Let me tell you the story about how I arrived in Kathmandu covered in blood and in a screaming ambulance towards Patan Hospital.
So I awoke on my flight from Istanbul to the familiar refrain of "Is there a doctor on the plane?" Only in my stupor did I realize that this was the second such announcement, that my subconscious had heard this through my thick wax earplugs and poked my brain until it acknowledged that no one had yet responded. So I stumble glassy-eyed to the economy section where an elderly gentleman was slumped in the bathroom. Nose gushing blood. I'm not talking a regular nosebleed; this was as if someone had slashed an artery in his nose and it was pumping like a firehose on a July afternoon. His shirt was covered, blood river rendering the floor pasty red, and the flight attendants were panicked.
ABC - airway, breathing, circulation. He was alert and responding, although hard of hearing, so I knew he had the basics. But the amount of blood choking the back of his throat, that he coughed up on the minute, was staggering. And dangerous. Applying pressure to the bridge of his nose, placing ice on the back of his neck and forehead, did nothing to staunch the flow. It gushed anew each time we changed the napkins, congealed clots dripping bubbling from his nose. One liter gone. More coming.
We find his meds in a plastic bag. The anticoagulant, for his pacemaker. The anti-inflammatories for his arthritic knees, having climbed Nepali peaks for the bulk of his 85+ years. And an aspirin bottle that he has started the day he left --- (country withheld to keep his identity anonymous), to "help" his headache and nose bleed of the day before. A recipe for blood-thinning-disaster.
It took an hour to land, crouched at his feet, knees caked in the river, pinching his nose. Fingers clawed into crampy submission. Random men on the flight telling me "oh, tilt his head BACK", "try putting cayenne pepper up his nose", and "I can help. Many people in my family are doctors". Shouting, shouting, shouting, "I am actually a doctor. You are being offensive." Mysogeny helps me grip tighter.
An ambulance arrives another hour later, with someone who claims he is a doctor. But he takes the man's blood pressure over his suit jacket. And has no knowledge of any of his meds. Luckily, the real airport medical officer arrives not long after, but we realize quickly that they have no capability to help. No IV kit in the ambulance. No meds. So I direct them to the safest place I know here, Patan Hospital. No care that the ambulance heralds from another one - Nepal is famous for its corrupt officials opening up medical schools that one can buy their way into and through. There are hunger strikes by dedicated physicians here against such happenings. I could not risk him ending up in their hands.
But I had watched Patan's response to the earthquake last year. I have seen the competence and skill of colleagues handle acute care, amazing family doctors that prove the value of what I do with Global Familymed Foundation. This is a fundraising not-for-profit, for which I am Executive Director, that supports Patan’s medical school to train their physicians to serve those most in need.
So I jump in the ambulance, no visa nor luggage, and direct it to Patan. Interns are wide-eyed at the foreign man and his younger companion wheeling into the ED. But the man refuses their care, the IV and blood tests that he needs. Despite years of trekking here, marrying a Nepali sherpa, and supporting the school system (construction and teachers’ salary) in Everest Base Camp region... He does not trust.
I'm trying to convince him to take Vitamin K, that his anticoagulant needs to be reversed in the short term until he stabilizes. Nope. Luckily the ED interns have called the ENT service, and the specialist has cautery and packing done within minutes. Her, he trusts. Despite his pallor and high BP (stress? Or causality?), he winks at her and me.
His ex-in-laws descend. He has already proven to the giggling nurses that he speaks a smattering of Nepali and the Sherpa language. They dote on him, an obvious admiration for all that he has done for their community. His people are here, I've signed over his medical history, and now they offer me the same kind of assistance I had provided. The Sherpa family hires me a taxi back to the airport, accompanies me to call in favors with officials to process my Visa quickly, and pays for my cab to Swotha Square. My heart is full with promises of a glorious visit to Lukla at EBC on my next trip.
I get to my guesthouse, the shock of being front-line here buzzing my jet lag away. My return here poses no fear of my days huddled awaiting collapse of the apartment complex during last year's earthquake, when I was safely if not guiltily evacuated.
It feels like home: the intricate wood-carved windows, marigold-garlanded shrines, the bustle (and incessant honking) of the cobblestone alleys. And the calm reassurance of the capabilities of my friends and colleagues here; I look forward to working with them for the next two weeks.
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