Hearts are breaking all over Cochabamba

We leave Cochabamba in 2 hours to start our very long (several day) voyage back to the United States. While we are sad to leave the hospital, the kids at the burn center, and Cochabamba in general, we are ready to get back to the states.

On Monday, Henry headed over to the burn center where he spent a lot of time playing with the kids, followed by observing some cleanings of burns in the OR. Paige went back to the Adult ER and passed the time helping clean and bandage patients' wounds while she anxiously waited for Dr. Amaya (general surgeon) to arrive. She got to go on rounds with the Bolivian medical students and see a lot of interesting cases, but the highlight of her day was a patient who came to the ER with appendicitis... A case of appendicitis may not sound exciting at first, but Dr. Amaya asked Paige if she would like to go with him into the OR and observe the appendectomy! This was a real thrill for Paige as she is very interested in abdominal surgeries. After the surgery, which was impressively quick, Paige returned to the ER where Dr. Choque allowed her to help suture a patient's wound...busy morning. Rachel went back to the main hospital with faith that the orthopaedists would once again track her down and drag her away to work with them for the day. Sure enough, within 30 min, Rachel was wisked away to external consult for trauma and ortho. She spent the day continuing to learn to read x-rays, diagnose patients, and determine the correct course of treatment. She helped change a lot of bandages and also took out some sutures from post surgery patients. In addition, Rachel impressed the ortho docs with her extensive knowledge of physical therapy and how to evaluate the extent of a patient's injury. Hanging out with all those physical therapy students at USC has really paid off. Monday afternoon, we went back to the Cancha for last minute souveniers. On Monday night, we all took a salsa lesson. Paige and Henry quickly learned the steps, and by the end of the night were able to dance Salsa pretty well as a pair. Rachel, on the other hand, learned the steps and added some latina pizzaz, but cannot be tamed enough to dance with a partner.

On Tuesday, Henry once again spent the day in the burn center playing with the adorable kids...a great way to spend his last few days in Bolivia. Paige went back to the Adult ER, hoping for some action; Rachel, being indecisive, bounced around between the Peds ER, external consult for ortho and trauma, and the Adult ER. Although there was not much action in the Peds ER, Rachel did discover a very good looking doctor and later brought Paige back to see him. External consult was the same as always. In the Adult ER, Paige helped clean the wounds of a lot of patients and change their bandages. Rachel finally settled on Adult ER, where Dr. Angulo, her intern friend, let her help suture two wounds on a woman's head, take out stutches from a man's nose and forehead, and help splint and bandage a man's hand who had broken 3 fingers.

In the afternoon, we went to the children's home where some of the patients from the burn center who are in recovery are allowed to stay. We played with the kids, took some more pictures with them, and got to see the TV and DVD player that had been bought with money donated by MS4BCI. The tv and dvd player will be used for a month for a burn prevention campaign and afterwards will be put in the burn center for the kids to use. We also donated fire extinguishers to the burn center because they didn't have any. A burn center without fire extinguishers... quite the contradiction. On Tuesday night, we went out with 2 Canadian nursing students (Rebecca and Louise) and a second year med student from London (Alex)...all of whom we met volunteering in the burn center. We had a great night sharing travel stories, making fun of eachothers accents, and learning about the different medical systems in each country.

Wednesday...sadly our last day in the hospital. And als a festival in Cochabamba. Much to Paige's excitement, there was an all day parade that we passed on the way to work. Once we reached the hospital, Henry chose to spend his last morning with the kids in the burn center, whom he will miss terribly. Paige went back to the Adult ER one last time. At first, the ER was dead. Good for the citizens of Cochabamba...bad for Paige and the docs. Around 9:45, the ER exploded with action: car crashes, soccer injuries, lots of fractured bones, and even a man who had fallen 2 stories. Paige was kept busy chasing around doctors, helping out where she was asked. Rachel took Alex, the med student from London, around the hospital to introduce him to her ortho doc friends since he is also interested in orthopaedic surgery. When Rachel brought Alex back to external consult to introduce him, Dr. Mustafa said, "Why are you here? Go upstairs and watch the surgeries!" Rachel and Alex gladly listened and ran off to watch Dr. Undurraga and his team repair a totally displaced, fractured femur head by inserting a metal plate. After the surgery, Rachel let Alex with the ortho docs to carry on her legacy and ran off to meet with Henry and Paige. We went out to lunch with Barbara (who works with BCI) and Dr. Montano (who set up all of our hospital rotations for us).

Now we're frantically packing (and blogging)...prepping for our glorious return to the United States. Meanwhile, we know that people's hearts are breaking all over the hospital because we are leaving them. Especially in orthopaedics... The ortho docs offered to pay for Rachel to stay for a few more weeks. Unfortunately, the new school year is starting so we have to get going.

We took the midnight train going anywhere

The most commonly asked question of us is “Where are you from?”, followed closely by “Aren’t you all so upset about what happened to Michael Jackson?” Everyone we’ve met is obsessed with Michael Jackson; everywhere we go, we hear his music blaring from car stereos or from tvs in restaurants. Even on our train ride to Uyuni, the first video that was played was an hour and a half long tribute to the ‘King of Pop’…which we thoroughly enjoyed.

We arrived in Uyuni on Friday at 11 p.m.; the entire town was dead, reminding us of a ghost town from an old western movie. Tired as we were, we were happy for the quiet and headed to our small, cold hotel to tuck in for the night. The next morning, we headed to the town center to have some delicious breakfast and then waited outside the travel agency for our tour guide to take us to the salt plains. Half an hour after we were told to meet (right on time for Bolivians), our tour guide pulled up in a jeep whose engine barely started and told us to hop in. We were joined by an Israeli couple who turned out to be very fun travel companions. Soon enough, our driver was flying down the dirt road on the way to the salt flats giving us more of a roller coaster ride than a tour. Unknown to us, included in our trip fee was a near death experience. Our driver came within an inch of slamming into a car that was stopped in the middle of the road! As we all screamed and our lives flashed before our eyes, the driver narrowly avoided the car and then continued racing down the road…clearly he had learned his lesson. Our first stop on the tour was the small town where they process all of the salt; there was also an open market where they were selling goods made out of salt. We were allowed 10 minutes to wander around before we had to re-enter the death vehicle. We headed out into the salt plains where we took beautiful, and some ridiculous, pictures. The salt looked like snow, only it was hard and not as fun to play with. Henry and Paige refused to have a “salt ball fight” with Rachel, so Rachel settled for building a ‘salt man’.

Our next destination, the salt museum, was closed, which is unfortunate because it is a building that is made entirely of salt. It used to be a hotel, but was converted to a museum to make more money off of tourists. After getting over our disappointment, we headed over to Fish Island, the final stop of the tour. Fish Island is not surrounded by water; rather it is a gigantic rock (that looks like a fish from far away) in the middle of the salt plains. We bought tickets to enter the island, and hiked up the trail to capture beautiful photos of the giant cactuses all over the island as well as the breathtaking view of the salt plains. When we returned from our hike, our tour guides had a picnic lunch set up for us on a table made of salt; we had llama meat and cheese as well as a variety of other delicious foods. After lunch, Henry and Paige each wandered off into the vast expanse of the salt plains to enjoy the view and the quiet; meanwhile, Rachel treated the salt plains more like a salt beach and laid down to catch some rays.

In the late afternoon, our guides drove us all back to Uyuni to enjoy the excitement of the town. (I use the term ‘excitement’ lightly as there is not much to do in Uyuni). Despite the lack of entertainment offered by Uyuni, we all found a way to pass the time, wandering up and down the streets, checking out every little shop along the way. When it came time for dinner, it was an extremely difficult decision considering that there were 7 pizzerias all with the same menus. We finally settled on one and sat down to order when our Israeli friends wandered into the same restaurant and joined us for dinner. The food was delicious, but what made the dining experience even more special was the mix of music videos playing throughout the meal, including some appearances from the beloved Michael Jackson. After dinner, we killed time in our hotel room until we caught our midnight train, reminiscent of that famous Journey song. Of course our train was not going just anywhere, it was headed back to Oruro where we caught a bus back to Cochabamba. The trip home was uneventful and much less smelly than our last bus trip, though Rachel did argue with a taxi driver over fare to the bus station…walking away and ignoring him until he agreed to her desired price. We made it home safely to the warmth of Cochabamba in time to go back to the stadium to visit the regular Sunday puppy market. Tomorrow, we return to work for our last 3 days in the hospital.

Superlatives:

Most likely to die in a fiery Jeep crash: All of us

Street dogs are just as dirty as they appear.

There is a hairy, dirty, fleabag dog that lives on the street right outside out apartment. He barks all night long, keeping us awake, and his fur is so long that we're pretty sure he can't see anything...but we love him. He welcomes us home every day by sleeping in the middle of the sidewalk and blocking the path. Every group so far has developed a special bond with the dog; Group 1 named him Molsen and Group 3 called him Shaggy. However, our group has topped it all. Henry and Paige tried for a week to convince Rachel to pet Shaggy...and she finally did. (She lives life on the edge.) It was disgusting, but Rachel has not yet gotten any diseases from the encounter.

Back to business...

During the day on Wednesday Paige got the chance to again scrub in at the Burn Center. She assisted in two more cleanings and got the chance to lay a skin graft with Dr. Romero's help. After tearing herself away at the agreed upon time of 1 pm, with Dr. Romero admonishing her to stay till they were done at 3, Paige headed back to the apartment to wait for the travel agent, Juan Carlos, to stop by and tidy up the remaining details of the coming weekend's trip to Uyuni. While waiting, Paige felt completely exhausted and ended up taking a nap from 3 to 6 and still woke up feeling wiped. All three of the group then ended up taking a 'semi-little-more-than-half-of-the-trip' celebration to Tuesdays (hooray American food!), the Bolivian's effort at an American restaurant loosely based on TGI Fridays. After having a pretty realistic dinner, Rachel and Paige went to the hospital for a night rotation. Paige went up to the OB/GYN ER to shadow Dr. Ferrel, but beforehand had to do battle with the scrub nurse who was extremely stingy with the few scrubs and boots she had remaining for the evening. After changing into scrubs, Paige watched a natural birth and 2 C-sections. Absolutely fantastic and well worth staying up to 1 am to go in and observe! Thursday morning brought bleary eyes and Paige feeling a little sick and tired out from the morning before. Pushing through it, as it was to be her last day in the Burn Center, Paige scrubbed in a final time and did 2 simple cleanings and set a femoral catheter in with 3 stitches. A great end to her stay at the Burn Center!

Henry recovered from his fish water illness and returned on Wednesday and Thursday to the Adult ER. On Wednesday, Henry helped insert 2 foley catheders and 3 nasogastric tubes. We are now confident that Henry could do either of these procedures on his own...with his eyes closed. Thursday was a slow day in the ER, but Henry still managed to find a way to help out. He watched Jorge take out stitches from a patient's nose, and then was told that he would get to remove stitches from the next patient who needed it. Immediately, Henry turned around to see another patient who was ready to have stitches removed from his stomach after having part of his colon resected. Henry stepped up to the plate and removed the stitches like a pro, all the while trying not to gag from the aweful smell of the man's "poop bag". Brave guy.

Rachel invited herself back to orthopaedic surgery on Wednesday, starting her morning by trying to convince a hospital employee to issue her surgical scrubs. After a 20 minute battle, Rachel won and headed into the OR. The ortho docs allowed Rachel to assist in the surgery, which resulted in Rachel's scrubs being soaked in blood, cleaning solution, and IV water. Both of the patient's knees were swollen and full of pus, and while the docs cut open the man's knees, Rachel sprayed 18 bags worth of IV fluid into the wounds to make sure they were clean. Gross, but fun. Not wanting to put up another battle for clean scrubs to enter another surgery, Rachel returned to the Adult ER to run an EKG. On Thursday, Rachel went back to surgery and didn't even have to fight for scrubs. In her first surgery, Rachel handed the doctors instruments as they cleaned up an infected leg wound from a previous ortho surgery. The docs remove part of the patients bone, cleaned the wound, and let Rachel bandage him back up. In hr second surgery, Rachel watched as a surgeon removed a growth from a patient's face that she swears looked EXACTLY like the scars on Edward Norton and Brad Pitt's hands in the movie Fight Club...though it is unlikely that the 92 year old woman was in fact a member of fight club. The surgeon offeed to let Rachel scrub in and help suture the wound. Afterwards, Rachel headed back downstairs only to be literally dragged away by three of the orthopaedists. They spent the next few hours in external consult looking over x-rays and diagnosing patients...and trying to convince Rachel to go dancing.

Tomorrow morning, we're off to Uyuni to visit the salt plains for the weekend.

**Pictures have finally been added to our previous blogs. We had technical difficulties until now.**

You shouldn't drink water that tastes like fish.

Bright and early Monday morning, we headed to the burn center to deliver the toys we had bought to the kids. Their bright smiles and excitement wiped away all our exhaustion from traveling and got us ready to start our week. Paige started her rotation in the burn center. She started the morning with rounds given by the interns. Eventually Dr. Romero arrived and the surgeries began for the day. In total there were 5, and were all very quick and without any real problems. All the nurses and doctors in the Burn Center are experts at what they do, and this day was no exception. Three of the surgeries were simple cleanings, with the bandages removed the doctors used the grater on the burns to reesatblish circulation to the injured areas, otherwise the skin would continue to necrose and die. All the same it was a shock to see the graters being used on the children, but afterwards the burns looked much better with all the dead tissue removed and the previously bleached white skin looking healthy and pink. The other two cases were of more note. For the fourth case of the day, a little boy had been burned on both feet when he and his brother were playing with alcohol that came too close to a flame. The burns were very deep and Dr. Romero decided the boy needed skin grafts taken from his thighs to cover the deep burns. Once the grafting was done and the skin had been laid over the injured area, Dr. Romero spent time explaining how the graft would attach itself as skin to the injured area, that after being burned now had no ability to regrow. The 5th and final surgery was of a young girl with a 3rd degree burn that began right on her hairline and went back along her skull. The burn was about the size of a large egg. After seeing the wound for 5 seconds Dr. Romero immediately decided that the girl's surgery would need to wait until the following day, since he planned to rotate the girl's scalp so her hairline would be approximating normal, and move the area where she would regrow the skin back to the middle of her scalp, where eventually her hair would grow over it and hopefully wouldn't even be visible in time. Dr. Romero told Paige that she could help assist in sugeries and scrub in the next day now that she had some experience and had seen the generalities of what they did. Paige finished the day happy she had stayed some extra time and excited about the next day.

Rachel decided to take a break from her one-track mind of pediatrics and give adult medicine a chance, spending the day in the Adult ER. Excitingly enough, it happened to be an ortho trauma day. Upon her arrival, Rachel immediately saw x-rays of a patient with a broken femur and displaced elbow; the orthopaedic resident allowed Rachel to help put casts on the patient's arm and leg. During the casting process, Rachel explained to Dr. Vegara that she wanted to be an orthopaedist, so he made sure allow her to see all of the ortho trauma cases of the morning, including two patients with fractured ribs, a patient who had fallen and broken her hip, and a car crash victim with a fractured radius and zygomatic arch. In the process of impressing the residents and interns with her knowledge of ortho and radiology, Rachel met another orthopaedist named Dr. Middagh who also offered to include her in his interesting orthopaedic cases. Just when things looked like they were going to settle down, ambulances started bringing in patients from a several car pile up. Before Rachel left the ER, she saw 5 patients come, followed quickly by the press. Rachel took vitals for one patient, ran an EKG on another patient, then spent the rest of her morning trying to keep the press away from the patients. Finally, Rachel returned to the burn center to play with the kids and their sweet new toys.

On Tuesday morning, Paige returned to the burn center to continue her rotation. There were four cases that morning, with the little girl's surgery from the day before scheduled last since it was estimated to take approximately 3 hours. Dr. Romero had his intern, Miguel, and Paige scrub in on the first 2 surgeries, the 1st of which was a simple cleaning, and the second of which Paige assisted Miguel in setting a skin graft on a little boy's hand. As exciting as it was to scrub in, Paige couldn't wait for the final surgery of the day. Another volunteer was allowed to assist on the 3rd surgery, and continued to help during the 4th surgery, but 1 hr into the scalp rotation Dr. Romero left the OR after completing the hardest part of approximating the scalp borders, leaving only Miguel and the volunteer to suture up the remaining borders. Paige then scrubbed in and was able to suture up a side of the wound while Miguel continued on the other side. When Dr. Romero returned from leaving the OR to finish the surgery he was impressed with both sets of sutures and told Paige she had done very well. Even though the surgery ran into midafternoon, FAR after Paige's lunch, she left feeling ecstatic about scrubbing in to surgery that day and had high hopes of seeing more exciting things the next day.

Rachel bravely went back to the Adult ER, hoping to catch an orthopaedist and convince them to take her to surgery. Much to her dismay, the ER was very quiet, though she did get to remove stitches from a patient's hand and later help stitch a man's split lip. Just after finishing the stitches, Rachel turned around to see who she thought was the head of orthopaedic surgery and ran over to introduce herself. Dr. Undurraga was thrilled to hear that Rachel was interested in ortho, especially since his own daughter is specializing in ortho in Chile. He took Rachel up to the orthopaedic ER and sent her straight in to observe a surgery. The patient being operated on had been hit by a car and had broken several bones in his right arm and leg. After looking at the x-rays, Rachel saw that his radius, ulna, tibia, and fibula had been fractured (into several pieces) and were completely displaced. Rachel watched with excitement as the 4 orthopaedic surgeons hammered an hige rod into the patient's tibia and screwed metal plates into his raduis and ulna. The ortho OR sounded like a construction zone with drills and hammers constantly being used. Surrounded by the chaos, Rachel felt right at home.

As for Henry, the title of this blog is his advice to all of you. Henry has spent the past 2 days at home, feeling too sick to work at the hospital. Pobrecito.

Finally, continuing our "marathon training", we went to the Cristo this afternoon. For those of you who don't know, it is a statue of Christ way up on a hill outside the city. Unfortunately for us, the automatic lifts were broken and we ended up having to climb 1,429 steps to get to the top. On the bright side, Henry is now ready to enter an Iron Man race, Paige feels prepped for the 2012 Olympics, and Rachel has the lung capacity of Michael Phelps.

Sit, don't walk, and spit everywhere

This past weekend, we journeyed 11 hours by a combination of bus and ferry in the bitter cold to reach Lake Titicaca. The excursion was off to a rough start when Bolivianos kept trying to oust us from our assigned seats on the bus at the first stop outside Cochabamba. We decided to pretend to be asleep to get them to go away, only to have them bring the conductor up to move us. And then we discovered that we were stupid and had gotten on the wrong bus. No worries, though. It was the correct company and destination, so we had made an honest mistake. Luckily the bus we were supposed to be on was right behind us, so we moved without a problem.
After a sleepless night on the bus, we were met upon arrival to the lake by our tour guide and immediately began our long list of activities. We enjoyed a typical Bolivian lunch in the center of Copacabana, followed by a boat trip (yes…more traveling) to Sun Island. The Aymara people, natives of Sun Island, greeted us by charging us to use the bathroom and take pictures of their llamas. We then climbed what seemed like a million stairs, which was no easy feat considering the fact that we were 12,000 feet above sea level. The hike was worth the effort, though, for the gorgeous view of the lake and other islands. Plus, now our lungs are so conditioned we could probably return to South Carolina and run a marathon with minimal effort. Our tour guide took us across the island explaining how the lake got its name, the history of the Aymara people, and the ancient Incan culture of the island. Along our trek, we passed countless donkeys, sheep, and llamas (who thankfully did not spit at us). Our guide explained that the donkeys are used to transport water, food, and other products up and down the mountain. He said that the llamas are less plentiful on the island because they are not as useful. “You cannot give the llamas more than 20 kilos. If you do, they sit, don’t walk, and spit everywhere.” At the end of our hike, we reached the summer palace of the Incan king; Henry and Paige had a bit of trouble trying to fit through the short doorways. After our tour, we hopped back on the boat to head back to Copacabana. Our guide took us to our totally awesome hotel, which was far from city center but overlooked the entire city and the lake. Plus, the hotel room had hammocks and a loft, where Rachel happily volunteered to sleep. We spent the evening exploring the city and buying souvenirs, followed by an early night back to the hotel to sleep off the countless hours of travel.
On Sunday morning, we ate the biggest breakfast known to man and then met with our tour guide to go see the Catholic Church. Bolivianos travel from all over the country to pray to the Saint Copacabana. Outside of the church, cars, trucks, and busses lined up to be blessed by the priest. They all decorate their cars with flowers and ribbons, and the priest comes around and splashes water on the cars and their passengers, blessing them for safe journeys. Finally, we wandered up and down the streets, which turn into a gigantic outdoor market during the day, haggling for the best price on Alpaca goods. In the afternoon, we started our long, uncomfortable, and exceptionally smelly voyage back to Cochabamba, arriving home at 1 a.m….exhausted.
We’ll fill you in on our latest hospital adventures tomorrow.

Crossing the street here = Live game of Frogger

We are currently packing up our bags to head to Lake Titicaca for the weekend, but before we take off, here's an update on how the rest of our week has gone...

On Wednesday night, we returned to the hospital to work in the Pediatric ER. While it was not an exciting night for traumas, Henry managed to brush up on his Spanish, Paige mastered her gauze folding skills, and Rachel explained the American medical school program to the on-call orthopaedist. That's about it...

On Thursday, Paige and Henry headed back to the Adult ER to work with Jorge where they got to see a man with bleeding hemorrhoids, a partially paralyzed woman, and a man who had sliced off his finger. Overall, both Paige and Henry totally dominated the ER that morning. Meanwhile, in the burn center, Rachel scrubbed in on another surgery. After showing her what to do, Dr. Romero stood back and watched as Rachel skillfully completed a skin graft on a child's leg...checking her work afterwards of course. The patient had third degree burns on her thighs, so we took skin from her calves to place over the affected area on her thighs. It was quite an experience for a rising 2nd year medical student. On Thursday afternoon, Paige and Rachel headed to the Cancha to buy toys to donate to the kids at the burn center, which we will be delivering on Monday morning. (After having tested them out ourselves, of course.) In other exciting news, Paige appeared in a picture on the front page of one of the Bolivian news papers in an article about the patient who had attempted suicide. So she's practically famous here...

This morning marked the end of our first, and very successful, week at the hospital in Cochabamba. Henry and Paige shadowed Dr. Farrel in the ob/gyn ER and learned about the miracle of birth. Dr. Farrel taught them how to measure a pregnant woman's stomach and cervix to determine how far along she is, and also how to measure dilation to know when to send a woman to the delivery room. Elbow deep in placenta all day... On a completely different note, Rachel went back to the burn center to observe 2 more surgeries. In the first, the child had been burned on his knee, so a graft was taken from the thigh to place over the affected area. The second patient of the morning had burned her hand and her fingers were stuck together and to her palm. Dr. Romero separated the fingers from eachother and from the palm, drilled pins into the 4 fingers, and bandaged up the girl's hand to heal. While Rachel did not get to assist in today's surgeries, she snapped a lot of great pictures and learned a lot from Dr. Romero. In fact, she dazzled him so much with her wit and charm that he invited her to spend every day assisting him in the OR until she leaves for the states...and then gave her a cookie.

Now its off to dinner...and then our 11 hour bus ride to the lake.

Superlatives:
Henry: Most likely to be the last one ready in the morning
Paige: Most likely to appear in the newspaper
Rachel: Most likely to find a Bolivian husband

Morena con ojos verdes

Other than feeding a stray dog (who Rachel fondly named Rocky) pieces of chicken outside a restaurant, getting lost in La Cancha (Cochabamba's crazy outdoor market), meeting a man from Rachel's home state, and trying a bunch of Bolivian food without getting sick, we've spent most of our time at the hospital. On Monday night, we all returned to the hospital to work a shift in the Pediatric ER. There were several kids who needed stitches for head injuries, some swine flu scares, and child who had been burned on her arms and face. Rachel was in future orthopaedist heaven when a young boy came in with a totally displaced broken humerus. We got to watch the doctors reset his arm, stitch him up where the bone had gone through his skin, and make him a cast.

On Tuesday, Rachel headed off to the burn center while Paige and Henry worked in the Adult ER. After an hour of playing with the kids, Rachel got to scrub in on procedures for 4 different patients. The first two were dressing changes of children with third degree burns. During the third surgery, Rachel got to assist Dr. Romero in grafting skin to a young boy's hand who had lost a finger. Dr. Romero gave Rachel a new nickname (since he waited until the end of the day to ask her real name). Dr. Romero calls everyone "Morena" or "Moreno" instead of calling out everyone's real names. However, Rachel got to be called "Verdes", which is short for"La morena con los ojos verdes". Now he just sticks to "Raquelita". In the final surgery of the day, Rachel got to assist the doctors in cleaning the wounds of a little girl who had been burned on both legs. At first, Rachel felt awful using what looked like a cheese grater to scrape off the patient's skin, but after the procedure was finished, the wounds looked so much better! By the end of the day, Dr. Romero had invited Rachel out for "pato", which, for all of you who don't speak Spanish, means duck. He had bet that if his procedures went well, everyone would have to buy him and his friend Raquelita a delicious duck dinner. We'll see if that ever happens.

In the Adult ER, Paige and Henry followed around a rotating intern, Jorge, an Argentinian who speaks very good English and is very willing to teach and show different injuries and how to treat them. Halfway through the morning a young boy of 14 came in completely flat-lined because he apparently had touched a live electric cable and gotten shocked. After extensive CPR, numerous defibrulator shocks, and nervous doctors looking around, the boy's pulse came back, thank the Lord. After stabilizing him he was wheeled away to the PICU to be monitored for a few days. All of the madness seemed to take no time at all but when Henry and Paige looked up at the clock it was only 20 minutes time till the end of the day. Time seems to really fly in the ER.

Wednesday morning was even more exciting for everyone. Rachel returned to the burn center to scrub in on another surgery...this time actually getting the chance to suture! The patient was an 8 year old boy, Juan Carlos, whose hand had been burned and his middle and ring fingers were actually stuck in a flexed position to his palm. Dr. Romero cut the fingers free from the palm and then used skin from the boys thigh to graft over the wounds on his hand. While Dr. Romero stitched the new skin onto the boy's hand, Rachel stitched closed the wound on his leg. As a huge confidence boost, Dr. Romero told Rachel that her sutures were beautiful. :) Rachel has also had a blast with the kids in the burn center. Every morning, she helps feed them breakfast and plays with them for a couple hours before going into surgery. They are so adorable and full of life!

And continuing the excitement from the Burn Center, Paige and Henry had another crazy morning in the Adult ER. When they came in to the ER at 8:15 am there was a boy of 18 who was being stitched up by a surgeon. The poor boy had tried to commit suicide when his girlfriend had died a few days before. When the surgeon needed help cutting the stitches and cleaning the wounds, Paige got offered the chance to put on gloves and help. There were a number of wounds that needed to be stitched up, and tendons that needed resewing. The whole process was very interesting, but both Paige and Henry became extremely angry when the hospital allowed the press to come in to take videos and pictures of the boy. Later in the morning after the boy was stitched up they even allowed the newspapers to come in to interview him. Goes to show how different some things are here in Bolivia. After the 18-year old, Jorge had another patient with a broken leg. Paige and Henry were allowed to assist in putting a cast on his leg and getting him set up to go home. As it was getting on in the day, Paige and Henry left for lunch, but were gladly invited back by Jorge to pull a night shift in the ER as he is working during the night as well.

Tonight, Paige and Henry will return to the Adult ER for some excitement while Rachel will be pulling a night shift in the Pediatric ER.

Until next time...