Is Never Too Late To Attend Medical School.

Life is full of Ironies. The more you wish for something, the more it eludes you or is out of your reach. It may seem like wishing, hoping, and dreaming are in vain. Reality, being the most ruthless of tyrants, seems to take pleasure in denying our desires. But life is merciful. Your wishes may come true—not on your schedule, but on life’s one.

I always recalled fondly a story narrated in his memory by one of our former presidents, J.B. Nostalgically; he described how when he was younger, in full use of his faculties as an intellectual and renaissance man, all he desired the most was to have time to read all those books that his political and professional career had denied him of the time to read. Then, in his late eighties, when he finally retired, his eye disease rendered him irremediably blind. He then had the time but no longer the ability to read. Reading with your finger is not a pleasant activity.

This is the story of a man called Raul Marcelo. A construction worker by trade. Since his childhood, being born in poverty, he had a strong desire to become a man of status and a learned man. Pain has that effect on people. It makes you dream. If you are paralyzed, you dream yourself sprinting.  Different professions appealed to him, as all things denied to us or out of reach. He wanted to be a physician. He felt very close to that noble profession because, with life being so difficult and, at times, painful, he always felt that these individuals dressed in white were like angels coming to people’s aid, alleviating their suffering.

He felt that his life was better for those hours or days of interactions with them, even as a kid. They gave him hope. He was mesmerized, drooling with admiration, by their authoritative manner and frown faces whenever they were deep in thought, trying to fix the patients’ damaged mechanisms. In his childhood dreams, he thought there was something majestic about these men and women in angelic uniforms. Later in life, reality taught him that becoming a doctor was beyond his reach, but that did not deter him from pursuing medical school.

Over the years, his desires grew stronger, but he was then mature enough to know that his dream was only a dream. “Life is a dream, and dreams are just dreams.”


It was midday on the island; the temperature reached the upper nineties. The sun is your enemy in the lands bathed by the Caribbean Sea. It battles you relentlessly. Your head gets hot. Your thoughts melt. Your body has no choice but to sweat constantly to keep you from burning. Your crotch is always salty and wet. Whether or not you had a calm temperamental disposition, riding in public transportation between the hours of 12 noon and 2 pm, crammed like sardines, would turn you into a grouch. In such proximity, your skin rubbing against the dirty guy next to you makes you develop a deep dislike for your fellow passengers. 

There was Frank, who was a student at the public university. He regularly took the bus to and from the University. Initially, he was not sure what he would finally study because, in High School, he felt a strong pull from the military. Later, his parents dissuaded him, and given his strong study habits, he decided to study Medicine.

Life at the public university, where most of the country’s students attended, was vibrant. At the time, there were over 80,000 students enrolled. Life was beautiful: new friends, joy-filled people, beautiful girls. Frank was gregarious by nature, a smooth talker, who, despite his outward appearance and temperament, had a well-hidden sadness that made him even more attractive to some girls. Their maternal instincts wanted to take care of him. He did not mind at all. Who can reject free sex? 


On the oriental part of the city, Raul worked long days laboring on a construction site. At the time of his story, in the late seventies-early eighties, Santo Domingo was experiencing a demographic explosion because life in the countryside was untenable. People were migrating in large numbers. The nation’s birth rate was also high. Most families had four children.

He started working in construction at an early age. After quitting high school, he joined the workforce. At first, he was a “Palero,” the guy who mixed the mortar. The work was plenty, and opportunities were in abundance. The need for young, physically fit guys was high.

In time, Raul went from “Palero” to “Pega blo”, meaning the individuals who lined up the cinder blocks, skillfully applying the mortar to build the walls; similar skills to masonry, but instead of bricklaying, it would be cinder blocks lining up. The typical set of cinder blocks used was the larger ones: 8 in x 8 in x 16 in, solid concrete. Very heavy.

Raul was a very responsible individual who paid close attention to details, which helped his trade. He became skilled at laying cinder block walls, but more importantly, he effectively communicated with his superiors on-site, the Engineer. At work, the site Engineer was the top dog, followed by the “Maestro” of construction, the foundations’ diggers, the wall affixers, the mortar mixers, and others.  

Raul was naturally agreeable, which made his ascent to Maestro a speedy one. By all accounts, he was a successful young man. But deep inside, his heart ached. He enjoyed construction but would have preferred to be a doctor for the poor. In his imagination, he saw no higher calling than alleviating the suffering of the poor.


The first day Frank set foot at the “Dr. Defillo School of Medicine”, as it was officially called, was like the experience of the devout in their pilgrimage to Santiago de Compostela. The faculty of medicine was like sacred grounds. In such a solemn temple, the students would learn to unlock the mysteries of the human body. Once they graduated, they would be like divine representatives of God on earth. Once fully qualified doctors, they would become arbiters of life and death.

In their first lecture, the professor said, “You are now medical students… the noblest of all professions,”. He then assumed a Pontificate’s air while explaining that in human society, the hierarchy is “first God, then Doctors.” Society gives you special responsibilities and rewards you with a place of honor.

Frank swallowed the pep talk in its entirety. It was like the gospel devoured by a guilt-ridden old lady. It was a necessary fantasy to be sold because it prepared the poor souls embarking on medical studies for the arduous, intellectually exhausting, frustrating endeavor of long years of fastidious studies, trials, and tribulations to be called “Doctor”. Contrary to other fields of study, the longer you study medicine, the harder it becomes, and the more you realize the inordinate number of things that you ignore. As your studies advance, the knowledge painstakingly learned in previous years starts to fade, making way for newer knowledge. Not in vain, Hippocrates said that one lifetime was insufficient to know medicine.


On the other hand, a construction site is like an orchestra. There is a Maestro, the master builder, coordinating the musicians: The ditch digger laying the foundation, the Varilleros, the guys in charge of laying the iron bars that would further secure the cinder blocks, the one laying the cinder blocks, the “Blocero”, and the mixer of the mortar, the Palero.

All these guys, rough individuals of thick skin and callous hands, dressed in soiled “wife-beaters”, battled daily the inclement sun. “Shut up!, don’t be a bit… the heat is all psychological”.

As in a standard symphony, the day starts in sonata-allegro form. The guys were still rested and full of energy. Then mid-morning, with the rise of the sun, a slow movement sets in, and after lunch and afternoon, the activities pick up again in a mid-tempo minuet and fast closing movements. It is an orchestration of fast-moving muscles, defying gravity and fatigue while building a space between the heat and the curses.

On occasion, they would pause the symphony to catwalk past some high school girls. “Cono mami y to’ eso e tuyo!” (Damn, girl, and you own all that!) or my favorite one: “Mami, si como caminas cocinas, guárdame el concon… pa’ rapatelo”. (Hard to translate, but means something like, “If you cook as good as you walk-move your hips-, save me a plate… to scrape your pot”).   Essentially, the offender wishes to discharge his pent-up testosterone on her big butt. 

They lived for their daily pay. There were no work contracts or Workers’ compensation. You worked your day and got paid before departure. They would bring the money to their wives, for the most part, but they felt entitled to their weekends, which included visits to the houses of pleasure.

Raul had no wife or family. He considered himself not the marrying type. He preferred the company of a different girl every weekend. The bigger their butts, the more appealing they were to him. I heard him one time say that he preferred them big because he had a big piece and feared that it might hurt a girl with a small butt. Other guys bet to differ. The rumor behind his back was that he was not really into girls. But he preferred sweaty black stallions.

Typically, the life of a construction worker involves little time for reflection. By the end of the workday, it was all about taking care of scrapes and bruises, sometimes chatting with the neighbors, and going back home with the wife and kids. He, Raul, was a different breed. He had the innate capacity for self-reflection and analysis. Nature had granted him a keen intellect as a curse or by grace. But society brutally placed him at a station where his innate talents would die a low, grinding death. At work, it was easy to see and display his visuospatial abilities. He read blueprints quickly and comprehended engineers’ and architects’ sketches and ideas without significant difficulty. His future was secured.

This new project was particularly stressful. They were on a time crunch. At the time, he was in his mid-thirties and had been Maestro for some time. The project involved rebuilding the neighborhood’s Catholic church. After the pedophile Spanish priest presiding over the parish was transferred to molest children somewhere else, the Diocese decided to enlarge St. Marcos Church and modernize its school. I guess they needed a larger space to indoctrinate more children in their opium-laden fairy tales. 

Raul had a clear idea of what had to be done. It was a large building with only two levels, but very wide and deep. It required more laborers, and by then, the Dominican men were not very enthusiastic about working in construction or sugarcane fields. The young men of the lower class were more interested in going to New York City or Miami to work in the drug trade. Thus, many Haitians began appearing at work sites. They worked well and handled the sun and heat better than the Dominicans, with fewer complaints. They just had weird habits, such as eating smoked fish, “Arenque” was called, for lunch. The Dominicans preferred eating at the corner dive—a hole-in-the-wall—with a big plate of rice, beans, and meat, accompanied by avocado or bananas.

One day in August, with the heat driving everyone crazy, Raul started having problems with one of the mortar-mixer Haitians. He already suspected that someone was stealing bags of cement because they were running out so quickly. He was already in a bad mood. He was also getting grief from the site engineer—”the boss”—when this one—a short guy with a bad attitude—noticed that one of the Haitian Paleros was mixing mortar with too little cement, which would put the prospective users of the building at risk. Raul had to confront the cement-mixing guy, but the Haitian did not understand what Raul said and caught an attitude, “Mila Mesie, yo ne te compla pa”, said the Haitian in a crude mix of Creole and Spanish.

The Haitian worker was a recent migrant, a poorly socialized, young punk, who ignored the hierarchy of a construction site. One does not become a Maestro without knowing how to impose one’s will on the workers, by fists if necessary. Construction workers are not known for their diplomatic skills or for their ability to resolve conflicts peacefully. The young Haitian punk got cocky, pumping his chest and raising his voice. By then, all the work had stopped; the symphony stalled. All of them knew that this was not going to end well. Raul blurted out, irate, “Oye cono, tu maldita madre!” (Listen, mother fucker!). He barely finished when the Haitian threw the first blow.

There is no need to explain that these guys had a collective BMI of probably 10. They were ripped, except for the occasional beer-belly older guys. The Haitian was a muscular young man in his early twenties with broad shoulders and big biceps. He was larger. Raul was on the smaller side but slender — close to 1.75 meters — and cut, in tip-top shape; what he lacked in volume, he made up for in agility and guts. The Haitian mistook Raul’s size and thought he could take him down easily—big mistake.

The Haitian’s first blow did not land. Raul was reflexively on guard. Being brought up in the hood, street fighting was a daily routine. He counter-attacked the Haitian with a couple of jabs and body shots. The Haitian was not a boxer but a street fighter. He launched himself swiftly and grabbed Raul by his waistline. They both fell to the ground. They started fighting like monkeys, throwing crazy punches, but Raul promptly ended up on the bottom, the Haitian saddled by Raul’s waist. Raul was in a precarious position, but he knew from all his previous street fights that the key to winning street combat was not so much brute force, but keeping your nerves controlled and your mind clear, while doing your job and protecting your jaw. The Haitian managed to land a couple of blows to Raul’s head. Finally, Raul managed to wiggle his way out of the bottom position and quickly regained his ground. The Haitian appeared possessed by the devil or some Voodoo work.

The site turned into a fighting arena. The Dominican guys were yelling at the top of their lungs, “Dale Cono, pa que repete!” –”Beat the crap out of him to teach him respect!”-. The other Haitian workers were itching to intervene but feared the Dominicans’ rage and malevolence. This Dominican crew was composed of migrants from the countryside and the north of the island, “El Cibao”. Notoriously hot-tempered and aggressive people, these guys settled their affairs with machetes and knives. The “Cibaenos” have murderous impulses that are very poorly controlled. The Haitians knew it. They resorted to backing their fighter “Frappe l, frape l, byen fo!”. -Hit him, hit him hard!-. Everyone was drenched in sweat. It was around 1:30 pm. The sun was blasting. Not the best time for a fistfight.

Motivated by his compatriots, once Raul wiggled free of the Haitian’s grip, he started working the Haitian’s body. This last one kept trying to repeat the same move that landed Raul on the ground. It had the opposite effect. Raul pummeled his head like a piñata each time he tried getting close to him. The punishment of the Haitians was now shown in red. The repeated hooks and uppercuts opened a couple of cuts on the Haitian’s face. He was bleeding profusely.

The Dominican guys were elated, “Coje ahi, Maricon!” -There you have it, Faggot!-. They yelled.

The Haitian was a street guy. He knew that he was a few minutes away from a devastating knockout and went native on Raul. In the middle of the last barrage of punches, he grabbed a piece of board on the ground. A construction site is the worst place for a fight. 


Frank’s life at the public university, the “Universidad Autonoma de Santo Domingo,” as it was called, was exhilarating but not without risk. The university, as a microcosm of the country, was going through the nation’s travails. Strikes were common. Fights between students and the police became the stuff of legend. More than a few of Frank’s friends gloated about their confrontations with the police and the destruction of property. The university’s classrooms were often closed for several weeks due to violent disturbances.

Inflation was the most common denomination of all fights. The moment there was an increase in the gas price and bus fare, one could predict with mathematical precision that strikes were coming. It was a known process: the political activist “students” would gather large rocks, empty bottles, and discarded tires, then go from classroom to classroom, chaining the doors. Class dismissed. These were not organic strikes by the student union. The country’s communist parties, socialists, and all enemies of the government would quickly hijack the protest with their agendas. That’s what made these confrontations so vicious.

At the same time, it was almost comical seeing the “students” lined up on one side of the street and the anti-riot police, “lo caco negro”, on the other side, as they taunted each other. Then, when a rock landed on the cops, all hell would break loose. Chases, baton beating, bombs, and showers of stones would be in full swing unless it rained. The moment it was raining, all the fighting would stop.

For Dominicans, democracy and some civil rights came at a steep price. As they were still dealing with the remnants of Trujillo’s dictatorship, they started fighting the worst case of all social maladies, endemic corruption. The political class, in cahoots with the international lending institutions, such as the IMF, was forever condemning all future generations of Dominicans to a life of misery and scarcity. The money from those “loans” reached only a small portion of the population —less than 10%. The remaining 90% were to be guarded under dubious “secrecy laws” in Switzerland, Panama, Cyprus, and other offshore tax havens.  So, it’s not hard to imagine that, since 1959, administration after administration has been busy securing the International Monetary Fund’s “development” loans. 

Back to Raul’s story.

The Haitian hit Raut twice with the board on his left side, bruising his leg and his back. This was no longer a clean fight. Now all Dominicans were furious and yelling “Mata ese mieida!” -Kill that piss of shit!-. The fight turned deadly. It resembled one of those vicious cock fights that are common in the Dominican countryside. Raul grabbed a hammer that mysteriously appeared near him, and they started what appeared to be medieval combat. Swings and dodges; hunts and grunts.

In the middle of the battle, Raul recalled a trick he learned during his years of street fights. To everyone’s surprise, he made an awful, nasty, loud noise with his throat, like someone with bronchitis spitting phlegm. He managed to spit a large chunk of gooey phlegm on the Haitian’s face. Everybody was paralyzed. “What the hell just happened…?”. It had the desired effect; the Haitian blinked. Such a puny distraction was all it took for Raul to launch a quick succession of hammer strikes to his left shoulder, chest, and one final, very dangerous one behind the Haitian’s left ear. Blood sprang like a well. The Haitian screamed louder than a delivering woman. The Dominicans ran and pulled Raul off him, “Lo va mataaa!”. They feared Raul was going to kill the Haitian.  

The island’s justice system used to be swift. After his arrest, Raul spent a couple of days in the precinct. Then the Sergeant-in-charge, “Sargento Cuevas”, AKA “El sanguinario”,
decided it was
self-defense and cut Raul loose. The Engineer— the boss—had already paid the Sergeant Cuevas and his goons.  He could not have his building’s work stalled. Anyway, the Punk was an “illegal” Haitian. Who cares?


The classes were suspended for a few weeks after the last combats. Several students were arrested, and rocks fractured a few cops’ bones. The country was convulsing. This was supposed to be the first truly democratic government elected by the people. But already there were talks of a coup d’etat. The military was confined to its barracks. Only mixed police patrols and the feared Marines were on the streets—a country-wide curfew ensued. The police and the Marines had a field day in the city. A smell of blood was in the air. In three days, by official counts, two hundred ninety five dead, and hundreds were arrested. It was the government of Salvador Jorge Blanco. The self-proclaimed “Citizen-president”. 

After a short while, the American embassy restored the calm. Frank returned to class.

It was the end of the fall semester of 1988. In the first semester of medical school, the curriculum included basic sciences, notably Anatomy. It was everyone’s favorite. In the dissection lab, there were a couple of real, mummified cadavers. The professor, however, instructed that everyone must procure their own, whether real or plastic, a replica of a human skeleton. The requirement posed a significant challenge for Frank.


After the fight, almost a year later, in the mid-eighties, Raul seemed different, and others noticed he wasn’t the same guy. He was calmer than usual and appeared very thin. He was having night sweats and a persistent dry cough. The other guys encouraged him to stop being stubborn and to go to the local clinic. He finally agreed. The clinician thought he had a severe case of bronchitis due to his daily exposure to dust and sand at work. She sent him home with antibiotics and an order for a chest X-ray.

He was grateful, as he always admired doctors, and wished he could have been one of them. But he did not get the X-ray. He knew that would require taking a day off work, and it would cost a lot of money. The doctors would then refer him to a private hospital. He knew the routine all too well. He had a similar episode one year ago and ultimately had to pay almost 300 pesos for an X-ray. They found something in his lungs; cloudiness or something like that. They were not 100% sure. He needed additional testing. He could not afford it.

As weeks went by, his health deteriorated. He could barely walk. He was short of breath and constantly coughing; breathing was painful. His nightly fevers worsened. He was losing weight rapidly and appeared very weak and emaciated. His ribs protruded and were easily counted. His eyes sunken in. His facial features also appeared sharpened. He was gravely ill. In a few weeks, he went from 195 pounds of solid muscle to a skeleton of less than 115 pounds. On his final appearances at work, the crew thought for sure he had cancer.

One of the Engineers, not the boss, who was fond of him, took pity on Raul and went down to the shanty that he was forced to move into, as he was no longer working. Then, he took him to a private clinic for a thorough examination. 

Bad news.

The physical examination, symptomology, sputum analysis, and laboratory work were conclusive and had an ominous report: He had advanced Tuberculosis. Too late for any intervention. The mycobacterium, unrestrained by lack of timely antibiotic treatment, ran rampant throughout his whole anatomy. It had already opened craters in his lungs. That was why he was coughing up blood.

His neighbors, one of whom owed him a debt of gratitude, knowing that he had Tuberculosis, mostly a bag of bones lying listless, bundled themselves up and brought him to the hospital so that at least he would die with some dignity, not eaten by rats, flies, and roaches. A few hours after his admission to the infectious diseases ward, he had a last fit of cough, blood spurring on his wife-beater. An intern, suited and masked, looked at him with compassion. Raul looked back at him, unable to speak. His chest was too sunken in, and his ribs too bruised for him to inhale and to produce words expressing his gratitude. He looked back at the intern with saddened eyes, thinking, “That could have been me”. He soon expired. He was 39 years old. 


Frank was in a predicament, and on many other occasions. Money was again in the way. He needed a complete skeleton, and his family did not have the means to purchase a replica like the ones the foreign medical students had. By then, Raul had been dead for more than one year. 

After a few days of discussion at home, the conversation fell on the ears of his closest friend, Nino. His friend intervened, “I know somebody in the cemetery.” Frank’s mother did not believe him. “What are you talking about, Nino?”. Nino’s friend claimed that the gravedigger at the nearest cemetery was a distant relative of his mother. He would talk to him. The next day, he returned with the request for 50 pesos to get a full skeleton from the cemetery. -Of course, Nino would pocket 10 pesos for himself. 

“What? No way… ”. Frank’s mother said. “I don’t believe you.” It was a lot of money, but she would manage. She always found a way to manage. For some ungodly reason, perhaps she felt sorry for Nino’s own predicaments; she was fond of the young man and trusted him as if he were her own son. She gave him the 50 pesos.

The next day, an eager Nino went to the cemetery. The grave digger took him to the far east part of the cemetery, behind some high trees and wild bushes, where prostitutes, thieves, impoverished people, and those without families were interred. He started digging. 

The grave-digger brought down a large, dark brown sack with him and, aptly, without care or regard, put all the remains collected from the makeshift casket into the sack. This particular skeleton was in good shape; no bones were missing, and the skull was not cracked. As he did not see a cross with the corpse’s name, Nino, ever observant, curiously asked the grave digger, “What was the name?”.

Grave diggers tend to have a morbid familiarity with the dead, like a landlord with the tenants. “I don’t remember his last name,” solemnly replied the gravedigger. He was annoyed but already had plans for the forty pesos; he was going to split it between booze and hookers. The grave-digger paused for a second, thinking hard. “But the guy that brought him kept on talking about him,” said the now animated grave digger, “the guy said that his name was Maestro Raul.”

In that filthy sack, there was all that was left of a once vibrant life. That person’s dreams, desires, and hopes were now trapped in a muddy sack. The sack was not large or heavy—probably ten, no more than fifteen pounds. We’re not as large once dead as we think we were when alive.

Nino rushed across the city, discreetly walking with the ragged sack on his shoulders, the seven miles between the cemetery and Frank‘s home. After all, even in a land with no discernible laws, he was illegally carrying the remains of a person. He happily presented his treasure to Frank’s mother. “Here is!,” he said triumphantly.

Everybody in Frank’s house was scared at first and started commenting and debating what to do with the skeleton. “We got the clean it!” said a voice with morbid joy. An old, evil woman named Juana added, “Hum? You know… when the dead are disturbed, they never go to the other side.” All present were spooked out. They finally decided to boil the bones. They figure that if that works to clean up chickens, it must do the same for human remains. Once cleansed and shellacked, the skeleton seemed as clean as a recently bathed baby. The skeleton was so shiny that no one would ever imagine the conditions under which it arrived in Frank’s backyard.

Frank was grateful to his friend Nino for his action. As a result, another significant obstacle was promptly removed. He then began attending his anatomy class with renewed confidence. However, something strange happened to him in his interactions with the skeleton, especially the skull. Whenever, in the privacy of his room, inspecting the skeleton with the joy of a child’s new toy, he felt that someone accompanied him. He felt a very strange proximity to the skull. He decided to treat it with some respect and reverence. It belonged to a human after all. It was not a plastic replica.

On his way to the university, Frank had always felt a lingering doubt and insecurity about his decision to study Medicine. It was not his first choice, anyway. He was also constantly irritated at having to travel on public buses. The whole university thing, once reality set in, felt like a major hassle. But today, as he rode the bus accompanied by his skull, he felt unusually relaxed and confident. He did not feel the need to complain or to be aggravated by the heat.

It was Monday morning, and he got back to the Anatomy dissection class. Quickly, the other students gathered together and started comparing notes. One of them saw Frank’s shiny skull and commented. “Hey Frank, you know… You have to give a name to your skull.  “A name.” Frank thought for a second, “You’re right… ”. The other students did not make much of it. Most of them had fake skulls with funny names. The other guy continued, “Yeah. I think it was a guy…the skull is big”. Of that, Frank was sure. He was a man named Raul.

The professor arrived, and they all sat in the amphitheater. Frank positioned the skull facing him on his desk. As the esteemed professor “Batista del Villar” lectured and basked in his own glory, Frank got distracted; he swore the skull was looking at him and smiling. He was shocked at first, but not terrified. He felt calm. He knew that he was not alone. All his self-doubts and complaints about his career choice seemed to have gone. “Medicine is great!” he mumbled, looking at Raul.

“Well, I think we’re gonna make it through medical school”.

P. R. Thompson.

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