The Community Hospital Strikes Again!

My shift started at midnight. As I'm walking toward the copy machine to photocopy some kid's insurance card (yes, I know, not my job, but hey, when you want something done...) I pass by traige and notice a pale, limp, bluish-grey infant breathing fast and grunting.

Oh ho, say I. What's this?

The lovely triage nurse replies that the patient had just checked in, but nothing else was known. We share a look. That look held all the knowledge and experience of all our previous shifts together. On a higher plane, we commune with the universe and come to a mutual, unspoken and instantaneous agreement.

Smoothly, we both move to the shock room. She sets up the pulse ox, I reach for oxygen. Our little baby is only getting 85% of the oxygen he needs. Orders are written. Without much ado, we get the IV. Wonderous. Fluids start, labs are sent. For once, everything flows like a river flows toward the ocean, smoothly and easily.

We decide to intubate. Medications appear, respiratory techs arrive. My resident easily slides the tube into the trachea. Glorious, glorious.

I have never had a code go so smoothly here at the Tub. I wonder how I'll be made to pay.

Pseudoseizures

Now people, this diagnosis is a pain in the ass. Pseudoseizures are events that look like seizures to non-medicos. But, guess what, they aren't actually seizures. The kids fake it. They might night mean to fake it - they're acting out against intolerable stress - but basically they're hamming it up.

Not a popular diagnosis. Picture this converstation:

Me - The EEG was negative; no seizures were seen. Your child had three events during the EEG. Therefore, given the normal EEG, your child is having psuedoseizures.

Parent - Does that mean she's doing this herself?

Me - Yes. She isn't doing it deliberately, but the jerking movements she makes are essentially voluntary.

Parent - ^%$#&^%( *&(&^$^%$#^%%(*&^*&% $&%^$# %$#EWS FGBVFGVB OIU^T*&^%# @$#EWQ@RE#$^%

Yeah. It goes just about that well.

It just sucks. If someone has abnormal, seizure-like movements during the EEG, but still has a negative EEG... seizure disorder has been ruled out. Period. One cannot seize without abnormal electrical activity in the brain. Period.

And teenagers are bad at faking. For whatever reason, kids with pseudoseizures always sort of twiddle their fingers during the 'attacks'. Let me tell ya, people seizing DON'T waggle their fingers in the air. Nor can they walk. But really, it's the finger twitching that gets me. Where do they get this stuff?

Retarded

In Houston, MRSA accounts for 60% of all the S. aureus in town. For those not in medicine:

1. MRSA = methicillin resistant Staphlococcus aureus = very bad bacteria that can kill you if not treated properly.
2. MRSA will not be killed by the old school antibiotics like Augmentin, Keflex, etc.
3. Good pediatricians should know the above information.

But hey, if you're not from around here, or didn't train around here, the MD might not know. Fair enough. However, ONLY A RETARD gets mad when I alert you, as the primary pedi, about the above facts.

Hey buddy, if you wanna get sued (and/or kill the patient) 'cause you're too proud to listen to some FRIENDLY ADVICE that's not my problem. I'm still gonna admit your patient, treat with appropriate antibiotics and disregard anything stoopid coming out of your mouth. Don't yell at me. I'm just trying to help.

I'm a GENIUS!

Sometimes, work is just funny. Medicine takes a lot of training, but sometimes it's the simple stuff that patients really appreciate. Example:

Adolescent girl carried in by her parents after a fall. On exam, her right patella is waaaaaaaaaaaay out of place. If the proper place for a knee bone is earth, this sucker was having a picnic on Pluto. Luckily, reducing a dislocated patella is easy: put medial and upward pressure on the patella and then flex (bend) the knee. Pop! Right back to earth. So I reduced her dislocation, causing this child to scream, "Yeoow! (Pause) OH MY GOD, you're a GENIUS!" Needless to say, I was very gratified. Until the entire department started teasing me about my Einsteinian status. It doesn't help that I have a button on my badge that labels me "Jenius". Heh.

I love my job.

6p - 2a

I've worked a new shift today - the 6pm to 2am shift, aka the 'swing' shift. I think I have mixed feelings about this new entity in my life.

Pros:

• Night nurses
• Night charge nurses (Nell don't take no shit, baby!)
• I'm the 'help' so I'm never alone, i.e. there is no part of the shift when there isn't at least one other doctor with me.
• It's a really fast shift, mostly 'cause of bullet #3.
• The shift runs during prime time - lots of actual pathology seems to show up in the evening. That's always fun. ;)
  

Cons:

• Night nurses - those ladies don't do anything they don't want to. If they disagree with me? Guess what, my orders won't be carried out for hours...
• 6p - 2a pretty much means I don't get to see the husband all day. A HUGE bummer.
• Getting home at 2a as a non-driver in Houston. Cabs are slow, and the shitty drivers work the graveyard shift. My cabbie tonight? Clueless. And he didn't have change. Sheesh.
• Feeling like you're abandoning the overnight doc. 'Cause, guess what, you are. When the swing shift doc leaves, the overnight doc is all alone for the next 6 hours. And they are a painful six hours. Tonight I ended up staying a little late to prevent unloading a procedure onto the overnight guy. Granted, it was a minor procedure, but still... Overnights suck, and I don't wanna make his worse.

Mostly, I think con #2 is the most disturbing. I like my husband and I like seeing him. This shift doesn't allow that. So I guess the cons will win and I'll sigh every time I see an evening swing shift on the schedule... but at least the silver lining is decent.

Aww yeah

Something odd happened today. Something that hasn't happened for a damn long time. I looked at somethin' on a website that I've seen a million times before - somethin' that, until now, had been sad and lonely. Before today, what I'd been looking at had been small, like an unsatisfying New Cuisine meal. Ya know - a leaf of baby spinach, a sliver of Ahi tuna, a drop of wasabi.

But today, oh Glory, my leaf turned into a salad, the sliver into a steak and the drop into a chunk.

By Goodness, that somethin' was my (MY - not my husband's) bank account. I have MONEY. For the first time in a long ass time, I actually have some cha-cha-cha-change. Okay, it's not Jay-Z pimp money. But it's a damn sight better than the big fat zero I had before today.

'bout damn time. Thank the fates.

First solo shift

Well, this morning I had my first solo shift. Let me explain - a solo shift is some fraction of an eight hour period in the ER without another doc to help out. Today I had four hours, half of my shift, flying solo. Luckily for me, I had an awesome family practice (aka FP) resident helping me out. Now the educated among you might ask, "Doctawife - you said you were solo. But you had a resident helping - that's another doc!" Well, residents only sorta count. They can see patients, so I can see another patient or write in the chart or call a specialist or whatever... but in the end, I'm ultimately responsible for the patient the resident sees. The buck stops with me, and sometimes, it's a pretty sick buck. And residents are not just in the ER to 'move the meat.' They are there to learn. Which means I have to take the time to teach. And that doesn't help move the meat. That actually slows the meat down.

Now mind, only other well trained pediatricians will understand how remarkable the sentence about "awesome family practice resident" is. Pediatricians generally don't like FPs. Why? As a group, pediatricians think that FPs don't get enough training in pediatrics. Which means they make mistakes. Most of them aren't bad, and don't hurt kiddos. But sometimes, oh sometimes, the mistakes are bad. And for whatever reason, many of the FPs that come through the ER are really terrible. In terms of pediatric knowledge, they're worse than med students, even.

Not this one. She rocked. I taught her about basic pedi stuff, and when the kiddo with the kidney stones came in, she reminded me about those. ('Cause usually 11 year olds don't get kidney stones. I hadn't seen one since med school. The FP resident had seen one the month before in adult-land. It ruled.) And even with the basic pedi stuff, I was more reminding her of common pitfalls than teaching her new material.

Oh, and I told her of common FP mistakes, and why I would beat her with a stick if she ever did any of them. Why the beating? 'Cause she's smart and has no business making any of them.

But yeah, solo was challenging. At one point I was taking care of ten patients. That's a lot.

It felt good.

Down with the negative!

The license... IT IS HERE! Here in my sweaty little hands, quivering with its own suppressed fury, beautiful in its supreme unimpressiveness lies the panacea to all my ills. Or at least that's the theory.

So, starting today, I get to throw myself back in the mix. I spent most of today filling out so many forms that I swear I thought my eyes were going to bleed. Frankly, dear reader, I didn't give a flying pootenany. I was at work! And by and large, people were happy to see me.

Meanwhile, the Texas State Medical Board has been attracting negative attention from the press and the healthcare bigwigs about the delays in licensure. Go journalism! Go activitism! Go greedy capitalism! 'Cause really, that's why people are getting so pissed off. The docs can't get paid 'cause they can't practice, the hospitals and clinics are losing money because the docs aren't seeing patients but can't hire someone else because the doc either has 1) a binding contract with the employer or 2) a specific skill set not already available. Texas has one of the lowest per capita densities of doctors, yet we have this HUGE backlog of docs waiting to work in Texas.

Does this make sense?

Oh yeah, this is Texas. I forgot.

Two a day

Okay, I'm not about to disrespect midwives. But I do want to comment on the midwife trainee on the 3pm (CST) House of Babies episode on Discovery Health today. Why? She's going through 'hell week' in midwifery school. Bascially, 'hell week' is the same as residency (the paid trainee stage of a MD's life) for midwife students.

But it only lasts three weeks. Total.

One week the first time through and two weeks the next.

WTF? Residency is at least three years, and this woman, who will be taking care of newborns and moms, is complaining about three weeks? Suck it up when you're on national TV! I know doing anything nonstop for four weeks can be hard, but if all anyone has to do is three (not even four) weeks, just deal.

Sorry. I know I'll piss off a lot of midlevel providers with this post, but damn, perspective, people! I have a lot of appreciation for experienced midwives, but now I'm not so sure about new grads.

Unless, of course, they didn't complain. If that's the case - more power to ya.

Productive!

Today I've managed to:

1) Finish my orientation to my new work, which means AS SOON AS my license comes through I can work.
2) Go to the dentist, get a cavity filled and get my teeth cleaned WITHOUT ANESTHESIA.
3) Cleaned my fishtank.

I have to say, the last of the three is the one that has required the most effort. Mostly 'cause I've been ignoring my tanks for the last four weeks or so. Why? 'Cause I was depressed as hell. But now? Now I should be golden. The glass is nearly spotletss, the plants and rocks are rearranged, and the fish are swimming around with all their fins out.

Life is good. And hopefully, I'll have my real job back by the end of next week.

Please please please - I want to be a doctor again.

Let is be so.

Second thoughts

I was going to use this post to talk about how much I HATE the fact that I don't have my medical license yet. About how I haven't worked since the end of July, I'm poor and I feel like my brains are slowly rotting away.

But I won't 'cause if I wrote my rants publicly about the Board the evil Intar-web police might get me.

They hide under the bed, ya know. In the closet too - once I turned sixteen they took over for the Boogy Man, who retired to Florida. I hear he's enjoying a nice spot on the beach oogling all the coeds.

Instead I'll write about cat poo. Yes, cat poo. My dear lovely feline has decided he's too good for the litter box. He has some favored spots - the stairwell, the closet, my suitcase, near the kitchen island. And sometimes, for extra special goodness, he'll excrete ooze of death along with his poop. This lovely slimey goodness is PURE mercaptan, also known as thiols. Basically, thiols be stinky stuff. Here, wiki can explain it much more clearly...

Many thiols are colorless liquids having an odor resembling that of garlic. The odor of thiols is often strong and repulsive, particularly for those of low molecular weight. Thiols bind strongly to skin proteins, and are responsible for the intolerable, persistent odor produced by feces, rotting flesh and the spraying of skunks. Natural gas distributors began adding various forms of pungent thiols, usually ethanethiol, to natural gas, which is naturally odorless, after the deadly 1937 New London School explosion in Texas, United States. Thiols are also responsible for a class of wine faults caused by an unintended reaction between sulfur and yeast. However, not all thiols have unpleasant odors. For example, grapefruit mercaptan, a monoterpenoid thiol, is responsible for the characteristic scent of grapefruit.

So yeah, when the ass juice of death appeared on my suitcase (that I had to use the next morning to go to a freaking interview!) I was a bit pissed off. Luckily, Lysol be some wicked strong mojo and saved the day.

That's my lief right now, people, interviews and cat poo. How did I get this lucky?

Salt Lake City, baby!

Traveling again. Once a week for the last three weeks I’ve been out of town. So far, all the trips have been great. Week #1 was Boston, #2 was Denver and #3 is Salt Lake City. Boston, of course, ruled the hiz-ouse. I will live there again – maybe nor for the next three years, but I will live there again.

Denver was also cooler than I thought it would be. Cheap movie matinee, nice downtown, people actually living downtown and good eats. What more does a gal want? Oh yeah… good public schools, too! (Although I only care for home resale value – not actual progeny. Remember – returning to Boston.)

Salt Lake I’m worried about. The pedi emergency medicine training is great. No question. I’ve met the faculty before at the conference they run out of Park City every winter. Good stuff – good learning and good skiing. What’s to complain about?

Oh yeah, 3.2% beer. And, possibly, overwhelming whiteness. Sickle cell crisis, anyone? No? No Black people… oh, okay then…

The Cat

Yargh.

My cat has been sick for the last two weeks, more or less. It started with his usual constipation/stool holding/inappropriate stooling nonsense that happens every time he gets a little stressed. We blamed the bathroom renovations. After all, how would you like it if someone dumped stinky adhesive in the middle of your dining room? Huh? I might just poop on the floor too!

Then his little butt go so miserable looking with stool bulging at the rectum, grass hanging from a stuck ball of shit, tail down shuffling gait... I just couldn't stand it. So being a docta I got out my lube and rubber gloves and went downtown, so to speak.

Oh boy, people, did I ever get that shit out. Grams and grams of the stuff.

Oberon usually sulks for a day, hiding and pooping on the stairs but then gets betta. Not this time. Well, I lie. He got better for a day or so, but then stopped eating.

Do you know what happens to cats when they stop eating? I did. This is what happens. To quote:

FHL is very dangerous for cats and can be life threatening if left untreated.

EEK! I like my cat. Actually, I love my cat. In the past I've ranted about how silly it is to dump tons and tons of cash into pets. My cat is not getting surgery for pancreatic cancer. My cat won't get daily insulin therapy. My cat will not get dialysis. Can you imagine giving my cat, who won't even tolerate pilling, peritoneal dialysis?

However, my cat will get urgent treatment for acute issues. Note the choice of words: urgent treatment for acute issues. There will be no after hours visits to emergency centers (unless, of course, there is massive bleeding or trauma - if the injury looks survivable, he might get a visit then). There will be no long term, expensive chronic care. There will be office visits to my regular vet during regular hours for complaints that sound something like, "my cat's not eating and I don't want him to die of liver disease. Help, please?!?"

We walked out of the vet about $100 poorer armed with meds to help his little belly push food through his stomach.

Unfortunately, this plan did not work.

Back to the vet we go... $500 later, still no definitive diagnosis. The poor cat comes home leaking barium from his anus (courtesy of his normal barium swallow) along with enema fluid ('cause he didn't poop during his hospital stay) and immediately starts pooping EVERYWHERE. Leaving little kitty butt prints everywhere from the barium. But, while at the vet, he did eat.

So that was good.

One of the meds he came home with was Valium (diazepam). Why? Apparently the stuff acts as an appetite stimulant. Don't believe me, check this out. Or, if yer lazy, read the quote.

# Uses of Diazepam

# In animals, diazepam is given as a sedative, to treat convulsions, to manage excitement or as a muscle relaxant.
# Diazepam is often used with other drugs to ease an animal in and out of anesthesia.
# In some animals, particularly cats, diazepam in small doses has been used to increase appetite and treat behavior problems such as urine spraying or aggression.

So we gave Ober-kitty the recommended dose of Valium this morning. It was a struggle. Twenty minutes pass. I catch something odd in the corner of my vision... Oberon is staggering around the townhouse. He tries to turn... and lands on his ass. Jumps from the couch... and lands on his face. He was a mean drunk too. He took Puck down in the daily fight for dominance. (He'd sobered up some by then.)

It was damn funny.

Tomorrow he's only getting a half dose. But for $50 I could arrange a private showing...

Yeah, so it's been a while

But I've been busy, damn it! First off to Dallas to see my brudder in law and my cutie-pie nephew, then back to the ID elective (which kicks ass - both in the learning department and in the holy crap I worked a lot of hours department) and then on to marathon pesto making and music-viewing.

Meanwhile, I finished residency. Yay! Now I just need to make sure my license comes through so I can start working...

Yargh.

Rules for paging a doctor

Now, I like my job. I do. But sometimes I just gotta blow off a little steam. And since it's July and all of the new interns are hitting the floors, I thought I would publish a fun and interesting guide to the fine art of paging.

Once upon a time, pagers were more than just accessories to low-budget drug dealers. Pagers (and those oh-so-secure little chains back to the belt loop) adorned the waistband of many respectable professionals. MDs were one of the groups that I'm sure fell into the early adopter category when pagers came out. What better way to free the doc from having to pay attention to all those annoying overhead pages? Now we could focus exclusively on the phone conversation at hand and only listen for horid little chirps from the mysterious black box on our waists.

Now the evil cell phone has replaced the pager for everyday people, and the Blackberry takes pagers to the next level. But alas, doctors haven't kept with the program. Early fears of cellular interference with medical equipment kept cells out of the hospital... which is okay 'cause a lot of phones won't get reception in the bowels of the wards anyway. So we're still shackled to the pager.

The problem is those paging the doc on call still haven't freaking figured out the basics of proper paging. In order to solve this woefully neglected need, below you'll find some guidelines for the art of paging. As with my rules for baseball viewing (see October of 2005), the most important rule with be first, with less important rules following.

Without further ado...

Rules for paging of doctors, version 1.0

1) If you page me, stick the fuck around to answer the phone. Do not walk away. Do not start another conversation on another line. Do not leave the phone to go to the bathroom. If you do not answer, I won't call twice. You will have to page me again, and I will protest if you say, "But doctawife I paged twice and you never called me back!" Yeah, actually I did. Your ass just wasn't around to answer the phone and you might find my foot so far up said ass that you can taste the breakfast taco I spilled on my clog this morning. You have been warned.

2) Page me with a complete call back number. If you miss the first digit of the five number extension, I ain't calling back. My ass is rolling back over to sleep (if I'm in-house) or back to whatever I was doing before you paged.

3) Speak clearly. If you have an accent, use the simplest words you possibly can to get the message across. I'm not a racist, but at three a.m. I am a bitch. Unless you can make English words like 'shock' or 'sick' or 'hypotension' understood go back to the ESL classes, do not pass Go and do not collect $200 and do not come back to work until I can understand you. I may be getting paid to listen to you, but you're being paid enough to be comprehensible. Capiche?

4) If I don't answer after 5-10 minutes, page me again. I might not have gotten an understandable message the first time. Sometimes, even I understand that the system can break rule #2, not the person trying to reach me.

5) If you page me, and I answer, then say I will be by to see the patient, don't page me 10 minutes later with the same question. I assure you, the answer hasn't changed unless the patient has changed. If the patient hasn't changed, then paging me just delays my arrival at the bedside. And that's counterproductive, ain't it?

6) Repeatedly paging an person who never ever answers probably means that the person isn't available to get pages. Try someone else or a supervisor. Example - increasingly ill patient worries nurse. Nurse pages resident. Resident went home post-call five hours ago and turned pager off (which is perfectly appropriate, by the way.) Nurse continues to page resident for three freaking hours with no response (duh) but nurse never tries to page any other doctor. Patient codes (ie gets really really really sick and tries to die - not good). Lesson - if paging a doc every 10 minutes isn't getting a response try someone else! 'Cause if the doc should be answering his pager and isn't the idiot deserves to be in trouble. If the page operator/nurse/clerk who made the call schedule has the doc's number wrong then at least someone will know what's going on. And usually that someone at least has some kinda clue who to call or what to do while waiting for the right person.

7) On a similar note, be nice... until it's time to not be nice. Non-urgent stuff shouldn't ever be flung at me at three am after paging me five million times for other equally non-urgent shit. But if someone is really Sick, feel free to kamikaze page me to your heart's content. Simple, really.

So there you go. Follow these seven rules and everyone's life will be better. Disobey them at your own risk.

Yes I can!

Yes I can read 300+ pages of Texas Medical Jurisprudence in three days! Yes I can pass the exam at 7:30am on Saturday. Whee! Even tho I've been out of college since 1999 I can sill cram! Go me!

And let me tell ya, Texas medical law is seriously fucked up. Not like that is much of a suprise to anyone who knows anything about Texas, but still. I guess I had had some sort of delusional state going on and hadn't realized how institutionalized our state of fuckitude actually had become.

(And yes, I know in the preceding paragraph I violated a whole bevy of grammatical rules, but I just can't bring myself to care.)

On another note, my grandma-in-law isn't as sick as we had feared. She still has lung cancer... and it's already metastisized, but we had originally thought that she was in intensive care and really really Sick. (The medical-slang use of the word Sick, not the I-have-a-cold use of the word sick.) Her cancer isn't the worst kinda malignancy, but since it has already metastized her prognosis is way worse than it would have been. Basically, she can do radiation and chemo but the chances of long term cure ain't hot. So she's still sick, but she's not gonna die right now, which is what we originally thought.

It's good and bad news at the same time. Good news, 'cause she still feels fine and eats and laughs and all that. Bad news 'cause the bad times will come.

Unless she gets hit by a bus coming home from her dream vacation. Which maybe wouldn't be a bad thing, ya know?

Sadness and Lung Cancer

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I grad-u-muated!

Wow. Holy crap, I'm an adult. When the fuck did that happen? Most of my friends are adults too... and I have photographic proof.

See?

We all growed up and stuff. Graduation was a blast, even with the inevitable and lamentable speeches. But they didn't go on too long, and the skits and SNL-style news jokes were a hit. The food was the same as it always is - some sorta nut-crusted chicken thing with what tries to be pesto rice but is actually just green and bland with overcooked veggies.

So now I've gotta get on with being adult... scary. And to really nail down my status as a 'mature individual' my husband is, as we speak, applying for a promotion. Holy crap! I hope he gets it. It would be really nice to have everyone else acknowledge that he's a FREAKING GENIUS.

'Cause he is, really. He's way smarter than I am. And no one gives him the credit he deserves. Which sucks. So promotion good.

USMLE step 3 and buffet food

Let's tackle the second part of my title first. I discovered something new today... I don't like Dimassi's Mediterranean Grill. Not one little bit. I shouldn't have been suprised since I generally don't like buffets/cafeterias/appetizer bar thingies anywhoo. Just read the article connected to the link. How many places actually have their employees "[k]eep all surface areas clean. Employees should quickly clean up any spills. Staffers should be made aware of the dangers of spreading germs through wiping cloths. Studies have shown that wiping cloths can contain enough foodborne microorganisms to make people sick. To prevent this from happening, store wiping cloths in sanitizing solution at the proper concentration at all times." Have you ever seen a cafeteria employee hit the sanitation bucket between every wipe? I'm sure that reputable chains try to teach that to their people, but come on! It just never happens. I didn't see anything wrong at Dimassi's, but I just don't trust the whole idea of a public buffet in general. And then there was the food.

It was passable. I could eat it.

But not much more.

I won't be going back - at least not for the food. I won't protest too much if someone I like drags me back (hi Keith!)... but otherwise hell no. For the same amount of money there is MUCH better food to be had. Oh well.

Now on to the step. It is the third of three United States Medical Licensing Examinations and holy crap will I be glad when its over. It has all of this (shudder) adult medicine on it.

YUCK! Smelly adults (nevermind that I'm a smelly adult.) All this icky stuff I haven't had to think about. Dementia. Diabetic foot ulcers. Schizophrenia. Freaking colon cancer!

This is the last time I ever have to study the adult pathophys... or is it? Oh yeah, I want to do pedi ER. That means one month of adult ER. Oh powers that be, if you exist, please help me through that month... and help my patients while you're at it!

Meeting the demand for pictures!

So I've finally figured out how to get pictures up here... and I've finally gotten Firefox to agree with me. Yargh.

Anyway, this was my office. I had a table, four scales, one bed and a bathroom with a shower. All the medical necessities. Hah!


And all of the reference books were brought on my back from the US.

Heavy.

But everything else was in Spanish or 20 years old. Not useful. The desk got more and more crowded as I learned more Spanish... suddenly I had everything in both English and Spanish. One copy for me and one copy for the patients.

It's good to know enough to be dangerous.

Next is the exam table and the sheets that were NEVER changed. Ever. Not once in four weeks. Very freaking scary.

And then there was Chiquimula - a teeming, busy, transit-oriented and downright scary collection of mid-sized town. I hadn't seen such a collection of poor people, bad smells, fresh produce and chickens since Hong Kong. Only Hong Kong smelled better.

Most of Guatemala looks like this... except the rich areas of Antigua and Guatemala City. Which would be really really small areas.

So even relatively ugly commercial and transport centers like Chiquimula have pretty bits. I really liked this frond tree. Until the old man beggar went for my camera. Can't win it all, can ya?

Up next, Mayan ruins!