Turns out that jumping feet first in the ocean is overrated for a few reasons. Number one, and the only real reason I carry any sort of disdain for the ocean, is jellyfish. Those gelatinous bastards managed to ruin my triumphant exploration of the corals surrounding the casitas on just about every occasion that I chose to swim. Even after mentioning it to Anselmo, who had at this stage become my shaman-resource of all things nature oriented ‘Ah yes’ he told me. ‘They come out when it rains, if it rains a lot they will come out. The big ones don’t sting, it’s the little ones with the long strands that can sting you’. Thanks for the tip I told him.

With his advice I understood that I no longer had to live in fear of the jellies, they were harmless cretins, soulless clumps of gooey nonsense that lived in greater fear of me than I of them. Or at least that’s what I thought, because one of those same big boys that were meant to be nothing at all crossed me right at the arm-pit on my next swim, somehow evading my rodent-esque surveillance of the field around me for danger, and stung me right at the close end of the arm. It stung, but honestly not very much. I wasn’t terribly alarmed, but I did glance at my watch to determine the TOS (time of sting). Lets see what happens I said to myself.

Far more concerning was how the jellyfish, wise far beyond their neocortical right, had organised to form a pseudo-pallisade around me, blocking my access to the ladder at the dock. That is the thing with jellyfish, they tend to roam in schools. They are clever in their disguise, as their translucency makes their discovery nearly impossible until you have them right upon you. This bunch was clever, and they were out for blood. I will admit that my heart rate skyrocketed, and I had to carefully plot my every maneuver, with a head like a merry-go-round at all times on alert. I had to dive deep, get under the first row of defences before I could break for the ladder. The bastards were everywhere, and I clung to the ladder with mighty grip, moreso in awe at that stage than in fear of their sheer numbers. I had one close to me, probably within two arms reach, and I watched his ginger strokes just to study his mannerisms for the sake of human knowledge. He was smaller, likely a teenager. I wondered about his teenage friends, what kind of nonsense they got up to on a Friday night; was this jelly a loser or a full blown chad? I would never know. I debated whether to kill him, right there in cold blood, out of sheer spite for his kind. That desire quickly faded, and I retreated with what dignity I had left. A quick once over in the shower twenty minutes later revealed the damage done, I was covered in hives from head to toe. At first I thought it was a weird sunburn, and all my flesh felt hot. Thankfully it only lasted about an hour. This was the first of many times the jellies would sting me during my stay, and for some reason I only got hives this once. Go figure

I had already made great strides against the creatures of San Cristobal, the chitras, and the mosquitos, had made such misery of me that I had a mission to outsmart them. I had officially decided on a set of dinner clothes, full pants and long sleeve shirts with pull up socks, to be worn after nightfall and at dusk in the morning. One of the cooks on staff, whom I met for a moment eating lunch on Christmas eve, told that the chitras came out most heavily during the full moon. He also told that they got hungry at high tide. Knowledge is power I thought to myself. To know my enemy is my greatest strength.

That night I woke up, in a frantic itch. My arms were on fire. It was an intense itch at my heels and at my elbows, so harsh that I couldn’t go back to sleep. Have you ever been so itchy that it woke you up from sleep in the middle of the night? That was a first for me, and I thought I knew bugs. The Canadian wilderness had me well acquainted with mosquitos, deerflies, and horseflies, the latter of which don’t even bother stinging, they just chomp a bite right out of your flesh. In the summertime depending on the month, you can’t walk three feet without one latching onto your legs, and the shocking surprise at real blood oozing from the wound after you’ve smacked them off. That’s the thing about horseflies that makes them different from mosquitos, mosquitos itch, and you can barely feel the sting by virtue of a protein secreted from their proboscis that acts like a local anaesthetic. Horseflies just bite, and it hurts more than it should. The chitras were another beast entirely, so small they were like fruit flies, small enough to fit through my mosquito net. I vowed not to let them defeat me, despite my lack of sleep, a clear sign that I was fighting a losing the battle. For some reason I tried to convince myself that they would let up for Christmas. If anything it primed them for a bigger feast.

On the morning of Christmas Eve I was out on the dock reading a book. Cutting for Stone it was called, given to me by a friend of mine from medical school. Not only given actually but purchased, he had won a giftcard for a bookshop and asked me to go with him. He was excited to point out the title when we stumbled across it. ‘Have you read this?’ he asked me. When I answered no he said to me I really should ‘it’s my favourite book’ he said. When we were checking out I noticed that he, along with some new pens and a sexy notebook, bought that copy of his favourite book. I didn’t think much of it at first, but then he handed it to me. ‘For you’ he said. It’s a long book, far longer than any book I would ever willingly read, as was the handicap of my short attention span. I felt like I owed the man a read, and so far I was enjoying it.

Anselmo came by the dock and we chatted some more. I told him the bugs were fucking up my shit. He laughed. Some people can’t take it, he told me, and up and leave after one week. Your body gets used to it over time (allegedly), it’s always far worse when newcomers arrive.

‘Look at Lexi’ he said. ‘He walks around with them all stuck to him, and they go hungry, there is nothing there to eat!’

I was finding out that this man was not shy at all, just quiet. I am so loud, a quality which on more than one occasion has brought me both trouble and good fortune, that I sometimes mistake being quiet to being shy. I got the impression that Anselmo loaned for having people at the base once more. He told me of the excitement that comes around when new volunteers show up on base. ‘Alta fiesta’ he told me. Music and drinking under the stars, and how people marvel at how many stars! ‘I always remain here’ he told me, ‘in case anyone shows up and tries to take something, I have to always be here. Should they actually be decent crooks and come with guns, there is nothing I can really do’. Thankfully he said that moment never came.

That same day there was a clinic at the base, hosted by Alison, a retired physician assistant from Colorado who now lived in Panama. She was very personable, and showered me with questions about my interests in medicine, and how fate and pulled me around and landed me in Panama as a white Canadian who spoke Spanish with a native accent. Our first patient was a woman, in her thirties, who was having some visual disturbances since an illness in March. Especially upon standing up from sitting, she would see stars in her vision, I served as translator from a safe distance because of my Covid isolation, and so Alison led the consult. Our patient was overweight, and had mentioned some bouts of feeling excessively cold, something which immediately jumps out to a physician as a potential thyroid issue. However she had made significant progress since her last visit, citing improved energy after being prescribed some vitamins and given tips on eating and sleeping well which she implemented. She was timid, and I found it difficult to get much out of her. I feel like my usual ability to break down barriers between people is lost when I communicate in Spanish, I have to struggle to find words instead of just talking from my soul. We scheduled a follow up appointment for three weeks, and if she wasn’t still 100 percent better we would have to send her onto the mainland for a thyroid function test. Therein lies the discrepancy between giving care with FD versus anywhere in the occidental west. I scrolled through all the blood tests we would have sent on her routinely in Ireland. It almost makes you laugh.

Our second patient was a forty eight year old male, of similar build as Anselmo, which I noticed was becoming a trend. He brought with him a little girl, probably seven or eight years old. He had low back pain on the left side. Upon discussion, it was classic muscular back pain, and he showed no signs of neurological dysfunction, slipped disc or fractures. Alison made a point to discuss his weight with him, and the consult became more about his diet and his lifestyle than his back pain, I really appreciated that about Alison. His diet consisted of plain bread in the morning with water, followed by some protein based meal during the day, usually pork or chicken with rice followed by plain bread with water at night for dinner. I asked him if he ate any vegetables at all. He said mainly pineapple and sometimes cucumber. I asked if there were any more and he looked at me almost as if I had two heads. I listed all of the vegetables I knew could be found in Bocas town since I had bought them there myself. He softly told me ‘No. We can’t really get that on the islands’. I sensed a frustration build in Alison, she knew there was only such much she could do. If people don’t have access to adequate foods what can you even ask of them? Here she was trying to counsel this man on a healthy lifestyle when his very existence was incongruent with any possibility of that kind. With my help we encouraged him to eat green as much as he possibly could, and try to get regular exercise; trying to shave down the belly helps, especially for the back. I tried my best to get something out of him conversation-wise, at the very least I asked him if he understood and he always said he did, but I struggled to get anything of substance from him other than our specific line of questions. I don’t know if that stems from the colour of my skin, or the anxiety of seeking healthcare for a population who seldom has had the chance, but I was frustrated at my inability to really get in.

That evening I was on the phone to my parents and I got a knock at the door. ‘Someone is here to see you’ I was told. It was just after sundown, and I knew the chitras would be out in full force so I decked out my longsleeves and pants and went out into the dark. Raphaela was her name, the head of the kitchen. She had been dying to meet me since the team was told I would be arriving to quell the silence of an empty base. She was very kind. A real maternal presence radiated from her, and I found it difficult to make conversation with her on account of the chitras launching an assault on my face. She was wearing short sleeves and shorts, barefoot. And here I was dressed like Juan Valdez basically whimpering on account of all the bugs. She was chatty, a well-received contrast to the consults of the day. She asked if I had any dietary restrictions and I laughed. Feed me as if you would a dog I told her. I will eat anything that you put in front of me. She was apologetic, ‘I wish things weren’t this way’ she told me. ‘I would have you at my table tonight for Christmas Eve.’ ‘Nonsense’ I said. I was happy enough to dine with the chitras.