Continuing Through

Can you believe it is already the end of November? Thanksgiving has come and gone (though not too far past yet), and I am just now pausing for the slightest of breaths before plowing full speed into the three weeks of cardiopulmonary before Christmas. It has been a whirlwind, that is for certain. In four months, we have completed four science modules and two doctoring courses. We have learned what happens in the first five weeks of development, the intricate insanity of what our cells are doing right now to keep us in energy, how our genes define our phyisicality, and the name of the muscles that flex our big toes. We have also learned to take social histories and what being a physician really means. I don't think I have ever studied so much in my life. Sundays before the exam have become twelve-hour marathons in the library complete with microwavable soups and three cups of tea. I've even started to like coffee (provided, of course, that it is at least half milk...). There is always that thought for a balance, but learning how to find it and then maintain it is something that is continually in progress. Thus far, I think I've done ok. And I am blessed to have marvelous friends who will make sure I do anyway. :)

Inspired by a fellow medical student and Fulbrighter from Vanderbilt, I will share with you some of the beautiful things that keep me going. On Sundays (provided of course they are not the Sunday prior to a Monday exam), I get together with a group of friends, some of whom are medical students and some of whom are not, and we share dinner. Someone cooks, I often bake, and we just enjoy it--and my friend Allie reprimands us if we talk about school too much. On Wednesdays, I am a part of a small Bible study, with people from all classes. We have dinner, sing, and just give an hour to focus on God, and that is simply lovely. It's an oasis, no matter the week. Saturdays, I volunteer at a place that is essentially an inpatient facility, taking on homeless patients that are in need of consistent medical care (and also provides them spiritual direction and substance abuse counseling). Working there allows me to leave the Georgetown bubble, to get out in the world and feel like I am being slightly of use. I have been there four or five weeks now, and a lot of the men know me now. It is beautiful to catch their smiles. Some talk to me, share bits of their stories, and I admire them all. One has no teeth and consistently makes me smile. Another looked at me and told me over and over how as a doctor, I will be making life or death decisions for my patients, and then he paused, and said "but I think you'll be good at it." And still yet another, a younger gentleman, makes me happy because he reminds me of four or five patients from Trinidad who I love dearly. If thinking of Trinidad isn't enough to consistently remind me why I am doing this, these men certainly are.

It's a privilege to be here. Some nights, as I walk home amid the trees glowing colored in the street lights, up to my tenth-floor apartment with a view of the National Cathedral, I am simply in awe. I can't believe that I live in Washington, DC, in this beautiful area, and I can't believe that in three and a half years, I will be a doctor. Sometimes it seems I need to wake up from this dream. It's really amazing. I know this is where I am supposed to be, and I am doing what I need to. While interviewing a patient with a friend for a class, the patient he interviewed told us "when I get sick, I put myself in God's hands, and He puts me in yours" (as doctors). I am humbled, and if that doesn't make medicine a calling, I don't know what does.

An Afternoon in the Life...

My desk/cubby space looks such like the typical med student's. On the shelf, my binder with a month's worth of MNE (metabolism, nutrition, and endocrine) module notes, a used pen, a Starbucks cup (no, I still don't like coffee, however I will drink a mocha on weeks like this where my body simply decides it doesn't want to sleep), and my ID (so I don't forget it if I leave the library, locked on a Saturday). My desk has colored pens in a pile, my Life is Good Nalgene, papers with lists and charts (in color), reactions (also in color), bullet points. My laptop blasts classical music while displaying slides on the urea cycle. My backpack on the chair next to me has a sweatshirt draped over it (the library is as fickle as New England in mid spring, temperature-wise), notebooks filling it, and a pocket of snacks to keep me fed and sufficiently distracted. My bare feet are tucked under me as the sound of typing fills the air....

Such is the weekend before an M1 exam, filled with mild to moderate tension (sometimes more), friends a text away in a pinch, in those moments of "Wait, what?" Otherwise, silence reigns and even a ringing phone conjures dirty looks (though the student snoring on the couch only garnered soft chuckles and a bit of envy).

It's intense. I knew that coming in. I love it, love the science, love the students and the intellectual stimulation and shared passions, the moments of patient contact. I hate it, the hours in the library, the guilt when you spend an afternoon talking about the universe (quite literally) rather than studying. But ultimately, the end is worth it. This is where I am supposed to be.

People keep telling me when you put the white coat on, people's view of you changes. You know what--they're right. I wore my coat this morning for the first time in a non-PPC setting, introduced myself as "Hi, I'm Nichole, I'm a med student here, how are you?" before taking their blood for a prostate cancer screening and making conversation in the way PPC teaches us, though without the nerves, the effort, the staging, the observation. This is the first of many times when it's you and a patient. Sometimes you come bearing a needle, sometimes a chart, sometimes simply yourself. But it's the beginning, when people start to look to you as the one who knows. Sometimes I step back and wonder if this is real. Am I really a medical student, three and three quarters years and more modules and rotations than I want to consider away from becoming a doctor? Do I really have an apartment with a view of the cathedral in the heart of an upscale DC neighborhood (just down the road from Whole Foods, where I can buy broccoli sprouts, which have tumor suppressing properties, and steel cut oats, which are lower glycemic index, thank you nutrition class)? It is surreal, but yes, this is my life. Even if I pay my rent in loans and wear a short student's white coat, yes, this is real. I'm on my way! :)

From Trinidad to DC

Sorry for a long absence! My last weeks in Trinidad got progressively busier, with a lot of patients in the hospital and finally becoming comfortable enough with the country and making good enough friends that I spent much of my free time away from my apartment. And of course, once I got back to the US, the whirlwind began, and was immediately followed by this thing called med school that seems to have taken over my life :)

My last weeks in Trinidad were some of my most amazing and my most challenging. Clinic-wise, we had a week where every day there were ten patients in the ward, and most of them were very ill, were dying. The following week was filled with new patients (I think one day, there were six, ranging in age from 24 to 50) and carefully coordinated visiting (I do not visit new patients during visiting hours unless they never have visitors for the twofold reason of wanting the patient to be able to talk to me about HIV and ask me any questions without worrying about in front of whom they are speaking and also to prevent either of us from having to explain how I, clearly a foreigner, know the patient). The final new patient I worked with in my final days was 77 years old. Truly, HIV can affect anyone. I experienced miracles in my last weeks too, one big, many small. I learned about love, what love really is and its incredible power.

Outside of the hospital, I went on a cayman tour with fellow Fulbrighter Sam, and we saw caymans (sort of like crocodiles in appearance), watched Port-of-Spain from the ocean, and saw some brilliantly watermelon-colored scarlet ibises in flight. The last weeks were filled with rainbows, brilliant ones, ones that caught me off guard as I made breakfast, rainbows that glowed with the sunset. I also saw a wonderful production of Aida!

My last week was filled with roti and farewells. The clinic staff threw me a party I will never forget, where we shared stories of how we impacted one another, and I learned how to whyne (I learned how to palance while I was in Tobago). SAS threw me a party as well, as did the young adults at church, and I could not have been more at peace to see so many people and to know that I had made an impact, and also to have a chance to say how much these beautiful people had impacted me. I spent time with my good friends. My last day was perfect, with goodbyes at the clinic, the ability to see patients in the morning (and take lots of bloods), then an afternoon going for a drive, talking and enjoying sahina with Vidya, world-record time packing (45 minutes to take the stuff from the floor of the living room and deposit it in suitcases...thanks to Vidya for her company and encouragement, and to Kiba and Marsha for bring my overflow stuff to the US for me), Bible class and goodbyes to the my home congregation of San Fernando, followed by dinner with two of my favorite people who just brought me so much peace and calm. I had a rainbow when I flew out the next morning, and lots of texts to send when I got home.

Needless to say, I miss Trinidad a lot right now. I miss the country and the food (I crave roti at times and would be so, so happy to find an Indian grocery in DC), the ocean every day, the spot downpours, but most of all, I miss the people. I miss the clinic work, the patients, the staff, all of my beautiful friends. I learned so much though; from technical skills (like phlebotomy) and how to be a doctor (I realize my physician-patient communication class tells us how to deal with difficult patients, to break bad news, and to talk about sex and I've already done all of that). More importantly though, they have given me a concrete affirmation as to the doctor I aspire to be and have filled me, reminded me why I want to do medicine with all my heart. If ever I have a bad day, I just need to remember one of the many patients who encouraged me, wished me the best, told me I made a difference.

I had six days in NH when I came home before flying to DC. It was certainly whirlwind of seeing family and friends, packing, cooking. I set more world records in packing, getting all my stuff for DC in 6 bags under 50lb in 90 minutes. I got to see my friend Kate before she flew to Ireland for her own life-changing experience. I got to see my aunts and uncles and cousins, my cousin's 7-year-old miracle daughter who I love more than I thought I could love a child. I got to see my beautiful 90-year-old grandmother which is always a gift.

And now I am in DC, have been here more than four weeks. I have a lovely 10th flood efficiency with a view of the National Cathedral. I'm four weeks and one module into medical school. It is, of course, the most intense academic experience of my life, but I knew that. Having Trinidad and Cambodia behind me, I know with certainty that I need to be here and this a necessary step in living my dream. The white coat ceremony at the beginning of the school year was incredible, just to stand together and say the Hippocratic Oath, to wear the coat and know I was that much closer to living a dream (as cliche as that is, I know). My fellow students are wonderful and bring with them a variety of passions and experiences that are teaching me, and I appreciate the friends I have made already and the camaraderie that is the library the night before an exam. Here's to hoping for the best.

I do promise to write from time to time, so you all know I am alive and well :) God bless you all, much love, and thanks for listening :)

The Beauty of the Rain

Time is flying here, as I never believe possible. Exactly one month from today, I make my way back to the US, for six days with my family and friends in NH, then a few days to catch my breath in DC before beginning orientation at Georgetown on Aug 3. I wonder where it all went? In some ways, I feel like I have not been here long enough. I feel now like I finally know most of the patients by name and am really starting to know them personally and they me. And yet at the same time, I feel like I have been here forever. The streets of San Fernando, once so disorienting, have become seemingly as familiar as those I grew up on, and I can navigate the twists and turns of my apartment in the dark.

We have slipped from the driest and hottest dry season on record (go figure, and I don't like heat) to one of the wettest months of June. It rains nearly every day, but I can't mind. For the most part, it keeps the air cooler, makes the nights downright cold when I use my air conditioner at night (which I love; something about wrapping up...) and I even made hot tea Sunday, when I came back from SAS's Father's Day brunch damp and chilly. Sometimes I wake up at 4 in the morning to the sound of rain falling hard, and sometimes when I wake up at 6:30 for work, the cars outside are beaded with droplets and puddles are just beginning to recede. I am lucky; most mornings when I am walking to wait for a taxi, it's dry. It may pour again once I reach the clinic, but I remain dry. Clouds here pass in spot downpours, sometimes harder than any rain I've seen, yet within a half an hour, the ground is nearly dry again. And the rainbows here....they stretch in complete arcs in reds, indigos more vibrant than I have ever seen. If I am really lucky and it rains in late evening, sometimes a cloud will pass with a fragment of rainbow opposite the sky exploding in pinks and deeper watermelons.

The beauty in this world comes in the most unexpected of places and, as I tried to convince my friend one night via text, in the details. In the rare sunset rainbows. In the white flowers that I can't stop staring at, in the ocean with dark clouds creeping by. In the view of PetroTrin, with all its lights and flames, right next to the sea that could swallow it whole if global warming keeps up. It is certainly a patient in the ward, who defaults clinic and was recently in prison and for all intents and purposes, would be someone I'd keep away from in the streets taking my hand in greeting every day and conversing with me quietly for as long as I have time for (I guess impressions are deceiving, yes?). It is in the moment last week, amidst the chaos of 30 patients, when someone told me how I was always smiling and I realized in an overwhelming sense just what my work here means. It is being curled up in Vidya's easy chair, watching Indian dramas with her and talking. In seeing the San Fernando Hill from kilometers away on the highway and knowing I am almost home.

Living a Piece of History

Monday marked election day in Trinidad. The day of the decision, where everyone by the end of they day would have their fingers dipped pink, a sure sign they voted. Based on proportions of advertising and listening to my friends talk, I thought the outcome would be clear--the incumbent PNM and Patrick Manning would remain in power. Though I enjoyed watching the country prepare, I wasn't sorry to say goodbye to the trucks passing by the hospital at the tail end of visiting hours, blaring "We voting PNM" at the top of their lungs, to the point where you can't hear the person in the bed next to you. Or the UNC truck parked outside my apartment last week, shouting "Who we voting? Carolyn. Who we supporting Kamla" to the point where the glasses in the cabinet were rattling.

Monday night, I was alternating between reading and writing when Vidya called me--did I want to go to Couva, to UNC headquarters? Though I was tired, I wasn't about to pass up an opportunity to see something unique and to possibly see history being made. We arrived, and finagled our way upstairs (though we weren't technically supposed to be there; once we were there, we were fine though...being foreign helped me, and Vidya has lots of connections), where results were coming in and every time the People's Partnership (UNC, COP, and a few others) won a seat, a green check mark was placed on the board to much cheering and shouting. I don't think the energy in the room could have been better. The partnership was doing surprisingly (to me) well, and kept gaining ground. When we got the swing seat of Tobago West, the room just erupted; people screaming and cheering and smiling, blowing into plastic horns and jumping up and down. The energy was contagious. I couldn't help being excited too. About an hour or two into the night, they announced that Manning had conceded; Kamla would be the next prime minister and the Partnership had won. It was a moment of history. Kamla was the "Change Candidate," like Obama, and the first woman prime minister--and she ended up winning by a landslide, the Partnership taking something like 29 or 31 of the country's seats. (Or maybe UNC alone took that many seats...can't remember.) It was a privilege, to be in the US to elect the first black President, and then to witness the announcement of the first woman prime minister in Trinidad. I wish I could explain the excitement in the room, all these people upstairs, many many many more downstairs, celebrating victory. The rest of the night passed with candidates and victors passing through to a cavalcade of cheers; Kamla's name was like a magic word--each time it was uttered, the joy became even more powerful, the screams louder. We of course missed Kamla--she didn't actually come upstairs, unfortunately. But as we left, just standing amid 100,000+ people gathered to celebrate, watching fireworks explode and the 3/4 moon rise, wow, just to be a part of that was incredible. Worth getting home at 3am for, absolutely. (I will say though, that the young woman waiting for a taxi with me one night was right on--election day is like Carnival...free food and drink, people coming in at 2am, an all-night party. Leaving though, despite the incredible traffic, reminded me why I love this country--cars going and coming would pause and talk on the street, passers by were helping cars back up without hitting anything, people called out excitedly to strangers...)

A week and a half ago, I traveled to the Performing Arts Center in Port of Spain (which cost more money than many citizens wanted to spend, has a hotel in it, and looks very much like the Sydney Opera House, though it illuminates very nicely at night) to see a steel pan show--Genesis in Steel, featuring the National Steel Symphony Orchestra. Steel Symphony Orchestra? You bet, and it sounds more orchestral than you would believe. I am almost always fascinated by steel pan music as a whole; I can't quite fathom how it makes the sounds it does, which are lighter and more elegant than you'd expect. Given that, the Genesis performance simply blew me away. Though the program did include Calypso (and Latin and Broadway), the entire first act was classical--Bach, Candide, Tchaikovsky, all that. (And Handel's Hallelujah Chorus, which gave me chills.) And wow. Just wow. I don't think I could describe it if I tried, but it just knocked my socks off. You could hear the strings and the brass within the steel pan. It was unlike anything I'd seen. I am only sorry I became aware of them just now, as I am getting ready to leave the country.

Trinidad At Election Time

About a month ago, the security in the clinic came down to where Sister Lewis and I were talking about the daily nursing report and preparing to leave--"Did you hear? Manning dissolved Parliament!" For those that don't know, as I didn't, the Trini Prime Minister can serve up to five years at a time, but he also has the power to choose when the election will occur--usually by dissolving Parliament (if that occurs, then an election date will be set in the very near future). In this case, Trini Prime Minister Patrick Manning dissolved Parliament just before they could give him a no-confidence vote (my sense is that is something like an impeachment, but I could be wrong there). And so we have elections May 24. I am excited for many reasons--even though I hate politics. I am curious to see how this thing plays out, what techniques candidates use--and I am learning how the political system in Trinidad is set up.

It works like this--there are two main political parties in Trinidad, the People's National Movement (PNM) and the United National Congress (UNC, in alliance now with the Congress of the People, or COP). Historically (and in reality, for the most part), the PNM is the black vote, and the UNC is the Indian vote. Trinidad is broken up into constituencies that are slightly larger than a single town, or are half a city like San Fernando. Both the PNM and UNC put a candidate up for Parliament in that constituency, and the people choose. The party that has the majority has control, and the Prime Minister is the party's leader. In the case of the PNM, it's Patrick Manning (though if the PNM wins but he loses his seat, someone else will take over the role of PM), and UNC is Kamla. It should be close. Listening to the PNM, Kamla is unprepared, and is not running a smart campaign. I just can't fathom Manning winning, if his Parliament nearly voted no confidence in him. I asked Mr. Beepath, a PNM supporter, about health care and he gave a bad but politically correct answer. The conversation after the SAS PR committee meeting yesterday reminded me so much of certain discussions I used to have at Marist....

So what's it like to be here during a political time? It's exciting. The undercurrents in the air are exciting. People are constantly talking, signs are posted everywhere, parties trash-talk each other constantly. I witnessed the fringes of a PNM rally last week (causing it to take an hour for me to get a La Romaine taxi to take me home), and walked through the beginning of a UNC rally on my way to church the next day. Hoards of people in the proper colors turned out, and the voices could be heard from quite a circumference. In the early morning, workers were out powerwashing the confetti on the Promenade down the drains. Music is the preferred medium for paid political announcements--and honestly, I find it works much better than the dull bashing of the other candidate or making empty promises of US ads. I heard the PNM song (soca--can you just imagine replacing Patrick Manning...my only concern is what if the answer is yes?) five times in an hour one day, and it ran through my head for the rest of the day. UNC has a few songs too--one talking about change, and another saying how Manning must go. Secretly (though don't tell Mr. Beepath), I am rooting for the UNC. In part because I could be witnessing history. After being in the US and electing the change candidate and first black President Obama, I'd love to be in Trinidad where the change candidate and first woman Prime Minister Kamla is elected.

I apologize for my continued long silence--now internet is even scarce, never mind time. My parents came up shortly after my last post--had a lovely visit, and loved the Tobago beaches (kudos to my dad, for driving the narrow, winding Tobago roads on the wrong side of the road!). Pirate's Bay, just a bit away from Speyside, is one of my most favorite beaches ever, with it's calm aquamarine water and palm trees and overhanging mangoes. In Trinidad, I am loving my work, loving my patients dearly. I had a wonderful time with a few from New Horizons, a place for socially displaced persons to get back on their feet, today--they always make me laugh. Last week, I was a part of a small miracle where a woman who was homeless and in the words of a nurse "liked living on the streets" finally wanted to get help--and everything went right so that she could. I still struggle with the balance between caring enough and caring too much, but I am getting there. We've now lost eight patients that I have worked with (I think actually nine now), but I am learning, and I am grateful. I leave Trinidad July 22. I will miss the people here more than anything. That's how it always is--I miss the people moreso than the place. The only place I miss is DC, so I will be happy to be spending the next four years of my life there. (By the way, if anyone knows anyone wealthy who wants to put me through medical school, I promise I will work anywhere in the world they'd like me to for four years after residency...I just signed my loan paperwork and the amount of money I will be borrowing is terrifying).

Be well, all of you, and God bless and keep you.

Catching Up

As my friend and fellow Fulbrighter Reina said, what happened to March? I really should apologize for my relative silence throughout the month. Typical of me, I took the first few months of my grant "easy" (which most would interpret as a normal level of busy), and around February, suddenly shifted into busy. I work in the clinic until 4, have taken to visiting clinic patients (and anyone else I know or come to know) in the wards after, not to mention sitting in on client support meetings at SAS on Mondays, attending Bible Class on Wednesdays, and singing group on Fridays (I have been told that before I leave, I will be able to sing on pitch and recognize when I'm off...well, Luke and Kenneth have their work cut out for them!). I rarely get home before seven in the evenings, and by that time, I am pretty much cooked. Not to mention that one of the ward patients is very difficult, demanding a lot of energy. Of course though--I am happy. I love my work, love the people I spend my days with. I feel so blessed.

When I last wrote, I was sitting on a hotel bed in Port of Spain, awaiting the arrival of Fulbrighters from Barbados, the Dominican Republic, Dominica, and Jamaica for the annual Enrichment Seminar. From the time they arrived and joined us Trini Fulbrighters (and program director Cara) at the dinner table, it was hard to believe we hardly knew one another. It was invigorating and energizing to be around so many brilliant, passionate individuals who are having an experience similar to yours. I learned so much from them, about Dominican deportees, slavery in the Eastern hemisphere, TB in the DR... Interestingly, five of us were doing work on HIV (that discussion was amazing!) and four of us (all female) will be going to medical school next year. Outside of the amazing interactions, we also had the chance to go out and do things. We toured the controversial performing arts center, with a design like the Sydney Opera House, and a restaurant and hotel inside. We traveled up to Matura to see the turtles, and were blessed to watch the entire process with one leatherback (with my hand on her chest...you can touch them while they're laying because they go into a trance (wouldn't it be nice if we could do that during childbirth too?)...I could feel her breathing; it was beautiful). Watching her and talking to our guide, it seemed as though animal behavior was coming alive. And what could be more perfect than strolling along the beach at night, while the ocean waves crashed just beside you and jellyfish popped under your feet? We also heard some Calypsonians play at a club...a few were old and classic (one wore a purple sparkly suit), and a few were younger. All seemed to love this group of Americans sitting in the front, and many catered to us, bringing a few on stage or singing tunes to which we could sing along.

Interestingly, as amazing a time as I had in Port of Spain, I missed South, and I felt very disconnected from my day-to-day life. It wasn't a bad thing--I needed the break and would never have traded the experience--but it was strange. Yesterday was Easter Sunday. A year ago, I was flying back from New Orleans with Dr. Ingalls, and I found out about the Fulbright. Yesterday was also my birthday--a year before on which I was struggling through CS/IS in the Donnelly lab where I spent more time than in N4, it feels, until my wonderful housemates rescued me and took me to dinner. Yesterday, my Trini family made me feel special. After church, Dominic, Annie, and Paul, along with an American couple who've been here a year, took me to Pizza Hut (the pizza is mostly the same, except they always offer the option to add pineapple, and it's standard to serve the pizza with pepper sauce and ketchup). They also delighted in watching me turn red as they sang. It was a lovely day. It made me feel so blessed to have the wonderful friends and family I do, both in Trinidad and in the US (and in Cambodia, for that matter). This world is a large and dynamic place, but I know no matter where I go, I will always have a home.

Challenges and Beauty

In the past two weeks, we've lost three patients on the ward and one at home, none of whom were more than 50. It's a crazy thing, when mortality strikes you in the face. Even when you're not suffering from AIDS or any other terminal illness, it reminds you how precious each and every moment is. Every day is a gift from God, and as my friend says, we need to praise Him for it every second. Let nothing remain unsaid or undone. Live each moment as if it could be your last, with no regrets. It's how I've always tried to live, but in these past few weeks, the importance of it is becoming ever stronger.

He was going crazy. Literally, I mean. I thought I saw it almost a week before he died, but I wasn't sure. He had told me he was a pastry chef, so though the conviction in his face made me a little skeptical, I thought his comments about getting flour and making me pastries were a combination of a joke and something he wanted to do for me once he got out and got back on his feet. But then he kept talking about it the next day, telling me how he needed help to get up, needed to find a tent, asking me to buy him flour. I mentioned it to the doctor in passing, and he mentioned toxoplasmosis or something, didn't seem too concerned. After all, this man had always been troublesome. He yelled, complained, moaned, sometimes disrespected others. He demanded. Who was to really pay attention; he cried wolf so often. But there were days he would remain covered in vomit. He was moved to the back, to "isolation," where his only companion confided to me in hushed tones "We're here because they don't like us." No real sheets, no pillow. I had to cover him with some of the clothes I had brought him. He spoke fragments of the Lord's Prayer and 23rd Psalm, and I filled in the gaps. On his last day, he made no sense. He had thrown things, and the floor around him was littered in urine and who knows what else. He told me he had seen me; I was dressed in white. He saved my life, and saved the hospital. Ok, I told him, I'm glad you did. The next day, I asked where he was and the nurse said matter-of-factly "in the mortuary." What?! My gut had said he wouldn't make it out, but I didn't expect it to be quite so quick. I knew at one point he had been discharged five days, and no one had come for him. I wondered if anyone would claim his body, or mourn for him at all. Pray for him with me.

On the upside, besides being ridiculously hot, the country is amazing. I feel I have become so close to so many people. I study with Dominic, spend hours chatting with Vidya in the evenings. I feel at home.

Saturday, I had my first exposure to Tobago, the sister island that is, ironically, farther away than Venezuela. People have been asking me since my second week in Trinidad if I had been to Tobago yet, and now, six months later (can you believe it's been that long?!), I can finally say yes. Everyone talks of how beautiful it is, and no one lied. It is a relaxed tropical paradise. The flight is a slightly bumpy 15 minutes at most. It takes no more than five minutes for the bags to appear on the baggage carousel from the cargo hold. Palm trees, white sand, glittering aquamarine sea. I went with my friend and fellow Fulbrighter Sam, and we met another friend and program director, Cara, there. Although we had no more than 24 hours, we made the most of it. We dropped our bags in our room (costing approximately $16US/person) and headed for the beach. Everyone had told Sam and I we had to try crab and dumplings, so we did. We didn't expect the crab to still be in shell, however. But after an hour's worth of effort and more than one green spot on our clothing, we managed to finish. Topped off with fresh grapefruit juice and coconut cherry ice cream, and I think we are near perfection. We weren't planning on renting chairs, but in keeping with the "it's nice to be nice" posted on the back, a couple of gentlemen rented chairs for us (this is when it pays to be a group of young American females). We spent the day bathing in the clear water and relaxing, reading. We took a sunset cruise, which neared perfection. Dancing, nylon pool (shallow sandbar in the middle of the ocean), sunset fading to dusk and stars coming out, palm trees becoming silhouettes....amazing. One of my favorite moments here so far. Even leaving at 10:30 the next morning (the latest flight I could get, booking three days prior), we managed to soak up a little more Tobago, having breakfast in the midst of a tropical garden, a mango tree just feet from the table (too bad it isn't mango season!). It's a lovely island, and I look forward to going back with my parents in April, and again after that.

What You Wanted to Know About Trinidad

I realize the last few posts have been a bit heavy, courtesy I guess of the reality of working with HIV. I'll try to keep it lighter here, have a little fun letting you know little bits of life in Trinidad.

It's too hot. Believe it or not, I actually miss the snow. All week, it's been hot and oppressively humid, on the cusp of rain but the rain never fell. Actually, there's a water shortage now because it's the dry season and we get so little rain. (I always wondered how much of a difference there would be, but it's stark--in the rainy season, it rained at least five minutes in every day; during the dry season, if we get one day of rain every three weeks, we're blessed.) I don't so much worry about it, because I live in a very well-off area, but a family that invites me for lunch after church Sundays will be without water for the weekend, at camp we had to take bucket showers to conserve water, and the clinic water comes and goes.

Sahina is my favorite Trini food. Everyone is surprised it's not doubles (channa, or curry chickpeas, with pepper sauce or sweet sauce in a thin fried bread), but if you're me, can you really surpass fried leafy green vegetables? Roti is also popular. In the mornings, sada roti is popular, which is kind of like a thick pita. Buss up shut is lunch time, a much thinner fried bread. I've gotten it twice in the last two weeks with channa and curry potatoes at Mom's Diner (run by a family I know from church) on High Street. "Mom" said she'd teach me to make curry and roti as well, so I can make it for all my friends in my spare time in the States. I made saltfish successfully for the first time today--perhaps you remember the fiasco that was the saltfish at Thanksgiving? Well, this time I was sure to rinse it, soak it, and boil it and it worked! I was proud :) I think it's grapefruit season here, and I think I could do a grapefruit diet for a couple of weeks, that's how good they are. I bought six on Thursday, and they make me happy. Today, on my way home from the hospital, I bought a semicircle of coconut bake and a cassava pone (kind of a tart thing...hard to describe), okra, cabbage, bananas, and a plantain for about $6US. Amazing, isn't it? Things that I am surprised to find I like: oysters (well, I think I like them!), okra, cabbage, cassava root, pepper sauce (slight!).

If I look out the window of my apartment, I can see fragments of the sunset, and it fills my kitchen/dining area with a lovely orange or watermelon-colored light if I time it right. In the evenings in the first quarter of the moon, I can also see the moon-sliver setting. On Wednesdays when I get up early, my bedroom is filled with a soft, muted light from the sunrise.

My perfect moment today occurred on my walk. I stood halfway down a hill, with the sun setting to my right behind a stand of silhouetted palms and a tower of clouds. Just to my left, the nearly full moon was rising large over a classic scene. Coconut palms heavy with fruit. Trini houses of vibrant colors, including violet, sea foam green, cream, and orange and teal. A slight breeze blew my hair behind me. In front of me, the road, with its potholes and softening pavement.

My favorite time of day here and everywhere is twilight with its silences. I can see the Atlantic from the back of the clinic, and every day it makes me smile. Sometimes, I can see the refinery in the distance, and the lines of oil rigs out if it's a busy week. The country here is filled with old sugar cane fields and wide open spaces. The people come in all colors and sizes, and they laugh easily. KFC serves fish during Lent. Driving and walking both take a mix of aggression, insanity, and careful precision. Everyone greets everyone else with a "Good Morning" or "Good Evening." Taxi drivers like finding ways to help the foreigner find a La Romaine car so I can get home. Stands sell pirated movies for very low prices, but you have to be sure of the quality. This morning, as I walked to the hospital to visit my patients, I couldn't help but feel the city itself was in motion.

Halfway Through

Today is, by Fulbright's standards (they started my grant on September 21st rather than the 18th, when I landed here), the exact halfway point on my journey in Trinidad. I am reminded of Ursula LeGuin's quote given to me by my friend Susie, trail name Hammock Hanger, when I met her just before lyme disease stifled her second attempt at thru-hiking. "It's good to have an end to journey toward, but in the end, it's the journey that matters." Here, the end is medical school, Georgetown, beginning August 3 with orientation. I am excited to go, excited to finally do what I believe I am called to in the world, but the journey through Trinidad to get there really is what will shape me, what will matter.

How has Trinidad already changed me? The list could be endless. I feel I have grown up here. I have moved from being an idealistic college student bent on saving the world to an idealistic adult (Naomi Shihab Nye did say if there were no idealists in the world, nothing good would ever happen!) who is realizing she can't actually save the world at all, but will still try with all she's got and let the ripples go.

I have learned to find my way completely on my own, and more than that, I have come to realize how much we need one another. For as much as I love my space and independence, I would have been lost here had Stanley not taken me around my first week, helped me get a phone, shown me how to catch a taxi. I would be terribly lonely without people like Dominic and Annie, Kenneth and Denise, the families at church who have offered their love, Vidya and her children. They as well as the clinic patients are making my experience what it is. I have learned about suffering and about strength, for I see both in patients every day. I am learning about AIDS and its harsh reality. I have learned I like things like callaloo and roti and channa and curry. I can eat raw oysters and even kind of like them. My least favorite dish is macaroni pie, which is the most American of them all.

I also continue to learn how God appears in the most minute details. The sunsets' brilliant oranges and pinks from my window. The ocean every morning as I traipse sweatily down the Promenade en route to the clinic. The flowers. A smile from a stranger, a text from a friend, a breeze.

I have started my research (finally!) and am excited to see where it takes me. I look forward to seeing what relationships grow stronger, what new ones are formed. What new challenges come to face me, what new blessings find ways of lifting me. I want to learn how to cook Trini food. I want to let something really open me and for something beautiful to fill me. I want a tan. More than anything, I want to continue to grow.

The Reality of AIDS

When patients come into the clinic for testing, I like to ask them what they know about HIV. If they realize HIV and AIDS are not the same thing (for those interested, HIV is the virus, which can stay in your system quietly for a long time, and AIDS is, last I looked, defined as a syndrome occurring after you have two or more opportunistic infections). I tell them that at least 75% of the patients in the clinic have HIV, but do not have AIDS. Sure, a few of them present with thrush, or pneumonia, or candidia, or something like it. I am sure a few would qualify as having AIDS, but not so that you'd notice. AIDS the way I had read about it, from doctors working at the beginning of the epidemic, was never real to me. At least not until this week.

The first patient is one whose story I had been a part of since probably early December. I knew his wife first, because I had been there when she was admitted to the ward and visited her and fought for her while she was there. When they came in together after both were discharged, she was fighting for breath and stressed, and he had to be carried in. All he said to me was "I remember your voice." They came in three weeks ago too, and that was when I nearly burst into tears to see her smiling and he walking nearly on his own. And then last week, his wife came back, with symptoms mirroring a heart attack (if I didn't know her better...but I know that she manifests intense stress that way), half sobbing, a wild look in her eyes. Her husband was back in the ward, a lot worse off than she thought. After working for an hour to calm her down and convince her to take her tablets and try to eat something, I promised to visit him. Monday, he looked terrible. My unpracticed medical mind thought it could be a coma. He was completely unresponsive. I took his hand and got nothing. His eyes were closed. Nothing seemed to know I was there, and yet...it may have just been a twitch, but I feel like he knew my hand was missing when I took it away. Still, I was shaken--enough that I came back on my way in Tuesday, just to be sure he was still alive (I was encouraged--his eyes were open, though his cheeks still twitched and his jaw gyrated). The doctor thought toxoplasmosis, but I felt he had a stroke--even now he still cannot move half his body. Both are common in AIDS. By the end of the week, his eyes were open, his mouth had closed (though still revealing a few decaying teeth). He was trying to form words, but couldn't quite. When I took his hand though, he would hold it tight, reluctant to let it go. Like I and his family were his only lifelines into hope and the world.

The other patient came into clinic just after the blood rush ended on Wednesday. I was the first to see him and greet him, asking him in my usual cheerful way, "How are you?" His reply was "sick," and when I asked why, the first reason he gave was the virus, and then he described his chest pain and general malaise. He sat to wait for the doctor. He complained of his temples being sunk in. When I asked him when he last ate, he said three days ago, and when I rubbed his back later, I could feel every vertebral protrusion and every rib. Brenda in the clinic helped me find some food to give him, and we also gave him some juice, which he promptly and loudly threw up (making me fight my fear, which I did reasonably successfully). While he waited, he moaned loudly and wondered why he was being ignored (I wondered the same thing). Ultimately, he was admitted and his admission sheet read like a classic AIDS symptom list: night sweats, fever, thrush, etc. I worried about him, but when I saw him the next day, his spirits were good. He was eating, hopeful, making plans for the future and seemed determined to live. I think he was simply starved for human kindness as well as food, and being around people who cared made all the difference. He was discharged, and I have not seen him since. I hope and pray he makes good on his word.

These two men were the first two cases of full-blown AIDS that really jumped out at me. I was re-reading a memoir of an AIDS doctor, and seeing cases he described in patients at the clinic. I knew it was coming, and am grateful for the opportunity to see AIDS and to learn how to deal with it. I am still working on the dealing with it part, but I am praying a lot and so blessed to have some very good friends here.

I wish you blessings, and challenges, and beauty in the midst of it all. Thanks for listening :)

Every Day

Every day I see the ocean. It always gleams some shade of blue from the top of the hill on the Promenade. Oil rigs dot it, some days forming a line out to see, other days just one anchors near shore. At night, you can watch them light up like neighborhoods at Christmas. The rains come in over the sea. Grey, misty clouds that softly overtake you, and then they pass. If you are lucky, maybe a rainbow will pass overhead, fleeting in its breathtaking pause.

Every night, the white flowers whose names I have never known find a source of light. Street lamps, moonlight, stars, it does not matter. They capture it, and they glow as if the light came from within. Other flowers, fragile lavender blossoms, appear as if dying, only to tuck themselves into a bud to rest when eyes would be unable to appreciate them anyway. Four-inch-long caterpillars make quick work of some leaves, arching their backs and smiling back at me.

Every day, someone here makes me smile. Sometimes, it's a friend in a text, sometimes a patient. A hug, a little six year old following you, grinning back with missing front teeth, peering around a door, not crying but laughing when her skin is punctured by a needle. Someone who wants to know--who are you? What do you do? What do you know? And they listen, they want you to tell them. Someone who tells you--you must visit Tobago. Jump up for Carnival. Try doubles. Tell me again what it means to have HIV? Sometimes they cry, and all I can do is listen. Is give them a hug, promise them yes, you are strong enough. Just to choose to fight is strong enough. I promise.

Every night, the sun sets. Sometimes it floods the floors with brilliant yet soft oranges and pinks, sometimes the colors are stifled by a cloudbank, or lack of clouds, and only tiny colors and pale rays of light can escape. The dusk sets in and carries the hush that silences all. Even the traffic obeys. The stars begin to emerge, reminding you they never really disappeared in the first place. Without them, we would have no light.

Four Months

Today marks four months to the day that I have been in Trinidad. I've been working at the clinic for about two of those months, and finally do feel like a familair face to the patients who come in frequently. I can't believe the time has gone so quickly--I made an appointment for someone on Friday for June. Laughing, I told him I couldn't think that far into the future. I know I still have more than half my time left in Trinidad, but I can't help thinking how immanent the end is now feeling. Before going home for my "vacation," it felt as though my time stretched endlessly into the future. Now, it feels like it's all slipping away. I keep wishing time would slow down like it did my first two weeks in Cambodia, where each day stretched on and on and yet never felt slow, only luxurious, like lingering in a warm sun patch. (Maybe though, lighting a fire isn't a bad thing, considering I've yet to start my interviews, and I have med school orientation Aug 3.)

I am so blessed. Every day I walk in and see the ocean glittering in morning sun. Wednesdays, when I get up early for CD4 day in the clinic, I can watch fragments of the sunrise. Evenings, I watch it set from my window, watch the sky burst into color and then watch it fade into the silence of twilight. I came back to church, and so many told me they missed me in the short time I was gone, and in truth, I missed them as well. It's a comfort and joy to know I am so loved.

The little things make my day. Today, I saw a woman I kind of consider my "first patient," if only because I took care of her on a day she came in real sick and we admitted her, and I visited her each day she was in the ward, and she came to trust me (and I feel like I know more of her medical history than the doctors did at the time). She greeted me with a squeal and a huge hug, which we both needed. I almost burst into tears to see her husband, who a month ago had to be almost carried into the clinic by two people and promptly set in a wheelchair and who seemed out of it and yet told me he recognized my voice, walking with just her assistance and talking and smiling. The way he took my hand when I greeted him told me he remembered me. The two of them have gotten so much better; it was so lifting to see. On Friday, two women were talking about their experience and allowed me to listen. Today, I found a woman willing to let me write her story and bring a human face to HIV/AIDS. I wouldn't trade those moments for anything.

Being Home

I am at the tail end of my ten-day stint in the US, probably the only time my feet will touch US soil between the beginning and end of my grant (we are only given two weeks of "vacation" outside the country). To be totally honest, I wasn't sure how the trip would be, only because I am not even close to the same person I was when I left for Trinidad three and a half months ago. For the first time, I am really evolving totally independently of anyone I had known. Even at Marist, I still talked weekly to my parents, came home every few months. Coming to Trinidad, I knew no one. And I grew.

As it turned out, the vacation was lovely. My mom had taken the week off from work, my brother was home from school. We visited family. My 90-year-old grandmother played the harmonica for us at Christmas and made sure her blind friend felt at home and ate well. My (almost) seven-year-old cousin's little girl (cousin once removed?) greeted me with a huge hug and a question of "where have you been?" I got another tremendous hug from a surrogate grandmother, one of my dad's wonderful clients. I caught up with a few wonderful friends. For the first time in years, we spent New Years by ourselves, relaxing and watching Woody Allen. It was nice to be home, to spend time with my family, who I love more than anything.

One thing that this year has shown me is that I have a home in many places. At first, the question was--what do I do now? Where is home, then? And then I realized I really should just shut up and be grateful--finding a home and a family everywhere you go really is an incredible blessing. I am home in NH, where I grew up, where my neighbors have watched me grow up and my parents will always welcome me with love and open arms. I am home in NY, where Maria and Richard have adopted me into their family, and where I first started to grow up on my own (and where I have many good friends who helped me along the way). I am home in Cambodia, where I have nine older brothers and work that fulfills me. And I am home in Trinidad, a home I have made for myself by the grace of God, where I have friends who love me dearly and take care of me and an apartment I found on my own. And these things don't end when I leave. My parents, Maria, Dominic and Annie--they will always be there for me, no matter where in the world I am or who I become through those experiences. I don't know I could find a more powerful or important blessing anywhere, and to those who love me and who I love--you inspire me and give me strength daily.