Category: Travel Adventures

Around the World in 10 Days: A Medical Elective in the Republic of Singapore

One of the things I’ve most looked forward to since Steph and I toured all over the country interviewing at 20+ residency programs was the prospect of an “elective” month. Almost every program had a month carved out for residents to choose an area of (educational) interest and immerse themselves however they pleased. Finally, after three years of waiting, this year was my chance.

I researched for months and finally settled on traveling to London to work with and learn from the London Ambulance Service, one of the world’s premier prehospital agencies. Combined with the emergency physicians aboard the London Air Ambulance, they are doing some cutting edge stuff – including point of care ultrasound, field thoracotomies, REBOA and true prehospital critical care. Plus I’d have a chance to visit Grandma.

So, needless to say, I was bummed when the opportunity failed to materialize.

But as luck would have it, just a few days later I bumped into Dr. Ornato, the chairman of our department at VCU. I mentioned it to him, and without skipping a beat he asked, “Want to go to Singapore?”

Uhhh… yea! Sign me up!

Less than 24 hours later I had an invitation from Singapore General Hospital and the Singapore Civil Defense Force (SCDF), and not long after that I was boarding a flight in Richmond aimed at the opposite side of the world.

Fun Fact #1: Singapore is a tiny island city-state, meaning the entire country is one big city (think Ancient Greece, but Asian). It has been at the center of the global economy for hundreds of years, from a refueling port for the British East India Company to what is now one of the largest shipping ports in the world, with up to 100,000 vessels traversing the Strait of Singapore yearly.

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Now when I say Singapore is far away, consider this: the Earth is roughly 24,000 miles around and this was a 12,000 mile flight. If I’d have gone any further I’d have been on my way back home. (And did I mention I was in a middle seat? My knees, back and bladder were not amused. But I digress.) Roughly two days after setting off I landed as far from home as I’d ever been and will likely ever be (until I make it into orbit, that is).

My first impression both in the airport moving through customs and in the taxi on the way to the place where I’d be stay for the next ten days was pleasant surprise at just how clean, efficient and organized the whole place seemed to be. No pushing or even a raised voice, just well designed infrastructure ready to welcome visitors, students, investors and most importantly: me.

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Marina Bay Sands with the Art-Science Museum on the left

I decided to try AirBnb for the first time. I was traveling alone and found it to be much cheaper than hotels, so why not give it a shot. There was of course the possibility of being murdered in a stranger’s home, and every listing looked far too good to be true, but hell what’s life without a little risk of being drugged and dismembered in your sleep every now and then. So I settled on a condo in an upscale residential district which boasted four swimming pools, a hot tub, free wifi, private bedroom and bathroom, plus walking distance to two subway stations, restaurants, shopping, and a few of Singapore’s ubiquitous dining halls (more on that later), all for less than $60/night. See what I mean?! Must be too good to be true.

But it wasn’t! I found the apartment to be exceptionally comfortable and convenient, precisely as advertised. I met my hosts – an American/Chinese Harvard grad and a Moroccan/French banker – who didn’t seem like serial killers at all. Again, pleasantly surprised and more than a little relieved.

I arrived early and had slept for 16 hours all the way across the Pacific, so after getting settled I was ready to explore. I stepped outside to an instant reminder that the country lies just one degree north of the Equator – instant, drenching perspiration. Nevertheless, I spent the first two days exploring the tiny country on foot, sweating profusely.

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Gardens by the Bay

Singapore is about half the size of London or Los Angeles with a population of just over five million. One of the most striking things about it was the diversity – a nation made up of Chinese, Indian, Malay, European and dozens of other nationalities living in near-complete harmony. That, combined with an effective, non-corrupt government, has attracted tremendous investment, and in just one generation the little city-state has blossomed to become a global center of commerce, ranking 7th in GDP per capita world-wide.

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Hand carved decorations at the Sri Veeramakaliamman Temple in Little India. Next door were two Buddhist temples.

Fun Fact #2: After independence from Britain following WWII, Singapore briefly merged with its big brother to the north, Malaysia. But thanks to racial strife between the Malays and predominantly Chinese Singaporeans, the island was kicked out in 1965. Singapore has gone on to become an economic powerhouse and first world nation while Malaysia currently ranks 79th in GDP. Whoops!

After eating my way around downtown, having coffee with some very pampered cats and strolling around the stunning Gardens by the Bay and exceptionally impressive Art-Science museum it was time to do some actual work. I spent the first two clinical days at Singapore General Hospital, in the emergency department with Dr. Marcus Ong and his staff. Here’s an excerpt from my Facebook travel diary with my first impressions:

“Spent my first day at SGH today. It’s a remarkably similar place, facing many of the same issues we do in the US. Grumpy consultants, slow throughput, ED boarding, and misuse of emergency services. That said, they see almost zero violent trauma, drug seeking is nonexistent, and psychiatric care is managed outside of the ED. Overall, the care is excellent and very up to date, with all the latest technology readily available but used in a more cost effective way.”

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Efficiency is key. Patients are brought to private areas long enough to be evaluated and have any procedures done but are then moved to a holding area to maintain throughput. There is an observation unit for those needing a little more TLC.
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To combat the ever-present risk of communicable disease the city’s ERs have separate treatment areas for febrile patients. They learned this lesson from outbreaks of SARS, MERS and, most recently, Zika.

I was impressed with the care but noticed it to be somewhat less aggressive than what we do in the US, with invasive procedures done emergently if necessary, but more often left to be sorted out upstairs. While they see very little violent trauma, I was fortunate to see how they managed a motorcycle accident victim – a wealthy British businessman with broken ribs and a collapsed lung. At VCU he would have had a team of 12 providers standing-by on arrival, been stripped of every stitch of clothing and irradiated from head to toe by our CT scanner. At SGH he cracked jokes for an hour while a nervous intern tried his best to place a chest tube.

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PSA in the subway station

Like everything else in the country, the healthcare system in Singapore is modern, effective and efficient (ranked most efficient in the world in 2014). Coverage is universal under the principle of no care being completely free which reduces wasteful over usage. Co-payments (typically 3-10% of the cost) and optional supplemental private insurance are paid from a compulsory personal savings account called MediSave. With the 3rd longest life expectancy worldwide Singaporeans spend just 1.6% of GDP on healthcare. For comparison, the US spends over 17% of its wealth on medical services yearly, and its citizens live just slightly shorter lives than the people of the Turks and Caicos islands at number 43 globally.

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A cardiac arrest case, eventually with ROSC. Note the built in xray in the ceiling and LUCAS device in action. This is not a 3rd world nation.
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Waiting for admission in the ED

After my time in the hospital I spent a full day with the staff of the Unit for Prehospital Emergency Care (UPEC) which is led by Dr. Ong. Just a few years ago the government of Singapore sent experts around the world collecting best practices and poured tens of millions of dollars into the project, tasking UPEC with modernizing the EMS system. At the heart of that effort is the SCDF.

The Singapore Civil Defense Force is a quasi-military 4th branch of uniformed national service which includes both the fire department and ambulance service. Unlike the US, the two branches are almost entirely separate, with firefighters generally providing no medical care and responding only to fire incidents. One exception is the new “firebiker” program, with an EMT trained firefighter on a motorcycle able to respond quickly through traffic to cardiac arrest cases. The ambulance service, on the other hand, is well equipped and staffed by paramedics on every ambulance. A unique aspect of both branches is the inclusion of conscripts, young men completing their two years of national service. While most are drafted into the traditional military branches, others fill the ranks of the SCDF.

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Morning inspection and roll-call at SCDF station Paya Lebar
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DART – Singapore’s elite technical rescue/USAR team maintains 24/7 readiness for deployment anywhere in South East Asia.
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DART HRT – Heavy Rescue Tender, with a mission-adaptable, modular back half.

Fun Fact #3: There are two emergency numbers in Singapore. “9-9-5” is reserved for emergencies, with a government SCDF ambulance responding. “1-7-7-7” is available for non-emergencies, and staffed by unregulated private ambulance companies. Calling 9-9-5 for a non-emergency can result in a hefty fine.  

I had a chance to spend time both aboard an SCDF ambulance and in their command center, where over 50 ambulances are dispatched to almost 1000 calls to 9-9-5 daily. Many unique challenges exist, ranging from the use of four primary national languages (English, Tamil, Malay, and Mandarin), to cultural and religious differences, not to mention a complex environment including dense urban centers and the surrounding swamps, jungle and sea. It was there I first heard the term “vertical response time,” the extra minutes which have to be factored in when lugging a stretcher and equipment to the 40th or 60th floor of an apartment or office building. To combat that particular challenge, the government has funded AEDs being placed in the lobby of every other housing complex as well as community hands-only CPR training, all organized by UPEC. The coordination of such an effort is a remarkable achievement.

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Much of the same capability at a fraction of the cost
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Red Rhino fire service QRV

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UPEC/DARE – Community CPR course. The government aims to train 50,000 first responders in the next few years.

Fun Fact #4: The government LOVES fines. Jaywalking? $20. Smoking in an elevator? Better have $1000 to spare. Even drinking water on the subway or spitting out chewing gum on the street will set you back $500. But most Singaporeans will admit the loss of a few simple freedoms is worth it and has led to a safe and orderly society, with essentially no crime.

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You don’t even want to know what they would do to you for eating a durian on the train.

As my time was coming to a close I had one last clinical opportunity, the one I was most looking forward to: race medical support for the Singapore Grand Prix. Now I’ve never followed Formula 1 racing, but if I learned one thing from the UCI Road World Championships in Richmond last year it’s that you don’t have to be a superfan to get excited when a big event comes to town. With an all-access pass, a chauffeured golf-cart, the scent of high octane gasoline and that distinct TIE-fighter whine of the engines I was soaking up an intoxicating atmosphere. The medical facilities were impressive, with the SCDF, dozens of volunteers from St. John’s Ambulance and the elite Disaster Assistance Rescue Team (DART) on standby. There were even fire-boats positioned to evacuate patients by sea if necessary, avoiding the inevitable gridlock of a city hosting a world-class event. Like everything else I came across during my time there, every detail was planned out and meticulously accounted for with robotic precision.

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Ferrari 458s compete in the warm up to the Singapore Grand Prix

After the race, having completed my educational syllabus, I used my last day in the country to be a shameless tourist. The highlight was undoubtedly the stunning botanical gardens, a UNESCO World Heritage site. I spent most of the day strolling through various areas like the Evolution Garden, Healing Garden, Bonsai Garden and of course, the jaw-dropping National Orchid Garden. Next time you find yourself in the area, do yourself a favor and pay it a visit. You won’t be sorry.

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The National Orchid Garden
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The Bonsai Garden
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The cable car to Sentosa island – in the distance, the whole world’s commerce passing through the Strait of Singapore

Although it may seem I was in a veritable utopia, by the end of my time there I was ready to come home. Not only was I missing my wife, but in a weird way the predictability of the orderliness, combined with the brutal heat became somehow… monotonous. Full of new knowledge and tremendous respect for the work being done to develop Emergency Medicine in Singapore, I caught the last seat on a full flight home after saying goodbye to my new friends at UPEC, SGH and the SCDF. Did I mention Singaporeans love abbreviations?

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Dr. Ong and I

But what about the food?! Up to this point I’ve purposely avoided mentioning it to prevent an irreversible segway into what I can only describe as the best, cheapest, most diverse cuisine I’ve ever come across. It was simply too good for words, with each meal better than the last. Singapore more than lived up to its reputation as an international foodie destination, so I can think of no better way to conclude than with a stream of epic food porn. Enjoy!

~Amir

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“Hawker centers” are Singapore’s answer to street food – delicious, clean and cheap. What more could you ask for?
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Bak Kut Teh – roughly “meat bone tea” – The most savory, flavorful broth with tender pork ribs. Sides include fried bread for soaking up the broth, various greens, a soy-sauce egg and braised pig intestine.
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Singapore Chili Crab – one of Lonely Planet’s “7 Iconic Dishes” worldwide
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Beef and Kailan greens with fresh sugar cane juice
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Believe it or not, this is a Michelin starred meal. Chicken Rice is just that – but better. On the left, roast pork two ways. Price? $5
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Fancy restaurant? Nope. This roasted Peking Duck is standard hospital food!
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The local coffee – “Kopi” – is thick and flavorful, sweetened with a dollop of condensed milk.
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Laksa – a rich Malay coconut noodle soup with various proteins
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Curry three ways: Rice with chicken curry, fish curry, and tandori chicken. Roti bread to soak it all up.
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Grilled garlic king prawns with fried rice, greens and fresh mango juice.

Beginner’s Guide to Tubing the James River

In our lives, “tubing” has two distinct meanings… this and this:

Prior to moving to Richmond, I’d been river tubing just once. It involved finding a rental company, making reservations, and forking over a lot of cash. So, when I came to Richmond and learned people tube on their own, I was intrigued. Turns out, it’s not as difficult as you might think. Just use this simple guide to help plan your tubing adventure.


Buy yourself some tubes

While there are tons of options out there, we’ve had good luck with the Intex brand available on Amazon.com.  You don’t have to spend a lot of money to get something fun and reliable.  There are many options, including single, double and cooler tubs, or our new favorite, tubes that connect.

The other piece of equipment you should seriously consider is a life jacket.  Depending where you decide to tube and the level of the river, life jackets may be required. There are some great alternatives to the huge orange foam things from the 70s and 80s.

Also, if you don’t have tubes that connect, you’ll want to bring along a sturdy rope so you can tie your team together to float as a group.


Plan the Route

The route we enjoy most runs from Pony Pasture to Reedy Creek and is a 3 to 4 hour float that takes you down 2.5 miles of beautiful James River scenery. Float time will vary with the water level, so be sure to check it and plan accordingly.

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You’ll need at least two cars to execute the required drop-off and drive back.  First, plug Reedy Creek (4190 Riverside Dr, Richmond, VA 23225) into your GPS. Have both cars meet there.  Pile all of your tubes (deflated), coolers and friends into one car and lock the other one up safely. It will stay behind at Reedy Creek.

Next, enter Pony Pasture (7200 Riverside Dr, Richmond, VA 23225) into your GPS. When you get there, you can pull up to unload all your stuff and blow up your tubes, but you may have to parallel park in the neighborhood as the lot is often full. Don’t forget to lock your car!


Launch!

A few important tips:

  • Stay to the right – the rapids tend to be on the left in the James.
  • Butts up! – lift your bottom up when going over rapids to help ensure you don’t get stuck.
  • Be careful when walking on the bottom. There are major, abrupt drop offs as there are rocks lining the bottom.
  • I REPEAT: The rapids past Reedy Creek are intense, dangerous and not fit for amateurs in innertubes. Don’t do it, or you may end up a Trauma patient in the ED with us!

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Don’t Miss the Take Out

After floating underneath the train bridge in the photo above, you should start keeping a lookout for the Reedy Creek Take Out.  The James will fork temporarily, and it’s important you stay to the right if you want to end up anywhere near your car. There’s a sign you can’t miss that says “TAKE OUT” with a big arrow guiding you to the right. Don’t go left. Even an UberXL won’t be large enough to fit your whole crew plus all your gear if you miss it.

When you exit the water and walk up, you’ll see the Reedy Creek parking lot where you left your other car.  Time to deflate the tubes and pile everyone in this car to head back to Pony Pasture and grab the other car.


Capture the Fun

If you don’t have a waterproof camera or a GoPro, you can easily take pictures or videos with your SmartPhone with the help of a $10 Joto Waterproof phone case.

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So that’s it.  Grab your tubes, +/- a life jacket, cooler and some friends, and get ready for an awesome afternoon on your schedule.

~Steph

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Exploring Virginia: A Day Trip to Tangier Island

Tangier Island has always been a place of intrigue in my mind – a mythical island of less than 500 people, disconnected from daily life. When we were young, my sister took an overnight boat trip there with family friends. A hurricane led to a near stranding and peaked my interest in visiting. In medical school, we learned of Tangier Disease, a genetic disorder causing reduced levels of HDL (good cholesterol), named after the island’s inhabitants who have a rather shallow genetic pool.

 

So when Amir suggested a day trip, I Googled “tangier ferry” and discovered Tangier Rappahannock Cruises, a 2 hour ferry service that leaves from the coastal fishing town of Reedville, VA. I recommend selecting the same-day return trip, and skipping the suggested lunch at the Chesapeake House (more on that in a bit).   Total cost round-trip for the two of us was just $57.24 including all taxes and fees. While you can just show up at the dock and buy tickets the same day, I recommend booking online to save yourself time and ensure your reservation.

We sat on the bow to get the best vantage point of blue skies and glassy seas. Osprey, fishing boats and crumbling barns float by, demanding the attention of your camera lens. I, as usual, captured them through the lens of my iPhone, Amir through his Canon DSLR.

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Tangier soon turned from a distant mirage to a beautiful green world just ahead. The skyline was low, consisting mostly of simple two-story houses with a rare deviation in height for a church steeple and a water tower. As we entered the man-made channel lined with little white houses and docks, our ship’s captain revealed that Tangier is the world’s source for soft shell crabs. The crabbers live in these tiny white shacks – shacks that are filled with blue crabs, checked diligently on the hour in anticipation of the golden moment when the crab molts its shell. The crab is then scooped up and placed on ice or into a freezer and sold to restaurants for a feast later that day. It’s a practice as unique as the island itself.

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We stepped off the boat and onto the dock, the end of which was lined with locals in golf carts offering 15 minute tours of the island, and friendly women with sun-aged skin offering coupons for the best lunch spots (there are only 7). We opted to skip the carts and create our own walking tour.

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Instantly we were struck by the strange collision of worlds. Tangier is part what you would expect – fishermen, boats, flip flops and simple life at a slow pace – everything I love about Chesapeake Bay living. But it’s also part Cuba, part 3rd world country. For an isolated island, bringing goods in is expensive, so you see signs of old everywhere you turn. 1970s motorbikes, rusted chain link fences, refrigerators from 3 generations past. If you want new and shiny, this is not the place for you.

And while old often equates with charm, there’s something a bit off in Tangier. Like bringing things to the island, disposing of them is also a costly task. So, garbage is everywhere – broken down golf carts, bottomless boats, and 20 year old Pepsi cans littering the land and the water. It makes you cringe. It doesn’t fit. A proud people so dependent upon nature for their existence, so careless in protecting it.

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For a half second my mind contemplated the missed opportunity – “What if they just picked up the trash?” “What if they had some eco-friendly activities?” I imaged the potential for increased tourism, and the subsequent revenue that could benefit this island and its people. And then I wondered, maybe this is deliberate.

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We decided to try Fisherman’s Corner for lunch. We entered the brightly painted, simple square building to find a bustling room tightly packed with tables of both tourists and locals. The menu was typical Chesapeake Bay fare – she crab soup, crab dip, fried shrimp, crab cakes and soft shell crabs. Clearly we had to try the soft shells. The food was simple, home-cooked and a tad pricy, but delicious. My soft shell crab was sandwiched between two slices of white Wonder bread. While I was initially skeptical of my minimalist bun, when topped with the zesty tartar sauce, the flavors combined perfectly. We skipped dessert since we’d already cheated and devoured hand-dipped ice cream cones on our earlier walk.

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Soft shell crab sandwich at Fisherman’s Corner | Tangier, VA
We continued our ambulatory tour of the island, scoping out the picturesque little houses and the oddly placed graveyards in each front yard. Tangier is only 4 feet above sea level and losing 10-15 feet of land mass per year, so space is limited. A brief scan of graves reveals repeating names – Crockett, Pruett, Pruett, Crockett, Crockett. I begin to better understand the origins of Tangier Disease.

There are two churches, one fire station, one police officer and one school. On an island with 450 people, you make do. The sign outside the fire station explains that until very recently, every household was provided with a single leather bucket. When a fire broke out, the entire town would arrive and form a bucket brigade. I wondered what hurricane preparations took place today.

In just 3 short hours, we’d experienced 90% of what Tangier has to offer. We heard a dialect I can only describe best as Old English garble. We marveled at the eccentric locals like bird watchers spotting a never-before-seen species. Tangier is a dichotomy of beautiful and ugly, but special none-the-less.

~Steph

Extreme Rental: Jeep Rubicon – Sedona, AZ

Originally posted on JPFreek.com

I always prefer the window seat. Mostly because I will hold my urine to the edge of kidney failure rather than try to cram my 6’5″ frame into an airplane toilet, and having to get up repeatedly to let my weaker-willed neighbors past makes my eye twitch. But there’s more to it than bladder control. I control the shade, and at my leisure I can peer out and down, unobstructed, over the great expanse below. 

windowJust a few weeks ago, I found myself in that prized position, looking down on the vast Senoran Desert, on my way to Phoenix, Arizona. From twenty-thousand feet, it’s a wasteland. Seemingly random outcrops of red stone rise and fall away, separated by endless miles of nothing at all, except every few minutes we’d drift over one of those mega-farms with the funny patchwork of circular fields. With nothing else to do but think of the bone-crushing pain being inflicted by the seat in front of me, I found myself wondering, “Just how could those first settlers have made it all the way out here in their Conestogas?” Gold or not, it looked impassable. 

Soon after, we landed in Phoenix, a quilt of strip malls sewn together with massive highways. I was there for a conference, but arrived a day early to explore with my wife. We settled into our hotel and quickly planned a trip to Sedona, just a few hours north, and set off early the next morning with our GPS aimed for Barlow Adventures

 We arrived around ten, and our hearts sunk to find half-day rentals start at 8 AM or 1 PM. They were kind enough to squeeze us in anyway, and with just a glance at my insurance card handed over the keys to Jenny. Oh Jenny. A red four-door Rubicon with the hips of a belly dancer and treads of an M1 Abrams. To my wife’s mixed dismay and delight, I fell immediately in love. 

The folks at Barlow gave us a quick, but thorough, tutorial of the best trails to suit our style – an easy climb to get acquainted, culminating in stunning views, followed by a technical crawl down into a valley full of history. With that, we put the top down, turned the radio up and got rolling.

Immediately, with a blue sky above us and red rocks all around, we felt we could conquer the world, just my wife, Jenny and I. Within a mile or two, we made it to the first trailhead and checked our notes. “When you pass the gate, put her in 4-HI and reset the odometer.” Done and done. 

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Schnebly Hills Trail is a winding, bumpy fire road up the side of what I can only assume was Schnebly Hill. Jenny plowed over everything in her path. The only thing limiting our progress was that we kept stopping to take photos because the scenery just kept getting better. Massive, imposing rock formations surrounded us with hardly another human in sight. Cacti, iron woods and the hot sun above us – it was the setting of every spaghetti western. At first, I tentatively wove my way along, afraid to test the limits of the $25 tire and glass coverage we’d added. But my lack of experience with off-road driving and the sharpest, most punishing rocks proved no match for Jenny’s sheer brawn. We made it to the top, where we went on foot to explore the “Merry-go-round,” a rocky outcrop boasting a jaw-dropping panorama of the entire valley. We sat down for a few minutes to soak in the sun and bask in the diem we were thoroughly carpé-ing. 

If the way up was a learning experience, the way down was an educatioAmirn in fun. A downhill slalom, probably at higher speeds than Barlow would have liked, with a Pearl Jam soundtrack provided by Jenny’s Sirius XM radio, Schnebly Hill melted away. At the bottom, once again on pavement, we consulted the maps provided to us to navigate our way to the next trail. 

Soldier’s Pass was an entirely different beast altogether. This time our notes said, “4Lo, nice and slow.” I dropped Jenny into low gear and flipped the sway bar disconnect switch, allowing the axles to move more freely. Free is good. Let’s go. 

11149437_10100612306839057_5446780083734526773_n (1)The first thing we came across was a sign telling us if we couldn’t make it down the first boulder crawl, not to bother with the rest of the trail. Needless to say, Jenny took it all in stride, and again more than compensated for my lack of having any idea what I was doing. We rumbled down the flight of rocks, coming to rest on a trail just a few inches wider than our Wrangler. For the next hour, Jenny took us back in time. We clambered up and down some gravity-defying inclines on our way to an enormous gaping sink hole exposing a few million years of sedimentary layering. On the way back we visited the Seven Sacred Pools, from where General Crook marshaled his campaign against the last of the Apache. Jenny never missed a step. From start to finish, all I had to do was point her in the direction we wanted to go, and our girl’s 285hp took care of the rest. Sadly, with our first two trails down, we were nearing the end of our four hour escapade. We turned back towards Barlow and, with heavy hearts, turned over the keys.

Needless to say, getting back into our rental car was rather disappointing. If it hadn’t been for the unbelievably good taco truck we found on the way back, I may actually have shed a tear to leave Jenny behind. The next day at our conference was even less exciting, but the last drops of adrenaline still had me feeling like Superman. I finally understood why people buy those burly, lifted, totally unnecessary vehicles – because they must turn even the most blasé commute into an experience

On the flight home, I thought again of the rugged pioneers who trekked across a continent in rickety wagons with every one of their earthly possessions in tow. I imagine they’d be pretty annoyed to know how easily some guy from the East Coast can do it now but undoubtedly proud that they paved the way. I tried to look out the window to catch one more glimpse of the great cactus strewn expanse where roads are once again optional, but I was stuck in an aisle seat. I didn’t care. We’d had an unforgettable adventure. And, more importantly, I was in an exit row. 


~Amir

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