10/3/2013
[Disclosure . . . the table at OSAPO is not round, it’s long
and rectangular.]
I’m currently sitting in the airport, enduring the
beginnings of a VERY long day of travel.
I’ve been in Haiti for two months . . . it’s time for a little vacation
(and by vacation, I mean 2 weeks in the great city of St. Louis . . . more
importantly 2 weeks of experiencing the post season for the greatest team in
baseball!). On the long ride from
OSAPO to the airport, I couldn’t help but smile as I reminisced over the way I
spent the previous day . . .
I was finally able to have another day in the OR. I don’t think words can express how
stressful operating here actually is.
[Don’t get me wrong . . . I LOVE being a surgeon, but your talking about
a completely different beast when you are in a third world country.] To start off with . . . there really is
no set schedule. When the
anesthesiologist says she will be there at seven, she really means nine, which
mean your day does not start until 9:30 or 10:00. Even though we attempt to keep a schedule of patients, they are
unpredictable as to when they will actually show up. There are some days where no one will come, and some days
where many will come and you need to send them away. Then, there is getting the equipment prepared. Every sterilized tray is like a piñata
of surgical instruments . . . you never know if you will have the instruments
you actually need . . . and if you don’t, then you are scrambling to find the
essential instruments you actually need, with the patient asleep on the
table. It is literally impossible
to be efficient and conserve resources.
[Oh, and don’t get me started on the lack of sterile technique of
everyone else in the OR, you not only have to focus on your actions, but you
are also manning everyone else.]
Once you actually get to the actual operation, you are exhausted just
from making sure everything is in its place.
Last week, when I was operating on my own, I was reminded
just how much I enjoyed it (both the challenges and success of knowing you did
everything according to the books, and that you truly did help someone). Yesterday, I did a hysterectomy with
the assistance of one of the surgeons in Haiti, who prides himself in his
speed. I don’t want to go into too
much detail, but I realized why he is so speedy yesterday. Those steps of Identifying the ureters,
double ligating all the serious vascular pedicles, assurance of a dry field,
completely out the door. I realize
that I’m just out of residency, and he has been a surgeon for many years . . .
so I did my best to be respectful, yet challenge things I didn’t feel
appropriate. It could have gone
more smoothly. [Janna, if you are
reading this, I did not say it before, I have so much respect for everything
you did the first time we came down here.
It’s a different game when you are the one in charge.]
So . . . back to my day . . . there were a couple of minor
cases I had scheduled for the afternoon, but unfortunately the anesthesiologist
had to leave early, and alas they were canceled. As I was going through my ‘office,’ making sure everything
was in place, Carine said there was another patient, who had just been admitted
who I needed to see. 70 year old
female, vaginal bleeding, hemoglobin of 7. Carine told me she had gone to see another doctor, but they
wanted me to see her, too. My
response was, not until the other physician actually does a pelvic exam, (she
assured me that he did, but I’m somewhat skeptical). [Now, just a little clarification . . . the frustration that
I have with no one doing pelvic exams here is a much different type of
frustration than that which I had in residency, when you would get called in
the middle of the night to go perform an emergent pelvic exam on someone with vaginitis. This roots deeper than the frustration
with pure laziness of others. At
least in residency, people made sure that patients received the proper care
necessary. Here . . . when I leave
. . . there is no one else to do it.
If people don’t start performing much indicated exams, no one will, and
significant pathologies will continue to go undiagnosed.] This poor old lady appeared to have
dementia . . . luckily did not appear to be in too much pain. Speculum exam: big fungating tumor originating from the
cervix. Bimanual exam: IIIB (at least) cervical cancer. Just a little shout out to the powers
that be . . . I get it . . . I’m still passionate about my work here . . . I
don’t want any more reminders.
So . . . up to this point, I’m sure you are wondering, what
about this day made me smile . . . I’m getting to it. My nightly schedule here is pretty much the same . . . work
out, shower, eat dinner and visit with the OSAPO nurses/staff (who, for the
most part are female). It is
always very entertaining for all . . . it feels so good to laugh with
others. Last night, one of the
nurses (Andre . . . someone who I’ve really enjoyed working with . . . she is
the one who helped me make my bat free room in the office) was asking me what
my plans were in St. Louis. I
mentioned going running with my dad.
Her response:
‘You
will not be able to run.’
‘And
why is that?’
‘Because
you are too fat.’
I
started laughing, ‘Andre, I am the same size now as I was when I got here.’
‘No,
your butt and legs has become too fat.’
By this time, some of the other girls were engaged in our little
conversation.
I
chuckled even more, ‘Nope . . . they’ve always been this big, it’s just the way
I am.’
One
of the other girls needed to translate this for her . . . her response with big
wide eyes and a big smile on her face, ‘Ooih.’
‘You
know, it’s not nice to call people fat.’
‘But
I love your big fat butt. It
dances every time you walk. I find
it very sexy.’
At
this point in time, I was almost crying, I was laughing so hard.
She
continued, ‘I want your butt.
Mind, I do not like so much.’
‘Well,
thank you. Now, I think it’s time
for bed.’
To really get (even more so) the comedy of this conversation,
I’ll provide a little background information (and don’t worry, I’m not going to
dive into the whole body image, insecurities, etc . . . I am by no means skinny
or completely satisfied with how I look, but what woman is). For those of you who don’t know me, I
am very much pear shaped, and yes, I have a ba donka donk and thighs. I am also very athletic, and it seems
that my butt and thighs are what tend to bulk up the most. I have ALWAYS had a complex about my
lower half, but have come to find it more a topic of humor than anything
else. When I was getting measured
for clothes in Vietnam, when measuring my thighs, one of the woman said, ‘hoooooaaaaa,’
in a deep voice as she widened her eyes.
Also, Andre has many a nights commented on my big butt (one night, she
asked why my waist was so small, and my butt so big). She is also one of the most lively people I’ve met . . .
between her persona, the cultural differences, the literal translations and my
apple bottom complex . . . I don’t think I could have engaged in a more
entertaining conversation.
Now . . . time for me to relax. For the first time in two months, I actually have goose
bumps (AC in the airport). Time to
allow all my frustrations and unpleasant experiences dissolve. Time to keep the happy memories on the
surface. Time to bring the
Cardinals to the World Series!!!
[For anyone in St. Louis, you should go to Sybergs (Dorsett)
tomorrow night . . . A fabulous band will be performing . . . and I’ll be
there, too, hopefully celebrating after the Cards game].
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