There are four major signs that you have a parasite growing inside of you:

  1. Unexplained, intense digestive and abdominal irregularities and discomfort.
  2. Dramatic loss in interest; feelings of apathy; exhaustion.
  3. Disconnection with the world around you.
  4. Joint and muscle pain and weakness caused by the toxins parasites release into the body.

Her moans could be heard from the street. Confused Nepali faces looked on as I rushed by, finally understanding why I had been so forcefully ushered back to the tiny guest house.

The owner, a graduate of the orphanage I had just come from and the only one who spoke any English, reached out and put his hand on my arm, concern in his eyes. “We tried to call you sooner; phones don’t work.”

Emma hadn’t been feeling well the few days prior, so she had been staying home from our placement at the orphanage in Pokhara. She was still asleep when I left to help the kids get ready for the day, so I was confused when, upon my return from walking them to school, my pathway was blocked by one of the house mothers mumbling at me in rapid Nepali. “Go home – now,” was all that I could make out.

When I opened the door to the tiny room Emma and I shared, I saw her curled up in a ball on the edge of her thin, straw mattress, clutching her stomach and letting out long, painful cries.

In the four years that Emma and I had been friends, I had never seen her cry. She had never missed a day at school, and she is one of the only people I know who never complained of physical ailments. Never once in four years had I heard, “I’m tired,” “I don’t feel well,” or “my stomach hurts,” while she had heard these words escape my own lips many times over. Unable to move or talk or do anything but moan was, for Emma, the ultimate form of weakness.

It was an all-consuming kind of pain. As I rushed around her, a blur of activity as I packed a small bag and tried, in a string of broken Nepali, to explain to our hosts that we needed a cab – now, Emma could focus only on the green and black flannel clutched between her fingers, growing moist as her fever took her farther and farther from reality.

It was July in Nepal, which meant monsoon season. While it was 98 degrees and sunny now, the night before had brought a torrential downpour, leaving the small dirt road that led to the guest house a mess of muddy puddles and potholes – and impassable by car. The closest paved road was about a mile away, and no taxi would come closer. We were going to have to walk.

Emma’s eyes twinged with pain. I can’t they seemed to beg. It felt like hours before we hit paved road, Emma’s eyes squeezed shut, as though she were trying to block out the pain. When we finally met the taxi, she collapsed into the back seat, head against the window, like a last-place marathon runner diving over the finish line in exhaustion.

The first hospital to which we arrived looked almost like a movie set. An old chalkboard hung crooked on the wall with a haphazard chart of open beds scrawled on it. A torn, dirt covered sheet covered the doorway and sounds of misery emanated from within, but no one was in sight. The cab driver had Emma hanging over his shoulder, her body slouched over in a 90 degree angle and eyes shut, arm around his neck, as I pushed forward, looking for anyone who could possibly help.

“Full.”

I turned around to see the taxi driver pointing at the chalkboard, scribbled X’s over all of the small rectangles.

“Kahi jane,” go somewhere else.

Panic pressed on my chest, heavier with each passing moment that nothing was being done for my friend. Her face was ghostly translucent. When we walked into the second hospital, my panic was replaced not by relief, but by fear.

When you go abroad for an extended period of time, everyone tells you to be careful. Be careful not to be kidnapped, not to drink the water, not to get too attached. However, as you deboard the plane, stepping into a foreign world of new smells, sounds, air, and languages, danger feels remote and unreal. But that won’t happen to me, you think. Until it does. The country that had stolen our hearts over the past four weeks suddenly felt profoundly unsafe. The strings of Nepali sentences that we had picked up suddenly went from impressive to useless. We couldn’t communicate with anyone, couldn’t read the labels on the IV’s of mystery liquid medicine dripping into the arms of other patients, couldn’t even get someone to see that we needed help.

They say that eyes are a window into a person’s emotions. In that moment, I looked into Emma’s eyes, bloodshot from being squeezed so hard, and saw that they had turned from her normal honey-brown to almost black, cloudy and distant from the reality in front of us. I saw my own fear reflected and then multiplied over in ways that only intense pain can do. “Thank god you’re here.”

The main hospital was one large room. One wall was either ruined in some natural disaster or abandoned mid-construction, leaving a gaping hole to the elements. Dirty cots lined the walls. Nepali families in tattered clothes gathered around different beds, while others stood anxiously by, with their own sickly loved ones, anxiously waiting for a bed to open up. When we finally got Emma onto a cot in a small, dirty corner, she lay there squeezing the circulation out of my hands for 40 minutes. Not a single one of the doctors wandering by the rows of beds stopped by our side. When I finally had pieced together a semi-correct sentence in Nepali, clumsily asking how we could get help, the nurse looked at me like I was an annoying small child, out of touch with the realities of the world.

“You need to pay,” she said. After a confused look from me, she held her hand up and rubbed her fingers together in the universal sign for money. “Cash.” I nodded and reached into my bag for my money pouch. It was empty.

Looking back, this moment feels dramatic, distant memories making a big deal out of nothing. But, in that moment, in that rundown hospital in the middle of an underdeveloped country, with no money and no one willing to help my moaning friend without cash on the table, and with no idea what was wrong, it felt like the world was spinning. Could I really leave her abandoned there to get money? I had to.

Emma clutched the green and black flannel between her fingers and looked at me when I told her that I had to leave, her eyes open wide for the first time that day. Another stab of pain hit and she squeezed them shut again, doubling over.

“I’ll be back,” I told her, trying to boost my voice with empty confidence, “as soon as I can. Everything is going to be okay.” She nodded wordlessly, her eyes still shut. “I promise,” I said feebly, my voice falling off at the end of the word, realizing that I couldn’t truly promise anything of the sort.

As the cab wove through beeping cars and mopeds and cows and dogs in the lawless, traffic ridden streets, I scanned the streets for a big white sign with ATM written in red block letters, used by shops with a cash machine inside. It’s impossible to know now how long I was gone, but each second that  Emma was alone and in pain, no means of communication between us, felt like an eternity. After two failed attempts, I was finally able to find a store with a working cash machine. We rushed back to the hospital to join the mob of Nepali family members outside the window of the makeshift hospital pharmacy.

With cash in hand, a doctor glanced over Emma and moved his head right to left in a common Nepali gesture, similar to a head nod or shoulder shrug. He scribbled something on a small sheet of paper and handed it to me, pointing to the window outside.

As I got to the front of the line, the room behind the take-out window came into view. The aids rushed around inside, grabbing the slips of paper being waved in their faces by the company of the sick. They grab white boxes and bottles off the shelves, taking fistfuls of cash and coins, and handing over the unmarked medication. Newly equipped with a brown paper bag filled with a plastic IV bag of clear liquid, a box of small, white tablets, a bottle of red juice and some crackers, I sat down on an upside down bucket at Emma’s bedside and watched as an aid hung the IV bag, took a needle out of her pocket, and inserted it in Emma’s arm. She instructed Emma to take 1 tablet per hour with the juice and eat crackers, if she could keep them down, and left. I had Emma blindly follow the instructions, holding her head up as she swallowed the tablet, and holding her hair back as she immediately threw up into the bucket that had just been my chair.

After a few minutes with the IV, her body slowly began to uncurl, her muscles relaxed. Momentary relief had come at last. Emma looked up at me, seated on the windowsill next to her cot. Her eyes were still bloodshot from the crisis of the day, and there were small wrinkles in the corners of her eyes, red from the intensity of holding her pain all day. Her vision was foggy, and she looked at me with a question in her eyes, as though she wasn’t quite sure where we were or how we got there. Slowly, her eyes shut and she drifted off to sleep.

The air in the large room was thick, but growing colder. I pulled a worn sheet up over Emma and wrapped her green and black flannel around my shoulders, looking down to find threadbare spots where she had grasped the fabric in her feverish hands. Seeing her at peace made the world feel just a little bit safe again, warmed by the false security of symptom-dulling medication. As I watched the mystery liquid drip into my friend’s arm, I studied the label on the back of the tablets, and the scribbled doctor’s note, hoping that the symbols would start to look a little less foreign and that the Nepali language would start to click in my head. Whatever the symbols, I knew they spelled relief. If only for the moment, we were safe.