Renu's Week

Monday, March 30, 2020

Report of 30 March 2020

Good evening!

The sky is blue, as is the sea.  The evening sun is shining brightly on the buildings around.  I have just finished talking to my aunt, who lives by herself in Mysore.  In her 70's, she was caregiver for her older sister, who had dementia.  These are fiery women, my mother's ilk. 

We are locked down and likely safer for it.  The gloom and doom predictions should be noted.  We know little of the virus and whom it will affect badly.  Some obvious risk factors have been publicised, but of late, it is also affecting younger and healthier people. 

Scott and I are working from home.  My pulse races every time the phone rings.  However, the Banyan is blessed to have exemplary staff and hopefully, a higher power protecting our precious patients.  There have been reports of occasional coughs, which I treat over the phone.  Temperature monitoring is being done on all.  The infrared thermometers used to cost Rs. 3000, now they cost Rs. 15000.  The Banyan is absolutely great about investing in what we need to save lives.

I talked to my father yesterday.  He has plenty of reading material and a TV, thus he is going through the lockdown with equanimity.

Naren is in NY, the new epicenter of the virus, and Navin in Philly.  Both are taking the pandemic seriously, and that is wise.  They are wiser than their mother, who has a likely foolhardy streak of optimism.  Yes, yes, I am honoring the lockdown, etc., and am still hopeful that we will triumph.  The newspaper is full of stories of birds chirping and wildlife returning to original residences: the lack of human noise and intrusion seems to be good for nature. 

We went to buy vegetables and essentials today.  We were stopped by the police 3 times and then permitted to continue.  I like this diligence. 

Please stay safe and well.

Unw -

R

Sunday, March 22, 2020

Report of 22 March 2020

Life in the times of Corona, said a headline in our newspaper.

At the Banyan, we have had to cancel clinics, stagger staff schedules, prohibit visitors and cancel all outside activities.  A residential facility becomes a petri dish in times of virus transmission, and our staff are being hyper-vigilant about symptoms in patients and staff.  The staff really are exemplary in what they do.  It makes it possible to work from home - sort of - though, of course, my pulse races when the phone rings. 

Scott and I have had to cancel our plans for U.S. travel.  The week before last, there was an announcement about the conference of the American College of Physicians being cancelled.  Usually, I try to get to the U.S. to attend the conference and with the cancellation, there is no need to go bolting there.  Especially in times of corona.

Last week, clinics at Kovalam were triaged, with a huge phalanx of staff triaging outside and directing patients inside.  Before clinic started for outpatients, I had to see several inpatients - making wait times longer for those waiting outside.  One of the outpatients said - during her visit with me - that I had taken too long to see patients.  I yelled to one of our community workers and asked her to take this lady to the waiting area, requesting her to clue the woman in on what/what not to say to the provider and to bring her in after I'd seen the next patient.  Much ballyhooing ensued, but the patient was taken away.  The next patient was one of my favorites, a local fisherman, unfailingly appreciative of what we do: as I apologised to him for the wait, he said, "Oh, that's okay," and it was like salve.  Were we a huggy nation, in huggy times, I would have hugged him. 

We got through clinic and then I had to give a lecture on coronavirus.  I enjoy teaching and we had a good session.  I went on to my private practice, found no patients and went home. 

The next day, I had to give the same teaching session at Adaikalam and the room was packed, as staff from all departments were urged to attend.  Scott is always envious of how willing my colleagues at the B are to learn, when his students are often not motivated.  The session at Adaikalam was lively and fun and engaging, and I am hopeful that the message went through.

By Wednesday, I was on the prowl to see if our residential facilities could get testing done on the premises, instead of our having to ferry our patients/staff to the very places where transmission could be high - testing labs with patients waiting.  I have no answers yet, but am hopeful that someone will consider our case.  To be poor - anywhere - means being left out of many therapeutic interventions.

On Thursday, senior leadership and I had a meeting on the severity of the situation and several measures - prohibiting visitors, staggering staff schedules, checking temperatures on all - were put in place.  I was relieved to see instant understanding from the team. 

We spoke to both our children and they are working from home.  It was lovely to see them, to hear of their days and their interactions with each other.  I asked that we talk regularly, as not seeing them in person is one unpleasant side effect of not travelling to the U.S. 

Scott is a good person to go through this crisis with.  He reads out online news, to my great benefit.  I only read the newspaper - finding lengthy exposure to the computer and phone a big strain on my eyes - and news in the paper might not be comprehensive.  I incorporated some of what he told me in my lectures and my meeting, and we are hoping all are spared the worst of this crisis. 

We hope you stay safe and well.  No hugging. 

Unw -

R

Sunday, March 08, 2020

Report of 8 March 2020

Happy Women's Day!

I hate everything about everything today.  I swam this morning and was full of bonhomie and gratitude earlier, then I posted on the Society for Hospital Medicine exchange and am now thinking the post was idiotic.  Thus, the blahs set in.  I made a dish for lunch and Scott does not like it.  I was not going to eat it, but tasted it and quite loved it, so have had 2 bowlsful.  It is made of a sprout and ragi (a millet) and some dhal; I had tried for years to make an Irani dish called orsh and this approximates it, so that should make me feel better.

We are well.  The Banyan is its usual nice self.  Responsibilities have changed based on distance from residence and I now go to Kovalam twice a week instead of once a week - exchanging the former Kovalam schedule for Adaikalam's; it is nice.  Last week, we had to tell some people from a nearby home for elderly that they have to access care at the Government Primary Health Center (PHC); they were not happy.  Our services have to be cut for financial reasons and urging people to go to the PHC is the way to go for now: at least there *is* a Government clinic nearby, unlike in many countries.  The Kovalam clinic is routinely slammed on Mondays, with upwards of 40 patients to be seen in half a day - and that is with reduced services. 

One of our adult patients came in with a blood test for diabetes and it showed her illness was out of control.  The student interning with us came in with the patient and proceeded to tell me that the patient really *was* trying to manage her illness, when all evidence pointed elsewhere.  When I said that, the patient - also on medication for mental illness - snatched the paper out of my hand and said, "Well, that's plenty!  If you are not going to give me the medicines, I am leaving," and stomped out.  We have resources to educate our population; they have to be willing to be educated.  The next week, her father - also one of our patients - came by and we mentioned this little altercation; he gestured, sighed and said, "Leave it.  If a person cannot speak with respect, they need not be treated," and we did not belabor the point. 

Adaikalam is fine.  We had an HIV positive patient return to see us; she is emaciated and concerning.  I ordered a ton of blood tests and found she had kidney failure.  She and her husband were eager to return home - about 10 hours away - and so, we asked that she follow up there.  She did go see the nephrologist and I was pleased.  It is quite, quite lovely when patients do as they are told.

My private practice is also fine.  We have several young patients come in with persistent cough.  With the new affluence in India and the plethora of Information Technology (IT) jobs, many employees sit in 24-hour airconditioning, to the detriment of their lungs.  I have had to try varied remedies and then hope for the best. 

We talked to both our children and they are well.  Movies are being released, job situations are being addressed and both are making a difference in the world - knock on wood.  That is all we want of our children. 

We attended a Hip Hop performance by a local band called "Black Boys."  It was good.  They emulate another band called "Casteless Collective," and sing about pressing local issues.  We also attended a couple of markets of female entrepreneurs and enjoyed them.

Unw -

Sunday, February 23, 2020

Report of 23 Feb 2020

Good evening -

The day is winding down.  We have travelled.  We went to Madurai 2 days ago to observe the 10th anniversary of my mother's demise.  There is a huge photo of her hanging in the dining room: her image was isolated from a picture of both my parents that was taken in Houston.  They had come for Naren's delivery and I hastened to get a studio pic of them.  She was young and pretty in the pic, and mentioned that the photographer had been very good in getting both of them to smile, thus the pic is lovely - the sari is well-draped, as usual, and my mother's smile is natural and genuine. 

We left on Friday, Scott drove as I was unwell, and we reached Madurai by lunch-time.  We had a delicious lunch - as usual - and rested.  In the evening, we bought some groceries for the house and hung out with my father.  The next morning - the 22nd - was the anniversary, and the young lady who works in the house + her husband had already bought a long string of fragrant jasmine.  That was hung on the photo, my Dad read from the Bible and the Daily Bread, and we scrambled to find a Hindu shloka to complete the puja by the auspicious time (7.30 - 8.30 AM).  We did manage, and then a plate of my mother's favorite food was left by her photo.  More was to come at lunch-time, after the young lady made the rest of the food.

10 years.  Scott said, "Just because she is not here does not mean she does not know what is going on." 

We headed to Pondicherry from Madurai and attended a photo exhibition of works done by my friend, Clare.  It was on disappearing urban professions and a story of water, and was well-done.  Clare also gave a talk on said professions, which was authoritative.  We then went out for dinner with her and her group of friends and family, and it was nice.  This morning, we met my school junior, a genial young woman named Sundaravalli, and her husband, Carel, for breakfast.  It was nice to sit and talk and laugh, and then we headed back to Chennai.

I was unwell last week and stayed in bed much of the time.  I did manage to get to Kovalam and promptly reprimanded a patient who had brought her 12 year old daughter for company.  I cannot abide children being yanked out of school for responsibilities that are way beyond their age, especially if there are others who can fulfill said responsibilities; our community worker - whom I bellowed for - came to the examining room and told the patient she would not be seen if her daughter came with her again.  The patient was clearly told to bring her mother as an escort. 

We hung out with Navin and that was fun.  Naren was unavailable and we heard from him as he travelled to San Antonio. 

I am heading bed-ward.  Have a very good day and week!

Unw -

R

Friday, February 14, 2020

Report of 14 Feb 2020

Happy Valentine's Day, folks!

I got to lie on the sofa today, sometimes the body tells one to slow down a bit.  Somebody gave me a beaut of a virus and the swimming pool - which ordinarily calls me on Friday mornings - did not send out as loud a signal as my bed did.

We are otherwise well.  The Banyan continues wonderfully.  Responsibilities are changing for me, and that is okay.  We had Adaikalam's Family Day last Sunday and staff of families joined us for biryani, sugarcane juice, cake, popcorn and cotton candy.  It was nice.  One of the more enthusiastic young employees had organised a Flash Mob and it was fun. 

Private practice is also going well.  The hospital is a good place and the owners are fine people.  I see a fair amount of diversity of cases and enjoy them.  Interesting is the young, unmarried, sexually active Indian - not a thing when I was a teenager.  At least, not publicly.  Now I have to caution the patients to use protection, at which point they often give me a surprised look. 

My father was in town last week, electing to stay with his plastic surgery colleagues at a hotel close to the venue of a conference.  We live about 30 km outside town, so getting him to and from his conference would have been time consuming and he is not a fan.  We went and saw him on 1 of the conference days and took him out for tea: my sister gets concerned at his sitting for 12 hours in an airconditioned room, as he has COPD, and we hoped to minimise his exposure to non-stop cold air.  It was a nice evening, and he indulged us before quickly insisting on returning to the conference. 

We saw "Jojo Rabbit" and "Parasite."  I enjoyed the former immensely and have become a Taika Waititi fan.  The latter was well-made, but since poverty is all-pervasive here, it was not novel and enjoyable for me.  Scott said it was a very well-made film and lo and behold, it won "Best picture" and a host of other Academy awards.  I like the fact that Brad Pitt won: Naren and I have discussed how some actors' stunning good looks often detract from their talent.  Mr. Pitt's comedic timing - as evidenced in "Burn after reading" - is also good. 

We "hung out" with Naren and Navin yesterday and that was fun.  I always enjoy the boys' perspective on all manner of things, and we laughed a fair amount, too. 

Hope you have joy and laughter in your life!

Unw -

R

Sunday, January 26, 2020

Report of 26 Jan 2020

2020 sounds cool.  Like hindsight.

It is India's Republic Day today.  The 71st one.  The Constitution was adopted on 26 January 1950 and we became a republic.  Hooray!

We are well.  I was at Kovalam this week and the bereaved gentleman came for a checkup.  I asked - as I ask of most of my patients - if he had eaten that morning and he had: rice.  I asked where, and he said, "Home."  I was delighted: he had not previously wanted to eat at home, in his grief - the food tasted different, it was not his wife's cooking, he preferred to eat at a hotel, etc.  His eating at home is a good sign to me that he is coming to terms with his wife's absence.  He seemed pleased that I was pleased. 

A lady came, stating that she was wary I would reprimand her for being noncompliant with her meds.  She said her grandson had died, and she had not kept up with her medication regimen, with the demise and the rituals surrounding it.  I was stricken.  It is a tragedy to outlive one's child and to outlive one's grandchild - I can only imagine the enormity of the sadness.  As I held her face in my hands and consoled her, then directing her to get her blood pressure checked at the next desk where our capable assistant, Keerthana, sits, the student intern in the room said, "How did he die?"  As though it mattered.  I imagine I was this pesky as a student, also.  Then the student - who does not speak Tamil - asked how the patient was; I said, "Grieving," and that was that. 

I don't know the fine art of keeping quiet, either, so I cannot urge it of anyone else, can I.

Adaikalam was good.  One of our patients has joined the staff as a health care worker and we are happy.  She is a very perceptive lady and jumps to attend to patients' needs.  She also gives good massages and I have been a happy recipient of this therapeutic service.  It is truly spectacular when a patient's mental illness comes under control, the underlying self-confidence becomes resurgent and the patient proceeds to use her/his skills, earning a nice living and getting more self-confident in this entire process.  We've heard of vicious cycles; this one is a benevolent, happy cycle. 

Scott and I attended a festival celebration of our rural heritage, saw artworks at the open house of a local artists' village, and saw the movie "1917."  I couldn't quite appreciate the finesse of 1 continuous shot, but enjoyed the movie and was saddened by many parts of it.  I did enjoy the fine cameos of well-known stars - especially Mark Strong, a favorite - in the flick. 

At our Pongal celebrations and at the village celebration, there was a performance called Parai Aattam.  Parai is a type of drum.  As the drummers played, the music spoke to my DNA and all my blood vessels; I did dance at the Pongal event when they called for audience participation and am unfailingly surprised that Scott can stay without moving a muscle when thumping, rhythmic, joyous music is played. 

We got to hang out with our sons this week and it was nice, though Naren was tired.  It was nice to talk and laugh and get updated on happenings in their lives.  I spoke to my Dad today and there were a couple of chuckles, which I appreciated. 

Today is the 21st anniversary of my handsome brother Manu's demise.  It is the first time in many years that I am not in Madurai, going to the cemetery with my father.  I miss Manu's presence and geniality and easy laughter, even his hideous turquoise blue tank top.  I am grateful his family stays in our lives. 

Enjoy your own family.

Unw -

R  

Sunday, January 19, 2020

Report of 19 January 2020

I wonder if one-sided shoulder stiffness can be polymyalgia rheumatica.  No history of accidents, lifting heavy weights, unusually strenuous workouts.  The right shoulder has been hurting all week, starting at a talk on Monday when I could not reach across the table for a bottle of water. 

Also, how does one get mold off swim goggles?  I have tried vinegar, Dawn, a local herbal hairwash product, and scrubbing with toothpaste.  Nada. 

We are well and hope the same with you.  Scott and I went to a talk on mental health in indigenous communities; it was organised by the Banyan and I learnt something.  It was a late night, and I had to make an effort to get to my workout the next day.  It was a well-attended talk, as Banyan talks are. 

I went to Adaikalam one day this week.  A few days ago, we got some splendid news.  The son of one of my former colleagues has been selected for a job in the Middle East.  He was careful and vetted the jobs carefully, ensuring that he did not go through an employment agent.  We have watched this young man get educated and then get his first job and now he is overseas, earning well!  We are as pleased as punch, as the family's economic status is now better, and the young man is at a job that he is well-trained for.  "Pull 1 person out of poverty."   

Yet another colleague, a health care workers, is studying by correspondence (distance learning).  She will finish her degree in psychology in a couple of years, we hope, and will likely become a counsellor; I can't wait.  She is a single parent, and is a shining example to her daughter of how not to wilt when a spouse abandons you. 

Pongal, our harvest festival, was this week.  Scott and I had a few days off and enjoyed being home.  I was a bit sick for 2 of the 3 days and am rabidly diagnosing myself.  What of this right shoulder pain, I wonder. 

We had pongal, the sweet dish made of rice and jaggery and ghee, made by the vocational training unit of the Banyan.  The lady who helps us around our house also made it using millets, a hardy and healthy grain.  So we had all manner of sweet treats to celebrate this important festival.  We were at Writer's Cafe yesterday - our favorite place to eat.  We caught up with familiar personnel there, and had a good meal.  After that, we went to a concert by "Violin Nomads," which was excellent.  Nice music from around the world, which is unfailingly lovely.  We saw my brother and his daughter at the venue, which also hosts classes in French (my niece attends); that was good fun.   

We spoke separately to both boys, who were busy.  I remain perennially grateful that they still find time for us.

Unw -

R