Location: El Dorado Airport, Bogotá

Hot diggity dang we’re here. I’m doing it. 

I’m going back like I always knew I would. It was inescapable. I knew fairly early on during my last stint here that my destiny would keep me linked with Bocas del Toro for a lifetime, and it was as I stood on the decks waving goodbye to everyone that I promised to try and come back sooner instead of later. I never really doubted that I would, and it’s so damn surreal that it almost hasn’t even set in.

I remember for the first year in Philadelphia I’d lay in my bed at night just salivating at the chance of laying in a hammock instead, with the sound of roosters, waves, or rain to lull me to sleep. I’ve been itching for this moment for a long time. I might even go so far as to say that I miss the chitras.

I probably wouldn’t go that far though.

So many things have changed in my life and at the same time almost nothing at all. I live in America now. I am a real doctor and have cut my teeth over the last 18 months in intensive care units and hospital wards equipped to the highest international standard. I am a far more confident physician and now I’d even consider myself a decent teacher. I have grown a lot. By the same token however, I feel the same as ever. I am still as fresh, emerging (thankfully) relatively well preserved out the back end of the hellish intern year. I am still firmly committed to my career and my craft, and if only my aspirations have grown equal parts deeper and more refined. In my personal life, in that way that only the passage of time can show you, my relationships have developed for better or worse. One by one the guys I grew up with are starting to get married, I have gained a slew of new friends in America, and others that I once considered part of my inner circle have left for complicated reasons. This is life. I even picked up a girlfriend throughout all that. Things fell apart with her in a little bit less than a year, and in reality it was only a matter of time before they did – she didn’t like the jungle.

Despite how good Philly has been to me, I feel in my heart this is not where my destiny lies. Medicine residents live such isolated lives by virtue of their profession. My social circle is made up of only people in healthcare. My hobbies have thinned significantly from what they once were; after all there’s only so much time in the day to balance all these things. I get so caught up in my day to day that it’s hard to take a step back and see the big picture sometimes of where my life is going. I am fortunate enough to have nothing tying me down, and whichever way the currents take me is good enough. I just need to check in every now and then and make sure I am on the right boat. For now, I am happy to be on the boat chartered to Bocas. From everything I have been told, things look a whole lot different now than my first foray. We have enough volunteers to fill the bunkhouse, and a full team of doctors – imagine that!

There’s a few things that I look forward to doing differently this time. Namely, I have better footwear and a more expensive rain jacket. As I reflect on what my true objectives are while I am back, I find myself struggling to grasp onto any single thing. The medicine of course, although I honestly feel like I know it quite well already. If anything, I hope to see what Floating Doctors (FD) looks like at full strength, and more than anything I look forward to walking barefoot in the dirt and reconnecting with my mission. I will do my best to revive the blog although I fear that it will be much harder to pull myself away to write with more action on base. You can bet there will be some more boxed wine as well with some familiar faces. 

Arrancamos. Here we go!

The flight in, alongside with arrival to Bocas was littered with nostalgia. The damp heat of Panama City, the smell of salt that lingered outside the airfield in Bocas, it all gave me a tingle somewhere deep in my loins. Pretty quickly though I realised that quite a few things had changed.

For starters, the dock where I was told to meet the team was a new place entirely from where we met up previously. It was only after walking to our original meeting point behind a laundromat in town, that I found the whole area fenced away with a big gate at the front. I doubled back and read again through the generic introductory email more carefully to realise the change. Arriving at the dock I asked around and was directed to a table of unfamiliar faces.

‘You’re here for Floating Doctors?’ a blonde lady said to me. ‘Welcome!’

I shook a few hands and exchanged pleasantries. Turns out I was talking to several staff members, part of a different branch of FD that was completely novel to me: the veterinary group. I also knew I was showing up several hours early for the pickup to base, and this group was actually heading back to base before sending out a different boat to pick up the new volunteers, myself included. 

When the pickup crew finally arrived I was happy to see a familiar face, as Cristobal, one of the Ngabe villagers who helped us out with several clinics, was now working full time with us. We shook hands like old friends, and then I met one of the other staff members, Fermin. He was actually a friend of my family in Argentina. My cousin had put us in touch shortly after I had my first stint in Bocas, and since that conversation he had gone on to spend a full year with FD and signed on to be the Medical Director for the next few years. Life is funny that way isn’t it? He got me up to speed relatively quickly. I also met three other new volunteers, two medical students from New Zealand and an undergraduate from California. Arriving on base I found Anselmo, the aging native head of security who came to be my ever present confidante last time around, and Jack, our clinic manager, equal parts flamboyant and fit who put cacao on everything, were practically unchanged, exactly how I thought they might be. There had been some turnover with regards to managers and captains from my first visit, although I was told most of them could still be found in new endeavours around Bocas. I hoped and looked forward to crossing paths with all of them.

I expected that things would be quite different this time around, and they were. It was an odd feeling, same but different. For reasons that I am still not quite sure, it felt slightly incongruent, almost like I lamented that this place didn’t feel exactly as it did when I came here the first time around; it was almost like coming home to find your parents had reorganised your room without telling you.

The most notable difference was the number of medical staff. There were now four full time ‘lead medical providers’, a licensed physiotherapist, and three veterinarians. There was even another physician who acted as Director of Community Education instead of working clinically. The medical staff outnumbered the non-physician volunteers. This made me now just one more doctor amongst many, and in some way my role felt relegated as soon as I arrived. This was evident on day one, where I sat through orientation presentations for the second time and spent the afternoon with the students doing manual chart transfers. Gone were the days of me being the only gig in town to make my own decisions. This was definitely a big upgrade for the populations being served, but I also wondered if the new hierarchy would make decision-making in the field more convoluted. There was even a clinic dress code which prohibited me from wearing my previous get up of nice shorts and an accompanied polo shirt, which I begrudgingly accepted. To make my trivial inconveniences even worse, I even found myself relegated on arrival to sleep in the bunkhouse inland instead of the staff casitas on the water. How I longed to sleep in that scrumptious little ocean shack again… Bah humbug.

The chitras, while still the ever-present menaces that they were, didn’t give me as much trouble this time around. A good part of that is certainly attributable to my own hyper-cognizance of their presence and appropriate clothing when they picked up steam at high tide. I also think there were far more delicious individuals to dine from. 

I was happy to be back. This time better prepared. I even brought a fully submersible dry backpack and my own headlamp. Things would start off light, with a week of three single day clinics in the nearby villages of Sharkhole, Valle Escondido, and Cerro Brujo. I only hoped I could be what I wanted to be for them, a good doctor.

For real this time.