Am I Really Already Leaving?

Thursday, January 4, 2018: And just like that another month has come and gone in whirlwinds of excitement, great experiences through my project, incredible landscapes seen, and most of all, welcoming family to Chile! I write to you now on a plane journeying across the Pacific Ocean. It’s almost hard to comprehend where I am right now. I left yesterday from Chile, only feeling like I was heading out on another excursion, yet to realize along the way that I had truly left. It’s hard to say goodbye to a place that you have grown fond of, sights you see everyday, customs you have newly become accustomed to; however, it is probably the most common occurrence along this year. Time continues to move, and so do we – to new places, new friendships, new sights to see, new things to learn, and new customs to accustom. To say that it is already 2018 blows my mind. In my head it means a lot of things – It means that I am essentially half way through this year. It means that this is the year that I finish the Watson Fellowship, and it is also the year I begin Medical School. Surely, 2018 has a lot to hold! I am excited, and nervous all the same. I hope that as you read this, you too face new fears and new excitements as you step into the new year with all that is to come. I want to give you guys one last update from Chile before I change paces a bit over in Southeast Asia. This past month was incredible; it began with wonderful, continued work with SAMU, the public ambulance agency, involved a trip to the driest place in the world, welcoming family for Christmas and seemingly parting too soon, and lastly welcoming in the new year as I took some needed downtime to reflect on where I have been and plan for what’s up ahead! Take a look:

Week 10 – (December 9 – December 15):

I spent a solid amount of this week working with SAMU again. Following the weekend, I joined medics on Monday and Tuesday, ventured out to a private helicopter agency on Wednesday, and spent my last two days with SAMU on Thursday and Friday. To have had such a full week with SAMU was really incredible. It was rewarding to know the work I had put in to get in touch with this agency had paid off, that I was taking part in the good work they were doing, and learning so much as I go. (As always, I’ll elaborate a little more on the project sides of things below following the pictures!) Oh, and Cory and I went to see Star Wars: The Last Jedi. It was epic.

Week 11 – (December 16 – December 22):

As it was our last weekend together, Cory and I set out on one more adventure. I had read about an awesome hike east of the city in the Andes in an area called El Cajon de Maipo. The hike would take us through El Morado Natural Monument up 5 miles to 8,500 feet and at the foot of El San Fransisco Glacier. We had a beautiful day walking through the valley that had been carved so many thousands of years ago by the very same glacier we were looking at that day. We ended our evening in the apartment ordering a well-earned pizza. On Monday the 18th, I took a flight to Calama, in the north of Chile, followed by a bus ride to San Pedro de Atacama. San Pedro is situated within the Atacama Desert, a massive desert that is also the driest place in the world. People often say that the landscapes you see there are seemingly extraterrestrial because of how unique they are. It’s safe to say they aren’t wrong. I had set up some tours before I arrived and had a full two days ahead of me. During my first day there I went out to the Altiplanic Lagoons, which are two beautiful blue lagoons that lie beneath tremendous volcanos. Following, we drove over to el Salar de Atacama, the largest salt flat in Chile. There we gazed at pink flamingoes wading through the briney water searching for food. In the afternoon we went to the Cejar and Piedra Lagoons where we could float like one does in the Dead Sea due to the high salt concentration. After, we went to Los Ojos de Salar and the Tebinquinche Lagoon to watch the sunset. The day was filled marveling at wonders of the world I once did not know existed. It was a day for giving thanks. The next day started quite early with a 4:30 am departure to El Tatio Geyser situated above 14,000 feet. There we walked along the 80 plus geysers and watched as the sun rose over the mountains and reflected beautifully against the rising steam. In the afternoon we went to El Valle de la Luna, named literally for its lunar-like landscape. We walked along mountains made entirely of salt and got to sit one last time for sunset. Knowing it was my last night, and not knowing when I may be back there, I rented a bike late that evening and biked away from the city on my own to find a quite place to sit and gaze at the night sky. I had heard the stars in Atacama are some of the clearest in the world. Again, people weren’t wrong. I got to continue practicing with my camera and I got to marvel at the creation in front of me. It was a perfect ending. The next day I busses back to Calama and ultimately flew back to Santiago. The 21st was a preparation day…for family! Mom, Dad, and Mary Kate had made their way down to Chile for a little Christmas Holiday! With many anxious jitters I did my best to pass the time until their arrival on the 22nd. Finally, I saw them walk through the airport exit and all was so well. We pushed through heavy traffic and finally arrived at our AirBnB. Tired from a long day we mostly relaxed, grab a quick bite to eat next door, and called it a night. We were just happy we were all together.

Week 12 – (December 23 – December 29):

This is really where the Family week began! After settling in our first night, we woke on the 23rd to hike back to the San Fransisco Glacier. It had been such a beautiful hike for me and Cory, I wanted them to see it as well. It did not disappoint the second time. We hike, picnicked, Mary Kate and I went up ahead and ran back to catch up with Mom and Dad – all of it was such a good time. Returning to Santiago, we refreshed and headed out to dinner at El Camino BBQ, a Texas-Style BBQ restaurant with a Chilean twist (we almost lost Dad on the metro). On the 24th we packed out bags, hopped in the rental and drove towards Valparaiso! Arriving and settling, in we walked to Le Pató, a yummy corner empanada restaurant. Afterwards we walked the beautiful streets, and did a little grocery shopping. We went back out to eat at La Paparazzo, one of the few restaurants that seemed to be open on Christmas Eve; however, it turned out to be exceptional (especially the Pisco Sours!). Christmas morning started out as it must, Mary Kate and I yelled from our beds asking if Santa had arrived only to be classically told that we need to prepare ourselves for disappointment. Much to our surprise (as always), Santa found his way down the pacific coast and dropped off two stockings! (Santa must have known I needed new socks, boxers, pens, and books – so thank you bug time, Santa!) Mary Kate and I went on a Christmas run, we drove up along the coast and found these enormous sand dunes to climb. We ended our day with family dinner and card games that took us late into the night. It was perfect. On the 26th we spent one more day out in the old part of Valparaiso. First venturing to 21 de Mayo, we took in a beautiful view of the City from above, did a little shopping and continued to wander the beautiful, artistic streets. In the evening we went to La Concepción, a second restaurant that perfectly ended our last evening together. On our last day, the 27th, we drove back to Santiago, strolled through the Central Artisan Market for a little more shopping and then onwards to the airport. It came and went so quickly. The 28th and 29th could have easily been spent in a state of isolation and loneliness after their leaving, but I couldn’t stop thinking about how thankful I was for having had the opportunity to be with them. It perfectly closed out my time in Chile and made me feel like my time there had culminated so well.

Week 13 – (December 30 – January 5 (2018!!!)):

Following family week, my sights were set on taking the time I had left to solidify more plans in Thailand, and also do some “closing up shop” in Santiago. I ventured to Valparaiso once more by bus on New Years Eve to spend the night with a friend named Felipe, who I had previously met and spent time with. Valparaiso has the largest firework show in all of South America. The show lasted for a full 25 minutes, with boats set out along the harbor launching hundreds and hundreds of fireworks into the sky in synchronized fashion. I welcomed in the new year in a new place and had so much fun doing so. Thankfully I found a bus back the next day – when I arrived to the bus station, almost all bus agencies were no longer offering rides to Santiago. On the 2nd I did my last load of laundry, and on the 3rd I set out on one last run, one last lunch, and packed my things. Leaving that evening, it was time to say goodbye. This week also presented an unexpected piece of stress. Originally, I would not be en route to Thailand as soon as I am doing so today. I had originally planned a trip to Mexico City, Mexico for a brief stop-over to see a close friend, Clementina, and her family for a few days before continuing onward. Only realizing in this week that Mexico is one of the fellowships no-travel countries due to State Department Warnings, a quick change of plans had to be made. Though much sadness was expressed on all sides, I learned a lot in this week about the power of friendship and its resiliency. Tearfully telling Clementina I could not come, I was welcomed with grace and understanding on the other side. So Clem, public shout-out goes to you on this day. Thank you for being my friend, for always understanding, and for showing me such a true example of the power of friendship. Mexico will wait, but I can’t wait to visit when I do. This experience also helped me realize how much I have improved at changing plans on the whim. I am pretty sure if this had occurred in my first week away, it may have crippled me. It’s awesome to be able to recognize such a difference.

Pictures: (There’s a lot!)

Starting our hike and seeing the mountain in front of us, Cory and I knew it was going to be a good one.

About 6 out of 8km in we came across a beautiful lagoon. A perfect spot for a picnic.

At the top, water rushed out from underneath the glacier!

Driving to the Altiplanic Lagoons, beautiful purple and yellow flowers blossomed everywhere.

Check out this series of flamingo flight!

At the Tebinquinche Lagoon, it almost looked like a field of snow!

Sunset was incredible through the desert haze.

Sunrise the next day at El Tatio Geysers.

The Great Dune in El Valle de La Luna.

Standing next to the Great Dune with the Salt Mountain Range behind me. These mountains block sand from overwhelming the city of San Pedro

Sunset in El Valle de La Luna (I promise I’m not that tan…)

I sat down to watch it fade away.

One of the many pictures I captured in the desert that night. Absolutely stunning.

Family has arrived!!!

Family pic mid-hike in El Morado Natural Monument

Mary Kate and I hiked up to the glacier (a lot had changed in the week since I had been there!)

Christmas Morning Stockings in Chile!

Selfie on top of a giant Sand Dune

Seemingly jumped off a cliff.

But in reality, we were exactly what this mural says, SO full of happies.

A final goodbye at the airport; sad to say goodbye, but so thankful for the time we had!

Project: (As if I was never going to get there!)

The last bit of time I had with SAMU was really great. Just as I had felt in Denmark after visiting more regularly, it felt really great to be more recognized among the other medics who worked there. It helped in conversation and in gaining more opportunities to ride in different ambulances on different calls. As much of this post involved either travel, family time, or Thailand prep, here is what came to mind in my last week of working with SAMU.

After having responded more frequently I began to notice a challenge that the ambulances face here: the traffic. At certain times during the day it is terrible, and the hardest part is that many cars often do not move. I asked the medics I was with about this, and they shared that one of the reasons why there is not much of a respect for ambulance lights and sirens is that there are always ambulances out on the streets with their lights on; however, very few are actually using them for anything urgent. I can verify this. Ever since my arrival in Chile, I always saw ambulances driving around the city and almost all of them had their lights on – kind of like you may see a tow truck in your home town. At first I thought, wow, there are a lot of ambulances out here transporting people, but later I found that the lights are a normal part of an ambulance driving. For SAMU, this poses a difficulty. As they are one of the few services that respond to emergency calls, their lights and sirens do signify something. They encounter problems with traffic because much the general driving population has become too accustomed to an ambulance with lights behind them. Of course, some cars stuck in a long line of traffic truly have no where to go, but there are still others who seemed to not move at all, even with sirens blazing right behind them. To me, this was discouraging. Not so much towards SAMU or anyone on the healthcare side; they can not control the actions of those around them, but in terms of a general community awareness towards the needs of others. Being at the end of my time in Chile, Its easy to look back on my time there in full and compare it to what I saw in Denmark. This may be one of the largest contrasts I saw – the difference in community reaction towards an ambulance. Its hard to pinpoint exactly where this difference comes from, and I would be naïve to say I have the answer, but I definitely think it’s a response that is conditioned. For example, the fact that all drivers in Denmark must be CPR certified to receive a license I think creates a stronger condition of awareness towards an emergent situation, but its hard to say. If Copenhagen were the same size of Santiago, its quite possible that due to traffic congestion, the same problem would exist there as well.

Early in the week we responded to a call pretty far across the city. Blazing across town we arrived at the location we had been advised to respond to, but there was no patient to be found, nor any person nearby flagging us down. This is frustrating, especially when the nature of the call sounds serious, but again, is out of the control of the ambulance drivers. If a person calls, hangs up, and has given an incorrect location, theres not much that can be done. En route we saw out of the windows huge plumes of black smoke not too far away. As we crossed over freeways, fire truck sirens rang out around us. Having not been able to find the patient and not receiving new information, our ambulance turned toward the smoke. Where I had been disappointed in the way I saw the community react on the streets I was blown away at the scene of the fire. A factory had burst into flames. Having trouble finding the entrance, a pickup truck flagged us down and then told us he would guide us there. Half driving on the sidewalk and half on the wrong side of the road, we weaved across traffic and finally arrived. We were the only ambulance on scene, but there were what seemed to be hundreds of firemen. Mostly standing from afar, we remained to treat any potential injuries. Luckily, there was none more than a few cases of overheating. As we stood, I learned about the fire service here in Chile. All are volunteers. I was blown away. Looking at all the firemen, all the gear they were using, and realizing that this was a collection of volunteer servicemen, all of whom most likely had other jobs, who had left at moments notice to drive across town and put out a fire. Watching them work, systemized and efficiently, a certain amount of respect grows for such strong efforts. Further, at the scene of the fire, more people showed up. From what seemed like every direction, people came pouring in carrying bottles of water. I have become so accustomed to people walking down the subway or at intersections selling you a bottle of cold water on a hot day. But here were people who had clearly gone to the nearest market and purchased as much cold water as they could. They then began walking around handing out bottles to everyone they could reach. It was really an astounding scene to watch. Essentially the community had responded in full to this event. Volunteers who had signed up knowing what they may get, and others who saw the smoke and came towards it to help. I was really moved by that scene and the collective cooperation that occurred there. It was a good call to finish the day.

Later in the week I went with one of the doctors I had been working with to see the helicopter he worked for. It is a private company that stations a few helicopters across the country. There are not many rescue helicopters in Chile, and only about 50% of them are publicly run. Learning about the helicopter there, the private service who operated it and the costs it requires to maintain, I found myself thinking a lot about the state of health care in Chile and the effects it has on prehospital treatment. I responded to a call later that week to a woman who had fallen and injured herself on the bus. Arriving on scene, the medics asked which insurance she had. After learning that her insurance was private, they then asked which hospital she would like to go to, rather than taking her to the one main emergency room in the city. Watching this transition struck a chord in me. It was the first time I had more directly seen the difference in the wage gap that so clearly exists in Chile. We transported the patient to the nearest private hospital, which just so happens to be 200 meters down the road from the public one. It was difficult for me to accept that this is life for a lot of people – this difference in care. For so much time, I had been seeing and learning about a public health system here in Chile that was capable and accessible for everyone. And I still think this is true, but the transfer of care differs for people, and that was what I found to be hard. I was uplifted to know that SAMU was accessible for all people, and further that their resources provided them with the capabilities to respond appropriately, but it was hard to know that their treatment may differ following due to their socioeconomic status. It is true that this occurs as well in the States and in many, many other parts of the world, but this having been one of the first times it was laid out so clearly in front of me, it leaves me searching to understand and learn more about where these differences exist in each place. For example, in Denmark, one could also pay for private insurance and a private hospital, but most often these hospitals were for things such as surgery, while urgent treatment was always delivered to the closest capable emergency room.

Of the many calls I got to respond to, one called us to an elderly woman’s home where we treated her for a fall. She had clearly broken her wrist and needed to be transported to the hospital. I thought a lot about her fall, what possible events may have lead up to it, and what this means for her moving forward. I thought about the stories in my own life of my great-grandmother falling and the events that eventually led to her loss of independent living. In Atul Gawande’s book, Being Mortal, he speaks a lot about these moments in elderly patients, and how so often a fall is the first step along a long and difficult road ahead. As we age and face complications with our health, it becomes increasingly hard for us to recover back to the same level we had previously been. Seeing this in Chile, again first hand, made me think a lot about what this would mean for this patient’s life. There’s no way to know for sure. Having finished Gawande’s book in my last weeks in Chile, I have thought a lot about the battle health care providers face in confronting the elderly. No matter how good a response system a country or community has, we still are unable to fix the complications that come as we age. We have learned to better manage these complications, but by the time an ambulance arrives, often the damage has been done. It makes me wonder what we can do. Given that so often the calls an ambulance responds to is for an elderly, I think a lot about what can be done to reduce the frequency in which ambulances are needed for the elderly. There’s no easy answer. As I transition to Thailand, I will be interested to see what I find in relation to this problem. Perhaps it is systematic, but perhaps it too is cultural.

One day we responded to a large factory fire.

As the medics on call, we stood a little farther removed ready to step in if needed.

It was a pretty hectic scene but amazing to watch, especially after learning that all firemen are volunteers.

A picture of one of the private rescue helicopters based in Santiago.

Near the Altiplanic Lagoons, I was surprised to see an ambulance drive by, so I snapped a pic and they gave me some peace signs!

Phew! If you made it this far, I congratulate you! That was a lot, but I appreciate you sticking around (even if it was just for the pictures – they often tell a lot). All this goes to show that so much good has happened in my final month in Chile. As it was in Denmark, a sort of bumpy start ended in a fantastic ending full of project, friends, family, and new sights. I am so grateful. As I finish this post, I am starting my third day in Thailand. It’s the morning of the 8th, but still the 7th over there for you east-coasters. For me, today I cross the 6-month barrier. Wow!

Soon to come: A Second Watson Quarterly Report!

Happy new year to you wherever you may find yourself on this day! As always, thanks for following along, here’s to the next adventure!

– Mark

2 thoughts on “Am I Really Already Leaving?

  1. Lib McAlister

    Wandering with Mark in Chile was a true gift for this mom! So loved our time in Santiago and Valparaiso with (most of) our family. Godspeed in Thailand! 143!

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  2. Mary Kate

    Couldn’t agree more with Mom! It was the best. I loved reading your recap of our time and laughed at some of the memories you shared — Dad in the metro, in particular.

    Lots of good noticings and lessons learned here, Mark. As stressful as the sudden changes were from Chile to Thailand, I am proud of you for growing in your ability to embrace change, be flexible, and communicate honestly with others. You’ve always had those skills, and this year is only strengthening them.

    I was struck my several things as I read about your project. Mainly, how the community responds to ambulances. I find that really interesting and definitely noticed the affect traffic would have while there, but wasn’t paying enough attention to see how cars did/did not react to lights. It’s such second nature to me to move out of the way, but unlearning a learned behavior is hard. How long would that take an entire society? Is it even possible for that habit to change? And secondly, this issue of care provided based on socioeconomic status. What DOES this look like in the States? What does this look like for tourists visiting in Chile? I’ll be interested to see what you notice in Thailand regarding both of these topics. Good questions!

    2018 holds newness for us both. Yours more set in stone, but I empathize with the dual feelings of excitement and nerves. I love the honest way you write these posts, and am eager to read your second quarterly report! 4312, bud. Counting down to March!

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