Report of 9 Aug '09

Hello from the libraire -

Hot outside, finally. July was so cool - ostensibly the coldest on record - that I had to lug out all the long-sleeved shirts I possess. And go for my workout in sweatpants, prompting at least one fellow spinner (cyclist) to ask how I could wear those. I told him that compared to 104 deg heat, what I'd left in India, I was freezing.

I changed locations and am working in methamphetamine country now. One of the clinics has 2 nurse practitioners (NP's), both of whom are competent. One of them had asked me to see a young patient with chest pain. No worries, we aim to please. This young woman had been hospitalised, worked up by a cardiologist and nothing abnormal was found; she was then in my exam room, and about 2 sentences in, stated she wanted Percocet (a narcotic pain medicine). I told her clearly that I would not refill the medicine, and continued taking her history; when I asked how I could help her, she stated again that she wanted a refill on the Percocet. Now, I had not spoken earlier in Tamil, or Coorgi, or Hindi, or Latin; I had spoken in English - accented, surely, but English. There was not a way for her to misunderstand, "I will not refill the Percocet." She then said she was going to call her mother, who worked at the hospital and was known to my colleagues, and I told her to go ahead, and left the room. I was furious: exactly why was I working her up, when the regular providers had seen her time and again? The NP's then clarified that they were puzzled by the chest pain, and I told them my finding, that it was likely due to the patient's wanting Percocet. Such patients used to say "Back pain," now they say the much more worrisome "Chest pain." I am not a nice person when I am angry, and when the nurse came back to me and said the patient was crying, that she had had a bout of chest pain right then, I told the nurse she could take an EKG by all means, but that there was no way this person was getting Percocet from me.

My father once asked why I was not content to work a while in these areas, wasn't the money great compared to what I make in India (about $0); I stated that patient interactions frequently deteriorated to this kind of drivel, and that, really, after about 3 months of this, I was ready to return to smiles and happiness and good humor *among the desperately, desperately poor* in India. The sad thing is, types like this patient deprive genuine cases from getting the pain meds they need.

There was another patient who came in with her husband, and both were delightful. The lady had noticed a change in her bowel patterns, and as I took a detailed history, the husband provided a fair amount of collateral; the love and affection between them was evident, which was lovely. He is an alumnus of Purdue Engineering, and has invented (she told me) a new, inexpensive building technique. He was kind enough to share the information with me, and I am looking forward to sharing it with other NGO's when I get home. This couple was extraordinarily good company, and all of us lingered a bit over the visit.

My father was at a plastic surgery conference in Mahabalipuram near Chennai, and on the last day (today), Scott had picked him up from the venue and taken him home, to spend some time before taking the train to Madurai. Several aunts and 1 cousin had gone from Coorg to keep my mother company during this time, and she sounded cheerful when I talked to her. I then called Chennai, and my family was well. Again, nice that Scott gets along with the in-laws enough to host them even when I am not around. Naren and Navin are also well, and keeping up (with mostly good grace) in school and college. We had had a long email discussion about the sensible choices they'd made, and I'd cherished it.

As the men had seen "The Hangover" with Anu's family last weekend and had raved about it, I saw it this weekend. It was funny enough, and I laughed out loud several times during it. Some of the humor was ribald and raunchy, which I don't care for, but many parts of the flick were just bloody good fun. And today, I saw "Julie and Julia." It was dreadful. Meryl Streep and Stanley Tucci were outstanding, of course, but they could not save the film. Some of the best food-based films - "Chocolat," "Tampopo" - have succeeded because the characters' art of making and eating the food are done with finesse. Here, the young pair (whatever their names are) smacked their way through delectable cuisine, ruining it, shredding my appetite, and then had singularly poor dialogue to carry off.

Unw -

R