A Man, a poem

December 5, 2017

Today President Trump came to Utah for his first time as president.  The president came, not to partake in the resplendent beauty of our state’s natural wonders, but to sign a controversial proclamation to significantly reduce the size of two of Utah’s national monuments, Bears Ears National Monument, and Grand Staircase Escalante.

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Photo courtesy: Mason Cummings

The occasion of the president’s visit seems to be a good occasion to speak of manhood.  Men have been under attack of late.  No doubt much of this is justified.  No woman should ever have to fear a man, no matter the situation.  Equality starts with respect, and if we are to be equal as genders, we must start by respecting each other.

At the same time, the idea of men being judged by a court of public opinion is frankly frightening in a way redolent of the Salem Witch Trials, or Red Scare McCarthyism of the 1940s and 1950s.  Don’t get me wrong, men who use power or manipulation to abuse women must be brought to justice, but in the United States we have a system of due process and a tradition of “innocent, until proven guilty” that must be upheld.

But in light of the current damaged image of manliness, we should remember to celebrate the kind of quietly strong men that we should strive to be, or to want in our lives.  What follows is a poem written by Louis Untermeyer about his father.

A Man (For My Father) by Louis Untermeyer

I listened to them talking, talking

That tableful of keen and clever folk,

Sputtering . . . followed by a pale and balking

Sort of flash whenever someone spoke;

Like musty fireworks or a pointless joke.

Followed by a pointless, musty laughter. Then

Without a pause, the sputtering once again . . .

The air was thick with epigrams and smoke;

And underneath it all

It seemed that furtive things began to crawl,

Hissing and striking in the dark,

Aiming at no particular mark.

And careless of whom they hurt.

The Petty jealousies, the smiling hates

Shot forth their venom as they passed the plates,

And hissed and struck again, aroused, alert;

Using their feeble smartness as a screen

To shield their poisonous stabbing, to divert

From what was cowardly and black and mean.

Then I though of you,

Your gentle soul,

Your large and quiet kindness;

Ready to caution and console.

And, with an almost blindness

To what was mean and low.

Baseness you never knew;

You could not think that falsehood was untrue,

Nor that deceit would ever dare betray you.

You even trusted treachery; and so,

Guileless, what guile or evil could dismay you?

You were for counsels rather than commands.

Your sweetness was your strength, your strength a sweetness

That drew all men, and made reluctant hands

Rest long upon your shoulder.

Firm, but never proud.

You walked through sixty years as through a crowd

Of friends who loved to feel your warmth, and who,

Knowing that warmth, knew you.

Even the casual beholder

Could see your fresh and generous completeness,

Like dawn in a deep forest, growing and shining through.

Such faith has soothed and armed you. It has smiled

Frankly and unashamed at Death: and, like a child,

Swayed half by joy and half by reticence,

Walked beside its nurse, you walk with Life:

Protected by your smile and an immense

Security and simple confidence.

Hearing the talkers talk, I thought of you . . .

And it was like a great wind blowing

Over confused and poisonous places.

It was like sterile spaces

Crowded with birds and grasses, soaked clear through

With sunlight, quiet and vast and clean.

And it was forests growing,

And it was black things turning green,

And it was laughter on a thousand faces . . .

It was, like victory rising from defeat,

The world made well again, and strong – and sweet.

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The Beast

November 14, 2017

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Photo credit: Zandy Mangold

Many of you may wonder how I’ve been able to do my first staged ultramarathon.  Let me explain to you about the beast.

The beast is not a person, nor an idea, nor a mantra, although in your mind you could imagine it as any of these things.  The beast is a pace.  It’s not a comfortable pace.  It is painful, but it is endurable.  And that’s the point.  The beast is the fastest pace that you can maintain for miles, that you can keep on the uphills and the downhills, where you can still consume calories, have a conversation, or manage your water and electrolytes.  You could likely pee at this pace, but you’d probably have to be going backward, and you’d want to know who is around you first.

For me, the beast is 4 miles per hour, but it might be different for you.  The beast is not a one night stand; only used when needed.  The beast is demanding of your time and your miles.  You have to know the beast before your start your race.

When you are passed by a pack of runners, and you are tempted to join, the beast mocks you: “You think you’re going to win this? You’re not a runner.  Remember nine months ago you’d never ran more than a 5K.  You are, at best, a mall-walker.  And you are my bitch.”  Besides, your real competition is not against them.  You’re really competing against the beast.

The beast is a hunter.  It is a wolf.  When that racer you’ve been bearing down on takes off at a sprint, the beast tempers you: “don’t chase the bunny.  It can only keep that pace for a few hundred meters.  You can practically see the serpents of anaerobic metabolism coiling around it’s legs, injecting poisonous lactic acid into those hard working muscle.”  When the bunny slows, that’s when the beast attacks.

But the beast is also compassionate.  It uses endorphins like an opioid drip, slowly diffusing into your body, hiding the pain, the blisters, the swelling.  You don’t notice these things until the beast is done with you.

The beast may be passed early in the day, but this is a race for wolves, not for gazelles.  It will make many of those losses back in the end.  The beast doesn’t burn itself up quickly, but plods on ceaselessly.

You may think you can escape your beast at the checkpoints. The check point staff will tempt you with music, shade, chairs, and friendly hellos.  It’s like being at Starbucks.  And if you’re not careful, you’ll become a regular.  But remember, you’re a mall-walker, and mall-walkers don’t lounge at Starbucks like high schoolers skipping class.  Be efficient: refill water, check your feet, apply sunscreen.  Remember to make a few friendly remarks to the check point staff, after all this is their vacation too.  Then get out.

The beast is waiting.

The weather is beautiful, I wish you were here!

Over the past yeah, so many people have commented to me about how crazy I am to be running 150 miles, 6 consecutive marathons, in a week. And while this particular adventure may seem a bit quixotic in the grandest sense of chasing windmills, when you show up at the event, and surround yourself with your family of like minded nuts, it can be pretty fun.

The last day has been full of reunions, renewing old friendships, and creating new best friends. And PACKING!

At this point, just hours before we board busses to take us to the first Camp site, which is also the starting line tomorrow, each racer is packing and repacking. The decisions we make now, and the ones we’ve made over the past few days will have major ramifications over the next week. The decisions we are making now, often times gut choices or things that “just feel right”, about things like gear, nutrition, and warmth can literally determine if we will succeed or fail, as well as how much we will suffer over the next week. Make the right choices, and you will do well, make the wrong choices and you may not finished, or could get really sick.

Some of my friends are making choices for the lightest pack possible, sacrificing warmth and calories for speed and less punishment on the shoulders and back, while others, like me, prefer a warmer, and slightly heavier, sleeping bag, or slightly more food that I have to carry.

One of my friends, Greg, is already paying the consequences for his decisions. He decided to check his back pack and all its gear in the plane from Buenos Aires yesterday, but the bag didn’t arrive in Bariloche. If it doesn’t arrive this morning, he’s going to have to scramble to find gear at the last moment, or he may not be able to run.

The thing is, there are no definitive “right” and “wrong” choices. A decision that is good for one runner may be disastrous for another. And the thing is, we have to make decisions now, and can’t go back and change them later. The die will be cast.

In this way, this crazy esoteric race is a reflection on life. Decisions we have made have ramifications in our lives, and may continue to have repercussions as each day goes forward. The decision that may seem good one day may lead to disaster the next. But humans have a linear relationship with time, and so we cannot go back and change our decisions once they’re made, and once we know their ramifications.

Milan Kundera explores this in his book The Unbearable Lightness of Being, which explores the consequences of the decisions made by the main characters during the Prague Spring in Czechoslovakia in 1968. The idea of the “unbearable lightness” comes from an idea from Nietzsche. It is the thought that our decisions are unbearably light because we can only make them once, whereas they would be heavy if we were forced to continually live through our making our decisions, good and bad, like the Kurt Vonnegut story Timequake.

But the eternal rub is that we are forced to live with the consequences for the decisions we make each day, and since time relentlessly marches forward, we have to keep making decisions, even when we would like to pause to reflect on our decisions.

And how we react to the outcomes of our decisions determines the people that we become. It is what makes us interesting as individuals as it builds character. For some, the repercussions of our decisions can help us build resiliency, and make us stronger people who are more capable of meeting life’s challenges; for others, the weight of our decisions can grind us down and bury us in a sisyphusian effort.

In the book of John, chapter 8, religious teachers confront Jesus and ask him to decide on the fate of a woman, based on the decisions she had made in life. She was caught in adultery and the leaders think she should be stoned to death. Like so many of these stories in the Bible, the religious leaders are trying to trap Jesus, to bring him down to their level. Will Jesus agree with them and send this woman to he me death? Or will he defy the law, and lose credibility?

But Jesus just draws on the ground. It’s one of the great mysteries of the Bible. What did Jesus write or draw on the dirt that day?

When the religious leaders pressed Jesus for an answer, he off-handedly commented, “let him without sin cast the first stone”, and then went back to his drawing. Slowly it dawned on each person in the crowd that they too were sinners. It was not their place to judge this woman for her actions.

After they had left, Jesus asked the woman, “Where are they? Has no one condemned you?” She replies “No one.” To which Jesus says, “Then I will not condemn you either.”

It’s so pretty awesome passage about forgiveness and judgement, but my favorite part, that often gets overlooked, is what Jesus says next:

“Go now, and leave your life of sin.”

Wow! The woman had made her mistakes in the past, however that did not determine her future behavior. So while she has made her mistakes in the past, and has had to pay the consequences or her actions, those actions do not determine her future behavior: just because you make a mistake doesn’t mean you have to keep making mistakes. Our decisions are light, yes, but they don’t have to be unbearable.

Each morning we wake up, we can be better people, just by willing ourselves to be so. And if we keep being better people for long enough, we may even become good.

The decisions I make today will have huge ramifications on my next week. And while today’s decisions affect my future, they do not determine my future. I am still free to make the decision to put one foot in front of the other. If I make that decision long enough, I will eventually cross the finish line, in spite of all the poor decisions I made today.

Here we go! Flying to Bariloche to start the Racing The Planet: Patagonia race, 150 miles through on of the most beautiful settings in the world. It feels like the race has always been far off, over the horizon, but not anymore. We start Sunday!!!

It’s crazy to think that 8 months ago, I’d never run more than a 5K. Now I’m running (more likely fast hiking) six consecutive marathons.

My training over the past yeah has taken my to some incredible places, including Costa Rica, the Tour du Mont Blanc in Switzerland, France, and Italy, Zermatt, Santa Fe, Telluride, Breckenridge, and a marathon run to Kings Peak, the highest point in Utah. I have fallen in love with running during my training.

Riitta from Racing the Planet, in her infinite wisdom, has grouped all the crazy doctors who have volunteered in previous races, but have decided to run in Patagonia into one tent together, along with the incredible Cindy Drinnan. I expect the atmosphere will be a bit like the old TV show M*A*S*H, and for me our tent will forever be known as The Swamp.

We may be a motley crew of medical professionals, but I fully expect all of my fellow Swamp Dwellers to cross the finish line!

Please follow our journeys at the 4 Deserts website, and send some prayers, karma, hopeful thoughts, and good vibrations to this crazy doctor!

Buy less. Give more.

November 9, 2017

feature_kellermann_foundation_01If you are like me, as the holiday season draws close, you begin to think about how to show appreciation to your loved ones. For many in traditional Western cultures, this means buying various trinkets and items that you hope will bring some joy to those you value. But oftentimes these items end up in a closet, a garage, or a basement, utterly forgotten until some future spring cleaning.

Buying something because you have the money, or because you feel like you need to give something, is not a good reason to buy it. But giving to someone in need because you have extra money or because you feel the need is a good use of resources.

Instead of buying meaningless gifts, show your loved ones how much you care for them by giving to the causes they value, whether it is a wetlands conservancy group for your nature-loving spouse, an arts endowment for the artist in your life, or to public broadcasting for your friend who listens to podcasts.

But if you still don’t know where to give, let me suggest you look at the Kellermann Foundation. The Kellermann Foundation is a 501(c)(3) nonprofit organization that was formed to support a group of internally displaced persons in the African country of Uganda. This group, a tribe of pygmies known as the Batwa, is a group of traditional hunter-gatherers who were forced out of their rainforest, the only home they have ever known. When they were forced off their lands into an unfamiliar environment and culture, the Batwa began to suffer and even die.

The Kellermann Foundation’s works include school building, education programs, scholarships, water and sanitation projects, home building, agriculture, healthcare, ministry, and projects to maintain the Batwa’s cultural heritage. The Kellermann Foundation has also built and helps maintain a hospital in the Bwindi region of Uganda, which serves the Batwa as well as surrounding communities. The Bwindi Community Hospital has been recognized by the Ugandan government as one of the top hospitals in Uganda, and it has a nursing school that trains care providers to improve healthcare throughout the country.

I have been to Bwindi and have seen the good works that are being accomplished with the Batwa people. I was impressed enough that I have become a volunteer board member to continue to support and direct the future efforts of the Kellermann Foundation.

At this time, the world needs more giving and less stuff. Show your loved ones how much you care for them by adding value, not buying junk. Tis the reason for the season.

Buy less. Give more.

hmpg_feature_batwafamilyDear Friends,

If you are like me, you may find that reading through your Facebook feed has become very painful of late.  Right now there is so much frustration, anger, fear, and pain in our country.  These days, we see very few smiles, and feel precious little joy.  It’s easy to become discouraged; it feels like there is so little we can do.

But one thing you can do is support the Batwa people.

The Batwa are a wonderful tribe of pygmies in rural Uganda. Traditionally, they lived in the rainforest and were primitive hunters and gatherers.  All that changed when their government forced them out of the forest, as part of the creation of a world heritage site for silverback gorillas.

When the Batwa were evicted from the only life they have ever known, they were left to fend for themselves with no food, no land, no resources.  As a result, they began dying at an alarming rate, especially children under the age of five. That’s when Dr. Scott Kellermann and his wife Carol were called to Uganda to help save the Batwa.

When Scott and Carol first arrived, the Batwa were suffering and dying.  They held clinics under trees, hanging life-saving IV fluids from the tree branches.

Through the Kellermann Foundation, the organization started by Scott and Carol, the lives of the Batwa are beginning to look bright.  The Kellermann Foundation has created a Batwa Development Program, which has purchased land for the Batwa to live and farm, has built schools and sponsored the education of Batwa children, has built homes for Batwa families, has sponsored water and waste projects, and has set aside a small part of the rainforest where the Batwa can maintain their culture and pass on their traditions to future generations.

The Kellermann Foundation has also built a hospital, the Bwindi Community Hospital, which has been recognized as the top hospital of Uganda.  There, doctors from around the globe come to learn from, work with, and teach Ugandan doctors.  The hospital has had some astounding successes:

  • • In rural Uganda, many women attempt to deliver babies at home.  If their delivery fails, they are left struggling to find a hospital that can perform an emergency cesarean section.  The complications can be significant, such as death of the mother, death of the baby, or vesicovaginal fistula, a communication between the bladder and vagina, which causes continuous leaking of urine.
    • o The Bwindi Community Hospital has created a Women’s Dormatory, where pregnant women can come to stay at the end of their pregnancy to be near the care they require at the end of their pregnancy.
    • o They have created a voucher program where a woman can receive prenatal care and a delivery for the equivalent of 1 US dollar.
    • o The hospital now delivers 1,200 babies annually.
    • o They have built a pediatric ward that not only treats children, but has a demonstration garden where parents can learn how to grow nutritious foods and a test kitchen to teach mothers how to prepare foods to help their children thrive.
    • • The public health efforts of the hospital, and their HIV/AIDS clinic, have brought the HIV/AIDS rate in the community below 5%.
    • • They have built a nursing school—Uganda Nursing School Bwindi—that trains nurses to improve healthcare delivery throughout Uganda. This year, the first Batwa student is entering the nursing school!

But the Batwa, the Kellermann Foundation, and the Bwindi Community Hospital need your help to survive.  We would love for you to visit the hospital and see the work they do; however, if travelling to Uganda is not in your near future, please consider supporting the Kellermann Foundation financially.

    • • $225 can treat a malnourished child.
    • • $750 can provide primary education, materials, uniforms, and transportation for a Batwa child for a year.
    • • $1,250 per year can support a Batwa child through secondary school.
    • • $1,400 can build a house for a Batwa family.
    • • $1,500 per year can provide tuition, housing, and materials for a nursing student.

The Kellermann Foundation is a 501(c)(3) nonprofit charity.   It has received a Gold level from GuideStar, and is a “Top-rated” charity by Greatnonprofits.org.  You can support the Kellermann foundation by direct donation, or can support them through Amazon Smile.

I first met Scott Kellermann in 2015 when he visited Park City, Utah.  I have done medical work all over the world, but was so impressed by the work that they have been doing that I visited the hospital in 2016.  This year, I have decided to volunteer as an unpaid board member to help protect the Batwa, and to improve the state of healthcare in their region of Uganda.  I hope you will support us.

In these tumultuous times, you may not be able to change the results of an election, or correct the wrongs of our society, but you can help the Batwa. And that’s something worth smiling about!

Thank you,

Andrew Nyberg, MD MPH

Board Member

Kellermann Foundation

Back in Kathmandu

May 19, 2015

Dear Friends,

Thank you for the well wishes, the prayers, the concerns. I am now back in Kathmandu with plans to leave Nepal in the next few days. It has been quite an adventure since the first earthquake hit Nepal on April 26. After assisting the evacuation of the wounded off Everest, we stayed open to be there for all the teams, guides, porters, etc. that were now leaving the region. In spite of this, we saw very few physically sick patients, but some very traumatized people. On May 5 we closed the Pheriche HRA post, as it had become clear to us that our mission for this season was largely concluded, and we were anxious to get on to other things.

After a beautiful walk down to Lukla, and a safe flight out of the Khumbu, I said goodbye to Katie and Reuben, who were headed back to the UK to work on their upcoming wedding.

Mama Bear and Papa Bear, parents to our favorite puppies, Black Bear, Brown Bear, and Grizzly Bear, waking up to say goodbye on the day we left Pheriche.

Mama Bear and Papa Bear, parents to our favorite puppies, Black Bear, Brown Bear, and Grizzly Bear, waking up to say goodbye on the day we left Pheriche.

Mama Bear and Papa Bear lead the way out of Pheriche.

Mama Bear and Papa Bear lead the way out of Pheriche.

Walking out of Pheriche for the last time.

Walking out of Pheriche for the last time.

Ama Dablam and the farm fields of Pangboche.

Ama Dablam and the farm fields of Pangboche.

The heavily damaged monastery at Tangboche.

The heavily damaged monastery at Tangboche.

Gobi and Tan relaxing at a Teahouse.

Gobi and Tan relaxing at a Teahouse.

A teahouse kitchen.

A teahouse kitchen.

The rhododendron in bloom.

The rhododendron in bloom.

Namche Bazaar.

Namche Bazaar.

The dental clinic in Namche suffered heavy damage

The dental clinic in Namche suffered heavy damage

Reuben and Katie at our favorite cafe in Namche.

Reuben and Katie at our favorite cafe in Namche.

The two bridges to Namche Bazaar.

The two bridges to Namche Bazaar.

The author, looking back on the two bridges to Namche Bazaar..

The author, looking back on the two bridges to Namche Bazaar..

The beauty of the Khumbu.

The beauty of the Khumbu.

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A “Bob Ross” waterfall outside of Monjo.

Cherry blossoms in bloom

Cherry blossoms blooming in Phakding.

Renee and I integrated into an awesome group of medical professional from Scripps (San Diego) and Mass General (Boston), who were operating field clinics in the Gorka region on Nepal for International Medical Corps (IMC). I’ve spent the past 10 days working with them, visiting several different sites by helicopter, setting up a clinic and camp, and treating the local population. In my time with them, we have seen well over 600 patients, mostly for common complaints and chronic conditions, but all of these villages have been devastated, and their “healthcare” infrastructure has been devastated, either because the community health worker is no longer their, or the community health post was damaged, or the medical supply line has been severed due to landslides and impassable trails.

The author.

The author and a satisfied customer.

Bringing medical supplies to a village to set up a clinic.

Bringing medical supplies to a village to set up a clinic.

Children playing with a wheel and stick, their favorite activity.

Children playing with a wheel and stick, their favorite activity.

Three Nepali children at play.

Three Nepali children at play.

We were in the town of Ghyachchowk when the second earthquake hit. Thankfully everyone was safe, but the second earthquake has played a major toll on the mental health of the people we are seeing. Their world was devastated after the first quake, and they were just starting to get over the experience and rebuild when the second earthquake hit.

The town of Ghyachchowk.

The town of Ghyachchowk.

Looking into a destroyed house.

Looking into a destroyed house.

The middle school, the pride of the village, ruined by the earthquakes

The middle school, the pride of the village, ruined by the earthquakes

Villagers demolishing a house for rebuilding supplies

Villagers demolishing a house for rebuilding supplies

After the second earthquake many of the Nepalis we saw were suffering from Acute Stress Reactions; fearful that any aftershock could be the next large earthquake. The emotional ramifications of what they have experienced will affect them for the rest of their lives.

A girl and her chick watch the activity at the mobile clinic.

A girl and her chick watch the activity at the mobile clinic.

IMC Nepali volunteers Ocean and Iman singing with the locals.

Nepali volunteers Ocean and Iman singing with the locals.

Our team has finished their deployment, and are now cycling back to the U.S. Another team from Stanford arrived the day before yesterday, and will be going into the field today to continue our work. Other groups from IMC and other aid organizations are in the field, performing medical duties, but also rebuilding water supplies and toilets, helping rebuild structures, identifying areas nutritional deficiency, and working with villages to develop coping strategies and mental health first aid.

IMC Dietary staff member Suzanne and Nepali volunteer Kul assessing the nutritional status of villagers.

IMC Dietary staff member Suzanne and Nepali volunteer Kul assessing the nutritional status of villagers.

In the future, I hope to provide more stories of my experiences since the earthquake, but it has been difficult to wrap my mind around the repercussions of everything that I have bared witness to in this country. In the meantime, please accept this short account of my recent actions and movements.

The night before last I was feeling great. I had been reading articles about climbing mountains online at SummitPost.org, and simultaneously reading out of High Altitude Medicine and Physiology, 5th Edition, a great textbook about what happens to humans at high altitude. I had no sooner put the book down, when I had my own fist had experience of what happens to human bodies at high altitude.

No sooner had I turned out the lights than my feet started to really hurt, specifically the first and second toes of the right foot, and then the second toe of the left foot. Like excruciating pain. I’ve never had gout, but I imagine this is what gouty arthritis felt like. Except I had it in 3 toes! I also had mild pain in the 2nd MCP joint (that’s the first joint on the pointer finger) and the 3rd PIP joint (that’s the second joint on the middle finger). I tried taking ibuprofen, without any improvement in symptoms. I had to reach for the hydrocodone with acetaminophen, which was finally able to control my pain to the point where I could get some sleep.

I have never felt such pain before!

When I woke yesterday morning, my feet were not nearly as painful, but still quite swollen, but the middle finger on my right hand was so bad that I could not straighten it, and my fingers, especially on my right hand, were quite swollen. My knees ached, and I was generally not feeling well. It is as if I had aged decades overnight.

Yesterday I was on the day shift, and we were steady with 7 patients. I felt like my right hand was a withered, crippled, claw. Everytime I had to shake a customer’s hand it was excruciating.

After the day was through, I pulled down Auerbach’s Wilderness Medicine, 5th Edition (the copy at the HRA post has actually been signed by Paul Auerbach and Ken Zafren, who is one of the medical advisor’s for the HRA), not an easy task in itself! After flipping through Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema, I got to a small one-paragraph section on Peripheral Edema at High Altitude. According to this authoritative text, peripheral edema will occur in 18% of people over 4200 meters, and suggests the use of a diuretic medication for symptom relief. Ah, Acetazolamide (Diamox), you always seem to be near at hand in high altitude. I never needed it for Acute Mountain Sickness, it’s most common use at altitude, but here I am relying on its diuretic properties to let me pee away my peripheral edema.

My hands on the night of March 22.  The knuckle on my right pointer finger is obviously swollen, and I can't straighten my right middle finger much past where it is without significant pain.

My hands on the night of March 22. The knuckle on my right pointer finger is obviously swollen, and I can’t straighten my right middle finger much past where it is without significant pain.

My feet on March 22.  Look how swollen each of the toes look!

My feet on March 22. Look how swollen each of the toes look!

I took 125mg last night, and had two good pees overnight. In the morning, my left hand and toes had greatly improved. My right hand is still being a bit problematic, but acetazolamide and I keep waging our battle against excess fluid. 250mg during the day, and I’ll take another 125mg tonight. I am mostly back to normal, but still can’t quite straighten my right middle finger!

My hands on March 23.  The knuckle on the right 2nd finger is still somewhat swollen, and while I can straighten my right middle finger a lot more than yesterday, I still cannot straighten it completely.

My hands on March 23. The knuckle on the right 2nd finger is still somewhat swollen, and while I can straighten my right middle finger a lot more than yesterday, I still cannot straighten it completely.  My left hand looks pretty much normal.

While my toes look much more splotchy than they did yesterday, they are not swollen and feel much better.  I have a blister on the left 2nd toe from the trip to Ama Dablam, and my right 2nd toe has a bruise on it where a nearly blind guy stepped on my toe today (casualties of wearing flip flops in the HRA clinic!)

While my toes look much more splotchy than they did yesterday, they are not swollen and feel much better. I have a blister on the left 2nd toe from the trip to Ama Dablam, and my right 2nd toe has a bruise on it where a nearly blind guy stepped on my toe today (casualties of wearing flip flops in the HRA clinic!)

A World Lit Only By Dung

March 17, 2015

The front of the HRA clinic in Pheriche, with the Everest Memorial monument out front.  It lists the names of all the known deaths on Everest, currently accurate through 2012.

The front of the HRA clinic in Pheriche, with the Everest Memorial monument out front. It lists the names of all the known deaths on Everest, currently accurate through 2012.

The plaque on the front door of the Pheriche HRA clinic

The plaque on the front door of the Pheriche HRA clinic

We have made it to the HRA post at Pheriche, and are slowly adjusting to our new routines. The valley that contains the small village of Pheriche is absolutely beautiful, with towering spires surrounding the houses, lodges, and farms. After arriving, we assigned ourselves rooms and got to work cleaning the residential side of the clinic. We then spent the next two days, March 13 and 14, cleaning the clinic, and arranging the medical stores.

View of the Pheriche Valley to the Northwest.

View of the Pheriche Valley to the South.

View of the Himalayas surrounding Pheriche.  Looking to the Northwest

View of the Himalayas surrounding Pheriche. Looking to the Northwest

The "business end" of the Pheriche HRA clinic, the reception area for patients, and the shop for selling t-shirts, etc.

The “business end” of the Pheriche HRA clinic, the reception area for patients, and the shop for selling t-shirts, etc.

The examination room, where we see most patients.

The examination room, where we see most patients, still in the process of being cleaned.

Our "Inpatient Ward" where patients staying overnight will sleep.

Our “Inpatient Ward” where patients staying overnight will sleep.

The kitchen, where Jeet keeps us well fed, and where there is an unlimited supply of hot water for drinks (my new favorite being a combination of Hot Chocolate and orange Tang, delicious!)  We sit around the small table for all meals.

The kitchen, where Jeet keeps us well fed, and where there is an unlimited supply of hot water for drinks (my new favorite being a combination of Hot Chocolate and orange Tang, which I call a Terry, after the British company that makes chocolate oranges.  It’s delicious!) We sit around the small table for all meals.

The common room at the HRA clinic in Pheriche.  My room is the door on the right.

The common room at the HRA clinic in Pheriche. My room is the door on the right.

A Panorama of the staff enjoying the heat of the Dung stove in the evening.

A Panorama of the staff enjoying the heat of the Dung stove in the evening.

My bedroom at the HRA clinic

My bedroom at the HRA clinic

When we arrived, we had the bags we carried, plus one bag carried by a porter. The rest of our supplies, including food, medications, and personal effects, were to arrive by Yak train. This hasn’t happened yet….

Supposedly they’ll be here by tomorrow. The clinic has now been open for the past 4 days, and we’ve seen several Nepali locals and guides, and have diagnosed two people with High Altitude Pulmonary Edema. One has been flown out, and the second is spending the night in the clinic tonight, and will be flown out tomorrow.

We have split up the schedule so every day there is a daytime doctor, a nighttime doctor, and a doctor who is off. The night doc is also responsible for our 3pm altitude lecture, which I gave for the first time today. Our schedule is such that you work each shift twice in a row, which ultimately gives each person 2 days off at a time.

So tonight is my first “night shift”. We’ve had good luck in the past not getting patients during the nighttime hours. We’ll see if it holds for tonight. Tomorrow I will also be on overnight, and then will have two days off. If I get good sleep tomorrow, then Reuben and I are planning on trekking down to the Ama Dablam basecamp, which is at approximately the same elevation as Pheriche, and is supposed to be quite spectacular.

It has been cold, and even snowed yesterday. Our building is powered by solar, with a solar water heater, so our ability to function is dependent upon how much sun we get, and how much we need to use the oxygen concentrators for our patients (our major source of energy expenditure).   It’s kind of interesting to have to be so conscious of our energy use. Many Americans and Westerners would probably be well of to have to live by solar for a period of time to have a better understanding of the implications of power use.

But today was sunny and warm, and we got enough of a charge that I could take a nice, hot, shower. This is the first shower I’ve been able to take since leaving Kathmandu on the morning of March 8, 10 days ago. The good news is that it is so cold here that you never really develop the bad smells that you would in more temperate climates, but I was still happy to wash all the days of travel off of me, and change into some fresh clothes.

Our daily routine is such: Jeet, our cook, has breakfast around 8am. We usually lounge, or work on projects until noon when we have lunch. If it is sunny, one or two people can take a shower after lunch, during the warm part of the day. Then at 3 we have our altitude talk. This usually brings with it a small flurry of business, as people realize that they are actually suffering from altitude illness. Dinner is at 6pm. Yesterday they bought a chicken, which was cooked with the Dal Bhat. I have decided that one determination of whether a country is civilized is how they cut up a chicken. Needless to say, I’ve been carefully picking around jagged pieces of bones here. But protein is still good! After dinner is the real treat of the day: Jeet loads the potbellied stove full of dried Yak dung, and we sit in warmth, the only external source of heat we have other than the kitchen’s gas burners, and the very occasional warm shower. For several hours in the evenings, we relax in the common room in comfort. We are only allowed one stove’s full of dung a day, so when it is done and the room starts to cool, people head towards bed. Renee and I have our bedrooms directly off the common room, so we have gotten in the habit of opening our bedroom doors after the others have left, and letting the remaining warmth of the dung stove heat our rooms before bed.

The following are pictures of the clinic, Pheriche, and nearby Dingboche, which Renee and I visited a few days ago.

The author in a PAC bag, which can effectively increase the ambient air pressure by 2 bar.  In Pheriche (4200m), this  simulates the much lower altitude of Lukla (2800m).

The author in a PAC bag, which can effectively increase the ambient air pressure by 2 bar. In Pheriche (4200m), this simulates the much lower altitude of Lukla (2800m).

Practicing with the PAC bag inside the sun room.  The author is currently inside.

Practicing with the PAC bag inside the sun room. The author is currently inside.

The village of Dingboche, a 30-45 minute walk from Pheriche. It is 200m higher than Pheriche, and quite a bit larger.

The village of Dingboche, a 30-45 minute walk from Pheriche. It is 200m higher than Pheriche, and quite a bit larger.

The village of Dingboche with Island Peak (Imja Tse) in the background (looks like a black diamond).  I am planning on climbing that mountain in May.

The village of Dingboche with Island Peak (Imja Tse) in the background (looks like a black diamond). I am planning on climbing that mountain in May.

Returning home to our small village of Pheriche.

Returning home to our small village of Pheriche.  Hard to see, but the HRA clinic is mid picture.

The Stupa in Dingboche.

The Stupa in Dingboche.

An old Stupa above Dingboche

An old Stupa that sits above Dingboche in need of repair.

The helicopter landing to pick up our HAPE patient.

The helicopter landing to pick up our HAPE patient.

The helicopter taking off with our HAPE patient.

The helicopter taking off with our HAPE patient.

Namche to Pheriche

March 12, 2015

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Namche Bazaar is a transition. It is the end of the world, and the start of Khumbu. It is the last place with a reliable power source, free internet, quality bakeries, and stores where you can buy high quality mountaineering equipment. Although most journeys into the region start at Lukla by flight, or Jiri by foot, Namche Bazaar has always been the embarkation point.

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On our acclimatization day, Katie, Reuben, and I visit two villages further up the hill from Namche: the villages of Khumjung and Khunde. Both villages are known for having green rooftops, to reflect the fertile farmland of the valley in which they reside. From the path to Khumjung, we get our first real look at Everest, Lhoste, and Ama Dablam. The village itself has spectacular views of Ama Dablam, which is one of the most incredible mountains I have ever seen.

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Khunde is home to a clinic whose clientele is 98% Nepali. The doctor who runs the clinic, Dr. Kami, is very famous in the region. It is important for us to visit this place, because this is where we will be sending many of our Nepali patients throughout the season.

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The trek to Khumjung and Khunde is arduous, however, as the snow is melting in the warm air and the trails turn to mud. By the time we make it back to Namche, we are very hungry, and an exquisite piece of apple pie and an cappuccino at one of the local bakeries hits the spot nicely, then we head over to a bar that shows a documentary called “The Sherpas: The True Heroes of Everest” every day at 3pm. The movie highlights a group of Sherpas, and the work they do to prepare the way for Westerners to climb Everest. It is truly remarkable how these people toil and prepare so that people from a far away place can bask in the glory of standing on the highest point on Earth.

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After the movie, we return to the Panorama lodge for some Dal Bhat, which is the local staple. Dal Bhat is a combination of white rice, a liquid called Dal, and stewed vegetables, sometimes with meat. It’s actually very good, and there is always a lot of it, because it is traditional and expected for you to get seconds when you are eating Dal Bhat.

The next morning we have a last delicious breakfast at the Panorama Lodge.  It is more pricy than the other places we stay, but it is well worth it because the proprietors treat you like family.  Before leaving, they blessed us each by presenting us with prayer scarfs to take on our journey with us.

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We start off early to take advantage of the night’s cold to cover some distance before the heat of the day brings back muddy trails. Again transition: below Namche, the terrain was pine forests familiar feeling to many parts of America. Above Namche, the terrain transitions into an alpine zone, where trees become more like tall bushes and life becomes harsher.DSCN0404

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Our goal for the day is the hilltop outpost of Tengboche, which is most famous for its Buddhist monastery, and also has a few rugged lodges for guests. After a long, seemingly never ending, uphill hike, we reach Tengboche. After checking into the lodge, we make our way over to the Monastery to have a look. Respecting the wishes of the monastery, I took no photos inside. The main room houses a large Buddha statue, and places for the monks to sit. The walls are adorned with colorful images of gods and scenes that hold no meaning to me, and I walk away with little understanding of what stories and lessons were being taught on the walls of the Tengboche Monastery.

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The accommodations at the lodge were extremely crude, and the difference in quality between the lodges of Namche and those of Tengboche is striking. However the Sherpa stew is good, albeit being made with some unknown overcooked meat. The secret jewel of the stay, however, was being able to eat dinner watching the sun set on Everest and Ama Dablam. The whole room was silent as we watched these mountains transition from white to gold, to rose.

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The next morning began early. Our porters wanted to be off with our bags by 6am. Their goal was to drop our luggage off at Pheriche, and then be back to Lukla. These three young men make their money carrying goods uphill, and when they reach their destination, they want to spend as little time as possible on the return journey. There’s simply no profit on the way back. Starting early again allows us to benefit from walking on frozen ground, instead of mud.

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The trail continues to get higher, the air continues to get thinner, and the trains of animals carrying goods, so frequent below Namche, has become a rare sight.   Reaching the stone mounds and prayer flags that mark the top of the pass before entering Pheriche is a cause for celebration. We now just have a short downhill hike before entering the town that will become our new home for the next couple of months. The hours cramped in an airline; the days breathing dust and exhaust in Kathmandu; the miles of hiking have all been for this: to reach the Himalayan Rescue Association aid-post at Pheriche.DSCN0477

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