The author examines a Bolivian patient.

Heart Condition

On a sunday evening in my final year of medical school, the AeroSur plane I was on began its descent into Bolivia. Below us lay snow-capped peaks, a 12,000-foot-high plateau, and valleys that fell away into the Amazon basin. Below us, too, lay millions of poor, ailing people. Like many other South Americans, Bolivians are plagued by Chagas disease, which causes fatal cardiac arrhythmias, and rheumatic heart disease. Traveling as a volunteer with Project Pacer International—a group coordinated by the Lahey Clinic of Burlington, Massachusetts, to provide modern cardiac therapy throughout the developing world—I hoped to heal indigent patients.

In truth, I also hoped to heal myself. I had entered Tufts Medical School because I wanted to make a difference in people’s lives. Humanitarian work had always given me a natural high. But sometime during my third year of training, I had lost that feeling. Maybe it was the solid month of study for the licensing board exam, or the sleepless nights during my surgery rotation, or all the time I spent focusing on an Honors grade instead of on the patient before me. For whatever reason, I felt jaded. Project Pacer International, I thought, might be just what I needed to rekindle my desire to serve. Yet I was nervous. What if I had lost sight of my purpose in medicine forever?

The moment we checked into our hotel, I grabbed my stethoscope and my English-Spanish medical dictionary and headed over to Hospital Viedma with our group of Lahey residents, nurses, and cardiologists. What I witnessed there took my breath away. Hospital Viedma was congested with patients—hundreds, maybe thousands. They had surmounted political roadblocks, walked for perhaps 20 hours, ridden a public bus for as many as five days, and spent most of their life savings—all for the chance to be cured by our cardiologists.

Over the next couple of weeks, such crowds became a familiar sight. I examined Bolivians whose heart problems caused severe oxygen deprivation, as evidenced by blue lips and fingertips that looked like the top ends of baseball bats. I saw jugular veins in which pulsations rolled like surfable waves. I heard heart sounds, murmurs, and rumbles so significant they could be picked up even with my stethoscope two centimeters off the chest. Mostly, though, I saw brown, blue, and green eyes pleading for help.

There was one patient I will never forget. Marisa was 35, but looked 30 years older. Rheumatic heart disease had left her with a heart valve that could not keep pumped-out blood from flowing back in. The delivery of oxygen to her body was so limited that she could not lie down. Even propped up on four stacked pillows she gasped for air.

Without medical treatment, her prognosis would be dismal. So, with an anesthesiologist watching her respiration and oxygen status, cardiologists advanced a catheter up an artery and positioned it in the middle of the faulty heart valve. Then a balloon at the tip of the catheter was inflated and deflated, over and over, relieving the constriction as I watched on the monitor. It took three hours.

The next morning, when I asked Marisa how her breathing was, she nodded. Mejor, she whispered. Better. The following afternoon, her teenage daughter was with her. I introduced myself as the medical student who was following up on her mom. When I asked Marisa about her breathing, she nodded, smiled, and looked over to her daughter, who then grabbed both my hands. Muchas Gracias! Mi madre se siente mejor! she told me—her mother felt better. I swallowed the lump in my throat.

Leaving Bolivia, I felt the same lump. Caring for patients like Marisa, for whom doctors and nurses were the only lifeline, I remembered what medicine was all about. I had regained my passion for helping others. And now, back in Boston, I feel alive. I will always be grateful for the opportunity to work with Project Pacer International. I would do it again in a heartbeat.