Report of 30 July '06

Hello from the Carmel library -

This appears to be testing time. Naren continues to act out w/ aplomb, Navin is not doing as he is told, grades are plummeting, Scott is e-tearing his hair out, and I get email msgs daily (sometimes multiple) which hold no good tidings whatsoever. I get to the computer generally in a good mood, and get this stuff from Chennai, and that's pretty much the end of any good mood. Interestingly, Scott gets no sympathy whatsoever from his aunt, who feels that he now has a fair idea what women go through. I too feel the 3 Weiss men need to work it out, but it ain't happening - and the genial good humor that the men are known for is disintegrating into anger and self-pity. "Circuitry gets rewired in adolescence," said a beloved Chennai neighbor, and that is very true. You fathers (and mothers) out there - please weigh in on this situation for me: I could use the perspective.

This week, also, a couple of incidents happened here that have served to remind me acutely that the work in India is not important to the people who spoke thus. They try to understand it, but in the grand scheme of things, it is not important at all. The quality that made the comments all the more startling was the honesty: I had been aware of the non-importance all along, truly, given the lack of funding (esp from a med school and a residency program both of which strongly emphasised dignified care of the indigent) and that folks simply expected that my work would somehow, mystically, magically, continue in spite of the fact that my annual income is $0. However, being told it was brutal. I missed Scott's perspective at that point, and was sitting in a movie ("Miami Vice") when I felt my jaw start to clench and the tears start to run out. The movie was dreadful, also, so part of the tears were for that, maybe, but part of it was most definitely my own share of self-pity.

And then, one of my best friends emailed me to speak of being HIV+. I appreciated the courage in sharing this, and was honored at the confidence that I would keep the secret. I emailed the friend back, and spoke of the news, and what I thought, and I think that this friend has so much more to deal with than I do. BUT - the disease now has some fine meds to keep it at bay, and good health as an asset is in my friend's future.

I also got some perspective from the 50+ yo patient who came in w/ a urinary tract infection. Her right hand and leg are unable to function, the residuals from a childhood attack of meningitis. She said Billy, the 8 yo boy next door, had told her parents that he would make their 6 yo walk, and walk she did. Also rode a bike, at which point Billy told her parents, "Now we'll never keep track of her!" Billy went into the Navy, and when my patient was 18, asked her to marry him. They married, and had 2 kids, and were very happy, and then Billy got cancer and died. My patient tried to kill herself after that by shooting herself in the chest, but missed her heart. She has a grandchild now, and feels that life is worth living, thank goodness. The story was lovely, tho', and I felt very happy that the little disabled girl had a friend who cared so much about her that he stayed by her, and stayed by her through much of her life. I like the romance of it, and the goodness it shows of people's hearts.

Speaking of which, I am now staying w/ 2 of the finest: Jeremy Kirk (a friend from residency days) and his girlfriend, Ali. We have talked, they have taken me out to eat, put me up in their fine home, Ali has hung out w/ me and both Jeremy and Ali have shown that the rough times in their pasts have only served to make them the gregarious, generous, warm-hearted people that they are. Their presence is like salve, and I have hugely appreciated that this week.

I saw Miami Vice as stated, expecting a lot of Foxx and Farrell and director Michael Mann, but it was so bad; neither F acted very much. Gong Li ("Memoirs of a Geisha") stole the show from right under the big names and she was luminous. Ali and I saw "Clerks 2" and the vulgarity was bloody annoying, but I have to say the acting and the premise there were infinitely better than the prior movie.

Let me wind up. I leave here on the 17th. We donated our old vehicle in Chennai to the Banyan and I got wonderfully gracious notes from them, including one passing on the gratitude and regards of all the drivers. It is a memorable msg, and I have saved it. The B is a fine place to be. Check it out: www.thebanyan.org.

Unw -

Renu

Report of 23 July '06

Hello all -

This is the stuff of which memories are made. One of my patients, RF, is a waiter at a very nice seafood restaurant and he just brought me dinner from said restaurant. It was very gracious, and a lovely addition to my day. He had asked in chitchat what kind of fish I liked and I'd answered, wondering why he was asking; well, that question was answered when he showed up. He's a handsome young man, made even better-looking by his nice gesture.

Speaking of this restaurant, it was where my friend Jon Marsh's parents took me out to eat last week. Holly and Frank Marsh are dear, sweet people and we met last year at Jon's graduation from St. V's residency program. Jon and I had danced ad infinitum, poor Jon being roped in as poor long-suffering Scott was unavailable, and then I'd spent a lovely evening chatting w/ his folks. So the evening repeated itself this year, and was just as lovely. I also met Jon's new girlfriend, Nicole. I tend to be very protective of my single male (and female, I think) physician friends, and am inclined to scrutinise their mates carefully. This might have unnerved Nicole, but she held her own.

A memorable patient from last week was a lady who'd survived breast cancer, and had had her right breast surgically removed. She was getting pain in the area, and removed her clothing so I could examine her. It's possible that a lot of people would think her flat right chest w/ the long surgical scar looked ugly, but she was beautiful to me: the missing right breast was simply evidence of her being alive. She was also extremely upbeat and funny, and we had a rollicking time. I love such patients, and asked her if she led a support group; she said she did not, as the parking lot was a long way from the hospital. I requested her to ask her cancer doc for some leeway in the parking, as I feel lots of folks could benefit from her perspective on life and her disease and her missing breast. Before I could stop myself, I'd hugged her at the end of the visit. She hugged back, so I guess she didn't mind.

The Banyan has emailed, asking when I'm returning. When I told them (17 Aug from here, to the B 1st of Sept), they sent a cheery note. It was nice. I miss the B. I miss the patients, who have come from such poverty and misery, but don't miss an opp to be nice to each other and to me. I miss the smiles. I miss the vanakkam (the folded hands, palms-together greeting) that even folks who have been beaten to a pulp will elect to give visitors. I miss Vandana and Vaishnavi, and others of their ilk who will do for others w/o thinking of return to themselves.

I have moved out of Deepali's warm, friendly home to the warm, friendly home of Maryam Massoumi, one of the staff MD's at St. V. This is a lovely place, and Maryam, Ali and their kids, Rustom and Golbarg, have made me feel at home. Ali lost a sister in the revolution in Iran; she was 22 when she was captured, rallied the prisoners into sharing food and sleeping space (they had to take turns sleeping as not everyone had the space to lie down at once), made the inmates donate cloth to diaper another inmate's newborn, and the guards did not like her because of all this. She was taken to trial, asked if she believed in Khomeini; she answered, "No, I believe in God," and was executed. As were several thousand other intellectuals. Isn't it amazing that repressive political regimes fear thinking/educated citizens. Her family was told 5 months later. This story made a huge impact on me, and now I know why Scott is so enamored of the democracy in India: we have sustained it in spite of differing political systems in the region, in spite of our colossal population and our different faiths. Maryam spoke of her father bagging the books in their house and throwing them in the nearby river; one could apparently be arrested by police barging into one's house unannounced and sent off to mysterious locales for reading/saying/thinking the wrong thing. It would be horrible for me to lose our books, and to have family members whisked off forever.

Cindy Ching, a classmate from residency days, hosted a get-together yesterday and Kris, Christy, Rich and I showed up - some w/ families in tow. It was fun, esp to see the little ones. Cindy is great about keeping up w/ us. I also saw "Lady in the Water" and "Pirates of the Caribbean - 2." Both were so-so, the latter was pretty entertaining. Managed to get together for dinner w/ Melinda and Colleen Taber, and that was a blast. St. Luke's has become a fairly regular part of my Sundays; there are certainly things said during services that I disagree with, but much there that captivates my intellect and soothes the soul.

Unw -

Renu

Report of 16 July '06

Hello from the Carmel public library -

It's hot out, and freezing in here. I used to have to take a sweatshirt to all summer classes at American schools as the airconditioner would blow mightily.

I have just returned from a weekend w/ the in-laws and it was relaxing. Ate, read, hung out, talked, laughed. My mother-in-law, Janet, and her sister and brother-in-law, Anita and Norb, have adjoining farms. It's a lot of greenery, and a lovely sight. We spent a fair amount of time outdoors as one of the dogs, Fred, is dying, and all the animal lovers wanted to ensure his comfort. I think this is enviable: to die in comfortable environs, surrounded by loved ones, pain-free and accepting. This is my goal for humans in India.

The week was good - lots of patient care. A memorable one was a lady late on Friday evening, who was in w/ a migraine. I saw that she had been diagnosed w/ HIV just this May, and was sorry. She was feeling very ill, having just vomited in a bowl in the exam room, and I kept the visit short. However, I did ask her about her HIV diagnosis, and she stated she had got it from her boyfriend of 7 years. I was sorry, and said so, holding her hand and asking if she was ok. The human touch is priceless for me: through various traumatic situations, whenever anyone asked about us/me and accompanied it w/ their touch, I found the concern doubly therapeutic. This then is the goal of my Hospice, where the dying (especially, especially if they are dirt poor) are given plenty of such therapy.

And then there was the 19 yo who came in w/ STD (sexually transmitted disease) symptoms, following his girlfriend who also had the same. The young man, AB, had not used condoms w/ 3 other partners in the recent past, and when the young woman mentioned this, I said it before I could help myself: "Ma'am, why are you w/ this man?" Anyway, that's up to her to figure out, and my job to get her to insist on protection from her partner. It was then AB's turn, and I tried not to look like I wanted to wring his neck, but he said it was evident from my face that I thought he was an a--h---. Anyhoo, I laughed out loud at that one, and said he really ought to start taking care of himself; he mentioned that the 3 extra-relationship encounters happened when he and his girlfriend were on a "break." I left that up to them to figure out as well, but the whole darn encounter wiped me out. Scott, his college roommate, Craig (whose irreverence I value very highly in my life), and I discussed this over email. It was fascinating and therapeutic. Thank goodness for the presence of Scott and Craig in my existence.

My mother's b'day was last week and I called home. It was a lovely conversation, w/ a fair amount of laughter and good wishes: my parents' sense of humor is also legendary, which might be why Scott and they get along well, knock on wood. My mother, esp as she is now housebound, is eager for snail mail, and I had sent her a card and letter which had thankfully reached. She mentioned all the wishes she had received, and then my father and I chatted; I mentioned having gone to church last week at St. Luke's United Methodist Church. (My father is Christian and my mother is Hindu, and we were raised w/ both faiths in the house, which I find very broad-minded.) The church service was casual, fun, full of good music, and a rather poignant message of God always being there for us; it was run by Carolyn Scanlan-Craighead and the msg was from Kim King, and I stopped to speak w/ both of them. It was also a nice chat, and I will return to St. Luke's for this week's service.

The 3 Weiss men are well, and in the throes of exam week. Scott's presence is invaluable at this time, as I simply cannot teach those that came from my uterus - not patient enough. I can teach others, sort of, but Scott does ably w/ all.

Let me wind up. Hope all of you are well. Please do drop me a note when you can and tell me what's up w/ you.

Unw -

Renu

Report of 9 July '06

Hello there!

Hope all are well. I'm fine and ruing France's loss in the World Cup, esp Zidane's ouster. Dang. I wasn't too pleased w/ the Mavs losing, either, but was pleased to see the humble and immensely talented Dwyane Wade get his ring.

I have moved out of Kris and Gabe's warm, comfy home into the equally warm, comfy home of Deepali and Devendra Jani. Deepali is a dear sort, nice to all, and her home is lovely. Their 2 kids, Anil and Ajay, are hospitality incarnate, and this is a nice place to be.

My patient w/ Diabetes Type I returned to the clinic, having tested positive for Chlamydia, a sexually-transmitted disease. That surprised me, because testing for it had been the incidental part of his visit. Anyway, we spoke at length as he was extremely upset w/ himself for not using condoms: rightfully so, I thought. Certainly his girlfriend at the time had this disease, but it was completely up to him to protect himself. I am of the firm belief that young, unmarried folks getting intimate w/o condom use is very irresponsible and self-abusing; some have called it stupid and short-sighted, but I don't grab that description first.

One of the staff at this clinic had sent her adult son to me last year to get his high blood pressure (BP) treated. The young man had taken his meds, and not returned to the clinic in my absence. He returned last week, and we spoke about his health, the need for him to continue taking his meds, and for him to take good care of himself. It was a nice visit, very humbling for me as he reposed so much trust in me, and he stated he'd be back in a couple of weeks. I am always very honored when the staff trust me enough to send their loved ones to me.

Life w/ the 3 Weiss men is benign chaos, w/ Navin falling ill and having to miss school. Scott is back there now, and gamely holding the fort. Naren's test performance is causing some anxiety, as the almighty Board exam is in March. Naren was in honors classes here, but he states the Indian system of education is much harder. I imagine so, but both Scott and I like it that way. It is mighty comforting for me that Scott and I agree on big issues: living in India, caring for the destitute, emphasizing education and not the opposite sex to our sons, sharing housework in the maid's absence, teaching the boys to cook. He's a good guy, ol' Scott.

Saw a bunch of movies, and have enjoyed the great outdoors in Indiana. Suddenly, the actor John Cusack is a great favorite.

Unw -
Renu

Report of 2 July '06

Happy Independence Day to all Americans!

Trust all of you are well. I am fine, and have spent the weekend immersed in Kris and Gabe's immense movie collection.

This is a great profession to be in. I saw a 22 yo patient with diabetes, the kind that comes on at a young age (Type I). This disease comes about because the body has no insulin, and patients must inject themselves w/ insulin daily (sometimes twice a day). This patient was a college student, had been cut off his health insurance by his father as they did not get along, and was in our inexpensive clinic. Our good fortune - we could definitely manage his disease, and the patient and I talked at length. I was very sorry to hear about his poor relationship w/ his father, and allowed myself a couple extra minutes to touch the patient, pat his back, answer all his questions. I really feel for those w/ poor or inadequate parental support. The patient said he'd return for a follow-up soon and that's fine w/ me.

Just today, a patient came in feeling ill. She has cervical cancer which has spread. This was tragic, to me: cervical cancer can be very easily caught at an early stage by the Pap smear. For various reasons, this patient had not gone to her doctor for a Pap, and by the time she went w/ stomach bloating and "pushing down," her cancer had spread and treatment options were and are much more limited. So hear ye, all ye women, get to that Pap asap. It is also very saddening that Black women have all kinds of illnesses beset them worse - including advanced cervical cancer.

I also had to tell a female patient that she had Hepatitis C, a disease acquired by unprotected intercourse or IV drug use; she did not seem surprised, though she has long since given up that lifestyle (I did not even know it had ever existed in her past). After working w/ the poor, I have developed a very almost-brusque manner, and had to tell a patient here who was busy complaining about her lot in life that there were many, many women far worse off than her.

The 3 Weiss men are well. Scott has returned to Bangalore, the boys are in the able hands of my nephew, Aditya (my sister Anu's 21 yo son), who is living w/ them in Chennai while doing an internship for law school. I tend to worry more when Scott is not around, but I think the boys are having a rollicking time w/ this male-bonding, young-people-independent-living thing. A fair amount of whining also goes on in Chennai and Bangalore, all of which serve partly to remind me that my being here is not such a bad thing after all. :)

Unw -

Renu