I was welcomed back to the United States with those infamous words, "is there a doctor or a nurse on board" over the loud speaker of the airplane. Though I was the closet to the patient and the first to volunteer, I was happy to hand over my responsibilities to the doctor that eventually came from the back of the plane. Besides, there was not too much that anyone could do for shortness of breath related to pulmonary hypertension in mid-air other than apply the oxygen mask. Until that trip, I never knew how many gadgets and medical contraptions were hiding out in that first overhead bin on the airplane. Though we were met by EMS when we taxied into the gate, the patient walked off the plane without difficulty. Needless to say, it was an eventful homecoming.

It has been about a week since leaving Guatemala and I am still trying to adjust to the reverse culture shock of my return. The clinic will reopen again this week, after being closed for the last two weeks for the holiday. I can't stop thinking about the patients that patients that will be there this week when I am not. In the past 3 months I saw over 50 new patients and 80 patient visits including follow-ups. However, there are the few special patients that will stick out more than most.

Doña Celia's baby is almost a month old now. I am sure that she is already so much bigger than the last time that I saw her. Pretty soon she should be given her name. In Guatemala, the newborns are usually given their name in a ceremony at about 1 month. Last time that I saw her, she was wearing the one-sie that the clinic had given her. Her eyes had turned from jaundice yellow, back to white after a week of sunshine therapy. Their family was the very last that I saw on my way home from clinic, and after over a week of home visits and check-ins, certainly the most difficult and teary good-bye.

Doña Rosa's c-section that dehisced is totally healed without signs of infection. She is finally able to lift things other than her newborn baby, who also has been given her name since the time that I left. I will miss her younger son who was so giggly and easily amused by rubber-glove balloons and water filled syringes as I cleaned and packed mommy's stitches daily.

Doña Clara's CAT scan came back negative for evidence of pituitary tumor or adenoma and she can now go back to focusing on getting surgery for her daughter with cleft lip and cleft palate. Doña Ramona exams have come back negative for any remaining evidence of endometrial cancer posterior to her radiation treatment in the capitol.

Though I have resolved these patient cases, I can't help feeling a lack of closure. This week I start phone interviews to look for at least a temporary replacement until we can figure out a more permanent solution as to how to staff the women's clinic. We will be holding a large fundraiser and silent auction at Vanderbilt University the February 12th to raise money for free pap smears for all patients in the women's health program. Our next goal is to start a more structured prenatal program as has been the biggest request by the women of the community. Until then we will be able to keep the clinic running with the remaining funds from the Hope through Healing Hands Scholarship. I cannot begin to explain how incredibly fortunate I feel to have been given this unique opportunity. The women of Primeros Pasos have affected my life and practice in a way that seems almost impossible to describe; I will never forget them. Thank you to everyone who has supported me in this endeavor.