Report of 28 June '13

Hello from the Carmel library!

All of this is free - even the airconditioning.  Yes!!

Work has been fine.  My colleague and I went in this week (our week off) to help out the other team, as they were short-staffed.  You can't really enjoy your days off if you know your colleagues are getting hammered by workload.  So we went for 3 of 7 days, and it was fine.  One of my patients came in confused, and every blood test I would normally order for confusion came back normal.  Her son eternally hovers, and I was impressed by his concern.  His sister is a nurse and together, they have been helping to care for their mother.  As I noticed some unusual meds on her list, he mentioned that they suggested them to her doctor and the doc prescribed them.  The story wore on and it turns out that brother and sister did not give their mother the pain med her doctor had prescribed but instead gave her a much stronger version of Tylenol and plenty of it.  She is now admitted with her liver having taken a bit of a hit - which can happen with loads of Tylenol.  I asked the son to please let the doctor practice her craft and then called the doc and updated her about happenings.

Let the doctor do her/his job.

We had some merriment around the house.  One day, I was awoken from sleep by some noises.  As I came down, I asked both boys what was going on and was told the noises were outside.  Then came a couple of thumps from next door and children crying; I listened, it sounded like a violent argument and I told the boys we had to call the police.  So I did, and the lady asked if I wanted to give my name; as I mulled it over, she said, "Honey, if you give your name, it goes on the report," so I did not.  A cop came, and hauled the man of the house off to jail.  A few minutes later, we heard, "Open the door!" and it was at our door.  I told the boys not to open it, and listened at the door; not hearing anything violent, I opened it and the young lady from next door was there, crying.  She asked that we please call the police if her mate's relatives came and kicked down her apartment door; she had been beaten by her partner, and was going to a relative's house with her children.  As we gaped, she apologised, we came to our senses and reassured her that we would do as she said.  The next day, we reported it to our apartment complex's managers.  I wonder at the terror a woman faces as her loved one gets violent.  I wonder at the numerous factors that make her stay on with him. 

My sister, Anu, once did research on this issue and found that 9 of 10 households she surveyed had the husband beating the wife; in the 10th household, the wife beat the husband.

We were privileged to briefly see Kris Rea and Gabe Soukup, and their lovely little girls, Isabella, Rosalia and Gabriella.  Always a treat - so much love in that house.

Scott was here last week from Seattle, and he and the boys did some fun things while I worked.  All of us managed to get to Olive Garden one evening to eat dinner, and that was fabulous: we listened to the boys' candor, their experiences with alcohol and such, and their easy, uninhibited chatter.  We are privileged in this relationship.  This week, the boys and I saw "Bling Ring (very so-so)," "Monsters University," and "White House Down."  The latter 2 were surprisingly entertaining; good lines in the animated flick and Mr. Tatum in "WHD" in a tank top, what's not to like.  The boys and I also went to eat at "The Cheesecake Factory."  The joy of having some extra cash is being able to spend it on someone else and I enjoyed watching the boys eat and then order cheesecake - which was easily 4 inches high - to go.  Again, I enjoyed their chatter and their rapport with each other: they spring to each other's defense, are quick to do favors for each other and unfailingly tell me that the other needs to be given space from parental interference :).  All of this is nice, even the last comment.

The matter of obesity in the U.S. is not a puzzle any more.  The cheapest foods are the unhealthiest.  And portions are never small.  4" high cheesecake.  A slice big enough for 2, served for 1. 

Hope you have a good week!

Unw -

R

 

Report of 20 June '13

Good evening -

Go home and hug your kids.  Hug those you love.  We had a patient come in, 18 months old, and he was found at his daycare somewhat caught against a "child gate."  I don't know all the details about the gate or the incident, but suffice it to say that the child could not be resuscitated in our Emergency Department, and died.  He had been looked after at an in-home daycare.  The parents were remarkably composed, and some saw fit to talk about how long they'd taken to get to the ED.  Who knows what was going on in their lives.  What is going on now is every parent's nightmare, that they have outlived their child, that they must plan funeral details, that a little being who delighted them just by his being and eating and smiling and loving will no longer do that.  They will likely look for him and be harshly reminded of today's reality. 

There were police officers aplenty in the ED.  They will investigate what went on in the daycare.  Respect for human life is large here in the U.S. 

I have another patient who is 35 and has an unusual cancer that has spread.  She speaks in a monotone and I asked her boyfriend if she usually does that; he mentioned that she usually speaks quietly.  I have urged her to consider palliative care, which she is balking at.  She is a nurse and knows what is happening.  She has finally agreed to consider the palliative care option and I am relieved.  As I told Naren, perhaps there is something finite and certain about cancer, so that you can nicely plan your life and what to do with what and whom.  Naren felt that was my non-cancer-patient viewpoint, that someone afflicted with cancer would be sad and scared.  Navin does not enter medical discussions, usually.  I like the boys' candor. 

So, there it is.  Hug someone, love, eat something you like, do something you enjoy.  We are blessed in whom we have.

Unw -

R

Report of 13 June '13

And this is bliss -

Both boys are here, we are about to watch the ball game (Spurs and Heat), and we have seen some movies and eaten out - all  joyous.  Today's feature films were "The Great Gatsby" and "This is the end" for the boys, and the latter for me.  I had not wanted to see a stoner flick, but it was very funny, well-made and beautifully-acted,   Nice job, Seth Rogen.

Work was good.  I had admitted a patient just before we left for Rio.  The man drank a litre of Jim Beam daily, and when he said he smoked a pack a day, I said, "Oh, don't want to live, eh."  He had given me a wry smile.  When I returned from Brazil, I had to sign some records and looked at his chart just to see what had happened: he had died.  I felt spooked; he and I had discussed death, and there it was.

I had another patient who was yellow from top to toe.  His liver function was off and so were his kidneys, all due to alcohol.  He was 33.  I read up on Hepatorenal syndrome, which this young man had, and found that the prognosis was very poor, with a life span of weeks.  This young man is going to die.  I know his mother; I worked with her elsewhere.  I was fairly relieved that she was not in the room when I went in the following day, after the patient had been given the prognosis.  I am a mother, too.

There was a developmentally delayed patient, admitted with fevers and a clogged feeding tube.  He lies in bed and yells all day.  As I read his chart, I found that he had suffered decreased oxygen supply to the brain after cocaine use.

Needless to say, the boys and I have had extensive discussions on choices open to them.  They have had some setbacks recently, but I am very relieved to state that none of these was because their moral compass was pointed in the wrong direction.  These other things (finances, school affairs) they can get over and do something about; if they'd done something morally repugnant, that would have been near-completely our (the parents') lapse.

The week off is nice.  I have studied and sat in on medical topic talks at St. V.  These days, all my benign flirtations and chatter involve saying things such as, "You look pensive, just like my sons," and so on.  50, my dears.  Middle age.

Unw -

R 

Report of 1 June '13

Hello from Indianapolis!

The radio is playing, the dryer upstairs is churning out the umpteenth load and we are back from Rio.

The trip was magnificent.  We did not speak the language, the people were welcoming and warm, the views of swimsuit-clad folks on the back were sexy, and the racial harmony was lovely.  The contrast was stark when we returned to the U.S. via Charlotte, NC (it could have been any U.S. city): the racial divide was immediately evident.

The best part of the trip was listening to our kids chatter and enjoy life.  On Navin's b'day, we took a trip to his choice of place - Pao de Acucar, Sugarloaf Mountain.  As we got off the cable car, Naren noticed in the line waiting to go down - most of the main cast of one of the boys' favorite movies, "The Hangover."  That was a hoot!  Ed Helms was spotted first and then we saw Bradley Cooper in a hat and sunglasses.  As Scott and I said, we have been on this planet for 50 years without any Hollywood star sightings, and what happens on Navin's 20th b'day?  They spot some A-listers.  When we mentioned this, Navin said, "There were probably no jet planes in your twenties, were there?"  :)

After that site, we walked down Ipanema beach, came to Copacabana and stopped at a beachside shop to have the national alcoholic drink, the Caipirinha.  Sugarcane liquor, lime, delicious.  All talked, especially the boys, some about their experience with people, college, alcohol, etc.  Their candor was a treat.  We have few secrets from the boys, and perhaps they are returning the favor.

As we wound up our evening, I asked the young, handome caipirinha stall employee to dance with me and he was startled, refusing almost instantly.  There was good Brazilian music playing at the shop and I cannot just listen to music, I *have* to dance. 

We also saw some local parks in Rio and the commercial center.  In many public parks, there is exercise equipment that the senior citizens use regularly.  At least in Rio, the folks were healthy-looking and we saw very few obese people.  We made new friends - Claudia Ferreira and her son, Luc.  (We met through other friends, Luciana and Greg.)  They joined us for dinner and we talked and talked.  I especially like meeting folks of other countries: we end up being so similar and, often, nicely different.

We went with Claudia to a favela (slum).  This was built on a hillside and the houses were brightly colored and pretty.  I specifically wanted to shop at a place where the money would benefit the less-privileged, and we stopped at a little store in the favela.  We bought some food and I found later that the pastry made there, with corn and sugar, was very tasty.  Markedly better than the store-bought treats.  The coffee at that shop was also among the best I have had.  The young man in charge of the shop undercharged us and I pointed it out; he said it was okay and told us we were always welcome back.  I appreciated having Claudia's help with the translation.  The favela was memorable. 

The flight back was nice.  US Airways' flight attendant, Lynette, engaged our boys in conversation and they liked that.  On the flight to Indy, there was a 20-month old in front of us and she leaned over their row to interact with us the entire flight, and make squint-eyes at the boys.  Both our sons like little kids and they were pretty enthralled with this attention.

I felt someone share a virus on the plane from Rio, and the virus is on me.  So, Ricola and tea for today.  I cooked madly yesterday, wanting home food, and the boys ate immense amounts.  We felt like the Hungry, Hungry caterpillar - eating a green leaf after gorging on tasty Brazilian food.

Unw -

R