Since my return to bustling Quito, I’ve been stationed in a local emergency room for 8 hours per day. In my first shift, I’m pretty sure I saw, learned, and did more than I had in the rest of my clinical experience combined. At 8:15am a patient walked in needing an electrocardiogram and my host, Doctor Cadena, bustled me over to watch an intern administer the test. At 9:00am another patient walked in needing an EKG and Dr. Cadena nudged me over and said ahora tú. My turn. A little surprised, I couldn’t help but grin at the opportunity and I was pleased to find that I remembered where all 10 electrodes went (which is definitely more of a product of my good teacher than of my good memory). At 10:00am a third patient walked in needing (you guessed it!) an EKG. We’ve all seen the sharp bumps and dips of a heartbeat, but I still had no idea what any of it meant. Maybe I just had a sneaking suspicion that doctors look at the mysterious charts, stroke their whiskers, grunting and nodding, and then pretend to have gleaned some important information. Either way, when the patient left, I asked Dr. Cadena to teach me how to understand the readouts. Next think I knew, I was shirtless, covered in electrodes, staring awkwardly at the ceiling as the little humming machine recorded all the electrical impulses whizzing about my chest. For some reason, the good doctor decided it’d be more fun for me to learn on my own readout. We spent the next couple hours poring over the little pink sheet, him pointing out the meanings in all the bumps and dives, me furiously scribbling notes in a jumbled mix of Spanish and English. In that (oft-interrupted) couple of hours, I managed to get the basics, and from that point forward, he has let me take the first glance at EKG readouts to tell him what I think.
This is not to paint the picture that the ER here is as quiet as a classroom—it’s far from it. While there is a decent amount of downtime, there are also a decent number of terrible injuries. Maybe that’s why the ER has begun to have a bit of a draw on me—there are such a variety of problems that could walk through that door, you kind of have to be prepared for anything. The most notable injury we saw that first day was a poor guy who had been struck in the leg with a friend’s machete as they worked to clear a section of jungle. He was hit just above the knee, his femur was cleanly chopped in two—just above the head—and a few layers of hamstring muscle and tendons was all that held the two pieces of leg together. During the ride to the hospital (he had to be carried part of the way in a horse-drawn cart), the leg had twisted around, so the two parts of the femur were disconnected, resting side-to-side instead of end-to-end. By some miracle, the guy was still conscious and reacted to some sharp prods in the toes—he still had the tendons and nerves connecting his brain to his foot and so should have been able to keep his leg. But there was still the slight problem of the lower half having twisted around on top of the upper half. Dr. Cadena ran down the hall and returned with a traumatologist friend. One held the thigh while the other pulled on the foot, twisting and scraping the bones back into the proper orientation. After about 10 minutes of grunting and tugging (the poor patient had long since passed out from the pain by this point), his leg resembled a leg once more, and he was sent off to surgery. It looks like he’ll get to keep his leg. While all of the nurses, interns, and myself were busy cringing at the severity of the injury, the two doctors leapt right into action—grimly tugging and grinding bones together to try to save this poor guys leg. It was pretty incredible to watch, and I definitely gained a newfound respect for the both of them. But that’s not to say they were completely unfazed—just about every two hours every day since then, the traumatologist has poked his head in the door with a grin to ask if we had any more machete injuries he could help deal with.
One final note—on that first day, I saw four men come in with injuries sutained in motorcycle crashes. Nothing was too serious, a couple broken bones and a strained knee-ligament… but it was definitely enough to make me reconsider my lifelong dream of buying a motorcycle so that I can ride around California like Tom Cruise in Top Gun. (Because of copyright issues that first clip couldn’t have the REAL soundtrack, so to get the full effect, mute the fist clip, and play this one in the background)
Side note: This scene, the motorcycle and the inexplicably 40-minute-long sunset, is probably about 96 percent of the reason I went to California for college.
Final final (random) note: I can honestly say that I’ve seen Adrian Peterson hit the gaps with less force than old Ecuadorian ladies do when they’re trying to squeeze on the trolley during rush hour traffic. I am very, very fed up with public transportation.