Baby Names

Descartar. libre albedrío. brigada. emocionante.

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I’ll admit, I didn’t think I’d be thinking about baby names for a while.

But it was a Friday afternoon, and Argenis, two visiting dermatologists, and I were sitting in the patient consult room looking at the large, blinking eyes of a 3 month-old baby. Her mother had come to get her baby registered with the local jurisdiction. This involved taking hand and footprints and signing a long, legal document–apparently this is something that can be done in your local doctor’s office. “What’s her name?” was our first question for the young mother, but she shook her head slowly. “I don’t have one yet.” I wasn’t too surprised as I had learned that this wasn’t too uncommon. But in that moment, Argenis took it upon himself to make a suggestion.

“How about ‘Ishani’?” he said, grinning my way. “She would be the first ‘Ishani’ in this region.” That, I’ll admit, was true. I had been frequently reminded that my name was rather original in these parts.

The others quickly chimed in, expressing their agreement. Being familiar with the often lengthy process that many parents (including my own) often go through when agonizing over the name of their newborn, I just stood there wondering if this was one big joke.

How do you spell it?” That was Argenis. I spelled it for him and watched as he wrote the letters neatly on a piece of paper and handed it to the young mom. Nope, not a joke. I was a bit worried at first, wondering why we were imposing my name on this child. As something that would follow her for the rest of her life, I felt unworthy to have been the reason for the suggestion. I was sure I hadn’t made some indelible impression on this child; rather, I had just been part of the happenstance of her registration. But in the end I decided that this was a happy thought more than anything else—this idea that this beautiful baby might share my name by virtue of the fact that our paths had crossed in this moment. She wouldn’t remember it, but hopefully someone would be able to tell her the story of her namesake one day.

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The doctors taking the little girl’s footprint 

Ishani, meet Ishani.” That was Alba, one of the visiting dermatologists. She held the baby in her arms and put the small, smiling face towards mine.

In a small community like Honduras, where the majority of people who live here have never left, many parents seek original names for their children. We had already come across many common ones. With regard to last names, for example, it seemed like Roblero Roblero were the second and third names of practically every other patient who entered the consult room.

I snapped out of my reverie. That was it. The young baby was registered and ready to set off into the world. I had been loving observing the consultations during these past days which were dedicated to problemas con la piel (skin problems), since the visiting dermatologists were in town. I had walked with Argenis to the neighboring township to deliver the written announcement just the other day, and could hear the call for patients to come visit the specialists blaring over the community loudspeakers. And so, they came. No two cases were the same and I saw everything from harmless sun damage to C.R.E.S.T. disease. But this one visit from a young baby and her mother left an even deeper impression on me. The ability to share a piece of your story with another person and to hear theirs in turn is at the heart of the clinical practice and the unique relationship between a doctor and patient. Whether in the form of a name or a conversation that leads to the correct diagnosis, this ability to be so vulnerably giving has always been one of the things that has fascinated me most about clinical medicine.

As the young woman left with a small pink blanket wrapped around her baby girl, I wondered whether I was saying goodbye to Ishani Roblero Roblero.

She certainly would be the first. :)

 

days like this.

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When you don’t need to worry there’ll be days like this

When no one’s in a hurry there’ll be days like this

When you don’t need an answer there’ll be days like this

When all the parts of the puzzle start to look like they fit

Then I must remember there’ll be days like this

Van Morrison’s smooth voice comes out crackly and crisp all at the same time as I catch myself pausing to listen closely. His words from a bygone era, his tone so calming. Well my mama told me there’d be days like this. He sings of days that are just what they are, normal, cascading like hills into each other, hurried by neither crisis nor deadline. Just days. Slowly fading.

It’s this song that I find myself dialing back to again and again as I sneak into my cocoon, up to my eyeballs in things that need to be read and assignments yet to be done. I feel a certain calmness that I never used to. A sense that as I remember someone once telling me: this too shall pass. 

These next three weeks look like they will bring the perfect storm of deadlines and midterms and last minute trips and visits. Before, I would have freaked out- or at the very least might have hid under my covers. Oh all the things I have to do I would lament. But now, things are different. Maybe it’s age. Maybe it’s maturity. But I’m a little calmer, a little more at peace. Not so hurried. Nor so worried. Willing to take a risk even, to step out of line.

I was watching the Ladies long and short programs the other day in NBC’s Sochi coverage and was thinking about that first 30 seconds at the beginning of any program, when it’s just you out there on the ice waiting for your music to start. When I first started skating, I’d flinch in those 30 seconds. No way is this going to work out, I’d tell myself. Just like I used to say this week is going to be a hot mess. But as I grew to be a (more) seasoned skater and competitor I started to enjoy those 30 seconds, the calm before the storm, when you can see everything (or almost everything) lying right there in front of you, the jumping passes, the intricate footwork, the simple crossover. And then the music, it begins. And you, you skate. But in that first moment of dead silence, it’s just you and the ice. The audience stares back at you just as you stare ahead, at peace, ready. And then when it comes, the music that is, you push off. Those first few steps very well might determine the rest of the program. But in that moment, if you get it just right in competition, it’s not a moment to be scared of, its a moment just like another day, a day like this.

 These next three weeks are my long program, tonight is the 30 second pause. And I’m choosing to savor the calm that I feel right now, the haste I know will come, and the sweet reunion with my sister and family I can’t wait for on the other side. Happy start to your week sweet readers!

Arco iris

Apenas. Redactar. tibia. friolente. arco iris.

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I’ll admit, I still haven’t gotten used to it. I was sitting in the “ciber café” (internet café) in the small community of Honduras where I’ve been living, minding my own business as the words of Gutmann lazily moved down my fluorescent screen. I was trying to finish my readings before tomorrow’s class with Professor Kleinman. Argenis walked in. “¡Hola!” I said, averting my eyes from Gutmann for a moment. We had parted ways after clinic hours had ended and he had clearly returned home to freshen up; I could smell the shampoo as he trailed into the room and came to stand behind my shoulder. I had noted that his face was rather close to mine, but assumed that he was just leaning over to see what I was doing. He lingered for a moment and then crooned in his characteristically goofy way “bésame, bésame, bésame” or “kiss me, kiss me, kiss me.” Oops! I had forgotten. I gave him a quick peck on the cheek as a smile broadened across my face. I couldn’t help but laugh softly to myself.

Now, before you get any ideas, a quick on-the-cheek kiss is the traditional way of greeting someone here—whether you’ve just walked into a room or just woken up in the morning. What a beautiful way to begin the day. And I’ve slipped up (that is, forgotten to reciprocate the gesture) more than a few times now—let’s blame it on the typical “I’m American; I’m going to assume I have a personal space bubble” trope. I’ve learned over time that this concept generally doesn’t exist in the other countries I’ve visited—and Mexico is no exception. Needless to say, the lesson is this: if a Mexican approaches you and leans in, just assume that you’re supposed to give him (or her) a kiss.

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The community of Honduras has surprised me in many ways. Sure, you have the momentary shocks of surprise when you see a speedy internet connection juxtaposed with traditional stone hearths and mothers patiently making tortillas from hand-ground corn. But more generally, I’ve been surprised by how easily I’ve been able to slip into life here. Though I once spent a summer in Tanzania, working and traveling throughout the country, it is here in Mexico that I’ve had my first true “homestay experience,” as they call it in all those glossy study abroad brochures. One colloquialism I’ve learned recently is particularly apt here—qué fancy. Yes, how fancy indeed. But the reality is far more simple, and the experience about far more than simply “staying in a home.” In the home of Doña Lori, where I’ve been living, I didn’t come to see it as the “homestay” that those brochures had promised on my first night.

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The home of Doña Lori and Ciro

When the young Fernanda (Doña Lori’s youngest daughter) led me to my room on the night I arrived, I pushed open the tin metal door to be greeted by well…nothing. I was content to see, though, that this stone-walled room still had the few basics I would have requested anyway: a lightbulb, a mosquito net, and an outlet (my macbook would be happy). The rest was for me to fill in. Plopping my Thermarest sleeping pad on the ground along with my Armadillo pillow, I pushed my suitcase to the side and settled in for the night. Simple, yet comfortable. I could get used to this. There wasn’t a proper wall separating my room from the kitchen and so I could still hear Doña’s pots and pans and perhaps the last few thuds of a few of her glorious tortillas hitting the top of the stone oven as I drifted off to sleep. It was 9:30pm. Qué fancy. I would be sleeping like a queen tonight, and it only took a sleeping pad to do it.

The next day I would be meeting Argenis at the clinic to begin my day. He’s the pasante (social service year physician) who works in the community clinic here. Since meeting him at orientation back at the CES office, I had sensed that this quiet, yet funny and always kind new doctor could be a friend. I’ve been so grateful for his guidance as I navigate a community that he’s lived in for the past six months. And so, in so many words, that’s how I’ve come to begin life here—in a new community and in a new home.

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And one last thing before I sign off— today was a typical day at the clinic by most measures, though there were more patients than usual on account of the many salesmen who were in town today. It was something like a small-town fair in the community. Argenis and I were sitting in the nurse’s office at the clinic. It was near closing time and all was quiet. Suddenly, Argenis heard a soft pelting from above. “It’s raining?” he said, his question mark hanging in the air. I shrugged it off—it couldn’t be. I could see the strong rays of Mexican sun streaming outside from where I sat.

Argenis got up suddenly and bolted outside to check anyway. Yes, indeed, it was raining on this beautiful town tucked within the mountains. I ran outside too, knowing that this combination of rain and sunlight could only mean one thing.

And so, there we were, two hopeful people standing in front of the clinic and gazing wistfully at the sky. We were looking for the arco iris—it would be my very first Mexican rainbow.

Qué fancy.

Retreat.

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It’s nice every now and then to get away. A swing set. A skating rink. Some days anything will do. As I grow older I find myself carving out more of these moments to sneak away.

I had a close mentor tell me last semester: I try and get away so that when I come back I see reality – for what it is. He made me think about how reality is a funny thing. How even as I have been on a retreat this weekend in New Hampshire, I catch myself zoning out of all conversations only to lend my ear to all of them from above. To pay close attention to the words people say, that they choose. A form of expression we use often but consider little.

I should have known that a retreat to New Hampshire with a lot of politically minded folks would lend itself tophoto 1 conversations with few gaps and many spaces, topics that range from Medicare to the withdrawal from Afghanistan, the prettiest sunrises we’ve ever seen and the Rohingya’s problem in Myanmar. But somewhere in between, I’ve found myself taking a backseat to these conversations and really treasuring what people have to say here and how they choose to say it. Words simmer through the air without much restraint. And I find myself listening, really listening to so many different voices in so many different arenas, from so many different backgrounds. It is a treat, this thing we call conversation – I’ve remembered this weekend why for so long it has been what sustains me, what keeps me full.

In subtle ways, I’ve see in the course of this weekend how college has changed me. I used to always want to be the loudest person in the room. Now I just want to be at the edge of it. My ears pressed up against the window – I want to hear and see… everything. As I unpack with my mind problems that have always chased me, I see things now with richer dimension, with a view to the actors, to the implications, to the people that are on the other end of the line when something goes wrong. I feel within me a sense of soft confidence that wasn’t there before, a confidence that whispers in my ear that sometimes I need not fill empty spaces with unnecessary words. A confidence that has given me a sense of direction, the freedom to sit with problems in my head, to wrestle with them—and with people :) – and to step back every now and again and just, what was the word, observe.

Happy President’s Day sweet readers (and for those oceans away, I hope this marks a good start to your week!) Missing Ishani a lot these days – realizing that in between bursts of conversation its nice to have that one person in the room who you don’t have to say anything at all to. Cause she already gets it.

xo Inesha

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Oro verde (green gold)

Despulpador. sembrar. ingreso. acopio. molido.

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Bienvenidos al estado del café. Welcome to the state of coffee.

Moi couldn’t have said it better. He recently took us to CESMACH, a coffee cooperative that is located just a few blocks away from the CES office. Having been raised the Sri Lankan way, it is tea that I drank all the time as a child, so I’ll admit that my knowledge about the difference between blonde roast and gourmet and organic is unfortunately limited. But while here, you can’t help but learn about “green gold”–as they say in Chiapas when referring to coffee– as it is the main cash crop and source of livelihood for the state’s many subsistence farmers.

As for me, my trip to CESMACH involved several hours of learning about everything from the proper way to toast coffee to the process in which coffee testers evaluate taste, smell, acidity and much more.

Two things in particular that I learned & loved:

  • There are 3 stages of smelling that must be completed when testing coffee. Seco, mojado, and rompimiento. Bending low to the spinning marble table before him, the guide who was showing us around the cooperative closed his eyes and took a deep whiff of the steaming hot coffee before him. You can’t touch it, he advised. Moving to the right, he bent down and did the same to the next white porcelain cup. These cups were lined up along the edges of the table, and each whiff was a means of discerning what seemed like intelligible differences between one brew and the next. For me, maybe, but to him each whiff told a different story about this particular coffee variety and where it came from. I’ve never seen such an intimate experience in smelling before but it was incredible to witness. I like to think my sense of smell is even a bit better for having given it a try myself.
  • I learned that there is one type of coffee in particular that is called “Café femenino”–it is produced exclusively by 175 female coffee growers in the region. Some are widows and almost all are  impoverished as they provide for their children in an occupation that is generally considered men’s work due to its physical burden. Our guide (Moi’s friend) told us that there are a few companies that choose to buy this coffee exclusively from the cooperative in order to support these women. I absolutely loved that. This reminded me of Inesha and my work with GrowLanka. Having the chance to meet some of these incredible women and hear their stories was icing on the cake.

A few pictures below!

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The novelty of journalism

I was reminded today of just why I love having a blog. I was glancing at some of my old posts from my summer working with a healthcare NGO in Tanzania 2 years ago and I came across this from June 9, 2012,

The excitement threshold, along with our expectations of what constitutes a “novelty,” rises exponentially in the middle years of our life trajectory. At 4, we can easily be entertained by the spinning wheels of a tricycle. And at 60, people like my grandmother and the medical professionals we have been working with during the mMaisha training sessions are positively glowing with giddy excitement at the concept of a successful email correspondence. Perhaps this phenomenon is limited to the world of information technology—but nevertheless, the elders in our life are noticeably more willing to be excited.

And what about us? The 20 and 30-somethings who are still figuring out their way, or perhaps are a little too confident that they have already found it. Maybe you can ascribe it to the typical youth angst and skepticism that characterizes this age group—the portion of society which keeps the institutions accountable since they will be the first to take to the streets should something be asmiss. For those of us who are in this age group, the excitement threshold is high.

Sitting at a desk in the Compañeros en Salud (CES) office in Mexico, I  wonder if I still agree. Do I still think it takes a lot to elicit excitement in a 20-something such as myself? Well, I do think (for me at least) that it generally takes something with a bit of novelty about it to get me excited. But I’ve now decided that what is of more consequence is how exactly I go about defining “novelty.” 

Let me give an example.

The worlds of global health, journalism, and Spanish language study have long interested me, but what I have realized in my time here is that it is incredible what novelty can be created in making something just a little different than it was before.

Stephanie Khurana, a woman I’ve always regarded as a brilliant and compassionate House Master at Harvard, once illustrated this point by using the following example in a talk she was giving. She explained that she realized her love for entrepreneurship as a child, when she used to sell strawberries by the carton in her neighborhood. Her profits were solid, she shared–not remarkable, but decent considering her market access and available resources. But one day, she decided to use the strawberries to make a strawberry pie, and then sold that instead. She had created value, and hence the novelty of the entire endeavor. Her profits skyrocketed (keeping this in perspective, of course).

When I met Rocío, the fiery red-haired Spaniard and volunteer journalist working in the CES office, I was excited to hear of her adventures traveling the world and writing about what she encountered. To use her pen as a means of reconciling viewpoints and uncovering truths—it seemed nothing short of idyllic. And she wanted my help with an article she was writing about the case of one particular patient with severe manchas (skin discoloration) that CES had recently treated. I had long been enamored by global health, journalism and Spanish– not to mention the chance to now learn more about her life–and so I gladly agreed.

And here, I realized that my opportunity to add value to Rocío’s endeavor was in fact an additional definition of novelty for me. Maybe the topics and the exercise were old, but the opportunity to combine these three worlds and to work out the unique rhythms of an English-language and Spanish-language news article allowed me to refashion what I had already experienced into something altogether new. I was already excited.

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Back and forth, between Spanish and English, Rocío and I talked. We found points of agreement and many more of debate as we tried to find the right way to express certain phrases in English and give them the same sentido in Spanish. And through these two languages I learned about the patient whom Rocío had been reporting on and how and why journalism in the field of public health so fascinated her. Much of what she said resonated with me–no translation needed.

I love and have always loved telling stories. Language–whether English, Spanish, or my parents’ native Sinhala–is incredible in its versatility. I hope that refashioning it around a story will always be one of the ways in which I create value. And for me, there is endless novelty in that.

Best seats in the house

Pacientes. un bebé chulo. quirófano. disparejo.

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I’m not accustomed to eating breakfast this way.

Steaming coffee perched on the makeshift table to my right, an omelette made with quesillo and tomates from the small tienda down the street, and Moi and Kevin giving an impromptu concert in the welcome area of the CES office. Breakfast has always been my favorite meal of the day, but on a typical weekday morning at Harvard, I know that I would most likely be eating it alone and–I confess–while perusing the news on my computer. The very idea of doing that here seems blasphemous. In Mexico, the rhythm of life is different, slower, and–at this particular moment–happened to be playing along to the beat of a soft guitar and drums.

But the rhythm I seek to describe here is of a different kind altogether. Let’s call it disparejo (bumpy). We started out early yesterday morning. The pickup truck was packed and ready to go (‘dispensas’ or food baskets for the community health workers had been packed in the back) and there were five available seats in the truck itself. I was eager to return to Honduras, the community where I will be spending the rest of the semester and where I will be focusing my research. It is a quaint community, where the pastelería and the lavandería and the peluquería are all located within a stone’s throw from one another. It’s the kind of place I’ll get to know by foot.

But first: getting there.

Hanna and I knew that there wouldn’t be enough seats for the seven of us…and so, two would have to ride in the bed of the truck. I was reminded of the many forms of transportation I experienced in Tanzania (from boda-bodas to dala-dalas) and I figured that this would be something I could handle.

To the back we went.

With hair tied back, sunscreen on, and the best of attitudes, Hanna and I squeezed in between the dispensas to settle in for the ~3.5 hour car ride. I know my mom would have expressed her reservations (or rather shared her cries of disapproval) but no matter how much dust or sun or stares came our way, I am convinced that we truly did have the best seats in the house.

This, after all, was the Sierra Madre.

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The laughs kept coming as Hanna and I bounced our way along in the bed of the truck, getting a feel for the beautiful landscape of Chiapas as it flew past. At moments the sheer ridiculousness of our situation left us in stitches; at others we were quiet as we soaked in the scenes around us. And of course, there was plenty of Spanish in between. The truck would come to a halt in one small pueblo or another whenever we needed directions but before long we were off again, no doubt leaving many passerby confused as to what these two foreign-looking chicas were doing gazing starry-eyed at the world around them. It was one of the best rides I’ve ever been on and I couldn’t be more grateful that Hanna was my companion through it all. We’ve literally climbed mountains together.

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Sights along the way

Upon arriving at the Honduras clinic, Héctor’s was one of the first voices I heard. “¡Hola Hola! ¿Cómo te va?” he said with a broad grin. I had seen him greet his patients with the same amount of joy and sincerity practically swelling up from within him. I hope I’ll greet my patients like that one day.

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The nurse’s station at the clinic in Honduras

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The pharmacy located across the street from the clinic

He was busy though–today was ultrasound day in the community. One of the three rotating ultrasound machines was currently stationed in Honduras and I could hear the speakers blaring outside to alert the community. “¡Señoras, señoras!” It called for all of the pregnant women to come to the clinic for what would be their only chance to see their children before the rest of the world did too. The flow of patients was continuous and Héctor, the visiting medical residents, and Argenis (the pasante assigned to Honduras) were all running around in order to keep up.

We decided we would come back  a bit later. After we had eaten, I decided to accompany Iván while he conducted interviews for his mental health project. Iván is a current medical student from Mexico who has been working with CES since January to develop a mental health course that he will be delivering to patients of depression in Honduras in a few months. Mental health issues are infamously ill-addressed in resource-constrained settings, and so I was happy to see that CES was putting so much emphasis on it. And while I have conducted interviews for articles and other research projects before, I had never done so completely in Spanish (and certainly not when discussing such tentative topics). I was eager to learn.

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Iván and a patient after conducting the first interview

Later in the day, Héctor was kind enough to introduce Hanna and I to a local partera (midwife) who told us that she has been delivering babies for over 40 years. She was more than happy to share some of her most memorable stories, waving her hands for emphasis as she explained some of the local birthing practices in the community. As I watched her share the experiences of a lifetime with the two strangers who had just walked into her living room, I couldn’t help but think that her energy seemed positively boundless. How wonderful it was that so many children had been brought into the world under her care.

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Una partera

As we left the home of the partera, Héctor, Hanna and I didn’t make it far before we saw a father approach us with his daughter in tow. Looking at Héctor, he began to explain that his daughter had a small protrusion on her ear and that it had been bothering her for some time now. He was looking for a doctor. Soon, another child was standing before us, seeking answers that he and his parents usually didn’t have an opportunity to seek out. Héctor gave each of them his time, no questions asked. No matter that he had other work to attend to nor that he wasn’t being paid for his time nor that he could have easily asked the patients to come to the clinic tomorrow–he was a doctor who could provide answers today.

I watched him with admiration. I knew that a similar query from a passerby to a doctor would probably have ended very differently in my hometown. Myself and most of the people I know are accustomed to having access to regular medical care, making appointments, and viewing time as a resource too precious to waste–especially when it comes to the healthcare system. But in the communities of the Sierra Madre, the freedom to escape from the pressures of a ticking clock is one of the things that I have appreciated most. I knew that Héctor would see every patient that approached him.

By the time we left Honduras the sun had fallen, and so I knew that our drive wouldn’t have us back in Jaltenango till near midnight. I stared out into the darkness as we retraced our way back through the mountains, this time carrying a patient from the community who needed to go to town for a referral. I could still see the mountains towering above us in the distance. Dark though it was, somehow they seemed familiar to me now. And they also gave me space to think.

My mind flashed through the scenes of the day–from the emphatic gestures of the partera to the baby chick I had held in my hand to the faces of the women Iván and I had spoken with. CES was providing healthcare here, where no doctor had come before. Miguel (a medical resident and our gracious driver for the night) explained that there are at least fifty more communities on the waiting list to receive a doctor. Town leaders have driven 4-5 hours to visit the CES office and to offer food, housing, and anything else that they are able to in the hopes that they too could have access to medical care. It was heartbreaking to hear.

And yet, even in the six communities that CES currently operates in, there are still misunderstandings and conflicts between the doctors who come from afar to deliver medical care in a community that they can only come to know with time. As much as they are providing a much needed service, the risk of their committing cultural gaffes is not uncommon. I may have studied the importance of cultural competency from my books and in reading the ethnographies of others, but I had never seen the concept unfolding before my eyes in real time. And CES, too, is not immune.

I knew that I would observe many more of these issues and various means of resolving them in the coming weeks and months. But in those moments, I was tired. Slowly blinking my eyes open, I realized too that we had long ago left the mountains behind.

In  a few moments, we were walking sleepily from the truck to our rooms. I could still see the beautiful views of the Sierra Madre flying past as my head hit the pillow.