The journey to the after moments

Surgeries get the big press here on Mercy Ships, and for good reason. The conditions people come to the ship with tend to be severe, far beyond what they would be in the rest of the world. The surgeons and the OR team work miracles. But this is just the beginning of the recovery journey for many of the patients.

When patient stories are featured, they typically show a few brief moments of rehab, then skip to the after moments, where the patient is recovered and home. These are the hard won moments which we are all waiting and working for. They are beautiful and the point of the person’s stay here, but I wanted to talk about what gets them there, from a rehab perspective.

We in rehab typically meet the patient the day they are admitted to the ward, which is the day before their surgery. We see them in our dockside tent, and we do as comprehensive an evaluation as possible on whatever their specific condition is. The majority of rehab patients fall under two surgical blocks: Orthopedics and Reconstructive Plastics. Therapists see patients of a variety of ages, addressing problems with necks, backs, and all joints of the arms and legs.

After evaluating the patients in the tent, we do not see them again until after surgery, when the surgeon clears them for rehab. The early days after surgery involve getting the patient up and moving, so they can access the toilet and eventually Deck 7. The hospital is on Deck 3. Being so low on the ship, it is without windows for light and fresh air. Once a day, the patients who are able climb the stairs to Deck 7 for an hour outside. Rehab makes sure those who cannot make the climb can eventually do it. The hand therapy patients can be seen for range of motion when their surgical wires have been removed. They also get custom splints made to keep them in the functional position achieved in surgery. The goals of physical and occupational therapy can be boiled down to: get them stronger and increase their movement so that they can function. The patient’s time in the hospital varies. Some stay a few days, others can stay weeks or longer, should they require it.

When the patient is discharged from the hospital, they come for outpatient. They typically live in the HOPE Center, which is the off-ship Mercy Ships run facility where people can live before and after surgery. We see patients for, on some occasions, 5 months or more, for the more severe conditions. Patients’ wounds heal, they get stronger and more functional, and then, when they are ready, they return home.

This year, I have the privilege of being a part of the after care of the orthopedics surgical block. This surgical speciality adds more complexity to the aftercare process. In the operating room, the children are casted with plaster of Paris. The initial casts are split in half to accommodate post-surgical swelling, and then they are overwrapped with fiberglass after a few days when swelling has gone down. After 3 weeks, the initial casts are removed and a new cast made only of fiberglass is put on, and then the children are x-rayed. Casts are adjusted through a process of wedging to help the bones heal with appropriate alignment. The kids keep those casts on throughout physical therapy, for as many weeks as are planned according the surgical protocol for what conditions the children had, as well as the age of the child. Casts must occasionally be changed during that time, as they are growing children who are also receiving nutritional supplementation. When the prescribed time for casting has been met, we remove the casts and take an x-ray. If the surgeon determines that the bones are healed, the casts are off for good and the child can start relearning how to walk again. If the bones are not yet healed, new casts go back on for another 2 weeks, and then the processes happens again. These tasks fall under the rehab department as well, as we have Orthopedic Plaster Technicians in our department.

We love getting to see patients for as long as it takes to get them well. We form such a close bond with each person we treat, and though it is a challenge, it is also a blessing to join them for so much of their journey.

This snapshot of rehab does not include the other areas of continuing care, such as outpatient nurses for wound care and other medical issues, as well as monitoring by the dietitians for nutrition. I hope that this helps to give a small taste of the long and complicated process that healing can be. Knowing what the patient has gone through can make those after moments so much more rich.

Moonrise by a palm tree.

It has been a while...

Two years ago, I made a post detailing the process of traveling from Tana to Toamasina. My intention after that was to actually update people on things. Describe in greater detail the beautiful country of Madagascar. Talk about the amazing people I’ve been blessed to meet, describe life on the ship, and talk about the work we are doing. Yet, as it does, life happened. I met amazing people, worked with incredible patients, and had adventures. I went home, worked, came back to Madagascar, reunited with old friends and made new friends, met new patients and had new adventures. I went home, worked again, this time for a year and near family (yay!), traveled to Sweden to visit friends during that time among other fun things, and now I am back in Madagascar for the rest of the year!

Madagascar sunsets with the ship provide a rich source of photo opportunities.

This trip marks a new chapter in my time with Mercy Ships. My first trip, lasting for six months back in 2009-2010 spanning the end of the Benin field service and the beginning of Togo, I was working in the sales department, making coffee and ringing up fellow crew members’ purchases, having failed to get into graduate school for occupational therapy. I applied again from the ship, and the week before I was to return, my parents called the cabin phone (we did not have cell phones then) and told me I got in to school! The second time I came was in 2022 in Senegal, getting to be a part of the first field service after the pandemic shut the world down. It was my first time as a hand therapist, and I returned the next year in Senegal for the Global Mercy’s first field service, and then Madagascar the two years after that. Those four trips lasted between three and four months each. This time, I have the opportunity to be the rehab team lead for the rest of the year. The past month of being on the ship has been filled with learning details of the new position, the nuances of the orthopedic surgical block, which I’ve not been a part of before, and of course, getting to know the new team. It is overwhelming at times, but I have a very good teacher and a lot of support.

Returning home

So I hope to be able to update more. I want to write on things happening here, fun times from the past two years, and post beautiful photos. We will see what happens.

In the meantime, I appreciate all the prayers you guys can muster! I want to do a good job in this position for the crew and day crew, so I can help them do a good job for the people we serve.

The mooring lines crossing in front of a nearly full moon. (It’s not a shadow on the moon, it’s the second line)

The arrival

Madagascar is a breathtaking country. That was my first impression as we drove off from the hotel the morning after our arrival. The city of Antananarivo, called Tana by most, was a mix of typical city scenes of traffic, and rural scenes of rice paddies.

Morning in Tana

Morning in Tana

As we went further, we were surrounded by lush green jungles. The going was slow, sometimes painfully so, as our driver artfully dodged potholes and lorries. People curiously watched us drive by as they manned their stands selling brilliant red rambutan fruits, called Chinese lychees by the people here, among other tropical delicacies. One hour turned to two, to five, to 12. We stopped for the bathroom and for drinks, but otherwise went on. My trip to the ship took a little over 14 hours. Long, bumpy, beautiful, difficult hours. But finally, through the darkness of the night in Toamasina, the ship became visible. We had made it!

Rice paddy

Jungles and mountains

It's gonna take a lot to drag me away from you . . . .

One of the most formative experiences in my adult life was serving with Mercy Ships from September 2009 to March 2010. I had been struggling for a couple of years to figure out what I wanted to do with my life. My parents allowed me to move back home after college, so like a good millennial, I lived in their basement and worked at Starbucks. I was blessed to have the opportunity to make use of the services of a life coach, thanks to my amazing parents, and he helped me to realize that I wanted to pursue occupational therapy as a profession. So I applied to graduate school and waited. Finally, the answer came: waitlisted. And I never got off the waitlist that year. I had mentioned wanting to work with Mercy Ships as an occupational therapist in my admissions essay, so I decided to apply to Mercy Ships immediately for whatever they needed me to do. That answer came back much more quickly and positively. Within a month of applying, I was on board the ship working in the ship shop, coffee shop, and snack bar. I applied again to OT school from the ship, and the week before I was to return home, I got the acceptance letter. It has always been my dream to return.

For the past 5 years I have been doing travel occupational therapy, in part to travel the country, in part to have flexibility to travel abroad for missions trips or for fun, but mostly because I applied for Mercy Ships and I figured I would be more likely to be able to go if I did not have a permanent job. Travel therapy has allowed me to work in a variety of places I would never have thought to work otherwise, meet incredible people, and participate in missions trips and other adventures. Mercy Ships kept my name in the talent pool, but then 2020 happened. Ship operations were significantly scaled back, and there was no need for a rehab team with no patients to treat. Finally this year they have opened things back up, carefully, to the joy of all involved. I was working in Alaska when I got the email offering me a time slot to serve. This time it was six months of waiting before I got to be back on the ship. But it was worth it.

Things are very different this time around. Different job, different people, and very different ship environment due to the measures taken to protect the crew and the Senegalese people we are serving from any disease risk. But it is still wonderful, and I am feeling so incredibly blessed to get to live out a dream that I’ve had for 12 years. I have been here just two weeks, and the adventure is only just getting started.

The Red Light

The streets of Delhi are like a fire hose to the senses. The cacophony of horns and press of auto rickshaws and trucks competes with the force of humanity to create a scene that is both intoxicating and overwhelming to my American sensibility. Colorful saris, garbage, cows, and the smell of gasoline combine with the heat of the day to cause an almost lightheaded sensation. Holding the hand closest to traffic out around hip level to signal that we needed the cars to stop, we crossed the street and entered Delhi’s red light district, three white women in a sea of the tanned faces of mostly men.

The GB Road in Delhi does not, at first glance, look like a place one would go to hire a prostitute. The streets are wider than they seem, as they are congested with pedestrians and traffic. The ground floors of each building are hardware stores. Men weave through outside displays of wares, while women sit and wait for customers.

They are not overly painted up. They may have on a little bit more makeup than the average woman, but there is not much about them to suggest that they are prostitutes. They look tired and worldly, and very hot, as it is a sweltering day. Their faces light up as they see us approaching. They know one of us. She lives here. She comes here regularly to talk with the women. They greet her enthusiastically, and she returns the greeting. In my limited Hindi, I catch a few words. “Were they asking you about marriage?” I ask. She nods. “They want me to get married so they can come to my wedding.”

“Would you invite them?”

I don’t remember her answer. But I’d like to think she would.

Down the road a ways, one of the prostitutes invited us upstairs. We carefully navigated a steep, narrow, dark stairway. At the top, we cautiously picked around two sweating workmen on a ladder struggling with some wires and a light fixture. The prostitutes directed us to the left. The room we entered was well lit and covered in blue tiles. There were several women in the room, sitting or lying on the floor. One woman was getting her hair dyed. Another was on a smartphone. I recognized the sounds of the game she was playing: Candy Crush Saga. After a while, the phone was passed on to another girl. I recognized the sounds of her game as well: Subway Surfers.

We sat on a bench while my friend chatted with the girls in Hindi. A woman behind us did laundry, near a young boy who was playing on the balcony. Johns came up the narrow staircase and went down the hall to the right. They didn’t tend to look to the left, at us. I wondered what they would think if they did.

The prostitutes were worried because there had been more raids on the street. Though these were primarily on brothels with underage girls, our friend explained, they were worried that this would affect their business.

We awkwardly sat for a while with the women, sweating in the stifling heat. The situation was surreal. We were in a brothel, in the middle of Delhi, with prostitutes, yet there was something so ordinary about it. This was life. The women interacted the same way every other group of women interacted. They were worried about job security. They complained of aches and pains. And they teased the our friend about marriage.

Finally we said our goodbyes and made our way down the stairs and back onto the street. As I looked down the street at the seemingly countless brothels, I felt sad and a bit helpless. I said a silent prayer for the freedom of all the people here as we melted into the crush of humanity on GB Road. 

Of Straws and Access

“Isn't the ultimate goal to not have a person with a disability treated differently?” I had posted an article on Facebook written by a woman with disabilities which discussed how the straw bans that are becoming more popular around the country have had a negative effect on people with disabilities who may need a straw to drink beverages. Suddenly, comments were just flying in. The above sentiment stood out to me, because the answer is about much more than having straws available. The answer is yes, but also, no. If the access is equal for people with a variety of abilities, then everyone can be treated equally. But if the access is not equal, then a person with disabilities cannot be treated the same, as their abilities are different. Let’s start with a basic definition.

The Americans with Disabilities Act defines a person with a disability as someone “who has a physical or mental impairment that substantially limits one or more major life activity.” In other words, people with disabilities are constantly running up against things that they cannot do. But why can’t they do these things? Disability, from a rehabilitation science perspective, means that the environmental demands are greater than the person’s physical capabilities. If the environmental demands are close to or equal to the ability of the person, they are less disabled. From this perspective, people with disabilities cannot participate in everything because the environment prevents this. An example of this would be a person with a wheelchair coming to a building with stairs but no ramp or elevator. Though some people who use a wheelchair for mobility would be able to manage the stairs without a problem, the majority of them would not be able to access the building. The access to the building is not equal; therefore, people with mobility impairments are treated differently.

https://www.tripadvisor.com/LocationPhotoDirectLink-g41508-d8489222-i143594370-Chilmark_Free_Public_Library-Chilmark_Martha_s_Vineyard_Massachusetts.html

With proper environmental supports, having a disability does not have to be disabling. In the late 1600s, a man named Jonathan Lambert immigrated from England to Martha’s Vineyard, to a town called Chilmark. He was deaf, and his children were deaf. As the generations went by, the population of deaf people in Chilmark became 1 in 25 people, as compared to 1 in 5,700 in the general United States population during those times. As a result of this, everyone in town knew sign language. If two hearing people were talking and a deaf person joined them, the conversation could easily and seamlessly transition from speech to sign language. People who were deaf in this town were not disabled because everyone could communicate. The town was set up to support their different abilities. (https://www.theatlantic.com/health/archive/2015/09/marthas-vineyard-sign-language-asl/407191/)

So what is the solution for access for everyone, for environments that enable people of all abilities to participate? That is the question, isn’t it? It does not provide easy answers, because the rich tapestry of humanity always provides for an exception to each rule. The best answer I have seen thus far is universal design.

According to NC State University Center for Universal Design, universal design is “the design of products and environments to be usable by all people, to the greatest extent possible, without adaptation or specialized design.” They have outlined seven principles to consider when evaluating whether or not designs are for everyone. These principles are:

1)      Equitable Use: People with a variety of abilities can use the product, without separation or stigmatization associated with the use of the product.

2)      Flexibility in Use: The product is designed to be used by people with a wide range of abilities.

3)      Simple and Intuitive Use: People with a variety of cognitive and skill levels can use or access the product without special training or abilities.

4)      Perceptible Information: The design communicates the information necessary for its use in a variety of conditions and for users with a variety of physical and cognitive abilities.

5)      Tolerance for Error: The design minimizes consequences of misuse or accidental use in the wrong way.

6)      Low Physical Effort: Minimal physical exertion is needed to use or access the product.

7)      Size and Space for Approach and Use: The area of access accommodates a variety of mobility devices, heights, and abilities.

Please take a look at the poster for more detail with each guideline. It is very helpful and clarifies the points better than I did: https://projects.ncsu.edu/ncsu/design/cud/pubs_p/docs/poster.pdf.

http://www.seattle.gov/dpd/codesrules/changestocode/curbramps/whatwhy/default.htm

The prime example of universal design is curb ramps in sidewalks. Let’s analyze them with the guidelines for universal design. People of all physical abilities can access the sidewalk or the street with curb ramps, including people in wheelchairs, people who use walkers or canes, people riding a bike or pushing a stroller, and people just walking (Equitable use, flexibility in use). The design of curb ramps communicates how to use them properly, and the texture of the concrete changes as one approaches the street to indicate where you are on the ramp (Simple and intuitive use, perceptible information). ADA guidelines for curb ramp dimensions require that they are at least 36 inches wide, which accommodates most wheelchairs. They have to have a ramp that is preferably no greater than one inch of rise per 12 inches of distance. And they require flared sides or return curbs on the sides of the ramp (perceptible information, tolerance for error, and size and space for approach and use). https://www.ada.gov/pcatoolkit/chap6toolkit.htm

For most of us, a ban on straws is a minor inconvenience until we get used to using the new lids or bringing our own. But for someone whose disability precludes drinking unless it is through a straw, not having one prevents them from accessing the goods and services a restaurant or coffee shop has to offer. Maybe one day, someone will make a universally designed beverage lid. But in the meantime, we should provide straws for those who truly need them, while making reusable straws and straw cleaning tools (basically a pipe cleaner) available and reasonably priced for all.

Something a little different.

As a woman in my early thirties, I have been faced with the realization that my metabolism is only going to get slower from here. Coupling that with a genetic predisposition to gain weight and a personal preference to eat anything but healthy foods gives the battle of the bulge plenty of ammo. I have sought internet classes, nutritional consults, and personal trainers in my efforts towards general health, and in spite of the amazing education and training they have given me, I have always allowed my bad habits and desires towards unhealthy food to take back over. Additionally, during certain times of the month, the ability to resist temptation proves to be far more difficult.

A couple of years ago I watched a video online of a male personal trainer breaking down each stage of the menstrual cycle with the hormone levels and what that meant for exercise and nutrition. It was pretty awesome to see a buff dude talking unembarrassed about ovulation. But it also opened my eyes to the fact that we women’s physiological differences from men can affect our fitness and nutrition depending on the time of the month. In fact, according to Professor Michael  J. Ormsbee in his online class Changing Body Composition through Diet and Exercise, most fitness studies on which recommendations for exercise and nutrition are based were done on men exclusively because the significant hormonal changes that occur during a woman’s month make the results difficult to generalize. It makes sense to look into the effects of hormones on women’s bodies though, and to eat and exercise accordingly. Hormones are powerful little buggers, and if we are generally familiar with the physiological elements of each hormone stage, we can best address our body’s needs and adjust accordingly. Plus, we can give ourselves grace for the tired, moody days. Not an excuse to lay around and eat ice cream, mind you. But understanding the underlying hormonal influences helps to take away the mystery and provide a plan to solve the challenges that can arise throughout the month.

Fortunately, there is information available online. I do not know the accuracy of these sources, but I thought it would be helpful to compile what I have found as it would benefit half the population to know this. I will explain each phase of our monthly cycle and then discuss nutritional and exercise recommendations. The time estimates vary depending on what source the information is coming from. My next challenge, of course, is to actually put this into practice. 

https://www.memorangapp.com/flashcards/103950/The+Reproductive+System%3A+Menstrual+and+Ovarian+Cycles/

PHASE 1: MENSTRUAL, days 1-5

Hormones: This phase begins on the first day of our period. A day I typically look forward to, in spite of the inconvenience it can cause, due to my tendency to bloat and crave sugar before my period. For me, it marks when my hormones will begin to normalize and then I will not feel like a water balloon for a couple of weeks. Anyway, as we are all well aware of due to basic health class and our own mountain of experience, our body is shedding the uterine lining and the unfertilized egg.

Hormone-wise, according to the Shape Magazine article “Your Brain On: Your Menstrual Cycle,” the first  five days of your cycle mark the lowest and most stable levels of the hormones estrogen, progesterone, and testosterone. Low levels of hormones can also cause low energy, which is something I think most of us ladies experience. Menstrual cramps and nausea are caused by compounds called prostaglandins. Not sure if it affects exercise or nutrition, but it sure is annoying. We are also more sensitive to insulin during this and the next phase.

Nutrition: The website www.abbyskitchen.com recommends increasing iron consumption during this phase due to our blood loss as well as to increase energy. Good nutritional sources of these nutrients are meats, particularly red meat, poultry, and fish, dark leafy greens, lentils, and quinoa. When combined with Vitamin C, which you get from basically everything but my favorite source is oranges, our body absorbs iron more efficiently. www.shape.com also recommends cinnamon and saffron to help with cramps and other PMS symptoms, and suggests healthy treats like dark chocolate and berries to satisfy cravings for sweets. Due to increased insulin-sensitivity, refueling with healthy carb choices is more important during this and phase 2.

Exercise: Light exercise is always a good thing, especially during this phase. It can relieve cramps, or at the least, help distract you from them.  However, according to Women’s Health Magazine, our lower level of hormones can cause us to have better pain tolerance and muscle recovery, so more difficult exercise classes may not seem so bad during this time. This phase and the next one have the female body primed to do anaerobic exercise (think HIIT).

PHASE 2: FOLLICULAR , DAYS 5-12

Hormones: Between day 5 and 14 (or 12, depending on the source), estrogen levels increase to prepare your body for ovulation. According to the afore mentioned Shape Magazine article, this increase in estrogen can also increase verbal fluency and the development of synapses in areas of the brain that control short term memory and decision making. This is, to me, super rad. We also begin to, shall we say, try to communicate that we are fertile in a variety of ways, such as wearing bright clothing.

Nutrition: For increased energy during this phase, it is recommended that you up your consumption of B Vitamins, and in particular, B12. B12 can be found in eggs, cheese, milk, and meat, as well as in foods that have been fortified with it, and B vitamins are found in nuts, legumes, and leafy greens. Nutritious carbohydrates are important during this phase for refueling after intense exercise.

Exercise: Energy levels are increasing, so you can increase your exercise levels. Women’s Health Magazine suggests that this is the time for increasing muscle mass with strengthening exercise, such as lifting and squats. However, they remind us that apparently our ACLs may be more susceptible to injury during this phase due to estrogen increase, so focus on warm up and form during strength training.  During this phase, we can continue with the anaerobic exercise training.

PHASE 3: OVULATORY PHASE, DAYS 12-17

Hormones: This phase also may be from day 14-25, but regardless it is the shortest phase. At this point, you begin to ovulate. Levels of estrogen peak at this time, and testosterone and progesterone begin to increase. This means you have more energy during this phase. Insulin sensitivity begins to decline. Serotonin also declines, which initiates cravings for carbs.

Nutrition: As you may be more active during this phase due to the energy increase, it is recommended to have well balanced meals of protein and complex carbs. This will make your feel more full for longer. Really, this is not bad advice no matter what stage we are in.

Exercise: Due to your increased energy level, this is the best phase to rock out some high intensity exercise. Women’s Health Magazine states that this is the time our body uses fat energy, so you can do more sustained cardio and fat loss exercise during this time. This apparently is also the case during the Luteal phase.

The American Journal of Sports Medicine found that the ACL injury risks carry over into this phase. Bengreenfieldfitness.com suggests supplementing with collagen, focusing more on warm up and recovery, and paying attention to your form with exercises. As an occupational therapist, I think you should ALWAYS pay attention to your form. But apparently especially during this phase.

PHASE 4: LUTEAL PHASE, DAYS 18-28

At this point, you are no longer fertile and your body is getting ready to communicate that to you in as blunt a way as possible. In order to do that, progesterone continues to rise, which causes fatigue and can initiate that awesome time of bloating and potentially constipation. This is every man’s favorite stage for their ladies: PMS. Our levels of the hormones leptin and estrogen are higher in this phase which can cause cravings, but it does not always happen like that. So being aware of cravings and making good choices when they do come up is our best bet.

Nutrition: Drinking water is always important, but especially during this phase. Due to the tendency to bloat, avoiding foods too high in salt can be helpful.  Also due to the potential bloating and constipation, eating more fiber like whole grains and produce is advised, although gas causing foods should possibly be avoided. Additionally, artificial sweeteners can increase digestive issues during this time. Healthier snacks can be berries and dark chocolate, whole grain crackers with cheese, or some trail mix. www.cyclediet.com recommends minimizing intake of saturated fat and too much animal protein during this phase, as well as excessive alcohol consumption.

Exercise: Per bengreenfieldfitness.com, this is the phase to focus on fat burning exercises, but not high intensity, so sustained cardio is recommended. This is the time for aerobic exercises. Perk of that: Your body uses fat as an energy source better during this phase, so it is a nice time to get rid of that. The pace of exercise should be slower for longer duration.

Considerations: This cycle can vary from woman to woman as far as duration of each phase as well as severity of hormonal symptoms. Advice on activities and nutrition seems to overlap from phase to phase and depending on the sources, so hopefully I got things on here as close to accurate as possible.

Tracking your period helps with managing your personal exercise and nutrition choices, and it is always wise to consult with a physician and nutrition and exercise professionals before changing things up.

It is never a bad thing to reduce how much soy you’re consuming as it can increase estrogen production, and many sources recommend limiting caffeine intake. Sigh. They don't know me. I will do what I want.

Regardless, do SOMETHING. Even if, or maybe especially if, you don’t feel like it. I tell my occupational therapy clients frequently that it is extremely rare that exercise is not recommended.

For more information:

https://www.womenshealthmag.com/fitness/a19935399/best-workout-for-each-stage-of-cycle/

https://www.theptdc.com/2016/10/women-weightlifting-menstrual-cycle/

https://bengreenfieldfitness.com/article/fitness-articles/planning-your-exercise-around-your-menstruation-cycle/

https://www.cyclediet.com/

https://www.shape.com/lifestyle/mind-and-body/your-brain-your-menstrual-cycle

https://www.cosmopolitan.com/uk/body/fitness-workouts/news/a46653/how-to-train-around-your-menstrual-cycle/

https://www.abbeyskitchen.com/menstrual-cycle-diet/

https://www.shape.com/healthy-eating/diet-tips/what-how-eat-based-your-menstrual-cycle

https://www.youtube.com/watch?v=vQr3K5KnGV4

Oregon

When I was a kid, my favorite level to play in the Nintendo game Super Mario Bros 3 was level 4: The Land of Giants. I loved playing as the tiny Mario (or Luigi, more often than not, being the younger sibling), hopping on the giant blocks and pipes, picking up giant turtle shells, and smashing giant mushrooms. 

Oregon feels giant like that world. It's not because of the mountains. The highest mountain in Oregon is Mount Hood, at a respectable 11,250 feet. But being from Colorado, a land of 53 peaks that are over 14,000 feet, I scoff at anything below that. (Have I climbed a 14er though? Shhh . . . don't worry about it). But the mountains in Oregon don't feel small. They are extremely rugged, and necessitate highways to be extremely serpentine with speed limits of 65 MPH or slower. Maybe it is the trees, of which the tallest is 327 feet and the widest has a girth of 37 feet 7 inches. Maybe it is the rivers, which seem to be everywhere. Or it's everything, and so much more. 

Stout Grove. Northern California, in all honesty, but I think of it as Southern Oregon. 

Over the past five months, I have had the opportunity to explore the southwest corner of Oregon. The natural beauty cannot be overstated, and truly must be experienced to be understood. 

Oregon Dunes

Something about this part of Oregon feels very untamed. Nature creeps in quickly, and one can easily get lost in the blink of an eye. One of my patients told me that people in Oregon don't age, they rust. It seems accurate. Homes that cannot be consistently maintained grow moss and the roofs rust over. Trees and grass around the homes have to be trimmed and kept free of too much leaf litter due to the constant threat of wildfire in the summer. But in the winter, it rains more days than not. Fog, dripping and moist, clings to the sides of the mountains. I love it. 

Mills Creek waterfall

I can certainly recommend specific things to do in Oregon, and maybe I will. I think, however, that people should just come here. Experience the vastness that makes you feel like you've entered into Honey, I Shrunk the Kids. It is absolutely worth the trip. 

The Big Tree, Caves National Monument

Trekking to ABC: Days 5-8

Day 5

I am getting more comfortable with pain. And it doesn't hurt that the pain is being had in one of the most beautiful places in the world! Waterfalls cascade from every high place and plummet into green valleys lush with trees. The air smells like flowers, and butterflies flit across the path as we walk. We even made some friends! A British couple named Greg and Sophie who had been traveling around India before coming on this trek, and an American couple named Dylan and Jessica, who have amazing stories of their adventures in obscure places around the world. It's fun to cross paths with them throughout the days and have people to chat with if we are lucky enough to be at the same tea house in the evenings. 

Not a bad view anywhere!

Day 6

The higher we have gotten, the more flies there are. They are not bothersome during the day, but at night they came out in droves and coated everything from the soap by the sink to the actual sink to the floor and walls in the bathroom and everywhere there is a light. It is super gross. But that does not matter because it's base camp day!

Looking back down the valley as we headed towards ABC!

We left at 5:40 AM to make the four hour trek, first to the Machapuchare Base Camp and then on to the Annapurna Base Camp. We wanted to get to base camp before the clouds rolled in and hid the mountain. I started having issues immediately. The worst was that my ankle suddenly had a sharp pain in it with each step. Our guide, Raj, had me remove my boot and rubbed it for a few minutes, and then the pain started to work its way out as I climbed. Kirsten, being the more experienced and fit climber, went at her own speed with our porter Sali and quickly outpaced me. Raj stayed back with me, for which I was grateful. Kirsten made the four hour trek in two hours. I made it in four, exactly the time the signs said it would take to make it to base camp. The clouds had long since obscured the peak when I arrived, but we got some good photos along the way. Kirsten came out to meet me when I got to the base camp sign and walked the last long few meters with me.

Machapuchare

My photo with Annapurna, a bit lower than base camp as we suspected that we should just get the photo while it was clear.

Made it!

While we waited for our lunch, Kirsten and I explored the area above base camp. Its filled with cairns, prayer flags, and memorials to climbers who have died on the mountain. Fog swirled around us, occasionally opening slightly to reveal the peaks above us. Sheep were grazing close by as well. It was a beautiful and haunting place.

Victory!

One of the many memorials.

After lunch, we headed down the mountain. Most trekkers stay at ABC overnight, but we had to cut a day off our trek and we wanted to go to the hot springs, so we had to cut back somewhere. As we had lost the view, it seemed like the best option to skip the overnight at ABC. On the way down, the clouds opened up to reveal Machapuchare above us like a glimpse into Heaven. 

Me, part of Raj's head (inadvertently cut off) , and Kirsten enjoying the view. 

Day 7

We hiked for eight hours today. It was mostly downhill, causing my quads no small bit of agony. It would have only been six hours, but we wanted to go to the hot springs. It was absolutely worth the extra two hours of hiking!

It was rainy all day and the main concern climbing back to our tea house after the hot springs were leeches. So gross. Our tea house that night had moths all over the areas where there was light. As a result, there was a bat swooping around so close we could have caught it if we had been so inclined. 

Day 8

The last day. I got three leech bites on our way down, and discovered later that there was a fourth bite that I had gotten a few days before but did not notice. I smell worse than I ever have. But this was an incredible time! 

Thank you to Trek Around Nepal (www.trekaroundnepal.com) and their awesome staff, in particular: Raj, Sali, Nawaraj, and the owner, Narayan. And thank you especially to Kirsten, for planning the whole thing, including me in your adventure, and putting up with my slow hiking and stubbornness! If anyone wants to visit Nepal, DO IT! It's a beautiful country and it is an experience I will treasure forever!

Nepal!

Trekking to ABC: Days 1-4

My friend, Kirsten, is an adventurous physical therapist with whom I had the pleasure of working for a time in Cheyenne, Wyoming. She and I became friends through many things, including similar senses of humor and the desire to travel. We kept in touch after working together and when she invited me to join on a mission trip to India and a trek to the Annapurna Base Camp after, I readily agreed. 

Exploring around our first tea house.

It turns out that trekking is a challenge. I mean, a real challenge. Kirsten just finished all the fourteeners in Colorado before we left, so she was more than ready. I was in good shape, so I thought, but not quite trekking shape. But I suppose I would be by the end of the trek. It was eight days of stairs, waterfalls, beautiful scenery, and amazing food. I would hurt worse than I thought possible and smell weirder than I knew I could. In the end, even with the misery I felt at times, it was one of the best things I have ever done.

I have never sweat so much in my life!

The following are excerpts from the journal I kept during the trip.  

Day 1:

It's so hot. I was so hot. Physically, I don't think it was too bad, but I could not handle the heat. Kirsten took some of my load, which was hard for me to allow her to do. I hate it when I think that people feel sorry for me. I hate being the weak one. But probably no one cares but me.

The staff at the tea house just killed a snake that was at least 5 feet long. They said that with the monsoon, they come out more. We asked if it was poisonous. They said it wasn't really poisonous. Just a little poisonous. Reassuring. 

Day 2

Today we woke at 6 and starting out by 7, hoping to avoid the heat of the day while climbing a set of 3500 stairs. I took my time and it was not as terrible as it could have been, although I did sweat through my wicking shirt which is apparently hard to do. 

The afternoon was in the rhododendron forest. It looked ancient, and it was absolutely stunning, with moss growing over everything. As we approached Goripani, our stop for the night, it began to rain. And that is when the leeches came out. I did not get bit, but I was not very ladylike with my mild freak out as I asked Raj to get them off my pants. Our tea house tonight is beautiful! 

View from the tea house

Day 4

Today we left at 6:45 to hike to the top of Poon Hill to watch the sunrise. It was brutal, as yesterday was all stairs and today we started off with stairs, plus I had nausea. I didn't care if I would make it to the top or not. But I did, just in time for a breathtaking sunrise that made all the pain dissolve.

Annapurna I and South from Poon Hill

Sea of clouds

Victory!

After sunrise, we hiked down and had breakfast, and then we were off. Today was an aggravating mix of intense climbs and long and steep descents. All. On. Stairs. My knees are killing me, and I'd be lying if I said I didn't want to die at points today, but I kept at it. Plugging away. I will not win awards for speed, but I am not giving up, either. 

Where Fishtail should be.

The beginning . . .

I don't think I ever officially decided to travel. As a child, I always yearned for adventure, to see things no one else has, to do what people do not get to do. During library trips, I would immediately go to the adventure section, and happily pick out as many of the books as my tiny arms could carry, and I would inhale the amazing stories they contained. I still do, but at some point, I decided it was time to live some adventures of my own.

So far in my life, I have had amazing opportunities, and I have been blessed to see so much of the world already. But I want to do more. And I want to share it.