Report of 30 April 2006

Hello from Carmel public library -

Boy, I sure like hanging out here and miss it (the typical American public library) in India. The closest thing we have there w/ easy access is the library of the very prestigious Indian Institute of Technology, which has lots of scientific journals; once Scott and I went there on "date day" sans kids, revelled in the books and the greenery, resplendently visible from the large glass windows .

Life is ok, now that the giant spectre of Immigration is not looming over my head. I've been privileged to round w/ Dr. Robert Love and getting refreshed on all the pressing medical issues in American hospitals and w/ American patients. Many patients are memorable. There was the HIV+ young man who had stopped taking his meds due to side effects, Dr. Love sitting down and explaining his condition to him, and the young man listening intently. Also, the woman w/ lung cancer who had told her cancer doc that she had numbness in her foot and now the cancer has spread to her spinal cord, who was headstrong and wanted to take charge of her own body; my cousin's daughter had leukemia diagnosed at age 3, and is now 7, also headstrong, wilful and delightful - this is how I'd want a cancer patient to be, ready to fight the illness and all battles in life, not willing to take things lying down even if family chides her to "behave herself." There was the delightful woman (just about my age) who had had trouble moving her food along in her gut and who had to be seen by a surgeon; we'd stop to talk, and she had obviously reposed such trust in her physician that she would accept the next step in her management pretty unquestioningly. She asked me where I'd got my earrings, and I was happy to tell her "India," and suggested she look in the local Indian store for similar ones.

As we plonked along in rounds, and I marvelled at all the technology that was available to all patients, regardless of their economic status (in India, before we order a test, we have to mention the cost to the pts and let them decide) which is so fabulous, I began to realise that patients here and there were similar: ultimately, what makes the difference to them is the doctor sitting down to talk to them, taking a little time to explain the illness, a touch or 2 here and there, the obvious manifestation in the doctor's face that she or he would want the best outcome for the patient. In all things medical, then, what is singularly comforting is the human touch from the physician, not the CT scan, the MRI or very expensive chemotherapy.

Scott left for India last week, got to see his cousin Rebecca in Chicago (who put him up prior to departure and that was very kind), and has got home safely. It is 43 degrees celsius in Chennai - 109.4 degrees fahrenheit. And no airconditioning in our flat. The chocolate we bought here in post-Easter clearance sales has been shoved in the fridge, per Scott. He looks forward to going to B'lore, where it is cooler. The boys and I caught a movie - Hoodwinked - at the $1 cinema (one of our favorite haunts) and headed down to my in-laws' farm. We spent yesterday w/ Scott's brother Mark and family at his nephew Camden's b'day. It was a wonderful time, full of bonhomie, and the food was spectacular. All of Scott's sibs and his Mom were present and Camden's mother, Marybeth, had some very nice friends there as well; we lingered, chatting, eating and laughing and thoroughly enjoying the day. We took a heap of leftovers home (I simply love leftovers - readymade meals!) and the boys will get to enjoy 'em.

I am back in Indy and look forward to a little more hospital work. Dr. Love and I have also discussed faith, how mine took a beating when my brother died, how my husband, children, parents and sibs still have theirs, how some events on earth cannot be explained. It was a nice discussion and I was honored to participate in it.

Hey, I have a question for you: why do folks here (U.S.) complain so much?

Unw -

Renu

Report of 23 April 2006

Hello there from the Carmel public library -

It is nice to finally put down temporary roots, and we have done so at the hospitable Tabers' in Carmel. Last week, we were w/ Scott's family. We flew from San Antonio after being wined and dined by Linda and Richard Luduena, and spending some quality time w/ our former neighbors, the Freemans. We also got to see Gabi and Lamont Potter, and their daughter Jasmine (who has cerebral palsy). The Potters are delightful, inspirational folks: Lamont's stories of growing up in abject poverty provide great perspective in our lives.

We spent Easter w/ Scott's sister, Diane, who'd invited the entire clan over for a meal. It was great to see everyone in 1 spot w/o travelling. All children of Scott's mother, Jan, were there w/ children-in-law and grandchildren; thus, plenty of photos were taken. We stopped and saw the Ruizes, who are family friends of the Weisses, and that was a treat. We also went to the cemetery where Scott's Dad is buried and paid our respects.

We spent 2 days w/ in-laws and then went to Brecksville, Ohio, to the home of my friend, Carrie Cassidy, and her family. We spoke at a Kiwanis gathering and were delighted to have the Key Club (high school portion of Kiwanis) present there. Naren spoke as well, and Navin and he spent the evening gabbing w/ the local teenagers, which was a treat for all. We headed back to Jan's farm, but not before visiting every major city in Ohio: Columbus, where we had lunch w/ our friend Michael Monteiro and his son Chris (we hadn't seen Mike in 12 years, so this was a treat tho' his wife Cathy and daughter Jessica couldn't be there, it being a working day); Dayton, where we saw the Ruizes again; and Cincinnati, where Scott said bye to his aunt and uncle, and grandparents. Scott's cousin, Deb, came to the farm w/ her sons and an enjoyable time was had by all.

We returned to Indy on Sat the 22nd, and had a great dinner w/ Kris Rea, her husband Gabe and daughter Isabella. Kris is a friend from residency days and it was great to see her happy and content. The next day, we had brunch w/ Mary and Sam Remster, friends from Special Olympics days (b.c. - before children); the meal was spectacular and the company great, thus making for a memorable morning. We had dinner that night w/ the Jani family, who'd kindly invited our other friends Kurt and Kati. It was a wonderful time, and we stayed the night there also. We spent the evening (after almost 3 weeks of traipsing the country and eating folks out of house and home) marvelling at the fact that our 5 year-old pants had suddenly shrunk in the wash.

We were at St. Vincent Hospital on Monday morning, and met w/ my former advisor and mentor, Dr. Robert Love, whom both Scott and I hold in very high regard. I've been privileged this week to follow Dr. Love on rounds - every word out of his mouth is a clinical pearl. We also visited Purdue on Monday and got to see some of Scott's former professors, which was great fun: engineers have a unique sense of humor! We had dinner that evening w/ Brenda and Jim Hillman; annually, the Hillmans welcome us to a huge meal, divinely cooked by Brenda, and we sit and eat and talk and laugh. B and J are avid gardeners, so their beautiful property is also a treat.

Ah, yes, the Immigration saga - had to go in to the local office, on the instructions of the Immigration officer at Philly airport, who'd foreseen dire consequences unless I went in and got my green card issue resolved (out of the country routinely for longer than six months at a time). Ostensibly, an appointment has to be made over the Internet to be seen and when I'd tried the previous night, the computer screamed a warning that the website was not secure. So, being accustomed to the Indian milieu, and being an inveterate optimist, I told Scott we'd explain the issue at Immigrn and go in and be seen. No chance - the security officer at the Immigrn office checked us in, and told us not to go up to the counter and "bother" anyone as no one would talk to us w/o an appt. I did go up to the window after seeing another person in my situation go up to ask a question, and was asked to leave by the security officer. (Dr. Love was incensed at this report, seeing no cause for rudeness; I considered it a person doing his job, sort of a little inflated w/ power.) In the meantime, Scott had fled to the local public library to make said appt, did so w/o any dire computer warning (preferring the distant lib over the office of the lawyer next door who'd make it for $10), and we were seen after I apologised to the security guard and a genial relationship was re-established. (Scott was pretty relieved I wasn't thrown in jail by this point.) Ostensibly, there is no issue w/ my green card other than a caution to expect to be questioned every time I enter the U.S. if I've been out longer than 6 months. I asked if I could get something in writing to that effect, esp considering the Philly warning, and was told that I was argumentative, that nothing would be given to me. Scott muttered a piece of advice to me that we ought to leave, and we did. I've not generally encountered rudeness at Immigration, but felt a total environment of mild paranoia on the part of the Immi officers this year. And I'm a legal immigrant!!

Wednesday, we had lunch w/ the good folks at Citizens Health Center, where I worked last year. It was great to see everyone - lots of hugs - and we stayed a while. We returned to the Tabers' and went out for a lovely dinner, Scott packed and took a Megabus to Chicago to catch his plane. His aunt got him a $1 (yes, $1) fare (www.megabus.com) and Scott found the bus deserted (5 passengers) but comfy.

More next week. It is great to catch up on medical stuff that I would not otherwise see and can easily forget. Also, perhaps my pants will un-shrink.

Renu

Report of 9, 16 April 2006

Hello from the United States!

How is everyone? I had a good trip in, no medical emergencies on the flight. The Immigration authorities in Philadelphia gave me a lot of grief about my situation of living and working in India and spending part of the time here. I mentioned that I was married to an American citizen, and then proceeded to hear that I must choose between my work and my status as a permanent resident. The officer was also yelling, I guess he thought that because of my accent, I must also be deaf. The first option he presented for my situation was giving up my green card ("very easy to get it back," he said but not in writing); after I had a good night's sleep, I decided that this option would not be as easy as he made it out to be and I am going to evaluate other options. The terrorists that brought down the World Trade Center trained for the deed on American soil, and were permitted into the country to so train; the officer did not want to hear squat about my being a physician and working w/ the destitute.

It has been a glorious couple of weeks seeing friends. Ann and Phil Bagley met me at Philly airport (they had a long wait due to the above merriment) and housed me in their beautiful home, full of their warmth, grace and Ann's wonderful meals. Olivia, my residency colleague, joined us there, and it was so nice to have her; we hung out at the conference of the American College of Physicians, which was, as usual, excellent. The 3 Weiss men flew into Baltimore later in the week and stayed w/ Craig, our friend from college days, having a rollicking good manly time. All 4 picked me up in Philly at the end of the conference, and Craig, Scott and I went out to dinner that night - speaking of work, play, Immigration issues (Craig was once questioned extensively at the Canadian border prior to his weekend visit there as his passport cover had a Moroccan - ?Islamic - design on it), and other fun things. It was a memorable evening.

We took the plane to Houston the next day (9 April), had a delicious meal w/ our friends Bojie and Satchi, who had gathered all the other Coorgis in 1 spot, making it very easy for us to see everyone. We saw my college friend Latha and her family, which was nice. We then went on to spend the night w/ Tori Scott and her family; her kids, Jordan and Caithn, took our sons to Cici's pizza (considered gourmet eating by all 4 teenagers) and the adults had a lovely salad at home. Tori had also made awesome chocolate chip cookies, which we don't routinely get, and we hugely appreciated this gesture, and all the spoiling! We hung out all the following day w/ the Scotts, Tori taking a day off and Jordan unexpectedly joining us as he had thrown up all night (kind courtesy Cici's, we suspected). We saw Chris Ortiz and Amy Mendez and their cute new daughter, Anna, and had a nice dinner w/ them.

We flew to San Antonio on the 10th and my former professor, Richard Luduena, picked us up. We have been staying w/ Richard and Linda, and it's been great fun in their book-laden house. Greg Brown, the med student who'd visited India, took us to Austin on the 11th to visit Christine and Ganesh Ramakrishnan, which was great - very kind of Greg, and his company was a treat, too. Scott and I spoke at a banquet that night for the American Medical Women's Association, which we enjoyed. I started to choke up when I spoke of the goodness and kindness of the people of the United States, remembered how moronic it'd look to have the speaker bawling her eyeballs out, and attempted to compose myself. All 4 of us were present the following day when I spoke at my med school at an event kindly organised by Abraham Verghese and his crew. We visited former neighbors (Aurora and Scott Freeman, Lamont and Gabi Potter) after this, and then went to dinner w/ former professors Linda and David Johnson. We had Tex-Mex food, Linda proceeded to spoil the boys w/ Best Buy gift cards, and then we went out for ice cream. This was, also, a memorable evening - full of the genial good time the Johnsons are renowned for.

Scott flew to Cincinnati on the 13th to spend a little time w/ his family w/o the entire brood tagging along. We will join him on the 15th. I came to school and saw some former faculty - Drs. Kozue Shibazaki, Vick Williams and met our new dean, Dr. Lee Jones. These interactions were absolutely lovely and I appreciate the time everyone has made for us. We spent the afternoon watching a movie ("Love, Actually") and the Luduenas took us out for a great Italian meal. Their strength, among others, is the ability to engage our boys in conversation and they did so very well, making for a chatty time full of camaraderie.

Greg Freeman, another former professor, took me out for b'fast today and we sat and talked for a while. This is always a treat for me. I also got to see Dr. Scott Johnson and we had a great time gabbing of his mission trip to Guatemala, and the perspective it has since shed. Good fortune took me by Dr. Lois Bready's door briefly, and that was lovely. All these faculty and their spouses are so staggeringly busy that I greatly appreciate when they make time in their schedules for me. The boys are w/ the Freeman girls - Michaela, Shaunessey and Arwen - having a marvellous time.

Better wind up. More next week. Hope you have lots of fun interactions of your own.

R

Report of 2 April 2006

Hi from Chennai -

Boy, 3rd April (date of departure to the U.S.) seemed really far away, and here it's the night before. I leave in about 2 hours.

Hope all are well. I wound up at the Banyan this week. One of our more troublesome patients, whose psychosis has been resistant to treatment (but I am unsure if she takes the meds) returned to the B and proceeded to get very violent w/ the staff. I am not educated enough to understand her illness and its consequences, and the acts seemed very wilful plus phenomenally damaging, so I let the social workers know and chastised this pt. We are all trying to come up w/ a strategy to cope.

Our pt w/ HIV is on Siddha (a form of Indian medicine) meds and I'd nagged the treating facility to find out if she ought to get on Anti Retro-Viral Treatment (ART) or not. As it turns out, they did a blood test, and determined that she should start ART. Thankfully, this lady has not had the infections that can affect those whose white blood cell count is low ("opportunistic infections") and I'm hoping her good health and good luck prevail. We gesture wildly to each other to communicate, as neither of us speaks the other's language.

We took some pics of my patients at the veg market, and they enjoyed posing. We also wound up tutoring w/ a lot of presents, many donated by you all, and I am ready to hit the plane. We had lunch w/ my brother and his family today and that was grand fun. My niece looks exactly like her father and brings w/ her all the novelty a little baby will.

"The most common of all antagonisms arises from a man's taking a seat beside you on the train, a seat to which he is completely entitled." - Robert Benchley

Unw -

Renu

Report of 26 Mar 2006

Hello from Chennai -

A dear friend named Maya created this blog for me and I have just found the time now to learn its workings and use it. Thank you, Maya.

The week has been good. It had its share of mishaps w/ the Banyan staff forgetting to document important details when they took the patients to the hospital. I can't abide this, because then I have no idea what the doctors there said about the patient, and I can't fully cooperate in the care of the pt. We continue to work to overcome such obstacles. The physical therapy department at the B now attracts interns from elsewhere, and I saw some of them engaging the patients in games like tug-of-war, etc., which produced much raucousness and merriment. One day, there was some singing and dancing, and I noticed that one of our pts, Ms. B, was particularly exuberant. She has lost both her arms, I dare not ask how (pts w/ mental illness are subject to a lot of violence in the community) but she has stated that it was a train accident; B was letting nothing stop her as she sang a Hindi song which I did not understand, and did a peppy little dance, which I clearly understood the sheer joy of. I stood mesmerised, w/ my head against the door jamb, and watched her - armless, far from her family, w/ the stigma of mental illness driving her from her town, and treated so efficiently by the B that her spirit has recovered and is well and happy.

The veg market folks are well, and rounds there were quicker than usual. The kids tutored and 3 of the regulars came to be taught. Next week will be our last tutoring session and we will wind up w/ a party.

I was fortunate enough to go to Madurai for a day and see my parents. It was a lovely time and I remain very grateful that I was born to these 2 folks who are uncorrupt, full of integrity, intelligent, compassionate, exceedingly funny; we talked and ate and laughed. I was lucky to see a dear friend, Dr. Leila Kurien, who is the mother of a friend and also my friend, and her perspective and company are always great treasures for me. I also managed to see my college friend, Selvalatha, and her son Arun; Arun was in a horrendous car accident in November, sustained head injuries, and is recovering slowly but surely. He can recognise people and converse w/ slow speech, eats well, participates in physiotherapy, and is working to make his speech unslurred. I think the children of close friends are akin to one's own, and I was particularly delighted w/ Arun's progress.

Scott and I went to see "Memoirs of a Geisha" today after I finished reading the book. Both book and movie were good, and I was very happy to have Scott's company, but I found the whole saga undeniably sad - that a young girl should be taken from her parents and sent off to a trade and the flesh market. Such things happen routinely in India still, and I was filled w/ a sense of good fortune that not only did this not happen to me, but that we can afford to keep our children w/ us. Lady luck continues to smile on us, knock on wood, and never more so than w/ our friends and family, many of whom we'll see next month. I so look forward to it.

"Life is far too important a thing ever to talk seriously about." - Oscar Wilde

Unw -

Renu

Report of 19 Mar 2006

Hi from sunny Chennai -

Worn-out, that's what I am. We had PTA meetings on Thu and Friday, and neither son got very good reports. We had burgers at the beach after it, and Naren thought the reports must have been good to warrant the celebration, but we had much to discuss and thought the serene setting of the beach would help matters. Naren can apparently correctly answer 90% of the questions orally asked in class, but cannot translate that into similar test performance. My aunt told him to practice written answers w/o looking at the book. Let's see; all suggestions are welcome. Navin ostensibly tries to get by on his intellect and charm. Charm?! Some of us are immune to it. This is an academically rigorous country, and the boys are reeling; they remark often that the U.S. was soooo much easier, but Scott feels they are indeed up to the challenge here. I agree.

The B is fine. One of our non-verbal patients, Ms. A, suddenly started favoring her left hand and it was astutely picked up by staff. As I examined her, I noticed she did clearly do so, and I sent her for an xray. Lo and behold, a fracture of the right upper arm bone (the humerus). Her arm is now in a sling and she is getting by. The staff have their act together here. My assistant, Ms. J, even pulled out an IUD (Intra-uterine device, a contraceptive) the other day, which I do not know how to do.

The staff at the B also line up for care and the housekeeping supervisor came to me w/ belly pain in her upper right (the "right upper quadrant"). As I thought gallbladder (gb), esp as she is a portly sort, she said clearly that the pain comes on after she eats foods like meats and not after veges. Really, the diagnosis was playing out, as the gb acts this way after fatty foods. I did have to send her for an ultrasound and await the result.

Scott's boss had consulted me over email for his 15-yo nephew in Mysore. The child had had persistent fever and a low white blood cell count. I spoke to the doctor in charge in Mysore, and he mentioned doing a bone marrow biopsy. The result confirmed cancer, the child was sent to the cancer hospital and was responding very well to chemo. However, he developed an infection and died last week. I was saddened to get the news. Scott's boss then thanked me for the support, and I don't think I did very much, but perhaps having another physician speaking on the family's behalf and explaining things to them counted for something. Such things always astound me.

Someone else looked after tutoring for me as we had all kinds of fun at the PTA and we will return there this week.

We saw my brilliant aunt and my equally brilliant sister last night and that was fun. My sister, Anu, heads to an all-exps paid conference in South Africa on injury prevention. I've often thought this'd be great: to get invited to a conference on one's area of interest. We celebrated Holi, a North Indian harvest festival, by spraying color on each other and having a whale of a time. The color is supposed to wash off, but is far from doing so.

"Holidays are an expensive trial of strength. The only satisfaction comes from survival." - Jonathan Miller

Unw -

Renu

Report of 12 Mar 2006

Hello -

The sunshine streams onto my balcony, the clothes give up their last bit of moisture, and I never knew the value of non-stop sunshine until I had to do without it in parts of the U.S. A friend emailed and talked of how nice it is to read of the sun in Chennai, while she is in the throes of winter in the U.S. Wow! We take some things for granted here, and it was nice of her to reaffirm my many blessings.

The weekend was exhausting. My days off are Monday and Friday, not the weekend. The 3 Weiss men and I had a talk last night, and I told them while they lounged about on a Saturday, my head had to whir with things yet undone: boys' haircuts, Navin's dental appt, veg market, await the cook, go visit my brilliant aunt, etc. As such, then, I needed help w/ a couple of errands either taken over by someone else or the men at least being aware of the same. They agreed, and I expect this will last 1 weekend, but at least we have these talks without the fam groaning and rolling their eyes.

We've had a string of fractures at the Banyan. Some ladies have fallen, and their bones are so osteoporotic (brittle due to lack of mineral inside) that they break. One of their xray reports only reached me a week later, in spite of my persistent asking, and I was dismayed that we'd missed a precious week of healing the wrist. So one of the founders, Vandana, the senior medical social worker, the human resources chappie and I had a meeting to iron out similar issues; I was impressed with the speed with which certain decisions were taken. Lack of bureaucracy is a fine thing.

One of the pts at the B is HIV+ and speaks a language none of us knows. So a lot of nonverbal communication is adopted. She has taken to coming and sitting on the floor by me when I am on rounds; I find this staggeringly flattering and humbling. She sits quietly, sometimes talks/gestures to herself and I could spend quite some time watching her, so content despite her dreadful illness. One day, the B sent an auto (a 3-wheeled cab) for me, and as we headed to work, we noticed a lame man trying to go up a rather steep road onto a bridge; he likely could not afford a prosthetic leg, and his left leg hung uselessly over the stick he used as a crutch. I asked the driver to stop, and in his inimitable auto driver style, he bellowed to the pedestrian, asking if he wanted a lift; the man smiled and declined, saying he was almost at his destination. That smile pretty much made my day, that someone could smile in the midst of his disability and adversity. Really, we have a lot to be thankful for.

The veg market was fine, and the vendors (90% of whom are my patients) looked well. One of them told Navin he needed to comb his hair, and I loved it (esp bcos Navin did need to). Indians are nothing if not opinionated. On an Indian train once, my co-passenger looked at my husband and 2 sons, and asked (not in a hushed voice) if I'd been sterilised yet. I lived in the U.S. then, and was thunderstruck at the question, but not many such words from fellow Indians faze me now.

Tutoring went well with us being hammered w/ students again. I continued to work w/ the little girl who does not know her alphabet, and progress is slow but existent. She can pick out the first 3 letters and "o" randomly. Methinks she may be held back this year, but that's ok; better that she gets to the next grade when she can handle its pressures. The kids drew thank-you's to the restaurant that sold us the food for the carnival, we took the artwork to the owners, and they loved 'em.

We took Naren out for lunch on Sat to an u.o.e. (unfortunately obscenely expensive) restaurant w/ spectacular food, then had a huge b'day party at home for him in the evening and many of his friends came. The SPL, Rega, is a special friend (I don't think it's romantic - yet) and we'd sent her a small bottle of perfume to congratulate her on her election victory; she said she liked it a bunch. (Scott's aunt Peg considerately buys a ton of such things - perfumes, candles - for me at garage sales in the U.S., even more considerately declines reimbursement, and these purchases come in very handy as thank-you/congrats/any occasion gifts.) Some parents had asked us to discuss the kids' addiction to gaming and adult sites, and I asked Naren if we could on Saturday, and he very graciously agreed. So all the kids, Scott and I had a talk, and we enlightened them on the dangers of such practices. Some of them thanked us later, and we had thank-you's from some parents today. We were happy to do it - forewarned is forearmed - and even happier that our son trusted us enough w/ his friends to unleash such "lectures."

I'm so looking forward to our U.S. trip. I'll attend a conference in Philly, which I eagerly anticipate, stay w/ my friend Doug's parents, who are now my friends also; visit San Antonio and speak to some students; go to Brecksville and speak at a Kiwanis gathering; get together w/ Scott's rambunctious, unmalicious relatives; and hang out in Indianapolis some. I look forward to the uncomplicated nature of our American friends and family, eating some salad, and revelling in the greenery and the movie theaters.

"It takes your enemy and your friend, working together, to hurt you: the one to slander you, and the other to bring the news to you." - Mark Twain

Unw -

Renu

Report of 5 Mar 2006

Hello!

Clothes on the line, sunshine on my balcony, husband and son just finished studying Physics - welcome to my Sunday.

Trust all is good. I had plenty of opp to question my choice of profession this week. Ms. S, the attention-grabbing lady w/ tuberculosis in her hip joint, returned after surgery to get the infection cleaned out. She refused to cooperate w/ physical therapy and lay in bed yelling of pain. Another pt, also Ms. S (we'll call her S2), came after her cataract operation. She is also pretty demanding but in a different way, and together, S1 and S2 (remind you of Dr. Seuss's Thing 1 and Thing 2?) proceeded to rile the patients in the sick room up to be belligerent and irritable. Aiyaiyaaa - I wrote in S1's file that we needed to get her out of the sick room and our able psychiatrist agreed; the social workers put her on a regular floor and now her cooperation or lack of is only visible to her and a few disinterested roommates. S1 has a crush on the psychiatrist and he even managed to get her to keep her leg straight for 2 minutes, which is more than anyone else had accomplished. S2 also got shifted out to the floor. She is Anglo-Indian, of a community that was started when the British were here and started, uh, interacting w/ locals. The community is rather poor, but very Westernised, wearing Western clothes and having distinctly Western rituals at weddings (dances, cake and wine, etc.). Peace and good moods reign once more in the sick room w/ S1 and S2 where they belong.

The young woman w/ the belly pain (near our flat) is better. Always surprises me (pleasantly) when my patients heal - this is a lovely profession to be in.

Tutoring was good. It rained on Friday and we thought the students would not come; not only did they come, they came early to beat the rain. We were short-staffed again, but did the best we could. Fortunately, some kids worked independently and didn't need us totally; I imagine regular classrooms are also like this. We have a first-grader who does not recognize her alphabet and I tried to work w/ her; as w/ most students here, she can say the alphabet by rote if we start at the beginning and go in order, but not if we go randomly. All suggestions to help are welcome: we really need to get this child to know her letters or she'll flunk this year.

The Banyan's fundraiser was last night. Scott and I went, and listened to some magnificent musicians including the mightily-talented flautist Rakesh Chaurasia, who was so humble when we complimented and thanked him later. We had dinner, hung out w/ like-minded individuals, and returned home at 12.30 AM after a fun evening - to find our sons awake and having a time of their own. No quicker dampener on the evening than that. Food had not been put away, laundry had not been hung up, and these 2 were waiting up for their parents (which they denied). Some words were had all around, including cuss words from you-know-who's mouth, and we are going to try again for law and order.

A cousin I'd run into at the wedding 2 weeks ago, whom I was seeing after about 25 years and whom I'd had a blast sitting and gabbing with, died last week. Mala had gone in for a hysterectomy and complications set in. As Scott and I had headed out of the wedding hall, Mala, her sisters and mother were at the entrance, making a very pretty picture, and Scott touched my aunt Padmini's feet. Mala then introduced herself to Scott and was gracious and exceptionally charming, esp in a place (Coorg) where foreigners are relatively unheard of. That makes a very good memory for me. One minute we were sitting and talking of climbing the nurpannu tree, staining our teeth and hands purple w/ the fruit (and getting reamed on by our mothers), and 2 weeks later, she was not with us. It was hard to take.

I'd better wrap up. See you next week.

"A word uttered from a pure heart never goes in vain." - Mahatma Gandhi

Unw -

Renu

Report of 26 Feb 2006

Hello from Chennai!

Sunny, bright, happy - that's what the day looks like.

Hope all are well. I just spent an exhausting weekend at a conference for CME (Continuing Medical Education). Forum 2006 was organised by Sundaram Medical Foundation (SMF) Hospital here in Chennai. I attended Forum 2005 and was so impressed I had to return for it in 2006. It is very well-organised, starts on time (a stupefyingly rare occurrence for Indian functions) and runs on time, has very pertinent topics for the primary care provider, and most of the speakers are thunderously effective. It's lovely to try to keep current w/ medicine. All in all, 2 days well-spent, though they were the 2 days my spouse was here from Bangalore. SMF was started in the memory of the scion of one of the big business houses who changed careers to medicine at 30, and died of a brain tumor before he could see his dream of a community hospital realised. The folks at SMF are mostly U.S.- or U.K.-trained, and see the Banyan patients for free, endearing themselves to me even further.

The B is good. I had a patient come to see me w/ the complaint of her heart fluttering, or beating rapidly. As I tried to rip through my head all the causes of a rapid heart beat (the heart doing its own boogie, thyroid excess, drug use, caffeine overuse ...), I waited ("Listen to the patient, he will give you the diagnosis," said a famous MD - Osler?). Then she talked about how these episodes happen when she goes to visit her husband and daughter, and has to experience the taunts of neighbors about her "madness." As she talked of their effect on her, how she has had to give up seeing her grandson, how her daughter and husband try to be supportive but the taunts are ravaging, she had me by the heartstrings. I had to blink rapidly to not start weeping in front of her, but the prospect of being unable to see beloved family members is not something I take lightly. She said she does not want to leave the B, and to the B's credit, no one is forcing her to. I explained in some detail about the gossip factor, how my neighbors gossip about me too ("There goes that weirdo from the U.S., in sleeveless clothes, who brings in servants' kids to our high-class complex to tutor them, and conducts carnivals for them") and how one must just let some things go. I acknowledged the difficulty of this, but reaffirmed to her that absolutely no one wants her to leave the B and her family was welcome to visit her here, as they have since been doing. This appeared to suit my patient well, and I was relieved.

I had to punt rounds at the vegetable market again as I was at the conf, and Scott went. He is rather welcome there, as many Indians have never interacted w/ a white man, and Scott even shakes hands (gasp!), which is stupefying to the vendors. Plus his gentle manner is nice for all. We had our share of patients coming by the flat, including a young unmarried woman w/ belly pain. Asking about sexual history in an unmarried woman in India is playing with fire, but I do it anyhow as I must rule out certain causes such as pregnancy. I have treated her w/ some meds to relax her belly and she is not back yet, but I imagine I'll find out soon if they are effective.

Tutoring went well, and we'd sent out an SOS to the parents of prospective tutors, so we had enough tutors, thank goodness. We gave out M&M's at the end of the session, which were welcomed by all. I continue to be impressed that the kids come to learn.

Naren was one of 4 nominated for School Pupil Leader (SPL - sort of like Student Body President) by his peers in 10th grade, who are leaving school. Elections were last week and he did not win, but was extremely gracious in defeat. He likes the young lady who won, Rega, as do we (Navin included), and considers her competent and capable. In a lot of co-ed schools, girls don't get opps to be in leadership roles and I am also glad Rega won. Navin has been selected to read books (fiction) and review them for the young readers' section of the city's newspaper; he finished one yesterday and wrote the review, which I must send off today. Our complex has parenting workshops run by a beloved neighbor and we discussed mind-mapping; yesterday, the 3 Weiss men and I discussed my mind-map of strategies to stop swearing. The men were very supportive, and this morning's bustle of activities went off swimmingly without one cuss word from my mouth; I expect this will last 2 days, but hope for longer.

I have been most happy to receive emails from Kristi Tough, a very dynamic and intrepid 4th-year student from my med school in San Antonio, who is extremely eager to help the work here. We haven't met except over email. I generally don't receive good news over email, and Kristi's msgs have been a treat as she tries various avenues for assistance. We hope to visit the U.S. this year and San Antonio will be very high on our agenda as it was a fine school to study in, and we still keep in touch w/ lots of folks from there.

"School days, I believe, are the unhappiest in the whole span of human existence. They are full of dull, unintelligible tasks, new and unpleasant ordinances, brutal violations of common sense and common decency." - H. L. Mencken

Unw -

Renu

Report of 19 Feb 2006

Hello from sunny Chennai -

I have just returned from a wedding in Coorg. A cousin's daughters got married: one to a non-Coorg and one to a Coorgi. As mentioned before, Coorg is a pretty place in southwestern India, in the hills where they grow coffee and rice, and where the people are known for their light skin (prized in this country), good looks, bravery and athleticism and not in the slightest for their intellect. Suspicion was that they'd descended from Greeks or Arabs, which has since been disproven, prompting the more enlightened Coorgis to remark that the scientist doing the disproving would be burned in effigy. Coorgis don't take kindly to their ilk marrying outside the community (ergo, my mother being ostracised and her brother still not having spoken to her after 50 years), but that is slowly changing. The weddings were fun, and it was great to see cousins, aunts, uncles and eat; the gossip in this tiny, closeted, agricultural community is something I can cheerfully do without. Ever read the "Asterix" series? Coorgis are very similar to Gauls.

We were happy to receive Greg Brown, from my med school, and his girlfriend, Sonia. They visited the B and liked it, and Greg pointed out that patients helping pts were rare in similar facilities in the U.S. Wow, pts helping pts runs the B - it also gives the ladies some robust self-esteem ("I'm working in Green Leaf beauty parlor, doctor, pls tend to me quickly as my bus comes at 9.15 AM."). Really, some things about the B are just so good. S and G also gave a donation to the B, which is welcome; thank you, Sonia and Greg. We were also delighted to receive a package of M&M candies from Ann and Phil Bagley, who are parents of a "jigri-dost" ("heart friend" or great friend), Doug. In addn to the M&M's, there were some multi-colored pipe cleaners and beads. These were so welcome, and the kids had a great time using 'em to teach math last week. The pipe cleaners are easy for little hands to hold. 1/2 of the M&M's were for tutoring, and the kids loved 'em. Thank you, Ann and Phil!

The young woman now assisting me at the B when I do rounds is a former patient. Ms. J was married off at the age of 16 to her maternal uncle (very common here), she had a baby who died and then her in-laws accused her of having an extramarital affair which produced the child. This caused the onset of a mental illness, she found her way to the B from Tiruchy, which is about 125 miles away, and was treated for the illness with wonderful results. Her basic medical training (taking temp, blood pressure; drawing blood) are now put to good use during rounds and I like this. She was not quick on the uptake at first, causing me a little annoyance, then I found out her story and we jell more. I try to teach her salient points of medicine as we go. One day, another former pt, now in rehab, came to see me w/ her grandmother; the latter is trying to find the former a job (a non-working adult in poor Indian families is a h-u-g-e liability) and I turned to J and said, "Tell her, J." As poor J blinked, I clarified, "Tell her your story and how getting treatment has equipped you to find a job." I asked J later if she had minded my blabbing her history and she said, "Not at all." Lovely place, the B.

Tutoring went well and we were sort of equipped last week w/ tutors. One of the students is a feisty little thing (sister of the 9th-grader who wants to do medicine) who does not hesitate to correct our Tamil and laugh at us, who is so eager to do work when she gets to our room that it's difficult to resist, and who will corner a large stack of markers (esp the stamp-art kind) when it's time to color. Her regular tutor groans when she comes in, as does her sister, but I'd rather have feisty little kids than docile, uninterested ones.

Well, I'd better wind up. Naren has exams this week. Navin won tickets to "Narnia" after answering a question correctly, and went w/ some friends. (In the U.S., we were used to the kids winning 1 ticket and our having to buy our own; here Navin won 4. Different marketing strategies.) Scott and I hung out at the weddings and enjoyed ourselves. Valentine's Day here had its usual share of fundamentalist individuals protesting the Western influence on our culture.

"The Art of Love: knowing how to combine the temperament of a vampire with the discretion of an anemone." - E. M. Cioran

Unw -

Renu

Report of 12 Feb 2006

Hello from Chennai!

We are back from Bangalore, where my sister-in-law, Susan, had her housewarming. Real estate is very expensive in big cities in India, prompting many of us to rent, and we are glad my sister-in-law and her family are somewhat settled. A housewarming (ceremony performed when one enters their own house for the first time) takes many forms here, depending on the religion of the owners. Susan is Christian, and the pastor of her church, plus many of her fellow parishioners, came to the flat. The pastor gave a nice sermon and prayed, and we are happy that Susan gets such solace from her faith. She mentioned that it had been a struggle soon after my brother died, but that her faith sustains her considerably now, which I am happy about.

Work was fine, if shortened. Dengue cut short a work-day for me, and since I work gratis, I felt not-too-bad about that. The patients at the Banyan are healing nicely. One of my favorites there, Ms. K, had been found on the streets and had her right arm hanging uselessly at her side. On X-ray, we saw that the upper arm bone was broken and she had surgery to fix it. (I think I've mentioned before that several of our mentally ill, destitute patients are often found to have badly-healed fractures from before the time we found them. This saddens me enormously, because it takes considerable force to break a human bone, and I am distressed at the extent of violence these ladies have been subject to.) She is recovering well, and is a placid, easygoing sort. Our able physiotherapist has worked w/ her, and she is getting more strength in her right hand. The other day, she pinched my cheek (a gesture of great affection here) w/ her left hand and I asked her to repeat the action w/ her right, which she did. I was thrilled. Ms. K has asked to go home, and the Banyan's expert rehab team is on the case; if the patient is able to recall an address, or even landmarks, the team goes, scopes out the scene, assures that the family is willing to take the pt back, and then starts work to send the pt home. If the family does not want the pt back, we make medical excuses for as long as we can, as we cannot have the pt know her kinfolk are rejecting her. If that fails, we take the pt back so that she can see the situation for herself, and then make subsequent plans accordingly.

We have had our fair share of patients around the flat, too, which happens as the folks know that there is a doctor that treats the folks for free. One of my earliest pts said she could not afford her meds and I nearly opened my wallet to hand her some bucks, then my very pragmatic husband dissuaded me. We decided I should not be known as the free doctor and the moron who hands her pts money to buy meds.

Tutoring went well. As always, we had tons of kids and last week, we were short of tutors. A couple of us had to double up and we did. A young woman in 9th grade who wants to become a doctor is normally tutored by Naren. As he was not available, I tutored. She had to memorise a passage on Stephen Hawking, and as usual, did it w/o understanding a word. I translated for her, could not find the Tamil word for "Sclerosis" and we did the best we could. This girl is one of 5 kids, the family has been abandoned by the father, and she does not let too much of that worry her on Friday afternoons: she and her sibs show up to be tutored, they ask for help where they need it, and study hard. They then color, get their candy, thank all of us very nicely and unfailingly(which is so, so gracious) and go home.

Naren was invited to the birthday party of a girl from another school, whose parents we do not know. As the location was close to a friend's place, I permitted him to go for a short while and he was pleased. Gotta pick your battles. Navin has also started getting phone calls from girls in his class (7th grade). Lest anyone think this is testimony to the fact that both our sons are irresistible to the opposite sex, let me assure you that part of this calling is completely due to the fact that the girls are bored and badly want someone to irritate (which the 7th grade boys also choose to do regularly).

On this warm note, let me wish all of you a Happy Valentine's Day and lots of love.

"Once love is purged of vanity, it resembles a feeble convalescent, hardly able to drag itself about." - Nicolas Chamfort

Unw -

Renu

Report of 5 Feb 2006

Hi -

It's about 80 degrees outside, the fan is on low, Scott is asleep on the couch and I am freezing. Feels like dengue, which is a memorable illness to have: high fever, thumping headaches and some hallucinations, which were actually pretty cool during my first episode. I'll just have to ride this one out, there's no treatment for dengue. We go to the Banyan's fundraiser tonight, and probably won't stay for the whole thing, glittery tho' it may be.

The week was very busy, which is always good. The Banyan continues to be a good place to work. One of our patients, Ms. V, is recovering from a fractured left leg. I want her to get crutches and be more mobile as I fear deconditioning will set in if she stays in bed. The period of rest is over and the ortho has said she can walk around; having had a fractured foot once, I know that getting back to normal gait will take time, but I want V to walk. She was also found on the streets, and told the Banyan rescue team that her husband had an affair w/ some woman who did black magic and gave V epilepsy. She stated that if she leaves the B, she will live on the streets as no relative will take care of her. I was struck by this story, and her insight. As I watched V drink her tea one day after breakfast, I felt enormous gratitude to Vandana and Vaishnavi for giving folks like V a place to live; V saw me watching her and offered me her tea w/ a classic Indian head motion and the utmost grace. I was very touched - such gestures make my day - and declined. V likes music, which plays in the sick room constantly; the TV has Tamil film hits and dances showing. One day, I saw V bopping to the music in absolutely perfect, magnificent rhythm and was enthralled. How we underestimate the power of music and dance in healing.

The veg market also had its share of successes. The young man who sells ladies finger (okra) had wanted an appetite stimulant and I had recommended one. When I went there last week, I saw that he appeared to have put on a little weight and looked quite fresh and good. I complimented him, and was pleased. I always think that what I do is nothing out of the ordinary, and am pleasantly surprised when my patients get good results. Yesterday, we had to go to the veg market in a hurry and I sent the 3 Weiss men: going there is like hospital rounds, which I enjoy when I have the time for it. Y'day, tho', I had something else to do, and so the men went, again returning loaded w/ especially good, fresh, tasty veges - which the vendors appear to reserve for my family, and which always, always warms me.

Tutoring the impoverished kids continues to go swimmingly, and we have about 8-10 kids coming. We were understaffed last week, and Naren and I had to double up, taking 2 students each. We have a 1st-grader who does not know her English alphabet, her tutor struggled w/ her and one of my students finished her English lesson, so had time on her hands; I asked her to pls teach this child her alphabet. She did, and managed to make much more headway than any of us. I tell you, sometimes you have to use whatever resources you have: tutors, students, grandmas, anyone. My student has a photographic memory and memorised her English poem in no time, not understanding a word. I feel for these kids, and wish they could continue being taught in the local language forever, but the powers-that-be have determined that that's not a good idea. And they're probably right: it'd limit these kids geographically.

The 3 Weiss men and I saw a Tamil movie yesterday and had our weekly game night. The kids are allowed to eat junk and we play a board game (not computer or Nintendo as a neighbor thought); we find this a pretty bonding experience and are glad the kids still play w/ us. We played Taboo, which is hilarious esp w/ Naren and Navin cutting up. The kids will sometimes tell us school events during this time, like Navin's friend writing a love letter to a girl, and Naren's friend getting dependent on the Internet for entertainment. A young woman in Naren's class calls daily, sometimes 2 or 3 times, and we unfailingly heckle in the background: methinks love is blossoming.

"Fame is a four-letter word. And like tape, or zoom, or face, or pain, or love, or life, what ultimately matters is what we do with it." - Fred Rogers

Unw -

Renu

Report of 29 Jan 2006

Hello from bright, sunny Chennai -

No option of Seasonal Affective Disorder here due to lack of sun or presence of grey skies, etc.

A virus has a stranglehold on me, and is getting worse w/ cough, etc., before it promises to get better. I think it very educational when doctors fall sick - can truly empathize w/ a patient's malaise when he/she has a cold, speaks of cooking any old dish for the kids and plopping back in bed, etc.

The Banyan is in the throes of a huge fundraiser, postponed from last year to 5 Feb. Scott and I have passes for a glittering evening w/ the stars doing some kind of Broadway production, and thanked the B for the generosity. As this event is consuming everyone, lots of things are sliding: timely arrival of my pickup, rotation of the current medical staff out of the sick room, etc. We can live w/ that, really, as it will end. The blood tests go out regularly, and I am glad because we have diagnosed leptospirosis in a young woman who is mentally ill and mentally retarded. She says nothing, so I had to rely on the caretaker who spoke of loss of appetite and fever; my suspicions of lepto and typhoid are low, esp after the recent floods, and I requested the blood test. I started treatment for this young lady, and she appears to be better.

Scott and I had to go to the U.S. Consulate to renew Naren's passport and that consumed quite the part of a day. We have generally had courteous and good service at the Consulate, which is welcome. U.S. citizens use a different entrance than the teeming masses waiting to get a visa to visit/study in the U.S. When I went to apply for my student visa 23 years ago, I went to stand in line at 6 AM and was late: the line had started forming at 4.

Someone else looked after tutoring for me as Scott and I were running errands. I am glad kids use the tutoring service, really. My intelligent, handsome spouse and I also went to lunch and a movie, then went to the beach until the virus reminded me it was time to notice it. It was a fun day, the kind that busy parents often don't have enough of. My brother, Vinu, is spending the weekend w/ us as his flat has no electricity or running water due to some maintenance problems, and we are happy to have his irreverent, opinionated, funny self here.

We were fortunate to have Gita the med student visit us, and she brought w/ her Greg Brown, who is from my med school. Greg spent 3 weeks in Vellore, and is to spend the rest of the time (10 days) travelling w/ his girlfriend. We had a lovely evening - speaking of India, the U.S., ways of life, dress, medicine. I am super glad folks wander in and out of our house. Greg is of above average intelligence and is able to see some good in India under the stench and filth. When we dropped him to check in at his hotel, apparently the clerk was rude. I was furious, and went in and told the manager of it: one of our strengths is our hospitality and if the doofus clerk couldn't show it, we really had little to showcase our place in the world. I believe there is a saying in Sanskrit that says the guest is God: Athithi Devo Bhava, I think. (More knowledgeable folks are welcome to correct me.)

"Visitors should behave in such a way that the host and hostess feel at home." - J. S. Farynski

Unw -

Renu

Report of 22 Jan 2006

Hello from Chennai -

The night is dark and I am home. Hope all of you are well.

The week was ok. One of my patients at the Banyan came in complaining of her jaw locking when she yawned or opened her mouth, and of not being able to open her jaw very wide at all. I wanted her seen by a dentist - one of the local ones sees our patients either for free or at a reduced rate - and so stated. Some of her symptoms are part of a condition called Temporomandibular Joint Syndrome (TMJ), and is best evaluated by a dentist. The young lady had a very serene face, and no dot on the forehead (bindi), which I asked about. The bindi started out as a religious symbol in Hinduism, and has since evolved into a quasi-cosmetic. Usually, Hindu widows do not wear the bindi, and Muslims and Christians eschew it if their religious beliefs are strong. The pt told me that her husband had died, which I was sorry to hear about and even more sorry when she worded it as "They told me my husband had died." She had apparently gone to her mother's house to recover from an illness, and when she returned to her in-laws', they told her about her husband's death earlier. They appear to also have told her that they felt no need to inform her as soon as it happened, and that she need not continue in their house. (I was very sorry to hear this, and again felt bad for those who do not have good in-laws/marriages, or who for any reason are separated from their husbands. One of my heroes, Aung San Suu Kyi of Myanmar, has been under house arrest by the military junta for 10 years and could not even attend her British husband's funeral.) I saw the same lady a few days later, carrying water up the stairs, and she told me she had been to the dentist and felt better. I was very happy to hear this.

The Banyan is adept at using patients to help other patients. Everyone does what she can. So we have residents cooking, sewing, cleaning, helping at the front desk, all of it. We had a young woman come in to comb the sick room patients' hair, and they loved it. There is something very therapeutic about having your hair combed and a little makeup applied. The young beautician has since scaled the wall of the Banyan and "escaped," and I fervently hope she is safe.

Tutoring went on without me this week as I was out of town. Naren informed me that several students came, and both tutors and students enjoy the activity. I was in Madurai, my hometown and where my parents live, to go to the cemetery to commemorate the anniversary of my brother Manu's demise. My mother's left knee does not permit her to move freely, and so she does not go to the cemetery; my father usually falters at the entrance and I feel sorry to see that. So I go, and accompany my father to the grave. This year, we cleaned it off, as usual, and put a large garland of roses on it. We avoided each other's eyes, blinked furiously and talked little, as both of us would have burst into tears. The visit is therapeutic for me as I feel that I have perhaps been, for a little bit, with my brother - robust, handsome, laughing, w/ a great love for his sisters and a fine appreciation of his brothers-in-law.

We went to see a cricket match played by blind players today. Regretfully, the newspaper got the time wrong and the match was over by the time we went, but the prize distribution ceremony was on. It started w/ an invocation by one of the players, and he sang a Tamil song. His voice was melodious and soothing, and the song was in praise of God w/ words to the effect of "Even in darkness, there will be light." This was especially poignant considering the players' blindness, and I was so moved by the singer's faith even in the midst of his hardship, his tremendous belief in God, and the beauty of the song, that I got teary. Naren and Navin remarked on this later, but not in a bad way at all.

The Governing Committee of the apartment complex had its meeting today, and has come out strongly against the carnival. Some objections were petty, and we are going to counter all of them. I have some support from other residents, and the new President is a cardiothoracic surgeon who will at least give us a listening ear, so we will not give up the carnival without a fight. Caste, shmaste.

Let me wind up. Have a very good week, all.

"Why are they called apartments when they're all joined together?" - Ron Cousins

Unw -

Renu

Report of 15 Jan 2006

Hello from sunny Chennai -

Naren and Scott are looking over some chemistry, Navin is off to do some handwriting as his is abysmal (Indian schools insist on legible writing) and I am emailing.

The week has been ok. N and N are back in school and I have increased my frequency at the Banyan. We have a nice young woman from Finland working in PR, and working here has been an adjustment for her. Her boyfriend is Indian, and she likes the work and the people here, but the working environment befuddles her. My brother, Vinu, told me early on to establish hierarchy clearly and show my subordinates who's boss. I scoffed at him, telling him that I treated everyone w/ respect, and sure enough my requests were always first and easily ignored: this is bcos the average Indian has no pride in his/her work and only works out of fear of the supervisor (and no one feared me). When my brother Manu was hospitalised, the neurosurgeon explained this to me, and we agreed this was very sad. Now I have an edge to my voice when I make a request, and tend to let everyone hear about it if said request/order is not carried out. This is not the way I'd like to work, but is the most effective strategy for the Indian milieu. My Finnish colleague is discovering this.

The driver of the B, Mr. J, who came to get me on Thursday had fallen and hurt his ribcage. He asked me about the injury, and said he was scared bcos it could lead to TB (tuberculosis). He said a neighbor of his had been beaten by the police on the ribcage, had been told he would contract TB, and died 6 months later. Apparently, the police would say, "You'll be dead in 6 months," as they beat prisoners. I enlightened the young man about TB and its mode of spread (not through police beatings), the possible causes of death of his neighbor, and attempted to reassure him. I noticed several other vehicles' occupants pausing to stare at us as they went by, and I imagine a passenger in the front seat was an oddity in itself, not to mention one in conversation w/ the driver (can't hobnob w/ the working class). After we got to the B, I examined Mr. J, realised it was a simple injury and prescribed an anti-inflammatory med. It felt nice to have educated a pt. The issue of police brutality is not one I'll currently tackle. One of the best pieces of advice from a mentor, Dr. Vohra: only do something about that which you can do something about.

We have a new pt at the B, one found wandering about and seen to have a fracture of the hipbone. (This is not uncommon; mentally ill pts are very prone to violence due to their illness, and we frequently get pts w/ unhealed fractures, etc., which always strikes me as very sad.) She has been operated on, and is now getting snotty: calling other patients "crazy" and insisting that her husband is a doctor and can take care of her. I tried the first few days to enlighten her about her fracture, and the need to keep her at the B. Now that she has started getting holier-than-thou and persists in calling the other pts names, I find that I am getting a bit irritated, and have deferred care of non-medical issues to our able psychiatrist. I don't like name-calling at the B: mental illness is an illness, much as physical illnesses are.

I punted the veg market this week as I could not find the time, and will return there next week as rounds are important - need to see how the pts are. Tutoring is going along swimmingly, and one little girl (student) this week had a birthday. As is custom here, the child brought sweets to share, I don't think could afford enough for the lot of us, and chose to give me one. I was honored, and we sang to her. As we were acutely short of tutors, I filled in, and this child was studying English w/o understanding a word of what she was reading. As I attempted to explain, I noticed her grasp was very quick and she caught on quickly. I do believe there should be more colleges in the local language: we will capitalise on folks' innate abilities, but will then tie them down to professional lives in Tamil Nadu as the local medium of instruction, Tamil, can only be understood well here. Each state in India has its own unique language, as different from the others as English from Portugese.

Scott and I had a most therapeutic evening at the beach yesterday, talking of life and laughing our guts out, dodging beggars, and watching a magnicent moon cast its shimmer on the waves. We had breakfast w/ my brother, Vinu, today and that was a blast. His girth and attempts to diet are subjects of endless jokes among all generations and all people, including himself. Scott leaves for Mysore tonight and will see Tina and Ahana, Vinu's wife and daughter, there tomorrow - Tina is still on maternity leave. Ahana is quite a cutie, and apparently as opinionated as the rest of us. I am glad my sibs-in-law and Scott vibe; they are what I call MIW's - Married into Weirdness - not unlike POW's, and must jell w/ each other in order to tolerate our many and unique idiosyncracies, poor things.

Ok, have a good week, all. We celebrated the Tamilian harvest festival, Pongal, y'day w/ sugarcane and multi-hued patterns on the ground ("kolam") made w/ rice flour and other colored powders.

"Nowadays they say you need a special chip to put in the TV so kids can't watch this and that. In my day, we didn't need a chip. My mum was the chip. End of story." - Ray Charles in Esquire

Unw -

Renu

Report of 8 Jan 2006

Hello from Chennai -

Boy, this is fatigue as we know it. The carnival finished today and 160 people showed up for it - about 100 kids and 60 adults. The adults choose to come I guess because we serve food free or because they like to see the children play games. The apartment complex's committee laid down several restrictions on this event; speculation was rife that the larger issue was that the "upper caste" didn't want the "lower caste" coming in and having a good time. India is full of indirect communication like this; I wish talk was as forthright as the U.S., but I guess manifest bigotry is a lot less appealing than couching it in terms such as "We don't want any disturbance to the residents." Anyway, a good time seemed to be had by all, and the host children had thought up some very creative games to play. We started to distribute some of the school supplies by lottery, as last time's goody-bag giveaway was chaos, and this time was similar chaos, so we suspended it. Parents came up and asked for the "gifts" and we turned them away.

The Banyan was fine. Ms. S w/ the limp has tuberculosis of the hip joint and needs surgery, so now the B will raise some money for it. In the interim, another orthopedic surgeon got into the act and wanted to look over her records; this was fine by us as long as someone could help her. One of the other residents is to be rehabed and settled outside the B; she cannot walk but states she can manage "outside life" well. She used to take a medicine called indomethacin for her pain and wants to get back on it; I saw no objection and have prescribed it. I watched Ms. A as she scooted her chair along, and was quite full of admiration: her husband has cheated her of all her money and left her, and she is full of only optimism about her proposed new life. The least we can do, I think, is try and get her a wheelchair, but I imagine our capable social workers are on it.

The vegetable market visit this week ended up like an outpatient clinic and most of the vendors lined up w/ complaints. I saw each one, and a 20-minute visit ended up being an hour. My sons and I were off to run errands, and this one was the longest; when I apologised to them, both were gracious enough to waive off any suggestion of inconvenience to them. We returned w/ more vegetables than we'd paid for, and were humbled by this.

Tutoring went well, w/ tons of kids coming. The 9th-grader who is tutored exclusively by Naren stood 7th in her class, up from 9th. She made a beeline for me at the end of tutoring to tell me, and I was pleased. Only w/ education will we lift these children out of poverty.

We had a few social items on our calendar, including a start-of-term party for both boys to invite whomever they wanted. So both genders were present for the first time, some of the parents also came by and a grand time was had by all. I'd rather Naren interacted this way w/ everyone, instead of solo dating which is not quite the norm here; as I'm discovering, a 14 yo dating is not quite the norm anywhere else, either. We had a medical student, Gita, from the U.S. over from her current rotation in Vellore, to spend the weekend, and had several neighbors over for brunch this am. India is not for the faint-hearted, esp in our profession, and I am quite in awe of folks who will tolerate it and even enjoy it.

Better wind up. Hope all are well. I was delighted that Texas won the Rose Bowl: hook 'em, horns! We spent 10 years in Texas and our loyalties are firm: Spurs, UT Austin, at one point the Cowboys.

"A pessimist sees only the dark side of the clouds, and mopes; a philosopher sees both sides and shrugs; an optimist doesn't see the clouds at all - he's walking on them." - Leonard Louis Levinson

Unw -

Renu

Report of 23 April

Hello there from the Carmel public library -

It is nice to finally put down temporary roots, and we have done so at the hospitable Tabers' in Carmel. Last week, we were w/ Scott's family. We flew from San Antonio after being wined and dined by Linda and Richard Luduena, and spending some quality time w/ our former neighbors, the Freemans. We also got to see Gabi and Lamont Potter, and their daughter Jasmine (who has cerebral palsy). The Potters are delightful, inspirational folks: Lamont's stories of growing up in abject poverty provide great perspective in our lives.

We spent Easter w/ Scott's sister, Diane, who'd invited the entire clan over for a meal. It was great to see everyone in 1 spot w/o travelling. All children of Scott's mother, Jan, were there w/ children-in-law and grandchildren; thus, plenty of photos were taken. We stopped and saw the Ruizes, who are family friends of the Weisses, and that was a treat. We also went to the cemetery where Scott's Dad is buried and paid our respects.

We spent 2 days w/ in-laws and then went to Brecksville, Ohio, to the home of my friend, Carrie Cassidy, and her family. We spoke at a Kiwanis gathering and were delighted to have the Key Club (high school portion of Kiwanis) present there. Naren spoke as well, and Navin and he spent the evening gabbing w/ the local teenagers, which was a treat for all. We headed back to Jan's farm, but not before visiting every major city in Ohio: Columbus, where we had lunch w/ our friend Michael Monteiro and his son Chris (we hadn't seen Mike in 12 years, so this was a treat tho' his wife Cathy and daughter Jessica couldn't be there, it being a working day); Dayton, where we saw the Ruizes again; and Cincinnati, where Scott said bye to his aunt and uncle, and grandparents. Scott's cousin, Deb, came to the farm w/ her sons and an enjoyable time was had by all.

We returned to Indy on Sat the 22nd, and had a great dinner w/ Kris Rea, her husband Gabe and daughter Isabella. Kris is a friend from residency days and it was great to see her happy and content. The next day, we had brunch w/ Mary and Sam Remster, friends from Special Olympics days (b.c. - before children); the meal was spectacular and the company great, thus making for a memorable morning. We had dinner that night w/ the Jani family, who'd kindly invited our other friends Kurt and Kati. It was a wonderful time, and we stayed the night there also. We spent the evening (after almost 3 weeks of traipsing the country and eating folks out of house and home) marvelling at the fact that our 5 year-old pants had suddenly shrunk in the wash.

We were at St. Vincent Hospital on Monday morning, and met w/ my former advisor and mentor, Dr. Robert Love, whom both Scott and I hold in very high regard. I've been privileged this week to follow Dr. Love on rounds - every word out of his mouth is a clinical pearl. We also visited Purdue on Monday and got to see some of Scott's former professors, which was great fun: engineers have a unique sense of humor! We had dinner that evening w/ Brenda and Jim Hillman; annually, the Hillmans welcome us to a huge meal, divinely cooked by Brenda, and we sit and eat and talk and laugh. B and J are avid gardeners, so their beautiful property is also a treat.

Ah, yes, the Immigration saga - had to go in to the local office, on the instructions of the Immigration officer at Philly airport, who'd foreseen dire consequences unless I went in and got my green card issue resolved (out of the country routinely for longer than six months at a time). Ostensibly, an appointment has to be made over the Internet to be seen and when I'd tried the previous night, the computer screamed a warning that the website was not secure. So, being accustomed to the Indian milieu, and being an inveterate optimist, I told Scott we'd explain the issue at Immigrn and go in and be seen. No chance - the security officer at the Immigrn office checked us in, and told us not to go up to the counter and "bother" anyone as no one would talk to us w/o an appt. I did go up to the window after seeing another person in my situation go up to ask a question, and was asked to leave by the security officer. (Dr. Love was incensed at this report, seeing no cause for rudeness; I considered it a person doing his job, sort of a little inflated w/ power.) In the meantime, Scott had fled to the local public library to make said appt, did so w/o any dire computer warning (preferring the distant lib over the office of the lawyer next door who'd make it for $10), and we were seen after I apologised to the security guard and a genial relationship was re-established. (Scott was pretty relieved I wasn't thrown in jail by this point.) Ostensibly, there is no issue w/ my green card other than a caution to expect to be questioned every time I enter the U.S. if I've been out longer than 6 months. I asked if I could get something in writing to that effect, esp considering the Philly warning, and was told that I was argumentative, that nothing would be given to me. Scott muttered a piece of advice to me that we ought to leave, and we did. I've not generally encountered rudeness at Immigration, but felt a total environment of mild paranoia on the part of the Immi officers this year. And I'm a legal immigrant!!

Wednesday, we had lunch w/ the good folks at Citizens Health Center, where I worked last year. It was great to see everyone - lots of hugs - and we stayed a while. We returned to the Tabers' and went out for a lovely dinner, Scott packed and took a Megabus to Chicago to catch his plane. His aunt got him a $1 (yes, $1) fare (www.megabus.com) and Scott found the bus deserted (5 passengers) but comfy.

More next week. It is great to catch up on medical stuff that I would not otherwise see and can easily forget. Also, perhaps my pants will un-shrink.

Renu

Report of 9, 16 April 2006

Hello from the United States!

How is everyone? I had a good trip in, no medical emergencies on the flight. The Immigration authorities in Philadelphia gave me a lot of grief about my situation of living and working in India and spending part of the time here. I mentioned that I was married to an American citizen, and then proceeded to hear that I must choose between my work and my status as a permanent resident. The officer was also yelling, I guess he thought that because of my accent, I must also be deaf. The first option he presented for my situation was giving up my green card ("very easy to get it back," he said but not in writing); after I had a good night's sleep, I decided that this option would not be as easy as he made it out to be and I am going to evaluate other options. The terrorists that brought down the World Trade Center trained for the deed on American soil, and were permitted into the country to so train; the officer did not want to hear squat about my being a physician and working w/ the destitute.

It has been a glorious couple of weeks seeing friends. Ann and Phil Bagley met me at Philly airport (they had a long wait due to the above merriment) and housed me in their beautiful home, full of their warmth, grace and Ann's wonderful meals. Olivia, my residency colleague, joined us there, and it was so nice to have her; we hung out at the conference of the American College of Physicians, which was, as usual, excellent. The 3 Weiss men flew into Baltimore later in the week and stayed w/ Craig, our friend from college days, having a rollicking good manly time. All 4 picked me up in Philly at the end of the conference, and Craig, Scott and I went out to dinner that night - speaking of work, play, Immigration issues (Craig was once questioned extensively at the Canadian border prior to his weekend visit there as his passport cover had a Moroccan - ?Islamic - design on it), and other fun things. It was a memorable evening.

We took the plane to Houston the next day (9 April), had a delicious meal w/ our friends Bojie and Satchi, who had gathered all the other Coorgis in 1 spot, making it very easy for us to see everyone. We saw my college friend Latha and her family, which was nice. We then went on to spend the night w/ Tori Scott and her family; her kids, Jordan and Caithn, took our sons to Cici's pizza (considered gourmet eating by all 4 teenagers) and the adults had a lovely salad at home. Tori had also made awesome chocolate chip cookies, which we don't routinely get, and we hugely appreciated this gesture, and all the spoiling! We hung out all the following day w/ the Scotts, Tori taking a day off and Jordan unexpectedly joining us as he had thrown up all night (kind courtesy Cici's, we suspected). We saw Chris Ortiz and Amy Mendez and their cute new daughter, Anna, and had a nice dinner w/ them.

We flew to San Antonio on the 10th and my former professor, Richard Luduena, picked us up. We have been staying w/ Richard and Linda, and it's been great fun in their book-laden house. Greg Brown, the med student who'd visited India, took us to Austin on the 11th to visit Christine and Ganesh Ramakrishnan, which was great - very kind of Greg, and his company was a treat, too. Scott and I spoke at a banquet that night for the American Medical Women's Association, which we enjoyed. I started to choke up when I spoke of the goodness and kindness of the people of the United States, remembered how moronic it'd look to have the speaker bawling her eyeballs out, and attempted to compose myself. All 4 of us were present the following day when I spoke at my med school at an event kindly organised by Abraham Verghese and his crew. We visited former neighbors (Aurora and Scott Freeman, Lamont and Gabi Potter) after this, and then went to dinner w/ former professors Linda and David Johnson. We had Tex-Mex food, Linda proceeded to spoil the boys w/ Best Buy gift cards, and then we went out for ice cream. This was, also, a memorable evening - full of the genial good time the Johnsons are renowned for.

Scott flew to Cincinnati on the 13th to spend a little time w/ his family w/o the entire brood tagging along. We will join him on the 15th. I came to school and saw some former faculty - Drs. Kozue Shibazaki, Vick Williams and met our new dean, Dr. Lee Jones. These interactions were absolutely lovely and I appreciate the time everyone has made for us. We spent the afternoon watching a movie ("Love, Actually") and the Luduenas took us out for a great Italian meal. Their strength, among others, is the ability to engage our boys in conversation and they did so very well, making for a chatty time full of camaraderie.

Greg Freeman, another former professor, took me out for b'fast today and we sat and talked for a while. This is always a treat for me. I also got to see Dr. Scott Johnson and we had a great time gabbing of his mission trip to Guatemala, and the perspective it has since shed. Good fortune took me by Dr. Lois Bready's door briefly, and that was lovely. All these faculty and their spouses are so staggeringly busy that I greatly appreciate when they make time in their schedules for me. The boys are w/ the Freeman girls - Michaela, Shaunessey and Arwen - having a marvellous time.

Better wind up. More next week. Hope you have lots of fun interactions of your own.

R

Report of 2 April '06

Hi from Chennai -

Boy, 3rd April (date of departure to the U.S.) seemed really far away, and here it's the night before. I leave in about 2 hours.

Hope all are well. I wound up at the Banyan this week. One of our more troublesome patients, whose psychosis has been resistant to treatment (but I am unsure if she takes the meds) returned to the B and proceeded to get very violent w/ the staff. I am not educated enough to understand her illness and its consequences, and the acts seemed very wilful plus phenomenally damaging, so I let the social workers know and chastised this pt. We are all trying to come up w/ a strategy to cope.

Our pt w/ HIV is on Siddha (a form of Indian medicine) meds and I'd nagged the treating facility to find out if she ought to get on Anti Retro-Viral Treatment (ART) or not. As it turns out, they did a blood test, and determined that she should start ART. Thankfully, this lady has not had the infections that can affect those whose white blood cell count is low ("opportunistic infections") and I'm hoping her good health and good luck prevail. We gesture wildly to each other to communicate, as neither of us speaks the other's language.

We took some pics of my patients at the veg market, and they enjoyed posing. We also wound up tutoring w/ a lot of presents, many donated by you all, and I am ready to hit the plane. We had lunch w/ my brother and his family today and that was grand fun. My niece looks exactly like her father and brings w/ her all the novelty a little baby will.

"The most common of all antagonisms arises from a man's taking a seat beside you on the train, a seat to which he is completely entitled." - Robert Benchley

Unw -
Renu