Do Not Rescusitate-Conclusion

Remember what I said about my surgeon yesterday?  Plain talker, not pretentious, good guy?  When you think of the hospitalist think the opposite of those qualities.  This doc gave me the distinct impression that rather than listening to what I was saying he was always thinking of what to say next.

When the hospitalist came in the room he sat in a chair for our initial conversation.  It seemed  rehearsed.  He asked if I wanted extraordinary measures taken should I have a medical emergency.  I said I had all that written down in an advanced directive which I had given the hospital.

“You’re saying the hospital has that on file?”

“Yeah.  My wife gave it to one of the nurses during admission.  She made a copy.”

“Well it’s not part of my file.”

“Yeah, well I gave it to them.”

“I’ll make a point to find it.  So tell me, in a general sense what are your wishes should we encounter the need to resuscitate you?”

“I don’t want anything heroic to happen if there’s no point.”

“I see.”

We talked some more, sort of.  Before he left he asked

“Mr. McClure, how can we help you better?”

“When this leg block wears off and I have to take other meds for pain you could give me morphine instead of hydrocodone.  I’ve had morphine in the past and it worked the best. I have good memories of that family of drugs.”

He laughed.  I had made the same request of my surgeon, each nurse I encountered, and while not laughing at me like this guy, all of them dismissed it. 

“We don’t give out much morphine these days,” the hospitalist said.  “Morphine is old.  There are more effective drugs now.” 

That seemed to be the general consensus.  Morphine was the only bright spot in my operations long ago, and now that was gone.  Also gone however, was much of the pain.  Hydrocodone is now king.

In less than a half hour the nurse, either my own or the nurse in charge, an older woman who looked like she knew her stuff, blew into the room and made straight for my bedside.

“Do you know you have a DNR?  Is that what you want?”

“DNR as in Do Not Resuscitate?”

“Yeah.  The hospitalist ordered it.”

“Generally yeah.  I guess.  I mean if it’s only going to prolong my life…”

“No you don’t get it.   Your chart has a DNR.  If you have an arrhythmia out of the blue, or some freak thing happens that you stop breathing, I can’t help you get over it because you are DNR.  Is that what you want?”

“Well no.  I mean if I’m in god awful shape and dying, you know, and shocking my heart back to life or putting in a feeding tube only lets me live a while longer I don’t want that.  But if as we’re talking here I can’t breathe then, yeah, I’d like you to help me out.”

“That’s what I thought.  I’m going to talk to the doctor.  I’m not sure he knows how you feel.”

My wife came back from the cafeteria about that time.

“Honey, let me see that Five Wishes thing.”

She dug it out of her purse and I started rereading it. 

“I talked to that hospital doc and he’s got me down as not wanting to live if I have some kind of an emergency.”

“What?”

“He marked my chart Do Not Resuscitate.”

“What in the world did you tell him?”

“I told him I didn’t want them knocking themselves out if I was dying.  But apparently a DNR has everyone standing around watching me die today and tomorrow.”

“Well you’d better change that.”

“No kidding.”

It wasn’t twenty minutes before the nurse, with the hospitalist five steps behind her, burst into my room.  She went to one side of my bed, the hospitalist took the other side.  I had the distinct impression they were about to settle an argument.  My wife’s eyes were wide. The nurse started.

“OK Mr. McClure tell (the young pretentious hospital doc) what you told me earlier.”

“Well I may have misunderstood your question, but I’ve read my directive here (held up the Five Wishes paper) and what it begins with, is this statement.  Let me read it to you.

I believe that life is precious and I deserve to be treated with dignity. When the time comes that I am very sick and am not able to speak for myself, I want the following wishes to be respected and followed.

I think that’s where the confusion came in.  I was talking about dying.  Do I look like I’m dying?  Hell, I’m 65 and just had my ankle fixed.  Other than that I’m OK.”

“Mr. McClure, with all due respect, that’s not what you told me.  You told me clearly that in the event that you were dying you did not want hospital staff to take extraordinary measure to save your life.” 

“He’s not saying that,” the nurse said.  The hospitalist gave her a dirty look.  She was challenging his judgment.

“Can I see that paper?”

He took the document from me and began to scan it. 

“I think what you have checked here for options in these scenarios backs up my decision.  There are three choices. 

o   I want to have life support treatment

o   I do not want life support treatment.  If it has been started I want it stopped.

o   I want to have life support treatment if my doctor believes it could help. But I want my doctor to stop giving me life support treatment if it is not helping my health condition or symptoms.

In each of these four cases, you’ve checked “I do not want life-support treatment.  If it has been started I want it stopped.”  That’s what a DNR is.  No life support treatment. That’s what I ordered.”

I had the distinct impression he was trying to save face with the nurse for the decision he made.  Thank God for that nurse.

“You’re missing the point.  This whole thing is built upon me being very sick and close to death.  Do I look very sick and close to death to either of you?  And what about the four cases?  Did you bother to read them?  Give that thing to me.  Here’s the four scenarios it applies to.

§  Close to Death

§  In a coma and not expected to wake up or recover

§  Permanent and severe brain damage and not expected to recover

§  Another condition under which I do not want to be kept alive

Do any of those apply to me now?”

Neither of them answered.

“Well do they?”

“Mr. McClure, we can’t predict the future,” the hospitalist said.

“You don’t have to.  Look at me right now.  Do you know why I’m getting this ankle fixed?  So I can take trips and walk around new places.  So I can golf eighteen holes, with a cart, and not have to ice my leg for six hours and hobble around the house.  So I can walk my daughter down the aisle.  It’s maintenance and repair for Christ’s sake.  I’m not dying.”

They didn’t respond.  I had a cup of melon chunks left over from lunch in a plastic cup with a spoon on my table.

“Are you telling me, that because I’m listed as a DNR, if I took a bite of this fruit and got a chunk of honeydew stuck in my throat and turned purple, neither of you would do the Heimlich on me?”

“Yes,” the nurse said.  “As long as you’re marked DNR.”

The hospitalist chimed in. 

“There are people you know, who believe they have lived a good life and do not wish to continue under any circumstances.  But look Mr. McClure, if you want to change your mind it’s fine with me.  I can change this order and I will.  Just tell me what you want.”

“How about this.  If I look like I’m dying in the next two days, and you can bring me back, do that. Then we’ll discuss what happens again.  And if you can’t talk to me, talk to my wife or my kids.  But I am pretty interested in continuing to live.  Life if pretty good.  I’d like to stay at it.  Hell, with any luck I might even break 80 on the golf course before I actually turn 80.  And I wouldn’t mind turning 80, as long as thing are going well.  So yeah.  Forget whatever I said, bring me back to life, and either me or my family will take it from there.  But I don’t want you making that decision.  Do you understand?  I want my family to decide.  They know me, you don’t, and there you go.”

I wished I had brought my flask.  I needed strong brown alcohol of some kind.  Any kind really .

The rest of my stay was uneventful.  The hospitalist visited me the next day, but his visit was short.  I was released the following day.

As they were taking me out to the Buick to head home, I asked Colleen to find my pocket knife in the backpack.

“What do you want that for?”

“I want to cut these damn plastic bracelets off my arm.”

It’s good to be back in the shack.  Stay out of hospitals if you can.

For information about The Five Wishes, click https://www.agingwithdignity.org/contact

Do Not Resuscitate-1 of 2

I spent a couple of days in the hospital getting my ankle fixed.  Rebuilt in a way.  It was elective surgery to fix an old problem.  I think of it as restoring a vital part of an old tractor; a two cycle John Deere say, or an old Minneapolis Moline.  The details are boring and often constitute the vapid medical discussions of people I’m afraid have nothing better to talk about.  This post is not about what they did to fix my ankle (well maybe a little).  It’s about experiencing and enduring the medical system.  As you may know, or might guess, there are problems.

Submitting yourself to a hospital is, in a word, dehumanizing.  I like my surgeon.  Just a bit younger than me, he speaks plainly and answers my questions.  He told me and showed me what the tests meant, how the procedure was going to work.  If it was just he and I, and he could have come to Ottawa and done his work in the shack, it would have been perfect.  But in order to accomplish this particular procedure both he and I had to comply with policies and protocols.  I hate both policies and protocols, and I don’t think he had much use for them either.  But for him it is the water he swims in.  I’ve been away from it for some time.  Since retiring I forgot, thankfully, how stilted and maddening the environment in a big organization can be.

Before I even got to the hospital I was required to see my regular doctor for a pre-operative health clearance that included blood work, EKG, and a lengthy office visit.  I rarely see my family physician.  In fact, my former regular doc left me, sent me a letter, moved up to administration, and I was assigned to a new young doctor in the clinic.  It matters little.  In reality, when I make appointments I always see a nurse practitioner whom I really like.  She is far better than any male family practice doctor I’ve encountered.  She listens, understands, and takes her time.  And in organizations, it’s the staff that matter.

However, protocol required even her to go through a lengthy checklist of questions about not only my present and past medical history, but my family’s as well.  I don’t know how many times in my life I’ve answered these questions but it’s a big number.  In fact, because I’ve seen her for so long, she knew the answers to most of them before asking.  But she had to ask them anyway, as if they might somehow change.  I answered them politely.  At some point don’t you think the computer system she works on would capture and retain my medical history, the sad problem-based rundown of my body’s failings?  It doesn’t happen.  At that point I could feel the system beginning to focus on my body and not me.  In the end she declared I was surgically good to go, and the deal was on.

I got to the hospital very early in the morning for surgery and after presenting my insurance card, verifying my birth date, and signing a bunch of financial stuff I was outfitted with three vinyl bracelets.  They were a white ID tag with bar codes, a yellow one which proclaimed me a fall risk, and a green one of undetermined meaning.  I was tagged and categorized.  Necessary I suppose if everything went south and they only had the tags to determine who and what the body attached to the bracelets was all about.

“I’m a fall risk?”

“Everybody 65 and older is a fall risk.” 

“I see.”

The put me somewhere else behind a curtain and I changed into the gown.  A nurse came in with a clipboard, smiled, sat down by my gurney and began to ask questions.  It was the very same long list of questions my nurse practitioner had asked a week before.

“You should have a report on all this stuff.  I did this a week ago.”

“That’s for your doctor.  This is for the hospital.”

“Oh.”

“Mr. McClure, we didn’t get a blood test from your doctor so I have to take blood again.”

“I had a blood test a week ago too.  You should have it.  Didn’t you get the results of the other tests?”

“I’ll check again. “ 

She fumbled through some papers on the clipboard. 

“Yep we got other test results but no blood report.  I can call your doctor and ask again but that will only hold things up.  I’m sure they’re not open now.  I can take the blood when I put in your IV or we can wait.  Your choice.”

She clearly didn’t want me to wait.  It would hold everything up. 

“OK, take it again.”

Another woman came into the room.  She also had a clipboard.  She gave me a pen and began rattling off more forms she wanted me to sign.  Instead of automatically signing them I scanned them.  As I signed she asked more questions. 

“Do you have a living will?  Power of attorney?”

My wife took care of that one.  It’s a little grisly but she had mine in her purse.  I was in the hospital after all.  She handed it to the nurse.  We have a relative who taught a course in medical ethics at Marquette University in Milwaukee and recommended a process called “Five Wishes.”  You can do it yourself on the internet.  It takes you through a series of questions and considerations and allows you to choose how you would like to die and who decides what happens before you leave.  I did it years ago when I had a health scare, now so well documented in who knows how many checklists in countless files.  It’s easy and thorough, this Five Wishes thing.  Plain language.  I gave a copy to each of my kids, who along with my wife are authorized to act as agents when and if I reach the end slowly and predictably.  As opposed to say, getting hit by a truck. 

“I’ll make a copy of this,” she said.  She left and returned quickly, giving the paper back to Colleen.

A form giving the surgeon permission to do the work listed the wrong procedure.

“That’s not what he’s doing,” I said.

“Are you sure?”

“Uh yeah.  Very sure.  That’s what he originally intended to do but he changed his mind after an MRI.”

“Well I’m sure he’ll perform the procedure you discussed.”

“I imagine so, but I’m not signing it until it’s right.”

She immediately stopped talking to me and turned the conversation to the other nurse, who had moved on to some other part of the prep work.

“When is he scheduled?”

“He’s (my surgeon’s name) first.”

“And is he getting a nerve block?”

“Yes.”

“Well that’s going to be a problem.  The anesthesiologist can’t put the block in until this is signed, and this could hold up the surgery, and (my surgeon) won’t like that at all.”

“And he won’t sign it?”

I was right there between them.  I’d been listening to their conversation as if I was watching a game of ping pong.  I felt like raising my hand but didn’t. They continued to talk without acknowledging me.

“No.  I can’t say as I blame him.  It is the wrong procedure after all.”

“Well you’re going to have to find (my surgeon).” 

“I’m not even sure he’s here yet.”

With that the nurse left in something of a huff, ripping open the curtain and sliding it back with gusto.  If it had been a door she would have slammed it.

Finally the first nurse spoke to me, or maybe to herself.

“This isn’t good.”

They moved me through the process anyway.  I was wheeled to something of a staging area where others were lined up in a holding pattern.  For all I know we each took a number, like when you renew your driver’s license.  They did more things to me, hooked me up to monitors, put sticky things on me and attached wires to them.  A young doc with a big cart came in.  As he began to take equipment out of his cart he spoke without looking at me.

“I’m here to do a nerve block prior to your ankle procedure.”

Before I could respond a nurse beside me said

“He hasn’t signed off on the procedure.  It’s listed incorrectly.  We’re trying to get (my surgeon) here to fix it.”

The young doc looked at her with disgust. 

“How long is that going to take?”

“We don’t know.  We’re trying to get (my surgeon) here right now but we’re not sure he’s available.”

“I’m busy as hell this morning.  If he’s not here quick I’m going on to my next patient.”

“Well this is (my surgeon’s) first patient and he’s not going to be pleased if that ankle is not numb and ready to go.”

The doc seemed to weigh this and gain a bit of patience from it.  About that time my surgeon strolled up.  He’s a tall guy.  Nice smile.  He shook my hand and looked right at me.

“What’s the problem Dave?”

“That form isn’t right.  It lists the wrong procedure.”

A nurse handed it to him sheepishly.  He looked at the filled in blank at the top.

“Yeah it sure is.  I’m sorry that happened.  That’s what we were going to do when we first scheduled this date.  Either my office or the hospital didn’t make the change.  I’m sorry about that.”

He was the first to acknowledge any fault or offer an apology.

“How about to speed things up you cross that out, write in the right thing, and we’ll both initial it?” 

I used to do that on state contracts.  I was trying to be helpful.  I felt guilty for holding everyone up.

“Nope the hospital won’t allow it.  I’ve tried before.  We’ve got to get a fresh form.”

The young doc there to numb my leg let out an audible sigh.  My surgeon gave him a look.  A nurse joined him in the look.  It seemed to cool his jets a little.  Then a young nurse came running, actually running, with a piece of paper, my surgeon and I both signed it, he drew a big blue arrow on my left leg, the doc with the block did his thing, and they wheeled me into a very cold room, where they transferred me to another table.  The anesthesiologist told me he was going to administer the sedative, and as I scanned the room looking for power tools I conked out.

Soon after (or so it seemed. It was actually four hours) I woke up in a private room and felt pretty good, unlike my experience when they worked on the same leg in the late 70’s and early 80’s.  My leg, from the knee down, might as well have been a block of wood.  I could neither feel or move my toes.  Pain management has come a long way I have to admit.  There were round bottles of medicine lying in the bed beside me feeding some magic liquid drug through through thin wires which drenched the nerves in my calf and kept my ankle numb.  They stayed that way till the day I was released.  Pretty amazing.  On top of that I took nothing else, not even a Tylenol.  My surgeon came in, told me the outcome of the procedure, and showed me X-rays.

“Wow those look like deck screws.”

“They are a lot like deck screws only stainless steel and a lot more expensive.”

“You went in at an angle.”

“Yeah those angles are important.”

We talked some more.  There is an element of geometry and carpentry to the kind of surgery I had.  Having built the shack, and trying to find a comparison I was familiar with, I related what he did to secure my ankle to my tibia as toenailing a rafter to the top plate of a wall.  He agreed.  Good guy.  Regular talker.  Not pretentious.

The rest of my stay was fairly uneventful.  The food was good, the Cubs were on TV, the staff were nice, and I felt little or no pain.  There was the usual parade of people with various job titles coming in and out of my room: nurse, phlebotomist, a woman who explains the menu and writes it down for you, candy striper, care aide, housekeeper, chaplain, physical therapist, my surgeon, the hospitalist.  The only one I really cared to see was my surgeon.  And while we’re here talking about hospitals, couldn’t they expand some job descriptions and eliminate some of those people?  Good god, it’s an army.

I have to say each of the staff were friendly and competent, except for the hospitalist, who ironically probably was paid the most.  I had heard of this newly created role but never met a doctor carrying it out.  As I understand it a hospitalist is the doctor for everyone in the hospital regardless of their problem.  When nurses have a problem they call the hospitalist not your attending physician, in my case my surgeon.  The hospitalist sees you every day.  Looks at your chart.  There is no way one doc in a big hospital can have a working knowledge of all the medical conditions and treatments that are contained in all those rooms on any given day.  I’m thinking he’s the ultimate generalist, keeps the specialists from getting too many calls, and knows a lot about the rules.  I bet somewhere he’s heavily involved in meetings about outcomes.  This hospitalist, a young doc with a cool demeanor asked this question each day.  It was his mantra I think.

“How can we help you better?”

Recommended Reading

The most striking thing about reading to a class of four year olds at Opportunity School was seeing their eyes on me. Ten pairs of clear, bright, hopeful eyes; looking up at me from where they sat on the floor, waiting to see and hear happens next.  I’m not used to it.  I’m used to being here, tucked away in the shack, by myself, unnoticed.  Those twenty young eyes took me back.

They took me back thirty years ago, when my two kids looked at me like that.  What’s for breakfast?  Where are we going?  What are we doing?  Such innocent questions.  Such hopefulness.  Only four eyes in my house, but they saw everything.  I was constantly reminded of my responsibility as the adult.  The parent.  It’s important how you answer.   

It took me back to when my kids went to this school.  In fact, I was a visiting Dad in this very room.  So many kids have gone to this school.  It started in 1968 as the brainchild of a thinking woman from the church where it is still housed.  Put kids in groups.  Let them play together.  Guide their energy more than teach them.  Make school a positive experience.  My kids were once sitting cross legged on that floor.

The teachers of course were in charge from the time I walked through the door Wednesday until I left.  The kids were already in their places, marked by tape on the carpet, sitting quietly.  One of the teachers introduced me and they greeted me with smiles.  Most volunteered their name.  It was a chorus of names and engaging smiles, trying to get my attention.

I sat down on a bench by the wall.  That’s when the impact of their eyes hit me.  I was on.  I asked them if they liked listening to people read.  They nodded.  One smiling kid said his Grandpa read to him.  I said I sometimes liked to listen to books being read through ear buds.  We were underway.  I had begun.

A talkative boy in the middle, busting to say something, said he had new shoes.  He extended one leg and pointed.  He demonstrated how they fastened with Velcro.  A girl on the edge of the group, not to be outdone, announced that she had new boots.  The group was pretty interested.  I was losing it quickly.

You forget so easily that phrases like “off the subject” represent adult concepts.  I think to the four year olds we were simply engaged in a talk.  And if you said something, that was indeed talking, and it fit right in.  My discomfort that we were suddenly talking about shoes rather than the topic I had introduced, listening to people read, didn’t register in those twenty eyes.  The teacher reached over and touched the boy on that new shoe he had shown me. 

“Let’s see what book Mr. McClure has picked out for us to hear.”

Thank you, I thought to myself.

And I launched into Cloudy With a Chance of Meatballs.    As soon as I began to read they settled in.  They listened very well for the most part.   At one absolutely random point the kid with the new shoes began talking about his new video game.  I realized I had picked a book with a lot of words for four year olds.  I began to read faster, and pointed out the illustrations.  I had to work to keep their attention.

I like the book because it is built around an outrageous concept.  Grandpa is making pancakes for his grand kids, recklessly, and flips one through the air.  That inspires him to tell the story of the town of CHewandSwallow, where it doesn’t rain rain, it rains food.  The people of ChewandSwallow don’t go to the store to buy food.  Instead they carry plates and cups, forks and spoons, and napkins of course, with them as they go through their day.  And when it is time for lunch, for example, they go outside, hold out their plates, and catch a hamburger that falls from clouds, usually followed by ketchup and slices of onions, with French fries blowing in from the east.

There is enough food for everyone.  City workers clean the streets after meals like bus boys and dispose of the leftover food in an ecologically friendly way, and life in the small town of ChewandSwallow goes merrily along.

The kids sat rapt, their attention on the growing amount of color in the illustrations.  I pointed out the syrup falling in perfect drops on nicely rounded pancakes, and milk filling glasses held outside of umbrellas. 

“If you lived in ChewandSwallow what kind of food would you like it to rain?”

A chorus of responses resulted.  The teacher quickly announced they should hold their hands and wait till I called on them.  They obeyed.  I pointed to the girl on the outside of the group with the new boots.

“Salad with ranch dressing.”

“Oh yeah,” I said.

“How about you?”

I called on the quiet boy in the first row.  He was sober and thoughtful.  Finally he decided.

“Spaghetti with the kind of sauce that has hamburger in it.”

A murmur of approval went through the small crowd.

“And you?”  I had called on the boy with the new shoes. 

“PIZZA!”

The very thought of pizza falling from the skies brought the house down.  One girl jumped to her feet.  It took a while to establish decorum after that.  Thank god for the teachers.

Conflict, which is needed in every book, is created in Cloudy with a Chance of Meatballs when the weather turns violent.  Huge porterhouse steaks crash through skylights and windows.  Mashed potatoes pile up in the streets like snowdrifts and city crews can’t plow through them.  They abandon their efforts.    Pancakes become so big they cover the houses.  One covers the school and the students can’t get out.

“What if a pancake covered this school?” I asked.  I pointed to the window beside us.  “We would look out and all we would see was pancake.”

They looked at the window incredulously.  I went back to the text.

“And then one day they heard a loud sound and what did they see but a tomato tornado!”

I pointed to a large red funnel cloud with tomato stems and seeds flying around inside it.  The mere sight of the tornado produced a chorus of comments.

“”We saw a tornado too and my Mom took us to the basement with our cat.”

“My Grandpa went to the basement but he left the door open upstairs and when he came up everything was blown all around.  He can’t find some of his stuff.”

The stories continued.  Unlike before, the teacher and I looked at each other and silently agreed to hear them out.  It seemed cathartic.  I had forgotten all about the tomato tornado.  Just a month ago a tornado hit our community.  That there was a tornado reference in the book I picked was a fortunate coincidence.  

And then I closed the book and the teachers directed them to thank me which they did profusely.  Loudly.  Especially the kid with the new shoes.

“Mr. McClure can we take your picture?”

“Sure.”

The kids crowded around me where I sat on the wooden bench.  I was hoping I could get off that bench gracefully.  She needed them to get closer.  They crowded in.  I felt a tiny hand on my calf.  It was the quiet guy who wanted it to rain spaghetti.  I looked out of the corner of my eye at him.  He smiled. 

“Look at the camera.”

We both looked straight ahead.  The teacher took the picture.

Try reading to kids.  I recommend it highly.  They will enjoy it and so will you.

Agua Escondida

From San Lucas Toliman we went up the mountain another 800 feet or so in an old school bus over bad road  to Agua Escondida where the clinic was set up in an old hall next to a church.  It was a steep climb.   There weren’t enough seats so some of us stood.  Each morning the bus was filled with conversation and laughter.  As we gringos crowded into the bus and drove up through the forest it was clear we enjoyed each other’s company and looked forward to the work.

I started volunteering for these clinic trips in 1985.  Each trip has found me among old friends and new acquaintances.  It is always someone’s first mission, and those of us who have gone on many all hope it is not our last.  This trip found me with my wife on her second mission.  I don’t know which mission it is for me.  I have lost count.  Every trip and every group of volunteers is different.  We were blessed with nine optometrists in Aqua Escondida, an unusually high number, which allowed us to use doctors for more than eye examinations.  We consistently had a doctor in the dispensary, where we choose the best match of the prescription a patient requires among the 6,000 some used glasses we brought with us.  Having a doctor in the dispensary meant the volunteers selecting the glasses learned a lot and made better choices.  By doing that we were able to give a higher quality service.

Being a small town, Agua Escondida became the host site for others.  Busses arriving morning and afternoon brought villagers from the surrounding towns.  Families often came together so there were a lot of children in the clinic.  Because the volume of patients was not crushing and their movement through the clinic was not rushed we were able to spend plenty of time with each person.  That’s not always the case.  The newer volunteers may not have realized the difference but I appreciated it.  We offered eye exams to the school children of Agua Escondida and they took us up on it.  That’s how I first knew I needed glasses, the third grade eye test by a visiting nurse to our farm town.  Like my classmates, most of the school kids saw just fine.  Notable exceptions were discovered young, as I was, and glasses were provided them.  That we had the time and provided those exams pleased me a lot.

We were staying at an old hotel on the shore of Lake Atitlan, a giant crater lake, technically a caldera, formed when a volcano erupted violently a hell of a long time ago.  It formed the largest freshwater lake in Guatemala, and became home for Mayan people who settled into a ring of villages around the lake.  On this trip all the patients could speak Spanish to us, although often they spoke Kaq’chickel to each other.  In an earlier post I mistakenly describe their language as K’iche.  Wrong dialect.  Both existed before white men came to the new world and continue being spoken daily in Guatemala and elsewhere yet today.  I hope the languages and its dialects endure.  They are unique.

On the third morning of clinic, a Monday, I paused as I walked up the steep cobblestone street to the clinic because I heard singing.  Across the street was a barred open window looking down on an auditorium.  It was the town’s public school students. They were having an all school assembly, presenting the flags of their state and country, Solola and Guatemala, and singing the Guatemalan national anthem.  Their voices blended nicely.  They were well behaved.  Their teachers stood among them.

Knowing the history of the region I thought it remarkable the students were so enthusiastic.  From 1960 to 1996 Guatemala’s government was at war with its own people.  The socialist government in Nicaragua was seen as a threat not only to the U.S., under President Reagan, but also to the U.S. aligned and conservative Guatemalan strongman leaders.  Guatemala’s resistance to the movement known as the contras morphed into a belief that all Mayan villagers were enemies of the Guatemalan state.  Among the Mayan villages, where we were operating our clinic and elsewhere, it is estimated that between 40,000 to 50,000 people simply disappeared.  The International community considers the actions by the Guatemalan government on its indigenous communities genocide.  Mayans were not only killed they were also conscripted into the army and forced to turn their guns toward other Mayans.  And yet there were the school children, in 2017, twenty one years after the war’s end, singing the anthem and waving the flag of the country that had so divided them. 

 Lake Atitlan sits at 5,125 feet above sea level.  Agua Escondida is higher.  I don’t know if it is the elevation or something else but we encountered a high number of myopes, those afflicted with myopia, commonly known as near sightedness.  As the days went on there was increased pressure on our stock of glasses with minus prescriptions, like mine, the antidote for near sightedness.  Some also had astigmatism but many did not.   After 25 years my Spanish has gotten quite good in these repeated and limited conversations about glasses.  Put me in another environment and I’m practically illiterate.  I always try to remember I am a visitor in their country and there to serve them.  It goes like this.  I do a simple thing over and over.  It’s my way of being useful.  I call their name as written on the intake sheet and direct them to a chair.  I sit directly opposite them, our knees almost touching.  I confirm their identity.

“Juan Gonazalez?”

“Si.”

“Agua Escondida?” (or their age, or their occupation, just to confirm it’s the right person.)

“Si.”

I extend my hand. 

“Buenos dias/(tardes).  Como esta usted?”  (Good day/afternoon.  How are you?)

They take my hand.  I look directly at them and smile.  They invariable return my smile.  I ask them if they have had glasses before and nine time out of ten, perhaps nineteen times out of twenty, they say

“Nunca.”  (Never.)

And so it begins. You do a lot of things in your life.  This I enjoy immensely.  If I am giving them bifocals I give them a bifocal explanation rap.  If they are old, or simply concerned about the concept, and I can see the bifocals confuse them, especially after putting them on their head, I often change our approach on the spot and give them a pair of glasses for distance and a pair of glasses for reading.  I explain the lenses, nearly all of them now, are plastic and should be cleaned with soap and water and a soft cloth so they are not scratched.  I babble a little.  But my job is to determine if the glasses work for them.

Reading their face, looking at it intently as they look through their new glasses for the first time, is the best gauge of the lenses suitability for their individual visual problem.  Often the technically correct prescription, especially for a middle aged or older person who has never has glasses and requires a lot of correction, is simply too much.  In that case we cut the prescription.  If we are confident their vision will be greatly improved we at times give them a weaker pair to begin with and urge them to use the stronger pair later after they are accustomed to glasses.  But presenting glasses to myopes, minus prescriptions to near sighted people who have not seen distances crisply for a long time or ever, is a joy.  I know because I benefitted from those same glasses when I was ten and continue to this day to function because of such help.

I put the glasses on their face, often for the first time, and say

“Mira alla,” (look over there) while extending my arm across the room.  When I could I would seat those myopes with strong minus prescriptions near the window overlooking a school yard and a view down the mountain.  After they looked across the room I would extend the other arm towards the window. 

“Y alla tambien” (and over there too).  I often asked them to stand.

When they stood and looked out the window across their town and down the mountain I got the biggest smiles.  I distinctly remember walking outside the Gailey Eye Clinic in Bloomington on a summer day, looking down Main Street at a maple tree in summer, and seeing not just green but every leaf on the tree.  It was wonderful.

I did that over and over in Aqua Escondida.   I did it for this ten year old boy.

My wife had found just the right pair, -3.00 in each eye with a touch of cylinder for his astigmatism, from our supply of glasses.  She was sitting beside me as I put them on him for the first time, and after he looked out the window she took the picture.  Like me when I was his age I don’t think he’ll be going without his glasses often.  I told him this

“El mundo eres mas grande con lentes.”  (The world is bigger with glasses.)  He laughed.

That boy and his laugh is why I go on these trips.  I’ll go next year if I can, as I have gone whenever I could since 1985.  Where we go doesn’t matter nearly as much as whom we serve.  We serve people who need glasses and lack the means to acquire them.  Our challenge is to keep finding those people and getting ourselves there.  So far it continues to work.

P.S.-I’ll take your old glasses.  A number of my friends find used glasses laying around their home, or their relative’s homes, and give them to me.  People with bad eyes feel safer having old glasses just in case.  The truth is “just in case” never comes.  We wear the same glasses every day.  Give your old ones away, to me or to the Lion’s club.  You can send them to me at the shack, 2110 Caton Road, Ottawa, 61350 or drop them in a Lion’s Club collection box.  Most of the glasses I Care International distributes are supplied by the Lion’s Club.  Old glasses are not worth much to gringos personally.  But to the people of Agua Escondida, like that ten year old boy, they are priceless.