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.

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?”

MariaSoMusicmountain

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.

IMG_9028.jpg

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 then 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 it’s 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:

 

 

Advertisements

The Final Frontier


A snapshot into the crazy world of what being married to me is like, based on an actual telephone conversation I had with my husband today:

“Ok, I need to tell you something really big,” I said.

“Big, as in I need to sit down, or maybe just lean on something? Or are you joking?” he said.

“No, I’m not joking, it’s not bad, but maybe you should lean on something,” I said excitedly.

“Okaaaay, well, what is it?”

Now keep in mind that not only was I over-the-moon excited about this news, I had also had a whole handful of chocolate-covered espresso beans which for someone like me who generally avoids caffeine, made me talk even faster than I normally do, so it came out something like this: “NASAistakingapplicationsforastronauts, and I want to apply!”

“What?! Are you serious? No way! Do you know how many space shuttles or rockets have exploded in the history of space flight?”

Silence on my end, then “I can’t believe you’re not supporting me in this.  You’re supposed to help me achieve my dreams. They’re going to go to MARS!!!”

“But, honey, don’t you know how dangerous that is?”

“Um, hello, firefighter/SWAT medic? Seriously?!”

“Uh, right. Point taken. ”

Big sigh on his end of the line, then “OK, fine. I didn’t even know you wanted to be an astronaut.” (Really, he’s such a good guy, isn’t he?)

“I’ve only wanted to be an astronaut my whole life.  It’s SPACE!  Who wouldn’t want to go to space?  How cool would that be?!”  Actually, it was one of several things I’d considered.  Almost a year ago, I posted my dream list of future occupations when I was a kid which included “Supreme court justice, Shirley Temple stand-in, crime-fighting assassin/journalist, astronaut, and finally, Nobel Prize-winning brain researcher.”

As I was talking to him, I had been scrolling through NASA’s website, looking at the requirements in more detail.  The article I’d read said only a bachelor’s degree in a STEM (science, technology, engineering, or mathematics) field (CHECK!), at least 3 years of experience in that field (CHECK!), and the ability to pass the astronaut physical (Well, going to have to investigate that further). What I was looking for specifically was the one thing I knew I couldn’t overcome based on will alone:  The height requirement.

“Oh no! It says 62 inches, ” I said despairingly.

“Well, that’s probably based on–”

“Hah! Wait, that’s only if I want to be a pilot or commander, plus they need over 1000 flight hours as pilot-in-command.  But I only have to be 58.5 inches tall if I want to be a mission specialist, and I’ve got that beat by a whole inch and a half! I could be a mission specialist.”

“A whole inch and a half, huh?”

I was so elated, I pretended not to hear the gently sarcastic tone in his voice. Then, as I continued to read the requirements to him, I dropped back down to Earth. Vision was another requirement, and I’m famous in my family for having horrendously thick glasses starting from age 8, until the miracle of contact lenses came along.  I had been told by one well-known eye surgeon, “We have no surgical options for you. Perhaps you’ll develop cataracts early.”

“Oh no, there’s a minimum vision requirement. 20/200 or better uncorrected. Hmm, maybe I should look into getting Lasik done anyway. Oh wait! It says correctable to 20/20, each eye. Ok, I’ve still got a chance. Or I could be a payload specialist.”

He quietly listened to me as I continued on in this vein for another 5 minutes, up and down the spectrum of excitement, as I came to the realization as I read further, that the likelihood of actually getting picked to go to astronaut candidate school was only about 0.6 %.

“Well, it would be cool just to get a rejection letter from NASA, right? I’m going to apply anyway. You never know! I could be the first PA in space. My collaborating physician would be available. . .on Earth!”

My son’s reaction when I told him NASA was taking applications for astronauts, and that I was going to apply, was even cooler.

“You’re going to be an astronaut?  Wait, how?  Can you take me with you?  I want to go to Mars, too!”

“Sweetie, you’re not old enough yet.  But if you want to be an astronaut, see how important it is to get a college degree in one of the STEM fields?” (I know, I know, not everyone needs to go to college, but seriously, Tiger Mama training dies hard.)

We surfed the NASA website together, and oohed and aahed over pictures of rockets and astronauts.

“Do you think they get to keep the blue jumpsuits?”

“Yep, pretty sure they do.”

“I want one.”

“Me too, buddy.”

We read more in depth about the physical requirements with him saying “I could do that!” and me saying, “Hmm, not sure if I can pass the swimming test (I have this horrible fear of drowning) and my little guy saying “I can though!” and right there, I watched the dream blossom in his eyes, and saw the final frontier open up for him. No limits here on Earth.  Not if you think you can be an astronaut.  And who doesn’t want that for their kids?

NASAlogo

Here’s the actual description of astronaut requirements if you’re interested in one of those blue jumpsuits, too:

http://www.nasa.gov/audience/forstudents/postsecondary/features/F_Astronaut_Requirements.html

Triskaidekaphobia


The first time I was truly afraid of a patient, I was standing in an outpatient family practice clinic in Detroit.  If you’ve ever felt mind-numbing fear, you know that it creates a dividing line between that moment and the next. Strange details imprint on your brain, like the heft of the chart in your suddenly damp hands, and the musty smell of an exam room suddenly grown tinier.  Grown men have told me that part of the attraction for going to war is learning if they have what it takes when confronted with the fear that is part and parcel of combat.  When we watch movie characters stumble into bad situations, we have the prescience that comes with being an observer, and tell ourselves that we would never, ever go into the dark house after the psycho or get in the car with the charming serial killer.  In actuality, how often do we do dangerous things and not realize how close we stand to the precipice?  As my childhood friends will tell you, I had what I considered a charming unawareness for these types of situations (until, of course, I became a mother), and perhaps it came from my innate belief that all people are good.  When I was younger, I traipsed into places and talked to people that now I would never let my children associate with, but again, I really didn’t think anyone wanted to hurt me, and I trusted that I would know it if they did, but perhaps that was hubris or plain dumb luck that I never got hurt.

This time though, the analytical, writer part of my brain was coolly noting that, for once, I was actually not only assessing the situation accurately, but also responding in what I thought was a very calm and non-threatening manner, though the other animal instincts in my brain that had made the fine hairs on the backs of my hands prickle within the first 2 minutes of meeting this patient, were screaming “Run! Get out of there, right now! Do not pass go, do not stop! Get out!”  It was like, and I kid you not, the good buddy in movies, you know, the sensible one like Velma, or actually more like the hyper-panicky one Shaggy, tapping on my shoulder and whispering “I don’t think this is a good idea.”

Shaggy_scooby

Having grown up in the suburbs of Detroit, in a town where everyone looked so familiar I would have trouble placing the face as being someone I knew from church, the gas station, school, or work, going to PA school in “the city” was exciting to me.  I knew I’d be exposed to situations I’d never experienced, and like my combat veterans, wondered if I’d have what it took. I wasn’t afraid of the crack addicts or gang-bangers. I was afraid that I wouldn’t know how to react, wouldn’t have what it took in the face of an emergency to do what had to be done–chest compressions, suturing, bandaging, reading EKGs accurately. I thought I’d be most afraid in the ER at Henry Ford Main, or during my psychiatry rotation where I was on the inpatient consult service for Detroit Receiving and Sinai Grace, because of the out of my control aspect of those situations.  In an outpatient clinic, I naively thought, at least you could kind of predict what kind of day you were going to have.  Appointments are scheduled, and you can predict what kind of patients you will see, unlike in the ER, when you can have a heart attack, gunshot wound to the hand, and head cold all walk in at the same time.  It was a controlled environment, I thought, and control of my environment is key.

All of us desire control. It begins when we’re learning how to talk and walk.  This is where the terrible twos (and threes and fours for some of us) get their name.  The desire to exercise our will on the environment is innate.  We want to be able to choose our path. We want to believe that we have control, though in reality, we have very little. Today is Friday the 13th, a day many fear, though most of us find it superstitious.  We scoff at people who would have “silly fears” of things like the number 13, but in reality, don’t we all pause for just half a second, if we have an interview or date that gets set for Friday the 13th or we’re placed in hotel room #13? It doesn’t stop us from continuing on with our lives, but given the choice, just to be on the safe side, wouldn’t we change the date or room number, if we could?

As children, many of the sayings that we grew up with enforce those beliefs: Step on a crack, you’ll break your mother’s back–so we avoid walking on the cracks, just in case. It’s part of the mistaken belief, these superstitions, that we can control our destiny. We believe that by following all the rules, we can control our circumstances.  As children we pray, if I promise to do all my homework next time, please let me pass this test. As adults we pray, if I promise to be a better mother, please let her be OK.  Fear is irrational, it compromises our illusion of control, because it shows us how little power we actually have.  When we see through the eyes of fear, nothing is in our control, and that is the most frightening thing.

The unkempt woman in the musty exam room looked right through me.  All of us want to be seen, truly seen for who we are, and when others do not see, it can be frustrating, and make us doubt ourselves.  When she did not respond to me, I wondered for a brief second, did I not speak loudly enough? I had read her chart before coming in the room. It was supposed to be a routine follow-up for her annual gynecological exam.  Her list of medications gave me clues to what was missing in the 1 sentence description of why she was there.

“Have you been taking your Clozaril?” I asked.

“My mother has blue hair. Do you see them? People walk on buses,” she said.

Being alone in a room with a schizophrenic patient off her medications is not a place for a green PA student.  My very first rotation was psychiatry on the inpatient wards. Ingrained in us were several rules: Make sure to always be between the patient and the exit.  Make sure that someone knows where you are at all times.  Make sure that you wear long hair pulled back so a patient cannot grab you.  I had seen schizophrenic patients on their medications, discharged them home to the loving care of family or friends, after seeing them admitted off their medications, when they could not distinguish between their reality and ours.  Most were not violent, but what was frightening was their inability to see us. To them, I could have been a 300 lb body builder threatening to take away their most prized possessions, and as anyone who’s ever been threatened knows, fear will make us strike out to protect ourselves.

Fear will take a perfectly reasonable person, and turn them into a knife-wielding, gun-toting, hate-speech throwing part of a mob like those we’ve seen on the news.  It turns off the reasonable, logical parts of our brains, and takes us back to the child we all were once, vulnerable and at the mercy of others.  When we point our fingers at others, tsk at the behaviors that we, of course, would never engage in, scoff at superstitions and phobias, we forget to look at what prompts them.  We forget to look deeper. We forget to ask ourselves what are they really afraid of–and what am I afraid of that I am too blind to see them for who they really are.

“You know what? I think I left your bloodwork outside. I’ll be right back,” I lied, and briskly walked out of the room, straight to my preceptor’s office, and explained the situation to him.  I never saw that woman again, but I’ll never forget her eyes or the trembling of my hands afterward.  Have you ever been truly afraid? Do you have any phobias or fears that may seem irrational to others? I’d love to hear about them. I discovered an irrational fear of heights when I climbed up on a ladder to explore an old B52 bomber, and could not make my legs work to climb back down the ladder I had just ascended 10 minutes prior.

Today I am grateful for reminders that all of us have fears that lie behind the facade of control we all cling to. I am thankful for the friends who kept me from making irrevocable mistakes in my innocence when I didn’t have enough fear, and hope my children will have such good friends as they make their way through a world filled with too many choices.

And because I’m a giant nerd who loves words:   Triskaidekaphobia is derived from treiskaideka, the Greek word for thirteen + phobia, fear of = a fear of thirteen.Pi