new m.d.
The Toughest Job I Ever Loved

Last week was the busiest and most demanding I have had during my short, modest career as a board-eligible ophthalmologist (approximately 8 months). It was remarkable! I saw more interesting pathology in 1 week than in any given year during residency.  

Monday, a concerned young mother carried in her newborn with bilateral congenital cataracts. On Tuesday, a man shuffled into the clinic with all the classic signs of leprosy. On Wednesday, an unfortunate 40-something year-old man, led into the clinic by his daughter, had the most severe chemical injury I have ever seen — near complete epithelial defects from his injury 4 months prior. Thursday, I removed my first black cataract. It wasn't brownish like a butterscotch hard candy, but black like a piece of coal. Friday was reserved for postops. They looked fabulous! All week, nearly every other patient we saw had an unfathomably larger pterygium than the preceding one and a steady stream of cane-wielding cataract patients, too numerous to count, tapped their way into the clinic.

These patients hardly represent the good folks who make their home along the western shore of the Narragansett Bay, where I reside. Instead, these were patients I had the honor to care for while volunteering in El Salvador.

Seeing a Different Way of Life

It is not everyday that you see this volume of patients debilitated from something treatable such as cataract blindness. People drove, walked, hitched, bussed, were wheeled, or carried, and had the roads been suitable, would have likely roller-skated into the clinic for evaluation. Long lines were the standard.

Patients' gratitude was genuine and sincere, often in the form of a hug, firm handshake, kiss, prayer, and for one patient, fried chicken with a side of cole slaw.

A Unique Work Environment

Our days began early in the morning with the absurd and unrelenting crowing of a rooster, and concluded well into the evening when the last brunescent nucleus was finally extracted. From the moment we arrived in San Salvador, we hit the ground running with the OR staff unpacking and setting up in a well-coordinated and expeditious fashion. Patients had been anxiously and hopefully awaiting our arrival, and we immediately began screening potential surgical candidates for the following morning's corneal transplants.

A cornea specialist had traveled the distance with a white styrofoam cooler brandished with a red sticker boasting its contents, "HUMAN TISSUE" (I imagined the flight attendant smugly instructing, "sir, you must stow your human tissue in the overhead bins or underneath the seat in front of you," with curious passengers sipping their complimentary beverages in puzzlement.) Peace corps volunteers endured long uncomfortable journeys on the ubiquitous converted school buses to act as translators. Because my own Spanish vocabulary is equivalent to that of a toddler, their assistance was invaluable to me. They spent long days with us in the clinic and OR with the satisfaction of seeing these people cared for as their sole form of remuneration. We all worked at a steady but brisk pace all week, loving every minute.

Coming Together for a Cause

There was something liberating and intrinsically rewarding about absolving myself of my usual superfluous considerations, instead focusing on providing exceptional care to these patients in need. This focus was shared among my fellow volunteers; it took us far away from home to a country we may not have otherwise visited, and brought us together with this single objective. We worked well collectively, and at the end of the day, shared each other's company like old friends. We left El Salvador with a sense of accomplishment, lasting friendships and a new and unique perspective on medicine.

It is not uncommon for medical staff to offer their expertise to underserved areas around the globe. I have gained a considerable amount of respect for these individuals, many of whom make this an annual commitment. They put their busy practices and jobs on hold, kiss their families goodbye, and pay their way to participate in these meritorious relief missions. I am pleased to have joined these special people. This past week was a memorable and enriching experience, one that I will always treasure.

Howard Amiel, M.D., practices at Koch Eye Associates in Warwick, R.I. His email is howard_amiel@brown.edu.