We arrived at drakes bay by boat, taking a secret shortcut through tangled mangrove forest, a waterway that reveals itself only once you're upon it, the roots and branches weaving closed the light before and behind the boat.  Then open sea, smashing bottoms on benches from swell to swell, cornering around rock formations, aiming towards an invisible point that becomes a line before resolving into a dirty beach. We wade ashore with our bags on our heads.

We sit on plastic porch chairs, eating ceviche and fried chicken in the heat while a shrewd chihuahua begs bones beneath the plastic table cloth.  A wilting hibiscus decorates a red vase.

We drag our melting selves back to the beach, walk along the fishing boats dripping lines and hooks, oil slick rainbows staining the sand. Over a decrepit bridge, spider webs bridging the gaps between the planks. A boy fishing from it with the spiders.  A musical bamboo grove, each spear thick as my leg, each segment yielding a different musical protest when beaten.  So tall that the bamboo curve over me when I look up, arching my neck then my back.   Over a rope bridge through a blue lagoon, more spiders dropping lines to catch flies. The whine of mosquitoes and distant speed boat engines.  Over paths marked out by shards of red clay crockery. Through the wet, heavy mist of hibiscus scent. Down concrete blocks set into mud slopes. Emerge through trees blinded by the golden afternoon light, as if preparing us for the surprise that is the secluded beach.  We are borne onto the beach blinking, unbelieving.  The entire beach seems to scuttle away from us, an illusion combined of our eyes' habituation to our constant movement suddenly ceased and the steady escape of the myriad startled hermit crabs. Warm water laps against the crescent of coarse yellow sand sandwiched between two rock cliffs.  I lay my orange sarong down. I lay down on my orange sarong laid down. A breath. But only a moment before we are off cavorting amongst the waves, handstands in paradise.

We stay too long. We race the sunset back to our hostel. We have no lights. We pick up a dog along the way, one bored by his people's slower pace. He jogs along behind us. My bag slaps rhythmically against my thigh.  Through bridges, lagoons, groves coloured by streaks of muddy sunset.   The view from the harbour pauses us, reds and blues mirrored off the calm bay.  By the time we get home, it's dark and a storm is underway.  Power outage.  The hostel owner hands white candles across the balcony. We drip wax to stand them on the sink to shower by.  Dinner is fresh fish wrapped in leaves, again by candlelight, again on a balcony, huddled under the awning with other revelers, sipping sprites bought from the market across the street.  A feeling of closeness, humanity, and optimism as the thunder cracks all around and the storm bears down.  When the worst of it passes, we follow a tip back to the beach, stumbling in the dark amongst fallen palms suddenly illuminated by distant lightening.  We wade into the water timidly, waist high as instructed, shivering against the falling rain, and wave our hands slowly...nothing.  I feel a bit foolish, but then I see it.  The water lights up in patterns, blue lights trailing our moving limbs, like the Sorcerer's Apprentice.  What delight.  What utter joy.  We whoop and laugh and splash in the dark in the blue light.

Wake excited and nervous before dawn to catch our boat to Corcovado.  The rain continues to pour, turning the sea slate grey. Waves reach out to menace the boat, tipping it this way and that. We are rewarded with the sight of a humpback whale calf and its mother. Two grey lumps amidst a grey canvas.

430am hike.  Rain stopped just in time.  Immediately saw two toads having sex, then a green tree frog, extremely shy.  Then I spotted a snake crossing the path in front of me.  Thought nothing of it.  Turns out it was a fer de lance.  Close call. 
Reached the river (the most dangerous in CR with the double whammy of bull sharks and crocodiles), saw a young tapir cross it and scoot off into the underbrush.  A mangrove hawk killed and ate a crab, smashing it open with rocks.  Crossed the river to the beach.  Tree of ten toucans and a hawk, then two pairs of scarlet macaws and a tapir's tracks.  The scarlet macaws almost went extinct, but they changed their behaviour.  The older males started raising the younger males' babies.  Now Corcovado has one of the largest families of macaws. 
Met the boat bringing breakfast and returned to camp.


We approached the resort in a long, two motored lancha, gliding around the bends of the murky waterway the same color as the tan crocodilio sunning itself on the bank, a trio of simple yellow butterflies playing about its sharp, narrow head, its tail twice as thick with muscle.  The captain cut the motors to point out animals hidden in the canopy, we crane our necks and scan the treetops with narrowed eyes.  The jungle closes in on either side of the waterway--vines and roots and epiphytes and bromeliads, like the scene from some Indiana Jones movie (Jon and I debate which, but I think we're thinking of different movies...both of which seem to feature an escape via biplane).

We're greeted at the resort by papaya umbrella'd drinks.  Borrowed some gum boots and tramped through the jungle behind our guide, a surprisingly quiet group of 20, splashing or picking (depending on one's disposition) through the sucking mud.  Saw the tent maker bat who bites the leaves broken so they hang all around in the shape of a teepee while it sleeps inside.  Crab, black hawk, howler monkey, walking palm, etc.

Obscured in dark clothes, we formed two ranks at the hind flippers of a massive momma green turtle, over a meter in length.  The guide shined an infrared light over its hind quarters.  I never saw her face.  I was part of the front five who knelt in reverence, close enough that if we were to reach out, we could catch each bright white, ping-pong sized egg as it tumbled into the nest.  Close enough to see the slime pulling into strands.  Distant lightening brightens the sky in intervals, during which we scan the beach for approaching mommas.  We stand, sit, lie in the sand as the turtle covers its nest, swimming a turtle shaped depression into the sand, all mothering instincts distilled into this one need to cover her eggs.  Powerful front flippers pummeling us with sand while the back ones pat it closed.  She crawls back to the darkened sea along the same ladder rungs from which she came.

The river washes us downstream.  Our cabin is right by a pretty energetic stream.  It's rush drumming me to sleep.   We are the only ones to float within the gorge, butterflies playing among the water sparkles, kingfishers looking up from their reflections as we pass. The occasional indigenous rope bridge overhead. 


Smatterings of jozi inspired thoughts

A constant paranoia underlies daily life.  High gates surround houses, local taxies are to be avoided, we were told not to sit in the driveway too long in our car, not to go walking after dark, not to use certain ATMs.  Southgate, the mall we pass everyday on our way to work, is a "black" mall.  We should go to the Glenn instead, "it's much nicer".  

Apartheid only ended ten years ago in 1994 (it began officially in the 1950s).  

If there's one thing I would've done differently, it's that I would have spent more time in ward 20 doing internal medicine.  They are less reliant on imaging so diagnosis is still very clinical.  Sure they do the CXRs and ECGs, but it's all stuff I know how to interpret (as opposed to ultrasounds and CTs, about which I have very little idea), so it feels like all the stuff I've learnt in med school is actually useful.  It feels more real, more gritty.  Feel like a real doctor.

I step up to the ledge to meet the horizon (I shouldn't be here).  The world tilts beneath me (oh my gods).  My voice rips through in bursts as I plummet, determined to make some last declaration, and it's not until the first bounce, that I remember this is a game.  Then I'm hollering and whooping as the cord stretches and holds.  I dangle like a caught fish.  Pressure builds in my sinuses.  I'm lowered slowly to the ground.

Watched the sun set over the lake.  Rocked in on the gravel road that parts the yellow grasses.  A herd crosses in front of us (elk?  Eland?).  Smaller kudu graze roadside.  The sky slowly bruises, then a ceiling of stars descends.  So many that it feels like a set.  Like im looking up into the underside of a cake dome.  So close that I stick my tongue out.  I feel a bit claustrophobic.  We lie there, listening to Josh's iPod, hunting shooting stars.  I see one that makes a Twock sound like an arrow leaving a bow before burning out in a hurry.  The Milky Way above us.

Galloping down the plains on a horse, holding on for dear life, stirrups bouncing every which way, hair, bag,etc streaming behind.  Two hour Ride down the forgotten valley.  Buttes above us, two owls asleep in a tree.  The grin permanently stamped on my face.  My horse was called taxi.  I fed it an apple.  

Walking to the policemans helmet w the amphitheater behind.  Scrambling alone up a soot cliff to get to the top, the view from the top breathtaking.  The same sense of giddiness as stepping up to the ledge in my recent bungy experience. My body remembering too easily.  Reminding myself not to jump.  Reminding my breath to stay with me, my heart to beat within my chest.  The boys a speck in the distance.   A moment of fright as I lose my way down.  A bird shrieks then falls in a crooked dive, straight down but buffeted by the wind, a victim of physics, like me, before pulling out.  My heads spins with it down into the ravine.  Calling for josh to come and show me the path, then hugging the cliff andI scooting back down slowly.  The descent is always my bane.  Then going off piste w the boys to track the gorge path for a different way home.  Eventually finding a creek in which to dip my dirty feet.  We lie in the sun.  I marvel at my survival.   A braii and s'mores before lying beneath the stars again.  

Our car is piece of junk.  It was to be expected--we got it from rentawreck.com.   It struggles to make it up the hills.  The boys have a theory that it's because the gas tilts back away from the engine when the tank is anything less than full.  The car rocks like it's on hydraulics, then stalls.  On a particularly onerous hill, we had to get out and walk.  Luckily we were still in the mountains of drakensberg, so the scenery was beautiful, and the wind whipped past us.  A piece of luck when a truck stopped and we hitched a ride, standing on it's back bumper and clinging to the netting tied over its goods.  Almost didn't get off in time before the truck drove off again.  Was definitely a moving dismount.  We refueled at the new Switzerland gas station, and took shelter behind 18 wheelers the rest of the way back.  Thus we made it home while the engine emitted funny noises and smells.  Poor little wreck.


Down in the pit

A bit of background.  The surgical pit consists of examination rooms w a clear space in the middle that holds 3 desks:  leftmost is trauma, center is surgery, right is orthopedics.  Walk-in patients get triaged at the nurses' desk to one of the three desks.  Right next to the pit is resus, which seems to fall solely under trauma's purview, so we're the only ones who receive patients directly from paramedics.  Once we stabilize a patient, we can then refer to surgery or ortho or burns or peds.  We also have two theaters dedicated solely to trauma surgery, which seems to run around the clock.  Obviously, there's the gunshot/stab emergency laparotomies and thoracotomies that we do, but for some reason, we also do wound debridement, skin grafting, and I've seen one bowel obstruction.  

On calls are 24h and run from 7am to 7am.  My first one was last Saturday, which happened to be the perfect storm of ppl doing stupid shit to hospitalize each other.  Not only was it payday, it was also a Darby between the two rival local soccer teams playing in Soweto stadium, and some rowdy political party's first year anniversary, for which they would throw a rowdy party.  Lots of drunkenness, which led to lots of stabbing, RTAs, burns, gunshots.  the stretchers in resus were wall to wall all night long.  You couldn't walk from the foot of a patient to their head without scooting at least 2 beds sideways, like clotheshangers on a discount rack.  More stretchers were placed helter skelter at the feet of the lined-up beds.  It was a war zone.  Things were even worse in the pit (except better bc those patients weren't immediately dying), with people lying, sitting, standing in whatever space they could find.  Patients literally lying on the floor!    We filled the entire pit.  We ran out of blood and X-ray forms at our desk and had to borrow from the fat pads at the other desks  We ran out of lidocaine.  We ran out of small and medium gloves, giving sets for drips, etc etc.  trash and sharps were strewn on the floor and kicked to a corner.   It was the best night I've ever had in a hospital.  And really, it beat most nights out too.  I learned to put in a chest drain, took a few ABGs under pressure, put in a wide bore line under pressure, dressed a burn, sutured and sutured and sutured--all stab wounds.  

That first night, we actually ended up staying till 11am bc josh was stuck assisting in a thoracotomy for an iatrogenic rupture of the internal thoracic artery during a chest drain insertion (not mine, a narrow miss, actually.  I had asked to put that one in, but bc the intern was under time pressure, she said she'd just go ahead and do it.  When she pierced the pleura, a gush of red blood came out.  I actually said "whoa" but she took it as a sign that she was in the right space for the hemothorax.  I'd never seen a hemo before, so I just went w it.  About ten min later, the patient starts getting really sweaty and   We had to resus him.  But bc the bleed was flowing directly into the drain, 1) there was no hydrostatic pressure increase to help staunch the bleeding  2) the bleed didn't show up on the fast scan.  The drain filled up quick though. He lost 1.5 L in no time at all.  He was a young guy, so he managed to compensate quite well initially, so his vitals stayed normal for quite a while.  Kudos to the intern for recognizing the crash just by him sweating.  I would've taken it as a ketamine overdose (we use it to sedate the patients and pretty much keep giving it until they tolerate the drain insertion (it's super painful)).  I also had to stay to sort out some pep stuff (more on that later).  By the time we got to the car, I was exhausted.  And of course, the car wouldn't start bc the battery was dead.  Matt reckons it's bc he left the lights on overnight.  It's a smallish car so we tried to push start it.  Then we tried to jump start it.  Then we tried to push start it again.  No dice.  Finally, the boys called the hire company to change the battery, and I called Chris (a driver I met earlier) to get of me the heck out of there.  Stopped to pick up some food, and Got home around 2pm.  Pulled Up to find the Germans sitting in our driveway.  I didn't realize that they were moving in today and was completely disheartened that my plan to eat an entire pizza in my bedroom while skyping Jon had been scarpered.  Ate in the living room while trying to be sociable.  Didn't get to bed till 3pm, slept till 10pm, skyped Jon for a bit, then slept again till morning, when I began my second 24h on call.  

Second one was just as busy for me--as in, I did the same amount of work, but we actually managed to clear the pit and resus by the time 7am rolled around.  Sutured loads of knees.  Two from car accidents where the driver bashed his knee on the dash and one from a tree falling on him.  Also learned to do a fast scan and cleared a patient w it on my lonesome (sort of, don't worry, the reg was looking over my shoulder at the screen while I did it).  Bc josh and Matt weren't on that night and bc I had had to give the Germans my key, I couldn't leave until they came in and gave me their key.  Of course, it's the one morning that they're late.  So late that the guy who had offered to drive me home leaves, and i have to get josh to drive me back again.  Cannot catch a break w getting home from on calls on time.  Anyways, managed to sleep a bit more, and am about to start my 3rd on call in a row.  Wish me luck.  

Johannesburg, first impressions

It seems a lifetime ago that Jon left me at joburg airport after what I think we are counting as our honeymoon (more on that later).  Here, in joburg, on my elective at the Chris hani baragwanath hospital in Soweto, my world has focused down to the hospital, the house we have rented in mondeor, and the gym.  This microcosm provides enough stimulation to keep me wholly engaged.  I'm like a newborn babe, content to try to make sense of my immediate surrounds before trying to wander wider.  

the hospital is like a tent city.  It's huge and always bathed in sunlight during the day (something no one who has lived in England for any amount of time takes for granted), which goes miles towards dispelling the mordor-like, Goliath slum image I had built up in my mind.  an admonitory tale describes a female doctor getting raped in the hospital while walking at night from obs and gyne to blood bank.  I had always imagined someone getting dragged by her hair to some dank cellar broom closet in a deserted hospital.  Actually, the hospital is never deserted, and obs and gyne and blood bank are on opposite sides of the hospital and requires walking outside for long stretches (a cardinal rule of survival in joburg is that no one should EVER be alone outside after dark).   I'm not saying it's ok that she was raped, I'm just saying that precautions can be taken to prevent it happening to me (so stop worrying, Jon).  Funny that the lesson ppl seem to have picked up is that girls shouldn't walk to blood bank by themselves at night as opposed to girls shouldn't walk outside by themselves at night.  Blood bank is really close to trauma (makes sense, eh?), but I'm usually forbidden from going to collect blood when I'm on call.  Seems weirdly superstitious, but I guess when personal safety is so down to luck, we try to make sense of things any way that we can.  The other day, a man in the hospital parking lot got shot in the wrist while making a bread delivery.  Broad daylight.  He was sitting in his car, some guy tried to carjack him, he drove off and got shot, fracturing both radius and ulna.  He was surprisingly nonchalant about it.  After he got set, splinted, and sutured, he absconded to go finish his bread delivery.  Pure luck (or lack thereof).  

The elective itself is fulfilling my need for adventure.  Every day I learn something new, and it's usually how to DO something new, not just a new medical fact (bc tbh, there are tons of new medical facts that I could learn and forget in every blink of every eye back in England).  The first week, I spent mostly on the ward, practicing cannulation and blood letting w unfamiliar equipment, getting to know people, tacitly absorbing all those details of a new place and its logistics that are long-term useless but short-term necessary and incredibly exhausting to figure out.   Did manage to do my first femoral stab, which was surprisingly easy.  Don't know why it's not done more commonly in the uk...British distaste for the groin, perhaps?

Things do feel more gilligan's island here, and by that I mean a little makeshift, but cool in that self-reliance way.  For example, they don't flush cannulae lines here.  They just attach a bag of saline, then lower it below the arm:  if blood flows up the line then you know the line is intravascular.  Or before extubating burns victims, they deflate the cuff and measure the exhaled co2.  If co2 is low, that means air is escaping around the cuff, so there's no soft tissue edema and the patient is ready for extubation. Clever, eh?  

And dunno if it's bc I'm in trauma, where everything is literally life or death, or whether it's because im in joburg, but the way they treat patients is...interesting.  Not good or bad necessarily...ok who am I kidding?  It's bad (but also often hilarious).  The balance of power is definitely shifted towards doctors.  Every night, I see the registrar slapping patients on the head: "hey man! hold still!  I'm trying to save your life here!  You're really starting to get on my nerves!" WHACK upside the head.  In her defence, the patients are generally drunk/high with multiple stab wounds, falling bp, etc etc and she's trying to get a central line in for ionotropes or something while they're flailing about and screaming their fool heads off.  Tbh, when she does it, I cheer internally.  Surely, every doctor has had that time when they just wanted to slap a truculent patient.  If the slaps don't quieten them down, the threshold for sedating patients is low,  and a surprisingly high number of them get rapid sequence induced and intubated just to keep them docile.  Dunno what the ethics on that is.  This morning, a lady w a pelvis fracture was lying in an L shape across hers and another patient's trolleys.  A reg dragged her bodily back onto her own trolley like a sack of potatoes while she screamed in pain (and she'd just been handed over, so the reg definitely knew about the fractures).

The way they deal w consent is likewise shifty.  I asked an intern whether she'd already gotten consent for a chest drain, and she looked at me like "why in heaven would I want to do that?"  A hefty dose of ketamine later, the guy no longer has capacity anyways.  In the wards, the only way patients express lack of consent is by being uncooperative.  One guy w a partially obstructed bowel kept pulling out his Ng tube.  I think they explained it to him once or twice that he needed the tube, but then by the third and fourth time, it was "hey, my man, I've already explained this to you multiple times. If you don't want us to treat you, then you can sign this sheet of paper and we'll discharge you, and you can go home and die by yourself.  And don't come back when it starts getting bad again either!  And the death WILL be painful!"  Luckily, it was only a scare tactic (they didn't let the guy go home after all, even though he offered to sign the form), but it's a scare tactic that gets pulled out w surprising frequency and facility.  Another man didn't want to let us take bloods.  He was immediately declared "confused".  "Hey baba, why are you acting this way?  You're confused!"  At least they still have to get written consent for surgery.

Bc the healthcare here is still v paternalistic, patients are grateful for the care they get, even though the care is free (cf UK patients' attitudes).  I've made grown men cry w pain while suturing them, but afterwards, they all thank me in this charming, sincere way.  It's amazing.  We went grocery shopping in our scrubs after work the other day, and ppl stopped us to say what good care they got at Bara after their accident.  it felt good.  Like i'd finally become a useful member of society.  Maybe this contributes to the lack of consent...bc doctors know best, and afterwards, patients are thankful, regardless of their feelings at the time.  Well, they're either thankful or dead.  



holy crap, it's been years and years since i started writing this post.  it's time to just send it out into the world.  i wash my hands of you, lamu.

*Ahem. i started this post a couple of months ago, so some things are a bit dated...(the year 2000, the year 2000...robotic being finally rule the world).

also, i seem to have written the beginning of this post twice now...so you can actually choose your beginning:

nostalgic version:

we took a bus to lamu...a bus that the state department warned against...that an american GI in uganda taught me how to hijack if necessary (his advice was to curse at the driver to keep his foot on the gas...and if he threatened to stop, i was to wrench him out of the drivers seat and drive the bus myself, at which point he asked if i could drive stick, the answer to which is no. "oh," says he.). nothing really happened on the bus ride there, except we got stopped by some heavily armed army men who were checking for marijuana. everybody got off the bus; we were split into women on the shaded side, men on the sunny side while they searched all our luggage. the bus ride back was much more exciting. we sat next to a bunch of tied chickens and an armed guard. the chickens sat docilely on the floor, tongues slightly out, not moving a muscle. we poured them some water from our bottle to drink. they seemed to enjoy that.

lamu is an island with no vehicle access. the bus dropped us off on the other side of the water, and everyone crowded onto a boat. we squeezed into the prow, stowaways. we could see a bit of sky thru the cracks in the wood. the roof was too low to straighten our spines. water sloshed in at us, and we shared this coveted bit of sitting space with 20 others.

lamu is a land of dhows and donkeys.

holy crap let's just get this over with version:
now that i am over a year behind in this thing, it is time to catchup in earnest. especially as my boss, in yet another bid to stop me surfing the internet, has blocked all internet mail servers, as well as youtube, and a few other of my standby entertainment sites. ah well. new beginnings.

erika, ash, and i couldn't convince the boys to join us on the dangerous bus route from mombasa to lamu. whatever, we didn't need them. other than the police barricade, where everyone got off (boys to the sunny side of the bus, girls to the yin), and they searched everyone's luggage for pot, the bus endured nothing more rigorous than the patronage of some thirsty chickens. on the way back, we had an armed guard escort.

From lamu 3-2009

From lamu 3-2009

lamu is only accessible by boat. donkey remains the main source of transport on the island, which has allowed lamu to retain its labyrinthine network of alleyways.

we arrived like stowaways, i.e. emerging from the dripping hull of a crowded boat, just in time for mawlid al-nabi, a festival celebrating muhammed's birthday. our timing couldn't be more perfect.

after rejecting a number of mediocre rooming arrangements and explaining to the offended owners that their home was nice, but we wanted toilet seats (holes in the ground are fine, but if you give me a toilet, then i want a seat), we finally found a lovely tiered house featuring flights and flights of non-uniform staircases winding their ways around knuckled flowering trees. i shared a "room" with ash at the top of the house.

From lamu 3-2009
We didn't even have to get out of bed to catch the sunrise.

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clever vs nice

there are too many clever people in the world.  when faced with a choice, be nice instead.  it'll get you less attention and make you friends more slowly, but they'll be better friends.

something it's taken me a long time to realize, and obviously something i struggle with.

anyone got a fortune cookie i can stick that in?


sick of all the weight loss advice...gonna write my own

tip 1: sit in bed emailing all morning...give those fingers a good workout. you'll lose weight if you're too lazy to go downstairs to the kitchen.

tip 2: eat lots of different foods so they'll fight in your tummy and cancel each other out

tip 3: chew lots to get all the flavor out, then swallow. these actions use lots of face muscles.

tip 4: lift your fork/glass/spoon to your face multiple times before eating/drinking off it. it works better if you count aloud during this process. if this seems daunting, you can pump yourself up beforehand by muttering "5 reps per bite" under your breath beforehand. thrash wildly when the men in white coats come to take you away.

tip 5: eat sketchy foods and develop a stomach bug. diarrhea is the best weight loss medicine.



4+2 years of college did not prepare me for bra shopping at victoria's secret. i stood in a stupor as the saleswoman explained the bra shapes complementing the boob shapes and which lines had what...in the end, i lifted my shirt and bought the ones she liked the best. i hope her tastes match jon's.