A travel history to beat all travel histories

Paul Sax: [00:00:01] Hi, this is Paul Sax. I'm editor-in-chief of Clinical Infectious Diseases and welcome to the Let's Talk ID podcast. Thank you for listening. Joining me today is Mike Reiss, a longtime friend dating way back to my college days. Mike, start us off by telling us a little bit about yourself, what you do, where you grew up, where you live.

Mike Reiss: [00:00:22] I grew up in Bristol, Connecticut, outside of Hartford. My father was the town doctor. He was a doctor, and I was a great disappointment to him for a very long time. He was very hard-working doctor. Everybody loved him. He was an internist with a specialty in gastroenterology. So then I went to college with you and I was on the Harvard Lampoon. And I am a comedy writer. I've been a comedy writer for 40 years now. 35 of those years have been on The Simpsons. I was there on the original staff, and I was smart enough never to leave.

Paul Sax: [00:01:01] Now, Mike, this is an ID podcast, and you're a comedy writer for The Simpsons. I'm trying to make the connection here. Why are you on this podcast? Well, I'll tell you why. Infectious disease doctors are obsessed with something that we widely call the travel history. We ask patients where they've traveled to see if we can uncover an exposure that explains their illness. So what would an ID doctor find out about you if he asked you for your travel history?

Mike Reiss: [00:01:29] They would find out I have been to 134 countries. Not by choice. My wife loves the travel and I love my wife. And if I want to take a vacation with her, it's got to be to North Korea or Lebanon or the top of Mount Kilimanjaro. I've been to all those places and I've been to the North Pole and the South Pole. And I recently took a submarine down to see the Titanic on the bottom of the Atlantic. I get around.

Paul Sax: [00:02:02] Did you travel a lot as a kid?

Mike Reiss: [00:02:04] Not at all. I did not. My father loved the Civil War, so we would just go to battlefields and joke that our family album looks like it was shot by Matthew Brady. That was it. I thought that was a vacation. There were five kids and he packed us in a car and drive us to a battlefield, which means nothing to a kid. I just came to dread summer vacations..."we're going to Shiloh, kids."

Paul Sax: [00:02:33] So, Mike, now you're going to places that are much more exotic. You've been to places that other people don't visit. You said North Korea and any other places come to mind.

Mike Reiss: [00:02:44] I've been to Iran. My wife was just dying to go to Iran. And I thought, Why? And she said, You'll like it. And we flew to Iran. And the second we got off the plane, we were hauled into custody. And they bring us into a back room, a couple of security guards, and we're just sitting there. We're sitting there. And then they brought us ginger ale and hard candy and I thought, this is like being held hostage by grandma. And then after two hours, they let us go. And I said, Why did you do that? And they said, Because you do it to us when we come to your country. From that moment on, I loved Iran. It was one of the friendliest, warmest places we've been to, Iran and Iraq. I'm almost sad and that we're running out of Muslim countries to visit because I just find them the warmest, nicest places in the world.

Paul Sax: [00:03:36] So you've been to Syria?

Mike Reiss: [00:03:37] I have been to Syria. And in fact, I got sick in Syria. I don't know if we're going right into medical history, but that's one of the places I got really sick.

Paul Sax: [00:03:46] Well, you know, I was going to transition there and ask you about when you travel. It puts you at increased risk for infections. In fact, there's an entire field within my field called travel medicine. So before you go on these trips, especially to tropical countries or developing countries, what kind of preparation do you do

Mike Reiss: [00:04:06] We look at the weather and that's it. And then we're off. In 30 years of non-stop travel, I only remember having to get one shot for yellow fever to go to Africa and that's it. We don't get the vaccines. We don't stock up on local medicines. My wife, I realize, has stayed completely healthy through all of this, and I think I've gotten sick six times.

Paul Sax: [00:04:32] Well, there's an entire industry of pre-travel preparation that you are depriving people of income by this approach. So let me ask you, you've recently been in Africa, I know that. Did you take preventive therapy for malaria?

Mike Reiss: [00:04:48] I did not.

Paul Sax: [00:04:49] Okay. Take it from me. A infectious disease specialist. That's a very good idea when you go to that part of Africa. Where were you in Africa recently?

Mike Reiss: [00:04:58] Recently we were in the southwest, I think it was Namibia and Botswana and Zimbabwe. I went to Zambia, which I didn't even know was really a place.

Paul Sax: [00:05:10] And?

Mike Reiss: [00:05:12] And I was fine. I really had a great time. And in fact, it was a very popular photo I posted online, which is you can go to Victoria Falls and hang over the edge. You lay down and hang over the edge and a man will hold your ankles so you don't plunge to your death. But you know, he's standing in the falls too, and it's his wet hands holding your wet ankles. So I paid to do that. So malaria is really nothing by comparison.

Paul Sax: [00:05:42] You have to understand that, that when people travel, some people travel with a tremendous amount of fear and so they don't eat the local food. They don't have ice cubes in their drinks. And what they're really afraid of is gastroenteritis. Your father probably used that word when you were growing up. You know, various other terms. People sometimes say food poisoning. Have you ever experienced that particular complication?

Mike Reiss: [00:06:07] Yes, I have. Yes, I have. And I like it. It sort of brings back fond memories. And the dumbest one was in Syria, where, again, I feel bad when it's happened in their country because these were the finest people in the world. I wish everyone on earth was a Syrian. They were so warm and inviting. One night I'm at dinner and I just sit down at a table full of Syrians. They kind of welcome me over and I'm eating with them and then I go to pour a drink. There was a, you know, it's hot and there's a pitcher of water on the table and they're all warning me, waving their arms, Don't do it. And like an idiot, I'm thinking, if these people are so nice, how bad could their water be? And I drank the whole pitcher of water. And then the next day, yes, I got terribly sick. I think I was at Palmyra. I was at one of the great world heritage sites, seeing these amazing ruins and just throwing up all over them and pooping everywhere. I was an absolute wreck. And I'll say, as a traveler, you travel for experience and. Why not? Any time I get sick, I go, Well, this is part of the experience. This is something I can't do at home, so I don't mind it terribly. And any bout I've had, which has been over in 24 hours.

Paul Sax: [00:07:33] Good. And you must have also experienced the inconvenience of these illnesses. Trying to find a place to relieve yourself.

Mike Reiss: [00:07:40] Yes, I had it once in Africa. I'm going to say Rwanda, where I don't even remember what I got, where I got it or anything. But I was fine. And then I was really sick and we had to go somewhere. It was like an eight-hour travel day in a van and I'm just stopping everywhere to poop. And at one point, I'm not proud of this, I went into a building that was under construction and there was a toilet there, and I don't think it was connected to anything. But I used this toilet and then I get back in the van and the amazing thing, he took me to a clinic and the clinic had, I think had been a deli like a week before. I mean, it had a meat counter and, you know, refrigerated shelves and stuff. But somehow it was just packed with people needing help. I went into this mob of Rwandans and I'm just sitting there and I finally get to see a doctor and he somehow understands my symptoms and he hands me a green pill. And the bill was $0.72 for the office visit and the pill and whatever this was, I took the pill and I was better within three minutes. And I not only didn't have symptoms anymore, I felt like I should run for president. I felt so good. So I don't know what that was. But, you know, very nice diarrhea experience.

Paul Sax: [00:09:11] Well, if you're going to get better, it's nice to get better fast. I also must say that your anecdote about the Rwandan toilet must be a long list of your experiences with the world's toilets. Any comments about those?

Mike Reiss: [00:09:24] If you like these stories and there's a good chance you do not. But if you like them, I do a podcast, the travel podcast called What Am I Doing Here? And it takes you to all the places that I had a really bad time. They're mostly just travel horror stories and they're all true. And it's a funny short podcast and it's scripted and produced and it's like a nice radio show. And so it's called What Am I Doing Here? You can get it anywhere you get podcasts. What I found is it's humiliating and that I've taken people all over the world with this podcast and everybody's favorite episode is the toilet episode where I talk about the different toilets of the world. So if that's your focus, just go right to episode 42, The Toilet Show.

Paul Sax: [00:10:17] You want to share some details from it?

Mike Reiss: [00:10:18] The ones that I loved telling was the idea that anywhere you go in Africa, you know, even in the finest hotels, they'll have beautiful bathrooms. It's marble and brass and beautiful mahogany doors and a beautiful toilet with no seat. You cannot find a toilet seat anywhere in Africa. I don't know where they're going. And someone is somehow sneaking in there and prying off the toilet seats and slipping them under a dashiki or something. That's clearly why they wear these big flowing robes, the smuggled toilet seats out. And what are they doing with them? You know, where did they go? Did somebody steal their toilet seat and they have to get someone else's or are they selling, you know, here's a nice toilet seat from the Ritz. I don't know what's become of all the toilets?

Paul Sax: [00:11:16] Well, you might want to contrast that with Japan.

Mike Reiss: [00:11:19] In Japan where the toilets are so beautiful. My wife is dying to buy one of those. They're probably up to $20,000 to buy one of those toilet seats that spray perfume and play music. And my friend has one and I go to their house, and I don't know how to use it. I don't know what button to push. And it doesn't work for me.

Paul Sax: [00:11:42] So you're a famously low-tech person, which must present very interesting challenges when you travel. Do you use any apps on your phone or anything in particular to get around?

Mike Reiss: [00:11:52] I don't have a phone. I don't have a cell phone. I've been in the USA Today twice as the man with no cell phone. I get by okay. I can still get around.

Paul Sax: [00:12:05] How do you take photographs?

Mike Reiss: [00:12:06] My wife takes photographs. My wife has a phone and I am always with my wife. That's one reason I have to follow her around the world. Sometimes I have to make calls. She takes thousands and thousands of photographs. She takes more photographs than the average security camera. So I do this podcast and it's full of travel stories, and I try and keep it light and entertaining. And there are many times I go, Did this really happen? But the podcast, What am I Doing Here, is coming out in book form later this year, and I had to go digging through her 100,000 photos to illustrate the book. And sure enough, every story I told was true and we had photographic evidence. So when this book comes out, I think that's a real bonus, even for people who've heard the show.

Paul Sax: [00:12:57] In addition to infectious hazards, there must have been other hazards you've encountered.

Mike Reiss: [00:13:01] Yes, I had one terrible, terrible experience in Pakistan. I went to Pakistan. My wife once was telling me I want to go to Afghanistan. And I said no. And she looked at me because she'd never heard this word out of my mouth before. And, you know, she speaks five languages and didn't seem to understand "no" in any of them. I said, No, I will not go to Afghanistan anywhere but Afghanistan. So we went to Pakistan and we went to the Kalash valley, this very remote valley, to see a pagan moon festival. And all they did was kill goats. It was just five solid days of killing goats. And then at the end of five days, I go we to get out of there. And there's only one road out of the collage valley. And a landslide had covered the road and the road is about 200ft up and it's covered with a landslide. But they brought in the only earthmover, the only bulldozer in the area, to clear the way, and the bulldozer slipped off its tracks. So it was now blocking the road as well, and it was teetering over the edge of the cliff, about to crush the whole city below that. It was trying to help and we had to get out of there just to get out of the Kalash valley. We had to climb over the treads of this bulldozer hanging over the edge of the cliff, over the city, in the mud with our luggage. Diarrhea is nothing next to that. This is my life.

Paul Sax: [00:14:46] In one of your podcasts, you mentioned seeing the evidence of the hazards of driving as you are being driven yourself.

Mike Reiss: [00:14:54] Yes. Yes. That was in Ethiopia. Ethiopia, again, one of the loveliest countries you can go visit. I recommend that to anyone and full of beautiful people and lovely sights to see. But Ethiopia, which is right around the equator, should be very hot. But they built every city in the country is sort of built up on a very high plateau that you can only get to by a terrible winding road. Every single city you go up a road, you're in a van and you look outside of the van and you'll see at the bottom of a ravine, another tourist bus. And it's usually it has fallen off the road and generally upside down. And again, that's to get anywhere in Ethiopia. You have to risk that and look at people who did not make it.

Paul Sax: [00:15:45] Now, you have given us one anecdote about medical care you've received. Have you had other times when you've needed to get medical care while you've been traveling? You or your wife, Denise?

Mike Reiss: [00:15:55] Only other time, and it's the sickest I've ever gotten. I'm not even sure what it was. I know nobody's thinking of visiting Uzbekistan, one of the most gorgeous countries in the world. And it's full of ancient things that look brand new, you know, mosques and temples. And you've never seen more beautifully maintained medieval things than in Uzbekistan. I really recommend it. And I ate a lot of horse. That's the national dish is horse. And I developed a real taste for it. And I come back to America. Where can I get a horse in New York? And the answer is nowhere. You can't eat horse in America. I was just there and I got so very ill with something. And this is about eight years ago, and I have a guess now. I'm obviously not a doctor, but it sounded like the very worst of COVID at the start of COVID, that's what I had. I was just drenched in sweat and coughing all night. I had a terrible fever and my lungs were filling with something. So it sounds COVID, right? I was just laying there dying in bed. And my wife, of course, it didn't slow her down at all. She'd go off touring. The funny thing is, I was working on a movie script with a friend. It was a collaboration. He was going to do it and I was going to rework it and we'd work the whole thing out.

Mike Reiss: [00:17:22] And the script was due in a couple of weeks. And in the midst of me dying, he sends me the script to work on. It should have been easy. We'd planned everything, worked it out, and it was a nightmare. He had done such a horrible job. I couldn't believe it. And I remember thinking, Is it just my fever that makes the script so bad? I spent what I thought were my final days on Earth trying to fix this screenplay in an Uzbekistan hotel with a 104 fever. My wife finally found me a doctor and we got a doctor who...it was funny because he said he was a doctor but it was in like an alcove in a hotel. And I mean, I think he may have been like an elevator operator or something, but he looked at me and he prescribed some pills for me and three different medicines. And again, they cost $0.72, just like the pill in Africa. I remember that. A course of three different pills for $0.72. And I got the pills and I took them. And I don't think they did anything. I don't think they did any good at all. But, you know, I survived and the script came out okay.

Paul Sax: [00:18:35] Well, you know, it's tempting for me as an ID doctor to try to make a diagnosis, but it sounds like you could have had the flu or you could have had pneumonia.

Mike Reiss: [00:18:42] It might have been pneumonia. It was really bad.

Paul Sax: [00:18:45] Everything sounds like COVID these days, but people obviously got sick with non-COVID things before COVID. So I'm going to ask you about fear of travel, because there are people who are very afraid to travel. And do you have advice for them?

Mike Reiss: [00:18:58] I would say just do it. I can say in 30 years, 134 countries, I don't know, I've had 2 or 3 bad experiences, you know, and I got kidnapped once. That turned out okay. It was funny. I got kidnapped in Honduras. That's my advice, I guess, to anybody is don't go to Honduras. Don't go there. It's a terrible place and everybody's in a terrible mood. But yes, I've been to really dangerous places and I guess the very worst places in the world. Your government won't let you go. I did get sick in places, but I got sick in LA too. I got food poisoning in LA and you can get sick anywhere. Once we traveled to Sudan, which had just been a war zone and people thought we were crazy. And while I was gone, a bomb went off on my block. There was some terror attack on 42nd Street, so I was better off in Sudan. So, you know, the world is a little bit dangerous wherever you are. I just recommend people do it. I think even though I don't want to go anywhere, it's really given me a kind of beautiful faith in people. People are really nice everywhere you go. Food is really good everywhere you go. So if you get sick, well, you get sick and you probably won't die.

Paul Sax: [00:20:23] Speaking of traveling and speaking of not being able to travel, the pandemic shut down travel for everyone. How was that for you and Denise?

Mike Reiss: [00:20:31] It was very interesting in that we live in Manhattan. I think people don't realize, you know, if you're in a place like Manhattan, you're stuck because we don't have a car. And for several months you were afraid to get on a subway or a bus. And we became like medieval peasants in that all we could do was see how far we could walk in a day. And in fact, is that just because it seems to be a theme of the day, all the public restrooms in New York were shut. So it was like, how far can you walk and still get home to use the bathroom, which is not that far. So we spent four months just at home watching TV, and I remember thinking, Hey, this is what I want to do. I realized for the first time in decades, we're doing what I like to do. And it was great. Yeah, we had a good time during COVID, I did at least. And then we started traveling. As one by one, things opened up. So we took a trip to the Catskills and then we took a trip to the Upper Peninsula of Michigan because nobody's there. It was weird. It was the Catskills, Michigan, and then Kenya. Kenya opened up right after that and we went to Kenya and it was really great. You know, everything's open. We could eat outdoors. And there was virtually no tourists there. So it's been fine. And we managed to visit every continent during COVID.

Paul Sax: [00:22:01] And how do you think we Americans are received these days when we travel?

Mike Reiss: [00:22:05] People are very nice to Americans. The funniest thing was someone said, you Americans, you apologize too much over the past couple of presidencies. We just go around, go. We're sorry. We're sorry. We're sorry. Actually a place like Iran, where you think they're going to hate us, they love us because everyone in Iran has had a cousin who came to America and made it good and had a nice experience. So Americans are very welcome. I would say everywhere, everywhere. They really don't have a problem with us. And almost every country understands you are not your leader, you are not your government because they generally are not their government.

Paul Sax: [00:22:45] So, Mike, where to next for you and Denise?

Mike Reiss: [00:22:49] We're going in a couple of days to the Philippines, where it's an Easter tour where men are crucifying themselves. My wife is just telling me, she said there's a man there who's crucified himself every year for 33 years and, you know, 33. He's about to break Jesus's life expectancy record. He's been crucified for 33 years. And I go, Well, yeah, after the first time, I'll bet it's easy. The whole time there. It's like getting your ears pierced. We're going to the Philippines, and then from there we hop down to a cruise ship on Western Australia to see a solar eclipse. And then we're jumping to Tasmania to visit old neighbors of ours. And then in my wife's typical planning, we're going from Tasmania around the world to Spain to jump on kind of a food and wine tour. So that's the next six weeks. And again, this is my life.

Paul Sax: [00:23:50] Okay, well, listen, Mike, this has been a really fun and fascinating conversation. I'm going to give you a chance to make some final comments to infectious disease doctors and other clinicians everywhere you want to make any.

Mike Reiss: [00:24:02] Just thanks for your hard work. Everyone appreciates what you do and then to see you poor guys come under attack during the last administration and have people not trust you is just insane. I mean, we can't thank you enough for keeping us alive and why you took any abuse just shows how insane and upside down the world was. Thank you for doing what you do.

Paul Sax: [00:24:28] Mike, thanks a lot. And once again, I've been talking with Mike Reiss, Simpsons writer and host of the podcast What Am I Doing Here? I highly recommend it. Thanks for listening.