Renu's Week

Sunday, September 24, 2006

Report of 24 Sept '06

Hello from the world of the working mother (like there are any that don't) -

Laundry hangs on our balcony, Scott is in the recliner doing some work, Naren and Navin are cramming Spanish. Navin vomitted violently last night. He has a nut allergy and when we were at the beach eating peanuts, I asked if he wanted one; my pediatrician sister had said he could be desensitised to nuts and that it was time. So he ingested a part of the kernel whole, without chewing it and seemed ok when we went to dinner, but then out came all of it later. Thankfully, Scott didn't hear it as he otherwise would have; so Navin and I cleaned up as best as we could, and came to the living room to sleep. Massive clean-up ensued this am, and Navin is better.

We were delighted to receive visitors from San Antonio, Texas, this week. My former professor, Vick Williams and his wife, Dorothy, are dear folks and they escorted a big group to the Banyan, en route to a conference in Vellore. The troupe was impressed w/ the B, and the Williamses were kind enough to invite the Weisses to join them for dinner. We had a great meal, the boys gorging on pizza which is normally too expensive for us to eat w/ any regularity (500 bucks for a large). The Williamses get dearer to us every time we see them, and we had a wonderful time. They brought me a package from Kris Rea, also a great friend, and it had some Tylenol and Ibuprofen (I am a snob for these meds) and some extremely welcome craft things (beads, colored popsicle sticks) for our tutoring. This was a really lovely gift, from a really lovely person.
My friend Jeremy Kirk's girlfriend, Ali Floyd, had sent a nasal steroid for one of the drivers here, whom I'd mentioned in talks there: he has constant nasal congestion due to allergies, and could not afford the steroid. So Ali sent Flonase w/ me, Velan has used it and is better. It is awfully humbling for me when the ripple goes out from my friends to their friends and these folks then support the work here in many different ways. Esp to make someone feel physically (and, consequently, mentally) better. Ali and Kirk are warm, loving sorts, not just w/ each other but w/ me as well.

The burns patient, Ms. U, is on the mend. As it turns out, her brother and his family visit regularly and the medical assistant has noticed that their interaction is loving and kind. U also mentions that she set herself ablaze. She is under psychiatric treatment and is variably responsive; still talks obsessively and asks to go home incessantly. The grand thing is that the burns have healed nicely; lovely to have a plastic surgeon at the other end of a phone line.

Chikungunya, a viral illness spread by mosquitoes, is doing the rounds here and one of the B's sous-chefs came to me w/ fever and looking frightfully puny. I started treatment for malaria, and as I looked at Ms. S's swollen fingers, I noticed that the right little finger was bent. I asked how this had happened, and she said that her husband had beaten her; I could feel the sadness combined w/ rage coming into my eyes, and I asked if the beatings were continuing. She mentioned that she had left him 3 years previously, and was living w/ her mother. 2 days later, I saw her again, and she looked lovely - healthy, lively, buoyant. It is nice to play a part in healing sick people. It is also fabulous to have a husband who does not beat.

The veg market had its share of patients, and it was dreadfully awkward for me as the place was uncrowded (2.40 PM - normal siesta time) and I was being treated like a celebrity - everyone lining up, waiting for me, finishing their treatment and then picking the best possible veges for our purchase. Scott said the vendors were just happy to see me after 5 months of my being away, but it was awkward nonetheless. Our tutoring sessions go on well, and the kids enjoy coming. We are occasionally strapped for tutors and I had to teach the other day; I was struck by how nicely the students helped each other, esp w/ sharing supplies. In the midst of their incomprehensible poverty, that they could be kind to each other - this is very gracious. The colored popsicle sticks and beads that Kris sent were so attractive, even I was tempted to do some math.

We got a note from Greg Freeman, a cardiology professor at my old med school (probably a much bigger cheese than he lets on), and a great, genuine friend. Greg mentioned that he was leaving the school and was going into private practice. He speaks of the school fondly, and it was indeed a fine place to be. This news generated much discussion w/ Scott, Vandana and Vaishnavi (V and V being founders of the Banyan) - we decided that there are some people who can say all the right things, schmooze w/ the right people, and get their goals (esp financial and professional) accomplished; then there are the rest of us whose biological makeup simply precludes all practice of the fine art of purposeful schmoozing and who, likely consequently, take a lot longer to achieve our goals. Hmmmm. At any rate, and my classmates reading this blog will agree wholeheartedly w/ this, it is the school's great loss that Greg is leaving.

My husband turned a year older last week - handsomest 45 I ever saw. He had a day off last week, I took one too, and we went out for an uoe (unfortunately obscenely expensive) meal (I end up resorting to thinking of the cost in $, about $30, and justify it thus as I snarf salad and tiramisu). We also saw a Tamil movie - a typical one where the husband can do whatever the hey he wants and the wife tolerates all of it. Scott did not enjoy it at all, and I on the other hand simply went to see the handsome male lead (Suriya). It was nice to hang out w/ Scott. We took the boys out to eat later in the week and cut a huge chocolate cake, gorged, and watched "Bend it like Beckham" and "My big fat Greek wedding," both of which the boys enjoyed - it's nice when they too like our favorites.

"I looked up the word 'politics' in the dictionary. It's actually a combination of two words: 'poli,' which means many, and 'tics,' which means bloodsuckers." - Jay Leno

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Sunday, September 17, 2006

Report of 17 Sept 2006

Hi there from breezy, balmy Chennai -

I was having a rather uncomplicated weekend, and then ended up in a discussion w/ Naren and Scott about the state of the union. Naren's marks have been less than expected and he has now started to say, "This is really the best I can do, I can't do any better." So the mood took a different turn, w/ some unrelenting belligerence from our 15 yo. Adolescence is tiring for all, isn't it. Anyone who wants to buff up Naren's confidence is welcome to do so at This lack of confidence has led to lack of thorough effort, and it has shown in his grades.

The boys were off school last week, so we went to Bangalore to visit Scott and then down to Madurai to visit my parents. Both spots were lovely, w/ their share of beloved family (Scott!!), and we had a good time. We visited my widowed sister-in-law, Susan, and her kids in B'lore, and I felt for Susan again as I saw her struggle to juggle work, home, kids and household help w/o her husband. My nephew, Sudhir, has failed 12th grade, and so college has been deferred for a year. It is a sad state of affairs as Sudhir's obstinacy in not getting good grades is primarily to irritate his mother, but he did himself in. My niece, Sanjana, tries to exist in this contentious situation. Am I my brother's keeper - no, but we have to do our part for his family. We also got to see a dear cousin, aunt and uncle, and had a scrumpcheroo meal there.

Madurai was fun, and my mother did not appear to want to let us out of her sight. Both my parents and I had long talks on all manner of topics, and I enjoyed their sense of humor, intelligence, grace and total regard for others. I did attend the clinical meeting at my father's work spot, and that was nice - except that I went in pants instead of traditional clothes and it caused big waves. Big whoop - I wasn't going to conform to some folks' antiquated sense of dress, esp when we can wear what we want to the B. I watched my father dress a diabetic leg ulcer, caused by the harvest of the vein underneath for a heart bypass operation, and threw in my 2 cents about control of diabetes. My father does not charge for such dressings, as he feels the ulcer was caused by the doctor ("iatrogenic" - caused by the doc) who did the bypass. The relief on the patient's face when he heard "No charge" was mammoth. I rather like my parents, they are good sorts.

Tomorrow, I return to the B, which I am anxious to do. I want to find out how my burns patient is. Last week, we celebrated my brother Vinu's 40th b'day w/ a very nice dinner cooked by his wife and as we played w/ their daughter, Ahana, it struck me that I am very fortunate that these folks didn't pour kerosene on me and set me aflame. I talked to my sister, Anu, yesterday and there were lots of giggles. I will always value my relationship w/ my sibs and sibs-in-law, and feel that nothing warrants breaking it. Should there be folks on this mailing list who don't talk to family members for whatever reason, pls reconsider. One of my biggest comforts in remembering my late brother, Manu, is that we were on good terms; I imagine I'd have thunderous regrets otherwise.

Scott will be in Chennai all week, and I am delighted. We receive friends from San Antonio tomorrow, and are all very excited. We were at an event today for expatriates in Chennai, and I viewed it w/ mixed feelings: I used to want to ensure that our foreign guests had a good time, but after one of our guests last year was miserable here in spite of our efforts, I feel that I can just do my part and it also depends on the guest's mindset as to what kind of a time he/she has. I was extremely happy to get a cheery note from my friend, Carol, and a healthy dose of irreverence ("Who wants to shoot you?") from Craig. We are so, so fortunate in our friends.

"Success is more permanent when you achieve it without destroying your principles." - Walter Cronkite

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Saturday, September 09, 2006

Report of 10 Sept '06

Yoosh - what a dreadful weekend -

I am in a very foul mood, getting less foul as I write. Both my sons have done very poorly in their exams. The testing methods in India are very rigorous, w/ the tests emphasising both understanding and memorisation, and the boys have flailed. They are required to write in some detail ("What would happen if an airplane is not pressurised?"), and being butt lazy, have taken the shortest possible route earning, naturally, the least possible marks. Perhaps they would thrive in the multiple choice environment, but they will be here for the foreseeable future - in the very stern Indian academic environment.

To a person, the teachers have said things to me like, "Well, now that you're back, we can get the boys in gear." This doesn't warm the cockles of my heart, exactly, because I feel that the boys should have held their own regardless of which parent had primary charge of them, and Scott does a fine job. However, this tanking of grades and the subsequent disciplining are an annual event, and will likely continue, because I do plan to head to the U.S. annually to work, update my knowledge, earn some bucks. I'm a mite clueless as to why the boys take great delight in irritating the wits out of their father, but perhaps it's a teen male thing.

Scott was to have mailed my car title to me in Indy, and passing it on to a friend was one of my pending chores. Scott apparently did mail it, choosing the cheaper option over couriering it, and it is eminently lost - likely in the post office's Bermuda triangle heap of photographs, thank-you cards, college acceptance letters.

We hosted one of Naren's friends prior to his joining his parents for a holiday, and this poor child was frightfully high maintenance: Game Cube (kindly given to the boys by Chris Taber), movies, a toothbrush, extra clothes, meat at every meal (which we *never* have). The last 3 were pretty easy to handle, but I cannot abide the sight of healthy teenagers sitting in front of a video game when there are plenty of other things to do - chess, ping pong (downstairs in our complex's rec room), read.

My fridge and microwave are not working. These appliances are from the U.S. and I am getting a bit tired of them wilting under the different electrical system here. Sigh. I have been known to hug our fridge, using it for everything from leftovers to mango juice popsicles and I miss it very much. We are going to purchase Indian appliances next week, and are assured that many of them have quality comparable to what we're used to. I loved efficient life in the U.S. - fridge worked, microwave warmed, electricity stayed on, the washing machine cleaned, faucet had water I could drink.

The Banyan is fine, and is attracting more and more physicians wanting to donate their services. It feels weird to be officially on the rolls, but the buck stops w/ me. I can no longer complain about the staff missing important test results, etc., but must do something to ensure that it does not happen. We had a patient brought in to us w/ bad burns on her back. (I think I've mentioned before that our patients are subject to a lot of violence pre-Banyan, solely brought on by the ignorance of their mental illness.) She was emaciated and reeking, the wound on her back oozing pus and w/ a lot of black debris on it. I was very sorry to see this, and not knowing how to manage a burn, called my plastic surgeon father right away. (Now, in case anyone gets mighty impressed about my father's profession, let me assure you he has also elected not to make mongo bucks; what is impressive is his track record of successes w/ burns, cleft lip and palate, accident injuries - not his bank balance.) So my father told me what to do: wash off the wound w/ saline, peel off the dead skin stuck to the wound, sedate the patient as this would be painful, apply an antiseptic ointment, leave the wound open, see to the patient's nutritional status. The nurse did the cleaning ("debriding") very well. The pt stated that she had attempted suicide and I discussed this w/ my father: it struck me that a person attempting suicide would light the first accessible body part, not the back. He agreed. It also seemed like someone had held the pt's head down, poured the kerosene on her back and lit it. This was staggeringly sad to me. The pt's brother and sister-in-law were due in to the B for a counselling session, and resultant police work. Through all of this, though, the pt (whose appetite is mercifully robust) stated that she wanted to return to her bro and s-i-l.

It strikes me as I write that there will always be people who are offended by what I write, given recent events. I am eternally grateful to my friend Carol, my best friend from 10 yo days (obviously, we have stayed friends for a reason), who stated, "Hey, even Gandhi was assassinated." One cannot keep everyone happy and I am not about to try. I imagine that my funding quests will continue to draw ire, or resentment, or apathy. People are going to be upset by what I do, and some are going to be upset by what I don't do. It is expected (especially by me) that my work will go on, and go on it will.

"Sign outside the Red Horse Saloon: Cheap T-Bone Steaks, 99 cents ... w/ meat, $10.99."

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Sunday, September 03, 2006

Report of 5 Sept '06

Hello from Chennai!

The place is cloudy and cool after an early am rain, and that is a welcome respite from the humidity yesterday that caused our deodorants to fail.

I am back at work at the Banyan and it is good. Vandana, one of the founders, and I had a long talk on my 1st day back, and she stated that she wanted me to join the B's rolls. I mentioned that I would be working part-time for now, as I am a single parent during the week, and would have to leave if the kids were sick, etc., and all these conditions were quickly agreed to. I am now the medical director of the B and get a pittance of a salary, but it is all the B can afford and I would work for a lot less.

Some of the patients that were in relative good health, e.g., Ms. V, when I left can now barely walk. Our physical therapist has left for England to try for a job there and we now get a physical therapist sent by a local college which pays her salary. As I sat there during rounds bemoaning V's fate, I wrote in her chart that I'd like her to be seen by PT (physiotherapy/physiotherapist). As it turned out, the PT was sitting in the sick room reading a book. When I was introduced to her by the nurse, I remarked how wonderful it was to have a PT on the premises, and asked her to see V. She didn't budge, in spite of 2 requests, and then stated that she'd already seen V, that V's BP was too low for PT to work w/ her (it was 100/70), that V got dizzy when she walked, and that this was a sign of a bodily ("systemic") illness, precluding all PT intervention. I disagreed, stating that it could be due to deconditioning, and the PT stated "Who told you?" and started arguing. It was a surreal conversation, as it was the first time I was meeting this woman, and everyone at the B has the pt's best interests at heart, and I was taken aback. My voice acquired an edge, I asked for the PT's supervisor and suggested that she have a talk w/ the PT. The social workers at the B promptly sat down w/ me in a meeting, and we discussed our other options, including hiring a full-time PT at the B instead of using this young woman. Unfortunately, I cannot work w/ those who'd rather read a book ("a spiritual book," she told her supervisor) than see pts and I am now too old to brook silly arguments (BP too low, pt too dizzy) from those who are eminently not doing what they are assigned to do.

My greatest apologies to everyone - my views on the entire funding quest appear to have upset at least 1 good friend, and I imagine there are others. Her comments are in the blog. This is what I want to say: I have made this choice and am happy w/ it; I must then take the consequences, including the fact that my refusal to bribe has resulted in my not having a licence to practice here; in an entire summer of trolling the place and looking for an entity that might sponsor my work, as Seton International did in year 1, it appeared that the cause would be considered and not the person; we have expensive tastes like cereal and OJ; resources everywhere are severely limited, and folks are doing magnificent work in other places w/ whatever bucks they have; it'd be great to have an adequate salary; this option of returning to the U.S. once a year to work and make some bucks is not such a bad thing *at all* because I have got to sit in on lectures and grand rounds, and can consult on all difficult issues w/ one of the best clinicians of all time, Dr. Robert Love in Indianapolis; I am not sure how to keep from upsetting other folks w/ my writings (and said upsetting might continue); I certainly do not want to be passing the hat here (as happened on someone else's insistence at my talk at St. Vincent last year, mortifying me); setting up a 501(c)3 appears to be very problematic; if the medical work is unfunded, I'd like to see about generating some income through writing, which I also love, and will cast wishes to the wind at regular intervals. Probably the best discussion I have had on the subject of working unfunded w/ the poor has been w/ Craig, Scott's best friend, whose irreverence I've mentioned before; Craig apparently grew up poor and said to me, "Oh yeah, if you're poor, you're hosed," and then we had a very insightful talk on the entire poverty-wealth issue. I appreciated being able to discuss the topic w/ plenty of humor.

Early last week, Dr. James Holly of the alumni association at Uthscsa med school (my alma mater) made a hefty donation to my work here, which I greatly appreciate. He stated he could not consider ongoing funding as he normally supports Christian causes. I appreciated the candor and have heard often that my work does not fit certain agendas that people would otherwise support - e.g., Christian medical mission work. By the same token, it would be a deceitful disservice for me to claim to adhere to one faith.

Last week was the kids' Sports Festival, and I got to see another side of Naren, the house captain w/ all the little ("kutty" in Tamil) kids high-fiving him and some kutties sitting on his lap. Navin took part in chess - a prominent game on the sporting circuit here. The weekend was spent w/ the kids' friends at a party at our house, and w/ my visiting father and Chennai relatives, also at our house. It is magnificently therapeutic to be where I can see family regularly, and I remain grateful that Scott likes it here.

"My son has a new nickname for me, 'Baldy.' I've got a new word for him, 'Heredity.'" -
Dan Savage

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