I began the actual observation portion of my clinical observation internship this past week in the Urgent Care unit of Hospital Sótero del Rio. The building was incredibly different from any hospital I had seen before. Between the dimly lit corridors, the glassless windows, and the holes riddling the peeling plaster walls, this hospital clearly lived up to its reputation as being one of the poorest in the city. The waiting room doubled as the examination room with only a musty red curtain separating the waiting crowd from the rickety examination table. The equipment in examination “room”, though still functional, appeared to have been made in the 70’s. But despite the rather grim setting, there was a bustling air of efficiency, and the staff went about their business with a reassuring professionalism.
I started my day with my program’s contact inside the hospital—a nurse by the name of Cesar. After about 45 minutes I was passed along to a nurse lower down the food chain, and then about 20 minutes later I was passed on again. It was a bit disheartening to be pawned off all over the place, but it’s easy to imagine that the staff had more important things to do than show an American around the hospital, so I wasn’t too put-off. It turned out to be lucky in the end—as I was in the process of being ditched for a third time, a doctor overheard the conversation and swung his chair over. He informed me that he was taking the wife to Vegas in November and he’d love to have me around to practice his English. Happy to have a real doctor to observe, and under the conditions that 1) I was going to respond to his English in Spanish and 2) I’d help him with his vocabulary so that he’d have some confidence in his ability to hold onto his money in Las Vegas, I began trailing him.
Obviously very knowledgeable, Dr. Calderon saw to it that I was kept in the loop at all times as he examined patients, teaching me—among other things— how you spot necrosis in digits (fairly obvious), how to recognize the symptoms of appendicitis, and how to use ultrasound results to find kidney stones. After a few fascinating hours in the examination room, he proclaimed it lunchtime and invited me to accompany him to the Doctor’s cafeteria. I gladly obliged and was treated to a pretty spectacular lunch—both in food and in entertainment. I’m not sure if you’ve ever seen a surgeon go to work on a chicken breast, but by the end those bones looked like they could have been picked clean by a committee of vultures. The best part of the meal, however, was the conversation. After a bit of talk about how healthcare in the US differs from healthcare in Chile, they switched over to their recent surgeries. iPhones were whipped out, photos pulled up, and just like that the doctoral equivalent of a pissing contest began.
“Check out the size of this tumor I removed yesterday!”
“Oh c’mon, arthroscopic surgery is nothing. Check out the before-and-after of this partially severed hand that I stitched up!”
This sort of thing continued for a surprisingly long time until the most senior doctor put her foot down with a laugh and told everyone to stop acting like children. It was a pretty comical scene, but then Dr. Calderon got a message from the Urgent Care secretary alerting him that his next surgery was ready, and the fun was over, back to work. I was a bit bummed that my day with Calderon was probably over, and began to thank him for everything… but then I realized he was handing me a pile of surgery scrubs. A bit dazed by the bustle of the surgery floor, I was in the pabellón (operating room) before I had time to realize how lucky I was, and then the surgery was starting. As it was only an appendectomy, the actual surgery was left up to his team, with Dr. Calderon supervising and explaining everything to me–pointing out the critical points and explaining the reasoning behind the order of operations (no pun intended). It was absolutely fascinating, and I ended up staying 2 hours beyond my allotted 8 hour shift discussing everything with Dr. Calderon and hoping he would get another surgery in. But eventually, when his shift ended, I shook his hand and thanked him, wishing him the best of luck in Vegas, and then left for home, tired but exhilarated.