Lightning and Thunder Comes and Goes

February 18, 2015

Its 8:45PM and dark; the whole town is shut down and everyone appears to be sleeping. We hear thunder. And then it’s gone. We see faint flashes of lights.

“Wouldn’t it be cool to sit in a thunder and rain storm?

We’re sitting on two rocks just outside Auntie’s house. Staring off into the horizon.

A perfect bright pink lightning bolt splits the sky. Blackness

Comes and goes.
There. Not there.

Even the in-between, with the plain darkness – there is so much beauty.

Is it because I know what it is capable of? Because I am anticipating something extraordinary?

Or something else...?

Drop of rain.
Sprinkle.
Hail storm!

Next morning - the sun illuminates the circumference of every tree in the backdrop. The dust and dirt all dampened to the ground.
--
February 26, 2015

It's now the last day of clinic. I’ve created so many relationships over the last two months, and though I am used to people coming and going from my life, I wonder about the patients – and their care (or lack of care) as the clinic closes for six months; and they will not have any reliable doctor whom they trust to care for them. Though we have been prepping them since day one - that our presence is not forever - how will they do on their own? It feels wrong…to just let them go…

There. Not there.

Is there beauty in the in-between, in the darkness?

Are we making positive change?

I hope so…

(to be continued)

Namaskar Uncle Lal

February 21, 2015
Saturday afternoons we have off. I need a break from working on my case study. I abruptly leave the dinning table, and take off without any word. I find myself in lotus pose yet again at a space on the ridge between two others I have been before. I see the bridge to my left where we cross to walk to Kogate and Suping. I see the jail on my right, near the field where l I often walk to in the morning.

I space out into the horizon, waiting, hoping…

Why am I always looking as far as I can, searching for something?

I look closer at a tree in front of me. Nothing. Closer, to the ground below me. Just dead grass and pebbles…

Well, would I be sitting on the alive plants in the adjacent field? No…

This grass that gives me a place to sit and meditate, and be “grounded” is here because it is dead and flat. I put each hand on a shrub of dead grass on either side of me. My hands float so my palms can meet above my head. Coincidentally, wind begins to stir around me. My palms settle down to my heart center. The wind stops. Stillness. My spine is long, and I am light and elated, yet rooted and calm.

It is the dead that support us, earths us, keep us present. Like Uncle Lal….

Uncle,

I’ve observed and

Watched you smile and dance.

I tried to keep you in mind as Bex’s patient, and separate myself because I was scared; I know I haven’t said much, but I feel I got to know you a bit over time. Your stories and your suave captured your life. I hope you know.

The way your nephew talks about you. The way your daughters and wife care for you - I know you were and will be well loved.

I heard your body was to be carried down. I was at clinic, and couldn’t leave my current patients, but all I was thinking, “I have to be there.”

I was given a way out to come see you one last time. I almost started running. I got to your house, and you weren’t there. Lost in translation, but I heard it was done. Pacing back and forth, unsure of what to do. But knew I couldn’t go back to clinic just yet. Then a mysterious man – your uncle? - took my hand, and ran me down to your funeral.

As we finally arrived, it looked as if the others were about to leave. Bex saw me and approached me, gave me a handful of gravel and dirt. I held it in my hands, without words knew exactly what to do. The family was telling me to throw it. I hesitated. Not yet. I must say one last prayer. The space was filling up you and your belongings disappearing. There were more sensations in my chest than words or prayers could describe. Rest in peace. Shanti shatnti shanti. So thankful and glad to have met you. You were always complaining – or wishing - to give when you were too sick to. “I wish I could paint you a painting. I wish I could go out and dance with you.I wish I could work, so my family wouldn’t have to work so hard…” But you did, you gave your family, and us all a chance to receive and give back, to feel love and compassion.

Though it was so painful to watch you suffer in your last hours, I saw your daughters hold your hand and chest, keeping you comfortable and safe. I saw your nephew shed tears as he took his turn to hold you. I saw your wife touch your face and prayed to God to take you, and relieve your suffering as soon as possible.

And the dirt and gravel flung from my hands. I watched it fly and fill the space, I took a step back, and my eyes instantly began to flood. I barely knew you, but you’ve touched me somehow, Uncle. I hope you know that too. Rest in peace and Namaskar.

Annoyed or Grateful?

February 15, 2015

Annoyed or Grateful?

“I have gastric pain”

“Okay, can you show me where?”

Patient points to her head.

The day starts and I’m a bit on edge; dialogues like this add up, and I’m beginning to get annoyed.

“My knees hurt”

“Ok, how long has it been?” go to start palpate knees

“and I have back pain!”

“Ok, wait, your knees…

“And when I bend over, and do this and that and this and that, its pain here, and here.” Patient flailing their limbs around, eliciting all sorts of pains

Trying to take needle an acupuncture needle near the elbow. “Just relax your arm.” Patient lifts their elbow towards me. “No, just relax.” Patient keeps lifting arm towards me. Patient locks their elbows “Relax!!” ….”duksha (pain)!”

Can’t remember how to say “see you tomorrow.” So….“Oodera jonkey” The first line of a chorus to a local folk song - I say to a patient as he gets up to leave.

“da-nama bangjiang”

“Resam pre ri ri”

It’s the first time I see him smile.

Some light to the day! The smallest things in life – really

I recall these scenes with my colleagues. We all laugh.

Annoyed? Or grateful?

Trust the Process

February 10, 2015

When you first came in, I flipped through you thick chart with apprehension. You are 76 years old and I feel your pain won’t improve.

I don’t want to lead you on, don’t want you to think I can heal your pain – especially since you walk to get here with your cane, and need to stop two times in a walk that I could do in 15 minutes.

You can’t lie down and I cannot thoroughly assess your back. You’ve been to the hospital and the health post with no satisfaction. You’ve tried injections and medications.

I tell you I don’t know if I can help much, yet you continuously come twice a week. Today was the 10th time I saw you. You no longer need to stop and rest, you come with a smile on your face. Though we still speak different languages, I feel we are now communicating with one universal language. We are able to look each other in the eyes; the translator is no longer an obstacle. We no longer need to speak about your pain. I know the pattern. Instead we now get to talk about your land, your farm, animals, your children, your grandchildren, what you enjoy cooking for breakfast, and even professional wrestling…

Healing takes time. Trust the process.

Sunday Picnic Introspection

“I believe that through open dialogue of not only my successes, but also my fears, challenges, and weaknesses, I will come to a greater understanding of myself and will help others do the same.” - ARP Manual

February 9, 2015

It’s our day off and we are traveling to a “palace” about 3 hours away for a team picnic. Our bus is full, and the trunk is packed with cooking supplies and food. We make one stop for more fruit and food, and another for this sugary milk fat condiment, kua. And then we just keep driving…

We arrive! But we have to walk about fifteen minutes up to the top.  I carry a large stainless steel bowl of more bowls and utensils atop my head because that is the only way I’ll be able to manage. I get a glimpse of what the average day is a like for the average Nepali woman, and how life taxes their bodies. Life taxes our bodies in the States too…just in a bit of a different way.

Auntie, Jessica, Urmila, Suman, and Ritesh immediately get to work. They are all speaking Nepali and moving quickly. I’m not sure what is happening, but I want to help. I assist with washing and prepping the vegetables. That I can do without much communication.

We walk down to the “sink” about 100 meters away. The ergonomics are not the most ideal for our bodies, but there is so much beauty in the scene that it doesn’t matter. There are five of us squatting around this stone sink. We are washing a five liter bucket of tomatoes, julienning daikon, and slicing onions, all against a backdrop of mountains, trees, blue skies, and the clear horizon. Though Urmila and Jessica are chatting away in Nepali, we are all still there together, working together, creating a meal together. It’s just…great.

"DUDH CHIYA!" Ah, the milk tea is ready. We’ve had so much milk tea since arriving, and this is probably the best yet because it was made over a campfire and because it was made with all of us there!

Then we have our bacon egg sandwiches for breakfast! Whoa is right. We are all feeling protein deprived, and this is certainly a treat.

As we clear the plates, I see Auntie preparing a giant pot of beans. “She’s cooking more?” I ask Tiffany. “Yeah, lunch” I thought the sandwiches were lunch! Nope. There will be more, much more. So, while we digest before lunch, we go for a walk and tour of the palace.

I’m sitting atop a stone wall where cannons were once placed, looking out into the horizon.

I didn’t intend to, but the space was calling. I find myself in lotus position.

Tell me the secret.

My eyes softly close.

Nothing.

Wind brushes my skin. Do I go with the flow- with the wind, and let it carry me? Do I stand like bamboo and find flexibility? Do I stand like an old thick tree and stay as still and strong as can be? Tell me.

Then the wind stops. I feel the sun warm my neck and back; it envelops my heart. The sun nourishes me. It lets me grow and be loved.

My spine is straight, my shoulders are back, my eyes closed, and my heart is open. I hear footsteps and wanted to open my eyes and break away from this moment…but don’t. Its not like I feel danger, just don’t want to be seen like this. But if I open my eyes, will I be shaming myself? Won’t I be illustrating that I am not good enough – for this love I am receiving and worthy of?

Why am I here?

If I can’t receive, how will I give? How will I become the practitioner I want to be – my whole purpose for this trip? I want to be the practitioner who not only who treats with competence but more importantly with care and compassion.

Hmm maybe that is what I needed – to know that I am worthy of love and compassion, and to forget all that bullshit and questioning of the pathway – whether or not I am on the right one, or doing the right thing. It doesn’t matter in the end. In the end, it all boils down to love and compassion (how many times can I say those words?) Cliché? Maybe. But so true.

From slicing vegetable with friends to my own meditation, there are many ways for me to practice. I'll grow as a practitioner. I'll grow as a person.

Typical Intake diagloue at the clinic

It’s a busy day; I’m seeing three patients at a time.  As the first is about to leave, a translator/receptionist asks, “Dr. Debbie, you free? Can you see another?”

Of course.

I have one patient in a chair in the main treatment room. I have another patient with back pain next door that needs the one massage table we have to share between the five of us doctors. I have another patient outside sitting in the sun, because he’s cold, and feels better out there.

I turn to my new patient waiting patiently for me.

What can I help you with?

I have dizziness all the time

So, how often do you have it?

It comes and goes. I’ve had this bout for one month.

Do you have dizziness now?

No.

Small Community

February 2, 2015

Small Community and What I Love

Contrary to what I said previously, we are all having a great time! The fun and games are certainly an important piece. I mean, how often do you get to take two months off from your “real” life and spend it in such close proximity to a small group of complete strangers, working towards a common goal?

We chat about cases, and then we chat about life. We play games, go for hikes (and then breathe in some necessary-alone-quiet time :D). But, I love how we all eat our meals together, three meals/day – not to mention outside with the sun and moons. We also brush our teeth outside with the neighbors, using the communal “sink” on the streetside. In the morning, we do so with the roosters. At night, we do so again, under the bright moon and constellations. After the initial feeling of being dirty, it now feels so natural – the way it should be.

I’ve also never lived in such a small community before! Soo small. And everyone knows us as the amazing white foreign doctors (hey, wait, I’m not white ;D!).

I love how everyone greets us with “Namaste” or “Namaskar” – on a bad day, these small moments of gratitude and compassion sparks the light back in me.

I love how the people all talk to one another like brother or sister…cause we are all brothers and sisters! The other day, Bex, Milan (one of the translators) and I went for a Sunday hike to Suping. On our way, a boy of 13 yrs came running from his house to catch up with us with a big sincere smile. “Hello! Hello! What is your name? What is your name?”

We invite him to come walk with us. He and Milan walk side by side and Bex and I follow. They chat like brothers the whole way (cant understand, but so it seems). We stop by a medicinal plant, and the boy tells us it’s used to stop bleeding. On our way back home, the boy invites us in to his home for tea. He shows off his dog, that he hopes to take to Hetauda to enroll in dog training school. I ask him, “Do you always invite random people off the streets for tea?”

 

Demons?

February 1, 2015

Demons

Man, I thought I had a good immune system, and strong GI - I’m thinking, yeah, I’ve been to other parts of Asia and have always been fine - but Nepal…sure is a different story

Demons. That’s right, no going out past dusk, otherwise they will get you…

Bex and I keep catching our demons at the same time – I think it’s when we go out to check on one of our patients, Lal, after dinner --

All the pictures I’ve taken have been of the mountains and greenery, but there is always a yang to the yin – and that is the intense unsanitary way of life here –the garbage, the burning of garbage, including plastic that permeates through the window cracks of my bedroom and wakes me every morning, and what else? The many medical conditions that could be remedied with some more frequent bathing, soap, water, and sunlight, like wounds, staph infections, UTIs. No judgment. Just saying. I guess that is why we are here – to educate and sustain good health.

TB: Common and Unfortunate, but Conclusive and Treatable

In lieu of a pic of TB

January 30, 2015
Spent about an hour at the Health Post with patient…frustrated and annoyed.

One of my patients has been coming in for finger/joint pain. She has also mentioned an enlarged lymph node she’s had for a few months (but everyone says their chief complaint began 3-4 months, or 3-4 years ago… so who knows how long she has had it). Previous practitioners have asked her to get a TB test, but it wasn’t until a few days ago after persistent urging, did she finally get tested.

I wrote her a referral to get a TB skin test at either the health post or the hospital. Her son took her to the Hitawda Hospital, and they measured her skin reaction at 20mm (only need 5mm to be positive), and the doctor sent her back to us, with no communication, diagnosis, or recommendations for her (frustration #1).

Ok, well, we will walk you to the Health Post, just next door, to get you enrolled into the “DOTS” program for TB treatment. Should be simple, but no, ended up turning into a headache. Person in charge said either he wanted patient to get a biopsy of the lymph node – by the way, it’s only available in Kathmandu ~3-4 hrs away – or test positive with the TB sputum test. Ugh, fine. Take the sputum test. Patient walks away with a small container to collect her sputum. 20min later…she comes back. Container is empty. What’s wrong? “I have no sputum.”

AND to make matters worse, if she doesn’t provide the sputum today, the tech/lab guy is going out of town, and wont be able to run the test until next week!

Shit – our clinic is only here for 4 more weeks, and there is no Camp until September. The DOTS program is about 6 months of treatment, and TB medication is similar to chemotherapy – not fun. We are her support to finish the treatment course, to help curb some side effects.

You’d think, in a country, where TB is pretty common, the system would be more seamless. Nope. My colleague here, Bex, also had a headache case of possible spinal TB. The poor patient, of only 22 years, has been to doctor to doctor, traumatized by the hospitals with test after test, nothing of which were cohesive or conclusive. They seemed to be looking to diagnosis an autoimmune disease - yes, possible differential diagnoses, but apparently TB was too simple of a diagnosis – not interesting enough….

The bright side…both these patients were a bit oblivious to our frustration. They were both actually quite thankful for the many people around them caring for their health. They felt resolution and grateful for a clear pathway they must now take for better health.