Report of 22 Oct 2017

Good evening from our balcony!

The sea and sky are merging in color.  The Northeast Monsoon is here and the usual chaos of flooding, etc., is imminent, unfortunately.  Both Banyan facilities are low-lying and I will hope like the Dickens that I can get there.  Otherwise, the staff is mighty diligent about contacting me by phone and we manage.

Life is fine.  Big rain today and the road perpendicular to our apartment complex has several puddles.  I had wanted to swim in our complex's pool and my engineer husband once told me that wasn't a swell idea, to swim when there is rain.

Our patient with a diabetic foot ulcer is back from the hospital after she was operated on.  She is an intelligent person, knowing what is going on with her body, and updated me well.  Sometimes, our patients are sent home to their families and all good intentions abound; then, the issues of the patients not taking their meds, etc., come flying to the fore and the patients come flying back to us.  The medicines are mailed to the patients free of charge - as another blogger said, "The Banyan is for life" - but the meds are not going to do any good at all unless they are placed in the mouth and some water follows, the meds are swallowed.  Noncompliance had happened with our patient and I am happy that the foot is not worse; she came close to losing her toes, but thankfully did not.  She is now on insulin as I simply cannot waffle about with oral medicines. 

Kovalam is fine.  The residents (postgraduate doctors) from a Chennai hospital have stopped coming and I was solo last week; it was fine, really.  We have our share of noncompliance with community-dwelling patients, also, and I had to have the social workers drill some sense into these folks.  For some patients, the clinic visit is social hour; many with blood pressure issues - who only have to be monitored once a year - come very week!  They catch up with the others in the waiting area, fill us in on their family news, share tales; unfailingly, our staff treat all the patients with respect and I imagine the patients like that and want more of it, it being revolutionary to an impoverished, "scheduled caste" populace.  A couple of weeks ago, as we briefly left to have breakfast in our dining hall, one of the patients told me to tell the staff to give her breakfast, just as another patient had asked the previous week for milk.  We do not have the resources to feed all comers, regretfully.  For this reason, I like the breakfast to be ready before the patients start coming, so that eating is completed before those who can afford little come to the clinic

Private practice is also grand.  As I have mentioned before, a new breed of patient is the sexually active unmarried Indian.  One such came, pregnant.  MTP (medical termination of pregnancy) happened and there was a bit of a complication as a pregnancy was detected in the fallopian tube (an "ectopic pregnancy").  I listened to my OB/GYN colleague (and owner of the hospital) explain this condition to the patient and was riveted; it is always nice to listen to other specialists, especially competent ones.  The patient went to surgery and thankfully, is okay.  I always insist on seeing these folks, as I give a huge lesson/lecture on condom use.  [Interestingly, since I am ex-U.S., younger acquaintances seem to think I would condone all manner of sexual practices and freely admit pre-marital liaisons to me; I try not to moralise, but do insist on condom use.]  All of us are relieved the young lady is fine and I gave the number of the Banyan for counselling, as she professed family problems; I never like stories of estranged families and try quite hard to keep the peace.

18 October was Diwali, our festival of lights, the triumph of good over evil.  Scott and I got up early, hair wash, new clothes, prayed to my mother and then ate sweets all day.  We are to also exchange sweets with our neighbors and friends, but did not as we capitalised on our rare mid-week day off to simply eat and read and Skype with the boys.  Speaking of which, we spoke with them today, too; that was lovely - candor and humor and chatter. 

May your days also be filled with candor, humor and chatter.

Unw -

R     

Report of 15 Oct 2017

Good evening from the world indoors!

I am late getting to this, because I went off to swim and then cooked my husband dinner.  He rather likes pasta and I made it.  I enjoy cooking immensely; it is always easy in the U.S.

We are well.  The Banyan is wonderful.  I was very sick this week, but heard that one of my beloved patients, Ms. X, had a urinary infection, and went to work.  She is mentally challenged and is hard to understand, but is unabashedly fun and always immensely considerate: "You eat, then I will," etc.  She had not been herself, and we checked bloodwork and urine, and lo and behold, there it was.  So I hauled myself in to the B, started the antibiotic, checked a billion other patients and left.  The kind folks in the kitchen made me ginger tea, which is a spectacularly delicious milky concoction with tea, ginger, pepper and a vat of sugar.  I felt better after that, and infintely grateful for this wonderful pampering/consideration. 

I did manage to get to my private practice and saw a patient who had attempted suicide.  She was about my age, and it was unclear whether she had consumed ant poison or rat poison.  The 2 are managed differently, and I asked the son which it was; he stepped up to the bedside and barked, "So which did you ingest?!!!"  My word; I asked him why he was threatening his mother and he apologised.  I referred them for counselling and left, feeling grateful that the 3 Weiss men would not treat me that way.

Speaking of which, we Skyped with both boys today and that was fun.  Both talk a lot and share a lot, and the adult Weiss men are a treat.  As were the younger Weiss men, of course, it is just nice now to not have teenage hormones flaring.  A young female colleague at the Banyan stated that she had skipped dinner the previous night as she'd had a fight with the family; I asked whom that had affected the most, she acknowledged it was herself, and I went on to speak of "The joys of boys," who fought until the next meal, and all was well as we ate together.  Nice.  Uncomplicated.

Scott and I drove to Madurai and visited my father.  I had a medical issue to discuss with him, and discuss we did.  We also ate, and reminisced, and laughed.  It was a nice visit and I returned, rejuvenated.

May you have refreshing times of your own.

Unw -

R 

Report of 8 Oct 2017

Hello from our balcony!

The Bay of Bengal is still blue, the clothes are drying and falling off the rack in the breeze, there is a cricket game in full swing downstairs, about a dozen custard apples are ripening on our kitchen counter and I have eaten.  That's a big thing for me - eating.  The word "Hangry" is a fine one; if I have to work and am hungry, all the cylinders do not fire, I get irritable, miss details in the patient's history or lab reports, etc.  And that's one day or one meal.  Imagine the unfortunate folks for whom hunger is a state of being.  We are indeed fortunate, my mother said, that we can afford the food we like to eat. 

The Banyan is fine.  There is a Diwali hamper-packing effort on, and many personnel were engaged in it.  The Indian festival of lights - Diwali or Deepavali - is coming up and one of the B's fundraisers is a hamper that can be gifted; we pack pickle and sweets and papads, and the giver can then gift it.  The B secured an order for 6000 (yes, 6000) gift hampers from a local company and then everyone was off and running; the pickle was made, the homemade papads were attempted but there was not enough sun to dry them and they had to be procured from elsewhere, the containers were painted.  The whole place has been abuzz with activity.  The patients are well and well-treated, and fed, this last being a matter of great pride for me.  There is a lot of dengue around and I have tried to insist on mosquito nets + repellent.  Dengue is a reportable illness and the city's health officials visited us last week after we reported a case.  We have no standing water on the premises, but there is stagnant water in a drain nearby that I have tried for years to have closed.  No success yet.  Let us see.   

My private practice is also good.  The owners of Swaram Hospital are fine, ethical and committed folks and all try to provide exemplary care to the patients.  One of the patients in the ICU a few days ago was a 24 year old lady who had attempted suicide.  I saw her, and she seemed fit for discharge; usually, I refer such patients - and other depressed folks - to the Banyan and did this time, also.  She told me she did not want to marry and that had caused stress in the family; when my 24 year old tells me he does not want to marry, I say fine, but - as the patient and I discussed - it is different for a young woman in a traditional family.  Her mother was alongside; she and I did not speak the same language but often motherhood is a language in itself, isn't it.  I held her arm as I explained through the patient our options for counselling, etc., and the mother started crying; as I looked at her, her face, and tried to find words or actions to soothe her, a slender arm came into our field of vision and long fingers gently wiped away the mother's tears as the daughter tried to spare her mother more sadness.  It was a spectacularly beautiful moment and I teared up at it, also; so there were 3 of us practically blubbering there.  That was really dignified, wasn't it - the physician also almost crying. 

Sometimes it is good for physicians to fall sick.  We then know firsthand what the patients go through.  I had battled a respiratory virus for 3 weeks and I think it has just turned bacterial; I am a little wiped out and am coughing up nasty stuff, and will start an antibiotic tomorrow.  I was also evaluated in Vellore by a great friend of my sister; the friend is a dermatologist and evaluated the hideous dark pigmentation on my cheeks and neck.  We have started treatment; as I told the dermatologist, I was not in a hurry to get this condition evaluated as my husband still thinks I am one of the most beautiful women he has ever met and I don't sit around staring at my own face all day, thus was not bothered by it.  It has distressed my patients and colleagues, though, and I did think it prudent to see a doctor about it, cosmetic implications aside.  Christian Medical College, Vellore, was started by an American at least a century ago and is one of the pre-eminent colleges + hospital in all of India.  My sister, Anu, and brother-in-law, Benji, studied there, Anu still works there, my niece, Sanjana, is now a student there and you can rest assured that an eval at CMC will be thorough and good.  My eval was no different and I am sitting here, comfortable as a clam with the treatment plan.

We got together with Anu and Sanjana after my derm appointment, had lunch, overate merrily and talked and laughed all afternoon.  It was a fine time.

We Skyped with the boys today and that was grand fun.  Lots of laughter here, too.  The boys are now at the stage where they talk freely with us about all manner of things and for this, as always, I am grateful.  We discussed intimacy today with some eye-rolling, but I stated my point and the young men listened: take your time getting intimate.  A med school classmate once told me she had stayed in a toxic relationship only because she and the man were intimate and I thought my sons needed to know that.  There were also various happy tidings shared by both sons and that was nice.

May you have many things that make you happy.

Until next week,

R  

Report of 1 Oct 2017

Good evening from our balcony -

There is an extended family plooshing about in the pool in the next building, our clothes are dry and the sea is a blue-grey as night falls.  My long weekend is over.  Tomorrow is Gandhi Jayanthi - Gandhi's birthday and a national holiday - but the B's patients know no such holiday and I will also return to my private practice tomorrow. 

The week has been fine.  Nothing like returning to the Banyan.  One of our long-time patients (file no. 7, when we have treated over 1800 patients!) is ill with dengue and hospitalised.  She is a beloved individual and all are praying.  She appears to be improving, and I hope for the best.  She also has diabetes and is a breast cancer survivor, and these things can contribute to complicate illnesses, so I am holding my breath.  Prayers welcome.

Kovalam was also great.  The proportion of mentally ill patients seeking physical illness care is on the increase and I am privileged.  By all statistics, mentally ill patients do not do well when physical illness hits and I am grateful the B has an avenue for both mental illness and physical illness clinics to happen at the same time. 

I saw a movie this week - a Tamil film called "Thupparivaalan," by one of my favorite directors, Mysskin.  Going alone to the movies here is not de rigeur, and I filled the manager in on my state of affairs; he gives me a non-crowded seat, if possible.  I am immensely grateful for this kindness, as I simply want to watch the flick without interruption from other viewers.  My profusion of grey hair helps this cause. 

We Skyped with the boys today and that was nice.  I will remain perennially grateful that they talk to us.

Scott is near me on our balcony, on his computer.  I have cooked a vat of pasta, ably aided by the sous-chef, the aforementioned Scott, and was grateful for his cutting assistance.  I was not as wildly impressed by the pasta, but Scott was, and had 2 bowls.  It is fun to cook; our kitchen is a tad small, but the sous-chef assistance helped in all manner of ways.

May you have fine times and meals of your own.

Unw -

R