A Typical Day

7:00 - Alarm goes off, I hit snooze, and pretend I don't have to get up. There is nothing worse than an early alarm on a Monday morning.

7:09 - Alarm goes off again and I finally get up. I grab mine and Karilyn's mugs and head downstairs to the coffee pot. The addiction to caffeine is too strong to wait any longer.

7:12 - I make it back upstairs, 2 full mugs in hand, and get ready for the day.

7:45 - Keith picks us up and we chat about the events from our weekend. We tell him all about snorkeling, the beach and Caye Caulker. He asks us if we applied sunscreen and we are caught red-handed for being burnt. We say we applied sunblock multiple times, but the sun is so much stronger here than back home.

7:54 - We arrive at the clinic and are welcomed by warm "good mornings" from the front office staff, the patients, nurses, and doctors as we walk from the front door to the doctors office in the back.

7:55 - The doctors ask us how our weekend was, we always reply "good" and tell them what we told Keith. Everyday they ask us if we went running or worked out the day before. Everyday we reply "no, maybe another day." I think about the shock on their face the moment we say "yes" one day.

8:00 - Patients start coming in. It's raining today, and we are informed that the people of Belize love visiting the doctor on days it rains. I make a joke that there is "nothing better to do than visit your doctor on a day you don't want to be outside."

8:02 - A middle aged woman waddles in complaining of lower back pain for 2 days. She cannot go to work because of how much pain she is in. We give her an injection in the gluteal muscle to soothe the pain, give her 2 days off of work, and send her on her way to rest.

8:10 - A young male comes in with a severe headache. He has blurry vision, lights and sounds bother him, and he is very nauseous. The physical exam is normal. We ask what might be triggering these headaches and he quietly admits they always happen after he smokes some marijuana with friends. We tell him it's not healthy to smoke and he says he can't help it, it's apart of the "carribean lifestyle." Doctora begins telling the patient about all harmful side effects of marijuana: you will loose brain cells, you get lazy, you get fat, males can develop breasts and they can even get erectile dysfunction by the age of 26. The young male doesn't seem to like the sound of the last statement and he promises he will smoke less. When he leaves, Doctora says "I just wanted to scare him a little. Marijuana is bad, but the only way you can get people to stop is by telling them the worst."

8:14 - Three more patients come in with lower back pain. They all get gluteal injections and 2 days off work. We suspect that these people are probably fine and just want a day off.

8:43 - An 18-week pregnant woman comes in complaining of blood in her urine. Doctora has been closely following this patient because of her high risk pregnancy. We check the fetal heart rate, it's 156 and strong. Just to make sure, we send her to the hospital for an ultrasound and can do nothing but wait until she comes back with the result.

9:01 - The office manager opens the front break room and the staff now has access to the coffee. Everyone, including me and Karilyn, head to the break room for a cup on instant Colombian Coffee. It's surprisingly good and I plan on buying some to bring home.

9:15 - The next few patients are regulars. They are at the clinic every month for refills on their blood pressure medications. I retake all of their blood pressures and listen to their heart and lungs. Some of the patients have blood pressure readings that are better than mine. Others have blood pressures of 210/120 and I wonder how they are sitting in a chair laughing away not realizing that their blood vessels could burst at any minute. They all get their medications, make promises they won't keep about eating healthy and exercising more, and tell Doctora they will see her next month.

10:12 - A woman comes in for a PAP smear. Karilyn and I gather all the equipment and prepare the room for the exam. When we enter she is extremely embarrassed to be in a lithotomy position and apologizing profusely. We try to soothe her as much a possible. The first few exams were awkward for us as well, but now it is nothing and we finish the whole process in 2 minutes.

10:20 - Doctora's husband comes for a visit. I leave to give them some privacy and head over to the nursing station to ask if there is anything to be done. I end up doing some more injections, some EKG's and I get lucky and get to remove some sutures.

11:10 - I come back in time to see a baby with a rash all over his legs. The mother states it has only been there for 1 day, but based on the various stages of healing of the scabs the doctor seems to disagree. He asks us what it could be. At first I think chicken pox since there was a case earlier that day and it was on my mind. He says no. Karilyn asks if it is eczema since the baby seems to be scratching the area a lot. Again, he says no. I think and look at the skin again and suggest impetigo, unsure if that is the answer. I have never seen it present on the legs and it was lacking its classic "honey crust" appearance. The doctor bursts into a smile and says "yes!" I am excited I guessed it correctly, but don't feel a sense of satisfaction because it took three tries to get it right. We give the baby some Bactroban ointment for the mom to put on and send them on their way.

11:22 - More patients come in for their blood pressure medications. I keep taking blood pressures and listening to their heart and lungs.

12:00 - Lunch break. The doctors and us get an hour to eat and relax. Karilyn and I always use this time to write SOAP notes and get work done so we don't have to do it later.

1:00 - We are back from lunch and ready to see patients. Doctora has no one at the moment so I listen to Karilyn across the hall interview a patient who has lost her voice. Out of nowhere I hear Karilyn ask "oh, you have a mosquito bite?" I start cracking up from across the hall because the question seemed so random. My laughing obviously caught her attention because she looked over and tried to start explaining herself. I throw my arm as to say "it's fine don't worry about explaining", but then she asks the patient "tu pica?" (are you itchy?). Apparently Doctor and Doctora find this hilarious and they cannot stop laughing. At first we don't get why they think that phrase is so funny, but after the patient leaves they explain that you have to ask "Donde tu pica?" (where do you itch) because you never know where the patient might point to. They keep laughing and repeating "tu pica, tu pica" the entire afternoon. They are probably making fun of us gringas, but at least they think we are funny.

1:13 - More patients with lower back pain come in. Doctora states it is because of the gloomy weather. I have to agree that the damp humid air makes all my joints ache as well.

1:44 - A woman comes in complaining of severe pelvic pain. She states it began after having sexual relations with a new male partner. She then goes into a lot of detail that leaves everyone a little uncomfortable. When we go to examine her and press on the area over the fallopian tubes, the patient screams and almost jumps off the table. I'm taken back by this extreme reaction and thought it was something you only read about in the textbook. We get the patient out quickly with a variety of different antibiotics to cover any possible urinary tract infection or sexually transmitted disease.

2:01 - More hypertension and diabetic patients keep trickling in with excuses that they missed their appointment last week because of this, that, or some other excuse. We refill their medications, take their blood pressure, check the sensation to the feet, and send them on their way.

3:30 - A 45 year-old woman comes in with a known history of stage 4 cervical cancer that has metastasized to the bladder and small intestine. She is now complaining of a 2 week history of severe constipation and growing abdominal distention. The patient is concerned because nothing seems to be helping her situation. In the physical exam the patient's abdomen is soft, but extremely enlarged. I can hear normal bowel sounds throughout the abdomen--a good sign to me to help rule out a small or large bowel obstruction secondary to malignancy. As I was palpating the abdomen for any areas of tenderness, it felt like I was touching a water bed. I have felt a lot of fat bellies, but this was different. I was feeling ascites secondary to this woman's cancer. I cannot imagine the pain this patient has gone through in the past 4 years since she found out she had stage 4 cancer. I give her and all of those with cancer so much credit; they are heroes and so incredibly brave.

4:00 - Keith picks us up to bring us back to our hotel and we talk about the day we had. It seems like it was good Monday on both ends.

4:35 - After changing, we head to the bank desperately in need of some cash after our weekend on Caye Caulker. Karilyn cannot get any money out of the ATM for reasons we do not know (thank you TD Bank).

4:55 - After the bank we stop at the grocery store, hungry and in need of food for the week. We are both missing home, the ability to cook in our own kitchen, and having our favorite foods. We end up splurging on tons of American food. Sometimes you just need some comforts from home to make it. Four can of Pringles, fruit, and bread for the week later we head back to the Hotel.

5:50 - I make a PB&J sandwich with some chips and fruit for dinner. I think this is the most balanced meal I made for myself since I have been living in this hotel.

6:15 - I finally get around to logging patients, finishing SOAP notes I started earlier in the day, and checking off things on my to-do list

7:00 - The Bachelor is on. I am so thankful we have Cable TV in this hotel because I am craving a little drama. Between commercial breaks I work on the blog, writing about our trip to Caye Caulker

7:08 - The drama from this TV show is too much to handle, but I love it.

9:00 - The drama ends. I get ready for bed and for it all to start again tomorrow.