Craig - Today was my last day in the labor and delivery room. It was busy right from the start with a C-section already in progress when I arrived. Although I have been observing these all weeks it is still incredible to watch how fast they can get the baby out. In less than 1 hour I watched the baby still kicking in the womb to a beautiful, confused little baby being lifted out, and the mother stitched up and placed in the recovery room. I also had the chance to follow the newborns back into the recovery room and watch as their APGAR scores were taken, and they were weighed, measured and taken to meet their mothers. After watching a second C-section shortly after, I observed another hysterectomy on a woman with advanced cervical cancer. The doctors seemed sure that the cancer was localized to the uterus so her prognosis seems good. I then had the opportunity to watch one of the more interesting surgeries I have seen so far. It was a 5 year old boy who had lost most of his ear in an accident. The surgeons had previously taken healthy cartilage from the boy and placed it under the skin in his abdomen. The cartilage was allowed to grow and today they were removing it to use in the rebuilding of his ear. Unfortunately the flap of cartilage was not large enough yet and was placed back under his skin on the opposite side. It was just amazing to see how far medicine has come and the incredible things that are possible these days. Afterwards I went and played with the kids in burn center for a while and met up with the other guys.

Marky Mark - This morning the pediatric emergency room started off quiet, but after an hour it started hoppin'. Most of the beds were kept full from 9am until I left around noon. Once again, I followed Carla, one of the students that has been working in the ER all week. The first patient of the day was an 11 month old that had a swollen humerus. After we took him to the x-ray department, it turned out that he had a dislocation at the elbow joint. Carla and I then took him over to see an orthopedist and with a little manipulation, and surprisingly very little crying, the ulna was back in place and he and his mother were sent on their way. The second case was a pretty disturbing one. It was a 3 year old boy that had been having convulsions with self mutilation. If we let his arms go he would immediately begin biting his hands. Unfortunately I left before many tests were run but with my 1 year of medical knowledge he almost resembled a patient with Lesch-Nyan Syndrome. After leaving the ER I got to spend another enjoyable hour in the burn clinic with the children.

CJ - Today in the burn clinic was outstanding. When I got there, I played with the kids for a little while before trekking out to the little shops outside of the hospital for a soda with Sumaya and Jenny. When we came back in, we found that the were about to start surgery (literally, about to start) and I was invited in to watch (but not scrub in). The first surgery was a partial-thickness graft of a little girl's hip. Dr. Romero used a surgical instrument known as a dermatome (literally shaves the first layer of skin off of an undamaged area). The skin that is removed is then placed over an area where scar tissue has been removed. This helps prevent contracture due to scars and such.

The next surgery involved little Daniela, a little girl I'd been visiting with for the past few days. She is 7 years old with burns to both thighs, inside of her legs, and her privates. The burn on her left thigh stretched down and past her knee. This could pose a problem if a keloid scar forms as she will not be able to extend her leg anymore. Right before the surgery was to begin, Dr. Romero told me to run out and scrub up because I was going to help! Dr. Romero took a full-thickness graft from her stomach (below her belly button to the top of her pubis) that measured about 3 inches. The hole that was left (as a full-thickness scar involves taking all the skin, glands, and fat from an area) was sewn shut. He gave me a chance to do intra-cutaneous sutures, but mine weren't as good as he'd like so he replaced them. He also took some partial-thickness from the untouched portions of her leg and covered the open areas (from where the burn damaged skin areas had been debrieded) on her thighs and privates. The surgery took a little over 3 hours to complete on little Daniela. I really, really hope that the grafts take so she can have a much better quality of life. She is an extremely sweet little girl.

Pete- Responsibility for a patient is something I expected to have in another 2 years, not today. Yet, I was presented with a 2 year old named Esquiel with such extreme laryngitis he could not breathe. I was told by the chief resident that I was fully in charge of monitoring his well being throughout the morning. I learned how to set up a nebulizer, take an axillary temperature on an irritated 2 year old, and how to place a electrodes for the heart monitor. It was unreal to actually be in charge and running around all morning making sure he was given his medications, and holding his hand when he was scared. He was most afraid of having his blood pressure taken, and would take the cuff off as soon as I put it on him. In turn, the an old Bohemian rhyme that my Grandpa Bob taught me way back when I was little came to my head. It distracted him enough to allow the blood pressure to be taken an for him to have a brief smile. I guess even an old Bohemian trick even works in Latin America, so thanks Grandpa for providing me with a needed trick today so I didn't have to resort to holding the young guy's arm down. I'm planning on going in throughout the weekend to check up on Esquiel and seeing the new patients.