Clouds

" If all of life were sunshine

our face would long to gain

and feel once more upon it

The cooling splash of rain"

- H. J. van Dyke

Most of us residents are familiar with the "cloud" phenomenon; that is, at one time or another, you get a reputation of either being a "black cloud" or a "white cloud," depending on what "goes down" during your shifts.

A "black cloud" is someone on whose watch disaster strikes. This applies to all call, but particularly seems to be the case with respect to OB patients. Rocky had about 4 code c-sections called on FP patients in labor (including one preterm labor/breech in the vaginal vault) while she was on night float as a 2nd year. I remember hearing about a call in which Jeremy had, amongst ER admissions which he always has, a 26 week pregnant FP patient come in with PPROM (preterm premature rupture of membranes) and another woman who basically coded on him post-delivery. Call is seemingly always like that for him which makes most of us very reluctant to switch for days when he was supposed to be on :). I did my last week of nights as an intern on OB with him, and I remember it was disastrous!!


Mehrdad, one of the FP residents that graduated last year, was also very very "black." On FP calls, he'd have like 7 ER admissions, 4 patients in labor, central lines to place, and at the end of the night he'd say things like, "That was such a great night! I learned so much!" VA calls were the same way-- I don't know how many codes he had to run there while on night float. But he had such a wonderful attitude.

Hao, one of the OB chief residents last year, was perhaps the blackest cloud I have met. She had a horrible vaginal breech head entrapment which everyone still talks about today. I prolapsed my first (and only) umbilical cord on AROMing someone on a shift with her, and have never worked so hard on ER consults or labor management as when I we were on nights together (I remember saying one time to her, "Hao, I have never had a night as bad as that one" and thinking to myself that that it was unsafe for patient care. You know she was a black cloud when she replied lightly, "You think that was a bad night?!".


However, lately, I wonder whether being a black cloud (in terms of work) is really a bad thing, or whether it just makes you better trained, as "what doesn't kill you makes you stronger," right?


I tend to have a white cloud. On FP night float, I found it amazing that I was able to sleep most nights due to the ER being quiet. I had no one code on me while on VA night float. There have been some 24 hour OB calls (including Thanksgiving, as well as last Saturday and this past Friday night) when, despite having the ticking OBGYN ER consult time-bomb pager, I have not had to go down there once. I felt so bad because last Friday night before I came on for my Saturday call , Sarah had, amidst a fairly busy night on the L and D floor, in a 12 hour period, seven ER consults, including delivering a placenta down there, and a couple of D and Cs! I think her former white cloud label (along with that of Jen, the chief she was on with), got revoked after that night.


Granted, I do a lot of pre-call praying that I won't get overwhelmed. I pray that the ER residents will just use their brains and figure out how to manage a miscarriage or vaginal bleeder rather than reflexively calling the obgyn resident every time (do they call cardiology every time someone comes in in afib? I think not. We joke that they consult us every time someone with a uterus rolls in to be seen!). I prayed my way every day to the VA in Rancho Cordova, and had not one veteran code on me. I'm not sure I can always attribute my luck entirely to prayer, but I'm wondering: why am I a white cloud, and is it really good for me?


I feel that, in some ways, being "lucky" may not be optimal for residency training and actually may, really, be very unlucky in the grand scheme of things. I have had pretty good OB training, including decent c-section numbers and antepartum management; however, I am limited in my experience particularly in operative deliveries (vacuum, forceps) , higher-degree repairs, and in dealing with shoulder dystocias. I have not been involved in any c-hysts (cesarean-hysterectomies, usually done emergently to control excessive bleeding).


It is pretty standard that we FP/OB residents don't get quite the volume of the categorical OB residents in most everything, particularly because they rotate at Kaiser, but I have basically had no training in the above. Maybe no one on my calls have needed operative deliveries because I am more patient with pushing, fetal monitoring strips, or am strong at getting people push harder or more effectively. I have not had any bad shoulder dystocias. I have not had a patient have a deep 3rd or 4th degree tear (maybe I protect the perineum well?). In c-sections, I have not yet lanced the uterine arteries or had a cystotomy (bladder puncture). Although it certainly wouldn't be good for the patient, I have joked that, one of these days, I am going to poke a hole in the bladder just so I can learn to repair it.


And while I got to do some cool things last week (such as a c-section for triplets I'd been following for the better part of the month!), I also felt very unlucky. I had never delivered twins vaginally before and it is pretty rare that mom a) goes to term, b) has the twins in a position to permit vaginal delivery and c) wants to try a vaginal delivery over just scheduling a c-section. However, last week we had two twin inductions, one last Saturday while I was on and another later in the week. The first mom (a multip) got to complete dilation with her twin A and then decided that she couldn't push any more than about 1.5h and requested a c-section. I almost said to her (but was definitely thinking), "you have got to be kidding me!" The second mom being induced ended up not having a stable presentation with twin A moving from vertex to oblique/other and, while I also got to do her c-section, I was very disappointed at not being part of a twin vaginal delivery, as I have had a grand total of zero.

This past week (my only week of the block that I was not antepartum resident) was my last full week on UCD Labor and Delivery until the end of the year when I may have to be "acting chief" (I do have some OB calls here at there this next month). There were four assisted vaginal deliveries this week during the hours I was on. I was present at each of them. I got to do zero of them. Maybe it's because I am not assertive enough. Maybe it's just not meant to be. However, as far as building my skills goes and in missed opportunities, this was the the "blackest" week I have had, which punctuated a pretty unsatisfying month in general filled with lots of call, early mornings, rounding, note-writing, and painful clinics.

While it is great for patients for me to generally be such a white cloud and it really isn't fair of me to wish an obstetrical emergency on anyone, I am nervous (esp knowing I will be chief next year) because I haven't seen/managed those complications so that, when they do happen, I'm not sure I will be prepared. Someday, and rather soon, I will be out in the real world without the kind of backup we have here and the best time to learn such skills is now, in residency, when we have a lot of help and supervision. I am pretty sure those people who are the "blackest clouds" are going to be the best trained physicians, and I do envy them in many ways.


So, from now on, I am going to stop wishing I am such a white cloud. Despite loving the sun, I'm going to try to embrace the rain. I'm going to tell myself that stress and a little disaster is probably good for me. Even if it means I have to go to the ER! :)

Tastes of the season

While in Peru/Bolivia on vacation, I had lots of time to feel like a "real person" with a "real life" and contemplate all the things/activities that I feel like sometimes I miss out on due to the hours and stress of residency. Cooking is one of those activities that has definitely fallen by the wayside during the past 2 1/2 years. While I will never be any JB Kit or claim proficiency in the kitchen, there is something satisfying about throwing together random ingredients and ending up with a meal! While I love to eat and, when I have enough time to plan, grocery shop, and have people over, also like to cook, I don't love to cook and, when tired or stressed, tend to spend my waking hours doing other things. The last thing I (very impatient by nature) want to do when I come home, sometimes well past the 5:00 hour when I would (if I had my choice) like to eat, is wait for my food. Because I love attending (and maximize) free lunches and dinners, am not very picky, and adore rescuing leftovers (including others' leftovers :)), there's not often a lot of incentive or opportunity to decide to make new and fancy dishes.

However, while in the salt flat in Bolivia, I started reading the Julie and Julia book about the girl, Julie Powell, who decides to master Julia Child's art of French Cooking, and was quite inspired. You will not catch me making any fancy french dishes with names I can't pronounce, but I (with Mindy as my witness) resolved to start cooking regularly. Or, well, cooking at all, which is more than I had been doing in a long, long time.

It has been fun! I had to photograph what was one of my first creations, and which I had already (just 2 weeks out from Peru) been missing...

Ceviche!

It was Char who spurred me to actually make it (incentive = her eating it with me), and it was both simple and very tasty!! My biggest challenge was peeling the limes in order to get them into my juicer (which is one of my favorite kitchen appliances and has been very underutilized lately!) so that I could make the yummy marinade. [I have since learned that there is some fancy device which squeezes the heck out of limes and obviates the need for peeling (and a juicer), but, alas, I do not have such an applicance in my simple kitchen.]

If you ever want to make what is, in my opinion, one of the tastiest dishes ever (and surprisingly very easy, even for the cooking-impaired), here is a recipe for the Peruvian specialty:

Ceviche

2 lbs white fish (i.e. tilapia/sea bass-- I think I used halibut)

1 1/2 c fresh lime juice (approx 5 limes)

additional limes for garnish

1 yellow pepper

1/2 c celery

2 garlic cloves, chopped

2 large red onions

3 Tbsp cilantro

boiled corn

lettuce

salt/pepper

1. Place fish in bowl, add 1.5 cups lime juice to marinate, refrigerate x 2-4 hrs

2. Drain juice, add pepper, celery, cilantro, onions, garlic, salt/pepper, and serve over lettuce leaves with additional limes on top.

Amidst other random creations, the next major project I undertook was this past weekend when we decided to have a potluck for Kristin and my November birthdays. I kind of wanted to do something Thankgiving-y beacuse I am on call on Thursday, and I adore Thanksgiving food; luckily, Kristin both put up with the idea and even offered to host the party :). [Actually, being on call for Thanksgiving for Labor and Delivery is probably the best place one could be if one had to work that day. Last week, one of the nurses asked me, ""Oooh! You're on for Thanksgiving, too? We're having a potluck! Are you working AM or PM?" It was with some regret I had to reply, "Both! I'm on for a 24-hr shift;" however, I realized that this means that I get to be a part of not one, but two, yummy potlucks! I hear L and D Thanksgiving feasts are so great that people from other floors all over the hospital come to Davis 3 to steal food :)]

Anyway, back to the potluck. I decided to try my hand at the first turkey I have ever made. I decided to use a small (7-8 lb) one, because, if I screwed it up, I would only screw up a small bird. As I always am when cooking for other people, I was very nervous (because I think everything tastes fine and will eat it anyway, lest it go to waste, it is very hard for me to discern what really tastes like garbage and what doesn't). I told Kristin that we should probably have "back-up birds" and she smartly had picked up some emergency rotisserie chickens. However, it turned out fine! I didn't brine the turkey over the preceding night (that would have taken way too much planning!), but did rub lots of butter under the skin (thanks, Kyla), season it with salt/pepper/garlic powder, and used one of those oven bag thingies which, I now know, is a must!

While I was made fun of by Phi, who asked me to go with him, Jeremy and Brenden to some ski-show but whose offer I had to decline because of the turkey roasting in the oven, I am glad I stayed to "babysit my bird," because I feel that watching the pop-up thingie and the meat thermometer to figure out when to take the bird out was perhaps the most important step of the endeavor! I am just glad I didn't toast the thing to blackness and, as far as I know, everyone who ate it is still alive and, I hope, gastroenteritis-free (The words of a ceramic spoon-holder I've contemplated buying that reads "People have eaten my cooking and gone on to lead perfectly normal lives," came to mind :)). I also made stuffing, which is, hands down, my favorite Thanksgiving food, and will definitely make it more often from now on. Like Christmas music, which, in my opinion, is fair game at any time of the year, stuffing never goes out of season :)

We had tons of wonderful food, including Thanksgiving tamales, mashed potatoes, cranberry jelly, pumpkin bread, cheese puffs, pumpkin and pecan pies, and a stellar raspberry "diva cake" from Rick's dessert diner. We then played a hilarious game of "Time's Up." It was a great time, and I think I'm still full :)

Enjoy the pictures, courtesy of Darina :)

The diva cake! (Thanks, Kelvin!)

with Kristin (whose real birthday is today!! Happy birthday!)

Can you appreciate how TALL this cake is? There were about 17 layers of raspberry...

Amy, Kim, Darina, and me

Ashby, Jose, and Char who eked out the victory in a rousing game of "Time's Up"

The gang


And in the spirit of giving thanks, while it has nothing to do with food, I wanted to share that I am so thankful for last weekend, which was one of the most gratifying experiences that I have had in a long time. There (when is there not?!) is a long saga of a story, but, in short, a continuity OB patient of mine who I'd been waiting to deliver for weeks, finally went into labor just before Kristin, Caesar, Mike, Helena, and I were to head to San Francisco to see the musical Wicked. I of course agonized about the decision, but said hi to her, went to the show (which was unbelievable. Loved it!), ate dinner at an awesome pizza place (Zachary's) in Berkeley, and made it back with plenty of time to make the rest of her labor course and delivery. It couldn't have worked out better.

(oh, it was!)

me, Kristin, and Helena


I have so much to be thankful for... Happy Thanksgiving this week to everyone!

Proactivity vs Serenity

In contrast to my recent travel posts, this week has been one of quite a lot of reflection. Through a considerable struggle in getting back up to speed in the "working" world after a three-week hiatus in South America and in both contemplating the theme of our Tuesday afternoon "longitudinal block time" didactic talks and in talking with several friends, I wanted to comment on something on which I hope to get others' input. I wonder to what extent one should try to "change" one's circumstances.

In blocktime, we are slowly (residency often does not lend itself well to ambitious outside reading!) making our way through Stephen Covey's self-help book The 7 Habits of Highly Effective People. Although reading this book, complete with its opening chapter quotes including things like (that of the first chapter) Henry David Thoreau's "I know of no more encouraging fact than the unquestionable ability of man to elevate his life by conscious endeavor," is quite motivating, I'm not sure I buy into all the principles he lays out. Or maybe it's that I don't know that I can adapt the "habits" that he states that, if I do adapt, will make me a "highly effective person."

It is interesting to contemplate what makes someone "effective." I would argue that most of my colleagues/friends that got to where we are -- through college, medical or graduate school, and (for us here) to residency are pretty effective and successful people. You can't really make it here by being lazy, complacent, or a poor communicator. And yet we all, and perhaps especially I, have a lot to learn from this book.


Habit #1 is labeled "Be Proactive." It discusses how there is a difference in being "reactive" (letting one's surroundings influence one's outlook and attitude to a large degree) and being "proactive," or taking the initiative to change those things to better suit your desires and goals. I definitely tend to be a very reactive person. My emotions and attitudes are often shaped by the things people say or do and which I feel I cannot modulate. In my current line of work, I have felt that attendings, other residents, and patients have all made me "cry" by things they have said which, some might argue, should never happen. People have told me that I need to "toughen up," that I should not be affected by things that people say, and that basically I need to have a less reactive personality.


When, last week, we were asked to give "examples" of proactivity, a few key friends came to mind. Although I, someone who also hates to be very vocal in public and say anything unless I can really articulate well, did not feel comfortable bringing those people and those examples up at the time, I definitely thought of them and did so with great admiration. If they read this blog, they probably know who they are, but let it be known that these are people who tend to know exactly what they want, know what they want to better their education, do not let scheduling difficulties dictate what they can and cannot do, and rarely take "no" or "that probably wouldn't work out" for an answer. They are people who may not go to certain scheduled or suggested activities when their time is better spent elsewhere. They do not care as much about pleasing other people or doing things because of what others' think, but rather do things that make the most sense. While I think, "Oh. I didn't get that procedure; it is good that I watched one more. There will be another," they get the procedures- I and Ds, joint injections, lumbar punctures, paracenteses, central lines, vacuum deliveries, etc., because of their confidence, attitude, and proactivity. They change their rotation or call schedules so that they can do awesome things-- attend friends' weddings, attend special conferences, or do international travel. They are not selfish in the least, but just resourceful. They make me feel, and appear in comparison, as a very ineffective person.

On rare occasions, I have learned from these role models and been more proactive. I switched a VA night call last year to be able to go to Ajit and Jeny's wedding in New York. I get circumcisions and IUDs on my own schedule, whether by being meticulous about scheduling or staying late on Fridays post-night-float. When Dr. Mayes asked me if I could come to Peru to work with the Richmond SSIR (sophomore scholars in residence) students in this Global Health week this past October (the first of my three weeks in South America), my first thought was "there is no way in the world I would be able to get off one week of OB antepartum service to go, even if I could make up the time." My normal reaction would have been to not even try to ask if it was possible. I could have let it go, wistfully, and hoped that I could go another year. However, with Kyla's help, I checked with the scheduling chief and was able to work out a plan, which entailed taking OB call in this coming December to cover others' vacation, so that I could spend a week exploring international health. It was amazingly and totally worth it. I can't believe I can't be more proactive at other times. I wonder how many great opportunities I have missed out on in my life because, more often than not, I accept things the way they are and because I feel that they were "meant to be" that way. It is after great outcomes like this that I tell myself, "I am going to be more proactive."

Everyone has things that they desire in this world. What I struggle with is to what extent it is important/necessary and definitely in one's best interest to go all out to try to change your situation, and when it is just as good to accept things the way they are and to learn to be content, happy, love one's situation and appreciate one's blessings. In Phillippians 4:11, Paul writes, "I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want." While I have not yet learned this secret, I am trying to get there. However, we are also reminded that "Ask and it will be given to you; seek and you will find; knock and the door will opened to you. For everyone who asks receives; he who seeks finds; and to him who knocks, the door will be opened." - Matthew 7:7-8. I probably need to both ask and seek more often.

I suppose it boils down to the Serenity prayer which states, "God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference." This I will continue to pray to help guide me all the days of my life. I welcome your guidance, too :)

Back Stateside from Bolivia (and ode to Mindy)

El Salar de Uyuni

Wow! I am finally back home, after 3 weeks on the road in South America. What an amazing trip! It seems odd to be back stateside, and this is the longest period of time (3 weeks) since residency started that I have been away from Sacramento. While I go back to "work" tomorrow, starting Sports Medicine 2, I figured I should post some of the remainder of trip pictures and relive what has been an unbelievably memorable vacation.

I wanted to recount how wonderful this trip was because of the people I was with. I cannot say enough wonderful things about how great a travel partner Mindy was, and so bear with me as I recount some "highlights" of Mindy amidst the highlights of our trip.

Mindy is ...
Positive
We had a bit of a disappointing day on Lake Titicaca, whereas, despite paying for a half-day tour to Isla Del Sol (which is supposed to be the birthplace of Incan religion), we ended up being dropped off on the North side of the island for a full day, which did not fit in to our travel plans to head to La Paz later in the day. After a 2 hour boat ride there (to the wrong port), we (due to the boat captain's decision that our plans were just "not mainstream") basically just had to turn right around and book it back on a return boat in order to catch our bus. While both disappointed at not being able to visit the island, Mindy and I had to look on the bright side of things (and she certainly helped me do so) in that we enjoyed a beautiful boat ride on the lake in lovely sunny weather.

Me, demonstrating disappointment


Mindy, uplifting as always


The sun at Lake Titicaca had this perpetual rainbow ring around it!!!

Bolivian flag

In better moods...

Mindy is fun!!!!
Oh my word. I cannot tell you how much fun we had on this trip.

From Lake Titicaca, we headed through La Paz to Uyuni, a town in southwestern Bolivia, in order to visit the Salar, which is the world's largest salt flat. It used to be a huge lake, but now is 12,000 square kilometers of awe-inspiring and explorable desert. Enjoy these pictures, which were really fun to take!

Jumping for joy

Lines in the sand made from changes in temperature

Train cemetary

Salt house (we learned that, in rainy season from Jan-March, these houses are just covered so that they do not "melt").

Badge, a Brit we met along the way, "tasting" the blocks of the Salt Hotel!

Trick photos

"On me"

Badge, "eating" the girls

Us, jumping out of Mindy's daypack



Natalie, "in" my shoe


"Hangman"

Flamingoes!

With our friends Badge and Natalie, who shared our trip jeep

Salar sunset

Mindy is... Athletic

The second day of our Salar tour started with hiking volcan Tunupa, which is over 5400 meters. As I mentioned before, Mindy is a serious hiker, having climbed over 30 of Colorado's 14000 ft peaks. She will climb anything that is nearby! After several hours of hiking, we had to turn back in order to be back "on time" for lunch and so were about 20 minutes short of the "Crater" view, but we had great views of both the colorful volcanic peak and the vast expanse of the Salar while doing so. It was so awesome to be able to do so much serious hiking on this trip with someone as interested is staying "active" as I am! And, with us having to do quite a lot of running to catch buses at altitude, Mindy led the way!

Volcan Tunupa

Isla del Pescado (day 2), or island of cactuses amidst the desert

Tasting salt of the salt flat...

Mindy is ... Adventurous
I think that I am a fairly adventurous person overall and game for most anything as far as experiences go; however, my dear friend Mindy definitely has me beat. Despite hiking the Andes, climbing another volcano at the Uyuni salt flat, braving the streets of Lima and La Paz, and paragliding off a cliff in Miraflores in Lima, Mindy wanted to go mountain biking on the "most dangerous road in the world" or "Death Road" outside of La Paz, which boasts (due to steep declines and hairpin turns) the most fatalities per year.


Unfortunately (for her--- I, on the other hand, felt a bit fortunate that my life may have been spared), the all-day trip down this death road did not fit into our plans due to our bus arrival times and cost; however, I gained new awe of my formerly sane and tame college roomie due to her ambition to travel this street!!!

Instead, we played in La Paz's city park, wandered the streets, visited the outskirts, and saw the music museum.

Park Mirador, with Mt. Illamani in the distance

City park slide

Alligator!

We played a big game of chess, my first!

Valle de la Luna, a series of canyons outside the city of La Paz

Beer is very fizzy at high altitude!

Plaza Murillo

An adorable child, feeding pigeons in the plaza


Mindy is... patient

While we were trying to figure out which tour company we'd go with for our Salar tour, I was getting stressed at all the attention we were getting from competing representatives. I'm not a good bargainer, and I kind of like to just get things set rather than spend a lot of time comparing and dealing with choices. Mindy, however, was always calm, collected, rational, and a perfect complement to careful decision-making.

Here is Mindy, calmly calling phone numbers from a public phone in Lima, which I could also not figure out and which caused me a lot of frustration!!

Mindy is thrifty
I thought I loved a good bargain! Mindy travels just as frugally as I do! I love it! She would, without fail, halve any cost a taxi driver tried to charge us. She bargains like no other. She has no problem eating crackers and fruit from grocery stores to have more money for better meals and better adventures later. She, like I, did not want to pay more than $7 for a hotel room in Bolivia, even though it had the best hot showers we had all trip. And she was game to spend a half an hour to try to flag down a microbus to get to La Paz airport rather than spending $4 on a taxi. We spent more money ($135) on the visa to enter Bolivia than we did the whole week!

View from our plane departing La Paz

Mindy is flexible

I know very few people would not complain once about 12-hour 0vernight bus rides to get to/from Uyuni for 2 days. Mindy did so without blinking an eye. Despite not sleeping anywhere for more than one consecutive night of this trip and not always knowing if we'd get a room, shower, or food, she never worried that things wouldn't work out; I loved her flexibility and adaptability.

Mindy is prepared

I am a terrible packer. Although I did a pretty good job of coming with what I needed for the trip, Mindy put me to shame! She came with all kinds of awesome travel gadgets which I now feel the need to purchase, including clothing compression sacs, an inflatable travel pillow, water filter, and non-nerdy headlamp, among others.... all of which fit into her neat backpack. She truly is a packing and organization-inspiration!

Mindy is considerate

I cannot believe how accommodating and considerate Mindy is. I think I recounted the story before about, despite her 0% interest in going sand dune hiking, her "110%" commitment to going with me. She is also incredibly generous!!! She never failed to share with me her seemingly-endless supply of candy corn and starburst snacks. I couldn't have asked for a more kind travel partner. I only hope that I was as considerate in return!

Mindy is musical

There are very few people who would put up with my random breakings into soundracks for Lion King, Sound of Music, or the fact that I think that Christmas music is fair game at any time of the year. Mindy (who was my college junior music recital partner) is the same way!!!!! Bring on the tunes!

The Museo de Instrumentos in Lima

Tocando the chimes

We (including Kelvin and Chamreun, who had a blast in Buenos Aires, Argentina) returned to Lima on the 30th and had one more day to relax before flying back home. I mentioned before that we paraglided in Miraflores (sorry no pics, as my camera shutter stopped working on the last day of the trip!); we also got to catch up with a friend of Mindy's from highschool who lives in Lima, as well as Juan Carlos, a Peruvian doctor I met while working on a medical trip in Iquitos in 2005. We had ceviche one last time, wandered through a beautiful park of fountains in Lima, and were taken straight to the airport by our city hosts. It was a fantastic end to a fantastic trip.

Despite a long day of travel, I am home. And I already miss Mindy, who made it safely back to her home in Colorado Springs! I wonder when our next travel adventure will be. New Zealand 2010???! :)

The (salty) taste of Bolivia

Hello from La Paz!

I am trying to upload just ONE picture from Mindy and my spectacular trip through the Salar of Uyuni (the world´s largest salt flat) to give you a taste of our latest Bolivian adventure, but I (quite technologically-challenged at times) cannot seem to get my memory card reader to work from our hostel in La Paz. Bummer! There was some more serious hiking, we met some hilarious people along the way, the sights were surreal, and I can´t wait to share pictures. However, it will have to wait until either from Lima (where we return tomorrow), or Sacramento, where I will return on Sunday. Can´t believe it´s back to the grind on Monday.

It has been an unbelievable trip, with too many laughs and memories to count.
Besos y abrazos!!!

Andean Adventures: Peru, Part 2

Hello from Bolivia! I have a rather slow internet connection, but am doing my best to upload some photos from the past week.


It has been a phenomenal vacation so far!



After my week in Pampas-Huaraz, Mindy (college roommate), Kelvin (residency friend), and Chamreun (Kelvin´s friend from jr high), met me in Lima for the next part of our adventure in Peru.



Quick pics from my wandering around Lima, where I visited the San Francisco Monastery, Inquisition Museum, and China town!



I love how everything in Peru has the -ito suffix!





We headed south on a bus to Nazca, which is famous for the Nazca Lines, mysterious sand art drawings made in the desert sand, which are quite impressive when viewed from the overflight. They were likely made between 900 BC and 600 AD, but no one knows the significance!


Mindy and me before the flight


"The astronaut" (looks like ET!)

Unfortunately, the overflight, complete with "now left, now right," left most of us very nauseated and some of us (i.e. me) with the experience of losing breakfast....

here is me with my barf bag...

Despite vomiting, we had great food in Nazca, including ceviche, which I could easliy eat, and love, for every meal...




We spent the afternoon in Nazca being quite adventurous and hiking up to the Cerro Blanco, supposedly the world´s highest sand dune. Although we got started late in the day, making our guide, David, nervous we (girls) wouldn´t hike fast enough, we made it in time to do-try some sandboarding, which quickly became sand-sledding. Although our hike back was entirely in the dark, and our shoes, clothes, ears, and mouths were filled with sand, it was an awesome experience! Even Mindy, who was not super thrilled about the idea to start with (her quote was, and which shows how good a friend she is, was "I am 0% interested in that, but I will 110% go with you!") had a good time :)


Kelvin-Chamreun

stone towers at the top

We then overnight-bussed it to Cusco for time to start our 4d trek in the Lares Valley. We were with a company called Chaska, and I cannot say enough great things about them. We four were paired with two Australians, Daniela and Lily, who were so fun, and the whole staff, including Susana and Huber, our guide, were outstanding. The food was amazing, the scenery spectacular, and the company just as great. Although Chamreun got pretty altitude sick, and the hiking (combined with rainy-haily-cold weather) was certainly not easy, we all made it up and down the mountains, which included 2 passes of 4450 and 4900 meters (just over 16,000 feet, which is the highest I´ve ever been!) . Although she totally schooled us, even Mindy, who has summited 34 of Colorado´s "fourteeners" (14,000 ft peaks) and Mt. Kilimanjaro, was challenged at times.



Our group (Daniela, Mindy, me, Kelvin, Chamreun, Lily)



with Kelvin

Huber and me



Llamas!

Clothing discrepancy!

Al fin

The Valley (Daniela likes taking diagonal pics!)

After the three days of hiking, we spent the fourth day visiting Machu Picchu, the Lost Incan city.


Enjoying mojitos in Aguas Calientes





Although I had been there in 2005, Machu Picchu is one of the most spectacular sights I have seen in the world, and certainly not overrated. We hiked Wayna Picchu and got great info from our wonderful guide, Huber.











Sudoko on the train back to Poroy.




Today, Mindy and I made our way to Puno and then to Copacaobana, Bolivia, where we will visit la Isla del Sol tomorrow and then continue on southbound (the boys are headed to Argentina).


Lake Titicaca sunset



Back to the states on 11-1-09. We are getting kicked out of internet!
Miss you all!
Love from Bolivia!!

Peru: Parte uno

Wow! It´s hard to believe that one week (of my three weeks) in Peru has passed. It feels like ages since I´ve been in the states! I am blogging from the guesthouse in Lima, with a foreign keyboard, so I apologize in advance for all the crazy punctuation typos which I will probably let slide :)

It has been a fantastic trip so far! I left Sacramento last Saturday and made it to Lima late, late in the evening after basically sleeping away all 12hrs of flights or so :) Although I certainly was sleep deprived, coming off OB nights with subsequent clinic, packing, and Friday night partying at Rocky´s, I keep my not-being-able-to-stay-awake-on-a-plane streak alive :) Dr. Mayes and the group of 15 Univ. of Richmond sophomores (part of this SSIR, or sophomore scholars in residence program) participating in his Global Health seminar, arrived and met me about 5 hours later in the Lima airport. After a sendoff breakfast at the home of the Espinozas (who started the nonprofit organization Pan Peru which serves the town, Pampas Grande, where we stayed), we drove the 8 hrs to the mountain town of Huaraz.

Huaraz

(I could live with waking up with this view every day! I think itçs the peak Huascaran, but I am not totally sure)

Students in el mercado

The next day, we drove another 5 hrs or so to the tiny pueblito of Pampas Grande, which lies at around 12,500 feet or so amidst the breathtaking Cordillera Blanca mountains of the Andes.

Pampas Grande, or "Pampas" as we called it

We were welcomed with a (much appreciated) meal of traditional cuy (roasted guinea pig) which I´m proud that the students tried! I´m glad the head was left off (when I was in Peru in 2005, I definitely got some cuy con cabeza!)

Here is Becky (another UR alum, and fellow adulto on the trip whose company I much enjoyed!) with her cuy!

We tried to acclimatize to both the weather (cold, cloudy) and altitude by going on a walk with the kids. Some photos of la gente

Leni and me

Las niñas loved playing with Kaitlin´s hair!

Ovejas

Welcome dinner, con mucho bailando

We spent the next 2 days participating in various activities regarding health promotion in the town. The Richmond students led workshops on toothbrushing, sex education, talks on first aid, child abuse, and domestic violence prevention.

Here is a picture of Becky and me in our Pan Peru vests, ready to start the day. 7 am was about the peak of warmth in Pampas when the sun was out



Me with "joven Jack," as he came to be known

I spent the days in the medical clinic just seeing patients who walked in for free services. They do have this small clinic there all the time, with an "intern" doctor doing his year of service in Pampas ¿all Peruvian medical grads spend one year serving a rural or underserved area before starting residency?... Unfortunately, I didn÷t take that many pictures. I also didnçt see as outrageous things that I did my last time in Peru, in 2005 with Amazon Promise in the jungles around Iquitos, but lots of abdominal pain, gastritis, parasites, and arthritis from hard work in the fields. Somehow, after disclosing the nature of my residency training program, I got labeled a "gynecologist" and ended up seeing lots of people in "consultation" for female problems... interesting. We brought lots of basic medicine to give out including antibiotics, acid blockers, pain medications, cough syrups, etc., along with vitamins, which were appreciated. While I felt that what I was doing did make a small difference, I still felt somewhat empty in thinking that, after weçre gone, I donçt know what would happen to patients that need continued care. There was really no place for things like antihypertensives for chronic high blood pressure, and I only wonder how many undiagnosed diabetics I saw. The work felt a bit limited, and very temporary, without a larger system in place to continue to deliver health care there. However, Pan Peru plans to continue to work to encourage trips like this one which gives us hope.

Here is a posted price list for regular clinic business. To give you an idea, one US dollar equals about 3 soles

Una paciente con su bebe

Las dentistas, who really were hard at work


Pampas at sunset

We spent two more days traveling back to Lima, where the Mayes group left me yesterday.

I have so many thoughts in my head, and while I have tried to convey some of it here, I feel like this blog entry has ended up too objective.

Not apparent in this post is the warmth of the people of Pampas, who welcomed us "gringitos" with such open arms. We were greeted by the schoolchildren of the town, with bouquets of flowers, and who shed tears on our departure, not knowing when they might again see a group of outsiders return to their isolated town. We were served 3 hot meals a day by Lucia and Pedro, which, for 19 people, was no small feat. We were given beds to sleep in and transportation and were cared for immensely. As we were there so briefly, I do wonder whether what we brought to the citizens of Pampas was any more valuable than what we received, in love, education, and experience, which I am certain none of us will forget.

Memories which I am noting for the sake of my own journaling...

= the children of Pampas playing futbol with such passion, and watching them light up at their first sight of a frisbee

= watching "Joven Jack" and his dance moves with the teenage ladies of the town

= how everything in Peru seems to get labeled =ito, which is a sign of affection

= the vast quantity of sopa and te we consumed in the course of the week

= what a tasty lifesaver Sublime chocolate is

= the bitter cold of Pampas and altitude headaches

= how a 50 foot hike up a hill at that elevation made me feel as if I had never worked out in my life

= how 3 days without a shower doesnçt seem that bad...

= the bucket seat and perhaps the most uncomfortable van ride of my life

= a van of college students singing Replay, over and over and over again

There are so many more things to say but not enough words to say them. The trip made me extremely nostalgic for college, as I remembered those days without worries about future jobs or responsibilities. I did kind of feel old ¿Becky and I, with Diana, joked about being the "adultos" that had to go to bed early, as a lot has changed at UR since I graduated in 2003. While, when I was there, there was a Girls" side and Boys" side to Westhampton lake, now the dorms are even co=edª Gottwald ¿the science building? is totally redone. I am wondering when I can next go back to visit.

I am so thankful to Dr. Mayes for inviting me on this trip. What a great and motivating start to another 2 weeks in South America. While I was a bit lonely today, riding public buses and braving the streets of central Lima, which Lonely Planet, on every page, notes is quite "dangerous," I have company joining me later. Mindy, Kelvin, and his friend arrive tonight and we set off for Nazca tomorrow. The plan is to visit the Nazca Lines, then make our way to Cusco, hiking, visiting Machu Picchu, and then Lake Titicaca and Bolivia.

Espero un buen viaje. Hasta luego for now...