Clinic Day

The Sunday after arriving to Guatemala was our clinic day. Imagine a waiting room the size of a tennis court filled with over a hundred people. Children hunch over coloring books we brought, some having others color for them because their congenital hand deformity won't allow them to grip a crayon. They are here to see the surgeon about that club hand. The parents socialize, forming an ad hoc community, lamenting how hard it is for their bowlegged son to go to school or how expensive it is to buy a wheelchair. The doors to the smog-filled street are open and fans are going full blast because there is no air conditioning. Volunteers check patients in and call them up to see the surgeons in a makeshift examination room. Screens are set up to give some semblance of privacy as surgeons test range of motion, check gait, hold X-rays up to the fluorescent lights. An interpreter and scribe are assigned to each attending surgeon and the process moves quickly. The surgeons determine whether we can feasible intervene; sometimes, we don't have adequate equipment, facilities, or follow-up. But if the child is a candidate for surgery, they will either send them to get further X-rays or see us in our anesthesia closet. On their way to see us, nurses take their height, weight, and vital signs. Then in a quick 10-minute visit, I go through the medical, surgical, and birth histories, medications, allergies, anesthetic plan, preparations, and expectations. I carefully record the patient's information and file the chart - the surgical evaluation, my pre-op assessment, a photograph of the child, X-rays, and a contact information sheet - away carefully.

After we have seen about fifty children, we convene to discuss the cases. We are operating for four days and we want to fill the slots with the most high-impact cases. We have to decline some children - the surgery is too involved, the anesthetic is too risky, there are undiagnosed medical illnesses, or the child is running a sky-high temperature. But for most of the children, we slot into each day, trying to create a balanced schedule. After making the week's operative list, we go back down to the waiting room to all the eager faces.