It’s 7:15 am on Wednesday. I’m on a rapido headed to Iquitos to transport Leopoldo, an 23 month old who swallowed a coin 3 days ago. We sedated him and looked down his throat with a laryngoscope only to discover that the sol had passed into his esophagus. When he awoke, he was active and eating so we sent him home, knowing that most coins will pass without complication. Last night, he returned to the hospital with his grandmother. He had been vomiting and choking for 3 days, and had not been able to keep down food all day. We are worried that he sol (which is slightly bigger than a silver dollar) is still in his esophagus and will need to be removed endoscopically. Being that this is an emergency, I am traveling with them to Iquitos. We will arrive at the port in Mazan in 5 hours, then take a mototaxi for 15 minutes to a port on the opposite side of Mazan, where we will get on another boat for 45 minutes to reach the Mercado de Productos in Iquitos. There, either our nurse or an ambulance will be waiting for little Leopoldo. This morning he looked much more content and was eating crackers and drinking coke... and then the vomiting started again.