Report of 22 Jan 2012

Hello from sunny Chennai!

Perhaps the sun will pick up my mood. There are several people feuding around me and I detest it. There is so much more that can be accomplished through congeniality and working together. That said, we have often disagreed at the Banyan and the grand thing about Vandana and Vaishnavi is that they very avidly listen to a dissenting opinion. In fact, sometimes they urge expression of it; there is now a move afoot in Tamil Nadu (our state) to have the primary care practitioners recognise and treat mental illness, and I have said I am simply not interested in this. There is a reason each of us choose our specialities and forcing me to study psychiatry would be similar to my forcing a psychiatrist to learn the nuances of low sodium in the blood. At various meetings with Government and other authorities, Vandana has urged me to voice my opinion because, though it goes against the cause of treating mental illness, she would like the powers-that-be to learn firsthand why a provider might balk at this move.

The B has been grand. One of the folks that works at cleaning the place came and told me of her urinary symptoms. I suspect an infection and have asked for the urine to be cultured. Ms. K is an older lady, and has been with the B some years. She lost her son a few years ago, and she and I have commiserated on her loss and my mother's loss in the passing of my brother. We appear to understand each other well, and when my mother passed away 2 years ago, she said, "Oh, now your mother has joined her son." She weeps on occasion about wanting to do the same, and I have said it is not her time yet. I have told her about this infection, that we will test it and treat it, and that she must not fret. She composed herself a bit, and appeared to be mollified. Truly, it is grand to be able to treat someone, make them feel better, and to do this in the course of a day's work. Especially if they are impoverished, and appear to have little other hope in their life. Ms. K told me that she had saved money and bought herself a gold chain. I was delighted!! Gold is a very big deal in India and a sought-after possession of the average Indian woman.

Training continues magnificently, and this week, the health care workers (hcw's) and I spoke of First Aid, and "First Aid for a healthy life." There were grand suggestions, including "One partner for each person." I had to tread a little carefully here, because the highest incidence of HIV used to be (I wonder if it still is) among monogamous wives of men with more than one sexual partner. I told them I did not mean to pass judgement, but for them to be careful. All were very matter-of-fact about this: there is tacit acceptance of men's philandering. Sad, overall; I do, however, want the wives I am in contact with to be careful. The women are bright and motivated and do not need to be told anything twice. The issue of alcohol use also came up, and I told them that I was fortunate that I did not necessarily have to address this with women in India (certainly some women drink and drink to excess, but it is not the norm); some women whose husbands drink provided valuable input on its cost - financial and otherwise.

I saw some movies - alone. A Tamil one, "Mayakkam Enna," had Naren's friends in side roles and they did well. I also saw "Coriolanus" and it was spectacularly dreadful. What Ralph Fiennes thought of having Shakespearean dialogue among current day costumens is just beyond me. It is probably one of the worst movies I have ever seen, the hottie Gerard Butler notwithstanding.

Scott, Naren, Navin and I Skype'd today. It was grand fun, though Scott's and Navin's mics did not work and they had to type. We are to do it again next week.

Unw -

R

Report of 15 Jan 2012

Happy Pongal!

It's the harvest festival today, and is a merry time. Our cook's little daughter and nephew have brought me some traditional foods prepared at their house, especially the sweet pongal - rice made with brown sugar and cashews and butter. It is considered good luck to eat this today, and as it's not usually made in our house, our cook likes to make sure we get our fair share of the good luck. Nice of her. The 2 young couriers were delightful in their new clothes and chatter.

The Banyan has been fun, as always. BALM held a seminar on "Employing the disabled" and it was excellent. There were intellectual glitterati from several spheres, and I learnt a lot. We were privileged to have Vaishnavi, the other founder of the Banyan, with us. Vaish has taken to doing other things now, and is a powerfully intelligent (having taught herself computer networking, and medicine) young woman with quieter ways; she writes extremely well and has a fine sense of humor. She is also given to seeing the perspective often less seen, and I usually sit mouth agape as she takes apart a concept, or puts forth some issues to be addressed with the Government, or offers yet another prospect for us to consider. I tell you, it is nice to work with intelligent people.

The seminar also had 3 success stories of Banyan women successfully employed. One of them now makes enough money to have her daughter with her, and they live in a house with a few other women; she stated that the fan and TV (an integral part of several Indian households - maybe not just Indian, huh) were paid for by her and that her daughter's expenses were met by her. She was visibly proud as she narrated this and I was pleased. She also thanked the crowd for their affection and attention in listening to her, and that was extremely humbling. I have met the daughter - a bit dour on the day I met her as she was ill - and am pleased that she is with her mother now. Several of our residents' children are in orphanages and boarding schools until the mothers can care for them. Our college-going next gen lady, Kaiser, is now in her 2nd year at a local college and thoroughly enjoying herself. She comes to the B on holidays, and is then everyone's daughter coming home for the college break. Her mother is okay, but not well enough to care for Kaiser on her own and Kaiser is so enjoying being in the dorm at college that she will be left there. We have gone to visit her there off and on, with sweets or chocolates in hand, and Kaiser is usually gabbing with a gang of friends when we have gone. She is visually impaired, but nothing stops her from enjoying life.

The B is undergoing renovations and the sick room - where the acutely physically ill are housed - has been shifted twice. It is now in a fairly airy area of the 2nd floor, and the patients seem happy. We have had unexpected rains, but hope that the dreaded gastroenteritis, which will result when sewage contamination of regular water ensues, will be kept at bay.

Naren is off in Bangalore today, performing at a pub with a theater group from here. Navin sent a note stating that his mid-terms had finished. Scott will visit him today, and then leave for South Carolina, where he has an assignment. I went to visit a friend of my mother's, widowed for around 3 years and very lonely; we had lunch together at her house. Ms. S is very wealthy and childless, and feels that she is being engaged by friends and relatives who appear to be nice to her only for the sake of her wealth. What an appalling state of affairs, my sister-in-law Susan and I agreed. I think for those who do not have interests to pursue, loneliness can be overwhelming. There are certainly things to do in Chennai, but I think Ms. S does not have the wherewithal to pursue any of them.

The training of the health care workers goes along swimmingly and I am very fond of these bright young ladies. We now have them role-playing various situations at work with the patients, in an effort to remind them of the need to treat patients with love and care. We are aware that they are short-staffed and overworked, and it must be tough to keep calm when the same patient asks for the umpteenth time to be sent home. The role play went well as did the class on the importance of vital signs. It is wonderful to work with such interested students! After the classes, I passed out some sinfully good, "foreign" (i.e., not Indian and thus, novel) cookies that visiting student Neelima's mother had kindly sent me and they were well-received; I got lots of thanks in return. Naren and I certainly do not need more sugar sitting around our house, and it has gone to those who would otherwise not have a chance to taste such goodies.

No movies this week. "Tinker Tailor Soldier Spy" played for 1 or 2 weeks and pushed off before we had a chance to book; I am disappointed, but perhaps we'll catch others. In D.C., I had wanted to see "Shame" - being a huge Michael Fassbender fan - but Scott and I were busy sleeping and eating out and shopping to fit the flick in. Given the content of the movie, I can guarantee that it will never make it here. Shame. :)

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R

Report of 08 Jan 2012

Wow -

Trying to stay awake is probably harder than trying to get to sleep. I have been prescribed a muscle relaxant and it sedates so much that I think I won't take it tomorrow; I do think I can live with a little pain. I have had some physical therapy, and that is bound to help; I am a huge fan of the allied health professions. The physical therapist is a young lady, very enthusiastic, and she administed Inferential Therapy - or an electric current and heat - to my cramped muscles, and also some ultrasound. It felt good while I was getting it done. I now know why massage is so popular; the touch is therapeutic and soothing. Not to be sexist, but to me, probably a bit more so if the therapist is female: there is just something nurturing about women, isn't there.

Being a patient often clues me in as to how I must be as a doctor.

The B has been wonderful. Our deaf-mute patient, Ms. S, suddenly swelled up all over ("anasarca"). I suspect kidney involvement and asked the nephrologist to see her; Dr. Suresh is a good friend, and a firm believer in care of the indigent, so my patients get fine treatment by him. The official word is that Ms. S has a urinary tract infection, but I do think there is a bit more to it than that. Ms. S is a young person whose uterus is prolapsing (coming out of her main body cavity) and she likely needs surgery for this. When the enthusiastic med students ("The Texas Team" or "The Banyan Bunch") took class on physical diagnosis, the issue of uterine prolapse generated a lot of questions. I remember a resident at St. V (in Indianapolis, where I trained) stating that she would opt for a C-section whenever she got pregnant and was ready to delliver, as she wanted to avoid this very issue. Ms. S is a mystery: she does not know sign language and has asked repeatedly to return to her family. We have absolutely no way of knowing where the family is, and it is fairly frustrating all of us. Perhaps we'll resort to a TV ad before too long, if we come up with some cash.

Vandana and the team of the Banyan Academy of Leadership in Mental Health (BALM) asked me to join them for a meeting about training, and I did. Vandana is a visionary individual, and grand fun, so the meeting was very enjoyable. It was punctuated with a lot of laughter and good humor, too, which epitomises all of what we do at the Banyan. I've been at other assignments where my place in the food chain was made obvious to me and work became humorless after a bit - but that is not the Banyan! We are fairly full of chaos, but also good actions, easy camaraderie, and a sharing of the vision of a 21-year-old and a 22-year-old, both of whom thought they could make a difference in the lives of mentally ill, destitute women - and indeed, did so.

We had 2 British volunteers, Sam and Martha, spend the night with us 2 days ago. They are just about Naren's age, and all enjoyed their company. Following morning, my nephews, Aditya and Vikram, joined us for breakfast at one of our favorite restaurants and that was a grand time: 5 powerfully intelligent youngsters in their 20's, some wonderful sausages, eggs, fresh fruit and all manner of juices, and some scintillating conversation to boot. Martha and Sam were effusive in their appreciation, and I do not know at all what I did to deserve such thanks: we talked, we ate, we hung out - c'est tout.

Naren and I spent a fun Saturday, booking movie tix well in advance and going to see "Mission Impossible 4" and "Sherlock Holmes." MI4 was dreadful, and SH was more enjoyable. I will see a couple of movies now just to stay awake until bedtime. This is one of the things I miss most about the U.S. - walking into a movie theater, tix being available and I sitting wherever I want and watching the flick; in Chennai, we have to book days in advance (for any movie), tix are often sold out and the seats are numbered. Also, a woman going alone to see a movie is extremely unusual.

Navin is fine at Rose-Hulman and is buffing up his driving, as he is due to try for a U.S. driving licence soon. Scott and I talk regularly, and I am super glad he is with his family because running 2 farms can wear anyone out, much less 3 folks in their 70's (Scott's mother, aunt and uncle). These 3 folks are among my favorite people in the world, and I was fortunate to spend some time with them when I was there; I always leave rejuvenated. Scott told me he had had to buy new pants; I watch our budget like a hawk and when I heard that he had helped his uncle with a cumbersome chore, I told him he could buy caviar if he wanted as he had done something for the relatives. Scott laughed out loud: it was a nice sound over a long distance telephone line.

It's a good life, and I feel privileged to be in the profession.

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R

Report of 01 Jan 2012

Happy New Year!

The blog is still makkarfying (causing hassles), so I'll have to write thus.

It has been a nice couple of weeks. The students were good fun, and to a person, appear to have liked the Banyan. This is the first time students have spent 2 weeks here. (A beloved friend, Greg Brown, came as a student, then an intern, resident and attending - the latter 3 in the "Banyan fan and good friend" category. The most recent time, he brought a love interest, Luciana, who quickly became our love interest, also, she is that sweet and accepting of all of India.) The students have worked hard at doing physical exams on the patients, very thorough ones which I have not had the resources to do. We have picked up all manner of pathology and that is good for the patients, students and us. They also conducted a class for the health care workers and experienced the same joy I have, time after time - the interest from avid health care workers who want to learn and learn, and do, and heal, and cure. The session was good learning, and easily overran the time allotted.

The students finished up their time with an entertainment performance. This was to be in the nature of a fundraiser, but that was logistically infeasible during the holiday break, so, at Naren's suggestion, the students performed for the residents. And it was well worth the effort. They did a Texas line dance, and it was fun - replete with the performers in blue jeans and cowboy boots. The crowd loved the novelty of it, and the zeal and consideration of the students in performing for us, and the students had to do an encore. Naren and I danced to a new Tamil hit named "Kolaveri." It's a slow song, and not a pounding Bollywood number, but it was fun to dance with my son. He was the only man to perform, and a man dancing, of course, made the residents very happy. There was a finale, with many of the residents climbing up on stage and dancing, and Vandana and I watched Ms. E, the lady mentioned in my previous report: she danced in perfect rhythm, with pure joy and a wide smile, feeling the music and moving in perfect time - the trauma of her past as a sex worker all but forgotten, the core-rattling of her brother selling her into the profession submerged under wonderful, therapeutic music and dance. It was riveting and inspirational to watch her, and Vandana and I shared the same sentiment: what on earth do we complain for - that our bellies bulge and our pants don't fit and our skin is sallow. A look at Ms. E and all these concerns seem minuscule.

There is another patient who speaks English, and she shared her story with the students: one of drug use and drifting away from her family. There have been men and at least one child, and it appears that the drug use phase has passed, and Ms. T is ready to reconcile with her family. Her brother had come the other day and that I always find heavenly: our ladies crave family contact and said families usually don't contact. So we become the surrogate family, and try to do our best for the patients, and know for a fact that we would also, in addition to the residents, give a lot to have their families visit.

I forgot to mention that one of the gifts the students gave me is a framed photo of the 5 of us, outside the Banyan, all smiling and in Indian clothes and revelling in the pure joy that the Banyan is. It is a very nice picture, and is a good memento of the students' time here.

For New Year's Eve, a friend got us subsidised tickets to a party, and all 6 of us went. I danced practically from the time we got to the Boat Club, moving away only to rest my ears from the booming music. My friend's whole family was there, including his mother, who is a dear friend also, and we spent a very pleasant evening. The students mentioned having fun, too. Naren dropped all of us home and went to another party ('tis the age, is it not), then meeting up with his girlfriend. I had brought the lovely (inside and out) young lady a tank top from the U.S., and she told Naren she liked it; when I was shopping with Scott and had picked it out, he said, "You see, this is the difference between men and women. You buy her something sexy, I would have bought her a turtleneck." I laughed out loud at this - in the store and all the way to the car. Naren agreed with his father.

On New Year's Day, we visited some friends to seek their blessings and luxuriate in their affection, and had a most lovely visit. We also got together with the students for dinner at our house, and exit interviews, and that lasted 5 hours - full of chatter, their intelligence manifesting in wonderful ways, and laughter.

Let me end by wishing you a very happy and healthy New Year - 2012. May you get what you seek.

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R