Report of 28 Oct 2012

Good afternoon from breezy Chennai!

There are clothes drying on our balcony, I have just eaten lunch and a sapota, and am trying to figure out what's up with this fever.  Leptospirosis and dengue are afoot here, yesterday the Banyan's nurse phoned with her personal lepto report and I am trying rabidly to figure out how best to improve the Banyan's hygiene.

So I have stayed home this week, but have had my share of patients.  The daughter of a good friend is home from college in Delhi; there are holidays now and this young lady is also sick.  A dengue test is positive, but it is a mild attack, thank goodness.  On my way back from seeing her (so like a daughter), a member of our apartment complex's housekeeping staff stopped me: she has had her cataract operation successfully done and wanted to speak of it.  I had urged completion of the surgery earlier, but she had had no money and subsequently saved enough for some.  This exhausts me: that my patients don't have cash.  I did not have to worry about this overseas, where I could order tests and surgery at will, and somebody else worried about the costs.  It appeared to make this lady happy to discuss her surgery and I was also glad everything had gone well.

It's not fun to be sick, is it now.  Even less fun if you're part of my family - I whine and carry on considerably and am not the dignified, quiet invalid that Scott is. 

We went out for b'fast a couple of days ago as I felt a bit better.  It was an upmarket restaurant serving sausage and eggs, and I was happy to go.  The food was cold and I complained.  I say good things as well when the service and food are fine.  There were good-looking young men in muscle shirts walking about - ostensibly part of the wait staff - and I found this hilarious, that the restaurant had to resort to eye candy perhaps to atone for their food.  Clearly, at age 49, I am out of the market that said muscle-bound Adonises cater to: I was there for the food.

I talked to my Dad briefly yesterday and he was at a meeting.  He is very active, and I am pleased about that.  Navin and we Skyped this morning and there was plenty of humor and candor; it is always nice to see our sons laugh and smile.  Naren is in rehearsals for a play and we see him between activities; it is great to talk to him, too.

That I see family when I want - this is truly a giant blessing.

Unw -

R

Report of 24 Oct 2012

Good morning from a very soggy Chennai!

The monsoon is here.  It makes for incessant rains, roads that get ruined, and huts that leak.  One year, Vaishnavi, one of the founders of the Banyan, went around in the rains looking for folks that would have been marooned; sure enough, she found someone, Ms. X, and this person was sent to the Banyan.  Ms. X had a touch of jaundice and I got a phone call; I was not going to work that day as the roads were simply not navigable - Adaikalam is situated in a very low-lying area and one monsoon, boats had to be brought to ferry folks to and fro - and promised to look in on her when I could get to work.

This is the joy of working for the B: the founders do for others in a manner as natural as breathing.

Our patients have been fine.  There is a much older lady, Ms. K, at Adaikalam who is becoming emaciated; she does not eat solid food and takes sips of fluid at a time.  She is actively dying, and might have cancer; I am not going to go searching for this disease as my management will not differ.  I have told the health care workers (hcw's) of the prognosis and asked that they not get upset.  This is also a joy of the B: the hcw's consider the patients their own, part of the extended Banyan family.  They address the paatis (grandmothers, older ladies) in the singular and it denotes great affection.  Thus, the prospect of losing someone like that is very, very difficult.  I mentioned to them how grateful I was that Ms. K was with us, instead of dying on the street - alone, unkempt, neglected.  The hcw's shower love and affection and dignity on our patients and - especially in death - that is invaluable for me.  Ms. K unfailingly asks about others still and likely has a family that she adored.  I am very fortunate that I can still see mine.

Kovalam is fine.  One of our patients is hard of hearing and had to place her face right next to mine to hear me; she then coughed fully in my face.  Dear dear.  "Turn your head and cough," is intended to protect the physician.  I came home from work with a headache and proceeded to run a fever.  No matter - this patient seemed pleased with the care and went to touch my feet (a gesture offered to much older/revered folks or Gods - neither of which I am); as I said to her that I was simply doing my work and not deserving of any feet-touching, the health care worker with me got very teary.  A subsequent patient said, "Even in private (private practice where doctors can charge a hefty fee), I am not treated this way."  Hmmm.  I asked my father once why it made such a difference to patients that I talked/listened to them and he explained that it was also very revelationary to them when we touched them; coming from the "Untouchable" caste, it gives them great status when we touch them.  Uh huh.  I can't diagnose without touching; that's all.  Wal-mart greeter skills, that's all.  Still, it is nice to work in a place where we impart such dignity and respect all in the course of a day's work. 

The patients start lining up at 7.30 AM (unheard of here) and I finish at about 2.30 PM.  The other day, I started to get hungry in the middle of this; when that happens, I get snippy.  I managed to curb snippiness and crabbiness and get through the work.  Little Ms. A sure helped.  I was examining a patient who held a 1-year-old in her hand; said baby thought I was going to harm her mother, or inject her (a mortal fear of all little ones here), and screamed and cried.  Ms. A wandered in, looking at the other little one quizzically: I've never heard A cry.  After the patient left and A sat comfortably in my room, reaching for the thermometer and the BP cuff and every other thing on my desk, I asked her who had been crying.  She answered, "The baby," as though she herself were 25 years old.  It was hilarious and I asked it again: "Paapa (baby)," she said.  There were blank papers on my desk that we use to write lab tests for our patients, etc., and I handed A a pen; she scrawled merrily on the papers and, while aware of the waste which we can ill-afford, I was delighted that A was gainfully and intellectually occupied.  A little while later, I saw her mother carrying her as she neared sleep or was sleeping; A is everyone's baby, but marvellously, in the manner of babies everywhere, she knows who her mother is and goes to her, and the mother, while reeling under a mental illness and healing, knows enough to pick up her child and take her for a nap.  Isn't parenthood wonderful.

It is, indeed.  We managed to Skype with Navin and that was fun.  There was a smile or 2 as I narrated incidents at the B, and it was nice to see our long-distance son happy.  There was also a fair amount of chatter and that is a grand privilege for me, that the boys would choose to talk to us.  Yesterday was a holiday and Naren stayed home; we talked of his plans and goals.  He said to us, "The only way I survived college was because both of you said, 'We have raised you, you are now free to make of college what you will.'"  That was lovely. 

Cary Laxer, the chair of the department of computer science at Rose-Hulman, was in India on business and spent 2 days with us afterwards.  That was grand fun.  As with all powerfully intelligent people, Cary had excellent insight and opinions and observations and those were cool to hear.  We did touristy things and then Cary came to the Banyan.  He does a lot of work with "Big Brothers, Big Sisters" in Terre Haute, Indiana, and we found commonality in our causes.  Cary was very respectful of Indian culture and that made him easy to be around.  We have had guests who continue to diss Indian culture and we tend to avoid the topic when we are around them.  Dissing another culture has always seemed a bit narrow-minded to me, and smacks of insecurity.

Scott and I saw, "Killing them softly," and it is not a movie to be seen in India, where a fair amount of heckling, etc., goes on.  We also went to listen to a band that did covers of Pink Floyd and Deep Purple; the evening was smartly called "Pink and Purple."  I love covers and Deep Purple is one of my favorite bands, thus I enjoyed the music.  It was deafening, however, and Scott and I left at intermission.  It is cool to have Scott's company; India is that much better when I have his wry sense of humor around.

I talked to my Dad and he is well.  It was good for me that I was there when he was ill; I got to treat him and see for myself that he was better.  Such a relief.

Unw -

R   

Report of 15 Oct '12

Hello from breezy Chennai!

Life is back to routine - as though I'd never left.  Today was a busy day at Kovalam.  I had pulled in there last week and as the security officer wished me, I heard a little voice echo, "Good morning, Madam!"  It was little A, the daughter of one of our patients with mental illness, saluting me and wishing me.  A is everybody's child and sharp: this morning, as I pulled in, I heard a sweet little voice say again, "Good morning, Madam," with no one's prompting and there she was again.  She is a little more than a year old, and came to sit by me as my room was being cleaned, took the newspaper from me and sat on it, then put her dolls on it; she saw a picture of a deity and took my right hand and put it on the picture as she has probably been taught to do.  It was a fine moment and this is our one starfish for today.

The seaside village, Kovalam, produces many patients and we had a house full today.  I started at about 0830 and finished at 3 PM.  One of the more memorable ones is a lady who came in stating that her R eye had blurry vision; in a monotone, she stated that her husband beat her regularly and this time, her head had been the target, resulting in the blurry vision.  Ohhhh.  She stated matter of factly that her first pregnancy had ended in a miscarriage due to the beating.  I could not move or think; I asked for our psychologist to come down and told her the tale.  As it turned out, it was the psychologist who had referred this patient to me and she (the former) plans to do a home visit.  The husband is an alcoholic and I do not know to what extent reform can happen, but we can hope, can we not.

I am fiscally tired.  The calcium for our patients - all of whom have brittle bones - has been stopped due to lack of cash, and my personal favorite, fruit, is non-existent, as always.  If I can get 365 people to donate Rs. 1000 or $20 each, perhaps we can get some fruit and some calcium.  Let us see.  I am struck by the inequality of it, and now see why practices and hospitals operate at a profit - they must.  Otherwise, the basic medical necessities simply will not be available.

Last weekend, I went to Madurai.  It was great to see my Dad and we hung out, attending a meeting on critical illness.  He ended up sick, with fever and trouble breathing, and I treated him; I slept on the spare bed in his room and he said that reassured him.  I am sure I would not have been much use to my father in the middle of the night because I was sleeping off jet lag and could not have been awakened easily; Scott gently told a neighbor that once, and suggested that she call an ambulance for her ailing father.  I speak gibberish when awakened abruptly (jet lag or no jet lag) and quite like the life of no call/pagers. 

I returned yesterday and we got to Skype with Navin, which was grand fun - good to see him.  We went to see Naren in a comedy show in the evening.  There were a bunch of skits and he was in a couple of them, wearing a skirt ("somebody's curtain," said Scott) and with hairy legs in full view.  It was a fun time.

We hope for fruit and calcium and I'll keep you posted on that quest.

Unw -

R 

Report of 9 Oct 2012

Good evening from Chennai!

I did not blog last week, though I'd spent some fine times at the Carmel and St. V libraries.  A bit of exhaustion with packing and moving had set in.

Some fine times before we left - Sid Norton and I had lunch during the week, and caught up with his work and home, that was fun.  Carolyn Scanlan-Holmes and I had dinner, talking of her recent marriage and her parents, also fun.  We stopped by the Sparzos, where Scott and John were discussing Lean, and said a quick bye; the Sparzo welcome is always warm and gracious.  I handed a gift to Dee, my remarkable 5 AM cardio-kickboxing instructor, and we shared hugs (sweaty though they were) and tears and laughter.  Dr. Angela Carbone, head of the stroke unit where I worked at RHI, took her team out for lunch on Friday and that was great; it is always cool to socialise with the folks I work with and Dr. Carbone makes sure everyone feels included and welcome.  I had plenty of exit interviews and farewell hugs - warm, loving, affectionate.  RHI was a great place to work.
 
Scott and I drove to IU on Saturday, in foliage country and that was gorgeous; we had lunch at the Snow Lion, owned by the nephew of the Dalai Lama, solely to support someone from Tibet.  The food was so-so, and the cause much greater.  We then stopped to see Scott's grandfather, recovering from having a pacemaker put in, and saw some extended family there; that was grand.  I like Scott's grandfather a lot, he is non-complaining, stoic and fun; he does not hear very well, but does not let that faze him at all.  One of my best memories is of him coming out with his armed forces photo album the first time we met, and Scott and his siblings had not seen those pics at all.  The photos were great, of course, handsome men in uniform and reminding us of a time gone by. 

On Sunday, we had a fine breakfast at a trendy little restaurant and then saw "Won't back down," which was surprisingly good for being a feel-good flick.  We then moved out of our apartment and drove down to see Navin; he had granted us an audience, which was lovely.  We had dinner at Taco Bell, a Mecca for those college students, and then saw "Pitch Perfect," which was excellent.  I hunkered down for an evening of chatting with the boy, and he said, "Well, good to see you guys," which meant the evening was over and he had to return to homework :).  We headed to the Tabers', our home away from home, and spent a comfortable night. 

On Monday, we went to Community South Hospital and caught up with former colleagues Nancy, Jolynn, Elaine,  Louann, Tammy and Staci, and it was very nice to see everyone.  I also stopped in to see Jasmine, who had sent us the giant box of raisins and other goodies: I had a gift from the Banyan for her, which she was loath to accept but did.  The Banyan remembers Jasmine's magnificent gesure well.  Scott and I then met Ed Stone, my former boss, and Bryan Benedict, a fine ER doc, for lunch.  As I told Scott, to be in the presence of 3 great minds was a treat for me.  Ed took me to meet Dr. Mulvey, another ER doc, and that was nice.  Scott and I then went to the dollar cinema, saw "The Avengers" again and then walked out of a terrible movie called "Light of Day."  "Sparkle" did not play due to projector problems, so we spent time at the Carmel lib.

On Tuesday, I went to Grand Rounds and then stopped to talk to Dr. Love, which is always, always very therapeutic for me.  I also said bye to Willette, Rebecca and Tami, and then Scott and I got some medical work done.  We went to see "Looper," which was good.  Then we met Colleen and Mark Taber for dinner, and that was the fun fest it always is.  It's nice to gab with intelligent folks, and then return to their warm, loving home.  On Tuesday night, I packed a little.  Wednesday was spent at Carmel lib and that was lovely; we also saw Kris Rea briefly when we returned her dishes and that was a nice bonus.  On Thursday, we flew out of Indy.  Scott and I had seats together all the way to India (this cannot be taken for granted these days) and that was fun; when I was not annoying Scott (who is slow to be annoyed, thank Heavens), we were watching movies or sleeping.  Service was excellent on the flights - quel treat - and then we reached Chennai, with our luggage (speaking of bonus), and were being hugged by our son.

We celebrated my nephew's graduation from Dental School and it was cool to see extended family.  I talked to my Dad and confirmed plans to meet later this week (I will head to Madurai).  Work resumed for me yesterday at Kovalam, and I was seeing patients who take 3 buses to come and see us, and I treated folks whose next meal is never a certainty.  It is heady to do this, because these patients appear to heal with just a kind word, even before I lay the stethoscope on them.  Today, I was at Adaikalam, passing out chocolate (gifted by colleagues in the U.S. as well as bought by us) to everyone and sharing the gift from an Indianapolis patient's wife with all the health care workers.  I got slapped by a patient today; her mental illness is out of control and she had no clear idea of her actions, though her motive was clear.  I saw the slap coming and mostly deflected it, otherwise it would have hurt; my colleagues were aghast and embarrassed and apologetic.  I told them there was absolutely no need to apologise, as *they* did not hit me.  My time with the Banyan has lasted 8 years and is likely to last a lot longer; I can now convicingly say, "Our patients can hit when agitated." 

It is good to be home.  It is good to take care of patients who are mentally ill and unfortunately, are separated from their families sometimes never to see them again, try though we might to reunite them.  As I whinge and carry on to Scott, as we share a dosai at b'fast, as we listen to our older son's plans and make plans to Skype with our younger son, I think of the tremendous good fortune I have - that I can see family, and take care of those whom I am privileged to.  My faith has been rocked, as many know, but it is when I see the impoverished and work in a non-competitive environment (not many want to work with the destitute - their loss; those that do want to, make great colleagues for me) and touch "the untouchable," that I truly feel the presence of someone who picked me up from med school and residency and set me firmly amidst the poor.  And I consider this my great good fortune.

Unw -

R