Report of 19 July 2011

Hello from the land of sunshine -

This is what it's like to parent teenagers and work and run a household and, and. Not as though I am the only person in the world doing this. This morning, the boys' room had the fan blowing on full without anyone in it (a giant waste of electricity) and when the younger boy came out of his shower acknowledging blame for this, there were 7 pieces of clothing in the bathroom. 7. Argh - I have told this chap before of the very same issues, and so a hefty financial penalty ensued. He even has to go to the bank to get the rest of the fine.

Time with both boys is otherwise wonderful - they are fun and funny and kind.

The Banyan has been good. I had a giant learning experience the other day. We have a non-Indian patient with a gender identity disorder: she looks female, but the male social worker suspected that she was male, and the senior coordinator asked that I examine the patient. The patient is floridly mentally ill, and refused to lie down. So the exam was done standing up. First mistake, said my father. The patient convinced me that his/her male genitalia had been offered to God, and there were no breasts, so I pronounced him male. A couple of days later, Leela, our able nurse, said the patient had been sent for an ultrasound and a uterus had been detected. Double argh. My father and I had a detailed discussion about this, and he is an expert at sex reassignment surgeries. It was an excellent learning experience, especially as I embark to the U.S. for a work assignment.

The week was fine. Naren was in a play for a competition. 10 ten-minute plays were staged last week and the best 5 are through to the finals; Naren's is one of them, and the director got "Best Director." She is an extraordinarily talented young person (maybe 22 years old), and we are pleased. 10 different plays will be staged this week and Naren is in one of those as well. Navin is usually delighted to show his support.

My father was up here, on our invite, to see the plays and to spend the weekend with us. This is not normally his cup of tea, he prefers lightning visits. But he agreed to come, and we hung out, saw the rest of the family at one meal. Then went to the plays, which were good. We also had a bunch of neighbors and friends over, and our old friends, Joan and Mohanraj, were kind enough to join us. It was a marvellous evening, full of bonhomie and good feelings.

Nothing like being in touch with the family, I assure you. Absolutely nothing in my world justifies fights and prolonged silences. It is nice to see each other, revel in each others' senses of humor, and have our children influenced by the goodness in our relatives.

Unw -

R

Report of 12 July '11

Hello from my living room -

There is a new kind of exhaustion: quite a bit due to sleep deprivation (for some reason, I could not get back to sleep last night after awakening at 12.30), and also a fulfilled kind, because I had a good day at the B.

Our patient with the possible seizures was evaluated, the neurologist agreed with the seizure diagnosis, and meds were started. Ms. P has fallen in the past and clonged her head, and there is a blood clot (a "hematoma") seen on the CT scan. This can cause some dizziness, etc., and I want neurosurgery to see if the hematoma needs to be removed ("evacuated"). I feel privileged to be able to take care of folks who have no others - and no money.

One of our older patients looks ill. It is patent on her face, and I asked for a heap of blood tests for Ms. V. The sodium came back very low, and I have asked for water to be restricted so that the sodium can creep back up. This is the joy of being an internist - that a blood test or two can tell you what a patient cannot. I had also thought Ms. V might have leptospirosis or malaria, but thankfully, she does not.

One of the ladies who cleans our apartment complex came to me, stating that her sister had not become pregnant six months after marriage, and people "were saying things." If a young woman does not deliver a baby nine months after nuptials, people "say things," and it is always the woman's fault. I asked for the lady to be evaluated at the local Public Health Center, but it has not been done as the mother-in-law does not approve. Right, then; our employee came quickly back to tell me and said, "I wanted to tell you because you'll shout otherwise." Correct; when this lady (our employee) had had belly pain and I was terrified that she had adhesions from her prior C-sections, she did not get evaluated as I'd suggested and I'd shouted at her, saying, "Who am I - just the doctor, right. You go ahead and do what you think is best." So she'd come back hurriedly to tell me her sister's update, and I appreciated it, telling her that we ought to wait for in-law businesses to settle. A little ire is sometimes justified, to me.

Mr. Vellodi, the senior trustee of the Banyan, turns 90 soon and the Banyan celebrated the grand occasion last Friday. It was a blast - plenty of bonhomie and camaraderie and enjoying each other' talents. Navin and I danced to a pulse-pounding Tamil song (Naaku Mukka), and it is on You Tube. We had not announced earlier that we were dancing, and the staff were surprised to see the physician jigging on stage. It was fun to dance with my son. My other son - just as good a dancer as this one - was rehearsing for a play and could not join us. There were plenty of other dances, too, and a cake was cut as well. All in all, a very fun and rejuvenating time.

Scott and I spent the weekend in Madurai with my father - talk about a fun and rejuvenating time. We ate, talked and laughed, and Scott and my Dad watched a little TV (I am not at all a fan, so did some work sitting in the same room as the men). Scott's gentle presence is very welcome to my Dad, and we spend a fair amount of time simply sitting and gabbing (and eating non-stop!). We also saw my friend, Tanya, celebrating her 50th birthday with her, and Mrs. Kurien, who did us the grand favor of examining my Dad's cook, who is pregnant and scared to go for checkups. It was nice to see both Tanya and Mrs. Kurien.

Unw -

R

Report of 5 July 2011

Hello from the B!

This is part of the joy of working here. One of the residents, Ms. P, now treated effectively for her mental illness and working in a beauty parlor, came up and mentioned that she was doing well. She had burst into tears at our last meeting, saying she was upset that folks were yelling at her. I had held her hand, told her to kindly ignore yells and gossip, and told her that we were all there for her; one of the other senior staff had apparently extended some special assistance with getting the psychiatrist to see her and she was grateful. She said even her mother would not take such good care of her. Ms. P is a young lady, with her whole life ahead of her, and with the mental illness nipped, I am watching her blossom and succeed. All joys. One of Bollywood's leading actresses had employed her once as a nanny, and Ms. P had flown to Mumbai (generating quite some envy - airplane rides are not de rigeur for our populace); however, she had not enjoyed her new environs or job at all, and came back. We are, indeed, quite happy to have her back. Whatever works best for her.

There is a new permanent occupant of the sick room. Ms. X has been falling often, and we need to make sure bones don't break. Every time she sees me, she speaks of her father, mother and brothers, mentioning them by name; I get near tears when this happens, because there is little chance that she will get to see them. She says she does not want a second marriage. When I looked at her file, I saw that she was rescued from the street, abandoned by her husband. With lack of family nearby or claiming her, and with the lot that befalls many women here, there is likely no attempt on anyone's part at a second marriage; this also saddens me, because Ms. X talks of it with some gusto. Certainly she states that she does not want it, but it sounds like a harking for something a tad happier - a nice husband, children, a life elsewhere. And this saddens me immensely. The Banyan is, consequently, a haven for me: that such ladies are accommodated and taken care of, so that even if their dreams elsewhere are indisputably shattered, we can attempt to rebuild their spirits and bodies.

Ms. X had had what I thought were seizure symptoms and we'd sent her for a neurological evaluation at the teaching hospital nearby; they usually do a very good job with our patients, and for free. I was not content with the subsequent diagnosis of vertigo, so sent a detailed letter to the neuro service, signing it with all my credentials. It looked like alphabet soup after my name. I usually avoid this, unless I want some extra care for our patients; then the MD (USA), AB, works wonders.

Scott and I had a day beyond amazing on Sunday. Neither boy was home, spending the night with friends, and we got up languidly, with no pressure to make breakfast or, indeed, do anything. I got a bunch of chores done, and then Scott, who was reeling under allergy symptoms, got up; we read the paper, had a nice meal, I talked to my father and sister-in-law, and then Scott and I managed to catch up on this and that. Scott is a phenomenally intelligent individual, with a very sharp wit, and a great love of India; all these make him wonderful company. We also got to play a game of euchre, a fun activity b.c. (before children), and it was a nice, relaxed, rejuvenating time. It was quite awesome. We had had giant issues off and on - with raising kids, the troubles that they routinely got into, the intense arguments that would ensue when 3 opinionated people went at it (Scott being the only placid person there) - and the fun in our lives had been a tad buried. Thankfully, buried in a shallow pit from whence it was easy to haul back out. I tell you, the day was more therapeutic than any other course of action we've been through.

My friend, Greg Brown, told me that his shenanigans as a teenager nearly caused his parents to divorce, and I imagine the stress of raising teenagers manifests at odd times. Or "all" times.

So the next morning, as both boys, of course, were their usual selves - milk mug not washed, dawdling over breakfast - I did a little dance and said, "In two months, this won't be our problem any more." In 2 months, both boys will be away at college, Insha Allah. Both boys were surprised, and Navin said, "Amma, you're not supposed to be happy at this." And then, when the jig continued, "I know you're just trying to cover up your grief." I laughed out loud, and when I mentioned the comment to Scott, his laughter matched mine.

We saw "The Green Lantern," and in my new Love Everything mode, enjoyed it. I especially like the supporting players in such movies, and thought Peter Sarsgaard did a great job. Way down in Australia, we caught the first X-Men movie, and old Michael Fassbender came through again. Naren just has to mention his name for my salivary glands to get into overdrive.

Right then, I'd better wind up.

Unw -

R