Editor's note - this entry is not for the faint of heart. In fact, it's pretty gross. However, as a true journalist, I'm putting it all out there, for you, the reader. Just beware.
Montezuma's revenge. The bane of a traveler's journey and something unavoidable if on the road for long enough. It's not fun, it's not pretty, but it's reality. And sometimes reality really sucks.
Just to put out the tough-guy disclaimer - I don't get sick. I can't remember the last time I went to the doctor. I had eye surgery in September of last year, and was prescribed antibiotics to prevent infection. I had to ask how to get the prescription filled. I honestly couldn't remember having to do it on my own. However, the world is a Petri dish. Subways, buses, restaurants, dorm beds, bathroom door handles... When you travel for this long and in this many different places, you expose your body to things it has never seen.
Re-tracing my steps, I think it all started my last day in Cairo. For lack of better options and a strong bout of laziness, I ended up eating a pizza in the restaurant of our two-star hotel. To be specific it was a pepperoni pizza which, as I recall, elicited a strange look from the waiter, took a quite a while to come out of the kitchen and tasted a little weird. I didn't think much of it - I've eaten much stranger things on this trip - until I was at the "Café de Paris", a little internet café in the bottom floor of a shopping galleria about five blocks away.
Just as I was finishing up a posting to the site, I was struck with one of the most violent bowel movements I've ever experienced. Equal parts pain, discomfort and eventually panic set in. It was one of those five-alarm, "must go right now or hell will be unleashed" feelings.
Unfortunately, Cairo isn't set up exactly the same way as the US. The café didn't have a bathroom, and as I found out through a painfully long conversation, the only one available in the entire building was on the first floor. I'm not sure what the record for ascension of stairs in that building was, but I hold it now. True to form, you had to pay to use the bathroom - a 25 piester charge, which I paid with a full Egyptian pound note, obviously not bothering for change. I ran into the first available stall, with little thought to my surroundings or neighbors.
As you might expect, the toilet was pretty gross and sans toilet paper. Fortunately, I always carry a stash of my own everywhere I go (possibly the best advice I could give any traveler at any time). It ranks up there with my wallet in terms of importance. Anyway, after a quick wipe-down of the seat, what followed shouldn't be described. It was something lacking in style or grace, and to which the only analogy I could refer to would be Harry's experience on the toilet after being given a copious dose of super-laxatives by Lloyd in "Dumb and Dumber". I'll leave it at that.
Anyway, the consistency of my digestion was sporadic at best over the next few days. As you'll recall, at this point my travels went through Sinai in Egypt and on to Aqaba, Wadi Rum and Amman in Jordan. I recognized the triggers, and tried to stay away from strange food as best I could. I was fine for a while, then not. Back and forth. Anything more exciting than a croissant turned out to be a gamble.
Fortunately, I wasn't completely ill-prepared for such an occurrence. I'd read about this "unmentionable" trouble in my guide book, and a good friend of mine who traveled in northern Africa for a while in the Peace Corps gave me some anti-diarrhea medication as a going away present. Certainly strange at the time - a box of Imodium AD sitting in a basket next to cards of well wishes on a table in a Kansas City bar, but an absolute God-send in the middle of Jordan.
Back to the story - I'm now in the middle of Jerusalem, and have reduced my dietary intake to bread and water. I was still feeling the effects, and reluctantly starting to come to the realization that I might have an actual problem. Yes, I'm a typical stubborn male. It takes quite a lot for me to realize something may be semi-serious. I was now pretty sure it wasn't just a bit of bad food, but that I actually had some sort of bug in my intestines. Again using my rudimentary medical skills (i.e. reading my guide book), I realized this could likely be solved by the application of a fairly simple antibiotic.
Before I left, I requested and was given a supply of Ciproflaxen to serve as a cure-all in case of such a situation. And, indeed it would have come in very handy right now. Unfortunately, however, I already used this supply of drugs back in Cape Town, when I was suffering from a sinus infection. Ordinarily I wouldn't have even thought about using the antibiotics. I've had many a sinus infection that my body has fought off. However, this one had moved into my ear. At one point, after about two weeks of misery I actually lost about 80% of the hearing in my right ear, which was semi-disturbing. I figured at that point I should probably start the antibiotics. They worked, but I was really wishing I had them now.
I wasn't ready to give in yet. Still determined to let my body fight it out, on Monday I doped myself up with about 3 tablets of Imodium for a trip down to Bethlehem. I didn't really want to get stuck on a bus or a cab or in a border line somewhere when nature started calling/yelling at the top of its lungs. Fortunately, all went well, and serious incidents were avoided - something I was glad of, especially when visiting the birthplace of our Lord and Savior.
The next day, I was actually feeling a little better, and I decided to give real food another shot. I opted for a little cheese pizza and a coke from Sbarro (yes, they have them in Jerusalem). Seemed fairly benign. Turns out it's not. About 45 minutes later, as I was enjoying some free internet access from a quaint little café, the all too familiar inner-rumbling started. One of the greatest gifts this trip has provided is a sense of self awareness. I know more about myself and my own body than I would have ever known before. At this moment, I knew I had approximately 12.3 to 14.5 minutes before a full scale melt-down.
Those of you who have traveled a bit can testify: Thank God for McDonalds. Say what you want about Roy Koch and his chain, but when away from home the golden arches are a little slice of heaven on earth. While admittedly I rarely eat there in the US, overseas the red and gold have become the international sign of good safe food, and (more importantly at this moment), relatively clean bathrooms.
I found the nearest one (having thought about its proximity before settling down at the café), and afforded myself the use of their porcelain. After finishing this crude and increasingly disturbing business, I'd reached the end of my rope. I simply couldn't go on like this, and after a week and a half, it wasn't getting any better. I knew I would probably have to see a doctor, which brought about all kinds of worries: Where would I find a doctor? Would the doctor speak English? Would I even be admitted? How much would it cost? How much would a prescription cost?
I walked out of McDonalds to the nearest pharmacy, and waited in line to talk to the pharmacist. Having a conversation with anyone about traveler's diarrhea isn't fun. It's even worse when the she's relatively young, and moderately cute. I took a flyer and tried to have them re-fill my prescription, empty bottle in hand, pleading look on my face. Perhaps I'd find a little leniency in a foreign country? Ummm, no. Knowing my next step, I reluctantly asked if there was a clinic around. She mentioned one about a block away in "the bell tower". Ok. It was only 3:30, so I darted out the door in search of a cure.
The 4th floor of the "Bell Tower" shopping center is home to a variety of medical facilities, including a dermatologist, a podiatrist and a general family doctor. I checked in with the receptionist, hoping she spoke a little English, and that I wouldn't have to re-tell my story.
Me: "Umm Hi. I don't have an appointment, but I was hoping to see a doctor."
Receptionist: "The skin doctor?"
Me (internally): "No, why? Is there something wrong with my skin?"
Me (reality): "No, just the family doctor."
Receptionist: "Ok, do you have insurance?"
Me (internally): "Oh shit! That's right. Insurance. Damn details. Yeah, I don't really have that."
Me (reality): "Well, no. See, I'm on a year-long trip around the world, and I only have traveler's insurance."
Receptionist: "Ok. Just have a seat and we'll call you."
Me (internally): "Thank the good Lord in heaven. Oh, and what is this going to cost me?"
Me (reality): "Thank you."
Surprisingly, after only about 30 minutes of waiting (strategically near the lobby's bathroom in case of an encore), I was called up. It turns out doctor's offices in Israel are a bit different than ours. The receptionist told me to go to room number seven. I plodded down the white-walled hallway, which was lined with doors. They all wore numbers in their centers, and most had traditional Jewish-sounding names engraved on plastic nameplates next to them. I stopped at number seven, the name card reading Youff Sinai, M.D. I knocked on the closed door, and gently opened it.
A 60-something older gentleman with a plaid button up shirt, olive skin, and a balding head sat behind a large desk made of dark-stained wood. He had a pleasant face, with old eyes and a large nose, below which sat a bushy white mustache. He stood and greeted me with a handshake. The conversation which then took place was as follows:
Dr.: "So, what seems to be the issue?"
Me: "Well, I've been traveling for about 6 months, and have been remarkably healthy until now. I seem to have developed a case of traveler's diarrhea, and can't seem to shake it. I think it would be cured by a dose of common antibiotics, but I've run out. I tried to have it re-filled, but was obviously unsuccessful..."
Dr.: "So do you want me to write you a prescription, or do you want me to examine you to find out what the problem is, then recommend what you should do?"
Me (internally): "Option A sounds pretty good. Would you do that?"
Me (reality): "Well, I suppose we should be sure what's going on."
Dr.: (smiling) "Yes, I agree."
He then asked me to sit on the exam table, which was right there in his office, along with all the other stuff you'd find in any exam room in the states. He asked a lot of questions about food, travel and symptoms while giving me a cursory examination and smiled when he put the stethoscope over my abdomen. "Yes... You're not done..." he said. Right.
Five minutes later he sat down to write out a prescription - which turned out be exactly the same medication I already had used up, making option A the best course of action, and apparently making me a near medical professional. We then got down to the business side of things.
Dr.: "So you don't have insurance, correct?"
Me (internally): "Good lord this is going to cost me."
Me (reality): "Correct. I have traveler's insurance though. So how does this work?"
Dr.: "You will pay me 300 sheckles for the examination, and I will give you the prescription, along with a letter to the insurance company explaining the examination and the course of action. You can then submit the letter for reimbursement."
Me (internally): semi-joyous - 300 sheckles? That's only like $70. I was expecting you to really stick it to me! I had prepared myself for a $300 dollar "non-resident charge." Anything under $250 USD would have been a pleasant surprise. $70 is damned amazing."
Me (reality): "Ok, sounds good. Do you accept credit cards?"
Dr.: (shaking his head): "No. Cash please."
Me (internally): What? No cards? That's kind of weird. Oh well."
Me (reality): "Ok. I don't have 300 on me though. I'll have to go get some cash and come back. Will the receptionist take...?"
Dr.: (smiling): No, you will pay me directly in cash please.
Me (Internally): Right. This seems... Pay the doc in cash? No receipt?
Me (reality): Ok, I'll be right back. Thanks.
At this point, he took the prescription and folded it up on his desk. I walked out, still trying to get over the weird feeling of paying a healthcare professional in cash. Just seemed weird. Like a drug deal or something.
I took the escalators downstairs, withdrew my money and went back up to the office. I stopped by the receptionist first:
Me: "Yeah, I need to pay the doctor. Can I go in?"
Receptionist: "He's with a patient right now..."
Me: "Ok, I can wait. Will you call me up?"
Receptionist: "No, just go back and wait by the door. When the patient leaves, just sneak in."
Me: "Umm... Ok."
So I did. I went back through the hallway and waited until Dr. Sinai's office door opened. A large man dressed all in black passed through, and I snuck in. I gave the doctor his 300 sheckles, and he gave me the prescription and a hand written letter for my insurance company addressed to: "Whom it may concern,"
All's well that ends well, I guess. A week later, I was cured, and my eating habits were returned to normal. As normal as they get anyway.
Nice doin' business with you doc.