for two hours is a cure for insomnia in its own right. Even with a Tony Robbins-like speaker, there’s a limit to how you can make mesoderm, ectoderm and endoderm remotely interesting. A double espresso gets me through until about 8:45. The fact that he calls roll to begin class at the stroke of 8:00 and penalizes after 2 or so absences violates international law somehow, I’m certain of it…

Social responsibility

I need to study for a Cell Biology exam tomorrow. I sit at my computer (missing biochemistry so that I can study, no less) writing this not so much because of procrastination, but because other things are on my mind that need to get out. I’ve talked about feeling helpless before, and if I were still working at UH, I’d have taken vacation days to help out at the hospitals, the ‘dome or at other relief organizations there, like the Star of Hope Shelter. I really don’t want to blog about Katrina or the devastation I see on TV, the ineptitude of our federal response or any polarizing, political diatribes. I want to write about my med school experiences, my life here, and the things that make me, well, me.

But one of the things that makes who I am, one of the reasons I chose medicine is because I do feel a sense of social responsibility. Helping others in and of itself is not a life calling for me, but without it, one can’t really be a decent physician by any standard. So to my classmates, friends, family, and anonymous people that read this and wonder if this site is going to turn into a political blog, I assure you it’s not. I DO want to get back to all the things that go on here, for better for worse, but they just so pale in comparison to other things. Please bear with me, but this is, after all, who I am.

Lastly, it is precisely stories like this that infuriate me the most. I can see myself as one of these doctors 5-6+ years from now, getting permission to leave one’s residency/job to help out temporarily in a national crisis. These doctors are in Mississippi, just 100 miles away in a state-of-the-art government facility, but are just standing there, waiting for someone from the government to actually deploy them. The reports from these physicians paint a completely different picture than what Homeland Security/FEMA would have you believe, that “it takes time to mobilize assets when dealing with a crisis of this magnitude:”

Dr. Jeffrey Guy, a trauma surgeon at Vanderbilt University who has been in contact with the mobile hospital doctors, told The Associated Press in a telephone interview, “There are entire hospitals that are contacting me, saying, ‘We need to take on patients,” ‘ but they can’t get through the bureaucracy. The crime of this story is, you’ve got millions of dollars in assets and it’s not deployed,” he said. “We mount a better response in a Third World country.”

How much more evidence is needed to show that Homeland Security is and has always been a mistake? This is the first test of Homeland Security in a major situation, and it has failed so miserably that no band-aids, no firing this person or that person will fix it. Unfortunately, it won’t happen in this administration.

NYT Op-ed pieces for yesterday

Some memorable articles:

• United States of Shame
• Do You Know What It Means To Lose New Orleans? (Anne Rice)
• Fallujah Floods the Superdome
• The Bursting Point

Pride is a deadly sin, literally

Pride heads the list of the seven deadly sins (the others being Envy, Gluttony, Lust, Wrath, Greed, and Sloth). These sins are “deadly” because in common belief, they 1) form the basis of all other sins, and 2) are a one-way ticket to punishment/antonement in the afterlife. However, there is another consequence of Pride, at least with respect to Katrina’s victims: deadly decisions made by a dead-wrong administration. Thousands have died or become gravely ill just because of pride on the part of politicians. Just a day’s delay meant hundreds of lives; in fact, every minute could possibly mean a life.

There is pride in not accepting help (at least not openly) from other nations. I understand if Iran or North Korea would pledge $500 million dollars that the US would have to say no, seeing as how “tainted” that money would be, but Canada? Germany? Australia? Hell, even poverty-ridden El Salvador offered to send in troops. When El Salvador says, “Oh shit, you guys need help,” to the greatest superpower in the world because of its ineptitude, you know you’ve hit rock bottom as a nation.

Pride is George Bush not speaking out against FEMA or Homeland Security, not canceling a speaking engagement to shore up political support for the war on terror the day a killer hurricane hit the gulf coast. Pride is “staying the course,” no matter how many people die or how many people tell you you’re wrong. Pride is thinking that the American way is the best way for the rest of the world, and in so doing, alienated us to the point where we are frankly lucky that other countries still want to help us at all. Pride is politicians being shown the horrors of the storm’s aftermath and the first words out of their mouth is that “things are going well,” or thanking so-and-so, making sure to get a shout out to their homies, because their prepared statements before the camera turned on were more important than what is being asked. Pride is administration officials not saying, “Our department failed,” or admitting their mistakes, or willing to point out certain shortcomings lest it have a negative impact for elections later.

Ghandi had his take on what constituted the deadly sins:

• Wealth without Work
• Pleasure without Conscience
• Science without Humanity
• Knowledge without Character
• Politics without Principle
• Commerce without Morality
• Worship without Sacrifice

Pride need not always be deadly. I feel pride in the relief workers, particularly fellow Texans and the Coast Guard, who were working from the minute they were able to help with the disaster. The policemen who stayed and risked their lives against the lawlessness, even while greiving or not knowing about all of their own families, should feel very proud. For those who have given to relief agencies, for those who have traveled in some cases thousands of miles just to help, one feels proud to count them among their fellow man. The difference is that Pride sees oneself and one’s own agenda as most important; being proud, particularly in these cases, is inescapable when shown self-sacrifice.

Where was Condi?

According to Gawker.com, Condi was well….

SHOPPING and enjoying a play while Americans were dying.

Nice.

Death of a Ficus

Something I’ve been meaning to post for a while…we have this huge 4-story ficus tree in our back patio (which isn’t really a patio, thanks to the monstrous ficus tree and roots) which was reportedly causing damage to the building, so we were told that people would come by to cut it sometime soon. We had upstairs neighbors that were in fits because it does provide shade for them, but for us it is so dense, that algae and mold grow readily on the concrete outside because it’s constantly damp and shady.

As it always is with Mexico, workers show up unannounced and need to go through our bedroom to get to the ficus. Claudia’s upset, I’m only home for 1hr to eat lunch, and I have to deal with this. They cut so much in the first round, you almost couldn’t see outside our sliding door, the leaves/branches were pressed against the glass. I left back to school, I came back and they were still at it! To make a long story short, they kept cutting and cutting and cutting…we were sure the tree was going to die. The instructions were confirmed that the would NOT uproot the tree. I guess whittling it down to a bald stick still keeps to the literal instructions.

Pictures are here. Keep moving forward to see all of them. Enjoy!

I didn’t know cholera affected speech

Obviously, I’m in Mexico, so as I’ve noted elsewhere on this blog, I don’t exactly get the creme de la creme of American television. As such, I didn’t get to see last night’s telethon hosted by NBC’s Matt Lauer for the American Red Cross to raise money for Katrina victms. Lots of celebrities appeared, such as jazz greats and NO natives Harry Connick, Jr. and Wynton Marsalis, among many other musicians and actors.

One of those “musicians” was rapper Kanye West, on last week’s Time Magazine cover dubbed, “The smartest man in rap.” Apparently, the threshold for what passes as intelligent is about the freezing point of water, because West had such bad diarrhea of the mouth, saying that “they’re giving [the Army] permission to shoot us,” and “George Bush hates Black people,” all with Mike Meyers delivering an Emmy-winning performance holding it together (punctuated by moments of incredulity). This is ridiculously stupid on so many levels. Isn’t Condy Rice Black? As much as I abhor most of Bush’s politics, I don’t think for one second he’s racist. Dim-witted, yes. A bigot, no. The issue is responsibility and leadership, and while race and class are very much factors in this crisis, it’s more a crime of apathy than racism or “genocide,” as the more wacky, fringe groups claim. And speaking of conspiracy wacky, in his lyrics and interviews, Kayne says the government intentionally spread AIDS and implicates Ronald Reagan in bringing down the Black Panthers, specifically by the government’s creation of crack and subversive planting in Black ghettos. Right. Is that a chip in your neck?

As crazy as all of this is, what’s sad are those conservatives who have a stick so far up their ass, they called their local affiliates and self-righteously announced that they’d be donating to the Salvation Army or another agency, blaming both NBC and the Red Cross for allowing this to happen. Well, at least they gave, I suppose, but to me, allowing this to affect one’s decision to give to Red Cross is more reactionary and short-sighted than West himself.

What about the little guy?

My husband addressed many of my thoughts perfectly so there is no need for me to regurgitate what he has so eloquently penned below. I do however have some thoughts that I must get out or else I feel like my head will explode.

I was born and raised in one of the poorest counties in the United States. A county that is close to the Rio Grande River and the Gulf Coast. We grew up with the threat of hurricanes and knew the drill well. First you tape the windows, fill up the cars with gas, buy the water and groceries then get ready for it. What, evacuate you say? Not an option.

My father was a hard working man who worked well over 40 hours to make sure we had food on the table and clothes on our back. My parents never received public assistance even though we were a large family of 11, and both he and my mother made sure we were good citizens.

We would not have been able to leave because you need money to leave, you need a reliable car to travel and then you need to spend quite a bit of money to buy the tape, the plywood, the nails to secure the only possessions you have. Then after all that, you need money for hotel rooms and food for several days if not weeks.

Had the big one hit, and we were left stranded, should we be judged because we did not evacuate even though we knew better? Should we just accept that we would have no food or water for days and days until FEMA came around to check on the small towns after they got dealing with the big ones? Do citizens who live in small cities matter less than the ones in the big cities? How bad are these areas that that according to the Mayor of New Orleans, those people are being brought into NO for aid? Let me tell you something, it is a totally different animal to be poor in a small rural community than being poor in a large city.

Large cities get all the attention in these natural disasters. I understand why that is–the loss of life is higher, the damage more costly and the recuperation more extensive. I get that. But I must admit that I got a chill down my spine when I heard that almost 1000 miles spread throughout different states had been devastated by Katrina.

Reporters are now talking about the other parishes and the level of destruction found in those areas. I remind myself that parishes are counties with many square miles, not neighborhoods with many square blocks. Counties full of citizens, many of whom had less than the people in New Orleans before this disaster. These people go to New Orleans to find the jobs that are non-existent in their rural town. It is mind boggling when you think about it.

In Houston I worked with many, many Louisianans. I wonder how their families are. These people’s brothers, sisters, mothers, fathers were residents of Louisiana–many from small towns. I grew to adore these people because I recognized the close relationship they had with Texas, especially Houston. They were so much like us and yet so wonderfully different from their accents to their celebrations. They were so full of life, vibrant and always lending a kind word to me and never rude nor abrasive.

How much lost life will be discovered in the next few weeks when the news from these small towns starts to get reported? Yes, the mayor of New Orleans was correct when he said thousands will die, and he was only talking about New Orleans.

Look at the map of the devastation in the gulf coast and imagine tons of small towns with populations between 5 to 25 thousand people that peppers the affected area from Louisiana to Mississippi.

Right now, the people in the bigger areas feel abandoned by the government. They feel forgotten, discarded. Imagine being from small town and knowing that your area is so low on the priority list that not even the reporters are paying you any attention.

Is their hunger not the same, is their thirst not the same, and is their devastation not the same? It took the President 5 days to get to the major areas, 5 days for the National Guard to start arriving to New Orleans. How long is it going to be before the rural areas get help?

Who is looking out for them?