Week of July 17, 2005

Hello from Indiana!

It is hot outside and I could not even contemplate bringing my sweatshirt into the lib, and it's freezing in here - all the benefits of airconditioning! I believe I am more dependent on my sweatshirt in the summer, when all the buildings are freezing.

Trust all are well. My work is fine. One of my favorite patients, Mr. H, missed his appointment the other day and I wondered what was up. He has just been released from prison for forging a check and is in a work-release program. He had been in a car accident some years ago and has back pain for which I prescribed a pain killer (Ultram, NOT Vicodin) and it appeared to work very well, earning me quite a bit of (really unwarranted) gratitude. His wife divorced him when he was in prison and they have since attempted counselling, etc., to reconcile. I discovered when his wife came in for her appointment that Mr. H had been hit by a car the day before his appt w/ me as he was walking and had broken his pelvis. As I told her that she needed to verify the care instructions for his condition - esp as he was back at work the following week, and when I broke my tailbone last year, it was 6 weeks of bed rest - she said that her phone had not been charged and so she might have missed the orthopedist's return phone call. Later in the week, she told me Mr. H had been reported as being "out of place" (somewhere other than work or his work-release residence) and had been sent back to prison. I was sorry, but amazingly, she did not appear to be. Hmmm.

Some of my other favorite patients came in too: a grandmother harboring her daughter and raising her grandkids very strictly; an 80+ yo survivor of breast cancer who says to me every time she comes in that she thought Dr. Weiss would be a man and I apologise every time for disappointing her to which she always laughs; the nurse who has disabling right arm pain and who states that as soon as her younger son finishes high school, she is coming to India to work w/ me. It is always a treat to gab w/ these folks and I value my time w/ them; I sometimes take longer than 15 minutes for the appointment, but I love the interaction.

The housing project clinic, Barton, goes well. The other day, I had a patient who had not showered in days (or weeks) and I could not close the exam room door due to the smell. Privacy had to take a back seat to my nose and I finished the visit, telling the patient directly that he had to shower every day (and change clothes, added the nurse). We had another patient come in w/ his partner - both are hooked on Vicodin and this patient tested + for cocaine. As I asked him about it, he said that could not be his drug test at all, then later said his partner had probably slipped him the cocaine. He even squeezed out a few tears. As I went through a big song-and-dance w/ the Medicaid folks to pre-approve one of his cholesterol meds (it was easier than I'd feared), I ended up talking w/ the pt's pharmacist who was from Ghana. We spoke for a while about the pt, that he had not been picking up his required meds but apparently had the $ for 2 packs of cigarettes PER DAY (not to mention all that cocaine) and we shared our views on the poor here vs. our home countries. Manu Ginobili (who is from Argentina) of our beloved San Antonio Spurs was interviewed on TV and said that foreigners who come here (to play professional basketball) tend not to take their jobs and privileges for granted; I think that is true of other professions as well.

The week was filled w/ rejuvenating contact. On Sunday, my friend and St. V pharmacist, Kurt Broderick, took me out for dinner. It was fabulous gabbing and laughing, and our food got cold in the interim! Kurt has given us crayons and markers for our tutoring kids and this time handed over a hefty personal donation for the work in India. We have a similar mindset, and so it was particularly fun to get together. Kurt is married to a wonderful young pharmacist named Kati, who regretfully could not join us. On Monday, I got together w/ the Hillmans for a stupendous dinner (featuring their home-grown veges), a gabfest and a walk around their beautiful, flower- and fruit-laden property. I even got leftovers for the next day and that was doubly great. On Tuesday, I got together w/ the children of our neighbors in India and got to talk of life here vs. there, our jobs, kids, etc. Ganesh and Christine are phenomenally intelligent and personable folks as are their kids, Lukas and Anaka. I got to walk some w/ Colleen who is getting ready to start a job teaching German in college. I was privileged to have lunch w/ Dr. Rob Manges, who is an oncologist at St. V and a person w/ a great sense of humor; it was nice to speak of our jobs and share a laugh or 2. I spent the weekend w/ my in-laws and it was the usual fun-fest. We also got together w/ Scott's Dad's side of the fam and laughter reigned. My mother-in-law was gracious enough to take me shopping to satisfy the boys' last-min lists, and I got plied w/ books, chocolate, candles and other goodies from all my in-laws. You know, even if they weren't my in-laws, I'd want to stay in touch. I was honored to speak (of my work in India) at my current workplace's quarterly staff meeting and it was so much fun, b'cos the audience was very interactive: "This patient did what?! Shuuuut uuup" and "Does your husband have a brother?"

I have 2 more weeks here. It's been fun.

Until next week -

Week of July 13, 2005

Hello from the libraire -

Well, my week was starting ok until I read the email from Scott that Navin was bitten by one of the dogs in the apartment complex. Things always acquire a grander significance when one is 12,000 miles away. Navin is fine and my pediatrician sister, Anu, was just a phone call away. Naren appears to be well, thank goodness.

The Tabers went on vacation last week and left the house to me. Colleen had told me that'd be therapeutic, but I had no idea how much so. It was quite fabulous, and I rented a bunch of movies from the lib to keep the evenings occupied after I had completed my evening walk in this lovely area. The Tabers' cat and I also bonded, and I can't say I was ever a cat person, but this cat caused a few of my opinions to change. They are independent, opinionated beasts, w/ quite distinct personalities, and I liked this one.

Work has been fun. I started work at a clinic ("Barton") that Citizens' Health Corporation runs in one of the housing projects. The work is good and often I get the impression that what I am doing makes a difference. "We do what we can with what we have." A 90 yo woman came in for a routine checkup, and she was doing very well, knock on wood. Hearing intact, walking on her own, all grace and courtesy - what a delight. With all patients, we are to run down a standard list of questions - "Gut ok? Any aches and pains? Are you depressed?" - which is called "the review of systems." One day, as I did this, the patient I was then seeing - a 60 yo woman - said, "Well, yes, you could say I am depressed." And then she mentioned that her 35 yo son had Aids, acquired from sharing an IV drug needle. She then wept, and I held her hand silently as she wept and talked, and then wept more. All this from a routine question - the power of the spoken word is enormous. Thankfully, the social worker at Barton had access to support groups and we referred this lady there.

Back at our regular clinic, a young couple came in and the lady had belly pains. She had been diagnosed w/ a gall bladder problem months prior and had missed a follow-up appointment at the county hospital ("Wishard"). On being asked why the miss, she stated that she was new to town, did not know the bus system but was currently more familiar. I don't like it when our patients miss follow-ups as it takes months to get these appointments. I called over to Wishard to evaluate my options w/ this patient and the emergency room doc told me to send her over there. When we told the couple this, they said, "We have no way of getting there." Once Scott got a mug for his best friend which had the most appropriate saying, "Pardon me, you've mistaken me for someone who gives a ----." (The friend liked it.) I felt like that here: we'd made a follow-up, for that day, the patients had assured me they were familiar w/ the bus system and now were telling me they were logistically-challenged. On probing further, we were told that a friend had dropped them at the clinic and would pick them up later. I told the couple the huge importance of keeping the appt, that if they had kept the prior appt the problem would not have now recurred, told them their transportation woes were theirs to solve and left. I was actually irritated and truly could not figure out why they were telling us their transportation woes; any hope of my pulling some bux out of my pocket were long ago given a reality check by Scott ("Don't ever do that b'cos you'll have patients lining up and not just for medical care, either").

I got to walk this week w/ Sonia, a friend, and that was fun; these walks are always plenty rejuvenating. I also got a lovely package of clothes from my med school classmate, Emily McNellis (who is expecting twins). (Emily sat next to her husband, Ryan, in med school and one day very early in 1st year, when the anatomy professor said, "Look around you - you unmarried students may end up marrying the one sitting next to you," Em seriously wondered if she would. And she did.) I don't buy too many pretty things for myself - not out of any deprivation agenda, but b'cos priorities have shifted esp after living w/ tiny closets, and I certainly do buy something if I absolutely must have it - but have to say these clothes were gorgeous. Emily read my mind, including lightweight and light-colored cotton clothes that I will get a lot of use out of in India.

My time here is winding down. The 3 Weiss men sound ready for it to end. It will be nice to be w/ them again. The work experience here has been great - and getting paid for what I do continues to be novel and fabulous.

Until next week -

Report of July 3rd, 2005

Hello from Indy!

To those in the U.S., Happy Fourth of July! I rather like the fireworks here.

The week has been ok. Started off w/ a Vicodin (strong pain med) seeker. She stated she could not understand why another pain med would simply not be called in when the prescribed meds did not work (she has been quite a demanding patient here, and not very nice) and why she had to come in to be seen. As I explained why it's good to re-evaluate pts, she stated that when her Medicaid (Government-sponsored health plan for the poor) kicked in, she would find another doctor. As it was not quite feasible for me to turn cartwheels in the room or jump for joy, and downright sadistic towards my colleagues to offer to find her another doctor, I simply stated that every pt should have a good relationship w/ his/her doctor and she was welcome to find someone who met her needs.

In the midst of the steady stream of STD checks was a patient whom the front desk called us about. She was dubbed crazy there and everyone assisting me dreaded her visit. As it turns out, she was a 21 yo w/ a history of panic attacks whose fiance had recently died due to a heroin overdose. Psychiatry is not a discipline I easily understand, and I respect the professionals in it. The pt was very teary, frequently bursting into tears as she talked; I let her talk and talk, at one point throwing in that it did not look like her fiance had made good choices. (As soon as I said it, I considered it inappropriate to say to someone grieving, but thankfully, she concurred.) I told her I thought she needed to see a mental health professional, and I spoke of how much a counsellor had helped me in the 3rd year of med school, when a string of deaths hit my family. I told her speaking to someone trained in diseases of the mind was as vital for her, as seeing someone specialising in diseases of the body. Then I gave her our special "sandpaper Kleenex" (paper towels) to dry her eyes. She was not as freaky as had been described to me - except for the green eye shadow from her eyelashes to her eyebrows, which did not quite match her blue outfit.

The 3 Weiss men appear to have had some chaos. Naren and Navin were sent home from school as their uniforms did not pass inspection; as I experienced trans-Atlantic angst and mild guilt at this ("oooh, what sort of mother is she"), Naren told me that 15 of 18 kids in his class had been sent home. Made me feel better. Though I don't agree w/ all the strategies the school employs, I had to agree w/ this one - it now becomes a collective family endeavor to ensure that the uniforms pass. Naren also brought home a 60 on a test, and proceeded to justify it w/ a "Well, you can never get higher than 85 in English and I was just 15 off." Yes, the child said 15. So I asked him how his math grades were. Then I decided their father could handle this, told Naren he just had to ground himself when his grade was less than 70 and mentioned that we really did not want him to spend all his teen years looking at the 4 walls of his room. Scott sent me a stream of rather nice emails, including one anticipating my return - 31st July from here.

I was privileged to get together this week w/ Dr. Malcolm Herring, a senior vascular surgeon at St. V. I told him he probably had some other grandiose title - VP, Exalted Poobah, Vascular Vishnu - but to me he is a mentor and good friend. We spoke of his work and my work, and issues of faith, which Malcolm is a strong believer in. It was a lovely, serene conversation, concluding in a most therapeutic hug. I also got to walk w/ Cindy and Colleen, great friends, and that was curative also. Yesterday, I went down to a little carnival here and listened to a very good band belting out oldies. It was nice to run into a former residency colleague, Karrie Adkins, there and see her 2 kids who were babies during my internship and her 2nd year. I also got to watch a couple of movies, and Live 8 on TV. When they showed the picture of the child who had almost died of starvation and told us what she had since become, then producing the beautiful young woman for all of us to see and rejoice in, Bob Geldof said, "One person can make a difference." Amen, brother Bob, amen.

Have a good week -