It's always an indelible experience for me as I watch some fellow physicians defend their actions, while others quickly admit to their mistakes or judgment lapses. No matter the circumstances, though, none of us ever want to hear the term "preventable death."
When that happens, it's an admission of failure and a breakdown of our entire medical system. In all my years of attending these meetings, I've only heard the term on a few rare occasions. Each time, it's caused the room to go stone silent.
Yet in Puerto Rico I have heard the term several times a day, every day, as local doctors, mayors and citizens worry that many of the most vulnerable citizens are at risk, mostly due to a failure of a timely, coordinated response by the authorities, both federal and territorial.
For want of insulin, blood pressure medications and antibiotics, things widely available at any neighborhood pharmacy in the US mainland, people in Puerto Rico will die -- are dying -- preventable deaths.
Puerto Rico was not a healthy island before the hurricanes devastated its infrastructure and lines of communication. Diabetes is rampant, and residents are older and poorer than on the mainland. Add an economic recession and a shortage of medical specialists, and you have the perfect storm. There may be 10s of thousands of hardy people who survived the hurricane and are now struggling to stay alive in its aftermath. They are teetering on the edge, with hardly any reserve.
I don't think I will ever understand or accept meaningless suffering. As a doctor and a journalist who has worked in disaster zones for 15 years, it is one of the most frustrating things on which I report. As a human, it makes me question what we hold most important and dear.
A few days ago, 62-year-old Josefina Alvarez lay sweltering on a cot in a shelter not far from San Juan. It was suffocating in there. The humidity was so thick I could barely breathe. No food, and just a few bottles of water. I saw one filled with urine on a windowsill.
For 10 days before my visit, she had battled unstable blood sugars, progressively lower oxygenation to her lungs and an infection that now required IV antibiotics. She survived the hurricane but was now quickly deteriorating and at real risk of developing sepsis: an overwhelming body infection that could kill her. As I saw her laying on that cot full of tears, pleading for help, I found myself suddenly crying with her, physically hurting with her. And suddenly I could not help but imagine my own family -- my own mother, dignified and hardworking -- begging for a simple medication that could save her life.
You try it. Think of your own family in the horror of a situation like that. It will knock the wind out of you.
Luckily, we were able to help Josefina evacuate to a hospital, where she needed antibiotics and an operation to clear the infection that caused her to be so sick.
The very next day, I traveled to Barrio Melilla outside Loiza, again not far from San Juan, with a team of medical volunteers from Project Hope, an international non-governmental organization. There we found more of the hurricane's walking wounded.
People like Jobita Cumaquita, battling both cancer and diabetes, but more concerned with how her 22-year-old granddaughter, Estefani, will manage without her father. A couple of days before the storm hit, he went to the hospital for an elective visit to address his blood sugar. He had made similar visits many times before, Estefani said, and he had always come home healthy shortly after treatment. But in the immediate aftermath of Maria, when they went to check on him, they were shocked to discover that he had died days before.
In the chaos that has gripped Puerto Rico following the storm, the family has struggled to get details about the circumstances of his death -- a sadly common byproduct of everything the storm turned upside-down. But the routine nature of his visit has the family wondering: Was his death due to fallout from the storm? We may never know.
What we do know is there are thousands of Josefinas, Jobitas and Estefanis here in Puerto Rico. They are too bed-ridden to leave their homes, or lack gasoline, or the ability to communicate with the outside world. They are mourning the loss of a loved one, or at the very least lamenting the terrible damage to their homes, their livelihoods, their way of life.
These are the people we must help now, the people for whom we can make a huge difference as doctors, nurses, politicians, humans. We cannot take our attention off of what is happening here in Puerto Rico.
Know this. When you hear the death toll has increased from the current official number of 16, know that most every additional death need not have happened. They were preventable.