Report of 31 Jan 2011

Hello from exhaustion-land -

We raced around today trying to meet a deadline; complete anathema to me. Scott and Navin work this way, and I think I must have got an ulcer as we had minutes to spare before the deadline lapsed.

My dear friends, Nina and Mrs. Kurien, have lost their father and husband respectively. Dr. K. J. Kurien had not been well, and passed away yesterday. Our families were closely intertwined, and continue to live on the same street in Madurai, and I felt for the Kurien family in their grief.

I have had family illnesses to treat, and that has been relatively easy. I also had a patient to treat by proxy, as our cook narrated his symptoms and I guessed at the diagnosis. This, obviously, is not the optimal way to treat, but happens more often than you'd imagine.

One day, I drove home after dropping Navin at school and at a signal, a man and his son crossed the road. The son was blind, and the man had a firm grip on his hand. They crossed in front of me, with the man gently telling the boy when to step up and down, and I was mesmerised. I do believe, like all parents, that the man would have cheerfully taken on the son's affliction than let his son suffer with it. But they were making the most of the situation, and there is a good school for the blind fairly closeby, which the young boy will receive a nice education at.

We had some good times over the weekend with our own sons, catching some movies including a well-made Tamil movie that unexpectedly had our Madurai friend, Marcus Cleur, in it. He is Anglo-Indian, a very nice guy, and played an Anglo-Indian in the film. I got a kick out of seeing and recognising him. We also saw "The Green Hornet" and "127 Hours." All of us were impressed with the presence of mind of the protagonist in the latter movie, Aron Ralston, but 2 of us found A. R. Rahman's music just a tad mismatched to the situation - and trust me, *all* of us are Rahman fans. Over lunch on Sunday as we discussed the movies, I enjoyed the time and told the boys that if I died the next day, I would die happy. At least one boy did not appreciate that train of thought.

Unw

R

Report of 26 Jan 2011

Hello from my breezy living room -

It is Republic Day today, and a holiday for us. Nice. Naren came last night to spend the night, and we did not get to have breakfast together, because our cleaning person (yes, we have that luxury in our overpopulated country) came right then. We don't like to eat in front of her, because we can afford many things that she cannot. But she did share a cup of coffee with us.

It is also the 12th anniversary of my brother Manu's demise. Robust, handsome, full of life, liked to dance, loved his sisters. I could not speak of his passing with any ease, and it has become easier after my mother has passed away; weird. Scott had booked tickets to go to Madurai and accompany my father to the cemetery, but a political party here pulled some stunts and was disciplined; fearing backlash and its repercussions on public life, my father suggested that Scott cancel his trip and he did.

It is a matter of great relief for us that Susan, Manu's widow, has stayed in touch with us and all of us get together regularly. The cousins, in particular, adore each other and that makes me happy.

Let me clarify when I say I've been off from the Banyan: I have taken leave to help Navin prepare for board exams. These are mammoth exams that are taken at the end of classes X and XII, and XII is particularly crucial as it is pre-college; however, the buzz is that potential employers are now asking for 1oth grade marks also. I've taken off for the boys' exams before, and it is de rigeur: ferry them to tutoring, to school for review sessions, ensure they eat on time, keep a carb load handy, etc. This has blown some of our American friends' minds, that parents take time off to see their kids through exams, but it is very commonplace here.

The Banyan has been alright. Before I left, one of our patients, Ms. Ma, consumed drain cleaner. This is not good, as it can corrode on the way down and on the way up (when vomiting). We sent her to the hospital, they did the treating and sent her back, and she did it again the next day. The health care workers who took her the second time said they got an earful from the doctors there, that this had happened again; however, it is very difficult to watch each patient at every moment of the day. During the first episode, Ms. Ma's mother was visiting from a far-off village (she's the one who had refused to take her back, after the Banyan contingent made the arduous trip over there from Chennai) and I asked her if she'd accompany Ms. Ma to the hospital. She flatly refused, and was negotiating to return to said far-off village at mid-day, before her daughter returned from the hospital. I saw Harini, our able occupational therapist, speak with her and Harini was furious; I like anger when it is appropriate, and this time, Harini was definitely justified in being angry that this lady did not give a rip about her daughter.

This is the joy in working at the B. None of us is really very "nice," but we are opinionated, passionate, angry and vocal. I like it.

Some joyous times: my school classmate, Derrick, visited us today with his friend, Bhaskar. Scott and I stayed with Derrick and his most lovely family in Toronto last year, and we were very pleased that he took time out of his busy schedule to visit us. His son, Aaron, is now in Poland studying medicine, and we talked of that and the ladies, Jacqueline and Alisha. They really are a sweet family, and we are pleased to know all of them. Over the weekend, Scott and I managed to get to the U.S. Consulate's free movie screening, for the first time since we moved here. It would have been easier to get into Fort Knox: all the security procedures delayed us a bit, but what the heck - they are apparently essential.

You know, I should be very careful what I say. Soon after Obama was elected, I expressed my joy though I have no great political leanings, and a lucrative U.S. speaking engagement went away, never to be reinstated. I am stricken, however, at the Giffords shooting and the suggestion to put Democrats in "crosshairs;" what sort of advice is that - to kill the opponents?!! The annual goal remains to keep my mouth shut, but you see, I didn't get where I was by doing that: in the homeland, working for the poor, unfunded. :)

We spent a good day today hanging out with the boys. Navin has practice exams and during a break in his studying, all of us watched "Training Day." It is violent and unnerving, but beautifully acted and thought-provoking on issues of ethics and doing the right thing. Especially when watching it with opinionated and thinking teenagers, the aftermath is wonderful: lots of discussions and a perspective that we would not otherwise have thought of.

My top 10 moments from last year (not in any order, except for #1):

10 - Ms. V getting a little steadier with her gait
9 - Spending Christmas with the family
8 - Getting to the alumni reunion and seeing old friends and classmates
7 - Going to the American College of Physicians conference with Scott
6 - Managing to get a wee bit of funds for the Banyan through begging
5 - The boys giving me a collage for Mother's Day, that depicted what they thought of me
4 - Boot Camp workout and spinning
3 - Working in Elwood and Alexandria
2 - My cancer patient cocking a shotgun at Hospice workers (showed his spirit)
1 - Leela reconciling with her brother

Unw -

R

Report of 20 Jan '11

Hello from my living room -

We have closed the balcony door to keep away the mosquitoes, but a gentle breeze is blowing and it is about 70 degrees outside. Many friends from the U.S. have written of their cold state.

I keep up with the Banyan by phone, and field results of blood tests, etc. 5 patients have died since I left, and I know the cause for 3. It is at times like this that I wish access to a post-mortem was within our grasp: if I knew why the others died, I could do a bit more in the prevention arena. But, as I have said before, we can't order a post-mortem here without insinuating blame, and then the police will try to extract a bribe from the institution where the death occurred, etc. Needless hassle.

That the Banyan exists is a source of great joy for me. Especially when I watch the women eat, I bless Vandana and Vaishnavi for ensuring safe sanctuary and food for those whom their families have cast aside, or whom mental illness has wrecked, or whom poverty has rendered ostracised. I often feel a tremendous sense of blessing when I treat these folks as it is a privilege to do for them. Also, there is very little competition and hurry and bluster - I can take my time, do the prevention bit, teach the health care workers about the patients and themselves, gab with the senior coordinators, check in on our older patients. It was even better when a Canadian volunteer trained some of our residents in massage, in preparation for sending them out for employment; I used to willingly pay for experimental massages by these ladies and it was fabulous.

Some fun times last week. Vandana's 40th b'day was 17 Jan, and she had a party on 16 Jan. Scott was out of town, and the boys and I went. Vandana, her husband, Senthil, and Vaishnavi made us feel welcome and important. The boys were in sherwanis - traditional Indian clothes (bought in Bhopal), consisting of pants gathered at the ankles and long tunics, along with a stole worn around the neck - and looked nice. We saw several people at the party that we know and like (that's one of the pleasures of working at the B, too, and Vaishnavi's parents are singular joys in this regard), and as we went to dinner, saw that the dance floor was empty and a hopeful DJ spinning some tunes. Navin, often painfully shy but kindly willing to join me, and I danced, and then others joined in, freeing Navin up to hold up the wall with a friend. Naren then danced, also, with his girlfriend and her mother and all of it was fun. I like this pair of ladies a lot, and we spent a very nice evening, mostly dancing and yelling to be heard.

The boys and I went to breakfast on Sunday, and it was nice to sit and talk and laugh. As the boys morph into adulthood, I continue to enjoy their opinions and chatter. At one point during a meal, one son said, "Can you imagine someone being scared to tell their parents they're gay?," and the other said, "Yeah, really." And that was nice, that they know us enough to know that such disclosures would not cause our world to split apart.

Chennai Sangamam, the street festival of folk arts, was on last week and Navin and I caught a show or 2. Naren was busy with college stuff, but did manage to join us for the aforementioned breakfast.

The annual conference of the American College of Physicians is coming up, and it is always a great show, full of learning. However, the fare to get there is hefty and I am on the prowl for speaking opps, etc. Someday, work with the destitute will get the attention it deserves; none of us is under any illusion that it will get the finances it so desperately needs. But the work, undoubtedly, will go on - enriching us, more often, than the patients.

Unw -

R

Report of 13 Jan 2011

Hello from Chennai -

The blog is getting a bit erratic, isn't it. Scott is away in Trivandrum, Kerala, with the computer, so access is interrupted. But I'll try to keep up.

"Days off work" I thought, but days off they ain't. Lots to be done, academics to be kept up with, my professional journals to be read. As Navin worked on a project to be submitted for a grade, I noticed that I was getting a bit obsessed with ensuring a good job. Then I backed off - what he sows, he reaps. Naren has been roped in to assist, because the boys tend to listen to each other more. When Naren got into a spot of trouble last year, Navin eloquently argued his case, diminishing the former's punishment. When Navin had a vat of studying to complete, before our return from Bhopal, it was Naren who coaxed him to "finish 2 pages before the plane takes off, because it's just sitting on the runway now."

My aunt, my mother's older sister in Mysore, has the beginnings of dementia: gets lost going to or from the store, does not remember that her parents are not living, does not know me. That is sad to see. As I quizzed her extensively, trying to judge if this was dementia or just loss of memory, she started to get a tad defensive about her memory lapses. My aunt is a fiery one: when she worked as a hospital administrator for one of the biggest hospitals in Delhi, she noticed that a hospitalised minister (politician) was dipping into the poor fund for his treatment. This fund was reserved to treat impoverished patients. My aunt made this public and resigned; it made big news, and she got marriage proposals (in her 50's) from as far away as Australia. She had already chosen not to marry ("Chee, who can spend her whole life staring at one man's face?"), moved to Mysore and indulged her love of reading and cards (rummy for money was a favorite). I am actually surprised that my aunt has been afflicted with dementia, because she was a voracious reader and kept her intellect sharp; however, maybe living alone and losing 2 of her closest siblings caused more and more reticence. My cousin, Sheila (my mother's brother's daughter - our parents did not speak to each other as my mother married outside the community), and I are in discussions about this aunt - a fairly beloved figure as she is affectionate, loving and chose to stay out of the gossip that is endemic in the Coorgi community (and our family).

Dementia is a cruel animal. At one point during my training at St. V, our inpatient team cared for an older lady with it; she was hospitalised for pneumonia. She recovered from the pneumonia, and one day, in her daily session with the physical therapist, her daughter walked in; when the physio asked the patient who that was, she answered, "That's my daughter." The daughter was elated, because the mother had not recognised her for years. I think the recognition was transient, but it made the daughter's day, and consequently, ours.

Lots of little illnesses around our apartment, also. All treatable.

My father was awarded the Lifetime Achievement award in plastic surgery from the Dr. MGR Medical University here, and came to Chennai last week. I don't know what the big deal is with awards, but we went for the ceremony and it was nice: it was combined with this year's graduation and it was a treat to see the senses of achievement in the graduates and prize-winners. We hosted a dinner at our house for the family, and Anu and family, and Vinu, Tina and Ahana came. Tina made some wonderful fish cutlets (patties), which all enjoyed, and some banana cake, which was also yummy. I tell you, it's awfully nice when folks bring food to share - especially tasty stuff. It was nice to have the family together, we missed Susan at this time, and my Dad was happy at the get-together.

Navin and I saw "Fair Game," and that prompted a lot of discussion. Indian school-children are well-informed and opinionated, and that makes for some lively conversation. Naren came last night to spend the night, and the flick has been recommended to him.

Scott's grandmother died last week and the funeral was yesterday. I remember how warmly she welcomed me into the family, and am glad the passing was peaceful.

Unw -

r

Report of 3 Jan 2011

Happy New Year to all of you!

May good health and happiness come your way all through the year.

It has been a tumultous 3 weeks since the last write. A beloved colleague, R, committed suicide. He had been successfully treated for a mental illness at the Institute of Mental Health (IMH), joined us at the Banyan, married a Banyan resident and fathered a very cute baby. Marital troubles ensued and on a Monday, just after several counselling sessions for the family with senior staff, R went home and hanged himself. We were stricken; he was a great guy, with a cheerful disposition, and an ever-present smile.

My patient, Ms. G, rescued from the street, started to lose weight in front of my eyes and began looking skeletal. I strongly suspected cancer (I think this is in a previous blog) and then, propitiously or otherwise, Ms. G had vaginal bleeding. We sent her to the doctor, they sent her back with a non-committal opinion, I was furious and sent her elsewhere for a second opinion; they confirmed the cancer and sent her back. I had a diagnosis, which I often don't in others who die: getting a post-mortem here involves casting blame on the institution (whether the hospital or the Banyan) and all are loath to do that. Ms. G died days after the diagnosis. In the interim period, I gave up attempts to make her sit for a while and let her lie in bed, ordered her favorite foods, and sat with her whenever I went to the B. She would say that she wanted to come home with me, or that she wanted me to sit in the room, and I would point to my chair and say that I'd be right there, in the room with her; she'd then say, "Khiladi," which mentions "mischievous" or "fibber." I would sit and talk to her, and put my hand on her back, feel just her bones, tell her how all of us were around her, and try and ease her giant apprehension at being alone. As I told our able occupational therapist, Harini, I was glad Ms. G had a warm, loving place for her last days.

Training the health care workers (hcw's) went along well until R's demise, and then it had to be suspended as no one was in the mood to learn. The hcw's are tremendously good beings.

I had mailed candy from the U.S. - Easter candy on clearance, Christmas candy available in May!! It cost me about $60, which was not really within my budget, and I privately berated myself for sending idiotic stuff. The candy was for children of staff members (most of whom are impoverished), and was handed out just before Christmas. Several colleagues came up to me after the receptionist gave out the gifts, and were rapturous about the novel (American) candy, and stated how much their kids would love it: seeing all the smiles, and the parental joy, and the wonder at the novelties, the $60 became a worthwhile expense. I was delighted to share the goodies, and was very happy that all the parents thought well of the gifts.

Naren was in the annual city pantomime and I saw the show 4 times. He sang and danced with gay abandon, and that was fun to watch. The panto invites heckling from the audience and I obliged with gusto; several of the main characters (including Naren) heckled back and I loved it. One of them even said things like "Yo, hot lady at the back," which, of course, fills every vanity requirement in us older women.

The 3 Weiss men and I travelled to Coorg and saw relatives, then met the rest of the family at my sister Anu's place in Vellore on Christmas day. We did not really celebrate, due to my mother's passing last year, but enjoyed each other's company and ate like pigs. All came to our house for lunch the next day, as Chennai is quite the central point for onward train and plane journeys, and that was fun. Our cook, Ajitha, outdid herself with the meal and everyone ate some more. My sister-in-law, Susan, and her kids spent a couple of days with us and that was a blast: we went out to eat and saw a movie ("The Tourist"), which all enjoyed. The Weiss family went to Bhopal for a short holiday, and that was nice: so much grandeur in our own country.

It is now time to focus on Navin's exams for Class XII. They are mammoth, and require a lot of effort - from him and me. :) We worked on some essays together, and it was cool to spend that time with the boy, getting to see a different side of him.

Each day brings a new activity or requirement, and I am glad to have 3 months off to balance all of it. There are wonderful perks to being able to spend time with the family, whether in the midst of exams or not.

Hope your year is great!

Unw -

R