Tuesday, December 13, 2011

Maybe, 2 ½ hour drive to the lake …



Nothing like a weekend in the country to unwind and relax after a hard week of technical difficulties. Nothing like the great outdoors to revive your spirits and awaken sleeping muscles. Nothing like a 2 ½ hour ride to a picturesque lake, a bit of Mongolian barbeque and a restful night in the great outdoors. Nothing like it. Nothing, at all.

I could not write this blog - seriously. You would have been bored to tears. What made us laugh and cry about this adventure does not translate. You gotta feel it - the wide open nothingness, surrounding you. You've gotta smell it - the dung fire heating the ger. You've gotta pee in the wide open spaces under that gigantic blue sky. You've gotta fly a kite on the top of the hill, see a functioning ancient district hospital, bare knuckle down to the lake, cartwheel at the lucky rock. You've gotta sleep in all your clothes, snuggled up with your best buddy in a child size bed, and still wake up everytime the dung fire goes out. You've gotta see the foggy morning rolling over the ger camp and the hawks circling high above. You've gotta remember to get a seat in the land cruiser. 

The pictures don't do it justice. You've just gotta ...

It's about the sky
This is why you ride in the Land Cruiser
Temple of this Dog
And we had pringles too ...

Cartwheels



Yes, I travel with a kite ...


The Lake after 9 hours of a 2 1/2 hr drive

Good Morning

Breakfast
Good Morning Mongolia




Wednesday, July 13, 2011

Rabbit, Rabbit (July 1, 2011)

I am tragically behind on this blog. Busy schedules, sleep deprivation, spotty internet, the usual excuses. We leave Mongolia today! I will hit the highlights on the blog in the next few weeks as I sort through this  experience from my balcony overlooking the Platte. For today, I give you the highlights of July 1st ... Bjoern joined our team and brought re-enforcements (medical supplies, toilet paper, horse sausage, cheese and german candy called apple shachft); JQ left us; we did 4 lap choles in COLOR and actually got some teaching done; and the night deteriorated into a mini-bar clearing party in my hotel room. But what you really want to hear about is the weekend .... stay tuned! and Happy Birthday Uncle Friday!!!  

Kids

Scott, Alli, and two post-op appy patients

Thursday I got to operate on a 13 year old boy with an inguinal hernia. The orthopedic hand surgeon assisted, and like all the other pediatric cases I have done here, the patient had a spinal anesthetic. So strange to be able to smile at your patient over the curtain as you are dissecting the hernia sac off of his spermatic cord … I’m just saying. 

The first night we were in Arvaikeer I assisted an open appendectomy on a five year old. Again under spinal, this child did not cry or squirm or protest as we worked. These children DO NOT get sedatives … just a spinal anesthetic. Can you imagine an American five year old holding still without some sedation?? These children are stoic.

I don’t get to do a lot of pediatric surgery on these trips, but when I do, I tend to marvel at the universal grace of my patients. The pediatric post-ops were all boarded in the same room directly across from the operating suite. We spent down time playing with them in the hallways and taking goofy pictures. They recharged us, made us laugh and helped us through our slow days.

I’ve said it before, and I will repeat if forever – kids are kids, wherever you travel – and they are magical, and beautiful, and joy – pure joy. 

5 year old appy patient - post-op

Ortho surgeon and hernia patient - pre-op

Scott and Jaja

I love what I do!!

Monday, July 11, 2011

Mongol/Basque Queens


This year the Swanson Foundation partnered with SAGES Go Global (http://www.sages.org/projects/global_affairs/) on our trip to Arvairkheer. In pursuit of the common goal of teaching laparoscopic surgery in developing countries, SAGES offers the Swanson Foundation an increased network of surgeons  and stronger industry connections. In addition, SAGES Go Global has organized an evaluation system used to assess the effectiveness of our teaching methods. The benefits of this relationship are obvious to both parties; but for the team this year, the biggest benefit was our time spent with JQ.

While in Mongolia, I read the book The Secret History of the Mongol Queens by Jack Weatherford. It was a fascinating insight into the powerful, bright daughters of Genghis Khan and their descendants. The daughters took control when the sons could not. The daughters found ways to learn from historic mistakes, and rebuild an empire that the sons had allowed to self-destruct into chaotic, internal conflict. It was a great, true historic tale of strong, capable women.

And then, we had our Basque queen, Jacqueline. Our fearless, capable leader helped us get lectures going, kept us fed and watered, and brought the fun along with her surveys. She insisted on taking the reigns – literally (when we went “camel riding” she made her escort leave her alone on the camel.) Thursday night we had to say goodbye as JQ headed back to the US. After our trip to the ger (see previous blog) we ended up at the local wedding palace for a team dinner, gift presentation, Mongolian flute performance, vodka toasts, and a surprise dance party (complete with flashing lights, limbo and jump rope). Surreal, yes; but all just part of a normal day in this Mongolian adventure.

It is always an honor to meet a fun, smart, capable new friend. JQ, from west side Mongolia, to west side USA – we love you!! We miss you!!
Cody and his Mongolian wife
Orthopedic Hand Surgeon playing the Mongolian Flute
Cashmere for our Queen
Allison and Tuvsho - Limbo!

JQ and a young member of the West Siiiide Posse :)

Wednesday, July 6, 2011

“And all I wanted was the simple things, a simple kind of life.”–Gwen Stefani



By our third day of operating, we managed to rig one “color” monitor. Subtle shades of pink and pale green added enough variation in our visualization and we were able to make slow progress with our teaching. We finished three cases and had plans to see JQ off with a trip to the countryside and a dinner with the hospital staff.

I have witnessed nothing as simple as the life of the Mongolian people. Today we visited a ger. Driving in an old Russian van over dirt roads we joked about the practicalities of having an address and the comedy of attempting to give friends directions to your house, but when we arrived, the silence, serenity and vastness of the landscape made sense. Silence, and space, beauty and peace – sweet peace.

The landscape is tree-less pasture as far as one can see. There are rolling hills, and mountains, in soothing shades of green and purples. The sky is vast and expressive. Clouds shift in the wind, slowly. The silence is hypnotizing and the simplicity is beautiful.

These people raise sheep, goats, horses. They make yogurt, and cheese, and fermented goats milk alcohol. Dung fires heat their small homes and cook their meals. The wear heavy “deels” covering their whole body and tied at the waist with a thick wrap. Simple.

As we watched the family milk their sheep, we began to hear distant bleating. The tethered ewes became restless and started returning the calls. Slowly, the volume increased and the energy seemed to change. There was an urgency. We watched as a herder on horse back lead the lambs toward us. The ewes were untied and the cacophony came to a crescendo as the lambs ran to their mothers to feed. No wasted movements, all fluid and grace. Such a simple moment, so amazing to witness with all its sound and motion.

“a simple kind of life …




Tuesday, July 5, 2011

Monday, July 4, 2011

The Blair Witch Project: Arvairkheer



“I am so scared …”
June 28th, 2011. Our start this year was fraught with some interesting challenges. Flickering images on a 15 inch monitor were interrupted with crackling electric surges. Five minutes of crisp, clear picture would suddenly disappear. After trouble shooting the camera, the light box, the camera box, and all the cords in between nothing seemed to work. Blank screens stared back at us as we wondered how we were going to get over this hurdle …

We started asking questions, raiding closets, and digging up old pieces of electronics. Idle, early generation laparoscopic equipment began to appear. Antique camera boxes, old cameras, we pieced together random parts donated by various organizations and patched together our mismatched solution. And there, in the operating room that is smaller than my closet, we performed laparoscopy … in black and white. Blair Witch lap choles – that’s the way we roll.

Blood/bile?? Not sure. Black and White. It was a surreal, retro experience that pushed our surgical skills and intuition to the limits. We made it work.

After completing our laparoscopic cholecystectomies for the day we were approached by an Australian aid worker we had met at our hotel. His translator had abdominal pain and everyone was convinced it was appendicitis … could we help her out? We moved our mismatched laparoscopic tower and set up for a lap appy.

And in the end, we walked home well past dark through the dusty, rock laden streets, wearing headlights – another Blair Witch moment to this Blair Witch day.  “I am so scared …”

Scrubbing with Allison


Thursday, June 30, 2011

Jumping the Shark/Dismounting the Camel … you decide

It’s tricky business, dismounting a camel. Not your usual, everyday, American experience. As the tall animal drops onto its front haunches, kneeling down, you have to lean way back in order to avoid going head over hump into the sand. It is a bit of an adjustment, a bit unsettling, a bit frightening. At least that is my experience.

So we are back in Mongolia. The newly named “Price Posse” has taken over the only operating room in the town of Arvaikheer, Mongolia. ‘Lonely Planet ‘says to skip this place unless you need petrol. We are here for two weeks.

Getting here was the hardest part … overnight to Beijing, layover, flight to Ulan Bataar, reunion with some dear friends from this far away land and then onto the van. Nine hours crammed into a van with our luggage and lots of snacks but no shock absorbers. We bounced through the desolate Mongolian countryside on relatively paved roads. The vistas were beautiful, the monotony quieting and the bouncing, mildly traumatic.

We stopped mid-way through at this mirage of a tourist trap know to locals as “Sandy Land.” And there for $5 US I learned about dismounting a camel. We were led around by enthusiastic young entrepreneurs (mine wearing a ‘Harvard’ hat) and soaked in the experience of being so far removed from what we know.

And now, we have dismounted the camel. Ice cold showers, nothing but mutton, rock hard beds, bring your own toilet paper, massive candy consumption and the laughter and love that come from working through all of it as a team. Adjusting the balance, stepping off gracefully, not toppling head over hump. It is just another grand adventure …

Allison and Suz in the Van ... 
Mongolian rest stop
"Price Posse" in "Sandy Land"



Saturday, June 25, 2011

Book Report: The Crisis Caravan by Linda Polman


An inspiring friend (who is mentioned in this blog more times than her humble self will ever admit) gave me this book to read a few months back. I don’t write many book reports but I thought this one was worth sharing on this blog. It is a pretty fascinating read and has provoked many conversations and email chatter amongst friends involved in service work.

I saw this book as a cautionary tale and also, a rallying call. It offered a wide perspective and global insight into issues and concerns that are often viewed at close range. The book has some harsh words for na├»ve, situationaly blind aid projects. The larger effects of even small generosities are exposed – sometimes as good and sometimes, as unintentionally harmful. The book does not dismiss or belittle the altruistic intentions in the face of human struggle, it simply points out that there is room for improvement.

The book encourages attempts to achieve a broader perspective, better communication (shocking I know!), and coordinated, goal driven efforts in situations where the scatter-shot approach is often the only approach. It asks us to be better at working with each other, defining clear obtainable objectives with measurable progress and outcomes. It asks us to help re-build crippled infra-structure, encourage sustainability and avoid areas of overlap. It asks us to concentrate on giving a hand up instead of a hand out. All of this is harder to do than to just throw money or physical aid at a situation but all of this is so much more empowering for people effected by natural and political disaster.

I invite comments on this book – and I understand it is an unbalanced viewpoint – but one worth examining and spending some time with. The world is smaller than we think, and the things that we do have an impact, ultimately on all of us.

Tuesday, March 22, 2011

Stephanie


Everyone grapples with the insurmountable obstacles Haiti faces in recovery. There is no way to spend time in the country, with its people, without somehow feeling overwhelmed by the hard hand this country has been dealt. But we all came to Haiti with hearts full of hope that somewhere, someday, this country will be healed.

Within four days of my return from Haiti, no fewer than five people had Stephanie featured in their facebook profile pictures. It is no surprise that this little one became the unofficial mascot of our time with Project Medishare and a facebook phenom.

She was at the hospital when we arrived on Christmas day. Tiny, gorgeous, spunky and getting better after a nasty infection. She needed wound care and some antibiotics, but mostly, she just needed attention. Her mom was always at her side - also gorgeous, small boned, fragile appearing, somewhat tired. After spending time with feisty and non-stop Stephanie, one quickly understood the source of her fatigue. Stephanie’s laughter would fill the whole courtyard. And her smile was a megawatt, bright lights, big city, heartbreaker, movie star smile. Unforgettable.

I was the one who okayed her discharge – I made enemies that day – but I craftily required that she return to wound care clinic for dressing changes – ensuring we would see her strutting around the campus up until our final day in Haiti. Stephanie was the energy we all needed in the middle of draining days. She was our sunshine.

In that small child, with her torn jean skirt and her dirty knees we wished for the future of this vibrant people. Her childish determination and spunk seemed enough to buoy our spirits and give us hope that all that Haiti has suffered, can be overcome. In Stephanie, we saw the courage, and tenacity of the Haitian people. We saw a spirit that knows great, unbridled joy in the face of so many unknowns.

To me, Stephanie represents our hope for Haiti – that it becomes a place worthy of this strong child’s future. Our hope that Stephanie can find happiness, and joy in her beautiful but injured country. Our hope for Haiti, laughing out loud and filling our hearts with so much joy. 

Friday, March 4, 2011

DIA (accompanied by Kings of Leon)


Re-entry. It is always after 9pm. Dark outside, while the iridescence of the terminal is uncomfortably bright. Those waiting around the gates are drearily wandering around or shifting restlessly in the uncomfortable plastic seats. I get my earphones in my ears and turn the iPod up loud as soon as I step off the airplane.  “…Running with the street lights, laughing at the grave, he swears he’s gonna give it up, it’s never gonna be enough…” This is reality, I am back, and I am not ready.

It is usually a long walk to the middle of the terminal, two escalators down and a wait for the next train. I turn the music up louder as I escape into the limbo that is the airport. “…I just wanna be there, when you’re all alone, thinkin’ ‘bout a better day... “

I don’t sit in the train, I lean against one of the poles by the exit doors, close my eyes and try to balance without holding on – train surfing to the music roaring in my ears. “...I just wanna hold you, take you by the hand, tell you that you’re good enough, tell you that it’s gonna be tough...“

At the end of the ride, up the escalator, and I walk quickly. There is no one waiting for me on the other side of the simple barrier gate. There is no sign with my name, no hug or smile to meet me. I just keep walking. “…’cause I ain’t got a home. I’m out here all alone...“

At the baggage claim I know I will wait again. I hop up on the cages opposite the carousel. Sometimes I lie down on the cage and close my eyes and just lose myself in the music “...‘cause I ain’t got a home...“

Sometimes I sit, dangling my legs, watching the people, making up stories about their lives. Over there is a team of dancers returning from the Orange Bowl, all wearing matching sweatshirts and sporting perky ponytails. There is a guy in a suit, making an important looking phone call and a little boy racing around with his backpack on, trying to evade his parents inescapably swift grasp.  A few feet away stands a cowboy – black hat and all – shifting uncomfortably in his boots. I close my eyes. “…Out here all alone, said I ain’t got a home...“

When my bag drops and rounds the carousel, I leave my perch. With one move, I pick up the bag, drop it on its wheels, pull the handle and move . . . down the escalator to door 413 and out into the bite of the cold, dark air that is Denver. My car is usually in K or L. I throw the bag in, jump in the drivers seat, iPod docked, and off, to pay for the parking and drive home.

It is dark and quiet when I get in the door. I have been gone awhile – it smells alittle stale. No Beau to greet me – I will pick him up tomorrow. I leave my bag downstairs dig out my cell phone charger and head up to bed. Tomorrow is an early day. Reality. I am back. I am not ready.  “…I’ll forever roam. I ain’t got a home.”

Monday, February 21, 2011

When I was Younger



"Take my hand, we'll make it I swear ..." - Jon Bon Jovi

Bon Jovi is playing in a tent next to the stadium. For real. I have a wristband for the party and I walk right past security as he is starting his set. Though time has softened the cocky beauty of youth on most of our faces, we recognize each other easily. The half of us who went to school together find this whole scene somewhat surreal. We are at a frat party - a really good frat party. The other half are too young to know these feelings, or were hired to make the place look extra pretty. At the back of the tent there are tables of free food, bars of free drinks, and did I mention, Bon Jovi?!

I have been back from Haiti for less than 48 hours and already, watched a paparazzi storm on the beach as Chloe Sevigny swam in the Atlantic, heard Vince Neil sing at a party full of playmates, swam in the National’s historic pool, and now, here I am, surrounded by friends from long ago, at a crazy party, getting ready to watch my team in the Orange Bowl. Haiti seems far away. 2010 seems far away. But they are not.

Less than 700 miles and 1.5 hour flight time from these shores, people are living in tents a fraction of the size of the one I am standing in. They are patching holes in those year old tents, afraid to move back into unsafe buildings. If they are lucky, a NEW tent will be their future.  As I drink my free beer, they struggle to find water clean enough to keep their children safe from cholera. It feels far away from this place, but it is there, in the back of my mind as I catch up with friends from long ago. It is part of me now.

I am wearing a sequined version of my team’s logo and it catches the eye of one of the younger party-goers. “Where did you get your shirt? Did you go to Stanford?”
“I got it at the bookstore and yeah, I did.”
“I went to Stanford too!” she says with slightly intoxicated enthusiasm. “Well, when I was younger I mean.” Suddenly she is serious “Like, last year.”

I smile. Inside I am laughing. I think of telling her to throttle back on the alcohol but I just keep smiling. It is an odd moment to reflect but something about the collision of my past and my present makes it impossible to avoid. At this dawn of 2011, I am struck by the 2010 that I just left behind. I had set out to learn, about medical service work, about other places, about myself. I stand here, amongst people who have known me for decades, and I love this life that I am privileged to experience.

2010 was magic. I now carry Mongolia, Belize, and Haiti with me. I have learned so much about myself and what I am capable and incapable of achieving. As I stand here, listening to Bon Jovi, I look back on 2010, smile, and think ... “when I was younger, like, last year ...”

First Day 1/1/11

All packed up and ready to go, there is a new team arriving - full of energy - and we are drained. (see photo below) Stefanie is running around making us all smile and the sun is shining. It feels like we have been here longer than one week. It seems we have known each other for longer than 7 days. It is hard to imagine not waking up to the roosters, making coffee in the pharmacy, anticipating meal delivery at 10 and 2, and escaping to the roof to breath. It is hard to imagine going back to “normal life.” We are shifting gears.
After countless group photos, we pile into the vans for the airport. We drink our way through the three hour wait . . . not much else to do at this point. 
It is a quick flight and we meet at baggage claim in Miami. Saying goodbye on the other side of customs, it is but an instant, and we have all scattered in our separate directions, to our separate lives. It is a lonely night in my big hotel room. It seems too quiet.

I miss my Haiti family.


Sunday, January 2, 2011

Better Days


630am 12/31/10

“Suzanne, they need a pediatrician in the ER. Mark needs you to come now.” . . . Somewhere in the back of my mind, the roosters were still crowing.
“I am not a pediatrician. Get Laura. Get Paolo . . . “ I say as I feel myself pulling out of bed, wrapping my hair in a ponytail, shuffling into my shoes.
“Mark said to get you.” . . .

We had just escaped the night and now, less then three hours later, there was another baby. 6 months old and unresponsive, cholera, no access. I unsuccessfully tried one 24 gauge IV and then someone passed me an interosseous line. I hit the tibia but I did not understand the odd mechanism – turns out we had a bone marrow biopsy needle in the kids tibia and I pulled the wrong stylet . . . Mark, the oncologist, got the IO line as I prepped for a subclavian. When we had the line, I took a breath and watched a baby, getting better, smelling that awful cholera smell, but looking at us, wide-eyed and full of life. Save. I went back to bed – for an hour.

Today was a strange day. Being the 31st, many people treated it as a holiday. Clinics ran half time, the staff seemed to run half speed. No one was harried – sure we ran another resus in the ICU, sure we did a few fun lacerations in the emergency department . . . but this was all mostly routine, easy stuff. It was a mellow day with lots of laughter and down time. We had time to reflect, time to blog, time to just sit on the roof and watch the sunset.

And so I did. I watched the sun leave 2010 behind – on a rooftop in Haiti.