Report of 27 Sept '10

Hello folks -

A busy weekend ends, a hectic week starts.

We are well, and hope the same with you. The Banyan has been great. I wish to extend an apology to you: when I mentioned the patient, Ms. S, dying last week, I went on to discuss the repercussions of her death. At no point did I voice sadness at her passing, and I am sorry. I was indeed sad at her passing, as I am sad at all deaths at the B. However, I am happy that Vandana and Vaishnavi founded the B, so that we could give a home to Ms. S and she could die surrounded by love and caring, instead of on the streets - alone and unkempt and in pain and miserable.

We have a patient rescued recently from the streets: Ms. Se has had some nausea and vomiting, and is also found to have leptospirosis. She was treated, and got better, and has been scrubbing the sick room spotless. Many of these women are used to running families, and so, cleaning and cooking and caring for someone else is second nature. Ms. Se is young, very attractive and was found semi-naked on the streets. She is HIV+, and is under follow-up for the same. One day, I asked what she had eaten for breakfast - the reply clues me in to all manner of conditions: dementia, forgetfulness, loss of appetite, state of mind. We (the Banyan) had had dosais, a flat bread made of rice batter. Ms. Se could not quite get the name of it, as she is North Indian and this is a South Indian dish, and I smiled; we met each other's eyes, and Ms. Se had a look of such innocence in her as she sought the name of the dish that the interaction was pure and fun for me. I told the Weiss men that we cannot assume Ms. Se contracted HIV through rape, as she is young enough to enjoy intimacy. Whatever the circumstances, we will treat Ms. Se and work to rehabilitate her.

The B's flat broke state continues. It is like pouring water in a sieve.

The weekend was busy also. Naren was in an intercollegiate play competition, which evaluates plays and the colleges' efforts to sell tickets, and Scott and I went to see the competition over 2 days. MCC had won "Best Play" and "Best Director" last year, and was expected to do well this year. Naren's friend, Ujjwal, a multi-talented and humble young man, wrote the play this year and it was brilliant. Unfortunately, the cast sank it - they were inaudible and did not revel in their roles, and I was furious. I have apologised to Ujjwal and have asked for my money back from Naren. A women's college named Stella Maris stole the show with some stellar marketing, targeting part of their profits towards transcribing textbooks to audiotapes for visually impaired high school students, and an excellent play. You go, girls!

Navin's exam grades came back, given at a Parent-Teacher meeting. As I told him, I have attended P-T meetings for about 14 years now, and if ever I heard, "He's done very well, and has realised his potential," I would faint and need to be resuscitated. It's always, "Can do better." Navin shaved his head yesterday, prayed to his grandmother's spirit and will attempt to apply himself henceforth.

Ahhh, the joys of raising teenagers.

Through all of this, however, I am grateful that the family is together and communicating. So many people do not have such good fortune.

I spoke to my father and he is doing well. He asked that I phone again, which I found very sweet.

Unw -

R

Report of 20 Sept 2010

Hello from the B -

If this is how busy life can be, while working part-time, I wonder at full-time.

Work has been frenetic. The Sir Ratan Tata Trust, our major funders, had their audit team come to check us over. We are a transparent organisation, and everyone can look at whatever they want. The 2 auditors who came, VG and BG, were young and at least one was a physician. Neither was adversarial, and wanted us to think of various things, and figure out how to get our reports to conform to their specs, etc. They were very, very sharp, and it was a joy to listen to them. An older advisor to the team, a psychiatrist, was somewhat combative, and he had several questions for me as the medical director: "Can you provide some proof that your training the health care workers (hcw's) has helped?" Serendipitously, that very morning, we'd had an emergency: Ms. S, our deaf mute patient, had had an attack of diarrhea, and then been found unresponsive, cold, clammy and pulseless. We'd resuscitated her and sent her on to the hospital. I narrated this incident, with very real and concrete proof of how well the hcw's responded, and there were no questions to the medical world after that, for that day. I had "run the code," i.e., medically led the resuscitation, but did not mention that. ("That does not matter," said my kind husband.)

The next day, the same combative advisor went on to say that primary care practitioners ought to diagnose and treat mental illnesses, there were training programs for the purpose, shortage of psychiatrists, etc. I do feel sorry at the shortage of psychiatrists, but I find this viewpoint unrealistic and arrogant, as I have absolutely no interest in psychiatry. I mentioned this, and the exchange was not pleasant; Vandana has, however, faced this exact issue in some other providers and so, this point of view is not new to her. Especially not from me: when she hired me, I told her I had absolutely no interest in mental illness and she was cool with that.

The lady with the broken arm, the one who had struck me as having once been a wife and mother, has died. She had surgery to fix the arm, and then her stomach bloated, and a day later, she died. I have no idea why, and again, feel completely deprived of valuable knowledge. Even in death, patients can continue to educate. We cannot request a post-mortem here without casting blame on someone, and that course of action is not available to us, so I have to shut up and "s--- it up." Sigh. I could use the information toward other purposes, such as prevention. A couple of years ago, some of our mentally challenged (not mentally ill) patients died suddenly, and I still have no idea why. I discussed this issue with Dr. Greg Freeman, eminent cardiologist who taught us in med school, and he had some ideas which I am implementing here.

I am always grateful for the mentor-ship of my wonderful former professors. Many continue to keep in touch with me, and I am richer for it.

Ms. S, our genial, deaf, mute patient, is apparently better after her bout of unresponsiveness. They kept her in the hospital for more tests, and I was grateful: why did a young, apparently healthy woman get this ill after 2 episodes of diarrhea? I am anxious to see the test results. This hospital, Sundaram Medical Foundation, or SMF, does a great job with our patients, and indeed, all patients. Scott had his surgery there 3 years ago, and we were pleased with the care, and the reasonable bill.

There were other responsibilities: neighbors wanted to see me, relatives wanted to get together, there were friends to call, and *plenty* of patients to see away from organised environments. I am not a big fan of the phone, but tried to keep up with phone responsibilities. On Saturday, Scott and I drove to Bangalore to see my widowed sister-in-law, Susan, and niece, Sanjana. Nephew, Sudhir, had to work, so we did not see him. It was good to see Susan: she is a warm, genial, loving sort and we had a great visit. She is always grateful for gifts that I bring her/them, and this time was no exception - little cologne, chocolate, etc., went over well. She had biryani (rice pilaf, with either meat or veges) for us, and that is one of my favorite foods, so I overate merrily; Susan packed leftovers for us, too (I told you she was warm and loving, let's add "generous" to that list), and I had some of those in the car before we left Bangalore city limits :). Sanjana is 12 and at that stage of growing up - where she wants to try wearing plunging necklines, etc. Boggles my mind. It is far easier, in that respect, to raise boys. I have wondered if one boy's shorts will end up around his ankles at some point, but there is usually underwear under the shorts.

It was nice to go on a road trip with Scott, and though tiring, we had our "Book of Questions" along. The questions are thought-provoking and fun, and often provide insight into each other that we would not normally get. "Have you ever walked out of a movie because it was so bad?" Once. Tamil movie, Dasavatharam. Otherwise I stay until the bitter end, even for stinkers like "Catwoman." "Hey, that was a classic in its field," said Scott. "Which field would that be?," I asked, and he laughed and said, "T and A." I did not know this phrase until a couple of years ago, and it sure fits the movie: "T--s and A--" (female attributes).

Craig called from the U.S. at the end of our trip. That was nice. Phone calls from the U.S. are rare, and I was happy for Scott that he got to talk to our irreverent, funny, witty, insightful friend. We celebrated Scott's b'day yesterday, and the whole family went out for breakfast (sausages and eggs - ooooh) and a couple of Tamil movies; it was great that all could go. Dinner was also outside, and our favorite waiter produced an extra chocolate mousse as a gift for me, and I told him the occasion, passing on the gift to Scott. The waiter's was a nice gesture, and the day, spent with the men, was fun and good and full of bonhomie and laughter - likely a direct gift from above. Naren said things like, "When I was drunk once," and as my eyes widened, I did feel happy at the candor nonetheless. Navin said my incessant message of "NSBM" - No sex before marriage - tended to come out at weird times, and that he had shared this with his friends. I had cried at a couple of points in the movies - for instance, when a boy educated in the Tamil medium had felt out of place at his big, fancy college; the men laughed and said, "Yep, Amma would weep at the opening credits." It was funny.

So, I just had to weep again, in secret. Ms. K and Ms. M are a child-mother team rescued from the streets by the Banyan years ago; Ms. K finished grade 12 this year, and is in college! One of the best colleges in the city, Ethiraj, and studying history. She is visually challenged, and the field work in psychology, her favored subject, would have been difficult, so the college suggested history and Ms. K is enjoying it and dorm life. I am delighted that she is moving along! Usha and Grahalakshmi, my colleagues, just mentioned this update, and Suresh, another colleague, whipped out the newspaper article about Ms. K, and I read it, and wiped the tears, and felt exceedingly happy at this news.

My good colleague, Gayathri, is taking 2 of the patients out for lunch and the 2 are so excited, especially as it is now time for them to go. It is nice when our mentally ill and marginalised are not marginalised.

Such a great organisation to work for, such a good life.

Unw -

R

Report of 13 Sept '10

Hello from the B -

The main is supposed to be switched off as some electricity work needs to be done, but there has been no follow-up instruction and I was told to continue working for now; so I am typing rabidly until the electricity must go off. To add to the chaos, the B's website is listed an attack site, preventing all from accessing it - oh joy.

Work at the B started in full swing, and it has been nice. One of our patients, Ms. V, talked of her mother admitting her to the B and taking off; Ms. V will be with us permanently. One day, another patient's very cute mother, Ms. A, came to visit; Ms. A is around 80, about half my height, with completely white, close-cropped hair (she likely shaved her head at a temple) and a very, very loquacious manner. She must have reminded Ms. V of her own grandmother, as Ms. V went up to her and said, very tenderly, "Ayah," which can mean "grandmother." Ms. A included Ms. V in her jolly chatter, talked of how many buses she took to get to us, and genially asked Ms. V if she was keeping well. Ms. V had started, earlier, to get belligerent on occasion, and all that fled when she saw Ms. A. It was wonderful to watch, that we could make someone so happy by another's relative's visit.

I wish all the Banyan residents had family visiting; it truly buoys up the residents, unlike anything we could ever do. But family has often abandoned our residents. As I looked at one of our patients, who has a broken arm, I thought to myself that she was, at one time, active in her role as wife and mother, and likely loved it; as soon as mental illness struck, she was then dispatched. Out of sight, out of mind. When I reeled under some weirdness after both kids were born, calling Scott one evening to come home quickly as I needed a break, he hastened home and that let me head off and walk. A few years later, a young mother in the *same neighborhood in Houston* killed all 5 of her children, likely in part because she did not have the same support.

Our deaf, mute patient, Ms. S, gestured to me that she had felt feverish and had body aches. So, I ordered some blood tests and there it was - leptospirosis. I have started treatment, and hope she feels better. Ms. S rarely misses work, but when she said she could not go the other day, we knew something was up. Ms. S has also asked for a hearing aid; she was evaluated by ENT, who has determined that Ms. S's hearing loss is congenital and would not benefit at all from a hearing aid. Woe. I have tried to explain this to Ms. S, with varying success. She also would like her home traced, as there is a little person waiting for his/her mother, but we have no way of doing that if Ms. S cannot communicate her home address or at least landmarks. Let us see - we are a "Do or die" organisation and we might involve TV channels if we need to.

So much to do, not all of it medicine, but somewhat healing, nonetheless.

We drove to Madurai over the weekend to see my father, and that was nice. He has to do a lot of the grocery planning himself now, and does well enough. He is also extremely active in the hospital, and as part of the Board of my alma mater, Lady Doak College. So he was gone for meetings ad infinitum when we were there, which might have po'd my siblings off, but I like the fact that he is busy. I'd bought him a Ralph Lauren suit jacket in the U.S., shopping ably aided by Colleen Taber; my Dad had asked for a jacket, and I spent much more than I normally do on anything. But what the heck, he is my father, and he quite liked the sharp jacket. It was nice to be home; my mother's presence so infuses every elegant room of that house that it does not feel like she has gone. It was also nice to take a trip with the boys: they are great company, and like getting together with their relatives, to our relief. We also saw Mrs. Kurien, a loving friend, and all 4 of us loved that, also; she had made the boys' favorite treat, banana paniyaaram (fritters), and the boys ate 2 plates-ful.

Our (my father's) cook has married and returned with her groom to live in the little house behind my parents' house, and we met the young man; he's nice. The day we left, he asked to talk to us and when we went down, he thanked us for "giving him a life," that he never expected to get such a nice wife, etc., and got very teary; he has a mild skin disorder, and all the young women proposed for him before our cook had vetoed the connection. Ms. A, our cook, was sent to work when she was 10 years old and her parents have since lived off her, and abused her, and stolen her assets; well, all that is at a stop now, and that's great. My mother apparently suspected that Ms. A was not her parents' biological child, that she was abducted from another family; my mother could not envision a daughter being treated the way Ms. A was by her parents.

It is wonderful when good things happen to good people.

Anu and Benji stopped by our house yesterday, to our delight. I know of families where sisters will not stop by. Anu brought me 2 pretty bracelets that she'd bought in Israel and she is wonderfully sweet that way: I have items from South Africa, and the Philippines, and the U.K., and other places that she heads to. The Perakaths were heading separately to see the play "Jesus Christ Superstar," as were we, and we met up at the theater again. The play had very good singing, but the production itself was a little bogus - the guards held guns, and several members of the cast wore street clothes circa 2010. Scott and I had had a day to ourselves, as both kids were off doing other things, and we *totally* enjoyed the day; in fact, when Naren had wanted to hang around in the morning and listen to our "Jesus C. S." cd, we had requested that he head off on his social outings sooner. :) Scott and I managed to see, on DVD, "Monkey Business," and loved the Cary Grant-Ginger Rogers-Marilyn Monroe flick. At one point in his 20's, Scott had visited his aunt in Oregon while there on business, and when I had mentioned it to my aunt, she said that boded well for *our* family life; indeed, it has - a young man or woman who is close to his or her family will inevitably run a good show when it comes time for marriage and kids. It is nice to realise that.

My University of Texas Health Science Center at San Antonio med school class will hold its 10th year reunion next month, and I so wish I could attend; all 4 of us have the best memories of school, meeting some lovely people and having neighbors who are still like family. However, finances preclude this, and it is when I travel (or don't travel :) ) that I acutely feel the lack of bucks. One of the best continuing medical education sessions happens in Chennai that weekend, so there are compensations for not going to San Antonio.

Okay, enough chatter. The Banyan is flat broke as usual, and I am going to have to see about getting meal sponsors. No luck so far, but hope springs eternal.

Unw -

R

Report of 5 Sept 2010

Hello from my bright living room -

Scott is asleep on the floor, laundry dries on the balcony, 1 boy is off being tutored for an exam tomorrow, and 1 boy has gone to attend a play. Jet lag is squeezing sleep into all my pores, but I am trying to stay awake for a little bit.

Settling back into the routine is easy. This morning, I woke Navin up and told him to go run, and he started laughing. Then, "Are you serious?" I was. I had worked out, using several exercises from boot camp, and felt good and invigorated. Clearly, no one else shared my love of the early morning hours, hugging their pillows and writing letters to Kumbakarna (our equivalent of Rip Van Winkle). But off Navin went.

I saw patients until the day before I left, and one of them was a young man of Mexican descent who was being evaluated for kidney failure. He, his wifeand children come up to Indiana every summer from Texas to work for Red Gold tomatoes, and neither adult has health insurance. We have had to extend charity care, but my bigger focus is on coming to the reason, or "etiology," of his kidney failure, which was discovered in Indy. The couple had several questions for me, and I had a lot of time for them, so we went over everything in great detail until the wife was satisfied that all queries had been answered; she was naturally unnerved by what was happening, and I empathised completely, giving her a hug at the end of the visit, and wishing both of them well. I will be curious to see the results of all the blood tests.

There were a couple of fine times before I left the U.S. Shilpa and Ravi Mallur and their kids came over to Colleen's, and we spent a lot of time talking, and playing with the kids; it was an idyllic evening. The following day, we ate leftovers at work - there had been a lovely lunch the previous day, including a very delicious Becky Lewis cake, which I had a piece of for breakfast. I was privileged to get phone calls from Ruth Smith, the former CEO of a clinic I'd worked at, and a very visionary doctor - we chatted and laughed and discussed work and family, all of which was lovely; from Monica Cooley, who taught me ballet at Lady Doak when I was 16, and whose friendship, solid perspective and sense of humor I have valued greatly; from Linda Johnson, my anatomy professor in med school, who knows my family well and considers us part of hers - we talk of several things, not just medicine, and laugh a lot. I had patients to see, and then an exit interview with Bruce Haga, the vice president of the organisation I work for. Bruce is very down to earth, grand fun to talk to, and we laughed as we discussed our respective 2 sons, and life, and working environments and by the way got to the feedback session. Bruce's assistant, Debbie Prier, had escorted me to the venue of the meeting, and I enjoy talking to Debbie as well; she is personable and warm and her eyes laugh when she does. After finishing there, I had some last-minute shopping to do, returned my rental car, Colleen picked me up, and took me to dinner with Mark and Christopher. All 4 Tabers have Mensa-quality IQ, and I loved the discussion on various topics over dinner. Christopher, in particular, has extremely insightful opinions and I love, *love* this kid and his sister, Melinda. I packed, and repacked, and had to throw; we ended up leaving later than expected on Thursday for O'Hare, after picking up some precious movies that Gabe Soukup and Kris Rea had ready for me - that was nice of them. Colleen was very patient with me as I did things at the last minute, including stopping by the post office. However, we made it to O'Hare on time and there was no line at all at the Lufthansa check-in.

I reached safely, and after a solid 8+ hours of sleep, Scott and I went to attend Harini's wedding festivities. Harini is an occupational therapist at the Banyan, and is of considerable calibre, and a very warm and wonderful spirit. I was exceedingly happy that her fiance, Sriram, seemed like a nice person, and both Scott and I were pleased to share in the merriment.

I also told my father of my safe return and he said, "Welcome to India." I think we will see him next weekend.

Last evening, after dinner, we discussed the boys' shenanigans. Naren had checked himself out of the dormand found himself a place outside, paying for it himself and not telling anyone until he told me last week. Navin's grades have not been optimal and that will not fly here - not in India and not with either of his parents. Both boys informed us that it is sometimes difficult to talk to us, because if they tell us of their stunts, they get punished; we countered that we always appreciate the boys' candor but that sub-par thinking will merit consequences. At various points, I yelled and cussed, and cried once; Scott stayed calm and presented his disappointment with gentle words and a mild tone. Naren said it (Scott's message) was powerful. Navin, who has mulled over law school, presented his brother's case eloquently, and it was distractedly nice to listen to 2 opinionated young men talk to us about their views. We finished up, with everyone appreciating the openness of the discussions, hugged with a lot of love, and went to bed.

It is nice to be home. I hope you have similar joys.

Unw -

R