preemies

i can’t get the smell of the gloves off of my hands.
__________________

“bon dia.”

i heard a female voice chirp behind me. i had been idly browsing Facebook, basking in the lull that occured after morning rounds and before lunch. i spun around in my chair to find two middle-aged caucasian women waving cheerily to me. “Margaret,” one of them said. “do you know where she is?”

i sat there for a second, blinking stupidly. “oh, you’re here to see Margaret. okay.” I thought at first that they were Timorese patients, poking their heads into the office in search of a doctor. i realized they were just Australian friends of Margaret’s, probably here to take her out for lunch. i beamed back at them. “come with me.” i got up from my chair, and beckoned from them to follow me out the door. the maternity ward was just a ten second walk away.

as i approached the doors, i remembered that the attending doctor was in maternity too. she had been called away just minutes before by a midwife, asking for help from a doctor. but as i got nearer, it was Dr. Dan who came around the corner, muttering to himself under his breath. “twins. two of them. but the first one’s only 500 grams. five hundred. it’s too small. too small.”

my brain didn’t register what he said at first. i was still on a mission to find Margaret. the short, sassy australian woman was one of several international volunteers here at the clinic today. she was a midwife by training, and had delivered countless babies at the clinic. i started to enter the first door on the left, but from the doorway i could already see her, carrying something wrapped in a pink blanket with gloved hands. she met my eyes for just a moment, then turned back to the item in her hands. i stopped, and spun back around to address the two women standing behind me. “she’s, um, delivering a baby right now. you can come in,” i began, gesturing towards the room, “or you can just wait out here.”

now it was their turn to stare blankly at me. then they realized what i had just said, and both of them started to laugh nervously. “no no, we’ll, uh, just wait out here.” they quickly backed up further down the hall, and i smiled grimly back at them. i had never seen a birth. i wondered if this would be it. i entered the room.
___

she was lying there, naked, on a black leather delivery table. there were no fancy machines surrounding her. there was no doting father with a camera who’d attended hours of birth classes with the mother. there was just a woman lying there, in the middle of the birth room, as midwives and nurses milled about. the first baby had just come out. it was only seven months old, and weighed 500 grams. it lay there, wrapped in blankets beneath a heat lamp, making faint breathing sounds. it was dying.

intracranial hemorrhaging. sepsis. necrotizing enterocolitis. these were all serious problems with babies born at 1.75kg or lower. after all, low birth weight is one of the most common indicators of high infant mortality. i had studied that in classes at Brandeis. but 0.5kg? two months premature? what could we do?

his arms were as thin as pencils. his tiny feet were smaller than the nail on my thumb. and his toes. his toes were the size of grains of uncooked rice. his eyes were still shut. i wondered how it would have felt to have looked that baby in the eye.
___

tiny. he was just so, so tiny. his nostrils were only partially formed, and he was fighting for air. the attending doctor explained to me that the grunting, wheezing noise he made was the sound of him fighting to keep his airways open. if he were to try and take a deep breath–if he acted like a full-term baby, and tried to breath properly on his own–his airways would shut for good. he would go into respiratory failure, because he isn’t capable of opening his airways up yet. “at home, we’d intubate him. we’d intubate him until he at least until he was 700 grams. but here, there’s nothing. absolutely nothing. we can do nothing.”

his ribcage kept thrusting in and out. if this happened to an adult, i’d have thought his chest were about to explode. but the bones weren’t even fully formed yet. the lungs must have been the size of dimes. in and out, in and out. churning like a living, breathing machine. but he had no chance. he was too young. he wouldn’t last the day.

she held him in her arms, warming his body against hers. he couldn’t self-regulate his temperature, and needed to be kept wrapped up. his head was especially important. we needed to keep him warm and comfortable.

there was still a bulge in her abdomen. “twins,” i remembered faintly. she was giving birth to twins. the first umbilical cord was still clamped on the tray in front of her. the clamp handles dug into her thigh, but she didn’t seem to notice. the midwives were speaking to her in Tetum, but i couldn’t quite understand it. “push,” they must have said. “push.”

the second baby crowned. a minute later, it was out. a midwife pulled it out, cradling it in her arms. but it was already dead. it wasn’t fighting for breath like the other one. it just lay there limply–decidedly human, but at the same time not quite there yet. the midwife turned away, cleaning it off. this one had no chance.

there was blood, of course. so much blood. both clamps were now dangling in front of her, hanging over a growing pool of blood. the placenta came out next, sliding onto the tray with ease. a nurse wiped the remaining blood off, wrapping everything up in a blanket. the blanket went into a plastic bag, and a sheet went over the mother. the hard part was over now. both of them were out.

“i don’t know if she wants to see the other one. some mothers need to–they need to look at it for themselves. but others don’t. and i don’t know what she wants. here, it just happens so fast.”

the attending doctor had already taken off her gloves. the only other gloved woman in the room was standing over the still-breathing baby, putting its hands and feet in mittens. i didn’t mind. after all, i came here expecting–no, hoping–for delivery room experience. but nobody expects something like this. nobody walks into the maternity ward expecting to witness a scene like this one. and absolutely nobody would hope for this to ever happen. not like this. not to this poor, poor girl.
___

its head was so big. disproportionately heavy, even for a baby. i wrapped it in a soft, baby-blue blanket. “watch the head,” the attending doctor kept telling me. i repeated it to myself, over and over again. watch the head.

this one felt even lighter than the last. not even 500 grams, perhaps. maybe not even a pound. i held its body with one hand, cradling its head with the other. it was just a few feet to the mother, but it felt like so much longer.

she watched silently as i laid it on her chest. she held it to her bare left breast. for a minute, she just stroked its face with her index finger. such a tiny, precious thing. so fragile, and so innocent. but soon, she started crying.

what could i say? what could i even think? even if there wasn’t a language barrier–even if this was america, or australia, or england, or even indonesia–even if we could have put one these children in an intensive neo-natal care unit, maybe given them a chance–what could i possibly hope to do here?

for the second time in maybe half an hour–good lord, it seemed like ages ago, that Margaret’s friends had come into the office asking for her–i simply didn’t know what to say. this time, i could blink and smile; i could pat her arm. i could hand her gauze to wipe away the tears. but i couldn’t say anything to her. nothing i said could comfort her. at the time, i didn’t even have the will in me to start praying.

i gently touched her hand, motioning towards the other baby. she nodded back at me silently, tears still shining in her eyes. i took it back up into my arms, carefully cradling its head just like before. off you go, back to under the heat lamp. next to your brother. back to sleep.

i laid him back down on his mother’s chest. we pulled the blanket back from his face, taking care to keep his head covered while exposing his cheek to his mother. remember, skin to skin contact was so important for preemies. it keeps them warm. the new mother’s skin, keeping her newborn baby warm.
___

the midwives could feel another mass in her abdomen. it was too oddly-shaped to just be her uterus. a third one? a triplet? none of us were sure.

but this one–the one who still lived–he was fighting so hard. he wanted so, so badly to live. but we knew we wouldn’t. at the end of the day, everyone knew, despite his fussing about, despite how hard his chest heaved in and out with every breath–that he was going to die.

a lab tech came in to draw blood. they needed her hematocrit, to make sure she hadn’t lost too much blood during the birthing process.

he tied off her right arm, and found a vein. the needle went in, and the blood came out.

she didn’t even notice.

she just lay there.

i asked the attending doctor if she’d had an epidural.

she responded flatly, gently–with no hint of sarcasm or malice in her voice.

“i think she just has other things on her mind.”

stories from bali part 2

Rosli and Hamid met us in the morning. We hit up a PC Cafe (speeds of < 1mbps for 4000 Rp. ($0.40) an hour….lawl yes plz) to send some emails and blog a bit, then grabbed a three hour lunch at the hotel restaurant.

the street outside the hotel

I couldn’t believe how chill Hamid and Rosli were–they basically were spending their entire days with us, chilling in the hotel restaurant, scootering us to the currency exchange office and to the airline ticketing office…they were just living their lives in Bali, taking life as it came, and enjoying things for what they were. They came from the same tiny village in Mudoora–a tiny island off the coast of Java, ten hours into the dense jungle–but had both made it in Bali for sure. Rosli had never been outside of Indonesia, but owned his own tailoring/clothing shop. He was doing quite well indeed. Hamid had been to Singapore once with his friends, but bemoaned the $500 cost for an Indonesian visa to Australia, even though it was just a few hours to Darwin.

We started talking about health care too. Hamid admitted that a legit doctor’s checkup could cost as much as $90 USD, and that whenever he got sick, he usually just slept for a few days instead. After all, if the doctor cost so much money that he couldn’t afford food, what was the point in going? Pretty sad stuff, bro. He was young, healthy…and smoked a couple of packs of $1 Marlboros a day -___-

After lunch, we decided to take Rosli’s advice, and to visit the temple on the mountain to see a traditional Muslim Balinese dance.

The problem was, how would we get there? Would we rent a car for 200,000 Rp.? Could I rent a scooter for just 100,000 Rp. and drive there? “Suuuure,” I thought. Can’t be THAT hard to learn, right?

False.

We spent the next couple of hours derping around in the narrow alleyway that led to Cantik. It was a bumpy stone path, probably not ideal for learning how to drive a 150cc scooter, but oh well. Way, WAY harder than it looks–I kept almost tipping over, and drove as jerkily as a fifteen year old in driver’s ed–but it was fun nonetheless. We ultimately elected to ask one of Rosli’s friends to accompany us to the temple. It was a 30 minute drive, he said, and promised it would be pictureesque. It was.

As we drove up and down the winding mountain roads, Rosli pointed out a sign for “Bvlgari Hotels and Spa”–a 25,000,000 Rp. ($2,500+) for the cheapest rooms. They apparently carved out a resort into the side of the effing mountain. Ridiculous, this island.

The temple was known for its beautiful views–and by gum, was the view effing amazing. No guard rails, no safety nets, just a sheer drop to the rocky beach below. The sun was just setting as we walked from our scooters to the temple path.

this view was sort of a big deal

A monkey stole a guy’s wallet, hid under a truck, and refused to be coaxed out by bananas and crackers. Hilarious to watch the poor Chinese dude try to argue with a monkey. More striking and less hilarious was when a dude’s glasses were stolen by a monkey, who proceeded to perch upon this post. Looks like a scene from a movie.

*anime music plays in the background*

how can you argue with that kind of creature?

These monkeys had NO fear of humans whatsoever. They literally ran up to you as soon as they saw something dangling, trying to snatch it up. Fortunately, by the time the rather intense Balinese dance was over, they had all gone to bed as Rosli said.

om nom nom i’m a monkey

LOOK AT ‘THEM FANGS

The bike ride back was pretty uneventful. I rode with Rosli as usual, almost getting squished to a stone wall by a passing bus. I asked Hamid to take me to a liquor store to “buy something for my friends in Dili”, but ended up picking up a bottle of Johnie Walker Red for Rosli instead (wtf $50…you can get like Double Black label for $50 in the U.S…). I had already brought a bottle of Burberry Touch cologne for Hamid 8D

The night came and went. Lisbeth woke us up at 6:58AM, two minutes before our alarms were to go off–typical of her–and we were surprised by a knock on our door from Hamid. He was awake so early! And Rosli was there with him! We paid for the hotel and dragged our suitcases down the stairs, met by the warm glow of the early Balinese sun. The street was already bustling at 7:30AM. Rosli called over his friend to drive us, and we were at the airport in five minutes–a far cry from the 20 minutes in congested traffic that had greeted us on Saturday afternoon. We bid goodbye to Hamid and Rosli, promising to see them again in seven weeks and thanking them for spending their entire weekends with us. Hamid said that hard liquor was “too hot” for his taste (he preferred good ‘ol Bintang beer), but I didn’t know how he’d like a bottle of cologne. After all, people sweat a LOT in Bali…

Oh well. I’ll ask him in August how he liked it, I guess. That’s when I’ll learn to drive a scooter properly.

stories from bali

Hamid met us right at the airport. It was the first time we had ever met each other. We had been introduced by his friend Husin, who was introduced by my friend Anthy from Brandeis. Unfortunately, the day before we flew out from Boston, Husin emailed me saying he was stuck in Java, and that on top of that, he was sick. Great.

We landed in Bali and immediately called up Hamid. Well, not immediately…the country code for Indonesia is +62, but the number we were given started with “08”. After like five tries, we ended up getting a TEXT on Lisbeth’s international phone (lawl $0.40/text, $4/minute back to the U.S.) from Hamid: “hello bro i am waiting outside in the pickup with a sign that says max”.

LAWL OOPS. We called him up, but his English seemed to be too poor (turned out his English was fine! He was just shy, and not confident in his speech) to understand that we had to 1. get visas 2. get through immigration 3. hit up customs. An HOUR later, we waded through the crowd of taxi drivers and tour guides (taksi? TAKSI????) to find a dark, skinny fellow with skinnier jeans and gold-streaked hair. I hugged him immediately, apologizing profusely for making him wait so long, but he would have none of it. “We need taxi?” he inquired tentatively, pointing at our three bags each. I nodded. “Yeah, should we find one?”

“Mm, I find. You stay,” Hamid replied, putting a reassuring hand on my shoulder. I towered over him and the rest of the Balinese men, my 6’1″ build eclipsing Hamid’s 5’6″ ish frame. However, in this country, we were truly at the mercy of the locals and of our wallets. We could easily have hired a tour guide from among the many, many men crowded there. But then we would have paid hundreds of dollars a day perhaps for the fancy beach hotel, tourist trap food, and the cost of rip-off taxis.

Instead, Hamid introduced me to Iwayan. He was a cheery fellow with very limited English, but enthusiastically helped us load up his stick-shift Chevorlet sedan. Hamid suggested Jesen’s Inn I, one of three hotels (I, II, and III–original, I know) in the same area. They featured hot AND cold water (omgosh), western toilets, and air conditioning. AIR CONDITIONING. And it wasn’t going to be insanely expensive, either.

We made it through the horrendous Balinese traffic, convinced we would be killed at any moment by the insane driving of Iwayan and his fellow taxi drivers. Jesen’s Inn turned out to be just 400,000 Rp. a night for two beds, a slightly-functional fridge, A/C, shower, and western toilet. Plus, we got 15% off at the restaurant and pub downstairs! WOOHOO.

oh hai Hamid

our friend Rosli

After dropping off our bags in our room and LOCKING the door behind us (*shifty glance*), we went off to lunch on the beach with Iwayan and Hamid. We ordered ten bottles of water and…all that effing food you see in the picture. And it was all delicious. Fjfkd;sajfaf. The rest of the day was spent walking on the beach, learning about Bali from Hamid, and eating an amazing dinner (washed down with DAT BINTANG…MMMM MM) at the hotel’s restaurant. Hamid’s boss–yep, he worked at a tailor/clothing store just across the street from the hotel–even dropped by to say hi. Rosli. And HE had amazing English, plus a smile that could charm the wings off of a butterfly. No wonder half of the restaurant knew him by name and had already ordered tailored suits and jackets from him, lawl.

We passed out by 9pm, full of good food, happy from the good company, and exhausted from the jet lag. Welcome to the other side of the world.

getting from A to B

Most of, if not all taxis, have the tops of their windshields blacked out with tape, cardboard, or plastic. “To keep the sun out, and the inside of the car cooler,” they say. FM radio transmitters blare out Beyonce and Don Omar with gusto. The speakers usually have the dirtiest bass ever.

lulz, “beik sa”.

lizzy…maguire?

okay, seriously, how is this legal. 55%+ of the windshield is obscured.

The inside of the cab will usually have a Mother Mary statue stuck to the dashboard, plus some prayer beads hanging from the rearview mirror. Most of the time, the design theme is Portuguese or Brazilian soccer. This particularly taxi had a rather unique interior design….

BRANDEISSSS

I take that back. This taxi–which took us all the way from Bairo Pite, to Tibar, to Comoro, back to Bairo Pite–takes the cake.

d’aww Keroppi sofa tissue dispenser thingie

and Keroppi seatbelt sleeves!

Microlets are popular as well. Only ten, twenty cents per person, and you get to feel the bustle of Dili’s traffic swirling around you. Young men will always be seen hanging out of the microlet’s doors, smoking cigarettes and texting friends. While traveling at 40km/h. Holding on with one hand. Ah, so safe.

holy sprit? .____.

SWAG

COMPLETELY SAFE.

However, no matter what anyone in the West says, motorbikes are definitely the way to travel. I learned to ride while in Bali, whilst hanging out with locals in a narrow stone alleyway. With wind whipping around you, sticking your shirt to your chest–feeling each and every bump reverberate through the tiny scooter’s frame–hanging on for dear life as your driver weaves between reckless taxis and lumbering U.N. trucks–you can’t help but yearn for an experience like this in the States. It’s a beautiful thing to cruise around town on a Boston summer night–windows down, blasting music without a care in the world–but you can’t help but wish for the same two-wheeled experience that you get in Asia.

taken while going ~30mph shot backwards on the back of Zario’s bike, haha.

Oh well. Maybe after college; maybe if my family’s Honda Pilot ever breaks down. Hah.

dreaming of home

I think this is a scene from 2010. It’s winter, and we’re all standing together on a balcony. Or maybe we’re lined up side by side along a wheelchair access ramp. There’s snow lightly falling silently in the darkness just beyond the awning. Dim orange light spills down from a lamp overhead. I don’t remember how many of us were huddled together, but there are at least five ICFers there. If this is back in 2010, then maybe it’s at Toah Nipi.

We’d have all just arrived at the retreat site on a cold Friday night in February. Every one of us wearing thick winter coats. Grey and black, peacoats and snow boots. Jeans that were too thin for the weather, already wet at the ankles with snow. Cream-colored wool scarves and white knitted beanies to keep our ears warm.

But really, it’s the glowing bond of fellowship and the emanating warmth of our laughter that keeps the cold at bay.

I wonder what we were laughing about.
___

The sun is setting. She’s standing in a grassy field, with the golden sunlight streaming through the trees nearby. The late-afternoon sky glows warmly, but she glows brighter still. Her smile lights up the field. If this is real, then almost an entire year has passed. But it’s still June, isn’t it? We’ve still got two months to go. Then this must be a dream.

As I walk closer, I notice that she’s wearing a simple but elegant yellow blouse. It looks new. Well, is it really new, or have I simply never seen it before? I can’t say for certain. A lot can happen in ten months. Twelve months. A year. Wow, it’s been a year. One whole year. Neither of us can believe it. We laugh and reminisce. What were we thinking? Young and foolhardy. Making promises neither of us could keep.

We’ve each found someone else. We’re both happy, at least in this moment. The song “One Day” by Jennifer Chung flashes through my mind. Is this what it’s like to write a song with someone in mind? Is this what it’s like to hear a song, and realize it was sung for you? It must be sad.

The sun hasn’t moved in the sky.
___

The taxi ride took fifteen minutes. The other passenger was let off on the beach, down by the coconut sellers and open-air vegetable stands. Campaign billboards and Timorese flags dot the rooftops and the sides of the road. We pull off the main road, off onto a side street, and I ring my friend. I’m a bit early; I left during the middle of morning rounds, after all. He’s surprised to hear my voice, but cheery nonetheless. He instructs me to continue a hundred meters up the street, to a big red gate. After the curvy bit of road. I see his head poking out. Aha! I hope I’m not under-dressed.

The compound is clearly still under construction. I meet other members of the church, from D.C.–Boston–Korea. Oh, you know such-and-such? I know so-and-so too, of course! He’s coming to Timor too? In August? I hope I can see him before he leaves. Yes, he overlapped a year at Brandeis with me. I’m not sure where he is right now, maybe medical school?

We enter into the living room. There are two dozen cushions lined up in a semi-circle. A projector too. I see Bibles, guitars, a veiled upright piano. Are we still in Timor? This feels like I’m back at a church in Boston. I spot another friend from the clinic, seated on a cushion in the front row. We smile at one another, and chat about our patients. Soon, more brothers and sisters trickle in. Some have studied at Bentley; others have worked at B.C. All of them have lived in Boston. They talk about a new H-Mart location opening in Central Square. We all laugh about H-Mart’s legendary presence in Burlington.

I don’t have to try and smile nervously anymore; I’m beaming from ear to ear. Who knew this kind of community existed here?

Worship is led by a single acoustic guitar. There are no amps, no mics, no drums. We crescendo to the chorus of Reign In Us, and I feel the Holy Spirit course through my hands. It feels like so long since I listened to worship music. But it’s only been a couple of weeks, hasn’t it? Two long, hard weeks.

The sermon comes from Matthew. The Parable of the Talents. The last time I studied this passage, it was in the context of men on Wall Street using it as justification for their reckless investments. The Pastor reads from the NIV, and I follow along with my ESV Bible app. I spot a couple of iPads being used nearby. Even in a country like this, we cling stubbornly to our technology. But sitting in this room, surrounded by this people, soaking up this sermon, I can’t complain.

They invite me to lunch. There are SO many kids. Each one cuter than the next. They introduce themselves with Biblical names like Isaiah, Abraham, and Samuel. One of the kids tells me he’s the son of someone I know. I look up. Whoa. My friend–the man who greeted me at the gate–he has a kid? The sassiest, bounciest, most talkative kid out of all of them? Go figure. I tell him to study hard, to become a wise doctor like his father. He giggles back at me.

The taxi ride back flashes by in an instant. The clinic is locked. The other volunteers have gone home, or have gone to the beach for the afternoon. I trundle home by myself, ambling my way beneath the hot afternoon sun.

I wonder if this, too, is a dream.

bele foto?

Oscar mike to Tibar.

Tia: 1, Parkinson’s: 0
BYAHHHH. Look at that beautiful walker too. Custom-made, son.

 

med students Crab & Josh

our dashing young interpreter Natto DJesus

chicken coop at Tibar

 

This is a random shot taken out of an ambulance window. It’s off the side of the road. No joke.