This story and what will follow is not for the faint hearted. It was as embarrassing to me as it was uncomfortable. But for the greater good of humanity it needs to be told. If even one person, male or female, heeds the call to the "scope" after reading this, my pain and discomfort will be justified. On a positive note, after this difficult week, I can think of little else in the world that will ever embarrass me again in the long years and predictable medical violations I expect to survive after last week's "scoping."
|On the job|
For the past seven years I've been an Emergency Medical Evacuation specialist. If you are traveling outside of what you consider to be the civilized world and have a medical emergency greater than Travelers Diarrhea, I know what to do. I know who, what, where and the fastest way to get you to a competent physician and hospital that will put your mind and body at ease. Sometimes I will even take you there myself. I've been part of successful medical extractions in Iraq, Peru, Kazakhstan, Congo, Cambodia, Ukraine, Papua New Guinea, Laos, Haiti, Nigeria and dozens of other countries. In these difficult places my clients all had one common hope: Getting to a hospital where the medicine is real, the scalpels are sharp and the doctors are adept. It takes a highly trained and cooperative crew of people to make this happen successfully even in the simplest of international circumstances. Much like Hillary Clinton's view of The Family, it takes a village.
|Your ticket to clean sheets, sharp scalpels and real medicine|
(mention of the company name is complete unintentional)
I'm lucky enough to work for arguably the best company in the world for Medical Evacuations. These guys are experienced, consummate pro's. I'd mention their name, but I'm once burnt and twice shy. Recently one of my previous "associated persons" demanded that any writing that included the company's name needed to be cleared by the bureaucratic powers that be in HQ. (I guess I should be a little flattered that they think my blog will have enough readers to make it worth the ink on their letter.) I'd written an account of work in a remote village where, under emergency conditions, I ended up saving the life of a newborn by doing an emergency C-section where no other medical person could do one. Furthermore, the mother died briefly on the table from a bad reaction to anesthesia. I resuscitated her and brought her back to life. In my story I made mention that during this emergency surgery, the doctor in this remote village tied the woman's tubes because her uterus had ripped. He felt that she would likely die if she got pregnant again-- especially since she lived in a place even more remote than our remote medical outpost. This is not a decision I would have made, nor did I have any part in the decision or the tube tying, but this is what happens sometimes in poor countries where emergency decisions and available resources do not match those of the privileged, second-guessing, fully internetted West. A few angry feminists took exception to this doctor's sterilization decision and unleashed an attack on my blog as though I was Dr. Mengele himself. They wrote to my former "associated persons", my former "associated persons" wrote to me and I removed the blog. In my former "associated persons" eyes, writing about the remote practices of one doctor (who was not part of their company) outweighs the good of writing about an employee saving a mother and child by performing an emergency surgery (their concern was that I was not supposed to be directly treating patients). Still, extreme situations require extreme actions and I'll always vote for saving a life over saving face. I would do it again. Some people can't handle the truth or the ragged edges that come with it.
But enough of those sour grapes. Back to my intestines:
I was on a scheduled leave leave from my jungle clinic and enjoying the culinary and infrastructural greatness that IS the civilized world. I had been in the remote jungle for five months and, finally, I was back in the mix. I was in New York, New Jersey and Los Angeles filling my face with all the delicacies that I would not see again after my return to remote Indonesia for another 3-5 month encampment. In Indonesia I am at least an hour's flight on a single engine plane from the closest Starbucks or McDonalds. To be even more clear, our idea of an upper class restaurant here is one in which wearing shoes is not optional. In America I attacked these restaurants and fast-food emporiums with complete abandon like a guy who was seeing them for the last time in his life. It was glorious: cheesesteaks, heaping plates of sushi, chicken parmigiana, popcorn shrimp, Mexican, Chinese, Italian, Japanese, Thai and Lebanese food. I didn't miss a country. I'm a little guy, but I can put it away when I want to. It wasn't until I was on the plane heading home, through Bangkok, that I knew something was wrong.
Without getting too graphic and descriptive, everything inside stopped. For me, whose colonic regularity was something I could usually set my watch by, this was distressing. Still, it happens to the best of us so I figured it, like all things, would pass. I was in Bangkok. Arguably one of the top five cities in the world to be for a man on a fine food tear. There was Kwiteow and Phad Kapow to be consumed. There was Tom Yum soup so hot and delicious that it would leave you in a frenzied craving for more even an hour later while your tongue blistered from the spices. And there was beer. Real beer in real pubs with over 30 brands at my fingertips. I ate, I drank........................and then I bled. Everything inside me ground to a dead halt. Something was terribly wrong.
Now I had a dilemma. Bangkok has good, if not sometimes great, medical care. It is a world hub of medical tourism and the hospitals more closely resemble the Peninsula Hotel than a scary, filthy Southeast Asian medical center. My son was born in a Bangkok hospital and my wife had a Cesarean section done so beautifully that it could be considered a work of art. This was definitely the last stop on the bus for medical competence on my road home. The problem was the Jungle Clinic. I was on a schedule. My replacement doctor was nearly on his way off the rock and I would not leave my post without medical coverage. I'm not sure I took that oath directly, but I felt responsible. My gut would either get better or it wouldn't. I'd sort out everything at the clinic and then deal with my own problems afterwards. Maybe this wasn't the best plan, but sometimes- most of the time in Indonesia- there is no perfect solution.
|Erik Travels: Blocked up and|
tore up from the floor up
Finally, eventually, I made it back to Sumbawa Island. I was jet-lagged, underslept and had stopped eating three days earlier for fear of exploding. I had lost nearly eight pounds of hard fought vacation overeating and the bags under my eyes were big, puffy and black. I looked like shit and felt even worse. I spent a day getting my family settled back in and catching up on the urgent loose ends and emergencies in the clinic. Fortunately it was quiet over the holidays. Now it was time to call in the cavalry.
I called in to our Alarm Center and reported the need for a medical evacuation. They asked me who. I said, me. They asked me to repeat that twice. They were not initially aware that our remote site doctors are permitted to be sick (though it is specified in my contract). They contacted our Asian regional medical directors and they responded like the God's of men that they are. From remote Sumbawa Island there are two options for the closest centers of medical excellence: Australia and Singapore. Both have excellent hospitals and doctors, but specifically they had clinicians adept in the use of the dreaded, yet unavoidable, colonoscope. I chose Singapore. If I was going for a beer and a steak, I'd have chosen Australia. For pure efficiency and service there is no place on Earth like Singapore. Within an hour the pro's at my company had the hospital and doctor (a renowned Singaporean MD who had done a fellowship at Duke Medical Center in the America) arranged. They found a quick replacement for me at the Jungle Clinic. He would head out from Jakarta. All I had to do was get to Singapore.
|Great weather for a duck, not a Seaplane|
I barely slept that night worrying about the things I could not control. The thought of delaying medical care for at least another day was making me crazy. I had all the signs of cancer. All that yoga and fiber for years hadn't done jack shit for me. At five-thirty AM I lay awake and watched the sun barely come up through the constant clouds and drizzle. At seven AM I called the mining site manager to find out if the planes were going to be flying through the storm. He's a friend of mine and I explained the situation to him.
"Hell, why didn't you say so?" he said. "We'll arrange the chopper to take you to Bali. You can take the Squirrel."
I knew the Squirrel. The Squirrel is the AS350 Eurocopter single engine chopper that I'd used to search for a downed helicopter a few months ago. I get douche-chills every time I hear it's name. It was our best chance of maneuvering around and under a storm. It would be ready for me by ten AM.
I said goodbye to my wife and son and drove to the port helipad. It was still pissing down rain. I was handed a small life vest and told to watch a comforting safety video about the Squirrel that explained what I should do if we ditch into the sea. The ground crew walked me out to the chopper. The Squirrel's engines were already primed and deafening. I couldn't hear myself speak. I jumped into the co-pilot seat and put on the headphones. The pilot looked over at me and smiled.
"Hey doc. Here we are again."
"Always in the best of circumstances. Are we going to make it through the storm?"
"We're going to try. Let's go."
We lifted off. I've still never experienced anything as unnatural as a helicopter lift off. Like someone's plucked you into the sky as a big joke, with the expectation that you will fall back to earth just as suddenly.
|The Sumbawa coast from the "Squirrel"|
The rest was the trans-international Asian equivalent to the five minute drive to West Jersey Hospital. One more airport, a flight on Singapore Airlines SQ942 and arrival in beautiful and efficient Changi Airport where the lines are short, the immigration is quick and everyone says Thank You. Singapore gives you the impression that everything is going to work out in the cleanest, most efficient, most polite way possible. If I were asked to write a National Slogan for Singapore it would be this:
"Welcome to Singapore. We are still Asia, but shit works here!"
|Directions: Head to the clouds and turn left|
The Prep is Hell. Modern medical science has this one down. Two separate medicines that will tether you to a toilet like an umbilical cord on a baby. You will go no further than twenty feet away from a bathroom, depending how fast you can move. The nursing staff at Mt. Elizabeth hospital is as conscientious as you'd expect a nursing crew to be in Singapore. They were pretty much in my room every twenty minutes whether I called for them or not. After a while I stopped being embarrassed with the conversations I was having with them behind the bathroom door. I trusted they could understand what I was saying between my thick American accent and the other horrific sounds coming from me. They speak English in Singapore, but it rarely sounds like it.
|Best view in the house|
I had traveled one thousand one hundred fifty seven miles of fear and uncertainty, but it took the last four and a half feet to bring me to peace of mind. I stayed one more day in Singapore for observation and then started the long journey back to the rock I call home. I had peace and I had clarity and it was as if this clarity had extended to the skies. It was clear sailing and sunny skies all the way back to Bali Ngurah Rai Airport and a smooth, unfettered flight home on the seaplane. After an hour we descended, ultimately landing on the calm blue waters off the Sumbawa coast. Our ambulance driver was waiting for me with my car. It felt good to be home.