I needed a bike for Burning Man….

So I did what any other person in my situation would do during this modern age: get on Craigslist and see what people are offering this week. 

Found it.  Found a few actually…stylish cruiser bikes in various colors and states of disrepair.  I figured $100-200 for a used bike would be reasonable and sure enough, I found the perfect fit.  Mint green with white trim…the add even described it as a “perfect bike to take to Burning Man” and the price was right.  Sold!

I contacted the guy who posted the add spoke with him via telephone a couple of times and eventually coordinated a time for me to go by his place to check it out. 

Scott.  That is what he said his name was I think…pleasant guy, but notable primarily for being VERY enthusiastic in his manner and speech.  Felt like I was talking to a kindergarten teacher who had just gotten a new puppy.  Huh.  Whatever, I’ll give him $150 in exchange for a snappy new bike to cruise around on the playa with, even if he is a little…odd.  And actually, given the Burning Man context, it actually seems pretty fitting. 

As I drove to the address I was given, it occurred to me that going and meeting some likely weird stranger at his house to look at a bike seemed to hold some serious kidnapping potential…as in, thinking to myself “Nah, I’m sure it will be fine…he seemed, um…nice…and this IS a nice neighborhood…” seemed like the beginning of some graphic horror flick where the girls gets kidnapped by the guy with the bike on craigslist and gets locked in the basement for sixteen years or something….

Obviously, lucky for me, that isn’t how it went down. 

I parked down the street and walked up the drive.  He came stumbling out of the house, bare foot and shushing my hello…

“Someone is sleeping inside…”  Tall.  Like lanky tall…and big eyes he opened wide to punctuate his speech.  Very, very animated whispering….honestly, I think he was shushing himself more than he actually needed to shush me.

“Wait right here, I will go around back and get it!” He tiptoed around what looked like shards of  glass from a broken neon light bulb in his bare feet. 

I stood there, politely waiting, feeling less likely to be kidnapped now.  The house was tucked back, off the street.  And there was a lot of stuff laying around the driveway and side of the garage.  Boxes with miscellaneous refuse., old office chairs, cowboy hats, lamp shades, plastic crates full of dusty old books…and boxes of dry food….crackers, pasta noodles.  There was a large van parked in front of the house that looked full…of stuff.  Was this guy one of those enthusiastic garage sale types or just a militant packrat?  Not that it actually matters…

He came back with my bike.  So cute!  A little rusty, but not too bad…nothing a little love wouldn’t take care of.  I took it for a spin around the block.  It felt great.  I felt like a little kid riding around without a helmet, completely the antithesis of the “cyclist” or “bike commuter” I have at times toyed with becoming. 

I went back to the pack rat’s house. 

“Why are you selling it?”

“Oh.  It’s not mine.  A friend of mine lost his house and I am storing a bunch of his stuff here…it is his and he is just trying to get rid of some things…so….”

“Oh. Okay, $150 right?  Here is $160.”  I handed him a little, pre counted stack of twenty-dollar bills.  I really didn’t expect to get change, figured that I could manage with parting with that extra ten bucks even before I knew that it was going to a homeless guy.   He offered to sell me a heavy-duty lock for my new bike but I told him that I actually already had one…

“Oh, great!  Okay…um…you want some food!?!  I have a lot!”  He sort of scampered off  (yes, I said scampered and that is actually what he did) around to the back of the van and opened it up for me.  It looked like he had just robbed a bakery….the whole back half of the van was full of loaves of artisan breads.  “Here, take some bread!  What kind do you like?  Here take a few!”

“Um…do you have any…um, how about one with rosemary?”

“Yeah, okay, here you go!  You don’t just want one!  Take more!  I have lots!”  He is wildly gesticulating while he enthusiastically encourages me to help myself to the pile of bread.  “Oh, you want some crackers!?! Or Pasta!?!  Oh, I have cookies too!  And salt!  You need salt don’t you?  Everyone needs salt! Do you want Kosher or Iodized!?!  What else you need!?!  Oh, do you see anything else you want!?!” By now he had opened the garage to reveal floor to ceiling of shelves packed with boxes of…stuff.  Like he had not only robbed a bakery but also the local thrift store.  On the floor were several boxes and bags of food…he literally had two boxes full of salt…three different brands…and yes, Kosher and iodized where indeed options. 

Not wanting to be completely rude, I graciously accepted a loaf of rosemary bread, two boxes of Wheat Thins, two boxes of spaghetti noodles, and a thing of Kosher salt along with my new bike. 

“You sure you don’t want any cookies!?!” 

There is nothing like a massage to ruin your day.

I know what you are thinking: “Great Kristen, you have so little to say at this point that you are going to actually bitch about having a massage.”

Relax (ha!).  I’m not really going to bitch about it, just making the kind of tongue and cheek observation that one can only make when they have the luxury of being on vacation.  And since I seem to be suffering from a lack of material in my novel new life, I am just going to run with it. 

So, for those of you who do not keep close tabs on me and my whereabouts, this weekend I am occupying a fancy schmancy time share condo up in South Lake Tahoe (THANKS MOM!).  Sweet digs to be sure (and man o man, they almost got me to sign up for one of my very own…but I think they may have still gotten my number since it appears that I have purchased a ten day vacation on Maui for sometime in the next eighteen months).  And Lake Tahoe, just as I remembered it from a brief drive-by I did back in my Mammoth days, is stunning.  But while Tahoe is the kind of place ripe with pristine natural beauty that I often frequent, the novelty of the aforementioned fancy schmancy condo is a bit disorienting.  Those of you who know me well can attest to me being more the camping, sleep-in-your-car-at-the-beach or live-in-a-van-with-your-stinky-boyfriend kind of gal rather than your grandma’s luxury time-share type. 

(Cue the Talking Heads right here…)

In the spirit of occupying someone else’s life, I decided to book myself an overpriced, ski vacation town massage this morning, as my back has been tweaking out (I think I am out of shape for working those 36 hour weeks…I know, you feel REAL sorry for me for that one too).  

It was great.  Maybe not worth the exorbitant price tag but I am, after all, pretty spoiled with the $6 medical massages I was getting on my old insurance plan. 

Then I had lunch with an old friend, which is probably another story onto itself (seriously…here is a little trailer for you: I had lunch with my best friend from first grade whom I have not heard from for a solid thirteen years).

My plan for my day had be as follows: get up, make coffee/breakfast, enjoy the jet tub in my unit with a hot bath, attend overpriced massage, meet childhood chum for lunch, rent kayak and paddle around this big blue bucket of crystal clear water, spring the dogger from the kennel for a few hours (no dogs allowed in fancy schmancy land) and go for a walk and maybe sit on the beach with her for a while, then dinner and chill. 

Things didn’t go awry until after lunch.  Somehow lost my motivation to finish the day strong (sorry dogger, but maybe I will catch a second wind here and we can go for a little sunset stroll). 

Like I said, I blame the massage.  Just too relaxed.  Clearly.  Plus it got cloudy and a little windy and kayaking sounded cold.  Going back to my big leather couch and gourmet coffee maker to write for a while and maybe read sounded better to me. 

So here I am…. 

“Letting the days go by…”

Hillsborough, California

From Wikipedia, the free encyclopedia:

Hillsborough is an incorporated town in San Mateo County, California, in the San Francisco Bay Area. Hillsborough is one of the wealthiest communities in America and has the highest income of places in the United States with populations of at least 10,000.

           

Area code 94010.  Yep, that’s me.  Living with my dog in one of the wealthiest communities in America.  Go figure. 

I feel compelled to actually wash my car for the first time in years…not that I haven’t washed my car in the last few years, it’s more like I have never felt like I needed to…I’m a little concerned that someone is going to call the cops about the vagrant with the red Subaru from Washington…since I obviously must be a squatter. 

But it gets better!  Wait, actually, a little back-story first: I am renting a few rooms in a big fancy house (in one of the wealthiest communities in America).  It is sort of an apartment that is connected to the rest of the house…private entrance, private bathroom, bedroom, and this weird “kitchenette” that consists of a microwave, mini refrigerator and some of my own Rubbermaid bins draped with sarongs hippy style, to provide me room for food preparation and coffee production.  And my “apartment” is separated from the rest of the house, via the actual kitchen, with a mirrored closet door that has been propped over the entrance to the real kitchen and then held in place between my fridge and the larger one on the other side. 

So it is a slightly funky set up. 

And, true to the same form that has provided me with such a high tech partition separating me from the rest of the house, the shared washer and drier on premises have been out of order since I moved in.  Of course….

I finally gave up on doing my laundry here a few days ago.  One of my house mates, another unsuspecting medical professional (an oncologist researcher from Maryland actually) suggested over a glass of wine the other night while we were comparing notes on our land lady, that the two of us do a trip to the local Laundromat together. 

So, Tuesday night, my new doctor friend and I packed all of our laundry into his car, and wound down the hill to the nearest Laundromat, located in the next town over, Burlingame.  You see, it turns out that one of the wealthiest communities in America for some reason does not have it’s own Laundromat within it’s city limits. 

Go figure.   

I can’t believe I have been to Siberian twice now in less than six months.

I am somewhere around 26 or so hours in transit…I think this trip is going to wind up being somewhere around 30 hours total, airports and actual planes.  I am actually getting pretty skilled in sleeping upright on airplanes…a year ago I was incapable of such a feat…kind of amazing what a body can become accustomed to. 

Even more astounding to me is how far I have come from a professional standpoint in this same time frame.  When I went to Siberia on my first trip, I really had only a rudimentary knowledge of congenital heart repairs…I knew how to care for a post operative open heart child in the ICU but it was a more task oriented knowledge.  I didn’t posses a really solid grasp on the physiology; sure I understood it all when procedures and complications were explained to me on a case by case basis, but I didn’t own any of that knowledge; I would have to look up every repair and almost every anomaly that came through the door…partially in an attempt to not look like a complete idiot. 

The first time I was in Siberia, I knew that I had very little to offer the local nurses and I sure as hell didn’t have a thing to offer the local physicians.  I also realized just how much more I could know; how nice it would be to actually understand this stuff rather than trying to wrap my brain around new info every time I got a new patient. 

I made a joke to my nurse counterpart from Melbourne the other day, about one of our patients who had had a post operative complication involving a blood clot in his superior vena cava which caused his upper body to become edematous and cyanotic.  She said something about how she keeps forgetting what the child’s anomaly/repair was and thinking that he was a Glenn (which is a surgery that is  part of a staged repair that routs venous blood from the upper extremities directly into the pulmonary artery).  I said
“You keep thinking he is a Glenn because he looks like a Glenn!”  We both had a good laugh because yes, the purplish tint to his lips did indeed look very much like those of a child several days following their Glenn surgery. 

I didn’t know this last November.  Yes, I had taken care of children with this surgery but I often had to refer to bedside drawings of their anatomy or definitions in textbooks when trying to remember what the repair looked like.  Looking back, I am blown away by this and everything else I have learned over the last few months. 

I got back from Siberia with a renewed motivation to learn; I read books, I studied each of my own patients in depth.  I looked at the long strings of incoherent words listed as diagnoses in cardiology notes and tried to piece all the parts together. 

And then Iraq happened. 

I was entirely not prepared to face the degree of complexity and stress that I had to cope with there.  But I did.  And I learned volumes. 

So upon returning to Siberia, I have come a long way.  I have a different point of view.  Yes, of course there is still so much to learn.  But I saw things from a different vantage point this time….my rose colored glasses seem to have gotten lost somewhere over the Atlantic.  That is probably fodder for another entry…for some reason rehashing the petty frustrations presented on this mission does not sound appealing to me at the moment.  In short, the ICU team clearly did not want us there.  Yes, the nurses are excellent at fulfilling their bedside care roles as Russian nurses; they have little interest or incentive in learning beyond what they already need to know to complete their day to day tasks (though, I did have the opportunity to give an impromptu lecture inside the ICU one morning about the aforementioned Glenn procedure…totally at their behest).  And the ICU doctors really had little interest in input from our nurses…to the point that it was an aggravating issue.  At one point, one of the doctors went so far in excluding me from managing a patient that he instructed the interpreter to not translate for me (she was appropriately horrified).     

Like I said, it was frustrating. 

But at the same time, I feel so lucky to realize that.  I feel like I have packed so much into the last several months…the last two years in fact.  The amount I have learned and the experiences I have had, both clinically and through repeated international travel, seem to expand beyond that time frame…it feels like I have crammed five years into two. 

I ran into my ex-husband briefly while in the Valley a few weeks ago.  He was friendly, if lacking sincere warmth.  Can’t really blame the guy for that honestly…but it was suddenly so shocking to realize how long it had been…but then not really at all. 

Two years. 

The common question “What have you been up to?” makes me laugh every time. 

“Ha!  Where should I start?”

“No running with tonsillitis!”

These were Pavel’s words to me when I left him at the hospital last evening, seeing now that he is my “personal doctor” and all, he apparently feels entitled to give me such advice…and he also knows that I will be off for the next twenty-four hours and naturally inclined to do something silly like that. 

Damn.  He knows me so well.

The funny thing is that despite my resurgence of feeling fatigued and miserable for the last couple days, I felt well enough all day today that while looking at yet another sunny day outside I said to myself “Maybe if it is still nice tomorrow I will take myself for a run.” 

Seriously.

I’m stuck by this strange power play between my brain chemistry and immune system…for once brain chemistry is loosing to my other physical needs…but she is not going down without a fight damn it. 

A few days ago, after a few days of antibiotics and a totally insufficient amount of sleep, I woke up and felt the urge to go for a run…despite the fact that I had slept for only four hours, had been given my tonsillitis/sinusitis verdict two days prior, and that it was raining.  I just was feeling energetic…so I hit the road for about an hour…maybe four miles?  And I totally got caught. 

“I saw you!  From the van, going to the hospital to check babies… and you were RUNNING…in the rain!?! Crazy girl with tonsillitis!”

What can I say?

And of course, I felt awful again for the following two, three days.  Seems that my compulsion to move may actually be bordering on pathological at this point. 

Sigh. 

I swear the nurses hate us here

I can’t say that I can blame them honestly though; they are all very good at their jobs and have extensive experience working with adult heart patients of all sorts (this hospital is devoted  entirely to heart patients).  The other guest nurses agree that we feel like we are invading their turf.  A few are friendly; most seem indifferent if slightly annoyed at times…and then there are a few who are outright cold. 

But it must be difficult and frustrating for them; they all work very hard and are arguably overburdened.  We come in and all of the sudden they have even more work to do because of the increased volume of cases plus they have the added annoyance of having us get in the way and ask them tedious questions like “what med is this?” or “when did you start this drip?”  Nothing is labeled in English, med-wise which at times is scary, especially considering that we have caught several medication errors already.  There also seems to be a general indifference about learning anything new; it feels like every time I make a suggestion I am met with an emphatic explanation of “this is how we do it.”  The physicians are just as bad; I don’t even want to bother making suggestions at this point so unless I feel like a decision is going to potentially harm the patient, I just let it go. 

This experience, though not really that much different from my first Siberian ICHF trip, stands in such stark contrast to my Iraqi trip.  The nurses needed so more much help but they were at least somewhat appreciative of our presence…and it felt like we were doing something.  Teaching, caring for patients, modeling good practice.  And everyone was so friendly. 

Not the really the case here…at least not clinically.  Which is a bummer.  And frustrating. 

Cutey Pie hanging in the ICU post BT shunt

SO, for the most part, I just try to stay out of the way: do data entry for our trip, catch up on emails and reading…and try to enjoy the fact that this isn’t a total clinical nightmare.  

This little guy has AV block and is stuck in the ICU on a pacemaker...I think he is over it.

Had my first “proper” banya experience.

It was rad. 

One of the local doctors who are hosting us has a little country home (Pavel called it a “bungalow” which prompted a discussion about the differences between simple tropical houses on the beach and rustic cabins in the woods).

This country home is about an hours drive from Kemerovo and situated in the Taiga forest; I was told that this is the larges forest in the world, though this is a fact that I have not been able to substantiate as of yet.  It was beautiful though…an expanse of birch trees and tall firs. 

Our hosts provided us with a generous spread of food, primarily of the type that appeals to hard-core carnivores…I counted nine different varieties of cured meets and three of cured fish (we are certainly not lacking for protein or sodium).  And of course, bottles and bottles of vodka.  And fresh beer (you can take your recycled two liter bottles to beer dispensaries that have a wall of taps and you can have your plastic bottle of beer filled over and over…and novelty aside, the beer itself is quite tasty). 

After our salty, meaty meal and libations, we headed out to the actual banya.  It was a little log building behind the house, with a toasty common area with a large sectional vinyl couch for lounging in between rounds in the sauna.  We lazed about in our swimsuits, drinking fresh beer and sparkling water and took turns in the absurdly hot dry sauna…by far the hottest sauna I have ever been in. 

Then they busted out the birch branches. 

So the practice, which I became acquainted with courtesy of one of the local ICU doctors (PS, this is a hilariously incredible departure from the customs of Iraq where men preferred not to touch women or even look them in the eye) goes something like this: You lay prone in the sauna and a beefy Siberian dude in a Speedo hits your repeatedly along your back and legs with steamy branches of birch leaves…after getting you “warmed up” a bit, he throws more water on the hot rocks, heating the tiny space up even more, wets the branches again, places them on the hot rocks and goes for the second round.  THEN they throw snow all over you…and in my case, being the first victim and subsequently having the privilege of experiencing the fresh enthusiasm of our hosts, I was so overheated that I could barely breath the scorching air and tried to escape…so they had to restrain me in the sauna while they rubbed snow all over my body. 

There was a great deal of squealing and screaming to say the least. 

The other first timers found the volume of my good natured protest to be a bit unnerving…though no one else seemed to have quite the same intensity of experience that I did…except our surgeon, but I think he asked for it. 

So once I finally escaped, I emerged form the sauna soaked with sweat, completely lobster read and covered with birch leaves…and I think I must have looked pretty shocked and disoriented by the experience…which made the other first timers just that much more nervous.      

Despite all my caterwaul, it was actually kind of great.

Did I mention that the weather has been absolutely beautiful?

Like so much nicer than it had been in Seattle when I left. 

Spring in Siberia. 

It is much cooler today, but I am still so taken aback by all the sunshine of the previous week. 

I was in the woods yesterday (another story, I’ll get to that later) and there were these little purple flowers sprung out of the dead grass.  My translator told me that they were the first flowers of spring. 

Our hotel is situated next to a walking path that runs along the River Tom.  All week there were people strolling along this path, roller skating, strutting around in their fancy spring threads…teenagers flirting, young couples pushing babies in prams (like the old school kind…pink, four wheels and a  little bonnet; the kind where the baby is in a little mobile bed looking back at you…you never see those back home, except in books and old movies). 

And the other morning, I was falling asleep in my room following my night shift with the window open and the birds were singing.  They sound just like the birds back home in the spring. 

So birds sing the same in Russian as they do in English.

Tonsillitis and sinusitis…

That is Pavel’s diagnosis for me this morning. 

I have had this yucky cold since I got back from my ski trip in Canada (over four weeks ago now)…god forbid I just take care of myself and recover right?  I mean, I have to drive all over the state, fly to California, pack up my place, socialize and climb at every opportunity, right?  Duh. 

After two weeks I stiff felt awful, so I did a round of antibiotics, felt better after a few days and then a few days later I have the same symptoms come back.  But like I said, god forbid I actually chill out for more than a day. 

So, of course I jump on a plane and travel to the other side of the world again, three or so days on planes and in airports with crappy sleep, then I pull a couple night shifts and low and behold, I feel like shit again. 

So today, I tell Pavel that I am sick and he is totally skeptical…then he looks in my ears and throat, etc and says “Eeeeewe.  You have tonsillitis and sinusitis maybe.”  So, he tells the locals, they send me to the lab for a CBC, give me antibiotic fluid to gargle with, one of the girls on the team supplies me with antibiotics, and I am promised some sort of nasal spray…Pavel has to go to the pharmacy to figure out what he can give me. 

And they all assure me that coupled with my scheduled trip to the banya and a little vodka, I will be better in no time. 

So they are taking good care of me…but they instructed me to not kiss any of the children in the ICU. 

I fear that this trip may not be as interesting to read about as the last one…

Which is actually kind of nice from my end, I must admit.  I will  not miss recounting tales of clinical horror and equipment malfunction like the ones I had for Iraq. 

Nope. 

Tonight I am working with two excellent Russian nurses whom I worked with during the last trip: Yulia and Irina.  Lovely women who are incredibly skilled and knowledgeable but are still happy to ask questions and take any information I have to offer.  So mostly, I am here tonight to stay out of their way and answer questions if they need me too.  Plus, I have an ICU full of stable patients and I am hoping it stays that way since I am flying solo.  We have brought a very bare bones team on this mission: one other nurse, a respiratory therapist, a perfusionist, a surgeon, a cardiologist, my darling intensivist friend, Pavel and myself.  ICHF teams are typically closer to 14 people. 

SO, during the day everyone but me is at the hospital…and I hang out in the ICU with the locals and my interpreter during the night just in case with Pavel a phone call away. 

This arrangement suits me fine so far, though six months ago it would have had me wanting to pee my pants.  Funny how much can change with a little more experience. 

Ah yes, tongue salad…and mayonnaise.

Yum. 

Seriously, this was my breakfast when I arrived at the Hotel Tom here in Kemerovo, Siberia.  That and something resembling potato pancakes.  And vodka. 

It is funny to be back in Russia especially due to the fact that it was clear and around 60 degrees today, weather considerably nicer than I left in Seattle.  Who knew that spring in Siberia could be so nice? 

It has been a long stretch of days; Seattle to New York, to Moscow for over twelve hours, then to Kemerovo, and after a short nap, a quick run in the sunshine and a lot of caffeine, I found myself at the Kemerovo Heart Center.  I went with the rest of the ICHF team (aside from the two who missed their flight to Moscow yesterday) to the hospital for meet and greet, said hello to many familiar faces and oriented my fellow ICU nurse (there will only be two of us this trip) to our PICU home for the next two weeks.  And then I gave a brief interview with the local TV news station about the work we are doing here…funny that these little interviews are becoming a regular occurrence, though I  have yet to see any of them so far…which might actually be a good thing. 

And now it is almost 8:00 PM and the sun is still out because it is mid April and we are far north of the equator here. 

I love that.

Sometimes I feel like I could survive on little more than sunshine and caffeine.    

I have been hiding out.

Well, sort of.  I really haven’t been totally reclusive after all…saw a few old friends, got my haircut, wound up getting new breaks for my car, etc.  I also packed up my place in Tacoma and buzzed down to Palo Alto to find a place to live last week.    

But mostly I have been sleeping.  At least for the first half of the week.  I have to do that a couple times a year it seems, what with the usual gallivanting and all. 

But okay, wait…I’ll back up. 

My new job doesn’t start until May 9…well, I could have started earlier but after my wild time in Iraq and the fact that I will be leaving the region, I opted to push it back.  Which is nice because I can be more relaxed about the whole endeavor…and go to Siberia for another heart trip real quick like before I move. 

My mom was pretty freaking delighted since she has a laundry room full of month old puppies and was scheduled for a Mexican vacation this week…so I have been house sitting.  

Hence the unstructured time for sleeping, reading, getting over my cold from hell, and hanging out with some adorable little squeaky fuzz balls.  Puppy therapy is hard to beat. 

So yeah, been pretty chill and boring.  Sorry that I don’t have anything profound or exciting to share.  But I got a lot done…and laid around in the spring sunshine and drank coffee in the hot tub. 

Like I said…not bad. 

Jeeze, I never wrote anything about Baldface!?!

Seriously?

Holy epic adventure that was.  And such a weird contrast to the month I had just spent overseas. 

I had worked a long, 14 or so hour shift on the last day, gone out for a late dinner and didn’t make it back to the hotel until like 11:00 PM…and seeing how I had to leave for the airport at 3:00 AM, I saw no point in going to bed.  So I packed…and drank.

Got on a plane and flew for two hours to Amman, Jordan at 5:00 AM, then a short layover followed by six hours to London; another short layover and then about ten hours to Seattle.  I had time for a relaxed SeaTac dinner and a couple of latte’s and then hopped on another plane to Spokane where my dear friend and kindred spirit picked me up and we and two new quality dudes all went out for a late dinner and beers.  Then, of course, despite the intermittent, poor quality, drug induce state that vaguely resembled sleep that I experienced on the airplanes during the previous 24 hours, I could only get about four hours of shuteye…perfect. 

Then NEXT morning, we all drove three-ish hours to Canada, got on a helicopter (which, by the way was AWSOME!!!) and flew into this remote ski lodge outside of Nelson, B.C.  

I then proceeded to have the best four days of riding deep champagne powder, freshly served up every day for my riding pleasure.  I also got to hang out with a lovely group of dedicated snowboarders and industry folks, riding, riding in the snow cat, sharing meals, stories, and libations.  To top that off, because seriously, it obviously wasn’t ridiculous enough, among the wonderful people I met up there, I met and rode with for three days my first (and arguably only) snowboarding hero, Jamie Lynn. 

The whole thing was completely surreal.  And it felt like some kind of otherworldly reward for my hard work in Iraq. 

Thank you universe, I feel like I owe you one. 

Cheers!!!

I left my ICU shoes in Sulaymaniyah….

…which I feel a little guilty about because they were a gift from our friend Aqeel in Nasiriyah (that whole, third-party-buy-now-pay-someone-else-later thing…turns out it doesn’t actually work). 

They were cute…sort of a funky Middle Eastern take on Crocs…blue plastic with a latticework of round ventilation holes…and they had little plastic flowers on them.  Very cute. 

Sulaymaniyah had the same sort of swap-your-shoes-at-the-door routine that we had in Nasiriyah.   Outside shoes are dirty you know…don’t worry too much about washing your hands but be sure to change your shoes (please forgive the sarcasm…I can’t help it). 

When I walked out of the ICU for the last time the other night, I decided to leave my shoes at the door.  I think someone will use them (occasionally, shoes will get borrowed by local staff to the great distress of some of our team members).  I hope someone will use them. 

Like I said, I felt a little sorry to just be discarding them…but it wasn’t exactly that unceremonious though…I put them down and took a photo of the on the floor.  I wanted to document that action for some reason. 

And then I walked out. 

This month in Iraq was very challenging on many levels.  Physically.  Intellectually.  Emotionally.  I don’t think I have ever worked so hard, for so many days, within so many impossibly difficult clinical situations…no, actually, I know I never have.  I have also never had to face so many deaths…deaths that the whole team worked so passionately to prevent.  But, I am very glad to say, I feel like I was able to rise to the occasion, time after time. 

By my last day, I was done.  Done.  I couldn’t do it anymore.  I was frustrated and bitchy and so broken hearted by the fear of  loosing another patient after we left…

But then leaving was so abrupt.  I gave report to the night shift ICU team…and said goodbye.  I went out to dinner with part of the team, and simply said good bye again.  I stayed up late with a handful of folks until the wee hours of the morning…and then a few of us left for the airport…then one by one, we all went our separate ways, off to our own individual destinations.  Headed home.  Back to our lives. 

(Well, except for me.  Silly girl.  I am just leaving on the next crazy adventure… flying from Sulaymaniyah to Amman to London to Seattle to Spokane, then being driven by a friend to Nelson, B.C. and THEN (hopefully after sleeping) getting on a helicopter and flying to some remote ski lodge in interior B.C.  Like I said, silly girl.)

I knew that this sudden extraction from this experience in Iraq would feel weird...that it would not feel satisfying in anyway…just a predictable succession of hurried goodbye’s.  That’s how it felt when I left Siberia…and Nasiriyah too.  Empty in a way.   

And honestly, I felt like I needed a little more closure than that.  Even if it was solely just for me…to carve out some peace in this experience. 

I needed a way to step away, to put this behind me so that I can more forward now.   I need an end point in time…

So I left my shoes at the door. 

This has been hard.

Siberia was different.  A challenge to be sure, but so much farther along in their management ability.  And we had interpreters.   And all of our patients did very well.  Everything went smoothly. 

Here in Iraq I feel as though we are entrenched in a way.  Limited resources.  Staff that needs so much direction and teaching.  And a multitude of complicated defects begging to be repaired.  Sick, sick children in the ICU. 

Chaos?

They told us that something like 350 people showed up at the hospital the first day in Nasiriyah…have I shared that detail yet?  It still blows me away.  And the surgical waiting list in Sulaymaniyah seems to be miles long…

I think it is hard to feel like this endeavor is little more than a gesture.  I suppose that there is a legitimate criticism to be made there.  But at it’s worst, I also believe that it is a gesture of compassion.  Of effort, regardless of the ultimate outcome.  We all do our best with what we have.  Today.

And while there may not be time now, maybe not today, I think we will be back. 

Someone had asked me while in Sulaymaniyah if I would come back to Iraq with ICHF….

…and I said “of course.”  Which is true.

They also asked where I would go after working in both sites.  The question was easy to answer but hard to explain: Nasiriyah?

This sort of threw everyone at the table during the discussion because I have spent most of the current trip relating horror stories accrued during my first two weeks in Iraq.  And really, nothing so far has been as bad here.  Even when we lost that kid the other night believe it or not. 

At first I couldn’t explain my rationale.  Why do I want to go back to ICU Hell?  Am I crazy? 

Well, yes, we all know that by now. 

But seriously….

I loved the people; “generosity without borders” as Pavel said.  The culture was so alien…and interesting.  The bizarre juxtaposition of men in traditional Arab dress walking down the same street as men in fancy three piece suits for example.  The funky, striped purple couch in our guest house; watching the news with our security detail…the security guys at the hospital packing their pajamas and sleeping in shifts in the conference room (seriously, they packed their jamies!).  The absurdity of it all…

And clinically…I feel like more of the nurses wanted to learn.  Which is not to say anything negative about the nurses here in Sulay…they really are not that bad…yes, it is hard to get some of them to chart and you have to remind them to give meds, but they know how to do most of the stuff, they just need some help with things like calculating pediatric doses and NOT giving meds through lines that are running pressors (I will say though, that there is one little guy who is awesome and has learned SO much, and there is also one woman who just plain rocks…and she did before we even got there).  But I feel like the handful of nurses in Nasiriyah who wanted to learn, actually really, really cared.  Aside from the aforementioned two exceptional nurses we had here, I don’t think I can say this about the Sulay nurses.

And then there is me. 

I learned so much in Nasiriyah.  Volumes.  I have never had any clinical experience or responsibility like I had there.  I felt like I played such an important role as a member of that team…which is true here as well, but somehow just feels different. 

And as far as explanation, I think that is about as good as I can do for now.  And I know it doesn’t really articulate my sentiments very well.  Maybe I will understand it better myself someday.

But maybe not. 

Did some site seeing…

Nothing glamorous really; Caroline and I followed a group of boisterous school children on a class fieldtrip through the natural history museum (which is one of exactly four destinations listed under tourism for the Sulaymaniyah entry in Wikipedia).  Lots of old clay pots and metal tools in glass display cases…old, old stuff.  Which was pretty cool…

After that we went down the street to find this other museum that we had both heard about: The Amna Suraka Museum, which translates into Kurdish as the "Red Intelligence Museum.”   This is how Wikipedia describes it (also one of the four tourist destinations in Sulaymaniyah by the way):

“…Located in a former Ba'ath intelligence headquarters and prison. This museum showcases the horrific terror of the Ba'ath regime upon the local Kurdish population. Visitors are guided through the prisons and interrogation rooms...”

When we arrived, we were told it was closed.  Damn.  Big disappointment actually considering that we had managed to find the place (and crossed six lanes of highway to get there).  But then, this guy came out and asked us our names; you see, one of the other girls in the group had visited a few days before and met the artist who had made the sculptures that were scattered around the museum depicting different prisoners who were known to have died there.  He had been waiting for us it seemed, and offered to make us a cup of tea and then give us a private, guided tour of the facility.  How often does that happen!?! 

It was haunting to say the least.  The first room he showed us was where the children were imprisoned.  I can’t even imagine what it would have been like to be one of up to 30 children locked in this dark room.  Alone. 

The prison was like a maze by design to prevent it’s historic prisoners from being able to keep their bearings while being moved, blindfolded, from room to room.  It was disorienting.  And cold.  Very cold. 

We walked through the facility, looking at different cells and then I was startled when I looked through a door and saw a white figure standing, taller than me and looking out the tiny, barred window near the ceiling.  It was one of the sculptures (made by our tour guide) of a known prisoner; an apparition in a way.

Many of the dark cells had ragged blankets thrown in their corners which somehow heightened the sense of solitude and despair that must have been present between these walls.

The whole thing was so unsettling…

I knew very little about the details of this particular genocide, and to be honest, I still don’t.  Granted, I know more now…but it seems to be “just” another tale of a disenfranchised people and the violence they suffered at the hands of the “other”…and I have no doubt that somewhere in the world today, people are still suffering in the same way. 

What do we do?

Girl’s night out!

I went out for dinner last night with another nurse from London as well as another lovely female intensivist…this one is from Czech Republic.  We wandered around a little and eventually found this restaurant on the top floor that served local and Mediterranean dishes.  We got a bottle of wine, a bunch of appetizers, had desert and great conversation that centralized around the differences in medical culture around the world.  It was really a treat. 

However, when we set out that evening, we had started with the plan of crossing the street (always a harrowing experience here with the four lanes of swift traffic and no guarantees that anyone will stop for you).  Our planned destination was what appeared to be a bar and hookah joint.  I was really curious about smoking some fancy tobacco out of one of these things since we have seen similar such establishments all over town.  Seems like a pretty authentic cultural experience and I wanted to jump on the opportunity to check it out.  When in Rome right?  Or…Kurdistan….whatever. 

Anyway, the three of us walk up to the door and the “bouncer” (although, he might have actually been just some dude) told us emphatically “NO WOMEN.”

Damn.  Really?  Even here? 

In Nasiriyah that sort of thing was expected.  Most of the women wore abaya and I didn’t see a single woman with fitted clothing or even her hair uncovered.  It is a totally different story here in Northern Iraq.  Yes, many women are very covered, some even truck around in abaya.  But there are also pretty modernly dressed women running around as well…fitted jeans, fancy high heals, stylish blouses, etc. 

Caroline, the British nurse I mentioned, and I had gone out for some site seeing earlier that day.  We got some looks, sure (“Is it really that obvious that we are foreign?” I asked her; “Yep.”) but nothing like the way I was starred at in Nasiriyah…I felt like I was running around with two heads in that city of 4 million people. 

But not being admitted to the “boys club” was still sort of a surprise.  Maybe not conceptually, but still. 

Over breakfast this morning, one of the night shift nurses (Jennie from Philadelphia) was relating her experience through the night with an eight year old boy we have had in the ICU most of the week.  He is sort of a brat.  I know, I know, I shouldn’t talk about these kids this way, he is sick and all, but we have had some legitimate issues with children who will defiantly not cooperate and will go so far as to hit their own mothers (they try to hit us sometimes too, but we are evidently more adept when it comes to restraining small children during their temper tantrums).  Anyway, she was telling me that she actually made some progress with the kiddo…she kicked him out of bed, sat him up in a chair, put on a movie for him (someone had conveniently left their iPad lying around, with movies on it…and evidently Shrek is amusing even if you don’t understand English), gave him a soda and he was very cooperative and contently sat there, watching his movie, drinking his soda.  Then his mom came in…total turn around.  He started whining, slumping down in the chair, wanted to go back to bed (Jennie would not allow it…someone has to set some freaking boundaries!)…the compromise for not getting back into the bed was that he could put his feet up on another chair.  But then the father wanted to sit in said chair…so the mother sat on the floor in front of her son and put his feet up her shoulders; “She was a human f***king foot rest!” Jennie related…horrified. 

Huh.  Wow. 

The things we as women take for granted in Western countries…

Retraction: It’s the “gas man” not an ice cream truck.

I received this information from one of the darling Preemptive Love Coalition folks:

“Oh, and by the way - the ice cream truck jingle? It's actually the gas man. Yep, trucks roam the streets everyday selling propane gas can refills. They used to bang the cans with a metal stick until the city got tired of that, and now they use the "ice cream truck" jingle.”

Oh.  I see.  Definitely an improvement. Big time. 

Thank you for the clarification Michelle!

An ice cream truck just drove by the hotel....

….same music chiming along that is so familiar back in the states.  But it’s 50 degrees Fahrenheit out there.  And raining.  And it’s 7:30 in the morning. 

Weird. 

(Pavel keeps telling me that Americans always say this word, “weird” a lot.  I think he thinks that  is weird.)

Anyway, that is neither here nor there, just sort of a funny tidbit that I wanted to share cause homey drove by just as I sat down to write. 

So. Sulaymaniyah update.  And Egypt update while I am at it:

Our darling surgeon, though I wouldn’t describe him as exactly the picture of health (what with the cigars, the scotch, the lack of exercise, and the fact that I don’t think he ever sleeps for more than three hours at a time) is having some health issues and we have finally managed to talk him into going home early.  I think.  Unfortunately, flights to the U.S. only leave every other day, so the logistics are thus far as yet to be determined, but at least he has agreed to go. 

But still, I am glad that he is acknowledging that he needs rest.  I think he has been burning the candle at both ends…like for 15 years.  He has managed to accomplish amazing things though…I think he might be my hero in fact, as cheeseball as that sounds.  But seriously…not only the kids that he has operated on, but all the kids that were also saved because of the teaching that he and the other ICHF teams have done with local teams around the world…that is where the real impact occurs. 

It sounds like the plan is for the rest of the team is to remain here and operate with the local team only.  So low complexity cases, fewer cases, and likely cases that do not require cardiac bypass.  We will see how it goes.  This is what we did yesterday in fact, which is nice because the ICU isn’t plunged into utter chaos as a result.  And when you remove the chaos induced by having exquisitely ill post-op open heart patients populating your ICU, we actually have time to teach.  Which means, that while we are not going to be able to “save” as many kids this trip, we can still work toward our ultimate goal.

Oh, and Egypt…not going.  Regional strife or something.  I guess the nurses are striking (they want better wages, benefits, everything we take for granted in the States, blah, blah, blah)…but actually, it is reassuring to know that we (the crazy folks at ICHF) really won’t be going places that are immersed in political turmoil.

Shucks. 

No excitement in the ICU today…

…and I am so thankful for that.  Two shifts in a row without any major disasters. 

What a relief. 

Subsequently, I don’t have that much to say.  And I am pretty exhausted.  So I am just posting this photo for today. 

So, I am becoming pretty competent at coding….

…which is good from a professional standpoint, but it sucks. 

We have done some very difficult cases; both trips.  We have had a few, worst case scenarios pan out as…just that. 

Mostly just plain, old fashioned, bad luck. 

I have been privileged to play such a part in these situations with a team of remarkable doctors, surgeons, and nurses, from literally around the world.  I have been directly and very actively involved in more life and death situations in the last three weeks than I have in my last three years as a nurse.  I have learned volumes.  And I am so grateful for this. 

But it gets very disheartening.  You compress the heart, you bag, you defibrillate, you give epinephrine, you give calcium, you give bicarbonate, you push blood and volume.  And sometimes it works…

…and sometimes it doesn’t. 

It’s hard when the bad ones start to pile up; unfairly, they matter to your own heart more than the saves ever will. 

Yesterday morning I was numb. 

Today, I got to read the following entry from the Preemptive Love Coalition Blog; I have gotten to meet Jeremy and work with him both here and in Nasiriyah.  He is a wonderful and devoted young man who illustrates, along with his equally remarkable counterpart Cody Fisher, just how much two people can accomplish with a little motivation and passion. 

I needed to read his words.  I didn’t know it until I did. 

Thank you for this heartening perspective Jeremy.

Yahya passed away early this morning after an all-night surgery. It was a surprise to everyone. When he was admitted to the ICU there seemed to be plenty of confidence that he would be just fine. But within just 30 minutes of admission his heart gave out and all efforts to revive him failed.

I still remember the first time I was introduced to Yahya. It was over a year ago. His uncle called my cell phone and said, “I’m at your office, I need to talk to you about a sick kid.”

It was after hours and I was already at home. But I could hear the urgency in his voice so I invited him to my home for tea. He arrived and made an impassioned plea for Yahya – his brother’s son. I was leery of helping Yahya after reading his reports – we had seen some children with complex heart defects like him die abroad and I couldn’t stand to put a family through that drama again. I did my best to avoid commitment and send Yahya’s uncle into the night without any solid hope for his nephew.

The following weeks were filled with phone calls and followup from the family, “Please help our boy!”

Finally, I met Yahya’s mom and dad and the little cutie himself. As they sat in my office they pled with humble urgency. They weren’t forceful. They weren’t rude. But they applied enough pressure on me that I couldn’t say “no” any longer. They made it abundantly clear that they understood the risk of his surgery and that they wanted it badly enough to endure whatever might come.

One of our core values as an organization is that we give “hope to the hopeless.” What that means is that we try to balance our impulse to be “last chance” people with our instinct to be “long-term” people. We held back on Yahya wondering if it would give him long-term viability. But we ultimately dove in with Yahya’s family because we were their last chance. No one else would take on the risk.

We solidified this core value in November 2009 when we asked you what to do about a little boy named Ramyar. We asked you if you wanted us to apply your money in a high risk surgery or save it for a “sure thing.” You overwhelming said, “We want this Coalition to be about hope for the hopeless.”

We haven’t looked back since. We are the Last Chancers.

Still, committing to Yahya was full of complications. His surgery in Turkey was cancelled due to an unavailability of an expensive assistant device. In fact, there was even discussion as to whether or not he should be included in our current Remedy Mission. Ultimately, we let the family themselves decide.

Our local cardiologist, along with our American surgeon, explained the risks of surgery, the option of waiting, etc. etc. Yahya’s dad was given a 50/50 chance of survival for little Yahya. Understandably, they wanted to give it a try. The couldn’t stand the risk of feeling like they had an opportunity to try and let it slip through their hands.

What would you have done? I have two kids – 5 and 3 years old. I have no idea what I would have done.

During Yahya’s surgery our Family Services Director, Jessica, sat down in the ward with all the parents whose kids were either in surgery or in critical condition in the ICU – those families whose kids were not “out of the woods” yet. As they asked questions about our organization and how long we’ve been working here, she recounted for them our past of taking children outside the country to significantly nicer hospitals than this Iraqi version in which we currently work. She told them about excellent American-trained Turkish doctors and fancy, pristine protocols abroad. Without fail, every family was so grateful for the chance to receive surgery at home. Let the Turks have their pristine hospital. “What if our child were to die abroad?” That would be a burden far too great to bear.

You gave Yahya’s family a chance that no one else would have. He had been rejected by every other opportunity out there. They are grateful to you. They will rest knowing they gave it their all for their only child.

And this is what we find almost universally – parents who just want a chance. And that’s what Remedy Missions are all about. We could continue to export kids to world class facilities, but who would invest in the future? We could continue to select the easiest children that almost never die, but does that make us any less culpable for the kids we pretend aren’t knocking on our door?

Was this a wasted opportunity? Did we waste the $670 that it cost us to provide Yahya surgery?

I used to feel that way when I child died in Turkey or Jordan or Israel. I don’t feel that way anymore. Yahya’s death – though a terrible loss – was still an opportunity for local doctors to learn an innovative technique that they will be able to apply in future situations. His death was almost certainly unrelated to the particular tactic used in attempting to heal his heart. Educational gains always have significant costs. Before we only had the “we gave this child a chance” platitude. It’s not untrue. But local learning is an equally deep reason why your gift for Yahya made a difference.

Thank you for your willingness to stick with us through life and death. The gains that are needed here will not be made without significant risk and vision. We deeply appreciate your demand that we be the people of the last chance. I think it’s easier to sleep knowing we tried, than knowing we played it safe just so we could publish numbers and blog posts that seem more palatable.

With you,

Jeremy Courtney
Executive Director

Preemptive Love Coalition

Okay, it’s Sulaymaniyah….

…or at least that is what my Iraqi Airlines ticket says.  I have just seen it spelled so many different ways as well as Googled it and gotten similarly different results. 

Anyway. 

[Oh, and FYI, I am posting these about a day behind when they are actually happening…I try to write them, go to sleep, then re read and post.  (But actually, this one is a couple days old.  Sorry.  I had a really bad night last night…got sort of wasted after work…more on that later.  Mabye.).  This loose editorial system can also be credited with whatever grammatical/spelling errors present in “the blog.”  But anyway, that is why the days may seem a little inconsistent.] 

Back on task. 

I worked yesterday and now I will work tonight and the next night.  Which is nice because it means I got a full night of sleep last night and am now about to lay down for a nap…after I finish writing and finish this here glass of wine. 

I was able to go for a little walk today after breakfast with one of the other nurses.  I wanted to procure a hooded sweatshirt since somehow I managed to leave the US without one (I think I had planned on wearing one on the plane so I didn’t pack it…then forgot about this clever plan…and I knew that if I tried to get one in Nasiriyah, there was no way I would be allowed to pay for it.  So yeah…).

It was so nice to walk around without the entourage I had become accustomed to!  I do, however, think that I need to be extra vigilant about not getting hit by a car here in Kurdistan (Mom, I promise that I am being VERY careful when I cross the street).

So yeah, found a sharp new hoody, found some beer, and snapped some photos. 

I noticed this when my flight was landing here, but Northern Iraq (i.e., Iraqi Kurdistan) bears a shocking resemblance to eastern Washington.  Landscape-wise at least.  Not architecture or construction for sure, but physical features of the horizon.  The hills in the distance look like the same rolling, tree-less slopes that I grew up with.  It looks like the view from my parent’s back porch. 

Only with densely packed, rectangular buildings between me and that skyline. 

Which is a big surprise.  But also in a way such a comforting relief.    

To quote Kristin Hersh from her recent memoir Rat Girl, “…it is like finding home in a foreign country” (p. 49). 

Day….????

….I am pretty sure it is Wednesday.  My first day in Sulaymaniah (or Sulymaniah or Sulaymaniyah…I really need to figure out how to spell it properly at some point) but I think it is the 3^rd surgical day maybe?  Pavel (a.k.a. Pasha…which is a nickname for Pavel by the way and will continue to be used interchangeably) and I got here late, as you all probably know, but it turns out so did four other people.  I guess there was some in climate weather on the west coast of the US?  People got stranded and delayed for days (this poor nurse from Virginia made it to Turkey by Sunday but they couldn’t fly her to Iraq until Tuesday….and then they lost all of her luggage). 

Among the missing were both intensivists (Pavel being with me) as well as the perfussionist, which severely restricted the team’s options for surgeries the first two days.  They were able to do a few “off pump” (i.e., cardiac bypass) cases but there were pretty much just two of our ICU nurses to manage post op patients.  And it doesn’t sound like things went smoothly. 

But nobody died (yay!).  And everyone actually looks pretty good.

Anyway…I came in this morning expecting a total déjà vu of my previous two plus weeks.  I was pleasantly surprised!  What some of the other nurses saw as random chaos, looked to me to me logically organized and totally navigable (is that a word?  Like “-able” of navigate?).  Better equipment, more of it, TWO sinks (!!!!!), competent nurses (I was told however that this was the “A” team and the rest of the staff wouldn’t be quite as capable, but still).  I was SOOOOOOOOO excited. 

And relieved. 

It was nice (and very helpful for everyone else) that I was already very familiar with local preparations of medications and how to mix everything the way I wanted it, which all came in very handy when we had a run of ventricular tachycardia on our first new case for the day.  And that sort of semi-code scenario actually went really, really well!  Granted, the surgeon accidently squirted the blood he was pushing all over me and our patient (nothing like a proper blood bath during a code to lighten the mood), but other than that everything went very smoothly!

After things quieted down a bit after all the excitement, one of the poor nurses who has been manning the ship solo for the last two days looked at me as said “You love this?  You want to keep doing it?”  I laughed. 

Later, this same nurse made a comment about feeling like she was forgetting something.  “Um, the documentation that you don’t really have to do?”  I replied.  “Yes!” was her excited but slightly disoriented response, followed by “Is that why you like it?”

“Because I get to just do nursing stuff and not spend hours documenting everything in case I get sued?”

Yep.  I get to be “just a nurse.”  That’s why I love it.

Nasiriyah is behind me…

…as is Baghdad.  At least for now.  

I guess I should recap the last few days since I was pretty much too exhausted to write last night.  Well, that’s not entirely true…I was exhausted but I found a treadmill at Saddam’s palace (where I spent the night) and couldn’t resist taking it for a spin after not running for two weeks…and after that, I was too exhausted to write anything. 

Anyway…

…to intone the Grateful Dead: “what a long strange trip it’s been.”

As we were speeding down the deserted highway out of Nasiriyah en route to Baghdad yesterday afternoon, I taught Pavel a new word: absurd.  I used it to describe the circumstances and events of the previous two weeks we had spent together in Nasiriya.  The whole thing was just so weird…being an American in Iraq, hanging at Saddam’s Palace in Baghdad, having the ever-present security detail, right down to the armed guards outside the ICU…the sick patients, the difficult clinical situations, all the stuff I learned how to do…and the fact that we had just driven past a herd of camels by the side of the rode…

He agreed about my usage of his newly acquired English word after I laid out how our experience illustrated it’s meaning.   

And then, one of our rear tires exploded. 

I looked at him and said, “and that would be our tire that just blew out.”  We both broke out into hysterical laughter at the additional absurdity that we with our six man babysitting team were now broken down by the side of the rode in middle of nowhere Iraq. 

Sweet. 

And absolutely ridiculous. 

And somehow, all I can do at this point is laugh about it all.