JUN-B-9
THE FIRST CLINIC
DAY IN TABO STARTS WITH A RUN
ALONG THE MUCH
DISPUTED “CHINESE BORDER”
IT ALSO BRINGS TO
A HEAD THE PROBLEM OF OUR
BIGGEST
NONCONTRIBUTOR AND HIS AMBITIONS
TOWARD BEING THE
AUTHOR OF MY EXPERIENCE
June 18, 2002
Our morning run took place at 6:30 as I led both Michael Eiffling and his stepson out of Tabo, and up the road toward the stupa and Mani walls I had remembered being there. It is a short run today, since we have come up to 11,600 feet and will alternate our exertion days as we keep going higher. I could see the bright prayer flags over the chorten and the extensive mani walls, each inscribed on rock with the elaborate scroll of “Ohm Mani Padme Ohm” repeated endlessly in large script or in small. That same phrase, of course, is on the prayer flags, the prayer drums, the chorten itself and every other sacred object in the valley of which there are many. Of the whole population of the Spiti Valley, only 8,000, 6,000 are around Spiti, 213 (as the town’s sign proudly announces) around Lari, where we entered the valley adjacent to the mountain wall of the Chinese border, the army post of the IndoTibetan Border Patrol, where there is the Changma Monastery.
We will later visit a couple of my favorite monasteries, Dhankar and the Ki Monasteries, and w are in the grande dam of them all Tabo, 1006 years old this year. So, if you consider the total population of this rather barren alpine desert, with the water sources running down from the snow-capped and glacial scoured mountains all around us on the close horizon, most of them in the hostile occupied Tibetan Plateau, almost all the population of this valley is scattered around the monasteries—the principle “industry” of remote Spiti. This would mean that the majority of the population are “economic drones” devoted mainly to a cultural activity as contrasted with an economic product, but that part of the GDP is what brought us here, so I suppose that twirling a prayer drum and endlessly inscribing a single phrase on remote desert rocks is to be considered a matter of “productivity.”
180 PATIENTS,
INCLUDING SOME VERY SICK PATIENTS WHO WERE
TREATED B Y OUR
TEAM OF LARGELY FIRST-TIME CLINICIANS
I had organized three teams using the other two real doctors here---first year medical resident Michael Eiffling, and California surgeon Jim Blixen as the nucleus of each of two tents, loading them with three each first year medical students. I was going to take a team that included the non-medical but nursing and PA students Keith Bair and Deborah Szyzmanski and my GW freshman Matt Gummerson. But I also recognized that Dr. Bishan and his junior doctor Dr. Pradeep were also going to participate and backed off to supervise all three teams and have the team I would have covered supervised by the two local doctors. This may have been a mistake since Dr. Bishan withdrew and only Dr. Pradeep and the most junior students were together, and with the press of patients coming to them, they locked the door so as to have adequate time for each interaction without patients pushing in to crowd them. This figured out to about a half dozen patients all morning at the leisurely rate of one patient for all of them every forty five minutes while we in the other teams divided up and saw multiple patients at 5 minute interviews, with no one else more senior than those freshmen medical students as well. So, I had to go in (after vigorous knocking, since they were excluding their helper by the locked door as well—and pulled patients from their group already standing ten to twenty deep to be seen in one of my other tents. I will take that team to morrow to move them into a higher gear.
But everyone but one of us performed to day, and the one to be expected as a noncontributing deadwood performed his role admirably as well, as a detractor. We even had Blake 15-year old son of Michael in the pharmacy, rolling up counted pills into small newspaper packets for the patients. To my great surprise after my return from the run and at breakfast this morning, Bill Norton announced that he and Blake would be setting up the pharmacy. I am sure the fifteen year old could have told him a lot about the medicines more than he might know, because we had give or more packing cases filled with very sophisticated medicines, many of them dangerous and some which I did not even know we had. And this was going to be “handled” by someone whose drug familiarity has been limited to that of an alcohol solvent!
I set up the pharmacy, with some later help from Michael Eiffling and Hem who would very ably take over the management of it, saying he had been trained by the best---Virginia! He recruited Blake who was the runner. Still, almost all prescriptions by the freshmen clinicians had to be redone and all of them shortened in duration and amount of drug. Some had been written for simply “steroid cream”—and almost none had doses or correct intervals. So, I either monitored the drugs as they went out or Blake was the runner who would come and find me to correct many of the questions that Hem would intercept.
AND THOSE TO BE
PRESENTED IN THE DIDACTIC CLINICAL COURSE
ADTER DINNER
TONIGHT
We had a large variety, including a couple of neurological problems—like a cervical radiculopathy, and encephalitis, and a lower extremity, possibly Potts lesion. We also saw a couple of rare congenital abnormalities, like the giant hairy nevus that “saddled” a young boy with multiple pigmented hairy moles around his face and trunk. There was also a large lipoma in the middle of the nevus, which was allegedly getting larger.
One boy was brought in with a lump in his neck, and I brought him around to show each of the teams and no one got it right. Even with a lot of help, when I had him stick out his tongue, or when I had him show by extending his neck what the position of this midline mass and described to them the embryology of the thyroid, I still had to tell them the diagnosis, which they will not now forget—a thyroglossal duct cyst. We will probably intercept him up at Kaza to do his excision, since we will be there about the same time he could get there. Ched, as a freshman medical student in his “first day in the office” asked if he could scrub in on the operation if I am going to take the TGDC out.
We had some patients with congestive heart failure, a few with altitude induced shortness of breath having just arrived from Punjab, and a wide variety of rashes, arthritis, acid peptic disease, and a large volume of eye problems. Many patients have conjunctivitis from the blowing sand and a few had ptyerigia---I thought I might also by the end of the day with the wind blowing sand through the tents. A few had cataracts and even more were complaining of visual loss. I saw every patient except for a few that Jim Blixen had cleared, and oversaw the diagnosis and treatment of a couple of really sick kids—one with what seems like Shigella, one that had a left lower lobe pneumonia that I could treat as a “veterinarian” without asking a single question in history about this illness. I also saw the few young people with such problems as UTI (urinary tract Infection) and URI (upper respiratory tract infections) and a couple who had PID. One had gallstones, and one had her gallbladder removed, now coming back for pain in the incisions. I saw one older woman whom I believe may have gastric carcinoma, since Kaza is the world’s highest incidence of this disease, and she had casually let slip that after her primary complaint about her eyes was treated, she had been unable to take in anything but liquids. She had lost weight, and had not been able to throw up. I saw a lot of little lumps and bumps that would probably not have been left alone in the USA but could be quite easily here.
--AND MOST
PREDICATBLE—
PROBLEM
ON THIS TRIP:
THE SELF-CONFESSED LEADER AND PRIMARY
AUTHOR OF A BOOK
ON THIS EXPEDITION
“DOCTOR BIIL”
NORTON
All this
time, Bill Norton sat in an imperious “supervising” position, moving over
occasionally to take pictures of what his wonderful humanitarian mission was
doing for him as his worker bees were generating data for “his book” which he
believes he is authoring on my mission.
His single qualification for being here is that he knows Ravi Singh and he likes to exploit that to give all of us the benefit of his vast experience in his two previous trips to India, in which he alleged that he was the leader of those teams and that was making him “feel good about himself, since he was becoming a better person, after a wasted life before his retirement in which he had drunk too much.” He does not hesitate to give us all detailed advice about the place we are going where he has never been, and even to me, because he is, of course, authoring a book on his expedition---“something that has never before been done.” He had sprung this little surprise on the leader of the trip and even on Ravi himself without permission or even notice, and had taken the first day’s dinner’s opportunity in Simla to “Welcome all of us on his trip,” (after all, he was friend and Right Hand Man to Ravi, and had been to India twice before—as often as I have been---but in the last month) and to pass around a handout for the sake of my students (without even a reference to me, but a sycophantic foreward and conclusion listed as Ravi’s contributions to his book—a surprise to Ravi also) so that they might have the real thrill of contributing a 1200 word section to his book on my trip.
Of course, Ravi said nothing at the time, and when I brought it up to him, he passed the word to Bill, in a very passive way so as not to risk confrontation, that this little surprise did not sit well with the team leader. His response was: “Glenn cannot stop me from writing and publishing a book on anything that I want,” I agree. Bill may feel free to publish the exciting climactic entry in this trip where he as the noncontributing deadwood detractor of this group is sent packing on a long and lonely trip back to Delhi by the team leader who has the authority and responsibility for this trip and its output. It will be no loss, since the book about this trip is already being written, and each of the previous expeditions have been completed into a book as well, so that there will not be any disappointment for potential publishers. And any good leader should nip such insubordination in the bud.
His is a classic passive aggressive continuous undermining, with public announcements on all occasions about how happy he is to be here and leading this fine group of people. He is supposed to be the psychologist, but he is a classic portrait of the dependent alcoholic desperately seeking affirmation of self worth. So, why not just get up and grab it from anyone passing by? He has never missed a ceremonial occasion to step forward and take full representational credit for what his team has done. This annoyed me continually on his constant effort in the Ladakh trip (the second time he had ever been in India and the first time there,) where he also counseled the students to relax and enjoy this experience, since it was a true expedition and each of us would have to roll with the punches--such as he had done in his precious experience in India in Dharamsala—the disastrous “Flying Doctors” mission that I had to fill in for the next time they canceled and left the patients hanging.
I had told
Ravi I did not want Bill Norton on this trip.
And here he is—all expenses paid.
He is the only completely non-contributing member, but is always upfront
in his Pickwickian splendor in any place of honor as the senior citizen of the
group. Perhaps it is a residual of his
previous history of overindulging abundantly in his life when he was not “a
good person,” but to look at the two of us, an outsider would never guess that
he is not all that senor to me. And he does not have a single qualifying
credential to be ON, let alone LEADING, such a trip. And now, the extensive
collection of books I have written on each of the medical missions I have led
is being usurped by a freeloader who is cashing in, and jeopardizing the
tentative negotiations I had entered with both Raghu Rai and with National
Geographic on coverage of my medical missions---if granted exclusivity.
So, I am carrying this freshman team on this and several subsequent medical missions while having also to watch out for the not just neutral dead weight of Bill Norton, but the sabotage he is determined to pull off, and is still convinced he will succeed. Since this, and no other trip needs two exclusive leaders, perhaps “Dr. Bill” should carry the students from here and also take direct responsibility for the next 1200 patients on this trip and each of the others scheduled this year.
Even if the leadership of this trip and the authorship of my medical missions should change hands, I can assure the usurper that I will notify the publisher, Himalayan Health Exchange and most specifically Dr. Bill Norton, ex-psychologist and heirs, of more than ten million dollars in damages should my publications of my medical mission books, the National Geographic Special and the Raghu Rai photodocumentary are jeopardized by his stealing this march on my plans and proposals. And, Himalayan Health will lose its chief drawing card and only academic credential. I have had many other medical missions displaced by this unpaid (and rather expensive and extensive) effort, and I can surely do more and better work without that kind of interference.
Since the only conceivable credential that “Dr. Bill” has is that he can claim to be a friend of Ravi, he counts on this to protect him in doing whatever he wants to do. But, previously, I had to read out Mark Head on a trip in which he decided to exercise insubordination. Last time in Spit, there was a rebellion that a lot of participants thought might represent a democracy, so they simply voted to secede with the vehicles and support staff and Ravi acceded to their wishes. He now has a very unpleasant task for him, since he does not like such definitive resolutions of festering problems—I will have Bill Norton sent back if he insists that it is his perfect right to continuously undermine me and defy me particularly on a subject of considerable importance to me on the only really lasting output I have hoped to accrue from these repeated projects I have led. So, it is time for a silver bullet, since I am NOT just letting this one slide!