Report of 23 October 2015

Hello from our living room as I look at gathering rain clouds here and over the Bay of Bengal:

Rain is very nice when viewed from inside, where one is warm and dry.  One monsoon, 1 of the 2 founders of the Banyan, Vaishnavi, drove around to see which impoverished souls were marooned.  I got a call at our apartment about a person she had rescued, who likely had hepatitis; I could not go to work because of the rains but promised to check the patient when I next went.  Truly, it is an absolute joy to work for principled bosses - and these 2 are younger than I am.

We are safely in Chennai.  The flights were uneventful and I was fed very well - always a pre-requisite for a good flight.  Scott hates flying domestically in the U.S. - the service is apathetic if not downright snarly, the airlines consider a soft drink a meal and delays appear de rigueur.  Not so internationally: food is free on flights, but offerings are getting meager.  Breakfast on the Chicago-London leg was a bowl of fruit and a croissant, when I was hungry enough to eat a full English breakfast.  Or a horse.  I think the flight attendant saw my look of "still hungry" and asked if I would like a bagel.  I declined, and later ate full meals on the next flight.

Work was fine.  I had a patient who was a nun.  It is a tremendous privilege for me to care for people of God and this lady and I talked a bunch.  She had had a fall, but was admitted for low sodium.  I saw that she had brittle bones ("osteoporosis") and the xray did not show a fracture, but I was very suspicious of one and got an MRI - lo and behold, a fracture.  The orthopedic surgeon saw this patient but did not recommend surgery.  On another patient who was an IV drug user, I was told by the Emergency Room doctor that she thought the patient had an infection of a heart valve ("endocarditis"); I was sceptical.  As it turned out, the study of the patient's heart - an echocardiogram - showed that she did have endocarditis.  I had missed it.

Listen to the patient.  Listen to other doctors.  Listen.  Listen.

We spent some fine days in the U.S. before leaving.  We had lunch with colleague Tena Hedges, and that was fun.  We saw a movie or 2 - Tom Hanks's grand "The Bridge of Spies," featuring a fine stage actor well-loved by Naren, Mark Rylance - and attended the beautiful wedding of Melinda Taber.  Melinda's parents, Colleen and Mark, are long-time friends and perennial wonderful hosts, and our sons grew up with the gentle Melinda and her fun brother, Christopher.  We had a blast at the wedding, officiated by another friend, Carolyn Scanlan, and enjoyed seeing old friends Sofiya and Mikhail, and Shilpa and Ravi.  We spent Monday cleaning and throwing, and getting together with colleague Jaswanth and his warm, hospitable wife, Nikhila.  We managed to see the genial Olivia Fondoble before we left, and shopped at Trader Joe.  We stashed our stuff in the garage of other fine friends, Kris Rea and Gabe Soukup, and felt grateful for their friendship, as well as that of others in the U.S.  We were privileged to see my competent and fun colleague, Dhanashri, on the day we left, and we talked endlessly on various topics.  We said bye to gracious neighbor, Becky, and her entire family.  Navin treated us to breakfast at Rose-Hulman on the day of departure, and we talked and laughed.  We spoke to Naren on the phone and that was fun, also.
 
I felt a tremendous sense of gratitude for the presence of our intelligent, candid, opinionated and affectionate sons in our lives, particularly as I help take care of many women who do not have the same joy of contact with their offspring - for a variety of reasons: illness, estrangement, ignorance of whereabouts.

Let me wind up.  Hope all of you are well.

Unw -

R  

Report of 16 Oct 2015

Good evening from the Terre Haute library!

Nice place, this.  I am exhausted - very little sleep last night.  Cell phone messages pinging, other noises.  I am a huge fan of sleep, and don't really subscribe to the "Hey, I can coast on 5 hours sleep every night."  Yeow, no.  8.  7 if I must.

I have finished work.  We leave for India on 20 October.  The week has been good, with patients with heart attacks that they have survived.  And the patients continue to smoke.  Very mysterious, but the addiction is firm, isn't it.  Literally a death grip on the person.  I think that any day, nicotine is more dangerous than marijuana; young Indians experiment with marijuana, but Scott tells me the danger here is that marijuana leads to cocaine and other vile drugs.  Those are not readily available in India, so we don't often have people keeling over from cocaine, crack and methamphetamine use.  Rave parties are becoming more popular, and are annoying.

The nursing staff and I have shared a couple of meals together.  It is very lovely to sit and eat, and talk and laugh.  At the Banyan, we do this regularly as free food is offered to all.  A one-time CEO tried to cut this benefit in an attempt to curb costs, and thankfully, it survived the cut.  I love eating other people's cooking, so eat there regularly.

Scott's mother fell, injured her head and fractured a backbone; Scott went to Cincinnati and stayed near his mother until she was transferred to a Skilled Nursing Facility (SNF).  We were to see his mother, aunt and uncle this weekend, and had to change our plans.  I wish his Mom a speedy recovery.  Age brings all sorts of adventures.

Next blog likely from India.  I hope all of you are well.  I mean that sincerely.

Unw -

R  

Report of 8 October 2015

Hello from the Terre Haute library!

It is nice to read and write, and be surrounded by books.

Work is wonderful.  Last week, we had the usual quota of alcohol imbibers admitted on Friday and Saturday.  One of them was a Rose-Hulman student, he of the school known for engineering excellence, 20 years old.  The drinking age in Indiana is 21.  We have admitted 18 and 19 year olds also for alcohol intoxication; the 19 year old had also smoked K2, a synthetic marijuana, and was to be arrested on discharge.  "Don't tell him that," said the nurse.  Said 20-year-old was seen to have pancreatitis - inflammation of the pancreas often from alcohol use - and I thought he and I should have a discussion on that.  So we did.  With young people, I don't present the best case scenario right away: I speak of the worst case, replete with horrendous outcomes, dire predictions and ominous facial expressions.  I can actually feel the expressions, leading Naren, our actor son, to remark to his professors that he and I are similar.  The 20-year-old, X, was mildly interested in the adverse effects of his pancreas shutting down, and then I spoke of the arrest of the other patient: that appeared to resonate with this one, and my medical advice to lay off the sauce until he was of legal drinking age may be heeded.

In rough clinics that I have worked in, young men have often not been interested in the life-threatening potential of marijuana; that it could cause impotence was often alarming.  Hey, to each their own in terms of priorities - "I don't mind being dead; that I cannot have an erection would be detrimental."

Synthetic marijuana is so much worse than natural mj.  We have no idea of the additives in synthetics, and how lethal they can be; I have admitted K2-users to the ICU with dangerously low blood pressures, and neurologists have spoken of K2 causing seizures.  As a teenager, I have been at parties where illicit substances were produced and it was quite a Herculean feat to decline: I felt as though a neon light would shine on me right away, that bells would ring in adverse fashion and that the whole world would sneer at she who would decline a joint.  None of that happened.

I have a week off this week, barring an evening shift tomorrow, and we have enjoyed it.  A bunch of colleagues came over for lunch to our pretty across-the-street-from-the-hospital apartment, and we enjoyed gabbing with nurses, techs, custodial workers, physicians, case managers.  The spicy food was eaten before the bland food, which unfailingly surprises me.  We got together with Dr. Robert Love, mentor extraordinaire, and with Louise Hass, friend beyond compare; annually, both give a nice boost to my spirits with genial conversation and sage observations on life and work.  Scott and I also saw "Sicario," I being a huge Benicio Del Toro fan, and groped for other movies to watch, but there are no other worthwhile ones out.

Our sons are fine, 1 in L.A. being an actor, and 1 in Terre Haute being an engineering student.  I spoke to my father today and that was wonderful: we will see him the week after we arrive in Chennai.

The annual struggle to contain our luggage as we return to India has begun.  I resolve every year to make our luggage manageable and then end up buying chocolate and goodies for those at the Banyan who do not travel overseas and cannot ordinarily afford chocolate; I like these folks to have the same experiences as others who have tasted chocolate and other goodies from overseas.  To have done so is considered a status symbol, and I would like the Banyan staff and patients to also have it.  My friend, Colleen, unceasingly understands this.

Hope all of you are well.

Unw -

R