Sorry. No funny titles for this one.
Friday, September 20th, 2002, the end of our third week in Mongolia. I doubt that I'll forget the events of this day for some time to come. The previous week, on Sunday, we had gone hiking up to the fire tower that watches over the protected forests above UB. Our host, Chris, is a former Marine and is in fantastic shape. For him, this 5km hike was probably a short little jaunt in the woods. For me, it was more than double the length of any hike I've done in the last decade of my life. On the way back down the mountain -- the trail was straight up and straight down -- my knees got all shaky and wobbly and I had to keep sitting down to catch my breath. UB has an altitude of 4500 feet, and the peak of the mountain was, according to my GPS, 6600 feet, so I'm quite sure that the altitude was causing some problems for me, as DC is only about 800 feet. I have never felt so inadequate and out of shape. That evening, I drank 1.5 liters of water and took muscle relaxants to prevent cramps in my legs.
The week progressed in a normal fashion until Friday morning, when I woke up with a little stitch in my side, a stiff, achy feeling as if I'd slept on it wrong. I tried to stretch it out, but without any success. I just ignored it, thinking that I needed to go out and get some exercise. Zina had a meeting at The Asia Foundation, and I agreed to go with her. We walked to the bottom of the hill to Chengis Avenue in order to catch a taxi. The stitch was not getting better, but worse and quite uncomfortable now. We arrived at TAF, and I had difficulty getting out of the cab. We did our things at TAF -- checking email and looking at a used cellphone -- and were preparing to go to Admon Printing.
This stitch had progressed into a full-blown cramp, and it was beginning to be very painful. Zina had been asking if I needed to go to the hospital, and I finally submitted to that suggestion. This cramp had become interlocked with my breathing: if I tried to breathe deeply, the cramp would spasm, causing me to huff out what air I'd brought in with the previous breath. Each spasm made the muscle more sensitive, and therefore more susceptible to spasm. I figured out that if I force myself to relax, things get better.
By the time we arrived at the hospital, each bump in the road elicited a groan of pain from me. It reminded me quite a bit of having broken ribs. I broke 4 of them at once, so I know what it's like, and this was about 70% as painful. At this point, the cramp is having a spasm with each breath, and my breathing has become quite shallow. My hands are cold, my fingernails are blue, and there is no color in my face.
Zina tracks down a Russian speaker and asks for the emergency room. There is no real emergency room in the Western sense, but we are directed to an exam room at the west end of the hospital. It takes an excruciating walk to get there, including a ramp that sends me into a gasping fit.
We arrive, and Zina speaks Russian to the nurses, explaining the problem, then goes to call TAF, requesting the services of Zola, the translator, who arrives very quickly. I can't really find a comfortable position on the bench, and discover that by pressing on the muscle that is spasming, I can reduce the occurrence. I watch the nurses fumble with the blood pressure machine, trying to get it to turn on. They succeed in plugging in the machine and reading my blood pressure -- it's at 147/85 and my pulse is 95, which is really high for me: my normal pressure is 120/65 with resting pulse of 60. I surmise that since I am not getting enough oxygen, my heart is working harder to keep my body supplied.
The doctor shows up while Zina is at the phone. He looks at my BP reading and listens to my chest cavity with a stethoscope. He does spend quite a bit of time listening to my left side, which is the side with the cramp. Apparently, he orders an EKG and a blood test. The nurse hovers over me, waving a sterile needle in its original package -- which I take as a good sign -- then she turns around and grabs a flyswatter, and chases down and kills a housefly. I have yet to see any rubber gloves or alcohol, so I tell the nurse that I'm afraid of needles. That seems to stall her, at least for the time being.
As I looked around, I notice that there are several glass liquor bottles and plastic soda bottles sitting near the sink. As I examine them, I notice that one of the liquor bottles is hanging from a hook in the wall and the cap has been modified to accept an IV hose. Horrified, I realize that the paper labels are still on the bottles indicating to me that these bottles have never seen boiling water for sterilization. I fervently hope that the doctor doesn't insist on a saline drip -- even though I'm quite sure I would definitely benefit from it.
Zina returns, and shortly Zola shows up. This proves a tremendous comfort: that we can now communicate effectively. In the interim, a nurse shows up with the EKG machine. They attempt to put the leads onto my chest without success: I am a very hairy-chested man, and the suction devices simply wouldn't stick. The funny thing is that she kept telling me not to move, blaming my behavior for the failure. The not-so-funny thing is that she kept palpating my chest and shoulder area to find the location for the EKG lead, and she kept poking my collarbone that has a plate and screws in it. I asked Zola to request that they be gentle on that spot, which instigated a flurry of questions about where it hurt and why -- it took a couple of exchanges with Zina and Zola in Russian and Mongolian to explain that it was an old injury. One nurse came to me with small, dull scissors and snipped away some hair around the spot where the EKG leads should go. She didn't understand that even a little hair would break the vacuum. After about 10 minutes of having this nurse jam and twist the suction cups into my skin, I finally asked Zola to ask for some soap, water and a mirror. I pulled out my pocket knife and made shaving motions. The nurse became very alarmed and took my knife away, giving it to Zina. I wasn't in any position to argue. They did stop messing with the suction cups, tho.
About 20 minutes later, a nurse showed up with an old-fashioned safety razor, the type that uses the extremely thin double-sided blades. She got the picture about the soap and water, and did lather up my chest before she started shaving. I found it amazing that she tried to pick the shaven hairs off the razor by hand until I told her "oos", the word for water, and made a waving motion at the faucet. Clearly, she had never had to shave anyone. In retrospect, it makes sense: most Mongolian people don't' have much body hair. With the EKG leads in place, and the nurse that knew how to run the EKG (out of the four nurses in the room) also in place, the EKG was taken and the precious meter-long strip of paper secured.
Since I had made the ill-considered comment that it felt LIKE broken ribs, the doctor ordered that my ribs be X-Rayed. I got loaded into a wheelchair -- one that was quite narrow and I barely could wedge into it -- and rolled down the hall to an elevator that brought us up to the ground floor. We then had to roll down the ramp to the front entrance lobby where I was told that I had to get out and climb a flight of stairs because the lobby elevator was broken. I did manage to climb the regular flight of stairs with 3 or 4 pauses to catch my breath and attempt to relax my body. The X-Ray room was at the end of the hallway, and I made it there with only 1 pause. The X-Ray machine is supposedly a new instrument from Japan. The patient stands on a platform at the base of a large box that I suppose to be a receiver. The platform is flanked by handles and there are head-stabilizing pads at the top. The X-Ray projector is located at the front and is fully articulated. Zina and Zola are given lead gowns to wear so they can interpret the X-Ray Technicians instructions. I'm instructed to stand on the platform and lean back against the receiver. Then, imagine my surprise when the platform starts lurching around! I has assumed that the since the projector was clearly articulated, that it would be moved to suit me, the pain-wracked patient, but this was not the case.
I don't know if it is something cultural with Mongolians: with the dozens of taxi rides we've taken here in UB, I would say that 90% of the drivers here don't understand that the brakes and clutch have the capacity be operated smoothly: they wait until the last moment, then slam on the brakes when stopping, and their apparent goal when operating the clutch is to release it as quickly as possible, and if the engine threatens to stall, they take several quick stabs at it, resulting in a series of harsh bangs. Admittedly, the clutch scenario is less common than the braking behavior, but I've witnessed this often enough to understand it as a trend.
In any case, I'd say that the X-Ray Tech might have a future as a taxi driver: she would rapidly bump the transit controls, causing the platform to lurch sideways repeatedly. Then the projector would move, then the platform would lurch, then the projector would move and I'd be told via Zola to assume a new pose. I cannot imagine how painful this whole operation would be if my ribs were actually broken: it was impressively painful as it was. They took close to a dozen images, or at least I assume they did by the number of poses I was asked to take.
Another shuffle-gasp-pause trip down the hallway and stairs, back into the waiting arms of the wheelchair, and back to the ramp where it took all 3 women pushing to elevate my big carcass, and back to the exam room.
The doctor announces that my EKG is normal, and that my X-Rays are normal, both of which I could have told him. We ask what is wrong with me and he says that I "caught a cold in the muscles in my ribs". He prescribes a sedative, a heating rub that winds up being much like Ben Gay, acetaminophen (Tylenol), a potassium supplement, and another, unfamiliar painkiller. We repeatedly asked him for a muscle relaxant, but there was a clear communication disconnect.
We were told that we had to leave because the hospital was closing for the night (!!!), and Zola had to attend to another translating job, so we shuffled/gasped/paused out to the front door, and grabbed a cab for home. Zina guided me back to our 4th floor apartment, complete with the frequent requisite stops. I immediately took two of the five remaining Norflex tablets, a muscle relaxant that I had left over from our rear-end accident just a month and a half ago. Zina helped me into my polar fleece and tucked me into our bed, wrapping me up in as many blankets as we possess. She then went to the market and bought four 1.5 liter bottles of water, and to the Russian pharmacy. We call it Russian even though the woman that runs it is Mongolian, she studied in Russia and speaks fluent Russian. Zina managed to communicate the need for a muscle relaxant and returned home triumphantly with the goods.
By that time, the Norflex had kicked in and I was actually resting comfortably. I can say completely honestly that it felt like I'd been beaten up with a baseball bat, and I was still really cold, but at least I could breath. I dozed on and off for a couple of hours, and Zina made a bowl of soup for me, which I managed to eat in the kitchen, the unpleasantness apparently safely past.
This was a hugely terrifying yet educational experience. First off, I learned that I never again want to set foot voluntarily into a Mongolian hospital. My new criteria are bones sticking out of my skin, excessive amounts of blood coming from orifices, or severed limbs. For the last example, I might instead chose to lash a wire tightly around the stump to stop the bleeding, dip it in wax and jump a flight to Honk Kong.
The other thing I learned -- actually it is something that I keep learning over and over in most painful fashion -- is to listen to the messages my body sends to me. I habitually disregard how my body is feeling and in a bizarre, illogical, macho display, "play over the pain" to use a sports cliche. Had I simply said "No, I'd prefer to stay home today" rather than obeying my intellectual and emotional desire to be a good mate and accompany Zina on our errands, the cramp would probably have passed without incident, and if not, I would have been within easy reach of the muscle relaxants.
Perhaps another lesson is the dangers involved in following advice meant for other people. My father suffered from high blood pressure and high cholesterol, and was prescribed a low-sodium, low fat diet to compensate. I grew up eating margarine and meals cooked without salt. To this day, I can't stand Campbells soup and find the seasoning at Outback Steakhouse overwhelmingly salty. Zina just read in a travel medicine guide that salt deprivation can cause headaches and severe cramping. Wouldn't it be ironic to discover that the advice that prolonged my father's life actually endangers mine? And, even more bitterly ironic may be the fact that for most of my adult life, I've been criticized by my more health-conscious friends and family for my copious thirst for Coca Cola. In general, I've tried to reduce my consumption for weight reasons, and since arriving in Mongolia, have all but curtailed my Coke intake. My current and possibly flawed hypothesis is that my body learned to crave Coke for its sodium content, not exclusively for the caffeine and sugar as I had previously thought.
This experience is feels like the closest I've ever come to taking the big dirt nap. I've done some pretty dangerous things with my body and sometimes paid a price, but they've all felt like merely painful inconveniences. This was different: it was something that occurred on it's own and was almost entirely out of my control. I now know what people mean when they say the world gets all gray and fuzzy at the edges.NOTICE: all contents copyright Alan Lapp 2002