Thinking

It finally rained in Kathmandu. Now we can use more than just one bucket of water to bathe!

Thinking

I have eaten 8 billion Jelly Belly's in the past day. Soooo nauseous.

Blood

The past few days, Megan, Joyce and I have been on rotation in the Gynae Ward. On Monday, we spent the morning looking at cervix infections, yeast infections and pregnant mothers until the gynocologist invited us to follow her to the post-natal ward. Two mothers had given birth earlier that morning, and she was going to check on them.

She walked up to the first woman, directed her to spread her legs, snapped on a glove, and started poking around inside the woman. After a few seconds, she started scooping out large chunks of membrane and placenta, which spilled out onto the bed and ground. The four other patients and their families crowded around and watched, as she finished pulling out the remaning membrane, and then moved on to the next patient.

After finishing in the ward, we went back down to meet with other patients. A girl, about 15 yrs. old, came in with her friends and boyfriend, and discovered that she was pregnant. Without even considering it, she immediately signed the sheets and paid for the abortion. So, Megan, Joyce and I watched another abortion, and then went to lunch.

After lunch, we went into the ER, and immediately ran into a woman with a heart rate of 243 and climbing. The other interns were in there, watching on as four doctors and tons of nurses ran about, injecting her with Adenine and Verapamil, and trying to check her blood pressure (almost non-existent.) The woman's heart rate peaked at 300, but after a few minutes on the drugs, her heart rate dropped to almost completely normal.

Pokhara, the novel.

On Thursday afternoon, five of us (Megan, Joyce, Nate, Amanda, and I) decided to go to Pokhara, Nepal. To get to Pokhara, one takes the same rickety bus down the same terrifyingly steep road out of Kathmandu, as if one were heading towards Chitwan. However, this trip is different, as it heads more west instead of south, and climbs higher into the mountains, instead of going into flat lands.

Pokhara is a small town located in the foothills of the Annapurna mountain range. On a good day, you can see many of the famous mountains, but more often than not, it's too cloudy to see a single peak (while we were there, we only briefly glimpsed Macchapucchre.) Besides the mountains, Pokhara is idyllic--the town is hidden away in the hills, and centered around a large, clear freshwater lake. In the middle of the lake is a small island, upon which a Buddhist temple is located, and perched on top of a hill, overlooking the lake is the World Peace Pagoda.

When we arrived in Pokhara on Friday afternoon, after a long, dusty and bumpy ride, we met up with two other interns, Carly and Melissa, who had stayed with us in Kathmandu a few days prior. They had been moved to Sarangkot, a little village on a hill above Pokhara, to work in the health clinic there, and were waiting in Pokhara to be moved to their homestay. After dropping off our bags, we immediately headed for the town to eat dinner, and then to the lake.

Some of the best Western food I've ever eaten in Nepal came from this one restaurant in Pokhara. In Nepal, if you want good food, your best bet is to order Nepali food, but often, places trying to cater to tourists will attempt to make Western food (note: not always a good end result.) But this place was so good, we actually didn't eat anywhere else the entire time we were there. After dinner, we grabbed Pringles, Pepsi, and whiskey, rented a boat and made it onto the lake in time for the sunset, which, I sure you can guess, was spectacular.

After we returned the boat, we wandered back to our hotel room (which was called 'the dormitory' because it was actually just three barren bunk beds), told stories and played games until one of us puked (they actually puked into my hands), one of us cried, and all of us fell asleep with no pants on.

The next day we woke up late, ate an amazing breakfast at our favorite restaurant, and immediately rented another boat. Carly had been feeling fairly nauseous after a rough bout with ED (or, explosive diarrhea) and this morning, she decided to sleep in.

Note: The moment we had arrived in Pokhara, Carly had started pushing the idea of staying later and trekking for four days in the Annapurna range, which none of us were expecting to do, or were prepared to do. Most people didn't want to go, and the idea of trekking with her feeling ill, and the rest of us also having bowel movements the consistency of water, was constantly on the back of my mind during the trip. Ignoring everyone else, she displayed how intent she was on doing it by yelling through the bathroom door to us about just, 'how awesome it would be.'

So while Carly was recovering (to make sure she could trek), we rented a boat and fishing rods, and headed out to a small cove across the lake. The poles were a mess, so we forgot them, stripped down to our undies, and dove into the water. We spent the rest of the morning and early afternoon swimming and climbing onto thick trees that hung out across the water so that we could dive in. Seriously, picturesque.

We dropped off the boat and picked up Carly, and wandered into town to do some serious shopping, which turned out to be quite fruitful ($56 North Face Jacket? Don't mind if I do!) We ate another great dinner, and then watched a cultural dance. At the cultural dance, we met another Canadian man, and Englishman, and a few drunk Nepalis. They wandered from touristy bar to touristy bar with us, telling us about how they too were interns, and they'd been living in Nepal for over 7 months. While we hadn't had much to drink, we were a smaller group of females (Carly had to run off to the squatter again) with a bunch of overeager men. And so Nate took care of us.

The next morning we awoke to Carly sitting on our beds, telling us that she was really, really sorry, but she just didn't think she could go on the trek. Nobody was too heartbroken. Instead, we decided to hike the two hours to the Peace Pagoda, which would be difficult, as it was 7:30, we still had no pants on, and she had to be back by 10 am to go to Sarangkot. We quickly got across the lake and started the hike at 8:40, and managed to make it to the Pagoda by 9:20 in what was probably one of the most intense and miserable hikes of my life.

Pokhara, like Chitwan, is very hot and very humid. The hills are covered in rainforests. But it is still at an incredible elevation. I hike a lot, but I have never sweat so much, and felt so out of breath in my life. I can't even imagine what those people taking pictures must have thought as I dragged my completely drenched self up to this pure, clean, white pagoda with this massive gold Buddha, trying not to simultaneously vomit and poop everywhere. I know they laughed. After a few minutes, Carly made her way up to me and said, "Maybe it's good we didn't trek--I feel like my water just burst."

We literally spent five minutes on top, took two pictures, and ran all the way down, where we caught a boat and made it back to the hotel by 10:15. The girls left for Sarangkot, while the rest of us hopped on a local microbus headed back to Kathmandu. The ride was wonderful, cheap, clean and fast. They even played Nepali pop music the entire way.

Thinking

Did you know that you can make brownies in the microwave?

Literally, microwave brownie mix for 6 minutes, and make brownies.

Thinking

The monsoon season is late this year, which explains why we have no water to shower. People are getting very sick and many are dying because of the drought.

Bhaktipur and the Gyno

On Saturday, Joyce, Erin, Maddison and I went to Bhaktipur. Kathmandu used to be divided up into three different kingdoms: Kathmandu, Bhaktipur, and Patan. All three of them had city centers where the main palaces and temples are located, known as Durbar Square. When Joyce and I arrived, we rushed past the men at the front, trying to convince them we didn't need a guide. And then we proceeded to get very lost in the actual town of Bhaktipur.

Eventually, we made our way to Durbar Square and met up with Maddison and Erin, who, coincidentally, had a tour guide showing them around. After many pictures of large temples and pagodas, we ate lunch and headed back home to Marhajgunj.

Three of the interns, Anne, Kelda, and Allison were leaving on Sunday, so we celebrated their time here by going out to a great dinner at La Dolce Vita, and then getting cocktails at a restaurant called OR2K (both in Thamel.)

The next day, the three girls left and were immediately replaced with two new girls, Megan and Carly. Megan, from Arizona, would be working in Helping Hands with most of the other interns, while Carly, from Juneau, Alaska, would be working in a clinic in Pokhara, Nepal (about 6 hours away from Kathmandu.) Both girls are really charismatic and fun, and both have the same love for the mountains and the outdoors as me. Unfortunately, Carly had to leave for Pokhara in two days, so Monday night we, once again, celebrated her time here by visiting OR2k.

Megan began her rotations with Joyce and me, and this week we started in the Gynae (Gynocology) Ward. The gynecologist here is very good, and she is the only female doctor in the hospital. She discusses every case with us, and lets us look on during every physical examination. So far, we've seen a prolapsed vagina, cervicitis, vaginitis (yeast infection) and today, an abortion.

The abortion was done via sucking the 6-8 week fetus out of the uterus with something that looked like an overlarge syringe. Surprisingly, this was one of the more sanitary procedures that we've sat in one, despite the fact that the gyno was wearing re-used latex gloves that had sat in an open container of bleach for a week. Throughout the entire procedure, the patient was crying and was holding tightly onto the hand of the nurse. The gynecologist talked the patient quietly through the procedure and after about 15 minutes of a disgusting squelching noise, the abortion was done.

The gynecologist told us after the procedure that the woman's husband was paralyzed on his right side, and getting pregnant was very difficult for the couple. The woman had desperately wanted the child, but after 8 weeks with no heartbeat and a lot of bleeding, the woman had decided to abort it.

It was good to see the doctor talking the patient through, and letting the patient display her emotions. It's fairly uncommon to see Nepali people talk about their feelings, which often results in conversion disorder (something the interns and I see frequently in the ER.) Conversion disorder is when the patient is stressed or upset, and has no way to get it out. Instead of discussing their feelings, the feelings present themselves physically in the patient. For instance, one patient in the ER became totally unresponsive when stressed. And the atmosphere of the hospital doesn't help matters.

Helping Hands Hospital is the cheapest private hospital in all of Kathmandu. The doctors that work there are not paid--the time they spend there is purely voluntary. Because of this, and the way Nepali culture is structured, patients come in and out as fast as possible. Spending more than 15 minutes with a patient is a rare thing, and if admitted, the patient literally becomes a number (even the interns refer to the patients in the ward by their bed number.)

Being in the ER and the OPD, you lose touch with the sensitive nature of medicine. Dr. Gupta, at OPD, will see 3 different patients at one time in a room that wouldn't even fit one person back in the States. There is no such thing as privacy in the Ward; no such thing as patience in the ER. But the Gynae area gives a nice balance between the hypersensitivity of the US and the lack of privacy of Nepal.

Thinking

I found a climbing wall 10 minutes walking distance from the house!
It's about 50 ft. and it looks pretty challenging...I'm sooooo excited.

Thinking

I have 8 million bug bites on one foot.

Mountains

Two nights ago, Jumong (an ex-Everest guide, who now works as the travel agent for The Mountain Fund) came to our door, offering a good deal on a flight that goes to Everest. Two other girls, Kelda and Anne, and I immediately bought our tickets, and the next morning at 6 am, were sitting with Jumong in a tiny taxi headed towards the airport.

After numerous body searches, we boarded a tiny airplane with 15 other passengers (not one of them white), and took off. Five minutes later, we came out above the clouds and immediately saw Langtang (above.) Then, a few seconds later, the entire range came into few, with thousands of craggy, rocky peaks everywhere, and some of the world's highest and most famous mountains directly in our line of view.

We could get up to take pictures, and the size of the plane allowed us to wander into the cockpit for a better view, and a quick chat with the pilots. The hostess came to each of us, pointing out the peaks and directing our cameras for better pictures. At one point, she had us all sit back in our seats, and then coming to each of us, she quietly said, "You see that one? That one with the perfect triangular top, that puts all the other mountains in its shadow? That's Everest. And the one on its left is Lhotse and on the right is Nuptse."

Everest is huge. The stewardess was completely right when she said that it puts all other mountains in its shadow. Looking out across the range of other Himalayan mountains, none are as prominent or as supreme. But that's to be expected--it is the biggest mountain in the world. So, after many pictures, the plane turned right around, and we were down, back in Kathmandu in time for breakfast (French toast and milk tea.)

After breakfast and laundry, we made our way to the hospital, where Joyce and I did our rotation in the ward. The day before we had noted a man with a disease known as Koch's Abdomen, something we'd never heard of. Today, the doctor was in, so we asked about it--Koch's Abdomen is another name for abdominal TB. The man had TB in his abdomen and lymphnodes, keeping him from eating or retaining any nutrients. Despite being TB, this type isn't as contagious, as it isn't in his lungs, and they had him on the DOTS treatment, a treatment endorsed by the World Health Organization.

In a lot of cases, doctors (including the physician at Helping Hands) will begin the DOTS treatment with one drug, and then add in other drugs a few weeks later, to ensure that the patient will be treated. If the DOTS program is badly installed, though, the patient has a chance of becoming resistant to not only one TB drug, but many.

The book Mountains Beyond Mountains tells the story of Paul Farmer, the creator of Partners in Health (PIH) and the founder of many health clinics in Haiti and Peru. A good percent of his work is dedicated towards work with TB, especially multi-drug resistant strains (MDR) of TB. MDR often occurs when the patient forgets or is unable to complete the full course of drugs for the disease. It happens frequently in third world countries with many different types of antibiotics, because often, the patients come from rural areas where their customs hinder them from being able to fulfill the drug course.

So, hopefully that man comes back for his drugs.

Thinking

My feet haven't cracked once since being in Nepal! And I wear sandals everyday!
Maybe this really is Shangri-la...

The Most Useless Organ in Your Body

Now that we're back in the city, we've been shoved right back into the hustle and bustle of the hospital. Because there's so many of us, we've been put on set rotations, allowing a few of us to be in different areas at all times. This past week, my roomate Joyce and I were in the ER.

The cases we saw included a broken wrist, lots of gastrointitis, enteric fever (another name for typhoid fever) and even frostbite (the sherpa had gotten stuck at Camp 2 on Everest.) The ER at Helping Hands is considerably less busy than any ER's in the States, due largely in part to the fact that there are only 5 beds in the ER ward. Because of this, we are allowed to wander to other parts of the hospital and attend any surgeries that are available.

Yesterday, there were three surgeries: a hernia surgery, an appendectomy, and the removal of a fistula in the sphincter. These surgeries are all back to back, in the same room with the same surgeon.

So, after a heated debate over lunch at our favourite fry-shack, the other interns and I finally decided who would see what. Mike, Devin, and I would go to the appendectomy; Kelda, Maddison and Yujin would go to the hernia, and Nate and Joyce decided that their laundry back home was more appealing than the sphincter operation. The girls went to the hernia operation at about 4, and at 4:30, the boys and I started scrubbing in.

When we walked in the room, the patient was awake, and sitting naked on the operating table. She was a young girl, about 20 years old, and was terrified. After a few seconds, I realized that the anesthesiologist was crouched behind her, injecting a local anesthetic into her spine. After he had finished, she lay down, and the nurses doused her entire body in iodine, to keep the patient clean. They started the procedure, cutting and burning through the thick fat, making sure to not let her bleed out, and eventually tied off and cut out the appendix (which is much smaller than you might imagine--think earthworm.)

The room is tiny--3 interns at max can fit in the room, along with two nurses and an anesthesiologist. It holds a surgery bed, two gas canisters, a large bureau of a variety of drugs, and two buckets of bleach, where they clean their latex gloves, tools, and vials (to reuse at a later use.) The OR is more sterile than the rest of the hospital, but that isn't saying much. Only the surgeon and the nurses taking part in the procedure wear masks and gloves, but the other doctors will come in and out of the OR, without changing clothes or re-scrubbing their hands. The general rule is that if you stand back 2 feet, you don't need to be completely sterile.

This is a huge change from the amount of sanitation in the US hospitals, where you wash your hands every time you leave/enter a room. When I watched a procedure in a cathader lab in the States, I wore new scrubs, a little overcoat, new gloves, and a new mask. And all I did was stand in the corner. But despite that, hospitals in the US have a fair amount of transmitted diseases in the hospitals--people get diseases from their neighbors, develop staph infections, etc. But here, where they have a man with TB in the same small, cramped, dingy room that's filled to the brim with 8 other patients, they have no records of any diseases transmitted throughout the hospital.

This could be from lack of records, because I think that if it can happen in the terribly sterile environment of the hospitals back home, the Nepali hospitals can't be that lucky. But when asked about it, they reply that they've never seen it happen, and that nobody has ever come back to complain about it, or charge the doctors with malpractice.

When I asked Dr. Gupta about whether or not patients claim to have caught diseases from the hospital, like they do in the U.S., he replied, "I do not practice in the US because there, doctors are the scapegoat. Here, doctor is god, and the hospital is his heaven. People expect to come to the hospital and get better--not worse. If a patient became sick with something in this hospital, they would never believe it was from the hospital, or the doctors."

Chitwan

Today is my first day back in Kathmandu after a long weekend in Chitwan National Park with 8 other interns. We left at 6 am Friday morning, on a rickety, jam-packed bus, and made our way down incredibly steep hillsides to the lowlands of Nepal. Kathmandu is located in a valley, so once the bus climbs up over the small foothills surrounding the city, the view opens up onto a massive expanse of very steep and very green hillsides.

Due to mining and farming, these hills are carved into steppes, and the farmers have also created thousands of little stone pathways up the hills, that all come out at this one road. The road that we followed was a supposed 2-lane road that went straight down the hillside towards the bottom of the valley, completely lacking any guardrails. And the traffic is almost the exact same as in the center of Kathmandu--motorcycles, trucks and massive tourist buses all fight for the right away down this hill, often resulting in a major accident. In fact, as we were driving, a truck went over the edge, flipping and coming to a stop at the bottom of a sheer 45 ft. cliff, near the river.

We finally made our way to Chitwan, where we were picked up by a jeep and taken to a lodge in a little village named Terai. At the Hotel Jungle Lodge, we were presented with Tang, hibiscus flowers and bindis, and shown our rooms (little wood huts.) After cleaning up, we walked around the village, which was incredibly poor. The natives are known as the Tharu, and for the most part, they live in mud/straw huts with thatched roofs. In this part of town, malaria is rampant, and as we were walking, we came across many underfed children washing their dishes with mud.
After the walk, we ate dinner and went to a Tharu Community Welcome Dance, and then crawled under our malaria nets and tried to sleep. Nepal is a country that starts early and ends early. Every morning in Chitwan, we were woken at 6am, and anywhere (even in Kathmandu), everything closes at about 8:30 pm. So, after an early breakfast, we canoed down the river that runs through Terai, hoping to see crocodiles (there weren't any.) We did barely see Anapurna though, and the other mountains in the range. Then we walked back through the jungle, hoping to see tigers and rhinocerouses--neither were seen either, but we did see a spotted deer which was...more than fascinating.

After we ate lunch, we washed the elephants in the river. We got in our swimsuits, and were allowed to climb up ontop the elephants (bareback) and then the elephant trainer told the elephant to fall over into the water, and we did everything we could to hold on. The water was amazing, even though we were downstream from other elephants depositing their fecal matter, and after the bath, we went on an elephant trek through the woods. I would like to say that I'm not afraid of heights, and I never really have been. And that the height of the elephant didn't really bother me. But every so often, when the elephant would shrug? And the little chair ontop that four of us were perched on shifted drastically downwards, sending us oh, so close to flying off? Made the ride absolutely horrifying. Oh, right, and that moment when our elephant started charging another elephant in the jungle. Oh. My. God.

The worst part about the ride, and the whole elephant experience, was the fact that the people who own the elephants a.) know close to nothing about animals and b.) do not care about the animals in the slightest. Everything in Chitwan focuses around the breeding of the elephants, and they have areas where they keep the elephants specifically for breeding so that they don't have to domesticate wild ones. The owners range from old men, stuck in their ways, to bratty teenagers, trying to prove their manhood. They use, get this, bamboo sticks, things that look like fire pokers (but with an extra spike), and even hatchets to try to control to elephants. The elephants have scars and massive holes all over their ears and bodies. If the elephant tries to graze, the owner just wails on its head, beating it until often, the elephant rears up, trying to throw the owner off. Every once in a while, an owner is killed--the elephant will literally tear his body to pieces. And the people we talked to would agree he deserved it.

Chitwan was beautiful--it is the stereotypical paradise. But after 4 days (we had to stay an extra night because the Maoists were striking again, and again, the buses were closed), we were dying to get back to Kathmandu.

A note on traffic

Picture this:
1. There are only two major roads in Kathmandu, upon which everyone travels.
2. There are no lights or stop signs.
3. There is no such thing as 'lanes,' and the pathways running in front of houses/shops are often used as roads.
4. There are no crossing areas or sidewalks.
5. There are no speed limits.
6. The idea behind driving here is: be as agressive as possible, and use your horn frequently
7. There are: pedestrians, vendors, people pushing carts, tractors, motorcyclists, busses, taxis, cyclists, chickens, cows, dogs, and even people living on these roads.

The best part about all of this: There are more accidents every day in the US than there are in Kathmandu. Since being here, I have yet to see an accident or an animal/person hit, and I've only seen one ticket given out. There are rarely traffic jams.

China

As part of our orientation yesterday, Renjan took us to a fairly popular temple known to tourists as the Monkey Temple, and to locals as Swayambunath. The grounds of the temple extend on for many acres, over a major hill that has pathways carved into it that hundreds of Buddhists walk on in prayer and meditation (the full path takes about 4 hours.) We walked to the top, where the stupa is located, and watched the rhesus macaques flood the grounds. After Renjan gave us all bindis (the red mark on the forehead), we went to lunch at a sherpa cafe.

At the cafe, we were sitting and waiting for our food, when a road child came up behind Joyce, an intern, and tapped her on the back (begging for money or food.) Immediately, the waitress yelled for the owner, who came charging out towards the child. The boy just stared up at him as the man slapped him directly across the face. It wasn't staring due to shock; more like staring from being high, and not really understanding what was going on. This sort of catatonic state from the boy continued, even when the owner grabbed a long reed stick and chased the boy down the road, whipping him across the back.

As we discovered tonight after going to dinner in Thamel, a good percentage of the road children here are severely addicted to drugs, most popularly, glue. We saw over 20 children tonight wandering the streets in packs, with more than half of them holding paper bags to their face, so as to properly inhale the glue.

We saw children like these today during our first real time at the hospital. Working at the hospital can't be better explained than describing it as being a full-fledged medical student. The interns and I are put on rotation--we go from ward, to ER, to surgery, to O.B./GYN, and then back again. But medical students? Have no where near the amount of freedom we have. Today, for instance, we strolled into the ward, having not yet met up with Dr. Gupta (it was 11, he wasn't in yet--very normal), and picked out a patient, looked at her x-rays (in front of her family and herself) and requested her file (high WBC, fever, abdominal pain--suggests enteric fever.) We did this for every patient in the ward, without even seeing an actual doctor the entire time. We even wandered into the lab to check out the equipment and the nurses didn't even look up at us.

As Dr. Gupta puts it, "You are white--you are 3/4 of way there on journey to being doctor."

Which is not to suggest that the Nepali doctors are in any way incompetent. In fact, every doctor I've met so far is more qualified to be a doctor than the woman I see in Grinnell, IA, who lets me prescribe myself. The major difference is a.) funds and b.) sanitation, but it is hard to have such standards of sanitation without the means to provide. What they do here for less than 1 USD here, we do for over 1000.

Interesting.

Thinking

People are studying for the MCAT's here.
Righttt...

Sister, you play?

Because of the Newari strikes yesterday, the whole house was stuck inside the gates and restless. After wandering around the house many times and attempting to read, I finally convinced an intern, Erin, to try to find the Buddhist monastery that you can see from the rooftop of the house with me. We wandered down the alleyways that run near the volunteer house, and eventually found it. Even though we were not allowed in, we were able to hear them chanting and praying.

On our way back, we passed a seamstress and her husband who invited us into their shop to sit on their couch and talk with them. The two of them were sewing, one in front of the other, and working together on the same pants and shirt set. They were young, and very Hindu (they were dressed in traditional garb, and posters of Shiva and Ganesh covered the walls.) After buying us both mango drinks from next door, the two very energetically started a very basic and halted conversation, lasting more than an hour. We learned that they were very young (27), he was a songwriter (he sang for us twice), they had three children, and that they were very poor. Finally, we left, but not before the husband insisted on giving us his mobile number and their full names, written on a piece of paper that he had written, "I love you" across the top. I think I'm going to buy a sari from them.

After getting back, the other interns and I played a good game of soccer with Bibu and Kritan, and Renjan (the 20-yr. old who helps the interns.) Then, because it was Angela and Jenny's last night in Nepal, we went out to a shisha (hookah) bar in Thamel, the touristy district of Kathmandu. The taxis had started up again, and, ignoring the weird tension created by the uprising, we found two to take us to Thamel. 3 girls went in one car, and 6 of us crammed into the other one, piling on top of each other, arms and legs splayed out the windows. At the shisha bar, we smoked a good hookah and drank good, cheap, beer and everything was lovely.

Thamel is a place that caters to westerners. It has Italian food, The North Face stores (knockoff) and other fun attractions. However, when we left, there weren't many taxis, and the ones that were there had had barely any business (notice: weird tension from uprising.) 3 of the girls went in one taxi, and when we tried to cram the 6 of us into another, the Neapli boys who had followed us insisted that Nate, an intern, get on the roof, which he accepted. Once on the roof, one of the Nepalis tried to get in the car with me. And of course, me having had a mite too much to drink, this is how it went down:
Him: "You like Nepali. Yess, you like Nepali."
Me: "Yeah right. Get. Out." *shoves him back out the door and shuts it*
Him (from outside): "But I'm very nice."
Me (at this point I realized Nate was still on the roof, and thus opened the door quickly, slamming it into theNepali's chest) : You're slimy. Get out of the way...Nate, get in the car!"

And then we zoomed (sort-of trundled, due to the immense weight of 7 people in a car meant for 2) into the darkness.