It was a quiet knock on my door that morning. So quiet, in fact, that I wondered if I was dreaming. Maybe if I went back to sleep it would go away.
Nope. There it was again: soft but persistent. This time I knew that it really was a knock, and it really was on the front door of my one-room cabin. What I didn't know was that I'd be hearing that knock for the rest of my life.
I got up, tired and rumpled, and pulled open the door. A young woman I'd never seen before stood there, barefoot and wearing the simple white linen dress of the campesina (as a woman who works the land is called in rural Paraguay). She was probably no more than sixteen, but in her eyes was the look of a mother, and something else: distress. In her arms she held an infant.
"Xe memby o-hasy (my baby's sick)," she said in her native Guarani.
I didn't understand a word, but I knew it wasn't good. I looked at her baby--face gray, eyes open, too sick to cry. What was I supposed to do?
Back then, I wasn't a doctor. Heck, I hadn't even taken any premed courses. I was just a liberal-arts major who'd "postponed graduation" from Berkeley "in order to get an education," as I explained to my incredulous father. Now I was the strange gringo (Peace Corps volunteer) living alongside a dirt road in the middle of the Paraguayan subtropics among a hundred or so peasant families, trying to help them literally hack a living from the jungle.
It was thirty miles to the nearest highway, 300 to the nearest hospital. This young mother had walked most of the night, from her home deeper in the jungle, to get to me. I was her last resort. She was out of options: there were no medicines and no doctors, and all the home remedies and the grandparents' ministrations obviously hadn't worked. Why not try the strange gringo?
"Ja ha (let's go)," I said, and motioned to my Honda 90 (Peace Corps issue) just outside the front door. I didn't know what else to do, but I couldn't do nothing. So I helped her onto the back of my motorcycle, where she clung, weeping, one arm clutching my waist and the other clutching her baby, and we headed for the crossroads where my little jungle road intersected the "highway." This route was just another dirt road, but it at least saw an occasional vehicle. One of these might transport her to the capital city, 300 miles away.
A half-hour later, almost within sight of the highway, the wailing in my ear suddenly changed. I knew what it meant. I stopped and got off. Then I held the young mother in my arms.
Speechlessly, in language that was neither English nor Guarani, I told her I was sorry.
We got back onto my motorcycle, turned around and headed back. For the next half-hour, I listened to the flood of a mother's grief--ceaseless, inconsolable, uncomprehending. The grief was hers and that of millions of mothers before her, across countries and cultures and time.
That sound, and her knock on my door that morning, has followed me through all the intervening years. It spoke to me when, after returning home, I changed my major from liberal arts to premed. It guided my choice to train in family medicine when I could have opted for other residencies. It is a gentle reminder when the frustrations of providing care in a seemingly deaf and broken health-care system pile up. I sometimes wonder
if I shouldn't have chosen something easier. But she always clears up my doubts.
I know now that she was my first patient, and will remain with me until the day I see my last. Even now, if I close my eyes, I can still hear her.
About the author:
Rick Flinders MD has taught and practiced in Santa Rosa's Family Medicine Residency Program in Northern California for the past twenty-five years. "One of the great gifts of medical practice is what we learn, not just about medicine, but about life. I find writing hard, but well worth the effort, for what it teaches us and allows us to share. I try to encourage our residents to do the same." He can be reached at email@example.com.
Beautiful, touching story. As a new mother, it brought tears to my eyes.
Some people are meant to taste only the nectar of a foreign culture in their Peace Corps experience. Others go, led by the deepest pull of a mysterious cosmos to learn a heavier truth, the lesson of what those in the East call, advaita, that we are one.
Your story, Rick is a poignant reminder of this notion. No matter what seems to separate us, culture, language, even an absence of medical nohow....nonetheless, we are one.
Your story should be spread everywhere.
Ted from Caazapa, Paraguay ('68-70)
where my lessons were of a gentler variety.
You rock, Rick. You rock.
It tugged on my heartstrings. This is a story I will remember in the years to come, since I am still merely a high school senior aspiring to become a physician.
I was very touched with this story. I am in my last year of undergrad, a few weeks away from graduation, and utterly confused about my next step in life. Your story has provided some inspiration to me, and in my future decision whether it is trying to pursue an MD or pursuing something else, this story will definitely stay with me in my heart. Thank you for sharing.
Wow. Such a tender story. Like you, I'll be feeling the aftershocks for some time.
I have been stuggling to find just the right article to present to the first year students next week when we meet to disucss Public Expectations of a Physician, what better way than to begin with this story. Thank you!
this is a beautiful and touching story. How fortunate you are to have such a clear, touchstone to help you stay grounded in spite of all of the disctractions that pile on throughout a busy day and career
A lovely story/memory Rick. These are the memories that keep compassion in our soul as we work
and write. May we never loose them. Pulse (thank you) has given us a place to share our stories from memory or imagination and I am grateful.
p.s. As a nurse at home in Bolinas, Ca. writing from Buenos Aires I am also grateful you are in Santa Rosa!
Wonderfully written. I could swear I was there with you.
Thanks for that beautiful story! I'pora, eterei!
Paraguay, and the medical needs of poor women there, gave me my medical vocation, also. It is good to go back to basics, to understand our true Hippocratic oaths, to try to do something for that sobbing woman, and to try to keep that baby from dying. Your story is a beautiful reminder. Thanks!
Seems strangely beautiful to be shedding a tear at Starbucks in Canyon Country, CA, while reading a moving story from rural Paraguay, well told by a compassionate physician in Santa Rosa—a story I just forwarded to my pre-med daughter, who leaves in 72 hours to go around the world trying to prevent illness. These stories are so important for all of us. Thank you Dr. Flinders and Pulse!
Beautiful job, Rick. This writing is the stuff of re-cruitment to a generation hungry for meaningful, honorable work. Thanks for helping us remember why we do what we do.
Blessings to you!
Your essay was eloquent and touching. I forwarded it to my 24 yo son who wants to become a primary care physician, just in case he was having any second thoughts!