I didn't post yesterday - I was given a day off and went with a group to the beach. Didn't know what to expect, but I was open to a new experience.
We needed to get from Milot to Cap Haitian, then from Cap over the coastal range to the beach. You don't just grab a cab or car service. We took the "tap tap" (a bus named because you bang on the side when you want to get out.) The ride was bone jarring, but gave us a chance to see the world from a local point of view. The bus wound to a stop along a narrow street at the cab stand. There were 20 young men on 125 cc motorcycles. No helmets, no meter, just a negotiation for the ride, $6. This would never happen in America, but what was my alternative? The bus is gone, and I've seen these guys all over the place, balancing boards of lumber, food, even their families on the bike. They must know what they were doing... I hopped on back and we fired up a dirt road through town. As I relaxed, I began to feel sensations that previously would have been blocked by fear. I smelled the crops, food cooking and the road beneath us. I instinctively leaned with the driver into the turns, and as we crested the hill, the ocean laid out 400 feet below us. He cut the engine, and we coasted down the hill, the the sun angling through the trees. When we arrived, I could still feel the vibrations. There was no sense of relief, I couldn't wait for the trip back.
Joseph lost his entire family in the quake. He was with us for a while, and then was taken in by one of the vendors on the street. He supposedly had family in the States, but no way to leave the country, as he had just turned 18 - the age at which you can get a passport. Several of our longer term physical therapists knew Joseph when he was an inpatient, and maintained contact with him. He was also friends with Patrick, our guide and interpreter for the beach trip. We asked him to come along. He was quiet and introverted when we got there. The other therapists convinced him to swim in the ocean, but he only had his underwear. He went in anyway and seemed embarrassed around the women. I gave him a spare set of shorts. He wouldn't eat when we had lunch. The bike ride back was every bit as exhilarating and it appeared we would ride all the way back to Milot, as the bus was nowhere to be found. We didn't take the normal route, but stopped at a small office- passport photos. His paperwork had just come through, thanks in part to our therapists, and all he needed was a picture. We watched as he posed, the first real smile I saw all day. His expression leaving the office and on the ride home says it all.
When I returned, they were looking for me. A 4 year old had been admitted with an enlarging abdomenal mass. Our imaging is limited to ultrasound and simple xrays. She was beautiful, with a massively distended abdomen. I felt a large mass with both solid and cystic components. The differentials ran through my mind. Our only choice was to explore her, at least for diagnosis, with hopes of cure. I spoke to the mother through an interpreter. I told her I wasn't sure I knew what it was. She looked at me for a moment. "Jesus knows," she said. This morning we gathered in OR 1. I was fortunate that an Ob/Gyn team was here and scrubbed with me. I hadn't done pediatric surgery in years, but the basic concepts of any procedure are the same. I made a small incision, high in the abdomen, in the only clear space I could find. We entered and gradually worked inferiorly. I slipped in my hand and the mass, was smooth and mobile. Clearly benign. Over the next hour, we did a right oophorectomy and appendectomy. Her other ovary is fine. I won't post the pictures, but the curious of you can ask to see the teratoma, complete with teeth and hair. I just returned from the unit. She is awake and playing with one of the nurse's I phone.
What do these three incidents have in common? I realized that I experienced faith. Growing up, I always felt that organized religion was a series of rules that were designed and meted out by a paternalistic deity. You must have faith in this power or bad things would happen. What I am growing to realize is that faith is what takes care of the things for which you have no control. Once I relaxed and handed control to my driver, I experienced a remarkable ride. Joseph must have had faith to keep going after the quake and to believe that one day he would get the passport and the chance to move to a new life. My patient's mother had faith in God, and at least acknowledged that I would do my best. And I had faith that by working with my colleagues, doing what I could, and recognizing that other things were beyond my control, I could live with whatever I found or did.
I was raised in an observant Jewish household, but I didn’t have faith. I tried to follow the rules, and things still didn’t seem to work out. As a surgeon, it is hard not to feel you should control everything and everybody around you (for the patient, of course) – you can’t. And in our own lives, we sometimes try to juggle multiple story lines because we don’t have faith in the present or the future. What I learned is that faith is universal and you don’t need a religious leader to tell you how to get it.
Motorcycles, passport pictures, and teratomas – in every experience is a lesson, even on your day off.
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