Wednesday, March 27, 2013

Squatting May Save Your Life

Why so serious, doctor?

I ask myself that question a lot these days.  Is it the relentless schedule of the job? Is it the twenty-four/seven on-call schedule for three months at a time. Is it the hundreds of miles away from a real hospital or a Starbucks?  Or is it the responsibility for the well-being of fifteen thousand humans on this remote island, blah blah blah.........?  

It wasn't always this way for me. It used to be light and fun and somewhat aimless.  These overseas jobs used to just be about the road-- the travel, the experiences and the good times in bad situations.   I  tend  to enjoy some fairly exotic roads.  There's a lot of guys like me out there.  We often end up in the same places and share stories about roads we haven't yet seen.  Then we make trips to see them.  We also share a lot of tips--survival tips, food tips, beer tips, shelter tips and, equally important, bathroom tips.  This last item comes up a lot.  As civilized members of previously civilized societies we tend to focus on our comforts as much as our needs.  These important bathroom tips tend to satisfy aspects of both comfort and need.

I was always a guy who would rather submit to three hours of intense abdominal discomfort waiting to use my own bathroom rather than use the rest-stops on the New Jersey Turnpike.  Any bathroom that you can smell outside in a snow storm seemed like a bad place to use. Thus a trip to  remote  central Tibet was a shock to the senses in so many ways.  On the positive side it did teach me the wondrous experience of relieving myself in the midst of panoramic, idyllic views of enormous proportion.  Also to carry extra underwear.  When arriving in China on the long, arduous trip to the Szechuan Province and ultimately the Tibetan Plateau, one learns an important lesson quickly:  never use a Chinese bathroom.  Never ever.  To call them bathrooms is a bit of a stretch.  Mostly they are cement shacks with slats- not holes--cut through the floor usually over some form of running water.  Also for your comfort there are no doors and certainly no seats.  The presence of a white person attempting a painful squatting position over a couple of wooden slats routinely draws a crowd.  And the crowds like to point and discuss.  This is a highly predictable scenario.  Two times was enough for me.  White people have almost no chance of taking a nice, quiet, private restroom ablution in  China.   You walk into the shitter and suddenly you are a Kardashian.

I'll say this too about the Chinese:  If their aim in the bathroom is indicative of their military's ability to aim we should not hesitate in going to war with them.

Chinese Toilet:  Deluxe Edition from the
 Beijing Ritz Carlton
Then there is the topic of squatting.  I have squat envy.  In Asia and most of Africa the use of chairs is all but unnecessary. They keep chairs around for foreigners    Most natives from these continents can do nearly any task given to them while squatting and they can do it for hours on end.  Cooking, eating, corporate meetings, smoke breaks, playing music, catching fish and, yes, shitting.  In the more rustic regions of these continents you'd find a unicorn more easily than you would a seated toilet (although oddly enough you can find a McDonalds easier than both of these things).  If you do find this seated toilet, it will not have a seat so sit at your own risk.  On my first epic trip to Tibet and China any necessary trip to the toilet was preceded by great anxiety.  Squatting is a talent that must be nurtured from birth.  There is the obligatory stretching of the Achilles tendon and the flexions of the hip that takes decades of participation to make a squat truly comfortable.  In fact, one of the ways that Taliban terrorists used to suss out Western spies was to observe them squatting.  If their heels remained off the ground while they squatted, they were likely covert infiltrators and dealt with accordingly. Any man squatting since childhood will do so with his feet comfortably, squarely on the ground. This is a true story.

The discomfort of the novice squattor is one thing.  The physiologic effects at an altitude of fourteen thousand plus feet in mountainous Tibet is yet another.  A novice dropping down rapidly for any extended period of time in a squat will likely lose consciousness from the blood supply being sequestered in the legs.  This novice might find himself disoriented and waking up on his back in his own feces.  This is not unprecedented.  When the dizziness starts, no matter what stage you are at in defecation, you stand up or bear the consequences.  

I found these toilet anxieties a bit sad.  While getting in and getting out of the bathroom quickly  is actually physiologically desirable  (decreased incidence of diseases of the "civilized": hemmorhoids, Diverticulosis, Diverticulitis and Irritable Bowel Syndrome), it does cut into the quiet moments of reflection and "me time" that Westerners have fought for dearly and grown to appreciate. Squatting has also indirectly resulted in greater battery life in my Ipad.

Some should never squat.
To live this life off the grid you have to be a go-along-to-get-along person.  You have to adapt or you  will be back on the New Jersey Turnpike in no time.  I've seen guys fight it and lose the good fight, but not without providing a good laugh.    Take my good friend Dr. Ken.  He had squattor-phobia.  Worst case I'd  seen in twenty years of traveling. Once his gut got to rumbling the anxiety would take over.  The lengths he would go to not squat were epic.  In Tibet, as soon as we'd arrive in a new town or  hospital, he'd slip away and do a quick and surgical recon search for a seated toilet or facsimile.  Ninety-five percent of the time none existed and Dr. Ken would transform into Toilet McGyver.  His skills and inventiveness in rapid toilet invention were unprecedented and, to him, well worth the effort.  The simplest of which involved dragging two wooden chairs into the bathroom and placing them in the stall on each side of the hole in the floor.  Then, as logic would suggest, one cheek rested on each chair and comfort was attained.  The best part of this was watching the helpful nurses drag chairs to the bathroom for him every day, have 2 minutes of discussion and giggle all the way down the hall.   Dr. Ken is a great surgeon and they know it. They figured whatever he was doing with the chairs must be the right thing to do.  The problem was that we were rarely working in hospitals.  Most of the time we'd have to set a makeshift field clinic up in the middle of a  Tibetan nomad village.  A quick search of one village revealed an old rusty spittoon funnel found in a box in the back of a tent.  You can do the math.

Don't even think about
asking for this

Dr. Ken and I did quite a bit of time in Tibet.  It was a pinnacle experience of a lifetime for the cultural and survival aspects that we experienced.  We lived sixteen thousand feet above sea level for weeks on end and  survived on a few handfuls of edible food per day (and a half a pack of Pringles--God bless Pringles). We learned a lot about our own limits.  But then again we are doctors.  We have the science and technology to alter and push those limits......within limits.  Take for instance Dr. Ken's squattor-phobia.  It didn't take a scientist to figure out that less squatting equals less phobia.  A simple Immodium tablet, strategically timed, could put off the harrowing need to defecate for a well-extended period of time.  This is the same model for efficient use of a dump truck in mining.   Efficiency dictates that a haul truck make  all its loads and fill up entirely before finally releasing the payload.  The difference is that dump trucks have scheduled loads. That need to unload doesn't surprisingly come in the middle of the bare Tibetan tundra in a  remote clinic where there are no less than two hundred Tibetans gathering around to get their first glimpse of a white man.

If you've ever been on safari or even in a safari park you know that its more fun to watch an exotic animal actually do something rather than sit around.  In central Tibet, high up on the Nakchu plateau, we were those exotic animals.  Who could blame our Tibetan hosts?  When  you live in the middle of nowhere and something resembling a ghost rolls up unannounced you are going to follow that ghost around and see what it is  up to.  When Dr. Ken's dump truck came upon that time for its scheduled unloading he started to walk begrudgingly up the road to the simple wooden shack set up for such matters.  Approximately twenty Tibetans got in line and followed him to the shack.  Did I mention that there is no door on the shack?  He turned to find the line of followers.  He stopped.  They stopped.  He started off again.  They did the same.  I stood watching.  I wanted to see how this was going to organically turn out.  He walked over to me.

"Don't involve me in your drama,"  I said.
"You see what's happening?"
"Yeah.  It's hilarious.  You are the Pied Piper of Shitting."
"I have to do something.  The Immodium wore off half an hour ago.  I can't do surgery like this."
"We need transport,"  I said

Tibetan Shit Chasing Cavalry
 in high gear.
We attracted the attention of one of our drivers and asked him to bring the Landcruiser around.  As he didn't speak English we had a more difficult time showing him the hand signals of what we needed it for.  Ultimately we just said,

"Let's go!"

Off we went in the Landcruiser across the tundra.  There were no roads out there.  Dr. Ken looked relieved until he looked out the back window of the car.  There on horseback, in full gallop, were three hard-core followers tracking us.

"This is unbelievable," said Dr. Ken.
"On the positive side," I said, "its only three of them and no women or children.  No big deal shitting in front of three dudes, right?"

He slapped the driver on the shoulder and gave him the hand signal for accelerating.

"Punch it Starsky!"

The Landcruiser had more horse than the Tibetan ponies could muster and we were finally free of the throng in a cloud of dust.

Yak poop wall.  Excellent spacing.
There was no Jersey Turnpike rest-stop to be found so we had to settle for the closest thing resembling a walled structure in the middle of the Tibetan tundra.  The only structure we came upon was, ironically, a wall of shit.  Let me explain:  There is one, and only one, form of combustible fuel here in the tundra:  Yak poop.  The altitude is a thousand feet above any tree line here and there's no grass for burning either.  Yak poop is readily available, dries quickly in the dry Tibetan climate, burns nicely and lends itself to easy stacking into structures.  This keeps it tidy and organized like stacked firewood.  This Yak shit wall was a good four feet high and eight feet long.  There were likely two thousand five hundred flattened Yak poops geodesically  stacked to perfection.  Certainly karmically adequate for Dr. Ken's cause.  When we got within twenty-five feet of it, Dr. Ken jumped out of the Landcruiser before it  came to a stop and sprinted the rest of the way.  He jumped behind the wall and disappeared.   Then there was silence.  We waited and waited.  The driver stared ahead in silence and I just sat in the back of the car giggling.  After what seemed a disconcertingly long time period out walked a man with a contented look on his face.  He strolled slowly back to the car with confidence in his step.  I was still laughing.  Dr, Ken said:

"All good my friend?" I asked.
"If anyone goes back there they are going to think one of the Yaks is very, very sick." said Dr. Ken.

Good times in Tibet.  Memorable times for sure.  That was nearly fifteen years ago and since then I've worked in every country in Southeast Asia and all the way out to Papua New Guinea.  I'm vocally proud of my squatting prowess by now. And even though I work in a place approaching a Western standard of living, I still visit the Squattie once a fortnight just to keep my skills up and my heels flat.  Keeping your skills sharp is important.  I give that advice to everyone.  After all, you never know where you may end up next.

The Road:  One seat, one beer, no waiting.............................


  1. I miss you, and im not afraid to say it! Your a Good Man Erik, and your Blog helps me walk along side with you as you go through these journeys.

    Vicariously, im right there!

  2. I enjoyed reading this! Hilarious. Crazy. Wild.

  3. GREAT...and so informative about something I never gave a shit about!! Oops!