Report of 28 Oct '07

Hello from rainy Chennai -

The monsoon (Northeast) is here, it has rained all day, Naren's school is closed tomorrow, and we haven't heard yet from Navin's, which has exams. Exams are kind of almighty and not easily postponed.

Our patient, Scott, is healing. It has been a challenge for me to not contaminate the wound when I am dressing it, as I am not a surgeon. The first day I was terrified of the procedure, but have since managed. The body is rather marvellous in that it will heal in spite of me. We have buffed up Scott's nutrition, too; he grew up not eating salad and fruit, and it has had to be forcibly introduced to his diet after marriage and now that he is not single in Bangalore any more. (For an all-day engineering certification exam once in his single days, his sustenance was 3 bags of chocolate.)

The Banyan is well. The new facility we have for the protected community ("PC" for short - those ladies who have no family to return to, or whose families have denied them) is by the seashore in Kovalam. We got an sms from Vaishnavi this morning that the cottages have massively leaked and the ladies are being evacuated, likely to the facility that I work at - Adaikalam. I am glad we have this option: there is nothing like dryness inside, esp for our destitute clientele, when all is wet outside. I have taken a month's leave to care for Scott, but am kept abreast of developments on the phone and can also call in medical management accordingly.

Tutoring is back! We tutored a young woman whose mother is a maid. The former is doing B.Sc. Maths in a local college and cannot comprehend her English lessons, so we went at it; she had an exam the next day. I am impressed at the tenacity of women who will educate their young, and at the perseverance of the young who want to be educated. At the end of the session, Ms. E melted our hearts - "I thought this would be so difficult, but it seems easy now." I shook her hand to wish her luck and she seemed taken aback: untouchability is alive and unwell in India.

Scott and I have had plenty of time to read (a recent jewel being Arundhati Roy's "The God of Small Things") and for philosophical discussions, esp on principles and such this week after another treat that I was promised went away. A professor at my med school suggested I suck up to wealthy donors and folks with resources, and I stated that there is a niche for those of us who will neither suck up nor grovel; granted it is taking care of the destitute, unlicensed and in a third world country, but Scott feels that I am happier with myself for not having compromised my principles and either sucking up or bribing someone. The licence would be nice, though; it's been 4 years since I applied for it, and not bribing someone means I have to sit in this limbo state. The money? - cherie, what can I say, my riches are at the dining table eating murukkus and arguing against an impending haircut. No TV, just plenty of reading and gabbing.

"Television: A medium. So called because it is neither rare nor well done." - Ernie Kovacs

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Report of 21 Oct '07

Hello from Chennai -

So this is what medicine is like from a patient's point of view. Scott had surgery last week and a chunk of flesh has been removed from his most lower back along w/ a couple of abscesses. I tell you, hospitals are scary places: illnesses are threatening phenomena, one's mortality starts to stare one in the face, and multifarious uncertainties creep in. Imagine if financial woes set in at this time. My father would say, when Manu was hospitalised, about "aall balam," the strength of numbers - meaning that it was always nice to have company when tending to the ill, as any number of chores would have to be done. Yes, I would have liked the company, but had the cell phone and newspaper, and they were worthy substitutes. Vaishnavi, one of the B's founders, kept checking in on us and that was as good as a presence.

Scott was discharged after a day, and is home. I was really ticked at his company for refusing him a transfer to Chennai, when they have a branch here, and indirectly causing his staggering weight/health loss; I emailed his CEO and colleagues, and got very nice notes back. Would you imagine Bill Gates (Mr. Narayana Murthy of Infosys is of that status) emailing an employee's wife?

Here is what I want all med students and residents to know:

1. Hospitals are scary for the patient and family.
2. Even educated people ask stupid questions in this flustered state.
3. Sit down when you talk to the patient.
4. Don't ask for vitals at night - nurses came in almost every hour between midnight and 5 AM, asking Scott if he'd urinated. After said urination, which Scott forced himself to accomplish, there was a celebratory procession of nurses lauding the achievement. Rest at night would be nice, instead of a check of temp, BP, pulse, etc. My mother laughed on hearing our experience, and said that patients have been awakened in the middle of the night to take their sleeping pill.
5. Give instructions, med dosages, etc., in writing and go over it w/ the patient and at least one caregiver.
6. After discharge, see that the patient is permitted to leave in a reasonable amount of time. We stayed 4 hours after the surgeon said we could leave, due to paperwork, etc.
7. Establish follow-up appts clearly, and if the appt is w/ you, try to be on time.

That's all for now. The boys are well, and have loved having their father around. There were games of chess aplenty between father and sons yesterday. I do not have the patience for chess, much preferring basketball as a sport, and thus welcome Scott's hefty intellect. He consented to go w/ us for b'fast today, and I pigged out on sausage and eggs. Our challenge now is to have Scott gain weight, and I have taken a month off work to help dress the wound and tend to the patient.

Thanks aplenty to those who have emailed!

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Report of 14 Oct '07

My, how things change in a jiffy -

We were sitting around, and it turns out Scott might have to go for surgery for a fistula. We await word from the surgeon, it could be today or tomorrow. There have been so many times that we've told patients that their recommended surgery is routine, not to be afraid, that the surgeon has a lot of experience, and now, when I am the patient's relative, I know firsthand how frightening the prospect can be. It is also at this time that all my patients' non-monetary blessings - "May your family be well," "May your sons have a long life," "May good things always happen to you and yours" - come ringing to the fore. With all this goodness about, we are very hopeful that will be well. We are seeking a second opinion at the hospital that sees the Banyan patients for free - Sundaram Medical Foundation - and will be in good hands there.

The Banyan has been fine. The patients are recovering and I get lots of smiles. Andrea has helped train the health care workers in CPR (Cardio Pulmonary Resuscitation) and these young ladies were delightful through the sessions - asking questions, answering ably, volunteering info, giggling occasionally. I love this populace - they come from the villages around, are impoverished and need to make a living, and with the appropriate training, prove themselves to be absolutely wonderful health care workers. Some day, they will marry and have families (1 or 2 already have), and I hope fervently that what they learn here will serve them well - medically, personally, spiritually.

Andrea loved her time here and left this morning. After a tumultous first week of getting used to the heat, the huge crowds, inability to sleep well at night, the absolute lack of personal space, she grew to love the smiles, the friendliness (complete contrast to Germany, she said), and the lack of emphasis on female skinny-ness. She gave very valuable training - concise, thorough, clear - and the folks at the B loved her, and are looking forward to her next visit. She has stated she would like to work here for a time.

I'd better wind up. Should you feel like emailing or calling, I'd welcome it.

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R

Report of 1 Oct '07

Hello from Chennai -

Scott and Navin are at the table looking over Navin's school work, Naren is on a school trip, and our guest, Andrea Schichan from Germany, is doing some computer work. It is nice to have Andrea here: she's a pediatric nurse, and brings w/ her solid common sense, ease of interacting w/ everyone and acceptance of new situations/surroundings. Awfully nice to have uncomplicated guests; we've had our share of demanding guests, and thus can easily appreciate those that are not.

I cannot get over the feeling that Ms. RR died because of something I overlooked. My attention is pretty consumed w/ the boys, as I have solo charge of them during the week, and I am afraid that my mind did not allow for much else. I'll know this week, when the post-mortem results come; a more detailed report will come a month later. Scott has been here for 3 days now, and leaves tomorrow, and it is a wonderful breath of fresh air to have my husband mess w/ school work for a change.

Ms. K, our HIV + pt who lost her son, was visited by her drunken husband last week. He told her to leave w/ him right away as the Banyan had "killed our son." The B's social workers were willing to send her w/ him, but after she got enough of her meds to last her a bit; ostensibly, the man could not wait, told Ms. K that she either leave w/ him then or all ties would be cut irrevocably, and left. I saw her the following day when Vandana came for a meeting, and she told Vandana about it in the odd fashion that she uses to communicate w/ everyone, and I patted her cheek. She leaned her face on my hand and I felt very bad for her: sad enough that she has lost her son, then this weird ultimatum from her husband. We will see in the coming weeks how Ms. K turns out. I am optimistic: she likes the B and thrives on praise.

Andrea and I attended a Continuing Medical Education seminar run ably by one of the best hospitals in Chennai: Sundaram Medical Foundation (SMF). It is frightfully nice to sit in a comfortable hall and listen to medical topics competently discussed. Added to that, SMF starts the sessions on time and sticks to the allotted time, a bloody big novelty in India, and that adds to my enjoyment.

As Andrea and I chat, as I see India through her eyes, I am discovering that there are certainly some things that we are doing right: the family support we get here molds our psyches enough to adjust to life anywhere - we have seen Westerners come and flounder mightily in India, itching to get back to the U.S., when there are millions of Indians living very happily overseas; Scott is continually impressed at the abundance of Indian female engineer co-workers, when intelligent young girls are told to conceal their intellect in the U.S.; the ease w/ which neighbors take care of each others' children here reminds me of the "It takes a village to raise a child" saying and reaffirms to me that the children cannot but get a sense of their worth when so many people care for them; poor people smile even in the midst of their abject poverty and take time out to ask me how I am, when they reel w/ fevers and malnutrition. It is lovely to be here, even lovelier to have a spouse who enjoys it.

"Few people can be happy unless they hate some other person, nation or creed." - Bertrand Russell

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