Neurology and more Bulls

Dang. its been a while.

Today was pretty short. I shadowed a neurologist. This man was old, very old, but very good. His English was average; he repeated himself many times over to make sure I understood what he was saying. For the most part it was alright though; I understood him well enough. He took me around to his patients, and told me about their cases. He wasn't really performing any procedures, so he didn't have much to show me. He did tell me about the Americans though; he was going to be discharging them. Having spent a lot of time with the American and his wife over the past week through visits, I knew that they were both anxious to get home, to familiar places. It's a pity that they had to come to this beautiful of an island under such circumstances; the lady said at the end that she couldn't wait to go back home, and that most likely she would not be visiting Europe again. She might have been caught up in the moment, but in her shoes I might have said that same.

After showing me some CT scans of the patient, the neurologist ran out of things to do; he mostly have meetings and paperwork for the rest of the day. I came home soon after lunch, and did work at the residencia before heading out later that afternoon to Joao's mother's place to watch a tourada.

This one was even more exciting than the last two; so of course i left my camera at home. The bulls in this one were crazy...I decided not to get on the street, because they were a lot quicker than I was used to, and I had skinned my knee scrambling up a wall during the last one and didn't trust my ability to run fast. We watched from behind the safety of a very high wall. There were two teenagers in who were particularly good at running; they would run around the bull to make it chase them, then with a hand on the bull's head, keep running until a) they got hit or b) the bull gave up or c) they climbed a wall. Everyone on the street was cheering them on; they were something like mini-celebrities.

The touradas get more exciting every time. I've started to recognize some of the same people that come to the touradas, and have made friends with a couple of them. One man, who lived for many years in New Jersey, offered to take us up to the mountains in a few days where the bulls live to see them in their natural habitat and in their training. Exciting.

Gastrology Day 2

Today I went to gastrology again with Chris. Instead of endoscopies, the unit was doing only colonoscopies. I saw 3 of these procedures, which was more than enough for me to decide that I never want to be gastrologist. I'll spare the details.

After the procedures, Chris and I talked to Fernando for a while. After giving us a fairly extensive tour of the colonoscopy room, we started talking about treatment choices. Fernando mentioned that in some cases, colonoscopy treatments are forgone even when they may be beneficial. As an example, as people age, they sometimes get diverticulums, which are pouches formed in the large intestine by stools that sit there for extended periods of time. Over time, these turn into actual pockets. If an endoscopic tube enters one of these pouches, they can rupture, releasing the contents of the large intestine into the peritoneum, leading to high chances of infection and death. In those cases, it is pretty obvious that a colonoscopy would be risky. However, Fernando also mentioned that if the patient is old and probably close to death, why treat him/her, and risk complications and death? I didn't know how to feel about this, because I got the impression that if a procedure was necessary, it would not be performed because of the possibility of failure. On the surface of course, I understand the reasoning; if the risks outweigh the benefits, there is good reason not to do a procedure. The ultimate call would be up to the physician, but it seems like a subjective decision to me; you really can't be sure about the probability of failure beforehand, can you? All you can do is guess, and is that worth someone's life?

Gastrology

Yesterday was the start of my first full week at the hospital. We got there around 9:30 AM and met up with Claudio. He was a little rushed, because apparently he had an emergency with one of his patients. But he took some time to tell us to get our ID badges made, and then dropped us off at each of our departments. Because I had shadowed Claudio for a few days last week already, I decided to go to a new department this week, and picked the Gastrology, as did Chris. We both walked down to the second floor and introduced ourselves to the department nurses. They were really nice; I was struck by how close knit of a unit they were. Everyone seemed to be really friendly with each other. The main person in that department in "charge" of us was a male nurse name Fernando. His english was pretty good, and he was very talkative. He had been a nurse for 15 years or so, so he was pretty well informed about the healthcare system in Portugal and Europe in general. More importantly, he was willing to answer any questions we had. Because Chris is also a nursing student, him and Fernando talked a lot about practices, etc.

The Gastrology department does mainly Endoscopies and Colonoscopies. Yesterday there were no colonoscopies scheduled, so all we would see were endoscopies. Fernando informed us that in Portgual, people didn't really use anesthesia for procedures (unlike in the United States, where they knock you out for pretty much anything). This included dentists, (some) operations, and nearly everything the did in the Gastrology department. The reasoning was that 1) anesthesia cost a lot of money and 2) the patient would be pretty much useless for a few hours after regaining conciousness. Even though most people didn't mind not getting anesthesia and were used to it, if the patient really couldn't tolerate the procedure, they could request it.

Anyway, we saw 3 endoscopy procedures, all sans anesthesia. Also one of them was a 90 year old woman. I'm guessing this has something to do with the machismo culture here (see: bullfights) . For those that don't know, during an endoscopy the nurses stick a camera down your esophagus into your stomach, and can go until the duodenum. It's used mostly as a diagnostic tool, to see what's going on down there. One of the patients needed a tissue biopsy from her pyloric sphincter (the spinchter separating the esophagus from the stomach), so the doctor used a claw-like appendage to grab several chunks of tissue for analysis. After the procedures, Fernando talked with us some more about healthcare practices, giving us a tour of the department and whatnot. (btw, colonoscopy tubes are terrifyingly large)

During our conversation, he mentioned that a bed at the hospital here would be around 150 euros a night. That's about $200. That's a LOT cheaper than in the US. I told Fernando that, and he said that that was because the insurance companies here did not play as big as a role in deciding healthcare options as they did in the States. However, he said that Portugal was trying to copy the US system (can't imagine why...), so healthcare was getting more and more expensive.

As mentioned before, the whole Gastrology department seemed really close knit and friendly. As I had seen in other areas of the hospital so far, the amount of time that these doctors spent with their patients was large, way more than in the US. Also, they are VERY good at what they do. I'd be hard pressed to find a more efficient and effective department anywhere else.

After we got out of the hospital, Aisha and I walked with Vanessa up to the University of the Azores so Vanessa could pay her housing deposit. It's starting to warm up, and the days are becoming warm and sunny...the island is becoming even more of a paradise. We took the scenic route to the University, along the cliff overlooking the Atlantic Ocean.

Afterwards, we came back to the Residencia and hung out for a little bit and did some work (I finally got started on those med school apps. word.). Later we went out to dinner, to the same place we went our second day here. The waiter remembered us, although I guess it's kind of hard to forget a group of 10 obvious tourists.

After dinner, a few of us went to the beach (about a 5 minute walk from the Residencia) and watched the sunset.

Overall, a pretty good day I'd say.

Tourada!

Yesterday we went to a tourada , which is a running of the bulls. I had only seen videos of these things on youtube before, and usually they ended up with someone getting hurt (which was probably the reason they were on youtube), so I was excited to see one in real life. The tourada started at the beginning of May, and will throughout the summer in different locations around the island. This particular one was in São Mateus, a city about 4 km away from Angra. One (terrifyingly fast) taxi ride later, we were there. The taxi driver dropped us off in a neighborhood, and we walked about a block before we saw the crowds and food stalls. It felt like a giant social event, where people from surrounding towns would gather, much like a local fair. Except with bulls.

In a tourada, bulls are essentially let loose in a street. The audience lines the streets behind the relative safety of walls, while the professional handlers and Azoreans taunt the bull. The bull is actually held back by a thick rope, which is controlled by a group of four handlers. Most of the time though, they let the bull run free, and only used the rope when the bull went too far off course. The locals would also get in the street and play with (but mostly run from) the bull. Because you can't always see the bull (because it might be around the corner), the handlers set off one firework when the bull was out of the pen, and two when it's back in. You had to be on your guard once the bull was released.

One firecracker went off. The bull was out. I stood on a knee-height wall with the other Atlantis Project folk, and waited to see what would happen. It took about 3 minutes for the bull to round the bend in the road. It was bigger than I had expected. And faster. You could always tell when the bull was coming your way, because there would be a handful of young men sprinting out in front of it. Everyone was yelling/hitting the bull as it came by. The first few times, I'll admit that I was scared that the bull would jump the wall, and make all our lives tough for the next few weeks, but thankfully that didn’t happen.

There were three bulls in all, released one at a time. By the third bull, I was felt like I knew enough of what was going on to venture out into the street. I joined a group of Azoreans and started walking up the hill towards it. Every few feet I would look to my side to make sure that there was a wall to climb in case I had to make a quick exit. The bull rounded the corner. This was the biggest yet, and seemed really (really really) angry. It was zig-zagging from one side of the street to the other, slamming into the walls on either side. This didn't stop any of the people in the street however, so I figured I had a good chance. I would try to get as close to the bull as possible without it charging at me. The trouble was, bulls are unexpectedly quick; they can go from walking to full out sprint in a second. As I got closer to the bull, my walk slowed to a creep, and my muscles tightened; if the bull made the slightest indication of being ready to charge, I was planning on getting out of the way quickly. I think the closest I got was about 25 feet away; close enough to hear it panting and hear its saliva flying from its mouth. I had started moving towards the nearest scalable wall when the bull charged, thankfully away from my side of the street. I was unable to make it all the way up the wall (it was quite tall), but hung on for a few seconds while the bull passed, after which I dropped back on the street. A few minutes later, they brought the bull back in; the tourada was over.

What a rush.

First Day of Work

Today was the first day of my internship at the Hospital de Santo Espirito de Angra do Heroismo. I was shadowing Dr. Claudio Olivero. Easily one of the most fun people I've met. His English is flawless; he did his undergrad at McMaster University in Canada, but he must have lived there longer than that. Anyway, when we got there at 9 am (got up in time this morning, holla), he sat us all down and basically gave us a rundown of what was going to happen. In a nutshell, he said that he was really supportive of the idea of us coming in and shadowing different departments and whatnot, and was really glad that we were here. Apparently there was a large departmental conference going on between several departments in the hospital, so a lot of those departments were severely understaffed. Dr. Claudio was picking up the slack, which meant he was assigned about 50 different things to do at any given moment.

He showed us around the hospital for a little bit, and then told us that only two people could be with him at a time while he did rounds in the emergency ward. Unfortunately, there were 7 of us there, so we had some decision making to do. Eventually we decided that Aisha would go with Dr. Claudio's friend in the pediatric unit, and a few other people and I would head back to the Residencia while two other people stayed. After a few hours, we would switch. I came back to the Residencia and did pretty much nothing until about 2, when the people who had shadowed in the morning came back. Nicole and I then went back to the Hospital and found Dr. Claudio still doing rounds.

Dr. Claudio had told us to watch out for "the haters," which were other doctors/nurses in the hospital who did not want undergrad there. I think this is something at every hospital; the places I have shadowed in the States have all had nurses and other administrators who give me the evil eye/get haughty when I or my mentor comes by. I can understand some part of this; in a lot of cases, untrained people in a hectic medical scene can get in the way...that has definitely happened to me more than once. On the other hand, how else is someone supposed to get experience? It's not as if you learn something more between when you're an undergrad/high schooler and when you're a first or second year med student. You could argue you learn a lot about ethics and whatnot, but which part of that isn't common sense? At its core, you're just talking to people.

I'm really impressed with how good of a doctor Dr. Claudio is. He told us from the beginning that he was overstretched today, because he was covering what seemed like 50 departments at once. Nevertheless, he took his time with every single one of his patients, and talked to us to great extent about ancillary things. Apparently his mother is really into Hinduism, and Claudio really wants to marry a traditional Indian girl, not one that will "drag her sari through the market" (whatever that means). We talked a lot about this, but he never forgot about this patients. He seemed to genuinely care about them.

After a few more hours of seeing patients, it was time to go.

Can't wait to go back.

I woke up at 2 today. I had forgotten to bring an alarm clock, so I had been depending on my roommate (who I hadn't met yet...more on that in a bit) to wake me up with his alarm. But for some reason he set his for 2 instead of 9. I was still laying on my bed in the hazy purgatory between sleep and consciousness when I got a knock at my door. It was Erin, telling me that they were about to go out around the city. Up to this point I still thought it was 9 am, so I was feeling good about heading out so early. It was only when Erian told me it was actually 2:15 that I realized how much of the day had gone by. I brushed my teeth quickly, and as I finished, my roommate came back in the room.

My roommate is name Rui. The R is guttural, like you would say it in French. I had not seen him yet, because he would wake up and leave really early in the morning and come back around 3 am, when I was asleep. So even though we had slept inches from eachother for two nights, I did not know what he looked like, or what kind of a person he was. I won't lie, I was a little apprehensive about meeting him...I think I automatically assume that people who I don't know are assholes. I don't know why I would think that, given that literally EVERYONE on this island is really nice. Anyway, I walked out of the bathroom and Rui was standing there. This was our conversation:

Rui: "HELLO GOODMORNING"

Me (thrown off by how much enthusiasm he used): "HI"

Rui: "let me know if you need any help with the kitchen"

Me: "...ok i will"

Rui: "or anything else really. I can help you out. Sorry my English is so bad"

Me: "hey man, your english is a lot better than my portuguese"

Rui: "haha"

Me: "hahah"

Rui: "ok I will go back downstairs, see you around"

Me: "ok bye"

Turns out he is studying at the university to be a nature guide. I'd say he's my age (like almost everyone else at this Residencia). Also I have the same pants as he does. word.

After meeting up with everyone downstairs, we headed out into the city, in search of a supermarket that apparently "put Walmart to shame" (according to Nico, one of the fellows from last year). On the way there we came across a cemetery in the middle of the city. I have never seen so many graves packed into so small a space. There were enormous Mausoleums and extremely intricate gravestones throughout the area. We walked around and admired them for a little bit, and then ran into one of the workers at the cemetery, named Moses (pronouced Moy-sees). We asked him if he knew English, and he said "A little." And by "A little" he meant "im fluent"...his English was near perfect. He had lived for a few years in California, and he had family there...his english had a mexican accent to it. Anyway, he was really talkative/nice. He explained to us how they bury the dead. Apparently they dig down two meters into the ground, and bury someone. Then they bury someone else in the same plot (usually from the same family). After 9 years, they dig the bones back up and put them in a box and put it on top of the grave, and put another person (or two) in the grave. This way, they can conserve space...there's not a lot of it in the cemetery. After that, he told us about the festival that's coming up in a few weeks, and invited us over to his house for food during the festival. I'll explain what the festival is about in a later post, but suffice to say that I can't wait for it to happen.

We pressed on to the store, where I bought soap, a notebook, and some COOKIES. not much to say about this place, except it looked eerily similar to Target.

We then walked back to the Residencia to drop off all the things we had bought, and then Nicole, Aisha, Erin, and I walked to the phone store to buy phones. I was buying a phone partly to stay in touch with the other members of the group/my parents, and partly because i really needed an alarm, as this morning had showed. The phone was actually pretty cheap (about 19 euros for the phone and the plan), so it wasn't that bad. They were selling the iphone 4 for 140 Euros (about 200 dollars), so I was really tempted to buy one. But I resisted and decided to stick with my throwback, 1999-esque phone.

After coming back to the Residencia, we chilled for a little bit while Laura R. flew in from Lisbon, and then we went to dinner...at a chinese restaurant. run by chinese people. This was the last place I was expecting chinese people to be, way out in a small island in the middle of the atlantic ocean. Whatever though, the food was good. we went to eat ice cream afterwards, and came back to the Residencia.

It's kind of funny how everyone we've talked to has said that they speak "a little bit of English," but most of these people are really good at it, if not fluent; the taxi driver who took us from the airport to our Residencia on our first day here sounded like he was from Texas. I think people are just scared of us judging them if they dont speak it correctly, so they leave themselves a buffer zone by saying that they only speak a little. This is funny to me, seeing as how most of us don't speak any portuguese at all in a portuguese country, so who are we to judge?

First Day

We did a lot of walking today.

This morning we met a man named Hugo (pronounced "oogu"), who lives in the Residencia with us. He took us to the university to pay our housing deposits/rent. This was around a 30 minute walk, but it didn't matter because the city around us was so beautiful. Hugo is one of the coolest people I've met here so far. He's from Madiera, another island in the Azores, but he's in Terceira to study Nursing. His English is really good, so he told us a lot about the island and Azorean culture. After paying our deposits, Hugo took the scenic route home ('scenic route' actually applies to any route in this city i think), that took us past the bay. It seems that the Portuguese built the city right up to the edge of the cliff overlooking the Atlantic Ocean.

Afterwards, we went to a cafe for dinner. I think my food cycle is still on American time, because I get REALLY hungry at 4 pm local time (noon US time). Oh well, the food's good enough to be eating 24/7 (I know someone who wouldn't have a problem with that at all...). I had been having issues with getting my credit card to work, but all that got fixed. word. Also around this time my camera ran out of batteries, which wasn't a good thing because I missed out on some excellent photo-ops. oh well, i have 6 more weeks.

Then we came back to the Residencia, and chilled for a little bit before heading out again. Originally we just wanted to see the Hospital (where me and everyone else but Laura, other Laura, and Singer would be working), but that turned into EXCITING ADVENTURES. we walked into an area of the city we hadn't been before (I wonder where the ghetto of this city is...probably isn't one). We came across a giant statue of three bulls. The running of the bulls is a big deal in this city. It'll happen in a few weeks; I can't wait. Anyway, after taking a lot of pictures with the (admittedly well-endowed) bulls, we pressed on. We came across a bakery, where I had the best pastry of my life. It was chocolate, and...ok I can't describe it. But it was good, and now I'm full.

We walked to the pier, and talked to a pair of swiss sailors who were stopping over in the Azores for the night. I kid you not, they were sailing on the Black Pearl. I think they were kind of mad at us though because were staring at their ship/home for 20 minutes.

I think what has taken me aback the most here so far is how nice the people are. Everyone here is willing to help us out. I'm kind of embarrassed to be visiting their country and forcing everyone I talk to speak English instead of Portuguese, but everyone is so patient with our broken Portuguese/sign language.

Arrival

So I'm in Terciera Island right now, my destination. I would write about stuff that happened before my flight yesterday but honestly I don't remember, so I'm not going to do that

I flew from RDU to Boston, and then from Boston to Ponta Delgada, another island in the archipelago...there was a layover there before flying to Terciera Island. This last flight was interesting for several reasons.

1) the guy sitting next to me smelled awful, a mix of tobacco, sweat, and alcohol. he boarded, sat down, and immediately went to sleep. I spent the first half of the 5 hour flight trying not to throw up (from the smell), and then I realized this guy had been throwing up regularly for the past 2 hours. Seriously, this was the quietest, most polite throwing up ever...I just thought he was coughing from time to time but by the time I realized what was going on he was ON HIS THIRD BAG. the flight attendant then came by and moved him closer to the bathroom so he could use it if he needed. We saw him later when we got off at the airport, he had some paramedics helping him out, so he was probably really sick.

2) the woman sitting across from me on the plane was WAY too interested in what I was doing. When I got my food (more on that in a bit), she literally leaned over the aisle to see what I had. it was the same as what she had mind you. I would then look up periodically and she would be looking at me. during eating. during the movie. when i shifted in the seat. WHILE I WAS SLEEPING. waking up to her STARING INTO YOUR SOUL was an intense experience.

3) when i booked my flight a few months ago, i selected the vegetarian meal. I don't eat beef and since the Azores has a massive population of cows, i didnt want to risk getting that (I was right by the way, it was beef). my meal was: steamed rice with steamed cauliflower. what. salad (with too much salad dressing), butter (with nothing to use the butter on), some fruit and a shot of water. the rice didnt taste like anything so i added two packets of salt, which was better, and then i added the rest of my salad dressing to it, which was a mistake. I had just eaten before boarding though so it was all good.

4) 8 hour layover in Ponta Delgada. Me and Chris went on a WALKING ADVENTURE around Ponta. I love this place. the weather is awesome...kind of warm, but the breeze from the atlantic ocean (about 2000 feet away from the airport) is constant and cools everything down. Then i realized i hadnt slept in over 24 hours and knocked out on sheet metal seats and now my shoulders hurt

We finally got to Terciera island around 4 PM local time (=12 PM EST) and spent the rest of the day exploring the neighborhood surrounding our home base. We're staying at a Residencia, which is kind of like the dorms that the students at the University of the Azores use. It's straight up a castle. I'm sitting in the common room right now and it looks like something you'd find in GRIFFYNDOR HOUSE.

This place is beautiful. Same weather as Ponta, but we're staying in a more populated area so its pretty nice. Pictures/Videos later, three hours sleep in two days is catching up to me.

Almost Time

T minus 20 hours until I leave for the Azores

The fact that I am using that method of counting instead of simply saying '9 hours till I leave' signifies that something pretty important is going to happen; most people have heard this in the context of shuttle launches, which let's be real, is a pretty important event.

Somehow I don't feel like I'm giving this the gravitas that "T minus" deserves. It hasn't really set in that I'm leaving for another country, another culture. In my mind, the Azores are "just outside of Charlotte."

This is going to be the first place I have gone overseas that isn't India. I'm thoroughly used to India. I am thoroughly used to the United States. Anywhere else? I have no anchors.

Bring it.

I don't know where my socks are.