All about teeth

Dental clinic all morning. Was really enlightening. I learned about the four most important reasons to refer to dentistry (FYI for my medstud friends, we know some of this but it's always a good review). 1. Before starting bisphosphonates (can cause bone necrosis and must do all dental work before starting the meds). 2. In the first trimester of pregnancy (for several reasons). 3. Before heart surgery (if possible). 4. Before starting chemo (which sounds really obvious but I never even thought of it.). I got to see lots of procedures. I saw a tooth extraction, multiple cavities filled, a couple of root canals, some diabetic dental care, cleanings… I got used to the drill sound and actually think I've conquered some fear of the dentist! The root canals, I have to say, was pretty neat. (photo of me on call yesterday)

The second half of the day I worked through “check out”, turning in my badge, making sure there weren't any loose ends on my notes. I said goodbye to everyone. I'll miss a lot of people here. Some folks made me promise I'd come back in residency. I think that would be an excellent idea. I'm going to miss New Mexico, Zuni, Zuni Hospital and the freedom I've felt this last month. (photo of Abbey, the instigator for all the barking - possibly part coyote?)

Football day

On call again (second one this week for those of you keeping track).

Today I made a flier for Zuni women on colorectal cancer screening. It's going to be used by Women's Health to help educate on risk factors, screening and the like for CRC.

No admissions, no transfers, the day was relatively slow until around 7 PM when it really picked up and the ambulances started rolling in with high school football injuries. One kid was trampled by a bull. Then there were babies with red eyes, folks with coughs, runny noses, etc. I got home and got some lap time with the doggies and crashed. Slept like the dead and didn't even wake to pee. (Photo of NaRak, the lap dog, the one that sleeps in my room. Wooly and Teddy do too sometimes)

Big wind... little post

The dogs woke me promptly two minutes before my alarm was going to go off. After I let them out and made coffee we had a bit of a cuddlefest in the living room. I set the camera up on the living room table on timer and sat back near the floor to cuddle and was able to catch the event on film.

Insane winds today - blowing from every direction. Howling winds. Strong enough to make me wonder if they could blow me away. Reminds me of a thought I had in Chinle. After Uranium clinic. I thought how it would such a fitting Navajo story to tell of the medical student who was blown from Chinle by the winds and landed in some unknown land…

I presented my data on colorectal cancer this morning. It went well. After spending three weeks on the chart review and collecting data the impact that CRC screening was so low compared to breast and cervical cancer has lost its power. But to the providers I presented to it apparently was enlightening. (photo of squirt, the old one, with flying nun ears)

Tuesday Quickie

The morning was prenatal clinic. A great experience and I am again reminded how I really need more OB experience. We had high risk, first prenatals, teen pregnancies… it was a busy day. In the afternoon I had designated project time to prepare for my presentation and then dinner with my preceptor and his wife. We had yummy pasta and talked until late and then, again, I wrangled the dogs in the house (with more success) and am about to crash. (photo of Wooly, the somber one.)

Forgot to tell the story of the kamikazee bunnies. When Jes and I were climbing into the mountains above Crystal Valley were accosted by bunnies. From the left, the right, diving under the wheels of her Civic. As we were winding up the mountains and the drop-off appeared to our right (my side), I began to prepare myself for the death of a bunny. They were evil bunnies, I was telling my sister. They were NOT cute cotton-tailed little hoppy things, they were EVIL and if they got in our way they might be dead, evil bunnies. Thankfully, we dodged them sucessfully and as we ascending the bunnies thinned out in number.... then we came to the cows. But I already talked about that.

Barkfest 2006

(Photo from a dust storm ahead of me on my drive back from Utah)
On call today. Long day, but not terribly busy. I was completely and totally exhausted from being up from the barking (and maybe from the long drive the day before). I was so tired I couldn't even fake being alert. I was a zombie most the day. Thankfully, from about 1-9 PM I worked urgent care. Seeing one patient after another. The constant motion keeping me awake. There was one admission, one transfer.

After much coaxing (pitching my exhausted voice high to fool the dogs into thinking I was excited to be standing in the cold in my scrubs I finally got all five dogs in the house and was able to close the front door (it was getting below freezing and the screen door was letting in a lot of cold air). I then collapsed into bed. (Photo of Teddy, the perky one.)

I woke again to barking. Thought at first it was coyotes again. Then after I got more alert realized it was dogs. They were howling and barking and making a ton of noise and, I realized after a few groggy moments, all in the house. I realized the five of them were in the living room making some sort of ruckus. So I padded out of the guest room, walked to the hall, faced the dark living room and, facing the direction of the dogs (no glasses and it was dark so I had to guess) I gave a loud, sharp “SH!” And immediately they all stopped. I went to bed and slept the rest of the night.

Adventures in Moab

I'll try to sum it up in one post…

Friday

Friday Jessica and I had breakfast at The Jailhouse Diner - an old turn-of-the-century jailhouse turned diner (of course). Shared an omelet and Swedish pancakes. Then we went to Arches National Park. Amazing! The park is enormous and we drove a lot. At each designated site we would take a hike to see particular marked arches or windows. For those who don't know, Arches is named for all these rock formations that resulted in arches of red rock. Apparently they formed from salt dissolving from under rock. Jessie and I saw a documentary on how all the canyons, cliffs, arches and such were created. It was really interesting (if somewhat cheesy) and described how water really was responsible for shaping most of what we were seeing. Everything there was under water once, and throughout the entire day in the park I kept thinking how it really did feel like I was standing at the bottom of some ancient ocean (just without the foliage). I liked finding shapes in the rocks, recognizing them as people and animals. Jessie was particularly fond of what geologists call “fins” these huge narrow fin-shaped rock formations that were splits from seismic shifting (if I remember correctly) and smoothed out by rushing water.


We visited places with names that were obvious like Balanced Rock, Windows and Fragile Arch (the one that is on the UT license plate). Other names required more explanation, like Fiery Furnace, a collection of needles and fins that, when the sun's low, light up a fiery red.


The weather was here and there Friday. One moment we were rained on, the next we were stripped to our tanktops, sweltering under the heat. One part of the park was gloomy gray while the next was blue with white fluffy clouds.

Saturday

Saturday we hiked a little more hardcore, going to Canyonlands National Park. We debated rafting but it was way too cold for watersport. We started the day with breakfast at a place called Eklectic Café where we met an earthy couple and their two tow-headed little boys as well as two men and their two playful dogs.

Canyonlands is divided into several parts, each with their own features, each spanning vast distances (a good few hours drive from one part to another). We stuck to the part that was closest to Moab, Island in the Sky, a huge Mesa surrounded by rippling canyons and remnants of bodies of water. There are several points where you can see the Green River and the Colorado and where they connect at one point, beneath a mesa that Anasazi once called home. (Anasazi, I believe, are predecessors to the Zuni who also call themselves A'shiwi).

Jessie and I hiked across a huge open field that eventually turned sandy, like dunes, and turned into solid rock with pools of water trapped in little divots. It was windy and cold but the hike kept us warm. We trekked across the rock until we hit more vegetation and then the cliffs. The hike took us around the edge of the mesa and we walked to what felt like the end of the world. It was really beautiful and we agreed that we both loved the vastness of the landscape and fantasized about building homes on the mesas or buttes.

Sidebar: Mesa is a structure wider than it is tall. A Butte is about the same wide as tall. A spire is thinner than a butte, taller than it is wide. A mesa over time becomes a butte becomes a spire. (fins, needles, canyons, arches and other structures are made by water, mesas, buttes and spires are made by erosion).

Our hike lasted a few hours. Then we drove around the park visiting designated sites and taking shorter hikes to various landmarks. One of these landmarks is a huge crater that they theorize might have been created by a meteor. Another theory is that a big salt bubbled kind of popped and created the hole. Scientists apparently can't decide. I prefer the meteor idea, it's much more intergalactic and romantic than a big bubble of NaCl.


We were totally and completely exhausted after the hiking (we were at Canyonlands for around 6 hours) however once we got back to the hotel we splashed some water on our faces and head off to see a cute town outside of Moab called Castle Valley. Jessica had written an article about this town and it's eclectic mix of inhabitants. From the shamaness who lives in a cave to the woman in the Styrofoam house, the gay couple who run a vineyard, the guy with the junkyard, the former Midwesterners with their cookie-cutter mansion. There were a spattering of yurts (domed tents that you can now buy pre-made but that originally were used by Turkish nomads), a teepee, an octagon house and many other spectacles. The valley is nestled in between fiery red rocks and distinctive structures on two sides. On the third side sis the way in near the river. There are mountains on the other side. We decided to take the mountainous way home. Probably not the smartest thing as it was soon dark and we were weaving up and up with what appeared to be sheer drop-offs one side and walls of trees to the other. We drove through the national forest on the mountain. We ran into an older couple in a pick up who asked if we were lost. They told us to stop a few miles into the forest and listen for the elk bugling. Then, near the top, probably an hour now into the long, dark, winding drive, right around where we were supposed to stop and listen for elk we saw a huge creature crossing the road. Elk? Not quite. Cow. On the top of a mountain in a national forest. The sight was so unexpected we found ourselves laughing

Sunday

Last day. No hiking today but we hung out at Mondo coffee shop (it became a hang out of ours over the few days as it had wireless access, good coffee, and was open late and early). We did al little shopping and then parted ways.

The drive back to Zuni was via Colorado and then into New Mexico. After the grasses of Colorado, the mountain ranges in the distance, I hit the top of New Mexico, drive through more Navajo land, it was desolate with the occasional rock formation shooting into he sky, the sandy landscape dotted by rare trailers and scrubby bushes. I drove through sandstorms. Passed a handful of gas stations and ultimately made it back to Zuni in between 5 and 6 hours.

My first night back, shortly after greeting the five dogs and two cats I finally sat and tried to relax. Suddenly coyotes started howling - all of them! It was remarkable. I wish I could have recorded it. I fell asleep like a dead woman and woke to barking dogs. Not sure if it was the five I'm sitting for r another but I tired to wrangle all the dogs in the house and makes rue they were all accounted for. It was harder than I imagined so I found my earplugs and managed to sleep through the cacophony.

Nuclear fallout and miso soup

Uranium clinic was interesting. Today was mostly down-winders. Downwinders are those who were exposed to nuclear fallout in the 50s and 60s. They are eligible for $ from the government if they have cancer. (Does Uncle Sam think this is a fair trade?) Really, any kind of cancer except prostate and cervical qualify. Lots of paperwork is involved, including required documentation from the Navajo nation (and Hopi but didn't see Hopi in Chinle). The record keeping is rather poor. Patients have to prove they lived in an “official” downwind area in certain years. School records are most commonly used. However many of the records are impossible to find as schools no longer exist or have purged their records. Birth certificates are also required. But some Navajo don't have them if they were born at home. Plus names on these records vary a lot. One name appears on a birth certificate, another on a marriage license, and so forth. So it's a hassle and the group of people I worked with today work on making sure these people have everything they need to file for their benefits.

Clinic ended pretty early. I had checked out of the hotel in the morning. I wanted to drive to Canyon de Chelly (pronounced “Canyon de Shay”) to look at some ruins but it was thunderstorming so I just hit the road for Moab. Was another beautiful drive (both drives were around 3 hours long). Had a mammoth root beer float from A&W in Chinle and had to pee so badly on the way thought I might actually explode. The bushes in the desert weren't big enough to even crouch behind so I resorted to holding it until the next gas station, which happened to be at a border town (between Utah and AZ) called Mexican Water. There I found a laundry mat, some caffeine to keep me going, and the blessed bathroom. I was still sleepy so after I was in Utah I stopped at cute town called Bluff at a funky artist co-op/coffee shop/old west museum. I had fresh brewed iced tea that was overpriced and fabulous. The rest of the drive was gorgeous as red rock formations started shooting up and I could see snow-capped mountains on the horizon.

“The Hole in the Rock” kitschy tourist stop greeted me in Moab. I arrived an hour or so before Jessie and pretty much just collapsed on the bed and read until she got there. We had some seriously yummy edamame (I pretty much ate the entire appetizer platter myself) and Jessie had a burger while I ate some very, very salty miso soup crammed with veggies. We walked around a bit and eventually went to bed. We awoke in the middle of the night by a thunderstorm with thunder so loud it rattled the windows and set off car alarms. The lightening was light a strobe light from the curtained hotel window. We both agreed we were glad we didn't go camping.

From Zuni to Chinle

On call. Checked up on pregnant/laboring women most the day. Worked on my colorectal cancer (CRC) presentation. It's coming along nicely. Also went to a meeting for the docs there. Interesting to see some of the administrative stuff they deal with - being physicians, government employees and part of a reservation all appear to have their won sets of issues.

My call was cut short so I could make it out to Chinle, AZ in time to meet up with the docs of the uranium mining clinic. The drive there was spectacular, Corn Mountain was lit up in my rearview mirror for miles as I drove into the low sun. Noticed a big difference from NM to AZ in just the roads. Right at the boarder there's a town called Witch Well. Or maybe it's just a bar. Kind of hard to tell in the middleofnowheres I've been driving by.

On the way the drive was incredible, I was surrounded by storms. Watching rain move across the horizon but staying dry on my drive. Once I arrived I saw tourists mingling around. A few government vehicles in the hotel parking lot clued me in that I was indeed in the right place. I had dinner with Dr. Z, the head of the clinic. We talked about uranium mining. I had looked at a powerpoint he sent me earlier that week.

About the cause: Uranium was found to be present in the four corners area. The miners, almost all Navajo and Hopi, worked for the government -- who knew well the potential harms (think: Tuskegee). I learned a horrifying story about an Austrian doctor (if I remember correctly) who came to the states, he knew of the dangers of Uranium mining and wanted to see the mines himself. The government not only censored him as soon as they could but they banned him from traveling west of the Mississippi! The diseases seen in the miners are lung related, usually fibrosis and cancer. If lung disease can be confirmed the miners can receive 50,000. If they don't have lung disease they don't get anything but the fear of getting ill.

Uranium is apparently becoming more profitable these days and there's talk of more mining. However they talk of a method of mining that involves extracting uranium with some sort of bicarb solution. The wash is collected and the uranium extracted, the “benign” wash going back into the earth… and the water supply. There's no “proof” that this method infects water because other sites with sick people in the vicinity don't have water samples before mining and thus can't rule out that the water was infected beforehand. Convenient, no?

Killer sunset you'll never see

(more pics from my hike here, too) Had Zuni home visits in the morning. One patient was a baby with an illness that is rather common among Ashkenazi but not so much here, especially here in the southwest. The parents appear to be doing the best they can but are thinking about moving north so they can find doctors who are more comfortable handling their baby's illness and where they don't have to remind the nurses how to handle the baby's treatments, etc. Saw other patients for wound care and the like. Scleroderma in one older lady. I'm always impressed how Scleroderma has such power to shape the face into that tight mask, making so many of its victims look alike, regardless of their ethnicity. The homes we visited were a lot like Big Al's. In fact, one patient was next door to Big Al's mother's house. As we passed, the nurse who I was going on the home visits with pointed to that house and said, “that's where we had a homicide a couple weeks ago”. I realize she was referring to the stabbing I talked about in one of my first posts. And I remember Big Al pointing out a couple of children running around. I had asked him if they were his and he said, “No, their father was killed recently.”

On a better note, I finished my chart review! All data from all 50 charts compiled. It only took me about 12 hours or so to collect the data (with some distractions in there, too). Now I need to make something of it and prepare some recommendations. But the data appears to look just like my preceptor and I thought it would, with mammograms and paps being much more common than CRC screening.

On the way here, to Gallup where I'm writing now, I saw THE MOST INCREDIBLE SUNSET! I can't even begin to describe it. There was a storm between me and the horizon that was lighting up with such bright hot pinks, reds, oranges, with some gapes in the cloud cover shooting colored light. The sun was a bright orange ball. I forgot to bring my camera of course. It was probably one of the most spectacular sunsets I've seen and I actually had to pull over on the side of the road. I took a picture with my camera phone but it doesn't do it any kind of justice.

I also have another housesitting gig my last week. A place with five dogs, two cats and two ducks. Plus satellite TV and wireless internet. My kind of place. The homeowners asked me what I wanted them to stock up on for me to eat while I'm there. Isn't that sweet? I refused and they insisted. So I said frosted miniwheats, chocolate, lots of dairy stuff, eggs and bacon!

Disconnected ramblings

(FYI: pictures are from my hike on the 10th) Last night the dogs in Zuni were barking. All of them. Every night I wake up to a few here and there, but last night it was a cacophony of barking. Some started howling. I imagined every reservation dog barking, every single one of them. Hundreds. It was really neat and I wasn't annoyed, just amazed. I also am managing to fall asleep quite well through the sounds of mating cats and barking dogs.

I've started my chart review. The charting system here is old. There's an online component but it seems to only compile face sheets with demographics and appointments.

I realized the charts were antiquated when I was flipping through them, looking for the lab results I needed for my study and found myself looking stuff from the 60s that indistinguishable from the recent stuff. I have to pull most the charts myself from medical records - another tedious task, but surprisingly, I'm not all that grumpy about any of this. I feel like this is something I need to learn to do. Plus, it's sciency and public healthy and makes me feel like I'm doing something really useful and important. Hopefully after this is all said and done I'll be able to make recommendations to Zuni Health that can be implemented and may decrease the incidence of colon cancer in Zuni women.

When I got home, exhausted but wired, I watched the movie, Alive, on John's DVD player. Fast-forwarded the plane crash part. Funny how the “doctor” on the plane is a guy who's been in medical school for all of 6 months. He manages to take care of the whole planeful of injuries - frostbite, lacerations, head wounds. If I was in that situation after 6 months of medical school I would be about as useful as a doctor as my textbooks would be useful for nutrition. But really, it made me think (dangerous, I know). I imagine I would be pretty put-together in that kind of situation. There was this one guy in the movie who was obsessed with getting a non-transmitting radio to work. I also thought there was a small chance I might be that guy - escaping from a horrible situation like that by getting a useless piece of plastic to work. I won't even begin to contemplate if I would ever eat people... anyway, the movie was more awful than I remembered.

Hiking and mint tea with faeries

Went for a long hike at El Morro National Park/Monument. It was incredibly gorgeous. I took a million pictures (all pics here are from the hike) and it's really difficult to pick which ones to show here… landscapes, rocks, flowers, ancient ruins. It was also a good workout with a 200-foot initial climb and lots of climbing in and out of structures on top of the mesa. The mountain, I believe, has been deemed a national monument because at the bottom, near a fresh pool of water explorers and conquistadors chiseled their names into the rock. The conquistadors beat the Americans to this part of the US and their engravings are the oldest. Except for the Zuni hieroglyphs of course, those surely pre-date the others.

After the hike I went to an art gallery opening across from the park. I was told about it from some people at the hospital. The art was an interesting mix of traditional-inspired art and modern whatsit's. When I arrived a man was just starting to read a story of his (from a collection they were selling there). It was about a paraplegic shot at the rally in Berkley in the 60s who lived on the reservation. There was a lot of free-love and marijuana in the story, and some pain and angst. Very beat. Then we wandered around, looked at the art, drank iced tea and mint leaves and ate some snacks (hooray free food!). The people-watching was extraordinary. Some guys were there from the nearby Zuni Mountain Sanctuary, a gay community (mostly men), a community known for being bizarre and alternative, a sometimes nudist colony, also called The Faerie Community. I met a guy named Balance who was wearing a teensy vest and a skirt and really young transman named Zion I think was hitting on me. The “Faerie” guys were dressed… I'm not sure how to describe it… shredded halter tops, wrap-around skirts, braids, Zuni jewelry, it was really awesome people watching. I was really having a great time. I talked to a guy about his sand paintings, a cowboy-type with a big belt buckle, a bigger belly, and an even bigger ten-gallon hat. He wasn't from the area. He told me about how his painting were the earth and started telling me about these esoteric artsy things that just made me smile and nod and think to myself, “I have to remember to wrote about this gallery opening in my blog!”

Angry little birds

This is another picture of John's backyard. This morning was lazy and sweet. I woke up around 8, made some coffee (brought the coffee maker over from the trailer as there isn't one here) and worked on the computer a bit outside on the table in the pic from yesterday's post. Then made myself a hearty breakfast of bacon, eggs and English muffin with OJ. A bonafide feast. The house was chilly in and I found it hard to warm up - my feet were blocks of ice from the cold floors (I have no slipper and there's a no shoe rule in this house). Wondering what to do about my chill I debated taking a bath. Then I though: hot tub! So I soaked for a while, warming all my cold parts thoroughly.

I watched the humming birds. Did I mention them buzzing my head when I was being shown the garden before I cam to stay here? Apparently they are territorial birds. Who knew? I have never watched humming birds so closely. They are very funny looking, I must say. Fat bodies, small heads, pointy beaks and blur for wings. They kind of make me think about armless worn out stuffed animals. And they are angry little things, turning their floating armless bodies in the direction of the threat and buzzing and chirping vehemently.

I head off to a store downtown where I bought a few fetishes and such as gifts. Now I'm at The Coffee Shop after a beautiful drive to Gallup. It was thunderstorming in Gallup and as I approached the storm I could see the sweep of the rain across the landscape and occasional bolts of lightening. Now I'm waiting patiently for my Albuquerque Turkey. I ran into Bridget here and we chatted for a long time about residencies, gardens, Zuni Hospital…

There are two girls sitting at the table in front of mine, holding hands across the table. Not the first girl couple I've noticed here. Makes me happy.

This week I do home visits with the Zuni on Tuesday. Wednesday night I head out to Arizona to attend Uranium mining clinic. Then a long weekend in Moab. Fourth year rocks.

Burrito victory

Clinic all morning. Saw a variety of ills and ages. Most amazing patient of the day was a patient who had a number of psychosocial problems, we talked for a long time, right through my lunch hour. We talked about alcohol and depression and anxiety, flashbacks, PTSD. I feel some breakthroughs were made and made sure the patient was coming back to see mental health the following week. It really lifted my mood and gave my so much energy for the rest of the day.

It also helps that I was finally able to buy those famous burritos. They were truly amazing. Don't ask me what was in them because I couldn't really tell. It was spicy but delicious. And filling. Bought two - one to reheat over the weekend. Also got a tamale again. Was told to eat it with butter and Zuni bread. Can't wait.

The afternoon I was scheduled for my research project. I finally decided what search criteria I'm using for my chart review and made the fields in a database. I am looking at cancer screening in Zuni women - cervical, breast and colon. The idea of the project is to make some better recommendations and educate on the topic of colon cancer screening. Apparently it's the number one cancer death for Zuni women. There's a great organization that helps women get breast and cervical cancer screening here and I'm hoping that some of my research will help expand that to colon cancer screening.

Then, at night I hit the hot tub, drank some sleepy time tea, watched some of Water. This picture is their back yard. Incredible.

The sewing machine

My second call. It was initially pretty slow until an MVA around noon- then it really picked up. The MVA was a little old lady who was in the rear passenger area of a sedan when it got rear-ended at low speed. The other four in the vehicle were fine. She's diabetic and frail so we wanted to r/o fracture.

The docs here read their won films. There's no radiologist. I find that really neat. I got a good XR review from the doc I took call with that night.

Later I stitched up a head wound. Even later I stitched a knee (20 stitches, 4 deep, 5 mattress stitches and then a running stitch across the rest of the wound). I admitted an elderly gentleman as well. An interesting case but not one I can talk about here. Patients were sent to Gallup for ultrasounds and Fort Defiance for head CT's. It was a busy night and I ended up staying later than my shift to finish the admission (all on paper, by they way, per government form documentation which isn't that much different than the typical M3 H&P).

Back home in just enough time to get 7 hours sleep before pre-rounding tomorrow (and to write this bit). Indicator of how busy I've been this week: bought a Snickers bar on Monday in Gallup. Haven't even thought to eat it yet. Will probably put it in my bag for tomorrow.

Home visits and feet

Home visits on Ramah Navajo reservation today. Was incredible. I kept trying to take pictures with my mind. Remember this, I'd say to myself. Huge sprays of wildflowers, incredible rock formations. It was hard work. Long drives down inhospitable roads, into rocky cliffs and onto farms dotted with sheep. Some of these people lived in areas so remote it took 30 minutes down a barely-there road before their house even came into view. At one point I napped in the van as the interpreter drove, the sun warming me as my hand held a stack of medication in place in the seat beside me. I learned some Navajo - hello, goodbye and pain or hurt. Saw a variety of patients. A tennis-loving quadriplegic was one of the more interesting. He was also fluent in English so it was easier to talk to him. We saw our patients in living rooms, kitchens, bedrooms, and outside on a stoop. Most were elderly, some disabled. Two patients in their 90s. A brother and sister who were blind. We had boxes of medication in our truck - day-to-day pillboxes to switch out for those on chronic meds. Bottles of refills. Other supplies like cough syrup, creams, Tylenol, things that might be needed. The blind woman received bottles of pills. She could recognize all by feel.

Reservation dogs were everywhere. The man I went on visits with warned me that they could be dangerous. A tall thin white man with a long, gray beard, he would make these hissing sounds to scurry them away from us. I feel I can get a good read on dogs and none of them seemed aggressive. Most were simply passive and not even that scared. Certainly hungry. One looked like a Catahoula. Another was certainly part Sharpei. One woman had a tiny toy dog - definitely not a typical reservation dog as it was inside the house and wore a collar. It was a yappy thing, one of those longhaired black dachounds. It jumped up on the arm of the couch the woman was sitting on and demanded I pet it through most of the interview.

The translator was pretty good however she would engage in lengthy conversation with the patients and not relay what they had talked about. The interpretation went pretty much exactly as we learned not to do in medical school. We would address our questions to the translator, not the patient (if we asked the patient directly the translator didn't understand that we wanted her to translate).

Podiatry clinic was in the afternoon. Ragged vasculopathic and diabetic toenails, cracked feet, ulcers, heel spurs and more. We removed a soggy cast from a woman who was post-op for a fascial release (the podiatrists have surgery privileges at Fort Defiance, a relatively close hospital). The smell after the cast removal stayed with me the rest of the evening. The podiatrist scraped off calluses with a scalpel. Looked so satisfying, I wanted to do it but here schedule was packed and didn’t allow for medstudent experimentation (a patient every 15 minutes all afternoon). During the day we talked about her home of St. Thomas island. Why feet? I asked her. It was a love she developed in college shadowing a podiatrist father of a roommate. No calls and no emergencies - the life of a podiatrist, she said, is very good. She did her podiatry residency in Detroit. Later, she invited me to bible study at her house Friday night. I had other plans so had to refuse. But we ended up talking about religion and Grandpa Willoughby and liberal Christianity a little waiting for our 4:30 who was late.

It’s my first night house-sitting but I spent most of it moving my clothes and food over from the trailer so haven’t enjoyed the place much – did notice they had the DVD Water (Deepa Mehta’s movie) so I’m planning on watching that at some point!

Yoga, tomatoes and other adventures

Gotta love the shuffle feature on the iPod. The Ramones are singing about how The KKK Took My Baby Away, Erikah Badu just wrapped a ditty on Afros preceded by a jam by the Wayward Monks (my brother's band - he just turned forty the other day too! Happy b-day Jason!) Check out the Monks at http://www.bie.org/Ravitz/monks.html)

Today I applied to residencies. Scary and exciting.

In the morning, after rounds, I had “group”, a prenatal care-type thing - like group therapy and education for pregnant women. They meet 10 times in their pregnancies, the group of them. They learn about the changes of the body, what to expect, about labor, delivery and the newborn. Here at Zuni it is not acceptable to talk about the baby before it is born. There is no such thing as a shower, you do not buy clothes for the baby nor know its sex until it is born. They appear to get very good prenatal care here, regular ultrasounds and check ups. This group is great - the women weigh themselves, take their own BP's and dip their own urine. They record all this in these binders they have - a tab for each of the 10 groups. Then the doc checks fetal heart tones (with a Doppler - that doesn't read out the rate so you actually have to listen), fundal height and does Leopold's (maneuvers to see what position the baby is in). Today there were only two women in group - the others having already delivered and home with their babies. We talked about sex, STD's, domestic violence, and brought up (briefly) the subject of the next visit where all those with babies should be coming and they will learn baby massage. Then we did prenatal yoga. I have to admit, I was laughing a bit as I did kegel exercises on the mat in the dark room. We squatted and stretched and downward-dogged for about 20 minutes and then had a session where the women were invited to ask any questions or address any concerns. It was overall interesting. I learned a little about pregnancy and child birth that I hadn't known before.

In the afternoon, after submitting my residency application I went to physical therapy. Here PT sees everything, from strokes to bowel concerns to wound care. The visits I saw today were predominantly wound care. Not very exciting for me. However the patients were interesting folks.

I am house-sitting for one of the John's this next week. I went over to get a lay of t he land as they showed me around. I can do laundry - which is great. They have a hot-tub which is awesome! They don't have internet access but they do have a TV (no reception but they have a VCR and DVD player) and best of all they have a huge vegetable garden that has beans, edamame, cherry tomatoes, cucumber, corn, and so much more! I ate a million tomatoes while they were picking them, trying to keep up, stuffing them in my face one after the other. I devoured raw beans - deep purple and traditional green ones. The bed is twice the size of the cot I have in the trailer and has a real blanket, not the thin scratchy thing from the hospital I've been huddling under each night. Plus, their neighbors are other docs so I may actually socialize with things other than crickets. Woo-hoo!

Free Ben

Ben, dear friend I will miss you. On a Thursday you appeared in my trailer. You kept me company, following me from room to room. Chirping happily at night. Today you perched at the foot of my bed while I lay atop the covers to read. I want better for you Ben. You deserve the tall grasses, the wildflowers. There are many mosquitoes outside for you to have as breakfast (what do crickets eat). So Ben, while I will miss you my little 6-legged amigo, I will catch you in a mug and release you under the clothesline. Run free, Ben, run free!

The drive from here to Gallup and back is gorgeous, as I've said, and I have pictures this time to prove it. When I got back in the earlier afternoon I read most the day. I released Ben - in truth he was appearing lethargic and the fact he hung out on my bed while I was reading kind of made me sad. Then as I was chatting on the phone with my mom my doorbell rang. It was an old Zuni man. He made a move like he was coming into my trailer and I held where I was, not knowing who he was and a bit defensive. He then told me he had earrings he was selling, wanted to know if I would buy some jewelry. While his turquoise and silver jewelry were pretty (and I told him as much) I was more outraged that he would come to my trailer and try and sell it. Did word get around that the medstudent was living there? Does he visit the Zuni family next door to ask them to buy his earrings? I hope it doesn't happen again. It really was a stark reminder that no matter how comfortable I'm becoming on the reservation I am an outsider.

Walkabout

Finally awoke with some energy this morning and took a long walk in the desert. It was a well-trodden trail and, though I was told to use a guide on my first walk in the desert, there was a main trail I stuck to and even after an hour I could still see the Zuni water tower hovering back near where I lived. The sand was red and a bit slippery from all the rains. I kept one eye on the grasses for rattlesnakes. I walked by the strangest contraption in the desert - looked like some sort of drilling machine but more like a trailer home. I walked across an old dam that wasn't holding anything in but fishy-smelling marshlands. There was a canyon out of the blue, possibly a holdover from when the dam actually held water and rivers fed a lake. It was a nice walk and I was glad to find it. There are smaller trails leading into the scrubby trees and bushes that dominate the desert here and I may explore those at some point. The flowers were blooming. Dr. N calls them New Mexico Sunflowers but someone else told me they believe they are called Black-eyed Susans. There is also this abundance of this orange flower that blooms in a spray around the trails.

I washed my laundry in the kitchen sink and hung it on the line to try - borrowing clothespins from the trailer next door (also medstudent trailer that is currently unoccupied). Then I went to Bridget's house to pick up the goods - Bridget is a doctor here who has decided to take me a bit under her wing, she told me about The Coffee Shop and also bought some supplies for the medstudent trailer once she heard about my living conditions. So I settled in the new silverware, pots, pans, mugs and now am pleased to say I have a microwave that is much less testy and even tells me what time it is, a toaster (yay for toast!), and a coffee maker among other wonderful amenities I didn't realize I missed so much.

Here is my little friend - a cricket I named Ben (after MJ's rat friend). The Above photo is from my kitchen window - here are some of my trailer and my street: