Day 3

Make sure to bring the med student with you when you pay for lunch. No more instant oatmeal or instant noodles on your watch today.

Set up the simulation machine that was never made to teach anyone anything, just meant to sell equipment to caffeinated and bored doctors between breaks at a national conference. Remember what they tell you back home, that anyone can teach a monkey IR. Struggle with the sim machine and feel offended for the monkey's sake.

Make a mistake at board review and learn from your own mistake out loud. You can't shake the feeling though. There are mistakes you learn from and mistakes you don't. There is a version of you in the future whose mistakes no one will catch. Be haunted by that thought as you tighten the bone window of a so-far negative CT scan. There seems to be no such thing as a negative CT scan here, no matter how much you hope and pray.

Take the van on time today. Push around the couches and tables when you get back. Fill a pot with water and use it as a weight to do squats and lunges. Burpees on the floor until you sweat. Shower before dinner. Bug spray but you can quit the sunscreen now as the sun dips in the sky. Sweat anyway. 

Wait for a cab by the gate. Watch the dogs come to say hello. One of them proudly drags a bag scavenged from the trash with something in it that still smells like food. The other is a puppy with one ear up and one ear down. Be more afraid of them than they are of you until you see the little one sneeze so hard it accidentally rolls over and bowls into her clearly annoyed mother.

Order the cheapest steak you've had in a long time and eat it all. Realize you've eaten as much as the emergency medicine doc sitting down the table who is twice your size. Order breadfruit fries because you've never had it before and eat some more. Make sure the med student eats. He was a plumber in another life, did you know. And aren't all of us plumbers really?

Beg for a mosquito coil from the guard man at the gate. Makeshift an aluminum ash tray. Burn it by your bed. Try not to think of the smoke filling your lungs as you fall asleep. Bargain instead with your future self, trading this for at least five meals with processed meat, three bummed cigarettes on a night out, and a day at the beach without sunscreen.

Day 2

Wake now to something that is starting to feel familiar. The bug spray, the sunscreen, the honking, the van.

There is a speech. There is shaking hands in a cold room. There are photos. There is another speech. Wonder if the words mean anything at all. Look at the equipment all displayed on the x-ray table. Realize that they represent a hope, future, dream. Wonder at their expiration dates. Notice this time when you walk through the blue hallways that the diabetic foot clinic is just a few steps from the radiology department.

Sit in the dark and count down years, so few. Count the metastases, so many. Count the systems, body parts affected. Ask about HPV screening. Ask about vaccines. Ask about MRI and PET-CT's. Ask about chemotherapy, immunotherapy, radiation oncology, pathology. Get to the end of your report and hem and haw about what to say. What can one possibly say.

There are more. Observe an ultrasound-guided biopsy for a pelvic mass so large, you could hit it from across the room. That's the joke, they say. That a blind man could hit it from across the room. Watch them prep the ultrasound probe anyway. 

Ask the anesthesiology resident staying with you why she cannot take the hospital van without you. Think that maybe this is a mistake, they've mistaken you for an attending here. Or something else is going on, something that gives you the power to sign reports full of cancer and empty of hope, something you resent.

Finish the overly sweet jamoon wine. Eat eggs mixed with leftover curried mushrooms mixed with sauce you find in the fridge. Peel the tiniest banana. Think about the medical student who came with you. Think about him eating instant oatmeal, instant noodles in a small room alone. Think about the things you have and the things you do not. Think about the things you had and the things you did not. 

Day 1

 Wake early to the sound of nothing. Spray yourself down with mosquito repellant and rub sunscreen on every exposed part. It has expired and is the consistency of cottage cheese but probably still works. The FDA has a program for re-purposing expired medications to send abroad.

Go down the stairs when the van honks outside. Keep it together on the bumpy ride and be grateful you didn't eat breakfast. Wonder about the other people in the van. Listen to someone speak Spanish for the first time.

Blue, the hospital is blue. (White, the cemetery was white. The British like white.) Take a tour of the hospital and feel relieved there is air-conditioning most places and ashamed at your own relief. Meet people in a dark room and immediately feel at home. Sink into that semi-dark whispering quiet and feel your eyes half close while the familiar caffeine buzz grips the nape of your neck. Titrate accordingly.

Tag along to a meeting with what you believe could be the medicine team. They discuss a pulmonary embolism that has been teetering on the edge of unstable over the weekend. No one wears ID tags or white coats so you have no idea who anyone could be but you get the sense there is a hierarchy here everyone else seems to know. It's like trying to sing along to a song you don't know the words to. Walk away from the meeting wondering what if anything happened and what if anything will happen to the patient now.

Try your hand at reading out as an attending. Realize how much the templates you've worked with have engrained themselves into your memory. Let show your dislike of neuro and refuse to read out any more ENT cases after a nasopharyngeal tumor makes you sweat. Stick to chest, stick to body, stick to peds. 

Promise yourself you will pay for lunch. Who knows how many people you pay for but it's cheap and filling. Eat more new fruits and vegetables here so far than you have all year. Calaloo. Jamoon. Duongs. Balanjay sounds new but it is stewed eggplant. They wrap it in roti and it spills hot over your hands as you give a lecture on gastrointestinal anatomy. Take bites that make your voice thick as you rush through how you'd treat a bleeder at home, and they tell you blood transfusions there are rare.

Watch them place drains. The room is green. There are more nurses in that room than you've seen all day. Give credit to the ingenuity of creating a sterile ultrasound probe cover using a pair of gloves, the elastic wrist cuff taking the place of a rubber band. Realize no one else in the room knows what equipment is needed to place a drain much less how to open the packaging of said equipment. Wince as multiple packages are opened unnecessarily. Realize the man on the table is not fully sedated. Watch everyone watch his vitals fluctuate and wonder what would happen if.

Dinner is at a Brazilian pizza place. They are out of Brazilian pizza by the time you order. Get a burger instead and watch out of the corner of your eye as it hisses on the open grill. Listen to the nurses who came with you talk about what it was like to grow up there. How going to the hospital then meant sure death. How far things have come that people can trust doctors now. Learn that the hospital is currently operating at 40% nursing capacity.

It begins to rain. Pouring on the tin roof and drowning out any conversation you could possibly have. Look outside and see a sheet of flickering white and realize that is what rain looks like against the street light here. Smell the petrichor--it's different here. Thicker yet cleaner like a sigh being released from the earth. Your senses lull you into a deep sleep.

Day 0

 Wake with the dread of a well-rested person that you've missed something. You venture out into the unusually large living room/kitchen area that you later realize has at least six full-size couches, three coffee tables, and space enough for a personal gym, though you are too stunned at the time to notice. The place appears packed, (white) people rushing too and fro. You retreat to your room and wait out the hullaballoo. 

Venture out again when you get hungry. The rooms are all empty--you can see inside as you walk down the hallway the mess people have left behind. The kind of messy people get when they know they are never coming back.

Someone comes to take you out and about. Realize you are completely at this person's mercy and feel a deep gratitude within your bones when she holds doors open for you and helps you carry grocery bags and tolerates personal-bordering-on-rude questions you ask her about her life. 

Pick up little tidbits. How she'd gone to church that morning. How the men in her life have mod'd out her car. She takes the long way around to let the speed bumps have mercy on her car. She plays Akon and Destiny's Child and Ashanti and Bruno Mars and sings along beautifully. How she needs to take a bus and two boats to go home. The nostalgia she has in her voice when she describes drinking milk straight from a cow's teat and the ruefulness when she talks about how she's become lactose intolerant and has to resort to almond or oat milk these days.

She is a nonplussed tour guide, answering our questions about her country's history the same way I might answer someone who visits New York and points to a random building to ask me what that building is. We read many plaques. She takes us to places she used to go to as a child, on a field trip. The Botanical Gardens, monuments and statues. Read the plaques but listen to her explanations too because her experience is a lived one. Could you answer questions about the political climate at the founding of your nation?

Less than a few minutes apart, look at monuments that honor the Indigenous peoples, the first Guyanese president who also happens to be ethnically Chinese, Cheddi Jagan (whom the airport is also named after), a Hindi/Indian man known as "Father of the Nation." See a true visual representation of diversity, colonization, enforced immigration.

Realize Guyana is beautiful, the shape of it. Statuesque Greco torso: Georgetown sits on her right shoulder as she turns to look at you coyly. Recognize bougainvillea and hibiscus. Google water lilies, lantanas. Learn about the flamboyant tree aka the flame of the forest aka the phoenix tree. Notice the cracks in the dusty ground, the dry fountains, the brown grass and really feel what it means for a tropical country to experience a drought.

Go to the grocery store. See the sun-bleached Transformers poster outside that is a relic from when the movie theater across the way was built. Feel yourself expand the way you do in the suburbs--no more shoulder-to-shoulder at the grocery store, no more squeezing your way past people to get in line to pay, no more looking over people's shoulders to see what they might be buying out of stock. Pause with joy and maybe even sadness when you recognize plants you have been trying to grow in the confines of a New York City apartment and realize what it truly means that they are "tropical." Buy local hot sauce, buy local beer, buy local candy.

Eat your first Guyanese meal. Of course get over-zealous and order way too much food. Papaya smoothie. Mutton curry. Soup from a Guyanese chain restaurant. Perhaps too confidently pour hot sauce on almost all of it. Suffer the consequences later. Watch sweat beads form on your travel companion's face and the amusement break out on the face of your local guide for the day.

Let her off the hook--she's played chauffeur and tour guide enough for the day. Let her go home to her family and relax on a Sunday. Take a nap and drink water--the brutality of the sun is a slow one, creeping up on you to sap away your vitality. Regroup before sunset. You've been told to go to the Sea Wall. The security guard is a stout middle-aged woman who tells us to be wary of the Sea Wall and not go out at night. Her warning has the feel of ominous foretelling, so take a car to the Marriott instead.

The Marriott is another world, air-conditioned and glowing. This is where (white) people come to vacation. The pool is teal. The cocktails are watered down. There is a wedding photoshoot happening in the background. No one stops you from going out on the terrace. Find a wine store (of course). Buy local wine made from a purple plant called jamoon that is known in Hindu tradition as sustenance for Rama during his exile. Watch cricket at the hotel bar. Walk to the edge of the Sea Wall and realize stupidly that it is in fact a wall from the Sea and not a beach where you can touch the water (suspect that the Dutch have been here before you). Go to dinner instead. 

Eat a type of roti you've never had before. Learn how to pronounce rogan josh. Over-order, again. Over-eat, again. Wax poetic on how this type of fusion cuisine is your favorite. Vow to eat something other than curry tomorrow. Vow to eat something green tomorrow. Sleep like the dead.

Day -1

 Listen with dawning dread as your travel chaperone describes a recent medical emergency he had on a plane. Promise his fiancee you'll take care of him regardless. Ask the pharmacist for smelling salts (he will look at you blankly). Consider packing an IV start kit. Learn that they have them on planes. Take mastisol from the hospital. Tell him to bring Vicks. Only buy loperamide. 

Pack sun screen, bug spray, citronella soap and body wash, lemon eucalyptus essence, and wrist bands infused with plant oil.

Make your travel buddy buy a liter of water at the airport. Make him also refill his other water bottle. Of course he will make friends with your pilot while waiting in line. The pilot had given his hat to his son because it's not mandatory for pilots to wear hats but his son likes it. When asked if he thinks his son will become a pilot, his answer is sad and lonely.

Remember your Priority Pass hasn't expired yet and get free hummus and an iceberg lettuce wedge salad--things you think may not get there.

Bring a book called "Erotic Stories for Punjabi Wives." Finish it on the plane. Drink wine on the plane and vomit quietly during landing. Don't make eye contact with your seat mate.

Regret standing in the correct line at immigration. Declare nothing at customs. See your driver carrying a sign with "Dr." in front of your name and feel something. Fall asleep intermittently as your drive down dark roads, speeding past semis and around late-night construction sites before pulling up to a gate where a stray dog lies outside. 

Realize your forgot your phone charger at home and do anxious slept debt calculations, hoping you will wake up in time the next morning without an alarm. Watch your phone die at two o'clock in the morning. Wonder if maybe you should just buy a watch instead as you drift to sleep.