Renu's Week

Sunday, September 19, 2010

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 -



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