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Residency Emergency Medicine, Latin America

I am a physician from Venezuela who is a soldier against death in my country. One of the most powerful moments of my life occurred in a crematorium. The shantytowns around Caracas, Venezuela, had been decimated by mudslides; I was working for the Venezuelan Red Cross, seeing patients from the tailgate of a four-wheel-drive pick-up truck. After a grueling day of shoveling in the morning and seeing over thirty patients in the afternoon, my last patient invited me to his home for soup. This patient, I remember, had severe hypertension. I spent some time with him teaching him how to take and the importance of accepting his medication. As we walked up a grassy hillside above the twenty feet of mud that had buried the village, I saw that the home he was referring to was a crematorium - it looked like an old railway car with a chimney on top. Of course, he, like most of the villagers, had lost his home. As I stooped through a square metal portal, our shuffling footsteps echoed off the charred iron walls. He offered me a seat on a mattress where four children sat, sipping cups of soup. Then he showed me a white ball of dough. "Arepa," he said. I repeated, "arepa" we teach each other."

That afternoon I learned that his wife and his wife's family had been killed in the mudslides. A few weeks later, I returned to California and started a clerkship in emergency medicine. I quickly realized that the feelings I experienced in the crematorium returned on some level with each patient interaction. Almost always, there was a sense of being "let in" to a stranger's life, a brief interaction in a stressful environment, one person needing help, the other hoping to be able to give it, but all the while a sense of a shared experience a bond supported by the understanding of the circumstances. I know I have as much to learn from my patients as they do from me, and I think this awareness strengthens my interactions. This isn't to say that every interaction is joyful or even necessarily positive; in the emergency department, we do not always get to see people at their best. It means that no matter the situation or conflict, I always try to leave each patient with their dignity intact. I have, in essence, entered that person's crematorium - it falls upon me to walk carefully, to be respectful, and to help in whatever way I can.

I first discovered my affinity for acute care one summer when I was head coach of a large community swim team, and a beehive plagued the pool grounds. I turned the lifeguard office into a sting clinic (complete with tweezers and topical anesthetic) and derived great satisfaction from comforting stung kids. When I realized I liked helping people in distress, I started volunteering at night in a nearby county emergency department. There, I discovered that I enjoyed the pace and helping those who had no other place to go for help. My father, a police officer, is well known for insisting that everyone should be treated with the same respect, regardless of what crime they may have committed. Though I learned from him early in life the importance of leaving people with their dignity intact, this philosophy was reaffirmed by those early experiences in the emergency department; since then, it has underscored my professional and personal lives, and I think it will help me excel as a leader in the field of emergency medicine.

In my second year of medical school, I experienced another powerful incident that shaped my life. I had been taking an emergency medicine procedures course, a popular course for its clinical exposure in an otherwise book-heavy year. It was my first day in the emergency department, six months before I would even start clinical rotations when paramedics rolled in an eight-month-old MVA victim. The paramedics said he had been restrained in a safety seat, but he did not survive. His neck had broken, unable to support the weight of his head against the frontal impact. His car seat, I learned, had been facing forward. Moved by this experience, I educated myself about child passenger safety. I began to understand that some simple messages about child safety seats could save many lives. To this end, I formed "One Child's Life," a registered student organization to promote child passenger safety among parents and health care providers; we give seminars for pediatric residents, assist police with safety seat inspection events, and speak at PTA meetings. Parents often ask why I spend so much time teaching child passenger safety. I usually respond by saying that it eases the sense of injustice one feels when trying to resuscitate an accident victim to know that one has done something to try to prevent it.

During my third year of medical school, I was forced to make a decision that would affect me personally and professionally. Because of the emergency department research I had done on sexual assault and an essay I published based on that work, in addition to my contribution as Arts Editor of the UCSF student newspaper, I was offered a job as an editor of my JAMA. I chose instead to work in malaria and leprosy clinics in Peru and with the Venezuelan Red Cross in Caracas. I do not regret this decision because I feel I learned some things about acute care that I could not have learned any other way. I knew, for example, how to diagnose malaria without a microscope by carefully observing fever patterns. I learned how to put in an IV without a plastic cannula. And, of course, I was enriched by my patients' many sad and extraordinary stories.

I look forward to a career in emergency medicine as a life-long exercise in learning from people who are sometimes very different from myself. We indeed do, as the Venezuelan man said, teach each other.

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