My Khmer teacher is definitely one of my top three Cambodians. She is like a mother to me & does a lot more than teach me to read & write khmer. I really do love her - an awful lot.
Last Friday she called me at 1 am to tell me she couldn't move. I slept through her first call because I haven't been sleeping well recently & was utterly exhausted, but I must have been partially woken because I was woken up by J texting me to tell me that S had also called her husband - G - to say she needed me. G was dressed & getting ready to pick me up on his moto.
When I went to my bathroom to ablute, the biggest cockroach I have ever seen in my life was walking around the bucket of water I have for showering (I still don't have a reliable water supply) - I saw this as a sign of ill portent. I am not sure whether it was being woken from a very deep sleep, the early hour or the monster cockroach but the surrealness gave a certain edge to my anxiety.
Scabby dog was pleased to see me, as always & Tony started his usual aggressive barking & growling assault on me for just walking out of my house. I sat on the stone bench outside my gate, by the little pharmacy shop, pondering on how many people were still up & about at this hour of the morning in Battambang & wondering what the hell I would do if S was seriously ill or died. I tried to focus on the prostitutes & drug dealers still going about their business, this was the more cheerful line of thought.
By the time G arrived I had dealt with almost every possible outcome the evening could bring & vowed never to cycle alone this late at night - there was too many undesirables about. I had also given up trying to get scabby dog back into the compound before I locked the gate - she is pregnant already so not much more damage could be done to her reputation.
S lives in an old french colonial corner house in the town centre & rents most of the rooms to other people. One of the women that rents a room & owns a shop in front of her house heard us arrive & came down to open the metal roll shutter door to let us in. I rushed up stairs to the room where I have my daily khmer lesson after work.
We sit at her table & talk about life, death, love, family, sex, illness, happiness, khmer rouge, loss & occasionally we even learn some language - S English much more than me Khmer. But that evening the room was empty, S was laying on her bed in the little windowless bedroom off this room with another of her tenants holding a boiled kettle on her feet & the tenant's daughter massaging her arms & legs frantically.
When I was 18 years old I sat with my Grandfather - who had a massive stroke & subsequently died - & my grandmother waiting for the GP & then the ambulance. Years later when my grandmother was dying of cancer I spent a weekend with her talking about a lot of things including that day & how even when I was a teenager she could see then the doctor that I would later go on to become. There's an intimacy in care giving which is a lot less stressful, I have recently learnt, when you can be sure of access to a good, free, health care system.
I felt very alone as I knelt down by S's bed, kissed her on the shoulder & asked her what was wrong, it was the loneliness of someone who is medically trained yet knows there is no decent health care facilities for 1000s of km.
G waited outside & was shocked to hear me being gentle, kind & reassuring - I guess my bed side manner hasn't been exercised much in the last 2 years. And then because in serious situations I always tend to be a little flippant or humorous I asked S if she needed to be coined - she smiled weakly & declined. G was relieved to hear the real Dr Esther was still in there.
She told me she was numb around her mouth & the right side of her body- this took some time to establish as I had not brought my dictionary & the word was not in hers. I now know that ស្ពឹក is numb. I have since pointed out to her that if she was a better khmer teacher & I a better student I probably would have known that by now but during a medical emergency & in the early hours of the morning was probably not the best learning environment.
Her blood pressure was very high, she couldn't stand & she felt weak and had already self medicated with an antihypertensive tablet, one of the many dangers of living in a country with unregulated pharmaceuticals.
At a loss to do anything in a country with no decent medical interventions & an absence of anything close to nursing care I gave her a big hug & we sat there like that for a long time slowly rocking with her chanting, like a mantra, "you are here now". This seemed to calm her down & after a while she got up, used the chamber pot & told me I must now stay at her house over night.
Since I started having my lessons at her house every week day, for the last year S has been conspiring to get me to sleep at her house, when I had Dengue she even tried to sleep at mine & now she had orchestrated a TIA (mini stroke) to obtain her goal. G was dismissed.
The boiled kettle was transferred to her abdomen & we all bedded down on various hard wooden day beds & benches - me & S on the day bed with a thin mattress, the owner of the shop downstairs on the day bed with no mattress & the neighbour on the cushion-less wooden sofa. I got the best deal but I couldn't sleep.
My mind was racing - had she had a posterior TIA? Was it a bleed? Would she go on to have a massive stroke? What would I do if she did? Where would I take her? How does anyone ever sleep on these really hard beds?
I came up with a few conclusions.
Firstly its a lot more stressful if someone you care about gets sick in a country where there is no available universal, free, good quality health care. My other experiences of sickness or loss in people I love have always been in an environment where I have believed & trusted that everything possible will be done for them. I realised that my anxiety & fearfulness could be so much worse without this security blanket.
Secondly if S dies I will really lose my shit with this place & have to leave Cambodia - I can't cope with all they premature death, suffering & injustice - I have nearly had my fill of it.
Thirdly I am miles away from my family & friends who I care about very much but this place has a strange hold over me that I can't articulate.
Finally I can never leave Cambodia as long as there are people that I love - as surrogate family, friends or some even a tad inappropriately - are living here, who can't access decent healthcare. Why should people born in one place be exposed to poor health & no medical care whereas others can afford good health without even appreciating what they have? I came here to capacity build the health care system & I really as a finisher completer I shouldn't leave until I have finished & completed this task....it was about 4 am by the time I reached this final conclusion, I was delirious with sleep deprivation & anxiety.
I must have finally fallen asleep because when I woke at first light the neighbours had left & S had gone back to her comfortable bed. She got up looking a little shaky & drawn. We drank ovaltine & talked now she was calmer & more coherent. I am sure she had been coherent before when speaking in khmer, its just I couldn't understand anything of what she was saying.
She had thought that she was dying in the night, she told me that she didn't know what she would do if I wasn't here - I suggested maybe never go to the government hospital EVER, under any circumstances. She agreed. I explained what I thought had happened, a TIA & what tests I would like to do (CT, ECG) and what medications she should start. We took our blood pressures - mine was a lot higher than hers now.
When she said again how afraid & scared she was that she may die I told her I would prefer her not to that. She then said that really what was so much worse than dying would be disabled & unable to be independent here in Cambodia - I agreed & offered to put a pillow over her face if it came to that. We talked about her going to France to be with her sister & her son but the cold & damp makes her joints ache & Cambodia is her home, where her ancestors bones are, where she wants to die & where her bones will also be.
G came early on his moto to take me home so I could go back with aspirin & antihypertensive medication to S's. She asked lots of questions about what the medication did & why the dose & for how long she needed to take it all for. Something that in the last 2 plus years I have never seen from any patient in the MoH hospitals. The thought of a stroke scared her but she understood that the tablets would reduce the risk of last night happening again.
J & I met for breakfast to discuss how to get a CT scan for S. We went to a private clinic where patients from the hospital J worked in with R, when she was a VSO volunteer, were sent if they needed a CT & could afford it. We were surprised to find the price was the same for us as Cambodians - $100 - we had expected a price hike. The private clinic is just around the corner from S's house so we went to find her but she had already been to check prices so had decided she would take her chances with just taking aspirin.
A long imploring conversation ensued which resulted in her taking $100 from her purse - not our intention - and agreeing to go with us to have a head scan.
At the clinic 3 people acknowledged me as a doctor from the provincial hospital which made me smile considering the doctors there don't even recognise my qualifications. It meant however that S went straight in for her BP check, ECG & CT scan of her head. She was quaking & afterwards showed all the signs of claustrophobia - thank god there aren't many MRI scanners in Cambodia.
The doctor called her through with the results & wanted to know why I wanted a scan if she hadn't had a head injury or a headache. I explained she had transient neurological symptoms & I was worried about a bleed or an infarct. Whilst we went in J paid the medical bill - as previously & repeatedly stated in this blog, J is one of God's better people. Unable to fully accept J's kindness & generosity S (J's landlady as well as khmer teacher) later bought a washing machine for J's house whilst we were working away from Battambang - Karma.
S has got it into her head that she has to do gymnastics to prevent further episodes - I am sure something I said has been very lost in translation. She also will take the aspirin & was amazed I could answer all her questions about it's mode of action & dose. I had to remind her that I am a doctor or at least I was one once. The kettle of boiled water on the feet is apparently a well known Khmer remedy for reducing blood pressure & coining is only for headache & fever - the fact that I didn't know this already is probably the reason S can't believe I am really a doctor.
The whole experience has left me a little raw - anxiously waiting for the next call in the night, dreading what the future may bring, fearful of the loss of the things I love the most.
After all isn't it the case that you can never truly appreciate something until you have lived without it.
Last Friday she called me at 1 am to tell me she couldn't move. I slept through her first call because I haven't been sleeping well recently & was utterly exhausted, but I must have been partially woken because I was woken up by J texting me to tell me that S had also called her husband - G - to say she needed me. G was dressed & getting ready to pick me up on his moto.
When I went to my bathroom to ablute, the biggest cockroach I have ever seen in my life was walking around the bucket of water I have for showering (I still don't have a reliable water supply) - I saw this as a sign of ill portent. I am not sure whether it was being woken from a very deep sleep, the early hour or the monster cockroach but the surrealness gave a certain edge to my anxiety.
Scabby dog was pleased to see me, as always & Tony started his usual aggressive barking & growling assault on me for just walking out of my house. I sat on the stone bench outside my gate, by the little pharmacy shop, pondering on how many people were still up & about at this hour of the morning in Battambang & wondering what the hell I would do if S was seriously ill or died. I tried to focus on the prostitutes & drug dealers still going about their business, this was the more cheerful line of thought.
By the time G arrived I had dealt with almost every possible outcome the evening could bring & vowed never to cycle alone this late at night - there was too many undesirables about. I had also given up trying to get scabby dog back into the compound before I locked the gate - she is pregnant already so not much more damage could be done to her reputation.
S lives in an old french colonial corner house in the town centre & rents most of the rooms to other people. One of the women that rents a room & owns a shop in front of her house heard us arrive & came down to open the metal roll shutter door to let us in. I rushed up stairs to the room where I have my daily khmer lesson after work.
We sit at her table & talk about life, death, love, family, sex, illness, happiness, khmer rouge, loss & occasionally we even learn some language - S English much more than me Khmer. But that evening the room was empty, S was laying on her bed in the little windowless bedroom off this room with another of her tenants holding a boiled kettle on her feet & the tenant's daughter massaging her arms & legs frantically.
When I was 18 years old I sat with my Grandfather - who had a massive stroke & subsequently died - & my grandmother waiting for the GP & then the ambulance. Years later when my grandmother was dying of cancer I spent a weekend with her talking about a lot of things including that day & how even when I was a teenager she could see then the doctor that I would later go on to become. There's an intimacy in care giving which is a lot less stressful, I have recently learnt, when you can be sure of access to a good, free, health care system.
I felt very alone as I knelt down by S's bed, kissed her on the shoulder & asked her what was wrong, it was the loneliness of someone who is medically trained yet knows there is no decent health care facilities for 1000s of km.
G waited outside & was shocked to hear me being gentle, kind & reassuring - I guess my bed side manner hasn't been exercised much in the last 2 years. And then because in serious situations I always tend to be a little flippant or humorous I asked S if she needed to be coined - she smiled weakly & declined. G was relieved to hear the real Dr Esther was still in there.
She told me she was numb around her mouth & the right side of her body- this took some time to establish as I had not brought my dictionary & the word was not in hers. I now know that ស្ពឹក is numb. I have since pointed out to her that if she was a better khmer teacher & I a better student I probably would have known that by now but during a medical emergency & in the early hours of the morning was probably not the best learning environment.
Her blood pressure was very high, she couldn't stand & she felt weak and had already self medicated with an antihypertensive tablet, one of the many dangers of living in a country with unregulated pharmaceuticals.
At a loss to do anything in a country with no decent medical interventions & an absence of anything close to nursing care I gave her a big hug & we sat there like that for a long time slowly rocking with her chanting, like a mantra, "you are here now". This seemed to calm her down & after a while she got up, used the chamber pot & told me I must now stay at her house over night.
Since I started having my lessons at her house every week day, for the last year S has been conspiring to get me to sleep at her house, when I had Dengue she even tried to sleep at mine & now she had orchestrated a TIA (mini stroke) to obtain her goal. G was dismissed.
The boiled kettle was transferred to her abdomen & we all bedded down on various hard wooden day beds & benches - me & S on the day bed with a thin mattress, the owner of the shop downstairs on the day bed with no mattress & the neighbour on the cushion-less wooden sofa. I got the best deal but I couldn't sleep.
My mind was racing - had she had a posterior TIA? Was it a bleed? Would she go on to have a massive stroke? What would I do if she did? Where would I take her? How does anyone ever sleep on these really hard beds?
I came up with a few conclusions.
Firstly its a lot more stressful if someone you care about gets sick in a country where there is no available universal, free, good quality health care. My other experiences of sickness or loss in people I love have always been in an environment where I have believed & trusted that everything possible will be done for them. I realised that my anxiety & fearfulness could be so much worse without this security blanket.
Secondly if S dies I will really lose my shit with this place & have to leave Cambodia - I can't cope with all they premature death, suffering & injustice - I have nearly had my fill of it.
Thirdly I am miles away from my family & friends who I care about very much but this place has a strange hold over me that I can't articulate.
Finally I can never leave Cambodia as long as there are people that I love - as surrogate family, friends or some even a tad inappropriately - are living here, who can't access decent healthcare. Why should people born in one place be exposed to poor health & no medical care whereas others can afford good health without even appreciating what they have? I came here to capacity build the health care system & I really as a finisher completer I shouldn't leave until I have finished & completed this task....it was about 4 am by the time I reached this final conclusion, I was delirious with sleep deprivation & anxiety.
I must have finally fallen asleep because when I woke at first light the neighbours had left & S had gone back to her comfortable bed. She got up looking a little shaky & drawn. We drank ovaltine & talked now she was calmer & more coherent. I am sure she had been coherent before when speaking in khmer, its just I couldn't understand anything of what she was saying.
She had thought that she was dying in the night, she told me that she didn't know what she would do if I wasn't here - I suggested maybe never go to the government hospital EVER, under any circumstances. She agreed. I explained what I thought had happened, a TIA & what tests I would like to do (CT, ECG) and what medications she should start. We took our blood pressures - mine was a lot higher than hers now.
When she said again how afraid & scared she was that she may die I told her I would prefer her not to that. She then said that really what was so much worse than dying would be disabled & unable to be independent here in Cambodia - I agreed & offered to put a pillow over her face if it came to that. We talked about her going to France to be with her sister & her son but the cold & damp makes her joints ache & Cambodia is her home, where her ancestors bones are, where she wants to die & where her bones will also be.
G came early on his moto to take me home so I could go back with aspirin & antihypertensive medication to S's. She asked lots of questions about what the medication did & why the dose & for how long she needed to take it all for. Something that in the last 2 plus years I have never seen from any patient in the MoH hospitals. The thought of a stroke scared her but she understood that the tablets would reduce the risk of last night happening again.
J & I met for breakfast to discuss how to get a CT scan for S. We went to a private clinic where patients from the hospital J worked in with R, when she was a VSO volunteer, were sent if they needed a CT & could afford it. We were surprised to find the price was the same for us as Cambodians - $100 - we had expected a price hike. The private clinic is just around the corner from S's house so we went to find her but she had already been to check prices so had decided she would take her chances with just taking aspirin.
A long imploring conversation ensued which resulted in her taking $100 from her purse - not our intention - and agreeing to go with us to have a head scan.
At the clinic 3 people acknowledged me as a doctor from the provincial hospital which made me smile considering the doctors there don't even recognise my qualifications. It meant however that S went straight in for her BP check, ECG & CT scan of her head. She was quaking & afterwards showed all the signs of claustrophobia - thank god there aren't many MRI scanners in Cambodia.
The doctor called her through with the results & wanted to know why I wanted a scan if she hadn't had a head injury or a headache. I explained she had transient neurological symptoms & I was worried about a bleed or an infarct. Whilst we went in J paid the medical bill - as previously & repeatedly stated in this blog, J is one of God's better people. Unable to fully accept J's kindness & generosity S (J's landlady as well as khmer teacher) later bought a washing machine for J's house whilst we were working away from Battambang - Karma.
S has got it into her head that she has to do gymnastics to prevent further episodes - I am sure something I said has been very lost in translation. She also will take the aspirin & was amazed I could answer all her questions about it's mode of action & dose. I had to remind her that I am a doctor or at least I was one once. The kettle of boiled water on the feet is apparently a well known Khmer remedy for reducing blood pressure & coining is only for headache & fever - the fact that I didn't know this already is probably the reason S can't believe I am really a doctor.
The whole experience has left me a little raw - anxiously waiting for the next call in the night, dreading what the future may bring, fearful of the loss of the things I love the most.
After all isn't it the case that you can never truly appreciate something until you have lived without it.
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