TEsting my utter limits

Thanks for alll of you for tolerating all the stupid mishaps of getting to this page, its kind of like how things are for me here, nothing is simple!!  First off, I want tothank the generous congregation of St John´s Episcopal in Salisbury for the fantastic donation for supplies here.  Last night, our director Dr Alex, left on an open boat from Anse a Pitres to Jacmel, about a 6 hour journey where he will buy some needed stuff like a baby scale that broke and some rapid HIV and urine pregnancy tests with $200 of the money they gave me.

I´m still trying to conquer the challenges of posting pictures on this blog.  I think you would like the pictures of the colorful boats, fishing nets, clinic sites, and of course the characters I will be talking about.

 I had the most clinically challenging day of my life yesterday.  After a sleepy weekend, withjust a few pts dripping in with common complaints, yesterday morning I was called into the little ER to see this 8 year old kid who had been hit by a motorcycle.  He had a serious deep laceration in his back, just above his buttocks and Alexandre tried to get the border guards let him into the DR to go to the ER inPedernales, but because of the cholera or because someone was a pendejo, they wouldn´t let him in. So I tried my best, cleaned the wound which was about 2 inches deep and 3 iniches wide and spent 2 hours sewing him up.  The kid was really brave, the anesthesia seemedto make it tolerable and now I have to just pray he won´t get an abscess, we will see him every day until we´re sure hes´OK.  That was stressful enough, trying to stumble through kreyol and find all the suture stuff and maintain some semblance of sterility in stifling heat, but then Alex tells me ÿou hve another accident waiting for you¨´  The doctors here, by the way, seem very dedicated and knowledgeable but do not do any surgery...anyway the cholera tent is now full so they and the nurses have been working around the clock, and everyone is exhausted.

Anyway, the next guy had gotten his hand caught inside a car motor and had done a good job of mangling his middle and ring finger, the index was swollen and painful, crushed but not broken. One finger was similar to wounds I have fixed in the past, but the second one was somewhat dangling atthe very tip.  Again the border guards wouldn´ñt let him through, so I did a feeble attempt to sew up what I could, after cleaning the wound and bandaging him up, giving him IV and antibiotics.  I did some heavy praying to all the lwa, La Altagracia, La Virgin de Guatalupe last night and today if he is worse I will sell my soul to get him some proper care.

Then, as I was shutting the door of my consultorio, looking forward to the walk home inthe fading sun and dying for a beer and a cigarette, with Alex hurrying to catch the boat to Jacmel and the other DR, LaMartine, exhausted and asleep in his room, in stumbles this phantom of a person, skinny, coughing blood, bleeding from the nose and lips, covered with kaposi´s sarcoma!!!  I came crying to Alex who was getting dressed )the doctors and a nurse live out behind the clinic compound) to come help me with this person.  It turns out he knows him, he had been in an HIV program at one time but stopped coming or something.  I guess he had just gotten really sick witha fever the night before, so his family, quite nonchalantly, brought him here.  No one protecting themselves from his cough or bloody belongings....Alex too was pretty relaxed about it, but he did wear a mask, as did I and Istarted and IV )something I haven´t done since my nursing days in Maine) and gave him some antibiotics for the kind of pneumonia that people with HIV have. 

So as you can see, it was not a boring day.  Thanks for listening.  Since I am reading ¨Cutting for Stone¨ an amazing book about surgery and practicing medicine in Ethiopia in the 40s,50s,everything seems particularly megadramatic, you know how it does whenñ you are living inside a book, but now I have two fantasy lives, and one is real!