Yeah, I guess it's alright.

You know, if you're into things like spending your first couple hours hanging out in a Palapa Bar 10 feet from a crystal clear tropical bay before being invited to a local's house for homemade lobster soup and grilled lobster tails with garlic butter (Lobsters that were, of course, pulled off the reef just that morning by the chef). If you like that kind of thing, this place is passable. Then of course you could always supplement that with things like snorkling for hours on end with the barracuda (Senor Barracuda apparently), sea turtles (Mr. Bojangles and friend) and a huge electric green moray eel (Murray). Or crashing a wedding reception and immeditaley being welcomed into the festivities. After, of course, saying hi to all the people you met at said Palapa Bar because, yes, they're there too. And yes, they all act like you've known them for years. In the unlikely case that you're into these things then, sure, I'd recommend Roatan. Let us know if you're planning a trip here because we'll probably be living here. Lobster soup anyone?

Snorkeling Karma

I must have stored up a lot of good snorkeling karma in my lifetime, and I think I spent it all today.

Today was the best snorkeling experience I have ever had.

It was actually a terrible day for snorkeling. The water was murky and rough, so that the crystal clear visibility that I am used was reduced drastically. It must be a cruise ship day (cruise ships come into Roatan about 2 days a week completely populating the island with tourists who just drop money in their path) because there were many more boats cruising in and out of my little peaceful bay than usual. I have realized that although I may be scared of big fish, that fear is nothing compared to the fear of being hit by a boat while snorkeling. And finally, my magical trick of smearing Palmolive dish soap on my mask to prevent fogging only seemed to work on one side so I had to stop frequently to clear my mask. The foggy right side with the murky water seemed like a sure guarantee of a terrible snorkeling day.

The other resident (who is also a third year resident at a Childrens Hospital in California (Fresno) doing a rotation in Roatan, but who aside from all of that has very, very precious little in common with me) asked me to go out to West Bay to snorkel with her today. West Bay is gorgeous. It is about a 45 minute walk from our place (or a cheap 15 minute water taxi ride). The difference between Half Moon Bay (where I am in West End) and West Bay is like the difference of getting Italian food from the Olive Garden and from a high end Italian restaruant in Italy. Seriously. West Bay is that great. So why don't I go there every chance I get?!

For a number of reasons, but mainly that I didn't feel like spending a lot of time with this person who finds a way to complain about the increible free accomodation we have on a tropical island. Also, the beauty in West Bay is so in your face and obvious. Half Moon Bay feels like it needs to be explored - has ground yet to be uncovered. And finally Half Moon Bay is literally 10 steps away from our apartment.

So, with all of this background now in place, let me tell you about the snorkeling experience. I will warn you that the only thing that seems to do the experience justice is a string of profanities. It was amazing (insert your own profanities at will as adjectives). Within 3 minutes of my murky, foggy, boat dodging swim I saw a huge Permit Fish (see picture above). So huge that it had a little carrier fish sucking on its side. I have never seen a fish like that before (I actually thought it was a Sun Fish at first, but after a quick consultation with my friend Mr. Google, I realized I was wrong). I did my usual snorkel out to the dock to say hello to the barracuda that hangs out there (Senor Barracuda, to which I always politely request he not swim too quickly in my direction), then headed out to the sunken submarine (a failed project of some crazy American who had an obsession of submarines and decided to move out here and build them), then out to the buoy where the boats leave to the open water. (You can actually see the dock and if you squint & look far out in the middle of the photo you can see the buoy, too, in the photo under the post "The Relaxation".)

I will admit that I go to the dock and the buoy everytime in search of sea turtles. I have heard of people seeing them in these locations, but in my 2.5 weeks had not seen them. Seeing a sea turtle became a new obsession for me. I saw one on the surface of the water while I was fishing, but that's not the same. My sea turtle obsession is very similar to my moose obsession while exploring the North East of the U.S. I was so desperate to see a moose that I think I made Eric and I drive at least 100 miles out of our way. We never saw one. I thought the same would go for the sea turtles of Roatan.

I swam from the sunken submarine (which always has fun surprise fish playing Jack-In-the-Box inside and out) out to the buoy, around the back side and all the way over to the west side of the beach. I saw 2 other Permit Fish and a ton of other HUGE fish. I figured that murky, rough water must attract the large fish. I saw enormous versions of the fish that I see everyday (Parrot fish, some ugly brown ones that hang out at the bottom, angel fish, etc) as well as new huge schools of big fish, that I can only describe as looking like large tuna with a beautiful blue stripe down their sides.

On my way back I stopped by the buoy again to check for turtles and headed back to the submarine. I saw a burst of sand in the distance, and swam towards it. There, on the bottom, was a glorious bat ray. It showed me its peaceful way of gliding through the water and I paddled after it in complete awe.

After a while I headed back to the dock and there, stairing up at me as if he had been waiting for me to get there all day was a large, docile sea turtle (I assume his name to be Mr. Bojangles). Mr. Bojangles looked at me gasping at him from the surface, opened his mouth a couple of times and then gently swam off. I followed him, too for a while, straight to the site of another bat ray.

Incredible!! (Remeber to insert the profanities for emphasis of how amazing this all was). I could compose my own version of a Partridge in a Pear Tree, with the ending being 3 Permit Fish, 2 Batty Rays and a Bojangle Sea Turtle. The whole experience made me wish that I had made finding World Peace or a Million Dollars in Half Moon Bay, Roatan, my latest obsession. Who knows? Now maybe it will be.

The Town of West End

I am living in West End, the SCUBA diving and snorkeling capital of Roatan. It is gorgeous. The town is small and quaint. Above is a picture of some of the brightly colored shacks that pose as restaurants, shops, internet cafes, bars, etc. It is the cutest thing a town could do - be made of tiny little wooden shacks all brightly colored and filled with friendly townsfolk. They are like little beads strung together to made a stunning necklace for the beautiful face of the ocean.

The nightlife is also very vibrant. With dollar beer nights 2 nights a week, an 80s night on Thursdays, and an amazing live band (seriously, I would pay a lot to see these guys in the States - where they are from - but instead I get to enjoy them for free) on Tuesdays and Fridays . . . well, it leaves for very few nights with nothing to do.

Life Without An Attending

The attending physician who was here from the States went home on Friday. Even the local doctor didn't show up for clinic today - I have no idea why. So, it is myself and another 3rd year resident running the clinic (until Friday when she leaves and then it will just be me). It is a little bit nerve racking, but to be completely honest, it has been wonderfully reassuring. It has been a true test of all that I have learned in residency. I am comfortable identifying who is dying from who is really sick, from who isn't very sick at all. And, with the exception of the limited resources here, I am comfortable dealing with all of those scenarios.

What concerns me is the potential patient who walks in with something I have never seen, or with something that I have never taken care of before. I guess the internet will be my guide (yikes!) and maybe a few phone calls to some people back at CHLA for help.

This photo is the entrance into the hospital. Usually the area just beyond those doors is hot, stuffy and packed with people waiting to get a number for the clinic or admission into the emergency department or hospital. It is a good predictor of how busy the morning is going to be. And the best part is, no matter how busy the morning is, I always have that gorgeous beach and lounge chair to return to in the afternoons.

The Relaxation

This picture was taken on the beach directly in front of the apartment where I am living. This is my life. I snorkel in that beautiful ocean everyday and then dry off in the sun while resting in that very lounge chair.

I cannot remember a time when I have felt so relaxed. I am so well rested that there are times when I have time for a nap, and I don't even take it, I don't need to take it, I can go for a swim or a walk instead. It is amazing. All that residency has sapped from me, this place has returned.

It should be a requirement that all residents do a month rotation in Roatan.

The Book

Every now and then I come across a book that within the first few pages I fall in love with. It is the type of book that you want to give to everyone you meet because you know it will enrich their lives. I savor each beautifully written page as though it were a piece of decadent dark choclate that I want to make last.

It makes me feel warm and inspired. It's a great book.

Not surprisingly one of my best friends, Chris Cho, gave it to me.

It's called Eat, Pray, Love by Elizabeth Gilbert: http://www.elizabethgilbert.com/eatpraylove.htm

You should read it. It's kind of girlie.

The Baby with Congenital Heart Disease

On Friday as we were getting ready to leave the clinic we got called into the Emergency Department (I am always grateful when they do that, because it shows their willingness to take our advice and be open to some of the teaching we can give them). There was a 2 month old baby named Yelsi, in there who had already been hospitalized in the past with pneumonia. The baby had respiratory distress and they weren't too sure what to do about it.

This baby was tiny. Had actually lost weight from her birthweight. She was sweaty and breathing rapidly and shallowly. She had an incredible heart murmur that could be heard everywhere - her chest, her back, practically her feet. You could feel it vibrate beneath her chest. Her liver was enlarged, she had large veins in her neck (JVD), and her lungs sounded very wet.

Essentially this baby has congenital heart disease, causing fluid to back up into her lungs, liver and veins. Her murmur was undeniable. Mom confirmed that she would sweat profusely anytime she cried or ate, which is a clear sign of someone whose heart has to work overtime to do everyday activities.

She hadn't been gaining weight because she had been working so hard and needed extra calories to help her grow.

In the States she would have likely been prenatally diagnosed, or at very least diagnosed at birth. She would have been started on medicine to help support her heart and remove excess water from her lungs and body. She would have been placed on a high calorie formula so that she could gain weight until her surgery. And yes, she would have likely had corrective surgery.

Here, she just slipped through the cracks. The pneumonia she was diagnosed with was likely just signs of heart failure that yet again went misdiagnosed. The fact that she is 2 months old is a good sign - maybe the heart lesion isn't so severe...but the fact that she is showing signs of heart failure is not such a good sign.

There is no ability to perform an echocardiogram on the island. There are no pediatric cardiologists (I'm not sure if there are any cardiologists). We tried to do an ultrasound of her heart, but it was difficult to pick out all of the chambers and the doppler wasn't working. We recommended giving her a dose of a diuretic and transferring her as soon as possible to a place that could do an echo and had a pediatric cardiologist.

The hospital doesn't pay for such transfers, and mom doesn't have any money, so luckily the organization that I am working with was able to set aside enough money for: taxi to the ferry station, ferry to the mainland, taxi to the bus station, bus to the larger city with the pediatric cardiologist, and then pay for the echocardiogram at the private hospital. Crazy.

The baby did much better after the diuretic, but she had a very persistent cough. She and mom were actually on the ferry with me over to the mainland. I sat next to them and watched the baby bob her head with each breath as she slept and flare her little nostrils - signs that even while asleep she was working pretty hard to breath.

I watched her and prayed that she would be able to make it to the hospital and then get the help that she needed.

I last spoke to the mom on Sunday - she had been admitted to the Public Hospital, but hadn't seen a doctor yet and didn't know when she would get the echocardiogram. I asked her to please get the phone number of her doctor so that I could call them and find out what was being done for little Yelsi. I feel fortunate that we were there to look at Yelsi and give our opinions, but at the same time I am frightened for all of those patients who don't get that chance.