Report of 27 July 2010

Hello from the world of Xanax and Hydrocodone -

As soon as patients say they *must* have these meds, it is a red flag to me. And then, as Scott's mother and aunt said to me, the ones who really need them won't get them.

There have been other patients who are much more reasonable. One of our rare younger patients, who is 20, came in after skateboarding and falling. He had an impressive bruise on his left hip and thigh, and could barely walk, so I sent him for an xray and there are no bones broken. The same patient had come in 2 years ago for a wrist sprain after skateboarding. As the nurse said, this young man apparently cannot see the connection; when I asked him about it, i.e., the plethora of falls and skateboarding, he said he did not mind, that he just loved the sport. To each his own, yes? I had another patient who had had a fall after "crowd-surfing" at a concert; he was 16, or so, and attractive, with long blond hair, and told me that he was crowd-surfing and "security was supposed to catch" him, but did not. This was hilarious; so security is not there to maintain law and order, they are supposed to catch those that are motivated to move along on the outstretched arms of fellow concert-goers?

One of the patients came to an appointment after shopping for groceries, pointed to the stash of groceries in her trunk (we were there to also get her bag of medicines), asked if I wanted anything; this was too sweet, and I accepted a banana. She pointed to some kind of German lunch meat, and said if she'd had bread, she'd have made me a sandwich. I was very moved by this, and as she was leaving, I gave her a hug, which I enjoyed. None of my patients here (and in India) is very wealthy, and all such gestures touch me enormously.

Some fine times last week. I got together with the doctors Diane and Patrick Healey, eminent geriatricians at St. V, for dinner. Their children and one child's friends were there as well, and the evening was full of peppy, intelligent conversation and simply scrumptuous food. We sat outside, which added to the lovely evening. My salsa class goes along fine: much depends on the person leading, and my instructor leads very well, so I found myself following the steps much to my surprise. I also enrolled in "Boot Camp," a fairly gruelling workout regimen, but very collegial and with others who will encourage the novices (I had to fall behind in a run with a body bar); it is bloody good fun. Zumba is fun, as always, and kick-boxing (or "Turbo Kick") with Stephanie rocks; she is an energetic and lively instructor, constantly moving around the room and working out near various students. I learnt about weights from a young man named Lloyd, and greatly appreciated the instruction; he and his wife are very fit, and I think I have learnt from a master.

Kris and Gabe graciously lent me the use of their home and I saw "Pulp Fiction" again, and laughed and laughed. I saw "Salt," which was the mindless, improbable fodder that summer movies are, and "The kids are all right," which was about a gay couple and their kids meeting the sperm donor; the acting there was quite first-rate.

I spoke to my Dad and there was too much static on the line for him to hear me; "shall we wind up, Renu, the vuvuzelas on the line are too much." :) The 3 Weiss men and I got to talk, also, and that was the merry fest it always is. Scott helped me through a tough day last week, simply listening as I whined and suddenly wept. Naren had been ill and that concerned me; he seems better now, and I was glad to talk to him. I told Navin that I liked Common of late (mildly replacing Russell Crowe), and he said he would download Common's music; I said, "Music? Who said anything about his music?" and Navin chuckled. It is nice to hear the men laugh on the phone, such a happy, contented sound.

Unw -

R

Report of 20 July 2010

Hello from Indiana!

And the emails have begun - "Hi, beautiful," etc. Soon, all of us (the 3 Weiss men and I) will be emailing fondness to each other, and loving, and missing, and it will be time to go home.

But not yet, as he said in "Gladiator." Work has been just great, and I like sitting in on lectures and Grand Rounds. It is always, always nice to learn more. The patients have been mostly good, also. There was a patient who has emigrated here from overseas, and I saw him for back pain so severe that he is now falling. He's a young guy, and young patients are often a nice treat in our populace of older patients. "Back pain," however, is a red flag, as patients will ask for narcotic pain meds stating this reason. This patient, though, summarily dismissed all pain meds - "I am a farmer." And we laughed. I've asked for an MRI, and I want to see what's going on. What's cool for us is never cool for the patient, and I hope the patient regains good health.

I am now at the warm, loving home of Andy and Marybeth Simon, and their daughters, Miranda and Morgan. They are in Hawaii, and it is nice of them to trust me with their beautiful home.

Some fine times last week - I saw Spain, my preferred team, win the World Cup. Them vuvuzelas did sound like bees. I watched Isabella and Rosalia while the game was on, and plopped in a movie for them, though I would have liked to hang out and do girlie things. Sid shadowed us again last week, and my colleagues were nice to him (of course); it made for a fun day. I met my former colleague, Theresa Jefferson, for dinner at her house and it was just fabulous: Theresa is of the community that I admire greatly - Black women - and we had a blast. We talked of all things family and work, and Theresa mentioned her straightforward request to her grandson's mother to maintain the contact with him. I loved that; I see little purpose in vendettas where the child's parent prevents contact with various family members - it hurts the child the most, and deprives him/her of some solid, loving relationships which would complete the child quite nicely. I met Theresa's family as well, and enjoyed that. A bunch of female friends and I got together for a potluck dinner on Sunday - Colleen, Sonja, Boni, Lolly, Kris, Denise, Amy and Natalie outdid themselves in both food and conversation and I greatly enjoyed the evening, with all of us sitting around the dining table and revelling in each other.

13 July was my mother's b'day. I deliberately did not talk to my father that day. I called him the following day and we spoke at length of how difficult the day had been for him. 2 years ago, the 3 Weiss men and I wrote letters to my mother on her b'day; she so loved getting letters that she was delighted with this simple gesture and said she read and re-read the letters. She said that one of my sons was unintentionally very funny. My mother made our b'days memorable - presents as soon as we woke up, our favorite foods for a meal at home and then a restaurant meal at the end of the day. I wonder how her b'days had been. My father felt like chatting, and I appreciated that.

I am taking Jazz dance and salsa classes, and like them. I saw "Letters to Juliet," which was a bit dreadful, and "Inception," which was about 40 minutes too long. I also got to talk to all 3 Weiss men, and all were doing well - Naren taking part in inter-collegiate competitions (de rigeur for the average college student in India) and doing well, Navin performing well on school exams, and Scott holding up both home and work ably. There is no substitute for getting good news like this - it does make the day, and year.

Unw -

R

Report of 11 July 2010

Hello from the warm and loving Rea-Soukup home -

The family is away at church. The girls, Isabella and Rosalia, are being "dedicated" today, and all were very well-dressed as they embarked on this momentous occasion. I managed to get a picture of this lovely family, and will preserve it.

Work has been fine, does not really seem like work. There have been the standard poison-ivy, blood pressure, diabetes patients. One of my patients, Ms. X, is a nurse married to an older man; they have adopted 2 children and live next door to an Indian family. The Indians do not celebrate Halloween (I suppose "observe Halloween" is a better phrase) or Christmas, and my patient said she asked their permission to celebrate these occasions with their son. I have no doubt this child appreciated it. My sons' favorite memories are of these 2 events. Free candy, who wouldn't like it. Ms. X epitomises to me all that is good and kind about the U.S. - welcome neighbors from another country, share all with them, treat the neighbor kid like their own, etc. Ms. X and I have had scintillating conversations, and isn't it true that motherhood has the same joys and challenges everywhere.

I had another patient come in requesting Valium for an "anxiety-driven" skin rash. "Requesting" is a polite term; "demanding" is likely more accurate. The dermatologist had agreed to the Valium but refused to prescribe it, the patient refused a referral to the psychiatrist, I too refused to prescribe the Valium, and the impasse has stayed. My father has often wondered why more providers don't work at such clinics in the U.S., as sometimes there is a premium in salary or loan forgiveness to work in such underserved areas. I pointed out this reason, that the demand for controlled substances supersedes all reason or rationality, and the visit deteriorates into an acrimonious encounter.

Some quiet times this week, and a chance to catch up on movies. I saw "The last Airbender" somewhat reluctantly, but quite enjoyed it. I talked to my Dad, and he's doing well; at the end of the call, I said, "Nice talking to you," and he appeared to really like that. I like communicating with my family; I am aware that there are families in which non-communication and vendettas are the norm, but I find these pointless. The 3 Weiss men are well. Naren is in the dorm and does not hate it as much as he had indicated; the young man had outgrown us - to kick a soccer ball around at 8 PM, or play his guitar, or take a walk at 10 PM with like-minded people, he needed to be in the dorm. We are happy he secured a spot. Navin is in the throes of studying - huge board exams loom in March, which will be here all too soon. Scott is holding the fort quite competently, and sends nice, detailed updates when we are not talking on the phone. The boys send messages, sharing much of their lives, and I feel very privileged; there are certainly secrets they don't share, which is appropriate, but they choose to tell me of other things, and that is very cool. One of the best things they have said before: "I wanted you to meet K/U/A; I knew you'd like him."

I attended a salsa (dance) workshop and enjoyed it. I also managed to chat a bit with Kris and Gabe, and enjoyed that, as always.

Unw -

R

Report of 6 July '10

Hello from Indiana -

It was a weekend straight from Heaven. My kind hosts left me the house for the weekend and I watched movies until my eyes drooped, talked to the 3 Weiss men, watched Serena and our beloved Rafa win Wimbledon (I enjoyed both victories, and especially enjoyed the tremendous grace that the runners-up displayed in congratulating the winners, and the reciprocated class from the winners), and watched part of the World Cup. I also went to an Independence Day festival, and listened to live music outside, which was a joy.

Sid Norton, a friend interested in medicine, worked with us last week and that was great fun. Sid is a gentle presence, engaging and interested, and all enjoyed his visit. One of the patients (female and older) wanted to take him home. Sid and I had dinner later, and caught up on how his day had been, how health care providers' days are never boring, how much the profession challenges the intellect, etc. It was a nice day.

We had our standard patients last week, and Mr. X, the 600-lb patient, has fallen back into his ways of not following up regularly with the doctor. He is on a blood thinner for blood clots, and that needs to be monitored weekly, but he has not come in. We finally managed to get him in last week, and I saw that his gums were bleeding - too thin, that blood. So his medication was adjusted, and he was supposed to have returned today, but did not.

I spent Monday rounding with Dr. Love and that was great. He is a brilliant clinician, and I learn a lot from him, including from just hearing him talk to the patients. The peer relationship is nice, too, and Dr. Love's sense of humor keeps the day going by very easily. He is very kind to let me follow him thus.

The gym goes well - odd place, if you truly notice. There are all manner of individuals working out there, and not just for the purpose of improving their health, either. But it remains a fine place to exercise, and I enjoy going there. I also take a Jazz Dance class with older adults, and I am impressed at the flexibility and grace that they exhibit; I used to think that Indians had a fine sense of rhythm, but abundance of grace there ain't.

Unw -

R