Report of 29 Sept 2019

Good evening!

The sky is pink, the sea is blue and there is traffic on the Muttukadu bridge.  Some of the newer buses have lights on their undercarriage, too, and look like a "boat bus;" I love the sight of them.

We are well and hope the same with you.  Kovalam's clinic has been cut to every other week, so I did not go this week.  The Banyan is trying to get the populace to go to the Government facility, so that the care can be transitioned in a sustainable fashion.  The management of the Banyan is visionary, so this is likely a good move; I do not know how the patients are responding.  Some of the older patients have not been told to go to the PHC (the Primary Health Center); they like coming to us and I like treating them.

Adaikalam was fine.  A plastic surgeon and head nurse from SMF Hospital came to give us a talk on pressure sores; it was excellent.  We have to focus on prevention.  Both the visitors were delighted to be with us: our staff and patients have that effect on people.  They want to come back, and we welcome them. 

One of my favorite patients was lying down when I entered Adaikalam last week; lunch was over and it was time for the post-meal siesta.  She asked if I had eaten.  She is mentally ill, mentally challenged, her speech is not very clear, her family and she are not in contact, and yet she had the wherewithal and the consideration to ask after me.  I am unfailingly touched by such words.  We are fortunate to work where we do. 

Scott and I went to Madurai on Friday and returned on Saturday.  We took some salami for my father, which he enjoys.  We spent time talking and laughing and eating, as families are wont to do when together.  The next morning, the young lady who helps run the house had crisp and tasty dosais for us for breakfast, made hot and delivered to our plates as we finished the previous one, and we enjoyed breakfast.  My father had salami again :).  Scott and I drove back yesterday and were lucky to get to our balcony before sun-down. 

We saw 2 movies this week: "Otha seruppu size 7" and "Kaappaan."  The former, a 1-person flick, was excellent.  Resul Pookutty, who won an Oscar for Best Sound Mixing for "Slumdog Millionaire," did the sound design for this film.  As the reviewer said, with a cast of 1, all other elements have to be first-rate and they were.  "Kaappaan" was dreadful; it is a "masala movie," intended as an entertainer and sans plot or intelligence.  It had Suriya in it, and I have a big crush on the man; or "had," after this flick.  There were some dance numbers and pretty people, and it lasted 165 minutes. 

We got to talk to 1 boy as the other was travelling.  I do like catching them when we can.

Unw -

R

Report of 22 Sept 2019

Good afternoon!

A certain young husband is sitting on the sofa opposite me in a new shirt, and has turned 58 today.  We are supposed to wear new clothes on our birthdays.  We bought this cotton shirt from a vendor at the market I have mentioned before and Scott likes it.  Cotton is great for this weather.

We are well.  We are struggling with bed sores at the Banyan.  I have asked for assistance from a local surgeon and their hospital's nursing team and they have agreed to come.  Each medical speciality has a unique niche; mine is not prevention or treatment of bed sores.  We need to learn it for the benefit of our patients and we are happy someone is willing to come and teach us.

Some rains landed this week, probably ahead of the monsoon.  On one Adaikalam day, they were blinding and so, I worked from home that day.  We welcome rains and must prepare for them; many roads get waterlogged, potholes are not visible and I try not to drive then. 

Kovalam was fine last week.  We were - as usual - overrun with patients and that got a bit exhausting.  Many social issues, which I must deal with right along with medical.  Fortunately, there are other personnel present who can assist when they are not similarly overrun.  It truly is a fine place, the B: the joy of working with those who would unflinchingly do for others is only revealed and magnified when working in environments where that does not happen. 

Scott and I toodled into town yesterday, had a sumptuous lunch with our friends, Joan and Mohanraj, and M's brother, Manoraj.  It was a fine time.  Then we went to see a play.  It was at "Museum Theatre," a theatre adjoining the Government museum.  Scott is a huge fan of museums; I am not always.  The mood has to be just right, I usually pick areas that I want to see and appreciate clear explanations that I can read quickly.  We went through this museum as we had a lot of time before the play and I was impressed.  So much beauty in our own backyard.  We will likely go back there. 

The play was fine and it was good to see the director, who unfailingly does a fine job.  His young and pretty wife was also there, which was nice.  I enjoyed half the play, it being bedtime at intermission; the 2nd half was fine, also.  We saw many of Naren's friends in the cast and that is always a joy.

Speaking of joys, we hung out with both boys today, which was a nice start to Scott's birthday.  Lots of chatter and laughter.   I will speak with my father later today; I am writing here earlier than usual as I had to grab the chance to blog while the Internet was on, it had been on the fritz earlier. 

It is a fine profession to be in.  I am glad and privileged to be in it, as I am to have studied in the United States and returned to take care of the people here. 

Unw -

R

Report of 15 Sept 2019

Good evening -

It is dusk.  The cows will be going home soon.  The sea has merged with the sky in color.  I have eaten a cold mango - you know, the manna factor.  I am lucky that the mango hoard is lasting until now.  Mango season is typically April to July.

A patient in Adaikalam has died today.  She had bed sores which got infected and then got more bed sores.  She had no appetite at all, thus we could not nutritionally get her buffed up for surgery, which she needed.  Scott had surgery once on his back; it left a gaping hole and we altered his diet - I put beef on the menu almost every day.  The hole healed in about 6 weeks.  We had no such luck with this lady: she would not eat, thus a tube leading from her nose to her stomach had to be placed and we poured nourishment into it.  My sister-in-law, Susan, even gave me recommendations on what to feed; Susan is an excellent nutritionist/dietitian and I welcomed the advice hugely.  Our staff were very diligent, considerate and loving (this is usual at the Banyan, so now you know why I work here) with their care, and the patient died.  We knew the end was coming. 

Through all this, however, I told our staff that I was grateful the patient was with us, that she was going to die with us and not untended on the street, homeless.  1/3 of patients with mental illness become homeless.  Not this lady.  She had a home with us, and a family, and received love and attention and dignity in her passing.  She died as she lived: with our respect and affection.  For this, I am profoundly grateful.

It does not alter the fact that I feel some things could have been done differently.  Many doctors go through this soul-searching.  The buck stops with me.  At one locum assignment in the U.S., when a pharmacist gave me wrong advice and I subsequently questioned the person, the answer was "Well, Dr. Weiss, you are just trying to put the blame on me for a decision that you made."  I said, "Not at all, the ultimate provider in charge of this patient's care is me, and I take complete responsibility for the situation.  I do wish to question you on your recommended antibiotic."  The buck does, indeed, stop with me and the pharmacist seemed mollified.  Folks in the U.S. are perennially scared of a lawsuit.

Kovalam was fine.

Scott and I were out and about yesterday.  We live well outside town, thus plan our sorties into town carefully.  We attended an excellent talk on stroke at a fine local hospital, ate at the hospital's cafeteria, and then went to 2 markets.  These are places where the vendor sells directly to the client without middlemen.  Scott has several cotton shirts bought at such places and my father has unfailingly admired them, so we bought him one.  We also saw a play, being supporters of theater.  Today, my sister, Anu, came into town and we met up with her.  That was fun.  We attended a market of home chefs, who had delicious fare on sale, and we bought quite a few things.

We spoke with the boys - quite unfailingly the highlight of my weeks - yesterday; that was the merry fest it always is and though it was very late for the boys - 10.45 PM and after - they were genial enough.  Trying to find a time suitable for all has become a quest: Naren and I sleep early and wake up early, and Navin may or may not remember the time we set up to chat.  All sorts of merriment, but the boys make it work.

Our swimming pool has reopened and I was fortunate to get a swim in this morning.  It was before news of the patient arrived, thus I had no melancholy to manage with the swim, it was just a swim - just the dancing water, the lights in it, the bubbles my breathing and strokes made, the blue sky and me.  It was therapeutic.  The day goes well when I have swum.  It has rained off and on, and the pool water has fresh rain water in it, not stale water cleaned and re-cleaned.  Thus I did not sneeze my eyeballs off after the swim.  Scott had a cup of hot tea for me after my swim and that also helps reduce the sneezing. 

I will talk to my father when I am done blogging.  That will be nice.

Enjoy your loved ones.  Give them a hug or - if you are not a hugging family - a kind word.

Unw -

R

Report of 8 Sept 2019

Good afternoon from our living room!

The smell of mangoes and cold air hits me as Scott opens the fridge to get milk - "tea time" for our acclimatised friend.  I eat dinner at 4 PM or so, and have acclimatised to American meal times.  Scott likes tea and a sweet treat at 3-ish/4-ish.  I find tea a useless meal.  We had cold mangoes for breakfast and with lunch - manna!

We are well.  The Banyan is also good.  One of our patients ingested a cleaning fluid in an intentional attempt to self-harm and was whisked off to the hospital.  She is okay, thank goodness.  During med school, one of the surgeons told us that if a patient drank lye in a self-harm attempt, we were to procure a gun, show the person where to point it for successful results and leave her/him alone.  I found that supremely callous and harsh, then the surgeon explained that the lye so corrodes the esophagus that the rest of the patient's existence was miserable: cannot eat, cannot get the esophagus repaired successfully, and suffering henceforth.  So, essentially a humane option? 

The Banyan patient mentioned above came to see me on her discharge from the hospital.  Able, wonderful and compassionate staff members (the usual kind at the Banyan, I am happy to say) had already alerted me that she was sad because her son had not come to visit.  I held this patient's hands in both of mine, said that I was also a mother, that I too craved seeing my sons and that I understood.  I told her that her son would visit when he could (Dang, I really hope so).  She is a dear sort, this lady, and takes wonderful care of the dogs, often referring to them as her buddies.  I am hopeful that she is overcoming her melancholy.

Kovalam, with its new reduced schedule for me, was not in my plans last week.  Clinic is every other week and last week, I did not miss it as Scott was on holiday for Vinayakar Chathurthi and both of us hung out at home.  It was nice to have an extra day of no work.  Scott does not get paid for holidays, but who cares - the time was nice.

I had dental surgery last week and it surprisingly wiped me out.  The assistant dentist had told me I had to take all the anti-inflammatories and pain killers, and I did; they surely helped. 

We went to a talk on environment and sustainability and it was good.  The venue - Amethyst - is popular: in the heart of town, it has spectacular greenery and an outdoor cafe.  We ate at the cafe after the talk and the food was excellent. 

I swam this morning.  The security man likes to gawk when I get into the pool, which is irksome.  I have plenty of menopausal and other cellulite and wear a swimsuit with quasi shorts, but that too is unusual for India.  I like exercising alone and have to contend with gawking now.  After a few laps, the security man went about his business until it was time for me to get out.  Sheesh.  Anyway, it was great to get a workout in, the spectator sport notwithstanding.

We heard from our sons and they are well, thank goodness.  I will speak to my father later this evening.  My sister is visiting India from the U.K. and will see him tomorrow, which I am happy about. 

Unw -

R 

Report of 2 Sept 2019

Happy Vinayakar Chathurthi (VC)!

It is the birthday of Lord Ganesha (Pillaiyar or Vinayakar in South India), and is a holiday today.  There will be no newspaper tomorrow.  He is the remover of obstacles and there will be pujas (worship services) galore today.

We were happy to speak with the boys online today and that was fun.  VC wishes were exchanged, lives were updated on and there was much laughter, also.  Profanity emerged on occasion - such as when a camera did not work well - something that our sons have learnt from me.  My usage has been toned down as Scott does not care for it.  Even the dean of our medical school mentioned profanity in his speech to all us interviewees, endearing the school to me forever and thrilling me when I got accepted there.

We are well.  The Banyan is fine.  I had to check on one of our patients who had had an abscess - a collection of pus.  Sometimes, these necessitate minor surgery.  This one did not: I used a medicine recommended by local nursing colleagues - "IG paint" - and it worked.  I was pleased.  We also had a male patient walk in after a motorcycle accident; he had scraped his knee and it apparently hurt.  Our trusted paramedical staff cleaned the wound and gave him a tetanus injection.  He came by my room and thanked me before leaving; I had done little other than ply my trade. 

Adaikalam is also fine.  Last week, I was there on one day, the 26th anniversary of the Banyan, 27/8/2019.  There were events galore at Adaikalam - speeches, cake, dances by the patients and lunch with chicken, a special treat.  Some of the patients had been trained by a volunteer dancer and choreographer, and did an excellent job.  The teacher and other staff mentioned that even a reclusive patient opened up nicely to the dance instruction, which was a joy to hear.  Truly, where would we be without the arts and therapies.  After the event and after the crowd left, some of the staff and I danced on stage with the young dance instructor; it was a blast.  It was nice to celebrate 26 years of this magnificent institution. 

Scott and I left for Madurai on Thursday and stopped at Kovanda Kurichi, a bit of a detour from our route but well worth it.  A former patient has recovered enough to return to this village, her native place, and now practices medicine there.  It was fabulous to see it - clean, well-maintained, happy residents and staff.  We had a delicious breakfast of dosais - made by the Banyan personnel - and then saw Vandana, who was also paying a visit.   

We continued on to Madurai and found my Dad sick with a cough and sore throat.  So I suggested gargling and a cough syrup in addition to the antibiotic he was already on, and he improved.  Thank goodness.  We also visited some close friends of my parents in a magnificent place called Gandhigram ("Gandhi Village"), set up by a visionary doctor years ago.  She was Brahmin and defied all manner of convention to marry a Scheduled Caste man, and set up Gandhigram.  These friends of my parents are a feisty pair of lady doctors, choosing not to marry and loving life.  It was very good to see them, though one has been afflicted with dementia. 

We came back to Chennai and attended my colleague Keerthana's brother's wedding.  It was nice.  Scott likes to attend weddings he is invited to and I rather like going, also; it appears to make the hosts very happy. 

I talked to my Dad on our return and he is well on the mend, thank goodness.  Just as it is tough to see little children ill, it is as difficult to see older relatives unwell.  And a particular treat to see them recover.   

Scott and I went to a market at Kalakshetra, our repository of the arts, and bought some fine things such as cotton clothing and pretty earrings made by a pair of ladies who are nice to buy from.  Lovely to support entrepreneurs thus. 

We have eaten cold mangoes today and I am particularly happy to be back in the homeland at such a time that mangoes are available.  Many years, the mango season has ended by the time I return and I am unfailingly irritated by that fact.  Not this year - hooray!

Unw -

R