TRAVEL, AND YOU GET SICK, sooner or later. This truth is universal. I remember reading somewhere that the queen of England, when she leaves her country, always takes with her a certain number of units of her own blood. (Ordinary blood would be unsuitable, I guess, should the queen happen to need a transfusion.) Maybe that's just a myth. The fact remains that if you travel, no matter who you are, eventually you will be brought low.
Even when you're healthy, the dislocation of traveling is itself kind of like being sick. (Of course, this presumes that you're traveling somewhere different from the place where you usually are, a distinction increasingly difficult to make in the USA.) To begin with, in a different place there's the strangeness of time, exaggerated, almost always, by jet lag. Then there are other strangenesses of smell, of light, of currencies, of the way people dress and walk and smile or never smile. Sometimes just the sparrows flying around inside the terminal are enough to throw me. If you don't speak the place's language, or don't speak it well, a spine-deep queasiness comes with that, too. And when on top of everything you actually do get sick in this place, the experience is generally several times worse than it would be at home.
Worse, that is, and then better when you start to recover, you may feel a weird elation that's as great as your previous sufferings were bad. The only foreign country in which I've traveled much is Russia, and I've been sick there twice. The first time was in a hotel in St. Petersburg, the Oktyabrskaya, a Soviet-era immensity with doorways receding to the vanishing point down bleak halls, and room telephones like flatirons that always rang with calls from prostitutes half a minute after I came in and closed the door. Late one night, lying on the narrow bed pushed up against the wall (Russians love to sleep against the wall), I awoke in the direst kind of renal pain. I was clammy, contorted, and shaking so badly I could barely tie my shoe. Once dressed, I staggered out to the desk of the floor lady, at an intersection where two of the endless halls converged. (Most hotels in Russia have floor ladies, sort of like monitors, on every floor.) I told the floor lady I needed a doctor. Without the least show of sympathy, she said she would call one and ordered me back to my room.
I lay there. The doctor didn't come. I sweated, suffered, writhed. The lamps in the room were of a Soviet modern style, set flush with the wall so they cast their radiance upward like the lighting inside a coffin. At one point, despairing, I put on my coat and set out for a foreigners' emergency room in a far neighborhood mentioned in my Cadogan guidebook, but the floor lady caught me, berated me, and sent me back to wait some more. The doctor, when he finally did arrive, looked like one of the Marx brothers, from their early movies when they were young. He had a long white coat, wacky side hair, and eyes that seemed to rotate in opposite directions in his round black spectacles. He carried not a doctor's bag but a big black box, with shiny metal reinforcements at the corners. Inside it were row upon row of German pharmaceuticals in glass ampules that could be opened only by breaking the tops. I described my symptoms the best I could (he spoke almost no English), and he took out two ampules. They looked like something a Nazi would use to kill himself. The doctor broke the tops, administered the bitter, mahogany-colored contents to me, told me to drink lots of water, gave me his card, and left.
Whatever had afflicted me a constriction of the kidney capillaries, brought on by dehydration, was his diagnosis began to moderate. The light of dawn rose faintly in the room's high windows. The morning's first trolleybus went by on the street below, the sparks under its wheels throwing reflected flashes on the ceiling. The city's ravens started their morning ratcheting. In my sudden, growing feeling of non-illness, I became so grateful to the mad doctor, and so restored to myself, I almost levitated. Sinister-seeming foreign medicine was actually curing me. My irrational love of Russia returned, and I rolled back against the wall to sleep.
WHAT UNDOES YOU, USUALLY, is what you gulp. Once, in a bar in Montana, I held my hand against the glass of a case containing a coiled and rattling rattlesnake; if I could keep my hand against the glass when the snake struck, the bartender said, he would buy me a beer. The bet proved a safe one on his part, because it is in fact impossible not to flinch from a striking snake, no matter how thick the intervening glass or strong your will. When you travel, a similar deeply conditioned response occurs: You know the food is bad, the water dangerous. You discipline yourself consciously, stick to bottled water, eat only the mildest, most scrutinized food. Vigilance carries you through one trip, maybe several. But then in an unguarded moment you're hungry, you're thirsty, something smells good, the water from the spring looks refreshing, your reflexes take over and you gulp.
(Although, strangely, what sickened me that time in Russia was not gulping but caution. I had been so careful about what I drank, I became dehydrated from not drinking enough.)
And the result of gulping, most of the time, is that you come down with a certain ailment. This ailment is in fact the most common one that travelers get. It is so well known that it does not need to be named; you know the ailment I mean. Usually it is caused by food. It is disagreeable and inconvenient but not serious. It sneaks up on you no matter how careful you are. Sufferers usually recover from the worst of it in two to three days. In its commonest form I don't even consider it an illness, technically. It will not kill you. What does kill travelers is accidents (if you're young) and preexisting medical conditions (if you're old). These problems are rarer, thankfully. But in almost all travel stories, an unmentioned amount of the most common travel ailment can usually be assumed.
People who described journeys in former times, when one refrained from being gross in polite company or in writing, indicated attacks of the ailment with the word indisposed. A caravan trekker who crossed Asia, reached the Great Wall, entered China, and then ate his first-ever Chinese banquet might report that after the feast he "suffered a most severe indisposition." Many notable journeys involved these indispositions, usually left more or less blank in the tale.
Francis Parkman, a Boston Brahmin and Harvard grad, went west the summer after finishing law school, in 1846, to observe and live with Indians on the Plains. When he and his companion, Quincy Adams Shaw, reached Fort Laramie, in present Wyoming, Parkman became ill. His "disorder" was so severe he could hardly sit his horse, and of course he made slow progress toward the Sioux camp, having to dismount all the time. Parkman kept riding, on to the Black Hills, so ill at moments out there in the wilderness that he feared he would die. His intrepidity and persistence not only outlasted the ailment but made his book and, arguably, his later career as a great American historian. Shaw, for his part, came down with poison ivy and spent much of the journey back at the fort "lying on a buffalo robe . . . solacing his woes with tobacco and Shakespeare."
At least Parkman didn't have to deal with the great discrepancy in bathrooms that exists today. Presumably, using the outhouse at Fort Laramie (not to mention simply the bushes) did not differ a lot from similar necessities anywhere. Nowadays, though, if you leave America and travel to someplace interesting like Asia or Africa or South America (I'm sorry, but I don't consider most parts of Europe interesting), you encounter bathrooms that are an unimaginable nightmare. Most countries that are not America occupy a different universe, bathroomwise. A friend who travels in China and Nepal says that what the U.S. should send to foreign lands is not Peace Corps volunteers or World Bank economists but plumbers and plumbing supplies. In northern parts of Russia, where winter temperatures go to 45 below, liquids freeze so quickly that a kind of stalagmite effect occurs in the outhouse, rising up through the hole in the floor. . . . As the poets say, let us draw a veil across the scene.
The common traveler's ailment causes many of us to see more of this sort of thing than we're really interested in. But, as with a lot of unfortunate circumstances in real life, it could get worse. You could eat bad fish in Thailand and get liver flukes. I'm not even sure what liver flukes are, but you don't want them. You could consume a generous helping of a coral-reef fish that has been feeding on crustaceans rich in some bizarre nerve toxin, and absorb the toxin, and fall into a zombie state (real zombies ingest this toxin deliberately, I believe, in order to become zombies), and lie in a near-death paralysis for who knows how long, as happened to the novelist Saul Bellow. In his seventies at the time, the Nobel Prize winner went out to dinner on the island of St. Maarten, came back to the hotel, felt poorly, and lay catatonic for months. Don't order the grouper is the moral here.
So many maladies for you to catch! Malaria is still quite active in equatorial climates, and drug-resistant strains exist now. Web sites devoted to the disease feature constantly updated maps showing the worst malarial zones. Cholera, a frightening-sounding illness, waits in drinking water and kills by dehydration; if you get it, and can keep hydrated and take antibiotics, it goes away in about a week. Tick-borne illnesses thrive all over, in temperate as well as tropical lands. Serious versions of Lyme disease that can put you in the hospital may be found no farther away than upstate New York. In Russia, a certain kind of tick that lives east of the Ural Mountains carries a fever for which there is no cure. Camping in the summer in Siberia, I awoke one morning to find a tick the Russian word is pronounced "kleshch," a triumph of onomatopoeia kleshching to me. I showed it to my Russian companions and they assured me that though it was indeed the kind of tick that carries the fever, the insect is contagious with it only in the spring.
Giardia, a troublemaking intestinal parasite, does well in much of India and can be in untreated water almost everywhere. It turns up sometimes in the tap water in St. Petersburg. A tricky aspect of giardiasis is the time-lapse way it presents: You think at first you merely have the common traveler's ailment, until it goes on too long. Schistosomiasis, another parasitic disease, also waterborne, has similar symptoms. A swim in the Yangtze or the Mekong may give you a dose of it. Dysentery also resembles the common traveler's illness, only it involves blood. Typhoid, hepatitis, polio, SARS, avian flu I'm getting depressed and of course the various STDs threaten travelers. A male flight attendant for Air Canada was supposedly the first major international transmitter of AIDS. Even watching the Travel Channel and eating snacks causes arteries to harden and plaque to accumulate in your veins. There is no real hope anywhere.
TRAVEL RULES THAT I HAVE LEARNED, sometimes painfully: Eat no unwashed fruits and vegetables, and no washed ones, either. Salmonella bacteria can persist deep in the crinkles of a lettuce leaf. No fruits or vegetables should be consumed unless they're cooked to a fare-thee-well. Ditto all other food, basically. If it's really cooked, it's probably not bad. Bread is usually OK; also cookies. In general I try not to eat seafood except in the U.S. (and I've gotten horribly sick on it once here, come to think of it). Never drink raw milk, though it looks tasty and bucolic. Carry Wash'n Dris and wash your hands frequently. Once, after visiting the men's room (to return to that grim subject) in the Omsk airport, I used about eight Wash'n Dris, then for good measure asked my Russian friend to pour straight alcohol all over my hands as well as on the soles of my shoes. My God, that place. I never saw anything so gross.
Alcohol, in strengths you drink, does not purify anything. Ice in drinks is always a bad idea; luckily, foreigners aren't as in love with iced beverages as we are. Boiled water is safe for drinking, but opinion differs on the amount of boiling required. I've heard that water needs merely to be brought to a boil, and also that it should boil vigorously for ten minutes at the very least. A travel doctor I consulted before a trip to the Russian Far East strongly recommended the ten-minute rule, and I promised myself I'd abide by it not a practical plan, as it turned out. After an open-boat journey in wind and rain in early fall with two indigenous Chukchi guys across a fjordlike body of water on the Chukchi Peninsula, the guys beached on a rocky spit, tipped the boat on its side, got under it, took out a blowtorch, and lit it. Then they applied the blowtorch to a teapot, quickly boiled water, made tea, and offered me a cup. At that point I could not really request that they blowtorch it for ten minutes more.
The travel doctor I saw also told me to drink only bottled beverages if possible. "You can get bottled water everywhere," he assured me. Conversations in a clean, quiet anglophone doctor's office in North America don't always give you a clear idea of the actual situations awaiting you. You cannot get bottled water everywhere. In fact, the purpose of many journeys is to go beyond the places where you can. In Russia, knockoffs exist of many products. There's even a watery version of Johnson's Baby Shampoo, eerily similar to the original, down to the bottle and scent. Of course, there's fake bottled water in Russia, too. Russians sometimes laugh at people who insist on bottled water only, and tell them it's just tap water with a cap on.
For more advice on such subjects, I recently called Dr. Mark Wise, graduate of Britain's London School of Hygiene and Tropical Medicine, director of a travel clinic in Toronto, and author of a book about staying healthy while you travel. On the water question, Wise recommends buying bottled water in places where you can see many bottles of it and cases of it still sealed. Failing that, buy fizzy water. "Carbonation is harder to forge," he says. As to boiling, Wise is a bring-to-a-boiler; two minutes of a rolling boil kills most bacteria and parasites, while boiling longer wastes water and fuel at a tiny increase of safety. The Canadian-made water-purifying tablet with the brand name Pristine tastes better than iodine, he says, and may be used when no other means of purification are available. "Sometimes, though, you just have to trust what common sense says is OK," he adds. "You can also go too far being paranoid."
Wise became a travel doctor because of the movie Butch Cassidy and the Sundance Kid, which inspired him to take a backpacking trip around South America. Contemplating a volcano in Ecuador while simultaneously enduring an acute onset of the common traveler's ailment concentrated his mind on what could be done for the suffering traveler. Today, Wise is the travel-medicine consultant for several nongovernmental organizations as well as for a number of unaffiliated travelers, and at any one time he has many patients scattered in different parts of the world who are in touch with him by e-mail. "Even on short journeys, a third to a half of all travelers to the poorer parts of the world will get sick," he says. "Usually it's with stomach or bowel problems from dirty water or dirty food. If you can keep hydrated, stay near a bathroom, and let the illness run its course, usually it clears up by itself in a few days. But people e-mail me about many other health problems, too malaria, animal bites, vehicle accidents, falls. I had a fall myself a few months ago while traveling in Ghana stepped into a dry, dark sewer as I was walking along at night and screwed up my leg and ankle."
A traveler's problem that Wise deals with more often than you might expect is psychosis. "Psychotic episodes are more common in the younger age group," he says. "The antimalarial drug mefloquine can contribute to them. A kid will be in a faraway country, in a strange environment, maybe taking medications which can cause hallucinations, and he or she will lose touch with reality. These episodes sometimes occur even without an obvious chemical cause. Sometimes we have to send a psychiatric nurse to take care of the person and get him or her out of there. That's one reason I tell people they can't travel without medevac insurance. In a worst-case scenario, you want to be able to have your mother fly over and bring you home.
"When you're sick in a foreign country, there's generally a lot of chatter around you," Wise continues. "You may be treated with presumptive medicine, where a doctor or somebody guesses at the problem and tries to cure you by polypharmacy. Or else people tell you misleading things local things, herbal things to try. None of that is necessarily bad, but it clutters and confuses your mind. You want to be sure it doesn't cause you to miss something important. In the midst of all that, getting in touch with North American medicine, even by a simple e-mail, can be a bit of a lifeline."
I know what Wise means. Global culture, which carries you along when you travel, is powerful but blunt. It doesn't bother about details, especially human details. As we pass from country to country, we probably have no idea what the people around us are saying, and what they're thinking is ten times more mysterious. Often the best we can do is listen for tones anger, joy, fear the way animals do. This ad hoc approach is unreliable and frustrating. I've spent weeks among people where my grasp of what was going on with them, and vice versa, was a scrambled TV signal almost constantly. The mutual obtuseness wears everybody down and makes them mad. When you get sick, your condition isn't generic but specific. Not getting it exactly right can have frightening consequences.
ANOTHER ALARM IN THE NIGHT in St. Petersburg: This time I was staying at a friend's apartment in the middle of the city. The friend was away. Russian apartments are double-sealed against the world, with double windows and often double doors. The outer of the two doors to this apartment opened with a key a long and heavy one, like a movie jailer's, which needed the touch of a safecracker to work. The second, inner door had a knob but no lock or key, just a heavy sliding bolt you shot once inside. With this door bolted, a person in the apartment could keep out anyone, even someone with a key. When the first symptoms jolted me from sleep, I wondered fearfully and obsessively about those doors, in between jolts. Should I throw the doors open in advance for the rescue squad? I never had enough of a pause between symptoms to decide.
The pains squarely occupied my middle, like a bull's-eye. This had to be a heart attack. Self-diagnosis is an objective, grown-up skill I lack, but in this case, further symptoms, lower down rumblings, crampings, and other demonstrations made the problem seem not cardiac but gastrointestinal. Maybe it was both.
I had come to the city a week earlier to report on its 300th-anniversary celebration. I had walked many miles, seen the elephant, stayed up all through some of the white nights. The day I got sick, I finished the last of my reporting around noon, and then to celebrate bought a two-liter bottle of Baltika Beer my first mistake, as the kielbasa the color of machine grease that I'd bought to go with it was my second. Later, I went to dinner at a friend's apartment in a high-rise on a far edge of the city. My friend's wife made a dinner of which I ate a lot, because she had gone to some trouble and seemed to have a hard life. I took several helpings of salad, possibly not thoroughly washed. Everything I ate that day was suspect, the kielbasa most of all.
Spasms and more spasms these Russian germs were mean. They grabbed and shook me like a soda can. I'll skip the full details. After an hour or so, I ruled out a heart attack in favor of the common traveler's illness, with all the extras. Or possibly dysentery: I had a symptom of that, too. I tried to drink bottled water to stay hydrated but couldn't keep up. I was hot and shivering. During a short respite after vomiting, I dressed and made it out of the apartment relocking the outer door took the last of my concentration and then sort of sleepwalked through the city's strange boreal dawn, down empty sidewalks to a clinic I'd seen advertised in an English-language newspaper. The walk proved harder than I'd imagined, and by the time I reached the clinic, I was all in. I veered across the waiting room to the check-in desk and said to the nurses there, "Dumaiu, shto ia umriu!" which means "I think I'm dying!" an overstatement, but on the other hand they didn't make me wait.
You hear bad reports about every institution in Russia, including Russian medicine. True, this was a clinic for foreigners; but to me, in off the street, it could have been anything. It turned out to be great. A young doctor named Viacheslav Zuev examined me and took my temperature and gave me an EKG. Zuev spoke pretty good English, and when he couldn't think of a word, he would snap his fingers on either side of his face and pull it from the air. He put me in a bed in a single room with the lights dimmed and started an IV. In Russia, sheets are still cotton, not percale or whatever miracle fiber has replaced it here. The sheets on this bed were white, fresh, like in a 1950s bedroom, and the pillowcases the same. Above the bed on the wall hung a clock the size of a steering wheel. I watched it fixedly and barely moved, waiting for this particular moment to be in the past.
The biggest surprise, and the point of this story, was the nurses. Russian women, I should mention in an aside, are beautiful; anyone who has been to Russia recently can verify this. No explanation exists for this phenomenon; it just is. I won't go on about it at too great a length, so as not to seem weird, but there are many, many lovely women in Russia. Anyway, these nurses were up to the standard of their countrywomen and then went beyond it. In America, nurses are brisk, goal-oriented, and upbeat. They don't get paid enough, and they have too much to do, and they want you to recover and move on, and that's fine. But Russian nurses (to judge by these) suffer with you. These wore starched old-fashioned nurses' caps, like the false fronts of buildings, and modest uniforms with pleats. They looked like the nurses little girls used to want to be when they grew up. I forget these nurses' names Liuda, Sofia, and Elena . . . When they talked to me, their voices cooed sweetly and mournfully. "Oh, yes, life is very hard," their manner seemed to say.
I conversed with them slowly in my limited Russian, the sentences as if taken from the beginning workbook. Where are you from? I live in the state of New Jersey. Have you ever been to the United States? Where do your friends in the United States live? Do your friends like New Haven? Do they like to study at Yale? My wife's name is Jacqueline. She is not a Frenchwoman. She was born near Boston, in the state of Massachusetts. Yes, that is not far from New Haven.
These nurses were of the tradition that compares nurses to angels. They sympathized quietly, wholeheartedly, and from someplace unreachably high. They came and went, and I lay conversing in a disembodied voice. As it became clear that what I had contracted (salmonella poisoning, according to the lab report) was not going to finish me off, I felt embarrassed to have gotten so carried away. Americans are crybabies that's me. No doubt my nurses had seen similar behavior before.
The window of the room was open, and I could hear the footsteps of passersby on the sidewalk just a few feet away. The steps increased in number as people awoke and the day began. I lay there listening to the steps. Like the nurses, they were different from the American version. They were Russian-sounding, cossack-dance footsteps, every one of them. I would not have confused them with American footsteps in a million years. For hours I looked at the motion of the clock and listened to the Russian footsteps. By evening I had recovered enough to be discharged. I consider this one of the most satisfactory days I've spent anywhere.
All journeys bring to mind the truck drivers' adage "There ain't no easy run." When we travel, we think we don't want to get sick, but maybe, less consciously, we're not so sure. If nothing of note happens on a journey, was it one? Travel pursues romance, and romance requires the unknown an element in shorter supply now that technology is encompassing the world with ever-multiplying pings. The goal is not only to arrive at some numinous, far-off destination; it's to return to your usual place clothed in exciting unfamiliarity: You're the boy who lived with pirates, the girl brought back from the wilderness who has grown so accustomed to Indian life she had to be coaxed away. A key element here is the cool impression made on one's friends. Illness is a passage, and when it happens on a journey a passage within a passage it leaves you doubly transformed. When you get better, you feel doubly recovered and strong. Getting sick while traveling is one of those tricky accomplishments you simultaneously want to have done and don't ever want to do.