Life on the Ship of Life

I really had missed the easy rhythms of life on the ship, the way the days in Cambodia both seem to stretch on endlessly and pass too quickly.

Knowing the poverty in Cambodia (and having learned much more about it last night from my friend Lieng, the night guard on the ship), it is an incredible privilege to be able to live on the ship, to have three meals a day (and the cook is vegetarian, so he always makes me vegetarian food! It's fantastic!), air conditioning, a bed (actually, I have two beds, but the upper bunk has become much like my apartment's kitchen table--covered in papers and things and completely unable to be used for it's intended purpose). It's a privilege to even be able to be here--both the patients who come on the ship and the crew who have already begun to feel again like brothers and uncles are beautiful beyond words. There is a simplicity among the people of Cambodia, their genuine smiles, the way a conversation or simply letting someone take my hand and marvel at my smooth, white skin can mean so much both to them and to me.

Days on the ship are much the same, and yet always different. We have breakfast at 7, and then by 7:30, many of the crew go out with the doctor to hand out numbers to the people who are lined up. Many come the night before, maybe at 3am, maybe at midnight even so they can be sure to get a number for the morning. Always, there are more people than there are numbers, though Dr. Tha, the full-time Khmer doctor on the ship, can see about 83 patients a day. Patients pass on and off the ship all day. Many seem to have nothing immediately wrong with them, but being able to see a physician for a chronic problem or simply to see a physician at all is a gift for them. One woman told me through Bunthoeun, the clinic assistant and often my informal translator, that she always wants to stay on the ship as long as possible. There is so much love on the ship. I watch it every day in the faces of the crew members and the way they interact with the patients. I love watching the ship's Captain or the pharmacist, Bun Roth, interact with the people. You can see the kindness in their eyes and their utter love for each person. All of the crew members are quick to pause a minute and joke with the patients. Even the cook, Sanh, who spends most of his time in the kitchen and rarely interacts with the patients, cares deeply for each of them. On Friday, we had a walk-in patient (who we rarely take, since Dr. Tha's days are always so full) who had liver cancer and in the absence of anyone who spoke proficient enough English to effectively translate for me, I asked Sanh to help. He ended up not needing to, but when he watched with concern and when he came back from the market, he asked after the patient. I think I may have said it last time I was here as well, but the Ship of Life crew are some of the best people I know--they have beautiful spirits, all of them.

My interactions outside of my interviews are relatively limited, given that though I am learning Khmer (I have an excellent teacher--I teach him English, he teaches me Khmer, and it works well for us both, and during the day, he will quiz me on the Khmer words and ask me the English ones), I still speak precious little and probably understand even less. Many patients tell me how beautiful my skin is, and Cambodia is the only place I have ever been where everyone tells me how beautiful my nose is--and often want to trade! (I am tempted to say yes....) They often ask me how old I am (among the only questions I understand in Khmer, and I can respond myself since I know the numbers in Khmer through 999), and inevitably will then ask me if I am married and ask why not? I am old for the villagers--many of them are married at 18 or younger and I am always a little astounded to hear from women in my interviews who are younger than me and have had three children, maybe a miscarriage. Between that and listening to Lieng last night, I know Cambodia is a completely different world than I am used to, but I do love it--the people here make the country a special, special place. Like with many of my patients last year in Trinidad, I wish everyone could see what I see when I look at Cambodia.

The last village we were in was filled with friendly children who loved my camera. My friend and translator for the week, Minea, and I, went out and played with them the last few mornings. Minea led the games and I joined the kids, with one little girl attached to each hand. Minea had taught them songs and we all sang "God is so Good" in English and Khmer--I cannot even begin to express how beautiful it was to witness that singing. I made friends with a 16-year-old who spoke decent English and spent half her time at the clinic with her blushing face hidden behind her clinic paper, giggling as she asked me questions and I responded. My favorite of the children was a little five-year-old with rotting front teeth and a daredevil streak (she climbed trees like a monkey), who sat on my lap while I interviewed her mother and always broke into a shy smile when she saw me. Minea had taught all the children my name, so yesterday as I moved about the ship, the children would all yell "Hello, Nicki!" (or some variation that sounded enough like Nicki)--from the riverbank, from trees, from the river near where the ferry docked. The village also had a lot of beautiful old women--the Khmer word for grandmother is vieille, or at least it sounds like that, which is the French word for old. I am delighted by them and they by me. I so love their smiles, always broad and bright, with one tooth, no teeth, blackened teeth, or full clear teeth. Some need help to move into the ship and up the stairs, while others move with an unexpected spryness for their age. Spunky, I will tell Bunthoeun as they come aboard.

Otherwise, the week was beautiful. It would storm every day sometime between 2 and 5 (though mercifully not yesterday as we moved the ship). The sky would darken, winds would come and cool the otherwise sticky air, and eventually, it would pour. Sometimes for a few minutes, sometimes for a few hours. There was such energy in the air! We are now at a new village, taking a breath for the day before beginning another week of clinic. It's a beautiful spot across from a pagoda, with some large trees and lights across the river that make the water iridescent at night.

I hope you all are well and wish you blessings in the coming week!

The Missing Suitcase and Other Stories: Week One

I'd forgotten how much I love Cambodia until my plane touched down, until I arrived at the boat 14 hours after that, until the first day of clinic when the Khmer patients flooded into the ship and I got to see their smiles again. Now, being back in Cambodia for just over a week, it feels almost as though I had never left. I have found my rhythms with the clinic, with my research, with the crew, with the country. I have three regular crew members to whom I teach English, and I inherit two more for the week next week. I had forgotten how much I love to teach English as well--forgotten the excitement of watching my students understand what a word or concept means, their smile when they get a pronunciation exactly right (believe me, there are words in English that are incredibly difficult for the Khmer to say, and Khmer sounds that it's hard for an English speaker to make), how proud I am of them when I know how much they want to practice. The entire crew is motivated to learn and practice English--it is fun for me, because I have the opportunity then to talk to all of them and learn their stories and learn about Cambodia--for instance, one was telling me how he started learning English under a porch because learning other languages was forbidden in his village until the 1990s.

I love the Khmer people because though I cannot understand them, they strike me as incredibly kind. The landowner of the area where we parked our ship last week, a man of about 75 with a single tooth whose smile just lit up his face, brought us fruit every day--sapodilla, bananas, jackfruit (which has an interesting sweet flavor), Khmer sweets made with banana and rice and wrapped in a banana leaf. It is the only place I have been where people tell me my large, French-Canadian nose is beautiful. I love how they try hard to talk to me and I try hard to understand, but how one woman will indicate a chair and tell me to sit without words, or how they will take my hand. I can put my palms together and thank them, I can tell them to go upstairs to get their blood pressure taken, I can tell them how old I am but do precious little else save for smile and simply be present. For as much as I wish I could do more, it might be enough.

I am doing my research too, learning much about the lack of care women have during their pregnancies. I look forward to doing more interviews. I was greeted this morning by the ship's pharmacist asking if I would like to meet the woman in charge of the health center for this village--of course, I said yes. Before breakfast, I took a moto ride with another crew member translator to the health center, learned about her work, and saw a delivery room from ages past, dusty, dark, warm. This is where women who come to the health center here to give birth will stay. If there are any complications--eclampsia, breach, bleeding--the woman must go to Phnom Penh, if they can make the multiple hour journey in their fragile state. Much work remains to be done in this world, for sure.

While I waited for my translator this morning, six little girls with dirt-streaked faces and shy smiles clustered around--close enough, but not too close. A 16-year-old who spoke some English asked me my name and if I had a boyfriend (many tell me I should find a Khmer man!). Last night while talking to a few of the crew, a little girl in the cluster of 7 who were standing in the weeds watching the barang, the foreigner, called out I love you and hid behind her friend, giggling. I love this country.

And if you were wondering about the title of the post, I did have a missing suitcase--it was gate-checked in Newark and didn't make it to Phnom Penh until Tuesday, to the ship on Wednesday, just as I had finished my last pair of scrubs in my other bag. Perfect timing :) Every day is an adventure and may it continue to be so. Blessings to you all.

Pre-Departure

Tomorrow morning, way to early for the fact that it's already after 11, I get on a plane and fly halfway around the world, touching down in four countries in 36 hours. It feels surreal still--surreal that first year is over, surreal that I've already been home and then to NY, surreal that I am going to Cambodia tomorrow morning. I am fairly certain it won't feel real until I get on the ship.

I am looking forward to the trip with much more excitement and less fear than last time. I am not entering a completely strange world this time (only slightly strange), I know more of the language entering than I did last time (which honestly doesn't take much), and I've met the people who will meet me at the airport. I am also a completely different person than the one who sat in this position in 2009. Once again, I know I am supposed to be there. I am looking forward to being more unplugged, more in the moment, more centered. I am looking forward to the beautiful people, the children, the experience. It will change me and that is amazing.

Thanks to all who have supported me in getting ready and in my first year. Really, I know I am blessed. Love to you all, and God bless you!

First Year Complete!

Well, we did it! The first year is over--somehow, we managed to get through every system of the body, learning the intricacies of the heart, the lungs, the brain, the muscles, and what happens if things misfire. It was an amazing and difficult journey--without a doubt, the most challenging year of school I have ever had, but I leave it knowing still, without question--medicine is my calling. I love this.

Five things I learned in my first year:
5) Cadavers really aren't creepy. They are all over medical school memoir as the first teacher, first patient we will encounter, and though it is probably cliche at this point, it is true. We learned the body by using our hands to move through this one--we learned her muscles and nerves, held her heart in our hands (that really was an amazing moment), examined her liver. She was ever-patient with our lack of finesse, tolerated each misstep with ease. By the time we finished, I knew where each of her major arteries hid, what tendon I could tug to make her fingers curl, and how arthritic her knee was. It was amazing. And you do get used to the smell.
4) What the brain lacks in first impressions, it makes up for in function. The brain is less than two pounds; looks really just like a series of gray curves and valleys, has sort of a gelatinous texture when you touch it. Hard to believe then, that this object is the seat of consciousness, emotion, higher thought, and coordinates basically every function. But delving into the minutiae of the brain...wow. Tiny regions the size of my fingertip coordinate language interpretation, and vision is way more than I expected (and the cerebellum is larger too...and is quite beautiful, if you bisect it!). Somehow, our brain controls everything--every breath, every thought, every beat of our heart.
3) Camaraderie develops just prior to exams. It's amazing. We all make our friends, have the people we hang out with, but before an exam, it doesn't matter who you are; it only matters that you're in the same class, have been in the library 8 hours to0, can't figure out what we need to know from the embryology lecture, can't quite keep these nerves straight... There are looks of collective understanding, wishes of good luck in the stairwell, a constant willingness to answer questions. I think we all are grateful.
2) There is nothing like patient contact. Whether it is ambulatory care or one of the doctoring classes, anything that gets me in my white coat and interacting with people is a reminder of why these four years are totally worth it. Everyone has a story. I've had patients make me laugh, put me at ease, and move me powerfully. Perhaps my favorite moment was when a man who had been through hell simply looked at my interview partner and I and said when I come to the hospital, I put myself in God's hands and He puts me in yours as my doctors, and another who had come in to speak about her kidney transplant told us you doctors are the answer to so many prayers.
1) We truly are fearfully and wonderfully made. If first year has taught me anything, it has given me a genuine and deep awe for the body. Just the fact that I am able to type this right now, watch a movie, sleep, and then wake in the morning is nothing short of miraculous.

Sorry for the hiatus, all :) I promise to be back, at least through my summer in Cambodia, and if you're lucky, during second year as well. Blessings to all, and thanks for reading :)

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 :)