Ross McKim

Sunday, June 09, 2013

Monterrey, Mexico

I have been in Monterrey for a week now. 2 other employees from CJ and I are here for a few weeks to help out. Visiting the city is a complete revelation for me. All I had heard before coming was that it is considered more dangerous than Juarez and State Dept employees are not allowed to leave the city. The city is impressive with beautiful large building, nice roads and plants. The neighborhood I am staying in is apparently the wealthiest one in Latin America. I can believe it with the Lamborghini and Porsche shops down the street.

The US consulate is definitely showing its age but the employees are very welcoming and appreciative that we came. Our objective is reduce the backlog of interviews and allow the consulate employees a bit of time to work on their own projects. There is a lot more work to do but it is in some ways easier- visa interviews are quicker and a lot more black and white.

The consulate employees are very active- in the week I have been here I did 5 activities with them. One day was watching Pariah, a powerful movie about a lesbian black teenager growing up in a dysfunctional home. Another night was an Asian-American Heritage gathering featuring art by Mexicans about the Asian American relationship, good Korean food, and a famous Japanese American ballerina performing.

Yesterday we had the annual softball game between the consulate and the Ciudad de los Ninos (City of Children). It is a very successful school which gives education to low income students and their families. Last year the school spent months preparing for the event and stacked the team. This year it was a lot more laid back with children taking our positions after a few innings.

One thing I haven't quite gotten over here is that there is water. In the 2 and a half months I have lived in CJ I have not seen rain. In the week I have been here it has rained three times. Today 4 of us received permission to go out of the safe area and go a park called La Estanzuela. It is part of the run up to a green race the consulate is helping to sponsor. We did a walk in the park with guides and a naturalist from the university. Afterwards we did yoga in the middle of the park with a instructor who has traveled all over the world studying yoga.

Wednesday, April 03, 2013

Bought Car
This Monday I went with a friend to check out used cars in El Paso. I checked out a bunch on SUVs but decided to buy a coworker's car. The options seemed to be $25,000 for a new Rav4 or $4000 for a used Honda Accord. The SUV would probably be helpful with all the potholes and flooding but most people seem to get by with the smaller cars. We also went to a health food store called sprouts which has every food you could imagine for those allergic to glutein. Afterwards we went to an excellent Palestinian restaurant.

Yesterday I bought the. The color is a little boring but it seems to run well and the coworker I bought it from as taken good care of it. The mechanic who inspected it was impressed with how well it runs. We did all the paper work in Texas and I had to buy American insurance just to register the car.

Earlier this evening I went over to El Paso to pick up some medications. El Paso is an OK town. It's pretty spread out so everything takes longer to get anywhere and it doesn't seem to have a center. I have been in no hurry to get a car and tonight I realized why. It is frustrating driving around a city you don't know. It was even worse on the Mexican side. In Juarez there are people waving flashlights around in the middle of the road trying to direct you to their parking places. The GPS on my phone barely works on the Mexican side and Juarez has the largest speed bumps I have ever seen. No roads go in straight lines for any length of time.

Work is frustrating and slow, but that seems to be the standard starting point for everyone. If anything strange comes up the answer to the problem is always: "There's an SOP for that." SOP is standard operating procedure and most of these are 25 pages long. A person who knows what they're doing can deal with a problem in 2 minutes while I might take me an hour to figure out the process. I wouldn't mind if I learned one thing at a time and did it several times to understand the process but most of the time it is in response to some strange issue with a particular person.

Tuesday, January 22, 2013

Celiac's and/or Crohn's


My Situation
I am feeling much better now. The clot has not returned. Every day that it does not return is one day closer to the promised land of being a healthy person. I don’t know exactly what they did differently to stop it from clotting again but the surgery was more aggressive in several ways so something worked. I am still very weak and get lightheaded if I move around much but these are all common effects of just being in bed so long. I still walk funny because the entry point was my ankle so I can not put pressure on it. My leg was all kinds of swollen but now looks relatively normal. I think I have a small clot in my calf but that is not surprising. The doctors are not concerned with small clots.

I will have a procedure done tomorrow, hopefully recover on Wed, and maybe leave the hospital on Thurs. I hope to be at work on Mon but my hopes and predictions have been wrong so far and I am not putting much weight behind them.

Celiac Disease and/or Crohn’s Disease and/ or something else?
I had occasional GI issues when I lived in Kenya and Tanzania and they mostly went away when I came back to the US. I also have anemia which has shown up pretty regularly over the last decade or so. I figured since I had decent insurance I should resolve all my health issues before I went to a new country. I eventually went to a GI doctor who suggested a number of tests. I did all of these before Christmas and got the results back a couple weeks ago. I phoned the doctor’s office and the secretary said “Oh, you have Crohn’s Disease.” She faxed the results and I had one sheet that had a big check mark next to Celiac’s Disease and another with a big check mark next to Crohn’s Disease. The Crohn’s sheet had “probability of complications chart” with 45% chance of complications in the 1st year and the probability going up every year. I have no idea what complications they mean but it sounds bad. It was pretty bad to go from thinking you are a generally healthy person to now knowing you have 3 lifetime diseases- some autoimmune disease that causes me to clot like crazy, Celiac Disease, and Crohn’s Disease.

I know what Celiac’s Disease is. A friend of mine has it and basically you can’t eat gluten or wheat products. The big things verboten are all bread products though there are a bunch of foods with preservatives that have gluten. If you don’t eat them your stomach is happier, you absorb all the right nutrients, and you are generally healthier. I am pretty flexible in general and can switch my diet if it makes me healthier. The thing that bothers me most is that I hate to refuse food. I believe food is one of the great connectors of people. Accepting and eating food from someone is a sign of friendship, love, and companionship. To refuse food is to refuse all of these things and to, at a basic level, reject a person and their culture. I also like to be low maintenance, not asking for special things or to make waves. Now, if I have this disease, people will have to make other arrangements whenever I eat at their house or we talk about going out to lunch. I also have never worried about food. I generally eat healthy food but have never calorie counted or had to worry about food. Now, my life is slightly more complicated in that I need to pay attention to labels and learn a whole new gamut of information. I am told that the assay I took is 95% accurate and that it would explain my anemia.

I have never quite figured out what Crohn’s Disease is. I have read all kinds of literature but it never seems to add up to something understandable. The definition is something meaningless like “inflammation of the GI tract”. The symptoms seem to vary quite a bit. A fellow grad student had it and my memory was that he had incredible pain in his stomach. The Wikipedia page told of people becoming retarded and had pictures of people with disturbing skin rashes. My brother told me of his neighbor with it who, because of it, leads a painful and useless life and cannot leave his apartment. Everything about it sounds horrible with painful and debilitating long term consequences. The GI doctor left a voicemail saying I have the disease and the results printout looks very definite with positive results and big check marks. The GI doctors at GW didn’t seem to think the assay is very accurate and that nothing in my history suggested that I have Crohn’s Disease. They did a CAT scan looking at my stomach which showed my stomach linings have not hardened which means there is a at least nothing exceptionally advanced.

When I received these results and talked to the GI team they said there was only one way to tell if either of these results was accurate. The test is called an endoscopy/ colonoscopy and involves a camera checking out your whole GI tract as well as some machine which takes bits of your stomach for later analysis. I was supposed to do the test last Monday but the GI team balked because I had an occasional high temperatures and my heart rate was high, both of which are side effects of clots. They are used to doing the test as out-patients and commonly delay the test if someone doesn’t feel 100%. This delay frustrated the hell out of me and my blood doctors, who are looking for a possible cause of my inflammation. My main doctor found a more senior GI doctor who is more used to working with non-traditional patients and I will receive the test tomorrow. The test will also say yes or no to a whole variety of other GI issues and things like parasites or other leftovers from Africa.

When I got the blood tests about Crohn's and Celiac's I showed them to one of the residents on my hematology team and he got very excited, photocopied the pages, and disappeared for several days. I found out that they were excited because this could explain everything that is going on. GI diseases like these can cause massive inflammation which can lead to both autoimmune disorders and cause clotting. They were especially excited about Crohn’s, as it often causes pretty severe inflammation, which my body was showing. The GI doctors on the other hand were saying- Don’t blame this on GI issues. His history is pretty mild and shouldn’t cause massive clots like this.

I was put on a very sensitive blood thinner two weeks ago in anticipation of this endoscopy but my blood has to be checked every 6 hours to be sure it is in “therapeutic” range. The situation is not ideal as my arms are like pin cushions with people often trying twice before giving up and finding the local blood drawing expert. The normal goal for the drug is 60-70 but for me it is 80-90 and my level regularly alternates from 30s to 120s in the course of a few hours. Even with the blood thinner my blood usually clots immediately so there is no bleeding from the blood draws. The hope is that with the endoscopy over I can go on a normal blood thinner by tomorrow night. There is considerable debate as to whether to take me off the blood thinner. It is dangerous to have thin blood while chunks of your stomach are taken out but my leg can also clot up again within hours. I never heard what the results of the debate are.

Roommate
Being in a hospital you see all the misfortunates of the world. Theoretically, I like to know that unfortunate people exist because it gives me something to work for and a reason to live and improve the world. Life is not just people getting bigger houses or snappier cars. I have had maybe 10 roommates who represent about as diverse a group of people as you can imagine. Generally people don’t affect me emotionally but the latest roommate gets me close to crying at times and other times I just want to yell at him to shut up and stop whining. He is blind, hard of hearing, can’t do anything, and is confused about the world. He still thinks JFK is prez. Every time anyone does anything too or for him he yells out constantly “Please don’t hurt me!” It must be tough to live in a state where you don’t know what is going to happen to you and to have no control over what is going on. Not that it was lacking before but I have much more respect for nurses now. 


Friday, January 18, 2013

Possible Success

The procedure was done on Tues and Wed so I did virtually nothing after both of the surgeries. Yesterday (Thurs) I started using crutches and doing exercises and my leg is doing far better than I expected. I have been doing leg exercises in my bed and walking around on crutches whenever I have the energy and nurses are available. So far I feel much better than I have since entering the hospital. I just talked to the radiologist. They added 4 new stints to my veins and they added some medications for now to reduce my clotting. It seems no matter what drug I have my blood can still clot very easily. I will have a procedure done on Tues and therefore will wait in the hospital until then. When I get the energy I will explain what the procedure will be about.

Thursday, January 17, 2013

Blood Clot

I have not written in this blog for a long time. Mostly because I was in communication with everyone and very little was happening in my life. Recently I have had many questions about my current health status so I decided to start up the blog again to let people know a little about what is going on with me. There may be more information than you wish to know. Feel free to skip through as you wish.

On the 17th of Dec I started feeling a pain in my left buttock. It only happened when I stood in one place. I figured it was a muscle pull and went on with my life. I had a slight limp but nobody really noticed. A little less than a week later I went to Belize to visit a friend for Christmas. While there I went hiking up a river through a series of sacred caves filled with artefacts and human sacrifices. I had no problem with all the climbing but could not stand, so I squatted every time the guide talked. The next day I found it hard to climb steep trails and at an ambassador’s reception I could stand to talk and be social but it hurt. The next few days I walked as little as possible because every step was painful. The embassy nurse had no idea what to do with me except give something a little stronger than advil. I scheduled a doctor’s meeting for the Wed after I got back but was in so much pain I went into the GW emergency room on Dec 30th.

The doctors quickly figured out that it was a blood clot. They also found out that my blood is (or appears?) incredibly thin but clots much more than most people’s. I can usually wrap my head around counterintuitive ideas but this one is still beyond me. The thinner my blood is the more it clots? Or my blood clots so much that my body doesn’t bother making clotting material and so it appears thin? They called it some form of autoimmune disorder similar to lupus. They only have guessed this based on how my blood relates to other people’s blood (not well?). I also have a fairly common anatomical disorder called May-Thurner Syndrome in that my left iliac artery is right next to my left iliac vein. This crossing point is a little below my belly button and to the left. These are the main blood vessels for the left leg and whenever there is a contest for space the artery always wins. Thus, sometimes the vein to my left leg gets very compressed. Throw in my tendency to clot and it is an accident waiting to happen. There was a debate with my primary team (all internal medicine) arguing to give me a blood thinner and send me home while the option of the interventional radiology team was to take out the whole clot, give me blood thinner, and send me home. Apparently, every day the clot stays in place it damages the vein as well as not being healthy for all the tissue not getting enough blood. It is also incredibly painful to have a blood clot.

The IR team won the debate and they took out the clot in a two-step procedure. The 1st is to have a catheter which slowly releases a powerful anticoagulant into the clot for about 24 hours. The idea is this will “melt” the clot ant turn it into blood. The next day they look at it and vacuum up any bits left and use balloons to open up where the vein collapsed. This happened on Jan 2nd and 3rd. The afternoon after the 2nd surgery (I forget surgeries don’t happen anymore, they are all procedures) I could walk slowly around the room, weakly but with full weight on the leg. The next morning I found it hard to take a few steps and they hurt much more. Whenever I asked the IR doctor about the pain and reduced mobility he said “You need to exercise more.” A couple friends took me home Sat the 5th. I used crutches but it was tough moving around. The pain just got worse and worse so that on Monday I called a taxi and went back to the hospital.

They tested me and my clot was completely reformed in the exact same spot. The doctor who had done the surgery was pretty unrepentant. He said that they had made a judgement call the 1st time in not giving me any stints. Stints open up the blood vessels and keep them open but apparently have long term side-effects and cause clots on their own. They had tried without stints which didn’t work so procedure #2 they added 2 stints in the May-Thurner spot where my artery and vein compete for space. They decided the 1st blood thinner didn’t work so they proscribed a different one. After the 2nd procedure I didn’t feel any better. The pain from walking was just as excruciating so I did exercises in bed but that is not enough. A couple days later they looked and the clot had returned a third time. Exact same size and exact same place. They did all the same procedures on me Jan 15th and 16th although they started much deeper in my leg. Instead of in the back of my knee they started in my ankle. They also added stints in the veins coming from both sides of my legs and leading up into my vena cava, the big vein of the body. They needed more holes near my stomach for this so it is harder to move. I think they also changed the blood thinner again just as a matter of course. I have been doing exercises on my own in the bed and managed to walk twice during the night. It was painful but doable. Once the rounds are done someone will come and I will give walking another shot. I will update this blog in the next few days.

Monday, February 20, 2012

Finishing training
I am just about finished my A-100 class. It is the orientation class for all Foreign Service Officers. It doesn't seem like much on a day to day basis but this was definitely the best month of education I have ever received. Every day has 4-5 modules and they cover just about everything you could imagine. A lot of the modules are on how the State Department works and simply how to navigate the system. These include the various offices and how State works with all the other parts of government. Other modules are on health and mental well being in relation to living abroad or on personal and informational security. These are all courses I would have expected.
Then there were lessons on all kinds of things I didn't expect. An example is the personality tests and how to work with your personality type. There were also bits on ethics, multicultural communication, and the history of the State Dept. We had several hours on State Dept. writing. Many of the students come from other parts of govt and the State Dept. apparently has a unique way of writing and communicating. We had a couple days where we changed location for what they call Leadership Training but I call learning how to work together. Think trust falls and the like but more sophisticated and much more difficult.
Part of the training is listening to the bigwigs give talks. Usually they describe their division and how it works but much of it is war stories (sometimes literally) and opinion. These are big name speakers who are highly sought after by universities and think tanks and their visit might be touted for weeks. The A-100 class might have 4 of these speakers in a day including speakers controlling tens of thousands of employees and billions of dollars. The stories are amazing and the opinions come from true experts in a relatively uncensored setting (i.e. they say what they really feel). Our class mentor recently came back from being ambassador to Egypt where she saw the Arab Spring unfold and probably played an important role in the situation.
The most surprising and powerful of the lessons were on Speech Making and Composure under Fire. I've been a member of toastmasters for years so I have a pretty good idea about both but these were intense sessions. The modules were taught by experts borrowed from press organizations or major universities. The speech was not easy because everyone gets videotaped and then your speech is picked apart. Not so much for content but for body language, gestures, voice, and the like. Then you have a couple days to redo the whole speech and get videotaped again. If I ever feel too proud I will simply pull out that DVD and see all of my mistakes. Composure under fire was far more difficult. Each person must defend American history, actions, and culture against a hostile audience from another country (played by your classmates). I got India and all the questions were about Pakistan. I answered one question with some ambiguity and the other students were all over me. It was like blood in the water and a feeding frenzy started. The second time I did the exercise was a more informal setting where the students surrounded me and asked inappropriate and tough to answer questions (You want to marry my daughter?, or my favorite: How big is your salary?). My goal was to take charge of the conversation and make the US look good. These sessions are like the "murder boards" often used except less specific and the questioners are completely supportive afterwards.
All in all I would say it was a pretty impressive training. I learned a heck of a lot in a short period of time. Sometimes you learn things that are good for a short period (like in preparation for a test) and sometimes you learn things that give little info at the time but inform you for many years later (like a trip to the zoo). Most of this training was in the latter category. It is hard to say exactly what I learned but I feel that I will keep recalling these sessions as issues come up in embassy work.

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Monday, January 16, 2012

Jan 16
I have moved into my new apartment. My stated residence is my parent's home which happens to be 56 miles away from DC. If it is under 50 miles I am expected to commute or get my own apartment. Since I am a non-resident I stay in a furnished apartment supplied by the foreign service. It is incredibly tasteful and has everything I could possibly need. It is also nice that most of the people training with me stay in the same location.
Today there was a welcoming party hosted by 2 classes ahead of me. Mine is the 165th foreign service class since they started counting and the 163rd class is supposed to guided us and help us. Everyone I met today was very interesting and came from a different background. Many people had just come from other countries and most knew at least 1 other language. Jobs before this ranged all over the place from a professor to the air force to one guy who spent most of his life making tombstones.
Tomorrow, apparently I get sworn in. I have yet to hear what the next weeks of training will be. When asked people dodge the question and say it is all kinds of stuff. Whatever it is it should be interesting.

Jan 14
I have spent the last couple weeks going through all of the debris picked up over the course of a life. I have gone through my parents attic and taken down most of my boxes. There are mementos I picked up from various countries, school papers from middle school, and hundreds of books. More than half of it all is going to the trash or donation. It's work but I feel like a little bit of weight is being taken off. My nephew Brandon is also here for a couple weeks before he heads back to college for his freshman year. Tonight my brother from West Virginia came for dinner. Whenever he comes he brings a certain level of chaos with him. Tonight it was in the form of his Irish Setter Duncan who tried to eat the cat.

December 17
I have just gotten back to America. I spent the last 6 months in Tanzania learning Swahili. My understanding was that if I could speak Swahili well enough to pass a phone test I would likely get a job at the Foreign Service. It turned out to be true. I took a test in Swahili Jan 6 and got the results back on the 13th and received a job offer on the 14 which makes me very happy. I was hoping to be called up for March class but they were running behind on scheduling the Jan class so I was invited. I start training on Jan 17 and will be sent to serve in an embassy sometime later that year.
It is a joy to be back in the United States. I loved Tanzania but it is nice to see my family, eat familiar foods, and have modern amenities. My parents have taken a house with several shortcomings (dried eggs on the walls, bright green shag carpets, etc.) and spent the last 30 years improving it. They altered the kitchen this year and it is a wonderful place to cook now. The house as a whole radiates serenity.
One of the reasons I came back is my mom gets her knee replaced in a couple days. My understanding is that it is a difficult operation with months of very slow recovery.


I have decided to resuscitate my blog. Partly because I have a good job and hopefully interesting stories. Soon I hope to add my stories from my last 6 months in Tanzania.

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