Simmering water

It's another beautiful day in Honduras. Hospital Loma de Luz is open for business. The gurgle of the Montezuma oropendola (Psarocolius montezuma) accompanies the howl of the Howler monkey creating a unique background soundtrack as I traverse the suspension bridges back and forth between the guesthouse and the hospital. All looks at peace on the surface. Yet, I feel the tension simmering beneath the steady façade I present. Sometimes it's harder to keep the imposter syndrome at bay than others.

The transition into September has left me as the sole surgical provider present at LdL. Not surprising with that transition, fielding the surgical consultations has been a significant source of the afore mentioned simmering. My current surgical schedule is full for the remaining two weeks of my time here. Yet a new patient presents with a cancer I have not seen before. Referring the patient away to the nearest oncology provider (hours away) would take a minimum of 3-6 months for them to even be seen let alone get the surgery they need. Unable to ignore a rapidly growing cancer, we add the patient on our schedule. A trauma patient comes in with multiple broken bones including hands and feet, which I have only seen fixated, not actually done myself. Again communicating with bigger hospitals in the cities 5-6 hours away, it would be minimum 3 months before the patient could be scheduled for fixation. In an effort to prevent the patient from being an invalid (rather than a productive member of society) for unnecessary and prolonged months we again add the patient onto the schedule. Who am I to remove cancer not in my regular purview? Who am I to fixate an elbow, pin metacarpals and plate metatarsals?

Each one of these cases (the two listed above being just two of many) creates an internal dialogue I carry on within myself attempting to justify what intervention I can provide while simultaneously looking at the situation through my US healthcare system lens. It is a perspective generated by the system in which I was trained, and a very legalistically motivated system which pushes everything into a specialized niche. In addition, I hate the idea of "learning from my mistakes." In the field of surgery, mistakes are often very hard to recover from, and frequently detrimental to the patient. I can't leave room for "mistakes." I am now currently feeling this pressure more acutely as I don't have another surgical opinion readily available to bounce plans and ideas back and forth. No one looking at the xrays with me offering their suggestions and what worked for them in the past. The internal dialogue continues and the tension simmers. I scrub into surgery each time praying for the wisdom I need and the protection and healing the patient needs.

I am very thankful for the presence of Willis CRNA who came to Hospital Loma de Luz to provide anesthesia for the patient's needing surgery the month of September. It has been a common occurrence that I finish a surgery and find a photo waiting for me on my phone that he snapped during the surgery and sent me. In a way it illustrates to me how focused I can be during surgery, as inevitably I am unaware that any photos were being taken. In the above photo, I appreciate how it looks like I'm playing with tinker toys.

Much Love.