Friday, April 15, 2016

The Dog Days of Winter

The broken ankle healed up well, and I had a few slow treadmill runs before my January vacation in Nicaragua. I was very much looking forward to kicking off the New Year with my first outdoor runs since I PR'd that Dempsey Challenge 10K.

On its face, it was a two-week trip to the Pacific Coast, a vacation invitation in honor of my parents' 50th wedding anniversary that I accepted gladly. A house in a beachfront community; my brother, sister-in-law, nephew, and aunties coming together to celebrate my parents in the sun. All pretty damn idyllic.

I flew into Managua on New Year's day, checked in to the hotel and took a cab to this outdoor 50-meter pool. 

The following morning I caught a bus up to Esteli to catch a connecting bus to Somoto, where I would hike-swim-hike-swim the beautiful, remote Somoto canyon. I love riding these local buses. They're hot and loud and stinky, the bus stations are chaotic and overwhelming, and the take on local culture is unsurpassed. These old Bluebird school buses from the US are the primary means of distance travel for huge numbers of people in this country. Most of them are outfitted with blaring sound systems of medium-poor quality, and many are festooned with prayers and petitions to Jesus and God, which makes sense to even the most secular passenger given the state of the road, vehicle, traffic, and driver.

I made Somoto in the afternoon, blazing hot and dry way up there in the hills near the border with Honduras. The small city is paved in cement cobblestones, the streets lined with low, brightly painted adobe houses. My backpack on my back, I walked up to the central square feeling young and wild and free, feeling so richly rewarded for stepping just a little out of my comfort zone into new geographic territory. I was a million miles from anywhere and full of joy. I checked in to a small family-owned hotel, gave a big thumbs up to my $13 room, and met my guide, Reynel, who would take me into the canyon the next day. I liked him immediately, and he walked me up to see the town's improbable Olympic swimming pool. I could not wait to hit it for a training session after the canyon tour the next day.

As the sun sank low, I set out for my first outdoor run since the broken ankle in October. I texted a 
photo to my coach as I left the hotel.

I ran 25 minutes up and down these charming little streets, finding my way up to the highest point, where the sunset clouds came in around the mountains to the west, the town below me as I turned around for an easy cruise back to the hotel. I'm BACK! I thought, my heart bursting with joy. My training is finally on track, I can run again, I've got a week of ocean swims ahead of me, my 2016 training is hereby launched. I am on top of the damn world. Neighbors gathered on their steps while dinners cooked. Children played on the sidewalks and chased balls across the road. I ran down the center of the street, grinning from ear to ear. 

Suddenly the barking of a couple of medium-small dogs intensified dramatically: they were coming at me. I warned them off with a sharp NO!, and in an instant the larger of the two had ripped into my leg, his top teeth sinking deep and holding hard. AHHH!!! OH YOU FUCKER!!! I yelled as I kicked him off. I skittered away, feeling embarrassed for roaring such an obscenity in this idyllic scene. I paused on the sidewalk to collect myself, and I saw the blood gushing out of my leg. Filling my shoe, pooling on the pavement. More than I've ever seen.

A woman immediately approached me and asked if I knew Reynel. YES! I said, so grateful for her concern and assistance. She ran up the block to get him, and a few minutes later he appeared with a first aid kit in hand. By this time I was crying. You’re fine, you’re fine, he said, a guy who’s seen everything. Turns out the whole thing happened in front of his house, so he walked me up there and invited me in to his living room, where we both got a good look at the wound. Ohhh...wao, he said. Es muy profunda.

Yeah, I was thinking it looked pretty deep too. Can you please call me a cab? I think I'd better get to the hospital.

bsolutely not. Tranquilo, tranquilo, sit down and wait, we're taking you ourselves, he insisted. The owner of the hotel, Hervin, and his son, Ervin, were there in a flash and loaded me into the pickup truck, Reynel and Ervin riding in the back. We were at the hospital in three minutes.
There were probably 20 people waiting in the filthy hall. No check-in, no triage nurse, no apparent system of any kind. Reynel grabbed one of the two people with stethoscopes wandering around and told him what was up. He told me to sit and wait with everyone else. I found a gurney and bled on it as I began to process what had just happened, trying to think clearly, trying to figure out what I needed, how to get it, the various implications tumbling in.

At some point I was told to go wait in a room with three beds. On one laid a woman in obvious pain. Four family members stood and sat around her, and they all ate chicken from a Styrofoam takeout container. The counter and cupboards were a 1980s prefab kitchen set. The countertop was covered in dirty medical supplies, used equipment, various bottles, plaster splatters, and soiled cloths. All the cupboard doors were open. It looked more like a construction site than an emergency room. 
The woman next to me told me she’d been waiting to be seen for six hours. Something about her back.

A cat wandered in from the street and meowed insistently, hoping for a discarded drumstick. Go home, I told my entourage. Go get some dinner. I’ll be fine. Not a chance, they replied. The angry gash from the dog’s powerful upper jaw bled onto the dirty sheet beneath me. New layers of tissue revealed themselves as I strained to recall the relevant anatomy and physiology lessons from a couple years back. On the back of my calf, two smaller punctures bled where the lower teeth had gone in. I was already bruising between the two, in the space where the dog’s mouth encircled my leg.

As I laid there wishing I had maybe washed the wound out a little bit before coming to the hospital, my thinking started to clear. The good news: the dog belongs to a person, and Reynel knows it. Nobody thinks it has rabies. In fact, everyone knows the dog is an asshole who has already bitten some people, including a couple of children. The other good news: these amazing guys, one of whom speaks excellent English, are clearly not leaving my side until I’m fixed. I felt embarrassed and humbled and very grateful.

Then the disappointments started trickling in. Obviously, no canyon tour tomorrow. Another forced break from running. No swimming. Oh God…I’m headed to the beach with my family. To swim, to surf. No swimming. And this: I had left my job on Dec 31 and I start my new job Feb 1. Facing a $950 COBRA premium, I had decided to risk a month without health insurance. I was totally uninsured. If this thing went south, I would face massive hospital bills. I had a dog bite and I was in the tropics and I was in a small, understaffed, under-equipped, unsanitary, local medical center with a stray cat in the ER. Now, I’m not a worrier, and I’m an exceptionally healthy person, but any one of those things would have given me pause. Now I had all three. Shit shit shit shit shit. Visions of competing in my next Ironman as an amputee, a recurring daydream I’ve had often for the last few years. Shit.

Then it hit me. I HAVE to be here. I'm a nursing student. I'm in school because I want to work in developing countries. This is part of my curriculum. I don’t know exactly why or how, but I need to experience exactly this. Of course. Yes. This is exactly the kind of place I want to work, the whole reason I'm in school. How incredible that I'm on the inside on my first day of vacation. The certainty of it pierced through my worry, and I settled right in, a new calm and lightness coming over me.

The doctor entered, avoiding eye contact with us all. He looked tired and unhappy. He asked a few questions, then got a light, set up a sterile field of questionable sterility and went to work cleaning and anesthetizing the wound. My three guys stood by, trying to maintain their equilibrium as the doc inserted his finger all the way to its base, tunneling beneath the skin where the dog had ripped me open. Good thing you’ve got empty stomachs, I laughed. Why don’t you go find your families for some dinner? I’ll be fine. They stayed.

The woman on the table next to me had been started on a juicy IV of pain meds that were definitely doing the trick, and she began cracking jokes about how the dog was hungry, and when it saw my big, beautiful legs running down the street, it decided that’s what was for dinner. Cena de perro. This gringa is doggie dinner.

You need the tetanus series, the doc said, plus an aggressive course of antibiotics, and we need to watch the dog, even though it's a pet, and we know it's a jerk, just to be safe. Even though Nicaragua has done a great job of getting dogs – pets and street dogs alike – vaccinated against rabies. I was scheduled for a follow up at the health clinic the next morning. I asked Ervin to explain that I have epilepsy, that I had a seizure in April—my first seizure in 20 years-- because I was on an antibiotic that lowered my seizure threshold, so I needed an antibiotic that wouldn't do that.

A medical assistant everyone kept calling "Doctora" had to go find carbon paper before she could hand-write my discharge papers. She wrote a prescription, and I asked Ervin to confirm with her that someone had checked it against some seizure list. He was clearly uncomfortable doing this –- I was seeing total deference to the medical staff, and he was obviously reluctant to question them. When she dismissed us both with a haughty “DOCTORS would never prescribe something that would hurt her”, I let it go and decided to just google it when I got back to the hotel before taking the pill. The guys took me back to the hotel, and the family invited me into their home and insisted that I join them for dinner. It was well after 11 and everyone was headed for bed when I discovered, with some texting help from my brother, that the drug they had given me was in fact contraindicated.

Oh shit. Shit shit shit. Everyone is going to sleep. I have already been an impossible imposition. Maybe I should wait. GET ON THAT ANTIBIOTIC NOW, said my inner voice, backed up by my little brother’s. Oh hell. I found Ervin in the dark hotel and asked him to call me a cab. Of course he wasn’t going to do that. He got the car keys from his dad and the security guard drove us back to the hospital.

The same medical assistant made fun of me when we got there and showed her the screenshot from – which Ervin kept calling “an app.” I could see that he was terribly uncomfortable challenging her on my behalf. I just didn’t have enough quality Spanish at midnight to do it myself. But I had enough to understand what was going on. She rolled her eyes and laughed when she said, fine, fine, let’s just get her out of here. I’ll write her another prescription if she insists on it, but she should get tested to find out what antibiotics she’s allergic to if she’s that worried about it. “It’s not an allergy!” I exclaimed, but dropped it, for Ervin’s sake and my own. The new prescription was fine.

I worried all night, trying to figure out the right course of action. If infection set in, I didn’t want to be up here in this town, a 4- or 5-hour bus trip back to Managua, with its gnarly little hospital. I decided I’d go to my clinic appointment and then I’d know what to do.

The decision could not have been made clearer. My pal Ervin waited with me for 90 minutes as we sat in the open courtyard watching the one nurse give vaccinations to all the children in town while also trying to treat random patients like me. My leg throbbed. An old woman asked what happened, then told me I should put lemon juice in it. 

“Did she just tell me I should put lemon juice in it?” I asked Ervin. “That sounds painful.”

“Yes. I think you would die,” he chuckled. “You’re pretty tough, but that might kill you.” A man said the best thing for a dog bite was gasoline. Just pour gasoline in it, he said. No problem.

A woman came in selling popcorn in baggies as I waited and hoped that the medical staff were inclined toward using sterile water instead of lemon juice or gasoline. Finally, the overworked nurse called us in to a small dark room that smelled strongly of urine. There were basins of liquid sitting on various surfaces, trash on the floor, two small tables jammed with supplies. I sat on an exam table covered with a soiled sheet. With one semester of nursing school behind me, I knew just enough to be really annoying and truly horrified.

I could see by the way she attempted to put on her sterile gloves that the nurse had been taught 
how to do it properly, just as I recently had, but when one didn’t go on quickly and easily, she completely abandoned procedure. She had me dangle my leg over the wastebasket while she irrigated it with a mystery fluid from an unmarked container, then swabbed it with gauze, at one point taking a swipe across the bottom of my heel before taking another pass over the wound. She had a runny nose, and it was when she returned to my wound after wiping at her face that I decided I’d be doing my own wound care from here on out. I also knew I needed to get back to Managua ASAP.

I spent the rest of the day finding gauze, the right presents for my incredibly gracious and generous hosts, and a bus ticket back to the city. We said goodbye with hugs and kisses, and I promised them I would write the best Trip Advisor review they’ve ever seen.

I arranged for a doctor from the Military Hospital – widely considered the best – to meet me in my hotel room in Managua. Roque was in his late twenties, adorable, concerned, attentive and reassuring. He liked how the wound looked, and he was glad I’d skated through the first 24 hours without infection. I told him about the conditions in Somoto. Even at the military hospital, he told me, they are under-equipped and under-staffed. The government pays for the last two years of medical school, but the pay is so bad that there aren’t enough young people becoming doctors. As we exchanged contact info so he could track my progress and advise me over the next week, I asked what I owed him. “Pay whatever you feel it is worth,” he said. When I pressed him for some guidance on a house call, he admitted that it was his first, but that the charge for an emergency visit in a private hospital was around $50.

Feeling reassured, I settled in to wait for the rest of my family to show up over the next two days. As the wound started healing without signs of infection, my fear turned to irritation, disappointment, and frustration as I realized that I would be spending ten days in a house at the beach with my family, unable to do most of the things that I was looking forward to—swim in the pool with my nephew, surf, take long swims in the ocean, and spend hours upon hours biking and running. For some people, a week to just sit around and read is a dream come true. It’s anathema to me. I mean, I love my family and looked forward to time with them, but I couldn’t bear the thought of sitting around like that. And not being able to exercise my way through any stress that might just come up with family? Oh man, they were going to kill me for sure.

Plus, I have always been the family member who creates drama, who has some THING going on. Like Jan Brady. Horrible little Jan. I wanted to be Cindy. Or at least Marcia, a little obnoxious, but so successful you have to love her for it. Not bitchy old Jan. I wanted this trip to be about my parents, about everyone else, not about me and my stupid scary thing. I am always feeling like this desperate attention-seeker, with some ridiculous medical issue giving me the excuse. Last year I injured my foot in Costa Rica. I made a bigger deal out of it than I meant to, and I ended up really regretting it. I had no idea how to do this any other way.

Of course I was aware of the ridiculous privilege inherent in this line of thinking even as I was thinking it, and while I let the feelings wash through me I resolved to keep my perspective. Even while the emotions came crashing in, I was buoyed by a calm and steady certainty that this was all exactly right, to my benefit as a future nurse, maybe, and that the script was playing out exactly on point.

Still, when we arrived at our beach villa and my brother found me to tell me he’d discovered seven surfboards in the hall closet, I burst into tears. This is going to be a long week.

I felt well enough to walk, though, and I discovered a gym, and on the second day my pattern was set—a 6:30 am fast walk of about 3 miles to the gym, some kind of light workout, and a walk back. I’d get to the house around 9 full of endorphins, energized and relaxed. We had great family time and I made all kinds of friends around the neighborhood. I changed my dressing daily and sent photos of the wound to Dr. Roque and my friend Mara, also a doc, for analysis. I felt tremendous relief with the growing certainty that I’d be keeping the leg after all. 

But my head was messed up. I have lived a blissfully, blessedly trauma-free life so far. And this thing screwed me up in ways that stunned me. Panicked by a friendly dog brushing against me, or terrorized by a street dog minding its business on the other side of the road, my mind totally clear that I was safe, my body seeing it differently, bursting into tears, reduced to a shaking, terrified, paralyzed mass. My walk home from the gym one day was delayed by half an hour because I couldn’t bring myself to walk past a dog at the resort entrance. I was crying hard every day. Aw hell, I thought, I need to fix this now. I cannot be limited like this. I can’t be this scared. I suddenly had a whole new kind of respect for people who have experienced massive trauma. There were times in this week when the terror from this tiny little bite was so huge that I felt I would not survive another dog bite. I wanted to scream and scream and scream and scream. Mostly I just cried. I cannot imagine working through something truly life threatening.

Lucky for me, I was on vacation with my aunties, who were described as “Boulder’s social work power couple” at their wedding in September. Aunt Cindy does a lot of trauma therapy, and she comped me a couple of sessions in between dips in the pool and beach trips. We worked through layers and layers of sadness, fear, anger, frustration, rage, and terror. I wadded up rolls of toilet paper on her floor as I cried it out. “Jesus Christ,” I said at some point. “It’s just a damn dog bite. This can’t be such a big deal.” Cindy reminded me that humans are the only animals that try to pretend everything’s OK. All the other animals let their bodies shake and yowl and run the trauma out. We are the only ones who stuff it in. Try not to judge it, she said. Just let it flow through.

And finally, tired of it all and to my greatest surprise, I felt just a moment of deep, sincere, unvarnished gratitude toward that little dog. To the universe, for this experience and all that it was offering me. Complete trust in the perfection of it. Pure love. Gratitude too for the relative simplicity of the situation, for the fact that I was not badly harmed. I cried again, now with joy and delight.

The following day, I stopped into the stables on my way from the gym. The guys working there were great, but I quickly realized that I was terrified of the horses I was so excited to visit. Will he bite? Will he bite? I asked again and again, almost panicky in their presence. No no no, the guys assured me. Muy tranquilo, muy tranquilo. I walked away crying, heading for home, disappointed in myself and dismayed that I felt so fearful. This thing with the dog was affecting everything. So I stopped at the front desk in the main building and inquired about booking a horseback riding session. Just let us know and we’ll reserve your time, they told me.

On our last full day, my Aunt CJ and my parents joined me at the stables for an hour ride on the beach. I got on my horse. You’ve ridden before? asked Lorenzo, the head trainer. Not for thirty years. And I’m really scared, I told him.

The next thing I knew, he had me on a line, leading me behind him like a child. Whoa whoa whoa, why am I being towed? I asked.

You said it’s been thirty years and you’re scared, he said.

Well, I said. I mean. I’m not THAT scared. Just. Just let me try it. By myself. I’m actually a pretty adventuresome person. I’ll be fine.

(FuckfuckfuckfuckFUCK I’m scared.)

My horse was called Mora Azul, Blueberry. She followed Lorenzo’s horse down the trail as we set out. My heart slammed against my chest as she went down into the first small ravine with a faster step. With the slightest pull on the reins, I ever so gently asked her to slow down, knowing that my own fear was the only issue here, feeling slightly embarrassed by the request. She immediately responded, almost before I’d even asked it, with such unconditional assurance and grace, that I was moved to tears. I put all my trust in this enormous creature, and she totally took care of me. My fear vanished and I embraced the ride. I knew this horse was way smarter than me, patient, and intuitive. She did what I asked her to, but she also did what I needed her to do, even when I didn’t know how to ask for it. She healed me.

The following morning, in the hours before we left for Managua, I went for my first run since the dog bite. I came upon two enormous guard dogs on the service road, and I just turned around and walked away. I didn’t enjoy it, but I didn’t lose my shit, either. And the run felt great.

By the time I got home, though, the flap of skin was black. Mara took my stitches out in my living room, and she urged me to go to the wound clinic at Pen Bay. The PA took one look and cut the big flap right off, along with the other dead tissue rimming the wound. I was left with a hole in my leg almost an inch deep. For two months, I packed moist gauze into it, changing dressings daily and visiting the clinic every week. 

As a nursing student, I loved this real life example of the healing process--suddenly all those Powerpoint slides were coming into focus. I made my classmates look at my wound every so often, asked one to change the dressing once. Texted photos daily to Mara.

The wound filled in from the bottom with textbook perfection. Millimeter by millimeter, it grew shallower and shrank in diameter. "I feel so lucky", I told my dear PA at the clinic.

"You SHOULD feel lucky!" he said, suddenly dead serious. "I don't mean to be morose, but this could have ended very, VERY badly." 

Yeah. You don't have to tell me that, buddy. For a few days back there, I seriously worried about losing the leg. 

However, I just kept getting better and better. Stay out of the pool until that wound closes up, my PA told me. So for three months I cautiously ran and biked, mostly indoors thanks to the excuse of weather, working through some fear about getting bitten again, but feeling very lucky and profoundly grateful for good drugs, good care, good genes, good health, and good friends. 

But the swimming. I really missed the swimming. It's the only one of the three sports that always feels good to my body. I dreamed of slipping into the water, my body supported and strong as I stretch and flex, gliding across the surface. No dogs to chase me, no cars, no potholes, no ice, no danger.

Three months to the day, the wound finally closed up completely. And on that auspicious day, I happened to land back in the tropics, a previously scheduled trip to Bimini. I jumped in that warm Caribbean sea with delight, and I swam with a loggerhead turtle, a giant reminder of steady, slow grace.
Photo by Kathleen Fisher, Bimini Healing Arts

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