You Get Used To It

You Get Used To It

Target publication: Harper’s Magazine

I went to Belize for two weeks in December on a service-learning trip—service learning is a kill two birds with one stone kind of deal: young adults (mostly college students) pay to go on a trip for a brief period of time (typically 2-4 weeks) where they learn basic skills associated with the medical profession, as well as perform acts of service, like setting up free health-clinics in areas where medical assistance would be unavailable usually.

I made the last deposit for the trip in October, a month in which I was sure I would be attending medical school in the future. The pitiful amount in my bank account was bearable because going on the trip meant I would be further propelling myself down the path. The path otherwise known as the go-to answer to give people (mostly peers and family members) about your plans after graduating from college is also the justification for your existence.

I mean your degree.... it is also the justification for your degree.

Really, the path can be seen as a friendly societal reminder that if you don’t have the next fifteen years after college planned out in a detailed manner, something is wrong with you. Plainly, without the path or a path, your shit is not together.

Well, November rolled around, and I suddenly came to the conclusion that I had no desire to go to medical school. Not only was my decision a slap to the path’s face, but did I also mention the last deposit I made in October was non-refundable?

It looked like I was stuck with a trip to Belize. A trip that would either confirm or discredit my decision to abandon the medical school path.

My timing in choosing to formally declare myself an English major could have been a bit better—while in Belize, my major often warranted the question, “So... why are you here then?” The seven other people on the trip were die-hard pre-med students, all in Belize for the same reason: the path. 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 am forever grateful that I can speak Spanish, or else I would have been completely useless during triage. We split into pairs to do triage, and I always worked alongside another volunteer who didn’t speak Spanish. My favorite partner was Allie, a girl from Zachary, Louisiana. Allie seemed to live and breathe the phrase “sweet as pie”, and her patience and easy laugh made me feel the least alienated.  

After triage, Doctor Yorleny, a Belizean doctor who regularly volunteered her time to the service-learning program we were participating in, would further examine the patients and prescribe medicine. We had a makeshift pharmacy, which we stocked with donated medicine, mostly consisting of vitamins and ibuprofen.

We used a community center building for the last town’s 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. It was during the last clinic that the case of a eight-year-old boy named Alex made me feel the most estranged from the other volunteers.

            Alex’s mother brought Alex to 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. Alex had been complaining of the pain since he first got the stitches.

            Allie and I called Dr. Yorleny 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 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 in anticipation. The cornbread colored walls seemed to be tilting like the tops we had been handing out earlier to the kids, and I weakly asked to 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.

            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. 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”. 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 joy, rather than the pain, that I would never able to get used to.

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.