Report of 29 May '05

Hello from the library!

Trust all are well. We in the United States had a long weekend, part of which we spent w/ my in-laws at their farm - and that was the usual fun event it always is. We also saw the Indy 500 parade, thanks to our hosts the Tabers, and rooted for Danica to win the race. She performed pretty creditably, we felt.

The week was good. Work is fine, getting busier as my patients return. I had treated a young woman w/ disabling abdominal pain for a condition called diverticulitis and she returned, feeling much better. Another woman came in complaining of dizziness when she did her laundry or housework and as I embarked on my path of trying to figure out the cause, she spoke and spoke. I waited. "Listen to your patient, she is giving you the diagnosis," said a famous physician. Out it came - lost 10 lbs in the last month, felt hot all the time and her heart was racing. I filled out the forms to get her thyroid tested and 2 days later, the diagnosis was confirmed: an overactive thyroid gland, which medication can help with.

Most patients are as above - upbeat, satisfying. There are a fair number of Vicodin seekers and a most memorable patient this week was a strapping young man who walked in to my exam room, spoke clearly and intelligibly, and told me he'd been in an accident a couple of years ago, the air bag had deployed and his right eye now had "a hole" in it, he was getting debilitating headaches and wanted me to fill out his lawyer's papers for disability. I know of the system of compensation for disability, know a couple of genuinely-disabled, deserving people on it, and think it is very well-intentioned. As with all such systems, the scope for abuse exists. I used to act (on stage) in much younger days, and it required much mustering of those skills for me to evince interest in my patient's claim when the greater instinct was to say, "Why can't you work? Esp in this country, where anyone can succeed." In contrast to this was the young usher at the $1 movie theater (a favorite haunt in my family), who was in a wheelchair (likely from birth); who appeared to have cerebral palsy; who reached for our ticket and couldn't tear it for the first movie and required help; who tore it for the 2nd movie. The latter process was a bit lengthy, but the result was a work of art for me - the torn ticket stub, produced by someone very disabled, but working in spite of it.

The boys spent an evening bonding w/ our former neighbors, the Everharts, and totally enjoyed it; Chelsea and Elisha tend to spoil them, and little Emma and Max were a treat also. We also got together w/ a former patient of mine who has since become a wonderful friend, Deepali Jani, and her family. We ate, laughed and reminisced, and my sons romped w/ her sons. Her in-laws were there, too, I know them (having gladly partaken of her mother-in-law's cooking on call when Deepali was hospitalised - it beat what I had to eat, let me assure you) and it was great seeing everyone again! Navin turned 12 recently and got to celebrate his b'day w/ relatives, which made him happy. Brenda and Jim Hillman had us over for a fabulous dinner, w/ the highlight of the evening being the gentle conversation they are renowned for and which all ages can enjoy; there were also presents for all, a giant ice-cream cake, and a very nice card. All of this made for a very memorable evening. The boys and I also saw "Revenge of the Sith," which they found sad, "Hitch" and "Are we there yet?" which were fluffy. There is more than 1 movie fan in the family.

We were delighted to receive cool clothes for the boys from our considerate friends, Tori, Jerry, Jordan and Caithn Scott. The boys are very happy w/ the clothes! We were also touched by the gift of clothes for my niece (who has 5 older male cousins and some - ahem - very boyish hand-me-downs) from our other thoughtful friends, Anita, Bryan, Krish and Priya Sigler. My niece will be very well turned-out w/ these gorgeous clothes. My in-laws, esp my m-i-l, loaded us w/ chocolate and what doesn't get eaten here will make it to Scott, who's likely to be as happy to snarf it as we are. There is also a generous donation for the work in India from Ann and Morris Taber, and one of their friends. A and M Taber's generosity of spirit and material is amazing.

Naren and Navin leave tomorrow, flying with the Unaccompanied Minor service. I hope for the best here. Scott will receive them in Chennai, having taken a temporary transfer there for the duration of my tour of duty here.

Hope all are well. Until next week -
Renu

Report of 22 May '05

Phew, I am whipped! Nice kind of fatigue, tho' - work-related, after hordes of patients, one of whom got so either moved or scared by what I said she cried.

The work here is nice, as are the folks I work with. A memorable patient from last week was a lady who came in complaining of dry mouth, needing to drink water often and urinating more than usual. I had my suspicion and, of course, w/ the machine to check blood glucose (glucometer) right on hand (I like working in an affluent country as a break), the diagnosis of diabetes was easily confirmed. The patient was devastated and I roped in all the resources we had: health educators, nurses, nurse managers, the contact person at the hospital where I was sending her to get admitted. I reassured her that her condition was very treatable, and that we would stand by her to take care of her as long as she needed.

A young woman came in for an employment physical and said she was a sophomore at IU. This is rare in my patient population - for folks to be in college, no offence intended, it's simply a fact - and I went about my visit commending her for being in school. She got to the part where she stated she was sexually active, that her partner did not use a condom and that stopped me. In the same matter-of-fact tone that I'd used for the previously incarcerated man who used cocaine, I enlightened the young lady that she was exhibiting some very dangerous behaviors, that she was bright and attractive, that it'd be a waste of a mind and a life if she contracted HIV, and I hoped she'd change her mind about condom use. I told her *I'd* be upset if she got a deadly disease, heck w/ anyone else. She told me the lack of condom use was an aberration; perhaps she will think about this conversation more as time goes on - in the throes of passion? Unlikely, but one can hope. I had the same conversation w/ another young woman today and she cried. I apologised for causing tears, but she said she needed to hear the msg.

The boys and I had dinner last week w/ Cindy and Kurt Smith and their pretty daughters, Jocelyn and Rachel - our former neighbors. We got to see Cindy's Dad as well and that was nice. The food was delicious - pork chops and mac-n-cheese (easily one of the boys' favorite foods ever) - and all of us pigged out. It was wonderful to be in the home of friends who care so much about us they take menu requests.

On Thursday, we rented a car (so easy here!) and drove in blinding rain to Brecksville, Ohio. My friend Carrie Cassidy had arranged for us to speak there and we did. It was extremely uplifting to see a friend after 22 years and realise that she had married a wonderful man. Rex did several things to accommodate the time Carrie and I had together, including taking our boys to lunch at their daughters' elementary school - the boys had a blast there! We spoke to the Brecksville Kiwanis and were approached after the talk by the Key Club members, who are teenagers. The talk appeared to inspire the young people and they had several suggestions for support: it was wonderful!!! Folks who write off teenagers as a breed are so depriving themselves. We enjoyed hanging out w/ the young folks immensely. We stayed w/ Rex's mother, Midge, and she was neat to spend the evening talking with. I also spoke at Carrie's church and that was fun, too.

I was supposed to speak at a high school in Indianapolis and that has not worked out for various reasons. I am sorry, esp after the experience in Brecksville. A friend who heard my talk said the high school was missing out, also, and that was an understated compliment.

We returned to Indy and piled into Colleen Taber's car w/ her and their son, Christopher, and trundled to Ann Arbor, Michigan. We stayed w/ Ann Taber, Colleen's mother-in-law, and that was a blast. All of us went canoeing - a memorable first for the boys and totally good fun for all! We had dinner Sat night w/ Kasha and Laura Newcomb, mother and sister of Matt, Scott's colleague in Bangalore. Kasha's perspective on life and her son were such a treat that we spent much of the evening laughing, and talking some more. The meal was delicious and the Newcombs' house and yard very beautiful. We were pleased that Laura joined us for the entire evening. I also got to speak to Bill Newcomb, Matt's Dad, on the phone and that was fun, too.

Morris Taber, Ann's husband, returned from a church conference just for that evening and it was nice to meet him. (A and M Taber had been in e-touch w/ me prior to this.) The Tabers do magnificent social work in Zimbabwe, Africa. We spoke at the Tabers' church yesterday and met all kinds of nice folks whom we'll stay in touch with. In fact, several folks we met at other talks have been emailing and that is the highlight of these events for me: to be in touch w/ those who are interested in the work and wish us well. We had a lovely time in Ann Arbor, thanks to Ann Taber, and the drive back to Indy was therapeutic too: I drove Mark Taber's new Outback, a treat for me since I am an avid auto fan, and got to gab w/ Colleen the whole way. Colleen is one of the most intelligent young women we have ever met and is able to put any situation into simple words and solutions. I think her young students are very fortunate to learn German from her.

Some spectacular news came my way last week. A patient at the Banyan, Ms. P, who'd come to us w/ a pelvis broken under mysterious circumstances, had complained constantly of pain even after she'd been cleared by orthopedics to walk. She had an abscess in her groin and I sent her to OB, but the pus remained. I finally had suggested an eval by the orthopedic surgeon who'd evaluated my nephew w/ cerebral palsy. In my absence, he'd examined Ms. P, found an infection in her bones ("osteomyelitis") and drained it surgically. Ms. P is now pain-free and walking about, ready to go home. This news has energized me for many days and will continue to do so. I am sorry to disappoint those who thought the "spectacular news" was about funding. "I measure success one patient at a time" - a straight lift from Morgan Stanley Dean Witter (if that is indeed their name now).

Hanging out w/ the boys has been fun, tho' they came perilously close to damaging a closet door at the home of Midge Cassidy in Brecksville. They got yelled at for that, said they were not having a fun vacn when I yelled (like I enjoyed the frequent fights, loo overflow and dryer-crayon episodes :) ) and I asked them how this situation could be win-win for all. After a couple of weird suggestions, they came up w/ "We could be good?" Einsteins of the world, unite. We have resolved to try and get along companionably for the remainder of the boys' stay here, i.e., until 1 June. I am not yet thinking of their solo flight to India.

Trust all of you are well. Hope your days are good, as mine are.

Report of 15 May '05

Hello from mini-paradise, the Carmel public library -

We are well and enjoying our time here. The boys have been putting on weight and enjoying the junk food - 'tis the age and the palate.

Work is good. I tend to get quite a few extra patients, esp late additions; the other day, one of the other docs was missing in action, his nurse was befuddled and his patient was irate. She had to leave and needed a quick exam and I agreed to do it to minimise inconvenience to her. The workload is ok, really, and I am getting paid to see pts, not sit around, so I don't mind. A memorable patient this week was a recently released ex-con who had a funny perspective on life and we had lots of chuckles. Then he told me he used cocaine on the weekends (social snorting?), at which point I told him graphically and in some detail what cocaine could do to his heart and brain. He said, "For real?" when I finished, I assured him it was, and he told me he simply had not known any of it, that he *could* stop the drug use. I noticed him picking up a lot of literature from our patient education desk when he was done and he has since called the clinic once or twice. An educated patient is our best resource.

I had a young physician assistant (PA) student rotate w/ me on Friday and she was fun to work with. One of our patients had complained of belly pain, nausea and a sensation like she was pregnant; I requested her fiance (a young man dressed in baggy shorts, t-shirt and high tops) to step out w/ their daughter and asked the pt a frank set of questions about the possibility of said pregnancy or a sexually transmitted disease. She quickly denied the former and said she was gay, at which I said, "Wait - isn't that your fiance?" She said, "Yes, it's a girl." I picked the PA student's jaw off the floor, continued w/ the exam, discovered the young lady had a stomach virus and sent them on their way. The PA student said later that I had to have seen that coming, because I rolled right on w/ the interview; I assured her I had not, but that when I got the white coat on, I heard fairly personal details of my patients' lives. This is a great privilege to me, that my profession affords me the wherewithal to draw such candor.

My schedule this month is working 3 days a week, b'cos I have my sons w/ me and wanted to spend some time w/ them. (In June and July, I will be full-time.) On my days off this week, the boys and I went to lunch at some of their favorite restaurants and saw, "The hitchhiker's guide to the galaxy." We also had dinner w/ dear friends from Special Olympics days, Mary and Sam Remster. Sam is followed by a cardiologist at St. V and has voluntarily shed quite a few pounds by staying clear of rice, flour, potatoes and sugar. Mary generated laughs by announcing her Sunday b'fast of donuts. We had a wonderful meal of raw veges, pizza (Sam didn't have this part) and fruit, and then the hosts produced giant bars of chocolate for the boys. We are grateful the Remsters made time for us in their busy schedules, esp as Mary works full-time, and I am particularly happy that the boys enjoy our friends (some of whom they are meeting for the first time, like the Remsters) as much as we do.

We spent the weekend in Dayton at the home of the Premanandans, who took excellent care of me when I was a homesick teenager at the Univ of Dayton 22 years ago. Premila is a great cook, and I remember being warmed by her meals as I wilted from homesickness. Mary, their daughter, is in nursing school and made a lovely addition to our time in Dayton by her consideration, gentle demeanor and special care of the boys. Their friends, the Islams, also had me over several times when I was at UD. This weekend, Sylvia Islam and their friends, the Kitcheners, aggressively got several of their friends together over dinner, I spoke of my work and a large amount of money was raised for it. Sylvia's drive and compassion will never be forgotten - she even turned her sons upside down until $ fell from their pockets - and the evening was fun, fun. Most importantly, I got to meet several people who are like-minded, have senses of humor that I value and whom I will stay in touch with for a long time. That was a treat for me.

Today in Dayton, we got to visit the Ruizes, who are great family friends of my in-laws. Mr. Ruiz gave me away at my American wedding, and Mrs. Ruiz routinely plies us w/ food when we get there. Mrs. Ruiz took us to the cemetery where Scott's Dad is buried as I wanted to pay my respects, and wanted to ensure our sons did, too. The boys remember the Ruizes from their making trips up to Indy for the boys' b'days, and all of us had a wonderful time. The Ruizes had just returned from Kuwait where their daughter and son-in-law, a Palestinian man, live w/ their family; they said they were treated very well and loved being there, that they left w/ a good impression of their daughter's in-laws and that the bonhomie was mutual. As an in-law told them, "I didn't like Americans until I met you." What great ambassadors.

We attended the art show and reception of Sofiya Inger, our former neighbor in Carmel - it's on at the Jewish Community Center on Hoover, for those in Indy who might like to go. Sofiya (Sonia to us) just quit her job, will concentrate on her art and we are richer for it - her artwork is lovely and there was one still life piece I particularly admired. Where would we be w/o artists, musicians, dancers and actors, who add so very much to our lives by their talents.

The home of the Tabers continues to be one where I have great peace of mind and a comfortable bed. The conversation is stimulating, the food fabulous, the company serene. We do as we want there, and I remain impressed that my poor hosts can deal w/ houseguests for this length of time.

We like Mapquest - it helped us get around very easily. We are tremendously fortunate in our friends, and this is reinforced to me repeatedly.

Have a great week -

Report of 8 May '05

Hello from the public library in Carmel, IN - which I love:

Happy Mother's Day, all you wonderful Mothers!!

Things are playing out as they are intended, I guess. I have a short-term job (a locum) at a clinic in downtown Indianapolis. We take care of the very poor, Medicaid and Medicare pts. The clinic is well-maintained, clean and pleasant, and the surroundings are very well-kept. One of the Family Practice residents at St. Vincent, Indy, where I trained, will join the clinic in Aug and she knew of this temp vacancy which came about b'cos the clinic's internist quit, and told me; I appreciate that. I enjoy this job immensely, and find that getting paid for what I do is a novel, uplifting experience.

The people in charge of the clinic are nice, and when I met the CEO, I liked her right away. She asked how much I wanted to be paid, and I asked how much they paid, and she said, "Slick!" I apologised, said that I had no clue about hourly rates there and then told the truth that what I earn here would have to help sustain the work in India as there ain't no funding coming. I mentioned to several people here that at the end of my requests for funding, I have started to say, "If your answer to this is a No, pls send it in about 2 days' time as there are only so many No's my spirit can take in a day." I have started to stagger out my No's; some folks found this very funny, and I suppose it is, but to me it's a survival mechanism.

My first pt was a lady w/ a chronic back problem and an anxiety disorder. I treated the back pain, mentioning alternatives like physical therapy in addition to powerful narcotic meds, and suggested that she also speak to a psychiatrist about her anxiety instead of getting dependent on a med like Xanax. She was willing. I had thought I'd completely forget Western medicine, working overseas, but found that the memory comes back: 4 years of school + 3 years of training help drill some things in. I also find that my perspective is altered by where I have been working: I am not quick to prescribe a pill or pursue expensive tests, I'd rather try phys therapy or enlist a psychiatrist to help w/ issues that I could use help with.

I like being here. My little Accord is a dream, previously owned and well-kept by Pablo Rabosto, a fellow St. V resident, and now well-maintained by Jim and Brenda Hillman. I drove it down to SE Indiana on Friday and spent a very therapeutic Mother's Day weekend w/ my in-laws at their farm; it was marvellous being there. We ate, talked, then ate and talked some more. The weather was gorgeous, after being cold and drippy last week, and we enjoyed every minute of our days there. My sons had spent 2 weeks w/ their grandmother, grandaunt and -uncle, and had revelled in it: they had learnt the art of farm chores, built up farm appetites and had totally enjoyed their relatives. Their experience w/ non-stop chocolate was initiated by Linda and Dave Johnson in San Antonio, who so indulge the boys (and their parents, actually) and this time, thought to do so by unleashing them in a grocery store w/ some money in hand. The sugar content in the boys' purchases could exceed the GNP of Cuba and that was as it should be. It was a memory worth having and a very novel treat. The goodies-and-TV continued at the relatives' and I did not stand in the way of it as chocolate is very expensive in India and our TV does not work very well there, thus felt the boys could make hay while the sun shone. Scott's sister and cousin joined us w/ their kids, and while all the younger cousins romped, all the parents could get caught up w/ each other's lives and remember what it is we like about each other. It was a spectacular weekend, made more so by all the laughter.

To be able to walk in uncrowded settings here is a treat, as is the radio in my Accord which is tuned to a variety station and plays dance music occasionally. As I got out at lunchtime at my JOB (!!!) the other day, Loverboy's "Turn me loose" started playing and I got back in the car. Had pts known this was their doctor bobbing around in the car to dance music, they might have reconsidered their choice of care provider, but I am yet anonymous there and could capitalise on it.

You know what is difficult to take here? The great emphasis on sex. I caught the ad for a TV show the other day and it featured a woman being proposed to by 2 men, whereupon she turns around and yells, "Hey, doesn't anyone want to just sleep w/ me?" She does get some takers and it might have been funny to some; however, after watching some of the apparel around and the blatant emphasis on trying to attract the opposite gender, I find that I can't quite agree w/ those priorities here.

Let me wind up. We will be in Indy the next few weeks and are enjoying the camaraderie of our hosts, the Tabers. I have also been most appreciative of little kindnesses along the way, such as at airline counters, banks, restaurants, and have filled out compliment cards at every locale. It is lovely to be helped, and to have good service.

Enjoy your day and week. I sure will enjoy mine!!

Fond regards,