A young doctor chooses to write about what his life is like – the ups, the downs, what worries him, what lifts his spirit, a kite –  he chooses the pen-name Fahr, and these are his words:

The Kite 

by: Fahr

Chapala is a lakeside town about 30 miles from Guadalajara, Jalisco’s capital. It houses one of the biggest foreign communities in Mexico, mostly retired folks from the US and Canada. It is a small paradise, for anyone willing to explore its whereabouts. Great food and a warm climate are its best attributes. Chapala has inspired many artists, including DH Lawrence and Tennessee Williams. The latter spent a few months there, laying the groundwork of what would become one of his most famous plays: A Streetcar Named Desire.

Friday was a usual day for me. I got up at 5:45 am, had a light breakfast and headed for the hospital. I started rounding at 7:30 with my team, and by 9:30 we were done. There were no new patients admitted since we were not on call the night before, that hastened things a bit. Maria is a 64 year old patient who has suffered various strokes due to an occult arrhythmia called atrial fibrillation. She is unable to talk because the stroke affected the eloquent part of her brain, which, in most right handed people is the left cerebral hemisphere. During her stay she caught pneumonia and is now completing a scheme of IV antibiotics. Heliodora is a 52 year old patient who came to the ER with dyspnea and a pleural effusion. She has a lung tumor in the apical right side of her lung, and after a cervical lymph node biopsy, we diagnosed a large cell carcinoma; a very aggressive type of lung cancer. One night her dyspnea worsened and she had to be intubated and connected to a ventilator. She is quite ill, and the family members don’t want any heroic measures due to her grave prognosis. Sadly, I agree with them.

After rounding in the women’s ward we go into the men’s ward. We have a young 16 year old patient named Alberto who has been  suffering from fever of unknown origin for a month now. We admitted him for study and during his history he mentioned recently having cheese and milk – it was probably unpasteurized. He also complained of low back pain. We immediately thought about brucellosis or undulating fever as the cause, and to our surprise, one of the studies came positive for brucellosis. We have started him on antibiotics. I think he will be alright. At the far end of the men’s section there is Augusto, a 75 year old patient with ascites (fluid) in his belly. He comes from Puente Grande, which is one of the largest jails in Guadalajara. What was his crime? I don’t know, and I urge my first year residents to avoid any inquiry. Inquiring always affects the way we look at patients, specially if they are accused of murder, rape or such vicious crimes. “We are here to cure, not to judge” one of my attendings once told me. Ignorance is bliss. After we punctured his belly to obtain fluid and did a CT scan we found massive metastases in his liver. We are now in pursuit of the primary cancer, the radiologist think it might be in his right kidney. Wherever it is, the prognosis is terrible.

At 10 we have a clinical session involving a complex neurology case which I presented in conjunction with the Neurology Department and several medical students. The diagnosis at the end was a mitochondrial disease in a young patient which seems to be affecting all his family members. The disease is called MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes). What a zebra! Unfortunately there is no real treatment for his condition.

The day ends around 4, and I head home, take a quick shower and decide its a good day to travel to Chapala. It was a long month, with call every other day and I feel like a I need to get away. The traffic is bad as I leave the city, but it gets better once I hit the road, I arrive at this awesome spa/hotel and stay there for the weekend. I need to relax, but I can’t help but wonder if on Monday I will still find Helidora* or Augusto. There are other doctors caring for them on the weekend with strict instructions to call me should something happen. It’s Sunday now and nobody called. No news is not always good news.

Now I return home after spending some time in the pool, having a few drinks by the lake side, ohh and yes, after flying a kite. Every time I come to Chapala, I fly a kite in the main malecon, right by the lake. There is a store by the bank in the main plaza which sells them for 23 pesos. People there must think I’m crazy, a 29 year old man flying a kite, but it is really an amazing feeling. There are always people giggling, probably thinking there is no way I would be able to fly it, and probably hoping I will look like a fool. At the end of the day I gave the kite to one of the local kids that was running around the plaza. He was thrilled.

I guess the kite reminds me of my childhood, a time where I had no real responsibilities at all. It also reminds me of freedom, and how we are all but finite. We never know if we’ll get sick and, like Heliodora or Augusto, unable to carry out our daily activities. Tomorrow is Monday again, and I have to be rounding on the same patients at the hospital, plus other patients who were admitted during the weekend. It was good to get away for a bit, I feel recharged and am able to start another long week.

As doctors, specially at a public university hospital, we work too much (sometimes more than 36 hours straight) with so little. In the US by law, medical residents cannot work more than 80 hours a week. Last week I was there for…let’s see….about 110 hours. Most of the patients we see there suffer from the only disease we cannot treat or cure: extreme poverty. To survive in the trenches (as we call them) one must have a lot of endurance (mental and physical), clinical skills, and most of all, a strong stomach – the trenches demand it. It is not a place for weak minds or souls. I have been at it for 3 years now and I am grateful to be in a place that is so rich in many aspects. Paradoxical? Yes. Would I do it all over again? No doubt. When? Tomorrow at 7:30 am.

So did I fly the kite? You bet.

* Heliodora has since passed away.

Alberto’s fever dissapeared, he was discharged.

The doctors are still looking for Augusto’s primary tumor.