Arkansas … Saskatchewan … Nebraska … This progression of places formed an interlude in a game of geography used to pass the time during a 16-hour van drive from Nice, France, to Madrid, Spain. I took this ride with a group of rheumatologists and their spouses who were trying to escape Europe in the aftermath of the Iceland volcano. When Eyjafjallajokull spewed ash menacingly across the continent, I was happily attending a meeting on targeted therapies for rheumatic disease in a Mediterranean seaside town called Mandelieu-La Napoule in France.
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Explore This IssueJuly 2010
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The drive to Madrid was a desperate effort to get out of town as the options on Expedia either vanished in the onslaught of other stranded travelers or required a second mortgage to afford. On Saturday, anxious to get flights when our scheduled Sunday flight disappeared with the closure of Heathrow airport, my wife and I worked frantically on a computer in the hotel lobby. Although we overlooked a glorious panorama of the sparkling azure sea, we focused on travel, getting frazzled as we searched for bookings. We tried to purchase an itinerary from Nice to Madrid to San Juan, Puerto Rico to Miami to Raleigh-Durham, North Carolina, but, by the time we entered all of the credit card information, it was gone. Luckily, we hit upon a Nice-to-Madrid flight on Sunday and a Madrid-to-Philadelphia-to-Raleigh-Durham itinerary on Monday. We choked on the cost, but that plan seemed better than other available flights through Bogota, Colombia, or Singapore.
Logging off of the computer, we were reassured that we could get home, albeit a day late. My wife went to catch some rays, and I went off to the morning lecture, an elegant discussion of a new model for colitis caused by deficiency of a transcription factor called t-bet. The model provides a curious but fascinating demonstration of the interplay between the innate and adaptive immune systems in the pathogenesis of gut inflammation. Unfortunately, I had to abandon the lecture when word spread in the lecture hall that the Nice airport could close down because the winds in the upper atmosphere shifted and the ash was drifting south. If the Nice airport closed, we could not get to Madrid and we would be stuck on the Riviera for a long, long time.
One of my friends, who was also at the meeting, explored more exotic options. He located a private jet for a direct flight to the U.S. Although such a flight sounded rather cool, the price tag was well out of reach. Even if the Sustainable Growth Rate is fixed, rheumatologists live on E/M codes that will not fund a one-way ticket on one of Lear’s sleek new models.
The straightforward solution to take a train to Madrid was also out because, in the southern part of France, the trains weren’t running because of a strike of the ticket takers. Despite the downturn in the European economy, with Greece teetering on the brink, the French ticket takers wanted a 5% raise, far greater than their compatriots. While the consequences of an act of nature can be accepted, its exacerbation by striking workers during a spreading disaster was incroyable. Whatever happened to fraternité, fellas?
“Instead of frogs, they should be called toads,” someone said, exasperated when he learned of the train shutdown.
Rental cars vanished in the exodus of travelers for home, and we had a trifecta of modern inconveniences. No planes. No trains. No automobiles.
Vans still existed, and the meeting organizers commandeered two to carry people over the Pyrenees Mountains to Madrid. We signed on, deciding not to risk waiting for the Nice flight that we had booked for Sunday. According to Google maps, the distance from Mandelieu to Madrid is 1,229 kilometers, but the prospect of action was more appealing than getting marooned on the beach and, like those refugees in the movie “Casablanca,” waiting, waiting, waiting.
The Long Journey
Our silver Volkswagen van was commanded by a sober-looking man named Salvatore who wore a white shirt and shiny blue silk tie and looked a little like the French actor Alain Delon. We were all in high spirits as we stocked up on water and wine for the trek through the night. With a full tank of diesel fuel, off we went, optimistic that we would make it to the Barajas Airport before the winds got crazy and covered the sky with the volcanic ash.
While I think of Southern France as the bucolic place depicted by the Impressionists—gentle and suffused in the blazing Mediterranean light—the road to Madrid is a modern highway that could easily pass for U.S. Interstate 95, even if it is populated by Renaults and Citroëns. Nevertheless, the landscape near the road is lovely. Twisting black vines fill the fields and silver-beige cliffs rise high in the distance. An occasional old stone farmhouse makes it clear that this is France.
Amongst the van riders, one read a journal, one did a crossword puzzle, four dozed, and two (including yours truly) engaged in a spirited discussion on the significance of clinical versus radiographic remission in rheumatoid arthritis (RA). We also talked about the emerging data on the relative efficacy of biological versus conventional disease-modifying antirheumatic drug treatment in Disease Activity Score–driven protocols.
Alas, talk of RA can only go so far and we moved onto movies, books, and good old-fashioned gossip about the comings and goings of people in academia. We passed the city where Van Gogh painted and the area where some of my favorite Languedoc wine originates. Through the van window I could feel the terroir.
A VW is supposed to have fahrvergnügen, but Salvatore kept to the speed limit and the kilometers passed slowly. One in our group had an iPhone and periodically gave us a precise update of our location. Nearly 900 kilometers to Madrid was better than 1,229 kilometers, but it was no great solace that the van would be our home for many hours to come.
“Rheuminations” won a bronze 2010 American Society of Healthcare Publication Editors award for best column.
As evening approached, we passed the Spanish border, which was a very informal affair, with far less scrutiny than the road blocks that our local gendarmes in Durham set to “check registrations.” In the twilight, we played our game of geography, but I bowed out when I didn’t know that Susquehanna ends in an a and not an h.
Time was moving slowly, but, as I will relate in my next column, excitement awaited in the Spanish mountains. Then, we will get on to the relevance of this odyssey to rheumatology. Patience, dear reader, we will eventually get there.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.