Thursday, August 31, 2006

On call


Wednesday, August 30, 2006
First call day. It's nearly 4 PM and our only issues were a woman who ran out of home oxygen and a woman who delivered last night having post-partum complications (incredibly huge labial hematoma - we had to call Gallup Medical Center to talk to OB and find out if they wanted us to send her up for evacuation).

I did talk a lot with one of the older faculty here. Dr. K. He is really a great guy. Jewish. I talked to him about the community and tribal feel and he reminded me that the Jewish people are truly a tribe. That we have our religious customs, our own language, history, etc. It was pretty neat. I didn't get on the topic of tribal land, though that may have been an interesting conversation. He also apparently has a gay sister who works up in Gallup. We also talked about family medicine, residencies and the like.

There was a patient today who concerned us for psychotic break. Apparently psychosis isn't common here but somatization and conversion disorders are very common. Dr. K was telling me about how he has seen stokes and codes that were really psychosomatic. Apparently their psychiatrist isn't here anymore (the coming and going of valuable specialists is an issue I might touch upon later) but they have a psychologist who has seen a lot of this. According to Dr. K the theory behind the prevalence is that it is acceptable and even preferable to express grief and emotions with huge outbursts. Hysterics and hyperventilation are the norm for people grieving or with other psychological issues. Each doctor I spoke to seemed really impressed with the amount of conversion disorders they've seen in their time here. I have seen only one case at UM (pseudoseizures coupled with Munchausen's and by proxy - the kid was admitted too) and was under the impression that most docs don't see very much of true conversion disorder. I am thinking this might make an interesting topic for my presentation and chart review I have to do before I go.

Food update: ate well yesterday. Had green beans and pasta for lunch and that sandwich at the café for dinner. Breakfast today was frosted miniwheats, lunch and dinner was hospital food with some southwest flavah (pear juice - yum! Dried out breaded chicken - not-so-yum.) Found a vending machine that dispenses coffee. Not much better than the instant at home but it's the only option here.

Note: today I'm on call and haven't really done anything at all. Well, not true, I have done a lot of AMSA and pathology stuff. However I feel like such a slacker sitting at the desk here all day just typing away, emailing. I share my office with other docs here and they come and go and bring charts in and such and aside from a few hours here and there I have just been sitting in the office.

Well... it got busy. Urgent care was pretty packed. Not like Henry Ford or anything but there was a steady stream of patients. I did three knee exams, an eye exam, a bunch of respiratory exams, and other stuff. Pretty basic. I taught the nurse how to play Go Fish (little Eliza would be proud) and he taught me Zuni Speed (we played cards while I was waiting to present to the attending). I stayed an hour later than scheduled but we cleared the rack so it was worth it.

I really love this kind of hospital. Everything in one place, All close by. The Lab is so cute and small but they do all the important stuff. The whole place is so easy to navigate and the patient load is really manageable for a couple providers (I think only one or two max are on at night). And I really love the Zuni. Dr. K and I discussed a bit about Zuni and how they are joker and laughers (compared to the more aloof nature of the Navajo). I really like it, I joke around a lot and don't feel like I'm crossing any boundaries. There's lots of friendly teasing and such. It's just such a pleasant environment - soooooo different from the stodgy academics of UMHS.

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Wednesday, August 30, 2006

Mudheads

Tuesday, August 29, 2006
Wow – what a day. Actually only saw a couple patients all day – however, I really learned a lot about the hospital and the Zuni people. Also got to FINALLY have brewed coffee! Woo-hoo! Had it from the patient waiting area :)

Spent most the day doing orientation stuff. Learned about how the hospital works, retrained on HIPPA (if I get another HIPPA training I am going to quite possibly explode). I met a lot of people, all of them so nice. Everyone has been incredibly kind. The pharmacists are all from the Public Health Service and have to wear these brown military uniforms. There’s one young pharmacist that’s a Navy officer and he always calls me ma’am. In every sentence he addresses me he uses it. I think it’s funny, but he’s so endearing I wouldn’t laugh for fear of making him feel bad.

I learned about where to go walking in Zuni. Finally. Apparently, I have been exploring a few tiny areas and the wrong area at that. Across 53 there is great hiking, you can climb the enormous Corn Mountain (it has a Zuni name but I keep forgetting it) and you there are ancient ruins. Then further West is the heart of Zuni with the Old Mission, artisan shops (as a hospital employee I get 50% off at one of the shops) and places where they sell food (including a pizza join I hear). Here's to hoping I have time to explore it all.

I was told about religious ceremonies they have in the Old Town. I heard about the Fourth World and the Creator (maybe will explain that later). There are these religious groups, several of them, that apparently come dance, sing and pray around the solstice. The celebrate summer and winter. And summer Solstice is still underway apparently because groups 5 and 6 of the Kachina. The Kachina, I was explained, are kind of like neighborhood Holy men. They have this role at different times. I guess some of the things they due are fast – which means no shopping or sex in addition to not eating (so if I ask a patient to fast before we draw labs I have to be specific and just say no food or drink except water and medications). The woman who was explaining this to me talked about how the powerful men of the Kachina “are separate from us”. All these concepts that I don’t quite grasp but I was adequately warned I might not. But the powerful people of the Kachina arrange the dances, the ceremonies. On the days of the ceremony the Kachina will dress in masks walk to the old part of town where they will dance and sing. Non-Zuni cannot be in the area that they dance, but they can stand on a roof of a nearby building and watch. When the Kachina walks to the ceremony they do not stop, look sideways, and seeing through tiny horizontal slits in their masks they walk non-stop to the site. So everyone knows they have the right of way and you have to stand at least 10 feel behind them.



I also learned about Mud Heads (the little guy peeking out behind the Kachina at left). Fascinating. They are also called "the clowns". They wear disfigured masks – the face supposedly the child of a brother and sister to remind us how incest is bad. They interact more with everyone (while the Kachina does not and requires a large berth at all times). While a man is acting as a Mud Heads he cannot be touched by women at all – that even means in the hospital. One Mud Head was transported by EMT with only women staff and at the hospital all the nurses were women and they had to transport him by grasping the sheets he lay on. The intake had to be done by a male nurse that was called in from home. Mud Heads are at the mercy of the Kachina. They apparently are always fasting. They can, however, eat food that is offered them. They cannot work either. So they have to beg for food, money and perform blessings in people’s home in exchange for meals. During the dances and prayers they apparently will sometimes interact with the audience. Even the Melikas (Zuni for white people. Belagona is Navajo for white people).

I learned about the cultural difference between the Navajo and Zuni. Navajo apparently are very superstitious and do not want people dying in their homes. They also prefer their medicine men to heal on the dirt and will often transport out (on pass) sick relatives for a ceremony in a Hogan. When a relative dies they do not view the body or mourn over it, the just take the information and go back home. Also, during childbirth, they are apparently very vocal. The Zuni, I’ve learned, are quiet during childbirth. Even the youngest teen moms do not make a sound. And in contrast to the Navajo, the Zuni prefer to pass on in their homes. When they are dying relatives and clansmen (which, I’m told, its pretty much everyone) will gather around them and wail. After death they will be taken to their Aunties house (if they did not die there) and overnight there “is a lot that happens” involving the whole family and ceremonies. The person is buried at dawn.

Pressers. At first I thought they meant pressors (for hypotension) but these in fact are people, kind of like healers. They come and press part of the body. If a woman is breech they press her belly to turn the baby. If someone has a broken arm they come press that. They press for headaches and abdominal pain. They are apparently often in the hospital and when they are doing their thing I’m not allowed in the room. These are not Medicine Men or religious figures – however, those people also come and I am also not allowed in the room for that either. However if the patient requests it apparently I can stay for these things but that is unusual.

Also, went check out a coffee shop in Gallup (called, “The Coffee Shop” – go figure). They had live folk music and lots of hippie folks noshing on sprout sandwiches and gourmet lattes. Much more the New Mexico I’m familiar with but strage in comparison to where I've been the last several days. I ate a “Turkey Albuquerque” sandwich and a cream soda and reviewed my articles on fat embolism after knee surgery (my paper for last month). I plan to go back – maybe finally get this blog up and running. Maybe even upload some pictures of where I am.

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Tuesday, August 29, 2006

Clinic

Monday, August 28, 2006
Ack – the quarterly report for AMSA is due in 2 days. I’ve whittled it down from 32 pages to 17 – however after I get up at the crack of dawn to add the 13 pin campaign summaries to the progress section and break them down by region it’ll be at least back up to 25. But it’s more concise. Not that anyone reading this cares (except maybe Tanya). The only satisfaction I have in turning in this behemoth is that the guy who formatted it last year - and made it have to be so freaking long - is in the position now where he has to read it (plus the other quarterly reports coming in).

Okay enough about that particular AMSA burden. Onto today’s excitement. I woke early and excited to start the day. Was grateful for my instant coffee (as nasty as it was) and even was able to eat what Suhani taught me was a One-Eyed Egyptian (though it sounds like code talk for penis, it’s actually an egg cooked inside a hole made in bread – quite yummy and, as I’ve just learned, was featured twice in the movie V for Vendetta).

I arrived in time for rounds which are usually between 8 and 8:30. That lasted about an hour. It was a large sit-down event with all the nurses, docs, PT’s, even the podiatrist was there. After that I got a walking tour of the place – the waiting room is really pretty with murals of dessert landscape and wooden carved pillars breaking up the usual industrial hospital-like architecture. Then I went to treadmill stress-test clinic (exercise treadmill testing or ETT for short) with one of my mentors and we made all these middle-aged overweight people run on treadmills all morning while we watched their EKG’s and took their vital signs every 2 minutes. Then I was able to saunter home for a few minutes to eat a yummy avocado with a potato and make a sandwich to take back with me to the hospital. Then afternoon clinic. I saw probably five or six patients in the afternoon. Notes were no biggie as they are all are paper and you can just jot down as you interview and leave it at that. Was very anxious to see patients by myself – so I just jumped in feet first and started seeing them. They all spoke English today and all had very typical medical issues. Really enjoyed talking to a giggly 13-year-old girl about safe sex (her 15-year-old sister has a baby and teen pregnancy is rampant here). Obesity is also a major issues along with alcohol abuse. I heard there was also a fatal stabbing on Friday – but violent crime like that is apparently rare.

Then clinic was over precisely at 5 PM -- because the double booked 4 PM patients didn’t show. Then it was pretty much exclusively catching up on email for the next two hours. Then home, rest of the avocado, some more instant coffee, and quarterly report. I do miss the TV. Staring at a computer screen makes my eyes hurt but it’s either that or stare at the stars and only one of those prevents my mind from running my to-do lists over and over again in my head. Emily and I always say that TV is one of the few things that can really just shut it all out. Though these days it’s becoming less and less true for me, at least TV is not work, it doesn’t hurt my eyes and I can put my feet up. This month will be good for me – maybe I’ll learn to better clear my mind without the boob tube (I can do it, it just takes more work).

So now I’m exhausted and ready for bed. I have to get up extra early anyway to get there in time to use the computer before rounds.

Oh, a small note, I really like one of the docs I work with, one of the two John’s. I like them both quite a lot but this one John is particularly interesting. He was a sociology major (go humanities!) and was working for social justice when he realized he wasn’t making any difference and wanted something bigger and better: a career where he can distinguish himself and make change (sound familiar to anyone?). Anyway, we talked a lot between stress test patients and have a lot to talk about over the next month. He also said I could house sit for him when he and his wife are out of town for a week meaning I don’t have to live in squalor! Plus, he might be able to arrange me a day at the uranium mining clinic (they made all these American Indians work the uranium mines around here and now they all are horribly ill so they have their own clinic: more info can be found at http://www.sonic.net/~kerry/uranium.html among other sites). It’s about 3 hours north but he says he’ll schedule it close to when I go see Jessica so I have a head start on the weekend. Awesome!

Okay, eyes falling out of head…. To bed….
but first... an old picture of the exact same view from my trailer.

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Monday, August 28, 2006

A New Light

Sunday 8/27/06
Day two:  saw the trailer in new light; figuratively and literally. Disgusting. Looks like I moved into an old abandoned frat house. Couldn’t find any cleaner - but roach Kill was ubiquitous. Not a good sign.

The shower stall filled with water as I showered. There was actually food in the kitchen sink. I don’t think the bathroom sink has ever been cleaned since its installment (maybe in the 70s). Medstudents are worse than 18-year-old boys. It didn’t help that I had no coffee. No tea. So I went to Gallup and bought some necessities: dish towel, cleaning stuff, light bulbs (all at the dollar store), and came home and did the handy man thing for a bit. Fixed dangling light fixtures with found screws, cleaning surfaces three-four times with dirt still evident on my paper towel. But in all I think I made some headway and the place is already feeling more livable.


The drive to Gallup was gorgeous. Passed some Native American chapter houses, passed a lot of jewelry and trade shops.  Still rarely see anyone white. Most everyone here is Native American. Not that I expected otherwise, but it’s just so awesome to see such thriving communities. I pass signs that say, “You are entering land”. Can you imagine if you saw signs proclaiming entry into your people’s land? Very cool. I can only imagine how it might feel to have that kind of connection with your community (although the LGBT community IS pretty tight). On the way back I stopped at a trading post to get some milk. Men were lined up outside and were being directed in one by one. I have no idea why. I was hesitant to ask what they were all waiting for so I just bought my 2% milk and head out (they didn’t have skim).

So I’ve been reading aside from the adventures. The phone here doesn’t work so it seems, for now. I’m reliant on my cell phone. Thank god I get service (and its not roaming!)

What I’ve eaten in the last two days (this is kinda sad and more for my benefit to convince myself to eat better):
Day 1: breakfast: fruit and muffin; lunch; Blimpie sub, Doritos and very large diet Pepsi; diner: fry bread, water, cotton candy.
Fay 2: breakfast: frosted miniwheats with rice milk (the only boxed milk stuff they had at the store in Albuquerque – find it gross - will buy real milk); lunch: McDonalds (debated going to a couple cute cafes in Gallup but didn’t feel like sitting down to eat alone. Still feel too much like a fish out of water). It was gross and I only ate half of it anyway. Snack: slim jim (from trading post) and more cotton candy. Dinner: the rest of my McDonalds, plum, peach, finished the cotton candy and ate a bunch of oreos – all this wasn’t at once, but scattered from about 4 Pm to 8 PM. I will make more an effort to eat better soon. The trading post walking distance from here has lots of canned goods so I don’t need to worry about running out of food.

I went for a long walk today. At first I was frustrated with my walk. Every road I went down seemed to end so quickly and I had to back track and try another route. Eventually I found the only roads that I could walk more than a block or two were the big paved roads with heavier traffic and no sidewalks. So I gave in and walked in a dirt trail along a barbed wire fence around a marshy area, with the red and black rocks and mountains on the other side. Cars whizzed passed and I felt very exposed, the very white girl in her khaki shorts and tank top. A bit out of place. Reminded me of Africa. At least no one was running around and pointing at me shouting “la blanche! la blanche!” I noticed that all the teens I've seen so far seem to wear black. A random observation but I’ve seen about two dozen teenage boys since I’ve been here and every one of them was in black (mostly concert t-shirts). Lots of skatoboarding. Walked by a homemade sakte park. Note: apparently half of the 9,000 residents on this HUGER reservation are under 25 years old. I think they have at least two high schools.

On my walk I was looking out for the ancient pueblos that seem to be so famous here. Nothing to be found (yet). Just government constructed identical homes scattered rather haphazardly across patches of red sand and knots of grass. I got a better look at the yellow wild flowers I’ve seen in such abundance on all my drives. They look like a cross between a sunflower and a daisy. Bigger than the daisies I know with a black, craggy, sunflower-like center. I walked down “Main Street” which was near to Highway 53. I saw a few dogs but knowing that they don’t have indoor pets here I wasn’t as compelled to pet any of them. At the start of my walk dog approached me barking. I kneeled to appeal to him and his hackles rose so I stood and left, not wanting a dog bite to add to my Zuni experience. As I was walking down Main I felt something wet on my hand. A little black and brown dog, a likely Rotweiller mix but with all the burliness bred out of it, was sniffing my hand. It smiled widely at me and I stopped and talked to it. It came around to face me and sat down expectantly, wagging his tail, and nuzzled my hand. I pet it for a while and after some time, both of us satisfied, we each went on our way. He, under a shady tree, me, to find my way back to my trailer. The dog seemed to invigorate me (and the slushee I bought for .84 at the trading post) and made my walk home very pleasant despite the heat. I also noticed that everyone driving waved at me. Something I found incredibly warm and uplifting. I was feeling a bit lost and grumpy earlier in the day and the walk really cured me.

I cam home and read for a long while – hours. Now the sun is setting, really lighting up the tops of the mountain range bright red. Mars is supposed to be out tonight. This is the perfect place to see it. The stars are so numerous and the Milkyway evident. Mars should be gorgeous – especially with such a clear night.

Tomorrow’s my first day. I’m a bit nervous but not too much so as I know I will learn a lot and am prepared to be humbled.

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Sunday, August 27, 2006

Zuni Day 1



Saturday, 8/26/06
I’m so tired but I am going to try and describe my day. It was remarkable in so many ways. I left my house around 5:45 AM for the airport where I was early for my flight (despite the ominous Orange security level).

Flight to Chicago uneventful. Flight to Albuquerque from there was a pain. We were in the midst of boarding – my group, 4, was announced – when people started getting off the plane. Apparently it was “broken” (seriously). So they got us a new gate and a new plane. Then we finally got on said plane and sat there an hour on the tarmac, first waiting for “food” from the first plane (that we never were served – it was probably for first class) then waiting in line for takeoff.

Finally arrive in NM, get the rental car, grocery shop (so hungry by this point – it is now a good 9 hours since I had anything to eat and it was just a muffin then) and drive the gorgeous 2.5 hour drive to Zuni.

Once in Zuni I find the hospital and Dr. B and get my linens and key. Key doesn’t work. Nice Zuni man (Andrew) comes and helps me and gets me the right key. Finally in and can put away my melted margarine and other stuffs.

Then the sounds of drumming is overwhelming and I decide to check out the Zuni Fair they have every year – ending tonight. It was incredible. It coincides with a carnival. There are rides and games and such at one part of the area, then there’s a stadium with traditional dancing and dance/singing competitions in another. And yet a third area houses a powwow. I didn’t take pictures – I read in one of the brochures they sent me that photos are not allowed.

I met a guy named Alvin and his son, Alec (pronounced al’Ek), and his son’s friend David. I ate fry bread with honey and drank some water. Between dancing and powwow and people-watching at the carnival I also ate some cotton candy. The vendor was a white guy. He looked at me and shouted “a white girl! I’m gonna have a heart attack!” Then, “Hey (whatever his helper’s name was), check it out, a white girl!” Then he looked at me like he was expecting me to say something - other than the "cotton candy, please" I had already said. I was tired and far from witty so I just said, “don’t have a heart attack” I think he felt a little strange for acting that way – and rightfully so! But it was true, there were Navajo, Zuni everywhere… and me.

I still hear the drumming and when the wind picks up I hear the chanting. I wanted to stay longer but thought I'd die from fatigue if I did.

The costumes: kids as buffalo with huge heads and fur down their back, furry hooves. So many colors. Rainbows of colors. Feathers – eagle feathers and huge feathers. Rattles and bows. Huge feathered get-ups rivaling Carnivale – haloed behind heads and like wings on the back. Head dresses. Turquoise - so much of it. Especially on the women – they are adorned in enormous beaded necklaces, bracelets, turquoise rings, oval stones laid in silver, nearly the length of their fingers.

I was often reminded of Africa – maybe because the sand is such a similar color: a reddish clay color. Maybe it was the dancing, the outfits, or maybe it was just my fatigue.

Now I must head to bed. It’s 2:30 am my time and I’ve been up more than 20 hours.

The stars are incredible here.

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