kinds of injectable anesthetic agents. Nitroglycerine. Cough syrup. Some antimicrobials. Antimalarials—mostly quinidine. A very small supply of codeine. Oh, and a handful of various other drugs that we can coerce from an occasional outsider who wanders through. When you have time, take a look. We keep the drugs in the locked closet just outside the clinic door.”
“Are any of these expired drugs?”
“Hey, we take what we can get. So if it’s not too expired, we accept it and, believe me, we’re glad to get it. One person’s expired drug may be another person’s salvation.”
“Isn’t that dangerous?”
He shook his head. “I check with the pharmaceutical company before I use it. I mean, commercial expiration date is one thing, but some drugs have usable life left beyond their shelf life.”
“But you do turn away some drugs that are expired?”
“Of course I do. I’m not going to put a patient at risk with an expired drug that’s not usable.”
“So when you call these pharmaceutical companies, don’t they offer to stock you with new drugs?”
“All the time. But who the hell can afford that around here?” Damien shrugged. “Like I say, I check it to make sure it’s safe, then I use it if it is, and thank my lucky stars I have it to use.”
She hadn’t expected anything lavish, but she also hadn’t expected this much impoverishment. Of course, she knew little clinics like this operated all over the world, barely keeping their doors open, scraping and bowing to get whatever they had. But, in her other life, those were only stories, not a real situation as it applied to her. Now, though, she was in the heart of make-do medicine and nothing in her education or experience had taught her how to get along within its confines.
“How do you learn to get by the way you do?” she asked Damien. “With all these limitations and hardships?”
He studied her for a moment, then smiled. “Most of it you simply make up as you go. I was a general surgeon in Seattle. Worked in one of the largest hospitals in the city—a teaching hospital. So I had residents and medical students at my disposal, every piece of modern equipment known to the medical world, my OR was second to none.”
“And you gave it all up for this?” It was an admirable thing to do, but the question that plagued her about that was how anyone could go from so modern to so primitive? She’d done a little internet research on Damien before she’d come here, and he had a sterling reputation. He’d received all kinds of recognition for his achievements in surgery, and he’d won awards. So what made a person trade it for a handful of expired medicines and good guesses instead of proper tests and up-to-date drugs?
Maybe he had a father who ran the hospital, Juliette thought, as her own reasons for leaving her hospital practice crossed her mind.
“This isn’t so bad once you get used to it,” he said.
“But how do you get used to it? Especially when it’s so completely different from your medical background?”
“You look at the people you’re treating and understand that they need and deserve the best care you can give them, just the way that patients in any hospital anywhere else do. Only out here you’re the only one to do it. I think that’s the hardest part to get used to—the fact that there’s no one else to fall back on. No equipment, no tests or drugs, no excuses...
“It scared me when I first got here until I came to terms with how I was going to have to rely on myself and all my skills and knowledge. That didn’t make working in this hospital any easier, but it did put things into proper perspective.”
“You’ve gotten used to it, haven’t you?”
“Let’s just say that I’ve learned to work with the knowledge that the best I can hope for is what I have on hand at the moment, and the people here who want medical help are grateful for whatever I have to offer. They don’t take it for granted the way society in general has come to take much of its medical care for granted. So, once you understand that, you can get used to just about anything this type of practice will hand you.”
“Then you don’t really look forward, do you?”
“Can’t afford to. If I did, I’d probably get really disappointed, because anything forward from this point is the same as anything looking backward. Nothing changes and, in practical terms, it probably never will.”
“But you chose a jungle practice over what you had for some reason. Was it a conscious choice, or did you come here with expectation of one thing and get handed something else?”
“I got recruited to one of the leading hospitals by someone like you. They wanted my surgical skills and they came up with a pretty nice package to offer me. Since I’ve never stayed in any one position too long—”
“Why not?” she interrupted.
“Because there’s always something else out there. Something I haven’t tried yet. Something that might be better than what I’ve had.” Something to distract him from the fact that he’d never found what he wanted.
“In other words, you’re never contented?”
“In other words, I like to change up my life every now and then. Which is why I came here to Costa Rica. The country is recruiting doctors, the whole medical industry is competing in a worldwide arena and it sounded exciting. Probably like it did to you when they came calling on you. And I’m assuming they did come calling.”
“Something like that.” But her motive in coming here wasn’t because she was restless, or that she simply needed a change in pace. Her acceptance came because she needed to expand herself in new directions. Someplace far, far away from her father.
“Well, anyway—they did a hard recruit on me. Kept coming back for about a year, until I finally decided to give it a shot.”
“So you did work in one of the hospitals in San José?”
“For about a month. The timing was perfect. I’d just ended a personal relationship, which made me restless to go someplace, do something else. You know, running away. Which actually has been my habit for most of my adult life.” Damien grinned. “Anyway, they offered, eventually I accepted, and it took me about a week to figure out I hated it.”
“Why?”
“Because it was just like what I’d left. Brought back old memories of my last hospital, of how my former fiancée thought I should be more than a general surgeon, of how my future father-in-law said that being a general surgeon was so working class. Like there’s something wrong with being working class! I’d always loved working for a living but that one criticism so totally changed me, there were times I didn’t even recognize myself. Tried to be what my future family considered their equal. Put on airs I didn’t have a right to. Drowned myself in a lifestyle that I didn’t like, just to play the perfect part.” He shook his head. “I really needed something different after I got through all that. Got it all sorted—who I really was, what I really wanted to do with my life. So one day I saw an ad where a little jungle hospital needed a doctor...”
“Like the ad you placed?” He had so much baggage in his past, she wondered how he’d gotten past it to reach this point in his life. It took a lot of strength to get from where he used to be to where he was now. A strength she wished she had for herself.
Damien chuckled. “The same ad.”
“The exact same ad?” she asked him.
“One and the same. No pay, hard work, long hours. Nothing like I’d ever been involved with before. So, since I’d come to Costa Rica seeking a new adventure—hell, what’s more of an adventure than this?”
“Maybe a hospital with Egyptian cotton sheets?” Everyone had something to run away from, she supposed. He did. She did. It was lucky for both of them that their need to run away had coincided with a place for them