Long Overdue - December 13, 2010

Inspired once again by the boredom of these tracks, I find myself at once remorseful that it has been so long since I last wrote--so much having happened--and eager to jot out my recent journeys.  While Sophia takes time every day to write in her journal, I am not so persistent nor prodigious.  I have a good memory, but memories, even a few days stale aren’t always the best fruit for reflection.  And while I try to reflect here, I am quickly realizing that it may not have been boredom that encouraged me to write, but the constant jarring of my grey matter, which swashes back and forth as the front of my train-car, where I currently sit is tugged from side to side in less of a sprint to Bangkok, but more of a waddle.  Right in front of me:

WARNING
PLEASE BE CAREFUL WALKING ACROSS
THE BOIGE JOINT WHILE THE TRAIN
IS ON OPERATION

Despite this type/grammatical error, Thailand has by far exhibited the best about use of proper English.  Good syntax, correct diction, so un-SEA-like.  Yet another sign that my last few days here are just that, at least for the foreseeable future.  And just now I’m realizing that my constant glee this past week may not be completely attributable to the experience itself, or the unbelievable scenery we’ve made ourselves privy to thanks to a super-powered rental motorbike.  Instead, maybe it’a all been tainted by the fact that I will be rejoining my family and friends in my hometown.  Seattle, Washington where I’m sure it’s currently raining and just above a freezing 32°F (not 0°C).  But for some reason, I look forward to that, and have for about a month now.  Properly raised in Seattle means you’re acclimated to any weather conditions, just so long as they aren’t seriously extreme.  In fact, you welcome the storms, knowing that it means for something more exciting, or in some cases, maybe an encouragement to take a few hours buried in a book, wrapped up in a blanket by the fire.  555.  I suppose that’s contemporarily inaccurate.  Rather: take a few hours covered up by your zebra snuggie, iPad in hand, hoping for a whiteout all Sunday long on FOX and ABC.

And while I fantasize about all of this, my heart is not only warmed by all that I love, but by this constantly evolving painting outside my window.  The sun fallen to the horizon, a bright orange-red illuminates the once-foreboding puffs that tower off the ground like mountains, billowing up and out, as if fresh from Absalom’s mouth.  Again, the scene is somewhat indescribable.  But this all unfolds above fields of rice peppered with palm trees, some flooded and replenished, mirroring the god’s Monet above.  The buzz-by creates a strobe of yellows, oranges, reds, magentas, purples and deep blues.  I took a few shots as we cruised through, right as the sun kissed the horizon, but even standing still I’m sure I could not have captured all I saw.  That is the crux of this art of light and lines, you only get a portion, and often, well, always, being there is just plain-out better.

So, as I prepare to depart in two days’ time, I must prepare to leave this land of overwhelming and moving cloudscapes and sunsets.  This is not a constant promise of the Pacific Northwest. Though other things, like Christmas prime-rib, mashed garlic potatoes, beef jus, roasted vegetables and Cabernet, are.  Other things like snow in the mountains and long blower turns under bluebird skies soon will be.  Other things like the constant push-in-your back to work hard, to perform, to reach for the sky, and not to take no as an answer, these things are imminent.  So while I enjoy my surroundings these last few days, I amp up for some of these things, and tune down some of the lackluster aspects of my life on the road, abroad.  I constantly remind myself that little good comes from worrying and only through preparation can you find that inner calm you strive for, often making your own luck.

Admittedly, it’s hard to say something like that when I hale from the most privileged nation amidst a cluster of second-world nations, and a vast majority of people living below my means; travel out of the question.  If there’s one thing I can absolutely say, is that everyone wants to be happy, but we certainly find happiness in different ways.  Nevertheless, apart from my differences with everyone I’ve met, everyone I’ve come into contact with, happiness is contagious, and it hasn’t come from any of the modern marvels of our western world.  I see more happy people here (in the cities and the countryside) than I could expect on any given day at home.  Well, maybe if the sun is shining bright in The Bay, the numbers are more equivalent.  This is the point exactly: often we find ways to wallow in what we don’t have, what we think will make us happier.  We don’t need the sun every given day, while even that is less than asking for anything material.  All we really need is a smile from someone in the room, a stranger or your best friend.  Happiness is easy to find, if you know how to look for it.  And I don’t profess to being the best at this, but I know it’s worth striving for amidst all I do every day to figure out what I want my future to look like, and how and when I want to get [to] there.

So, before I tell you what I’ve been doing the past two weeks, I want to say thank you for smiling, thank you for being easy-going, and thank you for not compromising a light heart with whatever onus you bear by choice or by birth or bad fortune.  I know that I’ve spent plenty of my life being “nasty” either by design or because I was mentally or emotionally preoccupied.  But this trip has made this fact even more apparent than my parents have attempted to for the last, oh, 22 years.  They are shining examples of this, so really, thank you to them.  Maybe this is all wrong, but it really seems all right, and as Gary would say, “all good,” credit to Fuldogg.

That’s all I’ve got for now.  More on my adventures due soon.

Flickr Thailand Set!

On the Train to Hue - November 30th

It’s been a travel-filled two and a half weeks until today, today included.  It’s 10:00 Tuesday morning, the 30^th of November and I’m on the night train to Hue from Ha Noi.  We left last night at 7:30, and with a promised arrival time 7:00 this morning, this train has done nothing but rested and reassured us that in fact, when traveling anywhere in SEA, always multiply the travel time by 1.25.  Seriously.

With Sophia still awaiting word on a new passport at the US embassy in Ha Noi, and my visa expiring tomorrow, we’re both wondering when (if ever) and how we are going to make our way to Pakse, Laos, where we have a flight December 7^th, back to Vientiane, to pack up our stuff, quickly recuperate, and head west to Chiang Mai and the south to Bangkok on what is becoming a whirlwind tour of UNESCOs favorite places in SEA in about 4 weeks.  I doubt Bangkok makes the list, but that might be a breath of fresh air.  I mean this purely metaphorically.

In case I’ve lost any of you, UNESCO has hundreds of designated World Cultural Heritage Sites.  In the last two weeks we’ve visited 3 as major destinations, and we may add a 4^th to the list in Hoi An.  And no, Hoi An is not just a wordscramble of Ha Noi, it is the purportedly the site of the oldest civilization in SEA, dating back to right around Jesus’ lifetime.  If we all did come from Asia 200,000 years ago, we migrated very slowly. Which brings me back to wondering about our migration out of Vietnam…

Week before last I spent in Viet Duc Hospital, in the middle of the Old Quarter in Ha Noi.  I don’t have much in terms of statistics on this place, but it is a major emergency/trauma center for Ha Noi, as well as a teaching hospital, full of residents working day and night in any capacity they are needed.  Seniority was apparent, as pointed out to us by Giang, one of our RY4 (final year) friends, who basically strutted around and told people to do things wherever he went.  At first glance, and after spending four days with him, and his crony Hai, I was convinced that they were about my age, and almost full-fledged orthopedic/trauma surgeons.  But when we finally got to small talk, they swore they were 27 and 26, respectively.

In the OR, both seemed perfectly competent in their skills, assisting both Dr. Scranton and Dr. Shields (the two American orthopedists I was following) in a number of surgeries from total hips, knees to ACL reconstructions and posterior tibial tendon transfers for drop-foot.  After the final day of surgery and a celebratory dinner for a week of some intense surgery, our new friends took us out for a tour around Ha Noi at night on their motorbikes.  We stopped on the way back for desert.  They ordered crème caramel, and they got Sophia and I these coconut deserts which I’m not quite sure how to explain.  The top was opened, then about an inch thick layer of sweet milk in a gelatinous form, underneath was frozen coconut milk.  If I had to guess, the coconuts were opened up, some sort of emulsifier was added, then the layers (fat and water) separated and the coconut was frozen.  Anyway, yum.

Sophia and I spent another day in town, bought an open tour to Ha Long Bay and took off Friday morning.  We spent $50 each on the tour, which was 2 days, 1 night.  After reading a number of reviews, we were a little scared off of the cheaper cruises, which you might be able to get for as little as $20 for 2 days and 1 night.  We went with what seemed the cheapest and most dependable/reputable option.  So, we bussed out to Ha Long City and immediately boarded our boat, and sat down to lunch while we cruised out into the Bay.  The accommodations seemed nice, nicer than what we have come to expect at least, and the food was good.  After lunch we took a small boat to a cave tour… if I had to do this again, I might not.  Some of the attractions in Ha Long Bay really seem more like Disneyland than anything else.  Also, with so much tourist attention, there are over 1,000 boats in the Bay on any given day, full of tourists from France, Spain, China, and the US (mainly).  So, at some times, the experience really didn’t seem like much more than Disneyland.  With that said, the views are gorgeous, and despite our constant cloud-cover, we were still able to appreciate and take in our surroundings, in the company of no one within 5 years my age.  Our tour was an out-and-back sort of thing, with a sleepover on the boat in your private cabin.  However, we were determined to extend our stay, so we took the boat on the morning of Day 2 to Cat Ba Island with a few of the travelers doing the 3 day, 2 night tour.

We rented bikes after a short bus trip into the island, which my “borrowed” Vietnam Lonely Planet describes as “straight out of Jurassic Park.” We rode slowly for about 20 minutes and parked our bikes, then paid a tour guide 10,000 Dong ($0.50) to take us up into the Hospital Cave, which was built by the Chinese (for the Vietnamese) during the war.  It was really cool, with cement-walled rooms built into the cave and a large space for the commoners.  Reportedly, there was, aside from a fully functional hospital, a cinema and accommodations for many politicos.  It was 4 stories, with the highest floors for the most important people, an escape out the top of the mountain, out the side, and an alternate escape route down on the first floor which was accessible by jumping into a chute and falling 3 stories to a water landing.  Not sure how much of all this was true, but I will believe it for the sake of awesomeness.

We biked into the small town near the cave, then back to the bus and through Cat Ba Island to Cat Ba City.  The main road is four lanes, divided by a nice grassy and trimmed-hedge mall.  On one side, the immense bottle-necked harbor (there are some pictures on my Flickr, my favorite being “Emerge,” please check it out) and opposite, quintessential 8 story Vietnamese buildings (each no more than 10 meters wide) backed up against the rock wall that towers over the harbor.  If you go into any of these buildings, every single one of which is a hotel, you will find rock as the back wall.

Our minibus continued through town to Cat Co 1 (a beach) where there is this monstrous resort hotel with sweet-looking twin water slides, two swimming pools, and a big beach which is frequented by hotel patrons and people from town come to enjoy a day in the white sand.  Much of the rest of the island is rocky waterfront.  We had read about this “overdeveloped” beach, and had our minds set on making it around the 1 km-long catwalk anchored into the cliffs that separate Cat Co 1 from Cat Co 2.

We sighted the path, and waved goodbye to our friends staying at the resort with the tour, and told Tee (our guide) we’d let him know when we wanted a pick up to continue the rest of the tour, the Day 2 that we had opted out of, which was really just lunch and a ride home.  We walked 70m vertical down crumbling rock stairs to the beach, strapped with our bags, cameras swinging side to side to find the a gate locking away our path to relaxation and a day on the beach, away from tourists.

Frustrated, we turned around and walked back up those rock stairs and then I hiked over a hill, carved between rocks, and still under construction, Sophia followed.  The road went three ways; we took the route that looked like it might lead to a beach.  Alas, we had found the bungalows we had read about.  We were ready to share a bed for a beach bungalow, even despite the “poor” weather.  Really all we wished for on top of what we had found was some real sun, unshrouded, constant, and hot.  Something that would make the water in our cove beach change from a little bit chilly to refreshing, air-dry imminent.  After having lunch, we rejoined to group for one last adventure to Monkey Island.  Now, if you want to go to monkey island, you ought to go soon, because there are allegedly only 20 monkeys left on the island, 15 down by the beach, feeding off of tourist refuse and flesh alike, (literally-we saw some people teasing monkeys get attacked) and then 5 somewhere in the hills, slowly dying off, as many animals are all around Ha Long Bay from overuse, this tourist game is hardly sustainable as it is done here.  UNESCO has certainly failed if they think they are working to preserve these beautiful dragon-crafted limestone karst towers.  So the legend goes, families of dragons swooped along the coast, to protect the Vietnamese from Chinese attackers, dropping jade in the bay which formed the rocks and created a barrier from the attackers.

Despite the underwhelming presence of monkeys, the small beach on the island was pristine, and we enjoyed sunset from here, and climbed up the hill to see the cove on the other side of the island.  Check out some of the sunset pictures: (Breaking against the Jetty, Sunset, Walking under the Sun).  Also, the journey there involves a short cruise through a huge Cat Ba floating fishing village, which is fascinating and unencumbered by the usual Disneyesque hordes.  Basically, go to Cat Ba and stay in a Bungalow.

Day 2 of the Bungalow was a day of rest and relaxation under the sun.  There was no sun, but we did a good job of pretending.  It also marked the beginning of our vow of sobriety for the rest of the trip!  Nonetheless, we did a good job making fun of the people who came from town and “cluttered” our beach (no more than 4 or 6 people at a time).  There were two couples though, and every one of them, aside from one guy was wearing a swimsuit a number of sizes too small, which provided some entertainment.  I feasted on fresh grilled squid with soy sauce and pepper (soooo good) and Sophia got fried ramen noodles (soooo exciting!) and we split fried sweet potato [fries], which had an interesting batter, but were delicious.  It was a fantastic day, and culminated with a nice long walk back to our beach from a less delightful meal.

In the morning, we met up with one of our tour guides who had had the day off; we boarded a minibus and headed back to a new boat for our trip back to Ha Noi.  We made it back in plenty of time to buy train tickets for the 7:30 train, have my passport nearly confiscated by a shop trying to sell me a visa extension, and get some dog spring rolls to go.  Don’t tell Max.

The night on the train was four-part.  The first was a quick game of gin to 500.  That lasted about 3 hours and 50 minutes.  Next, we sat, still waiting for our four berth cabin to fill up and Sophia learned that Minesweeper is not actually a game of sheer luck.  Eventually, she got bored and I played Space Cadet until I was tired, so I huddled into the blanket on the top bunk, under blasting cold air, the other bottom bunk devoid of life.  Sleep was part three.  Then we woke up to find ourselves still alone in our spacious cabin, and I began to write.

Now in Hue, quiet, relaxing, some cool UNESCO ruins which are being restored, recuperated and re-adorned in bigger-than-life fashion.  It’ll be interesting to see how the Forbidden City is transformed over the next ten years into a fully restored, shiny gold walkthrough replica of the original.  One thing they do seem to be getting right at least is beautiful landscaping, which seems a lot less corny than all of the faux-gold leafing on everything.  Don’t let any of that discourage you, what remains of the original is fascinating and beautiful and worth the 55,000 Dong ($2.75) entrance fee.

But I almost forgot the most important part of the day!  Lunch was hand-rolled at the table, fresh shrimp spring rolls for 30,000 Dong (you do the math this time) which was just what the doctor ordered… for every meal for the rest of life.  And served with Vietnamese peanut sauce.  Very good.  Lunch was bracketed by cups of Trung Nguyen Coffee (good, strong shit).

I’ll have some Hue pictures up eventually, but please, do check out all the Ha Long Bay pictures and others from Laos, the week before.

Vietnam
Laos

Thanks for reading!

The Conference - November 8-12th, 2010

Monday started “early,” well, I guess no earlier than surgery at the hospital all week, but earlier than usual for Vientiane.  Waking up 6:30, Sophia were on our bikes by 7:30 and to the conference by ten to 8.

Day 1 was the most hectic.  I was working the victims’ assistance workshop, and CMC volunteers were there mainly as logistical support.  CMC is one of the biggest organizations committed to ending the development, manufacture, and stockpiling of clusterbombs, and thereby one of the leading organizations at the conference, although it was officially designated as a UNDP event.

During my week away, I had been emailed by Manuele, who told me to ask for him when I showed up.  He wasn’t there at 8.  He was stuck in infamous Vientiane traffic.  Whenever there is an event in town, police swarm the streets to serve as impromptu traffic lights, where they are lacking.  (Through the middle of town, there are only about 7 or 8 traffic lights.)  Thing is, they also decide to work at the traffic lights, and I’m convinced that all they do is make traffic slower, because the traffic lights in town work perfectly fine.  However, once in a while, they’ll clear the road for an ambassador convoy, which is fun to watch.

Anyway, before Manuele showed up, I was asked if I was the IT guy, I wasn’t, but I switched Firoz’s laptop’s VGA connection in the projector from “Output” to “Input 1.”  Hard work.  Next, I went outside and Sophia gave me my nametag… her daylong task.  Manuele showed up and I was put to work with a woman from HI (Handicap International), printing, making copies, and highlighting in freshly printed packets.  However, no one could connect their computer to the printer.  Despite it being delivered the day before, no one had installed the printer on their computers (about 7 people).  To complicate the issue, the printer was so new that its plug-and-play driver wasn’t in the windows list, so it couldn’t be easily installed in anyone’s computer.  After about 40 minutes of struggle with that, we found the printer box and inside, of course, the driver disk.  And printing was a go.

Amidst all of this excitement, Sophia was sitting calmly at her desk, infrequently digging through the piles of perfectly alphabetically arranged nametag badges to hand to conference participants, enjoying free coffee, biscotti, and the friendly company of a number of the Lao volunteers around our age(s).

As the day wrapped up, we were reminded of the art exhibition and book signing that evening at the Lao Cultural Hall, where we would partake in enjoying paintings with complimentary box wine.  I did come to Laos for the Franzia, so after a month and a half plus, I am finally satiated.  We also spent some time that evening talking to a young American woman who was soon to become our new best friend (555).

Day 2 started off even more excitingly.  This time, we showed up at 11 am and were told we had to rearrange a room that was set up with tables in a U by making a narrower U by removing a table in the bottom section and adding two discontinuous tables at the head for a panel.  This may sound simple, and is in theory; however, the execution is much more complicated, because all of the tables are already decorated with drinking glasses with stems, water bottles, pads of paper and pens, and flower arrangements.  Then, all of the tables were connected by felt covers and a silky, folded drapery which ran the length of each table, continuously inside and outside of the entire U, and about every 10 inches pinned the drape into the felt table cover with a glamorous one-inch fold.  I don’t know much about this, or flower arrangement, but I did know that two people was not enough to accomplish this task of removing one table and bringing 8 tables toward the center at the same time.  Check that, they wanted both sides brought in, which means we would have to remove one table and then move every other one closer to the center.  I was much more positive about this endeavor at the outset than retrospectively, mostly because I didn’t really understand every little thing that needed to be done, undone, and redone.  We begged for hotel staff to come and assist us with the rearrangement, but they were elusive, as we found they always are.  After about 30 minutes of walking back and forth, inching table after table toward the center of the room, without ruining the décor, hotel staff finally showed up in time to redo some of our undoings which permitted the rearrangement, and by 12:00 we had a brand new room, which, as it filled up over the next hour became overcrowded despite our work at creating more room.  Snake-Five!

Sophia returned to the ticketbooth operation she’s worked at yesterday and I hopped on my still-functioning bicycle to get some copies of a booklet made in town.

I know this is completely uninteresting, but that’s essentially the gist of our work during the week at the conference.  Now a little about our time outside of the conference this week:

So on Wednesday, we stayed in downtown after work, took pictures of the new statue on the Mekong, and then went and did bike tricks on the promenade, above the river, and got plenty of pictures of that.  Basically, we discovered that day how awesome we are 1) at life, 2) at bike tricks and 3) how awesome bikes are… this is the sad part.

We met up with our new American friend, and went bowling.  We hopped into the back of a tuk tuk with a bunch of Australians.  Correction, our bikes hopped into the back of a tuk tuk and Sophia and I stood on the back, holding onto the roof and snapped a few myspace pics.  It was a nice shot of fresh air straight to the dome.  Extremely dangerous and refreshing.  On the way home from bowling, she told me that she couldn’t ride a bike, at 19 years, I didn’t believe this was a real thing, but I guess I’ve got friends who still don’t know how to swim… oh well.  So, I prompted her and it came out that she could in fact ride a bike; only she could only ride straight.  Being from San Francisco, she was definitely lying, so, I eventually convinced her to prove her inadequacies.  Little did I know, this would be the end of many things, both good and bad.

She rode about ten meters before a sudden turn left and BAM, she was on the ground, and the bike on top of her.  In my slightly inebriated state, this was one of the funniest things I thought I’d ever seen.  In retrospect, it is one of the funniest things I’ve ever seen.  She was up quickly, and physically uninjured, but I can’t imagine her heart didn’t ache.  BURN.  I picked up the bike and hopped on, but despite my peddling the bike wouldn’t move.  I hopped off and checked it out.  It took little examination before it was abundantly apparent that my back tire was no more.

Now, usually when a bike tire goes flat, it just takes a little pump-up.  If that doesn’t work, you patch up the tube, refit it to the wheel and pump it up.  Good to go.  If that doesn’t work, you buy a new tube.  What I saw that night I didn’t know was within the realm of possibility.  The tire was literally shred to pieces, with tube avulsing here and there, sticking into the brake pads, so the wheel couldn’t turn.  This was the epitome of a CLUSTERFUCK.  Excuse my French.  Go back to Paris.  Anyway, my lovely, over-endeared bike was essentially no more, with a total of about 7 days left in Vientiane, I was not going to repair it.  Anyway, without an apology our “friend” blamed the accident on my bike.  I put the triangle over my shoulders and walked her back to her hotel.  I found a tuk-tuk and headed home.  That was the end of my bicycle, and the end of a very short-lived friendship.  New rule: No American friends in SEA.

The rest of the week went well, and Friday night concluded with a volunteer party, with free food and drink, me giving my email to one of our volunteer friends and us drinking more beer than we expected due to excessive cheersing, a strongsuit of the Lao, and as I had learned the week before, also the Vietnamese (who cheers with vodka shots, not beer).  Here you say sok di which I think translates indirectly to “good luck.” I also took about eighty pictures with different groups of new friends, a good portion of which were couples shots with women.  I felt loved.

I also had a nice conversation with Mr. Benjamin McCabe, CMC’s intern, who happens to be the same age as me, and filling his post-graduate time with more regularly productive work.  He also happens to be Sophia’s new life love.  Hope you’re well, Ben.

Saturday we woke up early to catch our 11.5 hour bus to Luang Prabang City, for the first week-long trip.

Links for Cluster Munitions:

http://www.stopclustermunitions.org/
http://www.flickr.com/people/clustermunitioncoalition/

http://www.clusterconvention.org/index.php

http://www.clusterconvention.org/1msp/  THIS ONE'S ABOUT THE CONFERENCE!!!

Heading Home (to Vientiane) - November 7, 2010

I sit in the Ha Noi airport as I begin this entry.  It is otherwise completely unremarkable, just another mélange of overpriced duty free shops littering an international airway terminal.  As this week has rounded out, I’m quite excited to return to Vientiane, where things don’t cost so much, and the taxi into the hills doesn’t charge complete fare for both directions of travel.  It’s all part of a learning experience I suppose, and now knowing what I do, I will not take the “flying coffin” so-named by the nationals, or a taxi, but a coach when I rumble up north through the mountains.  I do fully intend to return there, an absolutely breathtaking and serene part of the world, at least when your bus isn’t playing chicken with the one opposite, and motorbikes going either direction are scattered about the road like traffic cones, completely at the mercy of the bus-drivers, who happen to be merciless.  Oh well.  I’m alive.

If there’s anything else I’ve learned over my first week here, in northern Vietnam, it’s that surgery is like sex to doctors here.  Maybe it is at home too.  But here, after a trip to the OR, they retire to their report-writing while working their way through packs of nationally-grown cancer sticks.  They offer them to everyone, “You want to try Vietnamese cigarette?” and as both Mark and Rob shook their heads and snickered, the doctors, smoke pouring from all three facial orifices, seem confused.

My four days in Son La concluded after seeing some 12 surgeries in two days of operations.  Aside from the number of corrective foot and ankle operations, I was privileged to be invited into the OR across from ours, where two general surgeons were talking to a patient receiving a spinal block somewhere in his thoracic vertebrae.  As the second exited to scrub, he explained to me that they were about to remove a bladder stone and a tumor the man had growing from his prostate.  As they scrubbed, the patient was sterilized with copious iodine, this was typical, in my experience at the Son La hospital.  I secretly prayed to myself that none of these patients had iodine allergies.  I don’t think Betadine even exists up there (a town of only 100,000 or so), and I seriously doubt that iodine allergy is part of the patient history.  Oh well, I didn’t see any harm done (I assume this part of the philosophy of western medicine wasn’t lost as it moved east).

I leaned over the table, camera in my hands or behind my back, snapping shots or squinting to see through the maze of two pairs of hands and retractors in this man’s abdomen.  Everything seemed to glide along the effacing muscular walls along the incision as not to displace something inadvertently.  (Though towards the end of the procedure, the spleen avulsed from under the retractor and both doctors worked to keep it in place as they put their first set of sutures into the abdominal muscles.)  The most interesting thing to see was the separation between the connective skeletal and sub-skeletal layers and the organs which lay underneath.  The bladder was opened up with ease, and the stone removed.  If you put the tip of your forefinger and your thumb together, you’ve got about the size of the stone, ovular and perfectly round.  A coal black surface covered by what looked like microvasculature, dark red in color and hardly apparent against its black background.  If you found this thing on the beach, you’d think, eh, pretty cool.  But seeing this thing come out of a man’s bladder about 400ccs in volume, you wonder how it was living with that inside of him.

The prostate came out next.  They worked their hand into the pelvic cavity, slowly cauterizing anything that looked like it might bleed and wasn’t essential.  After some cautery and scalpelry, out it came, even bigger than the stone.  The doc said it was the tumor, but I’m convinced at least some portion of the prostate came out with this thing.  You know when you see all those ads on TV for enlarged prostate?  Well this thing was much larger than you would ever think an enlarged prostate could be.  Both specimens were set on the sterile table at the foot of the bed, the tumor (prostate) headed to the lab afterward.  It wasn’t overwhelming, but this procedure was clearly bloodier and much gorier than any of the orthopedic procedures I’ve seen.  I contribute this partly to the use of a tourniquet, but mostly to the physical approach and the peri-operative injuries the surgery necessitated.

The second surgery I watched with the Vietnamese doctors was a kidney stone removal.  Apparently, this man had two kidney stones, one in each kidney, the one on the right had advanced into the ureter, and it needed to be removed.  The other, I guess, was not so important.  They opened from the front, through the right side of the abdomen, and soon were looking at the right ureter, about 4mm in diameter.  This was easily opened, the stone--the shape and size of a pill removed--and then the operation was closed up, with a drainage catheter emanating from his side, just the same as in the previous procedure.  This part was interesting to see, they don’t have premade drainage tubes, so they take the tube they have, bend it every inch of so and snip off the corner to make a hole.  With a pair of clamps, they pushed through (from the interior) of the abdomen until they broke into the subcutaneous layer, the other surgeon opened with a scalpel where the clamps were, and the tube was passed through, then sutured and tied to the skin.

The doctors packed up around 1:30, after surgery concluded on Thursday, did some rounds Friday morning, and then we hopped on the bus and headed back to Hanoi, to celebrate with a famous Vietnamese dish, hot and sour fish.  Cha Ca.  This stuff is unbelievably good.  That concluded my first stint with orthopedists in Vietnam.  Sunday I took my flight home to Vientiane to find Sophia worked to the bone by her CMC (Cluster Munitions Coalition) boss, and whining about it of course.

Surgery, Day 2 - November 3

When I pulled in yesterday, I had just missed the end of the first day of surgery.  Monday was all clinic and prioritization.  Here care may be less urgency-oriented and more “what is fixable” meaning any number of things.  Not everything is possible in the OR here.  Instrumentation is whatever the docs brought from home and that prevents a lot from being done.  This may come as a big shock to all three people who read my blog, but there are no reps here with a big shiny room full of blinged-out metal knees, hips, etc.  There aren’t plates and screws to fix anything internally.  (Though I did watch a Vietnamese doc ream out the proximal portion of a femur, insert a half-meter rod back up through the head from the fracture site, and then hammer it back down through the distal portion to set it.) There are pins and things, but no power-tools.  Also, prognosis is dependent on follow-up visits and complication likelihood (among hundreds of other things), which is prohibitory to many more procedures.

Back up to the surgery ward and through the first set of double doors. The first six rooms, three on either side of the long hallway hous any number of different logistical things.  Water tanks, autoclaves, closets of three-sizes-too-small scrubs (pants falling to hardly past my knee), extra cots and laundry.  For the most part these rooms seem unused. And through another set of double doors (2^nd set, just like at home minus automation) two rooms with filled cots, a seemingly untended ICU and immediate post-op outpost.  The two rooms beyond that are large ORs, deplete of curtains, replete with big French windows and operating tables.  Hardly bigger (if at all) than an OR in The States, surgeries are done side-by side, but with plenty of room still to move around and not knock your partner behind you’s scalpel through his patients nerve bundle from a knocked elbow.  The large doors entering each room were left open, laminar flow an unnecessary (?) commodity.

Want to know another unnecessary commodity?  Spinal blocks following general anesthesia.  I watched the anesthesiologist bore a needle into all our patient’s backs until the tip almost dripped out CSF.  Then in goes the block.  No tears. And only a few patients even winced.  Stoicism, now that’s something that we might not think necessary in this setting.  But here it is their culture and it is impressive to watch this shine through.

Many of the patients have neglected club-foot. Clubfoot they’ve lived with for five, thirty years, even more.  If you don’t know what that means, it’s hard to really imagine.  I’ll try to walk you through it.  First, pretend walking like a ballerina, right of top of your toes.  Now, (and I know most of you can’t even get your foot that straight), take the outside of your foot with the opposite hand and pull it under the ankle, with your toes pointed about forty-five degrees inwards.  Next, walk like that until the top of your foot, just outside of your ankle calluses and pads up, just like that thing you used to call your heel.  This is your new one.  Enjoy.  This is no joke.

The procedure for these depends is pretty cool.  After releasing the foot by snipping the posterior tibial tendon, the outside half of the foot is opened up and chunks of bone are removed either by hammer or saw, and wrench, until, when pushed back together, it looks anatomically acceptable.  Eventually the bone fuses together and though there is much less flexibility in the foot, the patient’s heel will actually be the patient’s heel.  Doctor! Doctor! [said in crescendo (that’s volume, not pitch)] Or so I’ve learned from my fanatical father who does this even after giving haircuts.  Or he just screams like a little girl (Can someone say if he does this in surgery too please?).  I didn’t get that gene.  I think this is best followed up with a blood-spattering high-five.  Although, that might not be the best idea when your OR has concurrent, parallel beds.

In other exciting news: I’ve heard from CMC people about work this week for next week’s groundbreaking UXO convention in Vientiane.  I only hope they still have use for me when I return.  Also, one of my friends who I’m sure doesn’t read this got into medical school, so congratulations to her, despite the fact that she neglected to tell me.

Hope all’s well in Vientiane in my absence (or thereby) and back in Seattle.  And the rest of the world too.  Except for Portland, for a number of reasons.  But seriously, straight love.

Also, for some inexplicable reason, I was the only person without a camera today.  I guess I forgot that HIPAA doesn't exist in Vietnam.  Tomorrow I'll take plenty of personally identifying and gory pictures that I will post with names, ages, hospital, dates, past medical histories, and procedures. (In case this might ever be used against me in the future: NOT ACTUALLY) I have mad (M-A-D) respect for personal privacy and dignity.

OK, on more thing.  Giants suck.

Hanoi and Son La - November 1 and 2

I have just arrived in Son La and been fed enough food for about 4 people: 5 full dishes.  I tried to eat half of it to be polite, but I am regretting that decision now.  I’m a little mystified as to my stay here, the driver picked me up this morning and after speeding through the mountains for 5 and a half hours, we were in Son La.

I called Rose from the hotel.  She’s the Vietnamese woman who seems to run POF (Prosthetics Outreach Foundation) on the ground over here.  She quickly handed the phone to Dr. Dales, as neither of us could understand each other with our accents and background noise enough to blare us out anyhow.  Mark said to stay put so I went to my room and about half an hour later I had a driver beckoning me to come with him to the Hospital.  Yes.

Pulling up to the hospital, there were vendors outside, selling dry and wet goods and people swarming, most likely family taking a walk as they waited for their loved ones to emerge from clinic or OR.  The fron the two buildings behind the wall and gated entrance wore sun-spots well, showing their age as well as some of the men and women they held safe, sterile, healing and jam-packed inside.  We drove around the first building and to the left, where two newer-looking buildings, less freckled, revealed themselves and parked right outside the front entrance.  I walked in, khakis, t-shirt and sneakers and up two flights of stairs, past thirty-some different family members of those past a set of double doors.  Surgery.  I arrived for the tail-end of patient consults, and entered what was the changing room, where the docs were lining up and re-evaluating tomorrow’s cases, some of the patients still present.  The room was crowded, something that would be deemed intrusive to patient privacy at home, but for the most part, the patients and families didn’t seem to mind.  I don’t speak Vietnamese or any of the tribal languages here, so I truly don’t know.  Facial expressions conveyed worry, fear, thankfulness and for physically unaffected family members and patients alike, hopeful happiness.  No matter how many people were in the room, everyone cared to improve the conditions which some patients had endured much too long.

Dinner was noodles.  So we thought.  It was actually hotpot with some noodles at the end, after everyone had gotten their fill from tofu, meat and greens boiled in some concentration of aqueous monosodium-glutamate.  Yum.  Rice “wine” was passed around.  At the other end of the table.  Boo.  This is no sake.  It is vodka.  As with lunch, I ate too much, I think all the whities here feel that way.  And its not hard with all the locals pushing food and liquor on you constantly.  The minute you look to your right to share a smile or some words, your new friend to the left dumps some more noodles and beef into your bowl.  Sigh and eat.  Even if it does mean an extra 1000mg Tums.

Tomorrow you’ll feel better and it’ll be a whole new adventure with completely different people.

WHHHHAAAAAA? - November 3

This post is only to warn that there are two, count 'em TWO posts going up now that I have internet.  Don't be too stunned, amazed, excited, or angry.  Just enjoy.