Tired...

Everyone who has ever traveled for long periods of time knows this: sometimes you just get tired. Traveling is great, possibly the greatest thing in the world, but it takes a lot out of you...

Usually, it takes longer than a month though... but maybe it's because I was already exhausted after Africa. 

I'm leaving Nepal tomorrow, and that makes me a little sad. I really like Nepal! But for the first time in my life, I am actually happy that it's an organized tour and for the next 7 days, I don't have to think much... (the only way to go to Tibet is with an organized tour, otherwise I would never actually book a tour, tired or not!) 

Anyway... After Tibet I have a few days in Chengdu, China, then flying to Bangkok... the familiar and happy bustle of Khao San Road, and soon thereafter, the amazing tranquility of diving. 

I'm definitely looking forward to that... :) 

I leave you with a picture of Durbar Square, Kathmandu, and its massive population of pigeons... 

Annapurna Trek -- Nepal

Hi folks... Sorry for the lack of news the last couple of weeks... 

I made it to Pokhara under torrential rain almost 2 weeks ago, and didn't think that rain at low altitude meant snow, and a lot of it, at high altitudes. 

I met a German girl who wanted to go trekking, so we got our permits and planned to leave on Thursday. Then the news started showing that a lot of people got trapped under avalanches, or lost their way in the snow, exactly where I was going, the Annapurna Circuit trek. 

I hesitated. 

But let me put this into perspective for you guys: I first heard about the Annapurna Mountains 11 years ago, in a magazine. I fell in love instantly and started planning the trip in my head. I even emailed a friend who traveled a lot, and asked if he knew about it and wanted to go. He actually replied with a picture of himself at Thorong La, the pass at 5,416m which you have to cross on this trek. He'd already done it. He encouraged me to go. 

Then, 8 years ago, I came to Nepal for the first time. It was January and I only had 9 days, so it was impossible to do the trek. I went to Pokhara anyway, because I wanted to at least see the mountains. But they were hiding behind a thick curtain of clouds and I didn't get even a glimpse of them... 

(View from lakeside in Pokhara with the mountains in the background)

Now, I planned my trip perfectly. The weather is supposed to be perfect this time of year, crystal clear skies, sunshine, no snow. But a typhoon in India messed everything up and created a storm up here. Last I heard, 39 confirmed dead and about 100 missing... http://edition.cnn.com/2014/10/18/world/asia/nepal-snowstorm/

But the weather cleared, and I decided to go, at least as far as possible. I had been waiting for this for too long... Got an experienced Nepali guide (just in case) and went. 

So we took a bus to Besi Sahar, where the trail starts. I could see the mountains getting closer and closer... 

(Lunch spot at Chamche, beginning of the trail).

We hiked 4 days up through the mountains, for a total of about 80km and an altitude of 4,000 meters. 

The views from the trail were incredible, the pictures really don't do it justice... Every day, getting closer and closer... 

And then, on a beautiful, sunny day, you hear a noise that sounds like thunder, and you look at the mountain in front of you and watch an avalanche.. (The cloud-like thing in the middle of the picture is actually snow coming down...) 

Then you have to actually climb over an avalanche, and wonder if there's anybody trapped underneath it... We saw rescue helicopters all day, every day... 

(All 3 of us, Larissa - my German trekking buddy, Iman- our Nepali guide, and I, on the upper trail from Pisang to Manang)

We finally got to Manang (3,540m), and were told that the pass at Thorong La (5,416 m) was still closed. We took a "rest day" and only climbed up to a monastery at 4,000m. (If you think 400m is not much, think of climbing the steps all the way to the top of the twin towers in NYC... They were 417m tall...) 

That's me at Praken Gompa, at 4,000 meters, with Annapurna II in the background, standing at 7,973m. The view from up there is just breath-taking... We just sat for a while, and admired the beauty and majesty of those mountains. 

It was a great place to meditate a while, and think about Chad... There were a few things still weighing heavy on my heart, but I think I made peace with it now... 

Walking up and down a mountain gives you a lot of time to think... 

The next day they reopened the pass, but said there was still a lot of snow on the top, and specially on the other side where you have a 1,600m *descent* and no sunshine... Slippery, icy, windy and potentially dangerous. 

I waited 11 years to come here. I really wanted to go over that pass and down the other side... but I wanted to make it *alive* and not stay permanently in Nepal, buried in the snow for some unsuspecting trekker to find next year when the snow melts... 

So we decided to come back down the way we came... that's 80km down the mountain again. We walked 160km in 7 days (4 up, 3 down). But not over the pass, which only means I'll have to come back to Nepal! :) 

Lunch spot with a view, already far down, somewhere just above Dhorepani... 

And today, back in Pokhara, with a beautiful sunset over Phewa Tal... 

Alive and well, with more muscle in my legs than ever before. A little tired, a little sad (I really wanted to make it over that pass!!), but alive. Happy. In peace. 

I think that's all I can ask for... 

Two places at once...

"When you travel far, give your soul time to arrive." African Proverb

My soul is confused. I think it stayed in Chad. My body was torn from Chad, from a place where my emotions were tried every single day, where electricity was only by generator (which sometimes didn't work) and cold water, "supermarkets" with only the bare minimum, and most importantly: sick people that needed me-- to Paris-- arguably the height of civilization, with abundant food, wifi, hot showers, starbucks coffee and chocolate-- to Kathmandu-- a magical place, that somehow confers peace just by being here. 

Nepal is wonderful, this is my second visit, and I am incredibly happy to be here. 

But my soul is confused. 3 days ago I was working in a hospital in Chad. How did I get here? And those 14hrs in Paris, was that a dream? Did that really happen? That was a giant culture shock...

I miss Chad. It's weird, I know. It'll take me a while to let go. I asked for news, and Dr. Scott told me that Blaise and Gombo are doing "really well" and another of my patients also got discharged. 

I will enjoy the hustle and bustle of Kathmandu for another couple of days, before heading to Pokkhara and the Annapurna Mountains. 

I hope my soul have arrived by then... 

Bitter-sweet

You know you did something right when every single one of your patients tells you they don't want you to leave... :) I went around this afternoon and took pictures with them and with the staff. I'll post some later... 

I'm a little sad, but 4 of my patients have been discharged and Dr. Scott said Fatimah will probably get discharged Wednesday. That makes 5 of my patients discharged. The two I fought hard for (Blaise and Gombo) are doing much better, and there's only one who is still in danger of losing her leg (2 year old baby girl!!) but she has osteomyelitis and there's not a whole lot I can do for her anyway... :( 

Tomorrow I take a bus back to N'Djamena and tomorrow night, a plane to Paris. Then I'll spend 12hrs in Paris, stuffing my face with croissants and stinky cheese, then get on another plane to Nepal. 

Tuesday: Tchad

Wednesday: France

Thursday: Nepal

3 continents in 3 days. That's a record for me! :) I'm excited about the next phase of my trip. It'll be fun! :) And I am at peace with my decision to leave. 

Ecclesiastes 3:1 "For everything there is a season, and a time for every purpose under heaven." 

All good things...

Irene got discharged today. Finally. She gave me a huge hug, her mom smiled and shook my hand, and we took a picture together before they left. I told her I was going to print it out and when she came back for her check up, she could pick it up. Something to remember me by.

It's been exactly 8 weeks since I first saw her. Since her amputation. 

She left, and so will I. 

The decision is made. There will always be more patients. I will come back. But it seems that the cycle has ended. Two of my other patients were discharged todayas well. Blaise is officially free of infection and not taking antibiotics anymore. Gombo also seems to be doing better and no more pus is pouring out of his leg. Tahir (the 11 year old boy) went from dressings to steri-strips. He's almost ready to go home too. 

I don't know if my patients will miss me. They have missed me during the week I was gone, but once they leave the hospital, I guess they'll want to forget everything about their stay. 

I will miss them. And I will miss all the blood and guts part of it, the right to walk into the OR and scrub in any time I want, having the keys to the entire hospital and actually knowing exactly what to do and when. 

This has been an incredible adventure. It has been harder than anything I've ever done, but I have also learned more than I could have ever imagined possible in 2 months. 

Today I helped put a humerus back into place, in an arm that was pretty much torn apart in a car accident. 

I have had my hands inside various body cavities, seen intestines, bladders, prostates, hernias, hydroceles, etc. etc. etc. 

That's Dr. Scott's hand this morning, nuckle deep in Gombo's thigh. I did that dressing change twice a day for a month. To reach inside someone's thigh far enough to touch their femur--that's pretty incredible... 

I'm going to miss all of that. Sticking needles into people's veins or muscles, putting on gloves and snapping them off, the smell of alcohol and waving my hands in the air so they dry faster between patients, so I can put on a fresh pair of gloves. 

Might seem silly, but I will miss all of that. 

In a few months though, I will be thrown back into the world of medicine, and I will be the best freaking med student this world has ever seen! 

So I am leaving. In 48hrs I will be in a plane to Paris, and after 12hrs of eating stinky cheese and taking the longest, hottest shower of my life, I will be on another flight to Nepal. 

I have another day in the OR tomorrow though. I'll enjoy every last second of it. :) 

Should I stay or should I go?

For the last few days I have been struggling to decide what I should do next...

On the one side, I have a plane ticket to Nepal in 5 days, and the incredible opportunity to realize a trip I've been dreaming about for 12 years, to trek the Annapurna Mountains, see Mt. Everest base camp and cross from Nepal overland into Tibet. When I started dreaming about this, it was not even possible to do it, the border was still closed between Nepal and Tibet (China). 

It has been possible for a few years, but I didn't have the means/time to do it. This is my chance, specially because the correct time to go is October, and once I start Medical School, I will never again have vacation or free time this time of the year. 

However, a few things have happened lately that make me think I should stay in Chad for another 3 months. A couple of nurses from the US who were staying for a year had to leave due to unforseen family circumstances. Our general nurse supervisor is leaving to go train as a mid-wife in Cameroon. Our *only* anesthetist has not renewed his contract and also wants to leave. 

Yesterday I had decided that despite all of that, I was leaving, that I am not indispensable, cannot do anesthesia, and they'll simply hire another nurse. There's also another nurse volunteer from Mexico who will be coming soon and can take my place. 

Today I arrived back at the hospital, and the faces of all the patients when they saw me, the smiles, hugs and handshakes, were enough to make me want to stay. 

But then, it was time for evening dressing changes. I left **very** specific instructions on how they should be done, and to one of the patients, Blaise (the one who almost lost his leg a couple of weeks ago), I told him to scream at the top of his lungs and not stop until someone came. 

Well, turns out they did his dressing changes 4 times and my other patient, Gombo, only ONE TIME during the entire week I was gone. 

I am furious! The night nurse saw me coming and asked if I was going to do the dressing changes (meaning she knows they should be done) and I said yes, because if I don't nobody else will. Why did it not get done? "Oh, we get busy and we forget" which is a blatant lie, they barely have anything to do at night, even if there are plenty of sick kids, after they start the IVs and put them on oxygen, there's nothing else to be done and they can certainly take half an hour to take care of the other patients. I asked her what if it was a question of life and death, and the patient died because she hadn't done her job, what then? This is not a question of life and death, but now he might lose his leg. How do you feel about that?!?!! --No answer. 

So now my resolve is all gone down the drain, and I predict another sleepless night as I wrestle with this decision and try to figure out what I should do... 

Any thoughts? Come on people, help me out here... Comment!!