Pizza, X-Rays and the Waiting Game

The ambulance driver indicates I should buckle my seatbelt, which seems a little conservative of him until he hits the road.

More than half the population of Mongolia lives in Ulaanbaatar, most of them appear to have taken their four-wheel drives out for a constitutional tonight, and their no-compromise driving style would make Chinggis Khan extremely proud.

Sirens blaring, we race through traffic, veering from the right side of the road to the wrong side of the road to somewhere in the middle of the road, and back again.

He drives with one hand on the wheel and one hand on a little microphone. Any time someone pulls out in front of us, or feels that their vehicle is large enough to face ours down, he utters, very calmly, what I assume to be the Mongolian for “ambulance coming through, move over, move over”.

Sometimes they do, sometimes they don’t. Sometimes they brake, sometimes we do. It’s…. bracing.

Shortly before 9pm, over 30 hours out from injury, we make it to SOS Medica, where Doctor Nicolas, the medical director, and Shirley, the clinic manager who’s been my first point of contact, are waiting for us.

Doctor Nicolas hisses audibly as the final layer of cottonwool comes off. Zac’s arm is so constricted that the veins are standing out like ropes against white, gauze-puckered flesh.

First up? Removing the splint. Oh god.

I’ve run out of maths challenges with which to distract Zac, so we go through soft toys for this one. “Tell me, what was that toy called that we left on the sleeper train in Finland? Was it Leopardy?”

“No. He was an owl! His name was Owlbert!”

“And we replaced him with something from Finland, didn’t we?”

“Yes, that one was Lucky the Huskie…”

Doctor Nicolas hisses audibly as the final layer of cottonwool comes off. Zac’s arm is so constricted that the veins are standing out like ropes against white, lined flesh.

“So it WAS too tight?” I ask.

“Yes,” he says.

Into the X-ray room Zac goes. I grab a coffee and a sneaky cigarette with Doctor Suki, who’d accompanied us on our helicopter evac.

“There’s nowhere in Mongolia that can fix that. I’ll be recommending immediate evac as an emergency to a centre of surgical excellence, probably Hong Kong or Seoul.”

Doctor Nicolas pins the X-ray onto a lightboard, and he, Shirley, Zac and I stare at it.

It is, indeed, the mother of all fractures.

“It’s a spiral fracture with a 2.5cm displacement,” says Doctor Nicolas, bluntly. “We can’t fix that here. There’s nowhere in Mongolia that can fix that. I’ll be recommending immediate evacuation as an emergency to a centre of surgical excellence, probably Hong Kong or Seoul.”

SOS Medica is, without a doubt, the best clinic in all Mongolia. And so that, I suspect, is that.
The nurses resplint Zac’s arm with crepe bandages, using a bendy metal frame that’s covered in plastic as support, and place it neatly into a sling.

That will be it, Doctor Nicolas confirms, for the splinting until Hong Kong.

“That’s a nasty case of sunburn you’ve got there,” he says to me. “Would you like some cream?”

“I’ve got moisturiser,” I say, acutely conscious that my face is now beginning to peel. “I’m sure it’ll be fine once I’ve washed.” It’s been well over two weeks since I last showered, and several days since that wonderful river wash.

“What kind of pizza would you like, Zac?” she asks. Pizza! Oh sweet Jesus! Pizza! “Pepperoni, please,” says Zac.

There’s no one but us in the clinic’s three-bed emergency ward, which is rather nice, particularly for Zac who, after a bedbath conducted by a male nurse, is very probably the cleanest he’s been since he was last bathed by a nurse, soon after he was born.

I can have one bed, and Zac have the next one, on the understanding that if another tourist falls off a horse (or a motorbike, for that matter) I may need to move to the sofa.

“Have you eaten?” asks Shirley.

“Not yet,” I say.

“What kind of pizza would you like, Zac?” she asks.

Pizza! Oh sweet Jesus! Pizza!

“Pepperoni, please,” says Zac. “And Goe. Or, if they don’t have Goe, Coke.”

“He’s very good, isn’t he?” Shirley says. “Is he always like that?”

“Pretty much, yes,” I say, adding a tad defensively. “I wouldn’t have taken him horse riding in Khovsgol if he wasn’t quite resilient.”

“If you like good coffee you can use the coffee maker in my office.” OMFG! Coffee! Real coffee! Next thing I know, she’ll have laundry and wifi. It can’t help to ask…

Shirley gives me a little tour of the SOS Medica clinic. It’s a nice, modern affair, clean and brightly lit, with sofas and flat-screens, all the glitzy corollary of a posh private clinic anywhere. “There’s a shower here – feel free to use it. Let me get you a towel…”

Both our towels are covered in vomit, my nails are black with dirt, so the prospect of a real, live hot shower feels roughly equivalent to a week in a spa right now.

“This is the kitchen — just help yourself to anything in the fridge. We’ve got tea and coffee, although if you like good coffee you can use the coffee maker in my office.”

OMFG! Coffee! Real coffee!

Next thing I know, she’ll have laundry and wifi. It can’t help to ask…

“Where can I get laundry done?” I ask.

“We can do it here,” she says. “Just fill up a bag and give it to the nurse.”

Since every single item of weather-appropriate clothing we have with us is ingrained with a fortnight’s worth of horse-riding dirt and open fire smoke, I only hope her laundry can cope.

“Do you have wifi?” chirps Zac.

They do?! Result! “Not tonight!” I say. “You need to rest.”

I sort our laundry, hand it over, and shower for 15 blissful minutes.

“We may need to adjust the morphine dosage,” says Shirley, ruminatively, as the same poor guy who washed the last lot of vomit off Zac an hour before comes in to change his sheets and gown and give him another bedbath.

The tone of this idyllic evening is only slightly spoiled when Zac, after demolishing half a pepperoni pizza, silently but comprehensively vomits it up.

“We may need to adjust the morphine dosage,” says Shirley, ruminatively, as the same poor guy who washed the last lot of vomit off Zac an hour before comes in to change his sheets and gown and give him another bedbath. “I’ll also get a duty doctor out to spend the night.”

“Would you mind wiring him up to one of those machines?” I say. “I know it sounds stupid, but I’m paranoid about him throwing up in his sleep and choking on his vomit.”

Zac is duly wired up, and nods off to sleep.

I get on the internet, ignore several hundred unread emails, craft a carefully worded email to Zac’s father and the family headlined “Zac’s Had a Bit of a Topple”, ring OneAssist to update them, and email them a photo of Zac’s X-ray.

In a refrain that will become familiar, their “medical team are looking at all the options”, including treatment in Ulaanbaatar. This makes me shouty.

I spend another couple of hours online, and send them another email, citing evidence from diverse sources that any injury requiring surgery will need to be done outside the country, and providing a handy list of upcoming scheduled flights to Hong Kong and Seoul, the two nearest options for international-standard surgery.

Near is, in this context, relative. We’re talking four hours flight time, minimum.

I’m just returning from a last cigarette before sleep when I hear the unmistakable bip-bip-bip of the alarm on the machine that monitors Zac’s lifeline.

At 2am, I’m just returning from a last cigarette before sleep when I hear the unmistakable bip-bip-bip of the alarm on the machine that monitors Zac’s lifeline.

My heart jumps around in my chest and falls like a stone through my gut, and I’m in the emergency room so fast that my head doesn’t even notice my legs are running.

“OH MY GOD, ZAC!”

“What?!” he asks, startled from his morphine sleep by a hysterical parent, yet again.

I look at the little screen. It appears the widget monitoring his pulse has slipped off his finger in his sleep. The duty doctor comes in and fixes it, and, freshly washed, I slide between crisp, clean, hospital sheets and… sleep.

Just to get Zac from a Mongolian rural clinic with no running water to SOS Medica in Ulaanbaatar cost our insurers over $30,000. If you’re planning travel, especially longterm travel, you might want to check out World Nomads travel insurance.