He's sitting in an 8x10 concrete room with two beds in it. There is a small space heater and a post where the rusted, gigantic oxygen tank is tied with a bow made of hemp cord. There are three mudas, or woven stools, sitting on the floor. His family members usually sit on these stools but they offer them to Debbie, Ritesh, Bibeck, Pawan, Milan and I because we've come at this late hour for a house call.
He is cross-legged on the bed, propped up against four stacked pillows. There is a fleece blanket draped over his shoulders, like something you'd find in a young American girl's room; cream colored with orange and white flowers. He wears a maroon sweater over two shirts and a thick, knitted beanie with a pom pom on top. Despite this, he's still cold and it's an effort for him to stick his fingers out of the blanket so that we can put the pulse oximeter on it. He does it patiently and for as long as we ask and when we are done, he quickly puts his hands back under the blanket. I see that he is anxious, he's afraid to die. I take his right hand and massage it gently, while I check the pulse oximeter on the other hand to see if the number has gone up. He sticks his left arm further out of the blanket and motions to a large area above and below his elbow. I ask him, "What happened?" Ritesh translates: "He got these at the teaching hospital in Chitwan, they kept trying to take his blood." I look more closely, some of the bruises are the size of baseballs, two on his upper forearm, one at the medial elbow and three more below. He points to a small dot at the mid-forearm telling us, "They were finally able to get the blood when they tried down here."
I feel my face get hot as I look into his sweet eyes. More of his arm is bruised purple than not. First, Do No Harm. I am overcome for a moment as I imagine the nurses or doctors at the hospital sticking him over and over with needles as he's having breathing difficulties. He puts his arm back into the blanket with a small shake of his head about the bruises. I look at Ritesh and I see that he understands I am mad. He says, "There's nothing you can do." I know it's true and I swallow it down and move on.
Debbie gently rubs his back between his scapulas. We are both sitting on the bed and doing everything we can to calm him down. Terry, our team lead, is in Kogate and Andrew is in Kathmandu. We can get them on the phone if we need to but otherwise we are on our own. There are four interpreters with us, everyone is watching us.
The tank is bubbling in the background, but as Bibek checks it, the pressure meter slowly falls to zero. We look at the pulse oximeter and see that our patient's blood ox levels have dropped into the low 70's. Ritesh makes a phone call for more oxygen.
The tank arrives and it takes three people to carry it in the room. It's five feet tall and looks like something Jacques Cousteau pulled up from the depths of the ocean. I expect an old metal diving suit to be attached to it, but nothing is, which is part of the problem. The neighbor takes his time fussing with the hemp cord around the old tank. Debbie calls out, "Can you please hook up the oxygen before you tie the tank up?" Bibek translates. The neighbor ignores us all, like we are flies in the room where he is doing some serious negotiation with the ratty cord. Debbie repeats. Bibek repeats. We are ignored again.
Twelve minutes have passed since the oxygen ran out. Our patient's cells are starving. I am scared and I can tell Debbie is too. We have to get the oxygen levels up but all that's going up is his pulse rate: 103, 106, 108. Debbie's thumb sits gently under his clavicle bone. She is counting his breaths. "Forty." "Forty-four." "Forty-six." His respiration rate is grating in the background like nails down a chalkboard. His eyes are pleading. He is drowning. Everyone is quiet. None of us can breathe. I check my watch: Fifteen minutes at 70%.
I look to the neighbor; should I grab the damned tank and do it myself? He has finally tied the bow and inserted the valve piece. Now he is fumbling with a wrench to tighten the seal. His incompetence is maddening. I think I could do it faster, yet I don't budge. I don't want to stir the calm. I stay frozen like all the others, watching, waiting, hoping for that top number to start trickling up so that we know his cells are going to live. I am trusting that something higher, perhaps one of the thousands of gods or goddesses that live here, is in the room with us to help this guy get his wrench dialed into the right setting and set the oxygen to flowing. They say that the Nepalese have so many gods there are three for every human. That makes twenty-seven gods in the room with us. Eighteen minutes.
Finally, the pump is turned on. Debbie and I haven't helped hook a patient to an ancient oxygen tank before. We don't know anything about this old bubbling gauge, nor what the setting should be on. Regardless, the oxygen finally flows and the number on the pulse oximeter flashes up to 74. The heart beat goes down to 102. Debbie lets her breath out and whispers, "Forty four." We are moving in the right direction now.
It's been eleven days since that first home visit to "Uncle" Lal Lama's. Since that time, we've stopped by his house almost every day, sometimes three times a day, to monitor his vitals. This has to be done during our lunch break or after a full day of work. It requires that one of the translators gives up some of their downtime to come with us and we are so appreciative of their willingness to do this.
We have communicated to the family that our recommendation is for them to go to the hospital. They have refused, saying that the hospital in Chitwan said there is nothing more than can be done for Lal. They don't trust the hospital either, due to a series of negative experiences that have made them quite scared to go there. The hospitals here can be very scary places. Our team can't do much more than monitor Lal's vitals and provide some anxiety relief with acupuncture and we've let the family know this. They still refuse hospital care.
Our Uncle is not getting better. For the first week after our initial home visit, he was able to get off the oxygen tank for 10 or 15 minutes and venture into the concrete patio outside of his bedroom. Each gigantic oxygen tank would last for around 48 hours. This week, Uncle cannot get off the tank without plummeting into respiratory distress. Some tanks last for less than a day.
He is pinned in his small, dark room, like a undersea diver who is just visiting this life for as long as the oxygen will last. I have seen him moving through the stages of grief as he realizes that his time here is short. I have moved through these stages of grief with him. One afternoon, Ritesh and I arrived to find him in a splendid mood. He was telling us stories about his boyhood. He was living in Kathmandu and had gone to art school. He would travel up to the Monkey Temple and look over the Himal. He would draw or paint the Annapurna range in a series of mediums, ranging from charcoal to watercolor. He was also a sculptor and carved a number of animals at popular temples. He won an award from King Bhirendra for a gigantic elephant he created and painted, poised on springs so that as it was wheeled in front of the king, a spring popped and the large trunk swung up to salute the patriarch. He was an entertainer and dancer in a comedy troupe and it brought him great joy to give all of his gifts of creativity to his community and country.
The day that Uncle told us these stories about his life, I started crying as I was behind him, checking his lung sounds. Ritesh could see me as he translated and I wiped the tears away and tried to regain a professional demeanor. I took deep breaths and sat with Lal until he was finished telling his stories. On the walk back home, I tried to hold it all in, until I could get to my bed and bury myself in my sleeping bag to cry. I couldn't make it and burst into tears about 50 meters from the patient's house. I took off my white coat and held it over my face, as if it would stop Ritesh and the town of Bhimphedi from seeing me do this. Ritesh put his hand on my back and said, "It's okay. I can't cry so maybe you can cry for both of us."
It was awful to walk up to the house and find the whole team sitting outside. They saw me crying and there was no way to explain it. Lal was in a better mood than he'd been in for days but they all worried that something bad had happened. I told Andrew he was fine but listening to Uncle, I knew he was going over his life and that he was getting closer to his death. I was also starting to realize what an amazing person I had just been sitting with. I know we are mortal, but as I sat there I saw that no matter how amazing we are, we will all die. I will die. No matter how I love, how I live or where my hopes lay, I will die. As I sat on my bed crying, I saw that I was crying for myself, not Lal. I was crying for the mirror that Lal had just held up before my own life. I am just another diver in this ocean, a diver with a tank that is a little bit more full than his, but who is equally exploring this beautiful shipwreck and will have to go up to the mysterious surface again at some point.
I applied to ARP and I came to Nepal to find myself because I had started to question my identity this year. Each patient and every team member here is holding up a mirror for me to look into my own soul. I have spent so many years criticizing myself and never finding myself good enough, but some of these mirrors are shining back a spirit of generosity that I never acknowledged. Lal is showing me that I need to honor this amazing part of myself and I need to continue to live life as fully as I can. I need to spend my time in this adventure looking for the treasure that I know is there. I miss all of you back home and I send the greatest amount of love to you all. --- Rebecca "Bex" Groebner