India

Three days later, and I'm getting on a plane again. I'm headed to India this time, for my cousin's wedding. I'm excited, but still kind of exhausted from the Azores...I'll have to take it one step at a time I guess.

I'll have less regular internet access while I'm there, so updates will be less frequent than the Azores.

My sleep cycle is going to be so screwed by the end of this.

More posts on the other side of 14 hour flights.

Tell the World I'm Coming Home

This is it. I'm sitting in the airport in Lajes in Terceira, waiting to board my flight to Ponta Delgada in an hour. From there its on to Boston, and then to RDU tomorrow morning.

This trip has been beyond amazing. From a professional standpoint, I've seen things at the hospital that have been enormously affirming; I know now for sure that medicine is what I want to do with my life. I can't thank everyone at the hospital enough, Dr. Claudio especially, for everything that they've done for us these past six weeks.

This trip has also been amazing from a culturally. Life in the Azores is completely different from what I'm used to in the States; the living here is easy; the people are very proud of their heritage, and fiercely protective of their traditions. They are some of the nicest people I've ever met; the openness of the Festas and the Sanjonina's festival are testament to that. The raw, breathtaking scenery of the rocky beaches, volcanoes, and rolling hills juxtaposed with the energy of the bullfights and Touradas make this an experience I won't soon forget.

Finally, there are all the people I met on this trip. All of us (Vanessa, Hamrick, Fei Fei, Aisha, Singer, Erin, Nicole, Chris, and Rozo) have become very close over these past six weeks; people I am sure I would not have met otherwise. I'm glad I got to meet them; we've had some awesome memories that have made an awesome trip 1000 times better. Love y'all.

There is a restaurant near our Residencia called 1516, where we ate at least 5 or 6 times. The food there was amazing, but we also kept going back because of our waiter. Pedro is easily the most energetic person I've ever met, and a perfect example of the type of people here. Our first time there, he gave us all nicknames to remember us better (maybe he knew we would all be coming back). I was "The General," because I asked something about the way the Chef prepared a dish. Apparently in Portuguese, Chef means "chief," as in the military rank. Ever since then, he's called me that. Last night we decided to make our last meal at 1516. When Pedro found out we were leaving the next day, he instantly invited us over to his house later that night. He wouldn't get off of work until about 2 am, so we decided to head over there after dinner. We walked around our section of the city talking for a little bit, visiting all the places that have become so familiar to us over the past six weeks. I was feeling a little nostalgic, which is funny given the fact that I didn't even know that the Azores existed before I got here. In six (entirely too short) weeks, this place has clicked with me.

Without a doubt, I'm excited to go back home and seeing my family. In a week, I'll be in India for my cousin's wedding. But I'm also sad to leave this place. I really hope to come back here at some point in the future, whenever that may be. Hopefully I'll have a similar experience next time, though it'll be hard to top this trip.

I love my team.

-Ranjan Banerjee

Weekend in Sao Miguel

Having spent 4 weeks on Terceira, some of us decided that it was time to explore some other islands in the Azores. We (Vanessa, Nicole, Laura Hamrick, Laura Ruzo, Aisha, Erin, and I) arrived in Sao Miguel on Friday by a three hour ferry ride and explored the city of Ponta Delgada. This is the same city we had flown into from Boston, but we hadn’t had the chance to explore it much despite a 8 hour layover because none of us had slept in over a day by that point.

Ponta Delgada is a tourist destination, and from the minute we landed the differences between it and Angra were clear. Everything was more city-like…they had high rises (!), hotels, tourist shops, and malls right along the ocean. Usually I don’t like over-commercialized tourist areas, but I think Ponta Delgada pulled it off quite well.

Anyway, we landed around 4 pm, and found our residencia. We were staying here for free, since we had worked it out with the residencia in Angra. I think this is a network of dorms for college students who live on different islands, something that’s very convenient for us. This residencia was very new, and very nice; much more so than our residencia in Angra. After freaking out about this for an hour or so, we got dinner, walked around, and went to bed. The next day was a big day.

We had decided that it in order to see the island fully, we would need transportation. We had initially wanted scooters, but ended up renting a car because 1) it was safer 2) easier to keep everyone together and 3) it was cheaper (when split among 7 people). It ended up being 26 euros per person for two days, which was nowhere near as expensive as I thought it would be. It turns out I’m the only one in the group who is 21 (the legal age to rent a car here). Luckily, I was also the only person in the group who knew how to drive a manual transmission car. This is a good thing because all they have in the Azores are manual cars. I’ve been driving manual cars all my life, so I was ok with being driver.

We rented a 7 passenger van. It was a brand new, 2011 Volkswagen Sharan. It was a little bigger than a Toyota Sienna, and a LOT more powerful. When I first got the car, I was feeling pretty confident about myself being able to handle it; how different can it be from the Honda Civic that I usually drive? With this in mind, I initially chose not to get the insurance when I was doing the paperwork for the car. That changed quickly.

First of all, this car had 6 gears (instead of the 5 that I’m used to), and the Reverse gear was on the opposite side of the gear schematic (in the States I would have to go right then down to go into reverse, whereas here I would have to push down on the gear shift, then go left, and then up). I didn’t realize this, so I almost rear ended the car in front of me as soon as I started driving because I switched into 6^th gear instead of reverse. After a minute of freaking out, I got my shit together and pulled out of the rental car lot.

The first hour was stressful. European streets are TINY, and this van is ENORMOUS. On top of that, people generally park and drive wherever and however they want on the street, so going down a city street here is an obstacle course. Also almost every street is one way, and all of them look the same. On top of THAT, the range for first gear in the van was wayyyy shorter than I was used to…I would have to switch into 2^nd gear as almost as soon as I started moving, or the car would stall. There’s nothing like stalling on a tiny, uphill street in a massive van with 15 pissed off Portuguese people honking behind you. It was ok though, I think stalling the first few times in a new car that you’re not used to is excusable (any time else, you run the risk of losing respect).

After going back to the residencia and picking up everyone else, we decided as a group to get the insurance for the car. I had good faith in my driving ability (and I’d like to think everyone else did too); I was already starting to get used to the car. But, it would make everyone else (along with me) feel a lot better if we knew we didn’t have to pay 2000 euros if we scratched the sides. So we went back to the rental place and purchased insurance; it worked out to 72 euros for two days, or around 10 euros a person.

We loaded up the car with everyone and set out. I was craving to get out of the city and onto wider, more open streets, so I could finally get out of 3^rd gear and see what this car could do. We took the coastal highway, and headed for the hot springs.

The view was beautiful. On one side we had rolling green pastures s created by volcanic lava flows, and on the other side was had the deep blue of the Atlantic Ocean. Moreover, I had started getting comfortable with the car, and allowed myself to relax. This car really was a blast to drive. It had a ridiculous amount of power, and it was fully loaded.

Anyway, we started driving up a mountain, where the hot springs were located. The weather had been nice on the coast, but as soon as we gained altitude, everything became shrouded in fog. The visibility was about 10 or 15 feet in front of the car. The scenery was raw nature; I think I preferred it to be a little foggy rather than completely clear, because it lent an air of mystery to our surroundings.

Along the way, we saw signs for sulfur springs, and decided to get out and look. The geysers were intense, and a reminder that we were on an archipelago made of up fully active volcanoes. By this time it was cold and drizzling slightly, so the geysers felt pretty good. After taking a lot of pictures, we sang and recorded the alma mater. I’ll talk about that for a little bit.

We’ve made it a point on this trip to record ourselves singing the alma mater at each point we stop on this trip. We record ourselves while we do this, with the goal of editing all of them together to make a massive 30 minute alma mater video by the end of the trip. For those of you that don’t know the alma mater and fight song (and seriously, shame on you if you go to UNC and you don’t), it’s below:

Hark the sound of Tarheel voices

Ringing clear and true

Singing Carolina’s praises

Shouting NCU (N – C – U!)

Hail to the brightest start of all

Clear its radiance shine

Carolina (priceless gem!)

Receive our praises thine

Fight song:

I’m a Tarheel born

I’m a Tarheel bred

And when I die I’ll be Tarheel dead

So its rah rah Carolina ‘lina

Rah rah Carolina ‘lina

Rah rah Carolina ‘lina

GO TO HELL DUKE (originally ended with rah-rah-rah, but this ones a lot better I think)

OK back to the trip. We pressed on to the hot springs, where we would be able to swim. We eventually found them in this sleepy little town, made lonelier by the fact that by this time it was cold raining pretty hard. After changing into our trunks (while freezing our asses off), we jumped into the springs.

This place was amazing. The water was 100 degrees Fahrenheit, which was perfect against the cold and the rain of the atmosphere. It was actually a ferrous spring, so there was a large amount of iron in the water, and the rocks surrounding it were oxidized to a deep orange. It was a great relaxant, especially after the stress of driving the van with the fear of crashing it, and losing our way more than a few times. Apparently you’re only supposed to stay in the iron pools for 30 mins at a time. However, it was so warm and comfortable, we stayed in it for about an hour and half, by the end of which everyone was feeling kind of woozy. So we decided to get out. We got back in the car (which had been precariously parked on a hill more or less in the middle of the street, which was ok because apparently everyone parks wherever they feel like it here) and took the coastal road back to the residencia. BY the time we got back it was around 6 or 7, and we were starving. We went out to eat, came back, and chilled until it was bed time. Good day.

By the end of the day I was driving like a pro; I had become totally used to the van, and could drive it comfortably even in the tiny city streets of Ponta Delgada. Nice.

Sunday morning we got started around 11. The goal this time was to explore the other side of the island, particularly the city of Sete Cidades (7 Cities) where we had heard from locals was a very beautiful lake. The drive there was uneventful (in the sense that we had amazing scenery all around us the entire way). Sete Cidades is a city located in the center of a MASSIVE volcanic crater, bounded by two enormous lakes. We drove into it from the top, getting a ridiculous view of everything around us.

The town itself wasn’t anything special; I actually drove through it on accident without realizing that we were already there. After turning around (using a 18 point turn, which was required with a van that large), we ate lunch (completely a rip off btw, but I won’t harp on that too much), and went hiking around the lake and crater.

I won’t try to describe how it was in words because that won’t do it justice. Suffice to say that it was awesome, and I took a lot of pictures. I’ll put them up (someday).

After spending a few hours there, we drove back to the residencia. By the time we got back, it was around 7. We stopped at the mall on the way back, got dinner there (KFC!!!!!!), and decided that some of us wanted to see The Hangover Part II at the movie theater there. Aisha and I drove Vaness and Nicole back to the Residencia because they didn’t feel like watching the movie, and then got horribly lost on the way back to the mall. I knew I took the wrong road off a roundabout, but I didn’t have any place to turn back around for about 5 miles, because EVERY FREAKING ROAD ON THIS ISLAND IS ONE WAY. Aisha and I ended up in another city all together, and I had to walk into a very seedy bar to ask how to get back to Ponta Delgada, which was interesting because he didn’t speak any English and I didn’t speak any Portuguese. We mimed and made noises for a little bit, and he finally understood where I wanted to go. I memorized the order and direction in which he pointed, got in the van again, and started driving.

The directions he had given me were totally wrong. By this time we were about 20 mins away from the movie starting. I finally decided that screw it, I’m going to take random turns until we run into something we recognize. Surprisingly this worked; Aisha spotted a pharmacy that we had passed earlier, so we were able to find out way back to the mall. 10 mins ahead of schedule. Score.

The people watching the movie was Erin, Laura H, Laura R, Aisha, and I. The prices were 5 euros (about 8 dolalrs), the same that we would pay in the States. We went to buy our tickets for the 10 pm showing, but that was sold out. The next one was at midnight, so we decided to catch that. We had about 2 hours, so we decided to get some drinks and walk around the beach.

After doing that for a little bit, we came back, watched the movie, drove back to the residencia, and went to bed.

Now I’m sitting on the ferry back to the Terciera, with about an hour and a half left in the journey. My back hurts from sitting up and typing this. I’m going to sleep.

Outpatient Surgery and Festas

Yesterday I got to the hospital a little bit later than usual. I could say that I had a good reason, but then I'd be lying, because I just woke up late.

I was walking around looking for Claudio, getting stares from the patients (blending into this island is harder than I thought). I was about to walk through the double doors that led into the general medicine wing when I was almost flattened by Claudio sprinting out the other way. He was in a hurry; there were many outpatient surgeries scheduled that day, and Claudio really wanted to see them. Even though he is an internist, he is a surgeon at heart; he's actually leaving for Canada next month where he'll be doing a surgery rotation.

Anyway, we ran down to the outpatient building, and realized that the surgeon wasn't there yet. So we got coffee while we waited, and Claudio told me part of his life story. Can't mention large parts of it in writing, so I'll let that remain a mystery.

After a while, we went back to the outpatient clinic and scrubbed in for the surgery. There were 4 or 5 of them scheduled that day, and they were almost all cyst removals. Claudio was really excited to do them, so he took over after the actual surgeon did the first one. I had two cysts on my chin back in the day, but it was still more gross than I expected it to be. This was the first time I'd seen people use anesthesia...which I guess is a good thing because it shows that Azoreans aren't invincible robots who FEEL NO PAIN after all.

Claudio gave me an up close look at all the surgeries; I was literally standing over his shoulder while he was cutting/suturing. The procedures them selves didn't take that long; maybe about 15-20 mins each. I could really feel the energy coming from Claudio as he worked; he was born to do this. Which I guess is a good thing for the patient.

After the hospital, we didn't do much, except go to a festa. I alluded to these in an earlier post, but in a nutshell, festas are open street parties put on by churches for a few weeks during the summer. Anyone can come to them...they have free food, free wine, and bread. They're a pretty big deal around here...when a meal is about to start, they set off fireworks so people from all over the city can find the street where the festa is being held. And then they flock to find it.

If beef and sausage didn't make up such a big part of the Azorean diet (there are more cows than people here, so the beef here is very very cheap...also very good from what I'v been told), I would literally never have to pay for food for the remainder of the time here; I could go festa hopping for all three meals. Oh well, at least the bread is delicious. Also the wine is a LOT stronger than I expected...I think its home brewed, because it wasn't like any wine I'd tasted before. Not that it was bad; but it really sneaks up on you if you're not careful.

Two more weeks left. Hard to believe I've already been here a month. I definitely want to come back at some point; this place is amazing.

Intubations

This morning I shadowed Claudio again. There wasn't much on the list; we saw some of his patients and he was officially done for the day. Afterwards, Claudio let us practice tracheal intubation on a dummy. The dummy was lifelike (besides the fact that it had no arms), so everything we did was at least somewhat close to reality. In teaching us this, Claudio also gave us a crash course in first aid and trauma response protocols. I had been CPR trained several times in the past, and what he told me was pretty similar to what I had learned.

In an intubation, I would have to insert a breathing tube into the patient's lungs, because they would not be able to breathe for themselves otherwise. I knew all about it, because they do it on every other episode of House. It was actually easier than I had thought it would be, but then again I wasn't under stress, with a patient's life on the line. I'm pretty sure it will be a lot tougher with the chaos of an emergency room and an actual patient.

After the hospital, Claudio took us out for lunch, after which we came back to the Residencia and had our meeting with Sarah for the academic discussion. Not too much going on today.

Volcanoes

Yesterday we went to Art's campground again to do some building work. It was mostly raking the grounds for leaves and large rocks, and setting up the tents and teepees. After a day of doing this, we camped out in the tents/teepees we built.

In the morning, we did a little bit more work (mostly moving stuff around and packing up) before coming back to the Residencia around 12. Soon after we got back, Chris, Vanessa, Singer, and I headed out again with Paul, one of the other students at the Residencia. We were planning on going to one of the volcanic sites on the island, and having a barbeque dinner there. This was my first excursion into the island interior, and I was excited to get out of Angra and see what else was out there.

The interior of the island is the most lush place I have ever seen. There aren't any houses there (most people live on the coast)...most of the land is used for agriculture and livestock. So there was basically miles of isolated green everywhere.

The first place we went to was a site where three tectonic plates - the African, American, and Eurasian - met. There were many sulfur vents active in the area, and a haze covered everything. It was pretty amazing (as was every other place we went to in the past few hours)...I'll put pictures up from it soon.

Then we went into a swamp-like area to grill and eat. not much to say here...the food and scenery were good.

Afterwards we climbed into the crater of a volcano, which had been overgrown completely by greenery. Like I said, I have never seen that much green in one place...it was pretty beautiful. Also all the volcanoes on the island are still active. good times.

On the way back, we passed by the American Base...and found out that apparently our government issued ID's (passports, drivers licenses, etc) are good enough to get us into the base. This is not what we heard before, so we'll be looking into that to see if we can get in. We did see american apartments, american cars, and american stores on the other side of the (heavily guarded) fence, which I think made everyone miss home a little bit.

It's kind of frustrating that it's impossible to capture what you're seeing on camera. The pictures and videos of natural scapes that I take on this island are small sections of what is out there...it's impossible to capture the breadth of the view and the feelings they inspire. Not for a lack of trying though.

Surgery

Today I was in surgery. I woke up at 8 (the earliest I've woken up since December), because they started their procedures at 8:30.

There really isn't much to say about the procedures themselves; the protocols and methods are exactly the same as in the surgeries I've observed in the States. Some of the same surgeries too.

Vanessa and I was talking to one of the surgery nurses in the scrub room before going into the operating rooms about how crowded the emergency rooms (which I had been in numerous times in the past three week) were. Dr. Claudio had mentioned to me on my first day there that there was a severe problem here in which people could come to the emergency room for things that could easily be attended to by the family doctor; coming to the emergency rooms for things such as allergy medications, missed periods, colds, or even to get a prescription filled may be quicker, but its a huge drain on hospital resources and manpower..it hampers access to emergency care to those who actually need it. Apparently this is a problem in the States as well; Chris told me a few weeks ago that there was a hospital in LA that had to be shut down because of the very reason...so many people came into the ER for mundane things that the hospital was pouring all of its money into that department, and went bankrupt. I guess we need to use our judgement in deciding whether or not a problem warrants and ER visit or whether you should just call Raleigh Pediatrics (as I would do in my case. also I'm not sure why i still see a pediatrician). Do I smell a tirade on decision making in medical settings coming up? no, thats just my laundry. I'm tired right now...don't have too much energy to think.

why? because I spent the day cooking. i think i really like it...there's something really therapeutic about the whole process. also your largest problem in the kitchen (provided you don't set something on fire) is whether or not you put too much basil in the pasta sauce (answer is always no).

that's it for now