Two months now, since I first arrived; one more month left. I feel now that I am two-thirds of the way through, I am beginning to close a very profound chapter in my life. I forged so many new relationships over these two months, and a part of me feels a little sad knowing that this will be the last time I’ll see them. The past week alone had been filled with goodbyes: Grace, Tucker, Stephanie and Mary, Clint and his family, Kristin, Gary, and Peggy. And even though I’ll come back someday, who knows how this island will have changed? Each day I see new developments, buildings that weren’t there before, tourists that are now aplenty. What will a year’s time hold for all of us who have been touched by the island?
And so it goes. The act of leaving and returning is as engrained in the island as is the ebb and flow of the tide. We see it everyday, in the coming and going of familiar patients, volunteers, and in the rise and fall of available medications and ample help. Life here is one giant cycle, creating the illusion that nothing has changed, although there is change in every passing minute. The point here is that in the face of adversity we can only rely on such small steps, to be patient and wait humbly for the correct timing. It is impossible to solve any significant problem in a short amount of time; healing involves a lifestyle and perspective change, to which there is no easy resolution.
Take the case of any diabetic patient. Last week a sixty-year-old Italian diabetic, chronic smoker and alcoholic, came into Peggy’s clinic with his son and daughter for a redressing. His left foot reeked of day-old eggs, a sign of a bacterial infection. There were cracks in his foot, yellow and black from lack of care, and a gaping hole through which we were able to see the aponeurosis. His right foot had gone through three surgical amputations; all that was left were his big toe, so bloated that the bone wasn’t even connected to his foot, and two other toes, scrunched together in his shoe and sock. His foot had been pressed together medially to form a permanent crease down the sole of his foot. What was most depressing was that the man didn’t seem to care much about his condition or what was going to happen to him in the future. He didn’t want to change his smoking and drinking habits (which was expected), but he refused to take his medication as well. Even worse, his children were powerless to change him; they seemed to lurk under the tyranny of their father, softly urging him to change but with him outright refusing. Finally Peggy gave him the unvarnished lowdown: he was going to die if he continued living this way. “How long do you want to live? How long do you want your legs?” she asked. Her curtness worked; he committed to the redressing of his wounds everyday after his consultation visit in San Pedro Sula.
The problem was that he had come for the first day, and the next he had not showed up until after clinic hours. I had just come back from my work at the hospital and saw him in his car, waiting, even though the clinic was clearly empty. He had just missed Peggy, and I asked him to come back tomorrow morning. His response was a grumble (he didn’t like mornings because that meant he couldn’t drink at nights). Next morning he came, throwing a fit at Dr. Raymond for making his feet turn black. I haven’t seen him since that day.
One of the most difficult aspects of medicine is that it is so easy to treat the nice ones, the compliant and obedient patients, or the quick simple fixes. But I think what separates the best doctors from the rest is that they treat the nasty patients the same way they treat the good ones. The one unifying quality about medical practice is an unnerving belief in life and the well being of patients. It is inevitably true that most will not conform to a lifestyle required to save their lives, whether it’s to quit smoking, to exercise daily, to eat a balanced meal, and will instead lazily fall into the cycle of sickness and treatment instead of prevention and cure. But when they come back with their worsened conditions, we treat them anyway, because that is the life we have chosen, and maybe, after each visit, some part of them will open up and change in the right direction.
