SHADOWING DR. SANCHEZ in the OPERATING ROOM and the CLINIC

So, two times a week we go to the government Hospital where Sixto works called Hospital Dos de Mayo. Dos De Mayo, one of the oldest hospitals in Lima, is perhaps not unique in compared to other hospitals here in Peru, however its unlike anything I have ever seen in the US. The hospital is most definitely located in one of Lima’s poorer regions: La Victoria. You can sense the area’s poverty just by looking at the building’s facade and neighborhood the walls are chipped, some windows broken, graffiti and dirt everywhere. You pass through guards to get into the hospital and have to make sure you know where your purse/bag is at all times. The hospital is not just one building (instead many) and it definitely does not give me the same white sanitary feeling of US hospitals (instead it just feels old and makeshift). Once inside the gates, you make it through a maze of buildings: the pediatric clinic, the cardiology waiting line, to get to the center courtyard, one of the remnants of the original hospital. Branching off from the center courtyard are open‐air wards, something I have only ever seen in a movie with beds and beds of patients lined up and down the long rooms, some people wailing (yep, the hospitals a noisy/busy place), some people sleeping, with nurses jumping back and forth between them to attend to their needs. One time I almost walked down one of these wards as a shortcut, however I was stopped by Sixto, not because I wasn’t allowed to enter the ward, but because I probably would not want to enter room that was bursting with tuberculosis patients. The center courtyard, like I mentioned, still has parts of the original hospital: statues and a grand marble tomb honoring the hero of Peruvian medicine, Daniel Alcides Carrion (A martyr back in the day who infected himself with a certain bacteria to solve the mystery of a fatal epidemic). So the hospital, similar to many things I have found in Peru, has two faces: grand columns and old statues but also graffiti walls and thousands of sick patients.

Well, we come to the Hospital (~30 minute taxi drive because of traffic) to shadow Dr. (Sixto) Sanchez twice a week. Some days we are in the Operating Room. On these days, first we change into scrubs, mask, hair net, and booties for our shoes. We wait inside the operating room while they prepare the mother/patient for a Cesarean Section (Sixto’s specialty): they give her a specific anesthetic in her back (epidural) and wash her stomach to legs thoroughly with copper colored iodine to sanitize the operation area. Meanwhile another intern sets up all of the tools: scalpels, scissors, tools to hold back the tissue, towels, thread (for the stitches). And once everything is ready, to the sound of salsa music playing (yes there is always a radio on in the Operating Room playing some kind of music), the Doctors begin. Andrea and I are allowed to watch as many surgeries as we want (we stand on little step stools about 3 feet away from the operating table and peer over the doctor’s shoulders to watch), we just can’t touch anything. I won’t go into all the details of the C-section but essentially the doctors cut through layers of the body to the uterus and sooner or later a baby comes out! The baby is immediately handed off to a pediatric team that measures the baby, weighs it, etc. This is the cool part for me so I usually sneak off an watch them do this. They show the baby to the mother (who is still awake because of the specific anesthesia) ~ 10 minutes later – given that all has gone smoothly. They bring the baby to the Pediatric ward and the mother will see it later that day. The rest of the surgery, which takes about 45 minutes in total, is stitching the mother back up. Thus far we have only seen C sections (which Sixto does) but Andrea and I are making friends with the interns here at the hospital in hopes of observing/helping a live birth.

Though the C sections/surgery itself was cool at first, it quickly became repetitive and slightly boring. The only interesting part for me was the baby! Was it OK? Healthy? What did they write on the chart? Etc. Andrea and I are trying to make friends with a Neonatologist so that we can shadow her! The other thing about C sections is that a lot of them are not necessary. About ½ of the births at the hospital are surgical! Thats a lot, and many that I have seen don’t seem necessary. For example one mother had a baby with a chord wrapped around its neck twice according to the echogram, but when they actually operated the baby was fine and did not need to be operated on! Also, things are not so pretty all the time. Last week we saw the birth of a baby that would normally have been a miscarriage. The baby had lots of things wrong: a tumor, kidney problems, heart malformations. She wasn’t breathing on her own and they had to intubate her (but luckily she is now breathing on her own). Though she has survived a long time in the ICU (Andrea and I check up on her when we go into the hospital) the doctors are not sure how much longer she will live. Its sad but a part of being at a hospital I suppose.

Lastly, there are a lot of things I am noting about this hospital that I would have done differently if I were here (and I think they are much different in the states). Mostly, this has to do with the Doctor-Patient interaction is very minimal! No one really asks the mother how she is doing or explains what they are doing while they are doing the surgery. Its almost like the Doctors are phased with the personal interactions with the patients and just look at each patient as an entity to inspect and cut open instead of a person. It seems very cold at times! Anyways this is just something I have noted.

So on days when we are not observing surgery, we help out Sixto perform consultations (check ups for pregnant women). This is in a separate building and we have to bring our white coats (check out the picture of my embroidered doctors coat that I bought for like $10!). There is a line of maybe 20 pregnant woman outside the consultation room with two doctors plus me and Andrea (I go with Sixto and she goes with the other doctor) and I will go outside with the patient’s chart and call their name. They come inside and sit down. Even with my broken Spanish, I try to make small talk with them and ask them how they are doing (since no one else seems to be doing it). Well once Sixto is ready we ask her questions about her last period, any complaints. We measure the gestational weeks and then do a physical exam. The physical exam consists of measuring the uterus size, feeling the stomach to find the position of the baby, listening with a little wooden or metal ear thing (instead of a stethoscope) for the fetal heartbeat, checking her feet for swelling, checking her pulse, etc. Sixto writes this all down on the patient’s chart and I copy it down on a smaller chart. If everything is good, we send her on her way! Usually we see 10-12 patients before lunch.

This is what we do twice a week! Its definitely confirmed my wants to be a doctor (though not a surgeon). Even though it is hard/sad at times, I still get excited to interact with these women and their babies on a daily basis.