[It has been a long time since I felt compelled to write. This is overdue, and a culmination of the influences of many friends, people, places, and experiences.]
At one point just over a week ago, I just sat down alone to contemplate the mess that I felt I had gotten myself into. "Mess" is a somewhat pessimistic word, but that is what it felt like. I was unsettled. There I was, in Port-au-Prince, doing the exact work that I want to do as my career, surrounded by some of the most unselfish, hardworking, fun people that I have ever met, working in a true humanitarian disaster, and I needed to figure out where I would be the following week.
I had a ticket booked to Johannesburg. I had a medicine board exam to take that I hadn't really been studying for. I had an apartment reserved in Denver. I had a job lined up in Denver. I had finally stopped panicking every time a pregnant woman, in labor, came into the clinic. I had received a phone call a day earlier from my recruiter at the locums agency who informed me that she had plenty of options for short-term contracts in Aspen, Vail, Denver, and elsewhere in the Colorado--I just needed to let her know when I wanted to start, and how long I would work for.
I tried to figure out which principles should guide my decision: professional goals/obligations, financial goals/obligations, my own ethos (the fact that I had basically given my word to a future job that I would be there on Sept 7). There were multiple options. Go back to the US, take boards, cancel my Jo'burg trip and return to Haiti for 2 more weeks. Go to the US, take boards, email my future job telling them I had changed my mind, call my locums recruiter. Not go back period?? I had already made one unexpected decision this summer (that being to return to PaP), and making another unexpected decision would not really raise eyebrows amongst family and friends. I could not come to a decision that day. I needed to sleep on a few things.
Somewhere over the Atlantic, I was two-thirds of the way through Where Men Win Glory¸ Krackauer's book about Pat Tillman. I was absorbed in the book. Furious at the US government/military, but also engrossed in the way Tillman made decisions. He was a man guided by his own set of principles, and when making decisions, it was his own dogma which dictated what he should do. And that is why I was on a plane headed to Johannesburg. The following day, after contemplating what do to, I realized that I had made a commitment to my future job and bailing out this late in the game wouldn't uphold the commitment which I have given. This was combined with the fact that my financial obligations really require some of their own disaster management. I had also planned this trip to Johannesburg long in advance, and since I wasn't sure when I would have time to visits Jo'burg down-the-road, it felt important to come back and spend time with my friends here.
As the plane started to descend, we flew just to the east of the city, in a path that went south past city center and then made a u-turn coming into the airport from the south end. Before making the curve back to OR Tambo Airport, I got one of the best overviews of Johannesburg. I could see the slow morning rush hour traffic on the M1 as commuters headed into the city center. Even better, I could see the new soccer stadium, and the famous water cooling towers of Soweto. And then Bara became visible. I tracked the road down from Bara, and saw Southgate Mall where I did use to go shopping, an even spotted my old gym. We flew just over my old neighborhood, and I was able to look down into the nature reserve where I use to run and hike.
And then it hit me, I was home. This is home. This is where I had the best year of my life (well, aside from the year I was 5, which was a pretty great year too). Some of my best friendships were made here. Some of the most meaningful work experiences happened here. I still picture many of my patients from Bara, and often think about how they are doing or if they are even still alive. Some of the most heart-wrenching deaths happened here, like the death of four year old KR. Some of the most bizarre things I have ever read happened here (cops vs. cops in shootout was a newspaper headline).
I felt an urge to get off the plane, get into my car, and just drive, at once, to all my favorite places. Instead, Andrew and David met me at the airport and then we went to lunch and had a great time catching up. When it took me two hours to get a new SIM card so I could have a SA phone number, I just had to laugh at the annoyance of going to 8 different stores in 2 different malls to find one. I was home.
I think that, somehow, I knew I needed to come back to Jo'burg for other reasons. My friends here would have understood had I bailed on my trip. But I knew that being here would give me some down-time to go back to those issues from above and to figure out my next game plan. I also needed to be here to spend time figuring out what the fuck happened in the year since I had left.
When I left, I knew I would be back. I was so certain of this, that I almost didn't bother to sell my car. I wasn't sure I would be back in South Africa; it could have been Lesotho, Botswana, or Swaziland, which would allow me quick regular escapes to Jo'burg. But I was sure I would be back in this area. If I hadn't needed the cash from selling the Bakkie (SA slang for a small pick-up), I'd be driving it now.
Days before I left South Africa, Randall and I had a really meaningful conversation. I remember it with perfect detail. It was Saturday morning. I had just made coffee, and was reading the NY Times on-line. Randall came onto skype, and we decided to catch up. We talked about his life in China and my impending departure to Massachusetts. He told me about the difficulties he was having in his personal life, but it seemed that things were getting better, and he was making plans for some changes. I whined that I wasn't ready to leave, and that I was envious that he had extended his contract in China. It had been a long year and then some for him, for me, and for us. I don't know how or why it happened that day, but during our conversation we seemed to have really re-connected. We actually decided it was time to fix things. He was no longer mad at me for asking him to not visit me when he had a vacation. I was no longer mad at him for abruptly ending things. And somehow we started to talk about future plans, dancing around the issue of other future possibilities. He wanted more time in China, maybe two years he said. I would spend a year finishing residency, and then I would work for a year in South Africa/Lesotho/Swazi/Bots . And then the following year we would both be back in Colorado. Two days later, as I departed South Africa, I knew I would be back in one year. A week later, Randall died. In the confusing time after his death, my plans to return here, to South Africa, died as well.
The highlights from the past year pale in comparison to the previous year (Bara, Nepal, Kilimanjaro, Ethiopia, Cape Town trip, backpacking trips and on and on). There was the wedding in Hawaii last July which included a luxurious stay at the Four Seasons in Lanai. There were some great dinners with friends scattered around New England. There was an impromptu road-trip to the cape, as well as to Maine. There was the joy of trick-or-treating with my nieces and nephews on Halloween. There was a great trip to California to see some of my dearest friends. There was the fact that I had finished residency, finally.
By far, the best highlights were my trips to Haiti. In February, working in Milot with earthquake survivors, had been one of the most challenging experiences I had encountered as a physician. When I was re-assigned to an adult tent (and pulled from the pediatric ward) , those 35 female patients were solely under my care. I was charged with managing their infections, their blood pressures, making sure they were getting their wounds managed appropriately, making sure they were scheduled for their cast changes, skin grafts, and revision amputations. The days were long, but the work was incredible. It re-affirmed that this was the kind of work I wanted to do.
My experiences, thought, in Port-au-Prince trumped Milot. Maybe it is unfair to compare the two. The services in Milot were entirely medical. While in PaP, I was part of a bona fide humanitarian mission. The organization I was working with, was responsible for managing a camp with 52,000 internally displaced persons (IDPs). The NGO had to provide/coordinate shelter, security, water, and medical services (among other things). The team in PaP was loosely split into "medical" and "non-medical." There seemed to be an honest admiration for the work that the other team was doing. Neither was more important; both were essential to providing for the people of the camp. And that was refreshing. To know that there was a larger mission than just medical care enhanced feeling like part of a greater team. I felt lucky, that in my month in PaP, the "non-medical" and "medical" teams enjoyed having dinner together, hanging out on Sundays (the day off) and drinking together.
What was most impressive though, was the almost-sacrifice-type commitment that people had made to be there. People were volunteering there because they wanted to be there. Everybody had paid their own airfare to be there. Some were using vacation time. Some were on summer breaks between college or masters programs. Yet others came to PaP in-between careers, and one made a career change partly influenced by being in PaP. Upon that background, volunteers slept in tents (either on cots or sometimes just sleeping pads), often showered under a garden hose, and spent most of the time confined to the camp where we were working. It was a pleasure to work with that crew, they were perhaps the most down-to-earth hardworking team I've ever worked with.
There was another element which I hadn't experienced, and that is one of the full humanitarian roll-out process, and working amongst the presence of so many different aid organizations, both governmental and NGO. At times I was amazed at the lack of coordination amongst the large groups, all working in their own microcosm in the middle of this city which has been destroyed. The allure of the UN was also enjoyable. Meeting UN soldiers from Bangladesh, India, Brazil, Nepal, Morocco, Philippines, and hearing their stories about being away from home, often away from families was inspiring. One of the best parts was being the invited guests to one of the Indian UN base camps, meeting their commanding officers, and being wine and dined for a night, which included fresh, authentic Indian food. Delicious.
I departed PaP on a Friday, arriving late to my place in Massachusetts that night. On Monday I was sitting in front of a computer screen, trying to answer questions about medicine, in the hopes of becoming board certified. A minutia question of differentiating the cause of anemia popped onto my screen. Are you kidding me? I know I'm suppose to look at this picture of red blood cells under a microscope and know if this anemia is from B12/Folate/Iron deficiency, Thalassemia, or some other cause based on how the cells look, but I don't care. This is not practical. A few days prior, as I pulled down the lower eyelids of malnourished, feverish child, and saw how pale the conjunctiva were, I diagnosed the child with anemia. I didn't know how low the hemoglobin was, I'd guessed less than 10, easily. I didn't need a microscope to know the cause of anemia… Malaria. Malnutrition. Why wasn't this on my test. I kept thinking back to my pals at J/P, knowing that it was Monday, they were short staffed, and they would be getting swamped that day. What the fuck was I doing in Massachusetts, taking this ridiculous test?
Less than 48 hours after the exam, I was on a flight to South Africa.
I'm envious of my friends who are still working in PaP, more envious of those who I know will be returning there before me, and still even more envious of those who are doing humanitarian work, as their career. I am humbled by those who are forging ahead and making it work. I look forward to the day that I can rejoin my J/P pals, on a permanent basis, sleeping in the tent, wondering if the chicken we are eating were the chickens that were alive out back a few hours ago, bracing for the onslaught of another Monday clinic. I look forward to the day when Chris calls me from Darfur (or what ever conflict-du-jour is taking place) asking if I can come set up a mobile clinic for his IDP camp. I look forward to the day that Matt/Jack/Jeff/Andy are only a radio call away as I call them because the hospital electricity as gone off, again, and I need electricity for the nebulizer machine for the child having an acute asthma attack. I look forward to endless hours of Frisbee with Mark and Lee, maybe not on the LZ, but across a rice paddy, or on the savannah. I look forward to the day when a crashing patient shows up in clinic, and Paul/Andrew/Annette/Mellissa/Jodie/May/Lindsay/Beth/Lee are there to help. I look forward to Sonia calling to say she is going to help bail me out, again.
And so, I find myself again contemplating where things are headed. This time, I am not sitting in the tortuous heat of Haiti. I am sitting on the back deck of Siza and Scott's house. It has taken me a few days to finally unwind and relax. The influence of good friends, and great wine have brought me to the point where I can finally sit back, in the warm winter Johannesburg sun, and realize how it is that I am here as a visitor, not as a resident. I am reminded that I am very fortunate. I have great friends (who are scattered around the world at this point- Sapna: where the hell on the globe is Chuuk anyway?), good health (even though my legs burn from running yesterday), a great family (who will be disappointed when I leave Colorado, but will always be supportive), and a profession which has plenty of job options. I still don't know for sure where the next move will be, but I know which direction I will be heading; it will be toward humanitarian relief work. It may be Haiti, South Africa, or it may be where MSF/UN etc places me. All I know is that as soon as I can, I'll be back out in the field.
Keep a tent open for me, I will be back.
Soon.
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