Report of 29 Nov 2015

Good evening -

Sick, sick, sick.  I think it is either dengue, or viral food poisoning.  Now I know exactly what patients feel like when they drag themselves in.  Often, after I give them IV fluids, they perk up nicely and state they feel better: at this point, the gratitude shown to me is boundless.  Very nice.  That is why I am in this profession, truly - for the occasional "Thank you."

I have whined away to Scott.  He is usually taciturn when ill, I am not.  Whine, complain, go off on tangents.

The Banyan has been good.  I have not had as much work as I usually do; I have often said to Scott that we must be the only profession that works to put ourselves out of business.  So, the B's personnel appear able to handle emergencies, thank goodness, or our census is lower, or all the mammoth preparations we do in prevention of illnesses is paying off.  Knock on wood.  As a result, I am bored witless.  I would like to practice hospitalist medicine here; many of you know the saga with getting permission to work here.

Last week, one of the housekeeping staff came to see me with a fever.  We ran several tests, I gave her acetaminophen/paracetamol and she is better.  I love to see recovery: the folks look like new clothing, fresh new personnel.  Another housekeeping staff member also said she was unwell, and that she was having terrible trouble breathing.  This is a huge deal.  I examined her from top to toe and found nothing.  There is always the worry that I am missing something and I told the admin personnel, who oversee the area of housekeeping; as it turns out, there is a possibility of this particular staff member malingering.  Phew.  I was relieved.  Then irritated.  I am glad she is okay, overall.

We are planning away for the Banyan's Family Day, and think we will have a good show this year.  We might have a merry-go-round and ice cream, as well, which we have the money for this year.  Hooray!  We always have plenty of candy, given out as prizes for games.  Both young and old enjoy the games - Guess the number of peanuts in the jar, Name the teddy bear (we then draw a name from the lot submitted), and such.  It is a fun activity for all, and I feel privileged that we can provide it.

We Skyped twice with our sons this weekend and ended up having an argument about their plans + lack of interest in the call.  At least one of them plans to live with a cousin or friends while auditioning for roles; I think a part-time job would be a fine plan.  As I stated to a friend and colleague, I am grateful that the boys mouth off; far better than drowning their sorrows and their mother's non-understanding in illicit substances.  The call did end on notes of affection and familial bonhomie, with plenty of "Love you"s.  

We saw "Secret in their eyes" earlier this week and attended a colleague's housewarming today.  The prayer at the latter event was very meaningful, and I was also glad to see other Banyan colleagues there, though I was taken to task for not wearing a sari :).

Unw -

R

Report of 25 Nov 2015

Good morning!

Here comes the sun.  Happy sight.  The rains have been relentless and flooding is ongoing.  The Banyan's team sailed out (sometimes literally) to deliver food and succor to folks in rain-inundated areas.  I had stayed home on severe rain days, and went to work yesterday, not fully knowing that it had rained heavily and for a long duration on Monday.  It was slow-going and I ignorantly thought I'd get there anyway.  Very close to the B, the roads were closed and I had to take a detour.  Ahhh - those roads were flooded and water on the roads was almost until my window.  Our car is a quasi-SUV and sits higher than other cars.  This was the first time this monsoon I was driving in such conditions and I was sweating.  The detour worsened to streets similarly flooded and when I asked for directions, the few individuals who were there could not tell me; thus, I turned around, and drove through the same flood that I had just gone through.  As I mulled over going home, I found that the prior road closure had been revoked, and cars were going through; the thought, "Halleluia, I can get there after all," started to evaporate as I ploughed into a similar deluge.  Ohhhhh.  I don't often pray but did yesterday.  Taking public transport was even less of an option as I saw that a bus had broken down in front of me and all the passengers had stepped out into the water and were pushing - de rigueur here.  Somehow, thanks to all the Heavenly powers and a vehicle that had just been serviced, I got to the B.  One of the drivers came out to park my car at a suitable spot and I was extremely relieved to see him.  And all of the B.

Now I know firsthand the troubles of rain-ravaged areas.  No food, water, milk for babies; dry clothes?  Relief centers in Chennai continue to operate, after closing joyfully in anticipation of cessation of rain.

The sea is a pale blue today.  We can see it.  No sheets of rain blocking the view.

The Banyan is wonderful.  As I told Scott, all of us work together, we age together and are one giant family.  I now wear glasses to read and write, several young colleagues have married and bred, and we have also buried/cremated patients.

Kovalam clinic was busy on Monday.  I had the assistance of SMF's doctor (doing Family Medicine residency at SMF), and was relieved: these docs are fine folks, and can see children, whom I am not trained to treat.  Schools were closed again and the children of our patients continued to romp about; this was a treat.  As always.  One of them came to see me of his own volition, which I love - he has a boil on the side of his face and we treated it.  The fathers of these children are not in their lives: uniformly, all the mothers have been abandoned.  Interestingly, the children are none the worse for wear: I don't mean to disparage fathers - I am plentifully grateful that my father and Scott are in their children's lives - but do see the tremendous contribution that others make in raising a child.  Colleagues see that the kids are bathed, fed and attend school regularly; any deviation from the norm as set by the B - good grades, respectful behavior, no sassing - causes the wrath of Khan and the children are spoken to.  Daily, my regard for my colleagues increases: as I age, I don't do things like disciplining children well or willingly.

Adaikalam was great.  We have brought a Kovalam patients who was so debilitated she could not walk.  I suspected reactivation of tuberculosis, but that is not the case - halleluia.  I have treated her for a presumed lung infection (I do not have her chest xray results), and she is better, wheezing less.  At this point, I need allied health personnel to swing in - make her walk, do some physical therapy, get her out of bed.  When there are staggering physical signs - like inability to walk - we must pay attention to medical causes; after those are treated, I need assistance to emotionally equip the patient to participate in recovery.

We saw "Spectre."  Yep.  All that fuss about the Bond girl being 52; Daniel Craig looked about 80.  We are going to talk about an older Bond girl?  What about an ancient Bond?  Oooooh.  He is a fine-looking man, with an enviable anatomy, but I can't say I enjoyed the flick.  All have their favorites - Bond, the women, the gadgets - and for me, it is the villain that makes the flick.  Javier Bardem really ruled; what an actor.  I cannot say I like Christoph Waltz's villainy: like Jack Nicholson, he appears to have the same expression for all his villains.  Still, it was an ok flick.

At a different theatre, we saw "Burnt" and enjoyed it.  There is a little snack shop outside that theatre where we eat before or after the flick, the theatre fare being very expensive.  The gentleman there and his son are lovely folks, and they had invited us to the son's wedding also; I attended the reception.  On going there last weekend, I found someone else sitting in the father's spot and the son at his usual place; the son told me his father had passed away.  We were rocked.  Like a close friend passing.  We condoled with the son, who got teary at recollections, and left.

Life goes on, does it not.  With joys and tears.

We are extremely happy to see that some of you donated to the Banyan's Family Day.  We can, this year, have ice cream for our patients, staff and staff families.  Thank you, thank you!  It makes me very happy when treats can be given to the Banyan family.

Happy Thanksgiving to those of you who celebrate it!  We have much to be thankful for, including the fact that our sons will be with good people (Naren with Peter Carley and David Gere and family, and Navin with my sister-in-law, Diane Wuensch, and her family) at T-g.

Unw -

R

Report of 18 Nov 2015

Good evening!

It is dusk.  The Bay of Bengal is still under haze, but not due to rain.  The sun peeped out today - halleluia!  The city is water-logged and flood relief efforts are underway, with the Banyan doing its part and cooking food for inundated neighborhoods.  Truly, it is a privilege to work here.

I ventured out to our seaside village clinic on Monday.  It was slow-going as the roads were flooded and I had no idea what was under the standing water - road or jagged potholes.  I like our car, and would like not to sustain damage, so crawled along.  The main road to Kovalam was dug up, so I had to take a circuitous route, but got there.  We thought there would be minimal patients due to the rain, but there was a ceaseless procession of them.  Fever, cough and cold.  Arthritis, worsening.  It felt good, so very good, to return to work.

The children of our patients did not go to school, the Government having declared a holiday for schools.  So all were at the clinic, milling about and gabbing.  They ate a late lunch with us.  It was wonderful to see them dry, safe and fed; the alternative is to have a mother with untreated mental illness and be marooned in the streets without food or with alms if the mother were lucid enough to beg/have her child beg.  We are saving a few souls, aren't we, a little bit at a time.

Classes resumed for the health care workers (hcw's) and we talked about heart disease as well as monsoon-related illnesses.  The hcw's are a motivated and fun bunch, and we laugh a lot during classes.  Not having daughters, I find myself quite responsible for these young women.  Especially as I age.  I was 40 when I started working in India and am now a middle-aged, grey-haired 52.

We Skyped with our sons last week and that was grand fun.  Also involving laughter, the boys' senses of humor came to the fore and it was a most enjoyable session.

I swam today, in an effort to reduce thigh blubber.  As said blubber has existed for over 25 years, I am not holding my breath that it is going to vanish, to be replaced by rippling musculature; however, it was grand to exercise.

Unw -

R

Report of 13 Nov 2015

Good morning from Monsoon City!

The vista is grey and hazy, the Bay of Bengal is a faint deeper grey on the horizon and the rain is here.  The road opposite our balcony leads to a school and a church, and it is inundated, with large puddles; folks with colorful umbrellas are braving the monsoon and walking about.  No one could do this on Monday, when the winds were gusting.

We are well, and hope the same with you.  The lady who cleans our house came yesterday; I messaged her today and told her not to come.  She phoned a little later and I repeated the word; she said her house was leaking.  Daily, our blessings are revealed to us, are they not.  I am not in the slightest bit religious - faith having been shaken after my brother's demise - but know a blessing when I see it.  When folks talk of how much I take care of others at the Banyan, I repeat with conviction that I do it for 1 reason - me: I come home, and look at our 4 walls and roof, a husband not beating the tar out of me, and sons who still talk to me and have not thrown me out of the house.  Truly, the Banyan lends perspective.

Said lady, Ms. X, told me yesterday that she fell over the weekend, likely due to water, and clonged her head.  The blood supply to the head is plentiful, and small injuries are likely to bleed heavily.  She had smartly applied ice and taken acetaminophen/paracetamol, and was better.  She is a widow, with brand new twin grandchildren.  In Tamil Nadu, and indeed in many parts of India, the parents of the mother-to-be are responsible for birth expenses, subsequent ceremonies, jewellery purchases, blah, blah, blah.  All part of a big conspiracy to continue to fleece the woman's family for years and years.  The twins arrived prematurely, and are slowly gaining weight.  Ms. X told me that ferrying the kids to and from the hospital was an all-day affair and there was no one to help.  I remember single parents coming to Lamaze class with us; after our respective kids came along, I wondered how the single mothers managed - the exertion of looking after offspring needed 2 people to cope with it!

We saw my sister last week, after she delivered a lecture here.  She is a pediatrician of international repute and is headed to Rio later this week for the world Pediatric Infectious Disease summit.  She is on the scientific committee and, as always, spoke lightly of this giant honor.  It was grand to see her; we giggled a bunch, exchanged little gifts, went shopping with her and then went separate ways.  I had asked her to bring custard apples - a fruit with a sweet interior - as they are cheaper and better in Vellore; she brought some and we bought some, and our fridge is now full.

I have not been to work in 8 days due to the monsoon and am feeling it.  If this is how retirement would be, I want to balance it with work.  I swam this morning in spite of the rain and got a buzz, as always, from the exercise.  As long as the body parts are working, I think I'd like to keep them tuned.

May you have some fine days!

Unw -

R

Report of 6 Nov 2015

Good evening!

We are on our balcony.  It was windy earlier and the sea looked like it had a ton of little boats on it; the white spots were actually spots of white surf being kicked up by the wind.  The sight was beautiful.

Work has been good.  Cut short this week due to the monsoon: Chennai's road drainage system is not very good and the roads flood in rains.  Commuting is a tremendous challenge.  So I said I'd work from home, was available on the phone 24/7 and got a fair amount done.  One of our health care workers (hcw's) lost her sister, aged 30, to what sounds like a heart attack.  I have some serious teaching to do, to educate the young women to get to a health care provider when chest pain hits, so that they may take these lessons to their families.  The hcw's, as I have mentioned, are spectacularly committed young women, thriving on lessons taught to them, being clinically astute, and staying unfailingly diligent with our patients, even when said patients are being difficult.

I'd brought chocolate for some of our hcws' children; not for all, luggage weight restrictions would not permit that.  One of the hcw's thanked me profusely; she said it was a huge deal for them.  I asked why; she said that even if it were a tiny thing, the fact that it was from overseas - assuredly out of reach for all of them - meant a lot.  She said the chocolate was tasty, and that her children had given a little piece to both parents.  It was a chocolate rabbit, bought for 25 cents at the $1 store's Easter clearance; that it should mean such a lot was novel for me.

My colleague at Union Hospital, Iqtidar, had given me a heap of chocolate, which I also shared with the hcw's.  They blessed him and his family.  Iggy is of Pakistani descent; the divide between India and Pakistan is only between the Governments, never the people.

Scott and I caught a fun Tamil movie, "Naanum Rowdy Dhaan" ("I am also a rowdy").  This was subititled, thus all the more enjoyable.  We spent 4 hours in line today at an Aadhaar card event.  An Aadhaar number is a unique indentifier, thought up by the Government to keep track of all of us.  The event was chaotic: there is no line/queue system in India and people pushed and shoved.  We waited, and waited, finally dispensing medicine to the sole Aadhaar official (very young and reeling from a headache) and getting our application seen when it was time to be seen.  The lack of lines and order here irritates the **** out of me.  Most things are so beautifully done in the U.S. - when the system works well.

The white cottony clouds are darkening, the grey ones are full of rain and headed elsewhere.  Our complex's swimming pool, where I spent an enjoyable 40 minutes this am, is being used noisily and another evening draws to a close.  My Dad saw a few patients with me at Kovalam this past Monday and said he enjoyed seeing patients again: he teaches and chairs sessions now.  I was grateful for his involvement, especially with an older lady with a pronounced hunch-back; he suggested a brace, which I had not considered at all.

It is a grand profession, and such a privilege to be in it.

We Skyped with both our sons and that was joyous.  As the boys used to want our attention when they were very little, we now are grateful for theirs - what a volte-face.  And when a kind word comes off their tongues, woo hoo!!!  Truly, the roles are reversed.  They are genial young men, thus speaking with them is always fun.

Unw -

R 

Report of 1 Nov 2015

Belated Happy Halloween to all!

Hope all are well.  We are fine, on our balcony looking out at a very soggy Bay of Bengal: the Northeast monsoon is here.  The balcony is still a grand place to be.

Work has begun.  I was at our seaside clinic, Kovalam, on Monday.  The folks there, as at our other facilities, are fabulous.  We are taking care of mental illness, and physical.  Nisha, the able coordinator there, who is in her late 20's and running the center oh-so well, asked if I'd see a patient after the regular crowd was done.  What Nisha says, I do.  I saw the patient, whose mental illness is under good control.  She is, however, tired and gaining weight, and I ordered some tests.  Her daughter had brought her, and Nisha shared that we help the daughter with her collegiate education.  Hooray!  What a place.  There appears to have been an abusive father, since deceased: no one seems sorry, except perhaps ruing the lack of finances.  The young daughter was ferrying her mother to the clinic, working part-time, going to college, doing it all.  I asked, before I could stop myself, exactly what the *&%$ the sons did, and then focused.  We ordered some tests, I told the daughter I was impressed by her being in college, etc., and asked that she please not quit.

It helps immensely to be in an organisation where we try to solve problems, where we are the solution.  It was wonderful to stare at the pretty young college student, and know that we would help her, come what may.

I went to Adaikalam on Tuesday and Thursday, and sat in on a meeting about Government schemes.  We have an academic wing called "The Banyan Academy of Leadership in Mental Health," or "BALM," and a couple of recent graduates of our Master's Program have been hired by us; these folks did the presenting.  It was eye-opening; there are schemes for widows and destitute women, etc., i.e., financial payments.  The task before us now is how to access these schemes.  We will find a way.  It was grand to be back with the nurses and health care workers (hcw's): these are young women after my own heart, and they got an extra dose of chocolate for it.  They are compassionate, and committed, and clinically solid, and downright fun.  My friend, Fanny, runs a trust and helps quite a few single mothers with the education of their children.  I had told her about a health care worker needing help, and that young lady thanked me for even mentioning it, getting very teary.  I was bemused; I had simply mentioned it - c'est tout.  As it turns out, the hcw needing help has 2 sisters who are helping pay for her daughter's schooling and she appears set, but still was profusely grateful for the mention.  

We remain a mite cash-strapped.  I would like an occasional meat dish to help our patients and staff get buff enough to combat illness without the aid of medicines.  We will see if that happens.  As you can tell, the lack of finances fazes no one.

This past summer has been epiphanic.  Medicine in the U.S. this year was about money.  Scott feared for the safety of our young sons, who are men of color; after the James Blake incident, it was evident that innocent bystanders of color are also attacked - by police officers.  I don't think the U.S. can blithely talk of human rights violations in other countries when its own citizens are suspect due to the color of their skin.  I realised that people in power - whether at corporations, hospitals or Volkswagen - can do anything.  I also realised that there are folks who will speak up for what is right, but it seems to me that those are becoming fewer.  On the flight back, as I was lying for the entire 10 hours despondently pondering these affairs, the flight attendant told me his parents had taught him to always look down, and do for those who were below him; that helped immeasurably.

My father is here this weekend and we have attended the wonderful conference organised by SMF Hospital.  That hospital is committed to seeing our patients for free, and their conferences are annually excellent learning opportunities; my father and I went, and had a spectacular time.

Through all of this, I have remained grateful for the morally upright folks in my life - those at SMF, the Banyan, my family, new friends I made in Terre Haute, old friends in the U.S. and here.  They have sustained me through turbulent last days in the U.S.

Ultimately, it is nice to be with folks who ceaselessly do for others.  I am fortunate.  We yell, and scream, and are not very nice, but collectively, we try to get the job done.

Unw -

R