Our Peak Experience
On our first trip (of 159) RAC and I went to Mexicali when Phil Collins had gathered a few people who might benefit from our services. Our first clinic. As I walked outside of Phil’s ramshackle home that morning into the bright sunlight of the bright sunlight of the northern Mexico climate, the “persons” had become “new patients.”
Our mindset regarding those who were seated there along the bench had changed rather instantly. They were no longer “Mexican” to our “American,” but they were not “persons” either. They had, in our mind eye, become patients. And the relationship between the patients and us changed also. Each person had a story to tell; the story was the CC(?), the HPI, the PMH & FH, the list of meds and allergies, imp. & DD. The Chief complaint what is the problem. The how, when, how much, what were you doing, how long, the facts in the history of the present illness, is the same as the opening lines in a detective story, or a novel. The PMH, or post medical history, was the supporting evidence, the clues which our “brilliant minds” would piece together to back up our “imp.,” or impression. The DD, differential diagnosis, would provide fodder and pablum to others in the sacred profession, and could differ from our initial imp. FH, family history, is always interesting and would bring out a “Hah! I thought so,” from us. Photography we did carefully, a comparative aspect of the records similar to fingerprints in investigative work. Upon arrival, each human instantaneously had become a Mexican, then a person, and now a patient. Both patient and doctor assumed different rights – they might share marital and sexual evidence and secrets; we could touch their shoulder or back in reassurance without breaking usual social behavior. We might even look into their mouth and nose, eyes, etc… We and they became perfectly OK with such liberty.
Our first clinic was held in Colonia Pro Hogar where there were no paved roads. It had only rained on one occasion in the last three years, and on that occasion we could not reach the clinic building. It was required for us to get out and walk barefoot through mud two inches deep. The rear of the house was a chicken coup to raise fighting cocks, vicious little animals which were not friendly to the clinic personnel. A pool table served as the bed for Dr. Chase that evening. He arose a little bit creaky in his hip joints, but he was as happy as I was to step outside into the bright sunlight. It was 110 degrees at 10am. As I walked outside of Phil’s low middle class home typical of the Mexicali area in Colonia Pro Hogar I recalled that this was Desierto de Altar – irrigated recently with Colorado River water, causing magical growth of alfalfa and barley. Feed lots and people had popped into existence to 200,000 in 1968 from 10 in 1910. Many were Chinese who worked on the Panama Canal, diverting water from Colorodo River to Los Angeles.
Each new patient was greeted by RAC in a cheerful and happy and respectful manner – the technique immediately adopted by me and always put to use in the next 158 trips. And, always at Stanford as well. He opened the conversation with something light, a little compliment or the local complaint (“weather”). I watched RAC, his mood and his energy, his optimism even when the progress of the patient was not very good: an example of a failed therapy would be, “this is great, now we are set for the second stage.”
I was happy that my mentor showed me how to do it. Taking a notebook, he made a record for each “person” who had then become a new “patient.” He showed me how these records would work. He had experience from working with leprosy patients in South India. But I had already begun to look at the first ones, sitting on the bunch in brilliant sunlight. A boy on mother’s lap with a brown paper bag on his head. 2 holes in the bag for his eyesight. I turned to Phil, our interpreter, and asked, “What is that bag for?”
“He has a scar on his face, and the other kids make fun of him. He is hiding.” Note: Actually, Phil himself was hiding. A Latin American mission program (LAMP) worker from Chicago who had ratted on the mafia friends. He was on the FBI witness protection program, sent to Mexicali, the North American version of being sent to Siberia.
RAC explained that the scar pulled the lower eye-lid down. He has ectropion. His eyelid is exposed to the wind and dust of the desert and will end up with keratitis, scar on the eye itself, the inflammation will lead to blindness. We thought of the social damage the scar caused Eugenio. He is stigmatized and he is a pariah. He feels he must wear a bag! We agreed that a full thickness skin graft would help immensely, perhaps a little cartilage graft would help a good amount too.
I thought for a momentito and then ! – “This is a case for a resident like me under faculty mentoring.”
“Yes, sure.” (Chase).
“If I arranged for a hospital, I could get down here and do this case for Eugenio and do other cases or he could come to Stanford.” We could ask for gratis service, free OR, and room at the hospital.
The thoughts ran on – a clinic could be held on weekends or monthly. The connection to doctors and the university and lions club do advertisements all over Mexico for patients… I thought of fundraising… This episode became a PEAK EXPERIENCE, a rather sudden clear coalescence of all previous training and education into one clear career path or solution. Connections, friends and assets are available! The needs assessment, the collaborative model, the task assignments, the implementation and evaluation review are all feasible. We could teach residents and med students that the disparity in medical services in the world could be decreased. Patient care, teaching, research, and community service was my job and my vision was that my job might be fulfilled by working right here. Indeed, I was bathed in virtual immediate success.
For 41 years. 60,000 patients operated by Interplast. 100,000 patient evaluations in 18 countries with 800 Interplast trips. And another 100,000 operations by other Interplasts, in other developing countries. 25% of plastic surgeons participating at one time or another was my ultimate goal. It was merely a dream at that point. 58 organizations or university departments would become involved in this type of work.
After this high dose of psychic income, I was caught in the inextricable trap in the peak experience. The obstacles were not really barriers, but were opportunities to meet respectable and knowledgeable people. I never thought of the foundation (the 501.c.3) at that time, but assumed that funds raised would be under my disposition. (They would not be.)