Tuesday, December 17, 2013

20 and 21 March 1999, Notification Day, Operation Smile, The Philippines

20 March 1999, Saturday, Notification Day

I did not shine today. I dropped the ball. I dropped the ball and let it roll away from me. Today was the day I was most concerned about: selection day, the day we winnow out those not suitable for surgery, the bad choices. The brutal and only feasible way to inform the mass of people who passed through our screening process is to simply post a list. There are no reliable phones here and many of the poor can’t access one anyway. I prepared for this at my training. If your name is on the list you win, you get the surgery, your life is changed. The manner is of passing finals, getting a good mark on your test, making the grade. Can’t find your name? You are shit out of luck.

After the build-up and tension of four days of screening, after the punishing travel many people endured for the chance at a life, we tack up five large sheets of paper, one for each surgery day, with the names of the lucky ones - the selected ones, printed neatly in tall block letters with a black marker.

I thought I developed a handle on the situation. I talked with the team leader, John, several times about when the list would be posted and where. I asked him to encourage some of the medical personnel to participate. I needed assistance explaining and answering questions. I knew there would be reluctance to do this. It is easy to offer information to someone just given good news. But the turn-aways, the children and teenagers who weren't going to find their name on any of our lists, no one wanted to face them. I spoke with the head anesthesiologist, a wise and experienced guy from Maryland. Quentin was the final approval in the medical team decision to put someone on the list. He was familiar with the public anguish accompanying notification. He saw the need to add some humanity to the process, to offer something to those who cannot be offered surgery. I made an announcement at Friday breakfast briefly outlining one more job to be done. I plastered on my most charming smile and invited all Op Smile team members to attend.

My weakest link was the one that gave way. I didn’t figure the sheer mechanics of the posting would throw me off. Irene, the medical records secretary, was up most of the night after the surgical team made its decisions, pulling records and actually creating the lists to be posted. She arrived at the hospital late for breakfast and, observing a crowd of anxious families, decided to put them out of their misery and post the lists early. She stuck them up with some masking tape and came upstairs and quietly went about getting her breakfast. I was already there, too nervous to take the opportunity for some extra sleep, casting around for a copy machine to reproduce some of the resource lists I compiled, and about to sit in on some nurse training. I thought posting time would be just before noon.

One of the floor nurses pushed through the swing doors to our makeshift cafeteria. She was sobbing. She sat down at my table and announced all hell was breaking loose outside. How could we be so cruel?

My heart clutched in my chest. I spit whatever food I was chewing into my napkin and ran down the cement wheelchair ramp and out into confusion.

Two extremes: prayers-answered, scared, tear-streaked joy and blank despair. As I think about it now there was no possibility of one person, me, handling it all. I was caught up in a maelstrom. I planned so carefully for notification day: empathic listening, calm guidance, steady, informative composure. Instead I found myself flustered with three and four people talking, often shouting, to me at once. The mixture of euphoria and hysteria and the non-stop stream of words were staggering. Everyone recognized me from screening. “Ma’am Trudy,” they called me. “Why?” “Why was my little girl not chosen?” “Thank you Ma’am Trudy for giving us a chance!” “Can’t you see I can’t send Franco to school looking like this?” “Can you ask the doctors for me, Ma’am Trudy?” “My baby won’t eat, can’t sleep, will never speak. No one wants to look at her. Why did you say no?”

My voice rose, trying to be heard over the commotion. I started shouting and making things worse.

Finally, I found some English speakers in the crowd and put them into play translating for me, helping people find their names, giving instructions: what to do, where to go. Some of the surgeons got wind of what happened and came down from breakfast to help. Quentin showed up and John and another John, a retired surgeon from North Carolina, through-and-through a gentleman, took places on the wooden veranda of the hospital and started offering some genuine answers to these people. I didn't know who to tell that they should try again, come back next year, their baby needed to gain weight or get rid of an ear infection. The atmosphere lifted with the presence of the experts. A bit of calm and reason returned.

Then Darcy arrived. She works across the street from the hospital in the physical rehabilitation facility. Small, well-kept, gold-rimmed glasses, and a voice like a bark, she heard the turmoil outside her office and came out to investigate. What wonderful English she spoke! She fell in beside me just as my voice started to give way and the doctors were forced to leave to attend a surgical team meeting. Her no-nonsense manner made all pay attention and soon everyone was lined up and participating in name searches. She gave a quick lecture to the lucky ones: where to go for a blood test, when and where to show up for surgery, and what to bring, and sent them off. We offered what we could to the others.

Oh yes, there was anger and some openly expressed despair. I found this easier to take than quiet acceptance. Again and again a jeepney would pull into the hospital entry and a father or mother would climb out with baby and siblings in tow. They would step speechlessly before each day’s list, running their eyes up and down and, just to be sure, going over it once again. After the last list, Friday’s surgical schedule is short and filled with only minor cases not likely to be complicated, reality silently hits them. Some go back and reread. This is so important to them. They are so nervous, surely they missed something. Others wander off the hospital porch, the implications of “no” forming in their heads. Life will continue as it is, as they know it now: fearful, outcast, and filled with shame.

The simple sheets of paper posted to let patients know they've been selected for surgery.

The Philippines is known as a country of beauty pageants. I see signs tacked up on lampposts and electric poles advertising “Most Beautiful Girl” contests for various age groups. I pass store fronts filled with those lacy confectionery dresses little contestants or their proud mothers favor along with snowy white anklets, patent leather Mary Janes, and carefully engineered cascades of brown or black ringlets. This land prizes beauty. These people are quite beautiful: dark eyes, smooth skin, round faces, a mix of tropical island ancestry, Spanish colonists, and the proximity to the Orient.

To be turned away, told to go back into hiding when the opportunity for a normal life in both form and function is so tantalizingly near – to take up once again the burden, the weight of this solitary dividing factor keeping you or your child from school, from work, and from the day-to-day tide of life must be soul-killing. There is nothing for it. I thought I came prepared for this. I brought my good old American can-do attitude, that omnipotent spirit of making everything right, knowing what is good for everyone, the Mom-connected urge to make the bad stuff disappear. Turning these people away fills me with sickening frustration. There was nothing I could say or do to temper this brand of resigned grief. I handed out phone numbers, addresses of Op Smile contacts in Manila. I reminded them to keep in touch with the hospital and with the sisters who ran it. I looked into their eyes if they were willing to raise their heads. I squeezed their shoulder, their arm, their hand. I experienced the bitter sensation of powerlessness when they thanked me for what little I offered them.

I give myself up to sleep and wish for no dreams. There is no moon tonight, only thousands of stars I do not recognize. The door to the balcony is open and drifting through it I hear splashes and laughing in the pool as some of my teammates indulge in a midnight swim. I can smell flowers from the garden, a heady mixture of sweet, over-ripe fruit, and some unfamiliar, un-tasted spice. The slow, varying breeze is tinged with the sour compost odor of the open sewer outside our gate. In the distance, when there is a lull in the truck traffic on the highway, I hear the vocal ebb and flow, a chorus of voices rising from the cock-fighting coliseum. 

21 March 1999

I am in paradise. It is our day off, one rest and relaxation day before we enter the tight schedule of surgery week. We need it. All around my teammates are napping on lounge chairs, reading, or quietly chatting in the hot tub. That’s right, a hot tub. It is connected to a pool connected to another pool connected to two other pools at different levels by slides. Our in-country hosts delivered us to this resort this morning, a former coconut plantation in the southern region of Luzon, for a taste of Filipino hospitality and recreation. So far, I love it.

My team: We are a group now - a good one, I think. I surmise the success of Operation Smile missions depends on the smooth dynamic of each surgical team. John is a wonderful leader: patient, soft-spoken, a great sense of humor. He is concerned with everyone. You get the sense he loves his wife and kids. This work pays interest on his good fortune. John brought half of our team, another surgeon, surgical and pediatric nurses, pediatricians, and anesthesiologists, from the University of Iowa. The rest of us represent the world: Hungary, Salt Lake City, Wales, Norfolk, Seattle, Columbia, New York, and Australia. The accents are wonderful. All of us are trying to learn Tagalog from our translators and counterparts at the hospital, some with more success than others. Each morning in the van on the way to the hospital I corner Michael, a young dentist from a suburb of Manila, for language assistance. He gives me a different phrase to use every day. I repeat it over and over trying to get the stress on the correct syllables. I can’t keep much in my head. Two words I use often: “Salamat” – thank you, and “Mabuhay” – welcome. Veronica, a pediatric anesthesiologist from Budapest, is putting together a little cheat sheet of phrases to use over surgery week, an idea I should copy. I like one phrase she’s translated, “We’re going to mend your smile.”

In the last week this group pulled together, no interpersonal dramas, no whiners, no noses set out of joint. There are some characters. My roommate Izzy is one of them. She is a straight arrow who longs for a warm Cinnabon and her scuffed house slippers. In a short week we all find ourselves comfortable with each other. At breakfast this morning we were all laughing at one of the doctor’s deadpan imitation of our morning wake-up announcement. He was just repeating it to the people at his table, but soon he had the whole room giggling, “Good Morning Kalapayan Estate, Operation Smile, time to get up!”

I am not in Kansas anymore. This resort is a feast for the senses, filled with absurdity and luxury. We are surrounded by acres and acres of tall, evenly spaced palms forming a tangled roof over our heads, a regulated jungle. Is that an oxymoron? There is undergrowth when you get away from the beaten paths but nothing insurmountable. Light filtering through the concentrated growth in the canopy is the same light you find in a medieval cathedral: sifted and made reverent by glittering patterns of stained glass. I look up through the breeze-blown fronds and see a sky fractured into a moving checkerboard. The sun falls through in small intermittent beams, soft and almost green in a place where all I set my eyes on is green.

I nabbed one of the big lounge chairs and I’m anti-social. My headphones are on and I’m listening to Pat Metheny. Several others do the same. We all could use a little time to ourselves. There is much to write about, especially this surprising place. I must get some rest though. I will write till I can write no more and then a nap.

This place: We arrived this morning after an incredible 1 ½ hour, high-speed drive past dingy apartment complexes, jungles, a smoking volcano, some dirty-looking industry, and more and more plantations. There was one limited access highway, a highway - with actual signs. The toll booth operators took our money with one hand and clasped their machine guns in the other. The vans dropped us off at the entrance and we were issued two tickets, one for lunch and one for a water buffalo ride. They call the water buffaloes “caribous,” but they sure look like water buffaloes to me. We all headed off to the museum, figuring we’d get it over with before eating lunch and hitting the pool.

What a museum! The signs said it was created by the former plantation owner before the property was sold and developed into a resort. I loved it. If you cram together all the American side-of-the-road wonders you can think up: Indian trading posts, alligator wrestling attractions, meteor craters, and the world’s largest ball of tin foil, and jam them into one dimly lit, musty-smelling hall it would come close to this. I can’t remember all of it. There were shrunken heads, a Japanese sword collection, mounted butterflies and dusty taxidermy snakes, lizards, and warthog-like creatures, various carts and floats with stare-y eyed saintly effigies, Victorian costumes and military uniforms displayed on mannequins qualifying as antiques themselves, stacks of ancient pottery, the Lord’s Prayer written over and over again in microscopic print formed into a map of Australia, an assortment of jawbones, and a large collection of souvenirs from what must have been a memorable trip to Bermuda: beaded belts, painted ashtrays, embossed leather wallets, and a scrapbook of postcards. It was, well, very American to me – like Aunt Lizzy’s attic or the mother of all garage sales. We were steeped in unexpected kitsch and it was quite pleasant. Outside we wandered about a formal garden decorated with Japanese and American ordinance from World War II, a nice finishing touch.
On our way to the resort museum under a canopy of palms.

We hiked far through the palms to find our meal. There must be a name for the room created by the soft floor of the jungle and a muted canopy above. The giant trunks bow like the ribs of a whale. The roof is thick and luminous, as if it quarters another level of life. Again, I keep coming back to the light: long moving shafts filled with golden motes.

It was surprising when we handed in our ticket and were told to check any bags we didn't want to carry along with our shoes. Past the entrance turnstile we descended four flights of steep stairs alongside a massive waterfall. The last step was into the warm, churning water. Long tables and benches were fixed into the rock of the stream-bed from the foot of the falls downstream for 200 yards or so. The steep banks and the waterfall formed three sides of the open-air restaurant. A large, red-clothed buffet was set up for our group further downstream.
The restaurant in the river below the waterfalls.

I was a little squeamish at first. My imagination got to work on all those organisms, micro and otherwise, lurking about ready to nip at my ankles, burrow into a toenail, or invade my circulatory system with an unpronounceable and incurable rotting disease. But the bottom wasn't slippery at all. One of the servers assured us the stream-bed was scrub-brushed every night. Other patrons were eating and happily posing for photos in front of the silver curtain of the falls. I loaded up my plate with more of the amazing mangoes and papayas and pork wrapped in leaves, and, oh-yes-rice-again, then waded out and found a seat with my teammates, all of us knee deep in moving water. We grew accustomed to the tumbled roar of the falls in the background and broke the unbidden silence that somehow settled among us. A curious sense of relief or giddiness took hold. The river banks were planted with ferns, palmettos, and hibiscus. At waist level the banks were studded with giant South Sea clam shells into which some of the flowing water was diverted to make a series of smaller falls. Our servers explained, these were for washing up when we were finished.

Some Op Smile team members, including Karlene, Michael, and John, enjoying lunch at the restaurant below the falls. Notice the water flowing past the table.

I sat mesmerized when my meal was through. It was hard to leave. Coal black and bright red and iridescent blue birds kept swooping through the airspace just above our heads and darting about in the curving canopy above us. This is no Disney World or Great Adventure or any other kind of carefully packaged, predigested entertainment. I felt wonder in me – immersed in this world – roiling, rushing, buzzing around me and with me.

I am very tired. 

Later on 21 March 1999, Sunday night

We’re back, sunburned and happily tired from our day at the resort. It is awful but I never caught the name of the place. How crass! I’m used to this sort of thing being in my face all the time: precisely designed logos on the napkins and paper cups and coffee stirrers in trademarked colors, hum-able ditties over the airwaves. 

Our drivers brought us back to Cavite via a different route. Joy, our hostess, wanted us to taste some fresh coconut so she led all of the vans to a ramshackle open market at the side of a busy road. We piled out, smelling of sun block with our straw tourist hats and cameras hanging from our necks. She picked through a shoulder-high pile of fat green coconuts till she found a few to her liking. The peddler handed her a dodgy-looking machete and this tiny woman swung it through the air and whacked the end off of each nut like she did this every morning before breakfast. I didn't get a taste of the milk but managed to nab some of the meat – delicious, thick, and different. Not your tasteless Stop ‘n Shop $1.99 two-for-one, but sweet and warm and with a nose to it.

During this demonstration two little girls in ragged undershirts and no underpants peeked out from behind the ripped half-curtain dividing selling area from living space. Their eyes soaked up our group with unreserved curiosity and a dose of fear. I found my eyes running over their perfect faces, their perfect mouths. I am accustomed to defect I think, or fast grown jaded by my exposure to so much physical imperfection. I wonder at my reaction to their appearance. They seemed so beautiful to me. Their feet were so encrusted you couldn’t see skin. The smaller girl sucked on the two middle fingers of one hand, leaving two wet dark rings up close to her knuckles. A half-bald dog sprawled across the dirt floor.

While the team hung about waiting for tastes I stepped down the road a bit, checking out the fruits and vegetables for sale. I hardly recognized anything. Colors swam everywhere, dark orange and purple and smooth yellow and green/ I love papayas and mangoes and pineapples but there are many fruits and vegetables in this place I don’t recognize: eggplant-looking things that are almost blood red and thick, segmented roots covered with fine hair. I looked for the leaves they make “crispy leaves” with. Our food service at the hospital served this several times and they are good. Our server referred to them as crispy leaves as if they were as common as French fries. On the plate they retain their shape, delicately scalloped and dark green. Perhaps they are spinach or grape leaves.

One of the stands was guarded by an old woman with spectacular wrinkles. We engaged in one of those conversations I am starting to get used to: lots of hand gestures and smiling and inane nodding. There would be difficulty understanding her even if she spoke a little English. Her mouth was small and puckered inward from lack of teeth. Her face was thoughtful and expectant, as if understanding me was going to happen at any minute. She selected a round yellow-green fruit, sliced it up, and offered me a piece. I cautiously bit into the inside layer. It bloomed in my mouth like tart ginger, sweet and burning at the same time. She refused my money, so I thanked her as graciously as I could and was about to turn away when she pointed to me and blurted out, “Murphy Brown? Murphy Brown?” This is the second time I've been pegged as Murphy Brown in these travels. Us Caucasians all look alike.

We scrambled back into our vans and I promptly fell asleep on John-from-North-Carolina’s shoulder. One minute I was looking out the window at everything streaming by and the next I was waking up as the van took the final curves into the hospital driveway. I was mortified. He was a gentleman. He let me sleep for quite some time. I hope I wasn't snoring or talking. I blushed my redheaded blush. I hope my sunburn covered it up.  

The hospital stop was a final check on rooms and supplies and tomorrow’s patients. The schedule calls for tomorrow’s surgical candidates to check in the night before their surgery so we can monitor them for fevers and make sure they have nothing by mouth before their big day. Every single patient was there.

The sisters cleared out one floor of the hospital for us. There is a central nursing station and four big connected rooms. These are filled with rusting metal cots; some better than others, all with makeshift IV poles. So many surgical patients showed up, the sisters brought more beds from the maternity floor. Beds line each of the hallways and there are two along the wall across from the nursing station. Four barely functioning toilets serve all of these people.

Our group trailed through each room, some of us still in our bathing suits and sandals. The surgeons gathered around and discussed some of the lips and palates, the nurses checked in with the Filipino floor staff. The rest of us went around shaking hands, greeting excited scared parents and kids. There is no food service at the hospital and only one bed per patient. Whole families arrived with many of the designated patients. They will be there to run out and obtain food, participate in the nursing, and sleep all together on one narrow bed or the floor nearby.

I was gratified so many recognized me. I didn't have a translator with me but discovered there is usually someone who speaks at least a little English nearby. American TV can account for this. I fell into what is become my habit here: asking if anyone had any questions and handing out the answers, unless they are very specific, in a public way. There is a natural shyness in these people, almost a form of politeness, along with the frightened reticence that comes before surgery. Always their children are in their arms, against their side, within an arm’s length.

This is a position I am familiar with: the hours before a surgery are scary and without end. The foreign place, a hospital with strange sounds, smells, and people displaces you and makes you question what you are doing and imagine the worst. You head is filled with “what ifs” and “I should haves.” Your child is frightened and will pick up any fear she senses in you. It is almost impossible not to be afraid.

I liked this part though. Despite the unknown, the great imagined changes occurring tomorrow, these are the people we’re not saying no to. They all heard Yes! Tomorrow will be daunting and busy and cruel in the price of passing physical pain, but tomorrow we start seeing results. 

My sons are on my mind tonight. I am missing them and wishing all is well at home. I hope Josh is making out okay in school. As always, I worry about Trev taking his medication. I’m halfway around the world and I find myself willing him not to forget it. I must allow this child to grow up.   

There is so much I want to tell Josh and Trev now: the people here, the plants. Trev would be wild for the birds I've seen. How things are so different here and very much the same. How parents love their children. How children want to live. I have one week more. I know I will be busy, busier than last week in a more profound way. I’m not frightened of this surgery. These doctors are a responsible lot. They are meticulous and, despite the stark conditions, they are not about to take any crazy risks. I am hopeful. I look forward to this work. This is where I can get behind what the parents are feeling. This is where I can hold up the light for them, show them the way to the end of this tunnel. There is work to be done: relentless, heated, tiring, bloody, dirty work. What will come of it is worth every effort. I better get myself to sleep. Tomorrow: surgery.  

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