Report of 26 Aug '08

Hello from the Banyan -

I just had to request that the staff turn down the sambrani (frankincense) that is routinely lit to keep down nasty smells. The smoke burned my eyes, and I had to bellow to someone, who quickly complied. Other staff came by with teary eyes, also, and it was actually quite funny.

The B's 15th anniversary is tomorrow. Vandana and Vaishnavi, the founders, are 37 and 36 this year. Vaish is on sabbatical, and Vandana plans to fast tomorrow to draw attention to the negative depiction of mental illness in the media. These plans haven't crystallised yet, but as with everything at the B, it will be done spontaneously, at the last minute, and very effectively.

It is nice to be back! My favorite "paati," (grandmother or older patient) has not been herself. Normally, Ms. A's eyes will smile before her mouth does, and she will gab for a bit, about what she has eaten, or other chitchat, before moving on. She does not do any work, as other residents must, but all are tolerant of residents who behave thus, to a point. Well, Ms. A does not smile or chat or whack the employees who indulgently tease her. One of the best lessons I learnt from the geriatricians at St. V, the Drs. Healey, was that illness can present as altered mental status. I've done a bunch of blood tests, and will see the results today.

The men and I carried installments of chocolate for the staff and residents of the B, and I was thanked mightily for the same. Chocolate can certainly work wonders. Scott's uncle gave me a couple of boxes of candy he obtained from a friend, and they are good Swiss chocolate bars - yummy!!

I went with my sister, Anu, last week to see her house in Bangalore. It is beautiful. She has accomplished a coup with this building. Real estate is staggeringly expensive here, and so are building costs. Scott and I rent, and I hope someday to afford an apartment. After we saw the house, Anu and I stopped by our widowed sister-in-law's place and had dinner with Susan and our niece, Sanjana. Susan manages life very well, overall; widowhood is not easy. It was a nice day, and I am grateful that my sibs and I talk to each other. We had breakfast with my brother, Vinu, and his family early last week and that was also a treat.

I went to Madurai at the end of the week and saw my parents. That was revelationary! My mother stated she heard that the Banyan was dirty and full of Aids patients, that she cannot imagine buying any products that our residents make, and does not want me to work there solely: she wants me to set up private practice and make lots of money. This refrain continued for quite a while. I lost it about halfway through, mentioned that the Banyan was cleaner than my parents' house, that even if it were full of Aids patients (we have 4), I would buy their wares and continue working there, and that I was thunderstruck at this snobbery from the woman who gave birth to me. Then my father started in (he was drunk at the time) about the types of locums I accept in the U.S. and that, after all, they were with the uninsured and indigent; I couldn't quite grasp the tone of this statement, and then realised it was his own snobbery at play, that I ought to take care of the rich and famous in the U.S. Wow. I did my share of yelling at my father, also, esp when he stated that he could not bear the sight of the mentally ill women at the B being herded along. I asked him what his Bible said about the meek; "Blessed are the meek for they shall inherit the earth." He did not answer.

It strikes me that, in my experience, it is church-going people who renege routinely on their promises, and conveniently forget the teachings of the Bible when it suits them. The number of women in the U.S. who wear white to their weddings, the number of men who rail against homosexuality as being anti-Bible while living with their girlfriends, the number of people who promise to get their entire church involved in helping the Banyan and then forget about it the minute I leave the premises - all these are eye-openers. I stopped attending church in the U.S. after crowds of people came up to me almost every Sunday and asked if I'd host a mission trip; in all honesty, it seemed like they wanted a safe haven in an exotic land, and any idea of doing mission work was secondary at best, or tertiary if you consider all the shopping they wanted to do.

It escapes me why my parents want me to make lots of money, esp when they eschewed it themselves. Their conversation does revolve around the income of their junior colleagues, and I imagine retirement and inflation in India are combining to cause them to pinch their pennies, and that they do not want this state of affairs for their children. I told them I wanted to work only part-time until my sons and nephew, Sudhir (my late brother Manu's son), were safely in college or settled in careers. Adolescence is a turbulent time, and it requires a lot of my time and resources to handle it.

Unw, from the land of jasmine and frankincense -

R

Report of 18 Aug '08

Hello from home -

Where the power just failed and my impassioned blog of 60 minutes ago vanished without a trace. Where the cab driver's definition of 7.45 AM and mine differ ("Welcome home," said Scott).

But it's still nice to be back. The International flight was unique - they ran out of food and the flight attendant, a rather nice-looking fellow, offered the genial explanation, "Well, Jet stocks 90 trays for 100 passengers, as we think 10 won't eat." Not eat, on a long flight?! Quel horreur. I was one of those so deprived, and a fellow passenger near me made such a stink that trays were hastily procured from business class. Hoo hoo - so I ate well.

There were posters from the boys welcoming me home, and a giant fruit salad (one of my favorite foods) made by them. Scott was waiting at the airport, and we took some time off later in the week to see a dreadful Tamil movie, which I fell asleep during.

A beloved older neighbor has been reeling from knee pain. He has been diagnosed with gout and appropriate meds have been started, but relief is intermittent. He cannot take aspirin/ibuprofen as he has kidney problems and these meds will worsen the condition, plus Tylenol is ineffective. I'd brought, from the U.S., some "Icy Hot" patches - topical patches with menthol - and I think the placebo effect of those is in some evidence, but again only transiently. It is hard to watch this gentleman in such pain. In medicine, futility is quite often a companion.

Unw -

R

Report of 7 Aug '08

And the cosmos realigns itself -

I'd told you about feeling a mite sorry to leave, correct? I requested a slightly light schedule at the clinic for my final day, and didn't get it. I was even double-booked and I thought, as I harriedly and hurriedly wound up affairs, and hastened to get the rental car returned, that this was fabulous: I was quite okay with leaving.

What is it with smoking? I've had patients whine to me about not being able to afford their diabetic testing supplies ($80 per month) and when they open their mouths for me to check their throats, the smell of cigarette smoke comes wafting out. That habit is $120 a month. A patient told me, when I drew the comparison, that smoking was her saving crutch, and I told her exactly what cigarette smoke does, and it ain't quite "saving."

Also, what is it with patients who think if they demand something enough, I'll cave in? One of my patients had a form with her for food stamps, and a physician had to certify that the patient could not work. This was my first visit with the patient, indeed her first time at our clinic, and she stated that I did not need to do anything other than sign the form; she repeatedly stated, "I know I cannot work, and they just need to know that, all you have to do is sign the form." When I stated that we needed her old records in order to verify what exactly her disability was, she stated that "they" had told her I did not need any of that, I just needed to affix my signature. "They" are referred to a lot in my practice; "they" prescribe Lortab, "they" give Xanax, "they" don't need paperwork scrutinised. I used to respect what "they" did, i.e., if another physician had given the patient Lortab, perhaps it was warranted; then I discovered that patients lie.

Some fun times last week. Colleen and I finished off my dreaded shopping, and she is the perfect person to do it with; I nearly gave up after 5 minutes at Target, and she kept me focused. We caught up with the Mallurs, who gifted me a very nice suitcase for my travels, and saw the baby Surya and his big sister, Keerthi. I had dinner with Kris and Gabe, and that was tremendously good fun; Kris also had some goodies for the Banyan for me to take. It was a big privilege for me to get together with Boni Hypes, Tami Horkay and Ruth Ranalletta, whom I know from Medical Education at St. Vincent. We had dinner together, a very fun time with lots of laughter, and I was given lots of clothes and gifts for my niece and me. These are wonderful folks. I was privileged also to get a package from Carol Dixon, my friend from 10-year-old days, who sent clothes for my niece and me, and something for my entire family. It was a big treat! Folks from 10-yo-days do tend to know us and indulge us, do they not. I had dinner with the CEO of the clinic yesterday, and that was a memorable evening. This morning, I had the chance to meet with my mentor and advisor, Dr. Robert Love, and that was therapeutic; he has good advice for me, usually, and I discussed many things with him.

So let me wind up and finish laundry. Next blog from Chennai, India - my life, my home, my love.

Unw -

R

Report of 1 Aug '08

'allo from ze libraire -

Such a fun place to be. The spirit calms down and revels in all the books and technology available to me - for free. Quel treat.

Do you know how difficult it is to buy affordable products that are not made in China? I have been hunting for such an umbrella for ages, w/o success. I find China-made goods very spurious in quality, and don't like them. China, as a human rights entity, is also not a favorite in my book because of several things, including their overrunning of our beloved Tibet. There are several Tibetan refugees living in India, and they are a peaceful, peace-loving, hardworking, wonderful people. The Dalai Lama is right up there with Aung San Suu Kyi in my esteem. The world sat by and watched China unleash itself on Tibet, because Tibet was not strategic enough to any one. The outcome was certainly different when Kuwait was invaded, was it not. All that oil.

Thusly, the Olympics, which I would otherwise follow avidly, are not generating much excitement in my irudhayam (heart). It is certainly true that the rich and powerful (countries or people) can get whatever the heck they want; some of us believe the poor can also be empowered to do this.

This weekend, Naren's band debuts at "Unwind Center" (I like the name), a hangout in Chennai. Scott and Navin plan to go for the show, and I am envious. I really want to see the show. So, after their debut, these guys will be big cheeses. I told Naren that the Banyan pays a lot of big name artistes to perform for us, and Naren's band are big cheeses in my book, so I offered again to pay; his response was that perhaps the (other) big name artistes should also refuse their fees. That was nice.

I am winding down my time here, and still have some dreaded shopping to do. As I have said before, there is not an almighty hurry to leave because work has been great - and also, returning to mundane, thankless, wife-and-mother chores ain't exactly thunderously appealing. The 3 Weiss men try to be grateful for what I do, and sometimes are; as a wife and mother, when my entire daily focus is someone else (apart from my sanity-preserving hour and a half in the gym in the early am) and there is inadvertent overlooking of my work, it gets exhausting. I am sure plenty of other mothers, and fathers, can relate to this. I am completely fine once I get home, and can merge back into daily routine easily. As I have said before, a "Thank you" helps me accomplish things.

The clinic has been fine. As I headed out for lunch one day, a motorcycle came zooming in to the parking lot, the young man riding it parked it and yelled something. I thought he was an example of the psychotic patients we sometimes see, and tried to continue walking, but he was directing his comments at me. I couldn't hear him, so approached, leaving plenty of distance to bolt if I needed to, and asked what he'd said; he bellowed, "I haven't smoked weed since I left you." Certainly bellow-worthy, was it not. And I thanked him, to which he said thanks as well. Small triumphs, but wonderful affirmations of efforts.

A 38 year old young man came in with chest pain, rating only a 3 on 10. We discussed his history, with his wife waiting in the waiting area, and I then did an EKG. It showed some damage to his heart, and I referred him to a cardiologist. I then brought his wife in, and all 3 of us discussed what he needed to do. I thought the man got teary and reached for the tissues to pass to him, but he said he was ok, and pointed to his wife; she started bawling. I held her hand until she composed herself, and let her ask all the questions she wanted. At the end of the visit, the young man thanked me profusely, and I thought to myself that I was just doing my job - but of course, the words were nice to hear.

Some fun, fun times last week: I went to my in-laws' place for a farewell visit and couldn't wait to get there, didn't even gas up my car. Some tasty soup was brewing in the crockpot, there was watermelon in the fridge, and all kinds of tasty goodies in between. Wooo! It was nice to sit there, eat, chat and laugh, and completely cleanse the soul with these fine people. The next afternoon, I left. I headed to Mary Remster's for dinner; her son, Donnie, had cooked a wonderful meal and I overate. The company, as always, was stellar, and Mary can laugh at quite a few situations in her life, which is absolutely awe-inspiring. The leftovers were packed for me, much to my great delight. This week, I have had the pleasure of the company of one of my hosts, Mary Beth Simon; her family is out East vacationing and she and I have managed to go out for dinner once, and see each other as our schedules allowed. Mary Beth is an unflappable, pretty, genial sort, and good for the soul. I've also managed to speak to friends - 3 from college days, Mala, Latha and Geetha. There is a special place in one's heart for friends from long ago, isn't there - jokes known only to us, things we say our kids do, favorite memories from days of reading dreadful romance novels and eyeing the boys from the boys' college. I also connected with Monica Cooley, who now teaches Indian dance in Nashville, and we talked for a long time; I'd wanted her help with a situation Scott and I are facing, and she had wonderful advice for me and a robust sense of perspective. Monica was a visiting student in Madurai long ago, taught us ballet for free, and we have kept in touch since.

Well, this library is bringing out the verbage in me. I was interviewed for some article over email, and poured out my heart about the work I do, especially to the question of advice for anyone else contemplating similar work - and the draft which I got yesterday looks like vanilla. Bland, passionless, lecture-ish. Aiyo. I asked the correspondent about it and she stated the mission was to make it look educational. I could understand, then, the reason for the blandification - I could also see firsthand how anyone could be misquoted by a journalist.

Unw -

R