Free Exiles by Cary Groner Page B

eighteen or nineteen.”
    Peter looked at Mina in disbelief. She just nodded.
    “So if you add eating and sleeping and walking in the evening, he gets how much sleep a night?”
    “About three hours,” Devi said. “Sometimes two.”
    Peter tried to understand how this could be possible. The only patients he’d ever had who slept so little were clinically depressed, which was obviously not the case here.
    He turned to Mina and spoke quietly. “Angina, don’t you think?” She nodded again. “Has Franz ever done any bloodwork?”
    “Last year he took a sample, but the vacutainer broke on the way down the mountain and we were in a hailstorm, so we had to let it go.”
    “Is it all right if I examine him?” Peter asked.
    Devi asked and the lama nodded, his eyes bright. Peter put on his stethoscope and checked Lama Padma’s carotid arteries, then listened to his heart and lungs. He thought he heard a murmur, maybe a little click or mitral valve noise. Usually this was nothing; sometimes it was worth paying attention to.
    “Did he ever have rheumatic fever as a kid?”
    Devi spoke to him. The lama replied, seeming somber now. “He says he doesn’t know,” Devi said. “When he was growing up, most children had fevers, and many died. He lost a brother and a sister to measles, but the other diseases were not called by any names that he remembers.”
    Peter noticed that the lama’s nails and lips had a bluish tint. “What does he eat?” he asked.
    “Mainly
tsampa
, roasted barley flour mixed with hot water and butter. Some tea. Rice, sometimes, also with butter. Lamb, when it’s available.”
    “He likes butter, I take it.”
    Devi didn’t bother to translate. “All Tibetans like butter,” she said.
    “Is it all right if we do some tests?” Peter asked.
    The lama nodded. Mina drew blood, and Peter hooked up the portable EKG they’d brought, which confirmed his impressions. He told the lama he probably had atherosclerosis and heart disease, and that he’d most likely had rheumatic fever as a child, which had damaged his mitral valve.
    “If you come down to the valley we can arrange an echocardiogram,” Peter said. “We may want to put stents in your arteries and repair the valve. Is that something you’d consider?”
    When the lama heard the translation of this, he smiled.
    “He says he very much wants to help you do your best, that he can see this is important to you and he appreciates it,” Devi said. “But his commitment is to stay here and practice.”
    Mina seemed unsurprised, but Peter felt frustrated. Why had he come all this way if no one was going to take his advice?
    “Unless he’s willing to exercise more, he may progress to heart failure within a couple of years,” Peter said. “And he should probably cut down on the butter.”
    Devi spoke with the lama, and he looked thoughtful for a few moments before replying.
    “Lama Padma says please do not be upset,” Devi said. “He says he will try to walk more.”
    Peter was used to patients disregarding his recommendations out of fear or carelessness, but this was new terrain. He didn’t completely understand, but he couldn’t deny the lama’s presence and evident kindness. He felt chagrined at his frustration.
    “Tell him I’m sorry,” he said quietly. “I just want to get him well.”
    Devi spoke to the lama, and he answered. “He appreciates this,” she replied. “He says he will even try to cut back on his butter, but that the whole monastery will have to pray if he is going to accomplish such a great challenge.”
    With that, Lama Padma and Lobsang began to laugh again.Peter looked at Mina; she shrugged, and her expression said,
Ke garne?
    Lama Padma spoke to Devi, then. She turned to Peter again. “He wonders if you know anything about Western science.”
    He was surprised by the question. “Biology, mainly,” he said. “That was my undergrad degree, and I try to keep up. Why?”
    “He’d like it if you would think