June 28, 2010. Petit-Goave, Haiti.

“Another turning point, a fork stuck in the road,

Time grabs you by the wrist,

Directs you where to go,

So make the best of this test,

And don’t ask why,

It’s not a question,

But a lesson learned in time.”

–Green Day, “Time of Your Life”

Ah, calm seas and a gentle night breeze. Tropical Storm ‘Alex’ made things interesting for us over the last few days.

At the western edge of the bay of Petit-Goave, we were exposed to a 5-6 foot swell rolling straight into the bay, with 35 mile-an-hour winds holding us beam-on to the seas. Misery! Imagine that your house is the head of one of those bobble-head dashboard ornaments. During a break in the weather, we moved the boat under the mountains at the eastern edge of the bay, giving us much needed protection and a good night’s sleep. We are getting ready for the 800-mile transit to our destination in Honduras…fueling, taking on supplies, clearing the decks, lashing down gear, ballasting the boat, and the thousand small things that have to be done to clear Southern Wind for a crossing.

Most importantly, though, we are waiting for a weather window. Tropical waves are continuing to pass over this area. The water between here and Colombia is pretty rough and pushing north across our course to Honduras. Alex is messing up the whole western Caribbean—not a good time to push your luck on the water. Besides readying our boat for sea, we have also used the time to say farewell to our friends here and to catch up on some last minute patients. The farewells are very, very difficult for me—to see people and places that have become important to me grow smaller and smaller until they disappear below the horizon.

To know what and who is still left behind with so many problems remaining, to wonder what will become of everyone is hard. I think of Yvenson, Bichal and Jonas, the three boys who canoe out and work with us every day. They learned to drive the inflatable, which they love and pilot very, very well, with the air of quarterdeck seriousness only a 12 year old could muster. They showed me how to cook breadfruit, helped us in our shore clinics, fished off the boat, and walked around town with us. There are Jean-Francois, the clinic head nurse, Fritz and George, who have helped translate for us, Dean and Jonel, who rowed out in their canoe when we first moved the boat to the western edge of the bay and asked us to do a clinic there and have helped us organize all our shore clinics……there are so many.

What makes it hard is that these aren’t just our helpers or translators or clinic organizers. These are our friends. It was hard to say goodbye in Florida but we have managed to stay in contact with some of our friends there. Here that is a much more difficult proposition. And for me, it is hard to leave after treating so many people. Practicing this kind of medicine sometimes becomes a blur. It feels like drowning in an endless sea of pain, but there are always people I connect with that remind me that each patient is a unique life, desperately important to that person and the people who love them. Sometimes it is hard to see the individual human beings in the forest of illness and sickness, so the patients that are necessary for me are the ones that I had a particularly positive effect on, sometimes helping make changes that will reduce illness and pain for many years, or when I was able to be the instrument that holds off death and loss one more time.

This is what sustains me and helps me keep going in the midst of so much human misery—that, and the way I have been thanked everywhere in the world I have done this. Here, when people say thank you for helping them, they mean it with every part of their being, because the help is needed so badly, and it is appreciated. Every day I can’t believe how lucky I am to be allowed to help. I will never change the world; no illusions about that. The sea of pain was there before me and will be there long after I am gone, but to have been fortunate enough to be able to extend a helping hand to even one person floundering in it is the greatest feeling in the world.

Tomorow, I am skiffing around the west point to check on Roland, the guy who cut his big toe in half with a machete and had his friend row him out to our boat. If he had not come out to us, I think he had about a 50/50 chance of living. With that injury, on the foot, in this environment, infection and septicemia would have been a very high probability. With no medical care within reach, he might have survived with a village amputation, if he was lucky. We cleaned the toe and gave analgesia. He was kind of in shock by the time he reached us. We administered an injection of antibiotics immediately, transported him across the bay to shore, flagged down a funeral van and begged a ride to the hospital, saw that he was x-rayed (first bone in the big toe split neatly in half, but not displaced), sutured and casted. We provided oral antibiotics that the hospital was not going to give. Now he has a 50/50 chance of keeping the toe. Roland’s injury will take many weeks to heal, and after we go, it is patients like him that I will think about at night, wondering how they are and hoping that they are ok. Tomorrow, I am going to change Roland’s bandages again and give him enough material to change it until it heals. I will show him and his wife how to clean and dress the wound.

All I can do is everything in my power, and the result is out of my hands no matter how much I wish it were up to me. Sometimes being a doctor means being the instrument of a cure and getting the result you want for your patient. Sometimes it means that all you can do is try to manage someone’s pain and fear as best you can and to be with them during a lonely death. And sometimes it means that you get to give people a fighting chance, like the guy with the injured toe. I sleep better at night when I know that I did everything in my power to help people like Roland get the chance to heal that otherwise would not exist here.

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