Friday, July 15, 2011

Gladeis' story...from Brendan's eyes

This was written by Brendan, one of the med students on our last medical trip a couple weeks ago.  It's a snapshot into some of the tough situations these medical teams deal with.
From across the diagnostics/treatment tent I see Dr. Josh gesturing for me to come over.  It is a rudimentary establishment, some blue tarp extending from the side of a clapboard-and-t in building, propped up by metal poles on the far end.  A plank laid across two wicker chairs serves as
a backless bench for waiting patients.  It is only late morning and already the temperature is climbing into the 90s.  Although the tarp offers a modicum of shade, the sun's heat combined with the moisture emanating from roughly two dozen bodies crammed into a tight space make for a tropical microclimate.  As I make my way over the treacherously uneven ground I realize there is no classy way to wipe away sweat as it pours down the bridge of your nose.

"Put your stethoscope right there," Dr. Josh says quietly.  Gladeis Jeanly, a slender girl of seventeen, sits quietly on one of the wicker chairs borrowed from the adjacent shop.  Her face remains expressionless, but the sidelong glance she is giving me speaks of trust, tempered with wariness.  "May I?" I ask, gesturing to the bell of my stethoscope.  She nods silently before Jaques the translator even says anything.  As the earpieces nestle snugly within my ear canals, I hear the background noise fade to a muffled hum.  Nearly all of my sensory input now comes from that device.  As I slide the bell into place on her left chest, my eyes barely recognize the satiny red fabric of her dress.  My brain is disregarding their input as superfluous; what matters is the sound that is being channeled from within her chest to my ears, and that sound is unsettling.  "Rheumatic fever," Dr. Josh says "or at least, that's what we expect happened.  We weren't here." He explains the auto-immune disorder that occurs with a certain strain of untreated strep - the body begins to dissolve the valves of its own heart in a woefully misguided attempt at attacking the infection.  For whatever reason, rheumatic fever is incredibly rare in the U.S., but it seems to be disturbingly common in Haiti.  

A healthy heart makes the familiar lub-dub noise when you listen to it. A heart with a "murmur," as a leak is referred to, sounds more like lub-swish as blood escapes the heart chambers through a faulty valve.  The only sound coming from this heart is an agonizingly long, unpunctuated  whoosh.  "We've been following this case for about two years now," Dr. Josh says. "We had an echo-cardiogram done. We suspect that she got over the strep years ago, but now all of her valves are completely gone."  I stare in silence for a second at her chest wall, imagining that heart pumping in vain, raggedy valves flapping uselessly.  "So. what do we do?"  Dr. Josh's jaw sets.  He says nothing for a while, and then, quietly: "This is why it would have been nice to see her when it was just strep."  

He sits back down in his chair across from Gladeis.  They look at each other for a few moments wordlessly, Josh sweating beneath his weathered Hawkeyes baseball cap, Gladeis in her red dress, hands folded in her lap.  The sun filters through the tarp above and washes the entire area in a faded pastel blue.  Josh shifts in his seat, not looking away from her, but obviously grasping for words.  He makes a glance at Jacques the translator sitting next to him, who nods in acknowledgement.  Turning back to Gladeis, he says: "What you have is something rare in the
United States."  The translator quickly iterates the Creole version.  Gladeis remains stone-faced. Dr. Josh continues: "These doctors here, they don't see this disease that you have.  You are teaching them."  A blink from Gladeis.  "Because of you, other people will be better."  Blink.  "You should be proud."  Maybe a slight nod, maybe just a tiny bow of resignation.  

I've had the stethoscope out of my ears for several minutes now, but the background noise seems to have completely stopped.  Assessments are occurring behind me, procedures and conversations and research inquiries, but none of it registers.  Right now the entire world revolves around this one moment, between doctor and slowly-dying patient.  "May I pray for you?" Gladeis nods.  Her slender hands disappear almost completely in his has he leans forward, hunching over in thought. He gently caresses her fingers with his, his veins bulging in the heat and rolling with the movement of his tendons.  They sit like that for a few moments, Gladeis serene and melancholy as Josh's hands articulate the frustration and anguish his face refuses to express.  "God, please help this poor girl-" I hear him begin.  Jacques dutifully interprets.  The prayer becomes a mumble to me as the scene sears itself into my memory forever - the serenity of Gladeis' face and weary-yet-resilient posture, the blue tint in the air under the tarp reminiscent of light through a cathedral's stained glass, the physical connection between hands communicating intent far before language refines the details.  I step out into the blazing afternoon sun and make a bee-line up the road.  No way in hell my eyes are going to stay dry for much longer.  My task for the moment is to find a quiet place to lose it while thinking about the difference that a few cents worth of penicillin could have made some years ago in the life of Gladeis Jeanly.

Gladeis' case is all too familiar.  I think about how often my kids have had strep throat, and how if not treated, their heart could become like Gladeis'.  These medical teams see some very tough cases.  In the same day the docs saw Gladeis, they also saw a 30 year old, single mother of 4, with late stage breast cancer.  There was nothing they could do for her medically.  They prayed with her, held her hand, and talked with her about the need to find someone to take care of her children soon.

But for all the frustrations of what the medical teams can't help with, there are just as many success stories.  Pre-ecclamptic pregnant women who get IV meds and taken to hospital.  Men & women with blood pressures that could stroke at any minute that are given meds to get their hypertension under control.  Babies delivered safely in a sterile environment.  Children receive meds whose bellies are infested with parasites.  Sometimes it's just being willing to sit with an old lady and listen to her story.  But at every medical clinic we do, I know this...Lives are saved.  Hope is given freely.  Love is administered to every single patient.

If you are interested in being part of one of our medical teams, please email me at

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