Getting my chest shaved in London, and other adventures in the ER

Souvenir from St. Mary's Hospital in London: the readout showing where my rapid heart beat was halted, then restarted at a slower pace. Click to see detail.

We go to London for the theater. But a brief visit last week brought some unexpected drama of a different kind.

What happened: in the wee hours of Saturday morning, I awoke to find my heart beating much faster than normal.

And stronger than normal, too: BAM! BAM! BAM!

I couldn't imagine why this was happening at 2 a.m. I hoped it would just go away, but I couldn't get back to sleep.

So after an hour, I woke up my wife. She measured the pulse as 140, and it showed no signs of abating.

What was up? Was it finally time for my big life-changing health collapse?

Time crawled by. Earlier that evening, we had seen 'Fawlty Towers: The Dining Experience,' a dinner-theater recreation of the iconic British TV sitcom.

Now, lying there, I found myself thinking of several 'Fawlty Towers' scenes set in British hospitals, and also of the episode where a hotel guest dies overnight.

That led me to think of a good option for an epitaph, should one be needed. It's what John Cleese says to three hotel guests whom he mistakes for undertakers.

"Your dress is very modern," he tells the bewildered trio. That would work well on a gravestone, I thought.

I know this sounds ludicrous. But what else would you think about in a hotel at 4 a.m. with your heart racing like you're running a marathon?

Daylight came at about 6:30 a.m. By then I was seriously short of breath and feeling light-headed, so we knew I'd have to get checked out.

One issue: my wife's relatives were scheduled to arrive in London by train at 8:50 a.m. for an action-packed day.

Well, it was clear I wasn't up for that. Just climbing the stairs to the lobby (we were in a lower level) made me feel like taking a siesta.

Fortunately, St. Mary's Hospital was two blocks from the hotel. I felt well enough to walk to the ER. So that's what I did.

My wife would meet the relatives at the train and wait to hear from me.

The main gate at St. Mary's Hospital in London.

So I trudged across Praed Street and entered the St. Mary's campus. A map directed me to the emergency department, and a woman at a desk sent me upstairs.

The hotel desk clerk had advised I might want to wait for an urgent care clinic to open because St. Mary's, as a large inner-city hospital, could be kind of a madhouse.

But early on a Saturday morning, I was the only customer. No waiting! Thus was my introduction to Britain's National Health Service.

And get this: besides my symptoms, all they needed from me was my name, address, and (because I was a foreigner) my passport info.

I was then put in a wheelchair and rolled down a corridor to the ER, where I was evaluated by several nurses working as a team. Everyone wore the same blue hospital clothes.

Before long, my chest was partially shaved so they could attach sensor contacts to me. I was placed in a gurney and wheeled into a medical room, with my heart racing as fast as ever.

All this before 8:30 a.m.!

Two doctors, Danny and Helen, tried non-invasive methods to corral my pulse: blowing into a syringe, and then a neck massage.

These had no effect, so the decision was made to use a drug that Dr. Danny warned me had an unusual effect: people who take it, he said, "feel like they're doing to die."

What? They feel like they're dying? What does death feel like, exactly?

What he meant was that the drug, Adenosine, would temporarily stop my heart from beating (for the first time since 1964!), and then very soon after it would start again, ideally at a normal rate.

But that time between was what people described as death: with the heart shut down, the body instinctively goes into shock. The heart restarts before this gets too far, but it can be very scary.

"Can I have a lollipop?" I asked, laying there, still wondering if this was what Redd Foxx used to call 'The Big One' on the old Sanford & Son TV series. (Wow, everything in life is related to TV!)

Before I got an answer, 6 milligrams of Adenosine were released into me through an IV.

I waited for death...but death did not come.

The verdict: I was a bigger moose than they'd figured. Hence the next step: double the dose!

In went 12 milligrams of Adenosine, and then I felt it.

For me, death felt like a huge weight pressing on my chest, and then quickly morphed into the sensation that there was some kind of strong vacuum pulling at my chest from the inside, trying to collapse it.

I closed my eyes in response to this, and found I couldn't open them!

But before anything else happened, my heart resumed beating, and at a much lower pulse rate of 90. It would drop further as I returned to normal.

Laying there, I was overcome with a huge sense of relief that was physical and mental. The moment my heart resumed at a normal rate, everything felt right again, finally.

Also I was relieved that I'd have time to think of a better epitaph than "Your Dress Is Very Modern."

After making sure I was stable, the doctors wheeled me into a holding area, where I needed to stay until they got blood test results back from the lab.

The hospital had great wifi, so I updated the wife and wished them all a good time! I would try to catch up later if I could.

The actual Emergency Department within the hospital, which is named after the Queen Mother, a long-time patron.

So for the next six hours, I got to watch the ER of a busy London hospital in action. It wasn't that busy, actually, but still a lot was going on—a broken femur here, a fall with head injury there.

More than once I heard people being asked "Who is the Prime Minister?" or "Who is on the throne?"

At about noon, Dr. Danny and Dr. Helen came by with an update. My results were fine. But because I was going to be on a long flight the next day, they wanted to keep me for one more round of blood tests as a precaution.

Specifically, they wanted to see if levels of a certain type of enzyme were increasing, which would indicate damage to the heart muscle or possibly another cardiac malfunction in the making.

By 3 p.m., the second results were in: I was free to go. And that's when I got my biggest surprise.

After putting myself back together, I asked Dr. Helen what I needed to do next.

"You're discharged," she said. "You just go."

"Go where?"

"Out of the hospital," she said, realizing that I was one of those foreigners who may not understand how National Health works.

"Isn't there some kind of paperwork I have to fill out—disclosure forms or insurance info?"

"You have a discharge paper, which you should bring to your G.P. back home," she said. "Emergency care is provided free to everyone."

There's a phrase you don't hear in U.S healthcare. Free to everyone!

You mean, I just took up eight hours of time in the ER of a major London hospital, and the cost is...nothing?!

Even better—I found out later that if I had travel expenses, I could take receipts to the bursar's office for possible reimbursement. Wow. In Britain, they pay you to go to the hospital!

But what impressed me most was the sheer simplicity of the transaction. No paperwork. No forms. No codes or waivers or disclaimers or disclosures.

And no gigantic billing infrastructure that adds to costs without medically helping anyone.

Of course there are costs. Someone had to pay for the services I received. In this case, it was the British taxpayer.

It didn't seem proper to take photos inside the ER, but I did furtively snap this one shot of my "holding cell," which had a nice view of a canal filled with houseboats.

But that same taxpayer does not have to pay always-rising insurance premiums or cope with massive deductibles like we do.

Example: Last month I had an MRI done as a precaution. The total cost for this two-hour procedure was just under $10,000, of which I had to pay 20 percent.

Thinking about that bill would be enough to prompt a cardiac incident.

But in my case, what seems to have been the culprit in London was me unthinkingly downing five or six cups of coffee during the previous day, and then drinking beer and wine in the evening, topped off by more coffee.

By the time we got back to the hotel, it's no wonder my heart went into overdrive.

But I'm fine now. It's been three days and no sign of any relapse. I even had a cup of coffee today!

So all's well that ends well. Speaking of which, I do need to work on finding a better epitaph.

Visiting Vietnam: Home of weasel coffee

People ask me why I'm going to Vietnam this summer, and now I have a very specific answer: for the weasel coffee.

I had never heard of weasel coffee until I came across this reference in a travel book I was leafing through.

"Vietnamese coffee is unique, and comes in a wide selection of flavors, including vanilla, anise, and chocolate. There are three varieties of coffee -- Arabica, Robusta, and Weasel."

Weasel coffee? What could this mean? Read on...

"While Arabica is the most expensive and richest, Robusta is cheaper. Weasel is also expensive and is made from coffee cherries eaten and defecated by chon, Vietnam weasels."

Yes, coffee made from beans that have gone through a weasel's digestive track! Count me in!

Aw, isn't he cute?

As I understand it, the digestive process basically "pre-treats" the beans, partially fermenting them and removing bitterness and other off flavors. After the beans are excreted, they're collected, cleansed thoroughly (one would hope), and then roasted.

I checked this out, and what you start with (after the weasel part of the process) basically looks like a Baby Ruth bar with way too many nuts:

And yes, the resulting coffee beans are considered a great delicacy and command a high price as a luxury item (up to $500 per pound) in Vietnam and other places along the Pacific Rim. I'm not making this up. Check out this deluxe gift box set from Japan:

Weasel coffee has prompted some inspired copywriting. Consider this sample I found from an online seller:

"On the eastern edge of the Dak Lak province in central Vietnam, we found a coffee plantation that was willing to sell us a small amount 100% weasel coffee. These are domesticated weasels, that live in a large cages, like zoo animals, and are fed coffee along with other foods. The quality of the product is exquisitely rich, with a chocolate overtone and creamy mouth feel. The street price of this coffee in Hanoi is $800 USD per kilo. We sell in 100 gram packages and custom grind to your specification. One of my clients wrote recently and emphatically stated: 'this is absolutely the most delicious coffee I've ever tasted.' See if you agree!"

Eager for more? Check out http://www.weaselcoffees.com/.
This whole ghastly concept quickly joined my list of things that make traveling worthwhile. One can only shake one's head in wonder at what people get up to.

How could this even happen? Turns out there's a logical explanation that, alas, involves European imperialism.

Back in the 19th century, French colonists wouldn't let local people share in the harvests of Robusta coffee beans.

So the people resourcefully extracted the beans from weasel dung, setting the stage for one of the world's most unusual culinary experiences.

Some folks say the weasel's ability to select only the "best" beans worth eating is another factor in why the resulting coffee is so highly regarded.

Today, varieties of weasel coffee are also produced in Indonesia and the Philippines. But I'm sorry to report that the United States, despite its agricultural prowess, is not a player in this lucrative field. Geez, we can put a man on the moon, but...

Although "authentic" weasel coffee can cost $50 a cup, versions made with other ingredients that mimic the flavor are much more reasonable. That's what I expect I'll seek out in July, when we're marching around the streets of Hanoi and Ho Chi Minh City.

So who'll join me in a nice refreshing cup? And afterwards, we'll all join together in a chorus of "Poop Goes the Weasel!"

Click for heartwarming video.

Just call me KYLE: Thoughts on departing to climb Mount Kilimanjaro in Africa

"Vacation" is definitely the wrong word for this.

A better way of putting it might be: "Planned near-death experience."

How else to describe a journey that will take us far above treeline, into air with only half the amount of oxygen that we're used to, trudging across volcanic pumice and living for a week in tents but otherwise exposed to the elements?

By elements, I mean jungle rains followed by extreme cold (well below zero at night) and potentially stiff winds at all hours. And it all takes place under the intense equatorial sun, which gets more intense the higher we go (despite the cold) because there's less of the Earth's atmosphere to protect us.

Oh, joy! But this is what it takes to reach the summit of Mount Kilimanjaro, the highest point in all of Africa. And that's what I'm going to try to do, starting in a few days, with a group of 11 other intrepid adventurers.

Some I've known for years, other I'll meet for the first time at Amsterdam Airport. That's where we change planes on New Year's Day for our flight to Tanzania. Kilimanjaro lies just below the equator, and just south of Tanzania's border with Kenya.

Kilimanjaro rises about 15,000 feet above the surrounding plains, making it the tallest free-standing mountain in the world.

We'll be joined by a support group of no less than 45 others—a team that includes our guide, five assistant guides, three cooks, and several dozen porters to carry in (and out) everything needed for the expedition.

We start on Saturday, Jan. 3. For seven days, we'll trek about 35 miles along the slopes of this gigantic dormant volcano, through five different climate zones. We'll slowly gain height, giving our bodies a chance to get used to the high altitude.

And it all culminates on Saturday, Jan. 10, when we'll be wakened before midnight. We'll then don our headlamps for the final overnight push along a ridge and up to the summit. It's done in the wee hours because the scree is frozen in place at night, making footing much easier, I'm told.

And if all goes well, we'll reach the volcanic crater rim about sunrise, and the actual summit (at 19,344 feet) a bit later. After spending only minimal time at the top, with its very dangerous lack of oxygen, we then make a quick descent, going down about 7,000 feet before the end of that very long day.

The summit of Kilimanjaro. You can see how it's a dormant volcano. We're aiming for the ridge on the right, Uhuru Peak, the actual highest point.

That's one big honking "if," of course. Any number of things could keep some or all of us from getting there. But it's doable. So we're doing it, at least trying.

So apologies to Yoda, who famously pronounced "there is no try." But then Yoda never attempted Kilimanjaro, as far as I know.

Doing it, or even trying to do it, requires equipment, including a duffel bag of a certain size, which I didn't have.

So I went shopping, and found that the local L.L. Bean store had several racks of returned canvas duffel bags at a hefty discount off retail.

The reason for the discount: all the returned bags had been personalized with embroidered initials or names!

So I looked through them, and narrowed it down to a dark green bag labelled "KYLE" in block capitals and a blue one with "Annemarie" stitched in cursive.

I chose KYLE because of the color, although I have to admit I'd feel a little funny using a bag with "Annemarie" on it to climb Kilimanjaro.

So KYLE, I don't know who you are, but the bag you rejected is going on quite a trip in a few days.

In some ways, it's kind of like the Apollo moon voyages some years ago. We spend all this time and preparation and effort to reach a very inhospitable place, where we stay for only a very short time before high-tailing it out of there and back to safety.

One way it's not like a 1960s moon voyage, however, is that we will be out of communication for most of our journey. With the astronauts, as far away as they were, at least they could always tell Houston if they have a problem. (Except for brief periods when orbiting the far side of the moon.)

On Kilimanjaro, there may or may not be cell signals or what-not available. But I'm not bringing my cell phone and will be genuinely off the grid for more than a week.

There have been good omens. I went to a local credit union the other day to do some year-end banking for my mother, and the guy who sat down with me was from Zimbabwe, just south of Tanzania.

Also, I discovered a wonderful store, Travel & Nature Adventure Outfitters in Exeter, N.H. and was delighted to discover that proprietors Robert and Sue Garneau summitted Kilimanjaro on their honeymoon back in the 1980s!

Heck, even the guy that does my taxes climbed Kilimanjaro last summer. Everyone's doing it!

Most interesting of all, earlier this month I learned that the conductor of the New Hampshire Philharmonic, Mark Latham, is the grandson of the first Englishman to summit Kilimanjaro, which happened back in 1926.

Mark was gracious enough to have dinner with me and two other Granite Staters on our expedition, Dave and Patsy Beffa-Negrini.

He brought along his grandfather's vintage photo album from the actual expedition, which included photos of the guy hoisting aloft a frozen leopard he'd found at high altitude.

This discovery, widely reported and remarked upon at the time, became a symbol that inspired Ernest Hemingway to write 'The Snows of Kilimanjaro,' a mountain he never actually visited or climbed himself. Just like Yoda.

But that didn't stop him from constructing a novel using the mountain and the leopard as highly potent symbols for...well, here's a brief description from no less an authority than "Cliff's Notes":

"During his otherworldly flight over Kilimanjaro, Harry sees the legendary leopard. The dead, preserved leopard can be seen as a symbol of immortality, a reward for taking the difficult road. Harry himself was a "leopard" at certain times in his life, as were some of his acquaintances in his own stories. Specifically, Harry can be seen as a leopard during...

• His youth, when he lived in a poor neighborhood of Paris as a writer

• In the war, when he gave his last morphine pills for himself to the horribly suffering Williamson

• On his deathbed, when he mentally composes flashbacks and uses his intention to write

• When he stays loyal to his wife and does not confess to her that he never really loved her

Some mystic impulse within Harry and within the leopard drove them to seek out God, or the god within themselves, or immortality that resided far from ugly, mundane reality.

In most civilizations, God or God's promise of immortality resides on the highest mountain top: Mount Olympus for the Greeks, Mount Sinai for the Hebrews, Mount Fuji for the Japanese. If the leopard was searching for some sort of immortality, then it found immortality at the summit of Kilimanjaro, where it lies frozen — preserved for all eternity.

When Harry looks at Kilimanjaro, he sees it as a symbol of truth, idealism, and purity. When he dies, tragic irony exists. The leopard died in a high, clean, well-lighted place; Harry, in contrast, dies rotting and stinking on the plains, lamenting his wasted life and his failure to complete his desired projects.

I'm not reading Hemingway's book, or doing any other kind of advance mental preparation for this adventure, other than to try to clear my mind of all expectations. I'd like to remain as open as possible to what I discover on my own.

I know I'm looking forward to the night sky on Kilimanjaro. Because of the high altitude and the lack of human-produced light pollution, I'm told it's unlike anything visible where I live in North America.

I'm looking forward to looking down on the clouds, if that happens. I'm told it's very similar to what you see outside the window of a plane, only without the plane.

But most of all, I think I'm looking forward to the experience, and seeing if I really can do this. I'll figure out what it means later on.

Heck, I might even change my name to KYLE.

Bringing order to the whole

Every day is a word.
Every week is a sentence.
Every month is a paragraph.
Every year is an chapter.
Every life is a novel.

What are you writing?

Regional flavor revisited

Something surprising in a news story about a restaurant opening in Manchester, N.H. To quote the proprietor: "The menu will be very similar to what is offered now in Merrimack and Milford. Cheung described it as “traditional New England Chinese,” with a few twists, including a Japanese-style sushi bar."

Traditional New England Chinese. Talk about fusion cuisine!

Boy, do I like this...

“The important thing is that there should be a space of time, say four hours a day at the least, when a professional writer doesn’t do anything but write. He doesn’t have to write, and if he doesn’t feel like it, he shouldn’t try. But he is not to do any other thing, not read, write letters, glance at magazines. Two very simple rules, a: you don’t have to write. b: you can’t do anything else. The rest comes of itself.”

—Raymond Chandler

Forgetting about the calendar

The whole year, spread out for you on one page.

If you didn't know what date it was, would that influence what you did or how you felt as you went about living today?

Say you didn't know the name of the month, or the day of the week. Or that you had no way to relate this day—today—to any in the past or any in the future. It's just today.

I suspect you'd feel more buoyant and more free because of it, and that life would seem to have more possibilities. I think you'd feel more optimistic.

Just as one feels lighter and more buoyant after a house gets decluttered, a person might benefit from forgetting the constant framework of passing time that surrounds us: hours, days, months. The subconscious "calendar" function in our brain would be deactivated, dissolving a set of limitations that perhaps hem us in and hold in check our emotions, our imaginations, and maybe much more. Who knows?

Alas, this act of forgetting is not easy to do, with time or with anything else.

My own personal experience in the difficulty of forgetting involves something that happened to me with music.

Consider: Beethoven wrote his 'Pastoral' Symphony No. 6 to depict specific scenes in nature: a babbling brook, bird calls, a storm, and so on. The piece is loaded with musical "tone-painting," and has long been accepted as a masterful example.

Okay, now to Leonard Bernstein. In his book 'The Joy of Music,' Bernstein wrote about the difficultly of listening Beethoven's Symphony No. 6 just as music, with the "Pastoral" removed. Could it even be done? Once you knew Beethoven's 'nature' angle, could you ever not know that, and just hear the music as music?

Bernstein believed it could—that a trained musician could indeed "forget" Beethoven's nature program and just regard the symphony as "absolute" and abstract music, just like its much more iconic predecessor, the Symphony No. 5, which is full of drama and beauty but tells no specific story and paints no specific scenes.

Beethoven, in a relatively good mood. Possibly having a bad ear wax day?

Why bother? Because, Bernstein wrote, it allows one (either a musician or a listener) to experience a familiar piece of music—a warhorse, really—in a totally fresh and new way. And that can have immense value in keeping a masterwork compelling across the generations, rather than have it sink beneath the weight of familiarity and accepted notions. If you can forget the program, what was once a warhorse is remade entirely. It can be heard fresh!

The notes haven't changed. Just your attitude has—because you've forgotten something about it.

I know this is true because it actually happened to me with this very piece of music. As a teenager who was into classical music (yes, it was a rough adolescence), I remember tuning into a Boston Symphony Orchesta radio broadcast from Tanglewood one summer. The concert had started and I didn't know what piece was being played, but it held my attention immediately. I was transfixed: it sounded familiar, like something out of the standard classical "Haydn-Mozart-Beethoven" era, but was also altogether different.

It was slow, and didn't seem to have a melody. Instead, it was more of a texture. The music ambled along, filled with graceful clarinet arpeggios and trilling woodwinds and not seeming to have any forward motion, but with one remarkable passage following another.

The music ended, and I was going crazy. What was it? When the next movement began, I recognized the piece right away. I had played the "second half" of Beethoven's 'Pastoral' many times (for the exciting storm sequence), but had never paid attention to what I thought would be the "boring" slow movement. Now I had just heard it, and with no idea what it was, and I thought it was great!

In this case, I hadn't forgotten anything. Instead, I just hadn't yet learned. But still, I was able to experience for real what Bernstein was talking about: the power of forgetting.

Which takes us back to the question of the calendar. How much of what we see and experience and feel about today is linked to our all-to-human awareness of it being Sunday, Feb. 3, 2013? A specific day with a specific number, related as such to all days before and all days to come. A framework that was in place before we were born and will live on after we're gone. Kinda smothering, in a way.

Does this knowledge in limit us? If we could somehow forget the day, the month, the year, would that allow us to be more fully in the moment right now? Would being able to disconnect from the calendar be like a housecleaning or decluttering of sorts, and result in us feeling more buoyant and light and full of possibility?

I think there's something there. And anyway, if the act of 'forgetting' is good for our soul, then I'm way ahead of a lot of folks just with what keeps happening with my car keys.