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.