Day 3

Make sure to bring the med student with you when you pay for lunch. No more instant oatmeal or instant noodles on your watch today.

Set up the simulation machine that was never made to teach anyone anything, just meant to sell equipment to caffeinated and bored doctors between breaks at a national conference. Remember what they tell you back home, that anyone can teach a monkey IR. Struggle with the sim machine and feel offended for the monkey's sake.

Make a mistake at board review and learn from your own mistake out loud. You can't shake the feeling though. There are mistakes you learn from and mistakes you don't. There is a version of you in the future whose mistakes no one will catch. Be haunted by that thought as you tighten the bone window of a so-far negative CT scan. There seems to be no such thing as a negative CT scan here, no matter how much you hope and pray.

Take the van on time today. Push around the couches and tables when you get back. Fill a pot with water and use it as a weight to do squats and lunges. Burpees on the floor until you sweat. Shower before dinner. Bug spray but you can quit the sunscreen now as the sun dips in the sky. Sweat anyway. 

Wait for a cab by the gate. Watch the dogs come to say hello. One of them proudly drags a bag scavenged from the trash with something in it that still smells like food. The other is a puppy with one ear up and one ear down. Be more afraid of them than they are of you until you see the little one sneeze so hard it accidentally rolls over and bowls into her clearly annoyed mother.

Order the cheapest steak you've had in a long time and eat it all. Realize you've eaten as much as the emergency medicine doc sitting down the table who is twice your size. Order breadfruit fries because you've never had it before and eat some more. Make sure the med student eats. He was a plumber in another life, did you know. And aren't all of us plumbers really?

Beg for a mosquito coil from the guard man at the gate. Makeshift an aluminum ash tray. Burn it by your bed. Try not to think of the smoke filling your lungs as you fall asleep. Bargain instead with your future self, trading this for at least five meals with processed meat, three bummed cigarettes on a night out, and a day at the beach without sunscreen.

Day 2

Wake now to something that is starting to feel familiar. The bug spray, the sunscreen, the honking, the van.

There is a speech. There is shaking hands in a cold room. There are photos. There is another speech. Wonder if the words mean anything at all. Look at the equipment all displayed on the x-ray table. Realize that they represent a hope, future, dream. Wonder at their expiration dates. Notice this time when you walk through the blue hallways that the diabetic foot clinic is just a few steps from the radiology department.

Sit in the dark and count down years, so few. Count the metastases, so many. Count the systems, body parts affected. Ask about HPV screening. Ask about vaccines. Ask about MRI and PET-CT's. Ask about chemotherapy, immunotherapy, radiation oncology, pathology. Get to the end of your report and hem and haw about what to say. What can one possibly say.

There are more. Observe an ultrasound-guided biopsy for a pelvic mass so large, you could hit it from across the room. That's the joke, they say. That a blind man could hit it from across the room. Watch them prep the ultrasound probe anyway. 

Ask the anesthesiology resident staying with you why she cannot take the hospital van without you. Think that maybe this is a mistake, they've mistaken you for an attending here. Or something else is going on, something that gives you the power to sign reports full of cancer and empty of hope, something you resent.

Finish the overly sweet jamoon wine. Eat eggs mixed with leftover curried mushrooms mixed with sauce you find in the fridge. Peel the tiniest banana. Think about the medical student who came with you. Think about him eating instant oatmeal, instant noodles in a small room alone. Think about the things you have and the things you do not. Think about the things you had and the things you did not. 

Day 1

 Wake early to the sound of nothing. Spray yourself down with mosquito repellant and rub sunscreen on every exposed part. It has expired and is the consistency of cottage cheese but probably still works. The FDA has a program for re-purposing expired medications to send abroad.

Go down the stairs when the van honks outside. Keep it together on the bumpy ride and be grateful you didn't eat breakfast. Wonder about the other people in the van. Listen to someone speak Spanish for the first time.

Blue, the hospital is blue. (White, the cemetery was white. The British like white.) Take a tour of the hospital and feel relieved there is air-conditioning most places and ashamed at your own relief. Meet people in a dark room and immediately feel at home. Sink into that semi-dark whispering quiet and feel your eyes half close while the familiar caffeine buzz grips the nape of your neck. Titrate accordingly.

Tag along to a meeting with what you believe could be the medicine team. They discuss a pulmonary embolism that has been teetering on the edge of unstable over the weekend. No one wears ID tags or white coats so you have no idea who anyone could be but you get the sense there is a hierarchy here everyone else seems to know. It's like trying to sing along to a song you don't know the words to. Walk away from the meeting wondering what if anything happened and what if anything will happen to the patient now.

Try your hand at reading out as an attending. Realize how much the templates you've worked with have engrained themselves into your memory. Let show your dislike of neuro and refuse to read out any more ENT cases after a nasopharyngeal tumor makes you sweat. Stick to chest, stick to body, stick to peds. 

Promise yourself you will pay for lunch. Who knows how many people you pay for but it's cheap and filling. Eat more new fruits and vegetables here so far than you have all year. Calaloo. Jamoon. Duongs. Balanjay sounds new but it is stewed eggplant. They wrap it in roti and it spills hot over your hands as you give a lecture on gastrointestinal anatomy. Take bites that make your voice thick as you rush through how you'd treat a bleeder at home, and they tell you blood transfusions there are rare.

Watch them place drains. The room is green. There are more nurses in that room than you've seen all day. Give credit to the ingenuity of creating a sterile ultrasound probe cover using a pair of gloves, the elastic wrist cuff taking the place of a rubber band. Realize no one else in the room knows what equipment is needed to place a drain much less how to open the packaging of said equipment. Wince as multiple packages are opened unnecessarily. Realize the man on the table is not fully sedated. Watch everyone watch his vitals fluctuate and wonder what would happen if.

Dinner is at a Brazilian pizza place. They are out of Brazilian pizza by the time you order. Get a burger instead and watch out of the corner of your eye as it hisses on the open grill. Listen to the nurses who came with you talk about what it was like to grow up there. How going to the hospital then meant sure death. How far things have come that people can trust doctors now. Learn that the hospital is currently operating at 40% nursing capacity.

It begins to rain. Pouring on the tin roof and drowning out any conversation you could possibly have. Look outside and see a sheet of flickering white and realize that is what rain looks like against the street light here. Smell the petrichor--it's different here. Thicker yet cleaner like a sigh being released from the earth. Your senses lull you into a deep sleep.