Back to London…

On my last morning in Paris, I slept in til all of 8 am. The morning started out with that crisp feeling that belies the coming of winter, but it warmed up quickly to a sunny 60-something degrees. My train was set to leave at three in the afternoon, which was something of an awkward time, since I had to be out of the hotel at 11 am. I didn’t want to go too far because of the time constraint (and because I had given all but one of my remaining Metro tickets to Anne, since I dragged her all over town last night), so I stayed in Montmartre. I went back up to Sacre Coeur, though I figured at that time on a Sunday morning, tourists wouldn’t be welcome in a cathedral. But it was open, though fairly quiet, so I went in and wandered around. At the statuette of Mary and the baby Jesus, I lit a candle and set it with the others on a stand outside the pews. Not because I’m particularly Catholic, or Catholic at all, but because some days it seems like there’s a lot to pray for.

I left the church and walked back around to the Place de Tertre and got a second breakfast of - what else? - a crepe, though I skipped the chocolate version this time. From there I took the slow route back toward the hostel, stopping at every corner to enjoy the view. This part of the city, despite its touristy aspects, has an old-town look with narrow streets and cobblestone passageways; every corner is a picture of past and modern mixed into the urban landscape.

Not ready to give up and go sit at the train station for hours, I remembered that the Montmartre Cemetery was just down the street. Last time I was in Paris, I stayed near the Pere Lachaise cemetery, where famous people from Oscar Wilde to Edith Piaf to Jim Morrison are buried, and I remember how intriguing the old graveyard was, aside from the celebrity aspect, for its ancient headstones tumbling slowly back to the earth. Situated in part underneath a busy overpass that shadow the south end, the The Montmartre burial ground is less known for its famous graves (the most famous monument is that of Emile Zola, whose actual body was moved decades ago to a more lavish resting place), but it has that same feel of stories untold, of names and dates, but not rarely more than a hint of what passed between. Some are very plain, some once fancy but now in disrepair, but they all speak with an eloquence of stories told in the bare rock that marks the graves. From behind one hill of newer marble markers, a black cat peered at me, but shied with feral grace at any approaching steps. If I were superstitious I might find that eerie, instead all that struck me was the pure aesthetic of sleek fur against the polished stone.

I made my way on foot back to the hostel, and from there by Metro to the train station. I didn’t want to risk being late, so instead I arrived early and waited out the hour or so until my train departed. Soon the French countryside was passing rapidly by my window, and then the dark of the tunnel, and then back into the light of the far side of the English Channel. Things started to become familiar again - signs in English, slight changes in the look of the land. And then, London. Returning home seemed disjointing - I had become used to answering everything in broken French, to getting around on the Paris Metro, to walking along roads where drivers travel on the right side of the street. It seemed like a let-down, and I realized how quickly I become spoiled - oh, how boring, going home to London! But it was also nice to headed to the tiny studio I call home - at least, a quiet place to sleep tonight. I got off the train, boarded the tube, and was at my doorstep in twenty minutes.

Finally, home.

TB Conference, Day 3

Saturday morning I was more successful at getting onto the right Metro line, though at the Porte Maillot station I had to show my ticket to the transit police (a regular and random occurrence throughout the Metro system). I pulled out probably six or eight cancelled tickets from various pockets until one of them finally proved to be the right one. Not so lucky for the guy in front of me on the escalator, who got one look at the transit police, turned, and booked backwards down the escalator at top speed, knocking asides several other pedestrians along the way. I guess he managed to get on without a ticket, though I’m mystified how people get through the turnstiles without them.

Again I arrived too late to catch the meet-the-experts session, though Anne did make it to the one that we had both wanted to see (from the plenary speaker from Wednesday evening, before either of us got to Paris), which happened to be cancelled. Apparently I didn’t miss anything.

Having missed that session, Anne and I went to see a talk on tobacco and TB, which is an area that I’ve been very curious about given that it’s so little talked about in most of the popular literature on the disease. The presenters gave a very strict review of the major literature, and concluded that there is some amount of moderate evidence that smoking both causes more susceptibility to TB and makes the progress faster once someone’s got it. Many irate audience member stood up and demanded to know how they could be so wishy-washy about what is clinically a very evident problem, as well as why some major studies were not considered (eg. one of the very prominent studies on this topic used death certificate data, which was not considered to be best way to tell if someone really died of TB or something else, and so it was excluded from the analysis). And of course, there one problem with any study on things like smoking and illegal drugs and the like: you can’t randomize people to smoke or not smoke, so randomized controlled trials are out of the picture. Any other study is considered second-rate compared to that type of study, so of course the data on smoking and ANYTHING is going to look wishy-washy. It was an entertaining exchange, in any case.

After a very interesting plenary session on the need to coordinate care for AIDS, asthma, and TB in developing nations (apparently, asthma rates go up as nations industrialize – partly due to industrial pollution, it is thought, but also because the entrance into the global market is inevitably followed by the arrival of cigarettes, which is thought to account for a large proportion of childhood asthma), Anne and I had lunch with Olivia, the former LSHTM student (now from McGill) who we met yesterday. She was scheduled to speak during the last session of the day, which seemed to be mostly graduate students giving a quick spiel on their research. She was nervous to the point of not wanting to admit that it was coming. I guess that’s one thing I’ve got going for me: I may be a mediocre public speaker (no doubt there: I talk too fast, and every other word is “uh,” punctuated periodically with some variety like “um” and “yeah”), but I do not dread public speaking. In fact, I rather like it. I think I discovered somewhere around seventh grade that if I was speaking in front of a group, everyone at least had to pretend they were listening to me, and that was a rare enough event that I kind of dug it. Still do. In any case, Olivia presented her piece very well, occasionally deferring to her advisor in the audience, who had done the literature reviews necessary to create her economic model on whether quantiferon (a blood test that is very sensitive and specific for TB) was an economically viable test for mass screening. Their conclusion was no, it was not. Too bad – a better test for TB is needed, but only if it gets cheaper can it be used on a wide scale.

After Olivia’s talk I snuck out to catch the last part of a session on ethical aspect of TB intervention (which has been a thorn in the side of TB researchers ever since the city of New York started jailing its high-risk resistant TB patients during an outbreak in the 1990s). This turned out mostly to be a discussion of the current situation in the Russian Federation, and it was conducted largely in Russian with English translation. This was a relief after some of the talks, where speakers attempted English but only spoke enough to read off their Power Point slides – it would have been more merciful on everyone just to use translators. The two I saw were interesting, but also pointed to one of the weaknesses of conference like this: many of the presentations are on recent studies and new data, and they tend to read like a chapter out of statistics book. I far prefer talks where the data is presented briefly, but the concepts, context, and larger lessons are emphasized. In any case, I had hit up this session to hear the last speaker, who was the professor from LSHTM who had first told us about the conference last week. I had given up on keeping quiet about ditching class, and figured that if I wanted to work on a TB project this summer, it might be nice to be able to mention to one of the big researchers at LSHTM that I’d heard his speech at the conference. Unfortunately, with the combination of my sleepiness and his pedantic speech (which covered all manner of philosophical approaches I had either never learned or tried to forget), I caught about half of it and spent the rest of the time struggling not to fall asleep. I’m not sure that did me any good in the kissing-up-to-the-experts realm, but at least I can say I was there!

I went to find Anne and the end of this session, who was talking to Olivia and her advisor, Dr. M, in the room where their session had just ended. Dr. M’s current research has to do with economic modelling, specifically on the question of whether the first-world recipients of migrating cases of TB from the developing world could save money by investing in health care in those nations themselves, rather than just treating the disease once it crosses the border. Specifically, they had just published an article in the New England Journal of Medicine that looked at costs in the US and several countries that feed immigration (especially Mexico and the Dominican Republic), where their modelling concluded that the US could save lots of cash by helping out those countries to keep TB under control so that it doesn’t leak across the border and into the US budget. Dr. M said they were pursuing lobbying on this front, and that at least in Canada they were getting a sympathetic ear from several federal representatives. I laughed – good luck getting anywhere with that in the States, at least under the current regime, which at the moment seems bent on “helping” the victims of last month’s hurricanes by cutting food stamps and Medicaid budgets.

In any case, Anne was busy finding out if there was any chance of getting together a research project for next summer under this project, and Dr. M was very interested. Part of the economic analysis involves quantifying costs of the disease on the patients who suffer from it (since TB takes months to cure, and is often debilitating before treatment is sought), and both Anne & I saw some intriguing possibilities there. She speaks French, but it turns out that wasn’t a help because the nations that he was analyzing were those that send immigrants to the US, the UK, Canada, and Germany, and though much of Africa speaks French from the colonial days, that’s not the population he wanted to look at.

I had just been standing there, but I saw a chance to interject that I spoke Spanish, and would that be useful somehow in collecting data in areas where Spanish was spoken? Anne told me later that she thought that he did a 180-degree turn when I said this, and was suddenly way more interested in what I had to say. I thought that was kind of funny, because I don’t consider myself a thunder-stealer at all (heh, though I’d like to know how to do that). In any case, we all exchanged email addresses, and Anne and I both left with the feeling that something good might come out of all this that would alleviate the stress of finding a project for this summer.

This whole project thing has been the one shadow over this program. Yes, we should all get some research experience, but the CID program has a big emphasis on sending students overseas to do work. Maybe this will be different because we’re all masters students and reasonably well qualified, but this rings a lot of my days at Prescott College, when the idea seemed to be: take a couple of classes, learn a couple of things, get an overblown sense of your own competence, and then run off to third-world countries to offend the locals. I really, really don’t want to deal with all that again. My suspicion that this was an issue was compounded when we ran into one of Dr. M’s collaborators, a Brit who had been doing work in India for years. Anne caught up with him and asked about doing Dr. M’s data-gathering at the site in India, and he said, without an instant of hesitation: No. Absolutely not. Then he kind of backed up a bit and said that he’d had some trouble years earlier with LSHTM people gathering data down there, sitting on it for years, then publishing it so far after the fact that it made India’s TB program look like it was still in the dark ages. His colleagues down there were offended enough that the refused to work with the school any more, and from then on they decided to use only Indian nationals to do that kind of work. He never said that it was a student that caused the problem, but he didn’t say it wasn’t. It just had that ring to it. So for me, finding a project that is based on tried and true methodology, and for which there are already willing collaborators on-site, would be a very good thing.

Anne had wanted to find something fun to do that night, being Saturday night in Paris, but we couldn’t find an internet café, and without any better direction, I steered us toward Montmartre and Sacre Coeur cathedral. I didn’t think she’d object once we went, since it is worth seeing, just for the spectacular view of Paris if nothing else. We took the Metro to Abesses, hauled our tired selves up those several hundred stairs to the church, and quietly went in among the tourists and the pilgrims. We sat for a while in the pews, the walked around toward the back of the chapel behind the main altar. When we came back around to the front, a host of nuns in pure white had gathered silently along the sides of the altar, and then they began to sing. In their draping robes and with voices floating in the ether of the church’s dome, they seemed closer to pagan worshippers than to modern people of a modern god. Even in the gaudiness of Sacre Coeur (whose stain-glass windows – replaced after their destruction during World War II – look more post-modern than traditional), one could see how religion in Europe forms an unbroken chain back far beyond the year zero, to a time when other worshippers sang to other gods in robes not so different from these.

From there we travelled only a few hundred yards to the Place de Tertre, where we must have spent an hour comparing prices at various crepe stands. I was starting to get an idea of just what a tight budget Anne is on, but I was also getting somewhat tired of walking endless circles around the plaza looking for the crepes that cost 3.50 euros instead of 4 euros. We settled outside on a covered patio, and shortly after we ordered a squall blew through and drenched the square in a torrent of rain as we dashed inside. At one of the highest points in Paris, every flash made me think of lightening, though I’m pretty sure that most of those lights were tourists taking digital photos of the passing storm. We passed the rainy time by eating “chocolate” crepes for desert, which are actually filled with Nutella and are so sweet they make my teeth itch, but which are worth every bite anyways.

From there I thought Anne would want to see the Moulin Rouge, and the neighbourhood called Pigalle was just down the hill, so we headed that way. After the requisite pictures of the neon-red spinning windmill, we stopped for her to get a toothbrush, which she had forgotten in London and was surviving without. Realizing that indeed, everything is less expensive when spending euros rather than pounds, I stocked up on hair care products and the like while she was looking for what she needed. After that we split up, she heading back to Republique and me backtracking only a couple of stations to Lamark, and said our good-byes until we met up again at school on Monday.

TB Conference, Day 2

I got up at 6:30 (well, 5:30 London time) - early enough to make it to the first session - but I’ve had a bit of cold hanging over me, and I decided after showering that the best thing for me to do was to try to get a little more sleep and get more out of the rest of the day, rather than haul myself across town early and fall asleep during the afternoon sessions. So I missed the 8 am “meet the experts” session with Anne’s former advisor, Anne Fanning. Her bent is always about the political angle – how can we turn good intentions into action – and usually I’m into that kind of stuff. But I figured I was not the best person – tired and sniffly – to sit around trying to come up with ways to get people fired up, when all I really wanted was a nap.

I did get up an hour or so later, grabbed a couple of croissants from the confused lady in the breakfast room (who I had totally confounded with my requests in Frenglish – and yes, I think I just made that word up – for breakfast to go), got to the Lamark metro station, and promptly got on the train going the wrong way. And not even by accident – I had very carefully reversed my route home last night and chosen the correct train for that, except that I came home from the south last night and the conference is far over to the western side of the city. Gaaah.

Back on the correct train, I got to the Palais de Congres well into the second morning session, but people walk in and out of these talks all the time, so I saw the last half of the session on contact investigations, ie. tracking down people who have been breathing the same air as known cases. This was fairly slow stuff, but ended on an interesting note with a South African who brought up the tough question of whether mothers with known resistant TB should breastfeed their babies – the pro side says yes, because a baby exposed to that disease in the home needs all the immune help it can get; but the con side says no, because those babies shouldn’t be exposed to the strong antibiotics that make it across into the milk. Tough question, with no good answer.

The next session was another plenary speaker, this one tackling the question of whether the BCG vaccine for TB will continue to work or whether its use (already marginal, in that it protects kids but doesn’t do much for adults) will fade as strains of TB change in response to the selection pressure of the vaccine. Another good question, which really just points to the idea that a new vaccine altogether is needed.

I didn’t run into Anne until I had gone to an early-afternoon working group session on migrant health and TB, an offshoot of yesterday’s session. I’ve run across this at other conferences, but I’ve never been exactly sure what a “working group” is supposed to accomplish. Apparently, this particular group’s leaders are also fairly adamant that they should still go on meeting every year even though they never do produce proposals or resolutions or any of that sort of stuff. Mostly, they just set up a listserve so that people working in that area can get in touch with each other to share info, ask for advice, etc.

We all introduced ourselves and our reasons for this interest, and after Anne & I spoke, the gal in front of us turned around and told us that she had graduated from our program at the LSHTM just a couple of years earlier. Another member of the small crowd was a third-year medicine resident from back east. When the session broke up, we four spoke in the hall for quite a while – the resident had some interesting things to say about working back east (mostly - and I’ve heard this before – that family medicine docs aren’t really allowed to do so much there as they are on the west coast, and that’s the main reason she decided on medicine instead), and Olivia, the former LSHTM student, had some interesting research going on that she’d be presenting on Saturday. She also works at McGill University in Toronto, which perked up Anne’s ears since she’s Canadian also.

Those two had much to talk about, but eventually we split up in different directions. The most interesting part of the various talks I popped into in the afternoon was a brief discussion of using a urine test instead of a sputum smear to rapidly detect TB cases. That would be a valuable advance, both because it’s hard to get kids to cough up gook out of their lungs when you want them to, and because certain groups of patients (eg. kids and AIDS patients) don’t have the immune system strength to stop TB in the lungs, and thus it’s hard to find in sputum even if it’s ravaging the rest of the body.

In any case, that finished out the day and I went to track down Anne, who was supposed to meet with a potential research contact from Zambia who didn’t get the email and didn’t show up. Instead she was chatting in Turklish (yes, I made that up too, that’s half-English half-Turkish) with an older gentleman from the migrant health session. I knew she’s been in Turkey for some time, working at an orphanage or something. She had a lot of questions, but I kind of lost the thread of the conversation, so eventually we moved on.

We headed back toward Saint Michel again, mostly because I didn’t know where else to go for cheap food. There are plenty of eateries along the Champs-Elysees, but none that would get us in and out for under 10 euros each. In Saint Michel we wandered a bit, considered about eight different ethnic varieties of food, then settled on an Indian place, mostly because we happened to be standing in front of it when we finally got too hungry to keep looking. The service was slow, but the ambience was good, if only I could get used to the fact that this is not San Francisco, and people are allowed to smoke inside, and that, annoyingly, is that.

And, plus, free entertainment: the five-foot-one manager of the restaurant we were at is apparently in a grudge match with the six-foot-two owner of the place next door over whose sign is over whose property line. This matter had little bearing on our choice of restaurant, but clearly those two took it seriously to have an actual fistfight, about two feet from our table, which I suspect is an every-other-night or so affair. Who knows, maybe they were just trying to impress the ladies. We were impressed enough to take up one of their tables for several hours while we yapped about TB and I drank wine spiked with fruit juice (Anne doesn’t drink; I’m not sure she missed out on much in this particular instance). Eventually we split up for the night, found our respective hostels, and slept off some bad wine.

Conference of the International Union Against Tuberculosis and Lung Disease, Day 1

I set an alarm but woke up before it went off after a mediocre night of sleep. With earplugs in, I hardly noticed the other people coming in, but still I did not sleep particularly well. I wanted to make it across town to the Palais des Congres by 8 am so that I could register before everything got started. I left too early to get breakfast at the hostel, so I had to grab something from a stand in the Porte-Maillot Metro station when I got there. I was able to register - which was not a big concern, but was something of a question given how late I decided to go. Two hundred fifty euros (about $300)...gulp. Oh well, I just charged it and will pay it off later. As one person encouraged me when I was deciding whether or not to go: I might be broke come June, but I'll worry about that in May!

Trying to pick which sessions to attend at a conference is always a fun challenge. An early-morning talk on migrant health - especially the problem of trying to track workers who are on the move during the six month-long standard TB treatment course (which, if interrupted, can encourage drug-resistant bacteria in that patient and anyone they pass it on to) - looked particularly interesting, so I went. It turned out to be very apropos - most of the talk was on the issues across the US-Mexico border, particular what happens when workers get deported in the middle of treatment, or are diagnosed during detainment. This was certainly not a new scenario to me (since Portland is on the I-5 corridor, and this is clearly an issue in the county clinics), but the programs to deal with it were innovative and fascinating - such as coordination between the Department of Homeland Security and the Department of Health to track migrants in and out of detainment. Another program worked to get repatriated workers to be met by TB treatment teams at their port of entry so that they wouldn't be lost to treatment during the transition period. I'd never heard of any of these program, and certainly it will be useful to keep those in mind when I go back to Oregon next year.

I noted the speakers and the organizations they came from for future reference. I also hid my face in my notebook for a good bit of the time, since half-way through the session a woman came in and sat a couple of seats down from me who I recognized as Delia, one of the researchers who had lectured to our class last week. Ooops! I did chat with her later in the day, so the precautions turned out to be moot, but I still wasn't entirely anxious to share the fact that I was ditching class for two days to attend the conference.

After that session, I found Anne out in the registration area. Her alarm clock had not gone off, so she had just arrived. We looked around a while, running into her former professor from Canada who just happened to also be the former head of the organization who was putting on the conference. Soon we went to the first plenary session, where a charismatic African-American woman spoke on the need to pull together the political will to start facing up to a disease which, despite technical obstacles, should be a 100% curable disease. She also outlined the newest technological advances on the horizon, which center on better diagnosis (since current methods rely on problematic smears as well as cultures that can take a month to return results), better vaccines (the current BCG vaccine is only partially effective, and no one really understands how it works anyhow), and more effective drugs to shorten the course of treatment from six months to, well, something shorter than six months.

That last part was interesting, because back at OHSU I had encountered a controversy between the general medicine doctors who wanted to use this drug (called moxafloxacin - kind of an amped-up version of cipro) for various infections and the infectious disease specialists who insisted on reserving it for its potential against tuberculosis. I was tempted to ask if there were any policy statements in the works in regards to this issues, but I held off in lieu of the fact that all the other questions asked were far more sophisticated, and by far more prestigiously-credentialed people than myself. I was also curious about how this drug - one of the most expensive antibiotics on the market owing to how new it is - was going to get into the hands of TB patients, who almost uniformly come from the poorest sectors of whatever society they originate from.

After lunch Anne & I split again, and I went to see a talk on the new vaccines in the pipeline. This turned out to be one of the less interesting ones I went to, since it was more biochemistry than anything else - what I wanted to know could have been covered in five minutes, and the rest was way over my head. Though obviously vital to the process of research, this kind of stuff is in the realm of what I decided I needed to largely ignore when I started medical school - if I try to stuff that into my brain, I'm going to lose the clinical things that I actually need to be a doctor. One radiologist at OHSU jokes about this with the analogy of penguins on an iceberg: you're iceberg doesn't have infinite space, and if you start getting too many penguins on it, they all start sliding en masse back into the ocean. OK, it's funnier when he tells it! The talk ended with a flamboyant southerner who presented some data on his work then ended with a grandiose comment on his supposed next project: coming up with a trivalent vaccine for TB, malaria, and HIV, which received the expected round of guffaws and giggles. Ha! A trivalent vaccine for TB, malaria, and HIV! Hilliarious! And that's when I realized that I have officially become a geek. I assume that will not be funny to anyone who can't claim equal geek-dom in the realm of infectious disease, but I was pleased that I at least got the joke, eye-rolling as it might have been.

At the end of the day, we met back up and without making any particular plans, we wandered away from the Palais des Congres with minimal directional sense of where we were going. After some amount of wandering, we finally looked at a map. Having wandered in several different directions, we managed to take a full hour to walk the few blocks between the Palais de Congres and the nearby Arc de Triomphe. We got our bearing, took a few pictures of Anne in front of the monument to send to her boyfriend back home (who is French by birth), and kept going. Still without any destination in mind, I aimed toward Saint Michel again, and we ended up repeated the epic walk I did last night, which after we did find a place to get cheap food. She had some kind of Greek dish and I had - what else? - a crepe, and we sat and talked for hours about class, the conference, and everything else. We finally cleared out when the cook/manager/cashier started glaring our way.

We walked around Saint Michel a bit more, deciding that we really had to have desert. This absolute necessity would be satisfied only by the Haagen Daaz stand on the corner. Anne had a long and somewhat esoteric discussion with the cashier in her passable but imperfect French, at the close of which the attendant charged her Visa 16 euros and gave her back a handful of change. Apparently they wouldn't charge a card under a few bucks, but after this negotiation, we got our ice cream and happily kept on our way. Thank goodness she is originally from a marginally French-speaking region of Canada, because my vocabulary would have run out right after I figured out how to say ice cream. From there we walked the very short distance to the island where the cathedral of Notre Dame stands. Inside the massive main hall of the church, a film was playing on a screen hanging from the ceiling. The rays of the projector splayed from the altar towards the entryway where we stood, spraying an eerie mosaic of multi-colored lights across the ancient walls of the cathedral. We stayed to watch for a few minutes, but exhaustion eventually won out and we moved back toward Saint Michel and the Metro station.

Before we split and went separate ways on the Metro, we made one last stop at a fruit stand. Anne is on a much tighter budget than I am (I knew this when we went, I just didn't realize exactly how tight until she told me explicitly - after which I tried to take on more of the expense, since it was my idea to go out and eat in any case), so she was trying to get some food for the next day. She picked up a persimmon and squeezed it a bit to test its ripeness, which brought the owner (a man of some unidentifiable race that is nevertheless almost certainly related to one of France's former colonies) running and hollering at her in his own heavily accented French to not squeeze the fruit. We slunk away before he could inform us loudly of any other social transgressions we had committed, amidst whispered comparisons to a certain soup chef from the show Seinfeld.

Back in Montmartre, I slept heavily but again not particularly well, which is not unexpected in the unpredictable activity of the hostel.

To Paris...

Last week, during class, one of the infectious disease professors mentioned that the big annual meeting on tuberculosis would be happening in Paris in a few days. I know I wasn't the only one whose eyebrows went up at that, but I figured at first that it wouldn't be feasible for me to go, between the expense and the time away from school and the fact that, heh, I wasn't really invited or anything. But I put it in the back of my mind that I might go. Later in the week, I talked with another person from the class (whose name I memorized as Anne-from-Canada in the first days of the course, when I still held out any hope of remembering everyone's name before the year runs out), who was thinking of going, mainly because her ex-professor used to run the organization who puts on the conference. But she didn't think she would be able to afford it, and I wasn't seriously thinking about it yet, so neither of us realized that we were both going until after we had both made independent arrangements to go. At some time over the weekend, we both had the same thought: cost or no cost, this is not an experience either of us would have time for again, and if we've come as far as London, why not go three hours further to Paris? And as far as missing school - well, someone would get the notes for us!

So on Wednesday, I left after the first class of the morning, caught the tube to the downtown Waterloo station, and caught the Eurostar train to France. Just under three hours later, I was in the heart of Paris at the Gare du Nord station; Anne came in a couple of hours later on a different train. From there I made my way to north via the Metro toward the neighborhood of Montmartre, where I found hotel/hostel Caulaincort just off the street of the same name. I had decided on a hostel to keep down costs. There was hotel very near the conference that was too expensive for me alone but would have been perfect if Anne and I had known that we were both going, but by the time we looked into coordinating this trip, they no longer had reservations open there. So I stuck with my hostel reservation, and for 24 euros a night, I couldn't really complain about sharing the room with up to three other strangers. The Caulaincourt was a little smokey and a little dingy, but having somehow missed the experience of staying in a hostel ever before, I was not disappointed. All I could think was: it's better than that hole I stayed in when I arrived in London. And, the shower was new-ish and very clean. And: free internet terminals in the lobby. Also a very good thing.

From there I went out walking, with some vague intention of finding something to eat. I came armed with my five key phrases in French: I don't understand French, Where is the bathroom, I want a sandwich, I want a crepe with cheese, and I want a hot chocolate. I find that this, used in the proper combination, gets me pretty much everything I need. I walked south, or at least tried to, and after a few turns around a hilly part of the residential area of Montmartre, I found the right direction. Much time later, I reached the Place de la Concorde, where I remember visiting once when I was 18 and in Paris with my mother, the first time I had been to the city. From there I crossed the river and headed east along a very quite Seine, toward an area I saw on the map that I seemed to remember from the last time I was in Paris, three years ago, just before I started medical school. I was entirely unsure if Saint Michel was the area I was looking for, but it looked right on the map and I remember it for its cheap, diverse food stands and restaurants. Along that route I looked up from the windy street to see the moon, just a few shades past full, rising through the thin clouds over the Lourvre, reflecting a dull light off the Seine itself. I didn't have a camera with me, and usually I don't regret that, but this time I did - I wish I could have captured that in a way that would never leave me.

In any case, it turns out that I was right about Saint Michel. After a good two and a half hours of walking through the chilly night along the tourist scenes abandoned in the mid-week evening, I found what I was looking for: cheap, plentiful eats. Even on a Wednesday in fall, when the rest of the river-side areas were eerily quiet, this little neighborhood was full of people, alive with smells of all sorts of food (since, oddly, Saint Michel is full of ethnic eateries, but of all sorts of ethnicities - Greek, Italian, French, Middle Eastern, Indian, even Mexican), and populated by people who speak enough English to communicate with foreigners like me, who can order a crepe-avec-fromage but can't answer whether I want to for there or to go. And that's what I had: crepe with cheese. It seems that every culture has some dish (quesadillas, grilled cheese, to name a few) that consists entirely of cheese wrapped in pure carbs, and I'll always go for that. Plus, in France at least, when you order something cheap with cheese, it's good cheese. No over-processed plasticized cheese substitute products, but real, good cheese.

From there I took the Metro back to Montmartre, since I didn't care to retrace the last couple of hours of walking, only backwards and uphill. Back at the hostel, my roommates were not in yet, and arrived long after I was asleep. It was a long day, and I slept well under the Parisian night.

Where there's smoke...

...there's me lighting my kitchen on fire. Well, not really on fire, because it was all smoke and no flame. I don't have a toaster, so I was toasting a bagel on the electric stove top, and I really didn't look away for more than a couple of minutes, but by the time I looked back they were black and pouring out smoke. I caught it in time to actually watch as the smoke wafted toward the ceiling, hit critical mass, and launched the smoke alarm. Several days earlier I had watched the building managers attempt clumsily to turn off a false alarm at the transformer box in the entrance way after someone smoked up the communal kitchen in the basement. I assumed that the alarm was a centralized event, so I got everything off the stove and started down the stairs to locate the managers and let them know it was under control. Half-way down, I realized that the sound was coming only from my room only, so I turned and ran back up to see if I could shut it off at the source. I pushed some things that looked like appropriate buttons, accidentally yanking it off the ceiling in the process, and finally it went quiet. Meanwhile, the room was filled with smoke, and I can see from taking a couple of breaths too deep why they say that smoke does more damage than fire. But, one good thing came out of it: I know the smoke alarm works. At least, it did until I knocked it off the ceiling.

As it turns out, fire alarms are sort of a social event around here. I met the French guy from down the hall when the building alarm went off last week, and the same evening after mine went off, someone upstairs set theirs off. The collective residents of my hallways (about half a dozen doors, only half of which are occupied) poked their heads out, and after determining that it was under control, we all introduced ourselves. The guy across the hallway said he was a little worried because that was the second time in one day that he'd heard the alarm. I rolled my eyes and told him the first was not to worry about - that little trick was my doing.

Which all brings me to this morning, which reads like a practical joke: unnerving at the time, amusing later on. I joined the gym in the University of London student union building, which is at the far end of the same block as the main LSHTM building. I did the work-out thing, hopped in and out of the shower, and was standing in front of a row of lockers wearing nothing but a towel when an alarm went off, alternating with an electronic voice telling everyone to exit the building immediately. Half a dozen other women were in roughly the same state of undress as myself, and we all kind of looked at each other, wondering who was going to be first to bolt to the rainy outside in a towel. We all probably thought that if given a moment or two, someone would come over the intercom to say it was a false alarm. That didn't happen. Instead, an employee came through the door in a hurry and told everyone in no uncertain terms to leave, now, no matter what they were wearing - just grab a towel and go. Fortunately, by that time I had dawdled my way back into my sweat pants and a sweat shirt, and I had the foresight to shove everything else into my duffel bag. At the nearest emergency exit, someone was pushing ineffectually on the door, so I went ahead and shoved through it. I was still fairly sure that it was either a false alarm or a minor problem, but still, I have no intention of dying in the locker room of a gym. As I was walking toward the school to find a bathroom where I could finish changing, a fire truck roared up, lights flashing. But by the time I came back down the street to the building where class is held, the truck was gone and the gathered crowd had apparently gone back in. False alarm, I suppose, despite the stern warning of the employee who told us to leave in our towels.

And that all brings me back around to one night, last week, when I opened the dumpster on the street to throw in some garbage. There inside the dumpster was a suitcase. One of those rolling things, about a reasonable carry-on size. It didn't look to be particularly old or beat-up, and it appeared to have stuff in it still, kind of spilling out the pockets. Hmm, I wondered, is this what they mean when they say, "Be on the look-out for suspicious packages"? Who throws a suitcase in dumpster? I mulled over the options: call the cops and be embarrassed when it turns out that one of my neighbors admits they just threw out some old luggage, or not call the cops and be even more embarrassed when the thing blows half the building apart (not my half - I'm at the other end, with a fire exit conveniently located at the end the stairs). The latter was not likely (especially since, though this is very close to where the bombing happened in July, it's actually a very quiet little neighborhood to the side of the main drag). More likely is that some tourist got their luggage ripped off and this was the skeletal remainder of their belongings.

In any case, I didn't call the police. The suitcase was gone the next time I looked in there, but so was all the garbage - whatever it was is now in the local repository for London refuse.

Vignettes from Hyde Park

With a gorgeous sunny afternoon promising outside my window, I set out for a long walk, destination Hyde Park. I remember being here during the snowy-cold winter when I was nine; a older man held seeds in his hand until it was covered with a teeming mass of song birds. That was more than 20 years ago; the man wasn't young then, and two decades later I suspect he no longer feeds the song birds from his outstretched palm.

I was mulling over this snapshot of a memory as I strolled through the park. At the western side of this open space, I slipped into a side garden, where a well-manicured square pond was gated off but with slots in the surrounding hedges to see into this miniature sanctuary where waterfowl swam unbothered. I sat down on a bench to take a break, and heard a voice nearby. I thought he was talking to me, but I quickly realized that the elderly man on the next bench down the way was chatting with the squirrels, asking them if they preferred peanuts or chestnuts. They apparently preferred both, in large quantity, and were happy to take it all right out of his hands. I suppose there are some things that have been going on for centuries and will go on until the end of civilization, and feeding the tame animals in Hyde Park is one of those things.

I continued on around the outer edge, passing by the children's park at the north end that has, among other things, a replica of a shipwreck crawling with dozens of thrilled children. Skirting the outside the kids' enclosure, I almost ran over a little boy, younger than school age, who was careening around in tears until he found a sympathetic-looking adult. To this random woman, he shouted through sobs, "I'm lost! I'm lost!" The woman, watching kids of her own, asked the little boy where his mummy and daddy were. He choked out the answer, "I don't have a mummy and daddy!" The woman looked about as mystified as me, but managed to get the kid to explain that he was there with another little friend's family. It didn't seem like there was much for me to do, and by the time I turned the corner two bobbies had been informed of the problem and were headed that way. I don't know what happened to the mummy- and daddy-less little boy, but he looked to be in good hands, so I moved along.

Past the lake where paddle boaters were out en force on the unseasonably warm afternoon, alongside the Princess Diana memorial fountain, over the grassy spaces where families nap in the rare sun. I exited the park as I had entered, through the northeastern edge and an area that goes by the name peculiar name of Speakers Corner. A better name might be soapbox corner, as this is a part of London that apparently has official sanction, or maybe just historical precedent, to be a gathering place for everyone who has something to yell from the rooftops, or at least from the top of a short step-ladder. All manner of outspoken folks show up, as do crowds who come more to heckle than to hear the spoken word. An African nationalist in a communist-era Russian fur cap and several dozen strings of Mardi Gras beads shouted about white men's diseases, at which one heckler shouted, "Alright, what about Asian bird flu?!" Another man was making no sense at all, but was wearing a baseball cap with what I can only describe as devil horns and a big white banana sticking out of the top; this was accessorized by a forty of liquor in his right hand. A woman in a wedding dress was handing out cookies, and though there was no evidence of her associations, it seemed to me like something the Scientologists might do. In one very quiet corner was perhaps the most inexplicable, a sign that said "Christian Atheists" and an apparently more reticent man wearing a sandwich board that said, "Reject god to follow jesus." Hmm...ok.

In a different corner was a more vocally religious crowd. I have to admit that despite all my politically correct intentions to the contrary, watching young dark-skinned men in semi-traditional garb shouting fundamentalist screeds with a Koran in one hand and the other hand in a clenched fist kind of makes the skin on the back of my neck crawl. Heh, almost as much as it does when I listen to white-skinned fundamentalist Christians shouting their screeds on street corners. It's all relative, ya know.

And that was my few short hours in Hyde Park.

Passing Seasons

The nice thing about living near downtown in London is that around every corner, there is something of historical or national or otherwise significance. Take today, for example. I had some errands to run. I went to the stationary store, dropped by the post office, and then took and hour-long swing through the National Gallery on Trafalgar Square. Oh, and that's the other nice thing about London: most of the big museums are free. Which is great for amateurs like me, because I can cope with about an hour of art-looking, and then I get bored. Since it's free though, I can take short jaunts through on different days and get to see much more that way - honestly, if I had to shell out 10 pounds at every museum, I'd probably just do without the art experience. Although I also have to admit that I haven't been into any given museum more than once yet - there's so many around, I feel like I might as well see a new one instead. So far: the British Museum, the Tate, the National Gallery and National Portrait Gallery, and...was there more? Probably...they all meld together after a while.

Last week I had happened by the crypt of the church of Saint Martin in the Fields - just off Trafalgar Square - where a photocopied sign noted that there would be a performance of Vivaldi's Four Seasons on the following Saturday night, tonight. I'd heard of St. Martin in the Fields before, largely due to a music academy of the same name whose performances frequently populate the air time of classical music stations everywhere. I'm not a huge fan of classical music, but if you know any classical pieces, you'd know the Four Seasons - if for no other reason, then because a large proportion of the 12 movements have been cribbed into the advertising world. I know this piece well - played a couple of abridged movements during my viola days, if nothing else.

So I went. I sat back in the cheap seats ("no view of the performers" warns the box office before you buy the 6-pound tickets), and even from there it was a stunning performance. The church is darkened to just candle light (ok, electrical candle light) for this concert series, and the 300 year-old walls echo with music not much older or younger than that. It was beautiful. It made me love London and miss home all at once.

Afterwards, I was walking back up Charing Cross Road (my flat is virtually a straight shot down Charing Cross/Tottenham Court Road from Trafalgar Square), stopped in a Borders Books (yes, they have those here too, often not far from the nearest Starbucks, *sigh*), then turned a corner to find dozens of people glaring at the sky. Because people are generally just glorified sheep, I felt the need to look up too. Rappeling from the top of the Centre Point highrise were two people, one hanging loose and the other sitting on a makeshift platform. I watched them come down 20 or so stories, and I believe they had started higher than that. I am completely mystified as to what this exercise was about. I figure it was either a failed suicide attempt or some kind of performance art. Given that someone was playing thumping techno music in the background, I'm going to assume it was performance art.

That was it for Saturday, except that I made a couple of phone calls to the States - through one of which I found out that one of my credit cards has been used fraudulently to order $3000 jewelry from Italy over the internet. Several other charges were also attempted, but all were rejected because whoever did it had the wrong expiration date. The account has been closed with minimal damage (none of the charges actually went through, so I'm pretty safe), but I have to wonder. Really. When you order something over the internet (say, for example, a $3000 brooch from Italy), don't you have to give a delivery address? And with the seller's computerized records, wouldn't that make tracking down the perp kind of a no-brainer? There must be something I'm missing here. In any case, this whole thing is a bit sobering, because of my other cards are also compromised, I'm kind of dead-in-the-water from a financial perspective until my financial aid check turns around - probably still 3-4 weeks from now. That's a bridge I'll cross if I ever come to it.