Show Me That Smile

 

The following is the second in a series of guest posts by UNMC third-year medical student Eric Nagengast, who is taking a year off from med school to  serve with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

I have no need for an alarm clock in Guwahati.  Like the roosters on the farms of Nebraska, the crows here alert everyone to the first sign of daylight around 4:45 a.m. At 5 a.m. the drivers begin bleating their horns on the street below, and by 5:30 a.m. the elder men of Guwahati clear their lungs, throats and sinuses with an aggressive, hacking cough. After years of breathing the Indian air, I probably would have to do that too, but the sound is certain to end any hope of a few more minutes of sleep.

I get up and efficiently use the 60 seconds of hot water my shower allows me each morning. A long hot shower is one of the things I miss the most about home. After a quick breakfast of one of the twenty protein bars I brought with me, along with some local fruit, I am out the door and thrust into all that is India.

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The streets of Guwahati.

India has a way of overwhelming all your senses all the time. The first thing I notice is the thick, polluted air. I will never get used to it as it’s my least favorite thing about Guwahati. The air is so polluted that some members of the team use an inhaler. Next is the noise. On my walk to the hospital, I am honked at by rikshaws, cars, buses, motorbikes and bicycles. In India it is custom to honk anytime you are approaching another vehicle or a pedestrian. Since the streets are crowded with both, the result is continuous honking. Of course, I see plenty of things that would be completely out of the ordinary back home like monkeys, massive amounts of garbage or a fight between stray dogs.

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You can imagine why everyone in the Delhi airport double-and triple-checked my connecting flight. Why would an American want to travel to this poor, isolated part of India?

When I step into the ward, I am reminded why I am here. The most deserving patients in the world fill the large room full of 40 hospital beds and today they will receive care they have waited many years for. The operating room in the Guwahati Comprehensive Cleft Care Center is just awesome! I learn so much assisting the expert surgeons here. There is not a center in the world that does more cleft operations.

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Nagengast assists a surgeon from the Democratic Republic of Congo who spent four months at the center learning cleft surgery. Before arriving he had never done a cleft operation. The surgeon, who goes by Desi, is now back in the Congo providing care for his people.

Yesterday’s patients are being discharged and today’s are undergoing preoperative assessment. I look for patients to interview for our quality of life study. Our goal is to determine how living with a cleft affects the quality of life for a person and his or her family. I interview a 14-year-old boy and his father. This boy has a cleft palate. His father makes $3 a day mining coal. For 14 years, this boy has lived with a defect in the roof of his mouth that leaves his nasal cavity open to his mouth. You can imagine the difficulties this has caused with speech and eating among other things.

The next patient is a 40-year-old woman with a cleft lip. This woman has lived 40 years without seeing a surgeon for something that would have been fixed at three months of age in the United States. At the center, I have seen patients as old as 65 with unrepaired clefts. I will say it again; these are the most deserving patients in the world.

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Patients without access to surgical care exist in many parts of the world. It is not just cleft lip and palate that they suffer from, but also obstructed labor, injuries, appendicitis, and on and on. Most of you reading this probably have had at least one operation, and if not, someone close to you has. What would life be like if you did not have access to safe surgery?

The greatest advancement in surgery in the coming decades will not be a new, high-tech invention. Instead, it will be finding a way to deliver surgical care to the people who need it most, and I hope to be a part of this discovery.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.

Taking a Year (of a Lifetime) Off

The following is a guest post by UNMC third-year medical student Eric Nagengast.

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For the past eight months, one of the hardest questions for me to answer has been, “Where do you live?”

In this time, I’ve spent two months in Rwanda, three months in Boston, one month in India and the rest of the time between Nebraska, Colombia and a few other countries.

Since I’m a medical student, people wonder how I’m able to spend so much time away from school. I’m able to travel because I took a leave of absence from medical school between my third and fourth years.

Yes, it may seem crazy, but I actually agreed to put an extra year between myself and the elusive M.D. because I am spending this year as a Paul Farmer Global Surgery Research Associate with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

At PGSSC, we believe safe surgery is a right that all humans should have. Through research, advocacy and clinical assistance, PGSSC strives to bring safe surgery to the people of low- and middle-income countries.

Historically, surgical care has largely been left out of global health priorities. So our battle is not an easy one.  Our group is composed of physicians from the affiliated Harvard hospitals, fellows, residents, students and support staff from multiple schools, countries and continents.

 I am writing this post 30,000 feet above the middle of the Atlantic Ocean, four hours into a 14-hour flight from Newark to Delhi, the major leg of what is bound to be around a 30-hour trip to Guwahati, India.

In the last six months, I have grown accustomed to spending large chunks of time in airports and airplanes. One can actually get a lot done crammed between a couple of strangers for hours with no contact with the outside world (that is, of course, once one has seen every movie the in-flight entertainment has to offer).

Along with traveling, I also have grown accustomed to leaving the luxuries of the western world behind (such as hot water and easy access to food), and I am actually looking forward to my next few months abroad.

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Nagengast with children at a refugee camp in Rwanda for those from the Democratic Republic of Congo.

In India, my team and I are working on a number of research projects in joint partnership with Operation Smile, an international cleft-care organization. Through these projects, we hope to give a voice to the voiceless. We hope to show the great need there is for surgical care throughout the world, and we hope to show this need can be treated in a cost-effective and safe manner.

While I am in Guwahati, I will be lucky enough to scrub in to cleft surgery with some of the world’s greatest cleft surgeons. For a medical student with the goal of becoming a plastic surgeon, this experience is a dream come true.

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Nagengast (left) assists Dr. Bill Magee on a cleft palate surgery at the Operation Smile Guwahati Comprehensive Cleft Care Center in India. Dr. Magee is Operation Smile chief executive and co-founder.

could not share my story without thanking those who have supported me and helped make my experience possible. In particular, I would like to thank my family and everyone behind the Nellie House Craven Scholarship.

This year is undoubtedly the best year of my life. I have met the most amazing people, I have seen the most amazing things, and I now have a vision of what I would like to do with my future. Most importantly, I am the happiest I have ever been.

I will return to UNMC a better clinician, a better researcher and a better person. I hope my story inspires more UNMC students to consider taking less traditional paths toward their degrees.  

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Stay tuned for my next post on a day in my life in Guwahati, India.

CON honors, remembers those lost

You just wanted to hug those kids.

Tommy, 10. A good boy, glowing, talking about his dad’s job, and jets. “Tommy can tell you about any plane around,” said his grandfather, Tom Blake.

Lily, 8. An angel (literally; she’d just danced in the Nutcracker) in a purple snow hat with hearts on it, and sparkly boots. When her brother blabbed about how she sometimes forgets names, she leaned in, stepped on his foot and gave him a look. That little-sister-to-big-brother look.

“She was born 19 days after our boy was killed,” her grandfather said.

The Blake kids, Tommy and Lily, pictured earlier in front of a display honoring their father, Navy Pilot Lt. Com. Thomas Blake, bottom left. In a coincidence, the other serviceman honored by the College of Nursing, Staff Sgt. Tricia Jameson, is in another of the photos, top left.

The Blake kids, Tommy and Lily, pictured at an earlier memorial display honoring their father, Navy Pilot Lt. Com. Thomas Blake, bottom left. In a coincidence, the other serviceman recently honored by the College of Nursing, Staff Sgt. Tricia Jameson, is also among these photos, top left.

“Your daddy helped make you before you were born,” her grandmother, Carole Blake, told her as she gave Lily a squeeze. “He and your mama picked out your name.”

Navy Pilot Lt. Com. Thomas Blake

Navy Pilot Lt. Com. Thomas Blake

Their mama is Jessica Blake, today a UNMC nursing student. On this morning, her Policy and Leadership class was different. The class – her class – was presenting her with an Honor and Remember flag.

Navy Pilot Lt. Com. Thomas Blake died in an S-3B Viking jet crash in Jacksonville, Fla., in 2005. He was 33. He left behind a wife, a son and a daughter he never got to meet.

The flags are a relatively new movement, started by a father who lost a son. The flags go to the families of U.S. servicemen who died “in the line of duty.” The flags have been officially adopted by 16 states, the charity’s website says, and have been “endorsed” by eight more (Nebraska is among those still being lobbied). They don’t come cheap. The UNMC College of Nursing Policy and Leadership class raised $700 for two.

The other went to Pat Jameson, a nurse, and the mother of Tricia Jameson, who had always wanted to be one.

While she applied to nursing school, Tricia, a staff sergeant, was serving as a full-time health care specialist for the Nebraska National Guard. She carried a medical bag in her car, in case she came across any accidents. She taught combat lifesaver training to Nebraska Guard troops. When an opportunity came up to deploy to Iraq herself, she jumped to the front of the line.

Today, Nick Hornig is a UNMC nursing student. In 2005, he was in the 313th Medical Company (Grounded Ambulance) in the Nebraska Guard, in Iraq, when Tricia showed up, a replacement. He helped her unload her bags.

Nebraska Guard medic Staff Sgt. Tricia Jameson

Nebraska Guard medic Staff Sgt. Tricia Jameson

She was the new kid; he barely knew her. She’d been with them for about three weeks when, out on the Humvee ambulance, she and her driver came across a convoy of Marines that had been hit by an improvised explosive device (IED) attack. There were casualties.

She was racing to the rescue when she was killed by another IED.

“It could have been any of us,” Nick said.

At that time it seemed like something like that was happening every day.

She was engaged to be married. She was 34.

When called to come up to accept her flag, Tricia’s mother took a breath and closed her eyes: steeling herself.

As she stood up there, Nick held his face, rubbed his hands and fought off the tears that welled in his eyes.

He’d barely known Tricia, but he knew this: he’d made it home to nursing school and she had not.

Tricia's mom, Pat, displays the flag presented her by UNMC nursing students with volunteer Cliff Leach.

Tricia’s mom, Pat, displays the flag presented her by UNMC nursing students with volunteer Cliff Leach.

When he heard about the flags, he’d asked his classmates if they could make this happen, for Tricia, and together, they had. Keyon Royster said that Jessica should get one, too. Kate Weidemann organized a bake sale.

With Tricia’s mom, Nick was tender. It could have been him.

It could have been any of them.

Those kids. Tommy, 10, and Lily, 8. Their faces said this was a good day. They got to hear about how great their dad had been. They beamed as they held up that flag.

But those other faces – those of Jessica, and Carole, and Tom, of Tricia’s mom, Pat – those were the ones that all but knocked you to your knees.

The audible sniffles in the auditorium said they were not alone in their tears.

These people had been wounded beyond endurance, and yet, somehow, they endured. There they were. Standing.

UNMC nursing student Jessica Blake, third from left, holds a flag that honors her husband, Thomas, a Navy pilot who died in the line of duty. With her are her husband's parents, Carole and Tom, and her children, Tommy and Lily.

UNMC nursing student Jessica Blake, third from left, holds a flag that honors her husband, Thomas, a Navy pilot who died in the line of duty. With her are her husband’s parents, Carole and Tom, and her children, Tommy and Lily.

And when it came time to click a picture, Jessica brushed the tears, lifted her head, looked right into the camera. And smiled.

Later, in the hallway, Jessica ran into Nick, her nursing school classmate, the guy who had the idea to do this to honor the fallen teammate he’d barely known.

She grabbed his arm. “Thank you,” she said. “That was really cool.”

She laughed at having made something for the bake sale, not yet knowing, at that point, one of the flags was to be for her.

And then, they were late. She was heading back into the classroom and Nick not far behind. They had a test to take. The flag ceremony was over. Quick as that, class was starting again.

Nursing school, much like life, keeps moving forward. And you remember, and smile bravely, and carry on the best you can.