Illness Abroad

Gyeltshen has had a cough for more than a month. It isn’t a slight, innocuous cough. It’s a cough that gurgles and stings. He wraps a scarf around his throat despite the summer heat and I have found him more than once keeled over on the stump in our yard, hacking and spitting up phlegm.

One day there was a call at my door and his wife, Sangay, told me that she wanted to take him to the Basic Health Unit—the BHU—in town. The nearest hospital, a simple one, is an hour away. For specialists you have to travel to Mongar, five hours if the roads are clear, which they aren’t now because of road construction and the havoc of the rainy season. Sangay doesn’t drive so she enlisted me to take the wheel of their beat-up, Indian hatchback. Gyeltshen was worse than I thought. He needed students to help him walk up the path toward the car. When he reclined across the backseat he hacked and winced in pain. All the windows were rolled up and it was humid and rank. I rolled mine down, edged toward the fresh air and started the car up the bad dirt road.

The BHU is a small building. In the hallways there are posters with infographics on the symptoms for leprosy and malaria. There is a box filled with condoms that says above it, “Prevent HIV.” There is a room that holds twelve beds all together. When we came in, the room had peeling paint and mold stains in the corners. There was a buzz from the fluorescent bulbs, though a few of them were burnt out, making no noise at all. Flies wended about lugubriously, as if they too had come down with something.

We brought Gyeltshen in and laid him among the others whose maladies one could only guess at. A mother held a small baby. The nurse’s assistant tried to put a tiny oxygen mask on the infant and it protested and cried. A monk with boils on his hands sat at the foot of one of the other beds. He wasn’t a patient, I don’t think, but was visiting another woman who lay on the same bed. An older woman with a long, regal neck, high cheekbones and slightly sunken eyes, sat cross legged and erect on her bed, a blanket covering her legs. She stared off into the distance, seemingly at nothing.

Gyeltshen continued to cough and lay down in the fetal position on the bed. Sangay covered him with a blanket. The nurse, our principal’s wife, came out in her matriarch way, strong armed and confident, smiling. She asked him some questions: When did the symptoms start? Has he had a tuberculosis test? (He hadn’t.) She jotted down notes.

We were at the BHU all afternoon and into the evening. I took a walk and Sangay stayed with Gyeltshen while he received an IV of some sort. In the evening I brought them home.

Two days later Gyeltshen was still coughing. I asked if he had been given any medicine and he said yes. He said he also went to the Lama who blessed him and told him that his house was cursed; Gyeltshen hadn’t performed rituals in the house, nor had the previous warden, so there were spirits that were making him sick.

I started coughing a day later. It came first as a slight tinge in my throat and then it built to a pain that spread and pulsed in my head and down through my chest. In the middle of the school day I broke into a fever and had to go home. Apropos to the name, I returned to the Boy’s Sick Room, lay down on my bed, put my down sleeping bag over me and sweat and ached through the night.

The thrill of living in a remote place comes to an abrupt standstill when you get sick. Suddenly your mind starts to imagine the worst. What if the fever doesn’t stop and I have to get to Mongar? What if it is TB and I’m put in quarantine for a month? What if I have to be evacuated to India? It is, and isn’t, unfounded hypochondria; the illnesses that exist here are very real, as is the potential to get one. A Canadian teacher died here a few years ago from prolonged sickness—septicemia. They couldn’t get her to a hospital in time. Her post was not so far from where I am now.

I started thinking about what was making me sick, as if the source would somehow reveal the severity. Gyeltshen’s sickness was first to blame, but perhaps not the only reason. The Boy’s Sick Room might not just be a place of reprieve from illness—it may be the cause. I don’t have a refrigerator and often eat leftovers that have been sitting out all day. My squat toilet is right next to the main room and a rank air wafts in constantly, especially in the heat; maybe the miasma carries some disease. Or maybe it’s something outside of the Sick Room. Every day, in almost every classroom, a student is absent because of a flu, a cold, fever, body aches, boils, dizziness, or nausea. Others cough and put their heads down on their desks during class, while we’re all crammed in there, sometimes forty-eight of us in a room whose max capacity is probably forty-five.  

Then I start thinking of how nice it’ll be when I have a job in a city again. That’s what sickness does—it makes me want to run away from the place I worked so hard to get to, a place whose very appeal came from how remote it was. I dream of Barcelona, or Tangier, or Muscat. Then there will be many hospitals to go to, with state-of-the-art medical instruments and no flies. They can serve up any drug that I need and the doctors will be well trained. One short taxi ride and I’ll be cared for and comfortable.

The illusion offers some catharsis. But such thoughts are weighted with regret. There is a gross privilege in fantasizing like that—Gyeltshen doesn’t get to think about escape, nor do my students. A life here, for many, is one were sicknesses can be severe and sometimes inescapable. In those cases, there comes an inevitable end.

Yesterday I learned that one of my students’ father died of illness over the weekend. The same student’s mother passed away when he was much younger. This story, of one parent or both dying early in their lifetimes, is common enough out here, another reality of living in a remote area. The people seem to weather such news with fortitude, a combination of both their habituation to it and their Buddhist beliefs. I have had to think of death here more than ever before, as a delusion rising from my sickness, with news that my grandfather passed away, and now with empty desks in my classroom as students return to their homes to perform funeral rites. It’s a meditation that I didn’t anticipate.

Each time that I move abroad I expect that great learning that will happen. In a remote Buddhist country like Bhutan, one can’t help but think that he will be affected spiritually, learning about oneness, compassion, mindfulness. But more often than not the most profound lessons sneak up on you. They come not when you relish a good lesson, nor when your mind is open and attentive, rather, when you’re afraid, or weak, or sick.

It turns out that this week’s lesson is a Buddhist one: Impermanence. You don’t worry about a candle blowing out until the wind picks up. With an imagined threat of death at my door, the lesson is one I’m paying attention to. Both Gyeltshen and I are getting better now; it looks like this sickness won’t be the one to end it all. But I am reminded of the certainty that, at some point, terminal illness will come, or an accident of some sort, and that, for this life as Joshua Cook at least, that’ll be it. If I’m lucky, it will come in old age and I will have been graced with longevity, spent on good adventures and with good people. Or the final curtain call may come soon after the next sore throat begins, or raspy cough. What I am doing now—and that I do it attentively and with appreciation—seems more important than ever.