Cam has been here for nine days. Our reunion was so wonderful, in the most beautiful tropical setting imaginable. We have cooked together, explored the reef out front of our condo, relaxed, read aloud from Cam’s adventure / scifi novel, worked in the clinic together, and relaxed some more. My last day at the clinic was Tuesday. The first two days of this past week were quite harried at the clinic. Gavin and Paul, two PA students from Robert’s class at Pacific University, arrived last weekend. Getting situated at the clinic always takes a little while. Their first days as Clínica Esperanza providers were especially tricky because Dr. Janice was the only CE provider present. Gavin and Paul worked in the main consult room, which holds two sets of exam table, desk, otoscope setup, etc, separated by a curtain. Dr. Janice sat in a chair in the middle of the two consult areas, answering questions and listening in on patient visits. I worked with both PAs as their translator. I felt a bit over-committed: besides translating for two providers at a time, Kate, our clinic manager, would flit in to the room every few minutes asking for help with a patient who needed wound care or diabetes education. Cam was amazed at the incredible bustle and multitasking going on in the clinic throughout its open hours!
Cam shadowed me during Monday and Tuesday afternoons. He got to see some interesting, challenging cases. One really struck us both. A 27-year-old patient I will call Marcy came in with her mother for a prenatal visit. Because of my interest and experience with “control prenatal” visits, Kate let me take the wheel on this one while she looked on. After a few attempts at engaging Marcy in conversation, it became clear that she has some serious developmental or psychological issues. Her mother started answering me, clearly frustrated at her daughter’s refusal to speak. Marcy had a sweet, vacant smile on her round face, which looked more like it belonged to an innocent teenager, rather than a nearly 30-year-old woman. She babbled a few phrases of nonsense when I asked her, “how are you feeling, Marcy?” Her mother would bark at her, “Stop talking crazy!” I took a look through the rest of her chart and found the following phrases in the provider notes: “patient reports hearing voices,” “patient affect unresponsive and distant,” and “mother reports patient will not take psych meds.” I started directing a few key questions at the mother, inquiring about how far along Marcy is in her pregnancy (28 weeks), if she is taking prenatal vitamins (no), has she felt the baby moving (yes), and if she had experienced any vaginal bleeding (no). Once I got a clearer picture of Marcy’s pregnancy, I decided to take her away from her mother for a while to see if she would open up. I led Marcy to the bathroom to take a urine sample. On the way there, I asked her, “Marcy, are you hearing voices that aren’t real?” She answered me in a long, lilting sentence of nonsense, her eyes out of focus. After that, I asked Dr. Janice to help with this case, because I didn’t feel comfortable leading the exam anymore. Dr. Janice, Cam, and I did her physical exam, measuring fundal height and listening for the fetal heart rate using the Doppler. Every aspect of the exam was normal, and we sent the mother and daughter pair home with prenatal vitamins and a follow-up appointment with Dr. Raymond in two weeks.
That visit left me with a sinking, hollow feeling in my stomach. Marcy looked like the victim of a sadly common phenomenon on the island: men take advantage of women with developmental disabilities. Often, they leave their victims pregnant without any support from the abuser and in an unfortunate situation that would only become more complicated and difficult with the birth of a child. A week before this visit, I saw the result of the island’s public health efforts to help these women: a patient came in who had been sterilized against her will to prevent her from ending up with children she couldn’t care for. This strategy makes me sick to me stomach. Instead of working to prevent the abuse of these innocent women, it abuses them in another way, furthering their disenfranchisement from their rights over their own bodies. I hope some of the compassion and care we gave to these two patients sunk in, helping them to heal a little bit from the wounds they have suffered.
On a much more lighthearted note, Cam and I have seen some awesome aquatic life in the past few days. On our dive, we descended right towards the one fish I had been hoping to see in my last few days on Roatán: a honeycomb cowfish! Check it out on google images, if you get the chance.
We also saw a bunch of nudibranks and a juvenile spotted drone, one of the cutest, coolest fishies around. It has two long, ribbon-like fins on its dorsal and ventral sides that swirl around mesmerizingly. It is striped black and white. This one was tiny, it’s body only about an inch long and its ribbons extending another two inches.
On our snorkeling adventures over the past few days, we’ve seen lots more cool stuff. On Tuesday, we saw a turtle that had wedged itself in a little cave in the reef to wait out the rather powerful waves. It looked so sleepy and content! On Thursday, we say two more turtles cruising through the depths. One was little, with a shell about a foot in diameter from head to tail! We also saw two spotted cowfish, with their long, skinny horns protruding from their foreheads. We saw many large parrotfish, whose mouths actually looked like parrot beaks, pecking at the corral. It’s been amazing!
Today, we are heading off to French Key for a day of fun and a delicious meal. It’s Cam’s and my 5-month anniversary!