Friday, March 12, 2010

The last days in Haiti and the D.R.

At the request of Uncle Scott, one of my loyal readers who said he read the blog every night at bed to the annoyance of his wife Tammy, I will finish up the Haiti blog. Thanks for reading, guys. Definitely adds to the experience to share it.

Sunday was a nice day off. The Mennonites move a little slower on the day of rest. Except for Jedidiah, who was picking up the puppies, carrying them across the yard and putting them in a cooler. Talk about a toddler from hell. Kidding. Cute kid.

Jason and I went to church. I promised the pastor I'd go (it's kinda what the guy does for a living) and didn't want to let him down, especially after everything he had done for us. Plus, I like experiencing church in other countries. We get there late, of course. Whatever this service was it had started at 0700. We rolled in at 9. Good morning, God. Not sure how to say that in Creole. Bonjour, mon Dieu? Everybody was in pews outside, and we snuck into the back and stood. The pastor spotted us, and showed us to 2 nice chairs...IN THE FRONT OF THE CHURCH FACING THE CONGREGATION. Great, I was screwed if I feel asleep during this one. And there was no leaving after Communion, either. We ended up staying for 2 hours before calling it quits. Who knows when that stuff was going to end. Lots of singing and clapping and praising the lord in Creole. Reminded me of a baptist service, although I've never been to one. The main sermon wasn't delivered by the pastor, not sure why. But they guy that did it had everybody laughing the whole time. And he liked to yell. Lots of heads nodding in agreement. I think I uderstood "Dieu" and "Jesui;" got my fill for Sunday. The pastor gave me one of those little Gideon Bibles in French. Sweet. Especially since I didn't have to steal that one I found in the back of the church. I tried to sing in Creole; and I thought nothing was worse than my speaking in Creole. I was wrong. Church was good, then we split. I did do some clapping.

Then Jane, the medical director and ein furher of the operation, came to pick us up to go back to Port-Au-Prince. We said au revoir to the Mennonites. Did I tell the beard story yet? By this time it's been a couple weeks since I'd shaved. So there are plenty of long hairs on my face. One Mennonite told me that when they get married, they grow a beard. I remember this guy earlier asking me if I was married. And I think he did it not because he wanted to know my relationship status, but because he wanted to know if that shit on my face was a beard. I told him no, and I think that made sense to him. Anyways, they were a kind bunch of round men with glasses that really looked the same. Arrividerci, boys. I handed over the keys, sign and papers to Noah and we were headed back to the capital.

It was nice to get back to better accomodations; the tent was fine, but the dripping water over my head led me to twice weekly showering, and let's just say I was "due" for more than an underwear change. That was an amazing shower. I definitely stole someone's shampoo.

This is hilarious. One dude, Louie, was a physician's assistant from KC. Big guy, he had sleep apnea, and needs to sleep with a breathing machine (CPAP) at night. Well, he didn't bring it with him to Haiti, and without it at night, he was exhausted during the day. We're talking sleeping all day. The dude came to Haiti and slept for 16 hours a day. He was in bed when I got there--snoring like a rhino--and last awake in the morning. Deadly volume. Lucky me, I secured the cot underneath the loud AC, which drown his snoring out. But not so lucky for the 8 others in the room. One other dude was snoring in sync with him, which was kinda cute, although Lou would occassionally stop breathing for 30 seconds at a time. Amazing that brain, living without oxygen and all. So another guy got everybody ear plugs. Anyways, Jane decides that Heart to Heart "needs" Lou to go to Leogane...hope the Mennonites get some rest the next couple days! Ha, suckers!

Monday morning, Jason and I joined the gang in the church clinic near ground zero in Port-au-Prince. We were a "mobile clinic." Literally, we had a bag of meds that we put together, and got in a truck and parked it at an intersection about 5 blocks from the church clinic. When we got out, people just lined up. Kinda wild. We were able to snag an empty tent nearby, and bam, just like that we had a clinic. We saw 67 patients that day. Mostly the same stuff: GERD, headache, backpain, vaginitis, UTI, colds, lots of high blood pressure, several like 260/140, out of control.

One guy came in with 2 weeks of this big swelling on his neck, by his adam's apple. It was soft and squishy. "What the hell is this" I thought to myself. I wanted to biopsy it, which will do a lot of good here since there are no microscopes or pathology. So I sent him to the main clinic and I think they popped it. I dunno. I wanted to cut it off myself but had no scalpel or lidocaine.

Another lady came in with a week of swelling in her right knee. No infection, just fluid after banging it up. She wanted it drained, so I cleaned her skin with alcohol and put a needle in there. We pulled off about 60 MLs of fluid, and the crowd was mesmerized. It was like magic, and of course, afterwards she was flexing it, demonstrating the miracle. Terrible medicine, hardly a sterile environment, although I doubt it will get infected. Most likely it will just fill back up in the next couple days, but maybe it won't, and at least it gave her some relief.

Our translator was Mark. He was cool, grew up in Haiti, spent 10 years in Miami, then got deported. He had less of an accent, and we got along. He liked me because I "didn't give a fuck." Initially, I was a little offended by this. I certainly considered myself someone who gave a fuck. But he meant I didn't let things get to me. Keep the compliments up, Mark, and we are going to get along just fine. For lunch, everybody else brought powerbars and ate like mice. No good for Lorenz. I rolled with Mark down the street and did a cardinal NO NO in the Third World--like a fat kid at a candy story, I gobbled some street food. Mark was nervous, he said I was going to make a scene since most of these people have never seen a white person, let alone someone who eats their slop with them. "It's like seeing Jesus." Flattered he compared me to Christ and liking him even more now, I told him too bad, I was hungry and cheap and let's eat. We ate a rice and beans plate, with chicken. And a generic Coke. It was ok, and filled my belly good. I definitely devoloped the shits for the first time since El Salvador (I pride myself on having rock solid guts), so bad in fact that I broke down and took Cipro. For a day or so, the toilet was my happy place. It was worth the Jesus comparison, but probably not the food. Damn street chicken. The locals definitely stared.

The afternoon mobile clinic was not good. No bon. It seemed like the morning people had told their neighbors what to say in order to get tylenol from us. Everybody had the same complaints--back pain, vaginitis. I was beginning to get skeptical and tired. We ran out of heartburn/GERD medicine, there was none at the other clinic either. So I was giving people with heartburn tylenol and gas-x, as if saying, "Here's something that doesn't work." Doesn't make you feel good as a doctor when somebody comes to you in pain and you send them away knowing what you gave won't do much. I was getting frustrated.

Near the end of clinic, one case really got to me. This 12 year old girl had a week of fevers, especially in the evening. No other complaint--no cough, no urine problem, no pain. I think she had malaria. Finally! Someone who was actually sick and had a treatable disease. While it's kinda sick to get excited about illness, this is what I came to do--actually help people. Now, the medicine to treat malaria in Haiti is choloroquine as there's not significant resistance, as opposed to Tanzania where resistance makes chloroquin ineffective. Not too expensive, takes maybe 6 pills to treat someone, and we had plenty at the other clinic. Well, of-fucking-course, we had none. Neither did the other clinic in Port-au-Prince. I was pissed. After seeing 66 patients that were not sick, we get one who is actually ill, and I can't do a damned thing. "Hi, you have malaria. Here's a medicine that works maybe 50% of the time if you're lucky. Good luck." Call me a doctor? Fuck that. So frustrating. Not like I could send her somewhere else or refer her. Nobody has these meds. Her body will likely clear it on its own, but people die of malaria all the time. AND IT'S TREATABLE. I hate that. At that point, I was like, "Why am I here? So I can put some band-aids on people and feel good about myself?" Worthless. Really felt like I was not doing much.

At that point, I was fried. Done seeing these people work me for tylenol. Street value for tylenol? Really? Only in Haiti. Done seeing backpain. Done seeing patients who trust you as a doctor and treating them with shit that just doesn't work. Get me out of here, I'm done.

Don't get me wrong, Heart to Heart as an organization has an excellent setup. Tons of meds, well organized and staffed, translators, patients, etc. It's very well run. But it ain't perfect. The needs are unending, there is no system, so you can't call it broken. And it had just overwhelmed me.

That night, I got the chance to skype with my best friend since 5th grade, Ben. He's a 2nd year law student at USF in San Fran, and wants to be an international human rights lawyer. If you an "international" to any job, by the way, it sounds more sexy and James Bondish. International Bartender. International accountant. International doctor is no different. Anyways, we've dreamed of saving the world together, and he's thinking about doing law work in Haiti in the summer. We got to chat about things--the UN, international aid, US foreign policy to Haiti, the history, etc. Lots of interesting issues. He was organizing a guest lecture from Haiti by yours truly. A little Q&A on the ground with Dr Lorenz. LIVE FROM HAITI. I was excited and definitely thought I was cool and important. Too bad the internet connection went down and only 3 people showed up (Ben + 2 others). Looks like my widespread fame for international do-gooding will have to wait for another day. But it was good to talk to him.

That was it. We left Tuesday. Instead of a drag-yourself-from-the-bumper-bus-ride for 8 hours, we took a 1 hour UN charter flight from PAP to Santo Domingo, Dominican Republic. That was sweet. Total rock star on that one. Heart to Heart, at Jane's insistence really, hooked that up. Then we crashed at the adult channel hotel (don't judge) and had a nice evening in store: it was Jason's birthday. The girls, Jane and Jeana, did girly stuff like massages. Jason and I hit the beach! We rented 2 ghetto wave runners for half hour, had some shrimp and beer. Ok, I had a coke. I got along well with our Dominican driver, and was feeling pretty good about my Spanish-speaking with him until the bill came. Funny how communication seems to be lacking when it comes to money. Guess I missed the "It's $35 each way to and from the beach, pal." That night, we went treated Jason to dinner at a restaurant overlooking the ocean. Very nice. I meet my old friend, El Presidente, and had a good time. Turns out there is tequila in the D.R. as well. Who knew? Facebook documents the results a little too well. I believe Jason called it "the best birthday ever." Not sure, as my English was probably poor by that point, too.

On the way out, I bought 4 Cuban cigars, and lit one up back at the hotel. I offered to share it with the hotel owner, and he in turn pulled out his top shelf rum. "Imperial," a Dominican rum he claimed was the world's best. I'm not a big hard alcohol drinker, but it did warm the gullet and was quite smooth. He generously gave me 2 shots, got me drunk, and started a conversation about US politics. Initially, we were having a good conversation. He asked me about health care in the US, and knew more about Obama's plan that I did. Ignorant American. My Spanish gets better when I'm tipsy (or at least, my awareness of how bad it is goes away), so we were hummin'--one of these great things about traveling and learning languages. You can really connect; doors to the culture and people open that aren't there if you are pure boring American gringo. In Paraguay, I loved sitting on the porch with Armando and his wife and talk about things we knew nothing about--like politics. Anyway, then he turned the clock back to 1492 as if he knew Columbus and started telling me the entire history between Haiti and the D.R. By this time, the rum was wearing off, and Lorenz was trapped in a history lecture. Merde! Oh, I listened to it alright. The prized French colony for wood and sugar cane. A slave country's freedom from imperial France, France's crippling taxes, wars, etc. WHERE'S MY RUM! He cut me off, and then the conversation got painful. I should have faked passing out, but I lasted to the end like a polite little American, and then went off to blissful sleep.

And like that, my adventure was over. Stay tuned for further big picture reflections to follow...

Friday, February 26, 2010

Clinic day 3: NGO speed

After an expected slow Thursday in clinic, we had an unexpectedly slow day today--and I realized that we've hit third world NGO speed, which is somewhere between first gear and neutral. There are plenty of needs and people to help WHY AREN'T THEY SHOWING UP IN MY CLINIC TODAY!!!

The morning wasn't so bad. I saw 27, we saw 40 total. Not a bad morning with 2 docs. The afternoon we had 3 docs total, and probably saw only 20 patients. A little confusing--where da patients at? So I decided we needed some signage and created a committee consisting of me to make a sign for the clinic. It is pathetic how hard this was. I mean, it's just a sign. Not a billboard. It ain't got no neon lights, Lt. Dan. Just a little sign with an arrow. That, my boy, will bring us the shrimp! Our clinic is in a church, down the street from the main road/highway 2. I surveyed the main road--tons of traffic. It was a mess, actually. I was almost run over like 4 times, once by an old lady with a cane. Lorenz in the headlights for sure. Anyways, it's not like there's an office depot down the street with fingerpaint for me. So I'm basically going through rubble and trash to create a sign. I settled on cardboard from some of the medicine boxes, and used a sharpie to write KLINIC GRATIS in Creole. I slapped that badboy up on this utility pole on the busy street, quite proud of my little sub-kindergarten level art creation. After I put the sign up, we had 2 people come in. I wanted to give her a little survey "How did you hear about us," and would have paid her if she checked the "I saw your sweet sign at the road" box, but I refrained. Turns out one of the ladys was there for church, not even the clinic, and they other lady didn't come in for the sign. Just depressing. So I gave $20 to this "artist" friend of the pastor, who we then commissioned to make the sign. We'll see if I just kissed that twenty goodbye or not. You watch, when that sign gets up, we will have established the next Haitian healthcare conglomerate! A couple more patients would be fine, too.

John, the other doc, suggested paying a taxi (tap tap) and doing a mobile clinic if it gets slow again. You know what I want? A backpack and a motorcycle. But there are more important things to be done. We need to get a better established referral system. Many come in with basic stuff I can do little about--pregnancy, glasses, TB, HIV, outpatient surgery (hernia, gallbladder)--and I refer them to "the stadium" which is down the street, but I don't know that anything happens. I've heard the Canadian hospital is packing up their bags and going home. We need some recon to establish some reliable referrals. And we need the end-all sign. And there is a clinic at this mormon church by the stadium that is closing, we need to get their meds and supplies so they don't go to waste. The medical motorcycle dream dies another day...

GERD/Heartburn (7)
Vaginitis (4)
Headache (3)
High Blood Pressure (3)
Wound Care (3)
Dry eyes (3)
Myopia (2) Need glasses
Ringworm/fungal infection (3)
Chronic abdominal pain
Urine infection (2)
Cold (2)
Dysentery (2)

I've had a couple of dudes coming in with bloody diarrhea, fever and abdominal pain. I treated them for dysentery, although can't be sure that's it. Also, a 20 year old girl with a year of enlarging lymph nodes on her neck. They were rubbery, she didn't have any other "B symptoms" like night sweats, weight loss, etc. I don't know what she has, but referred her for an HIV test to the stadium.

Can't wait for the sign to be finished tomorrow...

Thursday, February 25, 2010

Clinic day 2

Today the clinic was only open for the morning, so of course we had to figure out something to occupy the afternoon with: TO THE BEACH!!!

List of my diagnoses today:
Ringworm (3 cases)
Chronic Backpain
Chronic knee and buttock pain
Itchy eyes (2)
Myopia (near-sighted)
Chronic diarrhea
Knee pain

Definitely a list of clinic complaints above. We did have a 20 year old male virgin with 2 weeks of cough, night sweats and weight loss. Probable tuberculosis, I think. We referred him to another facility for x-ray, TB treatment and HIV test--a blood test of that virginity, ahem ahem. There's a fair amount of TB in Haiti, and often HIV presents as TB. Jason was in a closet (literally) with this guy for 10 minutes--he had a wound in a private part that and didn't want to drop trow in front of the other patients. Sure, you can have some privacy--at the cost of Jason's lungs, not mine. I don't think the exposure was too significant. I thought Jason should get a PPD when back, not necessarily 6 months of isoniazid and no beer. (Can't drink alcohol with those pills). Jason initially wanted some meds for his exposure. After I informed him of his alcohol status for the next 6 months, he agreed with my test before treat plan.

I'm kinda in charge of the clinic. The last resident passed on the key and money to pay the translators. We try to make it better in little ways. Jason reorganized the meds, which were in a little confusing disarray, putting labels on them. We made notes of meds we need; I think a scale would be helpful, especially for the little ones like that 7 month old with chronic diarrhea. Clinic tomorrow and Saturday should be much busier and all day.

TO THE BEACH. The problem was we had no idea where we were living, and how to get back from the beach. There isn't really an address, or cross streets. We are on HWY 2 in Leogane across the street from the big green and yellow sign. That's about it. This is nuts, but Jason's IPHONE saved us. He's got a googlemaps app on it where you turn it on, and with a little pin, it shows where you are. EVEN IN HAITI! I think technology often unnecessarily complicates and disconnects our lives, but damn. That was pretty cool. And it got us to the beach and easily back.

Like everything else, the beach was a mess. Tons of trash washed up on the beachside, with beachside resorts in shambles, but still clear blue warm Carribean waters. I thought about my incoming babygirl and picked up a pretty shell for her. A brilliant orange. Then we got taken advantage of by this dude who wanted 60 Haitian Gourdes for 4 beers, about $1.50 (as I later found out). When I stupidly pulled out a $20 and was trying to figure out how much a gourde was worth, his buddy saw an opportunity and took it, swindling us for our cash. I knew we got worked and wasn't happy. Then he trailed us the rest of the way, looking for more cash. Guess I should be happy they didn't rob us. In protest, I didn't drink the beer. John and Jason doubled up, and didn't seem to mind. Then on the way back, we hitched a ride in the back of a truck like bus with 32 Haitians. That was safe. The number of times I should be dead because I've been in an automobile in Latin America...Lord. It makes riding my motorcycle look like riding in a sedan with a childseat and helmet. When in doubt, just honk your horn, floor it and close your eyes and everything will be fine. I can't believe I haven't seen those roads lined with cars on fire and bodies running around in flames, but whatever. Guess it works for them.

That's one of the things I like about the third world. It's the jungle, man. The psuedo-civilized wild. I'm surprised there isn't more crime here in Haiti. I don't have numbers, but it feels safe--although it's got this brink-of-chaos feeling to it. What's to stop it? I'd heard there's all this international security here--and maybe there is near embassies or the big hospitals, but I haven't seen it. At the same time that you leave the safety of first world civilization behind, you can better connect into humanity and earth. I am in much better touch with my mortality and limitations, here. Any number of things could kill me here--from basic appendicitis to a car crash to malaria. Or even the next earthquake. And I'm aware of this. At home, I think I exist in denial of this basic reality, comforted by the illusion that everything is fixable at the local hospital. Which is nuts because I see people die all the time of things that we can't fix.

This morning, I woke up to the rooster's crow just before dawn. And I just sat there. I didn't have much to do. Didn't have a manufactured to-do list of important crap that absolutely must get done. It was nice, to just be, and kinda feel that rhythm of waking up when the earth gets up, and just breathe a little bit.

Wednesday, February 24, 2010

It's not that bad. Or is it?

After 6 hours in a van from D.R. to Haiti, we finally made it to Port-au-Prince. And my first reaction: where's all the destruction? I didn't think it was that bad. All those images I'd seen on CNN of building after building in rubbles...I wasn't seeing. Just didn't seem that bad. Maybe 1 in 10 was falling down. Most looked ok. I started to devise this media conspiracy plot to make it look worse than it actually was to get more attention and money to Haiti.

Let's just say I was wrong. And it feels worse to see all this in person. It looks just like it does on TV, except it never stops. You drive down a street and get sick of seeing all this rubble and concrete and mess. After a while, I was like, "Ok, I get it. Can we get a break here with a half-way intact block?" But it doesn't care, it just keeps going. It's exhausting and numbing.

Heart to Heart works a few clinics, and one main one is downtown, just blocks from the presidential palace and the hospital that went down. "Ground Zero" they are calling this area. There's just something about seeing such a monument as their presidential palace in ruins that puts an exclamation point on this earthquake's impact. Definitely gets that Keanu Reeves, "Whoa" when you first see it, even if you sweat you'd never sound like that goof. Across the street from the Nazarene church our clinic was at lies the rubble of a 5 story apartment building where 40 died. The other corner was a 5 level elementary school with over 200 lost. Their bodies are still there, somewhere beneath the pile of broken concrete. Creepy and chilling to think about. I couldn't see any body parts, and it didn't smell at all.

This morning we saw some patients. It's a basic clinic setup, not bad really. We've got a bunch of meds--several antibiotics like amoxicillin, keflex, flagyl, cipro, doxy--paracetamol (like tylenol), mobic (an NSAID), prednisone, liquid albuterol, pepcid. In a couple hours, I saw maybe 10-15 patients. Everybody complains of dry eyes from the dust everywhere, and we give them eye drops. #1 most common complaint. I thought they were a little bit needy with that one, but right now my left eye keeps clouding up on me. I might be blind. Or just sharing this dry eye syndrome. Another frequent complaint is "1 month of..." fill in the blank with any number of stress/earthquake related symptoms. Upper back pain (that lady's back muscles were really tight), headaches, stomach bloating (an odd common one that I havent quite figured out yet). Most are just related to being freaked out by the earthquake, or maybe are developing as people's lives are now changed in light of the disaster.

There were a couple good medical cases, too. A 12 year old girl with fever (102) and headache. Meningitis scares me, but she wasnt sick and had no stiff neck. No cough, shortness of breath or respiratory complaint, so I didn't think pneumonia. No diarrhea, so dysentery is out. No body aches or abdominal pain, so typhoid is less likely. And no palpable spleen, which might suggest malaria. We ended up treating her with malaria and giving her paracetamol for fever control, and I told her to come back tomorrow for a recheck. It's nice that the clinic is open 6 days a week so we can do that. With no lab tests or x-ray, that's the best you can do.

The other interesting one was a 50 year old man with chronic vomiting. This guy was cachectic, looked like a cancer patient he was so thin. His legs were the size of 2 of my fingers together (yes, slightly larger than my own calves). He had been vomiting most of the food he ate for 2 - 3 years. YEARS! This guy needs a doctor. Like in 2007. Anyway, we treated him for intestinal parasites and told him to come back in a few days. I want to do a CT scan of his belly and an upper endoscopy to look at his stomach with a camera, but I don't think they even have 1 CAT scanner in this country, let alone for me to use on this dude. X-ray studies with oral contrast is a realistic option, so if he isn't better when he comes back, maybe we'll refer him on to the big hospital, but who knows if they would do anything.

In the afternoon, Jason (the Mendocino from St Louis) and I were thrown out to the beach clinic at Leogane. Not the glamorous beach I hoped for. Actually, a Mennonite community where I already broke the no cursing rule when I was being devoured by those little mosquito fuckers. Nobody heard. Except God, I guess. And I think God would call them fuckers, too. Anyways, the Mennonites are very nice to give us a place to sleep, shower and eat. Word is they "fatten you up" at this place the food is so good, as opposed to the 2 squares a day at the other one.

At the afternoon clinic, there were 3 docs: 1 OB from KC (Children's Mercy), and 2 residents. I was on the sidelines getting a feel for how it goes, and then slowly assumed my thrown as alpha male attending, the one to rule them all. Not really. But I did circulate and help. The OB asked me about this guys infected hand and swelling, and I showed the med student how to numb it up and put a needle in there--lots of pus. Gotta love the success of draining pus. Another guy had a chest wound "from the earthquake" which we later found out he was really STABBED WITH A KNIFE. A little white lie I suppose. No pnuemothorax, he got wound care and antibiotics. We send the med students on him, too.

Other basic things so far: vaginitis, headaches, one prenatal patient 34 weeks along who hadn't seen a doc in almost 3 months, lots of wounds, burns, and even our favorites of back pain. Thank goodness there are no narcotics here. My nightmare: go to Haiti and get a clinic full of chronic backpain Haitians wanting Vicodin. Ahhhh. I'll take the abscesses and malaria every day.

Monday, February 22, 2010

Travel Day 1

I hate traveling. Sometimes. Like today. Jules and Audrey (my roommates) say I get "grumpy" when I'm tired. Well after a day of travel, I'm grumpy in the Dominican Republic. But at least safe and sound.

5 hour flight from SFO to Philly at 0830. After sitting on the runway for 2 hours, a 4 hour flight to the Dominican Republic, since flights directly in to Port-au-Prince are still unreliable. Had to get up at 430 to take BART at 530...blah blah blah I'm crabby and need a nap. It doesn't help that I worked a 16 hour shift in the Sonoma ER Saturday night, slept some Sunday day, then hosted 3 of our group (Jane, Jason and Jeanna) at the house, then decided to finish my Massachusettes medical license application and 2009 taxes instead of sleeping. Brilliant.

Airports are airports. I won't bore you with any further details.

But people are not just people. We met 2 Irish folks sitting in front of us on the flight to D.R. Part of the national network there, being sent down to do a Haiti story. It was interesting, they were kids like us, in their 30s. Guess kids are doing a lot these days. She talked about taking different angles to the story--international vs local control, the negative effects of US trade agreements with Haiti, and some other things that I found interesting at the time but just can't remember now of course. Jason shamelessly said they could follow us around..."We're both good looking." I quickly changed the subject, asking them more about Dublin. But don't get the wrong idea--I'm much more shameless than Jason.

The long day of travel had a happy ending--El Presidente light beer and pizza waiting for us at our hotel. I love Heart to Heart--the organization we are working with. They appear to have their stuff together. At the airport, someone was waiting with a little sign for us. One of these days there will be someone with a sign "Dr Lorenz" waiting for me with a limo or something. With some Cowboy cheerleaders, too. Maybe not in Haiti or the third world or ever really, but I think you get me. Anyway, the sign, van and pizza was nice. And I love shitty Latin American light beers. El Presidente light is basically Bud Light, Latin America version. After a couple of those, I'm ready for bed, and to get up in 3 hours for an 8 hour UN van to Haiti.

Two more things--the tile in the bathroom is amazing. Given my 2 recent tile jobs, had to include that shoutout and admiration of the Dominican handiwork. Finally, I get over 400 + channels in Spanish in this room. Don't worry, I'll be on the floor in a tent tomorrow. When the guy showed me the room, the first thing he did was find the 3 "adulto" channels on the TV. Hilarious. I asked him to find me some bad telenovelas and dubbed 80s action flicks with the governor of California.

Tomorrow, to Haiti...

Haiti blog

I haven't left yet. I have nothing to write. Come back later when we've something to talk about.

Thursday, July 31, 2008

Is there a doctor on the plane?

Camilo, thanks for the encouragement. Witness is a big word.

My plan was to wrap this little blog up. Most of the sexy stuff worth writing and reading over. My final thoughts about the whole experience, the processing and reflection, will take days to weeks, a lifetime, I imagine. I'm not ready to write about that--still need to sort more of it out for myself. And as much as I would love people caring enough to read the details of my adventures heading home through 3 days in Nairobi and 16 hours in London, I dunno--seems a little presumptuous (not like the rest of the blog wasn't, but nevermind that for the time being).

But, by popular demand, the blog goes on. Yes, someone actually requested that I continue to write about these things, and include the goings on of travels and the week long international AIDS conference in Mexico City. I thought about it long and hard (ya right) and well, because you twisted by arm...

The blog continues.

Let's start with the story from the title...


A 9 hour flight really isn't that bad. You just watch a bunch of really crappy movies (like, Definitely Maybe, Jumper and another I forgot it was so bad--Drillbit), talk with randoms, and take naps. Like more than one nap. You can also drink beer.

I was 6 ounces into an Amstel can when I heard the following:

"This is your captain speaking and I would like to say bla bla bla

The call to action. I imagined myself standing up, busting my shirt off button by button like Kent to Superman, with my red cross shirt on underneath (it was), and stethoscope around my neck, ready to respond to duty's call.

This is not the first time this has happened. I'm kinda an ambulance chaser. It's always worked out just fine, before. And by fine, I mean, I feel really cool saying, "Why yes, I'm a doctor," and then not having to do anything because someone's already there taking care of everything. I've actually never really attended anyone in the field. Except for the lady that showed up with chest pain at my house, but that's another story altogether.

So, they ask for a doctor, and I was drinking beer, watching movies wondering, "What did they just say? Should I be attending someone a little buzzed at 16,000 feet?" So I ask everyone around me if they were asking for a doctor, just to let the entire right rear section of the plane know that i was, in fact, a physician. Would have been more efficient to just jump up like Leslie Neilson in Airplane and say, "Yes, I'm a doctor," throw the stethoscope over my shoulder and just march to the front of the plane with my chest all puffed out.

But I chose the more subtle route. I just sat calmly and hit the waitress button once. She didn't come. This was a medical emergency. They needed me--they said so overhead. They just asked for a doctor, I'm a doctor, I'm responding, and they're not coming. I felt like hitting the waitress button continuously until they came--"buong, buong, buong." But the Amstel hadn't drained enough of my senses to know that would have been absolutely ridiculous, so I waited patiently.

Finally, I grab one of the waitresses, and tell her I'm a doctor, asking what's going on. Never at any point, mind you, did I really think this through. A plane is about the worst place to have to see a patient. What if they were having some life threatening emergency? And I had to make the call to land immediately? Or what if they had something that might be really bad, but I wasnt sure. Ironically, the plane was limited like the third world in terms of supplies and medicines, so I should have been in familiar uncomfortable territory at least. Nonetheless, did I really want to see this guy?

"They've already got someone."

What? A combination of relief and disappointment. But I'm a doctor, and you need me. Who did they get? What kinda doctor are they? Do they need backup? A second opinion?

I mean, this was my chance. After 2 years of residency where we take care of ICU level sick patients, I was ready for a little airplane medicine--not much in comparison. I totally wanted to save the day, be needed and put my training to use. As opposed to when the woman who showed up on my doorstep the first month of intern year, I was ready.

In Mountains Beyond Mountains, Paul Farmer landed many a seat in first class because he had, on numerous occassions, responded to such calls on flights. I was totally wanting to start that kind of a relationship with Virgin Atlantic.

Not meant to be. Some other doc took care of it. Looked like appendicitis, according to the waitressing staff. They gave him some fluids and antibiotics, and hauled him off when we arrived. Interestingly, there's quite a protocol they have to go through in order to administer medicines. You have to get the captains approval, then they have to call some consult service over the phone, and they have to check out all the doctor's credentials, etc. At least they didn't call on my credentials and shoot me down because I'm still a resident. That might have been a little embarrassing, "Uhm, is there ANOTHER doctor on the plane?" They've apparently got quite a slew of medicines, in addition to the automatic defibrillator.

Rest assured, Lorenzy, you're time to save the day (or deal with the tough airline cases) will come soon enough. With an 11 hour flight from London, and 2 flights to Mexico in the next 3 days, maybe sooner than you'd like...