Leaving so soon!

Happy baby!

I asked this hippie artist who was selling things he made out of wire in the street in Barranco to make a key chain for me. He asked what I wanted it to say and I said, "Mi hijo se llama Teodoro, por favor escribes Teodoro." (My son's name is Theodore, please write Theodore.) I guess my pronunciation was poor because this is what he wrote, "Te adoro" (I adore you), which in the end is perfect because it's true! "Te adoro, Teodoro!"

Thank you
I can't believe it is time to leave already! It feels like we just got settled and tonight I'm packing our suitcases as we leave for the airport tomorrow night! I know it's been a long time for Seth as he's home alone but it has been an amazing few weeks for us and it went by so fast! Not only was this a big trip to take my 6-month old solo on a long journey to Peru but to stay for nearly a month in a foreign country - some may say I'm crazy. I was confident that we could do it. I knew it was very safe (or I would not have brought him) and I wanted to see how it is traveling with kids internationally since my career likely depends on it. It surpassed my expectations and more - it was incredible!

It was wonderful to be able to stay with a Peruvian family, the Arambulos, and have a great nanny, Yani. It was fun to see old friends, eat at my favorite restaurants, and feel comfortable getting around since I know the city. I couldn't have asked for a better experience (except if Seth were here too since I know he's going to hate me after I post all these wonderful food photos below).

Tato's birthday party at their house. Pictured L to R: Me, Nicholas, Tato, Theo, Victoria and Mariasela.

The boys - Jaco, Luis, Tato, Theo, Marcelo, Nicholas and Jorge.

Sitting in the park in front of our apartment building in San Borja.

Hanging out by the pool "en la playa" (except there was a giant wall between us and the actual playa/beach).

Theo and Jaco got matching dragon tatoos!

Thank you Luis and Charo for your hospitality and welcoming us into your family. We can't wait to see you in Seattle in June! Thank you very much to Jorge, for giving us your room to stay, cooking us lunch everyday, and for keeping Theo entertained. Thank you to the rest of the Vinetea-Arambulo clan - Abula, Beto, Tato, Mariasela, Nicholas, Rosa, Carmen, Felipe, Fatima, Cesar, Gisela, Jaco, Marcelo - for inviting us to the club to go swimming and into your homes. Thank you Victoria and Brenda also for taking care of Theo and sharing the apartment with us and teaching me how to speak like a true Argentinian, "sha=ya". We'd love to visit you some day! Thank you Omar for once again, driving us to the airport. What would we do without you!? And last but not least, thank you Seth for letting me take your beautiful baby boy for a few weeks. I know it was hard but I'm sure those tubs of Ben and Jerry's and pints of local beer held you over as you enjoyed being a bachelor again. Te amo mucho!

Watching the paragliders in Miraflores along the Malecon.

Walking along the Malecon in Miraflores with Romina and Alvaro.

Romina, Bruno and I with Theo in Miraflores

Me, Bruno and Olenka dipping the famous Manolo's churros (filled with either chocolate, manjar blanco or vanilla) in hot chocolate...mmm!!

Romina, Olenka (her sister), Theo and I in Parque Kennedy

My despedida (farewell) dinner at Pescado Capitales - my favorite restaurant! Jorge, Luis, Charo, me and Romina.

Work
It has been a very productive month for me here. I was able to get a lot of work done on my chart review study from three years ago and pick up my binder of questionnaires to take home (however it weighs like 10 pounds which may tip my suitcase over the 50lb mark at the airport tomorrow...). I met with the CRONICAS research investigators and am planning some secondary analysis and a new project for next year (we'll be back January 6, 2014 for two months!). In addition, everyday I go the the Hospital de Emergencias Casimiro Ulloa and round with the medicine team on the Medicine ward and today I got to spend the day in the Trauma-Shock part of the Emergency Room where I intubated my first patient! They are one of three hospitals with an intensive care unit (only five beds) but often we take care of patients who are on ventilators on the floor. It has been very interesting to learn their system here. Unfortunately, this hospital does not have upper level residents, such as myself, and so they don't have any daily conferences or teaching like we do. Therefore, I have been preparing a short 15-30 minute presentation (in Spanish or Spanglish if it is on the fly) on a topic that came up with one of our patients that day, such as "Atrial fibrillation and anticoagulation," "Diabetic ketoacidosis vs. hyperosmolar hyperglycemic state," "Ventilator 101," "Blood gases," and "How to treat diabetes." The interns really appreciate it and I find it helps me improve my Spanish.

They are teaching me a lot as well! We see a lot of folks with heart attacks but they don't have a catheterization lab so they can only use thrombolytics (which we rarely use anymore) to break up the clot. We also see a lot of strokes and they have a CT scanner but they don't have an MRI to look at the vessels or interventional radiology to intervene if needed so these patients get a much different treatment. They have a laboratory but they only can run a list of 30 or so common tests so more specific things, like cortisol, get sent out and the result doesn't come back for a week or more. Others, like hemoglobin A1C, are just not done at all and we use clinical judgement a lot more (and trial and error). Their ICU doesn't have the invasive monitoring like we do and they measure the central venous pressure manually! It's been a great experience and they have asked me to return next year and bring some of our protocols to them to help improve their patient care since they often don't have access to medical journals or UpToDate like we do to look things up. I plan to return for January and February next year to work on some research projects and probably spend some time in Casimiro as well.

The team rounding - Stephanie (in the white coat) is a resident from Spain also rotating here. In blue, is our attending, and then the interns - Victor, Franco and Annie who are in their 7th year of medical school and work for 365 days straight doing rotations.

Rounding in the hallway with our paper chart cart.

Writing daily notes at the nurses station of one of the wards with 12 beds.

Measuring the CVP manually in the ER after I intubated this patient with septic shock.

Norepinephrine covered with a black bag and some red tape

The hospital where I'm rotating, Hospital Casimiro Ulloa, in Miraflores.

We had someone from the Ministry of Health come talk to us for two hours about Dengue Fever and how to treat it. Excellent talk and something I have never learned much about since we rarely see it.

My last day at work

Annie, Franco, Me, Victor and Robert eating alfajores on my last day at Casimiro Hospital.

The intern's call room - 4 people sleep here each night!

Writing my first daily progress note on a patient (in Spanish).

All my favorite foods!

Romina and I enjoying our entradas (appetizers) - ceviche de mandela (fish cooked in lemon juice with a special sauce), wantanes de mariscos y pulpo (fried wantons with seafood and octupus) and causa de pulpo (cold dish with grilled octupus, potato and greens) at Pescado Capitales.

Our entrees - calamar a la parrilla (grilled calamari) and tilapia y mariscos.

I'm in heaven! I have a maracuya sour and my favorite - pulpo a la parrilla (grilled octupus). The tilapia y mariscos (fish and seafood) were also delicious!

A cooler full of Inca Cola (tastes like bubble gum)

Palta rellena (veggie stuffed avocado). Also delicious but not pictured is papa a la huacaina (potatoes with a spicy yellow sauce), tamales, and empanadas de carne.

Lomo saltado (stir-fried steak with onions, tomatoes over fries and rice)

Dining out at Mangoes in Larcomar with Olenka. Enjoying my Pisco sour doble, some ceviche, yuquitos rellena (cheese stuffed yuca potato with hot sauce), and conchas a la parmesana (clams with melted cheese) while Olenka graciously rocks Theo so he will stop crying (it was way past his bedtime).