Internal Medicine:

Or how I stopped dithering and learned to love the nerds...

I decided on Internal Medicine after my third year of medical school rotating through each of the different specialties.  At some point or another I thought about doing all of them (except surgery those folks are crazy).  And I actually ended up with something that is pretty narrowly focused instead of Med-Peds or Family Medicine.  My favorite part about internal medicine is how nerdy everyone is and it is not a bad thing...in fact there is so much respect for the crazy smart that are also a little too enthusiastic about learning at the same time.  You also need a little swagger because medicine residents respond to codes.  I mean obviously they aren't trauma surgeons but you gotta do some procedures on the fly...intubate, central lines or in the words of Dr. Fearrington "hook 'em up to the house current."  Probably more on that choice later but here are my nuggets of wisdom for medical students:

1.  No one really cares where you are.  You can get away with not being present but I spent a lot of my time thinking I was being missed when I was attending legitimate meetings or going to class.  Eventually, I realized no one was looking for me...conveniently about the time I had surgery rotation.

2.  Medical Student advice for a code situation: Codes are crowded at the beginning but the crowd thins out eventually so stick around and learn as they go through all that they can do.

step 1: put on gloves

step 2: wait around until people doing chest compressions get tired (only people probably going to do this job are students or nursing assistants) and they really might need you

step 3: YOUR TURN! Don't be scared just put your hands on there and go to town just like they taught you

step 4: Breathe while doing compressions. It is hard to remember.

step 5: stop when you become less effective..there should be more people to help out

step 6: if they make it...rejoice (I haven't personally seen that happen yet) but if they don't you can take a moment to be shocked and mourn...a code is a crazy thing to be a part of.

3.  Study.  What do you think this is? Dental school? (j/k the dental students seem very nice and probably stressed out at times)

New posts will have more pictures as I start 4th year and the slide toward finding out where to go to residency!

love.

This is why you had to sit in the hall in Elementary school

First of all, this past weekend I survived the tornadoes of Eastern NC but it was far scarier than all the tornado drills of elementary school made it out to be. I mean it was the mountains, I didn't realize it was a real risk.
So, I went to the Roller Derby in Raleigh at Dorton Arena. Which is awesome in the first place. But then! They came over the PA and said "Usually we start the derby with this air raid sound but we aren't going to use it this time. If you hear it please exit and go underneath the stadium" I thought there was no way this would happen. But 4 jams into the derby the air raid horn goes off and everyone kind of scrambles down into the tunnels below Dorton Arena. We are just hanging out. I am excited because the Rollergirls are rolling around like "among the people" which I think is awesome. But then they come through and say "When we say GET DOWN, face the wall and cover your head with your hands." Again I didn't think it would actually happen but then we heard it echo down the tunnel to "Get Down!" Babies start crying, someone seems like they might have a panic attack. And then this gush of water comes through the ceiling like feet from us. We scramble up the slope of the tunnels. Eventually everyone starts to relax because you can only sit in such an uncomfortable position and be in fear for your life for so long...maybe 5 minutes tops.
Eventually we get to go back up and watch the best roller derby I have ever seen! Carolina Rollergirls win!


Studying over Easter break..mostly looking at weird skin pictures because I have dermatology right now. Wish me luck!

A peek into next year

So, yesterday some of the third year medical students came to tell us how things are next year. Provided we pass our giant Step 1 exam and generally keep our sanity through the end of the year. We have 6 rotations each lasting 2 months and here is a summary of what was said:

If you like standing up all day and talking in front of patients and people who know way more than you then Internal Medicine is the specialty for you. Show up every single day. Yes that means weekends rounding at 8:30. (Well since we aren't really that useful we do get 5 days off...)= Please no weddings March and April next year.

If you like getting outside your comfort zone and trying procedures on patients because you are the only hospital for 100 miles then Family Medicine is for you! Away rotations and a lot of worksheets make this one fun for everyone who likes not sleeping in their own bed.

If you like asking women if they mind you messing around in places that most strangers DO NOT get to mess around in Obstetrics and Gynecology is for you! 7 days of "night float" is good for the night owls, 12 hour days for anyone who likes coaching women through pain.

If you like having the strangest stories at the cocktail party Psychiatry is for you. The crazier the better you say? You have your calling.

If you like nice people that smile a lot and you like to smile a lot it seems like Pediatrics is for you. Bow ties and more relaxed dress code seems to be the best.

If you like the hours of 3:30-5:30 AM and reading frantically the patient history before you spend a couple hours holding their organs then surgery is definitely for you. Tips given by experienced third years: Don't lie to the attendings and always looking at the wound. 8 weeks of gaping wounds.

This is all pretty much in jest. I am actually very excited about next year, all of it sounds amazing. So, excited in fact that it is difficult for me to keep focused on looking at power points for 8 hours a day which is what I do most of the time.

A week in the mountains

I was home this week in Waynesville shadowing at a family practice. Lessons from the week are these:
1) I have learned something in the last 2 years. BUT I have much more to learn. Especially that no one uses the generic names of drugs. And that drugs are VERY important to the arsenal of what doctors can do.

2) Saw some cool physical findings, which is exciting to me because most of the time we only see "normal" so, finding something good means it is worth it to try and examine every patient. Tough things were heart murmurs and some lung rales. However I got a good look at interesting eardrums-scarred, full of nasty pus etc. Also saw a couple cool procedures chopping off skin cancers and lancing a cyst.

3) Loved the variety of people we got to see. People with lots of education, people with only a little education, poor people, wealthy people. People I knew, people I didn't know. It was great to wade into every room and expect something different but also to get to talk to very different people.

4) Got to toughen up for a final push of studying for my Boards during the summer (June 15th)

Picture from Ecuador mountains looking over the jungle but enjoyed the mountains of WNC this week!

Off the Map? Off the Mark

Hey guys,

Dad encouraged me to keep writing on my blog here in case people are still interested in what people who look at power points 7 hours a day do with their lives.

I thought I would start with the new ABC Show


Off the Map

I watched the pilot and have refused to watch since. It presumably takes place in the jungle of South America. Having been there for awhile it is of course beautiful but I was so disappointed in how they portrayed American doctors.
A) NONE of the new american doctors spoke Spanish. Every doctor I interacted with in Ecuador spoke Spanish. You cannot be a doctor if you can't talk to people and at least understand a little bit about the culture. These people they brought in were idiots. We are taught to fit our medicine to the culture of our patients and that sometimes culture is a much stronger influence on health than we ever will be. Why are they not at least TRYING to learn Spanish?

B) They don't NEED to be there. The governments of these countries have outposts into the jungle. Far better than any Americans could decide to do it. There is a health system there. They don't have everything that we have but they don't have to chop down coconuts to make a saline solution. So while they do need supplies they most certainly do not need doctors who don't understand the language or the culture.

That is my rant on Off the Map. I do continue to watch Grey's Anatomy...I mean after this long I am just getting old and can't bear to let it go.

I also study...but more on cool diseases later.
Let me know if you want to keep hearing about medical school!

Back in the USA

Thanks so much for reading along. I made it back to the US and I am very glad that everything is in English and I can drink water from the tap. I had some delicious Mexican and Italian food already. I will update some blog posts with better pictures and video once I settle back in and start organizing.

Hopefully I will see most of you soon to let you know in person all of the amazing stories that happened along the way.

Mud Colors

I feel like today was Get Back Day up at trail. We went on a long hike into the jungle and did not have any amenities like showers or beds and then today we did a long hike back out. I could seriously taste the lunch chocolate chip cookies during the whole hike. It was a lot longer than our get back hikes usually are. Definitely took a triumphant mud splattered photo once we returned.

These people live literally a 5 hour HARD hike into the jungle. The trail isn't exactly maintained (there were a couple bridges) so it is just a giant mud slide basically. I learned a lot about mud this week. There are many many different kinds. First, there are different colors: white, orange, brown then more interesting like green, purple and pink. There is mud that supports your weight even when you step down hard. There is mud that sucks in your boot and doesn't let you out. (I often felt like the poor horse in the beginning of The Neverending Story...ATREYU!!!) There is mud that clings to your boot so that you have a cement block to drag behind you. Also a note about the jungle boots (they are knee high black rubber boots= do not breathe and smelly feet) but they are pretty much the national shoe of Ecuador everyone in the jungle has them.

So, the cool stuff I did in the jungle. Learned about medicinal plants. One flower numbed your tongue if you nibbled on it a little bit! Then others are poisonous and are used to kill fish for food or worms under the skin. Another poisonous one that is to be used only for emergencies is for like huge machete cuts or bites to stop bleeding but its leaves are very irritating to the skin. Then another if for snake bites and inside that one lives these lemon ants. And they taste just like little bits of lemon. They were really good. You kind of lick them out of this little pod you crack open on the plant. We also hiked to a waterfall. The kids there LOVED the bouncy balls I brought with me and I got to play Equavolley. Like volleyball but...better. Pictures will come eventually. I am packing to head back to Quito and then home. I will miss my host family very much here but I am excited for some food that does not involve rice or plantains/bananas.

Quilotoa and Bus Rides

Hello amigos!

So, I made it all the way to Quilotoa and back. It was an adventure throughout. First, we rode with our family for 3 hours (shuffling two children between laps). We watched How To Train Your Dragon (I loved it again in Spanish). Then we got on a bus and so the buses stop whenever people want and at assigned stops but they dont like make announcements or anything. So, my solution is to make sure everyone in the vicinity of my seat knows where I need to get off by asking loudly each time we stop if this is it. Luckily this plan worked and we got off. Also, the moon is completely full and it lit up the whole landscape. I can't even describe how hauntingly beautiful and lunar it looks because it is so dry and cold there isn't much vegetation.

Then we got in a truck to our hostel. Luckily they still had some food and the fire was going in the woodstove in the center of the common room. It had been hot that day so it was quite a shock to the system to go to the cold.

The next day we set out around the rim of the lake. It is such picturesque country just craggy hills with squares of grain. There were shepherds and sheep wandering the steep hills. One had a cell phone it was pretty ironic. Also, the lake is at like 12,500 feet. So the altitude made it difficult. Every time we went up an incline I had to catch my breath. The terrain changed from moment to moment. Sometimes craggy rocks and sometimes sand like literally sand you would find at the beach to beautiful wildflower lined path. The lake was green though it changed colors as the clouds skimmed over it.

And then, to get home. We took the truck this time riding in the back to the first bus. Then we transferred to another bus that took us part way until we had to get on yet another. So, on the buses they are always playing music and people are selling stuff so I am going to do a stream of conscious example of my typical bus ride.
Maybe I'll practice my Spanish as I ride....what can I get here...your eyes...never leave...always...panflute interlude (the universal language)...song change...ok maybe this time I'll understand..."have to change" (was that you or I, maybe it'll come up again)...your eyes (again!)...love..the words you must...looking out the window: That aloe plant was the size of a Christmas tree!!...And drowning out the words now "Empanada, empanada...helado,lado,helado,cola"

Now you have had the feeling of the bus in Ecuador. Pictures are taking too long to load, you will have to come back. I head to a 3 day stint with a community in the jungle. We have a 5 hour hike into the community! I am excited and a little nervous. Won't be updating until Wednesday because I don't think remote Jungle villages have wifi.

Strange Pets

Hello.

Today I went fumigating for the mosquitoes that carry Dengue and Yellow Fever. Did not find any but we did find some very strange pets...an alligator, a parrot, a huge tortoise and another team found a small version of the flying monkeys from the wizard of oz.

Today I head to Quilotoa. wish me luck on my transfers from car to bus to truck?!

Meters...why America why?

So I have been meaning to post about this problem for awhile. My first day taking height and weight in clinic I was rudely awakened to the fact that I have no idea what the metric system means. Like how many kilograms should a child weigh? So, I could never estimate a starting weight when wailing kids were pried away from their mothers and plunked down screaming every time I would have to start at 0 and work all the way up because I had no idea what 20 kg even was close to as the kids wailed for mom. Or centimeters for height? Why did America do this to us? I am getting a little better but when we were comparing how much we had gained from eating a plate of white rice every meal I was convinced that I had gained 20 pounds until I found a calculator and someone more informed. (It was only 4 pounds luckily). Don't even get me started on actual thermometers with like ...mercury? really? in them. I had to be shown like everything on how to use one of those. It doesnt even beep at you to let you know it is done! No one had a fever because I wasn't patient enough to let the mercury (seriously?) move all the way.

On a more recent subject today we drove a long way to find some bugs. We found like 6 bugs, more specifically Chimburi bugs (I think). We also found a scorpion and the largest cockroach I have seen in my life. It was the size of my hand. It was in a woodpile but oh my it was huge. We did some excellent gravel road driving. It is kind of nice here because like estimation of travel time never really depends on traffic...(double yellow line means wait until you are out of the blind curve to pass, por favor)...it depends on how quickly the driver wants to power slide in and out of curves on these gravel roads. There are also speed bumps on large roads between cities...that would not go over so well in the US I decided. But Dr. Torres liked to use those as a kind of green light for the drag race to pass other cars.

Doing very well overall, one more morning with the Infectious Disease Control.

This weekend I go to Quilotoa. To a volcano crater lake that locals say has no bottom. It is supposedly very cold so I might have some alpaca wool pictures in the future.

Diabetes in Little Old Ecuadorian Ladies

Hey team.

I am tired today. Today we did blood pressure and glucose screening at the Diabetic conference in Puyo. We did a lot but were not super busy all the time, it came in spurts. I had some issues with Spanish today. It is a lot of active listening. You know you are fluent when you can eavesdrop. For me to eavesdrop takes so much brainpower it is not even worth it. And eavesdrop. what a strange word, so glad I don't have to learn English.

The best part of the day was watching a theatrical production put on by the ladies in the diabetes program here. They keep track of their numbers and have exercise class. They were the cutest little things you have ever seen! They were cracking on how tough the doctors were and how they couldn't eat anything. I mean poor things every meal here is white rice with a side of potatoes or starchy yucca with a piece of meat and then a fried starchy banana/plantain for dessert! Oh and juice with sugar added.

The diabetic talks are particularly rough in the clinics. They do not leave happy. Anyway them dancing their little dances made me happy!

Tomorrow I catch bugs that carry Chagas! I am so pumped. No really how could I be such a nerd. Gotta DEET it up.

Jungle Living

Hello friends!

Hopefully you are all doing well. I just had an amazing time exploring and learning about the culture of the people who lived and continue to live in the jungle. Yesterday we took a taxi (which are yellow trucks in Puyo, I suppose to make drives like this one), to a hike, to a canoe!, to a beautiful thatched roof home by the river in the jungle. I had such an amazing time. We had beds above a lower room with hammocks and a long table for eating. I actually got a splinter immediately on the handmade canoe and Manuel, our guide, dug it out with a new leaf just as strong and sharp as a needle. We went on a nature walk both days and learned about medicinal plants (like plants made into teas when babies are sick with vomiting or bark for snake bites.) Then we tried different foods as we walked around. My favorite was a mushroom that looked like an ear. We also tried pineapple of the jungle, heart of palm, a fruit that tasted like a coconut but with black seeds, water from an bamboo stalk, sugar cane of the jungle and actual raw sugar cane. Then I tried a live beetle larvae that are supposedly very good...it was not, the head had a pleasant crunch but a not so pleasant taste, maybe just unfamiliar then the body was chewy. I couldn't swallow it but just spit it out. But I tried it so that is more than the others would do.

Basically I rocked out at the jungle. Our other activities were basket weaving from a palm branch (I thought of Granny, someone please tell her), swinging from a vine just like Tarzan!, playing the flute and using a blow dart gun. (I was the only one to hit the banana that we were aiming at!)

I would definitely recommend this adventure to other people. Our guide had a great sense of humor and his family and kids were really cute! I gave them some bouncy balls. The wife, Vanessa, who I think is only 23 cooked our huge lunches over the fire. They have like a grate with a fire underneath. I can barely cook rice on the stove...but a huge vat of rice over the fire!! Manuel also had made basically everything there by hand from the houses to the roofs to the furniture, to the hammocks!

It was so much fun just hiking around and exploring. It was amazing because I didn't recognize a single tree or plant. Everything was new and exciting. I love the huge leaves of the palms and banana trees. There are palm ferns as tall as 5 people. There are the biggest palm trees you could ever imagine. And by far the biggest leaves I have ever seen. Bear Gryls would be in heaven there seemed to be so much to eat and drink. Yay fun walking around in the wild made me want to come up with a group name and put it on a pillowcase.

Tomorrow is in town at the diabetes clinic.

Whitewater fun!

So when we arrived in Tena it immediately started to pour rain and did not stop until Sunday. It rains in the rainforest...who knew.

We struggled to get a taxi to our very nice hostel. Incredibly clean and definitely the best shower I have had in Ecuador. It was hot the whole time with this amazing water pressure. It was an electric showerhead but apparently I have tamed it. Or maybe my standards were lowered in Arajuno's accommodations without any hot water at all. It was wonderful...then we switched rooms the next night to a private room with alternating burning hot/freezing cold cycles...can't have it all.

But on Saturday morning we went rafting. We were going to do Class IV but all the rain had made it too big and dangerous so we did Class III instead but it was amazing. The water was huge. All the rapids weren't so much rapids as like choppy water followed by huge waves formed by giant rocks underneath. I sat in the front of the boat and it was amazing. I would stare at walls of water 8 feet high and think oh dear just don't fall out of the boat and we would break through with a spray of water. It was soo much fun. Then we took a nap and went out to check out the local discoteca nightlife. We made some local friends and they helped me put my salsa class to use...though with merengue and others thrown in I don't know if I really did my teacher justice. All the guides and local people were out. So it was really more Ecuadorians than dried off gringos after a day of rafting.

We just headed home the next morning after breakfast. Bus ride took a little detour when we missed our stop! The bus didn't go where we thought it did, but thanks to some quick thinking by yours truly we got headed back in the right direction.

Made it back to do some laundry before heading to an indigenous Kichwa community tomorrow.

Weekend!

Last day at Voz Andes hospital. What great people there. They make me really want to do family medicine because they just did everything! From rashes, to sick kids, to pregnant ladies to even endoscopy and colonoscopy!

Now I am headed to Tena the white water capital of Ecuador. Whitewater from the slopes of the Andes into the jungle. I am pumped but still have to find an outfitter that will answer the phone of course.

Love.

Welcome to the Oriente

Hello friends!

I hope that you are all doing well! I am doing well also. I have had some technical difficulties...like last night I was going to update but all the power in the city went out! So, where I left off:
Monday: Orientation to Puyo and my next few weeks in the Oriente or Pastaza province. We are headed all over the province in small groups. Then we went to Parque Omaere right here in Puyo! Visit their website: http://www.fundacionomaere.org/ It was awesome where we learned about the traditions of the different indigenous people to the area and their medical knowledge of plants. It was all in English by this botanist Chris who is married to a Shaur woman. She makes traditional remedies with the plants. It was awesome to hear about the culture before I went tramping up to it. They had plant mixtures for everything from contraception, sinusitis, liver disease and GI problems. They even have awesome traditional houses. It was like Cherokee but less cheesy and more awesome because they live in the jungle. Chris was saying that the reason there are more plant remedies here is because they are more bioactive because of the temperature and the moisture of air in the rainforest.

Then we headed off to our first rotation as soon as we got home. Arajuno, a metropolis with one paved street. Luckily two of us went so we made it to our hotel after giving some locals quite a fright in their homes asking where to go. The hotel was...far from luxurious...but who needs hot water? We were at the Subcentro de Salud or kind of like a Health department for the area. It was disorienting because the doc we were supposed to be with was on vacation and no one else really seemed to want us. But I did a lot of height, weight, bp and temperatures (with a real thermometer, that I had to be taught how to read). Also the doctors dressed like teenagers in the US. Seriously. Abercrombie, American Eagle and Aeropostale t-shirts with jeans was the dress code for the young docs. I was so confused and thought they were patients! No one wears white coats..except us. We ate at the same restaurant for breakfast, lunch and dinner. They were a little different each time and each time pretty good at the bargain of $2 for soup (potato and mystery piece of meat) and plate with beans (or egg) and meat (chicken, beef or tuna salad). We walked around in the evening...and apparently there aren't that many white people that walk around in full scrubs because everyone stared at us. But the kids were great and really wanted to have their picture taken. Oh and on the two hour bus ride out (1 and 1/2 of which was unpaved) I heard Britney Spears, "Hit Me Baby One More Time" and laughed out loud.

Wednesday (Tuesday was mixed in above): We went out in the ambulance even farther into the jungle. It was quite bumpy but we did check ups on kids..everyone got Amoxicillin and I gave a penicillin shot in the butt to a very unhappy camper. Most of the time the docs ignored us but I am not quite sure why...a lot of people spoke Quichua. The local language so sometimes it wasnt just my Spanish being bad. Oh and the docs spent a lot of time making a "Boa" or like a chinese dragon for Chinese New Year. That took most of both afternoons.

Thursday: I went to Hospital Voz Andes where Dr. Teater was 22 years ago! It is a hospital run by American missionaries. It was comforting to be in a place where I understood the medicine a little more. I followed a family med doc who was "on call" and did endoscopies all morning. Much like in the US did not eat lunch until 3. (Way before the doc did though). I saw 2 and 1/2 endoscopies and got to peek at the esophageal/stomach line and small intestine. (there isn't a teaching screen, just one eyepiece.) I also heard rales and wheezing in a lung exam! Which I had never actually heard before! And I saw a positive costo-vertebral angle test where she just had pain over her kidney. I only had to ask a few questions in English and followed a good amount of the Spanish that the doctor spoke to the nurses, residents (from Ecuador on rotation there) and patients. Overall a great day and a place I could see myself if I were to do medicine abroad but I have trouble reconciling the hospital's place in Ecuador's medical system. It operates outside and patients have to pay when all of the other health care at the subcentros and public health hospitals are free. Of course there is already tiered health in that you can buy "insurance" each month to go to the state "Social Security" hospital. Which is a little better than the others but still only serves 18% of the population. And if you try breaking a $20 here you realize that there is not a whole lot of money even in the hands of those who are working.

Sorry no pics, having some mac/pc issues. This weekend to Tena for some jungle whitewater rafting!

Quito and Banos

Hey Team!

So quick update for those that like to just read the headlines. I am alive, left Quito, went to tourism capital Banos and am now in my home for 3 weeks Puyo. Gateway to the Amazon.

So now for the stories. Banos is known for its thermal baths that are superheated by the volcano. It is a vacation destination for Ecuadorians and gringos alike. But mostly I saw Ecuadorians.

We went on a hike to Devil's Cauldron! It was amazing and powerful! It falls like 150 ft into a rock hole. The spray comes up 50 feet and the whole area is one huge mist from the rebounding water. Then we went on a long hike to up above Banos, to Bellavista. It was beautiful and a pretty tough hike. It made me miss living in the woods all summer a la Wilderness Trail. Then we went to the banos. Or las Piscinas de la Virgen. It was at night and we watched the sunset with all the Ecuatorians over the mountains in the superhot mineral baths. (when we went back to the banos during the day today there were no gringos so I got a few stares). Heyre is a picture with me and all the locals...the water is that color because of the minerals. There is actually a very strict showering policy. There were warm showers and some spouts coming from the water of the waterfall above. (That fill the pools of the virgen beside the banos...where you can fill up your very own Virgen water jug.)

I have only two good traveling stories.
1. So we have been traveling in these big charter buses from Banos to the Cauldron and to Puyo. But they don't stop filling the bus when the seats are full. So I have been in the aisle for 2 out of three bus rides. The second is funny because I was in the very front of the aisle basically looking down and out the big front window. (They were also playing Fifty First Dates with Drew Barrymore and Adam Sandler.) I was looking down watching the double yellow line swerve back and forth sometimes on the left like it should be and then it would drift and I would be thinking "Do we really need to pass that truck around this blind curve?" But I made it ok. But think about standing in a charter bus going through the Gorge to Knoxville and you have some idea. The third ride was much worse all the way to Puyo...not for the car sick or those with weak vestibular systems.

2. My second traveling story involves a tourist trap. So banos is beside a volcano that has been "erupting" lately. And there are supposed to be a way to go see the lava and stuff from another mountain. At night it was supposed to be really cool. So we got on a night volcano cruise. Paid our $3 and got on the "chiva" which was a double decker bus. We went up the mountain leaving Banos behind...and ended up exactly where we had worked so hard to hike earlier that day. With no view whatsoever of the volcano. Not even close even. And ALL of the "night chivas" were there. Everyone is handed a "Canalazo" which is a sugar cane drink spiked with what they call "WHisky" but I think was actually rum someone said? It was terrible and couldn't even sip mine even though it was warm. And with no view of the volcano they instead do a "fire show" basically some guys juggling fire and stuff. And then a stand up comedian which from the laughs from those that understand Spanish was very funny...for me it was a listening exercise that a failed.

Summary: Made it to Puyo!

Electric Shower and the Mariscal

Hey team this is the view looking up the hill to my house. The clouds were just barely ringing the tops of the mountains. You can also see the giant street that I scurry across to school every day. Yes I climb that hill, every day...ok ok not to the top but you can see the tiny apartment buildings in the distance. They are far enough.



Ok and so this is the electric showerhead. Ok so it is sideways in the picture but you get the idea. I can´t figure out how to turn it because all the instructions are in spanish.


So this has been the best cultural adjustment so far. There isn´t like a central hot water heater. Basically the water for each shower is heated up at the shower head. With electricity, which doesn´t sound all that safe but apparently it is. Anyway so you have to just barely turn it on because if it is strong water pressure it can´t heat up the water fast enough. So this is how my shower goes...ease the water on, then wait until it starts to get lukewarm, jump in because you only have so much time. Try to get as wet as possible while it is warm, then it turns burning hot so I try and turn up the pressure a little bit. Then I hear the dreaded noise of like a sputtering. And the water slows to a trickle. While it is dripping freezing cold water. I soap up everywhere I can. I squint through the soap running down my face and ease the water back on. Then I jump in and try to rinse as fast as possible. Then I try and change it...sputters back to a drip. Conditioner...sometimes but sometimes it is just to cold and soft shiny hair isn´t quite worth it.

This is the cafe where we ate in the Mariscal after we got out early yesterday from the hospital. The Mariscal is ¨gringolandia¨ but I thought it was great and wherever we go there are never very many. Even last night after the salsa class some of us went out to try our moves. There are tons of people on the street trying to get you to come into their bar. And at the bar that herded us in with a very catchy chant of ¨gratis! gratis! gratis!¨ they were obviously specifically targeting groups of gringos and still there were probably 70% locals in the bar. It was an interesting mix of Lady Gaga, Black Eyed Peas and latin flavor. Salsa I think, it wasnt really reggaeton but it definitely made people move. Everyone in club ¨Yes¨was moving.

Today was my last spanish class and tomorrow I go on a tour of the old town and head to Baños. I am pretty excited. I was the one that made reservations for our group so I hope my spanish was good enough. There was a moment when she said ¨Confumadas¨and I thought she was asking about smoking so I said "oh no nunca fumar¨or we never smoke and she burst out laughing. Apparently all she was saying that our reservation was confirmed. Not the last time I will misunderstand.

Last note: the hospital is pretty much the same as the US but with less tests and scans. They say they spend more time examining and talking to the patient. Which is true...without gloves. And so far the only time so far I have been stranded without toilet paper was at the hospital of all places! Actually I have been pretty impressed with the time and care they take with patients. We havent had that much time at the hospital but so far I have enjoyed my time.

On to the jungle!

Old Town and Rules of the Road

So yesterday I went to Old Town with some of my companeros to just walk around and see what it was about. And it was amazingly beautiful with narrow streets and colorful buildings with these big old churches. You could look up to the mountains ringed with clouds and look out and across to the other side of the mountain where the colorful buildings kind of stretch up the side of the mountain. It is like houses lapping the sides of the mountains. But never any houses on top. It looks beautiful. Unfortunately I didn´t bring my camera.
The craziest part was the taxi ride there! I have been on roller coasters with less of a grade than these hills. And made out of cobblestones so the taxi is jerking down the hill in absolutely bumber to bumber traffic. Not because there are a lot of cars but that is just how they drive all the time.
My next fun fact: rules of the road are about who has the biggest cajones. If you want to walk out in front of a taxi that just cut off a truck and a bus then you have the right away. If you are merging and just put your car as close as possible to the others then you can get in. They also drive as fast as possible at all times. They also use the horn to kind of let people know they are there. Like when running red lights...
I´m still alive and even survived a Salsa class!

Pictures of Quito

Picture of Quito from my host mother´s daughters house. It stretches forever it seems like this one photo can´t do it justice.

The view out my window of the tallest peak and volcano: Cotopaxi this morning. How beautiful huh?

My host mom with so much patience and Bruno.

Fun fact: all of the restaurants that I have seen play simpsons episodes on the tvs. or maybe that is all that is on.

Fun fact: Who wants to be a millionaire only goes to $50,000. What a rip off. I keep talking to people about it and they are amused that in the united states it goes to a million. But come on it is who wants to be a millionaire. Of course 1,000 is ¨mille¨ so maybe it isnt a rip off.

In Quito

hello friends!

I made it to Ecuador all in one piece. In fact on my flight down I was bumped up to first class! I have no idea why or how but I must have had some good karma stored up. I have never been in first class before and do you know you get a tablecloth! A tablecloth and real glass and a cloth napkin. I felt a little embarressed about my windfall and did not take full advantage I think. Then I arrived in Ecuador. There was a little mix up trying to get to my host family (the director of the program took me instead) but I eventually made it. My host family is just one awesome lady and her dachsund, Bruno. I will post pictures very soon. I had orientation and got my schedule of intense spanish class and time in the hospital. Then I go for a weekend in Banos and on to Puyo. My very first week I stay overnight in an indigenous rainforest village. I am very excited. My spanish is a lot worse than I thought. So, I am in the very most basic level of class. My host mom, Gina, is very good about talking to me and trying to ask questions. Sometimes she launches into a long story that I cannot understand but I nod and smile and pet Bruno. I took some pictures of Quito from Gina´s daughter´s apartment roof. She also talked to me for a long time. Basically my family is amazingly accomodating of my poor Spanish.

All the students and teachers at the school so far have been really great. Today I braved my fear and went to a seafood resturaunt and tried Ceviche. Ecuador is famous for ceviche on the coast. It is basically seafood gently cooked with acid as I understand it. I tried shrimp and conch. I paid kind of a lot by Quito standards like $7 but I figured it was worth it to pay high dollar for barely cooked seafood in a very clean, nice place. I want to say I loved it but I didn´t it was a little weird because it is served cold. It was an intense flavor too. I liked the shrimp but not so much the conch because I kept biting into hard stuff (sand?). Anyway I hope to post pictures tonight. Yesterday was Sunday and everything was closed including the internet cafes so I couldn´t tell everyone I was alive. Luckily too the traffic was a little slower. But today it was a lot of scurrying.