At some point in the very early morning, the rain started and it hasn't stopped. Sometimes heavy, but mostly just a soft, gentle, sprinkle. It has given the evening a well needed cooling down. The humidity feels kinder when it's a bit cooler and the evening is lovely. I'm sitting outside my room, on the patio, enjoying the light back ground noise of voices from the street, a passing car, a young Honduran couple whispering to each other on the other side of the courtyard. Young love really does sound the same in every language. I'm not sure, yet, if you will get this post tomorrow morning. As usual, the power has been off and on throughout the day, Fransisco tells me that when it rains, the wifi often stops working. Which it has, for now. So, I'm writing in hopes of posting later on tonight. It was a very busy and productive day at the clinic. The physicians met with me at 7am for an hour of ultrasound lecture, patients were seen throughout the morning and afternoon, then Fransisco, Dr. Nester and I spent a little over an hour on a conference call with Eduardo, at MTI. 

There are always heart breaking cases on these trips, some harder to accept than others. Today, a young teenage boy and his mother arrived, to see Dr. Nester. This boy was diagnosed with a pediatric cancer at an early age, had his kidney removed by age 4, multiple intestinal surgeries at age 5, and his gallbladder removed in July. When the hospital opened him up to remove his gallbladder, a large tumor had taken over the space where his kidney used to be. The Surgeon closed him up, told his mother that the tumor was too close to his aorta to remove,  and sent him on his way. With a death sentence at 16 years of age. His mother drove him 8 hours to the clinic, because she had heard of Dr. Nester's reputation as a pediatrician, and didn't know what else to do. At home in the states, I would scan this boy with a poker face, pass the exam on to the Radiologist (tagged as a STAT), and carry that patient in my heart for days hoping that chemo, radiation, and surgery would give him another chance and not be too rough for him. Most likely, after his early diagnosis, he would have been closely monitored, and a new tumor would've never had the chance to grow to this size. Today, Dr. Nester and I had to discuss the ultrasound in front of the boy and his family, trying to keep the anguish off of our faces, asking about his history and symptoms, his dramatic weight loss and abdomen pain, and the refusal of surgery. In many developing countries, if you don't have money, your medical care is limited. If the government hospital does not want to treat you, you don't get treatment, and private facilities will not do surgery without payment first. So, now we are scrambling to find some way to try to give this young man another chance, or at least a few more years. 

Later in the day, I met an angel. There's always an angel or two on these trips. This sweet angel was born with Spina Bifida and hydrocephalus, and a multitude of developmental and physical complications that are associated. She has the most wonderful, loving family taking care of her. When she looks at you, you can't help but smile at her, and when you do, she lights up and reaches for you. She loved having her photograph taken and looking at it in my camera. This was one, of many, instances where my personal experiences allow me to give my patient more than just an ultrasound. This darling little girl had many of the same complications that my nephew struggled with, when he was her age, and I was able to share so much with her mother and aunt. Sadly, this is another example of the limited resources in developing countries. I know from personal experience, that taking care of a child with special needs is an incredible challenge, with the best of resources. It's almost unimaginable with few or no resources. Dr. Nester and I spent almost an hour with this family, and she's coming back in the morning, just so we can check on her. The emotional investment that Dr. Nester makes to his patients is incredible and inspirational. I am grateful to be part of this and I feel so blessed to know these people. 

As usual, Fransisco was my right hand man for the day. His English is exceptional, and his dental patients are few this week because of the local school schedule, so he has graciously been my tour guide, taxi service, dinner companion, and translator. He is a tall, bear of a young man, with a great sense of humor and a generous heart. He is pursuing a maxillofacial surgical residency, with hopes of performing facial surgeries in the most needy areas of Honduras. He's a super duper smarty pants. I've met two of his sisters, whom he adores, and I can see how he turned out so well. Dr. Nester refers to him as "my son" and after our first day working together said "he is like your little brother!". When we are packed up, and ready to leave the clinic for the day, Fransisco says "Let's bounce." And gives me the universal, cool guy, head tilt. He's also the best foodie buddy a gal could ask for in this town, making sure I'm trying all of the local favorites. We worked straight through today, without a lunch break, so we headed downtown to Popo's. I had to have another fresh iced lemonade and a steaming, gooey bowl of Anafres...smokey refried red beans with cheese, warmed over a clay hotpot, with tortilla chips. There are MUCH worse ways to end the day than with a pudgy belly full of Honduran food. ❤️ Until tomorrow, buenas noches y duerme bien!