Franklin Outline and You Get Used To It Revised

Franklin Outline

Complication: Paula doubts path.

Development: Paula visits Belize.

                         Botfly infects Alex.

                         Empathy trumps path.

Resolution: Paula accepts choice. 

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You Get Used To It

Target publication: Harper’s Magazine

Word count: 1679

The path: otherwise known as the go-to answer to give peers and family members about one’s plans for after college; the justification for one’s existence.

I mean degree...the justification for one’s degree.

From the age of 14, my path was medical school. I changed my mind, however, during the Fall of my second year of college. I knew by Thanksgiving that I had absolutely no desire to attend medical school.

I know what you’re thinking.

No, I didn’t smoke a bunch of pot.

And no, I wasn’t failing my science courses.   

I just decided I didn’t have the drive for medical school anymore. It wasn’t what I wanted.

 My mom was the first person I told: “Well...that’s just great honey. Personally, I always saw you in law school.”

“Really, mom? Law school?”

“Oh yeah, Paulie. You’ve got a real presence about you. And you’re so good with words.”

“So...you’re not disappointed?

“Disappointed? No, why would I be disappointed? Just as long as you’ve got some idea of what you want to do.”

I hung up the phone, thinking I would feel relieved because my mom accepted my decision.  Instead, I felt a shock of panic climbing up my spine.

Shit. I have no idea what I want to do.

I started running through the results of all the career tests I took in high school. I could...become a judge? Teach English? Make soap? Open a bakery? Live off the land?

I pictured the path laughing at me—Goddamn idiot, it was saying, wagging its perfectly manicured finger in my face. You have no idea what you just cost yourself.

It started laughing even harder when I remembered that in October I had made the last deposit for a medical service-learning trip to Belize. It was non-refundable.

My timing in choosing to formally excuse myself from the medical school path and declare myself an English major was, for lack of a better word, poor. While in Belize, my major often warranted the question, “So... why are you here then?”

I couldn’t really say, “You know, it’s a funny story. I decided to change my life’s major course of action...kinda on a whim...so I got stuck with this trip to Belize in a field I no longer want to pursue.” So I would just smile and make a noise that sounded like a giggle...maybe shrug my shoulders and then promptly avoid eye contact.

It also didn’t help that the seven other people on the trip were die-hard pre-med students, all in Belize for the same reason: their damn paths. I assumed the identity of the token Humanities kid, who of course forgot my blood pressure cuff at home and had the most trouble stitching up a banana.

I even started talking to myself, “You know why they can all stitch up their bananas so easily, Paula? Because they stuck to their paths. Where’s your path, huh? Gonna make some soap later? Bake a nice little banana soufflé?”

The others did honestly try to make me feel better: “Yeah, I can totally see you in law school.”

“Med school is always there if you change your mind.”

“You have so much material for a good interview story. Do you mind if I use some of it?”

Surprisingly, none of their attempts made me feel any more secure about my decision. It was actually the case of an eight-year-old boy named Alex that we received during our last clinic, which confirmed my choice to abandon the path.

We used a community center for the last clinic. It was the color of cornbread, somewhat dilapidated, and about the size of a Wendy’s dining room. The “windows” had no glass; they were simply cut out of the building, so kids would constantly call our attention outside, asking for another toy or for more instructions on how to use the toothbrush kit we gave them.

            Alex’s mother brought Alex to my triage partner, Allie, and me with the complaint of pain in his head. When I asked where the pain was, ¿Donde está el dolor?, Alex’s mom tilted his chin down to reveal a lump on top of his head of about a 1-inch diameter, sprinkled with tiny black dots. She explained that Alex had fallen and cut his head two weeks prior to visiting our clinic, and the lump we were seeing was where he had gotten stitches.

            Allie and I called Dr. Yorleny, a Belizean doctor who regularly volunteered her time to the service-learning program we were participating in, over to inspect Alex’s wound. After a ten-second glance, Dr. Yorleny calmly walked away and grabbed a facemask and a pair of gloves. She might as well have blown into a bugle because as soon as the other volunteers saw her reach for a facemask, they rounded up around Alex like he was the zoo’s newest exhibit.

            Sensing the volunteers’ curiosity, Dr. Yorleny explained, “There is a botfly in the wound. I must pop the wound in order to remove it.” A week before, I had done a presentation for the group on the human botfly, so no further explanation was needed. Everybody started pushing each other out of the way in order to get closer to Alex. Someone said, “This is so exciting!”. 

            I, on the other hand, felt like I was going to puke. I was replaying the images I had researched of the botfly and going over the mechanics of how it parasitizes its victims.

Basically, while Alex’s wound was open, a botfly had managed to get its eggs inside of it, and the pain Alex was feeling was the larvae growing and burrowing further into his skin. If not removed, the botfly would feed off Alex’s blood for up to eight weeks, at which point, it would drop out of the hole it had been using for oxygen and pupate. In a free-clinic in a small town in Belize, the best way to remove a botfly is to pop the wound like a pimple and hope the botfly is mature enough so none of its segments break off and stay inside the wound.

            Dr. Yorleny asked Allie to put on a pair of gloves, and the chatter of the other volunteers rose to a fervent buzz. The cornbread colored walls seemed to be tilting like the tops we had been handing out earlier to the kids, and I weakly asked no one in particular, “How can you be so excited when you know the amount of pain he is about to experience?”

            Katie, the oldest volunteer of the group, responded, “Paula, it’s what’s best for him. He can’t get better if we don’t do this now.”

In irritation, I said, “Thanks Katie, I think I get the logistics of the healing process.”

            She said, “You seriously look like you’re going to vomit. Maybe you should go outside.” She grabbed my hand, but I shook her off and told her I was fine. I walked over to Alex and crouched down beside him. He was already crying so I rubbed his back and told him how brave he was, “Tú eres muy valiente”.

            And then Dr. Yorleny started to squeeze the wound.

With each pulse of blood that spurted from his head, Alex’s scream sharpened to a new pitch of pain, each pitch shrill enough to cut through any of our attempts at comforting him. He writhed to the point where we needed three people to hold down his seventy-pound body, sweated to the point where I could not tell if his face was wet with tears or with perspiration, where I could not tell if the sweat on his mother’s shirt was her own or from the face of her little boy.

After Alex’s wound had been squeezed for ten minutes, it was found that the botfly was not mature enough, and Dr. Yorleny could not entirely remove it. Alex would have to wait another week or so and let it grow bigger inside of him. And then, he would have to go through the same process. All over again.

            Dr. Yorleny thought the wound needed to breathe, so we left Alex’s head without a bandage. She explained, “Now Alex, sometimes doctors need to do things that hurt you to make you feel better. Okay?”

            Alex looked up at Dr. Yorleny, and his gaze gave away what was going on inside his head. His brain was writing what had just happened into a memory he would keep into old age. I wondered if it would be one of his earliest memories of suffering.

Alex walked outside and stood alone, keeping his distance from the other kids. I followed him and crouched beside him, telling him again how brave he was, “Tú eres muy valiente, Alex”. Fruit flies were gathering around the fresh blood on his head, and I tried to think of how much better he would feel once the botfly was removed. But all I could focus on were the swarming fruit flies. They reminded me of the way the volunteers had swarmed Alex, and I felt sick to my stomach again.

When I walked back into the clinic, Allie took me aside and said, “When I shadowed at the ER, the first time I ever saw an abscess popped, I fainted. But it gets better, Paula, I promise. You get used to it.”

I nodded and tried to smile for Allie. But I knew she was wrong. It wasn’t the blood or the thought of the botfly feeding off Alex that bothered me. It was the excitement among the volunteers that made me feel weak.

It was the pleasure, rather than the pain, that I would never be able to get used to. I knew I would never experience the same sense of anticipation as the other volunteers had. No matter how directed, how justifiable the medical school path made my education, made my life, Alex’s case confirmed that it was not the path for me.