A Week In

I've been here a week now and have found some semblance of a routine. The first I was here, the 30th annual Jornadas Medicas somewhat disrupted the normal course of hospital rounds and teaching. But this week we're back to business. Yesterday was a full day of inpt work, were my host resident, Edwin, and I speed rounded on patients before morning bible reading and the overnight resident briefly checked out to the family medicine attending. Afterwards, we met up with our IM attending, Dr. Vasconez and were 'pimped' on anemia work-up. Interestingly enough, there are no family medicine attendings who see patients with the residents, only IM or peds as well as the specialists. Though per Edwin, family medicine attendings work at other hospitals, I found it somewhat counterproductive to try to promote the value of family medicine to not have FM attendings at the main residency hospital. But why do the family medicine faculty hear about the admits? More for a review of more serious/sick patients and some quick teaching for everyone present. Before we could discuss this further, we go called to admit a peds patient (yes, inpt work means both medicine and peds). Edwin, knowing my interest in OB, then advocated on my behalf to attend a c-section with our pediatric attending (which really just required asking as the pediatrician seemed very willing to have me along). So my first experience in a non-US OR was spent mostly examining the healthy newborn with the supervising pediatrician. After that, I luckily was in a good position to observe the OB/GYN close the hysterotomy, bring the rectus muscles together, etc before handing things over to the OB/GYN resident. Now if only family medicine doctors were able to do c-sections here...

So now that I'm here and we're back to the grind, what's my daily life like? Each day is different in the way my schedule worked out. I'm solely at Hospital Vozandes. This facility has two inpatient floors, including an ICU/NICU, an ER, a 24 hour lab, and "consultas externas" for both PCP and specialty clinics. My Mondays are basically entirely inpatient, with the last 2 hours spent in clinic with IM. Tuesdays are currently spent with an endocrinologist, who very much enjoys teaching, and a dietician. Wednesdays have worked out to be a cardiology day, which involved clinic and stress tests and the possibility of seeing more invasive procedures. Thursdays worked out to be a mix of rounding with ID, then joining the medicine team, and ending with dermatology. Being Ecuador, I've seen some fascinating cases already (to be explored at a later time). Fridays... well, last week neither of the attendings I was scheduled with were available so we shall see what this week brings. Responsibilities of independent direct patient care at this point are somewhat limited with lack of access to the computer system and working with such a variety of residents and specialists. It's also unclear at this point how many foreign residents have worked here and what expectations are from each individual attending I work with. The general reaction, however, tends to be "oh so you do have a basic grasp of Spanish!" Once that happens, most have been excited to teach and answer questions. We'll see what the rest of week brings...