Renu's Week

Saturday, March 30, 2013

Report of 30 March 2013

Hello from Chennai -

It is hot.  Summer is here.  About 93 degrees outside, 95% humidity and no airconditioning.  On the plus side, the mosquitoes have taken off and the mangoes are here.  Both joys.

Kovalam was less hectic than usual.  The high school student was with us again and cheerfully taking all of it in.  One of the regular customers brought her mentally ill daughter to be seen - with a chain around her leg hooked to her waist.  I don't mean one of them delicate ankle bracelets either.  It was quite horrifying and I made a heck of a scene, asking that it be removed, otherwise I would not treat the patient.  My declining treatment did not help the patient any, and I told the nurses privately what to do later; I hoped that my insistence on the removal of the chain migh help some.  As we negotiated back and forth, with the mother stating she'd take the chain off the minute they got home after my treatment and I wanting it removed as a precondition to my treatment, I noticed the patient's brother (also a regular patient of mine) sitting outside and exhorted him to treat his sister with a modicum of dignity.  Otherwise I'd decline treatment to him, too.  None of it worked and the family went home.  My other colleagues later told me that they'd told the mother to leave the patient with us, we'd give the mother a monthly stipend, and she had refused; ostensibly, she takes the chained daughter around and begs, hoping to elicit sympathy with the chain.

You feel grateful for mothers that don't do this, do you not.

Adaikalam was a bit of a mess, with my orders not being carried out, etc.  Intense fatigue set in, because any number of excuses are offered.  I had to rope Vandana in, and she looked over the files, sat with the other employees and an action plan has been formulated.  Thank you, Vandana.  I walked up to our auditorium in some ire, and started to teach the class on ovarian cancer - an important topic because this cancer has usually spread by the time it is initially diagnosed.  The health care workers were so interested and interactive and curious that my ire dissipated and all of us were soon laughing at some notion or the other.  I have a bit of a fascination for the actor Suriya and nearly all my examples involve him somehow: "So, if you notice that your belly is starting to bulge and you have some vague discomfort, are you going to continue watching that Suriya movie on TV?"  By the end of the half-hour, I continued to be impressed at the health care workers' easy uptake of what I teach.

The men are at my mother-in-law's farm for this Easter weekend and we will Skype tomorrow.

My friend, Pushkala, and I went to see a Hindi movie and it was fun.  I had a little shopping to do before that, and Pushkala kindly indulged me; shopping is so much more bearable when done with someone.  My aunt, Indira, was in town and she took me out for lunch yesterday.  That was a blast.  My aunts (mother's sisters) are fiery individuals of high intellect and intense opinion and powerful senses of humor.  It was a very fun lunch, and we lingered and lingered.  I got updates on the rest of my relatives, and that was very nice.

Nice to see family, isn't it.  What do people who fight with their relatives get???

Unw -



Sunday, March 24, 2013

Report of 24 March 2013

Good evening!

Welcome to paradise - the mangoes are here!  The best ones arrive later in the summer, but hey, these will do nicely for now.  I am off gluten in an effort to reduce the gut size, and am not seeing any results because of the number of mangoes I am eating.

Kovalam was nice.  We saw the usual ton of impoverished patients.  A young lady came in complaining of headache at the back of her head, and I asked if her husband had beaten her.  Her mother said yes, that he had grabbed her by the hair and slammed her head into the wall.  I was distressed.  Then I noticed a burn mark on her forearm and asked about it, not really wanting to know.  The patient said her mother had done it.  Apparently, the young lady had gone off with another man in the course of her marriage, and got his name tattooed on her arm, and her mother had burnt it off.  There was much more to this saga than met the eye, and I asked for both ladies to see the psychiatrist.  When I alerted our psychiatric social worker about this, she said that the mother had also done similar wandering.  Hmmm.  I wonder how much of philandering is genetic.

Adaikalam was fine.  One of our older patients is starting to not recognize me or interact, and this usually signifies an infection.  I checked, and she has none of the obvious.  The staff stated that she is her usual self with them, bantering and chiding.  Thank heavens.  I am okay with her not interacting with me, if she is herself with others.

The 3 Weiss men and I got to Skype this morning and that was grand fun.  There was lots of chatter and talk about plans, including plans to job-hunt.  It was nice to listen to the men and very cool to have adult, open dialogue.  Scott's project has gone very well so far and I am delighted.  He is an outstanding teacher/trainer.

A young high school student rounded with me last week and that was fun.  He is interested in medicine, and so I taught him what I could that morning.  He is idealistic and fun and good, and will make a great doctor someday.  Now I know why professors would thank me after I rounded with them; it is refreshing to have someone alongside in the course of a day's work. 

My father was here this evening, along with a young colleague of his.  They had come for a conference on cosmetic surgery, which my Dad had inaugurated, and then stopped here before their train.  (My father is not a believer in cosmetic surgery, and prefers to focus on plastic and reconstructive - with birth defects, burn injuries, etc.  He agreed to inaugurate and attend this conference because he likes to accommodate and learn whatever he can.)  That was fabulous; it is why we live here - that we can see family who transit through.  My sister and brother-in-law, Anu and Benji, happened to be in town and they stopped by, too, and it was a merry laugh-fest.  Anu and Benji work in Christian Medical College, Vellore, a very prestigious institution (started by an American!) and are brilliant clinicians and fine people.  After they left, I had a little professional reading to do on skin diseases and got to ask my Dad some questions on it; it was cool.  My father thanked me on leaving and I am always bemused by that: he is a busy man, and I appreciate that he finds time for us.

That I can see family when I want, and that we get along - I will always appreciate that.

Unw -


Monday, March 18, 2013

Report of 18 March 2013

Good afternoon!
Sun shining, plant on the balcony preening - you know the drill.

Work is good.  Today was my Kovalam day.  Last week, one of the older patients had had BP in the 200's over 100's and complained of blurry vision.  We gave her some medicine to lower her BP and asked that she call someone from home; she said there was no one there, so we made her lie down in a quiet corner and then our able project head, Salih, later went to her house with her.  They told her granddaughter to get her evaluated, and expressed the urgency; which other organisation would do this?  Well, in she marched today, stating she felt okay, and then she said to me, "There you went, giving me 1 tablet and then abandoning me."  I was not in the mood for this, so told her that if one good or kind or appreciative word came out of her mouth, I would faint or drop dead.  Salih then came in, and I asked that he mention the extent of the efforts that everyone made; he tried, but I do not think much of it registered.  It probably registered outside the exam room because we'd had to raise our voices to make ourselves heard - and this is not the patient who is very severely hard of hearing.

Appreciation - now there's a novel, refreshing, human concept.

We did get our share of grateful patients coming in.  After I finished examining one, she put both her hands on my cheeks and then removed her hands and kissed them - a gesture of great affection.  All because I'd laid a stethoscope on her.  My father says that the "untouchable" caste is unfailingly grateful to be touched; shoot, I'd hug many of my patients if I could.  But since that is not de rigueur here, I am okay with the folded hands greeting, or a smile. 

Adaikalam has been good.  One of our patients is 25 kgs, 55 lbs, and she is just a couple of inches shorter than me.  So we are doing some bloodwork - every internist's dream - and will try to figure out what is up with this weight.  The staff mention that she eats very well, so the lack of weight gain must have another cause - I hope. 

Vandana addressed a meeting with all the health care workers, on the issue of patients who hit and bite, and it was magnificent.  Just to be able to listen to her thoughts, and to see her ebullience, and revel in her robust optimism - these are big treats.  The main messages in the meeting were the need to protect oneself and to understand why the patients hit and bite; it was very, very enlightening.  I remain impressed with the hcw's, that they would tolerate physical harm, all in the quest to provide good care for those marginalised patients who know not what they are doing.

Naren turned 22 last week and we spoke on the phone.  He is job-hunting in the midwest.  Navin is well and very busy with school, and Scott is at his assignment in Seattle.  We Skyped yesterday, from 4 different locations, and it was fun.  I continue to enjoy my solo state, except when it is time to see movies; no movie-seeing has happened.  I did go to an event where my alma mater, Lady Doak College, was honored as the best college providing women's education in Tamil Nadu (our state).  That was a blast.  Some of my best experiences and great friends, not to mention careful molding by extraordinarily competent professors, came from Lady Doak. 

I have been invited to participate in a Global Health course from another alma mater, the University of Texas Health Science Center in San Antonio, and would *love* to attend.  Now comes the quest to find some bucks to get there.  Sigh - the lot of those working with the marginalised does not change.  However, it does give us some fine insight into what the poor must go through when they hear "No" at every step :).  My new goal is business class travel on any one leg of a flight: to sleep horizontal - the heck with the fancy food and drink - would be utopian.  I can dream. 

Let me wind up and get to reading that newspaper.  A new Pope, Mr. Chavez's legacy, more corruption in India - lots of things to read about.

Unw -


Saturday, March 09, 2013

Report of 9 March 2013

Good afternoon!

The sun is shining, the apartment is clean, quite a bit of junk has been thrown, my new set of self-learning books from the American College of Physicians is here - oooh, life is good.

My keyboard is skittish, so if you see extraneous characters anywhere, I apologise.

So now, I have had some challenges with the mentally ill populace.  When I get to Adaikalam on Tuesdays and Thursdays, I sit at the lone available computer near the reception area and work; of late, everyone has stopped there and voiced their litany of complaints.  I am not patient at the best of times, and with the amount of work I have to get done before the next person needs the computer, I am totally not inclined to empathize.  The complaints are of the nature of "AM stole my skirt," and "What's for b'fast?  I can't walk upstairs and find out" and "I shared my tea, no one is sharing theirs with me."  Honestly, I think people think I care.  Vandana and many of my colleagues are singularly amazing in how well they respond to such complaints, and I try to learn from them.  I'd much rather, however, deal with medical issues.

It is good for me to keep in mind that these ladies have endured considerable turbulence in their lives, and seeing their families is a forgotten luxury.  I can see my family when I want, and they endure my whines.  The issues I have to deal with can be handled, and I can ask for assistance to make them manageable.  A raging mental illness and family who has abandoned the patient or is ignorant of her whereabouts are something else.

We walk a fine line between mental illness and mental health.  There were many times I thought I'd wig out: soon after the birth of our 2nd son or when Manu died or when my mother was hospitalised and family came unglued. 

Classes for the health care workers go swimmingly.  This week, the topic was kidney failure and it generated a lot of questions.  A couple of the health care workers had taken care of a friend of the Banyan who'd had kidney failure and regretfully died at a young age, and they recognised the symptoms and management.  They are getting to be fine providers, these ladies.

Kovalam is fine.  We have a patient who is very hard of hearing and who needs blood tests, which must be done elsewhere.  She cannot fully hear or comprehend this, and we have bellowed every week that we need her family members to come and talk to us.  The social workers and community workers have also done their share of yelling, to no avail.  So, we do our best with this patient, educating her on her illness and again, trying mightily (literally) to make her comply fully.  

The 3 Weiss men are in their various corners of the U.S. and I am here.  Friends and neighbors have said I must be wilting in my loneliness.  Not yet.  I am enjoying the time to read and study, and can find many things to occupy my interest.  There are several vats of food in the fridge after Naren's farewell parties and I eat very well - salads and meat and yogurt.  We have a new lady to help clean our house and she has whipped it in shape.  Work is busy and challenging and rewarding: it is great to work with visionary colleagues.  The one thing I have not done is see movies, because a woman going to the theater alone sometimes attracts unwanted attention.  But life is good.

Unw -


Monday, March 04, 2013

Report of 4 March 2013

Hello from Chennai!

This is Moz (mosquito) heaven, I am telling you.  Nothing works on the critters.  There is a Chinese-made bat that zaps them, or riles them into vengeance.  I had little sleep last night.

As always, the B is fabulous.  Today, a patient came to Kovalam short of breath and looking ill.  As I mulled over - very quickly - the many reasons a man in his 40's could be short of breath, he then produced evaluations from an outside hospital from November 2012 where he had been diagnosed with tuberculosis and kidney failure.  He had ostensibly then pleaded inability to pay, and the hospital had referred him to the Government hospital.  He did not go.  His health is precarious now, and I yelled at him and his wife, asking why they could not follow up the diligent eval that had already happened.  Yelling at patients is de rigeur here: not all of them respond to kindness and gentleness.

The daughter of one of our alcoholic patients works with us now, as my medical assistant.  She is fabulous: keen to learn and looking on with me at new findings.  She also corroborates my exhortations to patients to follow up with specialists, and that is a benefit.  I discovered recently that she is just 17 years old.  What a treat!  She said she had dropped out of school as she "didn't get studies," and I thought her clinical acumen certainly is solid. 

We spent the weekend entertaining neigbors and then friends of Naren's.  He leaves soon for the U.S.  Scott left on Saturday for his assignment in Seattle, and I will hold the fort here.  On Sunday, we went to lunch with my sister's sons, who also live in this apartment complex, and that was joyous.  It is nice to hang with bright young people.

Adaikalam is good and the patients are healing.  We are about to start an immunisation drive for the staff, and will vaccinate them against Hepatitis B. 

Hope good things come your way.

Unw -