#20. Off Leash in Istanbul

The snow and slush in the streets was just a little higher than the edge of my running shoes, but the Byzantine tunnels were warmer, intriguing with their arched mosaic ceilings, and with darkness approaching, the light deep within completely irresistable.

We sometimes use the word Byzantine  synonymously with a description of winding and complicated. These tunnels are called Byzantine because they truly are winding, complicated, and from the era when Constantine ruled the Roman Empire from this city he named Constantinople. They are, in fact, Byzantine tunnels.

Not incidentally, a young Ottoman Turk named Mehmed came in and overthrew Constantine from power, changed the name of the city to Istanbul, and effectively ended the era long  known as the Roman Empire. Thus,I had just spent nightfall wandering through ground zero where Christianity and Islam originally threw hats in the ring.  And of course I had exited from a different point from my entry, and was lost in a city whose language, street signs, culture, and ambient temperature was not my own.

Being lost in a major foreign city is not newsworthy; in fact, my not being lost in a major city would be worthy of an essay all its own, and possibly a media call. So I do have contingency mechanisms for this predictability. First, it's best to stop and eat street food when you're lost. So I had the lamb that was steaming upright on the skewer and being shaved with great skill by an animated vendor.

This allows time to watch how the taxis and buses work, in case I was hopelessly lost on foot and would require mechanical transport.  Taxis are like living independent species of animals; they behave differently wherever you go. So they demand observation from behind, in this case, a plate of hot lamb and Turkish coffee. I considered some tea as well to dip my slowly freezing toes in, but thought better of it.

Being lost and subsequently aquiescing to taxi use has sometimes proven to be hideously embarrasing for me and perplexing for the driver, since the hotel can turn out to be just around the block. I'm certain the driver goes home and says, "Honey, you'll never guess what this (fill in the epithet for aging American skinny white lady) did today.."

But what I saw were tram tracks that might lead me back to my correct street. I do find myself in cities that don't trouble themselves with street signs. Or sometimes when they do, the alphabet is one of the many I didn't learn: Arabic, Thai, Khmer, Viet Namese etc... So simply remembering the address of my hotel is not enough when asking questions of strangers, assuming there are English speaking strangers.

In response to this reality, I sometimes don't even bother with the hotel address, which is often a worthless bit of information, even for taxi drivers, who often are not exactly professional drivers. Instead, I retain in memory the nearest major landmark that, supposedly, most locals would know. In this case it was Istanbul University.

I was following what I thought were my tram tracks, in what I thought was my direction back, and I spotted a young man who looked like a university student. So I asked him where the university is. He not only spoke English fairly well, but he knew where it was located. He was delighted - I think because his classroom English had flourished effectively in real time. I was delighted too, because I was closing in on warm dry socks.

I was on the right street, just going the wrong direction. As a practical fact, this has happened more often than I have patience or memory to list. As a philosophical reality, it pays to keep your about face move sharp.

Of course I made it home to Phoenix. Airports with signage that includes English as an afterthought is a specialty I hold dear right along with, say, Word catheter placement. Total flight time: 21 hours that included 3 flights. Total travel time: 72 hours that included 26 hours in lovely, frozen Istanbul.

My dog Lucy and I have remained inseparable. I've been visiting with friends and eating anything but Chicken and Rice, the Consulate mainstay where I spent the last 35 of the 105 days in Kurdistan. Lucy doesn't ask any questions; everything with her is unconditionally accepted. For instance, when I originally adopted her from the humane society, she did not ask why I hadn't arrived the previous week; I was here now. And that set the tone with her. Perfect.

 Friends, however, have asked what is good about the work. There have been other questions too, but that's a good question with an answer:

Singularly, the thing I enjoy about practicing medicine in relatively austere conditions with limited resources and the threat of potential violence is that there is no one prodding me to go faster for profit. I will go fast if it's indicated on behalf of the patient - not because of an administrator's demand.

There is no bean counting of the patients per unit of time, or revenue units of  care incurred, or coding of the nuance of how a product was dispensed, or any of the things attached to our work to make our every word or action billable. The patient care is simply accomplished as needed, a note is written, and the room is cleaned. My job is to get the patient healthy and back to work, not to create a bill for him to pay.

I had to go to the other side of the world and occasionally wear body armor as part of the daily job to avoid artificially created stress for speed and  bi-weekly post-it notes from the billing department. I must always have in my office a Kevlar battle grade helmet, but its purpose will never include deflecting e mails from how a chart could have been made more profitable.

 This journey has generated no regrets.  Well, I miss my dog; not a regret as much as a foreseen reality. But for these weeks ahead, she is sticking by me. Unconditionally.