La Clínica: A Doctor's Journey Across Borders

Prologue

 WE HoISTED THE BoDIES oNTo gURNEyS AND CUT THE blood-drenched clothes from their heaving limbs, necks, and chests— JohnDoes1,2,and3,becausewedidn’tknowtheirnames.Paramedics, holding bottles of clear intravenous fluid, described what happened— a gang fight with knives and baseball bats. Blood pooled on the floor. Nurses and paramedics ran into the room and out of the room, bumping into each other, eyes jumping from body to floor and back. An intern kept checking for pulses in the arms and neck and legs, looking up at me as the paramedics began to do CPR. I stood at the head of the bed, smelling the sweat and blood, checking the laryngoscope bulb, looking down at the long face and the body of John Doe 1. He had large protruding ears and broad muscular shoulders that contrasted with the delicate face of a crying Jesus tattooed on his chest. A single tear hung suspended near his left nipple. His calloused hands had probably carried heavy boards and beams for houses. His eyes stared up at the ceiling. When the paramedics began CPR, I knew it was probably hopeless. I said, “open him,” and the surgery resident cut through the face of Jesus down to the lungs and heart. Blood spilled out all over the gurney, gushing from the hole in the heart. “Stop,” I said. “He’s dead.” I watched the heart manage an occasional , ineffective beat. “Let’s move on to the next one.” John Doe 2 had buckteeth with braces. His parents had spent thousands of dollars on his mouth. He died slowly as we X-rayed his chest, probed the wound under his rib cage, and inserted tubes and catheters in every place we imagined it might help. His blood pressure had Prologue  • david p. sklar dropped suddenly when he returned from X-ray, and we were trying to figure out what the knife had cut. “Call the oR,” I said, scanning the room for the surgeon. And the surgeons took him up, but he died in the operating room of a cut vena cava. John Doe 3 survived. He cried for his mother as we stuck needles into his veins. He had a stab wound through a spider web tattooed on his shoulder. He was fourteen or maybe fifteen, and he watched his friends die on the gurneys next to him. I looked at his eyes as they darted about. “you’ll be oK,” I said. The nurses were calling to me. “David—Dr. Sklar—what should we do about John Doe 1?” “Put his body in the hall,” I said. “What about John Doe 2? They brought his body back from the oR.” “In the hallway too, next to John Doe 1.” As they called my name, it reminded me of Mexico, of the first time a villager had called my name to help someone sick, someone dying. “David,” they would whisper at my window at night. “Por favor, David,” they’d say and then knock lightly and insistently to waken me. Even though I was only twenty-two years old and was not yet a doctor, and even though I barely understood their language, they would come to my window in the middle of the night. And I’d dress and stumble over the uneven rocks of the unlit street to an adobe house with a single lantern illuminating a feverish patient lying on a burlap cot in the darkest corner of the room. I’d smell the strangepungentherbsandoilscoveringaplacewherethepainresided, usually the middle of the belly, or under a breast. After a while they’d whisper my name again. “David, David, is there no medicine for this?” And I’d have to walk back across the village to the clinic to find something that might help. Now, I walked out to the ambulance parking lot, following the nurses who needed a smoking break. John Doe 3 had been rolled down a corridor to the intensive care unit, and for a moment we were free. The janitor was already mopping up the floor, making the blood disappear, but now he stopped and followed us out, along with the two interns and a security guard. one of the interns fashioned a ball out  la clínica • of Kerlix bandage and white adhesive tape. The security guard rigged up some lighting for us, and the janitor unscrewed a broom handle so they could play stickball. I watched...