Thursday, April 10, 2008

Las Urgencias

My first week in Veracruz I worked in the Emergency Department of Veracruz Regional Hospital -- Las Urgencias. It's the equivalent of a county hospital, taking urban walk-ins and referrals from smaller surrounding cities. Although I've seen a few diseases that I wouldn't see in Iowa, mostly what I've seen is familiar diseases but in much more advanced states than I'm used to. I've had to ask about the calibration of the lab numbers, because some are literally ten times higher than what I'm used to seeing back home.

Of course, there are also plenty of traumas. As I mentioned earlier, it's rather nerve-wracking to be involved in a trauma or code in a language that you're not fluent in. However, in many ways I'm more comfortable with traumas than with some of the medical management. When a trauma comes in on a backboard by ambulance the initial steps are very much the same as back home, so I have some idea of what to do. My biggest limitation is that, although I've gotten to the point where I can (sort of) discuss a case with the doctors and residents, I can't really take a reliable history from a patient who is often in distress and has an accent I've never heard before.

But in general the challenge is that the patients are so sick. The ER has 13 beds plus a trauma bay. Of these, there are usually two or three patients on vents (sometimes more), and often additional patients on gurneys are wedged in between the regular curtain slots. Meanwhile, the parking lot outside is always full of people waiting to be seen, and the triage area is usually packed. At night I've seen whole families sleeping under the chairs in the laboratory waiting room.

The room with the computer I'm using is closing so it's time for an abrupt sign-off....

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