There are a few things I’m going to talk about related to seeing my grandma in the hospital, but I’m going to start with advanced directives because, well, that was the last entry I wrote.

Grandma Barbara has a Do Not Resuscitate order (no CPR, no intubation, no nothing). This makes sense because she lives in an assisted living facility, and it’s quite likely she could have an event and not be found for hours, and she doesn’t want people to try to resuscitate her after hours of brain damage have already occurred. She also has a no antibiotics order on her DNR, which sort of makes sense, because assuming the picture Grandma had in her head of how she is going to die, antibiotics would only be used to prolong her life, not to make her better.

Well, then Grandma needed surgery. It’s common, at least at the UWMC (which is not where my grandmother is, and if it were, she would be getting much better care, I think), for doctors to suspend DNR during surgery.* But that suspension normally ends when the patient is 24 hours(ish) out of surgery. Well, my grandma wasn’t recovering all that well, so she and my aunt, who is her durable power of attorney for health, agreed to continue to suspend the DNR. Also, I’m not sure why, but it took the docs 2 full days to start treating her post-surgical pneumonia and urinary tract infections with antibiotics. I think, though, that the delay might have been because her DNR said no antibiotics, and there was a period of time when although the family thought the DNR was still suspended, the doctors might have thought it was reinstated.

So, there are two problems with this whole scenario. One is writing advanced directives that only account for the most likely way you’re going to die. Don’t assume you’re going to fall over from a massive heart attack. What if you get hit by a car? What if you get pneumonia, or sepsis from a massive infection that’s potentially deadly, but equally potentially treatable? The other problem is not having a living will in place as well.

In my opinion, the place for requests like “no antibiotics” is the living will. The DNR needs to be a black and white document so people immediately know whether to start CPR, intubation, and ventilation or not. The living will is the place for gray areas and if . . . thens. It’s there that you can say under which circumstances you do and do not want antibiotics, or any other care. Also, having a DNR does not negate the need for a living will: there are many circumstances under which you may be unable to make your own decisions, but you don’t need resuscitation. And, if you’re going into surgery, you should review all of your advanced directive and make sure they are relevant to the most likely things to go wrong during the surgery.

Also, remember that your living will and DNR are meant to take care of you. If you are even halfway with it, you can revoke either or both at any time. You can also insist they be followed. You just want to make sure they tell the medical staff to do what you think they tell the medical staff to do.

I don’t mean to blame confusing advanced directives for shoddy care, though. Any medical staff worth their salt would check that the decisions they make based on the advanced directives with the patient and/or family to make sure that’s what the desired outcome was. Advanced directives don’t allow the medical staff to abdicate responsibility.

*This is not doctorly arrogance. There are many ways a person can try really hard to die in surgery, and very few of them have anything to do with how ready their body is to fail outside of surgery.

The first part is figuring out what you want. If your heart stops, do you want someone to attempt CPR? To shock you, and give you drugs to get your heart going again? If you are in a coma, do you want to be on a ventilator? Do you want to receive tube feedings? Hydration? Is there any point at which you’d like the life support to be stopped? Is there no point at which the you’d like life support to stop?

The second part is filling out the paperwork and getting it notarized. This makes it all official. For Washington state, the standard paperwork, which can be modified, is here. You can register your documents so doctors can retrieve them online here.

The third part is to talk to your relatives. They need to know what you want, they need to be able to ask questions and to get comfortable with the idea. The codicil to this is, if you have any relatives for whom you may be responsible later, this is a good time to ask them what they want.

These three steps are all equally important. For obvious reasons, you need to know what you want. The second part is important because it gives medical staff a jumping off point. But more importantly, it gives your family something to fall back on. I talked to a patient once who had two family members die. Both of them needed to have life support stopped. Both of them had talked with their families about what they wanted. For both of them, having the life support pulled was the sort of thing they said they wanted. But only one of them had a living will. My patient said even though they knew it was the right and wanted thing to do, not having those desires in writing meant they felt tormented and guilty about making the decision to end life support. When they did have it in writing, it changed everything.

I know for my family, with my grandma, having everything in writing helped a lot. Without the living will, I think we would have had an incredibly difficult time following her wishes, even as it became more and more obvious that she was never coming back. The living will gave us comfort that we were doing what she wanted, however hard it was to withdraw life support. Putting it in writing respects and supports the people who will need to carry out your wishes.

Talking to your family is just as important because if your family doesn’t agree, chances are quite good that your wishes will not be honored. This is true even if you have it in writing. Hospitals have been sued for trying to follow a living will against a family’s wishes, and generally the hospitals have lost—so they usually defer to the families.

Talking to your family also gives them a chance to decide if these are the sorts of decisions for which they are comfortable taking responsibility. If they agree with your living will, but think they’ll chicken out following it, or if they disagree with your living will and refuse to honor it, it’s time for a durable power of attorney for health care, which allows someone else to make these decisions. Again, it also opens up the conversation with the people you care about, without having a subtext of, “You’re old and are going to die soon.”

Ok, so are you convinced yet? Remember, you could be hit by a bus tomorrow, and neither be fine nor die. So get hopping, and sort out your living will.

I should clarify. My grandma wasn’t really sick. She had surgery two and a half years ago, and since then had become old. She choked, though, a couple weeks ago. Choked and my mom was there and she called 911 and my grandpa did the Heimlich, and then CPR, and then let the paramedics put a tube down my grandma’s throat.

For all intents and purposes, Grandma died that day, but we still had a week in the hospital–a week where sometimes she seemed to get better but mostly she didn’t improve and then got worse. This culminated in a visit with a neurologist and a test that looked so uncomfortable that we all cried. Except my grandma. We cried because she did not respond, her head lolled, she still did not resist the tube down her throat. I continued to watch what seemed to be nearly torture because it seemed only fair. If it was remotely possible any of her was aware of the indignities of what was happening, well, I could at least watch. That seemed the least I could do.

I don’t want to make it seem like the doctor was a torturer. He talked to her like she was there, carefully at first, a little more rotely as he became convinced she wasn’t. He explained things. “I’m sorry, Nancy,” he said, “This is going to hurt.”

In the middle of all of this, certain things happened that I knew would happen, even though I’ve never been in this position before–night long shifts at the hospital, day long shifts, watching, waiting, my entire body torn in half: should I hope, should I accept the outcome I expect from 83 years old, ventilated. These things, these rituals, were anchors to real life, a marking of our family’s place in the community, to hold our place and remind us where it is until we can occupy it again.

It starts with the visits, and the visits are accompanied by food. Sometimes we feed some visitors with the food from other visitors. You can tell who the adopted family is: they come too often and so only bring food the first time. They don’t need excuses for their presence, and their value to us is not only in helping us get through one more day.

The cards come, and the flowers, although since Grandma was in the ICU, that part was a little questionable; the absence of that part of the ritual seemed to derail some people–without sending flowers it was unclear what the next ritual should be.

The calls started with us. Mom and Grandpa and I called college friends, old friends, neighbors, cousins of cousins. I cried. They thanked me for calling, told me they were honored to be on Grandpa’s list of mandatory calls. It was a welcome distraction. Ritual binding us, giving us direction again.

The calls continued. One of my grandmother’s oldest friends called every morning until the day after she died, telling stories. There was a lot of telling stories. Some of the stories we told back to my grandmother, when we talked to her. Another thing that became ritual, especially as it became more and more clear she’d never answer us back.

We created our own rituals for her death: blessing her, telling her it was okay for her to leave us, tears streaming down our faces, telling her we’d be okay, we’d take care of each other. It was okay. She could leave.

We did the burial, rituals guiding us so we don’t have to think too much about what needs to be done. We sprinkled those with rituals from our family, from other good-byes.

Now we’re waiting for the memorial, more ritualized leave-taking, more stories, more everything.

And then the rituals that tell us how to thank people for their support. Thank you notes and dishes returned with cookies.

When the ritual ends, we are left, untethered in our grieving. But we hope the ritual will have brought us in to a place where we can navigate ourselves home.

At the time, I got what she said, but didn’t really agree with her vehemence. I feel differently now. It’s different, being a returned Peace Corps Volunteer, than being a Peace Corps Volunteer. It’s different and the fact that my Peace Corps experiences continue to influence the rest of my life don’t make it the same. It’s connected, sure, but every bit of our lives is connected. You can’t be who you are without having been where you’ve been. And yet the past is still past, and trying to hold on to it too tightly just stagnates the present.

When I made this blog, I was looking at the future, and it’s time to do that again.

It may look the same to my friends back home, my indecisiveness. But I can explain the difference. Before Peace Corps, if I would fail to make a decision and someone stepped in to do what I had failed to do, I would suddenly have a strong opinion. Whether that was because I didn’t feel like I could say what I wanted or because I was that out of tune with what I wanted, I can’t say. Most likely it was a mixture of both. But now, when I say I don’t care, it means I don’t care. If I say I don’t know what I want, I don’t know. I can roll a die, someone else can make the choice, or whatever I used to do to be slightly less annoying in making choices, but it doesn’t change anything because I really don’t care or don’t know. I really am just waiting for a good option to present itself. And if the option I like the best isn’t available, that’s okay, because I’ll just do something else.

I can only justify caring about things I’m willing to work for. And I can’t be bothered to work for things I don’t care about.
I’m also more confidant, although that’s in a weird way I’m not aware of. I still think of myself as being pretty shy, and in large crowds, I still feel overwhelmed and out of my depth. But, if I go to a party and I know one person, I call it good: I know I can meet other people, and if I get too shy I can return to my friend like a toddler checking in with a parent. I’ll start random conversations with people around me sometimes. I’ll continue random conversations other people start more often than that.

I was at a Yakima Valley Community College game with my grandpa for his birthday, and when we all got together again that night, my uncle commented on my fearlessness: an old umpire friend of grandpa’s was cracking jokes and telling stories with the other ex-coaches, and I kept asking for details and cracking jokes myself. I mean, come on, if you heard a story about a ball thrown to an ump asking him if he needed help because of all his bad calls, and you knew he wrote something on the ball and threw it back, wouldn’t you want to know what it said, too? Yeah, well, apparently my ears are too delicate for that information, so I razzed him a bit about not telling me.

When my uncle told my mom (admiringly? horrified?) about how I just got into the conversation, I at first thought he was crazy. Of course I did, I wanted to know what happened. But upon further reflection, I realized that before I would have wondered, perhaps made up a story to satisfy my curiosity, perhaps nudged my grandpa into asking for me. But just jump in like there’s nothing to fear in starting a conversation with random people? No frakking way.

Also, I am now very passionate about when people talk about “African culture” or “African language” or “African people.” If you’re not very clear about where the generalities of those phrases fail (which is to say, practically everywhere) don’t use them. Sure, Malawian culture has things in common with that of several other African countries. But it has more things different. And to pretend that Africa is somehow one people bound by more than their presence on the same landmass is to force yourself to completely misunderstand the entire continent.

I’m sure there are other things. The lines aren’t as delineated as I thought they would be. This whole process of returning home and returning to American culture hasn’t been what I thought it would be. I didn’t have culture shock. I sort of had a slow culture miasma. I’m still sort of having a slow culture miasma. Sometimes I think this is how it will always be. Sometimes I’m sad that it isn’t.

One lady told us not to sit where we were, because it was dangerous, but the stairs around the corner were safe. The most objectionable people we saw, were two guys pissing in the street, which I’ve seen in nearly every country I’ve ever been in, but usually people are a little less obvious about it. That’s not so bad.

One man, whose name I’ve forgotten, had the day off because of Eid, and attached himself to us so he could practice his English. He was very clear he didn’t want anything, so maybe it was really just English he was after. When we told this to Nebil later, he didn’t believe it: he said the guy was hoping he’d meet us again, and then he’s hit us up for money or whatever. Then again, Nebil was pretty down on people from Addis. And people from Axum. And anywhere else north of Harar, I think.

Sometimes the only way to free oneself from someone who has glommed on is to go somewhere they can’t go. So, after we found that the Dashen (the only type of ATM that works with foreign cards) ATM we were trying didn’t work, we decided to go to the Ethnographic Museum. In a taxi. But, after the taxi driver tried to drop us at the National Museum instead, We finally stopped at the Ethnographic Museum, and the driver tried to tell us that we had asked to go to the National Museum, I was very firm and a bit annoyed,** told him he was wrong. When we got out of the car, Mom said that I was too quick to anger or get rude or something like that. My reply was that, when people make noises like that they’re usually going to try to raise the price next, and the only way not to get into an argument is to make sure they know, from the start, that this argument is going nowhere. Mom thought I should’ve waited til I knew for certain he was going to hassle us. I don’t know which of us is right, I suspect I am, but if he was just commenting, I made all three of our days a little worse for no reason.

The museums were closed, because of Eid. Oops.

So, we went to the Ethiopian Air offices instead, which were not closed because of Eid. The people working there were very nice. We’d sit in the chairs, chat for a bit, go ask a question, discuss some more, go ask another question, etc., ad nauseum. Only, it didn’t seem to ad nauseum. Eventually, after reworking the itinerary a couple times due to full flights, we booked tickets for each of us. 5 flights, and because we had flown in on Ethiopian Air and still had our tickets, all 10 flights together (mom’s and mine) cost us $426. Each flight has a different discount percentage for people who fly into the country on Ethiopian Air, but one of ours was a 60% discount. The guy at Ethiopian Air even figured out which near by Dashen ATM would work with our cards and gave us good instructions to find it.

I’ve heard that riding in the buses is difficult because people don’t want to let evil spirits in, so you can’t open the windows, and because many people on the buses haven’t been on one before or don’t ride them often enough, so they get car sick. Also, one of our flights took 2 hours, but by bus it takes 3 days. So, yeah, I didn’t want that.

We celebrated by finding Veronica’s Cafe and getting a club sandwich, which was not exactly what I was expecting, what with the hot peppers and all, but it was excellent. Seriously.

We also had another fruit salad from the 7th floor bar at Semien—they put something on it, I think rose syrup, that makes it incredible. And then we relaxed into our overly squishy and sinkable beds.

*also, we’re both directionally challenged.
**Not the least because a)I didn’t think we had gotten a good price anyway, and b) the museums are very near each other, anyway.

The stuff I won’t miss though, is not what I think of first or last. What I think about the most is the things I will miss. I keep remembering that although I will take lots of pictures when my mom comes, I don’t have enough of other seasons. That I may never see a woman cracking sugar cane over her knee again. That I won’t have impossibly sweet and creamy avocados melt on my tongue. That chickens won’t wake me at 4:30am. That I’ll have to go out in search of places with little enough light pollution that the sky can be black black and freckled with abundant stars, or where I can walk home by the light of the full moon without even a torch, playing with the reflected shadows. That people won’t walk by my windows, speaking the now familiar sounds and rhythms of Chichewa, laughing, and singing. That I won’t hear the shh shh of dirt-sweeping in the mornings, or the call to prayer of the muezzin. That I won’t be able to listen to the music of a wedding celebration throughout the day, then the drums beating the wee hours of the morning, then the PA system crackling in the morning with more Lucius Banda and Bujo Mojo. That I won’t watch the earth change from sere red-brown and cracked to abundant with green. That I will inevitably lose contact with most of my Malawian friends, who have been my rocks in the last two years.

While I am absolutely ready to move on to whatever’s next in my life, I am also greatly saddened that this new phase requires leaving the last one behind.

When I went to Kory´s site in Liwonde, we started talking about Peace Corps, other volunteers, and Malawi. She apologized later for talking my ear off but I told her sincerely that one of the things I have become acutely aware of is that I won´t have anyone once I get home with whom to talk about the last two years of my life.

Sure, I can Facebook my PC Malawi friends and maybe even call some of them occasionally. But there´s no easy outlet for those random, “Hey, remember that one time, with the thing, back when we had transit houses?” thoughts. 

Thank goodness my mom is coming: she´ll at least have some frame of reference We´re doing semi-bwana traveling, though. She won´t know what it´s like waiting for a minibus to fill when you know you´ve got to get somewhere in ever decreasing time. She wion´t know what it´s like worrying about how ridiculous you look clambering up into a lorry (and then realizing you should´ve been worried about injuring yourself instead of about something silly like how you look).

She won´t (I hope) have any funny stories about trying and failing to aim in a chimbudzi.

Or understand the frustration of having the power go out every day just as you start to cook dinner.  She won´t get the should I/shouldn´t I light the mbaula dilemma.

She may or may not see goats in various stages of being slaughtered, but she won´t have time to get inured to it and then be surprised and disturbed by it all over again.

She may find the turns of speech and the signs amusing, but it won´t be with the affection many of us have who´ve been here a while: I laugh when Musi says stuff like “She wasn´t all that dead. Then she wasn´t all that alive” because I love how Musi- and Malawi-like the phrase is, not because I think it´s worthy of making fun.

If my mom had come during my service, we probably would´ve stayed in Malawi and I would´ve had a house and the chance to show mom what my daily life is like. Not that any of it is anyone´s fault;I understand why no one was able to visit me during my service. It just means that those bridges, between my old life, my current life, and my future life have not been built. Without the bridges it´s hard to reconcile each of those stages with the others.

But there’s also the reaction of people back home. People are “proud” of us (something that seems strange when the proud people have only the most tenuous connection). They’re “impressed” or, even worse (to me), “awed”. They say they couldn’t do what we’re doing–as if doing Peace Corps requires some specific, intrinsically morally superior gene rather than just a desire born out of any number of good or bad reasons.

Over time, we get used to this. What once might have been uncomfortable (I, for one, don’t know how to deal with compliments period, much less compliments I’m unsure are justified) becomes uncomfortable and comfortable at the same time. We get used to everything we do being automatically important and interesting. We get used to being impressive and awesome (although definitely in a non-scary way) without actually having to do anything to earn the accolades.* We get used to being worthy of attention. We get used to being able to be “exotic” and interesting when we want to be, but still being able to be “normal” when that seems better. Our specialness becomes a fancy coat** we can throw on when the occasion calls for it, and leave in the closet when it doesn’t. But we always know it’s there.

And then service ends. And we can talk about that awesomest piece in our wardrobes–the piece we used to have, that pulled everything together and always made us look perfect. We can even show pictures of how perfect we looked in the coat, and bore people with our insistence on talking about that coat “I had that one time.” But everyone has their own version of the coat that was perfect, and having had one once is nowhere near the same level of cool as parading around the actual coat, looking perfect. It’s barely worth a mention.

I think some of us who come back to our countries of service aren’t doing so out of love of the country (although we may also love the country) or a desire to be in the country. I think sometimes we’re just searching for that perfect coat, the one that makes everything we do impressive and everything we are important, just because we’re wearing it.

*Don’t get me wrong, many of us do things that are impressive, it’s just that the actual doing of things is not necessary to the impressiveness.
**you knew I’d get there eventually, didn’t you?

We start with the fact that technology is very expensive here. On average, new tech, whether that be computers or cars, costs about two times what it costs in America. And yet the average annual salary in Malawi is about $200 per year. One of the new Toyotas, the Prado, costs $40,000. Country directors of NGOs drive them, but that’s about it. If technology doesn’t decide to randomly implode just because it knows there’s nowhere around to get it repaired, the heat and dust and moisture will get to it eventually.

The cars that the middle class can afford have gone through numerous hands, and tend to be worse for the wear. Roads here are amazingly bumpy—even the tarmacked roads are too bumpy to be able to text easily. Even in the cities, some of the roads, like mine, are dirt. It costs more to live on tarmacked roads. Cars parts get worn out by heat and humidity and rough roads and sudden stops and drained tanks . . .and . . . and . . . . I have only rarely seen a minibus with a sliding door that did not need to be wrestled into place, with exposed metal bits that peek through the padding and fractured vinyl. Parts are difficult to get and expensive when you can get them, so things don’t get repaired, they get worked around or tied together with twine or muscled back on track.

It even extends to houses. I am beginning to believe that while land (if you can get permanent rights from your chief) is a good value, houses are not. The bones of the house I live in have existed for a while. In September of last year, my landlord finished a remodel that stripped the house down to almost nothing, and replaced almost all of the wood because of termite damage. He even had someone kill the damn termite mound along with the queen or super-giganto-termite in charge or whatever.

Apparently the super-giganto-termite in charge didn’t realize it had been killed and also evicted, because a few months later the little brown appendages were growing out of my door jambs. Mr. Makato, my landlord, was on those mini horizontal termite projections like Malawian children on a new white person walking by. Whatever poison he used worked, because those termites ran and hid.

Into my walls.

A few months later they decided to come out and play again. And again. Every time, the time between poisoning the voracious eaters and them coming back for another meal got shorter and shorter. Mr. Makato has spent the last couple months saving up to treat the termites properly.
Last week, Mr. Makato spent a whole lot of money on a brand new poison. Then he paid some other guy to borrow his drill to make holes into the foundation outside and inside around all the doorways, dug up all the flowers that were fertilized by the termite refuse.

At the same time, I’ve replaced the lightplates on 5 switches, some of them twice, and learned to live with broken switches when I can’t be bothered replacing them again. The rubber on my cold water tap in the kitchen needs to be replaced for the third time in the last so that I can actually turn it off. The wiring on my geyser was just repaired because something happened to it after the heating element was replaced for the third or fourth time 2 months ago. I’ve had to have people climb up into my crawlspace and strip out wiring shorted by faulty electrical devices.

One of the bases in my hotplate has rusted through, and while it still works, everything has to be cooked slantwise on that side. To be fair, the hotplate belonged to two other volunteers before it belonged to me, but one of them never used it, and it still isn’t more than 4 years old.

Oh, and clothes. Handwashing is labour intensive and hard on clothes. Scrubbing to remove the dirt eventually puts holes in the clothes; the soap needed to really get those clothes clean takes away all the dirt and half the dye, too. So clothes fade and look old, fast. Also, the powder detergent we can use doesn’t always completely dissolve in water–and then it bleaches little spots into the nice trousers or blouses.
I could keep going, but it’s getting boring. One thing though, is that I don’t believe in saving money in the short-term and I don’t buy the cheapest option. Neither does Mr. Makato. But we are limited by our possible budgets.

Everything breaks all the time. After two years here. I practically need to start over.