Report of 29 July '07

Hello a little late -

I intended to get to the lib yesterday and blog; before that, I'd planned to see "Evening." I did see the movie, w/ its phenomenal cast -Redgrave, Streep, Close, Richardson, Collette, Gumer, Danes - and it was easily the most boring movie I've seen this year. And interminable, so the library had to be punted. I also saw "No reservations," and though vapid, at least it wasn't boring.

The most Sprite I've ever drunk in one fell swoop was last week, after I contracted food poisoning. The cramping was kept down only by Sprite and so I even had it for b'fast, which is usually anathema to me. I had 4 meal appointments w/ friends, and had to eat gingerly, but am better now.

I have moved out of Carolyn and Will's warm, wonderful home to the equally hospitable home of Marybeth and Andy Simon. The Simons are former neighbors and firm friends, the types one is instantly comfortable with. Their pre-teen daughters, Miranda and Morgan, have been very solicitous also.

Lots of most wonderful interactions this week. First, the Semesters for Scott Semester's b'day dinner; it was a great evening eating salad w/ grilled chicken and steak, and being entertained by Scott's parents Jim and Barb, who are salt-of-the-earth kind of folks. They even packed dessert for the Simons. Then Maryam Massoumi's place for an Irani meal; Maryam and Ali have had unusual experiences living in Iran, and it makes for some introspective conversation, and marvelling at our current good fortune. Their children, Rustom and Golbarg, are completely treats, and I got lots of hugs. To Carolyn and Will's place for dinner on Friday, and to see her parents, LuBea and Earl, in from Chicago; that was lovely and I laughed almost non-stop at Earl's jokes and perspective on life. To Kris Rea and Gabe Soukup's for dinner on Saturday; Kris is a colleague from residency days and a very dear sort, as is Gabe. Both have undergone varied experiences in their own lives, which have only served to enrich them, and now have 2 daughters, Isabella and Rosalia, who do their fare share of enriching. It was therapeutic to be there, chat, laugh and eat some delicious Gabe-made fare. To the Remsters in Crawfordsville on Sunday, and we had a great brunch. Mary is a colleague from Special Olympics days and Sam is a patient at St. V, so we had a lot to talk about; I especially appreciated their input on raising teenagers. The food was divine - bread, meat and fruit - and I ate merrily. To Shilpa and Ravi Mallur's for dinner on Sunday - Indian food, complete w/ the universal panacea, yogurt. It was lovely to talk about home and here, and compare and contrast the 2, and I had a fun time, esp w/ their little daughter, Keerthi.

The patients have been good, and I had to refer a 322-lb young woman for bariatric surgery. She was excited about it, and said complimentary things to me, the most touching being that I was one of the few providers who hadn't said at the start of the visit, "You're fat and you need to lose weight." Losing weight for the poor here is a Herculean task, as the cheapest food is the unhealthiest: a bag of potato chips is 99 cents and a giant plastic bottle of soft drink is as little as 59 cents. I do feel for the folks here, who have to spend a fair amount of money to eat healthy; I experience no sense of political correctness when I tell an overweight patient he/she needs to lose some weight, however. Another patient is to get married soon, and when I stated that it (marriage) is a fine state of being, she asked if I still thought so after all these umpteen years; I stated most certainly, that emails from Scott come addressed to "Beautiful," or "Gorgeous," and it's a fun, fun time (most of the time).

So the 3 Weiss men are well, and we have all started counting down. I need to shop a bit more, but can endure.

Unw -

R

Report of 22 July '07

Hello from Carmel -

Trust all is well. We are fine in our respective corners of the world.

Some great times this week - I got together w/ Deepali Jani and her family. They now own a Subway franchise and we ate there; it is one of my favorite restaurants and she was kind enough to indulge me w/o thinking twice about it. It was nice to see everyone, it's hard to believe nice, funny Deepali was once my patient. I got to raid her closet, and hang out w/ folks that seem like family. It was also good to see a former residency colleague, Jeremy Kirk. His irreverence, sense of humor and devotion to patients have long captivated me, and this time, his staggering generosity humbled me. We laughed almost the entire time we were eating, and commiserated also; it was cathartic, and it was wonderful to see that Kirk is doing so well. I flew to Kansas to see my residency classmate, Olivia Fondoble, and that was great. We cooked Indian food for her family, hung out, talked, gossipped, laughed and watched "Hairspray," which was excellent. Olivia too passed on lots of clothes for me, and vats of treats for the family, and I returned to Indy far more loaded than when I went. Olivia is a gentle, generous sort, and great company for the soul.

I got to chat w/ lovely women we know - Meenakshi Ponnusamy at Bucknell, and Sharon Cole-Braxton in Houston, and as always, these ladies served to invigorate me. We are very fortunate in our friends.

The patients here have been fine also. I had a young man in, who had a cut on his right arm; the wound was healing, and I left it alone. I did ask him how it came about, and he said he had choked his ex-girlfriend's current boyfriend and she had cut him. Hmmm. I suggested counselling for him, and he said he did not need anyone else to work out his issues, that he would do so himself. I mentioned my experience w/ counselling, when I thought my world was collapsing around me after Manu passed away, and stated that counselling would not change the events around us, that it would change us, and how we dealt w/ said events. He was about 18 or 19 and handsome, not much older than my sons, and I would hope that if my sons were on the verge of such behavior, someone would alert them to their options.

I also saw a gay man in his mid-50's, who had sought help for his alcoholism, had been to a retreat, and stopped drinking, cold turkey, right after it. We talked about that, I expressed my admiration for his staggering achievement, and he handed me a note w/ some questions. Some of it was metaphysical and philosophical, but much of it was lovely and encouraging, and I have saved it. I never expect anything from my patients, other than a hope that they will comply w/ the treatment I suggest, and this note was very recharging.

The 3 Weiss men are well and wonderful, and send me great notes. Well, Wonderful, Weiss - that pretty much describes them. Naren is growing to like his new school a lot, and Navin has just finished some exams. Scott is bonding w/ his sons, and this experience might be much more therapeutic than all of us imagined.

Unw -

R

Report of 15 July '07

Hello from Carmel library -

Scott's youngest sister turns 40 today, and 2 friends turn 45 and 44. 15 July appears to be a great time for b'days. I used to think, in much younger days, that folks who had their b'days on 15th simply made up that date as a convenience and had actually forgotten their real b'days - until I had a son on 15 March.

Several friends emailed, called, and otherwise expressed their concern after last week's blog - mostly hoping they hadn't done anything to po me off. "... full of venom" said a dear friend and he's right. The point there was to unload and vent; taking care of the destitute is not without tremendous joys and rewards, and at the same time has tremendous challenges also. Not the least of which is people wanting to help and not following through. David Gere told me that the Indian actress Richard kissed had just committed to being on his Board to continue HIV work in India, and had pledged a large sum of cash, when other celebrities would show up to be photographed w/ R and then leave; ostensibly, R was so overwhelmed that he hugged and kissed Shilpa Shetty. Let me assure you, had someone pledged a ton of cash for the work I do, I would have hugged and kissed also.

That said, let me also ennumerate the ways folks *have* helped: donated money and supplies, paid for my travels, sent energizing emails, put me up, fed me, clothed me w/ their closet contents, sent me chocolate and their kids' clothes for my sons, made our favorite meals when we visited, followed through on offers to have me speak, arranged for me to go on rounds w/ them, sent me magazines and journals, given me clothes for my fatherless niece, emailed my parents and wished them well on their 50th anniv, had piles of junk food on hand for the 3 Weiss men to indulge their cravings on visits, given us the joy of their company in India, hosted us at very short notice, put the Banyan in touch w/ folks who could help, taken me out to eat (food is a joyously recurring theme here, have you noticed - hosting is a tad more challenging for the middle class in India as food and restaurant visits are quite expensive), and sometimes simply let me talk as I sat in their houses, revelling in their company.

The week was fine. One day involved a "coding workshop" for everyone except me, and the clinic was quiet, which I must admit to enjoying immensely. I saw patients that day in "calmth and warmth," and it was good. One of the patients had come to see another provider, and when I told her of the workshop, she continued walking past me to the pediatrician's station. When I told her of the workshop and said that *no one else* was present, she walked past me and said something. I didn't hear it, and the student medical assistant (MA) was beside herself, asking how I could not react to it; I asked what it was, and the MA said the patient had said, "F****** b****." Ahhh. So I went up to the front, got the CEO's secretary, took this lady aside, and asked what the matter was; she stated that she'd come to see her doc, and when I told her the MA had heard what she'd said, she said, "So what? I'm an adult." I mentioned that the patients ought to treat everyone at the clinic w/ the respect we showed them, and she said she'd just find another doctor. We said that was fine.

The new stunt to get Vicodin and Xanax appears to be to claim abuse. I had a patient weeping her guts out in my room, I gave her a pain med called Ultram, 7 pills of a sleep aid called "Trazodone," and told her she must see a psychiatrist. The pharmacy faxed me a copy of the prescription to ask me a question on the Ultram, and I saw that the lady had changed the "7" to a "17." We have reported this matter to the police, and sent the pt. a letter of termination from our clinic. I like the proper procedures in place in this society.

A middle-aged couple came to see me, and were so full of good humor - laughing and joking, pinching each other's rear ends (honestly) - that the visit was grand fun. We finished the consultation with great bonhomie, and that was a wonderful way to end the week.

I was very privileged this week to get together w/ Louise Hass, the former librarian of St. Vincent Hospital. Louise has a great sense of humor, and a solid sense of perspective, and we've both shared a loss in our families, so it makes the kinship rather more profound. Louise treated me to a lovely meal, we sat outside, and talked and talked, and then she has apparently left me chocolate and magazines at St. V to be picked up. I was also happy to get w/ Colleen Taber, and shop. It is much easier to get this onerous job done in Colleen's vivacious company - where she manifests a great sense of humor herself, and a very intelligent take on life's events. I saw "Harry Potter and the order of the phoenix," which I enjoyed, and a couple of old movies - "Groundhog Day" and "Good night, and good luck." The latter was particularly memorable. I saw "Sicko" last week and wondered why Michael Moore didn't get more confrontational w/ the health insurance executives, true to his style. I also got to talk to the 3 Weiss men, which was the delight it always is.

If anyone knows where to get used Game Cube games, pls tell me. Thanks.

Unw -

R

Hello from the Carmel library on 8 July!

Trust everyone is well. Life is ok w/ me, and I am quite starting the countdown to heading home. Work is good, and the patients are very grateful for good care. The pain is that there has been an awful lot of lip service towards helping "my cause," and no real action, and I'd much prefer it if people did not commit at all and said so right at the start. Need places to speak, no problem; need your airfare reimbursed as promised, no worries; need a very expensive rental car reimbursed as promised, oh sure; need to find resources to help pay off your student loans, yes we can do that; need a 501(c)3 set up, piece of cake. It's much easier for me when one adopts Dr. Love's approach: I know what you're doing and appreciate it, here's what I can do for you - send you journals. Very direct, very clear, no false promises. Let me reiterate that I certainly don't expect people to fall in love w/ what I'm doing and bend over backwards to accommodate me, but I certainly don't want a bunch of bull, either.

The Banyan is doing wonderfully. I was sharing photos of the B w/ my sister-in-law, Diane, and cousin-in-law, Deb, and each success story was so magnificent that I felt a renewed eagerness to return to this fun place. The patients are women who have shown steely resolve in overcoming mental illness, related stigma, ignorant or resource-less family members, poverty, and have now established a life for themselves. If there is any way I can help them stay physically healthy on their road to establishing a life for themselves, and sometimes their children, my land, it certainly is my privilege to do so. On the other side w/ my street medicine practice, if I can help the totally impoverished attain a semblance of good health, it is again my honor.

So said, work at the clinic is fine. I had a 40 yo patient come in to see me, wanting something for her nerves. She had been prescribed a hefty dose of Klonopin, a sedative, much earlier, and she wept as though her heart would break when she described her life. Though I detest prescribing Klonopin and Xanax, preferring newer and better drugs combined w/ regular visits to the psychiatrist, I prescribed a small dose and strongly urged Ms. B to set up an appt at the Mental Health clinic we regularly use. She was back the following day, saying the reduced dose of Klonopin was not working, and requesting Xanax plus Vicodin for her back pain. That's another drug I detest for its addiction and manipulation potential. She then stated, somewhat threateningly, that she might harm the grandson she babysat and herself, and I had had enough; I explained (in what I hope was a rational tone, not manifesting 1/100 of the ire I felt) that we were in the business of helping her, that the clinic had waived fees and reduced the medication charges, that we gave her a follow-up appointment w/ very short notice and that she really ought to cooperate by also setting up an appt w/ the psychiatrist. The social worker asked if she could talk to Ms. B's daughter and was met w/ a vehement "NO!" I imagine we'd learn volumes from the daughter.

And then there was the 41 yo lady raising her grandson, who came in for a physical for her job as a janitor. We went over aspects of her routine care, and I emphasised how inexpensive our clinic was, and suggested she come in regularly for her health care. She mentioned that she wanted to return to school to be a nurse, and I enthusiastically applauded this plan, mentioning that I was 33 when I returned to med school and if I could do it, anyone could - esp in this country, where everyone has a chance at success w/ hard work!! We had a most lovely visit, w/ my admiring her magnanimity in raising a grandchild and clearly expressing it, and she said she'd be back for a follow-up visit.

I was w/ my in-laws yesterday, catching up w/ Scott's cousin Jeff and his kids, who were in from Philly. Quite a few family members gathered, there was much talking and laughing and eating, and I enjoyed the time there, as always. I also got to go to a carnival on 4th of July, listened to a hard rock band named Zero Sum and enjoyed it immensely. I watched Wimbledon in uninterrupted bliss, enjoying Venus's win and hoping Rafa would pull it off (I like underdogs). I also saw a bit of "Live Earth" and read lovely emails from home, including very affectionate and concerned missives from Scott. My good fortune in the 3 Weiss men cannot be quantified - they are the people I want to grow old with (my sons would say "older" :) ).

Let me wind up. Hope your week is good.

Unw -

R

Report of 1 July '07

Hello from the Carmel library -

A new month is on us! And soon it'll be August and I'll be heading homewards.

The week has been good. Particularly memorable because I had a married couple in to see me - both were 80 years old and had been married for 60 years. The wife had a touch of dementia coming on, and the husband was a most attentive and loving caregiver - it was magnificent. I am very used to seeing single mothers, and men who have had children by 3 different women, and think nothing of it, but by golly, when I saw this couple, I said to them, "Ahhh, this is how it ought to be." It was as therapeutic for me as it might have been for them to be in my office, and I can only hope that Scott and I will be similarly blessed and fortunate. For various reasons, I have to ask about intimacy, and when I asked the standard, "Are you sexually active?," the couple looked at each other, said, "When we feel like it," and laughed. It was a nice moment.

And there were the usual folks needing to get checked for STD's. The medical assistant (MA) handed me a much larger probe than usual to check a male patient, I told her the probe was normally smaller, she assured me I had the correct one and I thought to myself, "Oh, I guess things have changed since I last worked here." So I proceeded w/ the exam, the patient nearly jumped off the table, we finished the exam and then the MA told me she'd double-checked w/ the lab and the correct probe was indeed much smaller. I had her apologise to the patient and we repeated the exam. The guy in the next room was there for the same thing, had heard the entire exchange outside and had very nearly left, but we found the correct size probe and he stayed.

I was privileged this week to get together w/ Dr. Ruth Stevens, prior CEO of our clinic, Jan Dallas, nurse manager here, and Dr. Whitney Moore, dentist here, at Jan's house. I completely enjoy getting together w/ other women, and Dr. Stevens is a visionary physician and administrator who incidentally has a phenomenal sense of humor. So the evening was wonderful, and we ate Dr. Stevens's lovely salad, and talked and laughed. It was invigorating.

My new home now is c/o Carolyn Scanlan-Craighead, pastor at St. Luke's Methodist Church, and her husband, Will. It is as warm and loving as the Tabers' home, and I have the run of it. It is in a nice neighborhood also, so my morning workouts and evening walks are fun. Yesterday, I went w/ Carolyn and Will to a wedding reception and we wanted to dance, but the evening wore on and soon it was time to leave. My idea of a great time on Friday and Saturday night is to be in bed by 8.30 PM, preferrably w/ a book. And I continue to eat salads out the wazoo; food is so affordable here, it's a treat. Most middle class Indians feel the pinch on their budget when a houseguest stays for more than 3 days.

The 3 Weiss men are fine and holding up. I will talk to them later this week. Today I missed them more, as I saw a movie they'd have enjoyed - Bruce Willis's "Live free or die hard," an ode to all of us who are aging. It was about 30 mins too long, but was the mindless entertainment I was in the mood for. Yesterday I saw "Ratatouille," and the animation was magnificent. I took a deep breath and also saw "A mighty heart;" the entire incident of Daniel Pearl's kidnapping and death continue to haunt me, and I had to brace myself for this movie. It was very good, and Ms. Jolie's performance was actually excellent. The movie played like a documentary. Of note to Indians, the chief of Pakistan police was played by Indian actor Irrfan Khan and he also held his own. It was heartening to see that at no point were any of the portrayals of the South Asians condescending or patronising. Friends want me to see "Sicko," esp as I'm a physician, and I look forward to it - it's another one I have to be in the mood for.

Hope you have a good week!

Unw -

R