Montserrat

My cold has progressively worsened. I decided I only had energy to sit for a train ride.
Montserrat is 1 hour out of Barcelona. This doesn't include the 1 hour it took me to find the right train. Then you can take the tram to the monastery and beautiful basilica. There's also a furnicular to the mountain top for great views and hiking.  I ate my lunch there, soaking in the view then rode the furnicular back down for coffee. It's not every day you get 3 modes of transportation in one day, let alone a furnicular!

Too many Gaudi sights, no time to post, must see all!

Beautiful!

Sebastia

My new friend Ansem took Kevin and I for a tour of Sebastia, once a significant Greek, Romen, Ottoman city. Afterwards we had a wonderful lunch at her home with a her family.

We are re in Ramallah now. Most of us have a terrible cold so I am staying in for the night to rest.

Kid photos

ICU

Peds. Floor

NICU

Rafidia Hospital

  Tuesday, day 3 of surgeries. 10 am and the team is deep into the first case, 3 month old with a tethered cord to be released.
  We start the hospital day with rounding the previous cases. Most are doing well. The most ill is Riyad who was 13 or 15 days old (conflicting information) who arrived at clinic altered level of consciousness cyanotic, bulging fontenell, heart rate of 70.
  We did an emergent VP shunt for hydrocephalus. Pt. was an IV nightmare.  Severely dehydrated.  Probably 10 IV attempts, including the one that was pulled out by mistake along with the ET tube. Oops, big feet.
Pt. Survived surgery, came to me, HR 90, cap refill 4 seconds, gave a fourth bolus an sent to NICU.
  The following am we were met by a very angry head of pediatrics. Loud yelling, short of tears i the hall. In short she was upset that they weren't notifed about such an ill baby. I have spent the last day and today doing damage control. She was right. We just don't know the system and thought protocol was being followed. The ball was dropped.
  Thankfully baby is recovering from sepsis, and dehydration he had before surgery.

Let the games begin!

We screened 50 kids today. Saw things I've never seen. One child brought in by his father with a huge hydrocephalic head, the local doctor put a 20 g angio in his head and drew out CSF and squirted into the garbage. That didn't seem so odd when I heard the dad had been doing it himself at home.

  We did 2 shunt cases. Got back to the hotel at 10.
Good night

Hotel al Yasmeen

  I arrived at the hotel yesterday at 5pm. Groggy my brain and foggy the weather. Half awake half asleep, hungry and nauseous.
  Kevin knocks on my door amd we decide to eat. Typical Palestinian meal, we have way too much food and yawn all the way through dinner. I slept fairly well, ambian is a life saver on these trips.
This morning I meet a new friend, Ansam, who lives nearby. She takes me to places in the old city I haven't seen before.
  We screened 10 kids for surgery and scheduled 5. More clinic tomorrow AM.
  I am back in my room. It is the only warm place. My heater is on so high it sounds like the ocean