Saturday, July 4, 2015

Half Way to Havana - My Near Death Experience Part 3

Inside the Cuban Healthcare System
Photo taken by Radio Ciudad del Mar

(See Part 1 and Part 2)

After surviving a heart attack and having a thrombolitic procedure I was relegated to the Intensive Care Room. The hospital where I was receiving care was called Hospital Universario Doctor Gustavo Aldereguia Lima. To be very honest, the doctors, nurses and technicians saved my life. I will forever be grateful. 

Believe it or not, I found this near death experience completely captivating. There was so much going on. I mean, there were things happening with my own body, there were wild thoughts occurring in my mind, and there was so much activity happening inside and outside of the hospital with other patients and staff. I tried to make sense of it all.

Once I was relocated to the Intensive Care Room I was connected via electrodes to a heart monitor, provided an intravenous therapy and was given supplemental oxygen. Every few hours one of the nurses would check my condition and provide me with some medicine. 

The first nurse that attended to me was Ishmael. He had a thin build, maybe 130 lbs, stood about 5 foot 6 inches with slightly graying hair. He wore eyeglass and if he was not wearing medical scrubs, you might think that he was an engineer. I'm guessing that he had been a nurse for many years. He certainly knew his way around the Intensive Care Room and was knowledgable about how to provide care. He was super efficient at checking charts, dispensing medicine, changing IVs and attending to patient's questions. He would do twice the work in half the time with greater accuracy compared to the other nurses. He often made little jokes to keep a light mood in the Intensive Care Room. He actually talked a little like a muppet. 

For the first 24 hours after my surgery I was advised to rest and recover. I did not know if I was still recuperating from the dehydration, from the surgery or just from all the drama of the previous day, but I did feel weak. I found everything that was happening around me so very intriguing. I wanted to stay awake and observe all the activity. However I was feeling tired, so I would drift in and out of sleep. 
When I was awake I found myself watching my heart rate monitor bounce up and down and make beeping sounds. Just like in the movies. However, realizing that the machine was connected to me was a sobering thought. Every now and then, I was given some type of medicine through my intravenous therapy tube. I don't know what type of medicine it might have been, but it felt like adrenaline. When the nurse induced the liquid I would feel a rush. My heart would start pumping at a faster rate and my body would tingle. It was thrilling and scary all at the same time. One time my heart was racing at such a fast pace that I called over the nurse to see if everything was okay. The nurse adjusted the drip of the intravenous therapy just a little bit and my heart rate returned to normal. Every once in a while the alarm on my heart monitor would go off. All my symptoms would be okay, the nurse would just punch a button and then continue working. Kind of scary to be awaken in the middle of the night and then realize that it was your heart monitor alarm. It was bizarre. 

My second nurse was named Hanoi, as in Hanoi, Vietnam. In Cuba there still exist a kindred feeling with Vietnam. Both countries had revolutions which followed Marxist ideology and are still Communist. There are statues, streets and I guess a few people that are named after Vietnamese people and places. In appearance, Hanoi was a contrast to Ishmael. He had a thicker build, stood about 5 foot 8 inches, 170 lbs and had a manicured look with a quaff of hair that a boy band singer would be proud of. He was very professional in his own way. He would direct other nurses in the proper way to provide care. He was very friendly to me, very respectful to the doctors, but demonstrated just a bit of attitude toward his fellow nurses.

Barbara, the lady from the International Section, visited me at my bedside to check up on me. She inquired how I was feeling. I told her that I was feeling much better. I wanted to put on a strong facade in the hope that I would be able to leave the hospital sooner. 

I actually wanted to get out of the bed, leave the hospital, board the next airplane to the US and check into a hospital in the US. However, I knew that this probably was not going to happen.

Every so often I would hear a phone ring in the hallway just outside the Intensive Care Room. I did not have a phone at the little table next to my bed as is the case in most hospitals in the US. I asked Barbara if there was any way that I could call my family to let them know what had happened. I shared that I had a Cuban telephone card in my wallet to pay for the call. 

Barbara said, "I know that you want to call your family. You probably want to call them for your own piece of mind, not for the benefit of your family. If you call them right now, they will just worry."  
I said, "I think that I know my family pretty well. I think that they would like to know."
Barbara said, "It is probably better that you not call them right now." I was not able to call.

I understood. I was not in agreement, but I understood. In the US we are very accustomed to having what we want, when we want it. I was not in the US. I needed to abide by the rules of the hospital and the rules of the country. I was in Cuba. I assumed that they did not want me to call my family in case I experience further complications. I felt a little trapped. I knew that I was too weak to leave the hospital on my own strength. I probably could have called for an evac (emergency evacuation), but that would have been expensive and unnecessary. 

Be patient… Troy... be patient.  

I'm always assessing my surroundings. Partly, I like to observe my surrounding because I'm a curious person. Partly, I evaluate my surroundings because I like to always have a plan in the event of an emergency. In this situation, I was not in an emergency. However, I scanned my surroundings and looked for a possible escape route in case I needed to make a break. Also, I tried to assess how strong my body was at the moment. Unfortunately, there was only one exit out of the hospital and my body was not strong. I would not be going anywhere for the foreseeable future. 

One of the more interesting things that I observed during my stay in the hospital was that there were a number of people walking around the Intensive Care Room. These people were not staff of the hospital. These people were relatives of the other patients. I observed how they walked freely in and out. They would sit and talk with their relative. At first I thought that this was peculiar because these people seemed to be present 24 hours a day. They would bring in food for their relatives. And once a day they would bring in clean linens, charge the sheets of the bed and bath the patients. The sheets, towels, pajamas, food and water were not provided by the hospital, rather they were provided by the family and friends. I did not know if this form of care was to encourage the patient or to save money for the hospital and healthcare system. I have a feeling that this tradition was to save money for the healthcare system. This activity was a little distracting at times because these caregivers would often receive mobile phone calls. They would then have an open and load conversation right in the middle of the Intensive Care Room. I learned quite a bit about my fellow patients' illnesses, conditions, families, friends, food preferences, likes, dislikes, etc. just by listening. I was not eaves dropping, all of the conversations were out in the open. In Latin America and in Cuba privacy is practiced differently. There really isn't privacy as we are accustomed in the US. People observe other people. People ask direct questions. And sometimes people talk loud. I found it difficult to sleep for more than 2 to 3 hours at a time because there was always someone making some noise.

So what about me? I obviously did not have any family or friends to take care of me in Cuba. Well, almost. I had a new friend named Jorge, the owner of the casa particular. Jorge helped me call the ambulance and actually accompanied me to the hospital. He was in the emergency room during my operation and guarded all my personal possessions. And, as soon as I was allowed visitors. He showed up to greet me. He brought me some basic necessities like some juice, toilet paper, toothpaste and a toothbrush. Because I was an international patient I was provide pajamas, sheets, pillowcases, a urinal and food and drink by the International Section. I had a special chef that would prepare me food. I was always served food before the regular mealtime. The other patients were always curious what I was being fed. I felt a little awkward eating while other people were watching me eat, but I got over it knowing that I needed nourishment. I also realized that I would probably end up paying for all these things out of my own pocket. 

The Cuban Healthcare System promotes that it offers free healthcare to its citizens. I learned that there are some minor costs. One of the nurses confided in me that patients often take advantage of the free healthcare. When someone is feeling like they want a little special attention they will check into the hospital with fantom symptoms. The hospital and the staff will provide them with air conditioning and attention, while their family members will bring them food and drinks. I may have witnessed one or two of these cases during my short stay.  

Website by Radio Ciudad del Mar

During my first 24 hours I was in one of the Intensive Care Rooms. Then all of the sudden me, my bed, my medicines, my monitor and my possessions were being packed up and transferred. I thought that maybe I was going to the International Section, but it turned out that I was being transferred into a newly remodeled Intensive Care Room. This room was larger, cleaner and had some more modern features. Some of the bed stations had new lamps, outlets and monitors. There were newer air conditioning units that were much quieter and colder. 

When I was wheeled into the new room I was given bed numero uno (number one). I was the only person in the entire room. I made a joke to one of the doctors, "Mira, El Chinito Americano es el primer patiente en el nuevo cuarto, el cuy!" (Look, the Chinese American is the first patient in the new room, the guinea pig!). He laughed and retold the joke to a number of the staff. The staff laughed and retold the joke to other staff. Then the doctor took a photo of me in bed number one and said, "El cuy, jajaja!" 

The room was nice, quiet and cool compared to the previous room. It felt very peaceful. I thought that I would certainly sleep much better. 

After about an hour of having my own personal Intensive Care Room my quiet and comfortable world was rocked. Other patients were slowly wheeled into the room. One by one the room filled up with other patients until every bed space was filled. Oh well.

The photo at the top of this post was actually taken by a journalist from a media company called Radio Ciudad del Mar that was reporting on the new remodeled Intensive Care Room. She took many photos of the room, but of course she chose the photo with the Chino Americano in bed numero uno to accompany the article. Jorge saw the article and sent me a link to the website so that I could read it later. I made a screen capture of the online article as a keepsake. If you can read Spanish you can enlarge the photo and read the whole story. Who else would or could read this story in Cuba was a mystery to me; the internet access in Cuba is very limited.

Many of the doctors, nurses and administrators were walking around the new quarters inspecting all the new beds, fixtures, air conditioners, desks, chairs, shelving and medical equipment. There was a little discussion about where the medicine shelves should be located. There was a big discussion about where the new television would be located. There would be only one television for the entire room, so the location would be key. The doctors, nurses and administrators all had an opinion of where the new television should be located. Even some of the patients got into the discussion. In the end, one of the head doctors entered the room. The administrator asked him where he thought the television should be located. The doctor pointed to a space on the wall at one end of the room. End of discussion. 

There were eight other beds in the Intensive Care Room and eight other patients. Patients would come and patients would go. There was one older gentleman that had some type of accident. There was a middle aged lady that was experiencing exhaustion. There a pastor that was having gastrointestinal pain. There was an old lady that had hurt her arm. There was a military officer that had a cardiac issue. All the rest of the patients knew my story and why I was in the Intensive Care Room. Whenever the doctor would talk with me the room would get very quite so that everyone could listen and find out everything about the Chino Americano (Chinese American). 

In the afternoon, a group of young medical students would enter the Intensive Care Room and practice their bedside manner by chatting and writing reports on the condition of the patients. Cuba has a spent a great amount time and money over the years cultivating their healthcare system. They send doctors around the world to "friendly" countries. They also allow medical students to study in Cuba for free. The students must pay their own room and board which can be pretty minimal, but the education is free. Some would say that this is a goodwill gesture. Others would say that it is propaganda.  I had a number of the medical students talk with me. They were from Russia, Ghana, Venezuela and Ecuador. Some were very good. Some were very bad. One student asked me a number of good questions about my case and finished the entire interview in about 30 minutes. Another student asked me the same questions over a 2 hour period and still got many of the facts wrong. It became tiring repeating my case time after time. After 2 or 3 of these interviews I would pretend that I was sleeping so that the students would not disturb me. Some of the new patients were quite eager to share their stories with the students. However, after a few days the patients would pick up on my trick and they too would pretend to be asleep to avoid the inquisitions. 
As I mentioned before, each patient had one relative that could stay at their bedside 24 hours a day to provide care and basic necessities. There were visiting hours when larger groups of people could visit inside the Intensive Care Room. However, outside of those visiting hours family and friends, except for the one caregiver, were not allowed inside the room. This did not prevent some people from visiting at all hours. The relatives would stand outside of the room on the balcony/walkway and talk or signal to their relative inside. This evolved into entertainment all on its own. Sometimes the people on the outside were trying to communicate with the actual patient and sometimes they were trying to communicate with the caregiver. Sometimes it was very touching to see family members communicating with just a glance or smile. Sometimes it became very annoying when us patients were trying to sleep. The nurses tried to put an end to this informal visiting hours by placing curtains in front of the windows. The families quickly discovered that they could stand in the bathroom that was attached to the Intensive Care Room inside one of the stalls and continue with the communications. If you wanted to use the bathroom you might first have to see if the stall was being used as a gossip room.
Honestly, I was not sleeping very well in the Intensive Care Room because of the constant activity and noise. Almost every day one of the staff would mention that they were planning to transfer me to the International Section of the hospital where they said I would have a suite, more privacy and an individual television. I imagined that it would be great. Almost every day I would politely inquire when I might be transferred to the International Section. Almost every day I was told, "Very soon, they are preparing a room for you." After a number of days I had almost given up hope. 

Then on my forth day in the hospital late in the day I was told to get my things together because I would be transferred to the International Section. My things were quickly compiled. I said my goodbyes to all my fellow patients. Then my bed and I were whisked away. I was transferred to my own private room… in the International Section. In fact, I think that I was the only patient in the entire wing. I had my own doctor, nurse and chef. 
Also, I have my own television. Interesting enough, while I was in the hospital, on the news they were reporting that the US made it official that Cuba would leave the list of terrorist countries. This step would pave the way to remove the embargo and open up the country to commerce and tourism. I watched this from a bed in a hospital in Cuba.

There are so many interesting little stories that I would like to tell about my experience in the Cuban Healthcare System. I'll try to share more of these stories in the future.

After four days in the Intensive Care Room and three days in the International Section, I was feeling well enough to ask my doctor if I could be cleared to fly back to the US to seek care. After some discussions the doctors and staff agreed to release me.

There was still the matter of settling my medical bill. My bill for the ambulance, emergency room, intensive care room, international section room, medicine and food was about 4000 CUC or US$4000. I had only brought about US$2500 for my entire trip and had spent about US$1000, so I needed to have some money wired to me. I was unable to make the arrangements while in the hospital, because I would need to personally pick up the funds from a Western Union office. After some discussion, Barbara from the International Section informed me that Jorge had agreed to be responsible for me. Meaning that he would personally escort me to the Western Union office to collect money sent from the US and he would personally accompany me back to the hospital to pay my bill. So after seven days in the emergency and intensive care units I walked out of the hospital.
I hired a taxi to take me to Jorge's house and casa particular. There I met his wife Maria. She was an excellent host that cooked me numerous meals that nourished me back to health.
Their casa particular was one block away from the central plaza. It was eclectically decorated.
My room had everything that I needed for my short stay. A comfortable bed, air conditioning, refrigerator, bathroom and even some art.
Jorge hired a taxi to take me around the city to manage my affairs. We first went to the bank so that I could exchange the US dollars that I had for Cuban CUC. I had about US$1500 that equated to 1500 CUC. The next day we went to one of the department stores. Inside the department store next to the couches, beds and linens department there was a lady sitting at a metal desk. It was the type of desk that you might have seen in a 1960's office. On the front of the desk was a sign that said Western Union. I approached the lady and told her my name and that I was expecting a delivery of money. My brother made arrangements in the US to send me about US$3000. He provide me a code. I shared the code with the lady behind the metal desk. She pulled out a wad of Cuban CUC and began counting. 1, 2, 3 thousand CUC. Done deal. It was that simple.

I walked out the front of the department store with over US$4000 in my pockets. Jorge and I would hire a taxi and travel directly back to the hospital to pay my bill. I asked Jorge if it would be dangerous to carry this much cash in my pockets. He said that it would not be dangerous. Cuban was very safe. He was right, but I was still nervous.

We arrived back to the hospital at about 10am. I shared with Barbara that I had the money. She said that she was surprised that I was able to get US$1000 so quickly. I said that I didn't have US$1000, but that I had the entire US$4000. She was astonished. Typically Cubans are only able to receive US$1000 per month via Western Union. I'm not sure why I was allowed to receive a greater amount, but I wasn't complaining. 

Jorge and I waited for the accounting office to add up my bill and hand write a receipt. It took about 4 hours. We passed the time in a lobby talking with an old friend of Jorge's who happened to work at the hospital. After the full bill was hand written we then proceeded to the accounting office cashier to pay the bill. The cashier was really something akin to a vault. I had counted and separated my wad of money into four neat stacks of 1000 CUC each. When I turned the money over to the cashier she promptly combined all the stacks into one big stack. Then slowly started counting bill by bill up to 4000. It took another hour or so to count all the money and hand write another receipt. It was close to 4:30 or 5:00pm when we finally left the hospital grounds. 
I did have a chance to walk around the central plaza of Cienfuegos. This is an arch on one side of the central park.
There was a stone lion at another end of the park.
This nicely kept government building was on one side of the park.
This colonial style building on the other side of the park.
The Cathedral was also near the park.
And this statue stood in the middle of the park. That's really all that I saw of Cienfuegos. In reality I probably should not have been walking around in the heat. I had just had a heart attack 7 days prior.

It took me one day to gather money and pay the hospital. It would take me another 2 days to schedule a return flight back to the US. I actually was only able to schedule a flight from Havana to Mexico City. I would have to make my own arrangements once I arrived in Mexico City.
After 10 day, all was in order. I was healthy enough to travel. I had paid my bill at the hospital. I had reschedule my flight out of Cuba. And I had packed my bag. I did not feel that I was healthy enough to pack and carry my bicycle all the way back to the US, so I gifted it to Jorge. The bicycle was monetarily worth the equivalent of a years wage in Cuban. Jorge was touched by the gesture. I was more than grateful for all the help that he had provided me over the past 10 days. 
Jorge made arrangement for me for a taxi with a friend of his. My flight out of Havana was leaving at 6am. We thought that it would be best if I took a taxi directly to the Havana airport. I think Jorge was a little concerned that if I spent the night or a day in Havana that I might try walking around the city and die.

So at 12 midnight a taxi picked me up at Jorge's house and wisked me away into the night. In typically Cuban fashion, the driver had made arrangement to take two additional passengers in the back seat. We drove through the night for about 4 hours.
The ride was swift. I rode with my window partially cracked. The air was cool. We made one stop somewhere along the middle of the route to rest and use the restroom. 
Just like clockwork, we arrived at the Havana airport just prior to 4am. I got in line with the other passenger to check in.
After checking in with the airline, I still had some Cuban currency. Cuban currency outside of Cuba is worthless. It is unexchangeable. The was a Currency Exchange booth within the airport. There were a number of people that were exchanging hard currency like US dollars and Euros for CUC. There was one gentleman in front of me that was going to exchange US$500 for CUC. When you exchange US dollars for CUC there is a automatic 10% fee charged. This fee was instituted to dissuade people from using the US dollar. I asked the gentlemen if he would like to exchange US$200 for my 200 CUC, thus saving both of use the currency exchange fee. He agreed and the illegal transaction took place. We were both happy.
I then walked around the airport and spent the last few remaining Cuban Pesos that I had.
At about 5:30am I boarded the plane and at 6:00am I left Cuba. What an adventure.

I flew into Mexico City where I had to negotiate with United Airlines to exchange my existing ticket for a ticket for the next flight back to Houston. The next flight back to Houston was at 2:00pm in the afternoon. After some discussion I was able to reserve a flight back to Houston. 

I landed in Houston and was welcomed by my mother. I think that she was relieve to see me. 

After my return, I would spend the next month navigating the US healthcare system on my way recovery. 

There were actually so many little stories that I have not been able to share with you. I was thinking about writing a book with more details about my Cuba experience, the Cuban healthcare system and the US healthcare system. If you would be interested in reading and supporting me in this effort please send me a message at I'll put you on the list for one of the first editions.

Thanks for being patient and supportive in reading this story. I hope that you enjoyed it.

Hasta la próxima,


Go back to the beginning.

Friday, July 3, 2015

Half Way to Havana - My Near Death Experience Part 2

On the Emergency Room Operating Table
Photo taken by Jorge

(See Part 1 - Half Way to Havana)

Blood was rushing to my head. I was feeling a little nauseous from the vibrations of the ambulance ride. I remember being wheeled into the hospital on a stretcher. 

There was a nurse walking beside the stretcher. She asked me what had happened. I turned to answer her… and immediately vomited. I don't really know if I vomited on the nurse or if I missed her. I apologized anyways. 

I wiped some vomit off of my cheek and then started to convey my story once again. While I was being wheeled through the hospital I realized that I was in a hallway or more specifically on a walkway outside of the actual building. To the right side of me I could see palm trees in the patio area. I was thinking, "oh, that's kind of nice." Then I was thinking… Hmmm, I wonder what kind of hospital this might be. 

I've been in a hospital in a developing country before. Once when I was motorcycling in Guatemala I crashed and separated my shoulder. I rode for one and a half hours to reach a city and a hospital. When I saw the doctor he put some tape on my shoulder, wrapped my arm in my own bandana and told me to rest it for two weeks. He didn't tell me that I had separated my shoulder. It wasn't the best of advice or healthcare. To this day I still have a separated shoulder.

I remember that the hospital in Guatemala had an open air type of architecture too. There were doors wide open. Hallways with breezes running through them. The rooms had windows that were open and sometimes without screens to keep the bugs out. In the US this might seem quite strange. Most hospitals in the US are enclosed, sterile and air conditioned. I speculate that in tropical climates that it is better to make the structures open to increase the air circulation. 

I focused back on my current situation. I was trying to gauge my surroundings and take in the atmosphere of the hospital. I remember passing by many windows. Some of the rooms looked like patient rooms and some of the rooms looked like administration rooms with shelves and cabinets. I passed by a person lying on a stretcher by the side of the walkway. The man was groaning. There didn't seem to be anyone helping that person. I looked around me and realized that there were probably 3 or 4 people escorting me through the hospital. I felt empathy for the man lying on the stretcher all by himself. The nurse began hooking up a series of wires to me. She explained that these wires were to take an EKG (electrocardiogram). I knew what it was. I was kind of surprised that they called it the same thing in Spanish as in English… an EKG. 

I turned to ask the nurse where they were taking me… and suddenly felt another round of projectile vomit launch from my mouth. The nurse jumped back and away. I heard her say "Dios Mio" (My God). I felt sorry for the nurse because she had to clean the vomit off my face and shirt. I decided that it would probably be better for me to keep quiet and just let these people do their job. 

I was wheeled into the emergency room and was transferred on to another stretcher. Some technicians pulled some curtains around my stretcher to create a privacy wall. I could hear the person next to me yelling and he sounded in much worse condition than I. There was a flurry of activity. There was somebody taking my blood pressure, there was somebody stripping off my shirt, there was somebody emptying my pockets. And there was a group of people huddled together having a very animated discussion while passing a piece of paper amongst themselves. Jorge, the owner of the casa particular, was in the middle of the group. 

The nurse with the EKG equipment appeared again and started connection electrodes to various parts of my body. I've had an EKG in the US and the electrodes were fastened to my body with little sticky pads. This EKG machine had suction cups and it kind of amused me.

When I was a kid I played racket ball with my friends. Once I split a racket ball open into two halves. The two halves made great suction cups. I took one of the suction cups and stuck it on my forehead. Then I ran around the house showing my family and acting like I'd been struck in the head with a racket ball. I thought that it was pretty funny. It was pretty funny when I finally took off the ball and learned that the suction had worked so well that it had created a perfect circle on my head by sucking the blood to the surface of my forehead. I had a circle on my forehead for about three days. I had to borrow some of my mother's makeup to cover up the circle. Funny how you think things like this when you are lying in an emergency room. I was wondering if the little EKG suction cups would leave little circles all over my body.

As the nurse was connecting me to the EKG machine. Somebody was asking me questions. I started to respond, but the only thing that came out of my mouth was some projectile vomit. This time I turned right and sprayed the nurse and the EKG wires. I could tell that she was pissed. I wanted so bad to tell her that it wasn't personal. I just could not control myself. She had to disconnect all the EKG electrodes and clean them.

A lady in a dark suit approached my left side. Maybe she had witnessed that my preference for spewing vomit was to the right, so she was playing it safe. She introduced herself as Barbara and that she worked in the International Section of the hospital. It was her job to look after all the international patients. I could tell from her uniform that she was not a medic, nurse, technician nor doctor. I assumed that she held more of an administrative or "government" role. I had a feeling by the way the other medical professionals interacted with Barbara that, while she spoke very gently with me, she held some real power. I conveyed my story to her. I added some parts explaining that I was legally in the country, that I had permission from the Treasury Department of the US Government to visit Cuba and that my passport and all my documents were in a pouch attached to the side of my hip. My security pouch was promptly removed and held for safe keeping. 

I asked her what the group of people were discussing. She then signaled for a doctor to approach. The doctor approached and introduced himself as Dr. Pavel. He explained that they were monitoring my situation. He said that my vital signs were not regular. He said that it appears that I had become dehydrated which led to a blot clot which reached a blockage in my heart and cause a myocardial infarction - a heart attack!


He continued and said that there was a procedure that they wanted to conduct called a Thrombosis (Thrombolytic). He explained that for the Thrombolytic they would make a small incision near my collar bone into an artery, insert a tube, inflate the tube, then inject a strong anticoagulant to help dissolve the blood clot.

He said that someone needed to sign the piece of paper to authorize the procedure and guarantee payment for the cost of the medicine - $70. They were trying to get Jorge to sign the paper. I said that I had just met Jorge. He should not be under any obligation to authorize or pay for any of my medical expenses. I asked Dr. Pavel to allow me to read the authorization and I would guarantee payment for the drug. 

I read through the authorization form and signed it. I thought that it was a worthwhile expenditure. ;)

Immediately the medical team went into action. They did a little prep work. Sterilized the surface of my skin near my shoulder. Gave me a local anesthetic. Then just as the doctor had explained, he made a little incision in my skin, inserted a tube, inflated the tube, then injected some liquid. The incision did not hurt at all, but when they injected the liquid into my artery it felt intense. I was awake throughout the procedure and able to talk to the doctor. After the procedure, the doctor sewed some stitches to close the incision. Then I fell asleep.

About two hours later I was awaken. The nurse was taking my vital signs. The doctor was asking me how I felt. I noticed a dramatic improvement. The nurse said that my vital signs were back to normal. I felt completely awake and aware. I was provided oxygen through a mask. There was an intravenous therapy connected to my shoulder. I believe that they were using the same incision from the operation. I felt alive… well pretty alive.

I was transferred out of the emergency room and into an intensive care room. Dr. Pavel told me that I would need to stay in the intensive care room for a few days for 24 hour observation. Barbara told me that once I was stabilized that I would be moved into the International Section of the hospital which would be a little more comfortable. I was just along for the ride.
Inside the Intensive Care Room
Photo taken by Radio Ciudad del Mar

I found the whole experience very interesting. I mean really… How many foreigners, and especially US Citizens, get the opportunity to see the inside of a Cuban hospital? Moreover, How many people get to experience first hand the inner workings of the Cuban Healthcare System… and live to tell about it?

This is Part 2. Continue reading Part 3, I share my observations about spending a week in the Cuban Healthcare System.

Thursday, July 2, 2015

Half Way to Havana - My Near Death Experience

One year ago on this date June 11, 2015, I almost died.
How did a nice little bicycle ride across a tropical island turn into this?
I spent 3 days in Trinidad and I was ready to move on. The next destination that I planned to visit was a city called Cienfuegos. No real reason other than the town was located along the coastal road to Havana. The route would be one of the longest rides of my journey. The locals were telling me that the distance between the two cities was about 90km (55miles) with no major towns, only small villages in between. For about a third of the route, the road would pass through a nature reserve park called Topes de Collantes. The park contained some of the tallest mountains on the island as well as caves, rivers, falls, grottos, canyons, natural pools and supposedly quite a few mariposas (butterflies).  
Knowing that there would not be any towns in between the two cities I filled my 3 liter water container and picked up some bread and bananas. I ate some bread and two bananas and carried two bananas with me. I was expecting that the weather would be hot and humid by mid day, so I wanted to ride as much mileage as possible as early as possible. I got an early start and left Trinidad at about 6:30am. 
As I exited the city, the road was paved, flat and in great shape. I encountered a little traffic - a young man on a bike pulling his horse. I quickly passed them. To the right of me was the Topes de Collantes nature reserve. To the left of me was the ocean. I was never really able to see the nature reserve nor the ocean because along the road there was a green wall of vegetation that was so thick I could not see beyond 10 to 15 feet.
I continued down the road. The sky was filled with clouds. I welcomed the clouds knowing that they were protecting me from the direct rays of the sun. I did notice that even though it was early in the day, it was quite hot and humid. 

After about 10km (6miles) I was not feeling quite right. I was feeling tired and was sweating profusely. Normally I sweat a little on my back. Today, I was sweating on my back, chest, face and even my arms. I drank some water and proceeded. I thought that maybe I just needed to break through a physiological barrier and that soon my energy would return. It did not.

I pulled over to the side of the road and stopped pedaling. 

I took a few deep breaths. I wiped sweat from my brow. I was dripping in sweat. What was going on? I felt weak. There had been times during my trip when I felt tired, times when I was short of breath, times when I needed to get off my bicycle and walk. This was different. I felt weak. 

I've experienced many strange illnesses while I've traveled. I've experienced altitude sickness in Nepal.  My whole body swelled up when I was stung by a scorpion in Guatemala. I've had food poisoning (Delhi Belly) in India. I was thinking that maybe I had food poisoning. I had been eating pretty much everything that was put before me. Some of the symptoms of food poisoning are stomach pain, nausea, vomiting, fever, dizziness, weakness and sweating. I had a few of the symptoms, but surprisingly no stomach pain at all. 

I put down my kickstand and dismounted my bicycle. I took a long draw of water from my water bladder. I slowly peeled a banana and ate it. 

OK, now wait, wait until that energy kicks in. You'll be fine. 

I conducted a mental inventory of my supplies. I had plenty of water, at least 2 liters. I still had a banana, some energy bars that I carry for emergencies, some pieces of candy that I had bought a few days ago. In my first aid kit I had some medicines - aspirin, ibuprofen, benadryl, rehydration drink mix. I always travel with a fully stocked first aid kit. I had a hammock and tarp if I needed to stop and camp for the night. I even had a lighter and fire steal if I needed to start a fire. 

I thought about sitting down and resting. But then I thought, no. Don't sit down. If you sit down, you might get complacent, you might loose motivation to continue, you might give in, you might give up, you might not be able to get back up. Don't sit down. Eat! Drink! Don't sit down!

I looked forward and all I could see was the road. To my right, nothing but thick vegetation. To my left, nothing but thicker vegetation. I even looked back, back toward Trinidad. There was nothing… nobody… no bicyclists… no horses… no cars… no trucks… no buses… nothing. 

I remember that for a long moment I was just staring at my bicycle. I was staring at my bicycle as if there was something wrong with it. But there was not. The bicycle was working perfectly. It was me.

Some thoughts started rushing through my mind. What am I doing here? Why am I doing this? No answers became readily available. I realized that I could answer all those questions later. Right now, I needed to save my energy to evaluate my physical condition and come up with a plan of action. I'm good at that. Keep calm and come up with a plan of action. 

I reviewed my options. I could wait by the side of the road until the next vehicle passed by. I assessed that on this part of the road it could be 1, 2, 3 or more hours before a vehicle passed by. I could simply stop and camp on the side of the road. I assessed that I had the equipment, food and water, but there really wasn't a good place to camp. The vegetation was so thick that I'd basically be forced to lay down on the side of the road. I could walk and push my bicycle. I assessed that I might be able to do it for a while, but to push my bicycle for a mile or more would take more energy than it would to ride. Or I could just hop back on my bicycle and ride.

I took a deep breath. I mounted my bicycle. I began to pedal.

I wiped the sweat from my face. I rolled up the sleeves of my shirt. I pedaled on… right, left, right, left, right, left. Trying to make the most of my energy I started to use circular pedal strokes. I began to practice some deep breathing technique to relax my body and take in more oxygen. My plan was to keep riding until I encountered some people.

After riding for some time my energy did pick up a bit. However, I was still sweating more than normal. And I started to fill a little pain in my upper chest. This was not good. I felt a tightness in my jaw. This was something new. This was not food poisoning. I needed to find help, and soon.

At various times in my life, I've actually been in life or death situations. I've always cheated death. I'm a survivor. 

My mind wondered… this would not be a such a good place to die. There was not a scenic view of the ocean. There was not a majestic view of the mountains. I was basically riding on an asphalt road surrounded by two walls of dense vegetation - it was a tunnel with no light at the end. I always imagined that if I had my choice of where I might die that it would be in a location with beautiful majestic poetic surroundings - lying on a beautiful beach with waves splashing against the shore or high in the mountains with the wind in my hair or even a forrest surround by tall and fragrant trees. This place did not meet my standard. I continued to pedal. 

I was pondering... I've lived an incredible life. I've done things, gone places and seen things that probably 99% of people have never experienced. I was thinking… I don't want to die, but I would be okay with dying. I'm a Christian, so I have no fear of death. 

I remember thinking… My mom would be really upset if I died in Cuba. Not wanting to upset or disappoint my mom, I pedaled on. I've always heard that when people are in a life or death situation, that it is not the thought of self-preservation that can sustain someone to survive. It is usually the thought of the need to return to loved ones that motivates people to survive. It is the love of family and friends that pushes them to survive. I pedaled on… I decided to live.
I pedaled for what seemed like a long time, but in reality it was probably only 4 or 5 kms (2 or 3 miles). I remember riding across this bridge. I was thinking, this is the best constructed bridge that I've seen in all of Cuba. At the far end of the bridge, I could see a few structures. Houses! Civilization! People!

As I neared the houses, I realized that the community was only a small village. The road leading up to the houses was more like a dirt pathway. There were maybe a total of 10 houses. It was not really a town, it was a village. I did not see any people walking around. There were two men standing by the side of the road next to a road sign which appeared to be a bus stop. Hallelujah! I pedaled up to the two gentlemen.

(In Spanish)
Me, "Hello, how are you?"
Cuban, "Bien, bien." (well)
Me, "Are you waiting for a bus?"
Cuban, "Si." (yes)
Me, "When is the next bus?"
Cuban, "Se sabe. Talvez en 30 minutos." (Who knows, maybe in 30 minutes)
Me, "My name is Troy. I want to go to Cienfuegos. I'm not feeling well. When the bus arrives can you help me put my bicycle on the bus."
Cuban, "Si, no problema." (Yes, no problem)
To the right of the road there was a building that looked like a store. The door was closed and the windows were covered with panels. I asked the two men if the store would be opening soon. They said that they did not know. There was a little porch attached to the store. I decided that I should wait in the shade of the porch.  I walked over to the porch, sat on the ground and leaned against the wall. I was not feeling great, but I felt well enough to take the photo above. I was disappointed that my body was failing me.

I opened up my medical kit, took two aspirin and drank some water.
Above is a photo of my bike by the side of the road. I folded it up so that it and I would be ready for the next vehicle that passed by. Next to the bus stop sign is one of the men that was waiting with me for transportation. 
This is an image that I captured from google maps. You can see the bridge that I crossed in the lower right hand corner. You can see in the middle of the photo the little village where I was waiting for the bus. There really wasn't much more in the vicinity.

We waited for an hour, then two hours.

I had some time, so I tried to get to know my new amigos. One of the gentlemen had a stick that was about three feet long (one meter) with a large metal hook protruding from one end. The hook reminded me of the hook of the villain in the horror movie Candyman. That movie scared me when I was a kid.  My imagination is vivid, I was thinking that this situation seemed like the perfect setting for a horror movie. A lone traveler riding a bicycle across a tropical island and encounters two men in an isolated village - one man carrying a stick with a metal hook.

I asked the man with the hook, "For what do you use the stick?" He said, "Para enganchar pesces." (to hook fish) They were fishermen. I like fishermen. I felt at ease. I inquired where they were going. They explained that they were on their day off and traveling to Cienfuegos for a friend's birthday party. We chatted a little more about the US, fishing and baseball,

A few trucks passed by, but did not stop. A bus passed by, but it was a tourist bus, it did not stop. A horse drawn carriage galloped by, it was not going all the way to Cienfuegos. A private car filled with people passed by, it did not stop.

After two and a half hours we were all getting impatient. A woman was walking up the road and stopped to talk to us. We explained that we had been waiting for over two hours. She said that sometimes when the fishermen stop working for the day they depart in their trucks from nearby the bridge. Maybe we could ask them for a ride. She advised us to walk toward the bridge to see if any of the fishermen were preparing to leave. We headed her words. The two men grabbed their things and started walking. I unbundled my bicycle and followed along. When we approached the bridge we could not see any trucks nor fishermen. The two men stopped at a boulder that was the size of a car that was laying by the side of the road in the shade. They took up a new waiting position leaning on the boulder. I joined them.

Within 30 seconds of positioning ourselves alongside the boulder a car passed by and then pulled to the side of the road. I think that the driver spotted me, a tourist, and decided to stop. We hurriedly ran to the car and began talking with the driver. He asked me where I was going. I said to the center of Cienfuegos. He said jump in. He looked at my two amigos. I said that they were with me. He told them to jump in. I think that it is a custom in Cuba that if a taxi picks up a tourist then the Cubans in the car get to ride free. The fee that the drivers charge the tourists usually makes up for the fee that he would have charged the Cubans. I did not mind. My two amigos sat in the back. I sat in the front. My bicycle was folded and placed in the trunk.

We cruised down the road with the windows open, wind in my hair and music playing. Cienfuegos was still about an hour away. I talked with the driver most of the way. The driver was a taxi driver that had just transported some tourist from Cienfuegos to Trinidad. He was now making the return trip back to Cienfuegos with an empty car. I learned that his car was a 1950s era Plymouth that was handed down from this grandfather to this father and now to him - an heirloom. The car was cruising along nicely at highway speeds. I complimented the driver on how smooth and strong the car was running. He said that he had replaced the old V8 cylinder engine with a 4 cylinder engine from a Toyota. The three speed was swapped out for a five speed. The suspension was different. He said that now the car got better gas mileage and was more reliable. I did not know if that 1950 era Plymouth was a magical machine, but I was feeling better. I sat back and enjoyed the ride.

As we neared the town of Cienfuegos, my two amigos signaled to the driver that they wanted to be dropped off. They asked the driver what they owed him. He said, "Nada." (Nothing) They thanked him. The Plymouth was soon moving again.

The driver asked me if I already had a reservation at a hotel in Cienfuegos. I told him that I wanted to go to the center of town and then I would find a casa particular. He said that he had a aunt that had a casa particular and that he would take me there. I said that I would look at it as long as it was in the center of town and if it did not cost more than 15CUC. I pulled out my iPhone and opened up a navigation app that I often use when traveling internationally called Pocket Earth. The app can function without a cellular signal. I tracked where we were traveling. We pulled up to a building and the driver ran inside. He said that his aunt was willing to accept 15CUC. I looked at Pocket Earth and told the driver that we were not in the center of town and that I wanted to stay in the center of town. My driver jumped back into the car and said that his aunt had another casa particular that was closer to the center. He would take me there. After a few minutes we arrived at different casa. I looked at Pocket Earth. We were still a fair distance away from the center of town. I told my driver that this would not work for me. In Cuba the central plaza is almost always called the Plaza Marti, named after the revolutionary Jose Marti. I told my driver, please take me to the Plaza Marti. He said okay.
We eventually arrived at the Plaza Marti. I told him to circle the plaza once and then I would pick out a casa particular from one of the many surrounding the plaza. He circled once. Then I picked out the yellow casa particular in the photo above. My driver pulled over and quickly ran inside. I believe that he wanted to quickly negotiate with the owner to ensure that he would receive a commission as my "jentero".  I was okay with it. He had been more than helpful. I unloaded my bag and my bicycle from the trunk. I asked him how much I owed him for the ride. He said whatever I wanted to pay him. I asked him again. He responded the same. I ended up paying him about 15CUC. He seemed happy. He turned to the casa manager, smiled at her and said that he would pass by later. I understood… he would pass by later to collect his commission.

I entered the lobby of the casa particular and sat down on a sofa. The woman that was at the casa said that the owner would be back in just a minute to register me and show me to a room. During the ride in the car I felt okay. When I was unloading my bag and bicycle from the car I felt okay. But once I entered the casa particular, I suddenly felt weak and dizzy. I reclined on the sofa. When the owner showed up, I stood up to shake his hand. I felt dizzy, the room spun and I sat back down. I told the owner that I was bicycling from Trinidad to Cienfuegos, was not feeling well, so I caught a cab to Cienfuegos. He seemed quite astonished that anyone would try to bicycle between Trinidad and Cienfuegos. He said that I probably was not feeling well because of the heat and humidity. I shook my head in agreement. I tried a second time to stand. I was able to stand and walk, so I asked him to show me to my room. 

We walked down a short hallway to a room. He opened the door to show me the room. I shook my head that it looked okay. Then… I blacked out. 

I blacked out. I felt myself falling over. It was all in slow motion. It was black. then there was a flash of light, then it was black again. This was all within a fraction of a second. When I saw the flash of light I stuck out my hand and braced myself against the wall. Then it went black again.

The next thing that I remember was that I opened my eyes and there were faces staring at my face. It was like a scene in a movie. I realized that I was flat on my back and that there were two or three people hunched over me. I could see their faces, with stern looks of concern. I said, "What happened?" They said, "You fell down." I said, "Alright, I feel okay. I would like to go into the room so that I can lay down." They said, "No! No! No!, Let's go to the lobby." There were two men and one woman helping me to the lobby. I lied down on the sofa.

I'm not sure how long I was lying down on the sofa. I may have closed my eyes. I may have kept them open. I may have stayed awake. I may have dosed off. I don't remember.

I remember after a while I was greeted by a rather tall man with a bald head and a mustache and goatee beard. He was speaking to me in English. He introduced himself as Jorge (George). He said that he was the father of the two younger men that had helped me to the couch. He said that he also owned a casa particular around the corner. He asked if he could take my pulse. I said sure. We then transitioned to speaking Spanish. I explained the whole story - how I was bicycling across the country, was traveling between Trinidad and Cienfuegos, started feeling weak, caught a taxi to Cienfuegos, then ended up at the casa. His sons filled in the details of what happened after I had arrived at their casa.

Jorge contacted a doctor that lived in the neighborhood. I do not remember his name. The doctor took my pulse and blood pressure. I shared my story once again. The doctor concluded that I was probably dehydrated and simply needed to eat, drink and rest. So I ate and drank some of my supplies. The doctor packed up his medical kit and left.

After about 30 minutes I was not feeling any better. Jorge tried to take my pulse and blood pressure. He said that both were very very low. I said that I thought that it would be better for me to go to a hospital. He agreed and called an ambulance. 

Within a few minutes the ambulance arrived. The medics asked me what happened, so I explained the whole story again. They took my pulse and blood pressure. Then they said that they would take me to the hospital. They brought in a stretcher and loaded me onto it. Once inside the ambulance they connected me to some machines and connected an intravenous therapy to my arm. 

I remember vividly that I was tilted on the stretcher with my feet above my head. I could tell that the blood was rushing to my head. I asked the medics if they could lower feet because I was a little uncomfortable. They said, "NO!"

This is Part 1. Stay tuned for Part 2 when I share what happened to me once I entered the Cuban hospital.

Wednesday, July 1, 2015

Trinidad, Cuba - UNESCO Treasure or Tourist Trap? Day 3

I felt like I had seen all the museums, parks, markets and tourist attractions that I wanted to see in Trinidad. 

Honestly, I was getting tired of being approached on the streets by Jineteros (hustlers) encouraging me to buy things, eat things or take a tour. The Jineteros can be helpful if you are looking for accommodation, a restaurant, a tour, a souvenir or just about anything really. However, they can be overbearing at times. Some are polite. Some are very persistent. Some are pushy. And if a Jinetero introduces you to anyone, anyplace or anything there is a built in commission that increases the price for the consumer - you. I was finding it disheartening to engage in normal conversations with the locals because at some point in the conversation a "pitch" would eventually be put forward. 

Jinetero, "Are you enjoying your time in Cuba?"
Me, "Yes, so far I'm having a good time."
Jinetero, "Where are you visiting next?"
Me, "Honestly, I don't know."
Jinetero, "You should visit ___."
Me, "Thanks, I will consider it."
Jinetero, "I have a friend with a nice hotel, I will call them for you."
Me. "Ahhh"

Jinetero, "How do you like the Cuban food?"
Me, "I've only tried a few dishes so far."
Jinetero, "Have you tried lobster?"
Me, "I've eaten lobster, but I have not eaten it here yet."
Jinetero, "My aunt has a very good restaurant, I will take you there."
Me, "Hmmm"

Jinetero, "Tour?"
Jinetero, "Cigar?"
Jinetero, "Rum?"
Jinetero, "Water?"
Jinetero, "Shopping?"
Jinetero, "Lady?"
Me, "No, gracias."

The requests seem to go on and on.

The reality is that necessity is the mother of invention. Because the political system and economy can not produce many things, people have relied on relationships and a barter system to coexist and survive. This system has been transplanted into the tourism market. There is a legitimate scarcity of many things and those with knowledge of or access to goods and services often expect some form of compensation for their expertise.
On this day I decided that I'd take it easy and check out a lesser known site outside the town center called Ermita de Nuestra Señora de la Candelaria de la Popa (Chapel of Our Lady of Candelaria). I walked past the Cathedral, down an alley, up a hill, through a neighborhood. I got a little lost and had to ask for directions. Then I stumbled upon this structure.
The Chapel dates back to the colonial era and was constructed in 1716. It was modeled after a similar chapel in Cartegena, Colombia because the two cities conducted trade. 
In 1812 the chapel was hit by a hurricane and sustained some damage. In the late nineteenth century the hospital attached to the chapel was used as headquarters of the US occupation army, between 1898 and 1902. In 1984 there were efforts to restore the chapel, but the efforts were not sustained. To the side of the chapel there was some new construction. I asked a local what was being built and I was told that it was a new hotel. The view of the city was nice from this vantage point.
I returned to the city center, found a stoop to sit on and decided to do a little people watching.
Bringing home the catch of the day.
Drying the laundry on a rooftop patio.
Walking the dog.
A man and a horse going to work.
A horse drawn carriage.
A horsepower drawn carriage
Sporting the stars and stripes
Sporting colors
Playing with a stick in the street.
1950 vintage
1940 vintage
Black song bird in a cage against a white wall.
Black song bird in a cage against a yellow wall.
I walked into the Casa de Cultura (House of Culture) to see if there were any events occurring over the next few days. Inside the building in an open air patio there was a stage with a number of young people practicing a dance performance. I sat down and watched them for a while.
After some time passed the gentleman with the red shirt sitting in the chair got out of his chair and approached me. He introduced himself as the head instructor. 

Instructor, "Where are you from?"
Me, "Texas"
Instructor, "But you look Chinese or Japanese to me."
Me, "My ancestors are from China, but I was born in the US."
Instructor, "We see many Europeans and Canadian, but not many people from the US."
Me, "Yes, I'm traveling independently."
Instructor, "Are you enjoying Cuba?'
Me, "Yes, I've enjoyed most of the places that I've visited."
Instructor, "These are my students. That man over there is my assistant. They are practicing dance."
Me, "Looks interesting. Are they preparing for a performance?"
Instructor, "No."
Instructor, "Can I have a drink of your juice?"

I was carrying a bottle of juice that I had just purchased at the grocery store. I passed him the bottle. He drank about half the bottle and handed it back to me.

Instructor, "Do you have any Euros or Dollars?"
Me, "No, I only have Pesos and CUC."
Instructor, "Oh, I was hoping to get some Euros or Dollars."
Me, "Sorry, I only have Pesos and CUC. I had to exchange my currency when I entered the country."
Instructor, "Oh, I was hoping to get some Euros or Dollars."
Me, "Sorry, I don't have any."

Instructor, "Do you have any cigarettes?"
Me, "No, I don't smoke."
Instructor, "Can you give me a five CUC to purchase some cigarettes? It is for the students."
Me, (pause to process what he had told me) "Do the dance students smoke?"
Instructor, "They need cigarettes to keep up their energy."
Me, "Sorry, I can not help you."
Instructor, "How about 1 or 2 CUC?"
Me, "Sorry, No." (thinking that I had over stayed my welcome.)
Instructor, "OK, it was nice to meet you."
Me, "It was nice to meet you, too."

The Instructor walked up to his students and told them in Spanish, "No me dio nada, ni un centavo."

I walked out of the Casa de Cultura with a new lesson in culture.

Back on the streets, I decided that I was finished having conversations for the day. I resigned to be an observer. 
I caught this group of musicians playing trova music in a small park.
I walked by a school with the classroom door open. The students looked about as interested in their studies as students anywhere.
This establishment was a repair shop. Bring in a toaster, radio or any home appliance and one of these gentlemen would repair it for you while you wait.
A glance through the window of a Cuban house revealed some vintage 1950s furnishing still in pristine condition.
I passed by the open doorway of this house and had to double back for a second look. I had stumbled upon Regla de Ocho also known as the Casa Templo de Santería Yemayá… a temple of Santería.

Santería is a system of beliefs that merges Yoruba slave mythology with Christianity and Indigenous American traditions. Santería involves various religious customs, including a trance, animal sacrifice, sacred drumming and spiritual dance. The doll dressed in white is Yemayá - a goddess of the sea. Traditionally she wears a long flowing dress, cinched by a wide belt, with a full skirt made of blue and white ruffles, which represent the waves in the ocean. As a mother, she's wise and virtuous, but she likes to have a good time and she enjoys dancing. Although she's maternal and nurturing, she's also fierce. She's fair minded and forgiving when proper remorse is shown, but her punishments can be terrible when she's outraged.

I didn't want to upset Yemayá or disrupt my day so I continued on with my walk.
Of a gentler nature, while walking by the Plaza Mayor, I saw this young girl having her photo taken and dressed like a princess. I'm guessing that she was about to celebrate her quinceañera. A quinceañera, also called fiesta de quince años, is a celebration of a girl's fifteenth birthday in parts of Latin America. This birthday is celebrated differently from any other as it marks the transition from childhood to young womanhood. 
Still more placid, a collection of straw hats hanging on a rack inside of a window.
An lastly, an old man in a rocking chair enjoying the world pass by his window.

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