Emergency Medicine Made Easy – The Orthopedic Bus Driver

Kids break bones. It’s a matter of fact. You might, however, hope they don’t do so in a foreign country. Then again, after today’s experience, I’m starting to think that prospect isn’t so scary after all.

First of all, I’ll say that it wasn’t our son this time, but one of their housemates here at Villa Cabo Fino. In one of the many acrobatic antics that the kids here enact, this dynamic seven-year-old dropped all of his weight on his arm in a fall off a wall and came up the steps sobbing. We suspected a break but waited until morning to drive to the local clinic. Being the one with the car and the comparatively solid Spanish skills, I was the lucky lady first in line to be a helpful companion to Lucinda and Colton on their adventure through the Dominican Republics’s emergency medical system. 

Like most of Cabrera’s buildings, the 24-hour medical clinic is a simple, concrete two-story structure, easy to get to by diving off the chaotic main road into a dirt parking lot. We went up to the front desk and displayed Colton’s arm to explain with our best Spanish adjectives that we thought it might be broken. Right away, the receptionist interrupted the doctor in the next room to show him. “It’s broken,” he said, after looking at the arm for only a moment. “Right here.” 

We were immediately led around the corner by a man with drooping watery eyes wearing a faded button-down shirt and pants that probably fit him properly twenty years ago—our radiologist. On the way, a woman glanced at the arm and said, “That arm is broken.” Sheesh. Were we blind? The radiologist gently laid Colton’s arm on the x-ray plate, taking care to position the protective apron over half of it so he could save the other half of the plate for a second image. Colton’s mom and I gave each other sideways glances. Isn’t that apron supposed to protect the internal organs of the person getting the x-ray? No matter. 

Sure enough, broken.

“It’s important that he not move that arm,” la doctora told us. I think she was a doctor, but honestly, it was hard to tell. No white lab coats or stethoscopes here. No handy nametags that say “Dr. So-And-So.” She and the radiologist took a rough-cut piece of cardboard, folded like a ‘v’ and gently laid Colton’s arm inside, then wrapped it with a flexible bandage as a temporary support. “Doesn’t it hurt him?” she asked. “I guess not,” I answered. “He hasn’t had any pain reliever since last night.” Lucinda chimed in, “And he slept really well all night.” The doctor gave a little shake of her head. “Los ninos son increibles, no?”

Now, where to find an orthopedist to set it right? It looked like we would need to drive either 90 minutes west to Cabarete or 60 minutes east to Nagua. We waited on a bank of welded, worn seats while la senora worked on tracking down a specialist who could see us today. I’ve been in my fair share of clinics and emergency rooms with my boys, and this one was not so different. Television silently streaming programs that might be of general interest. Slick white hallways that led to rooms with acronym-encoded labels over the doors. People with blue hairnets and masks. I liked how intimate this one felt, though. Everything, even while being squirreled away down mysterious hallways, felt closeby. And, perhaps more importantly, I felt like everyone talking to me was more personable than anyone in any clinic I’d ever visited. (Well, except maybe in Australia…)

While we waited, a kind man in jeans and a blue scrubs shirt that stretched like a beachball over his belly came to tell us a little bit about the procedure. Holding my arm to demonstrate, he explained they would need to stretch Colton’s arm a bit, then put pressure on the bone to set it right. No anesthesia. Too risky for such a little person, and the pain would be over quickly anyway. Once in place, they would wrap the arm and double-check the procedure’s success with another x-ray. Easy enough. 

“Do they know yet where we need to go for the procedure?”

“That’s why I’m here. I’m doing it.”

“Really?” We couldn’t believe our luck. No drive after all! This clinic was really resourceful! And my translating was perhaps not the best?

“Yup. I’ve been working with this kind of situation for fifteen years. It’s a simple break, really. It would have been much harder if it were closer to the wrist.”

He gathered the supplies and signaled Colton to follow him. “Best you stay here, though,” he said to Lucinda. We raised our eyebrows. Was that odd? Sending your seven-year-old son to have his bones re-set with someone who doesn’t speak his language? I swear I could see Lucinda’s heart beating in her chest as she tried to sit well with the suggestion. Nope. She decided to follow them up the stairs. Moments later, I heard, “Holly? Holly, I can’t find them. My mom-alarm is going off something crazy.” I followed her to the second floor, which was something right out of the movie 28 Days Later (curse the person who ever encouraged me to watch that thing). Seemingly abandoned. Windows without glass. Doors hanging off hinges. Random furniture shoved against walls. No sign of life anywhere. 

Then, a big sigh of relief. Someone appeared behind a deeply-tinted swinging door and stepped aside so we could enter. Colton was lying flat on a reclined, plastic-sheathed chair in a semi-dark room. A piece of fabric, maybe a small curtain, was looped around his elbow and the armrest. The orthopedist instructed the elderly radiologist how to pull on Colton’s arm and keep the tension while he set the bone. Was he thinking, no mother should see this? Is Colton about to suffer something awful? Why did he say we shouldn’t be here? The medieval-looking gynecological stirrups in the next room did not inspire confidence.

“Maybe I should have prepared him for the pain?” Lucinda wondered aloud. “Colton, this is probably going to hurt. Are you ready, big guy?”

It hurt. Colton screamed. Then he politely asked them through grit teeth to please stop pulling his arm. (Kids truly are incredible.) In a matter of minutes, though, the arm was wrapped in a cast, and the pain was over—just as the doctor had foretold. Colton went downstairs immediately for a second x-ray, which showed a smoothly curving ulna where the offending angle was only moments before. They wrapped the cast a little thicker, and we gave a round of applause. 

The billing officer called us in (the same person I thought to be one of the doctors earlier) and said she still hadn’t gotten in touch with our insurance. So she asked Lucinda to write her phone number down. “We’ll call you if you need to pay anything,” she said. Do we trust foreigners so much in our country?

We went back out to collect Colton and go home. Mission accomplished! It was a beefy cast. It would be able to hold a lot of signatures from the kids at school. We thought to ask the doctor about a proper sling to help support the weight. And here’s the punchline, folks. The doctor replied:

“No problem, I can take one to him at school.”

“Really?” (This was unheard of. Sling delivery service? What will they think of next?) “That is so nice! But do you know what school he goes to?”

“I know his bus driver.”

“You do?” I turned to Lucinda to ask, “What’s our bus driver’s name again?”

Lucinda looked puzzled for a second, “Alexi. You know Alexi?”

“Yeah, I’m Alexi.”

We looked closer. Oh my goodness. The entire time, we were working with the man who takes our kids to and from school EVERY DAY. I met him once, amidst the chaos of thirty bouncy children reverberating off the walls of the bus. Masks. Din. Expectations. We felt so foolish. How did we not recognize him?

I can’t dismiss the possibility that we simply couldn’t wrap our heads around the idea that a doctor moonlights (daylights?) as a children’s school bus driver. In my experience, to set a bone, you need eight years of education past high school, after which time you pay off astronomical student loans by working more than full time in one, two, or three different hospitals. At some point in the future, you get super rich if a malpractice lawsuit doesn’t get you first. At least, that had always been my view. 

Perspective widened. 

A little disclaimer here. Truth be told, my ear is still struggling to wrap its little cochlea around the Dominican accent, and my role as a translator today was not one upon which anyone should base any earnest medical anthropology studies. (I once took a medical anthropology class at university, by the way; on the first day, the professor had us spit in our palms and lick it back up again, what a radical!) While trying desperately to cipher familiar Spanish words out of the flowing, musical stream of syllables coming my way, I definitely missed a couple of crucial bits of information. These I tried to piece together with the help of the Dominican folks working back here at our house:

“The bus driver? Yeaaaah, he’s been fixing broken bones for like, twenty-five years. I remember him doing it back when I was in grade school. A doctor? No, no. If the break is really serious, he drives the person to the orthopedist in Cabarete or Nagua. He can’t do any surgery or anything. But if it’s an easy break, he’s the guy to go to. How did he learn? Oh, the Red Cross.”

Wow. Well, be you a midwife or a shaman or a neurosurgeon, or a bus driver, if the bone is straight, we’ll take it. Many, many thanks, Alexi, for your tranquil confidence, as well as your amiable countenance. We were in good hands today!

And as promised, he handed Colton his sling as he got on the bus after school.

Read about our trip to the emergency room in Australia…

Test Driving the Australian Medical System – The Joys of Traveling With Boys