Renu's Week

Sunday, December 10, 2017

Report of 10 Dec 2017

Hello from our balcony!

The green is green, the sea is merging with the sky in a haze, this is a great place to sit and write.  Scott is puttering about in the kitchen.

Work is good.  We had a patient come in to the Banyan the other day; she is a fish vendor, carrying a basket on her head daily, had complained of aches and pains, and some breathing issues.  I had prescribed some meds, including an inhaler; she had tried to do without the inhaler and I said, "You couldn't, could you."  She affirmed that, and then, in her speech, used an English word most appropriately.  I asked what level of education she had completed and she said, "10th."  I was riveted: she was forthright, comprehending, communicative, clear.  As I sat mulling over some options, my assistants in the room thought I had not understood the patient and gestured "10" with their fingers, repeated "10" in Tamil, and tried in all manner of ways to bring the doctor down from whichever ether she had landed on.  I stated that I had understood, and sent the young lady to one of our coordinators to mull over some employment options, such as community work or outreach.  Let us see what comes of this.  Empowering a woman is extremely life- and work-affirming.

Adaikalam, the facility I am farther off from, is also good.  The cook and a couple of others came by to see me, to get their blood pressures checked and treated.  It is fairly amazing that one can save a life or prevent catastrophic illnesses like strokes just by controlling blood pressure.

Private practice is nice.  My junior colleague had astutely evaluated a patient who had come in with trouble breathing, found that she'd had a heart attack and had consulted the cardiologist.  The patient and family were pleased with the care that our small hospital had given, and were a pleasure to interact with.  Gratitude is a fine motivator, as is niceness.

On Friday, Scott and I were invited to hear a medical talk by a colleague of my sister, Anu.  It was  a prelude to the annual conference of Sundaram Medical Foundation, which is always a good show.  I attended the conference yesterday, got quite a bit of knowledge out of it and then, Scott and I went to see  a pantomime by The Little Theatre.  This is also an annual outing for us, and we heckle mercilessly from the audience.  Naren acted in this production a couple of times and we enjoy going.  All of it is good, as is the fact that the producer uses the proceeds of the show to support the education of underprivileged children, who might otherwise not be able to attend college.  Fine endeavor, needed results.

We Skyped with the boys today, all 4 together for the first time in a while.  I enjoy listening to the boys interact with each other; there is a fair amount of questionable language like "B***h" but that appears to be the norm now and does not reduce the respect or regard each has for the other.  Naren narrated an unfortunate incident at the school where he teaches, and we talked quite a bit about that.  After this discussion, there were other topics, and a lot of laughter, which I unfailingly appreciate.  I also talked to my father earlier last week, told him I was not going to resign and he breathed a sigh of relief.

May you have much laughter and relief yourselves.

Unw -

Sunday, December 03, 2017

Report of 3 Dec 2017

So, being on Gmail, suddenly Blogger does not recognise me and says I have no blogs under my authorship.  The tech husband is trying to work on a fix, so in the meantime, here is the blog entry on email.

I am viscerally finding the need to write.  For some time now, resigning from the Banyan has been on my mind.  This is an organisation I expected to leave only with rigor mortis (the stiffness of death), and am now seriously considering resignation.  As a mentor said when he left a hospital that he had been associated with for a long time, maybe it's me.  I know that I am not happy at one branch, have started berating the patients and that is not good for anyone.  I plan to continue at the other branch, as that is "home" to me.

On the 18th, I dashed off to the U.S. to see my sons and realign the cosmos.  For a year or 2 now, I have wanted to give them a quasi home at Thanksgiving and we hung out this year.  There is a hotel in Carmel, Indiana, that we consider home, the service is excellent, we know most people there and we chilled.  I swam in the pool to my heart's content, we partook of the breakfast ad infinitum and on the day that all 3 of us were there - Black Friday - we spent an hour and a half at the breakfast table, talking, laughing, eating, drinking.  It was grand fun and I returned refreshed, with a suitcase loaded with treats for others.  We also saw my in-laws and watched "The Brave" there as it had not been screened in India; it was cool to see Naren on TV and hang out with the in-laws.    

Private practice is nice.  A memorable patient this week was a lady who works at the Cancer Center, who was diagnosed newly with diabetes at our hospital.  One of her well-meaning family members, knowing little about the illness, asked if she could bring her juice and I said no; she mentioned that the patient had declined, but that the relative wanted to check.  I liked the patient immensely: she was motivated to bring her illness under control, was prepared to do it with diet and exercise, and did all that we told her.

We saw 5 movies in the U.S. - Victoria and Abdul, Justice League, Murder on the Orient Express, Thor Ragnarok (2nd time for me, clearly I had to be forced to go and see the handsome and very funny Chris Hemsworth), and 3 billboards outside Ebbing, Missouri.  Navin did not care for the last flick at all, believing in the milk of human kindness; I rather liked the acting there and did agree that the premise (a rape and murder) was gruesome.

The sea is blue, the view is clear and the Christmas season is on us.  Scott and I headed townward yesterday to see a play benefiting charity, the tickets were sold out, we were happy for that, and headed home.  I got up very early this morning to swim, as I think the lack of exercise in my jet-lagged state this week truly hampered my mood.  I also got to talk to my father, there were lots of chuckles and we will see him in about 3 weeks.  

Have a great week!

Unw,

R      


Sunday, November 12, 2017

Report of 12 Nov 2017

Good evening from Greyland -

Everything is grey - the sky, the faintly visible sea, our immediate outdoors.  There was a new depression in the Bay of Bengal and we became due for more rain, which has happened.  I did manage to get a swim in this morning: that was lovely, because our apartment complex's pool becomes a lot cleaner with rainwater.

And we have Internet back in the house, courtesy a certain Scott Weiss.  Our router had conked out, and young Weiss was on the job.  Actually, neither of us is young any more, but that's okay.  Middle-aged, I think is the term.

Work is busy and fine.  The Banyan's clinic last Monday had fewer patients due to rain, no one complained.  The census is usually heavy and we have little time to actually chat with the patients, which we like to do.  Often, the time is taken up with having to figure out why some patients did not do the blood tests we had ordered, etc., and that is a time-drain.  Still, they are happy to see us and we are glad to provide care.  Some are so unfortunately impoverished that my questions such as "Do you eat fruit every day?" have to be substituted with "Do you think you could eat a small banana every other day?  Is that possible?" 

The other facility of the Banyan had a visitor a couple of weeks ago; Ms. X had been with us last year and came back just to visit.  She has HIV, has been disowned by her family, her husband has died and her in-laws are raising her children, whom she does not see.  The B treated her for various illnesses, had her reviewed by the Government hospital for HIV, and she now has a tailoring job in Hyderabad; she makes excellent money and brought fairly lavish gifts for many of us, including her favorite fellow patients.  A very pretty box of chocolate for me, which was unnecessary, but - of course - very sweet (literally and figuratively).  She was flying back to Hyderabad from Chennai.  Air travel is out of financial reach of most of our staff and all our patients; I am glad Ms. X is well and financially well.  A second marriage is on the cards, the groom-to-be told Ms. X that she could not visit the Banyan henceforth and she has told him what she thought of that idea.  Thusly, there is to be no 2nd marriage.

Private practice is great.  We had a patient (not wealthy) roll in with very high blood sugar and he was panting; I frankly thought the shortness of breath was due to something else.  He did get better breathing-wise after his sugar was controlled.  His wife had been very worried since the start of the hospitalisation and asked me repeatedly if he would be okay; I cannot with blithe confidence say, "Of course he will," and hoped for the best.  The day before discharge, when it was clear that the patient was better, his wife finally smiled and it was a very nice sight.

We saw a concert last night - Lail Arad and J.F. Robitaille.  There is another one tonight (Bennie Dayal and Anil Srinivasan), but the rain and distance are making me have second thoughts.  We also saw "Thor - Ragnarok," and that was simply fabulous.  What comedic timing that stud Chris Hemsworth has - wooo.  We Skyped with both boys this morning and that was also wonderful; lots of chatter, laughter, sharing.

May you have many sharing moments of your own.

Unw -

R

Wednesday, November 01, 2017

Report of 1 Nov '17

Good evening -

The NE Monsoon is in full force, the day is dark and grey outside, but our world is happy and bright: Naren messaged this morning and stated he was okay and safe.  He had been at the site of the tragedy a few hours prior.  We are grateful to all the powers that our son is okay.

Our thoughts are with the victims and their families.  What a real phenomenon gunmen are starting to become.  And in the U.S., not just Syria or Somalia or Sudan.  As one survivor said, "This does not happen in Vancouver." 

My whole day was spent being immensely grateful.  I was in my private practice today and had several extremely appreciative patients.  That was nice, also.  One of them has a stomach ulcer aggravated by his demanding software job and I told him to put everything in the balance, and to go to the Banyan for counselling. 

The Banyan is fine and one of my favorite patients, Ms. X, came by and gave me 2 bobby pins when I was there yesterday.  She might have found them on the ground, but I am grateful for the interaction.  She is mentally challenged and her speech is hard to understand, but she is unfailingly considerate and appreciative, and that is a great joy.  As is everything today.

One of the Security officers of the Banyan met with an accident last week and died, I am very sorry to say.  He was a good man.  His daughter is ostensibly getting married today, the wedding to go on as all arrangements were made so in advance and were in place.  His son died in an accident earlier this year, and he and I used to talk about it.  I miss him.  I miss our conversations, the respect we shared, his grey hair and gentle demeanor.  I feel for his wife and daughter, the survivors of this family.

I phoned my father today; he was reading the Bible and I gave him the news of Naren.  I also thanked him for his prayers, and he said, "Prayer helps."  We were delighted to see my brother, sister-in-law and niece over the weekend; that was grand fun.  Family truly is everything.

Hug your loved ones today.

Unw -

R   

Sunday, October 22, 2017

Report of 22 Oct 2017

Good evening from our balcony!

The sea and sky are merging in color.  The Northeast Monsoon is here and the usual chaos of flooding, etc., is imminent, unfortunately.  Both Banyan facilities are low-lying and I will hope like the Dickens that I can get there.  Otherwise, the staff is mighty diligent about contacting me by phone and we manage.

Life is fine.  Big rain today and the road perpendicular to our apartment complex has several puddles.  I had wanted to swim in our complex's pool and my engineer husband once told me that wasn't a swell idea, to swim when there is rain.

Our patient with a diabetic foot ulcer is back from the hospital after she was operated on.  She is an intelligent person, knowing what is going on with her body, and updated me well.  Sometimes, our patients are sent home to their families and all good intentions abound; then, the issues of the patients not taking their meds, etc., come flying to the fore and the patients come flying back to us.  The medicines are mailed to the patients free of charge - as another blogger said, "The Banyan is for life" - but the meds are not going to do any good at all unless they are placed in the mouth and some water follows, the meds are swallowed.  Noncompliance had happened with our patient and I am happy that the foot is not worse; she came close to losing her toes, but thankfully did not.  She is now on insulin as I simply cannot waffle about with oral medicines. 

Kovalam is fine.  The residents (postgraduate doctors) from a Chennai hospital have stopped coming and I was solo last week; it was fine, really.  We have our share of noncompliance with community-dwelling patients, also, and I had to have the social workers drill some sense into these folks.  For some patients, the clinic visit is social hour; many with blood pressure issues - who only have to be monitored once a year - come very week!  They catch up with the others in the waiting area, fill us in on their family news, share tales; unfailingly, our staff treat all the patients with respect and I imagine the patients like that and want more of it, it being revolutionary to an impoverished, "scheduled caste" populace.  A couple of weeks ago, as we briefly left to have breakfast in our dining hall, one of the patients told me to tell the staff to give her breakfast, just as another patient had asked the previous week for milk.  We do not have the resources to feed all comers, regretfully.  For this reason, I like the breakfast to be ready before the patients start coming, so that eating is completed before those who can afford little come to the clinic

Private practice is also grand.  As I have mentioned before, a new breed of patient is the sexually active unmarried Indian.  One such came, pregnant.  MTP (medical termination of pregnancy) happened and there was a bit of a complication as a pregnancy was detected in the fallopian tube (an "ectopic pregnancy").  I listened to my OB/GYN colleague (and owner of the hospital) explain this condition to the patient and was riveted; it is always nice to listen to other specialists, especially competent ones.  The patient went to surgery and thankfully, is okay.  I always insist on seeing these folks, as I give a huge lesson/lecture on condom use.  [Interestingly, since I am ex-U.S., younger acquaintances seem to think I would condone all manner of sexual practices and freely admit pre-marital liaisons to me; I try not to moralise, but do insist on condom use.]  All of us are relieved the young lady is fine and I gave the number of the Banyan for counselling, as she professed family problems; I never like stories of estranged families and try quite hard to keep the peace.

18 October was Diwali, our festival of lights, the triumph of good over evil.  Scott and I got up early, hair wash, new clothes, prayed to my mother and then ate sweets all day.  We are to also exchange sweets with our neighbors and friends, but did not as we capitalised on our rare mid-week day off to simply eat and read and Skype with the boys.  Speaking of which, we spoke with them today, too; that was lovely - candor and humor and chatter. 

May your days also be filled with candor, humor and chatter.

Unw -

R     

Sunday, October 15, 2017

Report of 15 Oct 2017

Good evening from the world indoors!

I am late getting to this, because I went off to swim and then cooked my husband dinner.  He rather likes pasta and I made it.  I enjoy cooking immensely; it is always easy in the U.S.

We are well.  The Banyan is wonderful.  I was very sick this week, but heard that one of my beloved patients, Ms. X, had a urinary infection, and went to work.  She is mentally challenged and is hard to understand, but is unabashedly fun and always immensely considerate: "You eat, then I will," etc.  She had not been herself, and we checked bloodwork and urine, and lo and behold, there it was.  So I hauled myself in to the B, started the antibiotic, checked a billion other patients and left.  The kind folks in the kitchen made me ginger tea, which is a spectacularly delicious milky concoction with tea, ginger, pepper and a vat of sugar.  I felt better after that, and infintely grateful for this wonderful pampering/consideration. 

I did manage to get to my private practice and saw a patient who had attempted suicide.  She was about my age, and it was unclear whether she had consumed ant poison or rat poison.  The 2 are managed differently, and I asked the son which it was; he stepped up to the bedside and barked, "So which did you ingest?!!!"  My word; I asked him why he was threatening his mother and he apologised.  I referred them for counselling and left, feeling grateful that the 3 Weiss men would not treat me that way.

Speaking of which, we Skyped with both boys today and that was fun.  Both talk a lot and share a lot, and the adult Weiss men are a treat.  As were the younger Weiss men, of course, it is just nice now to not have teenage hormones flaring.  A young female colleague at the Banyan stated that she had skipped dinner the previous night as she'd had a fight with the family; I asked whom that had affected the most, she acknowledged it was herself, and I went on to speak of "The joys of boys," who fought until the next meal, and all was well as we ate together.  Nice.  Uncomplicated.

Scott and I drove to Madurai and visited my father.  I had a medical issue to discuss with him, and discuss we did.  We also ate, and reminisced, and laughed.  It was a nice visit and I returned, rejuvenated.

May you have refreshing times of your own.

Unw -

Sunday, October 08, 2017

Report of 8 Oct 2017

Hello from our balcony!

The Bay of Bengal is still blue, the clothes are drying and falling off the rack in the breeze, there is a cricket game in full swing downstairs, about a dozen custard apples are ripening on our kitchen counter and I have eaten.  That's a big thing for me - eating.  The word "Hangry" is a fine one; if I have to work and am hungry, all the cylinders do not fire, I get irritable, miss details in the patient's history or lab reports, etc.  And that's one day or one meal.  Imagine the unfortunate folks for whom hunger is a state of being.  We are indeed fortunate, my mother said, that we can afford the food we like to eat. 

The Banyan is fine.  There is a Diwali hamper-packing effort on, and many personnel were engaged in it.  The Indian festival of lights - Diwali or Deepavali - is coming up and one of the B's fundraisers is a hamper that can be gifted; we pack pickle and sweets and papads, and the giver can then gift it.  The B secured an order for 6000 (yes, 6000) gift hampers from a local company and then everyone was off and running; the pickle was made, the homemade papads were attempted but there was not enough sun to dry them and they had to be procured from elsewhere, the containers were painted.  The whole place has been abuzz with activity.  The patients are well and well-treated, and fed, this last being a matter of great pride for me.  There is a lot of dengue around and I have tried to insist on mosquito nets + repellent.  Dengue is a reportable illness and the city's health officials visited us last week after we reported a case.  We have no standing water on the premises, but there is stagnant water in a drain nearby that I have tried for years to have closed.  No success yet.  Let us see.   

My private practice is also good.  The owners of Swaram Hospital are fine, ethical and committed folks and all try to provide exemplary care to the patients.  One of the patients in the ICU a few days ago was a 24 year old lady who had attempted suicide.  I saw her, and she seemed fit for discharge; usually, I refer such patients - and other depressed folks - to the Banyan and did this time, also.  She told me she did not want to marry and that had caused stress in the family; when my 24 year old tells me he does not want to marry, I say fine, but - as the patient and I discussed - it is different for a young woman in a traditional family.  Her mother was alongside; she and I did not speak the same language but often motherhood is a language in itself, isn't it.  I held her arm as I explained through the patient our options for counselling, etc., and the mother started crying; as I looked at her, her face, and tried to find words or actions to soothe her, a slender arm came into our field of vision and long fingers gently wiped away the mother's tears as the daughter tried to spare her mother more sadness.  It was a spectacularly beautiful moment and I teared up at it, also; so there were 3 of us practically blubbering there.  That was really dignified, wasn't it - the physician also almost crying. 

Sometimes it is good for physicians to fall sick.  We then know firsthand what the patients go through.  I had battled a respiratory virus for 3 weeks and I think it has just turned bacterial; I am a little wiped out and am coughing up nasty stuff, and will start an antibiotic tomorrow.  I was also evaluated in Vellore by a great friend of my sister; the friend is a dermatologist and evaluated the hideous dark pigmentation on my cheeks and neck.  We have started treatment; as I told the dermatologist, I was not in a hurry to get this condition evaluated as my husband still thinks I am one of the most beautiful women he has ever met and I don't sit around staring at my own face all day, thus was not bothered by it.  It has distressed my patients and colleagues, though, and I did think it prudent to see a doctor about it, cosmetic implications aside.  Christian Medical College, Vellore, was started by an American at least a century ago and is one of the pre-eminent colleges + hospital in all of India.  My sister, Anu, and brother-in-law, Benji, studied there, Anu still works there, my niece, Sanjana, is now a student there and you can rest assured that an eval at CMC will be thorough and good.  My eval was no different and I am sitting here, comfortable as a clam with the treatment plan.

We got together with Anu and Sanjana after my derm appointment, had lunch, overate merrily and talked and laughed all afternoon.  It was a fine time.

We Skyped with the boys today and that was grand fun.  Lots of laughter here, too.  The boys are now at the stage where they talk freely with us about all manner of things and for this, as always, I am grateful.  We discussed intimacy today with some eye-rolling, but I stated my point and the young men listened: take your time getting intimate.  A med school classmate once told me she had stayed in a toxic relationship only because she and the man were intimate and I thought my sons needed to know that.  There were also various happy tidings shared by both sons and that was nice.

May you have many things that make you happy.

Until next week,

R