Home is where my bike is...

I'm approaching my final week of residency orientation! It has been somewhat of a long 2 weeks full of paperwork, endless power points, safety briefings, and trying to re-adjust to being back in the Air Force. In-processing, the military word for checking in and starting at a new duty station, has pretty much been a painful experience for me. Mostly because something got lost in translation (i.e. my SSN-which is kind of a big deal) and made virtually every form I was supposed to have, every system that I had to have set turn out incorrect. Long story short, I had to do everything at least twice to fix the error in my SSN.  BUT...it's ok, it all worked out and I got a 2 week lesson in patience :)

In other news, I'm getting settled! I LOOOOOOOOOOVE my apt..well...with the exception of the elephant wearing high heels that lives above me. It has gotten better over the past week. However, the first week I was certain the upstairs neighbor was practicing her runway walk promptly at 3am daily!!! Aside from that, the apt/loft is amazing. It's the nicest place I've ever lived in and it makes me feel like a real adult...scary. Not only is the place awesome, the location is great. King William is a very unique historic district with a great soul. There are several galleries, independently owned shops and restaurants and just a general alternative. It's not your run of the mill suburbia and that's what I love about it! Probably the best thing I like about this location is that I can (and do) ride my bike pretty much anywhere. Downtown is a 5 min ride, King William is 1 block over from where I live. In phoenix, i really only rode my bike with groups and when I was specifically training for races. I forgot how much I loved just riding my bike places, no real training goal in mind. For example, i rode my bike to get my hair cut last week after a very very long day of orientation. It felt so nice, other than the little fall I had, to ride a bit and "unwind" after work! Overall, in just a few short weeks, San Antonio has brought me back to my bike and makes me feel at home. I'd say that's a good sign! 

So now that I have one week until I start and am more or less settled, life is better :) The interns and residents have been really nice and helpful so far. I know it's going to be a tough year in so many ways, but I can honestly say I'm excited and grateful. 1 year ago I was in San Antonio ironically. During that time I can remember feeling like I belonged here and praying that I would match here. Well..I did! (sort of...more on this later)This year, I'm here, and praying that I STAY here. I guess we'll find out soon enough. I mean, who would be more perfect for SAUSHEC (pronounced: SAW-SHEK), than Sasha! (prounounced SAW-SHA) I mean really...can it be more obvious that this is where I'm supposed to be!? ;) 

Here are some pics from the past couple of weeks!

The outside/inside of my complex: South End Lofts 

Waiting for a red light in Downtown :) (I'm an eternal tourist)

Houston St. and St. Mary's- sitting at a starbucks 

"Beauty...it rubs against one's tongue

it hangs there hurting one. insisting on its own existence

finally it gets so one cannot stand the pain

then one must have beauty extracted..." 

- this was something i saw on a ride home recently...it's pretty interesting, still trying to figure it out

My trainer!! (and makeshift riser lol) I love it! Now I just need a new bike for riding around town :) 

 Messy and a work in progress...but it's a start

<3

Something I just realized...

I need to re-do my collage above for it's annoying me. I'm not sure why. Maybe it's because some of the pics of Tim and I are stretched awkwardly and we look like fatsos.

Nothing interesting to speak of tonight. Just miss Tim a lot. I get to see him on July 1st!!! So that's great news and the countdown has begun! <3

Orientation starts tomorrow!! (gulp!)

Tomorrow the Air Force will attempt to orient, in 3 weeks, on how to be a doctor...yikes! I'm sure it's going to be a lot of briefings and trying to stay awake while they try to explain things that should only take a few minutes, in 3 hours. Nonetheless, I'm happy to get started! I'll let you know how it goes! In the meantime, this is me:

Fast forward 4 months!

In my last post, I was in a different country. And now, now only am I back in the USA, I am calling a NEW state, TX, home. LOTS has happened (i always say that) in these past 4 months, here is a list: 

- Was blown away by my awesome seester's BFA show and her work--> she is incredibly talented and I really admire her creativity and how she's following her passion.

- Graduated from medical school--> Was so happy to have my family and Tim come all the way to Kirksville, MO to share this special day. We didn't go to pricey dinner or have a crazy party. But we did spend time together, and that is more valuable to me than anything in this world.

- Became a Captain in the Air Force--> I can really get used to being called Capt Ramirez ;) 

- Saw my little brother graduate high school--> I'm so proud of him! He has grown up to be such a good boy/man but he will always be my little brown boy. 

- Went to Puerto Rico with my family and my Tim :) --> Beautiful place with my favorite people in the entire world. 

- Moved from Phoenix to San Antonio, away from Tim :( --> A very bittersweet day for us. But I know the greatest things in life are not always the easiest and everything happens for a reason. Hopefully this will make our relationship stronger than ever. 

- Started to process of planting my feet in Texas :) --> This is sort of a work in progress. I already know I love San Antonio from being here several times before. Moving in to my new place next week will be the next step. I'm so excited to design my place and explore and really make San Antonio my new home!

So, HUGE milestones going on and as always, it feels overwhelming, exciting, scary, and crazy all at the same time. It's tough to describe how it feels to be here, at this point in my life. One one hand, it's a feeling of relief and accomplishment, of, "wow, I'm DONE. I finished 20 years of school!" It is an accomplishment that is surreal still. On the other hand, I feel like things are only just beginning! It's sort of like a long, yet amazing, introduction to, what I hope will be, an equally incredible and fabulous story! 

The excitement I have for this next step and all of the steps to come is also tough to describe. It's almost like this is the moment everyone was talking about when they ask, "what do you want to do when you grow-up?" I'm grown up, it's happening right now (somewhat), but my answer to that question seems like it went from doctor, to doctor + a million other things! I have so many things I want to do in life and now that my introduction has been written, I can finally start the real story. 

Here are some of my favorite pics from the past few months :) More posts to come soon!  

3 days left in Colombia :(

My month in Bogota is coming to an end and I´m torn. Part of me really wants to stay and experience more, but the other part of me can´t wait to get home! I turned in my white coat today, the hospital gave me one to use, and I´m basically done working´now. The past couple of days I was getting REALLY tired of kids with gastroenteritis, so I think its safe to say I was ready to be done lol. All in all, im happy that I got to coem here and learn in a different system. Fundacion Santa Fe is actualy only a very very small picture of what the medicine in Colombia is really like though. It very much resembles the US in terms of EMR, medical resources available, etc. If i could do it again, after already experiencing FSFB, I would want to do EM in a not so nice hopsital in town that gets trauma or at a rual health center in one of the surrounding small towns. But that´s def later, once I have a few years of being a doctor under my belt lol. Maybe one day... :)

Anyway, now that Im almost gone, I´m starting to think about where I want to visit next. I know craziness (intern year) is going to start soon in June and I wont really have anytime, but I´ve decided that I want to always have travel plans in the works. If not now, then when will I ever do it? Its all too easy to say theres no time. ANyway, I would love to come back to Bogota with Tim and show him how amazing it is. I also have really been wanting to go to Brazil lately. My cousin was there for 6 months and, although I already have been wanting ot go for a looooong time, the way he talks about it is just making me want to go even more. Also, #78 on my list of 200 things I have to do before I turn 50 is: learn Portuges!!

In other news, now that i only have a few days left, ALL of my aunts want me to see them. Theres too many aunts and family and not enough time :( I have gotten to see a good fair share of family though since ive been here and Im happy about that. Everytime I come to Colombia I meet more cousins and I love that. I dont think you can ever have too much family, even if they are somewhat crazy or weird lol.

what else...Ive met some pretty awesome people here at the hospital too. I think I work pretty hard, but Im constantly amazed by how hard the med students work here. They are brilliant and juggle school, research, traffic, and life in Bogota (which can be tough at times). I can honestly say, they work MUCH harder to be doctors than most american students do.

ok, now Im off to make the bes tof my last 3 days here!

Week #2 in Bogota!

Time is really flying! I cant believe its already the end of my second week in Bogota! I feel like I just got here. This week was good. I am mastering the flow of the ED and learning the different quirks of the different docs/nurses (i.e. some like notes in a certain format, some don´t let me write notes, some want me to do everything, and some nurses get offended if I put a pulse ox on a kid without asking them to do it, very ridiculous, I know). Im also mastering the art of gaining weight! I´m not dieting while Im here but I have been trying, and failing miserably, to eat small portions and work out. Its not that I eat all the time (almost), but the food here is very heavy. Lunch always is some sort of meat with rice, potatoes, some other carbs, etc. I know its not the best, but I cant resist it!! ALso, if you dont clean your huge plate of food here, ive noticed tha tpeople look at you weird, like you are wasting good food. Im trying not to think about it and enjoy everything here, but I feel like a lard. I havent worked out in 2 weeks and that makes me feel more tired! Its sort of like the lady from the movie eat, pray, love, who has to buy herself some "big lady pants" after 4 months in italy. Im almost to the big lady pants point in only 2 weeks!! yikes!

In other news, walking home has been awesome this week! I figured out a faster, although initially more dangerous, route home. By more dangerous I mean I have to cross 2 really busy streets and a railroad track, and then its all sidewalks. Everyday to cross the initial 2 busy streets people (including me, but I let them go first so if anybody gets hit its them) have to sort of step right out in front of cars hoping they will stop. Nobody has gotten hit since ive been here, so Im assuming that tactic is pretty much the norm and cars are used to it by now. Nonetheless, i still get a little scared. After that though, the rest of the walk is side streets that take me through the mall and straight home. There are lots of cute stores on the walk home that Ive stopped in. Theres one, Inkata Design Store, that I really love. There are stores all over Bogota and theyre awesome! THey also have a really awesome outdoors store on the way home that I have yet to stop in because Im waiting until I have time to shop and buy things :) Ive also tried almost every coffee place (which is probably about 15) on the way home. The biggest coffee store here by far is Juan Valdez. Its the equivalent to our Starbucks, only better and they sell clothes! Its funny because at home, pretty much nobody would be caught dead wearing starbucks sweatshirts or jackets. But here, everyone wears clothes from juan valdez and its def in style!

THis weekend was super fun. I hung out with my cousins, went out one night, and explored the downtown area of Bogota. Some people say the "Centro" (downtown) is really dirty and ugly but I thought it was awesome! There are lots of homeless people around thats foro sure, but what downtown doesnt have those? The only difference between these homeless people is that they have no problems walking right up to you while youre sittin goutside having coffee, telling you a crazy story and asking you for money. THey will literally sit down with you until you give them money. After the 5th one, it gets really annoying. But the downtown is really artsy and down to earth, I loved it. Full of museums and really cultural places. I prefer that waaay more than ritzy parts of Bogota. I went with my cousin Mauricio, we were both sort of hung over from the night before lol. We called it the hangover trip!

I got a little sad today because I realized that there is soooo much more I want to do and see in Bogota and I only have 2 weeks left! I want to take a bike tour, go to more places with my cousins, go into the mountains. I know I wont be able to do it all while im here this time. :(  I wish I didnt have to work M-F and I could have more time to be on vacation! But I guess Im technically here for school. I have a feeling though that Im going to keep coming to Colombia for a looong time. Everytime I come here I want to come back more and more. Just have to make time for it somehow once I start working.

ANway, it was a great weekend. More posts to come...

First week realizations

My mid morning snack today :)


So Ive been here for 1 week now and everyday I´m getting a little more comfortable! I´m finally seeing my own patients and its awesome! I spent the first 2 days more or less shadowing the docs and "interns". I was really frustrated at first because I wanted to have the same productivity and initiative that I usually have but I didnt really feel comfortable´presenting a patient with the proper medical terms, nor did i even have the slightest idea of how to use the computer system. I didn´t really get an orientation or at least a "this is how things work" talk lol. I showed up, everyone said hello and welcome, and i was just ready to go :) Im getting the hang of everything though, even the crazy confusing program they use for notes lol. I made myself a little template of the proper ways to present a patient and write a progress note, without sounding like a gringa (aka white girl) Also, its tough to understand people because they speak SOOOOOO FAST!!! I can understand 99% of spanish but when they speak so fast I just stand there like, "ummmm.....huh???" But its going really well overall.

After 3 days of taking an hour to catch a taxi, fighting wiht people over taxis, getting ripped off by taxi drivers (they like to drive in circles to charge me more because they know im not from here and have no idea where im going), and getting lost in said taxis (here you have to tell most of them exactly where to go, the address isnt really enough for the ones ive been in), I decided to walk home everyday! :)  My family told me it was pretty far but when I walked it a couple fo days ago its pretty close! Its only about a 25 minute walk at a godo pace...but it takes 40 mins for me because I take pictures of everything. Its even nicer for me because I dont mind walking through the city and I can stop and get coffe, shop, etc on the way home.

I was talking with a couple of the interns today about the differences in their school vs. ours. I´ll try to explain. They go to high school, and go straight into medical school. The medical school is 6 years, the first couple being classroom oriented, and the last years are rotating in hospitals. Then they do 1 year of internship, which also consists of rotating through all of the specialties. After internship, everyone who wants to practice medicine in Colombia MUST do 1 year of rural medicine in a small town. This is required to get liscensed in Colombia. After that year is when they can apply for residency here. SO, eventhough they dont do college, it ends up being pretty much the same amount of time spent to become a doctor, excluding residency. One huge difference here is that they have to pay for internship and residency themselves! So basically, they dont get paid until they become attendings...i found this crazy at first.  How on earth do they pay for school and residency without ever getting any type of salary or anything?? There are some ways to get loans but basically, you have to have money to become a doctor plain and simple. When I first heard this I thought: In the U.S, NOBODY (well not me anyway) would be a doctor if we had to pay our own way through med school PLUS residency!!  The difference is this: the cost of their entire training, including residency, comes out to be approximately between $80-90K. That is less than HALF of what med school costs for us!! SO, in actuality, its not that bad. I just cant imagine working for a hospital, with intern hours and the 36 hr shifts they pull here (and in the US, despite new rules limiting hours) and not gettign paid. It seems like the hospital is totally taking advantage of the interns and residents, its crazy. But that's the system. Some people love it and stay, and some get leave to the U.S or other countries.

Here are some more random things I found to be really interesting:

- Metronidazole and other heavy anti-parasitic meds are given out like water here! A parent can actually call a pediatricians office and say, "my kid has belly ache and diarrhea"...and they will give you Metronidazole without even seeing the kid. Reason: Amoebiasis is rampant here! In fact, tons of people walking around here have E. dispar (the asymptomatic amoeba). Its so common that people just go to a parmacy and by metronidazole and abendazole and use them at the first sign of a stomach ache. I just thought that was pretty interesting.

- They RARELY use CT scans in the ED. We've had at least 5 kids this week who 100% wouldve had CT scans in the U.S. to confirm appendicitis. They use ultrasound in 95% of cases in the ED. The only times they do CTs are when the surgeons demand it. Which surprisingly, itsnt very often. BUT, its possibly a good thing in peds since CTs are waaaay over used in the US and ultrasound saves the kid the radiation.

- There is one day every 3 months whare cars are prohibited and only taxis, busses, and handicap cars are allwed on the road. There a really big emphasis placed on improving the air quality, the environment, and healthy lifestyle. So, that one day every 3 months is very cool because everyone either walks, rides a bike, or takes taxi/bus. My cousin said that just 4 days per year of eliminating cars has improved the air quality by something like 20%. As cool as it sounds, I doubt the states could ever do that because its so big and spread out. Bogota is big, but everything is fairly close.

- New mom´s are give 3 MONTHS of maternity leave. I think thats pretty awesome.

Ok well, more stories to come soon!

Heres a picture