Sylvia's Journal

Today is departure day again. I am half-hearted about it. I am psychologically not yet ready to turn around and retrace my steps all the way to the hotel in Dubai where I stayed the night of the 20th. It’s a touch-and-go of sorts.

I started packing yesterday. In the logistics letter that we get before a trip it stated: “There is a mild winter in Bangladesh this time. Be sure to have warm clothes available.” The internet tells me otherwise: temperatures vary between low to mid sixties at night and mid eighties during the day. Shawl weather (the one I lost at Schiphol).

Early in the morning yesterday we, the four co-owners of our deer-damaged plane, met to determine our next move on what to do with the (insufficient) insurance money we received in exchange for the plane. One thing that may happen as a result of our decision is that I might learn something about how planes are put together. In the meantime we will hitch rides on other people’s planes, such as the one we are going out on today to see if we can spot the snow on Mount Washington from the air.

The rest of the day I whittled down my to do list as I do before trips and take care of things that cannot wait while Axel was struggling upstairs with a school assignment that requires creative juices that have not been flowing lately. The best antidote for that predicament is, I believe, a walk or a trip to a museum. We chose the latter and went to the MFA with no particular exhibit in mind.

We ended up in the Asia section (China and Japan in particular) and admired the pottery, the giant Buddha statues and brushstroke/calligraphy exhibit with as its most memorable piece two blind men trying to cross a log over a ravine. We were told that the drawing is probably about (non) enlightenment – the drawing itself is very enlightened with its suggestive brush-stroked back and foreground and its exquisitely painted figures. It made me want to take up this art for a hobby.

We ran into Tessa and Steve (what are the chances of that?) in the American masters section of the museum. They were in the middle of their honeymoonesque weekend in town, with the fancy steak dinner behind them and the hockey game yet to come. We left them alone to still our thirst in the museum cafe – a thirst induced by the salty Thanksgiving ham that had served as our lunch (leftover meal #4).

In the evening we had been summoned to the local country club for a surprise 60th birthday party for our neighbor Anne with the high and mighty from the neighborhood. There were people that have their own planes and helicopters, one who just bought an island and at least one other one (if not more) about whom a film has been made. I felt like a fish out of water, more so than Axel who can swim in any pond. We were very much welcomed by our neighbors, both the scheming husband and the very (very) surprised wife. I like such surprise parties. I especially like the expression on the face of the surprised one, having been there myself when I turned 50 in Holland. She, like I at the time, had been led to the place of the celebration under false pretenses.

We left the party late enough that we were one of the recipients of the beautiful center pieces all done in white; presumably to celebrate the innocence of the aged.

And now it is time to plan my flight to the Eastern Slopes Regional airport in Fryeberg Maine.

All through the night I wandered through dangerous territories, much triggered by what is happening in India. I was supposed to travel through Delhi on my way to Dhaka. Before my itinerary was changed to route me through Dubai I received an email from the SOS Company to which MSH subscribes for its travelers. It reminded me that India was a dangerous place. I remember being a bit surprised as I had not considered it more dangerous than Afghanistan. It is as if they knew something was afoot. On a previous trip through Delhi on my way to Nepal I stayed overnight at the Taj Palace hotel, an obscenely luxurious affair. Sita has also stayed there and I remember we talked about the heavy security which may have been, in hindsight, more show than substance (like the TSA Theater). After that one time I have always stayed at a more local place; one that would surely not have been singled out as a place to catch foreigners.

The Indian embassy with its slow visa application process has unknowingly done me a favor. It is only for that reason that I am traveling through Dubai again where transit visas are stamped in your passport at the airport, without a fee, just a long waiting line. And yes, there I am staying at a luxurious hotel, frequented by foreigners; but there are hundreds of those and I have never felt like a target there.

Yesterday morning I received my passport, its absence the only obstacle between me and my next trip. Now that this obstacle is removed I started to think about leaving again, just when Sita comes home – we may cross paths at the airport. Psychologically I am not quite ready for the next trip – they rarely are this close, and I haven’t thought about packing yet. It will require some thought as I am planning to travel light, with hand carry items only since I am only away for a week and to a warm place.

Tessa went off yesterday to spend the weekend with her honey at the Hilton in Back Bay to celebrate some important day, go to a hockey game and hang out with friends in the big city. Puppy Chicha has been parked with Val and so we had the house to ourselves. We had out third ham and mashed potatoes meal since Thanksgiving and walked into town for a movie which we did not like. Like some boring old couple we went to bed very early. It is just that the dreams where anything but boring.

It is the middle of the night and I am wide awake. I just did the greasy dishes that had been left in the sink for the elves to clean, proving that they do. I had gone to bed early yesterday, not feeling very well and too low on energy even to watch TV or a movie. But when you go to bed at 7 PM, then 3 AM is about the right time to get up; hence the middle-of-the-night dish cleaning.

Steve had gone into work very early in the morning since the lab animals do need to get fed and cleaned, even on Thanksgiving Day. He returned early enough to have a nap before our meal. The rest of us stayed in our jammies until the day was halfway done.

Tessa was mostly responsible for our cooking and I was responsible, a tradition, for the pies: one store bought and two pumpkin pies made partially from scratch (later rated lower than the 100% from scratch pies I have developed a reputation for). Axel provided the libations.

It was a glorious day for a long walk which all of us did while the ham was cooking; we followed Tessa and Steve who had gone to the beach where Chicha could play with other dogs, free from her beastly collar. The walk was a little too long for the state that our joints, muscles and tendons are in; the final stretch was a bit hard but we felt good as it made the Thanksgiving Day experience more wholesome.

By the time we sat down for dinner Jim showed up, already full from dinner at his parents; we could not convince him to start over again and join us as we dismantled the ham; he took a back row seat. We tried to connect with Sita in France during our meal but that did not work out as planned.

Today is Thanksgiving Day. Upon waking this morning I went through all I am thankful for, people and situation and stuff. It is a very long list topped by people. That’s part of the wake up ritual on this day, and then I fell asleep again, also part of the ritual since there is no need to be anywhere or do anything today other than cooking our meal which we will do together; I do the pies and Tessa and Axel the rest of the meal. We don’t eat turkey, which we save for Christmas; Tessa chose ham.

To complete the arrangement we ate green eggs this morning, not with ham – that is for later – but with apple-smoked bacon, while we listened to the reactions to the Mumbai drama that is unfolding half way around the world from us. We are grateful to be living that far away and not knowing anyone involved but also knowing that the next attack could be closer to home. Life is risky.

Yesterday was my one long and full workday before the next trip. The Bangladesh visa has been stamped into my passport, the reservations are made and I should be on my way on Sunday again. This meant that many meetings had to be squeezed into this one workday. I did a dry run for my conference presentation and received some pointers to make it better and slower; the rest of the day was claimed by Ann B. who used to be my squash partner, my Halloween co-conspirator and my constant companion during many years of working in Bangladesh. Now she is interviewing a bunch of us to see if she can discern patterns in the way we go about our work and transform health professionals into ‘managers who lead’ in countries around the world. By the time the day was over I was hoarse from talking – it was also the beginning of a sore throat and possibly a cold, the first of this season.

I had offered to do the thanksgiving meal shopping and regretted it as soon as I stepped into the overcrowded and overpriced supermarket near my work. I refused to pay 45 dollars for the ham that Tessa had requested and sent Axel on a parallel shopping trip to a supermarket for ordinary people further up north.

I came home late and was not feeling well, and ready to go to bed at an early hour. But then I discovered that I had only emails of my itinerary and none said ‘e-ticket,’ which brought about a frantic search and some phone calls to my hapless assistant who was on a bus somewhere between Boston and NYC. I finally found the words ‘e-ticket’ on the Emirates website under the ‘manage my bookings’ tab and was reassured that all was well and everyone could relax again. The only thing missing, a rather important piece, is my passport which should be en route from DC to our house. Incha’allah, they say in the part of the world I am going to.

We also learned that this condition is rare; the top doc told us he sees at most one such a case a year. It would be a very complicated and difficult operation, without any guarantee that he could actually put the tendon back where it belonged. It was entirely possible that the sheath that is supposed to hold the tendon in place could not be fixed to keep it there, especially after such a long time.

We asked our questions about the risks of the surgery and the risk of not doing anything. The answers left us hanging a bit as they contradicted each other: one the one hand, he told us, the tendon is not where it is supposed to be and could eventually tear or split. On the other hand, correcting this condition may not make things any better (considering how well I function with it) plus of course the risk of any surgical procedure such as infection or a blood clot. It is hard to improve on a 2 (i.e. pain level) he said. Still not knowing what to do but less inclined now towards an operation, we left to see our next second opinion.

We stopped at JP Licks in Jamaica Plain for coffee and to regroup. We reviewed the answers to our questions and articulated new questions that had arisen as a result. Although we had been given a considerable amount of time with the doctor, by the time new questions surface there are subtle hints that the consultation is over.

A little after noon we presented ourselves at Faulkner hospital for a fourth second opinion. First stop was a new X-ray – required for any new patient (the darn machines have to be paid for, no?), even though I was carrying a huge envelope with all sorts of pictures that were taken in July). Doc #4 referred to the operation as a heroic one which gave us pause. After seeing me walk with ease on tippy toes (‘you shouldn’t be able to do that’) he essentially counseled against a surgical intervention and proposed as an interim measure orthotics and a return visit with a scan to establish a baseline and follow me closely through twice yearly visits.

We left the building in the pouring rain with more clarity this time: no operation right now. What the consequences are of this decision in the long run is conjecture – no one knows. At least both doctors were honest with us that this was not an open-and-shut case and the economic incentives to cut do not seem to play at this level of the professional hierarchy. I asked what they’d recommend if I were their wife, sister or daughter and was given the diplomatic answer that this would make no difference (and received no recommendation). The question was suggested by my doctor-brother in Holland. These doctors apparently treat everyone alike, so they say.

My dreams were about our new presidency and the people who will run my adopted country. That is not surprising since there is much talk about this. This morning’s newspaper had a picture of the team that will tackle the growing crisis. The picture was striking by what it was not: a team of grey-haired middle-aged white men. Obama is sailing the treacherous waters of not being president yet but expected to do something that will show we are in good hands. I skimmed through hundreds of emails that told me he is our savior. I am sure someone else, maybe also just back from Afghanistan, is skimming though the same number that show he is the devil incarnate.

Yesterday was part two of homecoming but in a touch-and-go kind of way: unpacking, but not entirely, filling in various forms for time spent and expenses made, reports, laundry and putting travel gear away but within reach since I will be leaving again in less than a week. The first signals from the visa front are encouraging: the visa application was hand delivered at the Bangladesh embassy in DC with a faint promise that Liz can pick it up on Wednesday and bring it back from DC.

Now that the trip to Dhaka seems more likely than it did before, I started to prepare for my 10 minute presentation at the BRAC conference about how to change established practices in health service delivery to become more effective. That wisdom is contained in a guide that was prepared by several agencies that sometimes compete and sometimes collaborate. I am representing the collaborative piece as part of a panel of people who have thought much and done research about the phenomenon of ‘scaling up.’

Part of the coming home routine is also delivering the gifts I brought home. I think Axel has claimed the small rug which will chagrin Sita (but then there is always a next time) because it is now unfolded on our bedroom floor and he does his exercises on it. Tessa got her henna which I picked up in an Indian supermarket across from my fancy Dubai hotel. As it turned out one packet says black henna which Tessa claims could not be right. She and her friend Valerie are the henna experts, so they know.

The Sinterklaas goodies from Holland will be stowed away until our hybrid Sint Nicholaas celebration on Christmas Eve before they are consumed prematurely. The bag with taai-taai, a chewy anise flavored cookie bar, is already half consumed because it makes for a perfect early morning snack with coffee or milk; but the chocolate letters are off limits – they will go in the shoes that we will put out by the fireplace for Sint to fill in exchange for carrots (for his horse). We hope it will be the new fireplace that was supposed to be installed this fall so we can burn up the 4 cords of wood from our cut up Norwegian maple.

Today Axel and I are going for orthopedic expert opinions number five and six (two were by phone so these are in person consultations #3 and #4) at, respectively, Mass General Hospital and Brigham & Women’s. One is at 9 AM and the other at noon. These are the long awaited appointments, made three months ago, which should bring some clarity about what to do with my ankle. As if it knows, it has been acting up/out a lot lately with the neuropathy at the bottom of my foot going from mild to very annoying and the pain and stiffness on both sides of my foot going from mild to sharp.

I am sliding in the ‘back home’ routine as if nothing has happened, waking up even a bit later than one would expect, coming from 6 time zones away. Lobster cove is shimmering in the early morning sun and beautiful as ever. Going away a lot and then coming home again is the best inoculation against being bored with what you’ve got.

Yesterday saw more snow in Holland for which the airport was not quite ready. All the planes left too late as we queued up for the de-icing and as a result we sat in the plane over an hour longer than the flight time had indicated. I had splurged once again and bought myself an upgrade with points and thus the extra hour was no problem – just more time to read.

In the morning Sietske, the dogs and I went for a long walk through cold and wet weather, good exercise before sitting for over 8 hours in the plane.

On the other side of the Atlantic Axel was waiting for me, after having had an extra hour to read the Atlantic. We headed straight for a restaurant in Jamaica Plain where we met colleague Liz for an orchestrated handover of passport and visa forms which should have arrived in Washington now. There they will be rushed off to the Bangladesh consulate for a quick turnaround visa. Taking the passport pictures in the dimly restaurant was a challenge. We first tried the bathroom with a white apron draped over the door (this failed) and then we headed for the kitchen with the kitchen staff encouraging me not to smile because that was a waste for such pictures.

In the end Liz left with a packet full of forms, letters, my passport and nine different passport pictures, just to be safe. We didn’t want to leave anything to chance. There is no room for error as there are only three workdays this Thanksgiving week in which the stamp can be put in my passport. Whether this will actually be accomplished (and whether I can thus leave for Bangladesh in a week) remains to be seen. I am trying to be philosophical about it but it appears to be high time I get myself a second passport to avoid this sort of last minute visa stress.

We stayed in the restaurant for a meal and then headed home where I tumbled in to bed, early for EST but late for Dutch time. And now I am back on schedule to resume my US life.