reflections on being a medical student in Baltimore

Today after our first exam of medical school we had our second "Patient, Physician, and Society" course. The title was "Physician Narrative" and we were assigned to read 5 chapters out of Abraham Verghese's My Own Country. While the lecture portion of the class was thoughtful and generally worthwhile (except that somehow the course director didn't communicate to the lecturer that we were assigned one of the chapters she read out loud), the group discussion portion was horrible. It was meant for us to reflect deeply about our new social responsibilities as a physician. The leaders of the discussion, two young female physicians, had nothing prepared for discussion and we were left to throw out insights or ask questions about how much their experience resembles the stories recounted in the book. Maybe some of the people in my class have never interacted with anyone different from themselves, but it was mildly insulting to have the facilitators telling us that "most drug users are actually nice people" as if that would come as a complete shock. And as though having to face the challenge of interacting with people so different from ourselves was a side effect of choosing to study at Hopkins. I am eager for the portion of the course where we, the students, will lead the discussion and share with each other as peers. There are a number of people in the group who have spent significant time in this city and have probably chosen to stay here specifically because of the diversity of the patient backgrounds and the resilient spirit of the people here.

More moving than that exercise was the frustrating occasion of my first flat tire on my bike. As I walked up Guilford Ave (my street) experiencing both brightly-colored, recently painted homes and those that have been abandoned and boarded up. Passing people sitting on their stoops conversing and passing the hot afternoon hours, I felt some of the sentiments that Abraham Verghese shared in his book: the feeling of being a part of a community where nothing is perfect but. A number of people noted the irony of me, a white student (my backpack probably indicated that) walking through a run-down black neighborhood pushing a bike. A few asked why I wasn't riding or confirmed that I had a flat tire, many others just said hello.

For some reason this walk and these interactions inspired me to reflect on the consequences of doing my training in this city. Now that I've committed to being here in Baltimore for at least the next 4 years, deciding to take on a career in improving the health of my community, I can't say that any aspects (good or bad) of this community don't have anything to do with me. I'm a part of it and it's a part of me. I share this neighborhood with people who have lived here all of their lives, and from this point forward we will build it and grow together. While I am growing and becoming a physician, other people will be experiencing equally meaningful life experiences like going through primary or secondary school, getting married, having children, etc. It's a powerful feeling to be a part of something bigger, a movement to defy what people think they know about this city and find ways of making it a place we are all proud to live.

MIA

Wouldn’t you know I got sat next to the John Deer dealer?! He’s from Mississippi and was very bitter that he was headed to New Orleans next, explaining that "those people" are constantly ripping off tourists and looking for hand-outs “I mean just look at what happened there after the hurricane. Everywhere those people went they’re trying to get rid of them.” He also explained that his hunting trip was actually helpful to the sunflower farmers because the pigeons and doves are a real nuisance.

The Miami airport has been a real culture shock. The late arrival of our plane, the craziness of the passport check, baggage claim, and gate assignment system shortened my wait time from 5 hours to 2, but it has turned me sour toward Americans, both new and old. I would guess that 80% of the staff and passengers in this airport weren’t born in the United States. Between all the people I had to interact with to get to my gate—the immigration guy, customs guy, airport information guy, wrap-your-luggage-in-saranwrap-guy, and five American Airlines agents, the most pleasant was the customs guy (and I’m not trying to say that he was super nice). Looking around at the passengers I have to ask myself “does your hair need to be that big? Do you really need to be the first in line at customs? Do you need to use that tone with your kid? How much time have you spent on that tan and those nails?”. I thought the Miami airport would have been a nice transition, but I just want to see familiar faces. It's kind of nice that toilet paper can actually go in the toilet though.

Taking off

I’m sitting in the Santa Cruz airport (Viru Viru) waiting for my flight to Miami to board. I just met a couple of Americans who are on their way back from a dove hunting trip 60 miles east of Santa Cruz. They got here Friday, headed straight to the resort/lodge, and are heading back home to the States now. The guy across from me has a John Deer pillow and I just found out he’s a dealer.

There are rumors of a possible confrontation today at the Trompillo airport between the military from Santa Cruz, the military from La Paz, and 2000 indigenous people who have gathered here for the parade. Other government and nongovernment organizations paraded yesterday, August 6 on Bolivia’s day of independence. Today is a full working day, but Evo Morales (the pres) will be in town and most cruceñans will be focused on the defile. Cruceñans (Cambas) are expecting trouble from the indigenous people (Collas), saying that they have arms and will provoke trouble with the military. Celso told me that the indigenous mentality is such that they put their cause ahead of personal safety and would use weapons even if that put them in danger. Chemita said she’s thinking of learning how to shoot a gun so that she can defend herself and her children if the trouble spills over into their neighborhood (next door to the airport where the defile will take place). But my indigenous taxi driver told me yesterday that was a lot of sensationalism, that the indigenous people arrived in peace and don’t wish any violence.

Susan and Mark (the founders of the clinic) took us out to dinner last night with Douglas, Chemita, Daniel (their son), Nune (girlfriend), Xavier, and Kelly, the new medical volunteer. We went to La Suisse where they had escargot and all sorts of fancy cheeses. It was nice, but felt a little awkward since I don't know them that well, and things with Douglas even felt a little strained. I think he was just tired from a long day.

There’s a woman who appears to be a sales lady who is selectively approaching Bolivian women to make her pitch. I’m not sure what it is she’s selling, since I haven’t been selected for her speech. She probably assumes I don’t speak Spanish, which is slightly insulting but an advantage in this situation.

Common words/phrases used in SC

No ve? (you see?)

pues (kind of like um)

Digamos (pronounced digamo)

Ratingo (very short moment)

Besango (big kiss)

Todingo (EVERYTHING)

Ahoringa (used instead of ahorita... the -ingo/-ango thing can be added to as many things as you could add -ita or -isimo)

Que te haga un hijo (if you are really excited about someone/thing)

Moving

I got home at 9 pm with a patient who is staying in the house with us tonight because he has an appointment for a urinary endoscopy at 7 am tomorrow. He is 25 years old and was run over by a tractor 4 years ago. He has been peeing out of a catheter ever since. Interestingly, he's the second patient who has moved in with us today. The first is a 33-year old from the other side of the country who Douglas met this past weekend. He has congenital hypothyroidism, and being an endocrinologist, Douglas is pretty excited to figure out the root of his thyroid deficiency. Unfortunately, I'm not sure the mother who accompanied him understands how little he can do for them at this point. He will never be of normal height or have normal mental capacity. But at the very least I guess this isn't a bad all-expenses paid vacation for them, living in a big house with cable TV with all their meals provided. To make room for our guests, I hurriedly moved all my scattered belongings to a new bedroom.

My replacement also arrived this morning. He's the youngest son of Susan and Mark, the American couple who helped found the clinic in Palacios. He just graduated from college and seems to have a lot of Spanish to learn, but so far seems motivated to get the job done. Driving around town with him and telling him about the responsibilities I'm passing down makes me realize everything I've learned in the past couple of months. It's makes this summer feel worth all the cold days.

Bloqueo

We left for the clinic this morning, drove out of town and through the first big town of Warnes, then passed the stressful stretch to Montero where there's no shoulder and you have to pass very slow trucks hauling two trailers of sugar cane if you ever want to reach your destination. After getting through the town, we found a bloqueo preventing us from continuing on the main road to Cochabamba. There was a fire in the road and a small pile of people standing around, and a bunch of cars turning around after realizing they couldn’t get through. We saw a couple of motorcycles try to get through and get beaten by the crowd for their attempts, but there were no threats to cars that kept their distance.

After chatting with a local journalist and a dude from town who had come to watch the chaos, we learned that the crowd assembled by university students who are protesting the conditions of the new local university that has no infrastructure and very few teachers. I knew that blocking a road is a very common way of making your voice heard here, but I hadn’t seen it first hand. We called Douglas, the clinic director in Santa Cruz, to see if he had any more information about how long it would last and what we should do. While waiting for his returned call, we waited and watched the scene. People who had been in buses that couldn't cross the town were walking across the blockade to get new transport on the other side. After watching for a while, we walked up to the protesters to explain that we work for a clinic that helps rural patients and that they were waiting for medications. They told us that they could let us pass, but that the back-up of trucks that have been waiting since midnight the night before (10 hours) might prevent us from reaching our destination.

Douglas called and didn’t have much more information except that this wasn’t the first student protest in Montero, and he suspected it would be over by noon. We decided to get some coffee and found a great shop that sells delicious empanadas con queso and all sorts of products from women’s cooperatives. While in town we found that they were shutting the market and blocking the road on the other side of town, on the way back to Santa Cruz. We decided to try and beat the crowd so that we wouldn’t end up stuck in Montero. This time we saw a huge crowd of people, mostly older women in traditional clothes—a very different crowd than the students. They were women from the markets “supporting” the students (or had been intimidated into abandoning their shops). We couldn’t get through that crowd, but were told that there was a back road out of town and followed a rich-looking woman also desperate to get out of town, and finally found our way back to Santa Cruz! Fortunately, we made friends with the owner of the coffee shop and got his number to find out if the blockade has ended and we should make another attempt tomorrow.

Maybe this is a good excuse to check out the new Harry Potter flick....

Hosting a tequila party

The tequila party was fun last night, although much more under control than I had expected. We hosted it at the volunteer house, one block away from Douglas' house, since it's bigger than his place. We were told it would start at 8:30, but no one showed up (including Douglas) until 9. Everyone had one or two tequila shots before we cut into the broasted pig on the table. It was a group of about 6-8 of Douglas' high school friends and their wives--a very warm group. We watched the second half of the exciting Brazil/Paraguay game in the Cup of the Americas, then they were out of the house by 11:30 PM.

feels like 37?!

So, I'm not a total wimp, because weather.com confirmed that it's very cold here. And what's worse than it being 45 during the day and feeling like 37 outside is that it isn't any warmer inside. No one has heat, so everyone wears their layers inside as well as outside. It even snowed 5 cm in La Paz yesterday! I finally broke down and bought an alpaca scarf and gloves. I'm crossing my fingers that this spell is over quickly.

Peanut Butter

One of the things I loved in Gabon was the fresh peanut butter that they sold everywhere in the markets. I preferred the darker stuff, made from peanuts that had roasted for longer. When the peanuts were in season, I even bought some raw ones to roast, shell, and pound into a smooth butter. Here in Bolivia I’ve only been able to find American brands of peanut butter at elevated prices in the supermarket….until I saw the Mennonites selling it at the intersection with all the kids who try to wash your windows and the ladies trying to sell you mandarinas. Ever since I made this discovery, I’ve been seeing Mennonites in every doctor’s office I enter. They also make most of the cheese that is sold in the grocery stores, as well as a variety of other products like Mexican style nachos in the grocery store. Apparently there are colonies of Mennonites throughout the country. They produce soy products and animal products and are mostly known for the butter and cheese they make. All the men wear overalls and the women wear long-sleeved dresses and bonnets. They don’t evangelize, and they don’t inter-marry. The men speak limited Spanish. I’ve been told by Bolivians that they either come from Germany or Canada. Hmmm.

Manners

Almost a week after the death of Marco Antonio, we had promised to visit his family in Yapacani. We had been planning to leave Arboleda (where we were seeing patients) around lunchtime, not certain if we'd have lunch before or after the excursion. Since it was our last day in Arboleda before heading back to the real clinic in Palacios, the community prepared us a big lunch, complete with speeches which we were required to attend. Lunch is the big meal of the day here, and this one was colossal, complete with beef, chicken, fish, salad, arroz con queso (unbelievably rich and delicious), yuca, and potato salad.

At about 2 pm with stuffed bellies, Joe, David, Guinda, and I started the 40-minute drive to Yapacani. We were very warmly received and introduced to Marco's grandmother and two siblings (the other was still in school). Then we were sat at a table and fed soup. We all glanced at each other as if to ask "We really have to eat this, don't we?". We did our best and just pleaded that the meal only consisted of soup. I don't remember the last time I've felt that full, but it would have been a terrible display of manners to do anything differently.

I had brought a framed photo of us with Marco at the hospital on his second day there (I think it's in a previous post) and was dreading the tears that would flow when I handed it over. When they started thanking us for our help, I decided it was an appropriate moment. Then Cristina brought out Marco's old notebooks to show us what a good student he was. She brought out all the other photos she has, just a couple of school photos. It was still unbelievable to think that he's gone. Cristina showed us the river near the house where Marco used to play and fish. Then she brought us to see his one-year-younger brother at the school who looks just like him, but very healthy. The visit brought me closure, but made it clear what a long period of grieving they will endure.

Marco

Marco Antonio, the 11 year old suffering from paracoccidioidomycosis, died this past weekend. He was in intensive care for over a week and I got the tragic call on Sunday morning at 2 am. I saw him just 6 hours earlier, so I knew he was in a terrible state and wasn’t going to hang on much longer. The night before he had suffered a heart attack and they had to revive him with paddles. The longer he stayed in the hospital, the less hope I had that he would ever return to full health.

We helped his mother get his body back to Yapacani yesterday, and the burial was scheduled for today. He needed a lot of blood in the last week, and we had a hard time finding someone who qualified to donate—the mother (Cristina), Lisa, Joe, one of the women at Douglas ’ office, and I all tried and were rejected. But a friendly cab driver was willing to donate as long as we would compensate him for the time he spent off the road! We still owe blood, so we're planning to try a new blood bank that might be a little more lenient (the other one they wouldn't accept Joe because he is taking malaria prophylaxis).

While I feel reassured that Marco isn't suffering any more, his mother is certainly devastated. Having our support gave her great hope that she would one day return to Yapacani with her son alive and healthy. She had barely been sleeping or eating over the last week because there isn't a bed for her in intensive care and they staff at the hospital relied on her being there to help them. She has also spent her last 4 weeks away from her three younger children and her mother. She believed that all of this sacrifice would eventually pay off. Cristina (the mother) called this morning wanting us to drive out to the burial, about 2.5 hours away. I probably could have dropped my duties for the day, but decided that she needed most to be with her family and that we would visit later in the week when we were out at the rural clinic (only 30-45 minutes away). It's hard to know how much support to provide without creating a dependence. In this case, we became Cristina's family during the time she was in Santa Cruz, and now we are suddenly far away.

Soccer and Politics

This week after the team from Potosi beat one of the Santa Cruz teams to win the Bolivia national championship, a high altitude soccer match made front page news here, and the NY Times summarized its local political impact pretty well:
http://www.nytimes.com/2007/06/17/weekinreview/17romero.html?ref=weekinreview

Notes from the week

The weather has been beautiful, and they’ve almost finished working on the bridge. Next week we expect to be able to drive all the way to the door of the clinic, but we probably won’t start seeing patients out there until July. While I’m excited to see progress on the bridge, I haven’t minded walking or riding horses from the bridge to the clinic. Horses are very common here, and they can sometimes been seen on the city streets. They’re used for transportation as well as keeping track of herds of horses. Out in Palacios, we see kids riding the family horse to school or to run errands, as well as mothers and fathers riding them to work.

The main crops here are sugar, soy, coca, and coffee and landowners are under more and more pressure to prove that they are using their land so that it won’t be reassigned. This means that they will clearcut forested land to plant sugarcane (even though this won’t earn them much income) in order to prevent it from being taken.

We rushed to the hospital on Sunday when Cristina called us because a tube was being inserted in her son’s abdomen to finally remove the fluid inside. I knew he had very little muscle mass on his body, but it was pretty shocking to see him without a shirt. Douglas finally came to the hospital to see Marco Antonio on Monday and he was moved to the ICU that night. He needed blood, and here that means that we needed to find a donor. Lisa, another volunteer in the house, went to the blood bank yesterday to donate.

Cautiously hopeful

Tonight is our second night at the clinic in Palacios, about 100 kilometers from Santa Cruz. After seeing patients at the village health post in Arboleda yesterday we drove to the bridge and walked about 1 km to the clinic. It hasn’t rained for at least 10 days, so the road was dry and the trek to the clinic was painless. The weather couldn't be any better--all week we've had temps in the mid-80s and blue skies. Joe (the undergrad volunteer here for the summer) was hell-bent on getting the internet to work out here so that he could write to his girlfriend.

Today Bolivians celebrated Corpus Christi, a holiday I had never heard of. The kids were all out of school and the stores were closed.

Marco Antonio, the 11 year old patient from last week, was immediately hospitalized at the main public hospital in Santa Cruz, Hospital Japones (built by the Japanese government). The pediatrician who saw him Friday morning ordered a bunch of lab tests, and said she felt it was likely he had a type of cancer, probably lymphoma. Then on Saturday we found out he was diagnosed with coccidioidomycosis (aka valley fever), a fungal infection. Joe, the college student who is here volunteering for the summer, bought him a story book, and David brought cards so that we could stay and keep him busy for a bit. On Monday he was on oxygen and appeared to be in more pain when he sat up. We came to see him while the doctor was doing rounds, and he let us know that we weren't welcome while he was there. We left for Palacios yesterday before I got all of my questions answered about his medical status, so I hope things turn around before I get back tomorrow.

Soccer and mandarins

What a full day! Full of sunshine, a few misunderstandings, and new discoveries. As for discoveries, I finally saw the clinic--the location where we would usually be seeing patients that has been inaccessible for about six weeks. It's in the middle of nowhere, and it's beautiful. About 5 km off the main road there's a bridge over a river, then another 1 km of road to the clinic. We drove to the bridge, then walked across it and the rest of the way to the clinic. The bridge went out after a heavier-than-usual rainy season, and the repairs have been slowed because of the rain as well. We tried to get there a couple of weeks ago, but the road after the bridge was too muddy to even walk on. Today it had dried up enough to walk with no problem, but they'll still need to resurface it before vehicles can get to the clinic. I also discovered Buena Vista, the biggest town after the turn-off for the clinic where we happened upon a high school soccer game this afternoon. We stayed and watched for a bit, enjoying the small town scene. All along the road, there are orange and mandarin trees are sagging with the weight of delicious fruits.

One misunderstanding was regarding an 11 year old who we sent to the closest hospital yesterday because he has a huge distended abdomen, skinny neck, sunken eyes, raspy voice, swollen feet, and just looks terrible. All the tests they could do showed that everything is normal, but he looks anything but normal. I discussed his situation with a doctor from the regional hospital this morning who said that his prognosis isn't good and that "we" need to transfer him to Santa Cruz. In that "we" I heard the we of the hospital, but he meant the we of the clinic (as in I needed to put the kid in the car and take him to Santa Cruz). Now I know to verify this in the future. Sadly, we called a contact at the hospital who told us that there weren't any beds and that he should come first thing in the morning. So, we transported him back to the city and we (the we of David and I) will take he and his mother to the hospital tomorrow and help them navigate the red tape there.

Another misunderstanding resulted in not getting tickets to the professional soccer game tonight between the two Santa Cruz teams. I thought it was clear that I was in for it, but instead I found out an hour before it started that it was sold out and we didn't have tickets. There will be other games, and it was probably wise to stay in since I'm headed to the hospital at 6:45 am.

Quick one

It was just as cold today, but the forecast predicts warmer temperatures tomorrow. These ladies work at our director's private office. They are convinced I need to run out and buy myself a chompa (winter coat).

This is second photo is DJ, konked out on Veronica's bed.

Winter

By now I've whined to just about everyone here: my coworkers, housemates, patients at the clinic, the attendant at the internet place, the security guard at the clinic, etc., etc., so now I will repeat it here--it's unfair how cold it is here! We are dipping into the Bolivian winter, and although it isn't nearly as cold as our Baltimore winter, it seems unfair that I have to live winter again after finally seeing a glimpse of spring in Baltimore. Okay, so I guess I chose to come and live here for the summer, but this should have been included in the job description (and especially the packing list)! Today is a particularly cold day--I don't think it has reached 60 degrees Farenheit. I think I will stop short of buying a down coat (like I have seen some bolivians wearing), but I definitely need to beef up my cold weather wardrobe. I wanted to include some photos of bundled up Bolivians, but my camera battery was too low--will do later.

Equipetrol

Things have been busy down here in the last couple of weeks, so here are some highlights...

Last Friday one of our patients had triple bypass surgery, and I got to watch the whole thing! I actually watched two open heart surgeries that day since I had decided to stay in Santa Cruz and not go out to the rural site. The intricacy and teamwork were fascinating. I got pretty light-headed at one point while they were prepping the first patient, inserting IV's (to be expected), but then made it through the rest of the day with no problems. Phew! The last thing those surgeons needed was an unconscious gringa. One of the surgeons came back late from lunch for the second surgery. The surgery wasn't delayed and his absence wasn't discussed until he walked in late and got the silent treatment.

The other big event on Friday was that we got a puppy for the house, and he has been a constant source of amusement. He's a two-month old golden lab who is super clumsy and affectionate. There will be pictures pronto.

I finally got to go out dancing on Saturday. I've been itching for it since I got here, but the other gringos have been either busy or uninterested. I succeeded in convincing Lisa, my housemate, to come out, and we had a great time despite being the oldest people in the place. Everyone on the dance floor seemed to be paired off for the duration of the night which was kind of discouraging. A medical resident from the public hospital, Rodolfo, joined us at the club. Anyway, the whole scene was entertaining--there's a strip of bars/restaurants/clubs called Equipetrol where some people actually go into the establishments, but many others just park their cars, blast Reggaeton, and buy beers from people who are walking around with coolers. It was good to get out on the town, but I can't say I've found my scene yet.

One week in Bolivia and already out of touch

Well, I had hoped to get this started a little earlier, but lack of internet access at the volunteer house in Santa Cruz has slowed me down a bit. Not to mention the time needed to figure out my responsibilities here and how to carry them out in my broken Spanish.

Anyway, I’m in Santa Cruz, Bolivia until the end of July volunteering for a rural clinic that provides medical care to some communities outside the city with few health resources. It was founded by two American doctors and one Bolivian doctor in 2001. Check out the website for more info on the clinic: http://hamantfoundation.org/centromedico/index.php

Here’s a quick summary of the first week:
Monday – Medical student volunteers picked me up and took me back to the house for breakfast prepared by the housekeeper, Nico. After breakfast, we spent the morning at Galene, the private clinic directed by Douglas Villarroel, the local supervisor of Centro Medico Humberto Parra. Spent the afternoon at a café at the Cine Center (fancy shopping center with restaurants and movie theaters) talking with David, an American who has lived here for five years, getting a sense of the role and current status of community associations in the provision of care from the clinic.
Tuesday – Spent the morning at Hospital Japones with a patient who needed surgery for his goiter. He was seen by the surgeon who requested that he have a pre-operative cardiology screening that afternoon. That afternoon, I accompanied him and another patient (with congestive heart failure) to the cardiologist.
Wednesday – My first day at the rural site. I met Maria and Guinda, the nurses who run the clinic, as well as Dr. Vargas, one of the doctors from the hospital in Portechuelo who helps out one day per week. We were actually located in the church building in Palacios because the bridge to get to the clinic is down. The medical students saw patients, and I managed anything that required more specialized tests or doctors that needed to be done in Santa Cruz. A local family provided our lunch, and we drove back to Santa Cruz after lunch.
Thursday – We saw patients at the health post in Arboleda with Dr. Alejandro. We totally took over the post, so I’m not sure what goes on there when we aren’t there. This facility has a lab technician, allowing basic urinalysis and blood tests to be done.
Friday – At the health post in Arboleda with Dr. Mario. The biggest community group was assigned to be seen, and there were loads of patients. Unfortunately, Dr. Mario walked off at about 3 pm. David and I had planned a meeting with the leaders of the community groups, so we were all quite tired when we pulled out at 5:30. I had planned to drive back (my first time here!), and it was dark by 6:00.
Saturday – Relaxed morning in the city walking around with Andrew, one of the medical students. In the afternoon we had scheduled a visit to the home of a patient in Santa Cruz, but showed up 1.5 hours late because we couldn’t find the house and didn’t have an address! Finally we got there and had a nice visit. At night we had a small gathering for Veronica, one of the students who lives in the volunteer house and had her birthday.
Sunday (today) – Relaxed morning, and spent the afternoon at a café with free wireless. Met some Americans who are Jehovah’s witness volunteers constructing new facilities at the branch here. There was a PCV at the table next to us, but I resisted the temptation to butt in on her lunch. I went home and made peanut butter cookies.

Whew! I hope to post more frequently from now on and plan to include more photos.

To Dallas!

The summer adventure begins! The Chevrolet Celebrity is packed to the brim, and we’re stopped at a Jiffy Lube on the way out of town to prevent any of the more obvious problems on the trip from Santa Fe to Baltimore. Elihu picked me up at the airport in Albequerque on Saturday evening, and we attended the engagement party of his former roommate, John and his fiancée Serena. Then we ate a late dinner at Del Charro—probably one of the best tostados I’ve ever had. We went home to watch a little Sports Center, finally understanding the controversial play in the Orioles/Indians game.

Sunday we had a potluck brunch at Byron, Louise, and Alana’s house, then ran a few errands around town. I spoke to Maggie, the former clinic coordinator at Centro Medico Humberto Parra, to glean some institutional knowledge about the ways of running the clinic. Then I went to the Ecco Café to use the free internet to print out directions and make a hotel reservation for Tuesday night. Elihu and I went by Big Star, the used book store where he has worked for the last year. I got to meet David, the store owner, and Nick, the grad student who replaced Elihu at the store. For dinner we hit up Bumblebee Burritos, then went back to the house to clean. I brought my laptop to drinks at the St. Francis hotel with Elihu’s friend Hannah where I signed us up for a AAA PLUS membership.

Jiffy Lube has worked its magic, and we’re ready to go. Dallas here we come!