Guatemala, “the land of eternal spring,” is the most beautiful country in the world. Steep green mountains in swirling fog, green flora of every sort, a colorful Indian culture in each pueblo, each a center of subsistence agriculture par excellence. Cliffs of 60º to vertical are terraced neatly, tended and preened more precisely than any seen in Central Europe. Each town member has rather an identical external façade; the patterns of red, black, blue, and white clothes are distinct from the next town’s “uniform”. Volcanoes, earthquakes, landslides, and storms – the weather is seemingly one foot away. Every surrounding gives you the feeling that the Indians are right: God is present here and many of these events are truly spiritual in nature.
Guatemala was chosen as the third Interplast site because the president of the republic’s wife, the Minister of Health, and the chief medical officer in our A.I.D. Office had surveyed all the hospitals in the country for their desire to avail our services. We had visited each hospital in four countries of Central America that had expressed a desire for our help. We were overcome with their needs, yet sustained by the warmth of the professional collaboration.
Jacaltenango sits 6,000 feet above sea level on a tropical hill. We came to be there via eight hours on a road constructed just the month before. The road was really a one-lane trail, of higher grade than a true four-wheel drive trail, but too narrow for safe driving. On this road it was an instant 5,000 feet down if you went one foot off to the right, another 3,000 feet down if you went one foot to the left. As we made our way uphill there would be only blue sky visible in front of the windshield. It was magnificent – a thrilling scenic vista and switchbacks all the way up.
“Rick, put your head out the front window and tell me if I’m in a good relationship to the road, I can’t see any land, it’s all sky!” Richard Siegel was riding shotgun in the pickup. Rick Siegel had caught the plastic surgery virus at the University of Pennsylvania as an undergraduate, and was lucky enough to be one of the first to start the combined 6-year surgery program at Stanford. Rick was very capable. By his second year of residency he had shown his rather impressive genius and was already more or less trained in the entire field of plastic surgery in regard to both technique and literature.
Beyond these capabilities, he was enthusiastic, social, and extroverted. He was in love with life. Rick would direct me – “Little left. There’s a curve ahead.” Or “Back up around the switchback ‘til your rear wheel goes off the road; then you can make the turn, otherwise you’ll never get around this one.”
I was driving a blue two-wheel-drive pick-up loaded with four size “H” green oxygen tanks side by side in the truck bed. They did not clank together on turns, as we had stuffed soft items of supplies between them. Our hearts were high with the prospect of doing surgery and with our foolproof Asensio cleft lip repair for the cases that we had lined up during a needs-assessment trip six months earlier. At that time, to reach the Maryknoll Hospital at Jacaltenango, we had to leave the truck and make the final six him and a half hour ascent on mules. Phil Collins of the Latin American Mission Program (LAMP), our social chairman and bilingual English and Spanish stand-up comedian, joked to his wife afterward that he had spent eight hours with Maria between his legs. Maria was a mule.
Now, with the new but dangerous “Camino Trail”, the thought was the oxygen tank is bouncing in the pickup truck’s bed – might it explode? And I be killed? My mother – would she be proud of that? Will my family, my kids, have any more money for college education? Now watch the gears. Don’t lug the engine so much… A helicopter would be a better way to Jacaltenango than a pickup truck, don’t you think? Our adrenal glands summoned the maximum corticosteroids possible – the fight or flight mechanism, We were fueled by awesome admiration of the country’s beauty and the cohesion and orderliness evident in their rural society.
Resident Howard Holderness, Richard Siegel, expert anesthesiologist Vern Thomas and I arrived at the Maryknoll Hospital feeling that we had encountered one of the most beautiful and daring trip sites. We introduced our team to Sister Georgia Mayer, the chief of the hospital from my hometown of Milwaukee, Wisconsin, a trained general surgeon and also a nun in civilian garb, the dress of all the nuns of her “clan.”
Our new friends, these hotshot supermotivated, supereducated sisters, had cremated the Maryknoll Rule Book and kept the ashes in a little niche in the hearth of their huge stone fireplace of their convent, their headquarters. To us, these sisters personified idealistic talents: they were cocky, well-prepared, pragmatic and entirely devoted to the poor. They saw the poor as those who are oppressed by an economy that is largely controlled by the modern day descendents of those German and Jewish Europeans who had built the huge farms, fincas, and factories, fabricas. By this definition, indeed, 72% of the population constituted the oppressed. These were the native Indians most could not even speak Spanish.
The Maryknollers, as they are commonly referred to, have traditionally been the champion of the poor in South America. They had evolved their own political theology which was “liberation theology” and have espoused a political agenda in support of change and, in many cases, even revolution. Liberation theology means priority to the poor, not in respect to each individual person but rather as a political agenda for making the rules and the laws. In recent years, Rome has attempted to reign them in and quiet their liberation theology fervor (Marxism was actually a word used in some official papal meetings because the papacy equated Lib Theo with reassignment of land ownership). In the interest of political stability in South America, Rome had decided against Lib Theo. More than one Maryknoll or Diocesan priest has had their hand in leftist politics in South America, and more than one of my friends has met their fate in death by assassination. These nuns lived by their liberation theology, working hard and courageously, absolutely committed to cultivating the dignity of the Indians. They knew their business well. They also realized that the Indians had a culture superior to ours in several ways.
View of Jacaltenango from mule back as we innocently entered. And as we passed along an 8 foot stone wall, Richard and I were greeted by what we thought was a howitzer shell slamming onto the stones 1 1/2 feet from our heads. Wham!
It was a celebration day for the natives and the Castillo (see sketch of a celebrant carrying a small house made of saplings in the shape of a castle completely decorated everywhere with fireworks on one very long wick). One of the rockets was ignited as the Indian lowered his head pretended to charge into the audience. A rocket ignited in the horizontal plane and smashed towards us. God spared our lives. Soon other celebrants set off the equivalent of mortars which were giant “bombs” in a pipe propelling a missile which in turn exploded at 200 feet altitude.
We were not scared nor fearful. This was an incredible adventure unfolding . We had the thought that we were equivalent to characters in a play on stage.We had no time to think about fear. Rather we were too busy reacting on split-second notice.
That evening we discussed how we could help. We offered surgery and education at every opportunity, both on-the-job training and semi formal lectures and jam sessions all the time.
We were also doing our business well, and on the second case of the second day of the surgical trip, we were reconstructing the paralyzed left face of a 4 year-old by using fascial grafts from the thigh to connect working muscles of mastication to non-motored eye and mouth parts. There, in the operating room of the Maryknoll Hospital, every piece of which had made the trip to Jacaltenango on mule, a huge window looked out and down over the jungle toward Chiapas, Mexico, forty miles away. We were presented with the loveliest setting in the world, perhaps a new definition of heaven: the beauty of Surgery with a team, maximum effort being expended by all, the beauty of green mountains, the jungle, the colorful Indian farms, their dress, their habits, new and daring.
Just then the radioman came into the O.R. and mentioned quietly, “Laub, the radio said that Dr. Gonzalez will visit you by helicopter at 10:00.”
“Keep an eye out,” I replied.
Doctor Enrique Gonzalez was a colleague, friend, and one of our sponsors from the capital.
10:00 came but the helicopter did not arrive.
Then at 11:30 AM in the O.R. we heard it. Plop, plop, plop… down it came.
We saw that it landed in the soccer field in front of the big window in the operating room, 100 yards away. A man got out of the the shiny new yellow and white painted helicopter, in full combat fatigues. He came up the hill to the hospital in a baseball hat, and an AK-47. In several minutes he arrived and stood in the very door of the operating room.
“Who is Doctor Laub?”
Shit, I’m dead, I thought. There’s no back door here. Okay, why not die with dignity? So. . .
“Bueno. Jorge Kong, the owner of the big soap factory, has been wounded in the capitol city by machine gun. Can you help? Please lend a hand.”
Now I thought, I’m alive! I’m going to live!
“I will… of course,” I said happily. But wait, I thought again, maybe this is a ruse. I thought very quickly under this stress. They still might kill me.
“May I take an assistant?”
“Claro que si, pero take one who weighs little.”
“Howard, close the wound, put the fascial sutures just here like so.”
“OK—no problem,” Howard said. Richard Siegel was the lightweight, the skinniest of the group.
“Richard, pack up dental wires, micro sutures, camera, magnification, nerve stimulator. So long, all.”
Up and away in the helicopter, but with the additional weight of Richard Siegel, we couldn’t make it up the canyon to get through the pass. The Indians on the side of the canyon in their fields, their milpas, were actually above the helicopter and some were armed.
“Doctor Laub, hand me that mail pouch,” the man in camouflage in the front seat ordered.
“Here, but it feels like a pistol with a 12-inch barrel.” –“We’re dead Rick,” I whispered. We both thought it through again. Our bodies will be dumped on the mountaintop.
“It’s only to return the fire of the guerillas if they shoot up at us.” Sighs of relief came from the back seat.
Before we knew it, we had arrived. The trip, which took eight hours by pickup truck, took surprisingly little time by helicopter. But we remained a little bit cautious with the conversation.
We came down to earth at the main airport, the International airport, in the capitol. A little caravan of VW buses was waiting for us, filled with tough men in white shirts and suspenders. They all bore scars. Everyone had bulges under their vests, trousers, and shirts. Scars and more scars. Everywhere there were radios chattering, gates opening and closing for our Mercedes 600. Our eyes darted all over the place. Oh my God. We “opened with a joke” albeit a very light and superficial one, and they gave us one of their own.
Feeling more secure, our self-confidence had metamorphosed from “probably about to die” all the way to “now we are the medical authority”. I began to wonder about the injury.
“How was Jorge Kong shot?”
“He was riding in his Chrysler 300 with his bodyguard, and followed by his VW bus filled with more bodyguards, and stopped at a traffic light. The pickup truck immediately ahead of the Chrysler was also stopped. A 50 caliber machine gun quickly came up from the back of the forward pickup. It was trained on him, firing pop, pop, pop, pop. The bodyguard took cover to protect himself but Jorge himself got out the right front, ducked below the open door and got off about 6 rounds at the assassin.”
“Where is the car in which Jorge Kong was riding at the time of the shootout?” I asked.
“Back there in the warehouse.”
“We’ll need to photograph it because Dr. Siegel and I are studying the ballistics and bullet wounds from low velocity guns; we’ve made a movie about the damage to the body related to muzzle velocity — the kinetic energy is equal to the mass times the velocity squared and that sort of stuff, you know.”
More radio talk. We took a U-turn. More gates opened, just like 007.
The Kong mobile was a Chrysler 300, the biggest model, with bullet holes splayed across the windshield. The bullets appeared to be .50 calibers, and very low velocity. We studied the damage to the vehicle and tried to re-enact the whole scene. We photographed all aspects, and made notes. This .50 caliber was a new weapon for our research study.
We piled into the cars and soon we arrived at the “Kong House”, which was a little enclave behind six-foot walls topped with pieces of glass imbedded in plaster topped with a strand of barbed wire, with two guards patrolling around, hands on the stocks of their Chicago-style automatic large bore old weapons.
We radioed the fact of our presence, and the electric door opened. The house was an “above average Guatemalan.”
Inside the “big house,” Jorge Kong was sitting up in bed with a facial and head bandage, glowering.
“Que pasó, Jorge?”
“Go-dahmcohmminists”, was the answer to every one of our ten to eleven questions about the incident.
Medical care had already been accomplished for him, and he was in good shape. We changed his head dressing and examined him closely. He had no facial nerve injury and his jaw fracture was stabilized nicely by the dental arch bar splints placed by a colleague, a Guatemalan oral surgeon. The bullet had entered at the angle of the jaw, skittered along the mandible beneath the soft tissue and exited out the mentum of the chin. He required no further surgery. We outlined his care. We photographed, reassured, and advised regarding secondary reconstruction. We assured him that his care had been excellent and he assured us that he did not have any affection for “Go-dahmcohmminists.”
Jorge’s younger brothers now took over. We were shown to a restaurant for a lunch of fine porterhouse steaks. Scar-faced bodyguards with the “bulges” stood at every flank. We sat with our backs to the wall and our flanks covered. A discussionbetween us and Jorge’s 3 30-year-old sons ensued regarding how to help the poor. Their conclusion was to help with increased taxes to the rich and distribution to the poor. And then a discussion ensued on how to save the world, of course. These sons were from a different generation and educational background . They were actually mindful and compassionate.
On the helicopter ride back to the very remote Jacaltenango, we were flying, literally and figuratively, bodily and emotionally. The endorphin release after this enormous, thrilling adventure was absolute ecstasy. We were on top of the world.
Bursting back into the hospital, we cried, “We did it!” We had stepped into the world of those who ruled without rules and had returned unscathed. We had a story for our progeny. We were in triumph.
But medicine is like a trampoline: it throws you up to the highest emotion, and it lets you fall to the lowest depths. For every yin there is a yang. Sister Georgia was pissed. She had no desire ever to speak to me again.
Her perception was that I had deserted a poor person, an Indian, one of those economically oppressed slaves of unopposed capitalism, right there on the Operating Room table in her “nerve center of the Maryknoll philosophy”, in favor of a rich and evil man. No liberation theology was practiced by me, thank you not. I had blown a chance to show that all people are equal and I should have refused to go. But I didn’t. I had passed up my chance to make a political statement. “They” had come onto her land, into her very heart, at the convent itself, and snatched a possession – me – away from the poor in a Mission Impossible-like task. “They” had won again, just as it finally seemed like her turn to stick it up their backside.
I was crestfallen.
I had done the right thing according to Hippocrates – I had taken care of my patient without any regard for his social or economic status – but the outcome was as bad as bad can be. I tried to seek a solution in my mind by saying, “Try to see the big picture Laub. Exercise better management please, next time.” But I could not come to any conclusion that would have me neglecting any human with a machine gun wound in his face, and who was asking for help from me. I needed to obtain resolution. The difference in logic between the two of us was intolerable to me.
Four years later, I made an appointment for breakfast with Sister Georgia at the Drake Hotel in Chicago at the American College of Surgeons Meeting. We spoke. We presented each side of the dilemma. We “understood” each other’s words because we knew the words of the English language. But we were and are still a mile apart. Being a mile apart, or even ten yards, is against all my instincts, my principles and my S.O.P.’s. It still remains insufferable.
“Good morning Sister, good to see you again.”
“Hello, Don. What do you know?”
“I know that Collegeum pulsationum Durarum, the school of hard knocks is a good teacher. I’ve been thinking about that time back then when Interplast first came to Jacaltenango.”
“I think that you could have shown the capitalists that you had an equal obligation to that Indian child. They have plenty of arrogance and they abuse capitalism; but they respect the raw courage of the North American. You could have taught them something. You know they take advantage and that there are plenty of holes in Capitalistic Theory.”
“Shouldn’t you help a rich person if he is shot?”
“The Indians needed an example of someone standing up to those Bastards who take advantage of them; they’re economic slave-masters.”
“But Interplast must stay in the central political zone,”
“You let me down.”
“I am, friends, truly friends with both the left and right. The rich ones are people too. Real friendship counts a lot, and is powerful in decision making.”
“It was poor judgment; it was wrong.”
“There is a commonality in medicine which crosses every political boundary, every ‘–ism.’ To repeat my wife Judy’s words: ‘every patient stands equal in front of a doctor; it is as if each is stripped of every circumstance, money consideration or group agenda. Poor is equal to rich and the rich patient has rights equal to the poor one.’ We have no agenda – just to help. Helping humanity pervades all.”
“Perhaps by more skillfully managing your tactics, you would allow everyone concerned to rise to a higher level of understanding.”
“That’s my approach, exactly, my Sister; and I still think that we can heal the whole world with Plastic Surgery.”
But I’d better do some introspection over the next few years to learn the full lesson, I thought. It has taken 40 years almost to the day to work out.
A year later, before breakfast in California, I’m about to finish this anecdote, and I step outside my home into “Paradise”. It is just dawn of a new day in our lives, and springtime in California is seductive: blue, white, pink and lavender blossoms everywhere emitting their wonderful and different fragrances. Going down to the little creek with its sounds of clear water over clean rocks, I add my little share to the creek’s volume and to the Pacific watershed. True pleasure – I’m truly in Paradise. I contemplate the finish of this anecdote, then I step in the excrement of the dog. I interpret stepping in dog shit while in true Paradise as a bad omen.
How can good and bad co-exist so closely, almost naturally? My mother Ella Donnersberger explained that in order to have good, there must be bad. Vice-Versa as well. The two must co-exist or we don’t have any of either. Therefore, in order to have poor, we must have rich.
In order to be providers of medical care, there must be recipients who have pathology – a condition that of course is more bad than good. Pleasure is the absence of pain; pain is the absence of pleasure, and be glad that you can experience each and understand their purpose for you.
So we need both good and bad, rich and poor. But in a perfect world we should have neither, simply equality. It is an unsolvable question, perhaps a necessary dilemma, and the best we can do I suppose, is to simply understand it. Thank you, Mother.
Years later, Rick Siegel reminded me of a small detail that had somehow slipped my mind: Jorge Kong had offered to compensate me financially the day our paths collided. He had his checkbook out and asked, ‘what is your fee?” I answered, “nothing now, but do us a big favor, a political favor when the time comes for one. We want to work in this country, and there will be those whose interest will be served with us out of here— Help us at that moment.”
Rick recalled, “I saw his checkbook; he had written $10,000.00 USD on the check, and I admired you very much for turning it away; but I never really understood.” I emailed Rick in December 2010 to ask him to elaborate on his thoughts on the events of that dramatic day. He answered with a beautiful personal reflection:
I remember the entire incident very clearly. . . It’s wild. . .It was Guatemala, circa 1972, and the country was frazzled by violence. The powerful rich v. the peasants, with some of the priests and nuns siding with the latter. We were doing a mission high in the mountains, Jacaltenango I believe (the same mission where the anti-United Fruit Company protests began, and where the 2 Berrigan brothers, priests who later would rally American youths against the war in Vietnam were radicalized) and we arrived later than expected, after a long arduous drive from Guatemala city. We were met by the head nun, around 9PM, after noting that the church was showing birth control movies (definitely NOT rhythm method) on the side of the church, to a large gathering of locals. The nun was furious with us- we were late for dinner, which was now cold, but available. As we entered, she pointed to the urn above the mantle “those are the ashes of the Rules of the Maryknoll order”. No other explanation. This was a radical group, not one to follow the usual rules. Whew! The next morning,the church received word from the main church in the city (they communicated by short wave radio each day at 8AM)that the President of Guatemala was sending his personal helicopter to pick up Dr. Laub and one assistant. We were to bring surgical instruments. The President’s good friend, Jorge Kong, major industrialist, had been shot in the jaw, and was waiting to see us and undergo surgery if needed.The same head nun had brought us this message, and immediately informed us that of course we would NOT be going. We had her children to operate on. Don briefly tried to argue at the breakfast table, the nun was furious, so Don suggested they go into a separate room. There was loud invective and a series of dull thuds. Don will remember, I’m sure. I drew the short straw and accompanied Don. The soccer field was empty, and then the new Sikorsky yellow and white bird landed. First time a helicopter had landed there. Within minutes there were hundreds of locals literally filling the massive field. The helicopter ride over the glorious countryside and mountains of Guatemala was magical. Until we neared the G.C. airport. The President’s pilot was anxiously looking throughout the 4 person cockpit for something. In Spanish he asked if we were sitting on his map case? He was very nervous, angry. As Don removed it from under his behind, I was starting to sweat: why would the pilot need his map case to land at his usual airport? He placed the map case between himself and the co-pilot , unzipped it to reveal – a shiny German Luger. He cocked it and took off the safety. The sweat was running down my arms. Were we “communists” perhaps, enemies of the state in their war? Did they intend to shoot us and dispose of our bodies in the hillside? No, the helicopter was brand new, couldn’t risk a hole or blood to foul the pristine leather. The pilot said nothing.We came down for a landing, and were surrounded by army men in a circle, with submachine guns at the ready. The pilot was no longer nervous. The gun was for protection, not for us. Don asked to see the car Jorge was driving in (his driver was killed) and we were off for a brief detour before going to see Jorge and his mansion. His Mercedes looked like a vehicle from the Capone-era, the entire windshield riddled with bullets. I have the photos. The story goes on, as his fortress-mansion (a guard with submachine gun sitting in a little basket at each corner of the outer perimeter wall) was amazing – glistening huge marble rooms with dozens of priceless Persian carpets everywhere on floors and walls, bathrooms with golden fixtures, and Jorge in a palatial bedroom, lying in a rich burgundy silk robe and pajamas, on a silk covered 4-poster bed, elevated 2 steps above the floor, with 3 associates at his bedside. His son escorted us to his bed, he dismissed his associates, and after brief pleasantries we examined the superficial wound over his left mandible: clean little track, no broken bones, no surgery, he’ll be fine. He then offered Don a $10,000 dollar check for Interplast. Don immediately thanked him, but asked that instead, he would prefer if at sometime in the future he needed help, he could call on Jorge. Jorge smiled, rang his bell, and instructed the servant to bring his 2 sons immediately. They arrived in a heartbeat, and Jorge told him to observe this man, Dr. Laub, and never forget that he came to Jorge’s aid that day. Anytime in their life, if Dr. Laub needed assistance of any kind, even long after he, Jorge, was gone, they would provide whatever was asked. They nodded obediently after studying Don and me for a moment.
It was another great Interplast moment. Don was such an international diplomat – brilliant and insightful. In a country like Guatemala – this sort of “marker” was priceless . . . It was pure wondrous unforgettable Don Laub.
Looking through the retrospectoscope, I think that going the route of being the figurative “martyr for the cause”, i.e. being a splinter in the rear end of the elitist “haves”, would have not have given Jorge Kong the opportunity to defend us politically, and the story would have ended with better sutures for the Indian boy with whom we did have such a contract. Befriending the ruling class was our tactic to gain permission to treat those with no access to medical care in rural areas. It is possible that a great good happened. We had some political protection to continue our work in Guatemala, and the Indian boy enjoyed a good result as well.
It would have been nice to have taken an intermediate course, which would be to make radio contact with Jorge Kong’s bedside to find out how he was doing. If his condition was stable, I could have made a political statement and supported Sister Georgia’s liberation theology with an illustrative case without martyrdom. I could have remained with the boy until the end of his operation, which would have taken less than an hour, and then gone to the bedside of Jorge Kong. It took me 40 years to think of this compromise. This would not have been possible without Sister Georgia’s disagreement pushing me to a higher level of thinking.
When two able highly motivated people each know that they are right and that the other is wrong, we require real maturity and an overarching wisdom. We did not have these two factors developed at the time, but I hope we have these now.
Each force enters into a new ambience, a new circumstance in which each cannot achieve any more steps toward their goal. Further, each has compulsion to convert the other to the “correct” way of thinking. Occasionally, alternate pathways to the goal eventuate—anger, or at least ill feeling, deviousness, scheming, preoccupation, or waking at 3 a.m. unable to figure out which paths to take in the circumstance which causes them dandruff.
Collegiality, fraternity, warmth of feelings, and positive spirit of upwards and onwards are all called to a standstill by the heretofore good person’s inability to produce a perfect outcome. Thus it was with the situation in the operating room 6000 ft in the air of the Central American mountain countryside that day. Each person did not ever want to try to adopt the other’s S.O.P. for solving problems. Though each may have used their own basic principle of life to achieve good, such “good” is many times a compromise from which greater things can be built or even both may advance to an entirely new vista.