La Clínica: A Doctor's Journey Across Borders

Chapter Seven

 I FELT A DULL NUMBNESS IN My HEAD AS I SAT IN My DIM house in Albuquerque drinking beer after beer. But all the sweetness was gone from the beer. The last sip tasted stale and metallic, and my head felt numb with the first sensation of drunkenness. I replayed my conversation with Laura. All those years she had been struggling and hiding it from me. It was too painful. I drifted back to Mexico, and let myself continue along the trail of reconstructed memories, filling in details as I closed my eyes and rubbed them with my fingers. I thought back to the whooping cough epidemic and our heroic actions. We had saved children who would surely have died. But after that, everything seemed to get more complicated. I thought back to those days after the epidemic, and what had happened still made me shake my head in amazement. After the whooping cough epidemic, I began to see my own patients, asking for help with Spanish or medicine as I needed it. Carl encouraged it. “That’s how you learn,” he said. We reviewed the library of donated books. “you can start with Differential Diagnosis. It tells you what diseases cause what signs or symptoms. Then you move on to Current Therapeutics and find what medicine you give for the most likely diagnosis. It’s really quite simple.” “What if you’re not sure, even after reading the books?” I asked. “I mean, for headache the book talks about brain tumors and meningitis and also migraines. one problem might kill the patient and for the other, you can give aspirin. How do you know which it is?” “you can never be sure,” he said. “So you try something, and if chapter seven  la clínica • it doesn’t work, you try something else. We have a whole roomful of medicines.” And then something occurred to me that I had neglected to ask when I had considered it previously. “Well, don’t people here in Mexico have to go to medical school and take tests to do what we’re doing? I mean, can anyone just go out and be a doctor? Wouldn’t that be dangerous? I mean, couldn’t I get into trouble?” “oh, the government knows what we’re doing here. I have a letter of commendation from the president of Mexico. They can’t get a doctor to practice here, and even the program for mandatory rural medical service hasn’t been able to send anyone here. No, we are all they have. Maybe someday one of our boys from the village will go to medical school and come back here. I keep hoping that by setting an example, we will inspire someone to do it. We’ll even help pay for it. But for now, you and I are their best choice and their only choice.” I nodded, and he smiled at me—a strange smile, as if he had now shared an important secret for which I should be grateful. And there was not a trace of concern for a mistaken diagnosis or wrong treatment. I followed his procedures. My patients didn’t seem to mind that I read books as I treated them. Everyone left with a small bottle of medicine because I always had some diagnosis, and each diagnosis had a suggested therapy in the book. And no one seemed to complain or suffer from a wrong treatment. A week later, when Carl told me he had to leave for a few weeks, I felt confident that I had a good system that worked. “I have to give a speech for the foundation’s fund-raiser, and then we have a meeting of the foundation’s board of directors,” he said. “What’s the foundation?” I asked. “It’s the way the clinic gets money, tax deductible. If you give enough money, you get on the board.” “oh, I wondered how we could give out medicine without anyone paying.” “Well, that’s only a small part. There’s the building and the Jeep and gas for the generator and trips like this one. We are very frugal here because every penny is precious.” “oh,” I said. “Well, I’ll try not to waste anything or let anyone die.”  • david p. sklar “Don’t worry. you’ll do fine.” He patted my shoulder and smiled. “I go back and forth to...