Sunday, May 18, 2008

Problemas de Corazon

They say a man shouldn't cry or that he should bite back his tears because "boys don't cry" (especially not in baseball). I think they should change that saying. A man should totally cry, he should just go outside to do it.

I scribbled this in my notebook 5 minutes before I went to tell a person about the options of life and death (oh yeah and the options are kinda like a life that is half death (dialysis) or a life with undetermined expiration (the bandaid of diaeresis until medicine functions no more). Within the whole life saving medical field, I realize the importance of such chats. I think I'd respect those that chat'em well. By now I more or less understand the medicine. I understand the docs like life. I know the fam needs to hear the options and hearing it changes their world.

In these 5 minutes of prep I was crying inside. I wanted to tell the fam how much I'd come to love them and how I am just as scared as them. I wanted to tell them the American docs are yes, Americans, and yes really great looking and yes they dreamed of this scenario from dubbed tv... BUT that they are not magicians. And that yes, we Americans in general and even more in comparison to them have lots of money, but that we'll never have enough to save this particular patient.

Then I went into the consult room and sucked it up. And I said and translated what we needed to say. And I said it while caring but while being "manly" and not balling. And while I was in the room with patient I thought of my conversation with Mike and what it means when we say "I'd come to love them." Anyways the daughter has chubby cheeks and chubby arms and really telling eyes but a really really really way stronger than me heart and mind. I felt super weak and unprepared. I told someone else this story and they responsed: " I am heisitant to say it.. you are too sensitive - I'm not sure I'd like anyone else to do such a life-and-death talk. Bien hecho, chiquita."

Well done, I hope. Exhausted, worn, but also really good and proud, I feel.

Saturday, May 17, 2008

Como no?

I'm 22, I know. I'm 22 and I'd like to call it a retirement.

May 26, 9:26 PM, email to THE Foundation

Hi all,

I´m writing to let you know I would like to pass on the coordinator position at the end of June. I´ve had a fantastic experience here. I think this clinic is awesome and provides an amazing amount for an amazing amount of people. This experience has been super influential on me and has inspired me to want to pursue further studies in non-profit management and development.

I feel I have put everything I could into doing this job well and I hope I´ve done a good job. At the same time, I have been overwhelmed by 6 straight months of non'stop work. I realized this when I had dengue and emotionally and physically I am realizing this again (hopefully without a repeat medical case). I´m also sensitive and my heart is starting to feel a bit raw. As you all know, the coordinator job is challenging. Of late, financial issues have been the most draining on me.This experience has taught me this is the kind of work I want to do in my life. I want to gain the experience and knowledge to really make a difference.

I hope to always be connected to this clinic and connected to Bolivia. I would love to re-visit this experience again when I have the skills and energy to make a real impact. For now I want to help facilitate the transition to the next coordinators. I´m working on some new forms, will draft a working training manual and will devote myself and Maria to pass on (in writing) everything we know.

I´m still in it heart and soul, my heart and soul are just tired.

Abrazos,
Rachel
__________

I think the American founders already knew. They know this job is untenable. They know that when dengue and deportation are vacations, 'burn out' is the trifecta perfecta. For all it's worth, my email took my Bolivian Jefe Dougman by surprise. I love him a lot (because everyone is loveable when you get to know what makes them shine) and I have enjoyed working and learning with him. This last month will be hard. I will be sad to go. He asked me in a Skype conversation from the States last night why I hadn't talked to him about this. I said, "because Douglas, in 6 months, you never gave me the chance." I told the truth. I care about people and no matter how frustrated I was, I care about him. Every Monday and Tuesday morning I enter the office to see Doug stressed and overworked, and almost always on the onset of depression if we add the foundations work to the mesa. If I were ever feeling stressed and overworked and overwhelmed, the last thing I wanted to do was tell him... just the other day he showed his shaking fingers...how effective would it be if we were both temblando juntos?

When Jefe comes to the clinic, I love it. I am always energized by his spirit and passion. On the Mondays and Tuesdays we have no money. On Mondays and Tuesday the sustainability of a chronic care institution that provides specialization and surgery yet has NO MONEY, drives us nutz and keeps us humble (and by that I mean internalizing a lot of pain and defeat).

This week my brother and I had the life and death talk with the dialysis patient we've been following (the one Susan found). We said her body seemed ok, but inside was failing. We discussed Argentina (where she has a daughter and could move to receive dialysis covered by the State). We discussed the limits of our treatments here in the clinic and how we can attempt to help for now but no one knows how long the help will make a difference. I made the band-aid analogy in spanish. In waiting rooms, during dialysis, while communicating and coordinating their care back and forth to palacios, I got to know this mother and daughter. The daughter is my age. At 22 she is dealing with the unimaginable. This was my first life and death talk. That I've heard. That I've thought about. And that I've given. My reality of understanding her situation, and the situation of all the patients we help, is only a very very very tiny piece of the weight of hers. When they left the room I sat with my brother. It took less than the closing of the door, for me to break down and cry. And I mean CRY. I know what we are doing is good. Maybe every consult, every treatment, every chat makes a difference. Maybe we involve ourselves in things that might be more natural, less difficult, less complicated and introduced to false hope, than if we leave them alone.

I realized about this position that the coordinator is stressed so that everyone else can be happy, can learn and treat patients in ways that they'll probably never forget. In my 6 months of being challenged and being overwhelmed and acting as Indiana Jonesina, every single volunteer has told me they had amazing time and has thanked me for helping make the experience possible. I've been told that people can tell the job is stressful but that "externally I handle it well." Damn external shells. I bet my shell is still not transparent. However, when I stopped being able to feel the difference inside, I new it was time to move on. I tried to tell Bossman it doesn't mean i didn't love this experience, give to this experience and learn from he and his clinic any less.

Friday, May 9, 2008

Autonomia carajo!

Now it is May and what has happened? hello friends and families. some say time flies. i say it bursts like a synapse with many bright colors, some strong smells and vivid flash backs-forwards-sides, with no communication between the explosions.

4th of May 2008
ahhh the date that will be forever known as Bolivian un-independence. In your CNN and NYTimes surfing of late, you've probably gotten a good glimpse of the Bolivian red yellow green flag. You may have heard that Bolivia is a poor lil country, robbed of a coastline and reigned by 173 presidents in 193 years.On Sunday I would say the rich whitish urban elite (meaning few) made their modern concrete move to smash and conquer the pobrecito indian rural campesino majority (meaning many). Evo tried to start the revolution from the bottom up... flipping over the bottom of the last 150 years of oppression. Unfortunately his indigenous social movement doesn't have any money nor business sense. On Sunday Santa Cruz de la Sierra, the region with ALL the natural resources and foreign investment, voted themselves Autonomia. The YES votes tallied more than a 87% margin. All the 'No' voters had two choices: get beat in the streets or get fooled by churrasco chancito (pig feast) dinners. Let's just say one can suspect not too many "No" voting potentials made it to the polling booths.

So that was the big day. Founder Woman Super added on a few days to her trip to stay as an International Observer. Have people heard that foreginers do this during contested elections as a citizen's kindness and as a fill in for Jimmy Carter when he can't make a personal appearance? All remained more or less calm inside the city. The news and the stories from friends were pretty horrendous: blockades, clashes, giant sticks with nails on the ends, stones, fists and feet, Guinda our nurse from Yapacani calling to tell us "The houses are burning." They really, really were. That all happened night before to day of. By night fall the Autonomistas took over the main plaza to have a gigantic celebratory drink dance and music filled celebration. We were there. In the gringo Irish Pub we drank some Bock and ate some Pique Macho. I may have been quiet about it but I did remember to recognize the contrasts.

the Friday before before:
One of these Thursdays before this Friday I spent in the jungle. I feel I may have dangerously messed with the hands of God. The sense it makes is nonsensical. Basically there is this young39 yr old man with Mitral St,enosis. Mitral Stenosis is a valvular heart disease that narrows the orifice of the mitral valve which day by day narrows ones possibilities for continued oxygen, blood flow, and life. The Solidarity Bridge is this non-profit organization that popped out of the wood work to offer free hearts, widen lives, and all that jazz. Anyways I got the green light from Solidarity Bridge on day Wed, took a field trip to the middle of the jungle to find the patient on Thursday, went to the city and waited and waited and waited on Friday. Javier de San Juan de Palometillas was a no-show. I never actually got to talk to him. I found his tiny hut, met his really dirty really tiny children and talked with his really sweet really innocent wife. "Ya ya doctora" is how she responded to my flash explanation of 1. valvular heart disease 2. importance of operation 3. immediate plan to get her husband evaluted, scanned, units of blood collected and SYNAPSE into surgery the following Monday or Tuesday. Her "ya ya doctora"s got increasingly less believable as her physical reaction became more and more real, heart-breaking, reality slapping by the minute. Javier works out in the Chaco to support his 4 young girls and 1 wife. They have nothing. He works when his heart feels ok. The wife was glad this week he was feeling ok and was working and will bring home something. We didn't talk about recovery time or how the family was gonna survive when their father went through the recuperation period of don't walk, don't talk, don't cough, don't lift more than 3 pounds. We also didn't talk about what will happen when this family doesn't have a father at all. I gotta hand it to ya God.... you have some tough work.

Ohhh yeah and the other heart patient, 61 yr old mitral stinosis A-Fib currently coagulated by us... is in pending surgery tambien. Every time she sees me all she can think of to say is "Miiiissss Raaaaaaaachhhelll. Mi angelita." Man man man, I wish I had never seen that Touched by and Angel CBS show where the presence of an angel didn't necessarily mean a life saved.

One Monday-Wednesday, Thursday May Day and then Fri Sat jungle clinic
And then this part their is really no way to start. The end will be when I see you next. Hmmm clinic drama is as follows: We met this 8 year old patient with the first name Bill Clinton Last name Sebollas Roca. His dad liked the way it sounds. And then Susan(Founder Super Woman) called the "contact Al Gore" number when we learned of the inconveniencing truth that these autonimista possibly racist land owners are trying to buy out the clinic land (26 acres of 150 acres of preservation) to cut down the forest, eliminate the clinic and start planting and farming a whole lot of pesticide laden sugar cane. Kinda nutz I know. They offered our clinic founders new land and the promise to rebuild our clinic anew, as is, but in a different location. This is all we talked about for a good 5 days. Susan wanted to go to the press, call the environmentalists, chain us and all of our patients to the trees. The contract was to be signed on Tuesday. It's now Friday and some exciting dramatic news stories have no follow-up. Oh yeah I also think this is not some random accident. It's too hard to explain Autonomia and Coilla Camba but I think this is an extremely strong and blatant racist move... that fights the Evo bottom up social revolution.. and displays a smack-down come back of serious oppression.

Oh yeah and we dont' have any money. Like seriously, NO money. We=the foundation. Yeettttt the founders were here so we started $280 a day dialysis to save a kidney failure diabetic, discussed buying a new lawn mower (right now our care taker maintains the clearing of 3 acres of jungle with a ELECTRIC POWERED lawn mower with tiny tiny cutting blade and a really long extension chord) for $500, shopped for printers/fax to total $600, met with our Knee Guy who needs an $8,000 operation so if TAL VEZ, maybbbeeeeeeeeee, someone can save his leg.

Yeahhhh maybe I'll become a business consultant. It sounds horrible but I'm starting think that's the only way to save the world. Money is the problem, when u have it, when u don't have it, when u think u might want it. When your rich you get blind-sided and can't pay for enough breast augmentations or when your rich and you get blind-sided and don't realize no matter how much you earn you'll never have enough to save and help all the people in the world whose needs meet your attention. If the rich are blind and the poor are too seeing, what does that make me?

Silly doctors. I hope they help me diagnose my synapses when I get enough distance from this intense, non-stop, incomprehensible, heightened comprehensive, experience. I think if I were really a nut-job and really untrustworthy, I would understand less and maybe not feel at all.