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She sat down in the chair surrounded by eight children--some of her grandchildren and great-grandchildren, she proudly told me. Extended family of her seven sons and four daughters, the living-birth children of her 18 pregnancies, each of whom had to remain in the village that day to tend house and field. They were polished in their Sunday best: a yellow dress with a tattered lace collar, a father's straw hat, a freshly changed cloth diaper. Shoeless, yet each with a shy, genuine smile.

"?Como puedo ayudarle, senora? [How may I help you, senora?]," I asked. She handed me small slips of paper, one at a time for each child, that listed name, age, and the reason for consultation. The usual array of complaints and concerns were presented: "Diarrhea... Tos y gripe [cough and cold]... Stomachaches... Skin problems...." As had been my routine that week, I began with the youngest child and worked my way to the oldest. Remembering--or at least trying to remember--the way to hold still a baby's head to find a tympanic membrane. Listening for expiratory wheezes above the noisy din in that crowded one-room schoolhouse. Holding a small, brown hand against the grin go whiteness of my own to check for scabies between fingers. This was rural Honduras, far from the secure sterility and familiar control of my gynecological operating room and clinics.

A decongestant here, antifungal cream there, acetaminophen for an ache or two. Beyond the standard reliance on corn, rice, and beans, this family somehow managed to find an occasional mango or banana, and told me they kept a few chickens around for eggs and for meat. Although small in stature, these children did not have the. telltale signs of kwashiorkor nor marasmus. Each one dutifully gave me a "gracias" and a grin as 1 shook their hands and dispensed their medications.

"?Y usted, senora? I inquired of the 60ish woman, after I had finished with the children. "Anything I can do for you today?" Every other adult I had seen that week had his or her own slip of paper, waiting to tell me about their "brain pain, dolor en los huesos [bone pains], or excess stomach acid." She leaned back and smiled, the lines in her face deep like the valleys of her homeland's terrain.

"Yo estoy bien, gracias a Dios," she replied. "I really don't need a thing, I just wanted you to see my family."

"Surely I can do something, for you, senora," I insisted in my American way. "Well, I do get a headache, but only rarely," she said, sensing a need to fill my void. The laying on of hands, isn't that what I can do? So, I took her blood pressure: 200/110 in her right arm and 200/95 in the left. She accepted a few antihypertensive pills, and I mentioned future follow-up examinations at a local clinic, knowing full well the limitations of what I and what her country, her lifestyle, had to offer.

"Muchas gracias, doctora," she said, with a gentle touch of my knee. "Remember, your love is the best medicine of all."

"Gracias a usted senora," I replied. Gracias, indeed.

Dr. Hullfish is an assistant professor in the Department of Obstetrics! Gynecology and Urology at the University of Virginia School of Medicine in Charlottesville, VA. In August 2002, she and 12 other people from Charlottesville and Richmond spent 10 days in rural Honduras on a medical mission. The team comprised two physicians, four nurses, and several lay persons and was assembled by a group known as Friends of Barnabas.
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Title Annotation:a personal narrative of a doctor's relationship with a patient
Author:Hullfish, Kathie L.
Publication:Southern Medical Journal
Article Type:Column
Geographic Code:1USA
Date:Feb 1, 2003
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