4. Source Control: Lessons Learned from a Trip to Egypt

What do feral cats, rolls of cash, elevator escapes, and a mouth abscess have in common? Listen to this tale of my recent trip to Egypt. It started well but it was a rough landing! We'll talk travel tips (including managing food allergies), lessons learned, why I lost a tooth in the process, and a reminder of why our profession is so special.

Topics:
- Background on the trip (1:40)
- Managing food allergies while traveling (3:05)
- I develop a mouth abscess overseas (5:27)
- The elevator escape (7:07)
- Lessons learned (10:22)

Links:
- UVA Infectious Disease and Travel Clinic
- Bilingual food allergy cards from Equal Eats (I do not have a financial relationship)
- What is Cancel for Any Reason (CFAR) Travel Insurance?
- Follow Dr. Bell on Twitter

Transcript

[00:00:00] Intro

Before the music starts. I just wanted to drop in real quick. This should be a quick episode. I started this podcast thinking I would gear it towards professional development, but it also had to reflect who I am. Those of you who know me know I love to travel and I actually consider it just as an important part of my development as anything else that I do. 

[00:00:19] But really, I just need to tell this story. I got back from Egypt. Took the whole family and it was a great trip, but it was also a wild story. It involves things like carrying around large wads of cash, cruising around with guys with guns, breaking out of a stuck elevator. And then it ended with vomit and a mouth abscess. We left blood, sweat, and tears in Egypt. And I even lost a tooth. 

[00:00:43] Now I know many of you in the Department also also love to travel. So I figured there's benefit in talking about my experience. So stay tuned. We'll discuss some tips on travel. Some great people in the Department lessons learned from my trip. And hopefully you won't repeat some of the same mistakes that I made when you're on your travels. Let's go.

[00:01:03] Hello, everyone! You are listening to This Medicine Life. I'm your host Taison Bell, a Critical Care and Infectious Disease physician at the University of Virginia. And, if you're like me, you may love being an academic medicine, but it's hard, y'all! The goal of this show is to make that just a little easier through the power of connection. We're interviewing medicine faculty, both inside and outside of UVA. Our goal is to connect with each other, to share our stories, our tips for success, and - together - become the best versions of ourselves in life and career. 

[00:01:40] Background and Planning

So background on the trip: I was invited to a wedding by one of our former internal medicine residents and ID fellows named Yusra, who's now at the Medical University of South Carolina. 

[00:01:54] And she invited me along with many other ID faculty members and fellows. Of them, Tania Thomas and Scott Heysell were able to go. So it was a cool opportunity to go see a place I've always wanted to see, take the kids out of school, bring them along with me, and our two families were actually going to meet up together. And it's really neat to travel with Scott and Tania because first of all, they know travel. They do a lot of work out in Tanzania as a part of their research. And so they just know how to do it. They know the flights, they know the ins and outs of getting to the continent of Africa. And they're just wonderful people. They're my travel buddies now, so you can't have them. But find yourself some friends to travel with. It makes it a much more enjoyable experience. We also traveled with my in-laws, which may or may not be an enjoyable experience for you, but it was great for me because I actually like them a lot. 

[00:02:42] So let's talk about planning. Very important. If you're going out of the country, it's a good idea to check in with the travel clinic. Tania actually directs the adult travel clinic and Emily Wong directs the pediatric travel clinic. And they have a few different providers. I saw Dr. Shannon Moonah and then his wife, Dr. Debbie-Ann Shirley, actually does pediatric infectious disease and does a travel clinic. So we took our kids to her. So we got everything that we needed. We were all set. 

[00:03:05] We also had to do some planning around meals. Our son has severe anaphylactic reactions to different food allergens. And so we had to do some planning around that. We actually took a carry-on suitcase with some snacks and other foods to supplement with the meals there. Pro tip: we had some liquids with us, but if you're going through the TSA, to avoid throwing your liquids out, if you can freeze them and it goes through in a solid state, it actually qualifies. So we were actually able to get some non-dairy milk at our son likes, freeze it, and then got it through the TSA checkpoint, which was great.

[00:03:39] We also had these food allergy cards that we got from Equaleats.com, where we can list the nature of the food intolerance, what he was allergic to. And it was great because there were as one side in English and the other side was an Arabic. So that worked out really well. As far as communicating what sorts of foods our son could eat. I'll leave that website in the show notes. 

[00:03:59] And the flight over from Dulles actually wasn't that bad. It turns out we were on one of the newer airplanes, the Airbus A350, and there's some cool technology that decreases jet lag. For instance they can increase the atmospheric pressure in the cabin to make it feel like you're at Denver rather than Mount Everest. That allows you to have increased oxygen tension, which means less jet lag. So I actually got off the plane just feeling tired but not that jet lag sort of loggy feeling .That you typically get.

[00:04:27] And then getting into Egypt was pretty smooth. We hired a tour company to meet us every single day and that worked out fine. That's exactly what I recommend. Egypt's not really the kind of place that you want to go lollygagging around. I mean, we didn't feel unsafe, but we did notice that we had armed presence around us everywhere that we went. There was even a day when an armed guard got into the van with us as we were touring around. And there were lots of police presence at the different tourist sites as well. So, we felt very safe. how much does that mean when you have so many armed guards around you? Not sure, but that said I wouldn't hesitate to go back again. 

[00:05:05] The wedding was fantastic. A mix of different cultures coming together. So it was interesting to see. And then we just had a few days for ourselves just to explore the country. So, started in Alexandria and toured a lot of great things around there. Alexandria is on the coast. And then we went to Cairo. We went to see the mummies, went to great pyramids, rode camels. Fantastic experience. 

[00:05:27] The Mouth Abscess

And this is where things start to get a little bit dicey. I gotten a root canal right before we left. And I've gotten these before and I usually don't have much issue with them. But I start to develop this jaw swelling and pain right at the site. And it's getting larger and larger. More and more painful. And I figure at some point, okay, this is probably an abscess. So I went to a pharmacy and getting antibiotics in Egypt is pretty easy. You just show up, tell the pharmacist what's going on, and they give you antibiotic. So I started clindamycin. And initially things were okay-ish, but then just kept getting worse. And so by the end of the trip, my jaw looks terrible. 

[00:06:08] I can't really eat and I'm just a miserable amount of pain. So trying to weigh the options. I'd much rather see someone in the US. And I think I can hold out for another one or two days. So the plan is to see a dentist in Northern Virginia right after we land. And then whatever happens happens. 

[00:06:28] The problem was--I discovered--that UVA's dental insurance has a terrible reputation. United Concordia is known to fight claims and not pay for care that's justified. And in fact, it's so bad that I had to switch my dental practice locally because my dentist stopped taking United Concordia. And this is a UVA specific problem. If you look just an hour down the road, VCU employees have access to four or five different plans. People that are directly employed by the state government have a different plan altogether. So, if someone's listening who understands this, please explain to me why we have an insurance that dentists are actively running away from. 

[00:07:06] But I digress. 

[00:07:07] Elevator Escape

Now, one of the last things I had to do before leaving the country was go to the ATM to get out some cash. We had carried around a lot more cash than usual because we did not have a credit card that avoided foreign transaction fees. And that's one of my regrets that I had. So anyway, I go out with my daughter, we go to ATM, get some cash. We're coming back into the building. 

[00:07:27] And we get stuck in the elevator. 

[00:07:30] It's a hundred degrees out. This building has no AC, so you've got to get this solved quick. There's a phone that connects to their front desk. But the person there speaks a hundred percent Arabic and I speak a hundred percent English and no one can understand what's happening. Look at my cell phone to try to see if I can communicate with my family. There's no signal. 

[00:07:50] We're banging on the door. No one's answering. I don't even think anyone understands where we are what's happening. So we got to break out. I opened the inner door. And then I managed to open up the outer door. We're in between two floors. My daughter, who's four years old, is with me. And she's a little savage and she's saying things like, " I think we're going to be stuck here forever, wouldn't it be sad if we died here?" Anyway, managed to get her out. And then I follow and then we decided to take the stairs back down to avoid the elevators, but there's feral cats and, and just excrement odor coming out of the stairwell. So that's not an option. We ended up taking one of the other elevators down, letting them know what was happening and then we went back up. Quite an ordeal but we made it out. And yes, it would have been much nicer to have had a person respond to our pleas for help instead of a family of cats. But that's why we'll be doing a hotel next time instead of an Airbnb. 

[00:08:43] We start to trip back home and that's initially going okay, I'm in pain, I'm taking NSAIDs around the clock, but I'm managing. I noticed my daughter's not eating anything on the airplane, which is very unusual for her. So we land. We've got about two hours before my dental appointment. And we get a ride home from a friend. We go into the lobby. My wife is holding her and then she just vomits all over my wife. 

[00:09:10] And if you could see the look on Kristen's face. Oh my gosh. It was this feeling of utter repulsion. But also trying not to act repulsed so that your daughter doesn't feel any more freaked out than she already is. And you know for us, if you've gone through medicine residency, vomit is really more like a Tuesday. 

[00:09:31] But I felt so bad for her. So she showered real quick. We left our daughter with our in-laws while she was still actively vomiting, because I need someone to come with me to the dentist appointment. And then we're on the way to the dentist. I'm calling Northridge getting advice from the nurse on what to do about my daughter. And then we make it to my dentist's appointment with Dr. Rachel Hubbard. She took some one look at my face and says in her professional way, "Your face is jacked, you need to see a surgeon." 

[00:09:58] So she immediately refers me to Dr. Chirag Patel who's an oral-maxillofacial surgeon. So I go in. He looks at me and says, " All right, my friend, this is bad, but I'm going to take care of you." 

[00:10:11] So I ended up having an I&D. The culprit tooth was extracted. I had bone grafting and I'm looking at getting an implant down the road. But, I'm doing okay. I'm on Augmentin things are getting better. 

[00:10:22] Takeaways

So what are my takeaways from this trip? That actually was a good trip, but just ended hellaciously. 

[00:10:29] The first is to make sure you have good travel insurance. If you're taking a big trip. I have purchased a policy and it was really nice to have the peace of mind knowing that if I had to change flights, if it got worse sooner, or if I had to go to the hospital, God forbid I had a mechanism to pay for that. And these days we know that travel can be canceled for a lot of different reasons, COVID included, so you want to look for Cancel For Any Reason insurance or CFAR insurance and I'll have some details about that in the show notes. 

[00:10:57] The second is that if you take international trips frequently, you should get yourself a credit card that has no foreign transaction fees. Arguably if I'd had that, I wouldn't have needed so much cash and maybe I wouldn't have gotten stuck in the elevator. 

[00:11:09] And the last lesson is really being on the other side of the patient-doctor relationship. Being in a situation where I really needed to help. And experiencing firsthand the power that we have to make patients feel at ease. I remember sitting in the oral surgeon's chair. Thinking about everything that I've been through in the last 24 hours. And finally getting to a point where someone could look at me and say, " I'm going to fix this." Despite everything, that was the most enormous feeling. And it was a good reminder of the position we have as providers where we might be having a regular day, but we have the potential to help people who may be having one of the worst days of their lives. It's worthwhile to remember the impact and the positive effect that we can have on our patients, just by saying, we're going to take care of you. 

[00:11:55] It's what put a silver lining to the end of my trip. And it's reminder of how special it is to do what we do.

[00:12:03] Outro

And that's our show! Thank you for listening to This Medicine Life. If you enjoyed the show, please subscribe, write a review, and tell a friend. We are available wherever you get your podcasts. This show was created, recorded, and edited by - me. Music is by Dr. Malcolm Lex. 

[00:12:22] Views and opinions expressed to not necessarily reflect the view of the University of Virginia or any other entity. Please send me your ideas for topics you want to hear about or guests you want to have on the show. My Twitter handle is my first and last name, @TaisonBell. Please stay tuned for the next episode. Until then, I'll see you around.