Oh Dengue

With each inhale I feel my engorged spleen and liver scrape against my ribcage. I can’t look left nor right because each movement in my eye socket is wrenching. My hips endure what seems like the weight of a semi-truck and head-to-toe I am speckled in a burning rash. Chills and heat flashes ebb-and-flow throughout my body and I can’t make my mind up; am I cold or hot?

As I sit in the crowded Emergency Room awaiting my official Dengue Fever diagnosis, next to a man holding his detached left thumb in a Ziploc bag of ice, on the day after Christmas and the day before my departure for Africa, I question if my trip to visit my best friend Adrienne in the Dominican Republic was worth it. My lightly tanned face and blonde streaked hair say yes. But something tells me that my near hemorrhaging internal organs disagree.

Dengue Fever is transmitted through female Aedes Mosquitoes. It is a disease that is endemic to various tropical regions of the world and incidences soar particularly high during times of heavy rain. The symptoms include, but are not limited to, sore eyes (check), joint and muscle aches (check), pounding headaches, fever, chills, a body lathered in rash (double check). The incubation period is about a week and the virus itself thrives on its host anywhere from 7-12 days. According to the CDC, 95% of those diagnosed with Dengue Fever will recover with no lingering hazards. If one were to have the unfortunate luck of getting the illness a second time, death is not uncommon.

Stark fluorescent lights and the hum of blood pressure monitors send my thoughts back to the scene of the crime. Trekking the back route to the famed 27 Charcos, a popular set of tiered waterfalls in Santiago, seemed like an efficient idea. By tromping through dense swamp instead of taking the main paved road, would give more time at the falls. I realize that by saving two hours that day cost me seven today.

The shortcut concluded to be a bad idea. My hands acted as flyswatters, slapping every inch of skin, but attempts at mosquito genocide were pathetic. I could have counted nearly 80 bites in the first fifteen minutes; I was the sweet-blood feast they had been waiting for. Their tiny, unassuming physique masked a ferocious demeanor. I looked around to see if my companions were also victim to prey, but they seemed unbothered. Mosquito torture: party of one.

In addition to being an all-you-can-eat buffet, the mud was so thick and sticky each step forward was really two steps back. Are we getting closer? Are we moving? I felt like I was on a Nordic Track exercise machine, moving in place but going nowhere. From that moment on, the excitement of being in a tropical jungle was jaded.

The ‘tour guides’ (local cane workers paid to show tourists the route) could have each posed for the cover of firefighter calendars, they were that good looking. It was biceps for days. Muscle, finely sculpted and magnified with bronze, Caribbean skin. When the path got too difficult to individually manage, one would simply pick me up and throw me to another, like a juggling pin. At first it was fun. I felt weightless and small. But, as the day went by, their hands were landing in inappropriate places; a little too high on the thighs and the sweet spot of my mosquito bites. And once they start itching, I can’t stop scratching.

I used to think there was nothing more uncomfortable than itchiness. I would rather chew and swallow living insects than suffer the wrath of an incessant itch. If I had to choose between having chronic strep throat once a month for the rest of my life or a prickly sun rash once a year, I would choose the strep. Basically, I wouldn’t wish itchiness on even my worst enemy.

But than I got Dengue Fever, and itchiness met its match.

So now I sit with pending blood samples in the lab, a bag of IV fluids flowing through my veins, dressed in a starchy buttoned gown. I am telling the on call doctor the onset of my symptoms and how miserable the last three days of my life have been.

“The pounding in my head is worse than any migraine I have experienced. I haven’t slept through the night in 72 hours; I ache everywhere. I am pretty sure I have Dengue Fever, “ I say. “My eyes are sore and I read on the Internet that that is a sure sign. Look at all these bites.”

“Hmmm, ok. When was the last time you had intercourse? Any unprotected sex?” he rebuttals.

What does he take me for?

“No, of course not,” I answer as I blush. “I also read that the joint and muscle aches generally come a day after the headache starts with Dengue. The headache started on the 23^rd and the aches came on Christmas Eve.”

“Riiight. What about drug use? Any exchange with used hypodermic needles? Were you sharing syringes by chance in the Dominican Republic?”

“Umm, no. I don’t do drugs,” I shoot back defensively. “But from what I gather, I am almost certain it is Dengue Fever. I was there just after tropical storm Olga hit, and Dengue was all over the place. And I am supposed to leave on a plane in the morning for Africa…to climb a tall mountain.”

He looks at me with assurance. “You know, we also call Dengue Fever break bone fever. If you had it, I think you would be in a lot more pain than this.”

“Oh. Well good then. Maybe it is just a bad flu.”

“No, I have discussed your case with the Infectious Disease doctors and we think it is either Leptospirosis (a common bacteria found in fecal matter of hoofed animals, transmitted through water) or HIV (a disease there is no cure for.)”

“I am sorry. Did you say HIV?” He had to be joking. My pulse tripled in those flailing moments. Of course I would be the first person ever to get HIV from stubbing her toe or something benign like that.

“Well, all your symptoms are manifesting like they do with HIV. So we can’t rule it out. Also, with all the water activity you took part in, leptospirosis is a possibility. Either way, we don’t think it is Dengue Fever.” As he walks out, he casually blurts out “and I don’t think you will be going anywhere tomorrow.”

The memory of the waterfall hike resurfaces and I glance at my swollen belly. Anxiety begins to brew and I am now convinced, backed by a potential diagnosis of HIV, that the trip was not worth it.

The IV bag finishes and the nurse hangs another. I watch the water slowly drip in the chamber and wonder why I am not feeling better. I thought IVs always make you feel better?

“I am sorry,” she says. “The tubes of blood that I sent to the lab somehow got lost in route, I am going to have to poke you again for another set.”

Defeated and angry and sad and in pain, I dig deep for a bit of understanding. It takes me some time but I offer her my left arm and tell her where she can find a good vein.

“And I am going to have to get a sputum culture with these Q-tips. No biggie, just a little bit of your boogers.” She takes the metal prongs, lightly covered with a cotton tip and jams it so far up my nostril I believe she pokes my brain. (Itchiness and dengue fever I would like you to meet a metal-pronged Q-tip, your match.)

As an educated, cautious and logical person, I knew I didn’t have HIV. My disappointment wasn’t that I would be nursing a fever with a diet of Tylenol and clementines for the next few days. It was that my year-in-the-making plan of hiking Mt. Kilimanjaro with my family in Tanzania was no longer in my future. Regardless of my properly named illness, I knew that I wasn’t strong enough to survive a flight of 16 hours. I wasn’t even strong enough to walk up a flight of stairs let alone the worlds’ tallest freestanding mountain.

A few more hours pass. I think about how I will spend my New Years, as there will be no celebrating. I ponder how disappointed Charlie, my younger brother, will be when I tell him he can no longer throw a rock concert in our living room. He was the only immediate family member not going to Africa and he was ecstatic about having the house to himself. An older sister has foiled his plan yet again.

Now two bags of fluid have infused. There is nothing more they can do for me and it is time to send me home. The infectious disease doctors stroll in. One rests on the edge of my bed, another sits on the rolling stool and the third stands against the wall; a team of white with no answers.

“We are sure you do not have HIV, “ says the youngest looking one on the bed. “You don’t have any gastrointestinal symptoms, so we are nixing leptospirosis. We are 95% sure you have Dengue Fever but we won’t know your viral count until mid January. Now, as far as your trip to Africa, we aren’t saying don’t go. We are just saying don’t go tomorrow.”

Dollar signs start popping up in great hues of fluorescent green. All of a sudden, the IV bags are blocks of gold and the Ibuprofen pills are hundred dollar bills. I have no health insurance. Tomorrow the travel insurance goes into effect but today I am without. I realize that I will pay a couple thousand dollars for a verdict that I already knew.

The one on the stool chimes in. “Dengue Fever is a virus with no medicinal cure. It will pass but it will be intolerable. Just treat yourself to a cocktail of painkillers and drink plenty of water. No alcohol.”

I ask them a plethora of questions. Will my liver be ok? How do I prevent it from happening again? Will I ever see the normal color of my skin again? They tell me that DEET should be my closest companion while in Africa as the four strains of the virus swarm that continent as well and I will live to see my organs normalize.

“You are lucky,” the older, standing man says. “Stronger forms can lead to Dengue Hemorrhagic Fever which is uncontrollable internal bleeding. Very deadly.”

“Actually, you are lucky…that it is not summer when the US mosquitoes are rampant…for me to pass it to others,” I say with a laugh. Elated that I was right and without a fatal disease in need of quarantine, I was able to lighten up.

We joke around for another five minutes. They ask about Africa and are baffled when I tell them my 50 year-old mother will make the Kilimanjaro ascent, probably faster than anyone else. I ask what the worst infectious disease case they have ever seen was and they go into gruesome detail. They were trying to make me feel better even though they knew I was bummed.

At home I take a warm bath then snuggle in my moms bed to watch her pack. Her enormous bag is sprawled out and all the insides are stacked in piles. I try to do her a favor by sneaking the items away that I know will weigh her down but she panics and throws it all inside. We discuss how I will join the group on the second half of the trip, just in time for the safari and the beaches in Zanzibar and the hopeful end of my Dengue course.

I pop some Tylenol. Is this the universe telling me I need to slow down? A hard reality when you are an un-caged bird. Dang it.

DeBanked, DeRailed, DeFeated

ME: I hear you are a mastermind at reading palms? What do mine say?

SHARMA: Ah yes, give me right hand. Hmmm, you be very like to talk

much yes? Social very good with family and friends and work yes? When

you have opinion yours-you talk it...you no hold back yes?

ME: Yes, that is true.

SHARMA: Lets me thinks...you are excellent planner - 100% with plan

but execution is poor yes? 60-70% execution...maybe 75%...at most

80%...just horrible! If you plan everyday and only do 80% how much you

lose only 1 day?

ME: 20%

SHARMA: 1 week only?

ME: Hmmm, 140%

SHARMA: Each one month only over 500%!!! TOO MUCH! Please, Please...do it everything you plan. And you follow your heart yes? You analytical in thinking mind, but you follow your heart yes?

ME: No, that’s wrong...I usually follow my mind.

SHARMA: OK, Please, just follow your heart. And me let see...you have white spots on your fingernails...you need calcium. And you are not very trusting yes? Why you not trust all the people? Trust is here a problem.

ME: Yeah, I need to eat more yogurt and cheese. But I am very trusting! Especially with people I hardly know.

SHARMA: Healthy here is good, very good. 70 maybe 75 years you die.

ME: (Silence. I feel my face turn white...Life long goal of reaching 100 years old...shattered on a Friday morning.)

SHARMA: And work is successful very much very much. After 24 it gets better much better and much more better. 27-30 change, 30-39 change and most better after 51. And yes multi-nationalistic work is good and better work for you. And I see apprehensive love with lover boys yes?

I show you many times with good men and good men but you say not now and no way. The time will be you to decide. 26 years...good man, 28 years...good man...31-33 years...good man. You decide...up to your choice. And babies! Don't you worrisome! That is problem no way. The soil is rich and alright...now just need plantation in the agricultural section!

My destiny unfolded while I sat in a chair in an ancient fort in the middle of the Indian desert. There were things he knew and stuff he clearly made up. But what he did not reveal were the happenings that befell me the following Monday....

Bag packed and yoga mat in hand, I boarded my train to Rishikesh, self-proclaimed as the yoga capital of the world. I was finally on my way to what would be a week of enlightenment and intense Astanga yoga amongst the backdrop of the staggering Himalayas. I took notice to the many Westerners lingering close by, their own personal grime in tote, and knew I was on the right track being that Rishikish is a popular tourist destination. Hoards of people quickly fill the car to find their seats and stow their baggage, pushing and pulling and groping just to slide by. Indian families travel seven or eight deep (in both children and luggage parcels). There were so many people that I struggled with the dexterity to get my bag off my back. To accelerate the process, I set my hand-bag down on my seat directly in front of me, lifted the pack to the rack and glanced back to my chair. In a matter of seconds, an abduction had occurred. The hand-bag was gone.

The bag that hadn’t once deviated from my line of vision so far, had disintegrated. It contained the following:

1) 1 US passport (a horrible picture yes, but vital for survival)

2) Over $240...a global stack of currency including dollars, rupees and shillings + 1 Mastercard

3) 1 Nokia cell phone containing all valuable phone numbers

4) 1 Cannon camera and flash-drive housing ALL my photo documentation of my travels

5) Eye glasses, my good/getting better book, my really good chap-stick....more and more.

Shocked and starting to shake I looked both directions but in the thick of the crowd I couldn't pin the culprit. I pushed to the left and than to the right...no dice. A split decision was made. I couldn’t get stuck in the foothills of the Himalayas with no passport, no money, no friends. I grabbed my backpack and de-boarded as the tears started to well in my eyes. I sighted a guard, meandering through the sea of people, his hand resting ever so calmly on his AK-47. I begin explaining what had happened as we stare at the kaboos and we watch the train slowly begin to roll away, my belongings as an unwanted passenger.

The welled tears were changing to salty streams. A crowd began congregating and I couldn’t help but think why, in a land that claims to be so holy, would something like this happen to such an angel? I was helpless indeed.

From the sea of observers, a random man was selected by the guard to show me the way to the police office. Fifteen minutes later, I find myself inside a windowless room with a smelling of strong sautéed onions. I was instructed to fill out my name and US address (so they could later send it to me if found?) on a blank piece of paper. Language barriers had never been more frustrating than in these 20 minutes. The stoic guard across from me didn’t even bat an eye. He saw this business everyday - naïve young travelers trying their luck with the desparate dispsition of New Delhi - and I could tell he didn’t feel bad. I knew that it was gone. I needed to come to grips with the reality.

But, it wasn't that I had lost my beloved physical possessions, my passport, all my money, my pictures of the world...my potential glossy lips. It was that my spirit had been crushed. My feelings ripped from my heart (the one I apparently follow) and blended into a curry sauce to be sprinkled in a urine scented train station. I was furious. Enraged that India hangs on the thinnest thread of survival. That thievery and begging and desperation is a mindset and lifestyle inbred and vibrant at every single moment. That this crooked system is corrupt and inhumane, relentless and unkind.

This story has so many complex intricacies but in short, by the grace

of Krishna, or Ganesh, Shiva or Ram...whoever, my bag was later

FOUND!!!...on the train, in the bathroom with everything in

it...passport, phone, mastercard, flashdrive....GLOSSY LIPS! (Of

course minus money and camera). Sada Sat, a saving grace, spent close

to SIX hours hindi-talking his way into tracking it. The bag was sent

back to Delhi the following morning, where we were reunited amongst a

$50 bribe and Chai.

But, the stolen bag saga doesn't end here with a happy reunion.

Because if it did, life would be normal. So please, keep reading.

Happy to see my glasses (quite literally) I immediately put them on my

face...and totally shocked that my passport and mastercard weren't

taken to be sold on the black market, I put them as close to my body

as possible. Praise allah because not even 30 minutes later...while

using the bathroom in McDonald's, the bag is stolen once AGAIN from

Bhani and Sadhs car...with their much trusted driver watcher over it.

(we are dealing with professionals here!!!!) A mystery? Yes. A

shocker? Considering my luck, not really. Words could not even exit my

mouth, I was so beside myself.

(This is where the Defeat comes into play). I am seeing the

signs...they are blatant and sooooo obvious, that I have clearly

overextended my vacation. Can you really call it a vacation anymore?

When the fun, relaxing, laziness of worldly travel turns into rage,

fear and emptiness? ("I know you can be overwhelmed, and at times I

feel underwhelmed, but can you ever just be whelmed?") That bag was

serious bad juju and for some reason is not meant to be in my

possession. But like Dengue Fever has taught me, everything happens

for a reason. And like Sharma read from my very own palm, I need to

listen to my heart. My heart, my mind, my bank account...they are all

telling me that this needs to end. Home SEEMS to be where I NEED to

be....barred inside with no belongings and no mosquitoes.

India has tickled every edge of my comfort zone. And although I didn't

take one single yoga class, or get to see the Taj ;( , a lesson has

been learned. Travel has taught me that patience is not only a virtue

(and a group of sick people), but that it is the sole travelers true

yoga practice. The ultimate testament of mind over matter and complete

detachment of anything physical. The art of complete submissiveness.

Breathing deeply even when you feel so stiffled and hot and irritable

and frustated, it hurts.

I write this email now from Arusha...ending my India exploration short

by 12 days and figuring out the details to head home (quickly) before

4 successful robbery attempts turn into 5. (Ethiopian Airlines lost my

bag in transit in Addis Ababa...typical...so it may take some time)

With all in hindsight, I am happy and healthy and although Tanzania is

in full bloom with it's tropical green hues welcoming me back and

pleading for me to stay, reallity is calling me back. And with my

heart, my gut...my analytical mind...I am answering.

Wear a money belt...

Love Jamie

Beautiful life, Healthy body

With each breath, the pinching increases. I can't find a comfortable position. I am healed over, hands on my waist, trying to create space in my chest. It feels like the tip of the sharpest knife digging right beneath my fourth rib; an elastic band squeezing my heart muscle without reprieve. Tears start to well in my eyes and I can't seem to calm my nerves. I lay on my stomach and try to imagine my heart pumping at a slower pace.

I lay and think about how robust one must be to surround themselves with sick people. Daily, I am immersed in an environment that harbors illness. How I haven't keeled over from pneumonia is shocking. How I haven't been attacked and knocked out by a psychopath is even more surprising. I once thought that I was tough enough to withstand anything and everything. As I grip my chest in pain like an obese smoking coke addict, I realize that even super-humans have their limits.

My thoughts start to wander from my own aches to chest pain patients I see at the hospital. Span three weeks ago, I had two of the more impressionable.

Days after his 18th birthday, a 6"8' freshman basketball player for a local university took a hardy spill onto his face in the mayhem of Haight street. He claims he was standing on the corner, by a curbside and obligatory garbage can, chatting with a few ladies, totally sober and drug free. The next thing he knows, he is riding code 3 into the trauma bay on hard backboard with a stiff collar around his neck, startled with his broken face. And how.

The brand new adult had several broken teeth, gashes galore along his chin and cheeks and it was evident by just looking at him that his jaw was crooked. Blood oozed from his ear. He couldn't range his shoulder. He started crying.

Him: My face is so broken! (cry cry cry)

Me: I know it hurts, but I promise, it is not as bad as you may think.

Him: Really?

Me: Yeah, your entire top row of teeth are still there. (I just couldn't bare to speak of his lower row...) And your nose looks totally straight.

Him: What's wrong with my jaw? My ear hurts.

(since his jaw was totally jacked it sounded more like "Whuts wong with muh juh? Muh err hewrts.)

Me: Well, it looks like your jaw might be broken.

Him: CRY CRY CRY

Me: But you know what, we are going to fix it. And this cut on your chin, we are going to have the plastic surgeon sew it. Which is great.

Him: I have a cut on muh Chinn? CRY CRY CRY

Me: Is there anyone you want me to call? Any family in the area? Mom? Dad?

Him: Don cull muh mom. Don cull muh mom.

Me: Ok, we won't call your mom....yet. Do you have any friends who would like a call?

Him: Yuh, I wa with two girls. I thin they came to the hospital.

Me: What are their names?

Him: .........I dun know............I met em a few days ago.

Me:........

Him: They arr pwetty

I take a stroll though our waiting room. I see a drunk passed out in his wheelchair. An adorable mexican family with 5 children...runny noses attached to all. An older lady who had just been discharged trying to extract coins from the vending machines. And as if they were two fish out of water, I see normal looking college kids. Ahhh.

Me: Are you guys with Joe? (not his name but lets just call him that)

Them: Yes! Oh my god...Oh my god! Is he okay? Oh my god! Is he going to be okay?

Me: oh yeah, he will be just fine. He broke his jaw and has a lot of cuts and bruises but he will survive to show the battle marks. What are your names?

Girl 1: Olivia

Girl 2: Olivia

Me: You are both named Olivia?

Girl 1: Yep

Girl 2: uh huh.

Me: Ah yes, Olivia...and Olivia.

I smile and walk away after telling them that I will come and extract them from such a scary waiting room as soon as Joe is back from his cat scan. They thank me profusely then turn to take their seats next to a smelly, shoeless man licking the inside of a Dorito bag.

Joe was where I left him, in the trauma room getting a few Xrays. I report back that the fine ladies who have come to his rescue, and what seems his new and best friends, are named Olivia and that they are indeed pretty. He is crying even harder.

Me: ohh, does it hurt? Do you want more pain medicine?

Him: My gurlfrien bwoke up with muh yestaday. CRY CRY CRY

What?! So this kid just moved to San Francisco for college, recently turns his childhood into manhood, gets dumped then falls 7 feet to a crashing demise. Un Fun.

Me: She did? Where does she live? And how long did you date?

Him: LA...fwee years. (thats 3 in broken jaw talk)

Me: Look Joe, your face is going to be fine. You are a strapping young man and at the peak of your youth. You just moved to an amazing city where the girl to guy ratio is like 7 to 1. You know, we call you a tall glass of water around these parts. Do you realize how much you can capitalize on that? See, the Olivias are subjecting themselves to the grossest situation I am sure they have ever been in by just stepping foot in this hospital...because they want to make sure you will be alright.

For a moment his crying had calmed. He took a deep breath and started to relax.

Me: I am going to put you on this portable monitor and you are going to be taken over to the CT scanner. When you come back, I will clean off your face, okay?

Him: Are you coming with me?

Me: No another nurse will take you...

Him.....CRY CRY CRY

Me: Joe, do you want me to come with you?

Him: I know this sounds werd...buh will you come with muh? I don't wan yuh ta leave...

It was the first time in a long time where I felt so appreciated. I am so used to demands and orders and screams that I was completely taken off guard that a completely rational and scared 18 year old needed me. I told him I wouldn't leave him. I was his shield from the reality of bad health, hurt wounds, gross ER's.

When we were reassured that his brain wasn't bleeding and his stitches were meticulously placed, I allowed the Olivias to come in. Their excitement exploded with energy that is reserved for underwater volcanoes in the pacific. It was as if they were long lost siblings who had been taken away to monstering foster families at the ripe age of 9. They threw themselves onto the gurney in unison, delicately trying not to aggravate his ailing body. He matched their enthusiasm with an equally baffling charge. He instantly turned from the scared had-been adolescent, to a courageous, unfathomed man. His voice instantly got deeper as he joked about the silly IV in his forearm and the unnecessary pillows propping his right, intensely swollen elbow. When they were getting ready to go home, they asked me for a note to excuse them from class in the morning as it was already 4 am and the two of them had been up all night. I immediately felt old. Anything for Joe.

So what does Joe and the Olivias have to do with my razor fierce chest pain? We had done an EKG on the young chap, testing the electrical rhythm of his blood pumper. Low and behold, it was abnormal. Meaning that all the electrical connectors in his heart cells weren't adding 2 and 2 to make 4. His ventricles were enlarged and causing a disruptive pathway to safely and effectively pump blood to the hot spots, mainly his brain. This causes a dizzy spell then a blackout phase...in laymen terms. Joe had denied anything like this ever happening to him before. Who just passes out and wipes the cement with their face? But as I dug deeper into Joe's high school relationship and as I mothered him in Trauma 3, he divulged to me that indeed this had happened before. When he was 16. The picture is now clearly being painted on an enlarged canvas in my head. Joe has a heart condition :(

Back to me.

I get ready for work trying to ignore the fact that standing up straight is nearly impossible. I pop some ibprofen and gear up for a twelve hour rendezvous with San Francisco's finest ER regulars. I power through it, because I don't know what else to do. By 6 am, I can't support myself without the help of a table or countertop. Praise the fine workings of baby jesus that I am completely trapped by medical professionals that convince me to "rule things out". I settle into Zone 3, and cry as I get my very own EKG.

Which turns out to be abnormal. Say what? You mean, I am not the healthiest human on earth? You mean, this chest pain could very well be something serious? AM I HAVING A HEART ATTACK? Blood is drawn, sent to the lab and also slightly abnormal. My head was starting to spin. I lay in a gown, under a sheet which I am sure has once covered a dead body and gaze at the cardiac monitor. My pulse is all over the place. 72. 83. 76, 98, 75, 86. When I sat up...it jumped 20 more points.

The short of the long is that I wasn't having a heart attack (phewsh). I wasn't even having a Pulmonary Embolus (double phewsh phewsh). Pericarditis they thought? Maybe. GERD...reflux....? Perhaps the murmur that I was diagnosed with at 21 was causing it? Doubtful. My millions of doctors weren't quite sure but it was wasn't a cardiac emergency so I was safe to go home.

It looks like Joe and I were surfing somewhat of the same wave. A silent abnormality with our number one ticker. Scary. I wonder when he decided to call his mom.

Joe is the sentimental patient. I felt bad that he would most likely be spending the first few weeks of his college experience with his jaw wired shut and his wounds slowly healing, all while watching his fellow basketball players from the bench. It made me appreciate that my work in the ER isn't all for nothing.

But then I get a patient like Mr. "Saps" (not his real name because I am not looking to get sued here.)

Mr. Saps is one of the regulars who presents with "unbearable chest pain" at least once a week.

I. Am. So. Sure.

The man sits in the hallway, refuses to take his t-shirt off so we can evaluate him and demands hot tea while people are dying, quite literally, right next to him. He certainly chose the wrong night to play chest pain while conveniently was assigned the worst nurse ever (me). It was busy. There were a million traumas. And Mr. Saps was complaining that he hadn't eaten since 10 pm....only 3 hours prior. He would stand up, disconnect his own IV and wander the hallway. No matter how many times I asked him not to. He looked me in the eye, stood up and started walking outside so that he could smoke a cigarette and phone his daughter in London. Not even my sweetest of sweet talking could convince him to sit his fat ass down.

And then it started. I became angry. I raised my voice.

Me: Mr. Saps, you need to sit down....or else I will have to restrain you. (eww)

Him: (in some eastern european accent) I need hot tea. I am hungry and haven't eaten in hours.

Me: No, you do not need food. You need to lay back and take deep breaths because your heart isn't working right!! YOU KNOW THIS ROUTINE! We are not a cafeteria. Did you come into the ER at midnight so that you could ask us for food? Worst idea ever. Sit down, stop getting up and quit asking for something to eat and drink.

Him: My wife is prettier than you.

Me: Yeah right.

And it was loud. He stared me down and told all the doctors that he wanted a new nurse. (I guess there really is a first for everything) He pointed at me and screamed my disgrace. Mind you, this is all occurring while my own heart is fighting for normality. I sat down and retraced my verbage. I was fighting with a patient and couldn't believe it. With all the chaos I deal with on a regular basis, I had finally reached a tipping point with an old chubby Russian.

When it was time to take him upstairs to his room on the 5th floor, I couldn't get moving fast enough. In the middle of bike crashes and stabbings, I threw his chart on his bed and started pushing him as fast as my sickly body could go. Our conversation in the elevator was sweet.

Him: You are a snob.

Me: Oh really? Well you are our least favorite patient ever. Did you know that? There is no one else we dislike more.

Him: You hate your job. I need a nurse who likes their job.

When others entered the elevator, I bit my tongue. The whole ride up I imagined pushing his gurney off a towering cliff that hovered over jagged rocks...

We stroll onto the 5th floor. He makes eye contact with a few of the nurses and they high five him.

"Ahhh welcome back Mr. Saps! How you feeling buddy? You're looking good. Ahh man, I can't believe you're back. How is the misses? Good to see you!"

Him: See, some people like me.

Me: Good for you...

I dumped him like a sack of molding compost and rolled my eyes at the lame nurse who praised his presence. I couldn't believe that he was someone that people actually looked forward to being around. I have since doubted all 5th floor nurses and their judgment in all things great.

I needed a serious reality check. What am I doing? I am working in the highest stress environment, at the most unhealthy time of day (nights), dealing with the most unmanageable people, while living with a flailing heart. And I chose it. It is not in my character to fight with people. I hate it. I hate being and feeling grumpy. I am a smiler. And a laugher. And a 'hey lets be good friends'er. I felt like I was being taken over by a negative nancy.

So, what do I do when I don't know what to do? Yoga.

I feel suspended in air as I rest on my back in a puddle of my sweat. Nothing seems to wring out my soul like a hot hour and a half of twisting, bending and breathing. Inhaling the good, exhaling the bad. In with the Joe's, out with the Mr. Saps. It always tends to ease my emotions, knowing that no matter how far away I may feel from sanity, that I can always turn to a practice that brings both calm and serenity. My left hand rests on my chest, my right hand on my belly and I envision a large, red, pulsating heart. I see the vessels that extend and vary in each direction. I see the flow of my blood run like a river. It is encased in a white bubble sealing it from distress, from anger, from unhealthy sentiment.

I remind myself that even those who power their bodies with goji berries, bee pollen and various other superfoods, can have trouble arise. Was I cheating myself all those times I opted white instead of red wine? Damn the Sauvignon Blanc. Was it all that running? Tread lightly. Quit my job? There are Joes and Mr. Saps in every aspect of life. Runaway to a far off destination? Tempting.

At the end of class, we chant the obligatory OM, and the teacher closes with one statement...

"Beautiful life, Healthy body"

This is what it must mean to take the good with all the heartache. How appropriate as I sip a malbec.

The Aftermath

After more than a month of returning from Haiti, and a few glasses of wine into the night, I am finally sitting and taking the time to "have at it" with my experience with the aftermath.

Pictures can tell a lot and so can news casts and magazine articles, but nothing will bring it home like an actual visit. I was there for only a week, so I claim no ownership in the rebuild. However, it brought out every emotion you could imagine and even though I saved a few lives, it is devastating to think about how such a resilient people have been blasted yet again.

Lofty and high, I glance down to a view I have seen numerous times in magazines and text books. From the air, Haiti, a dry and deforested brown tundra outlined by the bluest Caribbean water. With the cool breeze of the condensed air conditioning blowing on my face, I think about everything this country has endured.

I sit nervous in my cushioned airplane seat and wonder how the following 8 days will go. I try to remind myself that this is exactly why I went into nursing...to work with those who have nothing. To provide a skill that can help people live healthy lives. To see different cultures...to travel the world.

Like most developing countries, there is no rhyme or reason to orderly things. Lines don't exist, wait times are extravagant and I am certain that the metal detectors we walked through on touch down were turned off. Very typical. We gathered outside the terminal with an unwelcoming swirl of humidified heat to find a mass of Haitian hands grabbing the rails of the gate. A million little eyeballs fixed to the newest crew of white volunteers. We couldn't decipher if they were welcoming stares or angry glares. Either way, it felt intense from the moment we landed.

Project Medishare is a partnership with the Miami Global Institute offering relief to the victims of the earthquake. Putting us 2 months after the quake, I anticipated my time at the makeshift hospital to pair more with medical surgical wound care than trauma resuscitations. We had a taste of everything. The Emergency room was set on gravel and the OR was hidden between shelves of surgical supplies. With its 70 bed adult ward and more than 50 pediatric patients, including the very first and only NICU and PICU, it was an oasis in the sultry heart of a burning dessert. It was a full force of multi-disciplinary teamwork, in the middle of the poorest country in the western hemisphere.

I could rant on about the discomforts that come with 105 degree work days and the truth that came from being hungry and itchy, but I guess that you get the point. I know that for most volunteers, the reality that home was only days away, gave serenity in our nearly flattening heat coma. The UN, blesstheir unorganized presence, provided cold beers and french fries for our moments of starvation, not to mention endless entertainment of Bolivian soldiers shaking their Latin hips to songs from a crusty radio.

It was more than sad. The roads were nearly impassible. Intersections completely blocked by fallen debris. Most buildings pancaked to the point of unrecognizable cement. The government building, which once stood so white and round, had completely capsized and stood on its side. Schools gone. Hospitals gone. Bike lanes....not a priority.

Every week, the hospital would open it's iron clad gates (barbed wire) to fresh volunteers. On average, people stayed for a week only, some opting to extend. A large white circus tent erected as our lodging with rows and rows of cots. They were actually quite comfortable and if you were lucky, which I was only after my first assigned area flooded, to be placed in the back left corner where the air conditioner blasted your brains out, then sleep came with ease. If you were a night shifter...which praise Allah I was not, you would have to endure the balmy hundred degree day temperatures which made for a toasty nap. No one could complain. It was shelter and pretty cush for Haitian standards.

Locals would arrive at the hospital early in the morning to sit for hours in hope they would be seen by a doctor. Just like in the states, it was common to see everything from complaints of headache and fever all the way to full thickness body burns and car crashes. At triage, it was our goal to pick and choose which patients needed immediate care as our goal at Medishare was to serve as the trauma center and emergency room only. Imagine looking upon a row of the thin and ill, and handpicking a select few who are to be seen by a doctor. Horrible. All other complaints were referred to outside clinics and the county facility.

Except for the children. We held no restraints on the children. Every baby was given oral rehydration bottles and brought into the shade. Most were admitted for malnutrition, typhoid, malaria and oddly enough hydrocephalus, a condition that literally means "water on the brain". It was shocking. There was such a high number of babies born with this disorder it made us think there was something in the water or perhaps, a lack of water. The brain swells to astronomical size because intracranial fluid can not regulate normal levels and drain properly. The pediatric ward looked like a room of bobble heads. The solution? Surgical placement of a shunt that allows passive drainage. The amazing thing? The surgeries were possible as there were world class surgeons readily available in our world class open air operating room.

It was really incredible. Hard to find the right word to sum it all up, but I am glad I went, I am glad it is over, I want to go back, I hate really hot places, I love speaking foreign languages, It is frustrating being lost in translation, It was really funny, It was terribly devastating, I saw reality, Things and people can be faker than you think...

http://picasaweb.google.com/105817120290451146874/Haiti#

A link for my pictures. I am not the best at whipping the camera out to snap photos, but here are the few I gathered.

Haiti Bound

We have all seen the news. CNN can't get over it. The images are devastating and when you hear over and over again the magnitude of the quake, something deep inside your heart shakes more furious then those tectonic plates.

Haiti seems to never catch its' break. Ravished by poverty and a corrupt government, the Haitians seem to continually be hovering right below the water surface. Drowning with every unfortunate circumstance that attracts to them like a magnet to steel. I can't see any fathomable solution to a lifestyle so desolate. They are starving, they are poor, their landscape has been forested and pulverized, their workforce monopolized. Even their neighbors to the east in the flourishing Dominican Republic, cast them as second class.

So what to do? Send money. Send supplies. Financially support an organization whom you put total faith in.

When the tragedy first hit the Caribbean in January, my most obvious first reaction was "Shitballs, San Francisco is next." I have recently become completely freaked out with the notion that giant tectonic plates are sliding up and getting cozy with their other flat and hardy neighbor. First it was the smelly seals at Fishermans Warf...one by one.. heading north to Oregon. Then, Haiti is rocked (literally) to the most devastating degree. And finally, Chile, whose disastrous 8.8 quaked our days a zillionth of a second shorter by changing the tilt of the earth. Of course San Francisco has had a drill or two to prepare the city for what could be the next "big one" which may give us an upper hand in the aftermath, but I am hoping to the highest and most fictitious god in the lofty heavens that I am out of town when one San Andreas Fault decides to get down and shake its rump.

So, after that first reaction of "thank god its not me and wooohooo for not being Haitian" passed, my more compassionate side kicked in and pensively thought..."I should go help with the relief."

I filled out forms noting my incredible resume of knowing how to deliver babies AND deal with drunk people who fall, hit their head, bleed profusely and possibly break a fibula or tibia. If Haitians didn't have a problem with binge drinking before the earthquake, they certainly will now. Wouldn't the Red Cross be happy knowing they are staffing a nurse who can deal with their post-drinking tremors and their crush injuries? But no, I heard nothing. Just updates about how the military was sending in all their medical personnel and that too many have offered to help...there was no need for a nurse like you.

It was weeks later that the idea came back and tickled the inkling to travel down south. Dr. Singh, an emergency physician I work with, was joining forces with some of her UCSF Medical cohorts, creating a University of California at San Francisco contingent to head down there. They needed nurses badly as, to be expected, people were sick and getting sicker from open wounds. Did anyone want to go to Haiti? All you have to do is fly to Miami and bring a sleeping bag.

Sign me up.

And so now, I have just popped the third of my four oral anti-typhoid pills and have just hung up the phone with Phil, the nice yet repetitive man at REI, who is holding for me the last Mombasa Defender Mosquito net http://www.rei.com/product/728960 in all the Bay Area. In combination with Malarone and no less then 13 bottles of DEET OutDoors, I am hoping I can ward off such known diseases like Dengue Fever. (I couldn't be less afraid of malaria) Nothing would be more tragic then my liver and spleen experiencing another bout of that raging bull...not even another 7.0.

There will be about 40 of us I think from UCSF. Nurses, doctors, respiratory therapists alike. We will be working in cahoots with the University of Miami school of medicine and the Global Health Institute at the hospital directly next to the Port au Prince International Airport. It was leveled right after the disaster and sits right on top of swamp. Which should prove to be quite interesting when the heavy monsoons strike, scheduled to arrive right around the time we touchdown.

But the boggy underground and the noisy 747 airplanes are not the only concerning aspects of this situation. Here are a few more....

* Temperatures are topping around 95 degrees in the daytime with sweltering levels of humidity.

* Military style meals will be provided graciously from the Global Health Institute but I hear they go fast so if you are not ready and present at distribution.........let's just say I could feasibly lose a pound or two on this trip.

* We will be sleeping in a 140 person volunteer tent, cot-by-cot. Apparently there is a camp-wide scabies outbreak and chances are pretty high that everyone who comes to volunteer, leaves with those little bastards biting your skin. I would rather get typhoid....

* There are four showers for the entire refugee camp...and water is never promised. I will be lucky if I don't come home with dreadlocks.

* Most patients are in need of serious antibiotics. All the charting is done on loose leaf paper sheets so it looks like I will need to learn how to calculate drip factors and dosing rates as I won't have any of our fancy schmancy brain IV machines to do the work for me....oh brother. Use my brain?

* Family members have been unplugging their loved ones' wound vacs, a silly machine that could possible keep them from going septic and dying, and replacing them with their cell phone chargers. I don't think it will be like the trauma center here, where I kick out family members for being annoying and obnoxious. I have a feeling these family members might make me cry and feel guilty for living a very comfortable and easy American life.

It looks like it is destined to be a very challenging week ahead. I just hope I can hold it together and stay focused on what needs to be done. If I even for a second let down my guard, I could easily come home with two or three babies and a bearded old man. They could live in my sauna room!

Anywho, I am so hoping no governmental coups take place like they did back when I was very first scheduled to go to Haiti in 2004. All packed and immunized, just a week before takeoff, Aristide, the dominating dictator responsible for nearly all the downfall of the Haitian people, was ousted by local guerrillas. Boooo. I was then detoured to El Salvador where on my 21st birthday I sat in the campo, surrounded by horse flies, purple soda and hot dogs. The local people had thrown me a surprise birthday party! With hotdogs! I was given the only refrigerated beer in all the land. Jealous eyes from my travel companions stared as the cold bubbly slid down my dry throat. Oh what could have been in Haiti....

So send me good luck wishes as I am sure I will need during this mentally, physically and emotionally taxing time. No need for donated medical supplies but if someone could send me there sleeping bag, as my sister was too selfish to send me hers, that would be fabulous. (just kidding, I just want Sam to know that I am the giver in the family.)

Love to you all. I will keep you posted in the days to come. Seek stable ground if it starts to shake and remember that when heavy things fall onto your bones...they possibly could break. Steer clear from obvious fault lines and for good measure,,,,wear a helmet every minute of the day.

XOXO

Jamie