Insomnia

The baby was 9 months old.  His diabetic, hypertensive mother decided to bring him in because he had “lost his appetite” and “couldn’t sleep at night.”  She said this, completely straight faced, as her chubby-cheeked little boy lay sleeping in my lap.  To their credit he looked pretty damn adorable.  Definitely a keeper. 

I entertain her concerns and give his heart and lungs a listen to.  His ticker was clicking away with a regular S1 and S2.  And his lungs had a hint of baby snoring in the upper fields, but no crackles.  Clean bill of health.  Another case of insomnia, another case of a baby just not adhering to the parents’ sleeping schedule.  It was a year and a half ago when I was in Des Moines talking to an entirely different patient population…about the exact same complaints.  Tout moun se moun.

However, the babies who decide to sleep all day and party all night in the spirit of Sean Kingston are not the only people who complain of “insomnia.”  Yes, they actually use the word insomnia.  I guess they get the Lunesta ads down here too #BigPharma #ProbablyNotAMajorMarket.  And there are some treatments that have been spread by word of mouth.  At the market you can buy some ciproheptidate (not to be confused with a very useful antibiotic, ciprofloxacin) which acts as an anti-histamine much like Benadryl.  And I’ve heard many people tell me that they make tea out of some of the leaves found around here. 

But what about me?  Finally a disease I can actually relate with.  Sleeping in Haiti has not been an easy thing for me to do.  And apparently it isn’t easy for many people based on the patients with that as a chief complain.  I can’t fall asleep.  If I do fall asleep, I find myself tossing and turning, waking up, and then unable to fall back asleep.  And in the morning I don’t feel well-rested.  Granted this isn’t an everyday occurrence, but often enough to be stressful.  So, in trying to understand my patients’ burden and disease etiology I’ve tried to dissect why I can’t sleep.

First, I have the back of a seventy-four year old, osteoporotic Vietnamese woman rice farmer (I apologize to my large following from Southeast Asia if you are offended, but you gotta agree that the fictional woman described probably had a bad back).  Even in the States I can’t seem to find a mattress that doesn’t leave me with spasms in the middle of the night.  Call it payback for the twenty years of insults I’ve subjected my body to in the spirit of recreation.  And I would be hard-pressed to find many backs around here that haven’t worked long hours in stooped positions.  It seems like most people are farmers or construction workers.  These guys have to work hard from a young age.  And the women may have it worse.  Laundry is done by hand.  I want to re-iterate 'done by hand, not because it is shocking, but because it's difficult to comprehend how much work it is to scrub dirt and grass out of a shirt.  Getting water means walking to the public tap or other water source, filling up a 5 gallon bucket, and then throwing in on top of their head to walk back to their crib.  Everyone has seen the pictures, yes, but that shit is hard.  Don’t let their form fool you #ModelsUseBooksRealWomenCarryWater.  And the amount of axial load they have to bear seems impossible #CSpineCleared. 

Tylenol for everyone!  If only it were that easy.  I don’t hurt when I lay down.  It’s only after I’ve been supine for most of the night that my pain kicks in.  So what else is going on?  Well, it’s 7 pm, I’m sitting in the dirt/gravel “yard”, and we have to power our one light bulb with a generator.  Yes, 7pm and it’s pitch black outside.  It’s great if you want to stare at the stars.  Especially if you have an iPhone with a stargazer ap that traces all the constellations out for you, thank you Angie.  But if you want to stay up, watch a sports game, or even socialize with the family you’re out of luck.  No electricity.  Early sunsets.  Pretty much a recipe for laying in bed way too early and not being able to fall asleep.

So I’ve solved the great mystery as to why people, and I, “have trouble falling asleep”.  We can’t stay up to watch the evening news – or Illini basketball in my case…wtf?  Penn State?  Really?  But eventually everyone falls asleep.  My schizophrenia calms down. I ease my mind.  And I drift off to a place where hearts are shaped like hearts and the smell of pie can make you float.  Then the parties start.  I've dealt with voodoo celebrations complete with shrill screams, drums, and firecrackers.  I’ve had the church next door wailing away hymns too.  But the culprits most responsible for destroying the peaceful night are the animals.  Goats, dogs, and roosters.  Oh My!

They all seem harmless enough, I know.  But imagine how you would feel having a chorus of roosters that don’t base their cackles on the sun…at all.  I don’t think there has been a sunrise that they have crowed at.  They prefer to sing the three hours leading up to the 530 am dawn.  Not gonna lie, every time I eat chicken while I’m down here, I feel extra happy.  The goats are much more tolerable.  Number one, they are fun to play with.  And number two, they tend to maintain regular office hours.  But they were included because when they do “talk” they just sound like they’re whining.  It loses its luster pretty quickly.  Perhaps the worst contributors to insomnia are the dogs.  These mangy mutts look more like slightly overgrown rats.  “They aren’t fed”.  They aren’t pampered.  No one is carrying them around in their handbag.  These creatures just roam…and bark.

I’ll end with one last story about my own insomnia.  It occurred two nights ago.  Stayed up till 11 watching Community so I could fall asleep.  Success.  Little did I know that there was a dog lurking outside my door, just waiting on me to get into REM before letting loose.  And let loose he did.  He didn’t stop.  Ten minutes passed.  Still going.  I try to cover my ears with an extra pillow.  No effect.  I turn on my iPod and slip in my ear phones.  Too loud.  I turn off the iPod and just use the earphones as plugs.  Barking still penetrates the plastic.  A half hour passes.  Then an hour.  I toss and turn.  Finally, I can’t take it.  I stumble out of bed, tripping over my mess that comes from living out of a pair of luggage pieces.  My daily contacts, now in their fifth day without having taken them out, try to fall out of my half-opened eyes.  “Where’s the damn door?”  I push it open.  The dog is still going.  It’s pitch black out – as we’ve discussed.  I step forward trying to feel for where the sidewalk ends.  I bend down, grab a rock, and execute the worst throwing form in the world in trying to sling a deterrent towards the noise.  The rock travels ten feet…tops.  Mulligan.  I’m still asleep.  Give me a break.  I grab another rock, reach back and chuck it.  Somewhere.  The barking stops.  It’s 2 am.  I can get a solid 2 hours before the roosters start in.  #Haiti #ccInsomnia