Take THAT, All Work and No Play

I am getting oh so very excited. Cathy and her husband Nate are arriving from Wisconsin tomorrow!!!

Cathy and I met on our Himalayan Health Exchange volunteer trip in 2008. You know when you meet someone and instantly know they will always be a part of your life from that point on? I have to say I was lucky enough to have that feeling about several of the folks on that trip, Cathy was no exception. There is also something about seeing your colleague's underwear drying on the line day after day, for a month, that really causes all pretense to fall.  It is pretty hard to put-on-airs and be aloof when no one has had access to running water for 3 weeks. Ok, one girl was aloof but we won't go there (who brings a white felt pea-coat as their jacket on a backpacking trip??) Bottom line, you bond with people when you are living and working together in the midst of controlled chaos and pit toilets.

Just chillin' (literally) at 14 000ft.

On the trip, Cathy was a 4th year medical student waiting to find out about residencies, and I was a nurse waiting to find out about medical school interviews.

Needless to say our lives have changed a little since then! She's now an old married woman and 2nd year peds resident.

I haven't actually seen her since our goodbye in Delhi, but we've kept in touch via email and random gift packages.

I've worked like a mad-woman all week in the hopes of taking next week off. I even managed to finish my paper early, and most of my homework for the next case is done. Now it is time to enjoy some Irish adventures and shenanigans. I don't feel a lick of guilt for my planned truancy. Besides, Cathy is like some kind of brilliantly-hilarious-Asian-American-Halley's-Comet that only comes around a few times in one's lifetime. I've got to enjoy the downtime when I can get it, after all, the hospital will be making me it's bi*ch soon enough.

Speaking of which, I GOT MED/SURG for the summer! STOKED!! Too many people wanted to do med/surg as their first placement (instead of GP) so the school had to do a lottery. The big issue is many of my Canadian classmates (myself included) are trying to arrange electives in North America in the hopes of getting some residency connections and local letters of recommendation. As you can imagine, the hoops to get back into a North American residency are many--but one step that many people have advised is DO AS MUCH IN CANADA AND THE US AS POSSIBLE* when you are a medical student. Many of these electives require that you have completed your 3rd year med/surg rotation. Needless to say there are quite a few unhappy Canadians right now in my class. I am hoping it will work out for them, the school has said they will try very hard to give them the preparation and skills required. Still, it's a gamble. Anyway, I am so excited as I cannot wait to get back into the O.R and back in the hospital in general. The small flickering light at the end of the basic science years is starting to show itself!

But now I must get cracking and get ready for the arrival of my esteemed guests. It's going to be so great to re-connect with this formidable woman!

*Any of you want to provide the ultimate clerkship experience for me in years 3 and 4? G'head and email me!

Words of The Day

I had never experienced a "night terror" before traveling to Asia. Well, I thought that was what they were called. I'd wake up in the middle of the night and be: completely paralyzed, seeing someone standing in the door to my room, hearing someone saying my name loudly, or all three.

Then I'd really wake up.

It was extremely frightening, especially since I was mostly traveling alone and staying in, er, less than reputable places. Some of my accommodations were literally mud huts with bamboo doors on them.

Today as I was bumbling through practice USMLE questions I came upon this answer to a question:

So THAT is what they were!!

Hypnopompic and hypnagogic hallucinations.

Ok, so aside from the fact that they are seriously cool words to add to one's vocabulary, I was intrigued by the transient nature of my former "classic symptoms of narcolepsy".

I stopped taking chloroquine about 5 months into my trip and the symptoms stopped. Of course I have heard that 'vivid dreams' are a common side effect of the prophylaxis...but now I can't help but think they should add hypnopompic and hypnagogic hallucinations to the list!
 

Day 9--Chansal Pass

Today we rolled off of our therma-rests early and began the hike up to Chansal Pass. It was a steady and moderate climb.

At the top Cathy and James attempted the 'jump shot'. After about 17 takes this one worked.

As Sheele pointed out after starting his international emergency medicine fellowship, "it's mostly women that want to save the world". So true. So true.

The gang...can't you just smell the polypro??

Rockin' Shishue and MC Cathy Lee Bustin' Rhymes at the top.
Word.

I am never sure if it is all in my head regarding the altitude and how I am feeling. We've been taking it easy and acclimatizing slowly but I still feel like my chest is tight and a bit more short of breath than I'd expect. I am a wuss.

I've been taking diamox and am loving the fact that I am on a diuretic whilst hiking with a group of 20+ people, in the alpine, where finding a little rock pile to pee behind can be a challenge.
The diamox also makes you sun sensitive. I forgot about this as well and did not put enough SPF along my hairline. Thus (as you can see the sun shining off my forehead) I got a bit of a burn today. I can't wait until my hairline starts peeling. Hot. That is going to look hot.

The transient extremity parasthesias have been another interesting side effect. I am glad that Sheele told me about this possibility or I am sure I would have thought I was getting MS or something on the trip...

Two of the members of the team are down with what appears to be altitude sickness, two others are in the gut-clutching-running-to-the-poo-tent realm. The upside to that is at least there are spectacular views from the poo tents.

I am feeling tired and dirty. We're only on day 4 of camping which means there are still a couple of weeks of tenting left. This is going to be interesting.

My fingernails are disgusting. I am using wipes at night to give myself some semblance of cleanliness.

I think I will have a nap now. My heels are tingling.

So I have this super deluxe therma-rest which has a thin layer of down in it, and inflates to about 3 inches thick. It gives me, by far, the most comfortable sleep I have ever had in a tent. The mat is inflated by using the bag which it comes in. You close the bag (with air inside) then hook up the mat to the bag, squeeze the bag of air into the mat and it inflates. This process usually takes about 7-10 bags of air to inflate the mat to my desired thickness (wuss thickness). You can't blow in the mat to inflate it or the moisture from your lungs will rot the down in the bag. All along this has been fine and dandy, until today. Apparently when you are camping at 14 000 ft the air is a little thinner. Thin air=80-100 bags of air to inflate my little air matress by 3 inches. By the time I had it almost inflated for my nap I was ready to shred the contraption. Eventually I just blew a few lungfulls of air into it. Mouldy down be DAMMED!

Day 8---Peds Tent

I actually felt clean for a brief, flickering moment today. On my early morning walk found a stream from a field that had runoff into the nearby ditch. The field and ditch were separated by a height of about 3 feet. I headed back to camp and grabbed my camp wash. Took off and tied my long sleeved shirt under my armpits in an attempt at modesty. Washed my hair and face under the ice cold water, trying not to get my hair caught in the chicken wire that held stacks of rock back from topping onto the road. Clean hair=good no matter what the process.

Today was the second (and last) day of our first clinic site near Shimla. I was in the PEDS tent with Rachel, one of the pediatricians. It was mostly non acute presentations: nosebleeds, coughs, diarrhea, tummy aches... One very stoic boy who was about 11 years old came in with partial thickness burns to his hand and forearm. The burn was about a week old and not healing well, infected and beginning to abscess. Rachel drained it and the lad barely uttered a peep. The way that children handle pain and crisis never ceases to astound me. So many of them are such warriors it seems.


Did see a few interesting things, some shingles, some scabies...scratch...scratch...and THE craziest, boggiest, macerated ear drum...ouch! Thought that my time on Baffin Island had already shown me the worst of the worst in that department. "Baffin Ear" and "Baffin Lung" are euphemisms known by the health professions in the North to describe "nasty-draining-foul-pus-OE/OM-from-hell" and "RSV-happy-wheezer-whose-sats-are-80%".

It was a madhouse in the afternoon because most of our interpreters/drivers/donkey handlers/cooks all vanished to transport supplies and gear to Shimla. The medicine tent had one interpreter sitting in the middle of a 'translating circle' dealing with 5-6 patients and health professionals at once. At one point, Caroline was just taking random blood pressures on people outside.

Implements of dentistry torture....shudder...

Sterilizing above instruments...

All told we saw about 200-250 patients today. Can't help but wonder though...how much of a difference are we really making in the long term? Sigh.

Day 7--Triage Tent

This was the first clinic day...

I awoke to the sound of rustling outside the tent. Zipped it open to find a medium sized calf grazing under my laundry line of unmentionables.

You bond rather quickly in a group of people when only tent walls separate you, your toilets are holes dug in the ground, no one has access to a shower, and your underwear hangs from a line. You just can't put on airs or try and out-class someone in these situations.

We had a team meeting where everyone was assigned their posts for the morning.

And a stray dog slept...

There was a certain air of excitement as we marched down the path to the clinic site that first day. Everyone was still pretty shiny and new. Our scrubs still had that 'new hospital smell' to them.

It was a bit slow to start. Our "Himalayan Health" banner hung proudly, the tents were assembled, and we steeled ourselves for the crush of patients that were sure to arrive.

But 0900h came and went without anyone at registration.

We re-checked the lights in our scopes, stacked up our tongue depressors, clicked our pens.

Finally, after 1000h, our first patient arrived and Betsy and I pounced on him, happy to finally get things going.

Then the dam broke.

Dozens of people arrived. After registering with a couple of our translators they began hovering around the entrance to our tiny triage tent. Pushing into the tent, people leaned on each other...peered in, listened in.

There was no privacy as we asked, through our interpreters, questions like "when was your last period?" and "does it hurt when you pee?" We were assessing people and directing them to either the gyne tent, the med/surg tent, the peds tent or the ER procedures tent.

Things were always busy in the medicine tent. Always busy.

After being seen, patients were sent to the pharmacy to pick up multivitamins, albendazole if they were 18 or younger, and whatever else we could give them to treat their ills.

The pharmacy was inside a government house which we were allowed to use for the clinic.

It certainly provided its own crowd of onlookers.

The first of many adjustments I'd learn to make on this trip was the art of triaging. My background in ER has at times given me the job of triage nurse in major tertiary centers. In that role you have to really have your game face on at all times. Not only do you have to keep track of all the fading flowers in the waiting room, but who is in line, and what is coming in through the ambulance bay. You have to be able to run a quick focused assessment on patients, gather vital signs, take a reasonable history, and stack them in your mind. Do they fall into the "can wait until the next general election" category or do they fall into the "quickened footsteps to the trauma bay while trying to look nonchalant" category? And then how do they rank within those categories....and how are those folks in the waiting room doing, and who is the guy yelling at me about his dad? How am I supposed to know who his dad is anyway?? But I digress...

I quickly realized that triage on this trip was going to be quite different. First I would be deciphering the chief complaint which was written down by the men at the registration table, frequent complaints being "chest pain", "body lumps", and "back pain".

The next step was pronouncing the name to a large mass of people, this feat often met with peals of laughter, the crowd mimicking said pronunciation, then someone being prodded up to the front of the line. After the comedy act of me calling the patient I would be expected to take their temperature, BP, weight (in children), and assertain which tent they belonged in. Then I would walk them to this destination. Rinse. Repeat.

Initially I had been doing what I was used to in Canada, but it soon became apparent that we had to 'move the product' much faster here. I felt like the most useless triage nurse in the history of the world. A quick glance and off they went. Did we even need a triage tent? I had to re-adjust my 'sick look' radar as many people looked sick. Malnutrition and poverty apparent in the children, hard physical labor showing its toll on their parents.

All in all, we saw 75 patients today. Tomorrow we run a second clinic here and the numbers are expected to be much higher.

I have noticed that I felt a bit short of breath today. We are only at 7000ft but in two days will be climbing to over 14 000ft. Tonight I will start diamox. I am sure the SOB is mostly in my head, but I can't help but remember huffing at 12 000ft last year in Switzerland. So I will take it just to be on the safe side. The last thing I want is to be sucking wind at the end of the line because of altitude sickness. I didn't get those blood stained runners this summer to look like a chain smoker at elevation!

Day 6--The Day I Became "Shishue"

Nicknames. Usually either a sign that you are a complete loser or a sign that you are cool enough to warrant an alternate moniker. In this case, I am not sure which category I fall into. Wait. Yes I do.

Today I got up early and took dose 2 of the cholera/E.coli vaccine that I purchased in Canada. Since it has to be taken on an empty stomach it made me pretty nauseated. Especially when I stared thinking about what was contained in the cloudy liquid I had just poured down my gullet. The B-subunit of the cholera toxin I am ok with, but the whole inactivated V.cholerae count was rather unsettling.

After breakfast (of hopefully limited bacterial load) we piled into Jeeps for the long road drive to our first camp. I was in a Jeep with Cathy, James, and attending Liz.

The classic "do I have anything in my teeth?" photo...

We had an absolute blast in the jeep, entertaining ourselves with various car games like, "what is that lorry carrying?" Time flew by, surprisingly. At one point we stopped to stretch our legs and get some air. I took this photo as it was not an uncommon sight to see very small children wandering alone. This little one certainly seemed like she could hold her own.

After snapping the photo I walked around the side of the jeep, trying to negotiate my way around the deep mud and the standstill gutter which was full to the brim with black, murky, 'schmegma' as I like to call it. As I opened the door to the jeep and attempted to keep my telephoto lens from banging on the side I slipped and ended up calf-deep in the gutter. In the shit gutter. The black, liquid, toxic waste, oily, slime gutter.

I totally panicked. I didn't know what to do. I just stood there for a few seconds with my mouth hanging open, my heart racing, and my stomach churning. Liz sprung into action...dumped a large zip lock full of tylenol out and told me to drop my shoe in it, grabbed large bottles of water to rinse my leg and pants off, told James to find me some scrub pants, and asked Cathy for some spare footwear.

A few miles down the road we stopped at the side of the river so I could rinse off my clothes, leg, shoe, and orthotic. I would have taken a photo but I was still traumatized by the event.

Unfortunately there was a jeep of fellow volunteers parked behind us when it happened so it wasn't just my car that saw the incident. "Shit shoe" was my initial nickname, which was later shortened and softened to "Shishue". We decided that Shishue also sounded more Asian as well and was therefore more fitting. People have already started using expressions like "pulling an Erin" or "having an Erin moment". Great. As usual I make an impression in a group almost immediately for better or for worse...in this case the latter obviously.

The rest of the ride was uneventful except when one of the other cars in our caravan got stuck.


We arrived, set up camp, and then figured out our roles for the next day. I am working in the Triage tent which ought to be interesting.

Day 5--And So It Begins

Liz offered me space on her bed since there had been a mix up with my booking and I was without a place to stay. We decided since we were basically carbon copy versions (only with 5 inches of height difference but otherwise similar in appearance), both Canadian, and both in love with Smoking Lily clothing that it wouldn’t be weird if we crashed together after only hanging out for a few hours. Besides, the next month was going to involve living in a tent with a complete stranger anyway.

Enjoyed my last warm shower. Oh yes I did. Made a mental note of its greatness knowing it would be a long while before I felt the sensation of an overhead spout drizzling warm water over me. I know it is a cliché but we really do take a lot for granted in our day to day lives.

The group met at some ungodly hour in the hotel lobby. There was some quiet confusion and chaos as we eyed each other up. Some people had come in groups or with friends, others were solo travelers like me. A lot of big hiking packs and newly minted outdoor wear appeared on our tired and un-caffeinated bodies. We loaded into several taxis and headed for the train station. I believe there were 21 of us total but I could be wrong. If you’ve heard the phrase “cat herding” then you can make a visual representation of what we looked like in the train station in Delhi. Most of us had a large pack on our backs and a little day pack on our fronts. Okay maybe less like cat herding and more like deformed turtle herding.

We were divided into groups of 6-10 and given our assignments for seating on the train. I was at a booth-like seating with a handful of the group and another cluster sat a few tables away.

We clamored to get our bags into place in on the metal rods that ran along the upper sides of the train. Every seat was full and every square inch of space in the luggage area was occupied. I pushed and stuffed and squeezed my heavy day-pack on top of my big pack, directly above our table with the hopes that I could easily access it for various means of entertainment when needed.

Turns out I was the entertainment that day.

After we had been served our thermoses of hot water for tea and coffee, Leba (one of the members of the group) handed over her hot water to me, not wanting it. I was, for some reason making two simultaneous cups of tea when the rocking of the train caused my day pack to slide off the top of my bag and land with a major crash right on the table causing both cups of tea, several opened packets of coffee mate, and sugar to fly up into the air in a magnificent arc and land directly on my head and lap.

Perfect.

At first I was stunned. It happened so fast. One minute I was about to enjoy some sickly sweet tea, the next, said tea was dripping off my nose, down my pant leg and onto the floor. A light dusting of dried creamer and sugar covered my face and hair. Everyone on the train burst into laughter. Even has I write this it makes me chuckle and wince. All I could hear was Napoleon Dynamite saying “IDIOT” in my head.

Thankfully I was wearing my arcteryx rain pants so the tea just beaded and rolled off, but my pink shirt was not so lucky. I grabbed as much newspaper as possible to clean up my mess but it was a disaster. Somehow in the tea-water-fall I was the only casualty. It was amazing.
I scuttled to the washroom and offered my trip-mates some soggy newspaper on my way by “current events anyone?” John radioed Liz in the other car “Erin has had an incident with some tea but I think everything is fine now, over”.

The rest of the day was thankfully uneventful. We took train after train after train and finally arrived in Shimla around 2000h. Hungry and tired we wandered into the hotel meeting room and did group introductions. I got a pretty good vibe off of the gang, mostly young 3rd and 4th year med students, a few residents, Deb (the NP), 2 dentists, John and Liz (attendings), and me. Deb and I switched things up so we could board together. I liked the fact that she was older and seemed totally chill. In a possible world of type-A-overachievers I wanted to secure a roommate that was going to be mellow.

Tonight I take my sore-from-sitting-for-the-last-three-days-self to bed and enjoy the last time a mattress is underneath me for the next three weeks.

Day 4---The Taj

It is Oct 3rd by my watch and I am exhausted. Amazing how one can be exhausted from doing absolutely nothing.

This morning Liz, Sheele, and I met in the lobby sometime just after 6am. We had booked a taxi to take us all to the Taj Mahal. I hadn’t seen it my first time in India because I was on this holier-than-all-things-tourist trip and frankly, I just wasn’t interested in the detour. But here I was again, with no real excuse not to go.

As we stood in the foyer preparing to go a woman approached us and asked if we were with the HHE trip. Yes, yes we were. Turns out it was Deb, the nurse practitioner from the Bay area who was joining our expedition. With some finagling we were able to arrange another cab so that we could go two by two to the Taj.

It was a long, sweaty, day in the taxi. Deb and I quickly hit it off and were equally puzzled by our frequent and unexplained stops along the way. I was happy to be back in dahl, raita, and naan heaven. The thin pink napkins that I swiped from every restaurant table to keep as emergency tp in my money belt were still available. The only difference was now, I wasn’t the paranoid 20 year old. I didn’t bother with tucking my money belt into my pants anymore, I liked the ‘bandit look’ as I called it—slung over one shoulder.

At the Taj things were insanely busy. An Indian holiday meant a line up that stretched half the length of a football field. People approached us, trying to sell their guiding abilities, Taj key chains, and postcards. We stood in line in the sweltering head of the day. The sun seemed to push the humid air down upon us, through the smog and smells of the city. At security I was turned away, having to go lock up my power bars and my ipod. Electrical equipment and food is not allowed. The others ventured on in, I walked to the nearby locker and handed over my things. Got back into the line and was then turned away again, this time for my book, “Three Cups of Tea”. Apparently certain books are not allowed onto the grounds either. The frustration at my impotence in the situation seemed to be compounded by the heat and random nature of my ‘contraband’ items.

Finally we were all in. We put the booties on over our shoes and padded along the stone walkways. Ok, I’ll admit. The Taj is a beautiful structure. It is quite phenomenal in fact. But I was now drenched in sweat, hypertensive from my line-up experience, jet lagged, and hungry. And now I was staring down the barrel of a 4h taxi ride back to Delhi.

Back in the cab my shirt front dried from the air-conditioning, my back and legs remained sweat-soaked I shivered back to the hotel, fell on my bed, and fell asleep.

Despite the long, dusty day I was glad that I went on the excursion. Tomorrow we meet first thing and I will finally have a better idea of what the next month is going to look like!

Day 3--Dehli...Why the hell not?

The hotel did not send a driver to pick me up (as prearranged and paid for online). I would have been more discombobulated if things had gone smoothly. I remember from my last trip to India is that things never go as planned, and one should always expect the unexpected.

I had been patting myself on the back for being so wise to pack my down booties in my carry-on (they really came in handy on the ultra-chilled flight) but as I rifled through my bag pulling out mitts, booties, and fleece to find my hotel information in the stifling Delhi heat, it bordered on comedic. My shirt sticking to me and sweat running between my shoulder blades while I made a pile of down articles on the floor.

The sun was coming up, though barely visible through the smog. It was just after 6am when I got a pre-paid taxi chit and settled into the back of a mini-van for the 45min commute through the city. It was how I remember all of the Indian cities I spent time in. Hot. Dusty. Chaotic. Loud. Polluted. The traffic was a mix of lorries, cattle, dogs, rickshaws, pedal bikes, cars, motorbikes...even a guy on inline skates! No real observation of lanes and the horn being the 'signal' of choice to maneuver from side to side. I was happy to dive back into this throbbing city.

Somewhat apprehensive about what the next adventure will entail.

It's now 1050h and I am exhausted. Exhausted from doing nothing. Sitting on planes, and in taxis but I haven't slept since I left Canada. Only a few dreamy head-bobs that woke me right up again on the plane. I need a good stretch or a walk but the thought of stepping out into the madness is unappealing. I'll sleep for a few hours only so avoid exacerbating the jet lag. Then I'll go exploring.

1830h--So much for a few hours sleep and avoiding jet lag.

2300h--Came back from an email attempt to have a short brunette come running out of a restaurant at me, "You're Erin aren't you???"

"Uh...yessssss....."

"I can tell by your 'Smoking Lilly' t-shirt and your lululemon headband!! You've got to be a Canadian from the West coast!"

And so it was how I came to meet Liz, the assistant attending.

After a chai with her and John, the attending, I felt somewhat more reassured about the group I'd be spending the next month with. Both young, adventurous, and entertaining. So far, so good. Except she did shatter my notion of originality. I am evidently a walking stereotype: West coast girl. Suppose it could be worse...

Last time I was in Delhi I had a few friends with me and we had all dreaded coming out of the quiet beauty of the desert and hitting the big city. In an attempt to amuse ourselves we imagined the jobs of the Delhi tourism board trying to come up with slogans to lure tourists...a couple we drummed up were, "10 billion cockroaches can't be wrong!" and my personal favorite, "Delhi--Why the hell not??"

We're going to rent cabs tomorrow and head for the Taj. They twisted my arm. I didn't see it last time and I figured I really can't justify coming to India twice without seeing the Taj...

Day 1: Packing, Sleeping, Flying

Finally, after 2 am I started packing in earnest. Forgetting, of course, my raincoat. I looked at the pile and pared down a bit. (I'd come to regret the fact that I only brought 1 pair of climbing pants, one pair of sweats, and rain pants for a month of traveling).

Washed clothes, filled stuff sacks, charged batteries, jotted 'notes to self', sorted medical supplies by ailment (gastro, respiratory, blisters, rashes...), checked aamc website compulsively for mcat scores (not there). Finally after 4 am I fell into bed thinking about how it was going to be the last night sleeping with my pillow, my lavender and pine linen spray, and my bedside fan. I thought that due to the harried nature of the previous hours I'd toss and turn in a fitful slumber but instead I closed my eyes and within moments I was sleeping most soundly. Rare for this bear.

The next thing I am aware of is the phone ringing and it is 0730h.

I felt bone tired, my legs ached and stomach rolled from the lack of sleep. I know the ringing phone is my mother, the next thought is, "MCAT!!!"

Stumbled out of bed, stepped into the kitchen, flip open the lap top and logged on. No scores. Sigh. The morning proved to have other obstacles including uncooperative registrar people at my old Uni, some transcripts not yet received...picky paperwork ends that needed tying up.

Still has not sunk in yet that I'll soon be in India. Sure that as soon as I touch down it will come. Just hope the hotel people are there to pick me up so I don't have to deal with being hassled by taxi drivers. I remember how they descend on you like a pack of wolves in that place. Off to the airport. Here goes!

"Take half the clothes and twice the money..."

The title was sage parting advice from a friend. Is there any luggage really worth having in sweltering heat and a suffocating crush of humans?

Almost 10 years later and here I was...back in line at the pre-pay taxi stand...well 'line' is a bit of a stretch...more like 'wedge shaped crowd of pushy people'...it was only 5 am but already the rivulets of sweat were running down my back and I felt like a 4 day old bandaid. Tired and grimey.

Got to my hotel finally.
Cockroach in room count: 1.
1 is in the 'acceptable/to be expected' range.

I'd been up for >36h with no sleep. (If I can't sleep in a bed why would I ever be able to sleep on a plane??)

Hello Delhi. You haven't changed at all since I last saw you! You are still a pulsating mass of people, bony animals, thick dust, brownish smog, vivid sari's, sleeping beggars, road side barbers, and government officials standing on road sides. You are horns and incense. You still have ineffective ceiling fans, dank internet cafe's, rickety scaffolding, and Hindi music blaring out of tinny speakers.

It's good to be back. It's great to see you. What do you have in store for me this time???

Hello Himalaya!

The time is drawing near.

Right now the house has many Albinoblackbear-made piles around it. Clusters of electronic charging devices, stacks of medical supplies, collections of scrub tops and underwear, hordes of powerbars.

OK now it is starting to sink in! I am actually going to India!

Packing is a bit of a challenge as the weather will be changing drastically. I checked the temperature this morning and it is 31°C (about 88°F) in Delhi but in the first of the Himalayan cities we are going to the low is around 6°C (46°F) for today. So in go the flip flops and the down jacket I guess!

I finally realized one of the perks of working in health care when I showed up at my ER around midnight (knowing it'd be a bit quieter) and got one of my colleagues to give me a script for the little-old-lady-like shopping list of prophylactic meds I want to bring. Man I am going to have a tricked out first aid kit!

So I am not sure how much I will be blogging while I am gone (almost never) but I will be keeping a journal while on the road. I look forward to the emotional, physical, and mental shake up this trip is going to give me. It is most needed.

Until I post again!

ABB