Immigrants of Medicine

Both of my parents are surgeons in Venezuela, and I was with them in the OR all the time. They used to scrub me in, when I was 7. I would put my hands in the patient, and they will say, ‘Don’t touch anything, just watch, and I will do appendectomies.’ So I watched all the surgeries like, ‘Oh, bladders!’ But then, minimally invasive came, and my dad was one of the first minimally basic surgeons in my country. So then I started to watch on the TV monitors. Fun fact, I have a twin sister, and she doesn’t like medicine at all. She really hated the OR.  Maybe it’s because we are fraternal!

Initially, I wanted to be a surgeon. I actually came here to be a robotic surgeon. Being an immigrant obviously was very difficult. People told me that it was very going to be very challenging for me to enter to surgery, but I actually match at Penn for doing my 2 prelim years. And I was supposed to continue surgery, but before continuing, I did a patient safety and quality. And I loved it. I started for the first time, being involved with the anesthesia attendees. They were my mentors. Anesthesia was not boring at all. So I decided to transfer to anesthesia. And I have loved it since my first day.

I had always prepared to be a surgeon, but I like Anesthesia better. You take care of one patient at a time, and you’re all in on that one patient. And in my surgery prelim years, I slept 4 hours every night for 2 years straight. It was not sustainable for me. But in anesthesia, I finish the surgery, I can give the patient to the PACU and know there’s a team that will take care of the patient from now on. And I can go home and I can say ‘Oh, I did my job right.’ When I was in surgery, I was always thinking about my patients all day.

I feel like anesthesia outside the United States is a little bit more subjugated to what the surgeon wants. Right? I feel like in the US, you are basically the one that runs the OR. The surgeons is focused on the surgery. But if something happens, is there an emergency or a code, I will take care of the patient. You have the situational awareness of the OR. And over here you have a lot of more involvement here and do more invasive procedures. We do more invasive and larger regional blocks. In Venezuela, there’s not a lot of ultrasound is used. They are more delayed on the technology. Even central lines. I learned how to place central lines without ultrasounds, we’re all anatomical.

I love the technology here. I do a lot of POCUS ultrasound, just for the heart, or for the stomach to do blocks.  The US is more technology oriented.  Now that I’m faculty, I’m trying to do global health education and missions to Latin America, especially Venezuela and Colombia to teach.

Over in [Venezuela] they don’t use pumps. So they just bolus the patient as needed. Because they don’t have that much money or resources, they don’t waste as much medication. Here, we’re a little more wasteful with the pumps because we want to have our hands free so we can do other things. There are also no CRNAs over there. There are technicians that help the anesthesiologists, but they are not advanced like nurses or anything.

I feel like medical school is a little bit different here. Being a faculty, I have had students myself.  In Venezuela, it is very hierarchical. When I was in my surgery rotation, we had to memorize every lab of every patient in the unit. I still don’t understand what is the point. Nowadays, you have everything like in your hand. Why waste your memory saving those labs. But it was very hard. If you made a mistake, the attendings will say ‘Oh, maybe you need some memory training. So tomorrow, you’re going to memorize both units’ patients’ labs.’ Obviously, you will never go home. Like it was very, very long hours. And I don’t feel like students were very protected here. We also do oral exams all the time. With several professors. It made it a little bit more nerve racking. I think over here we’re more focused about the wellness of the med students.

I don’t know if its because here students pay for their school, right? So I think you’re paying, so you get more rights. In Venezuela, med school is free. And it’s very competitive. So you don’t have a lot of help. I did well though. I also had the advantage of my parents being surgeons. My mamma taught me how to suture. My dad is a minimally invasive surgeon and my mama was a plastic surgeon, so I knew how to suture very well.

We enter medical school right after high school. So I graduated at 23, after 6 years of medical school. At age 21, I was already delivering babies. I don’t know if that’s a good thing, though, because of the training and all the things I went through, I don’t feel like when you’re 18, you have the maturity. You know, to handle medical school. But in Venezuela, they force you to make a decision when you’re basically 17 to study and do well on exams to apply to medical school. And I feel like they don’t give you enough maturity to pick the specialty you’re going to do for the rest of your life. I had friends who didn’t like what they started but still had to continue. Because your parents don’t allow you to change, and the system doesn’t let you change either.

I always tell my mentees that it’s never too late to chance. It’s never too late to reinvent yourself. Because I did change. From surgery to anesthesia. And even though my parents thought, at the beginning, I was crazy. Right? Like I did training to be a surgeon my whole life. I cannot be happier now, right and now they see, and they say how happy I am, and they’re happy for me. I feel like actually being a surgeon really helped me because being in the surgery world all my life I understood where surgeons are coming from. If they’re asking you for something, I understand their line of thought. I know the reason. I feel like that has helped me get along with surgeons better and communicate things that were relevant to them. And also, the skills I got in surgery really helped me surgery. I was better at doing procedures because I developed my hand-eye coordination from doing minimally invasive surgeries. I was doing blocks with ultrasound as a first year and my attendings would say you are doing it like at a third year level. You are better than most of your seniors. It’s not because I was cool or anything. It’s because I already had the training.  I was not like a regular CA-1.

I feel like I’m a more warm person because I’m Hispanic. We actually hug our patients in Venezuela. That’s just the way our culture is. I talk with my patients with my hand on patients’ hand. I feel like my American patients also appreciate that. I was scared at the beginning of my US training of touching my patients, because here the culture is a little more cold, that there is more strict respect between physician and patients. But I think my American patients really like my style.

While at Penn I was the only Hispanic resident and nobody spoke Spanish. But then I got transferred to Temple, about 5 miles away. And I got to cover a big Hispanic community. I spoke  Spanish everyday. Like 60% of my OB patients were Spanish-speaking. I felt like I was making a real difference. Even other people would call me when there were traumas or emergencies, so I could help the patients understand things. So they wouldn’t be scared.

But when you see a patient very scared, and then you talk to them, and suddenly their face just relaxes. You can tell how they feel safe just because you speak the same language. 100%. That happens to me at my current university even with my pediatric patients. Imagine when I take these kids by myself away from their parents into the OR. It’s a scary environment, especially in pediatric anesthesia, to be able to speak the language of the parents and share their culture. Parents value this, and you can build trust with them. Language is a difficult thing in medicine. But it’s also a very powerful thing.

I have all those memories of working with my parents as a child. But now my relationship has changed from them being my parents to being colleagues.