Report of 29 June '08

Hello from the Carmel library -

This week, I found out what it was like to be a patient. I contracted food poisoning, proving that said disease is not the exclusive preserve of 3rd world locales. Usually, my stomach just hurts a bunch, and prevents anything other than Sprite to be put down it; no different this time. I am better now, but it helps a physician to gain some perspective occasionally by being sick. I told a patient about how my brother's hospitalisation taught me valuable skills.

Before the illness, I'd made an appointment at St. V's residency clinic to set up a doctor; I am uninsured when I am in the U.S. and this year got very nervous about it. The residents at St. V are well-trained and do a good job of patient care, so I went happily and saw a young intern (first year resident). I said right away that I wanted Vicodin for back pain, and she went to dutifully type it into her computer. I told her to please not, and explained the real reason for the visit. It was a pleasant encounter, and when she went over my meds ("none") and any complaints ("none"), she said, "Oh, a straightforward visit then," and I remembered how grateful I too used to be for the same.

Some days, it is just fabulous to be a doctor. I had a patient last week who came in complaining of anxiety. This generally elicits a groan, and an anticipation that the patient will be insistent on Xanax or Klonopin. Not this time - the patient was a very attractive young woman (she later said she was in her early 50's), who was going through a rough patch after getting divorced, losing her house and owing her lawyer beaucoup bucks. I listened for a bit, she was willing to try an antidepressant, and then I threw in some job hints that had worked for me: volunteering at the local library or hospital, avidly telling everyone in sight that I was job-hunting. All of a sudden, she hugged me and started crying. "It is always darkest before the dawn," I said, as I held her shaking shoulders, "and this too shall pass." We talked some more and as I gave her some samples of antidepressant (she had no health insurance), she hugged me again. It was great. I like hugs, a lot. It is a very intimate gesture and blows the minds of passersby in India when male friends hug me, but I usually don't pay attention. Our cook has mentioned that she is not used to hugging (I don't hug her, but she was making that comment I think to remind me to be circumspect), and I stated that yes, it must look dreadfully familiar. Out of the blue, I am inclined to ask my sons - if we are standing in line at a movie theater, or getting dinner on the table, or standing and talking - to give me a hug, and they usually oblige.

Some fun interactions last week - I spent part of the weekend with my in-laws to celebrate my mother-in-law's b'day. It was fabulous. These are among my most favorite people and we sat and ate and talked and laughed. Very, very therapeutic - esp after a hectic week. I then went to Kris and Gabe's place and watched some movies. This weekend I spent at Jeremy Kirk's house. Kirk is a colleague from residency days, and I love him very dearly. He rented me half-a-dozen movies - Oscar winners from years past - and took me out to dinner, which was lovely. I then spent the rest of the weekend in front of his TV, in a big movie binge. It was great, as was the chance to chat with Kirk and vent about medicine, life and all things related, and partake of his unique sense of humor. I managed to find time to see a flick on the big screen, again treated by Kirk - "Wanted." It was singularly dreadful; does Hollywood have no screenwriters these days? Why not then start making adaptations of old classical novels?

The men are well. There have been some issues with our son(s) getting on Internet sites they should not, and watching TV channels (while they were here), that they should not have. Anyone who has teenagers and thinks they are not prone to such activity at least once is truly deluding themselves. I have told my sons repeatedly that such curiosity is normal, but the deviousness and lying in cover-up are disappointing; I have also cautioned them against adult sites on the Internet as being the nadir of depravity. When one of the nurses at the clinic stated that one of the patients was complaining about me because I would not refill her Lortab stolen from her clothing drawer, I told the nurse that this was fine, I was a mother and clearly not put on this earth at the present time to be loved. Will the boys appreciate this strictness ever - that's hard to predict, isn't it. Perhaps when they are struggling with teenagers of their own. I know I have newfound respect for my parents - for all they endured with me, and for the freedom they gave me to traipse off to the West even though an astrologer had told them not to send me, that I would marry a white man.

Ok, enough prattling. Hope your week is good.

Unw -

R

Report of 19 June '08

Hello from this wonderful library -

Salve for the soul, this place. And free. The other (not free, but inexpensive) place I have discovered is the YMCA. Great workout equipment, fun exercise classes - quel treat.

Work has been very good. Busy, which is also good. Any day that I can work and see some patients is a fine one. I live for days off, too, which are great - esp here, where I can see movies ad infinitum and eat salad. Speaking of which, last weekend, I saw "The Happening," and "The Hulk." I am a fan of M. Night Shyamalan, but he has been ripping us off, of late, with some vague endings to his movies; it was no different with "The Happening." One of his first movies, "Praying with Anger," was made in India and featured him being an Indian settled in America, back in India to study in college; it was very well-done and depicted quite accurately the adjustment processes of the NRI (Non-Resident Indian). "The Hulk" was excellent; young Mr. Norton is quite an actor. I remember seeing him in "Primal Fear," and thinking "Who is this guy?" He was that good.

Yesterday, we had a patient who came in with recurrent ear infections. He does not have any health insurance, and desperately needs to be seen by an ENT (Ear, Nose and Throat) specialist, but due to his finances and lack of health insurance, no specialist in Kokomo can see him. I like having knowledge of resources, so told him about St. Vincent's residency clinic in Indianapolis (where the residents see indigent and non-indigent patients, and is about an hour from Kokomo), and the access to specialists that patients and residents have through it. I described the process in some detail, and was really delighted to have some resources for this man. At the end of the soliloquy, the patient said, "Well, travelling to Indianapolis is a problem, because I have phobias about getting into the car." He had come by car to our clinic in Kokomo. Once Scott got his friend, Craig, a coffee mug that said, "Pardon me, but you've mistaken me for someone who gives a s**t." I said to this man that he must then choose between his phobias and his ears, and shortly thereafter ended the visit.

There is a tendency for some patients to expect someone else, including the government, to solve their problems. This is considerably self-defeating.

Go, Celtics! They are Scott's favorite team, next to the Spurs now, and I am glad they won. I would have preferred a bit more of a contest in the last game, but the Celtics' hefty lead, sustained throughout, was good to prevent ulcers. I watched a bit of the French Open men's final, and Rafa's drubbing of Federer was also a bit one-sided. Rafa comes to India annually for the Chennai Open, and is a good guy, thus I am a fan of his, so his victory was also good in the ulcer-prevention department.

Kris Rea has been keeping me plied with movies that were nominated for or won Oscars in the last few years, and that has been a wonderful treat. Such kindnesses are so humbling for me.

I'd better wind up. Hope all of you are well.

Unw -

R

Report of 12 June '08

Hello from the Carmel library -

The F.R.E.E. library. What a place. I have about 25 minutes before I go to work, and figured I'd blog.

Life is okay. Work is on in full swing, and it feels like ages since the 3 Weiss men left. I talked to them earlier in the week and academics were on in earnest. I like the emphasis on education in India; it is truly the way out of ignorance, prejudice and poverty. The Weiss men left me notes before they left, and they are lovely; one of them was an appreciation, and, among other things, they appreciated the fact that we travelled. It is something *I* enjoy, and I'm glad the activity made them feel loved and considered. The other note was a collection of haikus (poems with paragraphs of 3 lines each, with each line containing 5, 7 and 5 syllables respectively); they were hilarious as the men attempted to find words that fit the criteria and managed to stay mildly flattering ("Radical mother"). Life with the men is always good fun.

Work is fine. Yesterday, 3 migrant farm workers came at almost the end of the clinic's hours. They had driven 1-1/2 hours to get to our clinic, and only my colleague, Grace, was available to see them; I was not scheduled for patients as I was working on the computer and was going to leave early. Grace did not want to turn the patients away (driving 1-1/2 hours!!), and was loaded with patients herself, so gently asked if I'd see them. I agreed, knowing full well the importance of it, and with the complete knowledge that Grace would do the same for me if my schedule was overloaded. It is absolutely phenomenal to work with considerate individuals, and those whose priorities - esp care of the underprivileged - match one's own.

So we saw the patients, and they needed medicines for diabetes and high blood pressure. One of them had been on insulin, and was blithely not on it any more, so some education had to be done on the need to take the meds regularly ("adherence"). I requested my Spanish-speaking non-medical colleague, Maria, to please emphasise this issue to the patients, and she agreed. Sometimes, what we say when we wear our white coats does matter to the patients: eat right, walk 30 minutes a day, don't smoke, minimise alcohol, take your meds. A friend of mine talks of how her Dad stopped smoking: his doctor wrote it on a prescription - "Stop smoking" - and then she handed it to him, and he stopped.

Some of our patients are absolutely delightful. One of my favorite people has had surgery to reduce weight (a "gastric bypass"), and is losing weight, and coming off her medicines for diabetes, high blood pressure and high cholesterol - because these diseases are coming under excellent control with her reduced weight. We had a great visit, punctuated by much laughter, and I commended her for this life- and illness-changing operation. I also commended my patient who had successfully completed 40+ days in rehab for alcohol addiction, and had not had a drink for that period. It is so thunderously heartening when folks take care of themselves.

Some fine times last week: graduation at St. Vincent's Internal Medicine residency program, where I saw some former professors, their spouses, and current residents. The speeches at graduation are always poignant for me, because they remind me of the nobility of our profession, and the extremely intelligent and diligent and worthy individuals who are in it. I went on to the home of Kris Rea and Gabe Soukup, and watched some older Oscar-nominated movies in their basement. Cerebral movies do not have a long run in India, so we've missed a bunch in the last 5 years. I am here in the summers for the blockbusters, which I enjoy, but I also appreciate a "Michael Clayton" or a "No country for old men" when I can get them - so the Rea-Soukup residence was a treat in more ways than one. This morning, I saw Carmen Bailey, a remarkable colleague at St. Vincent's residency clinic; she is from Panama, and a wonderfully ebullient sort. We made plans for dinner over Panamanian food, and I look forward to this very much.

I also got the news that one of my phenomenal colleagues at the Banyan, Vanitha, is engaged, and to be married in January '09. The fiance is lucky: Vanitha is a compassionate young woman and full of integrity and devotion to the Banyan. I am also lucky to be able to catch the wedding.

All relationships take work, don't they. Marriage, parenthood, friendship, daughterhood, daughter-in-law-hood. I think periodically we need to appreciate the good people in our lives, because we might not always have the chance to.

Unw -

R

Report of 5 June '08

Hello from Carmel library -

What a place this is. And free. Internet, magazines, newspapers, books - free. Anyone can just walk in and read. Quel paradise.

So, I have a day off today. The clinic I work at has Saturday hours and physicians take turns working. This Sat, I will. Last weekend, the Weiss family rented a minivan and drove with Colleen Taber to the East Coast. We stayed with cousins Jeff and Anne in Philadelphia, which was absolutely great fun, then toddled to JFK the following morning and dropped the men off. We turned around and drove to Indy, and it was a fun drive - 2 stops to change drivers, and at the last stage, we put in an audio book and that was lovely. (I remember using an audio book during long drives when we lived here; at about the time the boys got crabby on hour 8 of an 11-hour drive, we'd toss in the tape and all would listen, riveted.) I held my breath until hearing that the men had reached safely, as safe arrival is a great blessing.

Last week had some fun times, too. Carolyn Scanlan- and Will Craighead were gracious enough to lend us their house, and the 3 Weiss men and I cooked Indian food. We were privileged to see Kris Rea and Gabe Soukup and their darling daughters, Isabella and Rosalia; Diane, Pat, Sarah and Daniel Healey; Rich Bastian; Kirk, Daneal and Kirsten Holston; Mandy, John, Nick, Sam, Sophie and Olivia Sparzo; Scott Semester; Shilpa, Ravi and Keerthi Mallur; Colleen, Mark and Christopher Taber; Sonia and Anna Inger; and my boss, Terrance Drake. We had a grand time with everyone; to a person, all were easygoing and delightful, and the day was so beautiful that Naren and Navin entertained the children outside. Email id's were exchanged, and ostensibly, N and N made a prank call in a heavy Indian accent to a guest's friend; such is the stuff memories are made of. Our children and Christopher Taber went to the home of Maryam Massoumi and her husband, Ali, the day before we left for Philly; the boys adore her children, Rostam and Golbarg, and enjoyed the evening immensely. We were privileged to meet Maryam's mother - such a treat - and see her friend, Atafeh, again. It was a nice, genteel evening, full of the courteous hospitality Iranis are renowned for.

Work is on in earnest, now that I am full-time. Rural Indiana has its share of strange people. A nurse at work told me that she had a couple of skinhead parents once, complete with swastika tattoos, and strange messages; their child was named Violence, and the name had to be written starting with the Roman numeral for 6 - VIolence. And I thought the "Aryan Nation" tattoo was odd. I had a patient yesterday who proceeded to rant and rave at us for not controlling his pain; I asked if he would like to see another doctor, as I did not appreciate being yelled at on the first visit. No other doctor will see him. I told him he needed to lose some weight, he said he had trouble walking, and I offered swimming as an option; he had a counter for every suggestion I made, and then stated that he could not be around swimming pools as he was a convicted sex offender. My. He then proceeded to bleat about how poor he was, and I'd had it - I told him where I worked during the year, and stated that my patients in India could not even afford the Nike headband he was wearing. He told the nurse later that I did not appear to know what I was doing, and he could be right; there have been occasions when patient illnesses have mystified me. It is a bloody shame, however, that Americans cannot appreciate what they do have, and must always hark after something else.

I had another patient, a young lady with wild makeup on, who came in with Herpes. Her husband (now ex-) had apparently given her the disease, and the pain interrupted her work as an exotic dancer. I looked at the young woman, still so young under all the vivid paint, cautioned her about other diseases and the need for condom use; as happens so often during my practice in India and the U.S., I again felt the need to kiss the ground my parents walk on. Thank goodness they stayed married in spite of very tough times, slaved for the poor, showed us by example that all are equal, emphasised education (there was never an option for us not to go to college), have powerful senses of humor, and always, always gave us stability of spirit and composure. So none of us was motivated to go into risky professions, or choose lousy spouses, or waft about in the wind with no sense of worth.

Lakers and Celtics tonight. Our beloved team, the Spurs, is regretfully out of the tournament. My current favorite - anyone but the Lakers. Young Mr. Bryant is not an example I wish to adore or cheer for; those successful athletes who do not let adulation go to their heads are truly exceptional.

I'd better wind up. Enjoy your week.

Unw -

R