Miguel Tusa Lavieri, MS4, Weill Cornell Medical College
I gently shake Manuel from a deep slumber each morning, long before the first rays of sunlight peek through the hospital windows. I imagine his annoyance. “Why the hell did the medical profession collectively decide that disturbing our most primitive healing process - precious sleep - should be a central tenet of our practice?” Of course, he is not annoyed. He gives me a tired smile and dutifully answers each of my mundane questions.
I begin my exam, but there is an elephant among us in the crowded hospital room. We both know that an insidious cancer has taken up residence in his lung, but this does not need to be said. Perhaps it is out of fear that even allowing that word to linger in the air could be an invitation for it to continue on its destructive course. Perhaps it is out of sheer defiance of our misguided biology.
I perform the ritual of auscultation - first his heart, and then his lungs. My stethoscope is surely frigid against his warm skin, but he doesn’t move. As I lean beside Manuel, my hospital badge dangles before his eyes. He catches a glimpse of the faded sticker that partially hides the printed text, and his eyes light up as he recognizes our beautiful flag. Yellow for a country of riches, endowed with fertile soils. Blue for the Caribbean sea that embraces the maritime coast. Red for precious blood shed in Bolivar's hard-fought quest for independence, the price for seven shining stars.
“You are..?”
With his voice trailing off, I code switch to the warmth of an unmistakably Venezuelan vernacular. I responded with a smile, “Of course.”
“You don’t know how much pride I feel right now,” he says, reinvigorated.
“How old are you, if I may ask?”
“Twenty-five, sir.”
“Eres un carajito,” he chuckles. A crude, but well-intentioned colloquialism for children.
“You haven’t even lost your accent.”
“I hope I never will.”
I tell him a story that he already knows all too well. I tell him that I came to the United States as a young child, that my family left our beloved country to escape the repercussions of a society fragmented by the violence and greed of lawless government. I tell him that I have not returned to Venezuela in many years. Silence hangs in the air. We exchange tired glances because we both know what comes next.
“My grandfather — kidnapped,” I say, almost in a rehearsed fashion. I already know that he won’t be surprised.
I can perfectly recall my mother’s piercing scream as we received the news. I was tying my shoes before leaving for what was supposed to be a normal day of 7th grade. Luis Eduardo, “Lelo,” would go on to spend a total of 366 days under the captivity of the Colombian guerrilla. A man in his sixth decade of life was forcefully abducted and hidden away in an underground rain collection tank. One year and one day – stripped of all belongings except the wooden plank upon which he slept, and a bucket with which to relieve himself. Each morning, a small black coffee and arepa would be lowered into the dark prison, and each evening, two small bowls of rice and another black coffee would make the descent. During the rainy season, barrages of muddy rain water would flood the drainage system, leaving him to stand with the contents of the bucket at the level of his chest. A failed escape attempt earned him brutal punishment. The captors deprived Lelo of oxygen and forced him to breathe through a narrow garden hose for hours. “The key,” my grandfather likes to say, “was to protect my mind.” He counted his paces around the enclosure, sometimes reaching hundreds, maybe thousands of paces. When his mind tired, he would do push-ups on the damp floor of the suffocating cell until his arms would give out. At last, sleep would come in this hellhole without day and night.
I snap back to the present and Manuel nods in mutual understanding. Every Venezuelan person in their collective exile carries the burden of a similar story. I ask him about his own life. In return, Manuel tells me about his family, and about his travels as a public health professional across Latin America. He had recently stepped down from his role in the Venezuelan Red Cross to face his daunting cancer diagnosis, and was privileged enough to seek treatment in the U.S.
“You know, as proud as I am of everything you have accomplished — it saddens me that you were not able to find success in our own country.”
His words landed like a crushing weight upon my shoulders. He offered me a firm handshake and I excused myself, promising to return to see him later that day.
As I closed the curtain behind me, he sighed and said, matter-of-factly, “I will keep fighting this cancer. You know how we are, guerreros.”
“One day at a time,” I reassured him.
Warriors. Venezuelans know this sentiment well, inherent to the identity of a culture inevitably intertwined with strife. It is a word of encouragement from your mother when you fall off your bicycle and come home wailing about a bloody knee. Sé guerrero. In a way, it is a word of kinship between those who have endured scarcity, violence, and indignity. Be a warrior.
That night, I went home and ruminated over the day's events. I replayed the conversation over and over in my mind. I thought of children playing barefoot in the streets of barrios, their growing bodies nourished only by inadequate government rations. I thought about university and medical students protesting and marching down all of the country’s major avenues, their eyes simultaneously filled with hope and tear gas. I thought about the physicians stranded for hours in line to fill a tank of gasoline, in a country that sits upon one of the world’s largest reservoirs of petroleum. I thought of the irony of overcrowded and under-resourced hospital floors, while shipments of vaccines and medical supplies are confiscated by men in uniforms in the midst of a global pandemic. I thought of young children and families, jeopardizing their lives to trek across the treacherous Darién gap in hopes of a better life, any life. I was furious at Manuel, and that Venezuelan children did not have the same access to healthcare that he did. I thought of my grandfather, and his tireless will to live.
Medicine has a funny way of continually humbling those who are naïve enough to think that they will one day master it. It reminds us of who we are, and where we come from. In that moment, the bricks of my ivory tower crumbled to the earth and I allowed myself to sit with the weight of it all - the guilt, the pride, the brutal honesty of Manuel’s words.
He was right. What was different about me? What had I done to deserve this stupid white coat, an education, the opportunity for a life outside of the chaos? No difference, only privilege. There is nothing special about me, but indeed something exceptional about where we come from. Though Manuel’s resolve in the face of his dire prognosis was admirable, I knew that it was the only way that he knew how to be. He did not manifest rage about his cancer diagnosis or even his approaching death, in the same way that my grandfather somehow escaped his prison without a hatred of his captors. Their love of life overwhelmed their greatest fears, and the intense belief that life had more to offer gave them hope in their darkest moments. That is the way of the Venezuelan people. That is what governments and dictators will never take from us: our ability to laugh and create joy when there is none. Our gratitude for our imperfect country and the values it instilled in us. Our aspirations to make a difference in this inequitable world. That is what it means to be a guerrero.
We turn our gaze defiantly toward the future, hopeful that the world will be watching closely as Venezuela undertakes ‘free and fair’ elections in 2024.
References
Regional Inter-Agency Coordination Platform for Refugees and Migrants from Venezuela (R4V); 2023. Available at: https://www.r4v.info/en/document/rmna-2023-needs-analysis. Accessed October 24, 2023.
Daniels JP. Venezuelan migrants "struggling to survive" amid COVID-19. Lancet 2020;395(10229):1023. doi: 10.1016/s0140-6736(20)30718-2.
About the Author: Miguel Tusa Lavieri is a medical student at Weill Cornell Medical College from Maracay, Venezuela.
About the Work: More than 7.7 million Venezuelans are currently displaced around the world. We, the Venezuelan people ‘in exile’ are your physicians, patients, and fellow humans. It is my hope that this account, written in the midst of the global COVID-19 pandemic and marked civil unrest in Venezuela, will encourage its reader to reflect on the privilege of the patient-physician relationship, celebrate the resilience of our patients, and increase the visibility of the ongoing humanitarian crisis in Venezuela.
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