9:25 AM: Dr. Sánchez's house lies about 300 yards down the valley from the hospital; connecting the two buildings is a solidly built concrete walk about a yard wide. This morning, five minutes before the agreed-on time, Dr. Sánchez comes walking briskly through the hospital's rear gate, which stands just outside the laundry room and beneath tall casuarina trees. By Mexican standards Dr. Sánchez is a very tall man (about six feet) and slender. He's handsome and he smiles easily; his black hair shines in the morning sunlight.
This morning the whole hospital has been gearing up for his arrival. Having seen him coming, a nurse meets him at the gate, asking questions. Later, the moment the doctor steps into the hospital, ten visitors wanting information about sick relatives begin calling out questions: "Good morning, Doctor, and will my little Mario be coming home today?" "Good morning, Doctor, but what should we do about my mother?" For five minutes Dr. Sánchez takes care of this first order of business. Briefly he visits his office and gives orders to nurses. Then he begins making rounds.
9:35 AM: In Room #3, Patient #l, a forty-year old woman explains that forty-five days ago she was climbing twenty feet high in a tree, picking fruit, when she fell. She didn't break anything, but since then every third day or so she's been suffering attacks of cramps and suffocation. Dr. Sánchez advises her to go to Tuxtla Gutiérrez for electroencephalograph tests. At the mention of these tests the woman looks somewhat doubtful and asks if the hospital couldn't rather provide something for susto, or freight. Among the Indians, any vaguely-defined infirmity is ascribed to being susto,which commonly is understood as resulting from black magic. Dr. Sánchez suggests that first the tests be run; if that doesn't reveal the problem, then maybe he'll consider the freight problem, a phenomenon, he says, that he simply doesn't know about or understand. Of course he realizes that the woman wants a potion or a kind of ritual to work against the black magic that plagues her.
Patient #2 is an eighteen-year-old woman speaking only Tzotzil. She lies curled beneath heavy blankets, looking at us with huge, dark, frightened eyes. Patient #l translates the doctor's questions into Tzotzil. The young woman will only say that she has a terrible headache and a stomach ache. The doctor orders cold compresses and further observations.
Entering Room #4, we find the third patient, a twenty-five-year old woman, recovering without complications from a cesarian delivery conducted eight days ago.
The fourth patient is a seventy-year-old woman who has had a large hernia on her abdomen surgically removed. The Doctor proudly displays to me her nicely healing scar.
The next patient is a twenty-year-old woman recuperating from a cesarian, which took place five days ago. When she complains of constipation the Doctor orders that prunes be added to the woman's diet.
Patient #6, a twenty-year-old woman, arrived here at six o'clock this morning, suffering labor pains forty days prior to her appointed time. The baby was delivered without complications; she'll rest here for three or four days.
In the next bed a thirty-year-old woman recovers from yet another cesarian. Dr. Sánchez brings out an X-ray indicating that earlier the unborn baby's head had been the same size as the mother's pelvic opening. Today the patient is constipated so she'll also get prunes, and all the exercise she's willing to take.
l0:l0 AM: Having finished with the in-patients, Dr. Sánchez returns to his office to write records and orders. In the hall, more members of patients' families accost him with their questions.
l0:20 AM: A thirty-year-old woman is encountered standing in the hall groaning and breathing hard. She's in labor, with contraction pains coming rather closely together. The Doctor abandons his schedule and orders the nurses to prepare for a delivery.
l0:25 AM: In the midst of preparing for the delivery, down the hall a commotion develops just outside the Emergency Room; the Doctor goes to take a look. A forty-year-old Indian man lies unconscious on the table while eight middle-aged men mill around, looking concerned and worried, and talking loudly. These friends and relatives have brought the man in the back of a pickup truck from an isolated village. The patient is unresponsive and Dr. Sánchez suspects a stroke. "He's very ill," he tells the men. "He'll have to stay here for a while. One of you men can stay with him, but the others should leave." When the patient's nephew is elected to stay, the seven other men go outside and gloomily climb into their old, blue pickup truck.
l0:35 AM: In the Delivery Room the woman lies on the table with her legs up and spread apart, and her feet tied into fixed metal stirrups. "When the pains come, push hard, as hard as you can," the Doctor says. Contractions come about every two minutes. The doctor tells me that his only worry so far is that the baby is situated facing the wrong direction, so that as it comes down it'll have to twist around. During each contraction I can see beneath the cloth spread atop the woman's abdomen the baby twisting to one side as its descent begins. Between contractions a urinary catheter is inserted to drain her bladder. The woman is quite alert and responds well to directions. Earlier the Doctor ordered contraction-inducing medicine to be introduced intravenously but now, just as the nurse prepares to insert the IV's needle, the contractions become so frequent and intense that the Doctor rescinds his order.
At l0:42 the baby's bag bursts, squirting a generous quantity of fluid onto Dr. Sánchez's arm two feet away. During a contraction at l0:44 the top of the baby's black, hairy head appears at the vagina's opening, but then the vagina closes up again. At l0:45 the baby fairly plops out, crying as soon as it hits the operating table. The mother asks me what it is. "Un niño,"I say. "A boy." She looks satisfied. She's born three girls but only one boy. Even before the afterbirth is ejected at l0:48 the woman asks that before she leaves her tubes be tied. Dr. Sánchez agrees, if he finds the husband of the same mind. At l0:50 the Doctor comes near me enthusiastically explaining something; however, none of what he says sinks in because he's diagramming his thoughts in the blood smeared on his plastic surgeon's glove... At l0:55 a nurse ties off and cuts the umbilical cord.
ll:00 AM: In the office, a man selling drugs meets with Dr. Sánchez, and takes orders.
ll:05 AM: Vital signs of the stroke victim down the hall are reviewed and copied into a file.
ll:09 AM: The husband of the woman who should go to Tuxtla but prefers instead to be cured of susto visits Dr. Sánchez in the office. The main topic is how much the work done in Tuxtla will cost. It'll be about 400,000 pesos for tests, l25,000 for each day in the hospital, plus the doctor's charges -- in all, about $400 U.S. The man explains that he does not have the money, but that he'll find it. He'll sign promissory notes, or anything; the important thing is to get his wife healed. After the talk I see him outside leaning against a tree trunk, looking blankly into the sky.
ll:30 AM: In the Doctor's office a fifteen-year-old female who has suffered pains in her chest for two or three months is examined, given some medicine, and asked to return in two weeks.
ll:46 AM: A second medicine salesman is received, and orders are taken.
ll:50 AM: The stroke victim victim's nephew is spoken to about the problem's seriousness. "Sometimes there's complete recovery, sometimes there's partial paralysis, and sometimes the patient dies," explains the Doctor. The nephew speaks slowly in a thick Tzotzil accent. The cost is the main subject he asks about.
ll:54 AM: In the examination room the doctor looks at the healing scar of a young woman who has had a large boil lanced on her back. The scar bears a small, running sore. In order to understand the nature of the sore by examining the pus or fluid that runs from it, the Doctor asks to see the bandages that earlier were removed. However, the nurses already have destroyed the old bandage. For the first time today a procedure has been followed incorrectly; the doctor diplomatically but firmly demands that in the future this error not be made.
NOON: A local plumber is spoken to about building a steam bath for the hospital.
l2:09 PM: A twenty-year-old woman who for a month has suffered with an abdominal pain is examined, told to have a pregnancy test, and to return in a week.
l2:22 PM: For insurance purposes a man needs an official-looking paper certifying that his wife was operated on her last month. At his portable typewriter, Dr. Sánchez immediately types up a lengthy letter describing the entire treatment.
l2:40 PM: One of the eighteen-year-old student nurses comes in with a sore throat. Medicine is provided to her. She'll remain under observation.
l2:42 PM: A nervous-looking sixteen-year-old female brings in results from two tests the Doctor has ordered done at a clinic in Villahermosa. Only the single word "negative" is scrawled across the clinical report. The Doctor complains that he cannot be absolutely certain that the negative result is for both tests. Medicine is provided and the patient is told to return in a week.
l2:57 PM: A thirty-year-old man with a pain on the upper, left-hand side of his back is examined. No problem is found and the man is asked to return in two weeks. Then Dr. Sánchez launches into a twenty-minute talk about a boy he once knew who feigned a toothache in order to gain permission to go home from school. Apparently he's trying to unwind. He tells me to meet him at the gate beneath the casuarinas at 3:00, and we'll take a twenty-minute walk together.
3:05 PM: We meet at the gate but as we begin our walk a nurse comes saying that a new emergency case just has been admitted. A young woman lies unconscious in the Emergency Room. Her despondent husband explains that she had wanted to have a party in their house, but he didn't agree, so they fought, she got upset, and then she lost consciousness. The Doctor checks for reflexes by sticking a pin into the souls of the women's feet: No response. Then he folds a piece of white paper, opens an eyelid, and waves the paper back and forth, almost touching or perhaps slightly touching the eyeball, and this time there is a little response. He orders an injection and compresses, and then we take the walk.
4:30 PM: A fifty-five-year old man with diabetes, looking very tired and worried, comes for his regular checkup. He carries a urine sample, on which a nurse runs a simple card-test Soon the man is informed that his blood-sugar level is being kept more or less under control. During this man's visit nurses interrupt four times, asking for instructions on how to handle a patient down the hall who just has come in with a cut finger.
5:l5 PM: In the hospital's 8 x l5 foot classroom, Dr. Sánchez conducts a class for three student nurses. The topic is anemia, its definition, causes, symptoms, clinical diagnosis, treatment and prognosis. As the nurses take notes the doctor lectures extemporaneously.
6:00 PM: Leaving Dr. Sánchez in his office preparing to go home, I meet three Indian women with a sick child wandering down the hospital's dark hallway, looking for el médico. I tell them where he is, but am too tired to follow and take notes.