Mark's New Pet DVT

Our first two months in Astana have mostly been wonderfully mundane and reassuringly predictable with work, school, seeking new friends and setting up house. Mark and I drive to work early to avoid traffic and the kids walk to school. Ginsburg stays home and destroys books or whatever she deems worthy. We come home, walk the dog, workout, cook dinner, repeat. It's a wonderful combination of homeyness and repetition, especially given the launch pad we hit upon arrival to post. Four days after getting to KZ from Colorado, Mark flew to Tashkent to pick up his driving buddy (Mamed), Ginsburg, and our car for a 2,000 km, 48-hour road trip that involved uncertain border conditions, last minute surprise paperwork, and hefty fees (bribes) to get everyone here. Long hours in the car meant good company, storytelling, music and silence, and breaks in several Kazakh towns along the way. They drove past mountains and lakes, and endless steppe. It also meant eating too much beef jerky, roasted almonds, dried fruit, and coffee, and probably not enough water. Ominous circumstances (and hopefully lessons learned) because not long after, Mark's Astana re-welcome was interrupted with a hospital stay for a deep vein thrombosis.

Turns out, even in fit individuals, blood clots can happen to anyone and especially when circulation is diminished over periods of time. We suspect the clot started several weeks prior while in DC due to an upper respiratory infection that he caught in a classroom containing about 400 students. A day or two of feeling under the weather was followed by exercise intolerance at the gym. In Colorado, bike riding at 8,700 feet required Herculean stamina, but a cycling fanatic was gonna do what a cycling fanatic does - ride. Finally, after thousands of kilometers of flying, and bonus time in the driver's seat led to calf pain that he simply couldn't be stretched out or fixed with a dose of ibuprofen. It was the kind of pain he probably would have ignored had I not been insistent on bringing him in.

The doctor's visit led to a leg ultrasound, which led to a hospital admission, initiation of blood thinning medication, thigh high compression stockings, multiple lab draws, a couple of echocardiograms, and a CT, followed by more labs. No, I wouldn't be allowed to see him because doctors here follow The Protocol and do not allow deviation from The Protocol. They don't communicate nor collaborate with patients, insisting that visitors would stress him too much. He and I spent a lonely anxious night apart from each other with no answers and drained cell phones. By the time I was allowed to visit and ask his doctors some questions, I was met with resistance to knowing their plan beyond "more tests" and bedrest. In the US, once a clot is determined stable, the rest of the care is handled on an outpatient basis and bedrest in the meantime, medically unsupported. Doctors scanned his heart twice and found no signs of dysfunction, weakening, or pooling of blood. Labs and fluids were ordered to monitor a high normal creatinine level and eventually they performed a CT. The results showed clear lungs with exception to an old, chronic clot lodged at the end of a pulmonary vessel, suggestive of previous lung infection. In between the scant nursing care, he played video games, read, drank water, and took naps. We exchanged countless texts and memes. He doom scrolled and bought sweaters on sale.

After the fourth day, Mark's labs still looked great with nothing indicating that he'd inherited a clotting disorder. He was doing well on the medicine. Still, the doctors wanted to observe him for another week. Because, The Protocol. My request (demand) for open communication and allowing for US based standards of care, wasn't going to fly. It was at this time that I lost my mind, cried, and stomped around like a toddler - which finally caught their attention that we would not be ignored. Mark was as calm, of course, as he explained to them that American patients expect to have a say in their care, that we should be part of their decision making process. The doctors didn't agree. They knew best and anyone who defies The Protocol is risking death itself. That's exactly what they told us. In the end, as a compromise, Mark agreed to the initial 5 day stay instead of the 10 day one they'd hoped. On the way out, I apologized for losing my cool and they accepted it, hopeful they'd be spared further theatrics. I don't care if they thought I was hysterical - I will never stop advocating for him, or any other patient for that matter.

Recovery from DVT is fairly easy but it's also cheeky: exercise but not too much, stretch but not too much, drink water but not too much, wear compression socks but not too much... take medicine as prescribed, don't keep your legs crossed, and also... hopes and prayers because sometimes blood just clots. Mark feels great, though his leg does swell with abandon after exercise and is wary of tingling toes, a predictable and annoying side effect of having reduced blood flow to his lower leg. Recovery, annoyingly, is measured in months to years, if ever. Knowing Mark though, he will find a way to do it and in half the time because he's predictable in that way.

Lake Balkash, about 1/4 of the way through KZ.

The Balkash Town.

Getting to know each other's musical tastes.

Touring Astana with Mamed.

A male model and his dog.

After a fresh shower which scared the nurses to death
despite my being there. Or maybe it was because I was there...

Soviet IV. Kazakhstan is modern in so many ways, but not in others.
Medicine is still 30-40 years behind.

Sonographer making stern remarks to her colleagues who may or may not
have forgotten to restock the ultrasound gel. Fixing that error took over an hour.

Home.

Sad dinner of mashed potatoes and nothing else for the kids
because I just couldn't while Mark was out.

Hospital meal of buckwheat, cabbage, tea, white bread.
They were offended that I kept bringing in snacks and sparkling water.

Lonely walk with Ginsburg.

Kirkland sparkling water

Per the Foreign Service Act of 1980, this summer we completed our Home Leave “to ensure that employees who live abroad for an extended period undergo reorientation and re-exposure in the United States on a regular basis.” It took two weeks of DC concrete, two weeks of Colorado mountains, and two weeks of Missouri rivers to make it feel like Uzbekistan was a distant memory- but only just. The fun of home leave didn’t shake the heartache of missing my Tashkent friends and colleagues, but rather amplified it. I feel their pull of stories, laughter, support, and pranks, even as I write this from my new post in Astana. Only now, it’s the angsty pull of not just Tashkent, but the U.S. friends and family I reconnected with too.

In addition to seeing old friends from previous posts and lifetimes, highlights of Washington included our kids independently taking Metro down to the National Mall, visiting museums and monuments, and vibing at the Folk Life Festival while Mark and I went to trainings all week. Mark took a reassuring retirement seminar, while I learned how to get into a helicopter (pro tip: duck low) and drive a getaway car Fast and Furious style. After rekindling my love for music and rocking out with the Fowl Owls (or maybe it was the Foul Owls??) I bought a flute off Facebook and trialed it in a highly trafficked women’s bathroom at Nordstrom in Tyson’s Corner. We ate too much Costco “trash pizza” and drank cases of Kirkland sparkling water.

Colorado time was filled with daily bike rides but this time mostly on gravel. (Mark anticipates all season riding to work in Astana, so he bought a steel cross bike to manage his commute. School is a five minute walk from our house and our growing children (how do they do it so quickly?) so we got them cross bikes for their commute as well.) I only brought my road bike which meant they got 2 weeks of riding Centennial Cone trails, while I’d climb up and down Golden Gate Canyon. Then we’d meet for a family ride leading back to my parent’s house. It was pretty perfect. In between rides, we hiked in my parent’s backyard and schemed on stealing my brother’s poodle named Jed. Colorado evenings entailed Hazel Miller Band, Shawn Eckels Band, and Billy Joel, and SO many home cooked dinners, my favorite way to food and each meal paired nicely with cases of Kirkland sparkling water.

Fishing, hiking, and canoeing ruled our Missouri time. My father-in-law took us to Roaring River State Park, a place he used to bring Mark and Mark's brother Danny for trout fishing. They fished at Taneycomo Lake, a place “guaranteed for catches” and while the act of fishing was a success, they caught nothing. One try left, we canoed and fished the James River, something Mark would have never fathomed doing as a kid. Back then, the river was famous for being disgusting. So much so, Big Smith wrote a song about it called Dirty Old James. However, state conservation efforts improved conditions of the river so well that herons, eagles, and other animals have since returned. When we couldn’t get out of the city, the Springfield Conservation Center assuaged the need for bird watching and tree bathing. Other SPFD field trips included Buc-ee’s, a gas station of 24/7 Texan proportions with a vibe not unlike Black Friday, and the World’s Largest Fork (by mass) weighing 11 tons. Probably the same amount of consumed Kirkland sparkling water on this MO trip.

And poof! After hefting our rental car from Denver to Springfield and back and consumed ample amounts of Chipotle and Kirkland sparkling water in the world’s most monotonous 12-hour drive across Kansas, home leave time was up. In CO, we organized consumables, packed bags, and said a temporary goodbye to our bicycles before catching flights to Astana for the next round of Foreign Service life.

Kids on their own (credit: Margo)

Hiking with Grandpa Tom

Fishing with Grandpa David

On the James River, canoes from Hootentown (credit: Margo)

A big fork. SPFD.

Leaning into beaver culture if only for 20 minutes.

A rock we paid waaaaay too much money to see in Eureka Springs, Arkansas.

Driving across Kansas with Window Peeper,
 the green monster puppet.

Pretending we are either 8 year girls, or 80 year old women at that Brown Palace for Tea Time.
The Great 2024 Bestie Summit: my college bestie and her North Dakota bestie.

Hiking in mom's backyard. (credit: Mark)

Mark and the kids with Grandma Kaye, Grandpa Tom, their cousins Isaac and Alina,
Uncle Gabe and Aunt Nettie with Jed the dog. (Credit: Mark)

Centennial Cone

More hiking in their wee backyard.

 Hazel Miller Band and so many people wearing
hats at 13,000 feet.

Golden Mill with musician Shawn Eckels,
cousin/football player/cycling shorts model/actor/producer/Bryan Harris, 
and Pennsylvania stoop legend and dear friend "Tuesday" Jenn Marti.

 Vintage bike dreams do come true at Golden Velo

BILLIE JOEL! (Credit: Amy)

My first time scootering. (credit: Amy)

Kansas Meme-ing.

On being a nurse...

Earlier this week, I spoke to a group of high school students about my career in nursing. For a couple of weeks prior, I scrolled through tens of thousands of photos looking for apt snapshots of time spent in the various hospitals, operating rooms, and clinics throughout my career. The agony of sifting through hours of unlabeled Shutterfly and Google Photo albums inspired me to either reorganize them or hit delete altogether. Luckily, I did neither. Some messes I need to just walk away from, even digital ones. 

While preparing for the presentation, I enjoyed seeing old faces and remembering the kinds of medical care I provided. For example, I had forgotten that sometimes we'd deep freeze skull flaps for patients whose brains weren't quite ready to be re-covered. I'd forgotten how big a rigid cystoscope could be, which is a camera with a metal sheath used to look inside the bladder. All over again, I can smell the Trix cereal sweetness of the 3 liter sorbitol bags used to irrigate during prostate surgery, feel slickness of the floor when the plastic surgeon finished a liposuction case, or hear an organ donor's heart beating to silence. My nursing career started in the O.R. and while I moved onto different specialties, pieces of my heart still remain.

I had the time of my life working in urology too, but the fun was different. My job required lot of time educating, teaching, and finding appropriate resources for my patients, which meant I had to be at the ready, confident, and calm - every single day. Need to learn how to catheterize yourself because your bladder no longer works? What about giving yourself penile injections to treat erectile dysfunction? Maybe there's a cancer treatment to walk through, or you need a refill on your antibiotics because it's your 10th urinary tract infection this year. Urologic disorders are undiscerning to those with money and status, and those without. Because I lived in DC, I saw so many patients literally from all over the world. Some worked in government, others worked in the streets. Some were actual royalty while others were actual royal pains in the ass. I could recognize phone numbers calling in and knew exactly why they were calling. The urology clinic taught me to have massive patience and how to execute a professional poker face that was also empathetic, warm, and reassuring. 

Since we are getting ready to leave Uzbekistan in a few weeks, I've been thinking a lot about the events that will stick with me after four years. The spring 2021 covid vaccine rollout was notable feat. I still get goosebumps thinking about the logistical hurdles, blocks, and creative pathways we took to make it a wild success. Two colleagues and I executed an embassy wide earthquake drill that was equal parts stressful, hilarious, meaningful, and laden with lessons learned. Over 400 people were involved in the scenario including 20+ casualties with varying injuries (actors), dozens of panicked citizens (also actors) showing up to the consulate doors with their personalized "help me I'm an American" stories, the assault of hysterical colleagues, securing the premises and damage control, while maintaining the facade of calm, thoughtful responses and decision making. 

I got to visit hospitals and clinics in different regions of the country, creating medical resources for Americans living or touring in Uzbekistan. I worked with the school and other embassies on emergency planning, hosting multi-language trainings on CPR and multi-casualty management. I supported a nod worthy amount of medical evacuations. Because, sometimes lesions need a biopsy, appendixes get infected, kidney stones need removing, and someone with uncontrolled bleeding out needs a higher level of care. My boss and I like to joke that all bleeding eventually stops, but we're also not wrong. Living in a place that is medically austere means we have to be vigilant for our people, because it could be a matter of life or death. And at the same time manage the routine tasks like dispensing blood pressure meds, providing immunizations, drawing labs, performing well checks, or handling diarrhea woes. 

In the end, I don't know how much I inspired the students to go into medicine with my stories, but it was fun teaching them how to inject oranges with needles or pack wounds with gauze. Some were enthusiastic while others were anxious to get the session over with. Regardless how they might have felt, I appreciated the opportunity to think about my history with nursing, my mistakes, and victories. Now, I have so much more to look forward to at our next post in Astana and continuing my work in that health unit.

me and my bestie on UW campus
 with chunky shoes, and early 2000s flipped hairdo. 

skills lab, trying on pneumatic pants 
used for pelvic fractures 4/2023.

Foley'ing 

Teaching airway management,
Career Day 5/2024

vaccine rollout 4/2021

trying out some "panty liners" 4/2023

2006 between surgical cases.

Neurosurgery colleagues 2006

A very bad day 5/2022

T-minus 10 minutes to embassy wide drill 5/2022

Drill prep 10/2023

Traipsing across Scandinavia for the sake of decent snow

At home we have a metal painted sign depicting a person riding a bicycle that says in Bangla: "bones heal, bikes don't." During a ski trip to Sweden, Margo confirmed this declaration but with a ski pole, skiing so hard, it broke. And, on the last day of our trip, while skiing the back bowls she fell and broke her wrist. I point out the location because she had to take two T-bar lifts, a regular lift, and ski 45 minutes back to the front with a broken wrist and she did it like a badass.  

We took her to an urgent care for a 2-minute, $550 visit to confirm what we already knew. Assuring us that it was not bad parenting nor bad medicine, we could save ourselves the extra $1,000 x-ray and casting by getting them done back home in Tashkent. So we got her some Tylenol and flew home with a souvenir wrist brace. 

That was the end of our trip and the beginning was just as eventful when a winter storm hit Oslo so bad, they closed the airport forcing all planes to divert to either Copenhagen or Stockholm. Denmark drew the short straw, receiving plane full of people and no plan with what to do with us. The crew turned off the on-board entertainment and air conditioning, and took away water service. Still on the tarmac three hours later and fully marinated in displeasure, they gave us two choices: fly five hours back to Istanbul for rebooking, or deplane and Turkish Airlines would forfeit any assistance or reimbursement. Flying can be so lame sometimes.

Thank goodness for Google Fi, because by the time we emerged from the hot pot of body odor and angry customers, we had booked a hotel room and new flights. All we needed to do now was to walk through an abandoned terminal not unlike "Nightmare on Elm Street", fake smile at the grumpy, confused customs officials, and wait a couple more hours for airport employees to sort the bags that would need to stay on the plane versus not, and recieve them somewhere at baggage claim without notification of where that would be. 

Determined to make the most of visiting a new country, we did what what Schlinks do: death march walking. We toured Nyhavn, a 17th century waterfront that is as cute as it seems in photos. In the meatpacking district, we sampled beers and ate the best bbq outside of Kansas City, covering about 16km on the day before catching a flight to Trondheim, Norway. Landed, we then rented a car to get us to Are, Sweden, arriving just before midnight. Arrived, we would finally enjoy a few days of skiing with reindeer sightings, cozying up on reindeer fur covered chairs, and eating reindeer pizza.

Copenhagen

Merman espresso

AEDs everywhere.

Windblown warming hut.

Back bowls of Are.

View from our ski-in, ski-out airbnb. 10/10 recommend.

Inside view of our airbnb. 
Saving this photo for my future dream
mud room - complete w/boot warmers
and ALL THE HOOKS.

Are Summit.