ENCORE!

I woke up in the middle of last night with horrible abdominal cramps and the knowledge that something wicked this way comes...

I lurched out of bed and staggered towards the bathroom, stomach roiling, sat, and waited for the inevitable. What had it been - the yoghurt, the shawerma, the seafood pizza I'd had last week, the water? I waited for a wave of sickening nausea to pass, and eventually it did, and the hot, liquid stool stopped for the moment as well. But here was something I knew very, very well - being in international medicine has, unfortunately, meant that I am all too familiar in both a professional and all too personal sense, with diarrhea, in fact, it's in some sense part of my specialty - perhaps I should put that on my business cards: "MD, FACEP, Expert in All Manner of Diarrheas".

At least I knew what I needed to do, I've been prepared for a while, I walk over to the counter and take 4-milligrams-of-Imodium-starting-dose-and-500-milligrams-of-ciprofloxacin-twice-a-day-for-five-days, only since I have 1000 mg tablets I take a bigger dose of antibiotic than I probably need. I settle back in bed and wait for another wave of cramping pain to pass - I guess this means I'm probably going to miss the tour of Jerusalem in the morning...

The alarm goes off, and I open my eyes expectantly - I feel... good, I feel... normal. I wonder at the fact that diarrhea kills more children in the developing world than anything else - what a pitiable way to die. But as for me this morning, it looks like my auto-prescription has worked.

Which is a blessing, because today, we're supposed to have a guided tour of the Old City of Jerusalem. The guide, Osama, meets us in the lobby.

"Osama", by the way, is simply Arabic for "strength", and I imagine that since 2001 he's probably changed the English spelling of his name to Usama. We take a cab to the Mount of Olives, which is where we begin our tour.

"This is the chapel of the Ascension. Actually, it's a mosque now." During the course of the day he tells us the history of the place, the ancients, the Romans, the Persians, the Crusaders, Salah ah-Din.

Osama is actually a Palestinian Christian. He's currently working on a PhD, a multidisciplinary one that involves theology, history, and strategic planning, a management field - he's working on programs to keep the indigenous Christians here in the Holy Land. Many of the young Christians have been moving away, to America, to Europe, trying to escape poverty, the conflict between the Jews and the Muslims - the monotheists live here cheek-to-jowl, if not exactly in peace, at least in temporary quiet, God's chosen children, God's other chosen children, and God's other-other chosen children.

What's the point of staying? Osama took his seven-year old son to show him the place he'd been born in the Old City and lived until he was fifteen, just as his father had shown him, and his father's father had shown him, and so on and so on. That was the way we'd known so many of the places Jesus had been, the early Christians had shown their children where he'd been, who'd shown their children, and so on and so on.

"Emperor Hadrian built this arch... the city has been totally destroyed seven times..." I wonder during the day if Alexander the Great, or Salah ah-Din, or Genghis Khan, had ever been laid out with diarrhea during the course of their conquests, and try to imagine them dizzy and squatting over a camp latrine, thinking to themselves that they probably should have waited for the goat to finish cooking, but it'd been a long day and they were so hungry...

Osama is a thin man, short, about my height, but he somehow manages to well out-pace us - he doesn't break a sweat during the course of the day while perspiration pours off my forehead, and my neck, and my chest, my underarms, my legs - you get the point. He says that he once had a group that measured the number of steps they'd taken on a pedometer, and it worked out to about 7.5 miles total.

I can't imagine Genghis walking 7.5 miles, much less one, with diarrhea. Perhaps I can reformulate the taunt: physician - healed myself. Thank goodness for modern medicine!