3/15 THURSDAY — Thursday always means extra-long morning report, since we stay in the chapel with the whole group (nurses and so forth) after devotions rather than going to a separate physician room; the extra-long morning report then necessitated an extra-extra-long meeting with Bob to ascertain exactly what had been discussed, since much of it had been in Swahili. Afterward, we went up to labor & delivery and peeked at Adam — I finally got the chance to listen to his heart and lungs, which actually sounded perfect. While we were there, his mother showed up with two thimblefuls of colostrum that she’d expressed, obviously planning to feed him via his NG tube; she waited for us to finish our exam. I tried to convey via gestures that I thought he was beautiful, but I don’t think she understood. She did notice the stethoscopes in our hands and asked, “Nzuri?” — meaning, is he OK?
“Nzuri,” I said, smiling and nodding. (Well, relatively speaking, I suppose I was telling the truth…)
“Asante,” she said with a relieved smile, and slipped past us, along with the nurse, to feed her sweet baby in the only way she could.
We hung around L&D for a while thereafter, because, one curtain away, a young woman was in labor with her first baby. The nurse checked her cervix, and in the midst of a torrent of Swahili, I heard her say “saba” (seven); our hopes of finally seeing a delivery started to rise. Unfortunately, when she withdrew her gloved fingers, they were stained with meconium. Foiled again! So it turned into yet another c-section (and one of the doctors was forced to miss a chunk of the teaching seminar ;)). Oh, well, at least we had something to do!
And then… it was time for Zanzibar! We’d really wanted to take the bus to Dar es Salaam (eight hours) and then the ferry to Zanzibar (two hours), but we only had three days for the whole venture, so we decided to pay more and just fly rather than sucking up so much time on either end with the travel arrangements. Fortunately, Carol, our driver from the first week, owns his own taxi, so we were able to hire him privately to take us to the airport rather than trying to navigate a dalla-dalla and a bus; we didn’t have any bags to check, so the whole experience was very simple. Precision Air flies in a circle, from Kilimanjaro to Zanzibar to Dar es Salaam and back again, so I spent the hour flight next to a Canadian man who’d just finished a nine-day safari with his family (complete with hot-air balloon ride over the Serengeti); they were headed to Dar, so they stayed on the plane after we got off. He had never heard of PAs, but was extremely interested in the state of HIV/AIDS in Tanzania, asking questions about everything from prevalence to transmission methods to antiviral medication — so that conversation made the hour pass quickly. He was an older gentleman with an air of wealth about him — it was clear he was accustomed to receiving answers and obedience — so although he was perfectly pleasant, it honestly felt almost like getting pimped! ;)
Once we landed in Zanzibar, the 45-minute taxi trip to our lodge was a piece of cake. Our jovial cab driver opened the sunroof without being asked — he’s clearly used to tourists — and the roomy minivan gave us room to stretch our legs, which was a welcome relief after the cramped plane ride (only 18 rows!). From the cab, we saw red colobus monkeys, which are unique to Zanzibar, and the smells of smoked meat and grilled fish wafted through the windows at intervals, making me salivate. Tourism seems to have ensured a slightly better quality of life for the Zanzibari people than for those living on mainland Tanzania; there’s still some pretty desperate poverty here, but it isn’t as extreme as what we’re used to seeing. (Also, another telling contrast to the mainland — all the roads are paved.) We saw some men digging a ditch along one of the more major roads, and the cab driver said they were making preparations for a wireless Internet network. That would be completely unimaginable (as well as completely unnecessary) in, say, Machame.
Since it was a workday for us, we arrived fairly late, but there was still a little sunlight left, so we changed into swimsuits and splashed into the clear green water of the Indian Ocean. The tide was all the way out — multiple colorful wooden boats were temporarily abandoned on the patches of sand where they’d been beached — and the sand was so fine that it felt almost sticky along the damp water’s edge. We could just see a distant line of darker blue waves breaking in the distance — but although we walked straight out to sea for almost half an hour, the bathtub-warm water never rose any higher than our thighs, and the breaking waves never seemed to get much closer. I tried to drop down and swim, but there was little point; my hands hit the bottom with every stroke. I finally ended up just floating on my back, staring up at the cloudless blue sky, hearing absolutely nothing beyond the rushing of the water and the wind.
After spending an hour or so in the water, the sun was starting to go down, so we headed back up to the lounge chairs we’d claimed. We both ordered piña coladas (cliche, perhaps, but necessary ;)), then pulled out our Kindles and did some reading. The trees swayed gently overhead, the breeze was pleasantly cool, and the view couldn’t be beat; we kept looking up from our books to make sure it was still there, and exchanged more than one disbelieving remark about how lucky we were. I think everyone has at least seen a photo of Zanzibar (or someplace similar) — clear green water, powder-fine white sand, colorful wooden boats, dark-skinned fishermen — and I’m discovering that, in terms of photographs, this place is exactly the opposite phenomenon of the rest of Tanzania. I’ve mentioned several times how, in so many settings, our cameras just don’t capture the full spectrum of a situation… yet in Zanzibar, things actually *are* every bit as gorgeous as all those stunning, just-slightly-unbelievable magazine spreads and calendar photos. You sort of take the flat, glossy images with a grain of salt while you’re sitting in your American living room, but then you get here and it genuinely looks like someone has taken Adobe Photoshop to the entire beach! :)
Around seven, when we could no longer see our books, we headed to the on-site restaurant for dinner. It’s an open-sided building with a thatched roof, lit by table candles and hanging tin lanterns with decorative cutouts; they sway in the sea breeze as you eat. We started with an appetizer of chapati, tzatziki, absolutely delicious guacamole, and a very distinctive hummus, and then I had the best grilled kingfish of my life, served with a delectable coconut-based sauce enhanced with cilantro, mango, cumin, lime, and I don’t know what else… I see why Zanzibar is called the Spice Island! My stomach is literally growling at the memory — and as far as foods that have been ‘ruined’ for me back in the States, I’m fairly certain my generic frozen grocery-store tilapia filets just moved to the top of the list. ;) I capped off the meal with a fruit salad of watermelon, mango, banana, and passion fruit (which, for those who have never tasted it, has a definite ‘bite’ — but it’s starting to grow on me).
3/16 FRIDAY — We’d decided to spend Friday in Stone Town, which is the history-laden ‘city within a city’ inside Zanzibar Town, complete with Turkish baths and old slave markets. I set my alarm for 6am so I could get some pictures of the sun rising over the Indian Ocean — stunning — and then Erin and I went back to the on-site restaurant to collect our free breakfast, consisting of coffee, bread, butter, marmalade, chapati, eggs, and several different kinds of fruit. The front desk called us a cab, and off we went, complete with open sunroof and pleasant smoky smell. (I finally figured out what it smells like — the paper-thin smoked prosciutto I used to eat in the Netherlands. Yum!)
Based on our guidebook, we asked the driver to drop us off at Darajani Market as our starting point — which turned out to be every bit as chaotic as the Machame market, multiplied by about fifty. There was blood spattered on the ground from the various meats being sold, so while gingerly watching my foot placement, the first thing I did was walk smack into a bicycle parked in the middle of the sidewalk… nearly impaling myself on the contents of its basket: a gigantic doubled-over SWORDFISH! I’d had no idea how big those things get; it was at least four feet long from tip to tail. I was too stunned to even give a thought to taking a picture, but it’s definitely seared into my brain forever.
Like Machame, most of the market stalls were devoted to fruits and vegetables, which is great at home (EDIT: ha! Just realized I referred to Machame as ‘home’ ;)), but which we didn’t have much use for here. So we wandered away from the market, deeper into the maze of narrow twisty stone alleyways and colorful doors, clogged with clattering bicycles, jam-packed curio shops, enthusiastic vendors, and traditionally-dressed Muslim schoolchildren. We spent most of the morning browsing through the shops; a lot of what we saw was pure kitsch (I think every single shop had the same banana-leaf artwork and elastic cowrie shell bracelets), but we trawled long enough that we each found a couple of really excellent deals. Erin chanced across some necklaces made from polished coconut beads, which we haven’t seen anywhere else during this whole trip, and I netted several pairs of unique dangling earrings, including a pair made from malachite, for an average of $3 per pair. I also bought a series of small watercolors from a narrow private shop sandwiched between two of the run-of-the-mill curios — the artist was sitting in the back working on some pen-and-ink drawings, and his assistant came out and talked to us about the artwork. Zanzibar (and particularly Stone Town) is famous for its beautiful doors, many of which are brightly colored and/or festooned with brass spikes (in the Indian tradition; supposedly it keeps the elephants away), so I bought three small watercolors of the doors: one blue, one green, and one brown. They’re going to look great in my apartment, side by side in a triple frame.
The other gem of our shopping excursion was actually one of the first shops we chanced across, in a less touristy area of the alleyway maze. It was a wide shop, with two doorways, each flanked by stacks of small, attractive, hand-carved wooden chests. Unlike most of the other vendors, this man — who was fairly young and dressed quite Western, in Adidas track pants — didn’t call out to us and assure us of his “lovely prices”; he waited until we stopped to admire the craftsmanship, then explained to us how they were made and invited us to step into the back for a look at his cluttered workshop. Basically, he and a few partners collect old wood from all over Zanzibar and recycle it by hand-carving it into decorated boxes of every size, from palm-sized jewelry boxes to trunks the size of small footlockers. Some of them were subtly beautiful, with the depth of the carvings yielding variations in the wood coloring; others were more overtly decorated with gold fittings, latches, and drawers.
“This one has a secret compartment,” the man said with a grin, pulling out the two lower drawers on one chest. He grasped the divider between thumb and forefinger and pulled that out too — and lo and behold, two small square compartments were attached to its back side. I loved it, and was sorely tempted to buy it, but wasn’t sure it would fit in my bag when it was time to go home; plus, it was early in the day and we had a long way to go yet.
We didn’t even have to give voice to our thoughts. “Walk around, spend your day,” the man said with a smile, “check out some other prices… and then, if you decide to buy, I think you will be back here.” He handed us a card with his shop address — a good thing, since it’s unlikely we’d have been able to find the place a second time — and cheerfully waved us on our way. (Again, a far more relaxed attitude than any other vendor we’d come across *anywhere* in Tanzania!)
And with good reason… because he was absolutely right. We saw similar chests in a few other places (it’s one of the smaller things that Zanzibar is known for; the guidebook actually mentioned it), but none that were so unique or so fairly priced. So our last stop of the day was, indeed, back at his shop, where we handled nearly every chest he had, opening and closing and exploring until one called our names. For me, it was a small, simple, dark-wood box with a carved flower on the top — I’d really liked the ‘secret compartment’ chest, but this one just ‘felt right’ in my hands (and only cost $8!).
We chatted with the shopkeeper a little more — he just seemed so different from his counterparts, with better English and a more Western attitude — and, after inquiring about a giant color photo of a soccer team, discovered that he is actually a player for the Zanzibar national team! He runs the shop in the off season. That explained a lot, from the track pants to the English skills. Even the fairer prices and relaxed attitude made sense — the other Tanzanian/Zanzibari vendors are, in a word, desperate. This man wasn’t.
“Thank you so much,” I said as we left. “You are the only person today who hasn’t tried to pressure us into buying — and you were right; your prices are also the most fair of anyone’s.”
“This is why I opened the shop,” he explained, nodding vigorously. “I would come home at the end of a season and want to buy gifts for my friends on other teams, but couldn’t find anything ‘traditional Zanzibar’ that wasn’t overpriced — for the tourists, you know,” he said, with an apologetic glance. (Yeah, we know. ;))
We ate lunch at an open terrace restaurant called Archipelago; it looked over the water at a small sandy beach where the local fisherman launch their wooden boats. The menu stated that all their fish was line-caught, never net-caught, and was caught fresh each day, never frozen. I don’t remember the exact wording of the apology, but it basically read that, if, therefore, they weren’t able to serve a given item on a particular day, that it was simply the luck of the ocean. (As it should be, right?) I decided to be bold and go with octopus, which I actually really enjoyed. It was served with a side of pilau rice and the same type of spiced coconut sauce as last night’s fish — delicious. Of course, we had to get dessert; I had an orange almond cake which was unlike any cake I’ve ever had before: very light, not particularly sweet or dense, with just enough dough to hold the copious amount of crushed almonds together. We left the restaurant fully satiated, having tickled every taste bud with the wide array of flavors, but not bloated — none of the disgusting too-full feeling that so commonly follows an American restaurant meal. I wish I could eat like this all the time.
We wandered further — up and down the alleyways, down along the water where dark-skinned boys launched themselves off the stone walls and into the water. We sampled ice cream, investigated a women’s fabric co-op, visited a small museum where a musician sat playing local music. For dinner, we went to Dorohani Gardens, which is a large, green, open park along the water’s edge. Every night, local vendors set up booths selling various things — samosas, seafood kebabs, ‘Zanzibar pizza’ (thin pastry crust filled with chicken, cheese, tomato, egg, mayo, and onion), and various inventive desserts (I had a crepe with mango and Nutella, which was delicious). Each booth has a small grill, and the vendors cook the food while you wait. There was also a table selling sugar cane lemon juice — we got to watch them chop the sugar cane and squeeze the juice from the pulp — so we had a glass of that, which was very refreshing after our hot, sweaty day of walking around. As the sun sets, the vendors light lanterns at their tables, so the whole park glows with soft light and smells of charcoal and grilled meat. It’s a popular snack/dinner spot; people perch on benches or along the sea wall, balancing paper plates on their laps, nibbling and chatting as stray cats wander among the throng, begging for tastes. We bought most of our food from a guy named Ali, who took a liking to us; while our pizzas were cooking, he let us taste some of his vegetables and taught us a few new words of Swahili.
We ended our day with drinks at Mercury’s, a waterfront restaurant and bar named after Freddie Mercury, the lead singer of Queen, who was born here in Zanzibar and lived here until going to boarding school in India when he was eight. The bartenders were a lot of fun, and there was a live band playing a traditional version of ‘taarab’, which is a kind of fusion music combining Indian and Muslim influences; Zanzibar is famous for it. We stayed until 9pm or so, then called our cab driver from this morning and got him to take us back to Paje, exhausted but satisfied. I think we planned this well — by doing the exploring, walking, shopping, etc. on the first day, we ensured that we can just happily be a couple of beach bums tomorrow! :)
3/17 SATURDAY — It rained overnight, so our morning breakfast (same food as yesterday, but eaten at one of the outdoor beachfront tables) was a bit overcast, with a few distant rumbles of thunder — but beautiful nonetheless; the contrast of the dark gray clouds and light green water was stunning. Fortunately, the storm had blown out to sea by 10am, and the bright sun was back in full force. Erin and I camped out on the same two lounge chairs as yesterday, under a thatched umbrella, right beside a rustic rope hammock (which *feels* far less romantic against one’s swimsuited rear than it looks in a photo, I can assure you!), and spent the day alternately reading, swimming, journaling, and taking photos. The storm meant that the water was deeper and a bit cooler than yesterday, perfect for swimming, and there were masses of seaweed and colorful shells washed up onto the shore that hadn’t been there yesterday. We took a break from the sun at lunchtime and went into the restaurant for light salads and cassava chips, then returned to our spot. It was an incredibly low-key day, which was exactly what we both wanted and needed.
When it got too dark to read, we went back to the room, got cleaned up, and went down to the restaurant for dinner. We started with beef samosas with a spicy pickled mango dip, then each got huge slabs of grilled tuna as a main course, served with pilau rice and soft grilled potato wedges. We rounded it off with spice cake and vanilla ice cream, then had mojitos at the beachside cabana bar and sat outside and marveled at the night sky. Unexpectedly, just before we headed in for the night, I saw a dazzling streak of light over to one side — the brightest shooting star I’d ever seen. Well done, Zanzibar.
3/18 SUNDAY — Not much to talk about today; it was basically a day of travel. We got up early to try to get some sunrise pictures on this last Zanzibari morning (to no avail — too many clouds — making me glad I’d been proactive on Friday!), then hung out on the beach for a few minutes, collecting shells and marveling at how far out the tide was. We had our usual breakfast (the chapati is really growing on me, especially when you add some butter and marmalade), then packed up, retrieved our passports from the hotel’s safe, and hopped in a taxi back to the airport. It was an hour’s ride there, an hour’s wait for the flight, a quick hop to Dar, an hour’s wait *there*, then an hour’s flight to Kilimanjaro, and another 45 minutes or so back up to Machame in Carol’s taxi, so it was late afternoon by the time we staggered through the door to the guest house. We both immediately took showers — after having been sandy, sweaty, salty, sunscreen-y, or (usually) some combination of the above for three days straight, it was incredible to feel clean — then spent the evening simultaneously unpacking from Zanzibar and packing up for… home! In 72 hours, we will be back in Carol’s taxi headed back to JRO airport — I can’t believe it!
I think we planned this trip well by putting it at the *end* of the rotation; our Zanzibar lodge wasn’t a luxurious place by any means (tiny rooms, cold-water showers, and of course no air conditioning) but our perspective on ‘luxury’ is so different at this point that it felt like a darn Hilton! :) Getting a couple of days to just rest, relax, swim, read, eat good food, and experience a new place was really great. In hindsight, it was also wonderful to be ‘in charge of ourselves’ — able to do what we want to do when we want to do it, and not be dependent on anyone else’s input — since we’ve been so often disappointed when we entrust our daily schedule to the MLH higher-ups. But at this point, I think we both feel ‘recharged’, ready to go back to Machame and tackle our last three workdays full-out. We coincidentally ran into Dr. Masaki (the pediatric doctor that I’ve been trying to pin down for, oh, three weeks now) in Bob’s office on Thursday morning, and he ‘confirmed’ (for whatever that’s worth — Bob said to take it with a grain of salt) that he would be doing pediatric rounds tomorrow and Tuesday this week, so maybe I’ll finally get a little bit of peds time. Either way, bring it on, Machame… let’s see what you’ve got for our last few days!
3/19 MONDAY — Victory! We finally got to work with Dr. Masaki (the pediatric doctor)! Things started off a little rough (he was supposed to do five circumcisions, and one of the older surgeons pulled rank on him and basically gypped him out of an operating room), but he rallied, and the end result was definitely my favorite day here at Machame thus far.
First, I found my (tentative) presentation topic during morning report when Dr. Masaki discussed a seven-year-old boy who’d been brought in Wednesday with a cough. Via the history, he elicited that the child had drunk from the Kilimanjaro River two weeks earlier and had developed the cough shortly thereafter. On exam, the child appeared to have a foreign body in his mouth; he underwent minor surgery to extract… a worm! A ‘liver fluke’, to be exact, which is a kind of helminth that, near as I can figure, bears strong resemblance to a leech; it starts off small (the child evidently didn’t notice it in the river water he was drinking), then attaches to whatever bit of flesh it can and increases in size as it fills with blood (thus causing the child’s cough).
The doctor had saved the thing in a jar — still alive — so we took a field trip to the hospital lab to have a look at it.
“It was attached just behind the child’s uvula,” he said casually, peering at the jar, tapping the glass to try to make the worm stretch itself out. Fully extended, it was as long as a finger. “This is our third case here in two years.”
*shudder* …Forget the cough — if something like that had been stuck in *my* mouth for two weeks, I think the chief complaint would have been more like ‘persistent vomiting’!
We did ward rounds after that and saw a total of sixteen patients. The most common complaint by far was pneumonia, mostly in very young children (infants and toddlers), but we also saw a four-year-old Maasai child with worms, a twelve-year-old girl with a femoral neck fracture (highly unusual), and two really interesting three-month-old girls: one with fairly significant anemia (her palms and tongue were markedly pale), and the other with marasmus (severe malnutrition) — she was born at a weight of 3kg, but presented here last week at 1.7kg, which is less than FOUR POUNDS!!! I couldn’t believe she was still alive!
It was amazing to be so completely enthralled in what we were doing; the morning was over before I’d checked the clock once. There were a lot of things I didn’t know (like the *causes* of marasmus), but my brain was firing the whole time, making potential associations about what we were seeing, asking myself what I’d be doing for these children back home with our limitless resources. I was particularly curious about the anemic three-month-old after my rotation on peds heme/onc, and asked about splenomegaly, but none of us could feel a spleen tip today. Dr. Masaki said they can’t test for hemoglobinopathies until babies are older (I’m assuming that’s because they don’t have electrophoresis here, so they have to wait for most of the fetal hemoglobin to disappear before checking a blood smear), but that’s where my money would be, particularly since this family comes from a lower-lying area where malaria (and, thus, sickle-cell) is more common. This baby was just recovering from a fairly significant infection, too, so if she does have a hemoglobinopathy, it makes sense that her red cells could have taken a hit.
I did speak up about the femur fracture (whose leg was in a rudimentary traction system made of rope). “That’s a really unusual place for a child to have a fracture; do you think she has some kind of mineral imbalance?”
“Yes, this is very possible,” the doctor said, nodding his head. He showed me the x-ray, remarking that the child’s bones appeared uniformly light on the scan, not as dense as they should be. Then he added, “She’s also now complaining of abdominal pain and diarrhea, and pain when she urinates.”
Well, if that didn’t sound like “stones, bones, groans,” and so forth! “Has she had her electrolytes checked? Her calcium?” I asked.
The doctor smiled, as if he knew exactly what I was thinking, and said, “That has to be done at KCMC.”
“We can’t do chemistries here?” I asked in disbelief, trying my best to sound curious instead of appalled. He shook his head with a wry smile.
Wow. Just… wow.
Anyway, in my head, that girl’s going to have hyperparathyroidism until proven otherwise. I hope she manages to get the care she needs. The lack of lab support was a recurring theme today — there was another patient, nine years old, who’s getting an I&D tomorrow for recurrent septic arthritis of the knee, and when Erin asked about cultures, she was told that all they do is a Gram stain. Unbelievable.
On the up side, one of our sixteen ward patients was ‘Adam’, and he seems to be doing a bit better — although his suck reflex still isn’t super strong, he’s actually able to breastfeed now, so his NG tube has been pulled, and his mom and the nurses say they haven’t seen any twitching at all. I’m wondering if he didn’t maybe have some form of neonatal meningitis rather than a permanent brain injury. I hope so, for his sake.
In addition to being the house pediatrician, Dr. Masaki also works in the HIV clinic, so his rounds included a stop in the female medical ward to see an elderly HIV+ patient who is entering her fourth week in the hospital. He gave us a brief summary of her history as we stood by the bed, “…and then we found out she had TB,” he said casually, “so now she’s on the drugs for that as well…” (Erin and I are soooo getting tested when we get home…!) The patient has reportedly been sick for a year, but just started antiretrovirals on Friday (sigh), and currently has a CD4 count of 34 and a new complaint of a terrible headache. Dr. Masaki thinks she has cryptococcal meningitis (an opportunistic infection unique to HIV patients), so now she’s on antifungals as well. Based on looks, I had estimated her age at 86 for my Typhon logging, so it was a shock to discover that she was actually only 67. Very sad.
After we were done with ward rounds, we headed back toward the ORs. Four of the scheduled circumcisions had gone home when they found out they’d have to wait a few more hours (for the more senior surgeon to finish using the operating room) — they’ll be back tomorrow — but two brothers, aged two and four, remained. So Erin and I sat on the bench outside the procedure room, waiting to get started.
The anesthetist walked in before Dr. Masaki did, and looked at us, seemingly perplexed. “You are here to observe circumcision?” he finally asked cautiously.
“Yes,” we said.
He paused. “…You know what it is?” he asked.
“Oh yes,” we assured him.
“It is the removal of the prepuce — foreskin — away from the glans penis,” he said, carefully enunciating each of the medical terms.
“Yes, we’re familiar with the procedure,” I said, trying not to get defensive.
He came and sat down next to me. “You do this in your country too?” he asked, seemingly surprised, and we got into a conversation about the indications for circumcision (according to him, it’s mostly for cosmetic reasons and cleanliness) and the most common ages for it to be performed (usually after age two in Tanzania, but some boys don’t have it done until they’re teenagers, particularly the Maasai).
“I believe it also reduces HIV transmission a little,” I said, “is that right?”
“No!” he said emphatically. “How? How would this reduce transmission?”
“I don’t know exactly how,” I admitted, a little surprised, “but I’m pretty sure it does lower the rates a bit.”
Dr. Masaki walked up at the point, so we let the conversation drop. The nurse brought the younger brother into the room (two years old), sat him on the table, and positioned me at his side, wordlessly placing my arm around him in a half-hug, before she walked away to continue her preparations. Erin and I showed him the sheets of stickers we had in our pockets, and he seemed mildly interested in the animals, stars, and shapes we playfully stuck to his legs, but after a few minutes of this, he started looking around the room apprehensively, watching the medical preparations with suspicious eyes. He stuck his fingers nervously into his mouth, then turned his face into my coat with a wail.
I picked him up, patted his back, rocked him back and forth. He quieted down immediately and laid his head on my shoulder, which melted my heart into a thousand tiny pieces.
“You have to do peds,” Erin said, watching my face. “You’re in your element right now.”
I smiled. (As an aside, I actually think she’s right — one of the things I’m taking away from this rotation experience is a bit more certainty that I am, in fact, likely still headed where I thought I was headed two years ago when we started this crazy PA school adventure.) But I felt bad for the poor little guy — even more so when the anesthetist made me pin him to the table while he hunted for a vein and inserted the IV to inject the ketamine. It would have been so much less traumatic for the boy if they had just let me restrain him on my lap — or, even better, had let his father come with him into the room and hold him while the IV was inserted. I don’t think reducing fear on the part of the child is a big focus of what they do here — although this manifested itself amusingly when someone noticed the colorful stickers still marching down his limp toddler’s legs and asked us about them. Erin and I both pulled our stashes out of our pockets, and the doctor, nurse, assistant, and anesthetist all stared in wonder, asked several questions (“Did you bring those for the children?” …Um, as opposed to a bribe for my evaluators?!) — then helped themselves! The anesthetist asked, “Do you have any more with animals?” then, when I pulled some out, asked if he could have a sheet. Dr. Masaki asked if he could bring some home to his son; I told him I’d bring him a whole book of stickers tomorrow. It was hilarious to watch full-grown adults explore something so simple that they’ve just never really seen, like teaching the clinical officer about hand sanitizer last week.
I chatted with the anesthetist while Dr. Masaki worked, and at one point, a nursing student entered the room. Dr. Masaki asked her if she knew the indications for circumcision; she named a couple of things, and he started filling in the gaps. “There are also some studies that show that circumcision reduces transmission of HIV,” he told her, and I raised my eyebrows at the anesthetist and cocked my head toward the doctor.
“…She is just telling me this!” the anesthetist blurted out in surprise, meaning me. (I was glad the topic had come up again, both for my own confirmation as well as a way of ensuring that the staff didn’t think I was an idiot!) We continued the conversation — basically, Dr. Masaki didn’t know the exact mechanism of transmission reduction either (which made me feel better), but he did remind me that having an STI raises one’s susceptibility to HIV, and that circumcision definitely does cut down on STI transmission, so perhaps that’s a piece of the puzzle.
Each circumcision took about an hour all told — the procedure is fairly similar to the ones I’ve seen in the States, but more simplified in some ways; the foreskin is pretty much just cut off with a pair of scissors, and the majority of the time is spent suturing together the two layers of skin around the base of the glans. I’d never seen any suturing done in a circumcision before, and was told that it doesn’t strictly *have* to be done — but it seems like there’s considerably more bleeding among older patients (which makes sense as far as why we in the States do the procedure within the first couple of days of life), so the sutures likely help with that.
Erin and I grabbed a late lunch / early dinner at the canteen, and then she went to track down the orthopedic surgeon (who’s writing her evaluation); I’m planning to work with Dr. Masaki again tomorrow, and I’m hoping he’ll write mine. It’s almost 5pm, so the Swedes should be getting back pretty soon from their safari; I’ll be glad to see them (the guest house feels lonely with just the two of us!). Except that we haven’t had electricity all day long — woke up without it and still don’t have it; Dr. Masaki was holding his x-ray films up to the windows all day — so I hope the Swedes are slightly less desperate for hot showers than Erin and I were yesterday…
3/20 TUESDAY — Victory, for the second day in a row — with 24 hours to go in Machame, we finally saw a vaginal delivery!
The early part of the day was really nothing to write home about — Erin went back to internal med clinic with the awesome Dr. Massawe, and I went back to peds (no new patients, so no ward rounds today, but five, count ‘em, *five* circumcisions, one of which was on a six-month-old) and also spent 90 minutes in the internal med clinic with Erin and Dr. Massawe while the pediatrician went to lunch. Somewhere during those 90 minutes, Dr. M discovered that we were leaving tomorrow night, was completely aghast at the news (“No! That felt like only two weeks!”), and insisted on taking us out for drinks tonight at six. (“I think we can manage that!” we said in unison.)
Around 2pm, I ended up back at the guest house, doing some packing and cleaning… and was standing outside talking to the Swedes on the porch when Erin came trotting over the hill, exclaiming from a distance, “It’s baby time!” She’d stopped by the maternity ward on her way home and had been told “within 30 minutes.” Well, by this point we all knew that that meant “move NOW!”, so I grabbed my white coat and the four of us scurried back up to the hospital.
There were two women in labor, both first-time moms. One was at eight centimeters (she was the “within thirty minutes” candidate); the other was at six. Given the scope of my audience here, I’ll spare most of the details, but the baby, a healthy boy, was indeed born right at the thirty-minute mark, with no tearing, hemorrhaging, or other maternal complications. He was the fifth delivery of the day, and they had apparently been “Boys, boys, all boys!” said the delivery nurse good-naturedly as she tied a piece of disinfected twine around the squalling baby’s umbilical cord — then jumped as he let fly with a stream of urine, all over her front!
“That’s what you get for complaining about boys!” I teased, and we all had a good laugh.
Overall, it was a really good delivery (and the first one Erin and Maria had ever seen!). However, without being too graphic, I did notice that the ‘mechanics’ of the second stage of labor looked visually somewhat ‘off’ compared to other deliveries I’d seen — I was really afraid the mother was going to tear (and the nurses apparently agreed, since one of them had the scissors in her hand for an episiotomy at one point, then changed her mind). When the baby’s head finally emerged, it became clear that he was posterior (with the back of his head having been pressed against his mother’s tailbone), which accounted for the difference in appearance as well as for his mother’s painful ‘back labor’. As I said, she came through it extraordinarily well, but the reason I bring this up is that OB providers are supposed to be able to *know* a baby’s position, plain and simple, no matter how little technology you have available — because when you do a cervical check (to feel for dilation, effacement, and station), once the baby’s head is engaged, you should also ideally be able to feel for the fontanelles and therefore know the position of the head. Granted, it takes a lot of practice, but it’s worth it; there are ways to make a baby turn during early labor, which will make successive stages easier. If this isn’t being included as part of these nurses’ training, well, it should be. (Side note: interestingly, there was no physician in the room either; just two nurses and three nursing students, plus the four of us ‘wazungu’.) But I suppose all’s well that ends well; we took turns holding the brightly wrapped newborn (who blinked his swollen eyes repeatedly against the sunlight, trying to grasp the sudden dramatic change to his formerly dark environment) and welcoming him to the world, which made everything feel happier.
We went back to the house, still glowing with the experience, and chatted on the porch until 6pm, when Dr. Massawe came to fetch Erin and me. He drove us up the hill to a small hotel, which had a restaurant attached to it; the three of us sat in the flower garden and split a bottle of sweet red Tanzanian wine and a plate of the most delicious samosas I’ve ever eaten. He asked a bunch of questions about our lives and families, and told us about himself; he’s had a fascinating life. He’s spent time living in Australia, Italy, Germany, India, and a few other places, and it shows; his English skills are better than almost anyone else in the hospital, and he has a clear respect for cultural and medical differences that not many of these providers share. The last five or ten minutes of our evening were spent in a mutual thank-you exchange. “I am very sorry you are leaving. I have really enjoyed you. …Of all the students coming from Duke,” he said thoughtfully, “I think you two have caught me the most of anyone.” We had to work hard not to melt on the spot!
We made it back to the hospital just in time to meet Asha and Maria for the special goodbye dinner Asha had arranged for us — chicken, rice, gravy, spinach, and French fries. The canteen ladies are so incredibly nice; they were a bit standoffish in the beginning, which we’ve figured out was because of the Nebraskans (apparently they pitched some kind of hissy fit about the food during their first couple of days, before we showed up, and thus tarnished the reputation for all ‘wazungu’ yet to come), but Asha and her Swahili skills have really smoothed the way for us. The ladies couldn’t stop hugging us and talking about how sad they were that their ‘marafiki’ (friends) were leaving, and we all took a bunch of pictures together. We knew both women had teenage children and large extended families, so we had the idea to ask them via Asha if anyone might want some of the clothes we’re leaving behind; they eagerly said yes, so we’re going to drop a bag off tomorrow. Glad to find a good home for all those old clinic clothes — they’re dowdy and ill-fitting in our eyes compared to what we wear at home, but will be incredibly appreciated by someone here. And my black Teva flip-flops have survived two Duke Basketball Campouts in addition to a month in Africa; it’s way past time for them to go, but it makes me happy to think of one of the smiling canteen women wearing them here in Machame after I’m gone.
3/21 WEDNESDAY — Our last day at Machame was a bit fragmented due to all the things we needed to accomplish, but we did get to observe the maternal-child public health clinic, which was a new experience (and really nice for me to be able to compare with home, particularly the childhood immunization schedule). We got to do Leopolds again and try the wooden ear trumpet that they use for auscultating fetal heartbeats (I know that thing has a proper name, but I haven’t been able to remember what it is!), and I got some information on their schedule of vaccines, which basically consists of BCG at birth, three doses of DPT, polio, and hepatitis B, and one dose of measles (at nine months). One of the nursing students tried to tell us that babies were also vaccinated for hepatitis C, which we tried to gently challenge (there is no such vaccine, which is unfortunate, because the world would be a significantly healthier place if there were), to no avail. But nothing for meningitis, rotavirus, pneumococcus… not even a Hib vaccine. It’s definitely very different — but I guess they try to focus their efforts on cost and effort vs. mortality, which makes sense.
I’m really glad that other side of this clinic exists, too — because goodness knows these women desperately need prenatal care and counseling on family planning — but there were also a lot of things that bothered me about it, perhaps more than in any other area of the hospital, with the possible exception of surgery. Mothers aren’t given folic acid until week 20 of pregnancy; their urine isn’t ever tested for protein or glucose except at their very first visit (when the test is ‘really’ only being done to confirm pregnancy); and, my personal favorite, they all receive five, count ‘em, five tetanus shots during EVERY PREGNANCY, regardless of how long it’s been since the last one — and the tetanus is plain old toxoid, no pertussis or diphtheria protection included. Sigh. These things bother me because I feel like it’s a misdirection of resources. If you’re going to give folic acid at some point anyway, why not start it at a time when it can still make a difference as far as neural tube defects? If you’re only going to do one urinalysis per mother per pregnancy, why not just do a simple HCG at the initial visit (which they do anyway) and save the bigger test until a point in the pregnancy when it can actually give you some valuable information about preeclampsia or gestational diabetes? Sigh. Sigh. Sigh.
We got a lot of other things accomplished today, though; we finished packing, donated our leftover surgical eyewear and masks to the surgery department, gave our clothes to the canteen ladies, passed off our leftover stickers to the peds department, handed out thank-you notes to the people who’d had the greatest impact on us, and had a delicious lunch (pilau and beans) at the canteen with Asha and Maria. The most surprising and hilarious moment of the day was when Erin, from the shower, suddenly screamed. I ran to the bathroom to discover that a nearly six-inch-long colorful lizard had dropped off the curtain rod and landed down next to her feet! Amid much squealing and hilarity, I managed to get it out the front door — while Erickson, one of the young inpatient boys with osteomyelitis, nearly collapsed laughing as he balanced on his crutches in our yard — only to find another one in the water heater closet and a third crawling on our screen door. Time to go home! :)
Carol showed up at 5:30 and shuttled us down to the airport; our flight didn’t leave until 9:30, but he wasn’t keen on driving in the dark, which I could understand. We checked in, did a quick run through the (single row of) tiny airport shops, passed through immigration (they checked our fingerprints electronically! First time that’s ever happened — in Third World Africa, of all places!), went through security, and plopped ourselves into chairs to wait. We hadn’t eaten since lunch and both of us were hungry, but the airport restaurant had already closed (typical Tanzania…) and the only other sustenance to be found was Pringles, nuts, and candy, so we decided to wait. One nice diversion: a fellow passenger from Virginia discovered that we were budding PAs and told us that he had “a soft spot for female PAs working in emergency medicine”, because he’d once injured his thumb rather badly and had it sewn up so expertly by a PA (twenty-three stitches) that the hand specialist he later saw felt that even he wouldn’t have been able to do as well — and the wound isn’t even visible now. Props to PAs. :)
We finally got on the plane (next to a British safari guide who reminds me strongly of Muldoon from Jurassic Park), hopped over to Dar again (sigh), sat on the ground for an hour (double sigh), then finally took off again for Amsterdam around midnight Tanzania time. As much as I’ve been talking about the big-picture things I’ve learned and the perspective that I’ll take away from this trip — all of which is perfectly true — I am actually quite ready to leave Africa. The plane was taxiing and started to pick up speed, and an involuntary smile split my face; the only thought in my mind was, “yes, take me home, take me home.” I didn’t necessarily mean Durham in particular, just ‘someplace familiar’, ‘someplace I understand’, ‘someplace where I can actually talk to people’… like the Netherlands! :) I can’t even tell you how thrilled I am to be going back there, even if only for 48 hours. Just listening to the silly cabin announcements has got me all excited, because I swear they pick the KLM flight attendants for their crisp, perfectly enunciated Dutch — it’s like a symphony to my ears; I can’t get enough.
We’re gaining two hours on this trip — it’s a nine-hour flight, but it will only be 7am Dutch time when we get there. Right now, my body thinks it’s half past midnight, and apart from a cup of orange juice on the hop to Dar, I haven’t eaten anything in almost 12 hours. After a month of rice, beans, and fresh produce, that type of simple food is actually what sounds best to me — but if I’m honest, I’m still really looking forward to my little compartmentalized plastic tray of packaged, dyed, processed calories right about now! :)
3/22 THURSDAY — …Words cannot describe how incredible it feels to be back in the Netherlands! On the plane this morning, the ‘time to destination’ dipped inside an hour, and I had to work hard to hide the fact that I was simultaneously crying and laughing. “This City” came on my iPod around the 30-minute mark — too perfect — and when we started our descent, my breath did that thing where it catches in my chest and becomes too big for my body. Melodramatic reactions, perhaps — chalk it up to lack of sleep if you like — but this country was home for a year and a half, and has been my ‘second home’ ever since as far as my heart is concerned. Apart from a few days in 2007 on my way to England, it’s been eight whole years since I’ve been here; I never, ever would have thought that I would have — or could have — stayed away that long. The time lag has the effect of making everything appear at once dazzlingly new, like I can’t open my eyes wide enough to take it all in, and yet still absolutely and perfectly familiar, like a comfortable old pair of favorite jeans. It’s fascinating to me how completely I remember the language, the public transportation system, the necessary instincts to keep from being run over by a bicyclist — like flexing long-disused muscles — and yet my five senses are so hungry that the usual ho-hum, day-to-day attitude I remember is gone. On the contrary, I want to look at every row of houses, eat at every street vendor, ride on every tram, drink in every experience.
And I want to throw my arms around every single person I hear speaking Dutch; my ears are craving it, and it falls out of my mouth almost as easily as it used to do, maybe because I’ve been in ‘other-language mode’ for a month already. My thoughts are careening back and forth between two languages — a few mental phrases of English interspersed with a few of Dutch. Often, there’s a fleeting empty pause inside my head as a familiar sight or sound makes itself known — and a moment later, a Dutch word I haven’t used or thought of in eight years will suddenly blossom into being. And then, of course, there are other times when I get completely blocked (I asked a cashier for ‘stempletjes’ today — meaning ‘rubber stamps’, the kind they’d mark on my passport — when I meant ‘postzegels’ — the kind of stamps you use for mailing letters. Blond moment! Luckily, she figured out what I meant after a moment, and when I slapped my forehead, blushed, and explained that I hadn’t spoken the language in a long time, we both had a good laugh.). But I can still do it; it’s still there. Erin asked me today if I missed speaking Dutch, and when I emphatically said yes, she asked me why. I had to think about it for a second, and then I replied, “Because it’s something that I learned purely because I wanted to.” Practically speaking, it’s a completely useless skill; everybody in this country speaks English, so there’s really no reason for me to have bothered to learn Dutch. But for whatever reason, I just have this irrational love for the language — so I think it’s one of those cases of liking the things we’re good at, and being good at the things we like. I miss speaking it because it’s a skill that I’m proud of, that I worked hard to develop, and that I don’t often get to utilize. It’s just fun.
But what I really want to do is jump on the train back to Utrecht. I want to buy a ‘patatje met’ in Utrecht Centraal, stroll down the Oudegracht and pop into ‘my’ bookstore, eat a ‘broodje Mario’ from my favorite street vendor, nibble a warm stroopwafel while browsing the outdoor market stalls, climb the Domtoren and view the city from the top, hitch a ride ‘achterop’ the back of someone’s bike, drink a cappuccino on the wide brick plaza, ride my bike into the woods until that secret little red pancake house pops out like Hansel and Gretel’s cottage. I want to fully dive back in to this life, to live it all over again. None of that will happen, of course — we’ve only got two days (really just one day, now), so we’re staying in Amsterdam — but my heart remembers how it used to be.
All right, enough nostalgia. Actually, we saw and did a lot today. When we got to Schiphol, the trains in the major metropolitan area of the country weren’t working (which has NEVER happened in my memory; we were told it was due to a signal failure — faulty software), so we took a bus into the city, which didn’t go to the station, but to the Leidseplein, in the southern part of town. Fortunately, we’d been able to leave our heaviest bags in storage lockers at the airport (the Dutch think of everything!), so the walk wasn’t nearly as horrible as it might have been. We stopped at a little croissanterie for breakfast, then continued on to the hostel. After checking in and stashing our bags, the first thing we did was take a canal tour through the oldest part of the city — one of the things that every Amsterdam tourist must do. After that, we walked down to the Albert Cuypmarkt, a large outdoor market selling food, clothes, bikes, plants, electronic devices, and just about anything else you could think of. Erin had her first stroopwafel (huge, warm, and dripping with fresh caramel, eaten from a waxed-paper wrapper while walking through an outdoor market — the way the stroopwafel experience *should* be — none of these plastic-wrapped preservative-laden things! ;)), and her first ‘patatje’ (french fry) experience — she got garlic sauce, I got the ‘traditional’ mayonnaise. I also had a kroket sandwich (nobody really knows what’s in a kroket, and nobody really *wants* to know what’s in one, but they taste absolutely phenomenal with spicy mustard). After a month of simple, natural African food, I was pretty uncomfortable an hour or so after all that sugar and grease, but it was worth it. :) We stopped at a grocery store later in the afternoon so that I could stock up on all my essentials — amandelkoek, hagelslag, knoflooksaus, pannenkoekmix, and squeezable yogurt with sunflower seeds (don’t knock it til you’ve tried it!) — and also visited the Anne Frank House, which is something else that every Amsterdam tourist *must* do, no matter how brief your time in the city. We had dinner at a place called Tin Pan Alley (the *best* vegetable goat cheese lasagna I’ve ever had) and dessert at a chocolate shop just a few doors down from our hostel. Our last activity of the day was to visit the Red Light District (because, again, everyone should see it once) — Erin’s word for her reaction was “disappointed”, and I have to agree. I’ve been through the district several times now, and while it’s quite the sight, it still never gets any easier to look the women in the eye — you always wonder whether they’re happy, what they’re thinking about, whether they actually want to be doing what they’re doing. I find myself pitying them, and then I wonder whether I *should* pity them. It’s a confusing experience, and more than a little sad.
3/23 FRIDAY — This will be brief, since I’m trying to get packed to leave ‘for good’ in the morning, but wanted to write something…
How odd — I dreamed in Dutch this morning. Not all night long — but I woke up with a Dutch dialogue playing out in my head. No idea what it was now, of course, but in hindsight, that was kind of neat — hasn’t happened in years.
Anyway, we had breakfast at the hostel today — bread, cheese, salami, eggs, bananas, and so forth. The most interesting thing was the packets of ‘chocolate paste’ — like Nutella, but minus the hazelnut. I may or may not have stashed five packets in my purse. ;) Then we went to the train station (with functioning trains today!) and bought both today’s and tomorrow’s train tickets. The poor cashier couldn’t for the life of her understand why we needed round-trips to Schiphol today and then one-ways tomorrow; I had to explain that we were going to the Keukenhof (the famous tulip gardens) today, and the closest bus departure to get there was from Schiphol.
We rode the train back to the airport — do you have any idea how much I love the trains?!? It was a short ride, much shorter than the trip used to be from Utrecht to the airport, but I put on my headphones nonetheless, just for the atmosphere. I spent so much time on those trains when I lived there — going to friends’ homes, to concerts in other cities, to English sessions with the man I used to tutor, to swim practices with the master’s team, sometimes even to other countries (I went to Auschwitz and Paris on the train) — and something about it is just so amazing to me. The smoothness of the ride, the quickness of it, watching the world go by in a way you can never do on a plane — I love it.
Anyway, we had a bit of confusion at the airport; we found what the monitors showed to be the correct site to catch the bus to the Keukenhof, but we hadn’t been standing there for more than three minutes when a driver disembarked another bus and strode over to us, saying in Dutch, “Are you guys going to het Keukenhof, by chance?”
“Yes,” I said, a little confused.
“The bus doesn’t leave from here anymore,” he said, gesturing down to the far end of the airport. “Walk all the way down to the end and then around the corner of the airport, and there’s a little sign there; that’s where it leaves from.”
“Wow, thank you so much — we’d have been standing here all day!” I exclaimed.
We had to hunt a bit, but the driver was absolutely right. We made it to the park by 10am, and although it felt a bit like a theme park at first (tinny music, a gift shop at the entrance, photo ops with one’s feet resting inside giant wooden clogs…), it rallied quickly, because the place was absolutely *beautiful*. Most of the tulips weren’t quite blooming yet, but there were what seemed like millions of crocuses and other types of flowers, as well as towering trees, an old-fashioned wooden windmill, and a few carefully designed greenhouses with beautiful indoor displays. We wandered the grounds for hours and took picture after picture; it was definitely a day of photo ops.
We had another stroopwafel while wandering through the park, and then some ice cream just before leaving. (Cue the stomachache, again! I apparently don’t have my ironclad Western tummy back yet.) We took the bus back to the airport and then the train back to Amsterdam, then decided to wander back down to the Leidseplein. I bought a beautiful watercolor print of the cityscape at night, and we wandered back to the ‘negen straatjes’ (“nine streets”) district, where some of the best restaurants are located. We were meeting a friend of mine, Floor, at 8:30pm for drinks at a pub called De Doffer, so after much deliberation (admittedly, I was too cranky to be of much help in the decision), we camped out around 7pm at a table in the front window of a restaurant called Lust, directly across the street from De Doffer. The food was excellent (goat cheese loempia, guinea fowl with pumpkin, and caramelized pear with vanilla ice cream), but the service was quite slow, and I spotted Floor walking down the street before we’d even been served our dessert. I ran out to meet her and dragged her inside, so we ended up starting our evening right there, then moving across the street after we’d finished eating and a few more of her friends had arrived. Two of them — a girl from Australia and another from Ireland — were absolutely hilarious, and I wish I’d had more time to get to know them. Floor actually works at this pub once in a while, so she knew absolutely everyone there; at one point, she dragged one of the female bartenders out and made me speak Dutch to her (her disbelief was a nice ego boost ;)). It was a completely lovely evening in every way; despite the cold temperature (we were sitting outside) and knowing that we had to catch a morning flight, we didn’t leave the cozy gathering until nearly midnight.
——
And now… I’m home.
Wow.
Things are familiar, and yet not. Real coffee tastes too strong. It feels like a million years since I’ve interviewed a patient. There’s a new restaurant going into the strip next door to my apartment. I can’t remember what’s actually *supposed* to go in the pockets of my white coat (not toilet paper, packets of stickers, or extra socks?). My muscle memory remembers instinctively how to drive, and yet the roads feel so wide and sprawling, it’s hard to remember the importance of staying in my lane.
Physically, I’m feeling okay — jet lag in this direction is much easier than the other way around, because all you have to do is force yourself to stay awake for awhile longer (versus forcing yourself to sleep when you’re not tired, which is what you have to do when you fly east). I started my next rotation this morning with a minimum of fatigue. I’ll spare you the details, but I did end up with some sort of African intestinal issue within about ten minutes of landing back on American soil — I had chalked up the previous 24 hours of waxing/waning discomfort to an overdose of sugary, greasy Western food in Amsterdam, but the fact that I definitely had something African, ahem, manifested itself pretty clearly. ;) Ah, well, at least I got through all the fun stuff with a minimum of discomfort! And Cipro is a wonder drug; I’ve never taken it before, but had gotten some before I left “just in case,” and was feeling much better after just two doses.
Admittedly, I’ve missed a lot of things — my apartment, real coffee, dependably hot showers, tank tops, exercise, Target, my electric toothbrush, a bed without a mosquito net — and, as a result, a lot of things have been thrown into perspective. I wouldn’t say I have a guilt complex, exactly — but it’s crazy to think about the fact that there are millions of people over there on the other side of the world who don’t have electricity or hot water — never mind Internet or cell phones — and may have never known that amazing feeling of being truly *clean* that I so relished when I got out of the shower late Saturday night. Over there, whole families live in houses one-quarter the size of my tiny studio apartment. Three or four people could sleep in my double bed, instead of me luxuriating in having so much space all to myself. Those people have never walked into a supersized American grocery store, as I did yesterday, and seen the dazzling abundance and variety of food that we take for granted. I’ve asked myself this question a lot since getting into PA school, but now I ask it with a new meaning: seriously, what gives me the right to be this lucky?
Thank you all for reading, and for being with me on this journey. I am so very fortunate, in so many ways.
