Sometimes, the power must go out

1/24/12

We returned to work yesterday after our weekend of rest and relaxation. We returned to San Juan and found it surprisingly cool. We ate dinner and went back to the hotel to settle in. The next day would be a light one, at least on paper. Just a hernia and a scheduled washout of the femoral osteomyelitis (bone infection) on the 12 year old boy that Dr. Henry had initially debrided last week, but which the boy (Oliver) has been struggling with for months. If the planets align correctly, we could even be finished by noon and help the clinic team. (Of course, the planets never quite line up as we wish them to, and to plan your day around it happening is ill advised. I'm not a follower of astrology anyways).

I stayed up later than I should have due to an ill-advised game of team Scrabble (but at least Abby and I won with some come-from-behind double word score brilliance). No worries, I have perfected the MacGyver method of morning coffee and had everything set up and ready to go at 5:18 sharp. Alarm chirped at 5:00, I hit snooze twice per routine, then plugged in my immersion water heater ($5.99 on amazon) and sunk it into my 20oz thermos filled with filtered water. In 4 minutes it would boil and be ready to pour over some coarse ground beans in my French-press equipped Nalgene bottle. It WOULD be ready to pour had everything not gone suddenly dark and silent. The fans all stopped too, and though my coffee water stopped heating up, the room itself became still and hot. Fearing that I had blown the hotel's fuse, I walked out into the courtyard and feigned ignorance. I would later find that the outage was city-wide, so I think I am off the hook.

There was enough natural light for us to get ready for work. The water heater in the men's shower had never taken advantage of available electricity anyways. We still managed a hot breakfast since the clinic kitchen runs on propane. The hospital has a generator, so the outage should not affect our work there either.

Francis had left the evening before on a run to Santa Cruz to get more supplies and medications. The clinic team had added another Bolivian physician as well as Scott and Julie in the dental room. All together, this put us in real crunch for interpreters and I still do not habla mucho Espanol. The hospital team would have only one; Sandra. She is an excellent interpreter and a hard worker (her English is excellent as she spent two years in Ohio), but has yet to learn how to be in five places at once.

The day started with the usual "Where the heck is our patient?" causing us to send for Oliver instead, thinking we would get his short leg debridement out of the way so he could head back to his room at the health center (he is staying there for daily IV antibiotics and painful, deep dressing changes) and eat. By the time he got there however, so had our other patient who had been promised a morning time. Moreover, the head Japanese nurse would not allow us to do any other operations after Oliver since his leg was infected and would somehow permanently contaminate the operating room (though this didn't seem to be an issue last week). We complied so as not to offend our hosts, but this would put poor Oliver into an indefinite holding pattern wherein he would sit alone on a wooden bench with no food or entertainment. Any further cases we would find would bump his back even further. We felt bad for him. He has been through so much and always with a smile (always except when we are changing his bandages, that is). We did end up finding another case too - a bilateral recurrent inguinal hernia that would take a few hours to do (recurrences always take longer) on a man who had travelled many hours to get to us.

The morning was definitely off to a slow start. In addition to tardy patients and haphazard diplomacy with head nurses, the local orthopedic surgeon asked me to see some of the Japanese patients that had come in through the night (the Japanese general surgeon is out of town for the week). They were both elderly patients with potentially acute abdomens and both appeared quite ill. One was a 74yo male with typhoid and an ileus, but thankfully no evidence of perforation. The other, a 93yo woman, emaciated and moaning, who had been vomiting blood and with an apparent bowel obstruction. She was quite anemic and was getting short of breath, a bad sign when it is due to a problem in the abdomen. Her son seemed bewildered and concerned. These would not be quick consultations and would sideline not only myself, but also Sandra. We would not be able to start our first case until 10:00.

We had numerous obstacles in getting things started. The OR is out of anesthesia papers and the office was locked, thus requiring our one interpreter to ask for the key. The oxygen tank was empty, requiring our one interpreter to find the one man with a wrench large enough to change it out for a new one. The other patients' families had questions, many questions, all of which would require our one interpreter to answer. And Oliver, poor hungry uncomfortable Oliver could only wait. Siesta (11:00 - 2:00) was now fast upon us too, meaning the rest of the hospital staff would disappear and it would get even more difficult to move things along. And still, Oliver would wait.

I was frustrated and I felt like others were frustrated with me. Better planning from the medical director could have prevented this. This shouldn't be happening now into our second week. I felt pulled in multiple directions, which required me to pull our interpreter in even more directions, which I could tell was frustrating to her as well. Scott, our dentist, had shown up to look for some equipment and asked if I was alright. Moved by his concern, but was my frustration so apparent? I must have been wearing it on my sleeve, which only frustrated me further. And as soon as I start to indulge in self-pity, there is the 93 year old woman suffering through what may be her last day, and there is Oliver.

Of course, Oliver is now grinning from ear to ear. He is sitting on the same bench, but now he is with Fran, one of our wonderful OR nurses from Winnipeg. They are laughing together as she teaches him to play video games on her iPad. He would learn quickly, and she would entrust her iPad to him and his dirty little fingers, unsupervised, for much of the afternoon. She would come by frequently to check on him, to re-charge the battery, to make sure he wasn't lonely, and to imbibe in his infectious smile (Oh, were that the only infectious part of him).

The best advice is usually the hardest to follow (otherwise, there would be no need to offer it). I recall my dad once telling me (during the years where I directed a summer camp, having every detail planned out down to the minute) that the whole purpose of my well-laid plans might be to serve people, but that those in greatest need would likely show up as an interruption. At that point a decision would need to be made; put your head down and serve the plan, or set it aside and serve the interruption for whom the plan was all along intended. Today, I would again learn this lesson. It was a frustrating day, but then again, how would we learn anything without such frustrations, such interruptions.

In Mark 5, Jesus is on his way to heal one person and is stopped in his tracks by an unscheduled consultation. The scripture says he felt the power drain out of him (He who even has an infinite supply of it). He was also likely being prodded along to get on with things and attend to the task at hand (that task itself another person in need). Jesus is God, but he was also human. He had the same decision to make, and he chose to stop and not only heal the woman, but also to take even more time and affirm her faith and speak into the life of one who had likely been long ostracized by her illness.

I have a feeling I will need to learn this lesson again at some point, but for now, Fran's small demonstration of Christ's love for Oliver serves as a crystal clear reminder that we are here for the blessed interruptions. It would empower me to return to the elderly woman and take time, as much as required, to explain her plight and console her already grieving son - she would die that night. I am sure I will need to learn this lesson again at some point, and at some point that may just require the power to go out once again.