How Do You Solve a Problem Like Maria?

One month ago today on Friday the 13th, I flew into San Juan, Puerto Rico.  I volunteered to serve as part of the VA Disaster Employee Medical Personnel System (DEMPS) to assist with disaster relief efforts after Hurricane Maria touched down on 9/20.  I fully intended to write a journal entry every day, just to capture the memories that can be so fleeting in the moment.  I wrote one short blog post on the bus ride to the temporary Federal Medical Station at the Acrópolis de Manatí that I never published, then never wrote another word until now.

Acrópolis de Manatí before

View of the FMS at Acrópolis de Manatí from where we slept.

Though people have asked me over and over about the experience, though I dream nightly of being there still, and though I know I am forever changed by the patients I cared for and the friendships I made in Puerto Rico, I have been unable to find the words to express what I feel and think about it without feeling completely inadequate to the task, the weight of the experience anchoring my tongue and laying heavy on my mind.

“How do you solve a problem like Maria?
How do you catch a cloud and pin it down?
How do you find a word that means Maria?”

These lyrics from one of my favorite movies are on rewind in my head, the incongruent cheerful riff at odds with the churning emotions inside.  I am in contact still with some of the incredible people I met and worked side-by-side with in Puerto Rico.  I’ve shared some of their eloquence to give friends and family who ask a small glimmer of what it was like, but it feels a little like borrowed elegance, a little like cowardice to hold back what I’ve turned over and over in my mind like a many-faceted gem, and a whole lot like the type of pressure I feel always to paint the picture right the first time. I kept biding my time, waiting for the perfect words to come.

Then recently while at dinner in Phoenix, I had a sudden sharp pain in my L eye.  It felt like a torn contact lens, the sharp edges drawing across my sclera. I thought nothing of it, and driving to dinner with another friend, I noted a larger than usual amount of blood in the centrolateral aspect of my L eye from a subconjunctival hemorrhage.  Confirming this with my fellow PAs (really what better place for a curbside consult than at a leadership conference for PAs?), I knew it required no specific medical care.  On my 7-hour drive home from the conference, I mentioned that this had been the 4th one in less than a year or perhaps 6 months to my good friend, who happens to be an acupuncturist.  She gently reminded me that after travelling to Columbus for the National Girl Scout convention with Daughter #2, two weeks working nearly nonstop in Manatí, a short week home, then another nearly week-long conference in Phoenix, I might consider that I need rest.  Apparently the sclerology chart she sent to me indicates that the area of my eye affected points to a possible problem of the heart.

As a former cardiology PA, I know there is nothing wrong with my heart. I also know that when I think about Puerto Rico, I feel a pressure in my chest that has nothing to do with a myocardial infarction, and everything to do with another type of blockage, the kind that comes from feeling something so strongly, and being unable to talk about it in any kind of coherent way. I get updates from DEMPS personnel who replaced us there about patients I took care of, and it makes me wonder.  How is it possible to love being home with my family and wanting so badly to be back in Manatí, in a place where I don’t speak the language, but where I understand perfectly what my purpose is?  How can it be that everything here goes on as normal, commuters driving badly to work, kids struggling with slope and y-intercept homework, and at the FMS Manatí, patients whom I cared for still have no home to go to and still have no power for basic needs? How can it be that my patients are dying, and I can’t do anymore about it now than I could then?

I struggled with these thoughts, overthinking perhaps that by talking about it, I might be exploiting the prurient aspects of seeing a disaster up-close versus the need to show people what it is really like there in this era of “fake news.” And then today, a NY Times article about the mental health crisis affecting Puerto Rico was featured, and the trolls online could not type fast enough about how we are wasting money on an island that isn’t even a real part of the US, and I told myself it was time to tell the story. The 2 questions I’ve been asked most frequently: “Is it really as bad over there as they say it is?” and “What was it really like over there?” The short answers: Yes, and terrible, but wonderful.

The long answer, well, that’s harder. That’s going to take more than 1 blog post to answer.  And I promise you, it will not be any semblance of a perfectly presented answer to the question of how to solve the problem of Maria and its effect on the people of Puerto Rico.  It will be my truth about the privilege of being a PA serving as one small part of the federal medical response to Hurricane Maria with fellow VA employees in the DEMPS program, DMAT, DoD, USPHS, ICE, and volunteers from New York Presbyterian Hospital.  Stay tuned–there won’t be any nuns breaking into song, but there will be cake, clowns, and cops with rhythm.  There will also be stories about patients that will make you rethink what you know about love and devotion. It was my privilege to witness all of it.

Special thanks to my husband, my mother, and my friends who took over mom duties at home so that I could go and serve. I could not have done this without their support.  I love all of you more than I can say.

If you’d like to help the people of Puerto Rico:  https://www.fema.gov/news-release/2017/09/22/how-help-after-hurricane-maria

This is the main page for up-to-date resources and information on the federal response to Hurricane Maria:  https://www.fema.gov/hurricane-maria

This link will take you directly to the statistics for Puerto Rico: https://www.fema.gov/disaster/4339

The NY Times article about the mental health crisis in Puerto Rico that finally broke the dam holding in the words: