My heart dropped into my stomach. Oh my God, I thought to myself. I immediately typed an answer back to expect a call from me in ten minutes, while I set about wrapping things up with the other patient. I sent a message to Dr LaBrot telling him what I knew, and then I scurried back to the casita where I had my computer. I would have to update her on our follow-up spreadsheet, and didn’t want to fumble around when I spoke to her on the phone. It was all a bit moot, because as soon as I rang her and she picked up the phone I started pacing up and down the dock while she told me everything.

That Friday evening, the very night we sent her off to the bigger hospital in Changuinola, she was seen. A battery of initial tests prompted her to go into emergency surgery. She spent a week in hospital before being discharged, received IV antibiotics through the drip and other medications. The whole week was a blur to her, and she hardly knew the details. She had been out and staying with other family in one of the communities near the city, and was now attending her second follow up appointment after discharge. Her mother had traveled back to Ensenada, leaving her alone there with a cousin. She was feeling better, and doing okay, but she had no money to travel back home from Changuinola. I told her to send me photos of all the paperwork they gave her in hospital, and that I would link her up with Jack to see if we might facilitate some transport for her.

When her paperwork came in, I had to do a double take. She had a 1.3 litre abscess. That’s right, 1300 mL of infected pus, surrounded by a wall of granulation tissue (scarring) that had just been raging silently inside her until she finally started becoming toxic when we saw her. What made her case slightly deceptive was that she had a peri-anal abscess, not a pelvic one, meaning that the infectious bubble was at the floor of the pelvis in one of the many recesses surrounding the anal canal, and not near the uterus where I would have expected it to be from all the pain in her abdomen. She had a surgical procedure to drain the abscess of all its pus, and was given antibiotic therapy directly into the bloodstream, which had now been converted to oral medications to clear out the last bits of her infection. I called Dr LaBrot after and shared the news with him, we were both in shock to be quite honest; and to think that she had been discharged after being seen for only a few hours here in Bocas. There was a very real possibility of her going into septic shock and dying, it would have been a tragedy. I updated her notes on our spreadsheet and sent her another message thanking her and letting her know to show up at our next clinic in Ensenada so we could follow up with her. A bit of closure after that journey was well received. The benefit of hindsight tells us that we did the right thing, but so often we don’t even get that consolation. Had she told me on the phone that nothing was wrong with her at all and we made a huge fuss about nothing, I still wouldn’t regret having done what we did.

That afternoon we finished our humanitarian medicine conference, which was a Medicines Sans Frontieres sponsored film on the infectious fungal disease called Noma. It’s a rapidly progressive form of gingivitis that causes necrosis and destruction of the oral cavity and face, and is highly fatal. Patients that survive it get to live with awful facial disfigurement. It is not localized to any one continent, and is caused by a multi-factorial aggregation of several factors like malnutrition, poor oral hygiene, and generally poor living conditions. Again, it reminded me how far we still have to go for people to have a fair shot at life in some of the more underprivileged corners of our planet.

That evening the gang went into town for the usual debauchery. I met a gentleman at the bar who was a retired paramedic, and I shared with him some stories about our work with Floating Doctors. He was blown away, and got so excited during my storytelling that he kept cutting me off to ask clinical questions about the patients’ status or vitals, prompting his friend having a drink with him to snap after one too many interruptions. I honestly didn’t mind, I enjoyed seeing how excited he got, and likewise I think his friend was so interested as well that he was getting frustrated that I wasn’t doing all the talking. The power of a good story is transformative, which is a big part of why I crafted these journals in the way that I have.

After the boat brought us back under starlight, the gang was not finished, and we continued passing around the boxed wine at the dock, before moving on to the sailboat that was anchored just outside the base. We shared beautiful conversation about so many things. The people I got the chance to work with here are some that I will never forget. In some of my toughest moments, professionally and personally, they were the ones that saw me through. A confidence was fostered in me because of their faith that burns so bright it can never go out, and for that I am tremendously thankful. They made me understand what my capacity and limitations truly are, they taught a different perspective about life, about the fauna, about cooking, and about Panama. Many of you will notice that I have not enclosed pictures of any of them in this blog, and that is by design. I fear that putting a face onto the names of Chrystian, Jack, Nicole, Anselmo, Marlon, Sam, Kelly, Alexi and the rest would only make them human. I want them to remain mythical; faceless heroes that represent those things we can achieve with a little bit of mettle and some basic compassion. Someday, if someone reading this gets the pleasure of rotating through with Floating Doctors, they might get a chance to put a face onto the legends. For now they will remain unknown.

My final weekend was a joy in every sense. We made great food, and had the craic chatting nonsense all through to Sunday evening, with liquid courage sprinkled in to grease the wheels. That same Sunday evening, Alexi came by with a gift for me, a pair of Floating Doctors Captain’s shirts. I was flattered by the gift, and I told him I would wear them with immense pride. In return I gifted him my pair of neoprene water shoes. ‘These are very special to me Alexi’ I said to him with a laugh ‘I was wearing these when I met God’. He’d have more use for them here than I ever could in Ireland.

When Monday morning came around I was busy packing up all my things in preparation for my flight to Panama City. While the staff had their morning huddle on base I was running around putting hammocks back and emptying trash bins filled with cans of bug spray. I got a text that I was being summoned at the huddle, and so I went. The staff took a pause at the end of the meeting, and I got myself a little farewell speech, plus a few gifts. It was quite touching if I am honest.

I had a half an hour left to finish packing, and in typical Dr Bozo fashion I went to the final bell and wound up all stressed because I was running late. When I told the staff, who were busy packing medications and bags of rice, they all dropped what they were doing and walked me to the dock. We took a few photos and I gave a round of hugs to all those who wanted one, before turning to my OG partner Jack. He was the only one by my side through all eight clinics, a witness and crucial player to my ups and downs and metamorphosis from a bumbling caterpillar to a slightly less bumbling butterfly. One or two gasps sounded from the crew as I ceremoniously removed my hat, which had been essentially glued to my head all ten weeks due to the chitras, and placed it on his head before saying goodbye. As the boat pulled away I looked back and they were all still standing there, waving me off together like a mother and father at the airport—something that I knew all too well.

The boat cruised out of the bay, and a I saw a little skiff coming straight towards us. They heading straight on, almost as if we were going to collide. Neither boat changed their trajectory as they approached I saw why. There were three men in the boat, two workers and a pilot. The pilot was short and stocky, wearing a light blue poncho, which was gliding in the wind like a superhero. I saw the face of Anselmo, grinning with a smile that took up his entire face, pumping his fist up in the air with thumbs up. He was the first man who welcomed me onto his soil, my first friend. We locked eyes as the boats passed one another and he must have seen me light up. Nothing had to be said, and so instead I whispered something that only I could hear.

‘Nos vemos Capitan, I’ll see you later’