“You can’t bring the machine gun in there.”

 Those where the words that started my latest adventure in international travel…because going to Iraq again just wasn’t enough…so we had to make going home more interesting. 

We left our guesthouse, Pasha, Christine, and I at 0500 this morning in two vehicles.  One car with us and our driver and the second one a large, police/military truck with a machine gun on top that contained our security detail and all of our luggage.  We got stopped at the first checkpoint for the airport and there was clearly a problem.  There was a lot of back and forth, a lot of yelling, and then an American contractor type guy came out to straighten everything out for us and I distinctly heard him say “You can’t bring the machine gun in there.” 

The police truck that carried our security detail had been without any large, automatic weapons for our entire trip, but for some reason guys decided to outfit it with a large machine gun the day before we left.  And apparently they just didn’t anticipate that it would be an issue at the airport. 

So we go on ahead and are assured that our luggage will follow.  We have to go through multiple checkpoints before arriving at the terminal and eventually make it to the check-in counter.  But, alas, can’t check our bags yet so we can’t really check in for our flights yet.  We wait.  And wait.  And wait.  Oh, and by the way, our driver here in Iraq…a lovely man really…speaks as much English as I speak Arabic.  This has been a challenge to say the least.  Now, we don’t know what the story is with our bags or even what is going on. 

Eventually, bags arrive.  Not sure if they just drove home and dropped off the problematic machine gun and came back or if they went and found a cab to carry our bags into the airport compound.  But at this point we have less than an hour to get checked in and get on our plane.  And we are at the end of a sea of people. 

We make it on the plane.  I am told that my bags are checked all the way through to San Francisco via New York…which is hard to believe since what they have handed me is a hand written ticket that says IST, JFK, SFO and little else. 

Plane takes off late.  Plane lands late.  Delay in deboarding.  And then when I go to the information counter to get my new boarding pass, I’m S.O.L. because Najaf couldn’t check me in for my flight and the check in was closed by that point. 

Screwed. 

But not to worry, Christine is a veteran airline traveler, even more so than myself and has way more experience haggling with airlines.  So, with her help and some extra frustration, I was able to book a new flight to San Fran via Paris for the following morning, which means, I get another day in Istanbul for site seeing and I get to do it with my friend Christine and her friend in Istanbul!  However, it has been a very long day and I am beyond tired.  Two hours of sleep before we left for the Najaf airport and maybe two hours on the plane, followed by two hours in the hotel after our day of seeing the beautiful historic sites in one of the most beautiful cities I have ever seen.  I am, like I said, beyond tired. 

But now, I’m checked in and on my way to Paris, then one more plane to catch and

I think I got called a prostitute today…

…we checked on the children in the ICU this morning and got things planned out for the day for the local team.  We are trying to be pretty hands-off at this point and let the locals do the bulk of the work because we will be leaving in a few days and they need to be able to take care of the children without us. 

So, after we got everyone tucked in and had a little lunch, we went on a little outing. 

We went to this major shrine here in Najaf…the kind of place that pilgrims come from all over the world to see.   I can’t remember what it was called. 

It was beautiful.  Like the most beautiful piece of architecture that I have ever seen.  We had to remove our shoes to go inside…and Christine and I also had to don abaya, the local customary covering for woman in public.  It covers one’s head and entire body, apart from the face, and is pervasive here in Najaf as well as throughout Iraq.  Lucky for us they had a few spares at the entrance of the shrine so we could be dressed appropriately to enter. 

And like I said, the shrine was amazing.  Solid gold walls, colorful tile mosaics, beautiful carpets, and mirrored ceilings.  Spectacular. 

When it came time to return our rental abaya, Christine and I each removed the black cloth from our bodies in the middle of the street and handed them back to the local officials.  As we were doing so, an old woman passed by us and started yelling at us and waving her hands.  Our guides and body guards all started laughing hysterically!  We asked our interpreter what she had said and he sheepishly replied that she thought we were “very pretty ladies.” 

Yeah.  Right. 

Our interpreter ran up ahead of us and told her who we were and what we were doing here in Iraq.  She seemed mildly placated…

…but I am left to wonder, what it was she actually said about us. 

Not found….not present…

When I arrived last week I heard these words a few times from my team and it sounded like an inside joke….someone would say “Not present,” in some random context and everyone would laugh.  I didn’t get it, but whatever.

I was at the hospital yesterday and I was going through the medications for a patient with one of the local nurses and what was ordered was oral Lasix and we didn’t have any.  The local nurse said to me “Not present…not found,” and suddenly I understood.  And I laughed. 

And then today, when the internet wasn’t working again (or still...?) the page that popped up said “Server not found” and I had to laugh again. 

It turns out that the random power outages are not quite so random….

…they are quite predictable actually. 

This is how it worked when we first got here: the power went out around 10:00AM in most of the house and stayed off all day.  In the whole house.  Then it came on partially in the evening, not sure what time.  I had light in my bathroom but not the bedroom.  There were no lights in the bathroom down the hallway or downstairs.  Then at around 9:00 or 10:00PM all the lights would go out for a minute and then the generator kicked on and we had light in the entire house again, all night long.  Then the generator went off again around 10:00 AM and the whole thing started again. 

At least, that is how it worked when the rest of the team was here.  Now, with only the tree of us, they turn the generator off all the time.  I just had to ask for the second morning in a row if they would turn it on so we could see in our bathroom, charge our electronics and use the internet.  The other issue is that they turn the generator off on us at night.  The three of us are all total night owls and it seems like when our security detail gets tired of listening to us talk at night, the generator goes off.  We grumble about it for about an hour and then, resigned to our fates, go off to bed. 

And then there were three….

….or maybe, the title should be, “Left behind in Iraq, Part II.”

When I first went to Nasiriyah last year, my friend Pasha and I stayed behind for a few extra days to get the remaining children out of the ICU before continuing on to Sulaymania (P.S., I really don’t have any idea how to correctly spell the name of either of these locations, so sorry for the inconsistency). 

This trip however, I arrived under the pretense that there would be children left in the ICU after the rest of the team left and that they would need to be attended to.  Therefore, I arrived halfway through the trip with the intention of staying for an extra week.  Now it is Saturday, most of the team flew out this morning but myself, Pasha and Christine from Washington D.C. are here until Thursday morning. 

We have a full ICU.  Luckily, Najaf’s cardiac ICU can only accommodate four patients…and we are operating at full capacity.  One child is very sick…like I don’t want to talk about it sick…like Pasha and I had a f%@ked up night last night sick.  But the other three have the potential to recover fully and do quite well. 

So that is reassuring. 

After our crummy night, Pasha and I went back to our guesthouse for breakfast.  It was a beautiful sunny day and we opted to sit out in the “garden” for our dining pleasure.  We ate hard-boiled eggs with bread and cheese (a menu that is identical to breakfast every morning), drank bootlegged vodka and smoked cigars….actually, Pasha smoked a cigar and I smoked a “neonatal cigar,” otherwise known as a Montecristo. 

We laughed a lot. 

And tried to forget how stressful our night at work together had been.   

I had forgotten about the random power outages here….

…you will be typing away on your computer or sitting at the table at dinner and the lights will just go out. Usually it only lasts for a minute or two, and in the evening there is a conversion from electricity to generator power that creates a moment of darkness while that transition occurs.

Sometimes it lasts a little longer…like right now. I was about to post a few entries to the blog but no power means no internet, which means no blog posting and instead more writing until my battery dies.

But as I mentioned previously, I had totally forgotten about this detail of living and working in Iraq. I don’t know if I had the subconscious idea that since the war is over, normalcy would have been magically restored to the region and things like electricity would be available in a manner that we in the states are accustomed to.
Before I left, my partner Nate asked me if I had packed my headlamp. I sort of scoffed at the idea that I would need it, thinking that it wasn’t like I was going camping or anything. I brought it only because he insisted I take it and it was a point that hardly seemed arguing.

The minute the lights went out the first night I was here I was thankful that he had been so insistent.

Apparently it only rains three times a year in Iraq…

…and yesterday was one of those three.  Or at least it was raining that morning and when we asked our driver how frequently this occurred he said simply: “three times.”  We interpreted this answer to represent annual number of days with precipitation but I suppose we could actually be witnessing the third recorded occurrence of rainfall in this desert region (further confirming my speculation that snow is nonexistent here outside of snow globes) 

…but I think it is a lot more likely that he just didn’t quite understand what we were asking. 

This happens frequently in these environments where two languages have to intersect for understanding to occur.  You ask a question, it gets translated, you get an answer, it gets translated back to you and it doesn’t quite make sense, or doesn’t quite answer your question…there are so many links in the chain where communication has the potential to break down that it is difficult to pinpoint where that break down may be occurring. 

Add to that a few extra languages and accents and it is amazing that anyone ever understands anything on these trips. 

Especially this trip; this is the most diverse group I have worked with to date.  We have several Americans and a British guy who live in the U.S., a Mexican from Monterey, a Korean woman from Australia, an Australian woman from Australia, a Dutch woman from Holland, two Belarusians, and one American who lives in Kenya.  We are dealing with native languages of English, Russian, Arabic, Korean, and Spanish and still somehow managing to communicate.  And for the most part we are doing a great job at teaching and understanding each other. 

But I’m still left to wonder exactly how often in rains here in Iraq.

Christine, Christine, & Kristen

Yes.  There are three of us.  We have Christine the American ICU nurse that once worked at my current facility, Lucille Packard Children’s Hospital, but now lives and works in Washington D.C.  We also have Christine the German intensivist who has worked in Chicago and I got to have an extensive conversation about rock climbing with over breakfast this morning.  And we have me, Kristen, the latest exotic specimen to join the team here in Najaf. 

The slight variation that my name puts on the theme seems to be quite novel to the locals.  Or maybe it is that I am just a new face that showed up near the end of the trip.  Hard to say.  But they really seem to like me.  Today I was pulled out of the ICU by one of the local guys who gave me, with great sincerity, a small box as a gift in thanks for my coming to Iraq to work with this team.  I accepted my gift graciously and later opened it to find…. a snow globe. 

Yes.

An Iraqi snow globe!  With little globs of white stuff that fly through space when the globe is shaken and settle gradually to the bottom.  It has a temple as the interior image.  A snow globe, like you would buy at an airport in Chicago or New York.  But I don’t think you can actually find these at airports in Iraq….and I’m fairly certain that you can’t find snow anywhere in Iraq.

I forgot about the Kleenex napkins…

 I thought that was so funny when we were in Nasiriyah last year, that the “napkins” on the dinning room table were actually boxes of Kleenex in pink and blue.  They fall apart in your hands when you use them to wipe your mouth but man–o-man they are better than nothing when it comes time to do that. 

The first couple of meals here in Najaf at our guesthouse were definitely consumed in the absence of any form of napkin-like material.  Awkward….someone finally said something about not having any “tissue” and within minutes two rolls of humble toilet paper showed up at our table. 

I guess that’s just how they roll here in Najaf. 

Sweet! No drama in leaving Istanbul and no drama entering Iraq.

What a relief.

I did have to wait for what felt like an eternity at the visa counter in Najaf however.   An hour can feel that way after a few days of airplanes, airports, and hotels.  But I made it with a little assistance from my local contact.  The same local contact provided me with a wild ride to our guesthouse…very glad that there were seatbelts in the car; I think we narrowly avoided three accidents during what couldn’t have been more than a fifteen-minute drive. 

I arrived to find our beloved surgeon at our guesthouse, prior to heading into the hospital for the day, smoking a cigar and playing video games.  He provided me with a synopsis of our trip so far and also a run down of how the last trip, Nasiriya , went just a few weeks ago.  Also got an update on the whole Iraqi program and what the goals are for each site.  So far, things seem to running quite smoothly here.  We have a four bed ICU and most of the children have done well in the OR and been quickly extubated and sent to the floor.  The TGA that was operated on yesterday apparently looks great and will be extubated today.  This child had the fourth arterial switch ever performed in this country.  The previous three have been performed by our team over this and the last trip. 

After my briefing, the night crew arrived home and I got to meet my nursing counterparts from Washington D.C. and Australia, as well as a German intensivist.  I am generally bad with names but the fact that I am here with two other nurses named Christine should make things at least a bit easier to remember.  We ate breakfast together and then had a quick drink and visit before we all went to bed.  I wasn’t anticipating sleeping all day but I didn’t wake up until my roommate started getting ready to go in for her shift.  They all just left the guesthouse a bit ago and I am here waiting for day shift to return home.  I’m excited to see my old friend Pasha (Pavel, Habibi…) my Belarusian intensivist friend, and Frank, a remarkable nurse educator originally from London.  And then there are the new faces to be introduced to as well. 

Not sure just yet when my first shift at the hospital will be, though I suspect it will be either in the morning or tomorrow night.  So for now, time to relax and rest up for what will hopefully be an uneventful trip. 

It’s a beautiful day in Istanbul!

Sunny and around 45 F.  Found my hotel shuttle, found my hotel, took a much needed shower and I’m going to take a shuttle downtown here in a few to see some sites!  I’m still holding out hope that the woman who was my Istanbul connection might be able to meet for dinner or something.  Maybe grab another nap (I have been sleeping in 2-3 hour chunks for over 24 hours now, and feeling pretty okay about it so far).   Then back to the airport around 0100 to catch my 0300 flight…should be in Najaf just in time to start the day. 

But leaving Istanbul might actually prove to be a bit of a challenge.  Apparently, everyone in the team so far has run into a little difficulty boarding their flights.  Hopefully things will have been worked out by the time I get back to the airport tonight but we will see.  The last person to arrive in Najaf got pulled out of line while boarding her flight by the officials who were convinced that she must be trying to board the wrong flight…why on Earth would a blond American woman, traveling alone no less, be headed to Najaf, Iraq?

So, once again, wish me luck!

I’m a little nervous about this trip…

 …but only a little. 

It is our first trip to this site.  If I recall correctly, the last time I was in Iraq I was on a second and a third mission to each site and we were still deeply mired in the figuring things out stages.  Those trips did not run entirely smoothly.  To say the least.  And this trip, our first time in Al Najaf, will be when we really assess the environment within which we will need to work.  This is the trip that we get to figure out if local meds just don’t work, or that there is no sink in the ICU, or that we have to worry about running out of oxygen from our wall set-up.  You know…

…details. 

This trip will also be a little different for me personally because I am arriving late.  Last one to the party.  And one of the last to leave.  The rational for that being that in the event that there are children who must remain in the ICU when it is time for the team to leave, that it would be great if we had sort of an ICU skeleton team to get them out.  So it will be myself, another nurse from D.C., and my Belarusian intesivist friend from previous installments of my blog, Pavel.

It is going to go by so fast…

Right now, sitting in JFK waiting for the next leg of my flight.  Off to Istanbul!  I have a much needed a hotel reservation for my seventeen hour layover and am hoping to take in some local sites.  I had arranged for a friend of a friend to show me around but sadly we had a major miscommunication about when I was going to arrive.  She showed up at the airport looking for me just as I was leaving my house to try to catch my first flight…I received a few very worried emails just as I was about to leave my house.  And unfortunately, she will not be able to meet me tomorrow.  But like I said, I have a hotel lined up already so that will help.  I think once I get a shower and maybe a nap I will be ready for a little adventure. 

Wish me luck!

Well, I’m all packed and I don’t leave for another 13 hours.

 My bag is overweight again.  It always seems to be on these trips.  I have my essentials, which are arguably more than is absolutely essential.  But I also have diapers and stuffed toys and liquid Tylenol and bubbles…and three bottles of liquor (last time I checked, southern Iraq was still pretty freaking dry).   I took the coloring books and the baby blankets out of my giant suitcase and put them in my carry on which gets the weight down on my suitcase to just shy of 70lbs, the reasonable upper limit for overweight luggage. 

So, like I said.  All packed.  And now what?  What am I going to do until  my plane takes off?