Report of 30 Sept '11

Hello from Texas!

I finished a lunch of very good Mexican food, and am hanging out at my old med school. If I stayed in one spot on my days off, I would likely be rested; however, being back at school is rejuvenating. I have had splendid, intellectually stimulating discussions with a variety of professors and students, partaken of fabulous food, met up with a very fun classmate - all good.

Work was fun, and being 7 days on did not seem as exhausting the 2nd time around. I still had my fair share of patients, including an older gentleman with myasthenia gravis who had had trouble breathing. His family brought him in to die and he recovered very nicely; I was delighted because the 80+ gentleman was full of wit and charm and all things classy. The family was puzzled and, in some cases, irate as they had been given a bad prognosis; I mentioned that I was actually delighted with the outcome. Even the family pastor asked after a fashion, at our initial meeting, when death would happen and I was a bit surprised at that. So the patient recovered well, we spoke of sending him to a different rehab facility and then he abruptly died. The terminal stages of myasthenia are unpredictable like that, I imagine. I was saddened, however, at the - to me - unexpected demise, but Scott said the patient had had comfort in his last days and that I should focus on that. This is why good spouses are nice to have.

A patient and his wife were on their way back to Des Moines from North Carolina and they stopped in Indy. At that point, the patient's pacer/defibrillator (a device placed in the heart which would shock it if it went out of rhythm) went off multiple times, knocking him to the ground. He was brought to the ICU and placed on a ventilator; when I saw him, he got a little unstable with his blood pressure and heart rhythm and we worked to stabilise him. The ICU team of nurses was magnificent and I was grateful for this excellent support. The patient recovered enough to be responsive, but regretfully, coded (got very critically ill) again in the evening. The cardiologist ran the code and it was futile, which the patient's cardiac nurse wife fully expected. She asked that we terminate the code, and the patient died. I could not leave the patient's bedside for a while, thinking we had not done enough. The wife's class and grace helped the situation immensely, and at the same time, made me feel doubly like a heel that I had not done enough.

So, I finished an exhausting week and boarded the plane for Texas. We were, unexpectedly, a little bit late getting to the airport, which I do not enjoy at all, and Security pulled me aside for a "random" security check. I ordinarily never mind this, but was annoyed this time. Random? I was the only dark-skinned traveller there, and after me, a similarly dark-haired traveller got chosen as well. Unabashed racial profiling, as happens apparently in all Israeli airports, would be refreshing honesty. Also set people up for refreshing lawsuits.

A bunch of us met at the home of Dorothy and Vick Williams (Vick is a former professor of anatomy) to celebrate the 60th b'day of Greg Freeman, former prof of cardiology. Sara Luduena (a former prof's daughter) and her friend Madeleine, med students Neelima, Lisa, Caroline and Andrea, Greg's secretary Elvia, and I met to greet Colleen and Greg Freeman as they walked in. It was a surprise party with Indian food, and Greg appeared to enjoy it. I was grateful to Dorothy and Vick for hosting.

I then went to the home of Linda and David Johnson; Linda is a professor of anatomy and Dave is a pediatrician. It is always therapeutic to be here, the Johnsons' perspective on life and their senses of humor are salve, and we talked for a while, greeting Dave who had returned from the grocery store with Therapia de San Antonio - Blue Bell Homemade Vanilla ice cream. I get spoiled here routinely.

The following day, I spoke to med students at an event hosted by the American Medical Women's Association (Amwa). The talk was about the Banyan, and the intrepid patients' stories spoke for themselves. I got a lot of questions after the talk, and am still fielding them as I sit in the library. One of the questions has provoked some soul-searching: what made you want to do philanthropic work? As Vandana and Vaishnavi have hastened to assure people who think they have sacrificed their lives to do this work, with the info that this is what V and V *want* to do, I too am doing what I *want* to do. Why? That's hard to say - because poverty should not limit access to care; because very good professors in a fine medical system taught me to treat the illness and not base treatment on the size of wallets; because I like the smiles of the impoverished when they realise they mean something to me.

I rounded with Greg Freeman yesterday and saw some cool cardiology cases. Greg is robustly enthusiastic about teaching and I always learn something new when I am here. He is also a funny guy, and we laugh quite a bit in the course of the day. In the evening, my classmate and friend, Katharina Hathaway, made the trip from Austin to have dinner with me and that was a blast. Katharina does a lot of work with refugees, including those from Myanmar and Bhutan - definitely countries from my neck of the woods - and we had a good time talking of it. She has done some going-the-extra-mile work with ensuring access to care for this marginalised populace, and appears to love what she does; I can fairly guarantee that her patient populace is grateful.

Today, I went to pediatric Grand Rounds with Dave Johnson and appreciated the chatter on the way up. I stopped by the office of Alumni Relations and saw Sonia Rogers and David Perryman, fine folks there. We had a good time catching up with their work and family lives; they are efficient, personable and nice people. Today, I have also met separately with Dorothy and Vick Williams, on issues of faith, and have thoroughly enjoyed the extraordinarily intelligent viewpoints from a couple of deep thinkers. I will always be grateful to the Williamses for indulging me.

The 4 med students mentioned above are coming in December 2011 to work with us at the Banyan, and we will meet for dinner tonight at the Johnsons' to discuss that. The planned dessert: brownies and Blue Bell Homemade Vanilla.

Last week, Scott turned 50 and we ate at a very lovely restaurant recommended by a nice colleague. The service was very good, Scott got a free dessert, the food was very well-made, and the evening was memorable. On my request, Scott wore his new suit to dinner and looked very dapper. On our way out, it started raining and that is a very auspicious sign by Indian standards - likely based on the fact that we used to be a predominantly agricultural society, but I'll take the good fortune.

Calling home will have to be done this weekend, and I look forward to it. Both our sons are well, thank goodness, and Scott and I are slowly getting used to the fact that both young men are now out of the house, living their lives.

Unw -

R

Report of 19 Sept 2011

Hello from Greenwood, Indiana -

I have a few days off from work, and the socialising has been as exhausting as the working - in a different way, of course. My work shifts are 7 days at a time, 7 AM to 7 PM, and the days are long. Hospital medicine is good, though - the patients are truly sick. In outpatient settings, they could come in for anything. Or come in for 1 thing and mention 4 to me when I got in the room. Certainly, complications can set in, in our hospitalised patients, but there are some that one can anticipate.

The lack of the weekend takes a bit of adjusting, but days off include weekdays and those are nice. So, after working 7 days, I get 7 days off. And a weekend certainly does feature there, which is nice because Scott does not work then and we go off and do fun things.

The patient who used to be an IV drug user was re-hospitalised with a kidney infection and this time, she had an upset stomach, too. When one takes antibiotics, they can cause diarrhea, and that is indeed what she had: Clostridium difficile colitis, and I treated her for it. She was doing better by the time my shift ended, and we spoke of things such as her return to school. She would like to do behavioral science or psychology, and be a substance abuse counsellor. This is good. As she put it, "I would like to tell folks who think their situation is hopeless and they have to do drugs and there is no other way, that there IS another way. And I found it." Some of the best substance abuse counsellors are those who have recovered from it themselves.

There was another older patient who needed her gall bladder taken out. She was extraordinarily sweet and all - nurses, doctors, techs - loved taking care of her. I tell you, there truly is some truth to the adage "You can catch more flies with honey than with vinegar." I don't particularly like the fly analogy, but it was a great pleasure taking care of this patient. One day, her pretty grand nieces visited along with the fiance of one of them, and my patient had a very good visit. It is extremely therapeutic - usually - to see family.

Speaking of which, I talked to my Dad last week. He had received the "Plastic Surgeon of the Year" award from the Association of Plastic Surgeons of India, and was pleased. I was happy for him that he had got this award and we talked at length of it, and other things. Awards certainly float his boat: to each their own. I also talked to Naren, who just finished a small movie role! We talked and laughed about it, and it was good to hear him.

Some of Scott's relatives, including a beloved aunt and uncle, and his sister, joined several fabulous friends last weekend to celebrate his 50th b'day. A grand time was had by all, including the b'day man. A couple of our college friends, Cathy and Mike Monteiro, also came up for the party and that was therapeutic - to talk of old times, compare kid notes, parent notes (all of us are at the age where taking care of parents features in conversation), etc. The Tabers, Olivia, and Carolyn Scanlan and boyfriend, Andrew, rounded up a very nice gathering. Olivia spent part of the weekend with us and that was nice.

Before Navin left for school, we had visited Theresa Jefferson, who is an exceedingly lovely lady, and I was happy that he had been blessed by her. We had seen Kris Rea and Gabe Soukup (Navin's boss) and daughters as well, and that was like getting together with family; Navin particularly appreciated their kindness.

I met some former colleagues at Elwood and Alexandria and we had lunch, which was great fun. Some former colleagues at St. V and I got together for lunch with the former manager of Medical Education, Jim Hillman, and his wife, Brenda, and that was nice. Navin came up from college for Scott's party, and it was great to see him; his hair is wild and woolly and he is figuring out his way at college - it was challenging not to direct operations wtih this young man, and to take a back seat and let him do his thing, with his education. Our wonderful extended family - Colleen, Mark and Christopher Taber - took Navin back to school, and Christopher to Indiana State University, also in Terre Haute. Scott and I then saw "Contagion," courtesy a gift certificate from Olivia. I had earlier seen "The Guard," which was truly magnificent and "Crazy, Stupid Love," which was very good because I could easily get an eyeful of Ryan Gosling.

Time to wind up. Hope all are well.

Unw -

R

Report of 6 September 2011

Hello from Greenwood, Indiana -

It has been several weeks (5!) since I blogged and I have missed it. Blogging is a tad complicated by the fact that apparently a relative uses it to keep up with the whereabouts of the spouse and they then get into huge fights. This is bothersome and has taken away my love of writing, but this love is slowly returning. I have never seen a point to fighting or to snooping around, checking cell phones and messages, etc., for people's activities. One of my aunts has called it "cracked." To each their own, I imagine; it is nice that neither Scott nor I has to resort to alternate means to locate each other.

We left India on 8 August and spent 2 grand weeks at the home of my residency classmate and rheumatologist, Kris Rea, and her husband, Gabe Soukup. These are some of my favorite folks and Gabe owns a franchise of "2 men and a truck." Both K and G have battled some tough times, and have cores of steel and hearts of gold, and I wanted Navin to work with Gabe. Gabe promised no favoritism, which I welcomed, and Navin passed the movers' test and started working. He worked with some tough young men, including those who had once been incarcerated (he liked that Gabe gave them a 2nd chance), and learnt some invaluable life lessons. He wisely kept his mouth shut during arguments - a skill his mother is yet to learn - and earned some good money. I took him out for lunch one day at "Applebee's" and he looked at the menu and said, "This is so expensive." I liked it. He is paying for himself now, and knows the value of cash. K and G's young daughters, Isabella, Rosalia and Gabriella, were their usual loving selves, and Navin and I had a great time there.

We did visit the farm and catch up with relatives, including ailing ones. It was nice to sit outside and shoot the breeze with folks.

Scott came on the 25th, after I got teary on the phone with him. Navin and I had been at McDonald's, and some very scantily clad young women came by, then sprawled sexily on the Ronald McDonald figure to take photos. This was core-rattling - the culture or abject lack of it - and I requested Scott's presence. The nice thing is that Scott is set up to work from here and that has been therapeutic. We took Navin down to Rose-Hulman, enjoyed the orientation and magnificent speech by the president; among listing the students' achievements, these words: "You may be gay, you may be straight, you may not know. Differences are not a threat here, they are learning opportunities. We are Rose-Hulman." I was thoroughly impressed. There were upper-class students available to carry incoming students' things into their dorms, and I thought that was a nice touch. Navin beamed from ear to ear when meeting his chair and his advisor, and seemed happier than we have ever seen him. The welcome at R-H was palpable and we left feeling that Navin was in a great school, and I with a lot of relief that Scott was alongside.

I oriented at Community Hospital South, and started work last week. It is fabulous. I have not done hospitalist medicine before, i.e., taken care of inpatients. It is grand fun, though. It is nice to take care of the truly sick. As I left the room of a young (21 yo, not much older than my sons) ex-heroine addict who was admitted for a serious kidney infection, I heard a faint "Thank you, Dr. Weiss," and she had my heart rightaway. How fortunate are we who have robust family support, loving and guiding, so that we did not have to resort to intravenous substances for our joys.

Naren is well and enjoying his solo time in our apartment in Chennai. He is 20 and sensible, and so we have not had to lay down ground rules for him. He went over and wished a beloved neighbor on his b'day, and our friend's wife emailed and told me how kind that was.

We had a bunch of my colleagues over for dinner and it was a blast. We have also caught up with the entire Taber family - who are our home away from home. I love both Taber kids - Melinda and Christopher - dearly. We have also seen the Sparzos, Carolyn Scanlan, Mary Remster and Shilpa Mallur and their families. All lovely people, all dear to us, all wanting the best for Navin (and indeed, the entire Weiss family), all part of the support that ensures joy from their being and not through IV.

Unw -

R