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La Clínica

A Doctor's Journey Across Borders

David P. Sklar

Publication Year: 2009

Sklar recalls how his earliest experiences in a remote Mexican clinic helped shape his career as an emergency physician and educator.

Published by: University of New Mexico Press

Front cover

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Title Page: La Cl

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p. iii-iii

Copyright

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p. iv-iv

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Preface

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p. vii-vii

Stories that involve relationships between physicians and patients run the risk of either violating the privacy and confidentiality of the relationship or becoming so altered through efforts to disguise identities as to border on fiction. I have attempted to protect identities by changing names and altering characteristics while maintaining the ...

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Acknowledgments

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p. ix-ix

I had the good fortune to be the recipient of help from many people during the development of this book. Frank Huyler—first my student, then my colleague, and then my mentor—provided invaluable advice and unswerving encouragement...

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Prologue

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pp. 1-4

We hoisted the bodies onto gurneys and cut the blood-drenched clothes from their heaving limbs, necks, and chests—John Does 1, 2, and 3, because we didn’t know their names. Paramedics, holding bottles of clear intravenous fluid, described what happened—a gang fight with knives and baseball bats...

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Chapter One

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pp. 5-14

My pen paused on the word pain "This is a seventy-five-year-old man with a chief complaint of chest pain.” The pen drifted downward across the chart, as if it were a mountain climber sliding down a glacier, and finally dropped off into my lap causing me to startle, open my eyes, and realize I had fallen asleep...

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Chapter Two

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pp. 15-32

I slept for eight hours, and when I woke up I tried to remember what had happened before I went to sleep. Laura had been there, and we had talked about Mexico—about my going down to the village again—and as I was trying to remember what we said about it, the phone rang...

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Chapter Three

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pp. 33-38

The recollection of that first day and night released many fragmentary memories: the sounds of hands slapping tortillas and the smell of the tortillas roasting over an open fire; the feel of a horse between my legs, running full out; a face of death staring up at me. I sat in a daze and let the images continue rather than think about the meetings and problems I would have to address at work the next ...

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Chapter Four

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pp. 39-43

The village was perched on a low bluff overlooking a river that drained part of the nearby Sierra Madre. Tiny hamlets of three or four adobe houses dotted the horse trails that led up out of the village, but the village itself was the end of the road.

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Chapter Five

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pp. 44-54

When you sleep all day, you wake up in the evening hungry and confused about what time it is and where you are. That’s how I felt as I found myself in Albuquerque rather than Mexico, where and shuffled over to the refrigerator...

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Chapter Six

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pp. 55-63

As the darkness enveloped the house in Albuquerque, I decided to take a walk. The rooms seemed unfamiliar. Shadows and “Shit!” I shouted as I bumped into a stool and knocked it over...

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Chapter Seven

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pp. 64-68

I felt a dull numbness in my head as I sate in my dim house in Albuquerque drinking beer after beer. But all the sweetness was gone from the beer...

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Chapter Eight

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pp. 69-74

I didn't want to think about Mexico anymore. I grabbed the photo album to look at the pictures of my children...

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Chapter Nine

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pp. 75-77

Carl's world included people who believe in powerful spirits that could cause illness or death and in the intervention of other opposing powers to cure illness. The clinic straddled the spirit world, with its witches, spells, and evil eyes, and another world where tiny microorganisms caused illness, and antibiotics could cure them...

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Chapter Ten

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pp. 78-81

A few days after I had broken the witch spell, I had my most difficult case. Even today, it would be difficult, if not impossible. The woman in the house had tetanus...

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Chapter Eleven

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pp. 82-86

After an uneasy night of dreams and awakenings, I finally opened my eyes to the bright New Mexico sunlight sneaking through the shades. I had a full day scheduled in the office with meetings and faculty evaluations, and I needed to plan my trip to Mexico if I was really going...

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Chapter Twelve

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pp. 88-92

Every day, Deanna's brother Goyo would carry water from the river to the clinic to fill our containers. We used a lot of water to clean our tables and supplies and to give to the thirsty patients in the waiting room...

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Chapter Thirteen

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pp. 93-97

The memory of that day in the clinic merged with my memory of the next day, and what I had had to do. It started the next morning as I sat in Rosa’s kitchen waiting for Sopa vieja splattered in the cooking grease as I drank a cup of warm milk flavored with powdered coffee...

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Chapter Fourteen

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pp. 98-113

The phone rang, snapping me out of my reverie. I looked at my watch as I answered and realized the residents were already waiting for me...

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Chapter Fifteen

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pp. 114-121

Rick came back into the office, interrupting my thoughts. “They’re waiting for you, all the young doctors, waiting for you to impart the wisdom of why to become a doctor."...

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Chapter Sixteen

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pp. 122-130

"That was weird," said Rick. "You could be sued if you pulled teeth in this country.“ “Yeah, well you can be sued just about anytime things don’t turn out well. And that reminds me, the students and residents are waiting for my malpractice lecture,” I said...

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Chapter Seventeen

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pp. 131-138

El otro lado,” the other side, was how people in the village referred to the United States. The term referred to the Rio Grande, which separates much of Mexico from the United States, but the other side also meant more...

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Chapter Eighteen

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pp. 139-143

I sat in my office, my eyes passing over reports and memos and finally coming to rest on a stack of faculty evaluations that I needed to review before my meeting with each faculty member. The evaluation meeting was one of the most important parts of my job as chairman because it was the time that we made decisions about faculty goals and salary and figured out what had been accomplished over the past year...

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Chapter Nineteen

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pp. 144-153

When I returned from Mexico, I entered medical school with both an advantage and a disadvantage over my classmates. My advantage was my familiarity with the diseases with long complicated names. I had seen cases of hepatitis and had treated a woman with tetanus, a baby with tuberculosis, and a musician with diabetic ketoacidosis...

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Chapter Twenty

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pp. 154-163

As a student at Stanford Medical School, I had the opportunity to observe faculty physicians, residents, and other medical students. I would sometimes hear the medical team tell jokes about a patient during hallway discussions, only to watch the team enter the patient’s room with a false, exaggerated respectfulness...

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Chapter Twenty-one

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pp. 164-176

My thoughts about my days as a medical student and intern were interrupted when the phone rang. “Hi,” she said. “I just wanted to see how you were doing.”...

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Chapter Twenty-two

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pp. 177-

I had nightmares about my house. It had been bought by the television newsman and converted to a studio with actors and actresses. I woke up in the dark wondering where I was...

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Chapter Twenty-three

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pp. 185-187

My next encounter with the clinic occurred during a class that I took on international health. I had hoped it would give me perspective on my experience in Mexico, but later, as I watched the setting sun from my office, I realized that instead, the class had picked at my festering wound...

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Chapter Twenty-four

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pp. 188-190

The international-health class also led me back into contact with Carl. Some of the medical students whom I had met in the class wanted to invite Carl to be the medical school graduation speaker. He was becoming famous for his work at the clinic and the books he had written about it...

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Chapter Twenty-five

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pp. 191-199

A few months after my phone conversation with Carl, after a particularly frustrating resuscitation had failed, I ran into another person from our original group of La Clínica volunteers.The unsuccessful resuscitation was not the nurse’s fault...

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Chapter Twenty-six

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pp. 200-204

The memory of Tony's visit made me smile. He had survived crises, failures, disasters of all kinds, and here he was —traveling, enjoying the world, selling sandals...

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Chapter Twenty-seven

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pp. 205-208

As I was about to leave the office, there was a knock at the door. It was Rick. “You still here?” he asked...

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Chapter Twenty-eight

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pp. 209-222

After Peggy Norman left, I finished looking at my mail, signed a few memos, and decided to go home. After I parked in my driveway and went into the house, I decided to go for a jog along the dirt trails near the river...

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Chapter Twenty-nine

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pp. 223-226

"How was your trip?" Laura asked. “Fine,” I said. I had been back for only a day, and she had called to discuss the children...

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Epilogue

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pp. 227-234

After I returned to Albuquerque, I resumed my work in the emergency department. Sometimes between patients I would ponder my visit...

Back Cover

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E-ISBN-13: 9780826345257
E-ISBN-10: 0826345255
Print-ISBN-13: 9780826345264
Print-ISBN-10: 0826345263

Page Count: 248
Publication Year: 2009

Series Title: Literature and Medicine Series
Series Editor Byline: Elizabeth Hadas, Frank Huyler, M.D., and David P. Sklar, M.D.