I make my livelihood as a doctor. But what I want from my life is much more. I want to see and feel and live it all. As trekkers enter the Annapurna conservation area there is a cautionary sign: You are not here to change Nepal. Nepal is here to change you.

In the emergency room, I sit at the bedside of a new immigrant from South America. At the top of the chart is a little box labeled "chief complaint" where the desk clerk has typed in "chest pain." Chest pain is a claim that makes some physicians a little uneasy; it warrants serious consideration. I am obliged to ask a lot of questions about the quality and extent of the pain. But my patient doesn't understand my questions, and I don't understand his meaning. We both think the other is dense. Valuable time is ticking. After some interpretation through a seven-year-old child, we decide that it is not chest pain, it is heart pain. And his heart aches because he misses his family. There is nothing I can do for his medical problem - he doesn't have one. He has waited six hours to hear that he is not sick. Still no one has cured his heart pain.

Patients new from other countries experience this frustration every day. When I travel overseas I get to feel what it is like to be alone, or in pain, and not have the language to express those sensations. I experience the frustration of wading through a system that I don't understand. In return, I can appreciate the tumultuous state of mind in which patients in Canada may find themselves. I can better see my patients as they are, instead of how I wish they would be.

Trying to communicate with people who speak a different language, and have different priorities is downright shocking. But when every day of your professional life starts to melt into one long year aren't you just dying to be shocked? Life as an emergency physician is not dull. But I reach a point where it's hard to concentrate and it all seems the same. I have seen people change their car, their friends and their partners. When I arrive at a point where I no longer love working the emergency room, I escape to somewhere foreign.

I have exercised my privilege in India, Guyana, and Nepal. Working in native communities of the Canadian north is much the same. The opportunity is often termed a cultural exchange of information. Forced intellectual re-wiring is more accurate. In Canada, a patient complaining of pain in the right side of their abdomen inevitably ends up having gallstones, or kidney stones, or pneumonia. In Nepal, the same patient is more likely to have an obstruction from worms, or an abscess in their liver. All of a sudden the world as I understood it has changed; new neurons fire with delight. If there is anything more exhilarating than solving a problem, it is encountering one that is not going to be solved in any way I have learned thus far.

Just traveling isn't good enough. That would be like sitting down to a meal and only getting the appetizer. In order to benefit I have to be willing to accept what the community has to offer. All of it. Without the filters and doubts of my own cultural sensibility. Don't get me wrong. Volunteering is not an act of self-flagellation. Living simply, without electricity, cars, or grocery stores is not better, or worse, than living at home. It is just different.

On my last trip to Nepal a small boy fell off the flat roof of his house breaking both arms and his collarbone. His arms were sticking oddly off in all directions. Injecting small amounts of coveted morphine, we managed to put one of them back in place but the other required surgery. But getting to the hospital meant a two-hour walk down a valley where a small plane flew to the city twice a week, weather permitting.We were willing to pay for the plane fare and the family agreed to take him. But two weeks later the child was still walking around the village with a stiffening, wonky arm. One arm was good enough.

As a Canadian if something is broken I feel it needs to be fixed. In many countries, misfortune is accepted as a great teacher. And for many Buddhists, it may just be your karmic destiny.

The challenges of work overseas are different. Back home, I have X-ray, ultrasound, and a CT scan. There are always tests available that our patients press us to get done faster. And we, in turn, press our consultants and radiologists. And they press back. And, after awhile, we're all squashed and two-dimensional.

And some of us stay that way: flat, like a tapeworm, slithering its way through existence. When I volunteer I have only the tools that I carry with me. My hands, my brain, my stethoscope and a few books. But I also have time.

In India, I would spend an hour taking a good history, and another half hour examining the patient. And that was good enough. There were no demands for a CT Scan, or some magic pill. And they laughed - a lot. Their sickness was not a burden but a fact of life. Expectations were low. But degree of happiness was high. There was no confusion between what they needed and what they wanted. If a family member couldn't thrash buckwheat because he had pneumonia, someone else from the village would take his place. Problems took longer to solve but I didn't collapse, exhausted, at the end of the day. In India there was time to visit, time to hike, and time to eat. I returned a happier, rounder person.

Volunteering has its down sides. When I was a student in Guyana, we came up with a simple, effective, and self-sustaining project to reduce the spread of malaria from the interior of the country where miners worked in the gold mines. At the same time, we sought to eliminate sexually transmitted diseases flowing into the interior via the sex trade migrating from the city. One small clinic, strategically situated at the mouth of the river, could serve both mandates. When we returned a year later, the small wooden facility had been turned into a brothel. The microscopes we had bought to diagnose malaria were hanging from the ceiling as décor, and the health care workers we had trained and hired had been bought out. "The Lab" was a doing a roaring trade. Instead of stamping out disease as our youthful idealism had anticipated, we had served only to enhance the spread of it.

And then there is the culture shock. The shock of arriving in a novel land is so much easier than the shock of returning home. When I returned from volunteering in Nepal I had a panic attack in the mall. After three months of living in black and white, surrounded by glaciated mountains and stone and mud homes, I was overwhelmed by the return to Kodachrome. The small village where I worked was a place where my days were filled with natural light and the nights were dark, save that sliver which drifted down from the moon, or the occasional dimly lit candle. And then, upon my return, I was in the midst of a crowd, artificial light sprayed everywhere, and before me a display wall of a hundred different brand name running shoes. There was more colour and more choice than I could fathom. And I panicked.

I am grateful to be Canadian. We are privileged. That makes it difficult to walk the middle path. But one day in the not too distant future the ennuie will start to creep in. Despite all that I have, inevitably, I will become dissatisfied. I will become deaf to what I hear and blind to what I see. When matching towels in my bathroom seems important then it will be time for me to be shocked again.