With 3 days left until departure, I am looking at everything like it is the first time I had seen it. When walking the same streets to school daily, I had taken for granted a lot of the beauty Segovia has to offer. I had become acclimated to seeing The Roman Aqueduct, The Cathedral and The Castle Alcázar everyday that it became like just passing another building. Taking my final tour of the city everything looked clearer and it was if a slideshow of the last 3 months was playing in my head. Every place in Segovia was a memory I had formed with my new family.
The bonds formed with my classmates were intimate because they are your lifelines in a foreign country. You don’t have your family or your usually friends and you are in a new place where you do not speak the language. You go through phases of emotions. When I arrived I was overwhelmed with all the new cultural aspects thrown at me. It later changed to frustration due to the language barrier. One of the most difficult things is wanting to say something and not being able to communicate what is in your head. The worst was when people speak to you in this half sign language/interpretive dance, talking ridiculously slow and shouting because they think, as an American, you don’t understand Spanish. At times I got so angry that my brain said, “No thanks, I’m done” and checked out from the conversation. As the language skills improved overtime, I developed a confidence and eagerness to learn more. Wanting to have a conversation with everyone just to learn a new phrase. The moment I felt comfortable, the semester was over and time to go home. Going through this at the same time as the students other students created an inseparable friendship.
As I was enjoying my last beer with my friends in the fuencisla (a big field below Alcázar), I felt a huge drop of rain hit my shoe. When I looked up in the sky all my American friends were laughing and all of my Spanish friends were oohing and ahhing and clapping their hands. The raindrop that hit my shoe was a giant bird turd that was sure to stain my new boots. My first reaction was to try to smear it off in the grass. I attempted to clean my shoes and nearly got tackle by all my jealous Spaniards. It is the best luck you can have is to get pooped on by a bird. At this moment every cultural change that I had gone through had finally set.
Everything about this trip has changed the path that I was on. I have learned that it is all right to slow down and enjoy more than working toward that perfect G.P.A. When you are immersed in a culture for your whole life, it becomes easy to think that other culture do things the same as yours. Being thrown into a culture shock created a lot of uncomfortable moments leaving me feeling vulnerable. These moments make you feel like you are alone when you are in a room filled with people. Adapting to this forced me to change my mentality and approach on life. Being in a state of uncomfort forced me to learn new things about myself. I learned how to live in the moment and stop planning all the meticulous details of my future. Instead of thinking about 5 years in the future I am able to enjoy day-to-day and worry about the present. I took a change of pace to teach me to be truly happy.
I’m about to board the plan and the only thing on my mind is how everything is going to look when I return to the U.S. I keep thinking how weird it will be to hear everyone speaking English. Also, I am praying that I don’t get seated next to the person that wants tell me their life story, or the bigger person whose extra loving spills over onto your side of the seat. My room here is empty and my bags are packed, I know I will be returning to Spain in the near future.
After 4 weeks of shadowing, I finally got the chance to fly solo. Patient history was needed from room 5 and I was instructed to “go do it.” I was so eager to put everything I had learned into practice. I felt like it was a little out of nowhere for the doctors to let me do something on my own, as if they were up to something. As I left the nurses station all the doctors were looking at me with smirks slapped on their faces.
I walked into the room where there was an older lady sitting on the gurney with her feet dangling off to the side. It appeared as if she had gotten dressed in the dark. She sported bright green pants, a button up checker blouse, (the buttons fastened in the wrong hole) and a burlap brown jacket decorated with cat broaches. Her hair was teased so high, I was expecting one of her 20 cats to pounce out at any moment. She was Tammy Faye’s make-up doppelganger, with a lazy eye. I started confidently with, “So why are you here today?” Before I could finish my sentence she blurted out, “Why are you smiling at me! Do you think its funny that I'm here again? Stop that you little brat!” When she spoke, it sounded like a drunken parrot, squawking out orders. It was obvious that she had a mental illness.
It was not her illness that caused me to chuckle, but her form of self-expression. You have to imagine her looking at you, with her head slightly cocked so her good eye can see you, mixed with her tourettes-like form of speech. As she slurred out a list of fake problems, I fought back laughter. I struggled to not to smile, but occasionally a little sneer would escape here and there. After 10 minutes with the cat lady I knew that I had fallen into a trap, I had been hazed!
I finally made it out of the room and back to the nurse’s station. All the doctors were holding back their laughter; I was the entertainment of the day. They later told me this lady comes in once a week with the same problems and they just couldn’t resist setting me up. In any group the new guy is always put through some sort of hazing. With 2 weeks left in my internship, I finally feel like part of the group.
Besides learning hospital vocabulary in Spanish, my time spent in the emergency department has opened my eyes to a lot of things. Every patient and opportunity with the doctors has given me more insight into the medical field. Shadowing the doctors from room to room, being taught first hand how to read an EKG, how to properly set a wrist fracture, or having to tell someone their cancer has returned, has set the mold for the doctor I want to be. After dealing with difficult situations in the hospital, viewing patients as a numbers, and not human beings became my coping mechanism. It is a lot easier to tell give someone bad news if you can think of them as just a number. I was able to take a step back and understand the importance of patient care. This experience has helped me to reflect on what I need to improve to develop into a better doctor.
On of the biggest differences between hospitals in Spain and in the U.S. is where the money is spent. The cultural principles in Spain of enjoying life and knowing how to prioritize are carried into the hospitals. When you enter most hospitals in Spain, you see a waiting room of patients and doctors who are rested and working to the best of their ability. When you enter the majority of hospitals in the U.S. you see a beautiful water fountain with a solid granite back drop, a grand piano for no one to play, the newest more expensive furniture in the waiting room that will need to be replaced in 2 weeks, and of course a Starbucks. You almost have to do a double take to make sure you are walking into a hospital and not a day spa.
The point is, hospitals are places for people to receive treatment. Think about the last time you had to go to the emergency room. Do you remember the chairs in the waiting room and the tread count of the sheets on the stretcher, or do you remember the treatment you received? The money in Spain’s heath care system is put towards healthcare. This seems to be an idea that the U.S. cannot fully understand. The next time I walk into a hospital in the U.S., and see the all the unnecessary spending, it will be hard not to picture how my lives that money could have saved, or how many people it could have cured.
Once upon a time there lived a beautiful jovencita in a small pueblo of Spain. Her job was to walk to a fountain very far from her pueblo and collect water for her village. She spent all day collecting water for her people. Every day she grew more and more tired of her efforts. One day when walking to the fountain the poor jovencita could not take another step and collapsed. In that moment the devil appeared and offered her a deal, “I will build you an aqueduct so you will never have to walk this long journey again, but for the price of your soul.” The jovencita agreed to this deal with one condition, the aqueduct could not lack a single stone. Within no time a great aqueduct appeared. As the devil went to collect her soul, the jovencita noticed something strange on the side of one of the arches. There was a stone missing. The beautiful jovencita was able to keep her soul and never had to walk to the fountain again. Over 1,000 years later the aqueduct stands with only one stone missing.
It is a helpless feeling when one of your patients is dying and you do not have a cure. Even worst is having the responsibility to tell someone that they are dying. The role of a doctor is to provide a way out of the chaos patients have found themselves in. People come to doctors thinking no matter what illness they have it is curable. Yet there comes a point when it is too late. Not even daily visits, the perfect combination of medications and the newest experimental treatment can fix the damage.
Señora Mary A. was a petite 5’’3, 55-year-old teacher with short brown hair and a face filled with lifelines. She had that typical sweet little old lady appearance. When I first saw her it felt as though she just came to the E.R. to bring some fresh baked cookies. As she walked to her room in a slow almost wobbly gait, she glanced a warm peaceful grin at all of the doctors. That day I was working with Dr. Goyo. When he saw her shuffle by the nurse’s station he reached for her case file.
It read, “ History: smoker of 20 years, 25 cigarettes a day. Diagnosed 2001 with stage I pulmonary carcinoma. Progression to stage IV in 2009, received aggressive chemotherapy, currently tumor free. Reason for visit: complaints of headaches” When any former cancer patient comes in with a headache I immediately imagine the rapidly dividing cells racing to the brain and nestling deep into their new home. Slowly but surely eating away at memories and any future hope of life. When Dr. Goyo and I finishing reading the case history he gave me that look that you never want to see, the unpromising look of defeat. He put on a fake smile and we both trotted into her exam room.
He asked her, “So tell me what brings you in today?” in a voice as if he was oblivious to what we just read. She replied confidently that she had this strange headache for the past week and thinks it is an after effect of menopause. It was like she had forgotten that less than one year ago she had end stage terminal lung cancer. At this point I wondered if she was stupid or that far into denial. Just going through the motions Goyo ordered some x-rays to confirm what we both knew. It was at this time that all the forged smiles dwindled down and for the first time a concerned look emerged on her face. Before she could ask any question, her husband edged into the room giving us a chance to sneak out.
When the x-rays were ready for viewing it was like déjà vu, tumors scattered deep in the “no go zone” of the brain. Chemotherapy would only buy her a few more months filled with needles, forgetfulness and a slow deterioration of life. Surgically inoperable and too advanced for gamma knife or any experimental trials, she would conclude her life in about 4 months. This was my first experience giving someone a death sentence.
Goyo and I walked hesitantly toward the room. I held my breath as I passed through the doorway. Goyo approached her bedside and gently put his had on her arm as he let out at sigh. There was that depressing defeated look again. This death stare did more that any words could have. As this moment she burst into tears and in a panic kept repeating, “lets just take it out and it will be gone.” Every time she said this her husband turned away taking a couple steps toward the window. He stood tall with his arms folded, shaking his head and interrupting his wife every time she tried to suggest a miracle cure. In my head I was screaming, “even if we took out the tumor it wouldn’t stop the cancer from eating away some other organ!” At this point I wish we would have just lied to her and said everything looks good, here is a perscription for something stronger than ibuprofen.
Goyo was trying to calm her down by listing treatments filled with false hopes. She kept looking at me with tears streaming down her cheaks as if I was going to tell her something different. I then zoned out for a moment to focus on not crying. The best technique to momentarily look up, bite the insides of your cheeks and sing happy birthday in your head. She contintued to plead with us for the next 10 minutes crying out, “I know you can fix it, just take it out.” It was at this point that I knew if I wanted to help people I would have to start at the beginning. I couldn’t take back 20 years of smoking a pack a day. The only cure was to go back in time and stop the problem before it turned into a tragedy.
On March 11th 2004 Elena, my Spanish sister, was in Señora Rodriguez math class about to begin an exam. My friend Samu was in Madrid walking above a train station on his way to class when an earthquake like vibration awoke all of Madrid. Terror and Panic struck heart of the country, shifting the pace lives throughout Spain. Everyone remembers where he or she was and what he or she was doing on 9/11. The blank confused look painted on faces with one question racing through everybody’s mind, “what happens next?” The same numb sensation is what all of Spain was struck with March 11th, 2004.
Exactly 911 days after the attack on the twin towers, 11-M took place. At 7:30 AM March 11, during the peak of the morning work rush, a series of bombs echoed in extensive metro system throughout Madrid. This event forced Spain to adapt their approach on national security.
While driving to the grocery store, our car was stopped by the state police. There was a control check set up between where we were, and where we wanted to go. Every car was not stopped, only the ones that the police thought to be suspicious. The car was searched and everyone’s information was run through the police computer system. This was not the first time it happened. Every trip to Madrid or any major city, there is a police barricade serving as a safe guard for the city.
It is the European way to pull out “the polite filter” between the mind and mouth. Everyone is overly blunt and open about what he or she thinks and how they feel. No one stops to think if what they are about to say will hurt your feelings, because everyone has thick European skin. This mannerism translates into how the law handles homeland security. In Spain, when the police case profile, citizens don’t respond with thoughts of a violation of their rights. Feelings aside, Spain continues to take initiative in response to 11-M.
If she was a greeting she’d be a slap
sharp and unforgiving, but straight to the point.
If she was a dance she’d be a flamenco
all eyes are on her beauty, but powerfully stomping on dreams.
If she was a piece of clothing, she’d be a black tailored suit
in charge and all knowing, but speaks with no mercy.
If she was a sound she’d be a crystal vase shattering into pieces
an unexpected accident stinging with shock, but no hope to pick up the pieces.
If she was a smell she’d be carbon monoxide
Undetectable and reeking of hazard, but swiftly delivering death.
If she was a drink she’d be a hot cup of coffee on a cold day
Enticing with its warming comfort, but too hot to drink, every sip burning all the way down.
If she was a criminal she’d be a sociopath
manipulating remorselessly, but delivering the painful truth with no emotion.
If she was an animal she’d be a kangaroo
hopping from place to place, but delivering a painful punch.
If she was an insect she’d be a black widow
slowly weaving an intricate web of silk, but heartlessly taking lives.
If she was a piece of furniture she’d be a shower
constant and tranquil, but washing away future aspirations.
If she was a storm she’d be the eye of a hurricane.
momentarily calm and peaceful, but a fiery drastically altering lives.
If she was a competitor she’d be a card player
always wearing a poker face, but playing with the game of life.
If only she could take a step back to see what she has become, she would be the doctor she once knew.
Right now I feel like my life is a multiple-choice question. Imagine you are taking a course where your grade consists of 4 exams and a final. You have been working diligently all semester, always coming to every class on time, appearing attentive and actually studying more that 1 day before test day. You are consistently doing average on every exam with the exemption of that one test that destroyed you. Your grade now comes down to the final and you have been preparing for days. The type of studying that consists of long hours into the night where the only program on television is the infomercial for oxyclean and you are now on your second pot of coffee. Walking into the exam you are at the point where you can’t think anymore and all you want to do is laugh. Right then you are slapped with one of those multiple/multiple-choice exam with options ranging from a-g. Everyone has had that professor that just loves to throw down a multiple/multiple choice question final where every choice seems right. You narrow down the choices to either B or D, but then get down to option F that says, “Both choices B and D.” Shit. Coming to Spain is my option F.
I am at the midpoint with my internship in the hospital and to be honest, it is pretty boring. This experience is the exact opposite of what I expected. Everyday is the same case study, the same treatment and the same emotion from each doctor. For the most part I feel like this is the case for many doctors in any culture. Slipping into a pattern of muscle memory diagnosis. Every experience, good and bad, is a learning experience. Effective reflection and reflexivity does not allow anything to be taken for granted. Students may think they are well on the way to understanding something, and then realize they have to stand one step back and view the matter from a fresh standpoint and begin all over again with a new set of questions (Gillie Bolton 2005). First entering this experience I was expecting to learn how to become a better doctor from a different cultural standpoint. Instead this experience has prompted me to take a step back and look into a self-conclusion.
It always comes at the time least expect when one is blindsided by an experience that opens their eyes to a new set of questions. This experience can throw you from the pattern that so many people can get stuck in. The redundancy of the same life day after day, month after month and year after year makes it increasingly difficult to take that step to view life from the other side of the looking glass. “The past is beautiful because one never realizes an emotion at the time. It expands later, and thus we don’t have complete emotions about the present, only about the past’ (Woolf, quoted in Holly 1989, p. 26). At times I can be so sure of something, only to later look back and ask myself, what where you thinking. The past is not something that defines your character, it is countless learning experiences that shapes and guides you into the person you are today. This internship is not discouraging me from a career in the medical field, but has allowed me to live other aspects of my life.
In the U.S. the cultural norm is to go to college after high school, then go to graduate school or get a job in order to be successful before the age of 30. In the first year of college at the young age of about 20, we are pressured into deciding our major. Essentially this choice is dictating what we will be doing for the next 30 years of our lives. There is no turning back from this decision, unless you want to add on another 2 years of schooling and easily 25,000 more dollars. Once we start on the track of one degree it is hard to veer off and explore other options of interest.
Coming to Spain has helped me to look at life fully. In order to live the American Dream it is necessary to race through life. There is high importance placed on life in the work place were ones self-identity is their job. It seems like last week I was entering my first year in undergraduate school. All I have to represent the past 4 years of my life is a list of science courses completed. Twenty years from now I do not want to look back with only memories of long hours in the hospital. Looking back and living with “what ifs” is not living life fully.
Taking yourself out of your element will force you to look at life from a different standpoint and listen to the different voices within ones self. Reflection is emotionally demanding for those willing to be honest with their selves. Letting ones guard down and living with raw emotion is not a step that everyone is willing to take. Yet without letting you guard down you will always be living with the question of “what if?” I am slowing converting from the American mindset of always planning for the future and am living moment by moment. On multiple/multiple choice question exams several answers seem correct, but there is only one right answer. The difference is in the many multiple/multiple choice questions life throws at us, the right answer is constantly changing.