Yo tengo mucho sueño!

This is how most of my days end. We have lived in Miami 5 months, and I'm not sure that there is a better picture than this to let you know how it is going. Our experience of Miami is one of extremes. We live on an island 6 miles off the coast of the Atlantic ocean where children ride their bikes around the village green while 12 year old boys become "men" playing pee-wee football. We live in a gated condo, but I always think there must be some mistake- I may be more of a menace than all the people on the other side of the gate. Kelly is back to working 30 hours a week (mostly from home). I think this has been hard, but having the most wonderful niñera in the world (Maria) taking care of Lucy Bea has helped all of us. Kelly has an office set up in a corner of our bedroom and looks out onto Bill Baggs State Park. Driving home from Jackson (Jackson Memorial Hospital) takes about 15 minutes, most of which is across the Rickenbacher Causeway. Everyone simply calls the hospital "Jackson" as if it were some kind of person that you really like, but often has altered mental status. Many people have asked me why I wanted to come here ... judging from where we live the answer may seem obvious, but we really had no idea that the Lord would have such a haven as Key Biscayne waiting for us. I wanted the opportunity to work among the impoverished as a resident ... Coming from Vanderbilt, I felt like it would take me forever before I have time to go to places around the world where I can care for those in great need. I also wanted the opportunity to have intense exposure and significant autonomy in a great ENT program. Jackson certainly fits these things- maybe more than I was prepared for. One of the observing interns from Colombia (NOT Columbia, South Carolina) mentioned the other day that Jackson is just like the hospitals from home, but with air conditioning. Miami is a city in decay. My first month here, I was on facial trauma call 11 nights ... violence and drugs are simple facts here. Many of my patients did not need pain medication while I sewed together their faces ... They had taken enough heroin that nothing I might give them would even come close. I spent September on the Burn Service. This month, I often go help in the Burn Unit if I am on call and have any down time. A young boy called the police when he saw other boys stealing his father's bicycle. Fearing backlash, he stayed home from school, but the other boys found him, doused him in gasoline and lit him on fire. Seeing children burned was challenging and infuriating, but I'm sure this is not altogether unique to Miami ... What is unique (at least in the US) is Cuban Santeria and Haitian Voodoo. Both of these religions involve a ritual of rubbing Florida water (a VERY flammable concoction) all over the body and having out of body spiritual experiences. Unfortunately, they usually also involve fire ... being surrounded by candles, lighting chickens on fire ... I had one patient last month who suffered 90% burns from this. Jackson medicine is much more than simply learning new languages. Working in this environment is not without great reward. During my first month here, I was walking outside near McDonalds (where I'm told you can score some drugs just about any time you need), when a man was screaming at me. I thought he might hit me until I realized he was screaming "THANK YOU!" (all caps and ! included for how much he was shouting at me). I asked him what he was thanking me for and he said for "for serving this community ... it's been all but abandoned". I had a Haitian mother of one of our adult thoracic patients tell me that she thanks Jesus for me for giving her son new life.

So, the first 5 months here have been challenging but rewarding, violently grotesque and beautifully peaceful.