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September 15th 2008
Published: September 15th 2008
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Ok, so I have a problem Ok, so I have a problem Ok, so I have a problem

I know people think sunset photos are boring, but look at the purty colors!
(Note: I have written this over time. The server at Travelblog is malfunctioning, so there are no pictures, but two videos made it through. I will try to add the pics in a couple weeks. Love you guys, A)

How to describe the last ?? months.

La Y has been an experience that I will continue to digest for a long time. Years. Currently, I seem to be experiencing a healthy amount of indigestion, making it quite difficult to communicate to all of you where I am. I suppose I could just start with where I literally am at this moment. I am typing in my corner room. There are two blue screen windows, one on each wall, and some empty coat hangers above my head. The only place to put them was over the small desk, and as that is inconvenient, or at least less convenient than throwing them on the flow, I don't use it. There are two candles burning, one in a wine bottle and one mounted on an upside down wine glass, neither have been used for their purpose for quite some time. We actually have power tonight, but I prefer candle light, always
Chocolate GoblinChocolate GoblinChocolate Goblin

Making chocolate far too late into the night.
have. Plus, how else would I add to my bustling city of strange wax creatures I have amassed over the months? Who would keep the four eyed dragon company, I ask? Who? Outside my window, in the adjacent house (the one that looks like slots of light cut out of a black curtain in my last blog), is a man singing badly to the same Latino Johnny Cash-esque guitar riff that makes up a whole genre of music here. (Ok, time to spew hateful stereotypes: terrible voices here, terrible! Or so says this outsider with a biased sense of what makes music...) He sounds like he is feet away, but still further than and the symphony of frogs and insects that ebbs and flows with the patterns we forget in cities, with all their squared edges.

I spend a lot of time thinking about decisions I made during the day, or more often those made on some other day, and then watched the patient disappear into the campo, unlikely to come back before I leave. I have almost no feedback. None. This inevitably leaves a vacuum, and my waiting mind swarms in like a battalion of army ants, usually

Look at all the pretty pelicans, err, and trash.
leaving more questions than answers.

I spend a lot of time thinking. Punto.

I also read medical literature that I download every week in Quininde, draw, write letters or make things to send to Annie, try to read in Castellano, work on my residency applications (and then try to ponder more enjoyable pastimes, like drowning in palm oil), and hang out down in the pueblo. Once or twice I have written something I have liked, and in those rare times am incredibly energized.

Speaking of energized, I would like to take a political time out (in?). A couple things. One, I downloaded the Obama acceptance speech on Youtube yesterday in Quininde, and for the first time IN MY ENTIRE LIFE, I feel something that could be described as patriotism. Check it out, if you have yet to see it. I am sorry, but McCain, as much as you would have probably sucked much less than our current president, there is no way my friend, or at least there should be no way. The man is on fire. Shit, if he would take the next step and embrace a single payer healthcare system, I'd have his babies. My
Playa NegraPlaya NegraPlaya Negra

Everything I draw on the sand always ends up looking like a clown.
friends, if you feel anything resembling the way I do about this: please, I can't be there. Go out. Make some noise. Campaign in a swing state. MAKE IT HAPPEN.

(addendum: I am heading out to Montana to campaign somewhere between the 17th and the 25th of October if you want to come...)

The second of September, 2008. An ordinary day.

Today was a day like any other here: the same, in a different kind of way. Today is Tuesday. We had almost no patients, which was an amazing opportunity to get something done with the rest of my life that I cling to more tightly every day. In the morning a kid came in with a machete wound through the periostium of his medial malleolus. It was more than 24 hours old, so I cleaned him up and sent him on his way. The majority of the rest of the day I spent working on little parts of the chronic care system I am trying to set up, preparing for the brigada, and pretending to work on my residency applications. The day's gossip: I sewed up the lip of a 21 year old two days ago. He had earned his almost full-thickness 2 inch semilunar cut in a fight with a brother-in-law over land. It was a bite wound. I also drained a brutal abscess on the quad of a 32 year-old brother-in-law two days before. Apparently, as he relayed to Katy today while she changed his dressings, he was disabled and so instead of fighting, he dined.

The day went as such. Katy left early, as it was unusually slow and she had to go down to the river to wash her family's clothes. At 5:30, right when I was about to get some exercise, a motorcycle arrived, another wound. Didn't have what I needed here as usual, but you just improvise. At least it was aseptic. That's how it goes. Machete, machete, motorcycle. Machete machete motorcycle. 4 more machetes. Usually, right before I am going to get some exercise. (er, machete) But he was a good guy, we laughed about some funny things that happened and about our (still) communication slip ups. Today there were two. Tomorrow there could be 2 emergencies and 18 patients.

I feel much older than when I left.

A lot of that
The eyes they glowThe eyes they glowThe eyes they glow

This guy is almost as big as a small rat. It is becoming more and more difficult to think about insects as little pests.
is a good thing.

But, who am I kidding? I am just as immature as I always was. Tonight I came back from eating down at Doña Margaritas and headed back to the kitchen for some water. The walkway that leads back to the kitchen is pitch black unless you flip the circuit breaker, but I usually don't bother as I know every inch of it by now. I flipped on the light in the kitchen to find a Chinese scale ant invasion of our unlidded compost bin. The legions were at least 20 thick, streaming up and over the edge, into a virtual cesspool down inside. The other end stretched back up the path and around toward the house, the way I had come. They were visible for at least 35 meters. And these were not just any ants, they were Giant Killer ants, or at least that is what I would call them, were I a Entomologist with a limited vocabulary. They are highly specialized. There are the workers, who appear relatively normal, if perhaps less attractive (I don't know, I am not a lady ant. It's just a feeling). Then there is the ~1cm long,
Strong little buggersStrong little buggersStrong little buggers

Yes, that is an ant carrying a match down the side of tile.
ferocious, flying variety, which would ordinarily be incredibly intimidating were it not for the fact that they always seem to be dead, or at least sleeping. The reason I call them such killers, however, is the guard ants. They have massive, caliper like pincers that literally gleam in the sunlight, and oversized, football shaped heads. They stumble around trying to keep their overdeveloped masticators above the ground, looking for someone to bite. They reminded me of a lot of people I did not like in high school. There is a lot I do not miss from high school.

I backed up slowly, flicked off the light, and pretended I never saw them. At least they are organic.

How can I explain to you what it feels like to think you killed a four month old baby?

I sit outside a two story house built from the wood trees that once stood in its place. The cloud cover is a viscous tombstone and the stars are below us, swimming among the trees, flirting shamelessly, flaunting creation. Inside this house, are more than thirty people who hate me with the kind of darkness reserved for
The LagunaThe LagunaThe Laguna

(this is Karin Friederic's Photo)
an outsider who has take one of their own. There is a delicate brown eye and sparse eyebrow peaking out from a white burial bonnet and sash, sewn for a much larger body. There are candles forming mountains of wax on makeshift planks flanking the body, a ring of similar boards surrounding, serving as vantage points for an all night vigil. When I vaccinated her yesterday afternoon she was a gurgling, undulating embodiment of discovery, drunken with her new smile and vision. Four hours later she stopped breathing. No problems with prior vaccines, no allergies, exam perfect, everything, perfect.

I feel an incredible urge to defend myself, to tell them I just administered the vaccines, and did them properly. It slips out a few times. "But when Katy gave her the vaccines nothing happened. When you gave it to her..." said, Valencia, her 16 year old mother. Juan, her 19 year old father, was almost bent in two he was so slumped over. The skin on his cheeks nearly touched the floor. His eyes took the form of someone who was about to cry and sneeze at the same time. He said, simply, "We have nothing now."

Burgeoning PhotogapherBurgeoning PhotogapherBurgeoning Photogapher

She's Alex's, and adorable.
evening Don Lorio (the cousin of Jaun), Edwin (the director of FHN Ecuador), and I had climbed up the incline behind the family's house to look for phone reception and try to update the clinic. We sat on an old log amongst the intermittent dry rice fields that climbed another 100 meters to the edge of the forest and hill top banana trees. To add to the list of things I cannot describe was the view that unfolded below. The soft green that only rice reflects relayed the last of the day's warmth (I still believe that if rice was half as aesthetically pleasing it would not be such a global staple). The washboard hills that always reminded me of brail, topped with primary forest, more evocative of a single breathing organism than an ecosystem. The howler monkeys ROO ROOO ROOOing from within. A pillow of a bamboo following the river. The sun setting in seemingly completely the wrong direction, adding further to the sensation that this was not of the same world I live in. The beauty of their world brinked on absurdity, so it seemed. Don Lorio pointed across the valley at an approximately 9 by 9 foot
More moths than peopleMore moths than peopleMore moths than people

La Fiesta del Subcentro
shack and indicated that it was Jaun and Valencia's. I cannot imagine how small, and yet how empty, it must feel to them now. I am suddenly reminded of Steinbeck's "The Pearl." Imagine the emptiness.

I did not make the entire vigil that night. I told myself it was because I had to get some sleep to make the 3 hour jog/hike through the river back to La Y. I had to lead the meeting for the village health promoters and inform them about my brigada, I said. The truth is, I couldn't take it. I knew they were hurting, that this blame was something they needed at the time. I knew that. But I could not take it. This is not a culture that tells its children "It's not polite to stare." The eyes were unbearable. So I went up to the loft, curled up and shivered myself through the mosquitoes on the wood floor, using my thin, polyester dress shirt as a pillow. I never intended to go back down, and I never did until 6 when we hoofed it out.

So, now I know what it means to be in an, er, uncomfortable situation. Since then, the family has calmed down somewhat, and at least some of them understand what happened, as best as we do, anyway. The cause of death remains unknown but an anaphylactic reaction remains a possibility. Intussusception SP??? and non-vaccine related causes are other less likelies. Difficult to say with the history from the parents. We will never know. The members of our health committee and some of the volunteers helped them out with the expenses of the funeral. The death of a baby. Jesus.

New York

I went to New York a few weeks ago to visit Annie. It was amazing. We saw 3 boroughs via fixie (Annie got a friend to hook it up with a fixed gear). I have to say, I am a little stricken. So much control! And you all, who know me best, know how much I love riding through traffic. Well, New York has it. It turns out, New York has a lot of things, like knishes, and people. People wearing huge fur hats and curly sideburns. Skinny jeans and oversized glasses. Oh, and (and?) crazies.

We ended up having to crash a little ways out of town
The FamilyThe FamilyThe Family

The family of a patient of mine who passed away. They wanted us to take photos and gave permission to put them on my blog.
in the faculty house at Annie's old college due to a "rabbinical emergency" that befell the owner of the place she was housesitting. (Can anyone tell me what that might entail??) This just meant that I got to see more of the city and her life.

The last night we ate dinner at the 3 story brownstone of Jonathan Saffron Foer and Nicole Kraus. For those of you who do not know them, they are some of my favorite writers and all around amazing people. Annie watched their place and massive Great Dane/Labrador mix some months back and they became friends. I managed to say absolutely nothing intelligent. I was simultaneously taken aback by their intelligence and normalcy. Nicole has an incredible demeanor, it is really amazing to see. Jonathan thought about being an OB and was accepted to medical school. I am so glad he decided not to be another asshole like us, that would have been a loss. Jonathan's books have gotten more press, but I highly recommend that you read Nicole's "The History of Love," it's brilliant.

It has been tough for Annie and I, this whole thing of integrating two completely different worlds through 3 week-delayed letters (sparse on my end) and travel emails, but things have never been better. It looks like she will be coming to Seattle with me in November and Alaska for Christmas. I cannot wait. All of you in AK, gear up, we need to convince a very New York attached lady that that is no place like AK.

How to describe leaving.

I am about a month out from leaving but I am already making the transitions in the old noggin. We finally have a medico rural (Ecuadorian equivalent of an intern, only without supervision) coming in a couple days, meaning I can spend more time on things like public health projects and breathing. I am also going "al dentro" in a couple days for a two week brigada. I am a bit stressed out about not having my applications in until October, but everyone says I have to go on this one. Something about it being my brigada or something, I don't know, I wasn't listening... It should be great though, two weeks off the power grid, with just the frogs and insects for music. Unfortunately, I will not have
His Grandfathers graveHis Grandfathers graveHis Grandfathers grave

This was fresh as well and next door to that of my patient.
a camera to show you all. I gave Annie's back to her, I was not using it enough to justify having it.

I am fascinated by the idea of going "al dentro" (inside). Anytime you are in Quininde and you go to La Y, you are entering, or going inside. If you start in La Y and go further into the jungle, you are going inside. Most places in the States it seems that people usually refer to cities as the center of reference. They may have it right here on this account. The reality that exists al dentro is arguably more real than that of the city, the music and motion of the jungle appeals to me infinitely more than the bachata that rings from my friend Karin's going away party behind me. But still, thrilled. I cannot wait to hop on my bike, grab a beer at Browers, and hit up the Essential Bakery dumpster for some day old rosemary bread. And AK! Oh I miss you so much AK. It is palpable.

And, at the same time, I am going to miss this place. Don Jose and Junior, Katy's kid. Gido and Katy and Alex. And Fannysitu. Oh Fannysitu! I know everyone's name, the clinic is almost easy now, and the Spanish is settling in. I finally will have help, and maybe even days off. Como dice Kurt Vonnegut: So it goes.

Additional photos below
Photos: 23, Displayed: 23



I know, Grody, but it was a good picture.
She's got a pointShe's got a point
She's got a point

about the veges
The produceThe produce
The produce

Annie works one day per week at a farmers market with a lady named Kira. Kira has the good stuff.
This is the gist of itThis is the gist of it
This is the gist of it

We spent a lot of time cruising around on fixys. Good times.

I had no idea what knishes were. Answer: Fried potato, and stuff that is tasty.

5th October 2008

ophelia, reaching out.
andy, hey... so strange, glendy (aka ophelia) just called, AS i was looking at her photo on your blog. she reported that all are doing "un poco bien" (for the life of me, i still don't really understand what that means). but liliana is still struggling, and thinks she has rheumatoid now - because of dolor de los huesos. but guess what? i just made it official - i am now madrina of julissa's child (glendy's sobrina). the way they asked me was just too touching to say no, despite the fact that i was determined not to take on another ahiado. why am i writing all this on a comment? i don't know. but i wish you a great despedida (bachata-filled, perhaps?) from the ecua. you've been great. gracias!

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