Sunday, March 29, 2009

Heart

I am thinking about the heart tonight, don’t know why.

Most of us have dissected the heart, whether dissecting the frog heart in 8th grade biology, or the human heart in 1st year medical school. If not touched one, you have for sure seen pictures of a beating heart - the beefy, fleshy organ that squiggles like jello as it makes its lub-dub sound.
The heart is really a bunch of bloody lakes and streams. The lakes, our life blood, are inside the chambers, squeezing from one chamber into the next, then dumping into the body. The streams, the coronary arteries, are the life-blood of the heart.

Lakes are bigger, stationary, important, some might think, streams are smaller, flowing, more intimate. Lakes and streams are made up of the same stuff, water and minerals, but behave quite differently. We humans are also made of the same stuff, yet we too, behave differently. Some people see themselves as important, lakes, some just naturally flow, interconnect with one another, streams. Lakes and streams. Which am I today, and you, which are you?

I was thinking about the heart tonight and almost meditating, for sure visualizing it in my chest. I put my hand over my heart and held it there for a long time, connecting my image of a heart, with my real heart.
I thought about our expressions “ my heart was melting”, “my heart is full “, “you have broken my heart”…….lakes melt, streams are full, dams hold lakes in place and break……..

My heart is full of joy tonight.

flowing stream, steady lake,
intimate stream, powerful lake.

I love my heart, and I can’t decide whether I’m a lake or a stream?

G


The Bear

On the journey to Sukhumi two weeks ago, I was no longer human, but merely a package on the Georgian Pony Express. The "pony" was loosely called a transport device (TD). More appropriately, I liken it to a torture device (TD).
There is a cable in the back seat of the TD and it fit perfectly on T-10 (that’s thoracic vertebra #10). The cable and my T-10 had 9 hours of intimate contact. My back will tell you the trip was 900 hours, but my back just likes to complain when it has been mauled.
The packages, whether they are square and corrugated like boxes , or soft and voluptuous like me, it mattered not, they were all treated the same, with expediency, tossed from one TD to the next, ker plop. Heave ho! And off you go!
Over the course of the 9 hours, there were 3 drivers. We would arrive at a check point, and transferto the next TD (all TDs had the same cable that fit in the same location on my back).
The borders are 'unstable', even though there is no active war-faring, Russian presence is visible. Tanks at major crossroads and at the borders. It is no nonsense travel here. The drivers are scared, the "packages" are just miserable.

The second driver of the day stopped at a little village where we ate lunch. In the parking area was a cage, a cage with a bear. The driver pointed over to the cage and said “Zoo”, in jest. The bear was sleeping. The driver says “sleeps all time”. I walk over to see the bear. As I approach, I notice a large hole in the wire mesh in the corner, indicating that probably at some point the bear chose to eat what was OUT of the cage instead of what was put IN the cage. So I approach with respect. Others walked by, and said, “bear sleep all time”. I could see respirations as his chest rose and fell, and lovely brown fur and a touch of silver mixed in. He was not dead, definitely asleep.
I walked up to the sleeping bear, and observed the sadness of this lovely caged animal, contained, for humans to gawk at will. It was chilly, we had already been through a blizzard and it was no longer snowing but wet, cold. I would be curled up sleeping if I were a bear too.

I said, in a corny southern accent, “Howdy Pardner, how ya doin’? Becha ain’t seen the likes of me round these parts in a coons age.”
His (I don’t really know if he was a he or a she) ear twitched. Life!!!! I stood and visited with THE BEAR a bit longer, telling him what I was doing, where I was going, and that I was very glad to meet a Russian Bear - (he looked just like those bears in the Russian circus - longer snout than our black bears or grizzlies). It was a one-way conversation , but very pleasant none the less. At least he wasn’t spewing some Abkhazian garble that I couldn’t understand. He was peaceful, and that made me peaceful.
And then, slowly, THE BEAR opens his sleepy eyes, and directs them to me. He knew exactly where I was, he did not need to lift his head. And I said, “ thanks for acknowledging my presence. Isn’t it true, we all have our burdens? I have my travails, the TD, you have yours, the cage. It is the nature of life. And when we share our burdens with one another somehow they seem to be lessened.”
He stared at me for a long time, his ear twitched again. I took that as a “Yes, I agree, we find comfort in the strangest places, with the strangest company sometimes. Journey well, crazy american babooska girl, I will see you on your way back.” His eyes closed.

I took minor offense at being called a babooska girl from the bear, but I understand my hair is graying, and so, fine, I’m a babooska girl.

He’s a babooska bear. And a very nice one.
The bear was the surprise gift on that otherwise grueling journey.

Genie
(any good novel, I hear The Kindly Ones is good.) I'm almost finished with all my reading materials. I will welcome any book.)

Rain Game

Every child has misbehaved in choir, at least once, and probably lots of times.

Last night the all-night-rain reminded me of a naughty children’s choir.

At one point the ‘rain-children’ were crescendo-ing off beat, singing louder, and louder and louder until the poor conductor finally shouted, with a clap, “STOP”!!!!!
And for a moment the children become docile. Soon the conductor gracefully lifts his finger from his lips in the familiar ‘silence’ gesture. He is ready to expand the melody, with arms flowing, the children giggle, and sing in perfect rhapsodic harmony, but before the conductor has a chance to offer the next guidance, the children giggle again and break into raging Russian discordance.
The song-game goes on for hours, the children tireless in their mischief. The conductor, you can tell, is flustered at first, then gives in lovingly to the rain-game. He begins wielding his arms in wild motion, no rhythm, no rhyme, no reason. The children stop laughing to watch his tirade.
What’s the harm he says, let’s have fun tonight! Tomorrow our practice will be serious.
The rain-children exhaust themselves, the thunder-conductor too. They all fall asleep with a whimper.

I awoke refreshed this morning.
g

THE COOK

All MSF missions have a cook. Because of the expectations regarding a rigorous workload, they try to minimize distractions such as cooking. I like this. I’ve enjoyed having a housekeeper/cleaner in the past, never a cook.
There are approximately 10 expats (managers, head of mission, doctors,nurses) and 30 national staff (nurses, social workers, drivers, translators, logisticians, pharmacist, cook…etc) that break bread together.

Let me introduce you to Svetlana, THE COOK.
Svetlana stands 6’2”, weight 275, perhaps 300. No fat on this body. Strong as an ox, stronger. One bosom is the equivalent of my entire thorax and abdomen. The both of them dominate her presence.
Svetlana doesn’t speak, she Announces, Commands, Delivers, not with confidence, but with Supremacy, Authority, MIGHT. Svetlana doesn’t do things, SVETLANA IS.
Her tone isn’t loud, it’s Booming, Roaring, Clamorous.
She doesn’t walk, she walks with Acceleration, Velocity, Readiness.
Today I was Svetlana’d.

Innocently, with chuckles from the expats who have been here for a while, I volunteered to create the menus for our evening meals to carry my load. Everyone takes a duty or house chore, family-style. Recall, we are 10 folks all from different countries, all wanting a bit of evening comfort food, that suits our unique tastebuds. With a judge and jury, an arbitrator, 6 hours, 8 drafts, and a collection of mafia money (for those special items) , deciding on a menu is really quite easy I have discovered.

During the work week Svetlana creates the lunch menu, prepares and cooks it. We partake with all the staff in a shack, with a kitchen, behind the office. Svetlana also prepares the dinner, from our harmoniously (HA!) created menu, delivers it to the expat house, which we then heat up and eat in the evening. We cook for ourselves on the weekends.

I was walking to the pharmacy today to conduct a quarterly inventory, a curious job in a cold garage, with years of dust, grime and utter chaos, nasty inventory cards, lots of errors, a real gem of a job.

You know how a man or woman will gently grab his/her partner, locking arms, holding one another close?
Well, Svetlana comes walking up behind me, with speed and intention, and puts me in a bosom-lock, pulling me close to her, literally sweeping me off my feet.
I thought, I’m not going to die from landmines, car bombs, gunfire, disease, but by the hands of THE COOK. Right here in broad daylight. I was thinking “what have I done?” What atrocity have I committed? My family loves me, my precious granddaughter needs me, I must plea for my life, I must beg forgiveness. But no time to think really, just be swept away by the torrent of decisiveness from THE COOK. My heart rate is now 120 bpm (beats per minute) (my usual is 50-60).

“INGA”, Svetlana shouts (Inga is my translator, and constant companion, except when she mysteriously disappears several times a day, which I have figured out is for my own learning opportunity - I must sink or swim with Russian-speakers on my own). “INGA“, Svetlana bellows. And up the stairs we ascend in the unrelenting bosom-lock. I am able to touch-down on the steps with my feet only twice.
.
Inga is sitting at the desk and casually turns, and says, what I presume is something like, “What’s up Svet?” Svet doesn’t smile, but fires off linguistic bombs. I look at Inga. Inga says “she wants to talk to you about the menu”. Recall, I create the menu, I write in English and then a translator will translate to either Russian, Abkhaz or Georgian, depending on the situation. HR is now 100bpm. I cannot possibly die because of the menu, can I? It won’t be cold-blooded murder at the compound, just a chastising for poor menu choices, I think.

Svet doesn’t ask me to sit, however she sits like an elephant sits ready to receive unwelcome riders on its back, with disgust, grunting, "intolerable humans".
I then sit so she will not think I am attempting to challenge her authority. No smiles, no eye contact. She blasts again, Inga looks calmly at me and says she wants to know how many Abkhaz yogurts you would like, you did not specify. She also wants to know if you want red, green or white onions chopped for your pizza next week. HR 90 bpm. I answer, “6 yogurts, and white onion is good”.
Yet another linguistic blast is hurled. Inga translates “would you rather have cabbage salad with the walnut-stuffed capsicans, instead of lettuce and tomato, I think it is better?” HR 80 bpm, “Sure”, I say.
She says, “are you sure this is enough food?”
I want to say, are you asking is this is enough food for a heard of elephants or for 10 humans, but instead I say “yes, thank you, I believe it is plenty, but I will let you know at the end of the week.”. HR70 bpm. No smile exchanged.
Up, the elephant stands, a quick glance at me, a nanosecond of eye contact occurs between us.
A Final Blast, and she turns her strong constitution toward the exit.

Inga says, “Svet likes your menus”. And then she says, and she likes you. A lot!
THE COOK departs in brisk, commanding paces, back to her kitchen-kingdom.

HR 60 bpm.

genie

Wednesday, March 25, 2009

Humanitarian Aid in a Seaside Town

I have not told you about the town Sukumi(pronounced Soo Coo Mi). If ever there was a mix of abandoned ghost town and luxury seaside resort, this is it.
The WAR, and that means the brutal extended war in 1992-1993 between Georgia and Abkhazia, resulted in the population shrinking from 800,000 to now 150,000 persons. The war brought bombings, looting, deportation of Georgians. Houses were marked, like the Jewish homes in WWII, and led to all Georgians fleeing or being killed. Many others left either in support of or in protest to the plight of those being displaced, not to mention raw fear of being caught in the crossfires. Fleeing a war zone, rational.
But in doing so they leave behind home, belongings, history, neighbors. Once mundanities of life, those realities became treasures. They went to camps, deplorable camps, for displaced persons, they went to relatives in Armenia, Russia, they went where fate would place them.
Now, the Russian mafia has claimed many of those homes, declaring that after 10 years of unoccupied status, the building could be claimed. These buildings are being cleaned out, renovated, and turned into rentals for wealthy Russians to come in summer.
The elderly could not leave in 1992 - the family car was too full of children, food. Many refused to go, "this is my home, I will die here", "I will not go because I am just a mouth to be fed", "the war will be over and my family will return", "I have no car or money to leave",whatever reason.
10 years later those elderly still cannot leave, they are bedbound, starving, confused, de-humanized. The Local Red Cross(LRC) is trying to address needy, but simply can't do it all. The International Red Cross has pulled out, and there is no budget. There is a local clinic with doctors that used to do home visits, but resources are limited, and there is "more important " work to do. MSF has filled a gap for many years. There used to be 18,000 identified frail and vulnerable across Abkhazia. Now we are treating only those in Sukumi and another area close by. Several hundred patients, most have died despite our efforts. We provide food, heaters, wood for fires, slippers, a winter dress and a summer dress to the women, pants for the men. We provide in home medical care bringing medicines, a good heart, and a recognition that most illnesses cannot be properly diagnosed or treated. For those able to be transported, and are willing to go, we take them to Tbilisi, Georgia 9 hours away in a treacherous drive across mountains in the back of a TD transport Device. Border crossings are risky.
Transport is a problem. The drivers only work 4-5 hours a day, and smoke and play chess the remaining time. They often just refuse for what reason it is not apparent. It is not safe to drive without a local driver.
So, this program called HAP or Health Access Program is attempting to transition back to the Local Ministry of Health, and use the resources they have, the LRC, the local clinics. This will be hard, because the care, the attention will inevitably change. I am in charge of the transition plan, and maintaining the current program while doing so.
I'll tell you more as time goes on, about the program and my work with this program the the Tb patients.
But for now, know that I live in a remarkable, stunningly beautiful seaside resort town, has been.
It is springtime, the flowering trees are blooming, the tiny snowdrops pop up in the most unlikely places, amongst the rubble, and decay. The irises standout among the rust and piles of concrete.
The sun shines on the harsh and the humane. It doesn't matter. Neither do I.
My love, (tube of Bert's Bees lipstick, Watermelon color. Mine was stolen! Whoever did so is happy). I am happy today
genie

Saturday, March 21, 2009

Not So Comforting Comforter

I am going to complain, so skip this one if you want. The Caucasian Cooties are one thing, the gal dern bed covers are another.
Night after night I am in a wrestling match with this impossible"comforter". Comforter my a__.
It moves. Constantly. All night long I am in a leg-lock," joe-jitsuing" with this guy.
It is old, like every thing else in this place, and lumpy and it crawls. The lumps migrate to the edges, weigh them down and then cause the covers to crawl. It is very annoying. It is cold, the night noises are unfamiliar, and then to be constantly trying to outwit my covers is down right insane. I want tame, gentle, soothing, soft, luxurious well-behaved covers. It's all I ask. But it ain't gonna happen.
To whom should I escalate this complaint? My friends. You will pity me won't you?????
So I will continue on my nightly weight loss program and somehow I am going to get smarter. I thought about tying the vicious devil to the bedposts, but of course there are no bedposts.
I'm thinking about sending it to Emily Post School of Good Bedcover Behavior. If it does not pass which I doubt it will, I'm going to have it arrested by the Russian police, or even worse the Abkhazian militia. Now that's serious. I really hate to threaten, or to retaliate, but it is necessary. I mean this is not a preemptive strike, the covers assaulted ME FIRST.
Thugs, mafia. Tomorrow I will learn the Russian word for f'ing comforter, maybe it doesn't understand English, and if I threaten it, it will behave.........
Before going to bed tonight, I ask, in your prayers, you say "Thank you Spirit for nice covers, and may Genie's comforter be nice to her."
Nighty night.

GRUD

You know how as kids we mixed crayons together to make new colors, and would make up new names, like rellow(red and yellow)? So it is with nature.
Colorodans know the color of of aspen trees and snow, the frosty color, seen from a distance while skiing. Beautiful. The frosty gray is a different color here. The ash and chestnut tees are dark, and the frost looks very different, more amber, lovely.
There are other colors, ones I've never seen before, even while mixing crayons. Abkhaz colors. The one most disturbing I call GRUD. It is gray and mud. I could call it MEY ( mud and gray), but that sounds much too pleasant. Grud makes me sad and mad. It is made of despair and blood. Grud is an unnecessary color. No one needs grud in their town, or in their lives.

Grud smells. The stench is frightening. It is beyond squalor, beyond revolting, repugnant.
I am a geriatrician, no stranger to bad smells, they come with the territory. No baby fresh fragrances on my exam table or in the nursing homes.
Today my experience of color went beyond grud. Gray, mud, anger, despair, blood were only the top layer. No utterances are sufficient to translate the experience, the reality of this 'living being' in the same universe as you and me.
There was not a reason to ask how? Why? How long? Just advance to the bed of this barely living being, then greet, pray, work. Depart. Find my sanctuary, my little room, and sob.
I will be returning next week, and the week after, until this being no longer breathes grud any more.
God help us all, pity us all.