Saturday, June 30, 2012



Pediatrics is exactly where I need to be

Exactly, because it is so hard!

I started out with 22 patients – discharged  1 – got 4 more – and before I left – got another 2 on the next shift – 5 out of the 6 new admits needed transfusions with unbelievable Hemoglobins  in the 2’s, 3’s, etc.   

By the time I left tonight – 2 hours late – we had 27 pediatrics patients. 

The last 2 are camping out on mats on the floor – there are people crammed into every available bed, space, corner.

Gone are the beautiful days of being able to assess anyone – it’s all I can humanly possibly do to keep up with the new admits (searching for a vein on a dehydrated-fontanel-sunken-in-kid with a Hemoglobin of 3 takes time….), hanging quinine perfusion after perfusion, trying to do rounds on the quinine drips to control it (most of the IVs are positional)

Trying to control all my blood transfusions

Trying to see the sickest kids first – trying to delay the angel of death with IV ceftriaxone, dextrose, quinine, blood

People pulling on my scrubs

This drip stopped

That drip stopped

This IV infiltrated

Well, if you strap your kid to your back and walk around outside with the D5 bottle in your hand – yeah the IV is going to stop

The blood is finished

The blood is backflowing into the IV tubing

This drip is stopped

This drip is too fast

People pulling on my scrubs

Come see my child

No, come see my child

Asking again, again

My child is crying – can you give him medicine to stop crying?

My child’s stomach is “sick” we need to stop the blood

Running to the pharmacy

Running back

Trying to do more than humanly possible

But this is exactly where I need to be

Because I am getting frustrated

Because I regularly loose my cool

Because I have a tendency to snap

Because tears spring to my eyes

I have had several unfortunate altercations with male chauvinists – last night the pharmacist refused to give me another IV (the hospital is supposed to replace broken things if they are an accident de travaille)

And I’m sorry, but if you are sticking the scalp with a flimsy plastic IV – the tip of the lumen is going to crack – and when I have only 1 or 2 good veins left standing literally between this child and dying – you can better believe I’m using a brand new IV

So, he refuses

He tells me – you know, when you put in IVs, you should just do them quickly.  You shouldn’t stick people again and again

He tells me – you make children suffer more than any other nurse, you are always making children suffer

He tells me – you don’t know anything – you know less than the other nurses

And so on

And you can imagine how I took that – and how he took my not taking it

It is so hard here

Once someone asked me, do you feel like you are treated unequally here because you are a woman? – and I flippantly said – no, not at all

But I have come to realize that I misspoke

I have been noticing that I am talked down to a lot by the male staff – they must assert their dominance in every conversation and situation

They snap at me for things that are put very mildly

They get all huffy when the only thing I do is ask for things, like, oh, IVs so I can do my job.  Or when they have to come in to test blood for a transfusion

The other week the guardian of the gate refused to go call the lab tech for me.  No one had phone service and I had a child that urgently needed blood - and his reason for refusal?  Because I didn’t respect him when I asked him

As in – I didn’t say, how are you?  how is your work?  Bon travaille!! 

Because I didn’t ask how his family was first, because I didn’t ask him how his night was going

This is one of the hugest adjustments for me and one I get wrong every day

In the US – we say what we need in the workplace – we are all there to do a job and to do it rapidly and efficiently, ESPECIALLY if it’s urgent – we don’t first commence with pleasantries

So, I asked Freddie, our translator for Project 21

He himself being much down with the whole inequality, men are superior beings thing –

I said – tell me how to get along with tchadian men – because I am failing

And apparently – if a woman challenges, argues with, reprimands, or does anything that falls out of the realm of “respect,” then suddenly his value as a man is on the line – he cannot be seen to back down, or lose the argument, or allow a woman to speak to him like that – he will immediately lose all the respect that other men have for him.  He will lose his reputation.  He will lose his friends.  Men and women alike will make fun of him.

In this culture - maintaining your reputation at all costs is paramount

Relationships here trump urgency

In fact – almost nothing is urgent

And it infuriates me

And last night was also horrific – there was a little boy whose vein blew mid transfusion – he was exhausted, dehydrated, severely anemic – and so I was searching and searching – I kept getting blood flashbacks and then the veins were collapsing over and over again each time I tried to thread it. 

So I stopped.  I tried to call Hamadou or Seraphim – both geniuses at IVs – the best of the best. Usually I don’t have to call them but I would rather admit potential defeat then damage all the viable veins of someone who will die without IV products. 

But it was in a rainstorm.  No one had any cell phone service.  I couldn’t get through. I called over and over and over.   I called another girl – it kept collapsing on her too.

No way to do a central line

Then finally – I convinced someone to take their motorcycle and go to Hamadou’s house and call him – he came and searched for an hour and a half

You could see the little boy fading

And then finally – 4 hours later – the blood already 6 hours old,  Seraphim – the best of all the staff at IVs (and that’s about where his prowess ceases) – he came and tried  for an hour or so as well.  And he failed. 

The little boy died several hours later

He was so anemic he was going to die without blood.  It was a certainty.  And one I knew the entire time. 

 - and it was in the midst of this that I had 5 new admits.

- and had 20+ drips to control.   

- and was surrounded by a cacophony of screaming children.

- and had more infiltrated IVs. 

- and was hours late on giving meds.

- and had not even assessed a single patient.

 - and had children convulsing.

 - and had children with severe dyspnea.

 - and was transfusing 4 patients.

- and was being literally pulled in different directions by anxious parents.

- and hadn’t ate or drank.

- and despite running and trying and working at top speed was not even giving what I consider to be the bare minimum of care. 

- and had the grim and heartrending fact playing over and over in my head – if you cannot figure out a way to get this IV – this little boy will die – I could see him visibly fading.

And so it was in the midst of all this that I have the pharmacist telling me that I make children suffer, and that if anyone else was in my place – the children would not be suffering. 

And so I got angry – and I didn’t handle the altercation with him well. 

And then I started crying. 

And then I snapped at the poor parents whose lives are in shambles who did a culturally courageous thing and actually brought their kid to the hospital. 

Yes – I think everyone can agree that this was frustrating. 

You may even tell me anyone would have reacted the same way.

But that’s not true. 

It’s not okay

Its not okay to get in stubborn inflammatory arguments
Its not okay to burst into tears at work
Its not okay to to be short-tempered and unkind to parents

It's not okay

because I want to do nursing in situations 2o times more extreme than this

I want to work for MSF – who goes into the worst conditions in the world at the most dangerous times, who goes where no other organization wants to go

And I sit here and dream about that?  I sit there and think I can do that? 

I’m no where close to being able to handle that. 

And it’s a harsh truth.  And not one that I like admitting. 

If I can’t handle this – what makes me think I can handle being in a war zone with bullets flying and halls overflowing with patients?  What makes me think that?  Pure chutzpah? Hubris of the young?

So, as you can see.  This is exactly where I need to be. 

    I can think of no better situation in which I can practice handling stress, diffusing arguments, developing patience,

    I can think of no better place to work through overwhelming, unfair, and difficult situations without letting it overwhelm me. 

    I can think of no better place to figure out how to work under pressure, how to keep up with impossible demands, how to hone my reactions and thoroughly expose my biggest struggles.

Being here has brought out the best that is in me.  It has allowed me to do things I didn’t think I could do and to be the kind of person I have always wanted to be.  

Being here has also brought out the worst in me.  It has showed my aspects of my character that I didn't think where there and i became the kind of person i never wanted to be.

You know there's a problem when you end up acting more like Hitler than Gandhi. 

No, I have to stay here, I have to work through this madness until I can move through with grace and patience and kindness.

I have to stay here until I can consistently treat others like human beings – no matter how much they infuriate, insult, belittle, disrespect, or annoy me.

I have to stay here until I can work through a night like tonight by focusing the best of my energy on one task at a time, one patient at a time, somehow giving myself grace to know my limitations while still pushing the boundaries of those “limitations.”

and so, this is exactly where I need to be

I truly have an unprecedented opportunity tackle my character in all its gnarly ugliness head on, go to war with it, day after day after day, and come out on the other side. 

I have a chance to become the person I want to be. 

I have a chance to prepare myself for what I want to do. 

And so I am profoundly grateful.  And I am grimly determined.   

I took a magic marker

And wrote things like ZEN and SHUT UP and PATIENCE and KINDNESS all over my arm –

I am going to beat this thing

I have an entire month of unbelievably difficult nights ahead. 

And I am excited

I am always writing about doing poetic and glorious things such as “walking through the fire.”   

Well – here is my fire. 

Right here.

Right now.

And I cannot stop walking until I can move through it without it scorching me. 

Until I can work in it without burning others.

Until I stop fanning the flames.

Until I become water.

Right here

Right now

There will never be a better boot camp

And so, this is exactly where I need to be.


*** at the time of posting - Saturday night – there were 13 new admits Thurday, 13 more on Friday – bringing up the total to an all-time high of 30 something Friday evening/Saturday morning.  Tonight I had 23 patients with 5 more on the medicine ward (which the nurse in that department graciously took over for me).  Also am pleased to report argued with no one and was in general very kind tonight – will re-magic-marker my arm in the AM. 


Wednesday, June 27, 2012


this is the baby in a box

born 2 months premature - 1.4 kilos

tucked in with hot water bottles and a tiny striped hat

a perfect wrinkled face with old soul eyes

cocooned in our cardboard NICU -

all we have is a hope and a prayer and a desperate denial of harsh reality

but we are health care professionals

thats what we do

we try

we don't give up on life

and so Danae is boiling water

and making formula

and I put in a neonatal NGT

and Seraphim got an IV

and every time we check - she's still alive

i picked her up

just know, I said

to the baby in the box

that you are loved


this is my new darling,

a little starving pup with a manically wagging tail that somehow found
me one day and i couldn't resist

she sleep every night curled outside the bottom of my mosquito net

she would rather have her tummy scratched than eat

she is infectiously enthusiastic

she always wants to be where I am, as close as she can possible get

her name is Hester


the air is misty and cool and soft after the rains and I can see the pale bright moon casting shadows out my window

I decided to stay another month in Pediatrics - I was so sad at the thought of leaving - in a mad twisted way I love it there. 

These last 2 months of working there on my own and being part of the hospital schedule have been both the happiest and the hardest of my stay here.

hardest - because I had to try (unsuccessfully) to wrap my mind and heart and soul around the obscene death toll - and because suddenly I had personal responsibility in the matter - I was the one in charge, the one making decisions, and many deaths were on my watch.

happiest - because I felt for the first time that i was making a real difference.  I felt that the patients under my care were, well, receiving better care.  I loved not working under the Tchadian nurses and I loved being able to do my work in a manner more consistent with Western nursing and in a manner I felt that was ethical and right. 

I was convinced by Danae - and she is right - that it would be good for me to go to maternity for my last months - I would get invaluable experience, learn from the best, and it would surely be useful to be more well-rounded especially as I will be applying to MSF..... and so I decided to leave peds - but as soon as I articulated that decision - I started feeling sad

I realized I loved it there
I realized I loved the autonomy
I realized I loved the kids (although you would never catch me being all cutesy and playing with bubbles and stickers and making them smile)
I realized I loved the privilege of holding someone's hand as they slip into another world
I realized I loved the raw intensity - of being so close to the greatest suffering and the greatest love
I realized I loved looking at life with my lids peeled back

and this is tricky - its not that I love watching suffering - I don't.  It is heart wrenching and haunting and numbing and everything in between. 

but at the same time - how do i say this,

 I have witnessed the dregs of hell, cruelty, injustice, ignorance, and grief
 I have heard the soundtrack of life wail from the grittiest, rawest strings
 I have caught my breath as someone who was loved by someone more than anyone else in the world relinquished theirs
 I have smoothed close eyelids that saw their last colors
 I have have cradled heads in my hands whose necks can no longer support them
 I have held warm covered bundles in my arms that used to be children
 I have auscultated quavering heartbeats moments as they pump their final rhythm
 I have squeezed the shoulders of screaming rocking mothers as they life their hands blindly, beseechingly to an uncaring sky
and in those moments - I wouldn't have wanted to be anywhere else

standing side by side with life and wading in the muck and magic of its bareboned stripped rotten and steely core

it is in this sense that I say Africa has saved me but it also has damned me

I will always be drawn back into the inferno of life and death at its most elemental

and, inexplicably, I am not ready to give up the festering insanity

but to every dark side there is color

the age old paradox of contrast

the pendulum

the tumble into the darkest places to open the possibility of flights to the great bright dizzying heights

to roll on the ground with laughter, or be slumped against a wall racked with sobs

because in this place like no other i have also seen the best parts of life

a mother curled protectively around her child - fighting to open exhausted eyes to make sure that the quinine is still dripping
a father cradling his tiny baby in his hands - watching, hoping, moving it from one palm to another with the greatest gentleness
parents selling all they in this world so that there child might live
entire families camping on the hard cement floor - stoic and present and there
calloused fingertips resting lightly over a failing heart - murmuring fervent prayers, loving it into breathing
grandmothers coaxing bits of buille and sauce into the cracked drip lips of fighting children
just the love
the greatest love i have ever seen
walking through it
thick and soft and courageous
it melts around you
it breaks your heart
the tenderness with which these tiny souls are conducted across the great divide
teardrops of salt and pure beauty
it is unforgettable
it is unbreakable
it is undeniable
it is perennial
it is this great love that gives indisputable meaning to these flickers of life that were blown out to early by a dark stinging wind no one could control

I have had the solemn wonder and undeserving privilege of crossing paths with strangers at the most fragile, vulnerable, and beautiful place of their existence - i have been trusted to walk a few minutes with them on their path - I have been allowed to hold their hand as they cross into that which defies explanation

it is sacred
it is diabolical
it is awe-inspiring
it is wrenching
it is gutting
it is beautiful
it is painful
it is truthful
it is deceptive
it is baffling
it is infuriating
it is fervent
it is excruciating
it is unjustifiable
it is undeniable
it is inexplicable
it is inevitable
it is futile
it is hopeful
it is noble
it is pure
it is innocent
it is unspeakable
it is writhing
it is shrieking
it is gasping
it is screaming
it is rattling
it is terrifying
it is tangible
it is will-o-the-wisp
it is solemn
it is potent
it is raw
it is real
it is death
it is life
it is the core
it is the crux
it is the pinnacle
it is the crucible
of what it means to be human

Tuesday, June 26, 2012


Malaria season. 

It started today.

11 new patients – all with malaria.

24 patients.  23 bed pediatric ward. 


I think 7 transfusions – Hemoglobin of 2, 3, 4

The one with the Hemoglobin of 2 died waiting for blood

If they are that anemic – you can be sure its malaria – the malaria parasite, in this area plasmodium falciparum, attacks and breaks down red blood cells –  these injured RBCs adhere to and block the microvasculature in a process called sequestration, and they also stick to other RBCs.  RBC synthesis is also inhibited often leaving the patient very anemic.

This anemia is most pronounced and deadly in children. 

Children with whitish tongues, gums, nail beds, conjunctiva

Soles of the feet, palms of the hands




We transfuse whole blood here – not as effective as Packed Red Blood Cells but life saving

Normal hemoglobin is 12-16.

She died of anemia.  Because of malaria. Because she was born in Tchad.  Because she probably didn’t sleep under a mosquito net.  Because decades of bad politics and environmental lobbying have kept indoor residual spraying of DDT from becoming a reality in the areas that need it most. 

By the way – there isn’t a vaccine for malaria.  It is being studied, but not yet available.  Not one that is marketable, getable, giveable.

If there was – life as we know it in Tchad would be radically changed

My friend, belonging to the “Africa Club” at her school – was told there was a vaccine – kind of like a shrug of the shoulders, not my problem kind of response – just use prevention and vaccine and voila!

Well, think again Africa club.  In fact.  Come to tchad. 

See for yourself.  Auscultate the lungs drowning from pulmonary edema – sponge kids with tepid water that have a temperature of 105.  Watch a baby die from probably cerebral malaria after 7 days of IV quinine and ceftriaxone – talk to his mother, hope with her that just one more day will make a difference.  Watch him convulsing still on the 6th day – feel helpless not knowing what else to do for him – after he dies wonder what you could have done differently – come here, do this, and then tell me there is a malaria vaccine.  Tell me a simple answer.  I dare you.

Malaria is not just a health problem, it is much more far-reaching and sinister than that. 

Malaria changes the face of Sub Saharan Africa. 

Malaria governs customs, behaviors, beliefs.

Malaria means that you are going to have 10 kids instead of 2 or 3.  Malaria means you have a good shot at losing half of them before they are grown – Malaria means you know this cold fact and so you deliberately have more children. 

Malaria means malnutrition.  Malnutrition means malaria.

Malaria causes what we would term “poor family planning”  Malaria makes this make sense.  In Africa, in Tchad – children are everything.  A woman that cannot have children is ostracized, divorced, subjected to plural marriages, is insulted – is told “why are you eating?  You are eating for nothing.”  A woman without children has absolutely no value in Tchadian society.

A man without children also loses value, respect, standing in the community, even friendships. 

Children are everything here. 

They are your retirement.  They are your lineage.  They are what bring you meaning.

Family is strong here.  Building your family, expanding your family, creating the next generation, securing your lineage.

A man without children will not be remembered, they say. 

Replacement.  It is by far the most common explanation as to why children are so important here.  So we have someone to replace us. 




It is what gives a man and a woman personal meaning in life here. 

1 in 4 children living in the village of Béré will probably not grow up. 

I have talked to women that have lost 8 children, 9 children, 10 children.  I have talked to women who after they lost their last baby were driven from their homes by their husbands.  This surprises no one. 

I can think of only a few instances in my entire time in Tchad when I talked with someone who has not lost a child. 

And so you have more.  Given the essence of value in this culture, it makes perfect sense. 

Have 12 children.  Six or more might make it.  3 or more might be boys – the ones that take your name, make you proud, work your land – stay in your family. 

Girls are valued less because among many reasons they marry into a different family.  Not the one you are building.  Not the one that will replace you.

Family planning will never work here until people can be confident that their children will live past childhood. 

Malaria means poor education, fewer children in school, less attentiveness for the ones that go, the wrenching decisions of who to send and who stays home.

Malaria causes poverty.

It perpetuates poverty, it impoverishes the rich, makes destitute the poor. 

A death in this culture devastates you.  The funeral can cost half a year’s earnings.  It can put you into hopeless dept.  It can drain every penny you saved for a better life.

So, you have 10 children.  You can’t afford to feed them properly.  They get sick even quicker, get malaria more often when they are malnourished.   You are poor.  You don’t have hardly any food.  It is rainy season.  Several months before the rice harvest.  The hardest months. 

You aren’t really sure that its Malaria – no one ever really told you what do look for.  You just know that your child is burning to the touch, that he won’t eat or drink, that he’s vomiting, that now, suddenly, he is having seizures.  His eyes have that exhausted, rolled back half closed look.

You begin to panic while already accepting that he will probably die

You go to the traditional healer.  They palpate the abdomen, make rows  of small cuts over the liver, the spleen, other parts of the abdomen.  They suck out the poison.

Now your baby is in a coma.  You can’t stop thinking about how this is what his sister looked like before she died.

You sell your last bag of rice – you run to the hospital.  You spend all day waiting – finally you get a bed.  Except it has no mattress on it.  You put down a cloth and curl up around your baby.

The white nurse is emphatically telling you something in French that you don’t understand because you never went to school.

You watch the 4 year old beside you start gasping for breath.  You start to pray.  You already want to leave.  Your heart is chilled with dread.  You want your baby to die at home.  Not here.  Not like this.  You wish you hadn’t come.  But you still have a stubborn desperate strand of hope. 

And all that hope is hanging on a bottle of D10 mixed with IV quinine. 

You put your hand on the heart of your baby and will it to keep beating.

Your other neighbor dies


Who will it strike next.

Stop and imagine for a second.  Imagine there was a season, lets say summer, where you knew that there was a very good chance you would lose one of your children.  All the pollen in the air.  They could get sick, very sick, and die at any time.  This would be your certainty.  Your reality.

Imagine you had very little money – only enough to buy the barest amount of food.

Imagine you have no health insurance.

Imagine that if you take one child to the hospital, the other might starve. 

Imagine watching your child die, and not having the knowledge, the connections, or the resources to prevent it

Imagine that you took your last one to the hospital, and it died there. 

Imagine that you keep looking at your babies, trying to memorize their faces, knowing that you will probably lose one of them this year. 

Imagine that you had to go through this hell year, after year, after year


The mothers watch the rains come in, sweep the caked mud out of the dirt floors, gather their children tighter around them, and wait

And hope

And tie amulets of leather and wood around little feet, wrists, necks.  String red and black beads around the waist.

Pound the millet.

Sift the rice

And life goes on – but the old gnawing fear is in the bottom of your soul. 

As you watch the layers of grey roll in across the thatch roofs of the houses, as you feel the stinging wet wind on your face, as you see your baby splash in the puddles chasing ducks, you hope – and sometimes you don’t even dare to hope consciously – but you hope that not this child, not this time, not this season, not this year. 

Pound the millet

Sift the rice





Not this child

Not this time

Not this season

Not this year

Thursday, June 21, 2012


Dehydration malnutrition babies with cracked canyon fontanels sunken scalps and sunken faces deep eyes eyes eyes that look out from another world  eyes that live another world away eyes you can look into but cannot save dripping quinine chemical yellow b complex drip drip drip spike the bag hang the blood white tongue white lips white mouth call me crazy but I see blue there too starting at the corners of your mouth and spreading like delicate spider veins disappearing into your lips chests rising chests falling breathe breathe breathe one breath two breathe 120 breaths last breath wait not yet, shudder breath nother breath that was last breath strong heart weak heart rapid rate slow rate decal excel what the hell is this hell beat beat beat beat wavering now slowing now quicker now hope rises and falls with the rhythm skip a beat where’s that beat whats that beat gurgles murmers arrhythmias dysrhythmias your heart the only thing in tchad that doesn’t move with rhythm your heart stopping slowing 60 40 up to 70 nope 60 50 40 skip a beat shudder breath chest still you still the air is alive but you are not piercing screams tears spring from nowhere faces flooded hearts broken hope shattered life changes colors for those that still live it warm still warm now limp now grey now  hold you now in your last minutes someone loved you someone fanned you someone held your hand someone prayed for you someone cried for you  but you cool gradually i hold you in my arms waiting for the clondo back to the market  permission must be given to carry the deceased  you are still warm so warm wrapped up in a white blanket I used to have a white blanket I loved it worn and soft with the same checker oftwashed fuzziness give your seat to the woman I said it’s the only seat he said him sitting grinning her strong and silent and about to break one tear two tear stoic tear no tear grab the plastic bag grab it in your hand wrap the dead baby against you climb on the clondo hold your belongings at least those don’t die at least its something to hold onto back to the village back to the faces you left with a breathing baby you come back with a dead one back in peds the place to be the place to see the place to die the place to live the place to wait the purgatory of the anxious the broke the restless no money no money I have nothing exchange fabric for quinine quinine quinine quinine every one is on quinine drip drip hands and arms and feet and scalps quinine the miracle mosquitoes the curse bite one bite 2 maybe not this time but it will get you rainy season mothers shudder pulling bright shawls over strong shoulders please god not this time watching you anxious throw up once throw up twice take you to the traditional healer  splenomegaly the health center said cut one cut 2 lines and lines of small red slices  let the poison out of your spleen  the parasites don’t care rush once rush twice every 2 days they charge your bloodstream breaking red blood cells clogging and slowing and breaking and laughing Malade for 5 days malade for 8 days Malade for 3 months why now why today why not yesterday why not last week why didn’t you come thank you for coming never too late often too late always too late always we hope sometimes we never how many of you are in the ground are the worms eating you now eating through old rotting lung tissue raising little worm tykes in the hollows of your eyes one day you are only fire and water and rot one day you will melt back into the earth into the sky into the void one day the ones that loved you will die one by one by one by one you live in memories but what when the memory bearers are absent did you matter of course you mattered but how did you matter life matters one puff of life matters but tell that to the person with locked-in syndrome if we could ask him how could he tell you how do you know I decide you decide we all decide decisions decisions all of them a string of them a line of them blank before us sickening black arrows looking back every decision ever made and here is one tiny little outcome being eaten by worms parasites kill you and then parasites eat you and parasites in government suck the oil and grow fat and you have no rice no millet and you starve I haven’t eaten since yesterday I haven’t eaten in 2 days I have nothing I have nothing I have nothing try try trade barter exchange you say I have nothing i have nothing nothing else to do if you are hungry except feed you do you know that that you will be fed are you really hungry I would be I am never hungry ot the kind of hungry that makes you hollowed out and desperate that clawing other not the kind of hungry that makes me beg for food not even close so why do I judge your hungry why do I give grudgingly my leftovers what the hell is this hell whats that smell urine is pooling on the mats and tears are collecting in the silent eyes rags filled with diarrhea tossed on the floor old blood new blood your blood sweat and meat and rice and bouille rat droppings cockroach legs everyone is inside its going to rain the smell of unwashed and just cooked and dash of the wind on my face precursor to storm this is a storm it was a storm will be a storm  and then I burn incense and play Mozart and still i treat you with exasperation some things too mad to punctuate