Report of 29 Dec 2012

Good evening!

I am sitting here in my nightie and robe, 2 young men are out partying ("our evening does not even start at 7, when yours ends"), Scott and I have an evening at home, and I am blogging.

Work has been very good.  The 5 med students have enthusiastically performed physical exams on all the patients, and taught a class yesterday to the health care workers, who are game to learn anything from anyone.  Kovalam was fine, and busy; the person who is to have (likely) open heart surgery has come repeatedly to our clinic, though he is fine enough.  I think he is very nervous about the operation, and he has asked the same questions multiple times - "Is it a big surgery?  Do you think they are actually going to operate?  What are they going to do first when I am admitted?"  I have attempted to reassure him, and I know not if I have succeeded.  Poor or rich, nervousness before surgery is not uncommon.

Adaikalam has been fine.  One of our patients was losing weight with gusto, and I was very worried that it was due to cancer.  We sent her for a complete workup and no cancer has been found.  There is a bone from her backbone that is jutting into her food pipe, and she has trouble eating because of that.  So, Leela, our magnificent nurse, has put her on a high calorie, high protein diet that many folks with tuberculosis get - eggs, soup, some high protein legumes.  We are hopeful of results, and indeed, the person looks better today, almost back to her former cheerful self.  She is a bit mentally challenged in addition to being likely mentally ill, and family has not tried to find her.  This is the grand benefit of working at the B: we expend much effort to find the cause of a patient's symptoms regardless of who she is.

Navin got here!  He had had some serious misadventures, including having his passport stolen.  Getting all his travel documents replaced was challenging; the passport took the least time - I tell you, the U.S. is kind to its citizens in distress.  Getting the visa to India took a while and some magnificent machinery swung into place - friends, the Tabers; Navin's assistant dean of students; my mother-in-law, and Scott's cousin and her husband.  So net result is that Navin is here and all of us are overjoyed.  And appreciative of all the help.
 
On Christmas Eve, all of us (med students, a Ph.D. student from France and the Weisses) piled into a 10-person vandi (vehicle) and drove to Vellore.  We spent Xmas Eve and Day at my sister Anu's house, and a grand time was had by all.  The family was kind enough to welcome the students (but that's an Indian thing) and the students graciously adjusted to all our chaos.  We drove back on the 25th and were at work the next day.

I attended the wedding of the nurse who helped take care of my mother.  I owe her a lot, she was there when I could not be.  And did helpful things that I would have balked at.  My father and I attended the wedding, and it was grand fun hanging out with him and hearing his observations on life, liberty and wedding rituals. 

Today was "Family Day" at the Banyan.  We had some games for little kids, and an entertainment program, and biryani (a rich rice dish) donated by a famous chef.  The students from Texas also danced, and the B loved it.  The students have been grand and accommodating about our requests.  Naren and I also danced; he learnt the steps at 0600 this am (when he was half-asleep) and was correcting my count by 0930.  "Don't give me people who want to dance, give me people who have to dance."  Navin and Scott helped with the games, Naren and I danced, and it was all good.  Some friends of Naren's, a theatre group called "Stray Factory," also performed for our residents and they were good.  When folks do for the Banyan, I feel very, very happy.

The boys and we got ice cream after the show, and then went to the beach.  We talked ad nauseam.  Naren's romantic relationship has ended and I have voiced my support for him; he had hugged me then and said he appreciated the support.  Navin said he might not if it were him, and Naren told him he would appreciate the support.  It was a most morale-boosting conversation.

Unw -

R 

Report of 21 Dec 2012

Good morning!

Well, the world has not ended on this side of the planet.

How are all of you?  We are well and busy.  5 medical students from my alma mater, the University of Texas Health Science Center at San Antonio, are here to work with us for 2 weeks.  They are enthusiastic, bright and fun; the Banyan staff and patients are elated to have them here.  Students from overseas have a gentle way with our patients that we sometimes are too busy to adopt.

Kovalam has been hectic, and we simply clip along with what we have to do.  That day, I had to teach as I could and the students rolled nicely with it.  I then had to leave for a funeral service; my mother's best friend, Maggie Amritraj, lost her husband, and Scott and I went for the service.  We reminisced with Mrs. Amritraj, and saw her celebrity tennis player sons.  It is therapeutic for me to be with people who used to know my mother.

After I left Kovalam, the students were oriented by other staff.  They then went shopping and we met at Adaikalam the following morning.  The students do full physical exams on all the patients here - 180 in number.  As with last year's group, this group has picked up issues we need to investigate further.

Naren was in the annual Christmas panto as the dame, i.e., a female character.  A talented Indian designer made the dress and it was beautiful.  He rocked the role and we went to see the show multiple times, heckling from the audience and dancing with him when he came near us.  (The students also joined us for 1 of the shows and appeared to have enjoyed it.)  Naren passed on a request from one of the crew, for me not to yell as the crew member enjoyed Naren's lines and did not want to miss any of them.  This was a big dilemma, as it is genetically impossible for me not to yell at the panto.  I discussed it (yes, it was that big a dilemma) with the family, then the director and producer, and the latter 2 told me I could do what I wanted.  So, the crew person had to go jump, and I heckled to my heart's content.  We were invited to the cast party and a British guest there told me that was exactly the point of the panto.  Hooray.

The nation (and likely world) mourned the passing of Ravi Shankar.  We were fortunate to have seen him and his daughter, Anoushka Shankar Wright, in concert a few years ago.  The ONLY thing that struck me when he died was what a louse he was in the parenting department, siring children when he was 59 and 61, and then not maintaining any kind of genial/parental relationship with one of them.  Parenting is a privilege, isn't it.

We saw a couple of excellent Tamil movies and are getting ready for Xmas.  We Skyped with Navin on Sunday and that was grand fun - he has an understated sense of humor and I laughed out loud on many occasions.

We are privileged in our family.  Hope you have fine times with your own.

Unw-

R  

Report of 9 Dec 2012

Good evening from Chennai!

It has been a good week.  The Banyan has been busy.  Kovalam continues to attract a ton of impoverished people and last week, I had to limit the number to 40; at 15 minutes per patient (typical Western scenario), that would have taken me 10 hours, but I had 5.  So we had to clip along.  One of our patients has thankfully been evaluated in the free Government hospital (GH) for his chest pain and has been advised surgery; sometimes when I say things like "Please go to GH and see the specialist," the response is variable.  But this patient went, got evaluated and came back to see me - Halleluia.  Have I saved his life?  I do not know, but I know that I have eased mine - I would not have rested comfortably until this man saw a specialist. 

My colleague's grandmother brought fish and shrimp again and we ate well.  Our cook is a whiz with food and she produced tasty fare with this raw material.  I overpaid my patient again, and know that I likely paid less than I would have paid at the market.  And the stuff was fresh, too, hauled in that morning.

Adaikalam has been busy also.  There were rains earlier this week and I could not go to work.  When I did go, there were a few things to catch up on.  One of our patients who is quite disabled had left the Banyan and is now back with us; she is not permitted to chew tobacco or snort snuff and consequently, wants to leave.  I told my colleagues she could certainly leave.  This is the difference in my approach: even in the U.S., when a patient wanted to leave AMA (Against Medical Advice), I asked the staff to pull up the paperwork, explained risks to the patient, and left.  A lot of colleagues would sit down and coax the patient into changing his/her mind, and that is certainly an approach.  It's not mine.  Same in India; when I said this lady could leave, there were questions about "Where would she go?"  I know not; if she has a viable plan, let's have at it.  If she is safer with us, we can certainly discuss it. 

A neighbor's daughter, our sons' childhood friend, got married and we were at the festivities yesterday and today.  It was wonderful and felt like a family wedding.  The bride's mother and I studied at the same college, and the bride's grandmother is a lovely person.  I am a huge fan of friends' parents and have often felt delighted to meet them.  Naren joined us last night and that was fun.  Scott and I were at the wedding today, too, and felt completely welcomed and included.  We caught Navin on Skype today and that was fun, also.  We are blessed in our family and friends. 

I phoned my Dad today and he was heading to a carol service, so the call was short.  We were at a play on Friday, benefiting Aids charities, and there were carols sung before the start.  As "Oh, Holy Night" was belted out, needless to say, I started crying: it is such a beautiful song.  Thankfully, no one saw. 

We attended my friend Joan's mother-in-law's memorial service and there, too, we felt like family.

We are privileged in our friends and relatives.  We hope you have similar joys.

Unw -

R     

Report of 2 Dec 2012

Hello from breezy Chennai -

It is late - 9.20 PM - and I must head off to bed.  Soon.  It is very therapeutic for me to write.

We are well and I hope the same with you.  The Banyan has been frenetically busy.  Kovalam has so many patients that they are starting to impose a cut-off time for patients to check in; otherwise, numbers such as 70 are common.  I have punted documenting a complete exam though I do the exam (I document what I think is necessary), and dealing with umpteen complaints ("Can we focus on what's bothering you the most?"), and tolerating patients coming back and adding yet another complaint - yes, this happens.  But, the folks are grateful for whatever little I can do for them.

My colleague's grandmother showed up with shrimp!  It is the first time any patient here has come with a gift; many are way too poor to afford anything.  I love thoughtful gifts, honestly, and remember Scott's aunt and uncle's, and my patient's wife's, boxes of chocolates with great fondness.  I paid the lady for the shrimp; she undercharged me and I overpaid her.  Her grandson came by while I was examining her and I hailed him and yelled out what she had brought, which was a bit crass - but I was so thrilled!  I realised later that I really ought to keep my mouth shut, but as that has been a challenge since birth, I resigned myself to the inevitable.  I told Scott the only time my mouth would be shut would be when I am dead, and he said my mouth would likely be open even then. 

One of our patients at Adaikalam died.  She had been lethargic and I had been told she was on increased doses of psychiatric medications as she had been combative; the meds had then made her drowsy, they said.  I accepted this explanation and regretted it later; she became medically unstable and on being shifted to the hospital, they did an xray and found cancer in her lungs.  This was a lesson to me to go with my gut; if something feels wrong, it is.  I rather liked this lady; she spoke incessantly of home and all her brothers and mentioned them by name.  I always felt bad for her, because none of said brothers ever came to see her.  While we could feed and clothe her, there was a part of her soul that was reserved to be filled only by the sight or sound of her relatives; for various reasons, that did not happen.  No use putting a pox on the relatives, I assure you.

I went to Madurai for a former classmate's son's wedding.  Pavala Rani ("Queen of Coral") had traced my contact info from somewhere and sent me an invitation.  I went and met up with her and 2 other friends, Joan and Sumathy, and all of us had a great time!  30 years since we graduated, lots of stories, lots of great memories.  Pavalam was hospitality incarnate, and I just messaged and thanked her, getting a sweet reply in return. 

I managed to see my Dad briefly as he had commitments just as I did.  We attended a session on plastic surgery for the eye, and then I had to leave to return to Chennai.  Madurai has 14-hour power cuts while Chennai, being the capital city, has 2-hour cuts; grotesquely unfair and I felt every bit of it while in Madurai.

On return to Chennai, Scott and I went to watch a collegiate dance contest and it was fabulous.  One of the women's colleges outdid themselves in hip-hop (the prevalent form), replete with flips, handstands, etc.  They got a well-deserved special mention.  We stopped to speak with them outside and that was lovely: young people are so the repository of solutions to many, many problems.  One of the dance companies had their students do a demo dance and a little girl totally feeling the music and dancing her heart out beautifully reminded Scott of me, he said; this was very sweet.  Yesterday, Scott and I attended a Christmas bazaar for charity and then went to a Tamil movie called "Neer Paravai."  It was very well done and I enjoyed it immensely.

We had a brief b'fast with Naren today and then Skyped with Navin; both events were grand fun.  These boys are opinionated, candid and funny.  We are truly lucky in our sons, and I am very privileged to be able to see them and the rest of my family.

Hope your life is also similarly blessed.

Unw (Until next week) -

R