The week started as any first clinic day does, with a tour. I arrive at Clinica Esperanza early to get a lay of the land. I am greeted by the lovely volunteer coordinator, Beiry, who proceeds to show me around. On the second floor we have the Pediatrics clinic, the OB/GYN area, the Diabetes doctor (one doctor managing a program with 500+ patients, wow), and the administrative offices. On the ground floor we have the family medicine clinic, triage, the pharmacy, a treatment room, and the stock room. Pretty straight forward. I am to be working with Dr. Fernando Canales this week, an awesome young Honduran doctor from San Pedro Sula trained in a variety of Honduran and Guatemalan cities, notably San Pedro Sula and Tegucigalpa. He provides all levels of family medicine care, but has interests similar to mine. He aims to study Orthopedic Surgery in a few years in Madrid, so this was a bonding point for us for sure.
I was welcomed with open arms by the clinics staff, and even more so by the patients, who were more than happy to put up with my rudimentary Spanish. Others may shy away from the laughter that one’s attempts elicit, but honestly I kinda loved it. Bringing humor and most importantly comfort into the hospital/clinic is sometimes a difficult task, but if its as easy as the patient laughing at the Gringo trying to speak Spanish then I’m all for it. Plus I’ve gotten some very necessary Medical Spanish practice, and the only way to build a skill like that is to get out of my comfort zone and stretch my abilities through these conversations. Only then can I learn what I don’t know and build on it. I’d like to throw a quick shout out to Dr. Mark Wardle, my medical school mentor who I first began a Medical Spanish course with as a 1st year prior to a Medical Mission Spring Break trip to Ecuador. The same Dr. Wardle who wrote me a letter of recommendation for my INMED application. I think he’ll be happy to read that this week for the first time ever I did a full patient encounter purely in Spanish. I’m not fluent, or even close, but I think I can finally call myself Intermediate.
This week was an enlightening and eye-opening experience, for many of the same reasons that I came to love International Service or Medical Mission trips in the first place. Coming to a developing country, volunteering to assist in their healthcare, providing care to a community that really needs you, and using your skills and knowledge for a purpose and cause much greater than yourself. Each time I embark on a journey like this it only reminds me why I do this and cements my love for these trips. Here I can think of no better example than a story. As my patient leans over on his left arm, elbow and forearm flat, planted on the bed, hand draped in a sterile gown with his gashed (and likely fractured) pinky exposed, he begins to weep. I look up from the sutures I’m throwing and ask if he is okay. Choking back tears and covering his face, I only hear one word, “gracias”.
Allow me to rewind. I am seeing a patient for a routine checkup, a medication refill for their chronic hypertension. Un paciente en buena salud y sin otra sintomas, or a patient in good health without other symptoms. I finish adding their prescriptions to the system, have Dr. Canales check my work, and then send the note and the meds through to the Pharmacy. Que pase un buen dia, I say to the patient, as another doc at the clinic, Dr. Natan Webster, tells me of a pinky laceration that requires closure and asks if I’d like to assist. My eyes beam a little when I think of the opportunity to get my hands dirty in any procedure, especially a finger lac, as a hopeful future orthopedic surgeon I hop on quickly. With a nod from my preceptor I’m on my way. I find the man in treatment room, middle aged with dirty clothes, clearly having came directly from work, gripping his left wrist tightly. At the end of his left pinky is a circular gash, maybe 5 mm from the fingertip, extending from the middle of his nail around into his fingerprint, almost half the circumference of the digit. There’s always a whoa moment for me when I see a dramatic wound, and this was no exception. I ask what happened and he tells Dr. Webster and I of the rock that dropped on it at work as he was shifting a heavy load, and asks if I think he can return to work.
The next few thoughts I had brought with them excitement for the future, as I realized how much I actually learned these last few months on my Orthopedic Surgery Audition Rotations. Dr. Webster asks what I want to do, so I tell him. Antibiotics, tetanus shot, digital nerve block, irrigation and cleaning of the wound, debridement of dead tissue and the half-attached nail chunks, wound sterilization, primary closure, X-ray of the digit, and follow up 7-10 days later in clinic for suture removal. With a few nods he agrees with my overall plan. I arrange my supplies and we begin. First with our digital nerve block, something I had learned first hand from a 2nd year resident at Montefiore in the Bronx a few weeks prior. Lidocaine drawn up and injected between the web of the 4th and 5th digits, and the only part of the procedure where the patient drew back from pain. After a few more minutes we irrigate profusely, I pick out the small rocks and dead chunks, and then get my sterile gloves on. After poking around a bit and confirming the anesthetic works, I begin to suture. With quite a bit of practice up until now, I find myself humming along casually as I work. A few horizontal mattress sutures circling his finger and the wound begins to come together nicely. I get to the nail where the damage is a bit worse. As I circle back to the nailbed, with the worst part of the laceration already closed, my patient begins to cry. Worried about pain or him passing out I pull back, protecting my needle, and ask if he’s alright. Then I hear the one word, “gracias”, to which I respond “de nada mi amigo, es porque estoy aqui”. My Spanish, albeit broken Spanish, tries to convey “Its nothing my friend, its why I’m here”. With a mask-covered smile, I begin to throw a suture when all of the sudden I hear a click, as all the lights and power cut out and the room goes dark. I chuckle as I look up to Dr. Webster, who then pulls out his phone and turns on his flashlight. With his flashlight I finish one simple interrupted until a minute later the power kicks back on. Luckily the clinic has its own backup generator. One more suture, some cleaning, a nice bandage later, and we’re done and onto the next patient.
Fast forward a bit, and later that day I go on a scuba dive with two other volunteers. A nice little dive to a not-so-far offshore reef. A reef I had played around twice in already. Any scuba experience I’ve realized is unique and incomparable to priors, but this one, after the events of that day, features a moment I’ll never forget. At this point I’m pretty comfortable in the water, so I let my thoughts breathe into the surroundings around me, losing track of time. Never so quickly can an hour pass you by. As I turn a corner in the reef I spot a school of fish quite a few yards off, numbering around a hundred I estimated, coming straight towards me. My thoughts turn to my breath, as I try to inhale and exhale as slowly as possible, maintaining my depth without a kick or flutter of my fins. Without any motion save for my heartbeat and the stretch of my lungs, this school of fish, black and blue surgeonfish, swims right next to me. I find myself encompassed by this moving mass, and I can only picture the size of the smile I had on my face. A minute later and they proceed on their way. I’ll include a picture above for reference. You can determine a surgeonfish by a very unique spine, special to surgeonfish, seen in the pic above (its the yellow spot just in front of the tailfin). They have become a favorite of mine to spot around here while diving. I’m not one for signs, but as I hope to match into Orthopedic Surgery with Match day around the corner in a few weeks, I sure hope this was one. Another fish I’ve come to love is the Queen Angelfish (the yellow and blue one), one with quite a bit a beauty.
We end the night with a bon fire and smores at the Roatan Refuge, where another pic below was taken with the kids of the family hosting us. I couldn’t imagine a better day, and honestly I’m not sure my imagination could even come close.
Que una vida.