Thursday, August 29, 2013

The Toe

Bicycles are more and more prevalent in San Cris... a cruiser with a back rest

The late afternoon clouds were heavy with rain as I hurrying to get to the museo clinic. I was running late because I had extended my visit with a wonderful couple that has lived in the area for several years and are involved with a local charity organization, Amigos de San Cristobal.  Time had gotten away from me. They have always been supporters of Don Sergio and I had updated them on 'our amigos de El Andalón' progress.

Upon arrival, the museo was packed with patients as the clouds piqued and a gentle rain started: chipi-chipi.  There were 3 patients waiting to see me as Don Sergio worked on one of our most complex cases during my visit: a 50-ish year old male with uncontrolled insulin dependent diabetes who had a middle toe infection.  It looked bad last week and when I changed the dressing 3 days ago it looked even worse. Don Sergio and I knew what was coming for the last week so, he slowly prepared the patient for the inevitable: amputation and today was the day.
Backside of the current style of Zinacantan shawls and skirt.

As of yesterday we told the patient the toe needs to come off and we'd salvage the viable tissue. As I caught up with my patients Don Sergio proceed to amputate the distal bones of the toe (just the dried out blacked part). I put my 3rd awaiting patient on hold and helped Don Sergio with light, gauze and pressure to stop bleeding (in this case bleeding is good but too much is bad).  From a US medically trained background amputating any appendage in these conditions seems so risky. With calm hands, focused mind and matter-of-fact ease Don Sergio completed the job in a very clean fashion.

The departed portion of the toe sat in a piece of gauze off to the side: black and lifeless.

During the procedure the patient sat with his head turned away, calming holding his thigh of the affected foot/toe and his wife standing by his side, stoic with her hands on his shoulders. There were a variety of people in the museo: a group from Zinacantan, Chamula, pobre Mexicans and middle class Mexicans, kids, adults, adolescents, a total of about 15 people, mas o menos.

As Don Sergio worked there was an air of silence I cannot describe but will try. It was not like Championship point at Wimbledon but a heavy, yet soft blanket of silence. Everyone knew the intensity of the moment and no one spoke, heads slightly bowed, patiently waiting and no one moving a finger. Soon the chipi-chipi rain became heavy, then a downpour. I'd glance at the patient's face and his wife's face looking on as Don Sergio was engrossed at the task at hand.  After the operation was done and all was controlled, Don Sergio joked about the detached toe, bringing a smile to the patient's face and an abrupt laughter from the others....seamlessly.

The rain had stopped and we counseled on DM control, avoid getting the wound wet or dirty, taking Tylenol for pain (he couldn't feel anything anyway due to the DM neuropathy, but just in case), and lay off the foot as much as possible.  He said he would and we'll see him tomorrow.  He stands and leaves walking on the heel of the foot missing a crutches, no wheel chair, no walker.  This is the life here.

For the Maya, having all 10 toes and 10 fingers (the Maya use a base count of 20) means you are whole.

A visitor from France came in and told Don Sergio her Mother met him almost 30 years ago and gave him this paper in French from that time period.

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