One Day at a Time

I am set to depart on a medical mission to the Dominican Republic as part of a 33 member surgical team headed into the mountains to bring medical care to the poor of San Jose de Las Matas.

Packing for a place you have never been is difficult, particularly when it is an impoverished area. I like to travel light, but I don’t want to be without something I need, but won’t be able to buy because the nearest Wall Mart is not even in the same country.

I have heard that people just leave their suitcases and many of their clothes behind because the people are so poor so I pack more than I need. Still it is nagging me that I am missing something important.

The bus ride to JFK is fine. While everyone is eating at the food court, someone asked me if I have packed toilet paper. Toilet paper? I excuse myself and go to the men’s room where for the next fifteen minutes as I unroll and then reroll.

At the Santo Domingo airport, they wave us quickly through customs. Helps to be with a missionary group. I’m thinking about Arlo Guthrie coming into Los Angeleez.

We head for a place called “The Chicken Hilton.” It is a way station campground for various groups. We are sharing it tonight with a teenage church group of Dominicans from an area an hour away. We will be sleeping in mosquito net shrouded bunks in small concrete rooms. For dinner on open picnic tables, they serve us arroz con pollo, chicken with rice. We get water from a cooler. The local tap water is contaminated.

I sit down with two of the Dominican volunteers and make immediate friends. Jesus is a bullchested thirty-five year old. He is eager to help me with my Spanish. When he shows me his watch is always an hour early because “no queiro estar tarde.” He does not want to be late. I mention I like that, he takes it off his wrist and gives it to me. I a have forgotten to take a watch. Still I say no a couple times — I hardly know Jesus, but finally I take it when he says, “You can remember me by it.” His wrist is much thicker than mine, and the watch hangs loosely from my write. I thank him profusely.

Later I lay in the dark under the mosquito netting. I wonder what the trip will bring, wonder about my role. There are nine doctors, four nurse anesthetists(who will be operating without an anesthesiologist), eight nurses and several OR techs, in addition to some general helpers/interpreters. I sense most of them don’t know what a paramedic does. I just want to be useful, but I also know like most I have an ego, and I believe this is a trip where ego will need to be pitched.

***

After a three hour bus trip up into the mountains that included a land slide that temporarily blocked the road and a near stampede as a herd of cattle met us head on on the road, we arrive at the camp high in the mountains. The camp, despite its primitive living conditions(at least for us) — two story cement bunkhouses under corrugated roofs with what will turn out to be only occasional electricity, cold showers and sometimes no running water at all, is Shangri-La. The bunkhouses and open air dinning hall under a slanted roof are surrounded by lush green tropical trees, many fruit bearing. The view is spectacular — green mountains, sometimes shrouded in clouds. We are, in fact, above the clouds.

We take a fifteen minute ride into the town where we enter the hospital for the first time. The initial view is impressive. It looks like a 1950’s era building — one floor, but when we walk in, it is as if it is the hospital of a town that has fled an alien onslaught with just enough time to strip the hospital of most of its equipment.The place is deserted.

The rooms we will use are dark and spare. I am of initial use, standing on a step ladder to change the light bulbs in the ceiling.

Paramedic to the rescue! We set up two operating rooms, a preop, post op room, a post post op room where the families can take care of the patients when they are stable enough to leave post-op, a supply room, and an equipment sterilization room. The anesthetists seem initially puzzled by the ancient machines they will have to use to gas and ventilate the patients. The patient rooms have old stained mattresses, no pillows and no sheets. The only room with is AC is the operating room. The patient rooms appear to have little to no ventilation at all. Nevertheless by the end of the day the place actually looks like it may work. We’ll start seeing patients tomorrow.

I sleep poorly, anxious about the next day. The assignment nurse has told me I will be in the OR. While that prospect is interesting, I mention I do speak some Spanish and can do IVs as well, whatever is needed. She says well maybe I can help the nurses out in pre-op translating if I’m not needed in the OR.

***

In the morning the patients are ready for us. They are lined up outside the hospital doors. A resident asks me to scrub in on the first operation — a gall bladder removal. I “retract” which means I hold these long metal scoops in the body to pull the muscle fascia out of the way to enable the surgeons to better see what they are doing. At one point I have my hand inside the body. The surgery lasts a couple hours. My arms and back feel the tension from holding the retractors. It is hard work. I’m sure if I was a pro at this I would know how to hold in a way that would cause less muscle strain, now I rely on brute strength. While I am holding retraction, the surgeon on the other table asks me to translate what his patient is saying as they induce him to sleep. He says, he’s feeling sleepy, I say.

After the operation, I help clean up, emptying the bloody suction canisters, then find myself repeatedly being called on to translate. I can handle most translations easily, the type where I repeat a medical person’s commands to a patient or conduct a simple interview, but when they answer rapidly with a prolonged answer, I am sometimes lost. A couple times I have to go find one of the Dominicans to assist.

Later in the afternoon I help the two nurses in pre-op put together IV sets, attaching stopcocks and extensions to the drip sets. They ask me if I know how to do it, I nod, and mention I do it as a paramedic.

***

There are many more patients awaiting us this morning than yesterday. I am assigned to help translate in pre-op. Patients are identified with surgical needs in the clinic, told to come back the next day after having not eaten or had anything to drink. Their names are called, and they are brought to pre-op, where we have them change into a hospital gown, they weighed, vitaled, reinterviewed, then given an IV. Then they wait until surgery is ready for them. The nurse anesthetists come down and reinterview them and have them open their mouths so they can gauge how easy or difficult the intubation will be, then they are lead down to surgery.

I get my first chance to do an IV when one of the nurses misses, and I tell her I’ll scope out the other arm for her. I point out a vein, and she looks at it, and then tells me to do it if I think I can get it. I put the IV in, and then ask her, if she has a preference on how it is taped down. They later have me do an IV on a child and on a dark skinned Haitian. I sit back and wait for them to direct me. I don’t want to cause any turf battles. But if there is work that needs to be done, I offer. I’m always at battlestations, ready to go. I do most of the translating.

I admit to having some
tr
ouble with not being in charge. As a paramedic you are trained to take charge. Here I have to tiptoe around. I irk one of the anesthitists when moving a patient. I am used to moving a patient with just two people. They use six here. For a large woman, I suggest letting me grab her from the top, but he is at the head, and I learn the rule is the anestetist in the hospital is like the paramedic in the field — they control the airway, even when the patient is alert. I make certain to stay at the feet end.

When a caesarian comes in, Annie, the nurse running post-op, who is also a close friend of mine and who has worked with me for years on the ambulance, where she is a volunteer EMT-I, tells me to replace her in post-op. Her job will be to catch the baby and resuscitate it. She tells me later when they asked her to do the job, she told me I had probably had the most experience with resuscitations and deliveries. They responded that they needed a nurse.

The good thing about it that when things get busy, if you can get the job done, then the job is yours. In post op, I take the report from the doctor and the anesthetist, then monitor the patient, vitaling every fifteen minutes for the first hour, then every half hour after that.

If they have pain, I can give them Morphine, phenergan for the nausea.

When they are stable, they are transported down the hall to a large room with many beds where their families can take care of them until they are ready to be discharged. I give many discharge instructions, handing them percocets and ibuprophren. My friend tells me there is some grumbling from nurses about a non-nurse giving medicine, until she explains to them that it is something that I do all the time on standing orders.

The pace is hectic. I am constantly being called on to treat someone’s pain, take a report on a new patient, answer a family members questions, translate for a doctor, move a heavy patient, do an IV on another child. The rooms are hot and humid. I am sticky with sweat. I make a point to drink as much water from the color as I can to stay hydrated. There are several caesarians done, one child needs bagging and I am so busy I can only glimpse as my friend helps with the child’s breathing, bagging, and then hitting her cupped hand against the infant’s back.

We are the last to leave. The babies are all fine, the patients transferred down to the family room, where their family members will look out for them, bringing clean sheets from home for the old mattresses, brushing their foreheads with moist towels, feeding them home-cooked food. I say good night to them all, and we walk back to the bus, and I feel that today I found my place. I won’t get into the OR again, and I won’t be there for the deliveries, but I have a job that is important, and I believe I have proved myself.

After dinner I go for a walk off the complex with Santiago, one of the Dominicans, Nancy, an OR tech, who speaks fluent Spanish, and Alex, a college student translator. We stop at a roadside bar, which is really no more than an open shack and drink beer by candlelight as we talk in Spanish to the bartender, a beautiful woman, and her children who stand behind the bar with her.

I can say it is the best beer I have ever had — I get a cold liter bottle of Presidente and we click our bottles and I know already that these people will always be my friends for what we are sharing tonight and this week.

We were told that we were coming to a poor country to help people who have nothing, but what I am starting to believe is that while these people may not have financial wealth, they are richer than many of us for their family bonds, for the love they show each other, and for the joy they take in each day, in breathing the clear mountain air. They have laughter and smiles for each other. You cannot call them poor. In the United States, people work too hard to have more than their neighbors, to consume. We spend too little time with our families. Who is poor and who is rich?

***

The morning begins as all have with the old country song “One Day at a Time” being played over a loudspeaker. We use this as our true wakeup call, ignoring the silly rooster who begins crowing at 2:00 A.M.

One Day at a time, sweet Jesus,
that’s all I’m asking of you.
Teach me today, to do all the things that I have to do.
Yesterdays gone, Sweet Jesus,
and tomorrow may never be mine.
Lord, for my sake, teach me to take,
One day At A time.

There is no water this morning, just a dribble from the spout. Still I take a shower and am refreshed by it.

The day is very busy. Everyone seems to be melding as a team. I love the two women I work with in pre-op — they are good hearted. I am again doing double duty between pre-op and post op. There are more caesarians. I try to take time to talk with the patients, try to make them feel comfortable, get them to laugh and smile.

My Spanish is getting much better.

At night I go with Jesus and the other Dominicans to play pool in the town. With Spanish music blaring, and a light rain, I am a lone Yankee in a pool hall of Dominicans, many wearing shirts of USA athletic teams or names of cities. I feel grateful for being able to travel the world and see what I have seen.

***

On the bus ride to the hospital I talk with one of the doctors who has been on other medical trips to help the poor. I wonder what it would be like to go to some of the places she describes — villages that have never seen a doctor, people in refugee camps. We talk about how these trips can change you. I feel for me the changes are subtle. It is about shifting the focus away from the self, about opening up to the world and to the patient. I want to be transformed.

I find myself saying to many of the patients when they are discharged, “Que Dios te bendiga.” May God bless you. I am not a Christian. I do not believe in God. I believe in helping others, in trying to find in yourself a better, purer person, you best serve others, you best serve the world.Am I a fraud when I say may god bless you. I don’t think so. What I mean is may good things happen to you, you are loved. They smile when I use the words. They seemed touched. And that’s probably why I keep saying it. That and it is a simple thing to say. Maybe I am an instrument or maybe I’m just trying to get them feel better and maybe less afraid.

A woman has hypertension. Her pressure is 220/120. She is only 34. The doctors won’t operate on her. She could stroke out. She hasn’t taken her medicine for two weeks because she doesn’t have the money. She needs the operation because she is pain. We tell her another group of doctors will be coming soon, and they will be able to operate on her if she can get her pressure down. But she has no money. The nurses and I join together and slip her some money as she leaves. She cries and hugs us.

In bed I wond

er again about the self. Am I trying to good because I want to be seen as someone who does well. If that is true, is that wrong? I want my deeds to be purer. I want to be able to do good, and yet be unseen.

***

Our last day of surgery. On the ride in to the hospital, I stare out the window taking in the view. I will never have a commute like this again.

The operations today are largely minor as we will be leaving tomorrow. It is a day for taking time to remember the sights and the patients and the people I am working with.

A woman who earlier in the week was here helping a family member, has returned to help volunteer with us. She has a wonderful way with people, and tells me she would like to be a nurse, but cannot afford to go to school. I think if I had the money I would pay for her education. I hope she will met a benefactor or that someone will take her under their wing and guide her along. I give her my blood pressure cuff and trauma shears at the end of the day.

I go out and buy a cold pepsi from the vendor across the street. We talk in Spanish. I talk with some children outside the gate and take their picture and show it to them in the viewer. They laugh.

On one hand I am anxious to go home, to return to my work, to see how my world is changed. On the other I want to savour this world I am in now.

At the end of the day, we hand out bags of presents for the children.I wish the best for these people, particuarly for the children.

I hope their lives are rich with love and they are always blessed by someone.

We return to the bar at night, and I talk for a long time with the bartender, and hear about her life. She would like to one day see America. It is pouring rain outside so we stay longer, any excuse for another Presidente.

***

We take the long bus ride down from the mountains to Santo Domingo.

At a rest stop I eat chivo — goat — along with rice and beans and fried plantains with Jesus. We arrive at our hotel in the city at one, and we all head down to the pool, where we enjoy the sun and play nerf football in the water.

I think if I had a choice between a week at an all-inclusive resort versus this experience with just our two hours of pool time, I would take this without question. In the past I was always the type to never leave a resort, content to lie in the sun with a drink in my hand. I can’t imagine any better way to see a country than to do what we have done on this mission.

At the pool I talk with the trip’s medical director and he admits he did not the difference between and EMT and a paramedic before the trip started. He seems happy with my work and asks me if I am interested in a trip they have planned for next year with a smaller group, a first time mission into Bolivia. I tell him I am very much interested

At night we eat at a restaurant where I order a Dominican platter of shrimp, meat and eggs in rice and beans, accompanied by several more Presidentes.

I go in the casino where I find myself in a game of no-limit Texas hold’em with a table of crazy Dominicans. Texas Holdem is a game that requires patience. While I fold continuously, the Dominicans play nearly every hand. When one wins, he gets up and does a meringue dance while the live band blares the music close by. “Ladron! ladron!” one accuses the other when he catches a long shot card to win a pot. “Te Quiero, Maria, Te Queiro,” another tells the dealer when she deals him a winning card. A waiter brings out a plate of meat and onions and fries for all the players. I am continually amazed by the wildness of the play. When one raises another, the other calls with a poor hand. It is as if to fold to a raise is a sign of lack of manhood. At one in the morning I finally get my hand, and win a big pot, walking away a $1200 peso winner for the night. (About $50 US). I give the money to Jesus to use in his work for God.

***

The flight home is smooth, and soon we are on a bus back from JFK.

I arrive to a quiet house and a stack of newspapers. The lawn is overgrown. I feel oddly out of place. I unpack, tidy up the house. I download my pictures into the computer and watch them all. I think of Jesus and how last night after being garrulous all week, he was oddly quiet. This morning I gave him my new Littman stethoscope. I told him that I wore his watch on my wrist so that when I felt my patient’s pulses, I would always think of him, and now when he listened to people’s hearts when he helped out in the hospital, he could think of me. We embraced fiercely.

I play no music, just sit in the quiet house.

There are clouds in the night sky, occasionally breaking to show the heavens.

1 Comment

  • nurse2medic says:

    Wonderful post,Peter…Have you gone again? If you keep going,I see another book looming on your horizon.It would inspire us all!

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