It was a chilly, gray 1973 October day in Minnesota. My nuclear family, Kathy, Josh and Gaby and I boarded a Twin City flight headed for enchantment, the South Pacific (actually the North West Pacific), not to visit but to live there for an anticipated two years. For the prior year I had suffered burnout, boredom, depression, call it what you may. My work with the rural co-ops had become less and less fulfilling. If anything the co-ops were going nowhere and I sensed I too was going nowhere, stuck in a narrow trench in rural Minnesota.

When I read the recruitment advertisement in JAMA for doctors to work in the Trust Territories of the Pacific, I lit up. A chance to work on an island paradise, a world unknown, tropical, oceanic, populated by a mysterious people. I wanted to escape and this was as far away geographically and life-style wise as I could conceive of. I always had been a water person and on the map, Micronesia, the Trust Territories, was all water except for micro-dots of land strewn over a huge area of the western Pacific.

Adventure In The Sea

Josh was two and Gaby four-and-a-half years old. They would not be uprooted from schools and I would be able to have a life that hopefully let me know them more than if we stayed in Minnesota. Their childhood would soon be over, I thought. As for Kathy, well, I didn’t much think about what she would do. She was staying at home at the time, bringing up the children, and I felt that this would be a good opportunity for all of us.

She still balked at going, originally. I applied anyway, but as island ways are, as I quickly learned, it took six months to get a reply. I was hired and was assigned to be a Staff Internist on Truk Island. By this time, Kathy sensed I was desperate for a change, for adventure in my life, a Gaughan-like adventure (one of my heroes along with Joseph Conrad). She consented and I cajoled her into taking scuba lessons in September in Minnesota. Kathy’s and my scuba training progressed uneventfully enough through the pool and written portions. All that was left in early October was the open water test. Clear Lake, a clear misnomer with five foot visibility, was the test site our instructor used for the water practical exercise. The day was cold and raining. We all donned wet suits, most ill-fitting, which meant that the water that filled the wet suits that our bodies warmed did not stay put and thus was continually being replaced by more and more cold lake water. Thus our hesitating before our “suicide” plunge into Clear Lake. Entering was an act of faith. We were led to believe that the original cold horror would soon be replaced by wet suit contained heated water. We were betrayed and never stopped shivering. Kathy and I managed the surface maneuvers. Then came the snorkel mask drop to the lake’s ten foot bottom. We then were to dive to recover the mask and place it properly on our faces while still on the bottom. Kathy couldn’t catch her breath, her courage, to plunge under. After three abortive tries and my exhortation, she finally gave up her anxiety and free dove into the murky waters! Testing completed! We rushed ashore to the roofless dressing area, slid off our wet-cold suits and managed, shakes and all, to dress. Scuba certified in frigid water we now were headed, two small children in tow, for Truk’s, Micronesia’s, the Pacific’s warm tropical seas and surfs.

Friend or Foe

Micronesia, small-nesia. On the map the islands of Micronesia are just that – dots in the vastest geographical structure on the planet, the Pacific Ocean – some 6,000 miles from east to west and north to south. My first thought on viewing Micronesia’s numerous dots on a globe was that the Pacific would easily wash over these dots. I was afraid. I had received, from the U.S. Territories Government, a fifteen page mimeographed brochure. It was very candidly written, no doubt because of a multitude of disastrous experiences involving statesiders who were unprepared for island-style culture shock. The line that stuck in my mind stated that, “if you don’t drink (alcohol)  you likely will start drinking. If you drink already you will drink more.” So much for naive visions of escape to paradise. Some primordial force lived on Micronesia’s islands that afflicted the minds of stateside worker/tourists. it caused a disorder known fearfully as “island fever.” Kathy and I were non-alcoholics and undeterred. For the most part the brochure was a valid warning for those seeking escape, a new start. For those adventure seekers open to the exotic, the islands and their peoples turned out to be a tonic that lasted a lifetime.

I had never been to Hawaii. Florida, yes. I was overwhelmed by Hawaii’s green precipitous mountains and lush palm forests set solidly in a rapacious, all-encompassing sea. This certainly was tropical paradise, a place where I intellectually understood that, unlike Minnesota, I would never have to fear going outdoors in shorts. Then we embarked on the second leg of our crossing the Pacific to Truk Island, my assignment for the next two years. The Continental/Air Micronesia pilots delighted in taking passengers on a tour of Truk lagoon before landing on the 5,000 foot coral air strip on the main island, Moen, a former WWII strip used by the then Japanese occupiers of Truk. The plane dove to 500 feet between the exposed mountains islands dotting Truk lagoon. The pilot pointed out villages, caves, reefs, even shallowly sunken WWII ship wrecks. This was tropical paradise! The lagoon and its mountain islands made Hawaii look like downtown. Lush green island hills were interrupted here and there by a few scattered tin roofed hutted villages and occasional brown fields. Each island was fringed with multicolored reefs that gave way to deeper blue lagoon waters. A vast barrier reef encompassed all. I was overwhelmed with the color and shape and to this day sense a warm melancholy when-ever I view the unique images of Truk lagoons varying topography. It was/is as much an image of home for me as my youthful vision of Manhattan’s skyline.

One week before flying to Truk lagoon my family and I stopped at the Trust Territories headquarters, on Saipan, for initiation. The hotel we stayed at was on the west coast of the island, facing toward Japan, 1,500 miles away, and the Marianas Trench the deepest ocean bottom in the world at 30,000 feet plus, 50 miles offshore. Our first evening we ate at a lone Tapan Yaki Grill on the beach, the four of us facing the sunsetting sky, somehow made more magnificent by the presence of the great sea depth below it, with column-like clouds lined up on the horizon and a slowly setting sun. The sea was flat, the air silent. There were no other diners but us. The chef crafted our meal inscrutably, our first Tapan Yaki experience. It was as though I was participating in the most beautiful and wondrous of death scenes.

On to Truk

Dr. Jones, a surgeon in his early 60s from the Midwest was our official greeting committee at the grass hut terminal. Landing on Truk was a multifaceted adventure. First the pilot buzzed the coral strip to chase off any straying pigs, and then dove the 727 seemingly into the lagoon when at the last moment the runway popped out of the lagoon waters. If our wheels didn’t touch down within 50 feet of the runway’s beginning there would not be enough of it to stop on before falling into the lagoon at the strip’s other end. Each landing was a daring precision, excitement filled challenge.Once on the runway, the plane’s three engines were reversed full blast sending coral rocks flying everywhere including banging against the protectively coated under wings.

Dr. Jones picked us out easily enough among the mostly Micronesian passengers. He took us to the Mar Mar, a native owned screened in restaurant-hotel more or less in downtown by the lagoon. I was overwhelmed; from white cold Minnesota I had plunged into black, strange tropics. Jones treated us to local snacks and gracious chatter but my mind was full of cultural apprehension. The Trust Territories brochure had warned us that the male Trukese could get surly if we statesiders offended their cultural morays, especially those regarding women’s dress. Bare breasts were OK, but thighs caused erotic arousal amongst the island’s males, who rarely were allowed to see bare legs.

Jones took us on a tour of downtown in his beat-up station wagon. The roads were paved with dredged coral and with each rain, which was at least once a day, half the road would dissolve and wash away leaving more holes than road to bump about on. Speed limits were irrelevant. Instead of sleeping policemen here and there, you had pot hole prevention everywhere. Any speed over five miles an hour led to immediate disaster. We weaved along the main drag, past makeshift shops, grass huts, an open air market selling drinking coconuts, mar mars (flower leis, Trukese style), papaya, fresh caught fish and unknown fruit exotics. As we past the Quonset huts that made up the famous Truk Trading Co. I looked into the eyes of a twenty-ish male leaning nonchalantly against the building, no more than five feet from me. He looked back at me with all the ferociousness I was fearful of in these “new” people. Then suddenly his mouth opened, his eyes widened and his face radiated the most warm, loving, child-like smile I had ever felt. My fear evaporated. We had communicated, these Trukese were my human brothers. For the rest of my two years in Truk that smile epitomized my feeling for the Trukese I lived with and learned from and doctored to.

Truk’s hospital was a valiant enough effort, by its American trustees, to create a functional tropical facility. It was a two-story structure, set on a low altitude hillside, built with louvered and screened verandas to capture the breezes that swept down from the haunted green hill above, known for obvious reasons as octopus mountain. It’s vital interstices, the lab, x-ray and operating suites were air conditioned. I tolerate heat poorly and so I wore only a short sleeve white shirt with the two top buttons open, white tennis short shorts and Zories (plastic Japanese sandals) on my daily hospital rounds. Strangely, the Trukese doctors (actually they were medical officers, trained in British style on Fiji) wore long pants. After I was on Truk for six months, Dr. Kiosi, head of medical services on Truk, called me into his office and in a rare criticism of anyone that was not Trukese style, suggested I should wear long pants. I explained my heat intolerance and he backed off quickly enough. I truly did suffer hyperthermia to the point where I needed to go into Popo’s (pregnant one) frigid lab area for a horizontal rest (at 50 degrees Fahrenheit) to recover enough to finish the day. Popo was Bob Gelder, an obese-but-solid 6’2″, 350 pound lab tech with a much worse case of heat intolerance than me. He owned, I think, half the air conditioners on Truk and used a third of Truk’s meager and fragile electricity supply to keep his environment livable – cold and dehumidified. His apartment air conditioners drenched the porch outside the windows they sat on.

Almost all my patients were Trukese as they outnumbered the Americans, who were there as Trust Territory employees, 100 to 1. Almost every hospitalized Trukese patient came accompanied by a clan member or two to take care of the patient’s simpler nursing needs. They slept under the patient’s bed, shared their food (the cook always overloaded each patient’s plate, even when they were comatose). Not only did the clan member help with nursing duties and got free meals, but also helped ward off the great Trukese fear – being alone!

I rarely saw Trukese people alone. They generally went about in clumps, slept in clumps, fished in clumps, held hands, men with men, women with women and women with men, too, in clumps. I took Ngas Kanso, the first head medical officer I dealt with, and a clan chief, out to his village’s reef to show him how to scuba dive. A clump of his clan members came along. Without a word spoken, as I went to get our scuba tanks ready, the clump descended and got them ready. I went to put our tanks on, the clump descended again and mounted them. Ngas and I then walked out toward deeper water to dive the nearby reef. We descended and the clump followed along, we descended further and the clump sent out free divers to comfort us. We walked along the bottom and the clump followed us above and below the surface. We surfaced and the clump lovingly took off our gear. I thought to myself, “this is what you call belonging.” Twenty years later I returned to Truk and rented a non-undercoated Toyota pick-up, the standard personal vehicle of Truk. I drove the pocked marked coral road to the far reaches of Moen Island (5 miles or so). On entering one of the many shoreline villages I stopped and about fifty children and adults surrounded the vehicle. The setting was tense, the stared at my two children and me and we at them. If I had not lived on Truk I would have feared for our lives, but I realized we were being observed as outsiders. They were curious but not really menacing. Then a large man of about fifty came toward our truck and as he looked at me, and I looked at him, we both, after three or four seconds realized who we were! He was Kichou my x-ray tech. He exclaimed joyously, “Dr. Zuckerman!” and I, “Kychou.” We both beamed and suddenly every one of the fifty other villagers beamed and began talking, smiling and climbing all over the truck and my children and I. A half dozen of them then accompanied us to the high school that occupied the old Japanese hill fortress a half mile further down the road. In Truk if you belong, you really belong.

It’s all Relatives

Practicing internal medicine in Truk for me was like receiving a PhD in astronomy and then being sent off to a locale where the evening skies were clear and full of wonder and having only a rusty telescope with a cracked lens and no colleagues. I was University of Minnesota trained in Internal Medicine and fully adept at utilizing the virtues of a modern medical laboratory, a modern radiological department and a broad variety of medical and surgical specialists. All I now had was a primitive x-ray machine manned by a willing but poorly trained technician, a lab of faulty equipment with equally faulty, untrustworthy results, right out of the Trust Territories brochure, a drunken surgeon and an irregularly stocked pharmacy. (I often ordered and paid for antibiotics from Hawaii on my own). All this seemed not to matter much to the Trukese. When I tried to have the pharmacist reprimanded by Dr. Kiosi, our chief, for sleeping on the pharmacy floor, not stocking the pharmacy and disappearing on calm, sunny days to fish, I learned that, like Ngas Kansou, Kiosi was a clan chief. As such, he was obliged to his clan members to get them “work” and in true Trukese style, support them no matter what. The pharmacist was, I think, Kiosk’s eighth cousin or something like that. If Trukese died because of the pharmacists’ “incompetence” (in my eyes) that was not a big deal, people died of natural causes before. Few Trukese understood or cared about what the virtue of western style culture and medicine could do to decrease suffering and save lives. What concerned them was that the dying did not die alone, but in the midst of a clump.

Another big concern regarding the dying was regarding the surviving relatives who had a big argument with the deceased, one that was not settled before death occurred. I had three or four patients, middle-aged women, who came to the hospital as emergencies, paralyzed. Their affliction was sudden and shocking to my western mind. A spinal cord tumor or comprehensive bleeding into the spinal cord? Reflexes in the legs were decreased, pin prick of the feet not felt? Vital signs stable. What to do? Not much but observe. Usually in one to two days these women mysteriously recovered! After a year on Truk I came across a modest sized volume written by an anthropologist who had lived in Truk some ten years before me. His book was titled, “Trukese Medicine.” If I hadn’t been “practicing” medicine in Truk this would have seemed a rather bland title. The author had his eyes open and opened mine. Besides describing a secret language and reef patients used by an elitist witch doctor class on Truk, he described a paralytic condition brought on by “culturally correct hysteria,” of women who were abused by their husbands. This paralytic condition was greatly feared by the husbands as, if not corrected, it could lead to the wife’s death. With death came the unleashing of the person’s good and bad ghost. If the wife died without her marital problem resolved, her bad ghost would haunt (terrorize) her husband. I had seen the horror of this haunting on two occasions while in Truk. The haunted ran amok, unsuccessfully trying to free himself from the avenging bad ghost.

Armed with this insight I dealt with my next paralyzed woman, husband at her side, differently. I examined the woman and then surreptitiously snuck-up on her foot and poked it with a needle. Her foot jumped two to three inches before she could stop the action. Her husband did not notice. I then proclaimed to the husband that his wife was in dire straits and likely to die in the next day or two. His eyes widened in terror. The next day the lady, the abused wife, was “cured.”

Gossip

The day I arrived in Truk the passengers on my flight all flocked off, every last one. Almost all were islanders from one island in Micronesia or another. They were engulfed by a huge crowd of what I assumed were relatives and friends. Smiling faces, hugs and instant jabber that seemed incessant. By the time my family and I cleared the make shift customs inspection the Air Micronesia plane was being reboarded for its flight to Pohnpei and beyond. To my surprise, most of those who had disembarked had reembarked. They had gotten off the jet to stretch their legs and “gossip” with friends and relatives who lived on Truk and knew they were “passing through.” I thought of honey bees when they return to the hive and wish to tell their kin of the location of flowery fields. They dance – signaling the location. Here were humans dancing their information transfer with their tongues. The passengers, having transferred their gossip, and gotten new gossip, reloaded the plan to move on to the next island-hive to repeat their dance. 

I learned to be as big a gossip as the Trukese I lived amongst. Gossip, Trukese-style, didn’t differ much from that of rural Minnesota except it was less meant to be nasty tales about others. Rather it was meant to tell, without maliciousness, what others were up to. Island gossip had another special flavor. The plane allowed for the spread of peoples and gossip over a vast expanse of the Pacific

Ocean, the Size of the U.S of A

Within that expanse the many island of Micronesia dotted the sea were inhabited at the time by about 100,000 humans. Intense gossip could keep you up on the lives of most of that community. It seemed the island “telegraph” spanned the entire ocean between Hawaii and Guam.

When I returned to the U.S. I would still stay in touch by mail or phone and now by internet with a few of my American friends I met in Truk. “How is Clark, who married a Trukese lady so he could open a dive shop legally in Truk? Is Bill (his friend) still helping him or is he in Michigan at the cabin he inherited from his family and is he still living off the land?”

“Clark is in Hawaii with his wife, Enesita. They have two grown children. Business is not good in Truk and he may not return. Bill was recently in Half Moon Bay helping a friend built a boat. He is still single and skiing in the winter,” was the answer.

“Have you been to Guam recently?” I queried.

“Yes, and I saw your medical officer, Kanachi there. He is now working at the hospital in Saipan and told me that Daitfin drowned because he was drunk. Kimio’s diabetes isn’t letting him dive anymore and his son by Michi, his mistress, Greatfin is running the Blue Lagoon dive shop now. He has sobered up and has a wife and two children. He has a computer and e-mail address, on and on,” was the response.

I learned to love gossip. I learned to understand that gossip, Trukese-style, was a strong antidote to loneliness. That it is the one form of human communication dominated by feeling transfer. I shamelessly practice it whenever I can. In their primal actions, Trukese know best how humans were meant to relate.