"Ay, que se muera"

i'm not gonna go into medicine. i promise myself i'll never go to medical school. however, if i did, i'd go into geriatrics or really any field keen on palliative care. p.c.=treatment that recognizes boundaries, admit defeats, confirms that their are not always cures and concentrates on easing, calming the quality of life the patient has left.

yesterday i wrote my last update to the bosses. today already i am writing them a new email. it reads as follows. it's the follow up to the dialysis saga. i leave july 9th.. we'll see how many more there will be.
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Hola amigos,
Last night Doogs told me Vaca Diez decided dialysis patient needs dialysis up until she leaves. Plan last night was dialysis sessions this week (however many needed) and from there we buy her a plane ticket. If I understand correctly she had hongos (fungus) in her catheter and the dialysis last week was not effective.

I just talked to patient (she answered the phone) and patient's daughter. Liliana told me her mom has changed her mind about the Argentina plan. She doesn't want to go. Even if this means her death, she wishes to die at home with her family around her.

Please let me know if there is anything else we can do for her, to meet her wishes and help her be comfortable if that is possible. I'll catch Doogs in the morning and follow up with the fam depending on what he says.

Thanks
Rachel
ps. I plan to go visit the patient in her home next Sunday.

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alright i've learned to do good things. but all along i've learned the foundation. the foundation never admits defeat. the foundation doesnt believe in boundaries or limits. the foundation thinks that helicopters are the answer to road blocks and argentina is the answer to a failing kidney we cant transplant and a failing body we cant afford to dialize. since i've been here the foundation has never once engaged a palliative care conversation. i just learned this word so i'm probably pretty valiant to be the one starting it. however, i hear what the patient is saying. for the very least, that's why i'm here.

1.5 months ago this is the patient that broke me. i wanted to help the patient survive. now i'd be equally honored to help her meet her wishes.

Posi, Posichanco

the latest with the dialysis

or i guess me coming to terms with "giving everything you've got" to help another.

before giving was a requirement
its what i did cause thats what we do

and then when i had the patient on my floor

and rewoke at 3 am to take out the IV
i kinda got it.

what up friends. my blog should just hang out with my mind and my dreams, but due to its gran flojeracidad (laziness) i'll recount the headlines, you ask the details

1. Sloths. super cool. hung out with Monti in Montero while eating a Picole. At that time i was feeling pretty good because the day before i had slept from 3pm to 7am and pretty sad because i had just said goodbye to my last 7 months. not bad. also the Sloth... it seemed to really be living it up. it was chillin on corner end plaza chewing away at branch ends... every once in a while it took a break to take a wide sweeping view of its background surroundings.. then chomping resumed.

2. the saga of dialysis. i may have mentioned our renal failure patient and how my bro treated her for 3 weeks with diuretics (fluid removal) and how i am quite sensitive and have a heart that beats really fast (i have a pulse 30x that of all my friends) and a feeling in my heart that sometimes hurts. i think of things like families, and histories and economic situations and comfort and choices. docs think of the balance of water and minerals and a body's assisted drive to stay alive.

on tuesday i got back the lab results. one hour later i had a doc read them and knew we were in "ohhh shiittt" mode. i called the patient and the first call was unsuccessful. sometimes patients forget that spending 20Bs and stopping whatever they are doing to travel from campo (jungle) to city (bolivian miami) might be worth the bother. the second call i whipped out my newly perfected directness, alluded to untimely and uncomfortable death akin to that experienced by lethal injection, and the next thing i received was a prompt destination and ETA.

6:30 pm bundled (scarf and hat) swollen yet lucid patient arrives. By 7 Doogs had broken out the "look lady this happened to me. it's not all over. i had your disease and i am 15 years of health and counting. you are in bad shape now but if we devote the time and you commit to your future, we can get you through." we drew blood for Sodium and Potassium (to find out really how sick she was) and Doogs was done.

8 pm. this was the first patient i had brought back to the house. i forgot it's the Scruz mansion for a reason. it felt strange... Nico and I ran upstairs. We threw down some mattresses, some sheets, some comforters, some pillows. we set up patient camp planta baja (ground floor). we bundled the patient once again, this time in a more comfortable resting position. The ISI gringos, who had just sat down to a royal meal, asked Liliana the daughter if she wanted some pasta. Lilana asked me, as I was waiting the half hour for the lab results to come back, for some panuelas (adult diapers).

9:45pm lab results arrive. I call Doogs with the number 7.4 and hear Potassium is sky high. This is the point at which a heart can stop... a physical reaction mimicking lethal injection. Doogs response elevated "ohhh shhiit" mode. But he was good... he called his nurse and guided her to the cure.

11pm. Liceth the best licenciada (nurse practitioner) ever arrives at the Mansion. Ibyana and I assist in the creation of IV Souvenir Lamp Pole Fluid holder numero uno. 2 IV bags run, gluconato de sodio injected and the directions for Raquelita to close IV bags (so her blood didnt run up the IV?) and remove IV line in approximately 3 hours were given. ISI Americans think this is "really cool."Resident American Nephorologist with 30 years of experience in this type of care went to bed three hours ago.

2 am. What up IV that's still drippin and earnest Lilana that is still holding strong.
3 am. IV removal successful. Theoretically, Potassium burst averted. Heart noted to be functioning.

Wednesday
9:30am. At Institute of the Kidney we arrive. Dialysis begun. Repeat peritonitis discovered. Really cloudy dark diffusion (waste removal) observed. A few mean looks from the Peritoneal Dialysis nurse wondering "what have we done with this patient!"

3pm. I have returned home. Liliana daughter has my number. I fall asleep at my computer. 4:30 pm I awake to 4 missed dialysis calls and think "Man, if i was sleeping and Dialy patient died..."

5pm. Institute of Kidney, everything ok... meds bought, bills canceled.

6:30 pm. Despedida goodbye with Maggie American volunteer (1st at the clinic, on her 6th return). I think i wrote a text msg that said "Man,I feel like a wreck."

9:30pm. Patient released from Dialysis and directed to come back tomorrow. Peritonitis treated but repeat dialysis needed. Patient goes to Tia's home, I to mine.

Thurs. 7:30 am. Dialysis. Lilana looking good. She changed her purse. The new one was cute. I needed to head to Palacios for my last two days as jungle clinic Coordinator. Daughter tells me all cool, she and nurse give me release.

11:00 am. What up Palacios. Me, feeling good but tired, a lil sick.

2:30 pm. Lavitusmanos (the new coordinator) manual driving lesson.

3:00 pm. I'm a little warm and flushed and I get the "uh you're more than a lil sick" eyes from Sharon (she nursed me through Dengue).

3:15pm. Slumber, minor night sweats, not too shabby rest until Friday 7am.

Friday was great. That lots of sleep really helped. I said goodbye to the clinic. I waved to the trees where the monkeys reside. Kinda crazy, I know. And now i'm lightheaded. There's more... I'll revisit soon.

Monito vea, monito haga

halo there friends, what is happening in your neighborhood lately?

all's well in my neck of the woods. it's winter here so the crickets/frogs/sounding incests are at their very peak of noise production. that and the wind makes for quite the nice soundtrack. it shall be hitting stores soon.

heyyyyy guess who saw monkeys? i probably didn't share with any of you my long term bolivian jungle goals, but now you know that they totally involved monkeys. i do live in the middle of the jungle, literally. and yes the men strolling by on horses are on their way to hunt tigers. anyways to cut a story short, i hadn't yet seen any monkeys. the other day i realized i was leaving and because i hear them ALL the time, the seeing of the monkeys was on the top of my must dos. the two monkey sounds that occupy my environment are 1. the big burly roar (which i suspect comes from the big burly variety) 2. ooo ooo ahhh ahhh (the cute and lively, very similar to cartoon version)

i've been on lots of accompanied jungle walks. with the lack of my time left, i decided a solo trip was needed. i've heard the monkeys are curious and don't fear noise but tend to shy away from large groups. i took off down the forest path (aka latest forest destruction road) and took in my surroundings. it's fascinating how fascinating trees (and the flying of neon green yellow parrot friends) becomes if you pay it some really focused concentration.

This bolivian jungle consists of palm trees, motocou (a thinner more palm frommy variety), the tall old wise trees (the only tree in the forest sacrificed in slash and burn), Bibosi (the best hugging tree eva), all filled in by the unnamed out of control jungle growth. about mid way down the road i heard some Motocou rumbles. I stopped en plano esquina, plain path corner, and listened. Most normal americans who haven't lived in the bolivian jungle for the past few months probably would have been really quiet and busted out the tippy toes. i guess by now i've realized this one, me, is not so normal. i heard the ooo ooo ahh, i saw the palm fronds bounce up and down and i knew the real monkey hunt had begun. from there i pretty much chilled for the next half hour to hour... whistling and making cool imitative soundings, jumping around a lil bit, doing a little yoga/tai chi/"i'm interacting with monkeys" stretch sequence... and the rest is golden. you may find this hard to picture, but i think after dengue, deportation, political blockade... i've hopefully prepped you well. Monkey see monkey do is no joke. These little guys were great. I saw the little gray, black face variety. The first dude came out to give a peak (emerged from the heavy fronds to where i could see him) and from there, with my combined whistling, jumping, hooting, the rest of his forest friends followed. i prob saw about 6 in total and a larger darker a variety tree climbing in the distance. i stayed a while and as the sun started to set i returned American and thought "oh oh what happens if these monkeys really get curious... how close with they come?" after that, i soaked in the sights, said my goodbyes and jogged away.

basically 1st monkey sighting was a crazy success. I was stoked... I had definitely been waiting and the end result may have been greater than i had imagined. now I have one more reason to come back, for I know the monkeys totally would be my friends. Mumi told me, hey maybe next time they'll invite you back to their place. Ha ha.. that Mumi:).

oh yeah... we have this funny ISI (young catholic med students and docs and doc's wife nurse and priest) group visiting for the past 2 weeks. they are way more nutty and completely different than any group we've had. They are 9 Americans in total and they are here for "cultural immersion." the first week they were here our Palacios region was under intense political blockade. Anyways suffice to say they are silly nervous english speaking stomach sick a bit culturally unaware Ameri-cans. This is all fine and dandy because we all have our ways and we all have our rights to travel. Yesterday one of the group members said "Hey guys, did you hear today we get to see the Mayans?" Basically they are really into saying the words "indigenous people" and some genius thinks this part of the world was once inhabited my Mayans. It's cool America is geographically unlucky and when are world is flat we can't expect anyone to see it round. As always, I played along to the Mayan gig well. They wanted to see some Mayan paintings while they were here so this week at the clinic we collected a smattering of little kid "Mayan" artwork. the mayan kids had a blast with ISI's crayons and markers and the Americans can write home, "That's right honey, I was culturally immersed." A win, win situation:). Except for maybe the graves of the real Mayans.

Thank the world because it has monkeys.
RScout

Jefa Spice

hey hey judies... 7 month point yep wow:). it wouldnt be so impressive if everyday weren't so intensely insane absurdly hilarious and delightfully bolivian, but hey:). so i have not many words to coherently place but a few thoughts from me to me to you:

i've mastered the difference between jungle and rain forest. my life here has been jungle (out of control growth), where as rain forest would have been a piece of yummy dulce de leche torta ( with a canopy tree covering so thick no light ever touches the ground)

i will miss Picolo (the ice cream that made me love ice cream) and Picole the best leche fruit or vanilla flavored Popsicles in all the world.. .Sold in Montero across from the plaza. Def. add to your list of To Dos before you die. You might see a sloth too and that would just be cute.

I'll never forget the position of clinic caretaker. it seems we have this person to save us from bats (this has been an added job req. of late... we are doing some construction and living with lots of holes in lots of walls) anddd to cut the lawn. again, we live in the jungle. so the lawn means out of control control. so the job consists of a good 12 hours every day maintaining a jungle that regrows as fast as it is chopped. oh yes also the tool available for jungle control is 1. machete 2. tiny tiny electrical lawnmower.. that's right.. it has an extension chord. they want me to buy a new one, but i figured this little coordinator bought a fridge and a mattress and 4 new wheels, so i might pass it on to the next lil piggy.

so it's set that i am leaving now. so besides normal clinic coordinating life and patients and life and death and stuff like that, there is an added sadness and sweetness to all my interactions.my buddies are bummed and don't really believe i am leaving or quite why. i probably feel about the same but amazingly relieved my life will have a little distance of a little of this for a while.

Our "Star patient'.. we call him this because good attitudes are good and extra great names for extra annoying people make them all that more bearable. La Strella is Don Subirana who has nothing and no one and got in a machete accident which lead to his since 3 reconstructive urethra surgeries. Anyways he tracked me down yesterday and took me aside to ask very privately... "Will you sell my kidney for me?" I said NO! and then he asked, well will you at least take it back to the States for me and try there? Oye... que tipa. He told me he had sold everything he owned, the last being house.. His doc told him his kidney esta SANITO.. super healthy... and he came to me because it's all he has left to sell.

We had another ataxia patient yesterday. This time 23 years old, with a much more debilitating presentation than the last and a family history that spells bad news. His father, bro and sis have the same disease. His sis is in a wheelchair and her mom told me, through tears, that her limbs are starting to look like sticks.

I don't think i mentioned Adam and I went on a trip!? Uh, if i mentioned, Adam was here.. 3 weeks being a Docy out at the clinic. Basically he was fab with the patients, cares a lot, looks up everything, loves to ask me to come into translate just so he can say "This is my sis. She's younger than me." Ha ha, what a cutie. Oh yeah he also treated me, 2.2 times. Anyways I don't know if he'll make it to be a doc, but he'd be a damn good one one day. He says we may work together one day... I said, belligerently, I don't want to work for you! He said.. don't worry honey, you'd probably be running the place. I know docs are cool and respectable when they are good but not anymore important than anyone else you meet on the camino. What up organizational level... props to you!

I want to say Adam and I went to Oruro. We chilled at juice bars and I fell in love with every man in a suit. They wear suits there. Every where. Everyone. They look quite smashing and I think it's quite a lovely way to be. We took a series of four pictures (currently displayed on Picassa) of school children and their teacher doing the twist and shout. THey live in the Altiplano , its freezing, they can't point to the US on a map, but man do they do a cute Topnotes dance numba. Adam reminded that in juice and suits, these people were living it up, what's not to love. Oh yeah.. and cakes. man Oruro may be one of the coolest places on earth. everyone and their mother are buying cakes and walking through really crowded really busy market streets AND carrying cakes... cakes without cake boxes. At the same time, they love to say hello. And I mean they'd pretty much fall over and break their mother's backs if they don't utter a hello. This makes for lots of "HEy friends, whats up, how do you pass, beautiful weather." Even when Adam and I were doubled over from car sickness and altitude nausea the passer bys were still saying AMIGOS... como estan?

CUte. Even when I'm throwing up I'm accustomed to have a good attitude. Oh yeah and a monkey stole my camera. Well mono probably didn't steal it just borrowed it with no chance of giving it back. I went on an fun waterfall SUV adventure.. it tooks hours and we were crazy deep in the jungle.. but in the end we found gorgeous green rock formation pools and cascades that went up and up forever. Within the adventure my camera that has been with me for so many great sights bid me adeui. I was sad but then I remembered it was 1. sweet i had a camera in the first place 2. monkeys have way better perspective points that i do 3. if some campesino fam finds that shiny gray magic maker they can hopefully pay for their sick kid's hopsital bill or maybe their oldests' university. SOooo it's all ok in the end.

Love you kids, keep on reading those rainbows

Raqui