Ramón and the Pipes

My firsthand story of the titantic struggle pitting plumbing vs. surgery at Merida's University Hospital, and the patients caught in the middle.

Ilustración: Leonardo González

At first the bump on Ramón’s neck didn’t hurt so bad so he didn’t pay too much attention to it. Within a couple of weeks the thing was the size of an apple. That’s not a very good sign.

You can imagine what came next. Exams. Lots of them. X-rays, sonography, tomography and still none of his treating physicians had a diagnosis for him; so he was sent to get a biopsy. He was admitted and hospitalised, scheduled for surgery the following morning. It’s a simple procedure, a biopsy. If everything went fine, he’d be going back home in a day or two, and luckily, we all would have a better understanding of what that swelling in his neck really was.

Of course, it didn’t go like that.

Ramón came to Mérida’s University Hospital during my first week working/studying there, In Venezuela, the last two years at med school are an internship in which you work at a public hospital every day, helping your supervising doctors. It’s quite a unique experience, not to say the best way to actually learn, well… how to be a real physician.

As part of my usual pasante duties, I have to guide patients through the bureaucratic maze required to get admitted at the hospital, and that’s how I met Ramón. He was sitting in his wheelchair with a  big bulge coming out the right side of his neck.

An art graduate, Ramon is quite a character: a deeply religious guy who spent the next couple hours telling us how happy he felt about the treatment he had received from everyone at the hospital. With a smile even bigger than the bulge emerging from his neck; every time someone went to check on him, he would thank us, doctors, nurses or students alike. He actually seemed happy, something quite rare these days, especially in a hospital.

I was part of the team bringing him into the operating room the next morning, and again as a pasante, that meant I would stand there watching the surgeons work their magic while they bombarded me with questions about neck anatomy. I was pretty sleep deprived, as medical students tend to be, and it was taking its toll on me. Probably that’s why it took me so long to realise that a water pipe had broken right over the surgical area (in which all OR’s are located).

Obviously you can’t operate in the middle of an indoor replica of Lake Maracaibo

I stood in front of the shut doors for a couple minutes waiting for someone to take Ramon into his OR. Eventually a nurse came out and told us the whole place had been rendered inoperative as a result of the accident. I never got to see the actual flood: access was restricted, as the cleaning crew politely, but emphatically made sure everyone understood. Their wet boots and tired faces seemed to be proof in themselves, no one insisted.

Obviously you can’t operate in the middle of an indoor replica of Lake Maracaibo, we were not having surgeries that day. It was bad, but c’mon shit happens, right?

Esta vaina no puede ser- an anesthesiologist said while he took off his surgical scrub, doctors in my team were explaining how hard it had been to get a surgical turn that quickly in the overcrowded hospital. We the students were quite disappointed at not getting to watch what would surely be a pretty cool surgery.  

El tiempo de Dios es perfecto, he said, inadvertently casting an even darker shadow over the place as the infamous Capriles’ catchphrase echoed in our heads.

Everyone was upset, everyone but Ramón. He just was there, laying on his hospital bed, wearing a disposable scrub and smiling, blessing everyone telling us not to worry.

El tiempo de Dios es perfecto, he said, inadvertently casting an even darker shadow over the place as the infamous Capriles’ catchphrase echoed in our heads. He didn’t notice it though, and kept repeating how thankful he felt for seeing all the effort we were making to take care of him.

At this point I must admit that all this optimism was kinda creepy. I mean, we were all glad, but if I had that thing growing on my neck I would like to know what it is ASAP. Ramón however was calm. We put him back into his wheelchair and took him to his room where he told her wife how his surgery would have to wait due to some water-related imprevisto.

We were soon told that the broken water pipe would take some time to repair, and all elective surgeries (Ramon’s included) would have to be put on hold. This meant he would have to spend a whole week in the hospital, since leaving it would mean losing his place in line. Again, he seemed chill with that. In a couple days he had befriended all the other patients on his floor. He knew their names and stories better than we did.

He eventually told us how he ended up in a wheelchair: A birth defect in his vertebra had been compressing his spine for his whole life, making it extremely painful for him to walk and finally leaving him unable to do so five years earlier. He had a chance to get an operation to solve the problem back then, but he got tired of waiting.

He was not making that mistake again.

The week passed. Patients came, patiens went away and Ramón was again waiting at the OR entrance, I was already in my scrubs when I noticed something wrong: The place was way too hot That’s not good, bacteria love warm, tropical weather; so unless it is a strict emergency you can’t operate without air conditioning. It’s not a matter of comfort, it’s hygiene. I immediately had a bad feeling. Nos jodimos otra vez I thought, and a few minutes later it was official: no surgeries. Apparently a blackout last afternoon had left the hospital without its ordinary power supply and depending on its power plant, which was not powerful enough to get the ACs working again.

Me estas jodiendo? How on earth can you possibly cut the power supply off from the biggest hospital in the state for almost a whole day? That just seemed ridiculous for everyone around, and surprisingly, this time, to Ramón too.

He just couldn’t understand how could the country with the greatest natural gas reserves in the world cut the power to a major hospital.

He was mad. He cried, he cursed. He finally let out all that frustration he had been bottling up for the last few days. He knew what it meant, it was not just a simple delay. His 40-minute surgery would have to wait. And no-one could tell him for how long. Me and fellow pasantes stood there, trying to make him feel better.

He made it clear that he was not mad with us, that he knew doctors wanted to help him, that he was really thankful for the treat he had received from everyone in the hospital, from the camareras to the cirujanos. He just couldn’t understand how could the country with the greatest natural gas reserves in the world cut the power to a major hospital. He couldn’t understand why he had to stay another unknowable amount of time away from his home, using a bed that someone else probably needed more than him. He couldn’t understand what had happened to Venezuela. He said he was going to complain, that someone would have to hear what he had to say.

As I write this, Ramon has successfully had his procedure. He was lucky I guess. The happy exception that usually confirms the rule. Last time I checked on him he seemed cheerful again. His bulge was still there, but this time partially covered by a clean gauze and some adhesive. He said hi, blessed me and thanked me again for caring.

We still aren’t sure what his bulge is, his biopsy should be ready soon. It will be processed in a private lab since the hospital’s pathology service has been practically shut down for years. All we can do now is to hope the results are good. With current limitations, I’m not sure we can guarantee proper treatment otherwise. In the meantime however, I treasure his countless Muchas gracias doctor, as proof that no matter how screwed we are, our work (just like that of any other Venezuelan, in or out) can still make a difference.