Eyes wide open

The suffering of the boy who had fallen into boiling water was like the misery of the city’s streets: possible for some to ignore but searing to a medical student working in the hospital’s burn unit. A letter from Guatemala.

By Monique Aurora Tello, M.D.
Illustrations by Janis Melone

Automatic living … a life of comfort and achievement, accumulating possessions, honors, and the routine eating, mating, and financial habits of prosperous people, the soul sinking under folds of flesh, the rituals of social position; that was what the author of the Psalms meant when he wrote, ‘Their heart is gross like fat.’ This was the contented mind that had no dealings with death and whose sole concern was to remain contented. … It was the crushed spirit that knocked in vain, year after year, tapping on inanimate objects, pleading for the locked door to be reopened.
—Amos Oz, from Fima

Welcome to Guatemala City, Guatemala, where the brutal social dichotomy feels like a swift kick in the stomach with soccer cleats. Guate in December was a month of heaven, hell and social obligations. I ran around the pediatric burn unit like a frantic shadow—a shadow that fell in love with a three-year-old and came to life. Javier, Javier, soft and small, eyes wide and black; I will never forget your hoarse morning screams.

Every morning for a full month, including Christmas day, my job was to torture Javier. Somewhere in the Guatemalan highlands, Javier’s great-aunt was remembering the same screams, since she was there when Javier fell backwards into a cauldron of scalding water. In the village, the day’s drinking water was boiled and thus (one hoped) decontaminated, the pot set down on the earthen floor to cool. Accidents were not uncommon.

In the Guatemalan pediatric burn unit, always full, the job of changing dressings fell to the med student. For the month of December 2000, that was me. Maria the burn nurse—impossibly neat, admirably practical—showed me how.

Oh, Javier. The raw and oozing burn patches spread like a flowery rash over his penis and thighs, back and buttocks. The wet, sticky bandages had to be changed, every day, gauze dipped in Silvadene, Terazol and Vaseline, spread over the wasted buttocks, wrapped around his swollen genitals. He screamed. He clenched his tiny fists. But he did not struggle. He held his legs up when asked. He stood and squatted for the Ace bandage wrap, even while screaming.

And then, when he was all diapered, drinking his bottle, he would let me pick him up. Except for when he screamed during dressing changes, Javier was silent; he hadn’t spoken for anyone during his month-long admission. So I tried to make him laugh. I grabbed his nose and said, “Hey, where’s your pony? Where’s your dog? Where’s your cow? Over here? Under here?” and he would watch me sideways with a sad smile, as if to say, “I forgive you.”

I was in Guatemala City for a pediatric surgery elective at a nonprofit hospital downtown, but also to celebrate Christmas with my aunt and cousins. In Guate, Christmas is celebrated the whole month. The days were hectic, the nights a blur of mixed traditions heralding to both the Catholic and the pagan.

Imagine Quema del Diablo, a day of purification. For 10 quetzales (about a dollar and change) you could buy a red devil piñata on a rope. At every major intersection there were poor boys laden with large papier-mâché devils, happily unburdening them to happy shoppers. By 7 p.m. on December 7, most of the good citizens of the city had purged their homes of all unnecessary objects—clothes, books, mattresses, even old love letters—and had thrown them all onto piles in the street. Everyone gathered outside at dusk.

And then the world exploded. Each devil, stuffed to the brim with firecrackers, was lit and thrown mercilessly onto the piles. Families and neighbors gathered round the bonfires, and children tossed more firecrackers on top. We even toasted marshmallows. The next morning there were three new children in the “Burn Room”: a teen whose thigh was tattooed by the bottle rocket that had lit in his pocket, a 4-year-old girl whose hand was singed and bubbled and a 6-year-old boy with full-thickness burns on both feet.

For me, the daily culture clash between our comfortable family celebrations and the horrors of the government hospital was difficult to ignore. My family had started out poor. My father and aunt grew up on a finca, a ranch, where my grandmother taught the workers’ children and my grandfather was a mechanic. The fact that we are now all financially beyond comfortable is almost solely thanks to my father. Through a series of achievements and sacrifice, he landed a U.S. residency spot in Boston, and is now a physician in Massachusetts.

I felt sometimes that such humble beginnings had been swept under a rug. I got angry at my cousins for such transgressions as shopping at The Gap, eating at Pizza Hut and belonging to the country club. Their young children watch Disney and take swimming lessons and are completely sheltered from the obvious poverty that exists all throughout Guate. I’m not insisting that poverty is anything special or poetic. I am just asking my family to see it, to let their children see it. How about those homeless kids, barefoot in traffic, begging from cars, who can barely reach the driver’s window? Or the public emergency rooms, where clotted blood attracts huge cockroaches? It strengthens your spirit, to see and register the poverty and misery around you. I started to feel crazy when I realized that they don’t see it, that they have turned from reality.

My cousin Lea picked me up at the hospital the day I discovered that Javier was infested with head lice. Ana Luisa, a well-meaning junior med student, had picked a nit out of my hair that morning. Giggling, she squished several egg cases. “Oh, by the way, did you know that Javier is infested with head lice?” she asked. “Thanks,” I replied. I bought Lindane shampoo for us both. It was a bad day. Between the lice, the screams, the wafting putrid-sweet smell of the warm, sticky bandages, the nasty ER and its one dirty examining table, I was heavy with disgust and helplessness. I dragged open the car door and collapsed.

Lea handed me the baby, her chubby, white, blue-eyed baby who, no matter how I searched for some requisite compliment, always looked to me like a fat worm.

Lea chattered on about her day: a brunch at the Hilton, she ate too much, then she got her hair done, but they took off a bit too much in front, didn’t I think? And there was no food at home, she had to stop at the grocery store, would I come and help her, because there was simply too much to do.

Here, again, was the culture clash between home and hospital. Here was my cousin, an alien from an alternate universe of ladies’ brunches and salons. I felt frustrated anger. Then, I remembered the morning, and calmed:

Javier, Javier … After the bandages, I wiped his face of tears. I tickled his nose, I tried playing the animal game: “Where’s your dog?” And then, he reached out and grasped my fingers, and he spoke to me. It was only a hoarse whisper, strained from screaming. I couldn’t hear him. I thought quickly of lice, but I bent close anyway, so close his dry lips and hot breath tickled my ear. The little voice was so quiet, almost gone, but then, there it was:

“Tengo un chucho. Se llama Zorro.” (“I have a dog. He’s called Fox.”)
I bit my lip and smiled. “Oh, you do, do you, that’s amazing!” And we talked, for the first time, about Zorro, and how Javier sometimes stole food from the kitchen to give to Zorro, and got in trouble with his mother. I once read an article about adoption in a magazine, and this quotation stuck with me: “Some primates are so eager to nurture an infant, they will kidnap one.” I understood fully. I remembered this as Lea drove us to her fancy Western-style supermarket, and I held her baby in my arms, and I hated it. This baby represented the nouveaux riches of Guatemala, the younger upper classes who have effectively shielded themselves from poverty, dirt and pain. They live an illusory existence, in heavily guarded homes, with fierce dogs, watchmen, walls topped with electrified razor wire. And Lea aspired to this, as do so many Guatemalans.

I needed to escape. So I told her I had head lice. From Javier. It worked like a curandero charm. Lea drove me straight home and directed me to the shower. I was free from the car, the worm baby and the fancy supermarket. In Lea’s defense, she asked about Javier every time I saw her: how was he, did he eat enough, would his little penis ever be normal, did I think? Looking back, I realize that maybe she did see how different her baby was from Javier. Maybe that concern and curiosity was Lea’s spirit, tapping at her from the inside, saying, “See? See?”

I managed to avoid Lea until La Posada, a few days before Christmas. This is a procession of family and neighbors, led by the children swinging lanterns and beating gongs. Old wooden carved figures of Mary and Joseph, sumptuously dressed in velvet and lace, are set on a small bier. Lea and I and two other cousins got to carry it. We made our way around the neighborhood, singing and calling out: Mary and Joseph were looking for a place to rest, but there was no room at the inn. The traditional songs degenerated into giggles and shouts of “Lemme in, dammit!” until finally the last neighbor opened her gate, and everyone filed in for rum punch and cake, songs and small gifts.

* * *

A bunch of bananas: that was my reward for the daily torture routine. Javier’s parents came once a week to visit. Visiting hours were very strict for the burn patients. Infections were so common and so deadly, especially at the public hospitals, that parents could look at their children from the door, but they could never touch them. So a crowd of parents would gather at the glass door to the burn unit, and they would take turns to wave, some sobbing quietly, while Maria pushed the metal cribs up to the door, one by one, and the children screamed, “Please let me out, please take me home! Mama, papa, don’t leave me—”

Javier’s parents were indigenous Guatemalans. His mother was dark and slight, her long black hair tied back, a worn blouse tucked into a traditional woven wraparound skirt. She was wringing her hands, eyes wide, horrified. His father was wiry, strong, stoic. It had been one full month since they had been able to hold Javier. What kind of torture was this, to know that the child they had created was a hostage, in pain, and they could do nothing? They were being kicked out; it was 4 p.m., the end of visiting hours, no room at the inn. Javier was screaming in his sad, hoarse voice; husband and wife were practically cowering, on the verge of tears.

They were never there for dressing changes. They didn’t know that I was a torturer. They didn’t know that it was guilt that motivated me, right at that moment, when I gave Javier a cookie and he stopped screaming. They were so grateful for this that they brought me the bananas. I accepted with more guilt.

Sometimes my soul sinks under folds of flesh. Sometimes, I drown. Mine is not the complacent, contented soul Oz speaks of, but rather, something probably worse: hypocritical. I criticize my own family for trying to be comfortable, for trying to raise their children in safety. Who am I to criticize? They have no choice but to live in Guate. I only visit.

And since I was only there for one short month, I had no right to laugh, to enjoy the warm days, to escape. But when I was tired, I always had company: the burnt-out residents, so desperately sick of the daily misery of the hospital, and of being helpless, and of being the cause of more new misery for patients.

Doctora Lorenzo, my senior resident, had the ugliest, most beat-up 1977 beige Datsun, so unbelievably old and dirty. But one day Joaquin, the chief surgery resident, and Pablo, the second-year, and I piled in happily. The goal was to get some lunch at a nearby restaurant, a break from work. We were tired, and we simply left. What luxury!

I sometimes hated Dra. Lorenzo, even good-natured Joaquin. They didn’t use enough pain medication for the children. I often asked for analgesics for Javier and others, for dressing changes, but they would only allow Tylenol and Dipirona (another nonnarcotic). Throughout Central America, narcotics are rarely used in children, even for burn victims, for fear of overdose, or of causing addiction. Morphine was used only if the burn was so severe as to require debridement under general anesthesia.

Christmas Eve was an exhausting haul. My cousins and I had delivered a huge bag of inexpensive plastic toys to the ward, probably 30 kids. Every child who could be discharged went home that afternoon. Then, of course, one had to attend the Christmas parties on all the floors and sneak treats to our compatriots in the OR and the ER, and then the party continued at home.

The evening was a long trail of guests coming and going, tropical-fruit rum punch and fresh tamales until midnight. Besides eating and drinking, people appraised our Nacimiento, the Nativity scene that many families spent serious time creating. Ours was under the (rather sparse) Christmas tree: a red and green sawdust carpet with a dried moss border, and the simple clay figurines of Jesus, Mary and Joseph. Of course, we had to hear about our neighbors, who had a running water river through theirs, or my little cousins, who had done an entire village, complete with electric lights.

Throughout all this, we heard occasional cracks and whistles, forewarnings. Then, on the stroke of midnight, there exploded a deafening cacophony as the whole city set off their Christmas Eve firecrackers. Neighbors gathered in knots in the streets, and kids dashed in and out of the clouds of smoke, high on sugar and noise and the promise of presents, which were opened after this midnight blast.

Christmas Day started out so well. I went in early, winning the murky battle of the rum-punch hangover. Maria (who is truly dedicated) and I changed all the bandages. That made me feel good. But the rest of the day was a headachy blur. There was a Christmas dinner at the manicured suburban house of rich family friends, who served a large stuffed turkey. I wondered the whole afternoon, where did they get a Butterball turkey, in Guatemala? They must have had it flown in. Crazy! Then we spent a long evening at the secluded mansion of highly valued family friends, a family previously affiliated with the United Fruit Company. Their palpable wealth, their spoiled grandchildren, their servants … I felt so frustrated by their status, their complacency.

And then I left. Sure, this good-hearted little med student had worked very hard for a month, and (amazingly enough) maintained a bright affect through it all. I was bone-weary from a month of Christmas excess as much as from the burn unit. I had also struggled with the contrast between the social classes on a daily basis. But in the end, I turned my back on the struggle the moment I got on the plane for home.

Ana Luisa sent me several e-mails about Javier. He had finally needed skin grafts; they took, and he healed, then left the hospital slightly malnourished, in the arms of his mother. I don’t know where he is now, and I will never know if I mattered in his life.

The brutal social dichotomy does exist, and I feel caught in the middle. I understand why Lea wants to protect her own, and why just to live and live comfortably is considered an achievement. But we all need to see the inequality of the suffering of the poor, and acknowledge injustice. Seeing is the first step in contact, bridging between cultures, between souls. When you see, you wake up and realize, this is what really matters, and anything else is a dream.

I made real contact with people in all the social strata, moving freely between worlds. I felt like a spy, a clandestine revolutionary. But this is no revolution. This is every day, and while these social rituals are so beautiful sometimes, and occasional escape is necessary for one’s sanity, we cannot ignore the spirit, which taps and says, “Fight complacency! Make people see …”

And so that was the whole point of quoting Oz, to voice the need to fight complacency, to open the closed and contented mind, to wake people and help them see the harsh but beautiful reality around them. But how does one do this? How can I change even one person? If there are answers to these questions, if there are, among you readers, people who know, then please share. For the sake of many spirits. YM


Monique Aurora Tello, M.D., is a second-year resident in medicine at Yale. She spent December 2000 in Guatemala City while a medical student at the University of Vermont. The names in this story have been changed.