A Dash of Salt

by Julia Nascimben

“It’s salty!” eighteen-year-old Erneste exclaims, licking the fingers he has just dipped into the ocean water. He is grinning from ear to ear. Strangers look at us as if we are out of our minds. They do not know that Erneste comes from Rwanda and has never seen an ocean before. They do not know that he was so sick that he could not even be operated on in his own country where my father’s medical team was on a mission. They do not know that only two months earlier, death was knocking on his door, but that he was able to receive the heart operation he so desperately needed thanks to a hardworking team of health professionals including my father. “Erneste! You know you’re not supposed to eat any salt,” my father half-jokingly exclaims. It’s true—the type of open-heart surgery that Erneste underwent meant that he was not allowed to eat salt. Erneste giggled as he licked his fingers again in defiance. I had never seen someone so happy over…saltwater. It was as if this salt gave Erneste’s life a new meaning.

Six years pass. I am in the Dominican Republic. It is 6:30 a.m., and for the fifth time in a row this week I am walking into Hospital Plaza de la Salud, ready for another day of hard work. Today is going to be especially busy because we are aiming to discharge all 39 patients tomorrow. As I change into scrubs and put on the signature white coat I catch a glance of myself in a mirror. I pause and wonder to myself…Do I have what it takes to be a doctor? My thoughts are interrupted by a call for morning rounds. I locate my group and immediately the systematic patient check-ins begin. We waste no time—we have less than an hour to evaluate all of the post-operative patients before the day’s surgeries begin. I remember as soon as Melba sees surgeon Dr. Schumacher and I walking into her room, her face lights up.

“Do you feel pain today?” Dr. Schumacher asks her.

“¿Tiene dolor?” I translate.

Melba grins and shakes her head no.

“Today, we’re going to teach you how to walk again,” says Dr. Schumacher proudly, and I translate once more.

“Muleta, izquierda, derecha,” Melba repeats after me as she climbs the staircase.   Crutch, left foot, right foot. I am standing at the top of the staircase, awaiting her ascent. As she finally reaches the top step, everyone erupts in cheers. She glances at the piece of paper posted above the stairwell and lets out a huge smile. “Sí, tú puedes,” it reads. “Yes, you can.” She reaches over to me and hugs me tightly. Tears stream from her eyes as she tells me: “Porque ustedes son ángeles de Dios.” Because you are all God’s angels. Here is a woman who, just days ago, could not even stand on her own, who could not afford medical care, who is now walking. I had interviewed her preoperatively, looked at her x-rays, talked with her family, and learned more colloquial Spanish as I listened to her stories. In just a few days, I became known as her nieta, her granddaughter. I, her nieta, observed the anesthesiologists and surgeons working diligently on her knee replacement. Though I had gotten only five hours of sleep for the past four nights in a row, I was unable to take my eyes off of those performing a procedure that I hoped one day to perform myself.


The stairwell where patients completed some of their rehabilitation exercises was lined with adhesive foam stars

*          *          *

I was a junior in high school. The transition from a small private middle school with a graduating class of 75 students to a public high school with a graduating class of 400 was far from easy. I still felt as if I had not found my place. In December of 2013 my mother mentioned an opportunity for me to travel to Santo Domingo with a group of medical professionals. She said it would be a good chance to gain valuable experience in the medical field, experience that I could not gain from shadowing doctors in Boston. I had never been on a volunteer trip before, so I gladly agreed to go.

I remember looking out the plane’s window as we were getting ready to land in Aeropuerto Internacional de las Américas in Santo Domingo. Besides the beautiful bright blue water along the coast, the land was very green, littered with palm trees and neighborhoods of tin-roofed houses. One thing that caught my eye was the amount of baseball fields I could see— diamond after diamond stood out among the land that seemed otherwise like poor villages or farmland. I knew that there were many Dominicans in the MLB, and I would later understand that in the DR, baseball is seen as the prized, one-way ticket out of a country most see as a vacation spot. As our group’s bus weaved through the traffic, flocks of schoolchildren stared in awe. Other pedestrians seemed to be sitting around, soaking up the Caribbean sun. I soon realized that the city of Santo Domingo was poorer than any other city I had ever seen.

The majority of my time was spent translating to and from Spanish while shadowing the doctors. I gained valuable medical experience and insights that I would not otherwise have learned until medical school. Though the weather outside was unbearable, I loved being a “doctor” for a week. I adopted the role so well that some patients referred to me as one of the real doctors until I told them I was just a high school student. Sometimes, I would play along, just for kicks. My favorite moments were those spent conversing with the patients. Often when I told them that I was only sixteen years old they asked how I had ended up on a medical mission. I told them that I was mostly there to gain medical experience and to put my Spanish skills to use. I grew close to many of them, especially Melba, who was embarrassed every time I showed up when she didn’t have her dentures in. One particular time, I walked into her room with a nurse to change her bandages and give her more ice. She grinned, but upon remembering she did not have her dentures, gasped and immediately cupped her mouth in horror. We laughed and assured her that it was still okay to smile; she just shook her head and refused to remove her hands. I’ll never forget how hard it was to say goodbye to her on the last day. I told her to remember to do her physical therapy exercises like I had taught her, and promised her that I would visit soon. I felt as if I had gotten to know her better in one week than I had gotten to know any of my friends in high school in three years.

Melba and I right after her surgery

*          *          *

Just eight days after I first stepped off the plane in Santo Domingo, I was back in school attending my classes. Life must go on. When I first returned home I felt foreign—guilty, even—because in that week I had, for the first time, gotten a taste of the poverty that a large percentage of the world lives in. I wanted to go back so badly and not because I never wanted the trip to end in the first place, but because I felt as if in that short week I had gotten used to living a simpler life. I’ll never forget the one night when the Dominican medical students took me out to a local restaurant. It was nothing like the upscale, tourist restaurants where we had group dinners. Instead, it was where ordinary locals would grab a quick bite to eat on nights when they didn’t feel like cooking. It was right on the shore. A radio blared Latin music. The restaurant itself looked far from passing US health standards. The menu was simple and everything was very cheap. I didn’t know what to order, so I let the medical students choose for me. Surrounded by the salty ocean breeze, we didn’t talk about the patients, or x-rays, or how the day had gone. Instead, the students talked about some of their favorite things to do in their free time, about all the cool places in the Dominican that were rich in history and culture. They talked about how they would bring me, their hermanita de Boston (little sister from Boston), around everywhere if only I could stay longer. If only.

It was the moment at the top of the staircase with Melba that confirmed my childhood aspirations of becoming a doctor. More importantly however, it was the moment that opened my eyes to what true happiness is—both for me and for others. Tears rolled down my cheeks and into my mouth, the salt evoking memories of Erneste’s second chance at life. I finally understood the meaning behind all those sleepless hours and how both my parents could love such a stressful job. I realized that the entire trip was really a life metaphor—there are many stairs to climb, much hard work ahead, but also much dedication, passion and compassion. Erneste and Melba are two special people whose experiences will remind me of the impact our lives had on each other. They have added the salt, the missing flavor, to my childhood dreams. In spring of 2017, I will return to Santo Domingo with the same medical team. Aside from performing orthopedic surgeries, the group surveys patients from past years, in person, to gather feedback on how they have recovered since their operation. This means that I’ll be seeing some of the patients that I last saw in 2014. Maybe my abuelita Melba will be there. I sure hope she is. And I hope that I can see her smile again, with or without her dentures. Porque ella es mi ángel de Dios.

A letter written by a patient’s son (translated into English by a Dominican medical student)