Yo les invito a todos, pero cada uno se mata su toro

That translates to "I'm inviting all of you, but each one kills their bull" . That is a phrase used here when you are talking about going out to a dinner, going out for drinks, or just in general if you are the one talking about going/doing something and are inviting other people. It's to say, I am inviting you, but you gotta cover your own bill.

Today was the hardest day of work I have had so far in my three + months of actually functioning in the role of a nurse.  It was actually a night shift from 1930pm-0730am, but the nightshift was pretty calm (we had about 38 people in our ER during the night). We didn't have any true emergencies, but we did have alot of belly aches and urinary tract infections. Literally at about 07:33 am, in came the only emergency we had; unfortunately it was already too late. In the relative calm of the morning came running in a grandmother and mother combo (the mother in her teens), the grandmother holding a baby wrapped in a fleece blanket crying saying "our baby is dead, our baby is dead".  I was the first to come to the patient, grabbed the baby who was flaccid, pallid, not breathing, cold, had a bit of milky whitish secretion coming from one nostril, and as we came to see once we removed the blank, had cyanotic streaks forming along the left side of the body around the pelvic/lower abdominal area. We ran into the Unidad de Críticos, our critical unit where the crash cart is and where supposedly all of the supplies we would need for an emergency are.

This baby, of three months, was realistically already dead and we didn't know for how long, but we began efforts to resuscitate. I grabbed the pediatric ambu bag, and the doctors began CPR. Margarita, the other nurse, and I tried to look for peripheral IV sites but were unsuccessful. By this point, the doctors/nurse from upstairs in Neo (NICU) had been called down. We probably had 10 or so people in the room by that point. I prepared a syringe of Epi diluted, and efforts to put in an IntraOsseous iv were started by one physician by using our #18 gauge introcath needles, which were too delicate to puncture the calf bone, and the efforts (4-5) were nil. #18gauge is the largest needle we use; we don't have #16 or #14 gauge needles readily available from our locked stockroom (that only 2 people have a key to). The baby had no saturation, at this point was intubated but without any IV site we couldn't pass any Epi. It was, even though probably hopeless from the start, one of the the worst codes I have seen. Very disorganized, and like always, we were running around for supplies that we just didn't have enough of in our "Critical Unit". The boss of all nurses, Lcda Maria Teresa Benavides was there to witness it all.

The saddest part about all of this, is that this same baby of three months, was in our ER the day before, and had been discharged at about 10pm with a diagnosis of pneumonia.  It had literally left our ER at 10pm alive, and returned at 0730am, dead.  Due to the state of the baby upon arrival, and the milk that was escaping from the nose and the whitish secretions that we removed from the lungs via suction during the code, it was evident that the baby had aspirated on his mother's milk, most likely from spitting up after feeding and breathing in the liquid without the mother knowing, and thus went into respiratory distress, respiratory arrest, to cardiac arrest. It likely had little to do with the pneumonia diagnosis, but clearly that baby was already in a compromised state of health, and who knows where the blame lies. Should that baby have been hospitalized the night before? I do not know; although I did see that baby the night before, I didn't attend to it or the family in anyway whatsoever, so I didn't know the story of the baby at all until the morning. I do know however, had that baby been hospitalized, it would be alive right now. Was it just poor timing that the baby was sick and just so happened to aspirate the morning after a hospital visit? Were they interrelated incidents? Was there something we could have done in the morning or was it really a hopeless effort?

When the young grandmother entered crying, she started saying the story how they had been there last night and he had recieved an IV and oxygen and all this treatment and now he was dead...she even pointed to me, and said "you were here last night, you know what they did to him last night!" which was true, I had been there the night before (I stood out as the gringo in a pink uniform, so clearly she recognized me), and that was when I connected the stories. It was very tough. What made it worse was after the code, we had a "meeting" with all the personnel (minus the doctors) who were there at that moment, and with Lcda Benavides, to discuss how we didn't have the supplies, we were disorganized, how everything went bad. Well Lcda Benavides, sorry to say it but this is how every code is. We are always leaving the "Critical Unit" to get other supplies. It was a blessing that she at least saw the disorganization, because at least now she knows. But, like always, that "meeting" was a circle of blame, with the subject of conversation centering back to the SAME dumb topic that we have talked about for the last three months: that we are billing patients incorrectly and therefore not having enough supplies.
Now that I am much more fluent in Spanish and have observed enough of our department and how it works, I think I have the ability to finally make my case heard. My Spanish, I believe has been accelerated by times when I am all worked up like today, after bawling in the supply closet, I went to breakfast with Margarita, the other nurse, and Diana, the technologist who I had worked that shift with. At breakfast, we discussed what happened, among other topics, and I didn't hold back anything on what I was saying; I was capable enough to express all of my thoughts without being frustrated. It was kind of like our debriefing session that we probably should have had in the ER with the rest of our employees, but I don't think the "debriefing" idea has really hit Ecuador yet. What I've realized today is that I can't continue to sit back and have problems with my boss; if she, Sandra, doesn't want to change anything then I am going to have to go above her, to Lcda Benavides directly. We are dealing with people's lives, y punto.
Three months.
The amount of time I have worked in this ER; the same amount of time that baby lived.
Two totally different perspectives on an equal amount of time.

Quilotoa Hike

Hiking 7.5miles around Quilotoa lake/volcano. This is located about 4 hours south of Quito.

I went on the hike with Alana, current Medical Brigade Coordinator for the Timmy Foundation, and a group of "montañeros" or people interested in mountaineering, called Zona Verde.

Just a beautiful photo

This photo was taken upon arriving at the top of the highest point during the hike, and after finishing the hardest part of the hike, go Team America, we were the first people up!

This was not a friendly hike like I had been on before with pretty switchbacks, wide paths, and steps cut into the path to make it easier...this was a legit just worn down path, that was very steep and rugged!

Quilotoa was the hardest hike I have ever done in my life! It took us 4.5 hours to walk around the 7.5 mile loop, and then we also hiked down to the lake and back up (25 min down, 50 min back up), which was sooooo hard because our legs were so sore already! I likened it to how I felt after running the marathon, that is how sore I was! I also am out of shape right now, so that certainly didn't help. I desperately need to start working out again!

Ecuadorian Breakfast Club

So, as everyone well knows, the longstanding Breakfast Club tradition held on game-day Saturdays at Purdue University is a favorite pasttime of mine...one could even go so far as to say it is a cherished passion in my heart. Dressing up in homemade costumes, waking up at 6 in the morning to stand in line, getting all messy dancing around in Where Else? and then bar hopping until getting kicked out of Jakes when "normal" customers begin arriving around 11am., I have very fond fond memories of those Saturday mornings.  So, when walking to work on various Saturday and Sunday mornings at 7a.m., I noticed that a local little tienda called Viveres Lorena hosted some sort of crab breakfast, and there were often people visibly drinking outside on the sidewalk. I thought, "bingo!", there is my Breakfast Club location. I had already brought beer pong to Ecuador, or at least to José, and thought it was time to move on to a bigger challenge. Unfortunately I have a very small pool of people to inform here in good ol' Quito Sur, so I ended up only peaking the interest of four other people. That did not stop my dream!

We arrived at Viveres Lorena at 7:15 in the morning (without los disfraces, or costumes), and promptly had a bowl of crab broth with a crab sitting on top, set in front of us. I ordered the one 24 oz. beer, which we all split. Unbeknownst to me, everyone who came with me actually had other plans for that Saturday which they had to attend to after our breakfast, and could therefore not partake in some friendly chupando, or a slang term for drinking (it really means sucking, but in certain context it is used to say drink some beers).  I was sadly disappointed by the amount of meat in the crab, because their wasn't much, but it was my first time eating a crab and therefore my first time whacking the crab with the little mallet, which is super fun and a totally redeeming quality of eating a crab! The crab boil that Viveres Lorena has every weekend is called "una cangrejada", el cangrejo is spanish for crab. I could probably have done without the "caldo de cangrejo", or crab broth, because it was filled with conchas, or mussels (I think), and I am not very fond of those.  All in all my "Ecuadorian Breakfast Club"only met one of several requirements to actually be considered Breakfast Club. That is, I taught my fellow BClubbers to play a card game called Screw The Dealer, which is an extremely easy game that can be played with large groups of people and in loud settings, which makes it perfect for bar scenes. Costumes, no. 5 a.m. wakeup call, no. Drinking, no. Loud, noisy bar scene with 80s music and crazy dancing, no. Laughing, yes. Card game, yes. Good times with friends, yes. I guess it met more than one requirement afterall! See photos below:

Outside of Vivires Lorena.  Lorena, the store owner, is sitting on a stool just inside the door, like always. I have chatted with Lorena a couple of times. She told me the weekend before there had been a Gringo (white male) at the cangrejada. Unfortunately, she had no other details to share with me, so he is now "mystery Gringo".  I think the lady serving crabs is her sister, and the little boy in the green sweatshirt is that lady's son.

Poor Mister Cangrejo...about to be devoured.

All smiles on this Saturday morning!

Lupita and I, with our cangrejo friends.

Marco, aka the Spanish version of Papa Joe.

Fuimos a la Playa!!

View of the beach and city of Manta, capital city of Atun (tuna)

Other side of Manta beach, the fish market

José and I on the bus! Only almost 9 hours to the beach.

View looking North on Crucita Beach

The hostal we stayed at directly across the street from the beach, $15 a night...which was actually really expensive because it was the holiday (New Years)

Proof that I went to Crucita

Yay, a sunset!! I don't see sunsets in Quito, the mountains block it and normally it's cloudy or raining at that time of day!

If it has wheels, you can ride in it

Not even a great photo, but just one of thousands of examples

There are no transit laws in Ecuador - or there are laws, but are NEVER enforced. Every single truck that I saw in the costal region (and often times in Quito) had a truckbed full of people! Sometimes they had plastic chairs in the back, and like a moving tailgate the people were just hanging out in the back while the truck was going 40mph.  I also saw a multitude of little motorbikes with the guy driving wearing a helmet, and his wife/girlfriend sitting behind without a helmet, and in between them one or more children under the age of 6 also without helmets.  Extremely unsafe, it kept scaring me everytime I saw it! Basically what I concluded in Ecuador is that if it has wheels, you can ride in it.