Renu's Week

Sunday, March 25, 2012

Report of 25 Mar 2012

Hello folks!

We have eaten pizza - a rare treat - and one young man is sound asleep. I've also eaten an entire packet of jackfruit and some watermelon. Fruit is such a fine thing to have and I am trying to match Naren in the "No added sugar" department; he is doing better than I.

We are well, the B is great. Naren and I had philosophical discussions about whether I ought to be embarking into full-time private practice. BUT, I so love what I do and have time for myself that I don't see this changing. It is nice to heal the poor, and teach, and dance and write and read.

We had a lapse the other day at the Banyan with my not being notified that a certain patient's toe was fractured, seen on xray. I was furious, sad and disappointed, and Leela and I let everyone have it. We got to the source of the problem quickly and have tried to rectify it so that there is no repeat; the staff are accepting of this and no one is holding ill will towards us. Again, that's one of the grand joys of working here - when we must reprimand and discipline people, they know it is for the ultimate benefit of the patient.

Our deaf, mute patient, Ms. S, has asked to go home again. We've been over this, and have tried to teach her sign language, but the NGO that did it found that she did not have the comprehending ability to learn it. So we are back to square one, with no way of knowing where her house is as she cannot write. It is a frustrating position for all.

Training has gone swimmingly, and this week, we discussed female issues. We talked about the menstrual cycle, and pregnancy, and sexually transmitted diseases - the incidence of HIV being the greatest in the monogamous wife of the philandering husband. It was a candid discussion, and extremely rewarding for me as a teacher.

Vandana had a meeting last week, for which all of us gave up our responsibilitiies, and she told us of our lack of responsiveness, accountability, etc. She is off to do much bigger things and is changing the face of homelessness and mental illness on a national level (with great ease, I might add), but the B is not doing very well from an admin standpoint: emails unanswered, donors not thanked, etc. So we will brainstorm next week for suggestions. Rane, a big corporate house here, ran a training session for us last week and I enjoyed it. We hope for improvement - the truth is that many of us do this work due to the personal charisma of Vandana and Vaishnavi.

One of our two senior health care workers, a very lovely young woman, got married today and Naren and I went for the wedding. It was in a village about 1.5 hours away, and was at 7.30 AM; so, if you do the math, we had to get up at 5 AM and hit the road an hour later. The scenery was pastoral and gorgeous, and the wedding hall festive and lovely. I met Koliamma's parents, who came down from the dais to greet us, and spent many minutes talking. We had an excellent breakfast, and when we went up to greet the couple, that was the first question Koliamma asked me: "Doctor, have you eaten?" We chatted a bit, and laughed, and took a photo, and Naren (being half-white, tall and hairy) got a lot of attention. Koliamma's grandfather then asked that I look after her - she chose a husband who worked in Chennai and who would let her continue working at the B, to our great relief - and I promised; "like a mother," he said, and I realised that I was indeed that age. It was a fun wedding, and to get the knowledge that we have improved a young woman's economic status and given her financial independence was very heady. I gave K a sari bought at Nalli, a very prominent sari house. I think all impoverished people must get saris from Nalli, just as they must get U.S. chocolate. I have felt that the expensive coffee in doctors' lounges at hospitals must instead be given to the custodial staff.

I saw "Kaadhalil Sodhappuvadhu Eppadi," a Tamil film, and went alone for it - always very risky in India. It was very good, and I am glad I went, on Naren's recommendation.

Shortly, the 3 Weiss men and I will Skype. That is always grand fun for me.

If any of you have suggestions on how to improve email response time, and ensure that all emails are answered, please would you let me know soon. Thanks.

"After all is said and done, more is said than done." - Unknown

R

Sunday, March 18, 2012

Report of 18 Mar 2012

Hello from sunny Chennai!

It is hot. The only cool place is our tile floor, and I have lain on it and read The New England Journal of Medicine, which Dr. Love kindly saves and sends me when he's done reading it. I like this mag: it is well-written and challenges our knowledge base, plus gives us a whole lot of info to build on it.

The B is fine. Kovalam is good. Last week, one of the staff members brought her daughter to be seen. I am unfailingly honored when colleagues bring family members to be seen by me. However, this daughter was 8 years old and I am not a pediatrician. Anyway, I saw her because she had a simple enough stomach ache, likely from eating chicken that was left out for a few hours. I asked the mother to give the child acetaminophen, and asked if the child liked soft drinks; yes, so I recommended them. This is the only time my pedatrician sister allows soft drinks in kids: when they are sick with belly pain or fever or vomiting or diarrhea. My young patient was delightful, and I asked how she was doing in school; I suggested she enter my profession so that we could work together. This little girl was like most Indian little girls, with pretty brown skin, great big expressive black eyes, and jet black hair tied in a braid. Thankfully, I found some Dora stickers in my bag and handed them over - beats candy. I phoned Kovalam the next day and heard that the child was well enough to go to school and after-school tutoring. Halleluia!

Ms. E has taken to hanging out in my room for a bit. She had leg pain, and the xray did not show a fracture, so I prescribed some pain meds. Ms. E also spoke extensively of her life in Mumbai, in the red liglht district, with a great big obese woman as her Madam. Regretfully, I did not have the stomach for those details and changed the topic. Ms. E spoke of her married life, of cooking for her husband, how he would not eat if she did not, how he would slap her if she wasted food (this gesture interpreted as some weird demonstration of love). As the psychologists doubt if Ms. E has been married at all, I simply let Ms. E talk - unknowing if the picture was accurate or not, but seeing that it gave Ms. E some joy to speak of a life that may or may not have existed.

Training goes along swimmingly. We spoke of cancer, and this generated a ton of interest. We spoke of cervical cancer, and that young people became sexually active early in the West. Lest each of us became holier-than-thou and judgemental, I mentioned that our practice of turning a blind eye to adultery could also lead to deadly diseases. We get into philosophical discussions, too; some cancers' risk factor is poverty and we spoke of that.

Mysteriously, I have been exhausted of late. Might be the sapping heat. I am also disappointed with our (the Banyan's) financial state of affairs, that we cannot do all that we want as we are so short of cash. We have outstanding personnel, and perhaps in time, we might be solvent. I am also a little puzzled at the number of people all over the world who ask us favors: if they would help with the same zeal, that would be grand, would it not.

I had a delightful letter from the Bartons. We met in Greenwood, and Scott and Navin had visited them recently. Mrs. B wrote with a lot of affection and I enjoyed the note. The Bartons are very nice folks, and we had had a good visit with them before I left the U.S. It is very therapeutic to make new friends.

A friend and I saw "The Vow" and enjoyed it. I like Rachel McAdams a lot. Naren turned 21 last week and we went to breakfast at the very upmarket Hyatt ("Ek din ka sultan," my mother used to say, "Sultan or king for a day," meaning splurge for a brief moment). We had a great meal - sausages and eggs, very non-Indian, by our choice - and then, when I asked for the bill, the manager said the Public Relations Manager had taken care of it. Que??? Enna?! Naren had done an article on the Hyatt for a magazine and apparently, that merited extra attention. Scott and I laughed and laughed; we've lived here for 9 years, and when was the last time our jobs merited a complimentary meal? Never. We do live off our children. Yesterday, my nephews, Aditya and Vikram, joined us for pizza and that was joyous: I love listening and talking to young people. I also greatly appreciate getting together with family. It was a treat for me to pay for the meal; I like this state of affairs, when I can treat folks. Afterwards, Vikram, Naren and I went to see "This means war," and enjoyed it. The men were kind enough to let me stop at Ethiraj College beforehand and try to see Ms. K, a Banyan patient's daughter. She was not there, having gone to Loyola College for a sports meet for the disabled (K is legally blind). I received a good report on Ms. K, that she was happy and doing well; I had known that, but to have it affirmed by her peers was good.

Scott, Navin, Naren and I skyped today, and again got into a trans-Atlantic argument. I do not tolerate lack of respect at all, whether in person or a phone call, and let everybody know that. The men assured me that it had been inadvertent on one of their parts, and we wound up amicably. I spoke to my Dad today; he had returned from receiving yet another award, this time in Nagercoil. I've mentioned before that these totally float his boat, and we gabbed for a bit, chuckling at his choice of words for some situation. He will visit us on the 31st, which he appears to look forward to, and I was glad to note that.

"Parents should conduct their arguments in quiet, respectful tones, but in a foreign language. You'd be surprised what an inducement that is to the education of children." - Judith Martin

Unw -

R

Monday, March 12, 2012

Report of 11 Mar 2012

Hello from Chennai!

It is dark, I am tired after a long day's work and I want to write.

Work is good. Last week, a gypsy came to our clinic in Kovalam. She had not bathed, and was a bit smelly. I asked for the door to be kept open, and for the hcw to educate the patient on hygiene after I'd seen her. She wore a swirly skirt, as gypsies do, and not the sari or the salwar kameez (the pants and long tunic); there was also a short midriff-baring blouse and a sash over the whole ensemble. It is actually a very sexy outfit, and young gypsies look very attractive in it. My patient had come with her brother's daughter, who appeared to have a mental issue. As I started my visit with my patient, she mentioned how tired she'd been and how she ached; I probed some more and, pending blood tests, prescribed a rather tasty iron tonic. I asked the social worker if this lady could have a bath on our premises next time and she acquiesced; so I told my patient about the importance of hygiene and all of us suggested she bring clean clothes next time and bathe at our clinic. She mentioned that all of them bathed in some river, and the water was not the best; they also slept in the open (being homeless), and a cow had stepped on her leg and caused a bruise. So I examined the wound, prescribed a pain pill, and explained my various therapeutic maneuvers in some detail. At this point, the patient got teary; I asked what had happened, and she said, "I have come for 5 days, wanting to see a doctor, and ...," and then she looked at me with such gratitude that I pretty near got teary myself. I narrated this to Naren later, mentioned that I'd managed to maintain my composure to his great relief, and both of us laughed at the prospect of a blubbering doctor seeing a patient: pretty darn hilarious, I tell you.

Back in Adaikalam, Ms. E was released from isolation and came to see me. She is very young, and complained of back pain, which is somewhat unusual in the young but not in our patients. When I saw her again, the simple anti-inflammatories had worked and she was so cheerful that the bright smile she gave me fairly glowed. She walks with a slightly odd gait; it is customary for sex workers to be tortured here and I was sorry to see Ms. E walk this way. She was, however, extremely happy and that had big lessons for me, as always.

Women's Day was celebrated with grand gusto at Adaikalam, and the residents and staff played games, chilled out, etc. One of the residents was so overjoyed with the proceedings that she sang a song to herself and danced in perfect rhythm. (That is one of the great joys here, I tell you - people dance due to happiness and also manage to stay in rhythm, which is not always manifest in the countries I've visited. Scott has stated firmly that white people cannot dance :). ) I looked at her, and thought to myself of her now-happy spirit, that in spite of mental illness and being away from family, the spirit can sing and dance and be happy. A fine place, the Banyan.

I managed to see a couple of movies with a dear friend. "The Iron Lady" was magnificent: I felt like we were watching Mrs. Thatcher and not Meryl Streep, she was that good. We also saw a Tamil movie - "Aravan" - just for me to drool at the hero, and the flick was dreadful. Naren and I also managed to see a play, which was so-so, and I caught a very nice dance show by the U.S. troupe, "Bad Boys of Dance." There was a 2-day conference on diabetes and heart disease over the weekend, and one of the leading doctors here who knows my work negotiated for me to attend for free, which was fabulous. I enjoyed all the learning.

The conference of the American College of Physicians is in New Orleans in April, and I am seeking inexpensive accommodation. If any of you knows of options, please tell me. It is when I travel that I feel the lack of money most acutely and am sick of it: the flight attendants appear less than thrilled to see us in economy class, and I wonder what became of service in the service industry. Sometimes, when I ask for a piece of chocolate or a toothbrush, I am actually told that it is not available in economy class. Hmmm. Anyway, perhaps things will change sometime. And pigs will fly.

Naren gave up sugar on 1 February and has managed to stay off it, liking the way it makes him feel. This was inspirational and now I am also off. I nearly caved in during lunch at the conference, at the sight of "Blueberry Mascarpone souffle" but managed to maintain a modicum of dignity. We have vats of fruit in the house and I like that.

All 4 of us Skyped yesterday and talked about the challenges in parenting. There are several, for me. Joys as well, but challenges that all heard about along with some trans-Atlantic profanity. The demure, submissive, reticent Indian (who?!) spoke up.

"I haven't spoken to my wife in years - I didn't want to interrupt her." - Rodney Dangerfield

Unw -

R

Sunday, March 04, 2012

Report of 04 Mar 2012

Hello from Chennai!

It is sunny and hot. A little too hot. The bright orange towel hanging on the balcony does not seem to think so. It is so hot that our clothes dry in minutes and we did 2 loads today. Even my thick bedspread dried quickly.

As I write, one son is hanging out with his Dad in the U.S. and the other one is gallivanting with his friends. I received a very nice sms thank you from him - the Chennai lad. There was a surprise party here to celebrate his 21st b'day and a couple of his friends did a fine job colluding with me on pulling it off. Both Naren and I have become antisocial, and I told him I had invited some folks over whom I'd casually met a few days ago; he and I crabbed as we got the meal together and cleaned, the worse the moods because the power goes off between 8 and 10 AM and the heat increases ill humor. Anyhoo, we got the prep done, heated the food that our cook had kindly made and then off went Naren to pick up a cake from our favorite bakery, which also trains underprivileged youngsters in the art of baking. By the time Naren returned, 8 of his high school buddies were here (many study out of town and many had exams to prepare for), and he was suitably surprised. We'd also done this for Navin's 18th b'day, and it is fun to put such things together. I quite preferred hosting these young folks to hosting my own age group, as all I had to do was cook a couple of things, cursorily clean, ensure at least 3 types of dessert and then I could sit back and watch the natural goodness of these fine people come to the fore. It would have been grand to sit and talk to them, too, and I managed to do that before the birthday boy landed; the rest of the time was spent by me catching up on the newspaper and by Naren catching up with his friends. It was a fun time.

The Banyan continues to be good and one day, I started thinking that perhaps I ought to devote a little more time to private practice for gain. And then, it was time to train the young ladies; the topic was cancer and the discussions were robust and bloody good fun. Every day, these women become more and more like nurse practitioners/quasi-doctors. Empowering these folks I wouldn't give up for the world. I get lots of morning greetings and chatter, and many of them appear to enjoy what they do. One does not realise the importance of working with such folks until one has done a turn working with folks that don't enjoy what they do.

The man in Kovalam with the injured foot returned to be evaluated for fever. I asked for several blood tests, and gave him acetaminophen/paracetamol. He then mentioned coughing mightily every night and said his son had told him to investigate the possibility of TB (tuberculosis). "Listen to the patient; he will give you the diagnosis." - Osler. So I asked for the sputum to be sent off for tests, and I will get the results tomorrow. He does look a little TB-ish, and I will know yes or no soon enough. I'd reached Kovalam early last week and had taken a walk to the beach; I'd come across this patient on my walk there and we had stopped to talk. Most of all, I am grateful that this man feels he is being heard, and listened to, and treated with care. The poor here often have no such luxuries.

Back in Mogappair, a sprightly young hcw (health care worker) fairly skipped in to my office, and told me she had not had my answer to her question. She had asked about donating an eye, or a kidney, and I had asked at that time if she needed money (selling organs illegally is fairly big business here); she had vehemently denied it and professed an altruistic intent. I'd told her not to consider organ donation. When she brought up the question again, she admitted that she did need money to "settle" her brother, an electrician and driver. Their father had died, and the paternal grandmother had refused to give them a share of their father's property. Both kids had been brought up by their mother and procured what education they could. This hcw wanted to give her brother a better career, and we are working with her on this (without her having to sell body parts). I rather like the affection expressed: in spite of life dealing her tough blows, this young lady - first and foremost - wanted to take care of her older brother.

Last week, several of us went to Pondicherry for a conference organised by the French Institute there and us; the theme was "Food, physical health and mental health." It was fabulous; nice to learn from others. Our younger colleagues (at the Banyan) also handled all logistical issues magnificently. My sister-in-law, Susan, a nutritionist and dietitian, presented and it was very good; I learnt so much. It was nice to see Susan and hang out. I, too, presented - on the link between physical and mental health; I abhor research and the presentation was based on case studies. It was after lunch and a snooze-inducer. It finished, thank goodness, and generated a question or two. The best presentation was from an NGO working with scheduled caste (outcaste, you might know this term better) female farmers and helping them grow millets; not only were the families fed but there was enough grain left to sell, too. Fabulous! Hunger can do strange things to folks and in one of the films made by a village lady (who was present), an older lady spoke of times gone by and how she could not feed her children then. That is a matter of horror for me: imagine not having anything for my sons if they said, "Amma, I am hungry."

The French culture was intriguing: they spoke the language without worrying if those around could understand it or not, they served themselves first at lunch (anathema to the average Indian - "Athithi Devo Bhava," the guest is God), and smoked outside without asking those around if the smoke would bother them. "It's just different," said Navin, when we Skyped today. Truly, we borrow the world from our children, do we not.

The 2nd anniversary of my mother's demise was last week. I did a puja (worship) at home to her picture, and fed the Banyan. I requested a non-vegetarian dish and some fruit; it was pricey, but my mother so believed in feeding people well that I was simply recreating a meal that she might have served.

The current big dream is to write for a fee. I am finding the need to do this, and will pursue all options. As I told people, I doubt very much that I will make money practising medicine. Scott is a dear to understand this, accept it and - what's more - encourage it.

Naren and I saw a play last night called "Cast party." It was excellent. We were seated in the VIP section by the usher, who knew Naren. There you go - connections from our children.

All 4 of us Skyped this morning and will Skype again this evening before Navin returns to college: his computer does not have a working microphone (we tell him often that an engineering student ought to repair that :) ) and I am grabbing this chance to hear his voice on Scott's machine.

"When I was fourteen, my father was so ignorant I could hardly stand to have him around. When I got to be twenty-one, I was astonished at how much he had learned in seven years." - Mark Twain

Unw -

R