We descend the stairs of our chartered bus into a muddy pit spotted with hairy baby pigs.  I carry the portable ultrasound, a bag of chux, and the two pieces of plywood that serve as our stirrups, carefully shimmying through the crowd of women gathered around the door.  Most are from the small Guatemalan town we’ve called home for the last week, but several have trekked in on foot from their farms tucked away in the neighboring hills.  We watch the earthy lumps from the bus and play a game – Hill or Buried Mayan Pyramid? The women I’m trying not to accidentally smack with the makeshift stirrups probably know.  Time spent indulging in archaeological discussions is time better spent seeing another patient.

Like a horny teenage boy I have to talk the women out of their clothes.  “Everything?” she asks. “Everything,” I respond.  She strips down, leaving only los bloomers.  “Those too,” She looks at me with skepticism. “I know it seems odd, but there’s no way to do an exam with those on.”  Many of the women have never had a pelvic exam, especially the younger women.  Their first will be with a white foreigner in a strange green pajama suit and her Spanish-speaking sidekick: me.

I translate directly the first day, turning the doctor’s English words straight into Spanish.  By the time we’re 50 patients in (day 2), we’ve established a routine. “Give her the talk,” the doctor says, and I begin to explain fibroids (benign tumors of the uterus), or how to protect against kidney infections, or that after having 12 children the pelvic organs often begin to descend, even prolapsing out through the vagina (seriously). These are talks I hear her give every workday in the States to American women with the exact same problems.  Here, however, we are not armed with a gynecological artillery of birth control pills and pessaries (a device used to hold up pelvic organ prolapse).  Our small pharmacy keeps only the necessities.  In some cases, the most we can do is reassure that what they’re feeling or seeing or sensing is normal.  Until it’s not.

She’s been bleeding for months.  She knows.  The minute she pulls up her emerald hand-embroidered skirts and the exam begins, I see the doctor’s eyes widen, not in confusion, but in sadness.  The doctor asks me to meet her outside of the “room,” which is actually several plastic drapes duct-taped together and slung over a clothesline.  I step out.  She follows.  “This is invasive cervical cancer,” she says, “and she will probably die not long from now.”  Then I realize why we’ve stepped out of the breezy blue kludged-together exam room.  “You’re going to have to tell her,” she says, knowing full well that I, a recent convert to the medical profession, have never told anyone this before.  Now my eyes widen. I breathe deeply, wondering if I will cry, or if she, the patient, will cry, or if we both will cry.  Neither of us does.  She already knows.

I present her options to her – radical hysterectomy at the national cancer center, which requires a long and expensive trip to Guatemala City.  It probably will not save her.  She can’t hear me though.  I’ve seen the glass-eyed look before. Everything sounds like you’re underwater and the picture starts to blur.  So I stop.  I walk her out of the cinderblock schoolroom to the desk a few doors down where her care, or lack thereof, will be coordinated.  I ask bleakly if I can find any of her relatives to come sit with her.  She shakes her head no.  I want to hug her so badly, to tell her it will be ok, but I can’t, and it won’t.  So I return to the little room we call clinic.  We see another patient, and another, yet the line never seems to dwindle.