Friday, February 3, 2012

Medical Mis-Adventures--Part 2 -- Nepal, 1998

Miracle and Jubilee: A Thanksgiving Story

If words were pictures, and I could show them to you now, you would see a full December moon hanging over the Taj Mahal. I would describe a perfect white Christmas on a tropical island, five degrees north of the Equator, white sand, white clouds, white surf and white hot days.  I would show you gorgeous days “Down Under” when, in May, leaves were at full peak autumn color and the first winter snows were dusting the Great Southern Alps of New Zealand.

But this is not a travelogue.  This is, instead, a story of jubilee and thanksgiving.
A year ago this week I found myself in Nepal.  Trekking the Himalayas had been a long-held dream, but our Northern Hemispheric summer is not the time to visit that part of Asia.  Monsoons obliterate views of the mountains and the rivers are dangerously high.
Nepal’s season is November when days are clear, blue and warm.  Poinsettia trees are coming into bloom and the rains, recently ended, have cleaned the air and all around is a lush, semi-tropical green.  Views of the mountains are at their most magnificent.  It’s the perfect time to visit the Himalayas.
On the morning of November 17, 1998, my guide, Gorkha, and I flew into Jomson, a small village shadowed in the valley of the 25,000 foot Annapurnas.  From Jomson, our plan was to hike up to Muktanath.  At 4,000 meters, this was the highest Tibetan village in Nepal.  From there, it was, more or less, a seven day downhill walk to Pokhara, our ultimate destination.
These days were filled with magic and wonder.  Hiking would begin early and we’d punctuate our trek with long breaks.  By 2:00 p.m. most of the trekkers were settled into a tea house where we’d chat, play cards, read, journal write, dine with new friends then retire early.
This was how I spent those first, exhilarating days in the Annapurnas.  By the fifth day, however, I was ready for a break, and the village of Tatopani was the perfect place.  It was the largest town on the Annapurna Circuit for good reason; it was almost home to multiple hot springs that kept trekkers in the village for days.  It was the ideal location to rest tired muscles, and gear up for the two remaining days of hiking. 
And that is what I planned to do, until…life took one of those…unexpected twists.
Now…be warned…the story that develops is mighty low on the scale of human misfortune.  It is, simply, a cautionary tale, a thanksgiving metaphor, a lesson in miracle, and an encounter with the divine.
On the morning of November 20th, I decided to start the day with long soak in one of the hot springs.  Now, these springs lay on the banks of the Kalikandaki River, and for those adventurous, or foolish enough, the sport was to heat up in the springs then dash into the river a plunge in.  This was no balmy act; the water was icy cold, glacial runoff, but there were plenty of crazy people on the Circuit, and we’d soak up the heat until we couldn’t take it anymore, then jump into the river.  No problem there, until…the final plunge…when I landed on an incredibly sharp object.  I knew I cut myself, but had no idea the extent of the injury until I hobbled out of the water. Blood was gushing from my foot, and when I lifted it I could see tissue and fat hanging out of a deep, two inch laceration.  The bleeding would not stop and the only way to control it was through tourniquet.
I tried to be as unobvious as possible, and managed to wrap my foot in a sock, gather my things and begin the slow walk off the beach and up the stairs to the tea house.  Immediately, I strapped on First World assumptions.  This is just a gash, I reasoned.  I’ll go the emergency room.  It needs stitches and all will be well.
Gorkha saw me first.  I showed him the foot and said, “I need a doctor; take me to the clinic.”
Well, it didn’t take long for initial assumptions to be shattered.  I was in Nepal, not Plattsburgh.  How presumptuous of me to assume there was an emergency room in this town.  There wasn’t even a clinic in Tatopani, nor was there a doctor, or a nurse or any medications to ease the pain and stave off infection.  The nearest town with anything close to a medical facility was easily a ten hour walk away.
But then a series of miracles began to unfold.  Oh, not the miracles of Biblical proportion, but the subtle little events that you just know are the acts of an omniscient God.
One never really hikes alone in Nepal.  You’re constantly bumping into people you’d passed earlier on the trail or met the night before in another town.  From the beginning of this hike, I’d unofficially teamed up with Michelle Jones, of London.  We’d been on the same flight, our guides knew each other and Michelle and I seemed to have the same destinations in mind.  She’s start our earlier than I, but my mid-day we’d connect for lunch and seemed always to stay in the same lodges.   We had a lot in common and she fast became a good hiking companion.
I was sitting in a chair in the garden of the tea house, foot elevated, trying not to think about my foot.  No one was quite sure what to do.  I wasn’t surprised, then, when Michelle emerged into the garden and asked what happened.
Like me, she knew the full extent of the problem.  We discussed options.  There was no way I could walk.  Gorkha suggested I be evacuated by helicopter—for $2,000.00.  But two thousand dollars was two month’s budget, and it certainly wasn’t an option, at least for the moment.  But, in the tropics, where all sorts of microscopic creatures lurk, expediency was a priority. 
Michelle did what, I suppose, many of us would do.  When help isn’t immediately available, the best thing to do is go out and find it.  And so she went, angel that she was, onto the trail, stopping people as they approached.  And then the first miracle began to reveal itself.
In the end she found sutures, a half bottle of antiseptic and a used needle.  Others at the tea house contributed items a surgeon might need: gloves, an irrigations device, Betadine, bandages.  Fine supplies, if you’re a doctor with the skill and know-how to use them.
A young British couple entered the garden and questioned the gathering crowd.  Did I need help? they inquired. 

And this was the second miracle.  Both of them were physicians.

Sarah and Peter took control.  They assessed their limited equipment, issued orders: boil the needle, bring scalding water, layed out supplies in order of need.
And so, in the garden of a Nepalese, tea house, on a stunningly beautiful mid-autumn morning, these two doctors, using a limited reserve of medical tools. Stopped the bleeding, cleaned the wound, stitched it up and said, simply, You must leave now and return to Pokhara as quickly as possible before infection sets in.

And so I bid farewell to my new-found friends I’d met along the way, thanked Sarah and Peter.   Michelle gave me her bamboo hiking stick, we hugged, and I was off.
But some things are never simple.  Gorkha had ordered a horse, but in order to get to the horse I had to climb a considerable distance up, and over, a huge landslide.  And so, with new stitches, we set off for the long, difficult hike to the horse.  Good Gorkha, who’d never experienced this sort of thing before, carried everything.  Never did he stay more than a few feet away from me.  Step by step, walking on the heel of my right foot, I made my way over the slide.  Four hours later we arrived to where the horse was waiting.

That night, wrapped in a sleeping bag, I sat on the stoop of the simple guest house Gorkha had found.  I was the only Westerner there that evening and I felt really alone.  Finally, the fears flooded in.  Would the stitches hold?  Would I get back to Pokhara without infection? Would I have to end the trip? Would I lose my foot?
Looking deep into the clear, inky, star-studded skies of Nepal, I remembered what my friend Margie had written to me earlier when I’d asked her to keep me in the light because I was doing this trip alone.  Of course you’re not doing this trip alone.  God is with you all the time, she wrote back.  And I remembered my mother, who daily circled me in God’s care.  And I thought of every God imagery I’d learned and I knew, just knew, that at that moment I rested in the palms of a loving, protective God.  It was then that I was able to turn it all over and say, It’s in your hands, God.  This is too much for me.
And a great peace came over me that night, and a confidence borne of Christian faith, and I was absolutely convinced that I’d been cared for that day, and that I would continue to be cared for that night, the next day and every remaining day I’d be away.  In the midst of fear and aloneness, I felt the presence of God and experienced what the writer of Hebrews had written: I will never leave you or forsake you.
Well…Gorkha and I, the faithful horse and its owner finally made it to the trailhead.  Two hours later we caught a bus that brought us on a nightmarish ride out of the mountains to another town where Gorkha hired a cab.  Ultimately, I did get to an emergency room—33 hours after the accident.  Two doctors examined the foot.  It was clean and uninfected…and…the stitches had held.  They simply rebandaged it, gave me a Tetanus booster, a ten day supply of antibiotics, complimented the good doctors from the UK, and said, “You’re a lucky man.  The Buddha was with you.”
Later that week I moved on to Kathmandu, reconnected with friends I met earlier, and together we shared a Thanksgiving dinner.

How coincidental, I though, that this occurred during Thanksgiving week.  The metaphor wasn’t lost on me.  I wasn’t observing the holiday in the traditional sense, but it had been a week of powerful thanksgiving.
I thought of Michelle and her selfless act of tracking down surgical supplies. 

I thought of strangers who provided needle and suture.
I thought of Peter and Sarah, good Samaritans, who’d performed the surgery under difficult conditions and with true Hippocratic spirit.

I thought of Gorkha, who stayed with me right to the end and lever left me out of his sight.
I thought of all those praying for me at home, and I knew, again, that this had been no coincidence, but a well orchestrated miracle.

I think of this story often, and on many levels.  Over the past year it’s gone beyond a simple story of care and ultimate thanksgiving.  It was, after all, a minor injury, corrected under extraordinary circumstances.  But after months of traveling through Southeast Asia, living and mingling with some of the world’s poorest people, I began to see how privileged I really was.
I’d taken for granted many of the peripheral events in this drama.  It was sort of fun to come out of the Himalayas on a horse.  “How romantic,” one trekking friend commented.  “Riding off into the Nepalese sunset.”

I never considered our two hour taxi ride back to Pokhara as anything more than a two hour taxi ride getting an injured patient to hospital.
I never stopped to think about the immediate attention I received.  Two doctors consulted with me and a third intern was left to administer the Tetanus shot and rebandaged the foot.  Nor had I taken into account the lack of triage that evening.  I simply went to the head of the line.

It was only later that I put it all together.  As a Westerner in Nepal, I was given preferential treatment.  Doors opened for me that might not have opened to a poor Nepalese.  With dollars in my pocket, all things were possible.
In Nepal, where the typical income is about $2.00 a day, what would the average resident of Tatopani do had it been him who’d injured his foot?  Would he have been able to hire a horse, pay for the bus and taxi and double medical consultation?  Would he have been able to afford the Tetanus booster and antibiotics?  What would have happened to him in that village that day without even basic medical services available to him?  I think we all know.

Countries are poor, or rich, for a variety of reasons.  Nepal is poor because of forbidding terrain and tough climatic conditions; it’s poor because of its diverse social structure; it’s poor because, in a way, it’s still emerging from its feudal past.
To offset this, loans are offered countries like Nepal.  Few governments turn down the offer.  Ultimately, however, there is a huge price to pay—the piper must be paid.  Today, Nepal’s foreign debt is about six million dollars.  A  huge chunk of their national budget is used to pay back that loan.  Think of what those payments could do for hospitals and schools.  Think of clinics that could open, even in small towns like Tatopani.
There is a Biblical prescription for this, and that’s the year of Jubilee.  Levitical code dictated that ever fifty years debtors be freed of their debts, thus allowing those most heavily in debt a way out of their misery, a way to restore financial balance in their lives. 
In a few weeks it will be the year 2000.  Radical Christians worldwide are suggesting that poor nations,  like Nepal, be freed of their debt and creatively use debt payment for programs that will improve living conditions.  Indeed, this would be jubilee in a small country like Nepal.
Our bottom line probably recoils at this but it’s not a bad idea.  We, in this country, certainly have more than we need.

Well..Thanksgiving is over, but what was it for you?  Was it simply a day off from work, a day to spend with family and friends?  Did we even catch a glimpse of the excess we have in this country?
I have finally reached this conclusion.  As full, fat residents of the Developed World, I don’t think we have a clue.  It’s not our fault, really.  The only way most of us are exposed to the poor is through television, and we all know how numbed we are by that medium.

However, when we see human need first hand, it’s a bit more dramatic.
Two weeks after the accident, a little boy in New Delhi caught my eye.  He wasn’t speaking to me directly, but his words still haunt.  He was holding a tiny baby and his word still haunt.  “Milk please,” he said.  “Milk please.”  Like many of us, I adjusted my blinder, passed him by.  I’ve often felt guilty about that; and I’ve never forgotten him.
Last week I was coming out of the Farmers market in Montreal, when an elderly man approached me, asking for food.  Ahh…chance for redemption.  I’d promised myself I’d take off the blinders the next chance I had, and this was it.  “I’ll be back in five minutes,” I told him.  A sausage stand was selling hot dogs, so I bought him one. 
As I was leaving the parking area, I saw him smoking a cigarette.  Hmm, I thought.
On the way home, I figured I’d been taken, but I also knew that I’d done what Jesus would have done.  Later, I was thinking about the number of times Jesus had been burned, taken advantage of.  Certainly, some of those present at the multiplication of the loaves and fishes had been opportunities.  I knew I’d done the right thing.
You’d think I’d have all the answers after this year away, but you know something…I don’t.  But I do know this: we have to give,, and go out of our way.  We have to bend over backwards, take chances with people and run the risk of being swindled.  It’s was those strangers in Nepal did for me.
It’s what Jesus would have done.
It’s what he did.

(This was originally given as a sermon at first Presbyterian Church in Plattsburgh on November 27, 1999. When I decided to include it as one of my medical mid-adventures, I initially thought of adapting it for my blog but decided against it.  Twelve years and three months later, the original story still has impact. While the style and tone is different from my usual writings, the message remains the same.)

Medical Mis-Adventures--Part 1 -- Singapore, 1990

Singapore.  Early August. 1990.  Latitudinally, I’m one degree north.  I have a raging fever, although I don’t know it.

It’s a Sunday, and I’m poolside at the hotel where I’m staying.  I’m shivering uncontrollably and have no energy to do anything but lay by the pool, trying to keep warm, under a white-hot and blazing equatorial sun.

I’m exhausted and there’s no reason for this.  Only after returning to my heavily air conditioned room, when the sweats begin, do I know something is terribly wrong with my body.  My body alternates from being so cold I turn off the air con and wrap myself in every blanket there is in the room, to being so hot that I have to turn the air back on to avoid sweating rivers.

I rest a bit, have the idea that I’m sort of ok, and leave the hotel and wander around my neighborhood and decide to eat fish (I never eat fish) at Long John Silver. Only after eating, when nausea takes over and the sweats being again, do I acknowledge the need for help.

“I need a hospital,” I tell the young man behind the counter.

“Mount Elizabeth Hospital is around the corner,” he directs me.

Off I go.  I’m rapidly becoming the stuff of Emergency Rooms.  Luckily I have my credit card and suitable identification.

I check in. Someone takes my temperature, looks at my tongue, and pushes me into a cubicle.  My fever is dangerously high, but it’s in Celsius and it means nothing to me.

They ask questions and are not pleased when I tell them I’d spent all afternoon lying in the sun.

“But I was freezing,” I tell them.

Yes,” they said, “but it spiked your temperature.”

They can tell I’m dehydrated by the coating on my tongue, and that I need antibiotics to lower the fever.  I’m prepped for an IV then spend the night and a good part of the morning in the hospital.  By noon, though, I tell that I have to leave, that I have a flight to catch that evening.

“But you can’t discharge you,” they tell me.  “You still have a fever.”

“Yes, I know,” I tell them, “But the next available seat on this flight is in September and it just isn’t an option.  I’ve got to return to my hotel, pack, check out and get to the airport.

So I check myself out, against their good judgment.  I’m literally half way around the world and I just want to go home.

By early evening I’m at the airport waiting for the daily Royal Jordanian Airline flight from Singapore to Amman. It’s an absolute struggle just to sit upright.  I’m still sick with full-blown influenza, but I have no choice.

It’s a full flight...and long.  Twelve hours maybe.  I sleep, but not the good sleep the sick need to recuperate.

I arrive in Amman early the next day. There’s a huge time difference and my body is on Asian time.

I catch a taxi to my hotel, shower and crash, waking up seven or eight hours later.  It’s late afternoon in Jordan, but could be the middle of the night in Singapore.  My entire body clock is off kilter.

But I feel remarkably better.  And hungry.  My natural curiosity tells me to hit the streets, take a look around, have some dinner.  So I decide to take a walk.

Downtown Amman.  Late afternoon rush hour.  I’m just wandering around, getting a feel for the place, when I meet a small group of young men.

One of them asks me: “Are you a Christmas man?”

I know what he’s really asking.  Am I a Christian?  The irony isn’t lost on me.  I love Christmas so, yes, I think to myself, I am a Christmas man.

But I don’t want to embarrass him, so I respond.  “Yes, I’m a Christian.”

Passions in the Middle East are high at this moment.  Kuwait had fallen five days earlier to Iraq and support for Saddam Hussein was running high.

I do not have my wits about me.  I still have a fever, albeit lessened, and my body is pumped up with antibiotics.

“Are you American?” one of them asks me.

Hmm, I think.  Not good.  I tell them I’m Canadian, that I live in Montréal.  It’s not the first time I’ve played the Quebec trump card.

"Bad,” another one says.  “Friend of America,” he hisses.  He catches me off guard and pushes me off the curbing, into the street.  Fortunately, there was no oncoming traffic.

OK, I tell myself.  Get yourself out of here…now.  Just walk away as quietly as possible.

Which is what I do.

I get back to my hotel, but the seven hour daytime sleep, coupled with the who-knows-how-many-hours time difference there is between Singapore and Amman, prohibits my body from sleep. 

Nine o’clock.

Ten o’clock.

Two a.m. 

I dose, only to be awakened by a Muslim call to prayer.  My hotel is right night door to a Mosque.

I simply cannot sleep and have heaps and heaps of time to think. 

I develop a plan.

By 8:00 a.m I’m out the door.  I grab a taxi to the nearest Royal Jordanian Airline office.  My ticket, an around-the-world deal, is extraordinarily flexible.  When the office opens at 9:00 I’m the first one in.

“Can you get me to Amsterdam today?” I ask the clerk. 

She searches the flight’s database.  “You’re lucky,” she tells me.  “There’s one seat left in your class of ticket.  But the flight leaves in four hours.”

“I’ll take it,” I tell her. She rebooks me and I grab another taxi.  This time I tell him to wait at the hotel while I repack and check out.  Within fifteen minutes we’re on our way to the airport.  I play the Montréal trump card against his twenty questions, but this time there’s no need. He wants to get out of Jordan, emigrate to the USA, does not like living in the tension of the Arab/Palestinian/Jewish/Christian issue. 

Eight hours later I land in Amsterdam.  My dear friends Lomme and Ina do not expect me for another two weeks.  I find a pay phone, and a phone book.  They’re home.

They pick me up and for the next week I use their home as a health sanitorium.  They bring me to their doctor and I’m put on additional meds.  I sleep fifteen hours a day.  It’s there that I recover, but it’s not for another six weeks that I feel fully back to my old self.

I have never forgotten their kindness, and whenever I see them, I remind them once again of the gift they gave me.

I was sick and I was exhausted.  They opened their home and gave me the time and space to recover. And for that I am forever grateful.