Until Next Year

     Here I sit in my comfortable living room. My children are healthy and well-fed, intelligent and kind. They are well clothed, with shoes that fit and coats that keep them warm..... They have regular access to medical care, getting their dental, medical and eye check-ups yearly. My pets are not emaciated or flea ridden... My husband and I both have well paying jobs. for miles in ill fitting shoes. ....I have a car that runs well, on streets that are paved, well-maintained. I have heat to warm us in the winter, air-conditioning to cool us in the summer. We have hot water. We have washing machines and dryers. We have electricity, cable TV, reliable internet access. We have so much to be thankful for. We have each other, family and love. Those three things are universal. The “stuff” is just a perk.
     This was my 4th trip to the clinic in San Raymundo. Please do not think of me as a self-sacrificing, amazing person who goes for completely altruistic reasons. It is not true. I go because every year, I receive so very much. Personally, it puts into perspective, my life, my goals, my desires. Do I really need a new phone, a new pair of shoes, another gadget? It helps me to rely not on diagnostic testing, as there is very little available to me when in clinic. But, rather, it helps me to develop my hands on skills and diagnostic abilities based on patient presentation, what I see, what I feel.
     I bring back the blessings of hundreds of people, thankful for a moment with the gringos and the care we provide. I bring back the stories of love, hope and sorrow. I bring back knowledge from every single member of the team I travel with...they all teach me so much. The students I worked with this week made me a better teacher.
     The translators, our voices and our ears, infuse the spirit of their people into English that we can understand. And, sometimes no words are needed, simply a tearful hug says so much more than any language can convey. I come home with more friends, the camaraderie of the providers, the long hours, the tears that we’ve shared, bond us in a way that I’ve never been bonded to others before. Do not think of me as a giving person. Think of me as a person who has been enriched beyond anything she has hoped to be enriched, loved more than ever, taught in a way that she’s not been taught before and thankful for things she’s never been thankful for.
     As I sit here and attempt to put into words the week that I had, I find it difficult. I arrived in San Raymundo with a bus of about 45 other volunteers. The team is made up of many different people with unique skills. We had pharmacist, pharm tech, non-medical people, surgeons, students, nurses, nurse practitioners, laboratory techs, dental hygienist....so many skills, so many uniquely appropriate for this trip. We arrive on Saturday and unload our belongings, claim bunk-beds, set up rooms, ORs, labs, pharmacy. I was able to help do some physical exams on some patients who came in that night in hopes of having surgery in the morning. Clinic then runs from Sunday thru Thursday. We start at 7:30 and go until the last patient is seen. Meals are provided and prepared by a staff of local women. I miss that already. ………
     We saw sicker patients this trip than I’ve seen in the past. More grossly abnormal clinical findings. More heartbreak than before. More joy than before. We had several patients that we simply had to say, there is nothing we can do for you, your condition will ultimately lead to your death, we are deeply sorry. It is such a difficult conversation to have in this country. But, to have it with a patient and their family that have the wild hope that the gringos can fix anything can cause my heart to stop for a moment. We hold hands with these patients, we offer comfort medications, we help the family to understand how to help these people have a peaceful death. We pray with them. We cry with them. …..
     Andrew and I had a patient that came to us. She had a history of stomach cancer about a year ago. She presented to us with a mass in her abdomen, weight loss, decreased appetite. It was obvious to us that her cancer had returned. After consulting with other providers, we were sure that there was no medical treatment left other than comfort care.
     Nancy came in to translate for us. I was the medical voice, the one that gave Nancy the words to speak. The woman’s family came in, her niece, daughter, sister, brothers. Such an amazing family ready to take her home and love her, to give her comfort and care in her last days on earth. The patient clung to me, I held her, kissing her dirt streaked cheek, answering questions from the family. The love enveloping her was palpable. The family embodied strength for me. I cannot help but think about my own personal story here. My dear uncle is terminally ill with metastasized prostate cancer. My family embodies the same strength, the same palpable love, the same joy and appreciation for my uncle and one another. I couldn’t help but cry then. I am crying now as I type this. Family love is universal.
     In the midst of the tears, the sometimes hopeless feeling that we are unable to help, to do anything....we were blessed with the joy of a birth in clinic. Our midwifery student, Deb, took the lead. The room was full of counting...I’m certain I can count to 10 in Spanish now after doing it several times. Mom was stoic, dad was quiet. This was their 8th child. I was not in the room for the birth, but to hear that newborn cry across the clinic. To see our students deliver, comfort, assess and beam with pride was amazing. There is so much hope in a new child. So much joy. So much awe.
     Guatemala is a lush, green country. The volcanoes, flowers and amazing weather make it a fantastic place to visit and enjoy. As we drove from clinic to our 2 day stint in Antigua (where we were able to unwind and be tourists), I plugged myself into my ipod and stared out the window. It is also a country of poverty. of garbage strewn across the countryside. Of children running down the dirt roads with no shoes. Of dogs running wild and emaciated. Of people lying beside the streets, on makeshift sidewalks. My hope is that they were simply asleep there, that they were still breathing, but I cannot be sure. …..
     What made this trip the best ever for me? It’s hard to sum it up in a sentence or two. The entire
medical team was amazing.We worked together with a seamlessness and efficiency I have yet to encounter. No one said “I don’t want to do that” or “I cannot do that”. Everyone was ready, willing and able to go outside of their comfort zones, they were able to move away from things they knew and were able to do well, to find new and creative ways of treating and caring for their patients, to help other members of the team....no question was too dumb, no provider knew everything. Patients were receptive and thankful. Difficult situations posed all of us opportunities to grow, to empathize and to learn.
     I have come home more content with my life. My family, my loves. I am happier with my career and where I am. I am a better student. I am a better teacher. I would not be half the practitioner I am if I did not take these trips. I am able to use skills that I don’t always use in the states, but am reassured that I still have them ready and waiting should I need them. I am more thankful for my health, my friends and the health of those around me. I am more thankful for mi familia, my friends and my colleagues. I am more than when I left. I thank you all for being with me in spirit, in kind and in body. I am just thankful and blessed. I am ready to go again. Until next year....
Jennifer Tucker, FNP

Jennifer Tucker is a Family Nurse Practitioner. She resided in Medina, Ohio with her husband of nearly 17 years, Jeffery, and their two children, Jillian, 13, and Joseph, 10. She works full-time at the CVS Minute Clinic. Recently, Jennifer was awarded the Lifesaver Award at the annual Convenient Care Clinician Congress in Orlando Florida. She received this award for successfully managing a full cardiac arrest and anaphylactic incident in her stores this past year. Jennifer was a ONAAT schlarship recipient in Feb 2010 and she just made her 4th trip to Guatemala this October, 2010. Jennifer precepts students from her alma mater, Case Western Reserve University, on a regular basis.