Report of 28 Oct '13

Hello all -

I am in my balmy and breezy living room, having eaten dinner.  Red rice (very healthy, apparently), chicken, veges, yogurt, a salad.  And a sapota for dessert.  I love fruit here - the seasonal variety is eagerly awaited, although I miss mango season every year. 

Work is great.  Young Master X came to see me.  His mother is a patient at the B, and must be at our Transitional Care Center as her mental illness is not under good control.  His grandmother accompanied his mother when she returned to the B, his father having abandoned the family - not unusual when a woman has mental illness, but very saddening.  Soon after, the grandmother made a trip home and returned with X and 2 of his cousins - their parents had separated and remarried.  X goes to school and I am delighted - he used to speak only Hindi and now speaks English and Tamil also.  "Why aren't you in school?," I'd asked in Hindi.  "The weather," he'd replied in English, gesturing to the rain and storm clouds.  He is a strikingly good-looking child and very bright.  He'd had a cough and cold, unresponsive to cough syrup; I am hardly a pediatrician, but I started him on a low-dose antibiotic and he is evidently better.

I feel for this child - a mother with mental illness, he at times having to cope with it.  However, all at the B help look after him, he goes to school instead of begging on the street for his mother and himself, and he has a doting grandmother nearby.  His abundant intellect is also engaged.  Nice job, Banyan!

Home was my destination last week as the monsoon is here and the rains are copious.  Roads to our other facility, Adaikalam, tend to deteriorate with heavy rains.  I also noticed I ran a low-grade fever fairly continuously, and have diagnosed all manner of catastrophic illness in myself :).  I got to see my sister over the weekend and that was fun.  She'd come to give a talk and stopped by our apartment later, looking mighty chic in a silk sari.  Scott and I ate out at our favorite restaurants - upscale, but as an occasional treat and because we so love the food.  The wait staff stopped to say Hi, and that was fun.

Diwali, our festival of lights, is the coming weekend.  I bought a silk sari for the lady who helps clean our house, and she loved it.  She is a widow with 2 daughters and has tenaciously educated both of them: one is a college graduate, and married, and both girls are gainfully employed.  Truly, one of the joys of having some extra cash is to be able to spend it on someone else.

Our sons are well and email regularly.  That we have an open relationship with our offspring - though, of course, they likely have secrets from us - is a joy for me.  As it is to be able to communicate with the rest of the family.  What joy is there in fighting? 

May you have lots of joys of your own.

Unw -

R  

Report of 21 Oct '13

And how the cosmos rights itself, eh -

I had not looked forward to returning home, and did not have the zeal of prior years.  Our sons are in the U.S. and the apartment would seem empty.  But we came, and my Dad arrived shortly after we did, distracting us quite nicely from the silence of our empty residence and filling it with his genial chatter.

Then today, I resumed work at Kovalam, our sea-side village.  My father came with me.  Salih, the project head (all of 29 years old, a little over 1/2 my age) and very capable colleague, had asked a young boy in the village to come and see me with his mother.  The boy, X, had injured his arm, and the mother had done little about it, finally forcing Salih to send the child to the hospital, where an xray was taken and a break in the upper arm bone (the humerus) seen.  X was to have been admitted and surgery done, we have no cash for such activities and neither does the mother.  So, we were going to send X to the Government hospital where care is free and respect for the average patient is hard to come by.  My father, sitting in my room at work for the day, stated that the surgery would be intricate, the break having some at a spot near the growth plate, and said we had to have it very carefully evaluated.  As already mentioned, money for private care is non-existent, so we sent the child to the excellent hospital where our patients are seen for free or at a discount: SMF Hospital is known for its quality and rigor, and the child has been seen and told to go to physical therapy.

What a relief when those without resources can still get good care.

X's father has abandoned the family; X's mother (while still in poverty) has raised 2 children and the older one, a girl, sounds like she has ADHD.  I have not met her, folks speak of her.  X has a hearing disability and might be learning-impaired: he is in 7th grade and cannot read or write well.  I was flabbergasted, but was reminded that teachers in the Government schools here - where education is provided for free - get rewarded for the pass percentage, and I suppose they kept passing X so that their record would look good.  I feel for the mother: though plenty of colleagues faulted her for not caring closely for the child, I think she should also be psychoanalysed and her stressors delineated.  It's very easy for us to sit on the outside and get holier-than-thou about the lady's maternal instincts, is it not.  

A medical conference conducted by SMF over the weekend was excellent, and I enjoyed it.  My father came up from Madurai to attend it.  I had to be in charge of my father the whole time, and did not mind it; it is quite a privilege.  Things have changed with my Dad: gait is slower, need to go to the restroom has increased, he likes his plate of food handed to him instead of trolling the buffet line, etc.  What has not changed: his genial good humor, love of a new experience and tremendous fondness for his son-in-law, my husband.  It was a very fun weekend.

Hope all of you have fun of your own.

Unw -

R   

Report of 6 Oct 2013

Good afternoon!

It is wet outside and I am at the Carmel library.  What a place!  Internet, books, mags - all free.  There is a book sale on today; I hit it earlier in the week.  Today is Bag Day - a local grocery store has provided bags and a buyer can fill it with books for $8.  What a deal. 

We are packed with books in India - 5 bookcases worth.  Thus, little place for more. 

Work has been fine.  It got busy but manageable.  One of my patients, Mr. X, is in Hospice.  He'd had a knee or hip replaced, and went to rehab.  There he felt puny and returned to the hospital.  His lungs started misbehaving for reasons unknown, the pulmonologists "threw everything" - steroids, antibiotics, nebulizer treatments - and he did not improve.  Normally, our patients who go to Hospice are really weak, might be in and out of consciousness, but Mr. X is not - he's alert, awake, conversant and knows he is dying.  That makes it very difficult for the providers, to go in and see Mr. X, and know that he is aware of his prognosis, that none of us can do anything about it.  If he were unconscious, it'd be that much easier.

This last week was my last week off.  I did things on my own.  I was fortunate to meet former boss, Dr. Ed Stone, for breakfast.  Ed is a great person, a very successful entrepreneur, and a fine doctor.  I had a lovely time, and Ed remains one of the best bosses I've ever worked with.  I managed to see Carolyn Scanlan for brunch, and that was also fun: Carolyn is a pastor and has a totally fun outlook on life.  I met new friend, Maltie, for lunch and it was good to chat.  I've seen practically every movie in town: "Thanks for sharing" and "Gravity" were memorable.  I also went to a physician for my check-up: the cancer patient mentioned in the last blog was instrumental in that epiphany.   

Navin got a job!  (Maltie, the friend mentioned above, was instrumental in providing this lead.) He works at a firm run by Rose-Hulman alumni and is doing computer science kinds of things.  He will take a year off and work, and all of us, including Navin, feel it would be good for him.  He's pleased to have this job, especially in this economy: both boys had tried rabidly for employment and were unable to find anything but minimum wage jobs. 

Naren is well in NYC.  He was at Oktoberfest yesterday and rabidly texted his brother through it.  He appears to enjoy his coursework.

Scott is fine in Seattle.  He wrapped up 1 course and his clients are getting ready to start another.  Scott is a natural-born teacher, and I imagine his students learned a lot.

I spoke to my Dad earlier in the week and there was plenty of laughter and chatter.  Yesterday, Navin and I went to my in-laws' farm, and provided dinner.  That was a blast, too.  It is nice to get along with family.  One of my patients could not believe that I returned to Indiana to see my in-laws, among other reasons; "In-laws?!  Hmmm.  I certainly would not go to all that trouble for my in-laws."

Hope you have a great week!

Unw -

R