JUN-B-5
THE EVENTS FOLLOWING ARRIVAL OF A JET-LAGGED GROUP
IN SIMLA, A “HOUSE CALL” ON OFFICIALDOM, AND SETTING UP
A LECTURE IN THE IGMC MEDICAL COLLEGE DESPITE LACK
OF MY BAGS LEFT FOR READY ACCESS” IN DELHI,
AND THEN ANOTHER CONVOY TO NARKANDA, HIMACHAL
June 14-15, 2002
Our group has now gathered in Simla, and it seems “all hands are on deck.” There may be more hands than anticipated or needed of the kind competent to run through 1200 or more patients, and already there is evidence of interference from the dead wood that I knew would be a non-contributor, but now I learn that he has plans to steal the product of all the efforts I have put into the extensive journalism of my Himalayan experiences.
After arrival at Delhi around 1:30 AM local time (who knows after 11 ½ hours taken off the watch what time that might mean on “biologic clocks?”) we had to spend over an hour filling out claim forms for Michael Eiffling’s stepson Blake’s missing backpack. Only coincidental to this process did we discover that the duffel bag and Action Packer I had hurriedly re-packed on departure from Kathmandu and carefully left with the Delhi travel agent to have readily accessible for this trip was not available to accompany us on this train and convoy north. It was for this reason that I had NOT taken it back home, which also allowed me to use my expanded baggage allowance to check in ONLY three MAP packs loaded with medicines. I have only a small carry-on with some of my stuff, and at the last moment packed up a couple sleeves of slides on “Tropical Surgery” since I had recalled I was supposed to make some formal presentations along he way. There was no room for carrousels of slides I had prepared for talks on goiter and hypothyroidism, but I had thought that was for the later Ladakh mission in any event. So, they had also thought, but in this case, I was right in what I had carried and they were very wrong in what they had overlooked. “What? I thought those supplies were for Ladakh!” “”Yes,” I said, “For there, too!”
A drive through the monsoon clouds and a bit of wind and rain brought us up to the Himachal Province government’s tourism guest house for lunch, for which the group was drowsy enough afterwards that they hardly were terrified by the breakneck drive along the wrong side of the road “overtaking on the right” along the unguarded precipitous side of the road, between signs that say “Accident in Hill
Country is Always Fatal.” This public health message of encouragement is to stimulate careful driving habits, and reassurance to a western group not accustomed to the annoying blaring of horns into oncoming traffic. This habit means “Well, you are on notice now that I am about to do something perfectly foolhardy, so if you collide with me on this blind curve, it is your own damn fault!”
We arrived at the Holiday Home, and got checked into rooms, and despite contrary advice, a few of the group went directly in to take a nap, which probably has them packing the floor at the 1:00 AM as I am using the same lag time to type this note. Ravi, Raju and Anuj met us and we heard that Ravi wanted a hose call for protocol reasons on the grandson of the “crowned King of Kinnaur”—one of the oldest monarchies in the princely states of India where we had visited his ancient wooden fortress and palace in Sangla over the Kinnaur Valley on my first visit there in 1998. He is the head of the HP state’s Congress Party, and was voted out of office when the VPJ came in under current somewhat discredited prime minister Vajpayee, characterized in the Time magazine I picked up along the inbound flights as a “drowsy drunk” in poor health and leadership capacity at this crisis point in Indian history. This means that at the December elections, the VPJ will be out and the fortunes of the Congress Party and its HP local chief will rise with it.
He has troubles of his own, with poorly controlled diabetes and insulin reactions, and since we have Michael Eiffling with us, a juvenile diabetic on an insulin pump, we will have to return in the morning tomorrow early before my lecture at IGMC to make a medical/political return house call to do “patient education” on diabetes control. He was not in as we went to his military guarded estate on top of the hills of Simla to examine his grandson, who is a retarded neurologically impaired six-year-old with what was reputed to be Down’s Syndrome when we were asked to come and evaluate him. Now what we can do to assess Down’s Syndrome and just what they thought we might be able to do for it is hard to understand, but I do understand the medical diplomacy that makes it imperative that we make a house call on the child, since we have imported medical expertise coming into town—no matter that they are each coming off a round-the-world trip with a two hour nap in Delhi before starting another long travel day---and nothing will do but hat the head of this medical delegation gives his opinion on his condition. It may not matter that the head of this delegation is a surgeon and the child needs a development pediatrician, but we have none present, so, RHIP!
My opinion is that he certainly does not have Down’s Syndrome, no matter what the advance misinformation might have been. He has Williams’ Syndrome and cerebellar ataxia, and a systolic ejection murmur. He is undergoing PT for spasticity, has had no cardiac evaluation, is on a god anti-seizure medication started by a Mumbai (formerly known as Bombay) pediatric neurologist who should be following him. So, the evaluation was complex, including his divergent strabismus, his retarded milestones (waling with spasticity at age 2 ½ and a failure of speech despite good hearing) but the advice is simple---go find whatever expertise he will need in follow-up services and stay with them, since he has a n acquired, not genetic, birth defect subsequent to an anoxic difficult C-section delivery, and will require life-long follow-up and continuing therapy. Since the mother says this is not available to her in Simla, to which she has returned to her politician father's home after divorce, she will have to go back to Mumbai or Delhi to get his cared followed.
We walked back through the Simla Mall—as much vertical as horizontal—during a special festival going on. Some part of this may have been for the Dali Lama’s arrival here—but it is unknown, as yet whether he has departed. But his advance parties could not get to Tabo Monastery where he is supposed to meet with us, since the snow was just cleared away from the Kunzumla Pass yesterday (and I am thinking that all my wool and down outfits are in the wayward duffel and Action Packer which will probably not catch up with me before I am shivering in Kaza in my tropical weight clothes appropriate only for hot and humid Delhi) so that the Dali Lama’s participation in Tabo seems to have been canceled. That does not seem to have canceled our clinics there, but the lessened crowd may move us into the monastery buildings themselves despite the new clinic tents we had custom made when I had left from Delhi last month.
We gathered our gang of fifteen at dinner. About seven of the trip participants had backed out, and I was thinking that if they had all shown up, they would have overloaded us, especially with under experienced first time clinicians. As it is, all of our medical students are first timers with no seniors. I am the only veteran, but we have two people more with MD’s. Jim Blixen is a surgeon from southern California, and I am happy to see him, as well as Michael Eiffling, a first year medicine resident from Colorado who was on last year’s Dharamsala trip this time traveling with his fifteen year old son Blake. He will be here for both Spiti and Ladakh, getting his program approval for these two treks as a clinical rotation, and taking the time between to do an as yet-unplanned trek in Ladakh. I also met Deborah Szymanskii who had been with me on the last Ladakh trip, a nurse from Colorado, and she will help. All the others are either freshmen medical students from Creighton, Buffalo, GWU, Indiana, Dalhousie, or a PA applicant, like Keith Bair, who had canceled and re-joined.
And then there is Bill Norton, an officious retiring school psychologist from Georgia who is Pickwickian, but front and center stage at any official function. “Doctor Norton’s” qualification for being here is that he is a friend of Ravi’s, but he is not in any way useful in seeing patients, of course. But, he is most happy to officiate as Master of Ceremonies. He asked to say a few words to the group, and wanted them to know that “I welcome you all to this expedition; how happy I am that you can be joining me, and that you are courageous in being here, will require a lot of flexibility and adaptability as much is going to be required of you as the trip evolves.” He pointed out that this is HIS third trip with Ravi (fewer times than I have been to Spiti alone) but he would be happy to help any of the newcomers to this adventure. Then came the surprise.
At lunch earlier in the day, he had craftily asked, “Have you written any more books?” I replied that “Tropical Surgery” had just come out. “Oh!” he said. But, he saved his surprise for later.
“I have a handout prepared for you, since if you could submit to me about 1200 words of your most interesting experience, I will include this in a book I am writing on this expedition. You will be part of a published author’s book! Imagine that! This has never been done before, since no one has ever undertaken to write a book about a single medical mission expedition which this is.”
No one, of course, except me, and every one of the students here has had access to the complete descriptions of each of these expeditions, as has the good Doctor Norton, and as especially Ravi knows, (since we have had extensive discussions about publisher searches and the archives of my collected trip logs), and since every one here has received the extensive manuscripts and supporting photojournalism in my series of the “Himalayan High”—and even the carry-on pack is embroidered with the title of this collection of the books I have written----but now, it seems, Bill Norton is going to be the author of my experiences! Somehow, this carefully kept secret is revealed now at this time publicly, complete with xeroxed sheets of information to each participant on how they can contribute to Bill’s book. As any reader of these pages would easily recognize, Bill’s sudden inspiration for being the author of a book on these experiences is hardly an innovative inspiration, and Bill’s exploitation of this trip for these purposes of exerting his leadership role is hardly a surprise, but the clever announcement of this while keeping the plot under wraps in the presence of the leader and principle author of each of the trips is especially crafty. I of not believe I require a Boswell, and do not believe Doctor Bill should be the author accredited with this rather later-coming proposal while deliberately ignoring the extensive and voluminous efforts at recording these experiences by the one most directly involved over five years working on it.
Ravi explained the routing of our long road trips around the hairy roads of the upper reaches of Himachal, skirting around the Pin Valley and only now entering a couple of the passes snowed in until yesterday. We will go about 80 km tomorrow after noon which should take over four hours to Narkanda, and then we will make the all-day brutal trip to Sangla, as an aside into the Kinnaur Valley. We will then back up to our principal clinic site in Tabo, and leave from there to Kaza. We will go from there all the way to Manali, through Kunzumla and Rohtang Passes, probably arriving at night in Manali, with a short time for consultation with Laji Varghese in Lady Willingdon, which Ravi does to like, he said, since this superb institution is “Catholic” (actually a Protestant mission dedicated to serving all without reference to their creed.) Ravi undervalues Laji Varghese’s value as an inspiration as he was to such students of mine as Bill Barrett, Elizabeth Yellen, Hadley Abernathy, Christine King, and Amy Hayes.
There will be an awfully lot of road trip miles on this “expedition” and not very expeditiously given the conditions we are beating back as we go. And I certainly hope that my expeditionary forces equipment will catch up with me at some point before I have to find myself cuddled in someone else’s sleeping bag or parka! I already have some one who is taking upon himself the writing of my book; I will now have to be in the position of advising all others on what to take on this adventure and then borrowing what they have since what is mine is sequestered at a place where it is paradoxically left where it can be of most use to me!