One of the highlights of the course has been the clinical rounds. The concept and execution represents a masterwork by the staff. We saw patients in 3 hospitals in Cusco and Iquitos and 4 in Lima, each representing a unique clinical and social experience. With a few understandable exceptions, we saw at least 3 new, interesting patients per day. All the groups got to see all of the interesting patients. It was a good opportunity to learn about parts of medicine that I have never seen before (unless I have missed it) and learn about healthcare in Peru.
As I previously mentioned, the class was divided into groups of 5 – 6 people, each constituting a clinical group. I got to know the people in group #6 the best because we worked together 2+ hours every day. The patients and rounding attending physicians changed but we always traveled together. With their permission, let me introduce them.
Paulina, an RN relatively recently graduated from nursing school in British Columbia, is the group member that I admire the most. I struggled mightily from the start with 30 years of practice backing me up so I cannot imagine what it was like for her. Every day she was cheery and ready to go. There were many interesting lesions, radiographs and ultrasound images. Because she had a nice camera, Paulina became our default photographer, mostly. She did it unobtrusively and well. I felt like I was hanging out with one of my daughters. That is something that I don’t get enough of.
Esther is doing one year of Internal Medicine before starting Dermatology in Boston. Tropical Medicine is a gold mine of interesting lesions, some by themselves and some as manifestations of other diseases. As in clinical practice almost everywhere, most of us are clueless about Derm. Never mind she hasn’t even started her Derm training yet, when we did not know what we were looking at, we turned to Esther. She has a wonderful air of confidence – confidence to try, a willingness to expose herself, even when she did not know. This wasn’t arrogance. She was just willing to take a shot. It sounds like she was brought up in a home where it was a given that anyone could do anything. It shows. Plus, Esther is always ready for a good laugh even at her own expense.
Jinny is the Pediatrician in our group. She is a fellow (if a women can be a fellow) northern New Englander from Vermont. Like me she took a circuitous route to get there but seems to fit the bill of my vision of a Vermonter, albeit transplanted, nicely. What can you say? Jinny is smart, compassionate, funny, insightful, and a pleasure to work with. She managed to do this course with her 14 yo son living with her for a few weeks before her husband came to join them. That fact alone merits special commendation for her. The 14 yo is a good kid but he is 14 yo. I found it hard enough by myself; I could not have been Mom to anyone.
Brent comes by way of the Canadian Armed Forces. He is Family Medicine trained with subspecialty fellowships in Infectious Diseases and Critical Care Medicine. Oh, and by the way, he is an aviator (flew fighters and rotor wing) and has worked as an engineer for GM. This was tough for Brent because he has done 2 tours in Afghanistan, and has another coming up, all while being both a father to 3 young children and a husband. I didn’t get Brent at first but I think I do now. He takes his responsibility to care for his guys personally. In the military you get trained and then are tossed into the frontline, usually in a place vastly different from where the training took place. The fact that you are alone does not help. There seems to be an element of immediacy for him about the information offered here because of its practical, day-to-day relevance to his military mission. Brent is like a bulldog so he grabbed a hold of everything possibly pertinent to this mission until he got it. I hope his patients appreciate what a smart, compassionate, stand-up guy he is.
Clevy is a wonder. Her background is also in ID currently finishing her training in the Dominican Republic. How she knows so much about ID, especially the complicated nuances of HIV/AIDS and Tbc at such a young age is a wonder to me. When we had opinions we would toss them out (in my case, they were pretty feeble) and then Clevy would put the case together in a convincing and clear way. I may have learned as much from her as anyone else here.
Although Brian was not part of the group referenced above, I have spent more time with him here than with anyone else. He was my roommate. Allow me to digress. Despite all of the effort to make the move here as seamless as possible, very few of us had places to live prior to our arrival in Lima. In the context of advice about what to study before the course and warnings about the dangers of not securing a safe cab at the airport, the process of finding a room sounded as though it would be straight forward and simple. In reality, it was somewhat stressful and confusing. On an appointed day, we all met at a hotel, were introduced to some real estate agents and then sent out on a bus, en masse, to see the available properties. Some people were fairly aggressive and latched on to the first places we were shown. Most of the rest of us were clueless until it became clear that if you didn’t secure a place on the first day, you would have to do it all over again the next day with no guarantee that you would actually find something. (One of the agents said that she had no other new properties to show the next day.) Because most of the apartments were for 2, it seemed important to connect with someone to room with, ergo Brian. Both processes felt like a hybrid between musical chairs and speed dating. When I approached him, Brian made it clear that he was not a partier. I wasn’t sure if he was warning me off because he had an antisocial personality or putting me on notice that he would not put up with any crap from me. As it turned out, it has been a good fit. We are both more Oscar Madison than Felix Unger. Both of us are independent, letting each other live and let live. Most of the time we managed our respective meals separately and kept our own company. I enjoy his sense of humor and the person that he is.
Brian is a Peds ID Fellow at the U of AL. He really cares about kids. You can see his compassion and his clinical acumen with any of his interactions with kids. Peds ID is a tertiary hospital sub-specialty. U of AL has a good ID department so the fact that he is there means that Brian is smart but also that he has research obligations. Clinical and research are not necessarily compatible. It will be interesting to see how he sorts this out.