‘Well, here we are.’

‘Where is that exactly?’

‘Right where we wanted to be. This is your dream, remember?’

‘Why doesn’t it feel that way?’

‘Good question.’

  –       A conversation between me and myself, on repeat for the last three months

The garden-variety caterpillar lives an interesting life. Born in its larval form, the caterpillar slithers around, eats leaves all day, and does not much of anything. Then suddenly one day, it stops eating leaves, hangs itself upside down from a twig, and begins to build a silky cocoon. In this cocoon it releases enzymes to digest itself, dissolving all of its tissues to produce an unrecognisable caterpillar goo. This goo, in a process still not understood, slowly reorganises from a liquid matrix into a completely new cellular architecture. Then, when it’s ready, it bursts from the cocoon a fully formed butterfly thinking to itself, ‘what the fuck just happened?’

Hold that thought for a moment. It will make sense – I promise.

I find myself in a very peculiar transition period, both in my career and my life. Part of what I have always tried to do with these journals is keep it as real as possible: my successes, my failures, my moments of retribution and periodic self-doubt. So this is me being blunt. In honest truth, finishing residency and taking the first steps into becoming a full time humanitarian doctor were hard. They were really hard. I got hit with multiple stressors from all different angles, and it took me to places I didn’t think I would find myself. 

I finished residency riding the highest highs of my life. I had good health, a community, amazing friends, a person in my life that made me happy, money, an amazing job that I felt damn good at, and all the glory of stepping into a bright future that appeared to be everything I always wanted. I was king of the castle.

Then, after not too long of being away on a series of benders to celebrate my graduation, several realities took hold at once. Leaving Philadelphia hurt me more than I thought it would. Moving back in with your parents at age 30 gets old fast. The person in my life didn’t work out; the distance and my jungle lifestyle again provided the wedge. My savings, initially looking nice and chunky, were thinning faster than anticipated and I had no viable prospects for income—the US was off the table due to visa restrictions, and Canada was a mess of paperwork that would take me close to a year to complete. Then, my projects abroad started getting pushed back repeatedly, leaving me to wonder if I was ever going to set out at all. Not only that, but I went from spending 70 hours a week doing what I love with my friends, to spending all that time alone, isolated behind a screen, taking walk after walk in the park not knowing where my future was going. I found myself asking if I really wanted this life all, closing my eyes and seeing two possible futures: one in the back of a pickup truck in Sudan, travelling from crisis to crisis, alone, broke, and misunderstood, with all my friends far away, and another where I worked a fun job that paid well in North America, with a big house and a family with someone I loved. Bit by bit, all that glowing light from the last three years faded, and for the first time in my life I felt lost, like a kayaker in open ocean, with the sun setting behind me and darkness closing in.

I was suffocating.

Then, I flew back to Philadelphia to write my boards. I stepped back into my favourite place in the world, Pennsylvania Hospital. I did some teaching, saw my friends again and all the smiling faces in the building who were happy to see me. I walked the halls like a local legend. That hole in my heart was filled again. In a moment, the darkness cleared, and I was sailing as the captain of a high liner yacht, vibing behind the wheel with a smile from ear to ear.

I’m back! I thought.

In reality though, it was ruse. An illusion. The ship was made of cardboard, and water seeped in, unsteadying my feet beneath me. I was living a life of incongruence, in a false reality that couldn’t be. I returned to the hospital for meetings a few more times, each arrival to less fanfare. I started feeling like that guy that wouldn’t go away. Residency was over, I knew that, but why was it so hard to move on? The hospital certainly moved on. The moment I left someone else took my place and that was that. The final straw was the last time I went back: I walked in and felt uncomfortable. I was uncomfortable in the one place I never thought I could be. The boat around me now came apart, and a lightning bolt shot down from the heavens and set the whole thing ablaze. I was plunged into the water deeper than before, and stayed there. For a period, melancholic ruminations filled my mind. I stopped being present, existing everywhere else but here, looking back to days missed or looking too far forward into a shroud of mist that echoed emptiness and doubt. I felt like human goo.

Shit, I probably looked like it as well.

Then I felt hands pattering at my sides. My friends and family gripped the collar of my shirt and pulled my head above water. I stayed there for a time, just long enough to breathe, until I found the strength to climb back into my vessel. I pride myself in being strong, independent, infallible, and all these things that men should be, but I leaned on their help more than I like to admit. I am thankful for that. To think that some people go through these things alone is heartbreaking.

Of course with time, I settled. I thought back to the caterpillar. Sure, I could try to remain a resident forever, a king in larval form. I knew however, that my destiny was always to fly. I was never meant to follow the script, I had to write my own, my way. I had to take this leap of faith from the cliffs, and for a time before I find my wings I am going to tumble and get the crap beat out of me, fine. Maybe I’ll fly or maybe I won’t; I can live with the outcome. To not jump however, would be a mistake. So it had to be this way, no matter how much it hurt.

Now, I just had to accept my enzymatic digestion, and build my cocoon. So how does Juan Lopez Tiboni, board certified internal medicine specialist, build his cocoon you ask? The best way he knows how—boarding a plane for a 92 day journey to the Middle East.

First stop? Jordan.

The mission? A joint humanitarian project between my primary contact Tayseer with the NGO Pious Projects and the Jordanian army to build and deliver a caravan-based mobile hospital to one of the worst humanitarian crises the region has seen in a generation: Gaza.

Ready? Let’s go!

I won’t spend much time detailing the background of the situation in Gaza, as I presume anyone reading this has also seen the news. The horrors are well documented. Regardless of what viewpoint you take on the conflict, one thing is clear:  too many innocent people are suffering and dying. Bombs are falling everywhere. Nine out of ten people have been displaced, most of them several times. There is malnutrition, disease, generational trauma, and death, it’s unfathomable.

Tayseer, the project coordinator who I worked with in Uganda, had been putting this project together since I last saw him in November 2023 in the first months after the war. Initial plans to deliver medical services and aid through the Rafah crossing in Egypt proved fruitless after several months of trying to get reasonable security assurances from the parties involved. So the project pivoted. Now, we were calling on the assistance of the Jordanian Royal Medical Service (JRMS), which is essentially the medical branch of the Jordanian military. JRMS already had a field hospital in Khan Younis, Gaza. Due to good relations between Jordan and Israel, their field hospital was the maybe the only health facility in Gaza that hadn’t been bombed. So, bringing in additional health services in a joint project seemed like a good way to make sure patients could see a benefit. Specifically, the mobile hospital was a maternal and neonatal facility given the astronomical need for pregnant women and infants.

So what could I, caterpillar extraordinaire, possibly have to offer?

The answer is not much. Certainly not on the ground anyways. I don’t speak Arabic, I don’t understand how combat zones operate, and I don’t even do much trauma in my clinical work.

What I can do though, is teach. More specifically I can teach anyone, educated or not, how to use a (fittingly named) butterfly iQ ultrasound probe for a ton of different things. So this was my role. I would be teaching medical staff, nurses, midwives, and anyone else deployed to the field how to use the portable device for clinical decision making in the field with no other imaging. Before departure I built a small curriculum and prepped some materials. I would deliver the training in Jordan and then the staff would take the probes with the hospital into Gaza. I would be providing tools instead of being the tool. 

Getting off the plane in Amman may have been the biggest ‘how the fuck did I get here’ moment of my life. I was two months removed from being a resident, now being met by a Jordanian army officer to escort me through customs to train the military before their deployment in Gaza.

Suddenly I felt a bump in my goo.

I anticipated some issues at customs since I was bringing a lot of money’s worth in technology with the probes and their displays. I got stopped and confusion ensued, but it turned out not to be a concern after the army captain stepped in to deal with it. I love a man in uniform.

That night I met Tayseer at the hotel and he got me up to speed on the status of the project. It was a mammoth undertaking, a scale on which I hadn’t appreciated. Tayseer was being worked to the bone in the process, having put together the entire project without any help. We’re talking about institution level resources passing through him buying caravans, solar panels, medical equipment, negotiating terms with the military, Jordanian and Israeli, hiring contractors to build, install, and trial the equipment, etc. That night, we sat at a hookah bar while he met with both his suppliers and the project photographer. He was interrupted with phone calls so many times I lost count, and this was close to ten o’clock at night. Truly impressive.

He had his hands full putting together the brick and mortar facility and coordinating the roll-out, which meant that I had to take control of my branch of the project without being too needy, which I was ready to do.

The next morning, I met my volunteer translator, a very pleasant family doctor, in the hotel lobby before our driver arrived to take us to the military hospital. As we drove up a hill some twenty minutes from the hotel, the complex came into view – it was huge. An entire campus of buildings got bigger and bigger as we drove in past the security gates. Finally, we arrived at the maternity building with an open courtyard full of people in military and civilian attire. With the help of my interpreter, we came into the building and were directed to an open office. In the office I met the head of maternity, who sat behind a desk. He had a small frame, with a friendly faced and silver white hair.

‘Tea or Coffee?’ he asked.