Wednesday, October 31, 2007

Halloween on Tinian






Halloween frights

Today is Halloween. Unlike many places that have now banned costumes in school and in neighborhoods, or have to make ‘special arrangements’ for the children due to the danger in today’s society, Tinian is more like living in the 50’s, where we did not have to worry about such things. The children dressed up in their favorite costume prior to going to school. Then school was let out for a short time so that the children could have a Halloween Parade down Main Street. The parade started at the elementary school and up the street to the Mayor’s office, and then returned back to the school.

The police closed the road to traffic, and the children followed a police car up and down the street, sirens blaring occasionally. After visiting with the Mayor, they made a loop and returned to school. Some of the small children also visited the police station and clinic to show off their costumes.

Tonight there will be costume contest at the large ball field. Prizes and money will be given out for best costumes in many different catagories.

Terri was not able to see the parade, because Wednesday is baby day at the clinic (perhaps Terri’s favorite day of the week!). This is the day small babies are brought into the clinic for their ‘well-baby’ check. They line up in the hall and the nurses usher mother and baby into Terri’s office, where she waits excitedly to see the beautiful children. In fact, I think she laughs and giggles more than the babies do!

Just when I think Tinian couldn't get any better, it surprises me again!

Monday, October 29, 2007

Weekends On Call

I don't mind weekends on call because I've learned a lot. Not only am I on my own, having to use all the medical knowledge I've acquired over the years, but because I really have to rely on my clinical skills as most emergencies seem to happen after 6 PM. Medicine is harder here after 6 PM because that's the time of the last flight from Tinian to Saipan. Not only does it mean that I can't send patients to the hospital (well, that's not exactly true . . . I can call in Life Flight, but that's $2000!), but I can't send blood for labwork either. I can draw the blood and hold it until the morning flight and then wait for the results, but there is no such thing as STAT blood work. You know those scenes on ER where they send off the blood and even before the next commercial break they have the results? Doesn't happen here.

Two weekends ago I had two emergencies come in within 15 minutes of one another. In fact, as I have only one emergency treatment bed, I had to move one patient out of the ER and into our hospital room prior to the next patient arriving by ambulance. One was a patient with chest pain and the other a post-stroke patient who seemed to have had a seizure. For chest pain, the first thing we do (after checking for breathing and a pulse) is to give oxygen, an aspirin, nitroglycerin, and morphine for pain. Then I hooked up an EKG and saw ST-segment depression with inverted T-waves. In any ER on the mainland, you draw blood and order tests, which verify that the patient is having a heart attack prior to any real intervention. Here, I draw blood and put it on ice so that it can be sent to Saipan the next morning to verify that what I'm about to do anyway was the correct thing to do. Working like this is not a bad thing . . . it is a different way of doing things. I truly have to rely on my sense of things and my clinical exam. I actually have to listen to the heart rhythm and look at the veins in the next to see if they are distended. I have to PRACTICE medicine and I have to evaluate the odds and possibilities or "differential diagnosis."

As mentioned above, 15 minutes after this patient arrived, my suspected seizure patient arrived. No EEG, no CT scan, nothing but a good history and exam.

I've learned to rely on my instincts and gut feelings. I've learned to hold patients for observation and watch for changes. I've also learned to play the "what if" game.

If I call my radiology tech in tonight for an ultrasound and he finds "X," will that change what I do tonight? Sometimes yes but most of the time no, so I wait until my radiology tech arrives in the morning and just observe the patient for any change.

When I finally got the labs back for my chest pain patient, I found out that she really had had a heart attack and that my instincts, and my interpretation of the EKG had been right.

So I've learned to be very exacting in my physical exams and to trust my instincts.

This weekend was pretty exciting as well with injuries, minor surgery, and hospital admissions. I have great nurses here and they all know that I think by talking, so they very patiently let me work out the pros and cons and differential diagnosis and the "where do we go next"s.

By Monday, I'm exhausted but satisfied that I've learned more on this island than I would have in the states.

Friday, October 26, 2007

Thoughts of Christ and Sandals

We all carry the image of Christ wearing sandals. Since living in the tropics, this is something I totally understand. I have tried wearing sneakers here, but it is impossible . . . at least for me. I see the bush cutters dressed from crown to toe, totally covered to protect themselves from flying objects and I don't know how they do it. I put on a pair of shoes with socks and I almost faint. It's just too hot!

So, as a good beach doc, I wear sandals to work. I wear sandals to walk. I wear sandals all the time. It's the only way to survive the heat and humidity. You have to let your toes breathe.

So why do I think of Christ? I think of it because of the ordinance of washing feet. You see, we all wear sandals to Church as well. We all shower and get into our best clothing to attend church, but once you've walked to church in your sandals, although your hair, body, and clothing are perfectly clean and prepared for worship, there is dust upon your feet. Kevan and I equate this to repentance. Although each one of us must repent and make certain our souls are clean and prepared to present ourselves to God, just the act of getting ourselves those last few feet into the presence of God brings with it dust upon our sandaled feet. Christ, therefore, waits at the door to remove that last bit of dust we bring with us on our final journey. To me, this is a tender representation of Christ's love for each of us that while it does not excuse us from cleaning ourselves for the final moment of worship, Christ is there to welcome us as well as to wash and anoint us for the penultimate introduction.

I think of this parable every day as I carefully watch the ground for holes so that I don't fall on my walk to and from work. It helps remind me that I serve as Christ's hands here on Tinian while he waits to remove the dust from my feet.

Rhythms

As we've lived here for 2 months now, I've noticed certain new rhythms in my life.

We have not set an alarm clock since we've been here. I've always had a pretty good internal clock, awakening about 15 minutes before the alarm would sound, but we've stopped even setting an alarm anymore, much to my liking.

One has to plan very carefully when to shower. I always think of my parents when they were living in Mongolia. There, the water was heated by the steam generated at the main power plant and so when they heard steam in the pipes, even at 2 in the morning, they would get out of bed to shower. Here, we have absolutely NO hot water. A cool shower is really appropriate in the tropics, but it still takes courage to step into the shower in the morning. Kevan solves this problem by showering after we take our walk in the evening and he's all hot and sweaty, so he enjoys the coolness. I, on the other hand, have to look professional in the morning, so I shower in the morning. Man, talk about a wake up call.

Even though there is no hot water, I find myself choosing to turn the hot water knob for certain chores while turning on the cold for others. For instance, when I'm washing the dishes or wiping down the kitchen counter, I ALWAYS turn on the hot water faucet. If I'm brushing my teeth, it's always the cold. I've noticed this for the past few weeks, and even when I'm totally conscious of what I'm doing, I can't seem to change the habit. I will add this to my list of "rhythms."

Last but not least, when I open the silverware drawer, I open it, count to two, and then reach for the silverware I need. Why you may ask? Because every once in a while there is a gecko that likes to hang out on the edge of this drawer, so I count to two to give it enough time to scurry somewhere else and not onto my hand.

Ah, the rhythm of Tinian.

Thursday, October 25, 2007

Odds and ends




One of the few drawbacks of walking is that you occasionally get caught in one of the tropical downpours. Terri and I have usually been very lucky. Every morning as we walk to the Hospital, the rain seems to end just long enough. And even at noon, when Terri walks home for lunch, or at night coming home from work, Terri seems to catch a break in the weather. But not yesterday! Even with an umbrella in hand she came in soaking wet. It was a sight!

Charlotte (our personal spider) has outdone herself this time! She seems to have caught an insect much larger than she is...perhaps she is putting in her years supply of food storage. This is an inside joke for Mormons. For those unfamiliar with Mormon culture, we have been taught to be wise like the ant in the fable, and store food away--often a year's worth--for bad times. It sometimes becomes quite a comedy when Mormons move, and have to decide what to do with all the food they have squirreled away!

We have become very comfortable in our little apartment at the LoriLynn Hotel. We still have a desire to find a two bedroom home to move into, but there are none available, and we are happy where we are, so we are in no hurry! We occasionally hear of homes either in the hills, or in some odd location, but since we are content where we are, we can be choosy about where and when we move into a home.

One of the unusual sports one can find on Tinian is wild chicken hunting. Oh, yes, that’s what I said! Wild chicken hunting (those who are really brave go after the roosters). Many people on the island keep chickens in their yards. Over time, the chickens have migrated into the bush, and they have multiplied. So some take their cross-bows (no guns, please!), and go chicken hunting! It has to be a very difficult sport...I have seen how fast those chickens run! It is just another of Tinian’s unique island traditions.

The final hill



Tinian 10/25/07 The Hill…the final rise?

Each day I try to conquer the hill on Tinian I get a little farther. I have decided it is a little like boot-camp—the worst part is at the start, but after a while you get in shape, learn the ‘marine way’ and come out the other side a steel-hard human weapon (I do have flights of fantasy, don’t I?). The start of this long hill is boot-camp, but I have discovered that once over the first rise the ground levels quite a bit, so the walk is much easier.

Now that I have climbed that first rise several times, it is nowhere near as intimidating as it once seemed—although I continue to be put to shame by a young man on a bicycle that always seems to be riding up the hill as I descend! As far as I can tell, there are no gears on his bike—it is similar to a mountain bike—and is rather old, but up he goes every day on his way to work, perhaps at the airport.

I believe that I have made it to the last rise in my climb up the hill. It is another steep climb (not quite as steep as the first one), but it is at least another half mile to a mile away, so, once again, I must stop, turn around, and try again another day.

I have begun to wonder what I will do once I have conquered my hill. I will always remember something my father once said, while reflecting back on his life: “What do you do after you pay for the first round?”

My father, in spite of being raised by a terribly abusive father and in poor circumstances, has succeeded in almost everything he has tried. He was a good father, good husband, very successful businessman, active in the community, etc., etc., etc. So picture my father after another successful business venture, handing out cigars and buying drinks for everyone—having a real celebration to commemorate his success… Then what?

What do you do after you pay for the first round? If your happiness was tied to reaching a specific goal in life—whether it be a specific job, becoming wealthy, or any of the many things people spend their lives trying to accomplish—what happens once you reach your goal?

We have a wonderful local celebrity by the name of Walt Goodridge. He is known as the ‘Passion Prophet’. He is a positive thinker who has written books, articles, and often speaks at local symposiums, etc. He often speaks about success being a journey, not a destination. I am beginning to believe that he is right!

If we are relying on specific goals or destinations to achieve happiness, I don’t believe that we will ever find it. Because what happens once we have obtained our long sought-after goal? Does our passion for life end? Does our desire to work hard vanish?

We have all seen the results of such thinking: people who have worked all of their lives just so that they could retire and live the ‘life of Reilly’ end up dieing sooner than those who keep working. They have a greater percentage of depression, anxiety, and Alzheimer disease. Look at how many people who have won the lottery end up either losing it all, or becoming miserable in their wealth. Many actually wish they had never won at all. We peer with fascination and envy at the ‘lifestyles of the rich and famous’, as portrayed on TV and magazines, and then watch in horror as these same people destroy their lives with everyone watching. They all reached their goals. They should all be happy. But they are obviously very miserable.

Unlike so many others, I don’t have to worry about my next goal, or where I should go or what I should do after reaching the top of the hill …because I already enjoy the journey! I enjoy walking, I enjoy looking down upon the small village on Tinian, and I enjoy walking along the beach with my eternal companion at my side, listening to the waves break against the rocks. I enjoy life. But how did I get to this point? How does one finally begin to enjoy life when everyone around them is miserable? Believe it or not, it is the reward for living a way of life that brings universal and eternal consequences of good.

Every religion believes and teaches a form of Karma. Whether you believe in a personal God, or simply some kind of universal power or unifying force, there is a universal theme that runs through them all: the knowledge that our thoughts and actions have consequences.

Like all the other laws of physics we are so accustomed to accepting, our thoughts and actions have consequences. If we are positive in our attitudes, and spend our lives thinking good thoughts and doing good deeds we are rewarded by receiving blessings in our lives. Good things will happen to us, our relationships with people become stronger, and we will become happy and successful. It is a natural and universal cause-and-effect law. What goes around comes around. We sow what we reap.

Of course, the opposite is just as true! If we spend our lives thinking negative thoughts, carrying a chip on our shoulder and a negative attitude about life; if we think evil thoughts, gossip and backbite, and purposefully do harm to others, we are rewarded by receiving evil in our lives. Bad things happen to us, our relationships with people are weakened and destroyed, and we become unhappy failures. It is a universal cause-and-effect, and just like gravity, no one can escape it.

Happiness is not a lifestyle (think ‘lifestyles of the rich and famous’), it is a way of life. If our ultimate goals in life are to do good and to make others happy, we will not need to seek after happiness—it will find us!

So as I walked down the hill this morning, pondering about life and goals and passions, I came to the understanding that I had already found my Nirvana—I was living it.

Wednesday, October 24, 2007

Oh my, what a day!

I was on my own today and I guess because it was raining, everyone decided to come to the hospital to be seen. I saw 40 patients today, which included follow up on a patient who had a heart attack 10 days ago (more in another post), a short surgical procedure, a joint injection, taking care of a critical patient with renal failure and transferring the patient to Saipan, two out-of-control diabetics, a breast lump, a breast abscess, three different staph skin lesions, and probably 10 new pinkeye patients! Not to mention that we're having a variety of viral syndromes here . . . kids with high fever and nausea and vomiting while adults have high fever and muscle aches. What a great place to practice medicine.

But on the bright side, Wednesday is BABY DAY! I love Wednesdays. Next week, I will take pictures of my favorite patients and post them. You see on Wednesdays, since we don't make appointments, all my pediatric well baby/child checks are done. They do make beautiful babies on this island, and there are a lot of them. More on this part of my day next week . . .

All in all, I survived and even had all my charts done by quitting time today. There hasn't been a day, though, that has gone by that I haven't seen something new and truly interesting, so keep checking the blog, and I'll try to share some of them with you.

Typhoon season

Tinian 10/24/07 Typhoon season

It is definitely typhoon season on Tinian! It has been raining on and off (mostly on) for several days, with no let-up in sight. It seems as though many of the typhoons in this area generate right over us (better than slamming into us I guess). It is hard to explain how hard it rains here…at times you literally cannot see across a one-lane street, you have to raise your voice to be heard by the person sitting next to you, and it rains in your window—now, understand me—I don’t mean a little rain is getting through the screen or something normal like that! I was sitting on the couch at least 3’ away from the window, and the book got wet I was reading, the rain was coming in the window so hard!



Sleeping reminds Terri and me of our ‘camping trip’ in Connecticut. For those who remember, when Terri and I moved to Connecticut with our five very young children (Liz was just out of diapers), we actually lived in a tent for a couple of months. All seven of us were living in a 10’x10’ tent in the middle of a forest. The first week it rained every day. Everything was wet, or damp, or moldy. As we climb into bed at night of late the dampness brings back those memories…

We received some more boxes today! It takes at least two months for boxes to arrive from the mainland using parcel post. We received a fan (this is great, as we were using our air-conditioner all the time, and we both hate air-conditioning). For Terri and I, just a fan blowing on us is enough to make us comfortable.

I received some pots and pans. I have been cooking using one old fry-pan for everything, so the addition of some pots will be a great help—although with our one-burner stove with its one setting of ‘high all the time’, I’m not sure how much it will improve my cooking! I can always tell when Terri doesn’t like the food I cooked (she is always very diplomatic about it…), as she compliments me on the salad! I am slowly learning a few dishes that work well, but it seems to take me more time than most to get the flavors right. I used to have a few good casserole dishes, but since we have no stove, it wiped out half my repertoire! Here are a few of the dishes we are surviving on:

- hot dogs and beans
- spaghetti with meat balls
- marinated fish with rice
- chicken and rice
- fried chicken and rice
- hamburger and rice
- peanut butter sandwiches
- tuna
- fresh produce from the Chinese lady



As noted before, Terri seems to like my salad a lot… There is a Chinese woman that has a garden (there are very few here that have gardens for some reason), and she comes by Terri’s office once a week with whatever is ready; mostly green beans, boc choi, and cucumbers (which I supplement with whatever I can find at the local grocery).
As you can tell, I make a lot of rice (it is the far east after all!); and I seem to make great rice: I put it in the microwave and push a button! However, now that I have some additional pots and pans, hopefully I can expand our eating habits. No wonder we are losing weight here! It’s the new Tinian diet: Kevan’s cooking! Our family is accustomed to great improvised cooking by Terri; we used to call it ‘Terri terrific’ meals. My improvised meals are called ‘Kevan catastrophes’! I always warn Terri ahead of time that I am trying out a new recipe…and then she smiles and compliments me on my salad…

We also received more books. Terri got more medical books—she has built quite a library at the hospital, not only for her own reference but for the use of anyone who wants to use them. And I received the rest of my reference and research books. It was a good day for us!

We also received a box of books we shipped from Kingsley that we are giving to the local library—just a reminder: if you have any books you aren’t using, send them to us for the local library!

Perhaps the most used item we had shipped to Tinian was our bead maker. It works very well and I end up making bread two to three times a week. It makes any kind of bread you can think of (just add the ingredients), but our favorites are the regular bread and the cinnamon and raison bread. I tried sourdough, but it didn’t taste very good (I am afraid I ‘soured’ it to the point of botulism…).

Terri is back on call every day and night for two weeks. I have yet to understand the system at the hospital for ‘on call’, but Terri doesn’t seem to mind, she is enjoying the work too much! It really is a perfect world for us right now. Terri is fulfilling a life-long dream and I finally have the time to do the research and writing that has been swirling around in my head. In fact, sometimes I feel guilty as I am reading the Mishna (a book about Jewish laws), while I look out the window at palm trees and tropical paradise…but I soon realize that this too shall pass, and I need to take advantage of the time we have here. So for all of you sitting cooped-up in some office or work-a-day job somewhere, I feel your pain…or then again, maybe not!

Tuesday, October 23, 2007

The Hill...again





Tinian 10/23/07 The Hill…again

Once again into the breach (a little WWI talk)…or, in other words, up the hill for me! And once again I failed to reach the top—but I did get to the next rise…only to see not one, but two more hills in front of me! Oh well, perhaps tomorrow.

I have to assume that once I get to the top of the hill I will be able to see the other side of the island, which, of course, gives me another goal in my walking: to eventually walk from one end of the island to the other. It is a dead-straight road from one shore to the other, and the back side is a much more gradual slope.

Tinian was just missed by another Typhoon, which went north of the island, but which brought a lot of wind and rain. The last two or three days has been very windy and rainy. At times it rained so hard you could hardly hear. But this morning the weather had cleared just enough to permit me to walk Terri to work, and then to attack the hill again.

As usual, the walk was worth the effort, as the view was spectacular! I could clearly see the entire south end of the island, the Dynasty Casino, the beach, the village, etc. I could even see the waves breaking on Goat Island that sits to the south of Tinian.

My stopping point was the next cross-road to intersect Broadway on the way to the airport. As I made my return trip, I was able to view the other side of the sign at what I once thought was the top of the hill, saying ‘Welcome to Tinian’. The sign got me to thinking…

As I looked down upon Tinian this morning, my mind went back to our visit to Saipan. We continue to be asked about how we are ‘managing’ on Tinian, everyone being very concerned with our welfare. They are very shocked and surprised that we actually love living here. For some reason that has totally escaped Terri and me, there is a definite bias against Tinian by many of the people living on Saipan. It has been clearly stated to us that they just could not live on Tinian! They even try to persuade us to move to Saipan.

As we ask questions to try to discover why people are so concerned about us living on Tinian, we find that many who have the strongest opinions about Tinian have never even been to the island! They have just ‘heard things’ about the people, about the politics, about the living conditions, etc.

Perhaps we are just naïve, but Terri and I think they are all nuts! Although we have not lived on Tinian long enough to discover all the ‘deep dark secrets’ that seem to be hiding somewhere on the island, we have experienced the Tinian lifestyle long enough to be able to disregard most of the negative things people have to say about Tinian. We honestly don’t know where it comes from or why it is perpetuated. Tinian has some problems, it is true, but we have found that the people of Tinian have a wonderful attitude and have responded very well to the challenges that face them.

I believe that those living on Saipan that perpetuate a negative view of Tinian are straining at a mote, when they have a beam in their own eye! Saipan has many more problems, and more serious ones, than anything Tinian is facing. For example: Saipan has serious crime, wild dogs roam the streets everywhere, the roads and beaches are littered with refuse, and the pollution generated around the island keeps the beaches closed on a regular basis. And then of course there are the power outages and the water problems (both with access to water and the quality of the water supply).

All of these are serious problems that Saipan faces every day (and fails to do anything about). Tinian has none of these problems. What few dogs we have seen on Tinian are well behaved and have collars on, or are chained up in a yard. We seldom run into a stray dog on our walks. Although I am sure that Tinian has some crime, we have neither seen nor heard of any serious crime on Tinian. We have felt very comfortable walking around the island any time day or night. There is some litter on Tinian’s streets and beaches (we can always do better!), but very little. And I have yet to hear of the beaches being closed on Tinian. We have yet to experience any serious power or water problems on Tinian. Given what we have seen of both islands, we would choose Tinian every time!

We have also been impressed with the efforts the people and government of Tinian have made to keep the island beautiful and inviting for visitors. Even now, though they are going through some tough financial times (as all of the CNMI are), they continue with various beautification projects. Everyone can debate about how to use the money allocated to the island government, but simply the fact that they have continued to choose to spend some of their money to enhance the appearance of the island is commendable.

So as I looked down upon Tinian from the hill above the village, I was very happy Terri and I had made the decision to move here. We are learning to love the people of Tinian—we already love the island and the lifestyle here—and hope we can return the favor by being good citizens and assets to the community.

I should close now…the rain has begun again, pounding the palm leaves like thousands of little drums. And the rain is coming in my window—sideways rain…who would have thought?

Monday, October 22, 2007

Flying to Saipan





Tinian 10/27/07 Trip to Saipan

Last weekend, with Terri off call at the hospital, we decided to go to Saipan to do some shopping and catch a movie.

One part of living on the islands that is the most fun is the chance to fly the puddle-jumpers from island to island. Freedom Air has two sizes of planes: a seven-seat (two seats in the back, three in the middle, and two in the front, which includes the pilot) and a smaller six-seat (two seats in the back, two in the middle, and two in the front, which includes the pilot). We have always flown the larger plane, but this time we flew the smaller plane.

It is so different flying a small prop plane! It flies lower, slower, so you get a real ‘feel’ of the plane as it cuts through the air. Every cross-wind and updraft can be felt as the little plane moves up and down or sideways. Often the plane will fly so slowly (compared to the jets we are used to) that it almost seems you are standing still. You get a close look at the island and ocean below you, and have time to recognize everything you see.

I remember a line in a movie/documentary we saw recently (which, I recommend for anyone, is ‘Little Dieter needs to fly’, about a pilot shot down in Viet Nam and his escape—it is a movie now, but the documentary/movie is much better), in which he describes an event that led to his desire to fly. During WWII an American pilot was on a bombing run and flew past his building. He said he could see the pilot so clearly—he was so close and moving so slowly—that the pilot waved to him as he passed. From that moment on ‘Little Dieter’ wanted to fly. I could not understand how someone could see a pilot that clearly—after all, planes fly fast! But now I understand. The smaller planes just don’t need the same amount of speed to fly.

The flight back was even more fun! There were storms all around, and we had to wait for a while for the weather to clear. When we finally took off you could see a large squall just moving in to the area. As soon as we were air born you could tell how windy and unstable the air was, as the plane moved sideways several feet and tipped. But we had a good pilot who quickly corrected the plane’s wings and off we went. We were forced to take a circuitous rout around the squall, and as we got to the other side, could see Tinian was relatively clear.

We were almost disappointed that the rough ride was over, as Terri and I were enjoying the bumpy ride, and thought the rest of our flight would be smooth. But that quickly changed as we started the approach to Tinian airport. Once again, the cross-winds began tossing the little plane around, sending us sideways and tipping the wings back and forth. For a moment I thought the pilot would pull up and try again, but he just kept correcting the flight path as we descended towards the runway. The landing was just slightly rougher than normal—I thought we would be bouncing down the runway—and then it was over. It was just great fun! In fact, now Terri wants me to take flying lessons…

Friday, October 19, 2007

The Hill...reprised




After several attempts to conquer ‘the hill’, unsuccessfully I might add, I was more determined than ever to make it to the top. So this morning I started out early to make another attempt.

It seemed such a minor task. When looking up the hill from the bottom, it doesn’t look that big! Perhaps a half mile or so is all…and after all, Terri and I have been walking 2-3 miles a day for weeks. So off I went again.

As I passed the side-road halfway up (my usual stopping point), I still felt good, so I continued—my next minor goal being the sign at the top of the hill that says ‘siyluus maase’ (come again) to those leaving the island via the airport. With some extra effort, and a lot of slowing, I finally made it to the top…or so I thought.

Isn’t that so much like life? We set arbitrary goals for ourselves; goals we think will make us happy or make us rich, only to discover that it was an illusion after all?

As I neared what I thought was the top of the hill, and the sign I had set for my goal, I discovered that the road did not end, the hill simply flattened out a little bit. From the bottom of the hill, it looked as though there was a definite top or crest to this hill. But in fact, the hill is much higher, and the road much longer than it looked from the bottom. In fact, as the next section of road began to rise ahead of me, I still could not see the end—just another crest. My legs told me this was as far as I would go today.

However, even though I had failed to reach the top, there was a bright spot to my efforts: the view of the village and the southern end of the island was beautiful from up there!

Perhaps that is also like life…we can only appreciate the path we have traveled, the hardships we have overcome, and the tremendous growth we have achieved, by taking the time to look back on our lives—to see our life in a ‘panoramic view’, so to speak. It is only then that we can realize the beauty and blessings that surround us. It is only then that all our efforts come into some kind of perspective.

As I slowly walked down the hill, I was not disappointed, but exhilarated! Even though my perceptions had been completely wrong (there was no top to the hill, yet), and even though I recognized how much farther I had to go to reach that goal, the beauty of the world around me made the effort worthwhile.

Thursday, October 18, 2007

Walking home

I walk to and from work three times a day; in the morning, at lunchtime, and in the evening. I had a pretty quiet afternoon today as I think people are staying home because of the pinkeye epidemic, so I walked home a few minutes early. I absolutely love this walk. The bush-cutter was whacking away at the central island grass, the chickadees were congregating in the flame trees along my walk, and the kids were walking home from after-school activities. There is so much life here.

Next door to the hospital is the public safety building, which houses both fire and police as well as ambulance. Very often, these men are sitting outside awaiting an emergency and they all wave and shout "Hi Doc" as I pass. Then I pass the Mayor's office and often one or another of the island's public representatives will shout "Hi" or call me in to ask me something.

All the while, since there are no sidewalks along this main thruway, cars slowly pass me and the occupants shout greetings as well.

I finally turn the corner onto a smaller, quieter street. I first pass some homes built from corrugated sheet metal (they do have air conditioners, but their windows are often open - can you imagine the heat?) and at night when I'm on my way to an emergency, I often hear a greeting from inside these homes as parents calm their children for bed see me walking by. I then pass Kerida's restaurant and the dog tied to the corner. No matter how many times I pass that dog, he still barks and barks at me. Luckily, his chain is stronger than he.

As I enter the LoriLynn, the concierge, Nancy, and the owner, Ben Manglona, greet me once more with "Hi Doc," and I know I'm home.

I am content to serve as I receive the sincere gratitude of everyone around me.

Sunday, October 14, 2007

Dynasty Hotel and Casino

Kevan and I went to the Dynasty last week and walked through the basically empty magnificent lobby. It seemed a sad place with many people keeping busy with no one to serve.

When we went to the Dynasty last night, many, many busloads of people were arriving for holiday. What a wonderful difference. There is something special about adequate groups of people gathering for holiday in a resort - which Dynasty offers as it is much, much more than simply a gambling casino. The enthusiasm of people who have worked hard and saved to come to our small-but-magnificent tropical paradise for vacation was infectious - almost as infectious and contagious as pinkeye here! It made the step lighter and the heart leap with joy.

Now if it just doesn't rain all week!

Yes, brothers and sisters, there is Pizza on Tinian

Of all the things about Tinian I've accessed on the internet, no one has ever mentioned pizza. May I be the first to anounce to the world that there is FABULOUS pizza on Tinian. Kevan took me to Monster Pizza at the Dynasty Hotel and Casino last night to celebrate my birthday. We ordered a pizza with pineapple, ham, tomatoes, mushrooms, onions and garlic, and extra cheeze (6 toppings as the onions and garlic count as one topping). It was WONDERFUL. All the toppings were fresh and well placed in equal proportion. The mozarella cheese was magnificently stringy. We got a 14" pizza for just less than $20 and the service was attentive and punctual. The establishment was very, very clean and inviting. The silverware was scrupulously clean and provided without having to request it (although who eats pizza with silverware?).

May I recommend this pizza to anyone visiting Tinian. You'll not regret the experience.

Friday, October 12, 2007

Communication skills

As I mentioned in a previous post, we're having a pinkeye epidemic here. I've prescribed ophthalmic ointment to some of my patients and have explained that you place 1/8-inch strip in the eye and blink several times to spread the ointment. A family returned today with a new case in a sibling. Her eye was particularly bad, so I wanted to place the ointment myself to get her started. After I placed the ointment, the mother gasped and started laughing. I asked what was so funny, and she told me that they had been using the ointment on the outside of the eye, rubbing it around on the eyelid. After all, who would put ointment in the eyeball?

After I washed the egg off my face, we all decided that I needed a course in the subtleties of being Chamorro and that for now, demonstration was probably better than conversation. You see, I have trouble with their accents and they have just as much difficulty with mine!

Live and learn.

The demise of our HDTV

It was Christmas in October today. We received 17 boxes by US Postal Service, which means we're close to receiving all our boxes. It is true that one box is totally missing, one only had two books in it when it arrived, and another had half my books and half someone else's books (I guess my box and their box broke open at the same time, they scooped up some contents and divided them between the two), but all in all we have been impressed by the USPS. Everyone who has moved overseas by container has stories about the nightmarish condition of their things when they arrived, so we thought we'd try moving by US mail.

Two of the boxes were our technology boxes and included our desktop computer, our printer, our DVD player, and our HDTV. There were some loose things jingling around in the computer, so I opened it up and they were just two plastic clips. I plugged it in and it started up just fine, but I'm not certain it is working as I don't have a monitor to which to hook it (see demise of HDTV). The printer works great, although the DVD that was packed on top of it is totally mushed. I can deal with all that.


The box containing the HDTV was opened and the toilet paper rolls packed around it had been mushed. But I was hopeful as they obviously took the impact and the box looked unsquashed and intact. We unbubble-wrapped the TV and it looked wonderful. Hooray - my big TV! In it was plugged and alas, a beautiful contemporary design appeared in place of a television program. The screen itself was unscratched, but the glass behind it (it is an LCD) was shattered. So, not only did I lose my HDTV but my computer monitor.

Luckily (silver lining), we have found the Slingbox and computers to work very, very well and we are not missing our television shows and ballgames. They were insured, so now we just have to put together all the necessary supporting documents. We'll see what happens . . .

Thursday, October 11, 2007

My beloved Prius

My dear husband gave me a Prius for my 30th anniversary gift 18 months ago. I LOVED that car. It drove me all over Connecticut, and I loved driving it. I loved being in it. I loved everything about it.

I also love to drive. It was the one thing I really worried about when thinking about coming to, and living on, an island. Where would I drive? There is nowhere to drive to. Besides, we had vowed not to get a car.

I don't miss my car. I know my Mom is taking great care of it and is enjoying it as much as I did. I don't miss driving. I love walking.

So, I guess old dogs CAN learn new tricks.

Filipinos

I have the privilege of working with many wonderful Filipinos. Each one of them works very, very hard and are very well educated in the field of medicine. They are my nurses, radiology techs, lab techs, and pharmacy techs. They are here on Tinian to make a better life for their families.

I am impressed by the sacrifices they make. One of my colleagues has been living on Tinian for 8 years. She doesn't make that much money and certainly not what we would expect someone in her position to make should she work on the mainland, but she works hard in order to earn a living for herself here while sending as much money as she can home. You see, she has 2 children living with her sister in the Philippines. They have been living apart for the past 8 years. When I asked her how often she gets to go home to see them, she said, "every two years," much to my amazement. In order to support them, she has left them. Next month, instead of being an agency worker with few benefits, she is becoming a government worker, which will enable her to get a housing allowance and will afford her the privilege of bringing her two children here to Tinian to go to school. She is very excited and I don't blame her. She has worked so hard!

My parents served a mission for the Church of Jesus Christ of Latter-day Saints in Hong Kong for 2 years. My mother has mentioned many times her admiration for the Filipina women who work so hard, so many hours, as foreign workers in Hong Kong. She has told me many times of their sweet nature, and I concur.

So for my Filipino friends, "maraming salamat" (thank you very much) - Think I'll ever learn Tagalog?

Learning new things

I had some time without patients this afternoon, so I went in to help Irma, our pharmacy tech, to put away the drug shipment that arrived yesterday. $18,000 for two-months' worth of drugs!

There used to be another tech besides Irma, but her contract was up, so she left for Ogden, Utah (small world, huh?). So with boxes and boxes and bottles and bottles, there was work to be done.

Although her inventory is computerized, the prices had to be placed on each individual piece. I figured I could help with that, as it was not too complex, but I had to keep reminding myself to make certain I wasn't putting the prices for the 500 mg tablets on the 250 mg tablets and vice versa. So, I spent about an hour or so helping out.

It was great for me. I spend a lot of time running back and forth to the pharmacy, which is not far from my office, asking what drugs are available in any given class and then the inevitable "how much per tablet" because so many of my patients have no insurance but pay out of pocket. I have been happy overall with the drug selection and the affordability of them.

We practice medical economics here. We don't use the newest and greatest drugs, but we have everything we need to treat our patients effectively. It was great for me to actually work in the pharmacy so that I could become familiar with the available drugs.

Sadly, we have a LOT of asthma here on the island (so much for the idea that most asthma is environmental - not much pollution here) and most of my patients simply use albuterol MDI to treat their asthma. The problem with that is that albuterol really does not treat asthma but simply rescues the patient from an asthma exacerbation. I've made it part of my mission to treat the asthma by controlling it, and that is done with inhaled steroids. While albuterol is about $45 a month for an inhaler, a steroid inhaler is $150! To convince a patient that they need to spend that kind of money to control their asthma is difficult if not impossible. As cheap as prednisone is, it seems that anything else that has a steroid in it is very, very expensive. Nasal spray for allergies, inhaled mist for asthma, and steroid drops for eyes are all expensive. Can't seem to figure that out.

But it's not all dismal news. Our generic meds are like 10 cents a pill and I do have access to most of what I consider needed. So as a result of my stint in the pharmacy, I feel better prepared to prescribe what we have available.

Thanks Irma!

Spiders and Hills



The spider

The bugs on Tinian are amazing! Each night they gather outside our door, due to the light that is situated on the corner of our building. When coming home at night, we have to ‘run the gauntlet’ as we try to avoid being attacked and get inside the door without having too many follow us in…

Now we have help in our fight! It seems a giant spider has spun a web across one corner of the arch leading to our door, and is feasting on the gathered swarm. I only had to watch a few seconds to see this large spider in action. A moth flew into the web and the spider, with lightning fast moves, captured its prey. I suppose it should be unsettling to us to have a large spider outside our door, but instead, we take comfort in that now we have a guardian to protect us. Besides, we are too big for it to eat, and ‘the enemy of my enemy is my friend’, so I guess we will consider him friendly. Or perhaps it’s a she…

Of course! We’ll call her Charlotte!

The Hill

One of the goals I set for myself after moving to Tinian was to climb the ‘hill’. Most of the population of Tinian is settled in a village near the south end of the island. The ground rises sharply from the beach about 50 to 75 feet above sea level, then flattens out. It is here the village is located—far enough above the sea to protect it from most storms and tsunamis, but still quite low compared to the hills surrounding the village.

To the east and north the land begins to climb sharply again, rising high above the village to a height of about 300 feet. It is here that the airport is located, and it is in these surrounding hills that many people have built their homes, for the view, and perhaps, as in other places in the world, to get away from the ‘riff raff’ below.

Broadway, the main road running north and south on the island, was built by the Seabees during WWII and literally runs from the south beach to the north shore, dead straight. It is here, as the road leaves the village and heads towards the airport and the northern side of the island, that the ‘hill’ is located.

Terri and I have been walking one to three miles a day, almost every day. Trips to the clinic and the store and back easily give us a mile or two a day. And then the walk to the beach and back (if we walk all the way down the beach to Dynasty casino), is three miles. So, now that we have been here a while, and we should be somewhat in shape, I decided to try my luck climbing the ‘hill’.

To my chagrin, I only made it half-way up the hill! It is amazing how much a little bit of slope adds to a short walk! As I approached the hill, I was completely confident I would make it to the top without a problem. About a quarter of the way up I began to breath hard as the slope got steeper. Then about halfway up there is a road that cuts across the hill, going east to some homes. I debated going farther, but decided that ‘discretion is the better part of valor’, and remembered that I still had to walk back!

So my first try was a failure. But at least I know what I am up against. Perhaps in another month or so I will be in shape enough to make it to the top.

Tuesday, October 9, 2007

Terri's impact on Tinian


It is hard to describe adequately the impact Terri is having on the people of Tinian. Terri has been known for her comfortable bed-side manner. It is one of the reasons seven doctors signed a paper asking colleges to accept Terri as a student to become a PA—they all knew she would be a good provider.

That unique bed-side manner showed up again during her clinical rotations at school. Even though each rotation was only six weeks, within a short time doctors would be relying on Terri to work with their most difficult patients—knowing that Terri could help them both understand, and actually make the difficult decisions that need to be made in hospital settings (most of you will remember the story of the man that refused to have his leg amputated—every doctor and nurse had tried to explain that if the leg wasn’t removed, he would lose his life, all to no avail; but just a few moments with Terri, and he was ready!).

That bedside manner, and care for her patients, is now on display every day at the Tinian Hospital. Let me give you just one example.

Wednesdays are well-child day. Women bring in their small children for regular check-ups, and just to make sure everything is ok. One day a woman and her small daughter (perhaps 5 or 6 years old) came to the clinic to be examined. Terri examined the little girl, and then had her do a few physical activities to check her skills and at the same time be able to check her bone structure and muscles, etc. Terri asked the mother and child to come out into the long hall in front of Terri’s office so they would have more room. Then Terri had the little girl walk down the hall and back, then hop on one leg, and then the other, etc.

But suddenly there was a serious problem that came to light…when asked to ‘skip’ down the hall and back, the little girl looked confused. She didn’t know how to skip! So, without missing a beat, Terri took the child’s hand, and was soon ‘skipping’ up and down the hall with this small girl. All of the nurses and other patients laughed and clapped as they watched this unusual spectacle.

For the last ‘test’ of the child’s ability, Terri asked the little girl to run as fast as she could down the hall and back. With a broad smile and a giggle, the little girl took off as fast as her small legs could carry her, up and down the hall. As she ran back , Terri knelt down and let the little girl run into her arms, Terri lifting the little girl off her feet in triumph, both of them laughing and giggling with joy!

And so it goes. Each patient given time and attention, each child made to feel warmth and love, bed-side care that can only come from a provider that truly loves her patients. It is easy to see that Terri is truly where she was meant to be!

Ferry memories


Tinian 10/9/07 Ferry memories

Last night, Columbus day, Terri and I went for a walk to and along the beach about sunset. It is a regular walk we take just before dinner (sunset is around 6 pm here). As we rested on a wall by Taga beach and watched the sunset, we saw the ferry coming in to Tinian, and it reminded me of our first trip here.

Last May we visited Tinian, and took the ferry from Saipan to the island. It was a memorable trip! The boat leaves at 5 am, so we had to get up in the dark and be driven to the ferry. With luggage in hand I stepped to the window to get my ticket. They refused to give me a ticket, and pointed across the way. Confused, I asked for a ticket again, and was refused, and with a frustrated sigh, he pointed again across the way.

As I turned the second time, I noticed another office with a small light on. We went to the window and asked for a ticket. They don’t sell tickets…this window was where we paid our taxes prior to buying our tickets—the government was to have their take first!

Once we paid our taxes, we took our receipt to the first window and bought our ferry tickets. We walked up a small gang-plank onto the ferry and found a seat. The ferry is a two-tier boat (you pay more for the upper tier), with comfortable seats, and completely enclosed with windows. We were not able to see much on our ride to Tinian, as it was either too dark, or the windows were fogged and/or wet with spray.

There was a large group of Chinese tourists that came on the boat after us, all headed for the Tinian Dynasty Casino. As the boat slowly pulled out of the protective cove, we could all feel the boat move up and down on the waves. I wondered if anyone would have stomach problems on our trip to Tinian…

Terri and I both love carnival rides, so I wasn’t worried about our ‘sea worthiness’, but we watched the others on the boat with curiosity. As the boat moved away from shore and out into the ocean, the waves became much larger and the boat’s movement up and down became much more noticeable. Several times cries of surprise sounded around the cabin as the boat dropped all too swiftly, giving everyone that carnival ride feel.

As time went on, and as we neared the island of Tinian, we all felt everyone would make the trip without incident. But just as we began to feel safe, the first sound of wretching could be heard. A young Chinese boy in the front row had his head down, trying to hit the sea-sickness bag he held in his hand (every seat had an adequate number of bags available!). Once the sound, and smell, of the first hit the rest of the cabin, it wasn’t long before a chain-reaction began, and others were heard throwing up into their bags.

Terri and I felt badly for those experiencing this well-known sea malady, but could do nothing about it. Olive skinned Asians were suddenly pale white, each holding a plastic bag of morning breakfast. When the trip was done, perhaps a third of the passengers had experienced the full treatment…

We have been told that the trip back to Saipan is even worse, as the boat is going against the current. Terri and I can’t wait!

Monday, October 8, 2007

Columbus Day

I was off work today because of the holiday, but not really. I was on call and my phone rang at 8 AM with the first of many calls today. I'm on the first day of my next 12-day call stint. In I went at 9 AM and then back at 10 AM and then a few phone calls during the rest of the day but I didn't need to go in. At 7:30 PM, though, I got the right lower quadrant pain phone call. You know, the one that could be nothing or could be every other "quick surgery" thing in the book. And when you live on an island, you have to make decisions. The flights have already shut down for the night, so if your patient has to go to Saipan quickly, I have to call the helicopter. If I were on the mainland, I would send the patient for a CT scan, but since that's not possible, I called in my radiology tech and he did an ultrasound on the patient. Not the ideal test, but at least a "peak" inside. You see, I can't do labs either. I can do a dipstick urine, which will tell me some things, but it doesn't define specific illness either. I can draw blood, but it will have to wait until the first flight out in the morning . . . 6 AM.

Thank goodness for good physical exam skills. In I went and decisions were made. I have great staff support and my patient has been tucked into a hospital bed for the night.

So, at 10 PM I starting walking home with my iPod in my ears, listening to Rhapsody in Blue played by the 5 Browns and a gorgeous night sky. Millions and millions of stars are visible, including the Milky Way! There I was walking down the middle of Main Street in paradise. We may have geckos and gnats but we don't have mosquitos and it was a magnificent walk home.

So here I am practicing the best kind of medicine - person-to-person medicine - in a tropical paradise. Who could ask for more?

Sunday, October 7, 2007

Unique customs

Tinian has many unique and interesting customs Terri and I have discovered. We have talked about a few of them, such as the men that cut the grass using what I call a weed-whacker (but I was corrected by a local: they call them bush-cutters here). Here are a couple more:

As election time nears, those running for office use loud-speakers to proclaim their candidacy and ask for votes. A pick-up truck with a large two-sided poster of the candidate in the back, and large speakers attached to the top of the cab, drives around the island playing music, and giving speeches, etc., so that people can hear it, even in their homes. They drive slowly through each neighborhood to ensure everyone has heard their reasons for running for office. Unfortunaelty, most of it is in the local language, which we cannot understand, but we can enjoy the music!

Occasionally they will have a soap-box preacher located in the center of town, giving a rousing sermon on some subject of the gospel, and calling for people to repent and be saved. Last night the preacher was located just across from the Poker Palace/laundry. We weren’t sure if that was to shame those who ventured inside, or simply because this is a very busy intersection. We stopped to listen for a while and were very impressed by his abilities and enthusiasm.

As Terri mentioned, we went to the beach to go snorkeling, but found the waves to be very large and the sea to be very agitated. We probably were foolish to venture out into the raging sea, as there are rocks in some areas, but we felt if we stayed in the narrow area where the beach was, we would be okay. But the rip-tide was worse than we thought, and it often carried us too near the rocks (as Terri can attest, as she ‘sat’ on a couple as she was carried by a wave). But as soon as we saw the danger, we quickly left the water and went to the beach. But it was great fun while it lasted!

So far our favorite place to eat is at the Fleming Restaurant. We have yet to eat a bad meal there, and in most cases the food is as good as any restaurant anywhere. If we are celebrating a birthday or other occasion, or just want to treat ourselves after a long week, we go to the Fleming.

The Dynasty has three restaurants (Japanese, Chinese, and Western) and a pizza parlor, none of which we have tried as yet (we try to support the locals first), but I am sure we will get around to it after a while, especially if their pizza is any good.

We are still attempting, without success, to find scooters to buy for Terri and I. We may have to go to Saipan to get them. We keep hoping we will find them here, but it doesn’t look good.

Medicine on Tinian

I wasn't certain what kind of medicine I would be practicing on Tinian. I knew that I had to be prepared to treat whatever walked in the door, and I knew I would have to do a lot of "clinical" diagnosis; i.e., using the physical exam to determine a diagnosis without relying on a lot of testing. But would I see just sore throats, diabetes, hypertension, and physicals or would I see more exotic illness such as dengue fever, TB, and tropic disease?

I have now worked 14 days . . . 12 of those days in a row. I take call every weeknight and then every other weekend, so I work 12 days in a row followed by two days off. No complaint here! I'm practicing medicine, and what medicine I am practicing.

In the 12 clinic days, I have seen 278 patients. I do see a lot of sore throats, runny noses, and congestion. I had a run of pink eye this week. It was a pure epidemiological study. You see, almost everyone on this island is related. One person went to Saipan the week before last and then there was a family party over the weekend. In the next two days, I had 4 cases of pink eye then 4 cases the next day, then 3 cases with all the cases being relations. On the fourth day, classmates and community acquaintances started arriving. We ended the week with about 25 cases of pink eye.

I see a LOT of gout and staph aureus skin infections here. As far as the staph, it is all still quite sensitive to Bacitracin and Keflex, so I'm grateful for that. But because of the constant humidity here, these sores really become very large wounds very quickly. They seem to come in groups as well as I saw 3 patients with culture-confirmed staph in just 2 days.

We do have diabetes and hypertension and weight issues. I have seen 4 perforated eardrums. I keep thinking that this would be a great place to be a student because you see so much here. We don't have dengue fever or even any "tropical diseases" per se. I do a lot of TB testing because we have a lot of foreign workers living here but I have yet to see an active case.

As I said, I'm always on call and so I've had to get used to answering the phone many times a night, listening to my nurses' presentation of the cases, and then making the decision as to whether just treat over the phone or to go in. At first I had a difficult time with that decision but I think I have a formula for the decision now. I pretty much jump forward to what is the worst outcome that could present itself and decide if a nurse should handle it. If not, I'm out of bed and walking to the hospital. I'm only a short 5-minute walk and it's beautiful here at night. The walk gives me time to clear my head and make decisions before I get to the hospital.

I was called about a hypertensive patient with a blood pressure of 190/120. Out of bed I sprang and I actually jogged into the hospital. Treatment with a calcium channel blocker and vitals every 15 minutes, and 90 minutes later we were out of the woods and I was back in bed.

Of the big cases I've had there's been a large bowel obstruction, which turned out to be volvulus (the large intestine twisted on itself), the hypertensive urgency, a possible stroke, gangrenous toe, and chest pain.

Medicine? I practice a wide variety of medicine here and I love it. I have even had a few "what the heck is this?" cases. These cases are keeping my journal searching abilities fresh.

I walk to work, home for lunch and back to work again, and then home in the evening. On each of these walks while I'm either looking forward to the day and what will present or reflecting upon the day I've had, I am grateful to be here. I can't imagine being anywhere else. This is the medicine I've always wanted to practice. It's Mayberry here . . . as I walk down the street every driver that passes waves and people call out to say "Hi Doc." Yes, they know I'm a PA and I tell them over and over again, but this is a term of endearment and not an acknowledgement of a medical degree. I'm grateful that I'm here and that I have had the exceptional training necessary to appropriately treat my community. I can't imagine being anywhere else.

Going to the Beach

After a three-week hiatus, Kevan and I went to the beach today only to find huge, crashing waves. I know everyone has the famous picture of Hawaiian beaches and waves in their minds when they think of the Pacific Ocean, but we usually have 1-2 foot waves that lovingly sway you back and forth in the water. This is truly a snorkeling paradise with crystal clear water that is rather sedate so you don't get knocked around.

It has been raining cats and dogs pretty much round the clock for a week, so as I approached the ocean and heard thunder, I thought we were in for another storm. I was mistaken though. The sound I heard was not thunder but simply the waves CRASHING against Taga Beach.

Being the land-lubbers we are, we never thought to check the marine advisory before we left for the beach. Turns out there were, indeed, marine advisories out for waves 7-8 feet . . . and they were! But as forbidding as the waves were against the rocks, neither one of us could resist the temptation to get into that surf . . . and we did.

The only people at the beach today were two Japanese women tourists with their two boys. The boys stuck to the beach, content simply to sit on the beach and let the waves cover their legs. Not the Clawsons! We had brought our new snorkeling equipment to try out, but we knew that was out as the sand was boiling in the waves and visibility was nil - not to mention the waves being out of control. With equipment left upon the beach, we ventured into the water - slowly at first, testing the rip tide. We felt safe enough to go a little farther and so into the water we went. We had a wonderful time in those 8-foot waves, allowing ourselves to be lifted high on the waves and at other times ducking under the water, letting the wave break over our heads. There was a bit of a rip tide, so we were careful to keep our eyes on the buoys and the shore and not get out too far.

There was only one problem - as beautiful as our beaches are, they are a combination of sand and rocks. As the surf became progressively aggressive, I found myself being moved toward the rocks and it takes time in that kind of surf to move yourself to any specific location. As the surf crashed and I felt the rocks below me, I maneuvered myself to save my head from the rocks. I managed to protect my head, but my poor gluteus did take the brunt of it all. I have two rather large abrasions on either cheek (if you know what I mean). Needless to say, it was a long walk home. You'll have to use your imagination on this one as it's a picture I'll not post, but here I "sit" at 1 AM not able to sleep because I keep sticking to everything as the wounds ooze a bit.

I'm not sorry at all, though. I had a wonderful time. I think that next time I'll check the marine advisory.

Tuesday, October 2, 2007

Laundry day on Tinian

Since we are without transportation here on Tinian, except our feet of course, we are constantly coming up with ideas on how to get around to do our chores. One of the most difficult can be laundry day.

For now, we simply use one of our suitcases with wheels o carry (or should I say roll) our laundry to the nearest Laundromat. There are several within walking distance, in various stages of cleanliness and repair. Of course the cleanest and newest is farthest away! So I have to decide whether I want to confront the ‘Poker Palace’ laundry, with its dingy atmosphere and old machines that work questionably well (but has large washers and is very inexpensive), or the ‘lumber yard’ laundry with its mud road (and which is always busy, since it is the cheapest laundry on the island), or walk a bit further to the ‘grocery store’ laundry, which is new and bright and clean, but has fewer machines, is much more expensive, and can be very busy.

Yesterday I tried the latter for the first time. It had rained all day long, and though I had a long list of chores to do (yes, as ‘Mr. Mom’ I now have to do all the household chores—Terri says that I am a better wife than she was!), the rain was so constant I did not think I would get out of the house. But since we had few clean clothes left (and since I am charged with making sure Terri is presentable at work) I took off for the laundry the first break in the weather that came, around 3pm our time.

With hat on head, umbrella in one hand and dragging a large suitcase in the other, I headed of on a fast pace for laundry #3. I just made it when then sky let loose again. As I sat on the benches conveniently placed in the front of the laundry for the patrons (the inside is just too hot and muggy), I read a book and noticed that I could not see the other side of the street due to the sheets of rain coming down, and wondered if I would ever make it back home!

Just as the laundry was finishing, Terri walked in, umbrella in hand, coming home from work at the clinic. We folded the clothes and placed them neatly back into the suitcase, and then stood for a moment under the shelter of the canopy debating our run for home. The weather had let up just a little (you could actually see where you were going), and hoping for the best, Terri and I headed out.

The first half of the walk was not too bad, since it was downhill—we were going with the flow of water cascading down the street, but as we turned the last corner it was all uphill, and we were fighting both the rain and the river. Fortunately my sandals have a strap in the back, which keep my feet from coming out. Terri had normal sandals and had soon been washed right out of them and was walking bare-foot up the street.

We made it home without incident, and to our surprise, the suitcase had kept the clothes dry. As for Terri and I…it was hard to tell if we were wet due to the rain, or if the humidity had simply soaked us.

There was no getting dry that night! Even with fans going and dry clothes on, everything still felt damp. Terri said going to bed was like being in a sleeping bag on a camping trip: just a little too damp and sticky. All that was forgotten quickly as Terri received her first call of the night from the clinic—someone in pain needed medication. This will be the second week in a row Terri has been on call 24/7. I keep telling her that it is her ‘boot camp’! In spite of the long hours, she loves what she is doing, and is very, very good at it.

The weather channel says rain until Friday…I guess the chores will wait.

If you look to the right of the red car, you will see the "poker hands" in the window of the Poker Palace. If you keep walking down the hallway, you get to the laundry. The great thing about this laundromat is that the hallway creates a great wind tunnel effect, so it's pretty cool on the bench outside while you're waiting for the dryer.

And here is the lumberyard laundry. The lumber is housed in the building to the right. The laundry is just beyond the car with its trunk open.