People I meet: Enrique


People I meet: Enrique.

This is a series of articles about the people I meet year in and year out. I travel—on average—twenty times a year and the most valuable thing I take, over the miles, the layovers, crappy hotels, faulty A/C and stale cookies, is the people.

 

I met Enrique in the U.S. in 2011 when I visited San Diego for training. He was a thick man with a bushy moustache, eyeglasses and gray hair.  We instantly clicked as both us used sense of humor to cope with everyday life. The thing was, his everyday life was completely different from mine.

It was after meeting him that my perception of the medical industry changed.

Enrique had been working for IC Medical for fifteen years already. When the recession hit in 2008, IC Medical had to cut costs and it meant milking the living crap out of every single one of IC Medical’s tech minions, Enrique included. The manufacturing shifts—in which he was included—went from the normal 9 hours to a 13-hour permanent overtime shift. But the salaries didn’t proportionally. IC Medical claimed a lack of income as the sole reason.

Granted, it was a problem that hit all of the U.S. and the world.  But, if it only had been that their lives were the same, with just a bit more work then there’d be no problem. But Enrique’s wasn’t.

His wife had suffered an accident, displacing three vertebrae on her back and, ironically, needed the equipment IC Medical sold to fix her condition.

Given that healthcare in the U.S. doesn’t use a socialist basis, Enrique could only afford certain hospitals. Hospitals, by the way, which were not willing to use IC Medical’s products to cure her, because the hospitals were “married” with other companies. Enrique was left with an alternative: either dig and burrow through his house for more money or turn to his employer for support.

So he turned to IC Medical. If his own company could pay for a hospital that did use the products, then his wife would make it. IC Medical didn’t even flinch. At the moment, providing the products for free was out of the question. I’m talking about two or three consumables and one machine: a cost of about 1000$.

So, as he told me this, whispering of course, I started thinking about all that I’ve done throughout the years. I’ve sold to doctors just because they want something cheaper, I’ve sold to doctors just because the brands I distribute are prestigious and I’ve sold to doctors just because their employers bought our brands. And in all three cases, I’ve wondered if they’d even flinch when I ask them for help.

Just like IC Medical with one of its own employees. A veteran nonetheless.

I kept in touch with Enrique after the training. I send him emails every once in a while and the most recent email I got was that his wife is now permanently disabled. IC Medical offered to pay for a percentage of the insurance required to have her home all day. But nothing else. Enrique is still being milked for every last drop of effort he can get. And I still sell IC Medical.

Why? Because I have to. Because Enrique has to. Or else, we f***ed.

Awake


A shadow walks by.

Staring at a window, at myself.

I breathe deep. Everything goes dark.

I open my eyes. I force them open. I know they’re open. But there’s only darkness.

I scream. But it muffles me. I move. But it pins me.

I want to cry. I can’t.

I see myself as I walk away, staring at a window then staring at myself.

I feel the pain, the saw, the scraping, the blood dripping down.

I want to cry. I can’t.

I want to go back to sleep.

About 17% of patients awake during surgery. Some are lucky enough to open their eyes, thus alerting the staff. Some can’t open their eyes. People have referred to the sensation as being “sleeplocked”.

Sleeping beauty:


Hospitals will drain your energy away.

If it’s not the surrounding death, nor the bleach-meets-blood-and-body-odors stench, it’s the pace, the stress and the diet consisting of mainly vending machines and soda, lots and lots of soda.

Keeping the engine running in this environment is nothing short of difficult, almost miraculous. It sounds as though I’m exaggerating but I’m not. Just last week I meet a forty-year-old orthopedist who arrived at our company to show his gratitude towards the owner and the great German stents we sell.

An orthopedist thanking us for stents? That’s as weird as a computer engineer thanking BMW for great brakes.

There was only one reason: even at forty, stents can be necessary.

Stents are tiny meshes introduced into fluid conducts (the urethra, veins or arteries) to expand them and allow for stronger flow. They can fix irregular flow to the kidneys, urinary insufficiency, even the esophagus!

But this case called for coronary stents. That’s right! Such was the wear and tear on his body, the stress, the diet, the oblivious cholesterol piling up, the lack of sleep after hours on end working and the irregular physical activity, that he ended up with a triple stent insertion.

At forty? That just doesn’t sound right.

So, it is best to make do with what one’s got. Take this example: about two months ago I met a doctor, probably about fifty, that was as fit as a tiger. How did he do it? Pretty simple.

With four things:

– Never use the elevator. Stairs are your friend.

– If it’s wrapped, then it’s not good for you.

– Dunk yourself in a pot of imaginary oil, so that all worries slip away.

But there was one thing he didn’t tell me. I came to find it out later. He sleeps and sleeps regularly.

And then it hit me: we are told that driving while tired is just as dangerous as driving drunk. Doctors spend over thirty hours straight working, between watches and shifts and emergencies and such. Isn’t being a doctor while tired just as dangerous?

I understand doctors and healthcare professionals are valuable. But our lives also are.

I’d rather be a hammer


…Than a nail. That’s how the song goes.

It was 3:30 in the afternoon and I was on my way to the biggest hospital in my country. I must admit, I was foolishly–naively–thinking I’d be out of there by 5:00 to carry on with the research for my upcoming book. Never celebrate early, it just won’t work, that’s what my dad says. My coworker was waiting for me in the lobby and we walked into the operating room with motivation and determination.

I’ve never been able to explain it but I’ll try: I really don’t feel I’m crossing a barrier when I enter an operating hall. I mean that’s the so-called “most sterile” part of a hospital, right? And still, I just walked in, changed my clothes and stepped into the “clean area” looking like an oversized leprechaun with a hairnet and gloves. There wasn’t any control, any restrictions and it doesn’t make me feel right. All I could feel was the air getting colder, life being drained out and all emotion being put to the side.

It’s a long hallway—white tiles on the floor so that blood stands out, glass all around giving the place no sense of security, no sense of shelter, silence all around so machines can warn of any upcoming death—and operating rooms to the left and to the right. There’s no way to avoid them.

There it was, resting against the wall like a passenger waiting for the subway, our target: the cursed operating table. For about two years now we’ve been struggling with this table and its record isn’t exactly pristine. Five patients have died (no blame on the table), it gets jammed in the mornings and won’t hold its position in the afternoons and moves with free will. Doctors hate it and it’s not my best friend either.

We just looked at it, I like to do that before actually opening it up. Sometimes, with the simplest gaze, one can find out the most complex of problems. This time though, it wasn’t the case. We had had a report of nuances including a jammed elevator, a stuck brake on the wheels and a wobbly leg supporter and we decided to attack the “easiest problem”: the stuck brake.

Thirty minutes passed. The air got colder, my head actually hurt—a piercing pain shooting from the back of my head to the front—and I cursed not having lunch.

That damned brake would release. I was pretty sure that, if I could just get one more inch, just one, of visibility I could sneak in a screwdriver and release the spring. But the brakes are covered by a stainless steel shroud and I had two choices: either rest my head on an operating room floor or lift a machine that weighed up four hundred pounds—and do that with a bad back. I resisted both. I did everything: I used my cellphone camera to get an idea of the issue but nothing; I tried feeling the problem but couldn’t get anything but gunk and dirt.

I exhaled in frustration while my partner told me he wanted to give it a go.

Forty minutes had passed. My headache was now unbearable. The research for my book (consisting of an interview to an amputee) was now becoming a farfetched reality. My body demanded fuel. And that damned brake would not move.

My partner leaned back, literally sat down on the floor and exhaled, copying my gesture.

Fifty minutes had passed. The ten minutes we had conversed about possible solutions had been useless. No solution seemed worthy of a try. There just wasn’t any area.

Sixty minutes. The patient in the operating room next door had just been sedated. In about two hours his leg will be completely sawed off. My partner came up with a solution that required great effort. We had to life the table and put a support below and that way we would have precious inches to work with. He chose to lift it. I chose not to oppose him. We both inhaled, he braced for a comfortable position and humph-ed the chair into the air—or just two inches—I quickly slid the support just when he pulled his fingers free. One more second and they would’ve been chopped off. Success, we had lifted it.

I took a look at the brake. The spring was jammed and I thought: “if I get my screwdriver there and undo the whole system, I can clean the gunk, blood and protein, then rebuild the system and test it.” But the access was small, a gap of two inches maximum. I’d had to rest my head on the floor and, though it had been cleaned, hospital clean isn’t really clean at all. And so, I leaned my head as much as I could, my neck stiffened as it struggled to keep me from the vile invisible demons that lurk in the deceiving white tiles. I would feel them crawling towards me, wanting to stick to my skin and then seep slowly through my pores: flu, leptospirosis, MRSA, you name it and it was there. Suddenly I stopped breathing as if that would help. Then I hissed. I was wearing a mask.

A working surface at the hospital

Hospital “clean”

I fought to get that sharp edge inside, it was just microns away, I could feel the screw and I swore it had actually turned but my hand trembled, my fingers cramped, the position was just too uncomfortable. Dammit, I had to give up.

I rested on my knees and looked at my partner with surrendered eyes.

In him I saw the opposite: in a surge of determination he disappeared. Seconds later he was back: in his hands were a can of WD40 and a hammer. He gently shoved me out of the way, then emptied half of the WD40 on the brake. After inhaling the “enlightening” fumes, he aimed at the brake. It was literally make or break: if he missed, the dent on the table would be impossible to hide.

He swung the hammer and put every drop of strength into it. I could see the forearm flex, his veins pop out and his eyes shrug with effort. The bang was so loud the doctors on the other operating room actually peeked to see if something had happened. Silence followed.

For seconds.

Pop! The brake unjammed.

A hammer and WD40 can be the best tools in the world.

We left at 5:45 pm.

Price of Life


I can’t explain it—trying to find the right words is just boring sometimes—but during flights, I think the most. The engines create sort a vacuum in my ears as if they want to deafen me from reality, the cramped seating forces me within my own boundaries and no one else’s. That stillness of the horizon is daunting, even if we are flying at a blazing speed, nothing seems to happen as though the rest of the world has stopped, until we land. Then we realize the world hasn’t stopped; if anything, the world turns faster the very instant we forget about it. Nonetheless, flights are moments in which I ponder.  

 

Day in and day out we are told that life is valuable. We are told every single breath is cherished and we should live each moment like if it were our last and-if we think about it—it’s fine to believe just that. But what if someone told us that we have to pay for life? That every breath is a quarter, a dime, or a dollar? It sounds unfair, right?

 

Well, it is unfair but it’s also true. At any moment in life, especially when you have been to the doctor, you have paid for life. Be it the comfort of knowing there’s nothing wrong with you or being told the worst news of your life, you’ve paid for life or the lack there of.

 

I’ve just left a tropical paradise, where the major distributors of a said brand—which we’ll call Pacifair—were called to promote the growth of entire Pacifair line. Amidst white-sand beaches, crystal clear waters and the two most dangerous words—open bar—, we are told that we are the fuel that moves the Pacifair engine. The product Vice-president even flew all the way from New York to be with us.

 

And that’s great! There’s nothing better than knowing that the company actually supports and believes in us. That’s not the chip on my shoulder.

 

We are given the schedule, the bracelet indicating we are over 21 is placed on our wrists and then we are told: “you’re free to do whatever you want, just as long as you make it to the different conferences.” Everyone nods and flies off to the sand, the pool, the ocean and the bar.

 

Everything is going great at this moment. So great in fact that no one wants to actually go the conference rooms when it’s time to do so—I understand it, though. Can you imagine someone from Pennsylvania in this tropical oasis? Of course they want to enjoy every minute they can.

 

Alas, it’s time to learn, it’s time to see why it is that Pacifair is important.

 

The instructors usually all begin the same way: with the principle or theory behind the product. In this line of work, most products come from doctors who look for ways to improve their methods. It is very probable that the improvement comes because:

a) Someone died,

b) The machine is too cumbersome or slow or

c) The previous method is considered risky and no one wants a death on the résumé.

 

Now, that’s not to say people don’t want to innovate, they do, but most of the time, innovation comes from mistakes. Mistakes in this medical world are costly. 

 

A bit of history is provided about the mind behind the invention. What really happens is this: The doctor designs a system and looks for a manufacturer to help him create said device. The manufacturer is either interested or not and if they are, they invest a heap of money and science minions to develop the product with a tiny detail that’s patented by them and boom! The price tag on whichever unit they sell is sent skywards.

 

Many companies, just like Pacifair, are always in the lookout for this (to the point in which they have hired doctors as consultants) and why not? He or she is a talented healthcare professional whose opinion is praised (companies don’t go after just any quack), looking to develop a machine that will either save money, time or both. Oh! And human lives as well but that’s secondary.

 

A machine that sells high, saves time, money and lives? Bingo.

 

Just as long as there are patients to use these products on, which is why conditions that are individualized and random usually don’t call for development of technology. It’s just too expensive for one person.

 

After the history, comes the theory. This is usually my favorite part because I’m interested in how things work. Being an engineer, there’s always a part of me questioning everything: if it fails, what happens? If it slows down or speeds up, then what? If I make a mistake, will it kill the patient? I ask these questions with a scientific point of view. Others ask them as well but with a commercial point of view. If something happens to the patient, the patient might die. That’s another life lost and probably a lawsuit. Money, once again.

 

The theory of operation is brief when I believe it should be the most extensive. Anyone related to the machine must understand it. If not, how would they explain it to the potential customer? Coincidentally, the theory part is usually the shortest as sales reps usually don’t care about it. They care about making bucks.

 

The slides are read in just minutes and the topic shifts to the commercial aspect. Who do I sell to? Who do I talk to so that I can convince them to buy this product? If the doctor is not the big boss, then must I talk to the twenty-three-year veteran nurse? Well, yeah, you should. You should also take some donuts and coffee while doing so. We all should if we want to make a sale.

 

In this section, all the possibilities of a sale are highlighted point by point, and the reps get all excited. They start imagining themselves talking to different doctors, convincing them of the greatness of this product, how it will save lives with a better infection control, lower operation times, improve scarring conditions and so forth. All great but perhaps all too equally great.

 

Finally—and this is usually the most entertaining part for me, as a viewer, not as a rep—the competition is explained or should I say dissected like a lab frog?

 

Why is this my favorite part? Because it shows how cutthroat everyone is willing to be for that extra sale. Pacifair’s competitors could only wish they knew the amount of units have been purchased by spy doctors just to be handed to the hands of Pacifair’s eager engineering minions to dismantle, test and review. Then all the flaws, like an ex-girlfriend being analyzed by a mother-in-law, are highlighted to us, the reps, so we can kick the competition in the shin.

 

Within the competition analysis, all points of attack are valid but patient safety is usually the most frequently scrutinized: all data regarding lawsuits, incident reports, deaths, injuries and all those sour events are sought after like gold. There’s even a website!

 

Using scare tactics is very delicate as with anything in this line of business. Once, a sales rep from another company told the doctor that the competitor’s product was harmful and his was better. The patient ended up dead because of poor instruction by the sales rep. 

 

The patient, however, is not really that important. It’s only his or her safety. Just look at this: if the patient has a better survival rate with Pacifair’s artificial heart and this product is more expensive, the price is justified, right? If Pacifair’s bionic kidneys are ideal because they never get damaged and all patients with them have survived AND they are cheaper than Mikotanabe’s brand, then it’s a win-win situation. Patients become numbers, numbers translate to money and money is what everyone is after.

 

So, as the conferences end, everyone’s excited. Reps are excited because they know their products can be easily sold with evidence. Money can be made. The company is excited to see the sales force excited. Money will come to them. Engineers are excited because more machines mean more work, which means more service fees. And everyone is excited because the beach is just yards away. So is the bar.

 

And, as the sun sets on the tropics, I board my plane knowing that in about one or two years, I’ll be returning here to get another boost of motivation to keep selling. I’ll probably see different faces, perhaps I won’t, but I know everyone will always look for one thing: to make money out of two things, life or the lack thereof.

 

 

**NOTE**

 

I understand that, as we are raised in a capitalist point of view, everything has a price. Everything included our health: if we want it faster, we pay more. Still, in Costa Rica, that will not necessarily mean better.

Little lumps


Little lumps all around. They are connected to machines, heartless machines that are the only source of life. With a beep comes a heartbeat, with a pump comes a breath. They look around but find no one. Little lumps all around.

It’s cold, it’s white, it’s gray. There’s nothing else to it but that.

Little lumps all around. Their black eyes filled with innocence stare at me quietly, expecting me to do something. If only I could pry those cables off, take them home and give the childhood they deserve.

Little lumps all around and they don’t deserve to be here. One cries, another one gets startled and for one second, does absolutely nothing. Then he remembers he is scared. Does he remember his mother is not around, his father is probably a worthless rapist and the humans around him won’t look at him with a kind gaze? They will make sure he survives and is sent off to a troubled life. He starts to cry. They all start to cry. I smile inside. They’re still alive.

Little lumps all around. Pale, scared, lonely.

God, I hate visiting the children’s hospital.

Biomed’s rule number 1.