Jennifer T., RN, FNP

When the fall winds of September blow, and the smell of drying leaves are in the air, one thinks of bonfires and football games.  Sweatshirts and trick-or-treating.  New school supplies.  Guatemala.  I spent my September and October readying myself for my 5th trip to Guatemala, to that little town, San Raymundo, to the clinic that I’ve grown to love.We arrived in San Ray on a Saturday afternoon.  The smell of cooking fires and burning trash floating, not unpleasantly, through the air.  The cooler temps had us in sweatshirts as we joined the rest of the nearly 50 people strong medical team that would be my family for a week.  I love arrival day.  I love seeing people that I haven’t seen in a year, hugging each other tight, knowing that this week will bring us together in heart and spirit.  I love seeing the new people arriving for the first time, a little trepidation but excitement in their eyes.  It’s strange how much I relish getting my bunk ready.  How much I love the kinship that begins the minute we step foot on this foreign soil.We don’t generally see patients the day we arrive.  The surgeons generally screen about 5-10 patients that the local physicians have referred to the clinic so that the first day there is a full surgery schedule.  This year more than 30 people were in need of being seen.  Clinic was up and running, students and teachers all pitching in to help screen patients for surgery.  It was a busy evening.  It was wonderful to see everyone work together and see patients, get meds that were still in process of being unpacked.We were up and running early and the patient load seemed bigger this year.  Our first full days in clinic had us seeing patients until 6:30 each night.  We were able to see, in our 5 days, nearly 600 patients.  I think this is the most we’ve seen in clinic in the 5 trips I’ve made.I spent some time this year reflecting on how I’ve changed over the past 5 trips.  I have truly grown up in Guatemala.  My first trip, in 2008, was as a nurse practitioner student, getting ready to graduate.  I was excited and terrified.  I was nervous and unsure.  That first week gave me the confidence in my skills to go forward and begin my career.  As I’ve returned, I’ve been further along in my own career.  Every year, I grow a little more confident.  I’ve been able to hone my skills.  I’ve been able to take on the role of teacher.  This still surprises me.  That in 3 years I’ve moved from student to teacher.  That I’m allowed to give advice, to help mentor and encourage.  Sometimes it’s not about how much you know, but to know your limits, to know when to ask someone else for help.  I come this year as an established Nurse Practitioner.  I come this year with a career that I couldn’t imagine in 2008.  I came this year and learned what it is to be a teacher, when to push and when to be gentle.

I truly love what I do.

One of the most difficult patients came to clinic on our last day.  Margaret had left for a speaking engagement, leaving Jenn and I to run the clinic.  I had just sent in a young family to see Lauren, a FNP student from Case.  The young family carried their daughter into the clinic room, along with quite a bit of paperwork.  My thought when I saw them was that the child had a developmental issue.

Lauren came to me not 5 minutes later, tears welling up in her eyes.  This beautiful young 2 year old girl, was diagnosed 2 weeks ago with liver cancer.  The paperwork was reports with the dire diagnosis.  The child had a huge belly, distended by the cancerous liver.  She had a jaundiced cast to her skin, her sclera were yellowed with disease.  She had stopped eating or drinking.  She was dying.  Her parents were tearfully looking to us for help, cure.

A cure would not come for Karen.  The only child who’s 3rd birthday was just a few short days away.  The entire pharmacy team, the clinic and the CRNA staff from the OR worked together to come up with medications to palliate her suffering.  As we were working on this, my friend, Antonio came out of the room.  Tears made his sad eyes alight.  The parents were waiting to hear that we had some cure, some hope to give to them.  I couldn’t let them continue to think that we were working on a cure while they waited patiently in the exam room.

Antonio took my English and told them what they didn’t want to hear.  We explained that  their young daughter was not going to be with them in body for much longer.  The yellow cast to her eyes, her skin, the protruding belly full of diseased liver, the way in which she was working to breath, the shallow, quick breaths of one not able to do so for much longer.  We explained that we were working to get medications to help their daughter live the rest of her life in some semblance of comfort.  Tears ran down the father’s face.  Mom did not meet our eyes, but silently rubbed her child’s arm.

Carmen, one of the pharmacists that traveled from New York, came in with our various medications.  She is fluent in spanish.  She helped us to explain to the family some of the symptoms that their daughter was experiencing.  She took time to explain the various medications, their uses, when to give them to their daughter.

Before the end of the visit, we were all in tears.  The family made a circle around their daughter with myself and Antonio.  Jenn and Lauren were in the room, others came and went.  While it has been my experience that prayer is done silently, this group spoke out their prayers.  Crying to God. Thanking God for the gift of their little girl.  I did not speak, but listened to the anguish and joy murmured in a language I have only rudimentary understanding of and cried.

I hope that the kindness that we were able to give to the family brought some peace.  The medications that we were able to compound to make her more comfortable.  The suckers that we were able to pull together, Karen seemed to happy to suck on a sucker during the greater part of our time together.  That they were able to leave with some love and comfort in their time of grief.

We had joy in the clinic during our time there.  A baby was born on Sunday.  Through cortisone joint injections, we were able to bring comfort to many.  The kindness that the students brought to every patient was incredible to watch.  We were blessed often.  We grew together for the week.  We slept together, ate together and worked together.  We do what we love and gave it freely to all around us.

On our last day, sitting in the courtyard with the sun on my face, I sighed.  My heart was full and my soul was at rest.  A calm came over me and I was at peace.  This is the greatest gift that Guatemala has given to me.  It’s given me a place to grow, a place for peace and an amazing amount of friendship.  I am blessed beyond belief.  I look forward to next year when I can come again.

Every time I travel to Guatemala, I come back a richer person.  I come back with more blessings than I can count.  I come back with a more thankful heart.  I come back with a soul that is at peace.  I come back with more friends that I can call on when I’m in need.