Last cut is the deepest

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You know what it’s like on the final day of a trip. There is the last minute buying of presents, finishing the packing and waiting for the trip to the airport. So I thought I’d go and have another haircut.

I asked the guesthouse manager where was the best place to get my hair cut. He suggested I go to the same place he goes. Well, his hair didn’t seem that dreadful. It was short, neat and tidy, so I followed his directions and couldn’t find it. I cycled further down the street and caught the attention of some ladies selling breakfast noodles wrapped in banana leaves. I made a scissor cutting gesture with my fingers in my hair, and they pointed me back the way I’d come.

There was a motorcycle repair shop and what looked like a normal house. Now I wasn’t expecting a red and white striped pole outside, but for a barber’s shop it was certainly well disguised. Looking through the locked gate I could see a typical barber’s chair in the front room, and a bench on the verandah – the waiting area, obviously. But no one was at home. I checked with the bike boys and pointed to my watch. He replied by drawing his finger across his throat. Although this gesture left some room for interpretation, it looked like I wasn’t going to get my hair cut at this establishment. It was a pity, because the guest house manager said it was only 75p.

So, I cycled off in the general direction on the backstreets where the Burmese barbers have those extravagant illustrations of windswept hairdos. But I couldn’t find them. I ended up in a part of town I have not visited much, but I found a barber’s shop. I peered in through the plate glass window to see a man with his face up to the stylist’s mirror, plucking hairs from his nose.

He wasn’t the barber; he was a watch mender with a stall in front of the shop. He let me know that the barber was on his way, using the universal symbol for revving the twist grip of a motorcycle. I looked around. Pretty seedy. Old tiles with brown spots of water staining, barely clinging to the ceiling. A photomontage on the rear wall featuring now retired Brazilian soccer stars. An original eight track stereo, with a fancy graphic equaliser, pumping out Thai pop songs. The chair was another classic, tubular chromed steel with red leatherette, but this one didn’t tilt backwards like Sweeney’s.

At last my barber arrived. He looked older than me and was really puzzled to see a ferlang (foreigner) as his first customer. I looked around for a David Beckham poster, but all I could see was a bald Rivelino with the other Brazilians (who all had Afros). Then I saw a photo of a nice Thai boy, with short, neat, tidy hair. “I’ll have that one!” I said pointing to the photograph. The barber cocked his head on one side, scrutinising my barnet. He seemed sceptical. Then he made a chopping motion on his index finger. “I’ll have it a bit shorter than that, please.” I think he was beginning to enjoy this, because he smiled as his chopping gesture came closer to the second metacarpal head.

We agreed on a length, and he gowned me up. After the electric shears, he started cutting the long hair on the top of my head. He stopped, cocked his head, but I wanted my money’s worth. More! “Ah, namba wan!” We’ll, not Thai military cut, but shorter. He kept swinging the chair around to use the natural daylight coming in the big window. The fluorescent tube on the ceiling was fizzing and popping, so I was pleased he had a well lit view of the task.

Finally, he said it was finished, and opened a drawer to take out what looked like a shoe polishing brush. He polished my neck with it in a futile attempt to remove the loose hair. Then he had an idea. Did I want the razor? “Only on the neck and sides, please,” I told him. Luckily I got the new blade of the day. He lathered me up and scraped away. Then he patted me dry and applied surgical spirit. That woke me up, but he turned me round into the breeze from the fan and it cooled the burning sensation immediately. He nodded with satisfaction.

He still had to do my eyebrows, nose and ears with small scissors, and then I was done. £1.50 the poorer and feeling much fresher in the humid heat. I cycled back to the office, and started rewriting the sexually transmitted infection guidelines. They still recognised me. I wonder if Andy in South Knighton gents barber shop will, though.

Moving On

I really do.
I really do.

The nights get cooler during the rainy season here. I have been comfortable sleeping with the windows open, not needing the air conditioner. However, there is a pond, a grove of trees and an open field outside my bedroom window, and the racket from chirping cicadas and croaking bullfrogs has been keeping me awake. So last night I closed the windows and set the air con to low, hoping to get a good night’s sleep.

I must have drifted off at midnight, but woke up in the wee hours of the morning, still befuddled with night dreams morphing into day dreams. I was pondering fate. What did the future hold for those patients I had encountered with complex medical conditions since I arrived in Mae Sot, almost three months ago?

Regular readers of this blog will already know that I’m a “story person”. I like narrative. I teach using stories. Studying the story of a patient with disease X makes the book-learned facts of illness come to life, as well as making them easier to remember. I give advice to my patients using stories. Stories help them to understand what’s happening. Creating a story is distilling experience to reveal meaning. (My BS detector has just gone off!)

I prefer stories to have an ending. I don’t like stories which end without anything having been sorted, leaving you “up in the air”. Conclusions might not be pleasant, but they help me to make sense of the tale.

I wanted to know what happened to the man with advanced lymphoma who still had to work to support his family. His disease was progressing rapidly and I was amazed at his resilience, but wondered how long this would last.

Would the three children I saw with kidney disease recover? They all defaulted from follow up when it became clear there was no instant cure available. Their parents promised to bring them back, but they never did.

How long would the young mother with diabetes be able to manage on oral medication? Insulin would not be an option for her. What would become of her disabled child?

Would the lady who was the victim of domestic violence be able to escape from her abusive husband?

What sort of life awaits the poor baby born with no hands or feet? The mother had delivered at home and brought the baby to the clinic for its first immunisations. Even for the NHS and social welfare system of the UK, these deformities would present enormous challenges. I just hope it does not end a life of mendicancy.

Would surgery be a successful cure for the little boy whose massively swollen kidney needed to be removed? It was bigger than a rugby ball, filling the central part of his abdomen. Could the baby with congenital cystic adenomatoid malformation lead a healthy, normal life after it was surgically removed from the lung? Both these children have been referred to the medical children’s charity, Child’s Dream (www.childsdream.org), for operations in Chiangmai.

In my “borderland state” (a curiously appropriate term used by Andreas Mavromatis to describe the transition between sleep and wakefulness), I wanted to gaze inside the crystal ball, to see the future. The medical terms for phenomena occurring when shifting from “awake” to “asleep” and vice versa, are hypnagogic and hypnopompic hallucinations. Hallucinations being the operative word. I fantasised about a film sequence, like the final scenes of the HBO TV series, “Six Feet Under”. This is a montage of the fates of the major protagonists, to the haunting soundtrack of Sia’s “Breathe Me”.

Well, not quite. But after my first cup of coffee this morning, I had a minor epiphany. A light bulb of insight illuminated what this was really all about. It was about Me. My fate.

I like to feel I’m in control, even when I’m not. I like to have a plan, to know where I’m going. I admit, I do have a hankering to see a sneak preview of the next chapter of my life, but I know this is futile. We can’t predict the future. I have spent my working life coping with uncertainty. I should be an expert at it by now. Perhaps I need to adopt a more taoist approach to life, to go with the flow, and not to fret about the direction.

I’m leaving tonight to return to UK for my youngest daughter’s graduation. She got a first in her dissertation and an upper second class degree with honours at Leeds University, in medical sciences. I’m very proud of her, as well as my two other daughters (doctor and graduate entry trainee nurse). They are a credit to their wonderful mother.

Domestic

This little boy may look sad, but he is not connected with the story in any way. His father loves him very much.
This little boy may look sad, but he is not connected with the story in any way. His father loves him very much.

I felt so invigorated after yesterday’s massage, that when a middle-aged lady came into the out patients department this morning complaining of neck, shoulder and upper back pain, I thought I’d give her some physiotherapy.

She told the medic that she had been having increasing aches and pains which were interfering with her normal routine activities. I asked her if I could help, she nodded and I passed on some of the moves I’d benefitted from 24 hours earlier. Her deltoids and trapezius were tight and knotted. There was some muscle spasm between her shoulder blades, too. As I gently massaged these areas, she kept on talking to the medic.

I spend quite a lot of time trying to get the medics and nurses to look for underlying causes. They are aware that tight neck and shoulder muscles can occur when people are stressed. The medic asked about her work and social circumstances, but it was only when I suggested that she should get her husband to do this for her, that the whole story came gushing out.

The husband was the source of her pain. He was alcoholic and regularly beat her up when he came home drunk at night. He kicked her in the back when she was eight months pregnant. He refused to take her to hospital when the delivery became complicated. Their baby had been born deformed and died shortly afterwards, but he went off drinking and watching DVDs instead of staying with her and being supportive. On one occasion, he had threatened her with a knife, and she had had to run away to escape from his anger.

She shed a few tears and told the medic what a mess her life was. She felt she could not leave him, as that would make her and the children destitute. Informing the police was not an option, as she would probably get beaten up more as a result. There are no Women’s Refuges, where she could take shelter. “What am I to do?” she asked the medic. The medic had no answer for her, but kept eye contact and demonstrated her concern. “No, I don’t suppose anyone can help me. I’ll just have to struggle on,” she said, “for the sake of my children.”

When she left the consultation room clutching her lemma (the patient-held medical record card) with a prescription for some paracetamol tablets, I asked the medic how common this was. “It doesn’t happen much in the big cities in Myanmar, but in the countryside, men can sometimes behave violently towards their wives.” I told her that there was domestic violence in my country, too, but sadly, it could occur anywhere, urban and rural. I said that I felt bad because I was powerless to help her, but the medic just shrugged her shoulders in resignation – that’s how life is sometimes.

Thai Massage

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I’m feeling poorly. For the past couple of weeks I’ve lost my appetite, had nausea, “eggy burps” and frequent diarrhoea. My muscles ache and I’ve felt weary. At lunchtime today, I accompanied two doctors to our favourite restaurant/open shack, but did not want to eat. The cook/manager is seven months pregnant and her friend was giving her a massage. So when she got up to prepare food for my colleagues, I stepped up to the plate.

I sat on the edge of a wooden bed, smirking to my friends, with the Thai masseuse behind me. Suddenly, she whacked me on each shoulder with a karate chop. Well, it was more like a slap than a chop. Perhaps this was meant to put my body on alert, so she could detect where the tension was based. It didn’t take long for her to find the knots in my trapezius on both sides. She dug in her thumbs until I squealed, squandering any street cred I had ever accumulated in the village.

Women in labour here have no strong analgesia, no epidurals, no Nitrous Oxide. They endure labour in silence. Contrast this with my wimpish behaviour having a therapeutic massage to ease my muscular aches. I buttoned my lip, grinned and bore it like a man. But it did hurt.

I’m sure my verbal ejaculation caused her to dig and prod less deeply. She finished with my trapezius, and moved up to my neck. Then she twanged my para spinal muscles and moved on to the area around my shoulder blades.

The whole massage lasted less than a few minutes. The cook served my friends’ meals and I joined them at the table. My back felt wonderful, loose, warm and relaxed, if a bit sore. She was obviously no amateur. I was impressed.

Of course, I’ve always shied away from massage in Asia. My daughter, Ruby, and I had a foot massage in Guelin, in China last year. The best part about it was when she stopped. The relief was heavenly. But Thai massage has connotations. Thirty years ago, I met someone who went for a massage in an insalubrious establishment in Bangkok. He wisely enquired about the price and expressed surprise that the “special massage” cost less than the “body massage”. His masseuse explained that this was because, “Body massage is where I massage you WITH my body.” He didn’t last long, but he was happy.