08 October 2014

Ill on the road: The limits of control (Part 1)

When, lying on my back on a gurney in triage at the Max hospital in Saket, New Delhi, I felt something very unbloke-ish slip from the corner of my right eye and trickle down my cheek, the cause wasn't sorrow or regret or that odious emotion, self-pity, but immense gratitude. Gratitude for two things in particular: my family and friends, whose aroha sustains me; and the kindness, compassion, and assistance of people who at least initially were complete strangers. That thought continued to sustain me, and often choke me up, over the next several days while I underwent exhaustive testing leading to an eventual diagnosis of and treatment for a nasty case of amoebic colitis.

Who knows where I picked up Entamoeba histolytica? I'd been persistently unwell since late August, but the parasite might have been biding its time for much longer; conversely, the other, mostly mild, illnesses might have been unrelated. Travelling in India during the hottest, most humid time of year puts great stress on the body, and a stressed body resists infections less effectively than a more resilient one. I'd had a mild cold during late August and that, too, can't have helped. Later, in the UK, something suddenly flattened me: fit and well one day, I ended up shaking, feverish, and asleep the next. My luck held, though, and my aunt looked after me superbly despite being clearly frustrated by my refusal to abandon my onward travel plans. That illness, however, was almost certainly unrelated and probably viral, and I recovered well and in time to travel onwards to Kazakhstan (briefly) and then to Kathmandu.

That's the dilemma of dealing with illness while travelling: do you tough it out and carry on with the plans, trusting the illness will pass (as most do), or disrupt the travel, stay put, seek treatment, and waste precious time? In my case, I suspect an early diagnosis would probably have been inaccurate because the symptoms were mostly nebulous, and the treatment would have been similarly ineffective.


The acute phase begins after the first day of a trek into the Annapurna Sanctuary. After the earlier illnesses, and considering I've lost a frightening amount of weight, I've been apprehensive about my ability to handle the walking, but the fear proves unfounded. I pace myself well, my legs and lungs handle the sometimes steep ups and downs easily, and I find my spirits lifted by the environment through which we walk. This, I think, will be what I need.

What I don't need, though, is the evening's vile meal: bitter, indeterminate vegetables fried with stodgy, greasy noodles. I wake in the night with a stomach ache, a headache, and feeling unwell, and by morning I realise continuing further towards the Sanctuary is out of the question. If my condition worsens, I'll be in serious trouble, two or more days' walk from the nearest road. I pull the plug. We walk out via the river trail and catch a bus which, for the first hour, creeps along a jeep track at about walking pace. I don't mind; shattered and unwell, I simply sit back in my seat and gaze out the window. Somehow I still manage to find joy in the sight of small, golden-brown dragonflies thronging over brilliant green paddy fields; at the diverse and abundant butterflies flitting and bobbling everywhere; at waterfalls plummeting from the mountainside into wild little streams that surge across the track; and at shacks of all descriptions -- fowl houses, storage sheds, simple shelters, and homes, sometimes with little to distinguish one from the other. The journey back to Pokhara takes about four hours.

Medical treatment in Pokhara is unreliable -- misdiagnoses of pathology samples are reputedly common -- so I take it easy for a few days. At times I find myself literally running with sweat but have no way to tell whether this is the result of fever or simply the heat and humidity -- power, and therefore a cooling fan, is unavailable much of the day in Pokhara because of Nepal's load shedding programme. Well-spaced doses of paracetamol + codeine, interspersed with ibuprofen, keep the headache, and perhaps the fever if that's what it is, under partial control while I try to decide what to do. Eventually I book a seat on a bus to Bardia National Park in the far west of Nepal, thinking I'll stop there for a couple of days then cross back into India and head for Delhi to seek treatment if I'm still unwell.

A well-regarded travel agency sells me a ticket on a bus and says it will take about eight and half hours to get to Ambassa, the transfer point for Bardia.

It takes thirteen hours.

Thirteen hours of hard travelling.
Thirteen hours of having the two different passengers in the seat next to me squeezing up against me, using my shoulder as a rest for their greasy-haired heads.
Thirteen hours of loud, monotonous, mostly similar-sounding Nepalese pop music that relies heavily on excessive use of violins and male-female duets.
Thirteen hours of humidity and sweating.
Thirteen hours of trying to find a position not uncomfortable enough to prevent sleep.
Thirteen hours of trying not to think about the time.
Thirteen hours of resignation and patience when the bus stops yet again.

At a stop in the dead of night, I get off to stretch my legs and stumble towards the rear of the bus. A woman dangles her baby through the window into the cool of the night, and it looks at me, astonished by this thin, pale apparition. I smile and wave. No response. I try again, and from the dark in the back of the bus I hear the mother laughing; she picks up the baby's hand and waves it back. She laughs and says something to her child and we wave at each other, and eventually a wide smile transforms the baby's face.

It transforms my heart, too.

At Ambassa I transfer to a jeep, which bumps slowly along a track and crosses a river bed. An enormous and beautiful owl sits on a rock in the shallows; it turns its head to regard us then lifts into the air and flies into the night. Despite the noise of the diesel engine, the owl's soft, silent flight is almost palpable.

Further along, we see two wild boar by the side of the road, and my excitement mounts -- already we're seeing wild animals. What else might be next?

Nothing. Dogs, a few people, buffalo, cattle. At the lodge, I'm so tired I go straight to my room and sleep for three hours, which in retrospect is nothing like enough to recover enough energy for a guided walk in the afternoon, a walk which turns into a nightmare.

Just an hour into the walk I realise this is a mistake. I must turn back, I tell the guide, but he insists that just a short way further on is the best place in the park to see tigers. Persuaded, I agree to continue, and a few minutes later I'm rewarded -- not with a tiger sighting, but with a close view of three giant hornbills. The guide gasps, and clasps my shoulder.
  'You are a lucky man,' he says, explaining that to see a giant hornbill is far rarer than seeing a tiger -- he hasn't seen a hornbill for six or seven months.
Later, the lodge manager confirms this. I try to feel lucky, but by now I'm having difficulty concentrating on anything other than staying upright and mobile.

The best place in the park for seeing tigers is occupied by people working with elephants. Much shouting and noise; no tigers. We walk downriver to a quieter spot and wait for tigers to come and drink and bathe. They don't. I feel a pinprick on my ankle, reach down and instinctively pick off the agent -- a leech, which hadn't yet fastened itself to my leg. When the elephants leave, we return to the lookout tower, which sways alarmingly. I step backwards and just manage to skip sideways to avoid falling down the unprotected stairwell. Things aren't going well.

We do see an adolescent rhinoceros come to the river to drink, but it's a long way off and dull in the hazy afternoon light. Nothing else noteworthy appears.

How I manage to walk back to the lodge remains a mystery -- sheer force of will, probably; a determination to keep putting one foot in front of the other. The guide slows to explain how the tower we're passing is called the Deer Tower; others are called the Tiger Tower, the Elephant Tower, the Rhinoceros Tower, and so on. I think to myself, 'I don't give a rat's arse what you call them, just keep walking,' but of course I politely say, 'O.K.,' unable to expend the energy to think of something more intelligent.

At the hattisar, the elephant stables, I now know I'll make it, and I allow myself the luxury of stopping and leaning on my bamboo staff to rest. The half blind rhino eats his evening meal at the fence of his enclosure, so close I could reach through and touch the monstrous beast, but because I know he's already killed someone, I don't.

I spend the next day trying to recover, and failing. The tiny amount I manage to eat runs straight through me and I know I'm weakening rapidly. By evening I know I'm in serious trouble, with no Internet access, at least three hours from the nearest airport, and with only enough cash to buy bus tickets but not flights -- and I wouldn't survive the necessary bus journeys.

I talk to the lodge manager and arrange a jeep trip to the closest airport, at Nepalgunj. He has a travel agent friend who will try to arrange a flight to Kathmandu, he says; be ready to leave at 7 a.m. I pack almost everything, manage to survive the night, and shortly after 5 a.m. comes a knock on the door. The lodge manager's ready to go, and within minutes, so am I.

The jeep crawls towards Nepalgunj at 40 km/h, even on the black top, but eventually we arrive at the airport. The travel agent has not only booked a flight to Kathmandu, but an onward flight to Delhi;the catch is that I have to endure a gut-battering ride on the back of his motor bike over a rough road through clouds of dust and filth into the city to find an ATM that will accept one of my cards. The first accepts neither, but fortunately the second allows me to draw out just enough to pay for the flights. Then it's back on the motorbike for another gut pounding and filth drenching.

We get back to the airport as the plane takes off.

The young travel agent works wonders, though, and gets me on the next flight, less than an hour later. At the gate, a young man who looks distinctly Tibetan chats with me. He and his companions have just completed a trek in Lower Dolpo, to Phoksumdo Lake. The route Schaller and Matthiessen took on their journey to Shey! I feel a twinge of envy but know I could never have managed such a journey with this illness so the envy's minor -- instead, the overriding feeling's one of delight at talking to this kind and interesting man who's just been where I'd have loved to go. He asks about me and I explain my situation; he expresses concern and reassures me we'll get to Kathmandu in plenty of time to catch the flight to Delhi. Kindness like this brings a lump to my throat and at times I struggle to retain my composure. Emotions are very close to the surface, but I manage to avoid embarrassing myself; more importantly, I avoid embarrassing him and others nearby who would no doubt feel hugely uncomfortable at the sight of a haggard, filthy foreigner wiping tears from his grimy face in the middle of the airport. 'Get a grip, mate,' I tell myself, 'harden up,' and that blunt, down-to-earth, antipodean stoicism saves me on more than one occasion.

Later, in the hospital, I think hard about all the apparent indignities I've been put through, which have turned out to be nothing like as undignified as I would have expected. On the other hand, bursting into tears in public would have been as undignified as anything I could imagine. I find myself wondering about dignity, and while convalescing, I discuss this via email with  my aunt, and in person with the friend who's provided such wonderful, tangible support here in Delhi -- recommending the hospital, collecting and storing my luggage, arranging transport and this marvellous place to recover, extracting me from the clutches of the hospital's administration system after I'm supposed to have been discharged (more about that later), running errands for me, and much more. Dignity -- the concept seems hard to pin down, perhaps because I'm unsure what questions to ask, but my initial feeling, and one I still think comes close to capturing its essence, is that it's the gracious acceptance of what's necessary. That certainly describes what I feel was my reasonably dignified response to some of the diagnostic procedures I was subjected to -- but how does it explain why I'd have felt such a loss of dignity, such mortification, if I had, after all, broken down in the airport? Necessity and acceptance would have had nothing to do with that situation, if it had happened.

Perhaps dignity depends on understanding one's limits and capabilities. In an early email my aunt suggested it might depend on self-knowledge and 'the ability to be true to yourself in changing, sometimes diminishing circumstances'. Often this manifests as the appearance of reticence, or a distancing of oneself from the situation; sometimes it can cross the line into the kind of aloofness that can appear haughty, which may or may not be deliberate. Usually, I imagine, it's simply that one doesn't know any more appropriate way to react other than to do nothing, and this kind of unresponsiveness can be seen either as dignified or haughty.

But, perhaps a well developed understanding of oneself is not always necessary in order to act with dignity. For a start, how well do any of us really know ourselves? Someone who agonises much less over these things might have only a vague idea of their capabilities and limits yet still have an entirely healthy sense of self-worth that allows them to act in a dignified manner. Put simply, 'I might not know much about myself, but I know I'm just as worthwhile a person as anyone else.'

My friend suggests a distinction: one kind of dignity relies on a justified (and not inflated) appreciation of one's own worth; another relies on knowledge of appropriate behaviour in particular circumstances, especially in cultures that differ substantially from one's own. For all I know, if I'd broken down at the airport, I might immediately have been surrounded by people wanting to comfort me, by people who saw no loss of dignity in what I'd have perceived as mortifying weakness but who instead welcomed the opportunity to support a fellow human being.

At Delhi I'm so weak I can hardly carry my bags, and although my main pack weighs a mere 9 kg I resort to a trolley to wheel it to the Metro. Crossing from New Delhi Metro station to Pahar Ganj requires battling the crowds fighting to get through the security check, and without shame I jump the queue and elbow my way through. I take the quieter, back way to the Smyle, where the recognition and obvious delight on the faces of the staff lifts my spirits after this punishing, twelve-hour journey. They have no room for me, but the manager arranges one -- quiet, dark, clean, with a fan and a/c, and reasonably priced -- at a hotel just around the corner, and gets one of the staff to carry my bag there. Here might not be home, but I'm close to friends, and treatment is no more than a night's sleep away. For the first time in days, I begin to feel safe.

1. Part 2, about my time in the hospital, is on its way, but I can't promise how long you'll have to wait.
2. '...whose aroha sustains me..': The concept of aroha's a little tricky to pin down, but it's better than the word 'love', which is almost useless unless qualified.
3. '...The route Schaller and Matthiessen took ...': Described in Matthiessen's remarkable book, The Snow Leopard.

1. The guest house where the acute stage first manifested.
2. Annapurna South the following morning.
3. Pokhara night life.
4. The yearling rhinoceros at Bardia National Park.
5. This lizard in the garden at the Bardia Jungle Cottage had just gulped down a small ant.
6. The first day after being discharged from hospital. Nothing left in the tank. (Actually happier than I look; just worn out.)

Photos and original text © 2014 Pete McGregor


Relatively Retiring said...

Sorry that the frustration was so evident, but even you would have to admit that it was understandable.
I can hardly bear to read what happened next.

Barbara Butler McCoy said...

This leaves me rather stunned and speechless. Perhaps a prayer of encouragement and thanksgiving on a Tibetan prayer wheel would do, but here in Atlanta that sort of thing is scarce. (There are Buddhist monasteries, and the Dalai Lama has visited several times, in part to advance the Emory-Tibet Science Initiative.) In any case I am glad you found respite, with your aunt, in hospital, and now decent lodging. Wishing you Well.

pohanginapete said...

RR, not only was it understandable, it was justifiable. I probably overstated it, too -- I thought you were remarkably tactful, and I still can't believe I was so lucky to have you looking after me when I needed care so badly. I'm so looking forward to visiting again under better circumstances!

Barbara, thank you. I appreciate any kind of good wishes, irrespective of the manner in which they're conveyed! The prayer wheel does seem very appropriate, though ;^)

Zhoen said...

You fell into a time slip to a medieval journey. Gods, you are emaciated. Pour on the eggnog. So much weight loss means your brain isn't working properly.

In my patients, dignity is the apparent attempt to be brave and hold together. Not necessarily achieving it, but doing one's best. Tears don't count. By that standard, yours is intact.

Ruahines said...

Kia ora Pete...I have always admired the dignity you show in things such as the patience in brewing up your tea in a Ruahine hut, or explaining your knowledge of the bird, insect, and plant life without condescension. It is a rare quality. To know the value of a look of concern, or the tone of it, or the mere feel of it, must be an extension of that. To still be able to recognize the beauty within small moments of such physical and mental agony, to me, is both dignity and inner strength . Maybe they are the same. I must write I had a few tears when I saw that photo of you at the end. I wanted to give you a hug. The camp oven will be full...
Something tells me the song of the whio would do you much good..Rest easy and travel safely as is possible. Kia Kaha e hoa...

pohanginapete said...

Zhoen, I'm still emaciated but recovering slowly. It'll be a long haul, though. In fact, I'd lost so much weight I was beginning to scare myself with the thought of organ failure. I hadn't thought of eggnog, but it sounds appealing (when I get back to NZ, though -- I wouldn't touch egg here unless it's cooked).
Thanks for the reassurance that my dignity is intact. I'm still pleased I didn't break down completely, though.

Kia ora Robb. Your comment reflects precisely the kind of aroha I was referring to: the kind that kept me going through those difficult times. I thought often of you and Tara, and still do. See you soon, e hoa!

leonie said...

Wow, Pete, thats quite the story and not a chapter I imagine you were happy to experience, let alone write about!

I love following your travels and am sorry they came to such an abrupt, and physically troubling halt. I am glad you are on the mend. Hoping you regain the weight and are fully well again soon.

Safe travels from now on

pohanginapete said...

Leonie, thanks for the good wishes. I'm recovering well; today, after a good night's sleep, I feel noticeably improved. The journey has been entirely unlike anything I'd expected; however, I've learned a great deal and will be the better for it. Perhaps surprisingly, I've been happy to write about it -- I've had to think hard about what I want to say and work hard on how to say it. Anything that forces attention to the substance and craft of writing is worthwhile. Besides, I had no choice in what happened, so I'm glad I could turn it into something that might prove worthwhile, even if only as mere entertainment, for others. :^)

Brenda Schmidt said...

So sorry to hear you've been so ill. What a moving read and an evocative consideration of the matter of dignity.

pohanginapete said...

Thanks Brenda. Well over the illness now, and I'm regaining my strength rapidly. I've been lucky.