Last Day in Iquitos

Last night in Iquitos. 


I’m writing this tonight because I can’t sleep.  I’m too overcome with what I can only think is emotion, I honestly have never felt anything quite like this.  It’s like from the moment we closed clinic my chest has collapsed into itself and I’m left sitting here in pieces.  These last 4 days have been among the best in my life; the most hopeful, sad, courageous and outrageous, heart felt and amazing.  4 days can change your life.


I’m a medical student.  I sit in a classroom and at a desk day in and day out.  Pages fly past me with diagnosis and prognosis; systolic and diastolic, 35 year old male on high dose prednisone for 1 week, erythematous masses and benign hemorrhagic diseases.  I can memorize and categorize, chart and differentiate; preparation for dreaded ABCD question forms with my name and date in the corner.  But I am not a doctor and even further from a physician.  I’m cold and calculating.  I am a differentiating, diagnosing, examining machine with a box of tools and short white coat.  At least it seems as though thats what the first 2 years of medical school is training me to be.  Everything seems artificial, but let me tell you about something real.


Before I ever donned a white coat or put a stethoscope around my neck with purpose I received what most doctors dream and few will ever see; I walked into work through a crowd of patients giving us a standing ovation.  These people, sick and cold, waited in line since the morning first broke free decided to stand up and greet my group of colleagues and I like we were a gift they never thought they would see.  What most doctors dream of, I received without ever really deserving.  But this was more for vanity than enlightenment, so I will digress to what I learned next…trust.


I am scared.  I will always be scared.  Nothing in life prepares you to be a doctor except 2 things: a caring professional and a scared but trusting patient.  I found both in Iquitos.


Our mentors treated us like colleagues and our patients like professionals.  For 4 days I was a doctor for no reason other than because I wanted to help and I had the bare minimal skills to do so.  I started out feeling like a jagged piece of stone that just fell from a cliff into a rocky sea, but before long I was carved into something worth looking at.   But I was still a machine; calculating and differentiating, weighing and measuring.  This was until I met one patient.


I”ll call her Maria, that seems appropriate.  She was a 70 y/o female malnourished, malaise, presenting with facial squamous cell carcinoma for 10 years prior.  This was all a very cold way of saying she was frail, poor, and had a skin malignancy that had dessimated half of her face.  I was never told her name, only a diagnosis and told I needed to look.  I walked into a crowded room of people staring and saw her sitting in the chair; she was so helpless, so scared.  Something changed inside of me.  Subtle at first , but then grew.  I did not want to take a picture.  I walked up to her unafraid and got down on my knees beside her.  I held her hand and did something that felt completely real…I looked her in the eyes and in my broken spanish told her my name and that it was very nice to meet her.  It was so simple, so seemingly insignificant, but the look in her eyes captured the emotion that keeps me awake tonight… she trusted me.  I wasn’t another person staring, I wasn’t’ s stranger, I wasn’t cold or callous and she was not pathology on a piece of paper in front me.


I was with her in a way that made all of the chaos seem superfluous.  I gently held her hand as my other held her cheek so I could take a look.  I thanked her for coming in.  She was so brave.  I wanted nothing more in that moment than to not let go.  To hold her hand till the cancer went away and her skin returned to its tan and beautiful complexion, but I couldn’t.  The moment t I shared with her was so brief and so sad, but it was as far from cold and calculating as I could get…this moment was significant because it was real.


My last lesson in Iquitos, strangely enough, taught me something about love.  We talk about love like it’s something esoteric or rare, but it exits in everything.  I met her after my last day in clinic, after my last last rotation had finished.  Patients had all been seen, charts were marked, prescriptions filled and as I walked around aimlessly I watched two little children playing in the hall; they were so beautiful.    The boy would throw a little pebble he had found in the courtyard  against a wall as he and his little sister  would scramble to catch it.  So simple, but brought them so much joy.  The little girl could not have been 4 years old.  I did not know whether we had treated her, her brother, mother, father, aunt or uncle, but she smiled at me each time I walked past.  Finally I got down on my knees beside her.  She took me by the hands and I told her in my improving, but still broken spanish “Tu es Muy Bonita (you are very beautiful).  Her smile lit up and she came close and kissed me on the cheek.  I loved that little girl.  She left me with exactly what I needed and it wasn’t a plaque or a poster or a standing ovation.  She left me with a sincere thank you that warmed my heart in a way that will keep me from every forgetting.


I am 25 years old and I have already had to leave so many things behind already.  HIgh school friends, lost loves, old college houses and countless sports teams, but nothing hit me like a sense of abandonment like the run down, tiny clinic in Iquitos.  Countless numbers of gauze pads, alcohol swabs, Q tips, bandages, saline drips and surgical needles along with 1432 patients pass through those halls.  And with my myriad of new friends, my head full of treatments, and a pocket full of unused latex gloves I left with my 3 lessons.  My first of gratitude, my second of trust, and my third…love for a complete stranger whom I may never see again, but hope the world for.  We all hopefully had similar experiences, but mine gave me hope.  I have hope that I may one day become the physician I want to be, the one I was in Iquitos.  Goodnight everyone, I can finally rest with this off my chest.

Categories: Updates from Peru

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5 replies

  1. Anthony, I’ve enjoyed all the posts here, but yours left me in tears. Thank you for the depth of your perspective and the honesty and beauty of your writing.

  2. Anthony, I read your post and cannot help but remember times gone by and the wonderful young man you were in high school. I have to say that I am extremely proud that you continue your life’s passion of serving others through medicine. I think that what you have experienced in Peru will make you a much better doctor. Your ability to articulate your experience has made it all so real. May these life lessons be what drives you. Thanks for giving of yourself in such a selfless way. God Bless! Be safe!

  3. Welcome to doctorhood, Dr. Agrusa! I am so glad God touched your heart in Peru. I knew He would, He’s like that. 🙂 He can use you in an even greater way if you stay open to it.

  4. Anthony,
    As I told you in 8th grade and will tell you again …you are a wonderful expressive writer. However, this post not only brought me to tears but brought me back to reality. It is so important not to take life for granted. Your efforts in achievemant have obviously done you well. I am proud of you. Thanks you for all you do in this world to help others.

    Mrs. Coffey

  5. Anthony, there are no words to describe the passion, love and caring you present to patients. I am so proud of the bright, caring, and loving young man I have had the privilege to know and see grow. The insight you shared is who you are. You are the Doctor who patients, colleagues, family and friends willl look into your eyes and trust.

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