Report of 30 March 2020

Good evening!

The sky is blue, as is the sea.  The evening sun is shining brightly on the buildings around.  I have just finished talking to my aunt, who lives by herself in Mysore.  In her 70's, she was caregiver for her older sister, who had dementia.  These are fiery women, my mother's ilk. 

We are locked down and likely safer for it.  The gloom and doom predictions should be noted.  We know little of the virus and whom it will affect badly.  Some obvious risk factors have been publicised, but of late, it is also affecting younger and healthier people. 

Scott and I are working from home.  My pulse races every time the phone rings.  However, the Banyan is blessed to have exemplary staff and hopefully, a higher power protecting our precious patients.  There have been reports of occasional coughs, which I treat over the phone.  Temperature monitoring is being done on all.  The infrared thermometers used to cost Rs. 3000, now they cost Rs. 15000.  The Banyan is absolutely great about investing in what we need to save lives.

I talked to my father yesterday.  He has plenty of reading material and a TV, thus he is going through the lockdown with equanimity.

Naren is in NY, the new epicenter of the virus, and Navin in Philly.  Both are taking the pandemic seriously, and that is wise.  They are wiser than their mother, who has a likely foolhardy streak of optimism.  Yes, yes, I am honoring the lockdown, etc., and am still hopeful that we will triumph.  The newspaper is full of stories of birds chirping and wildlife returning to original residences: the lack of human noise and intrusion seems to be good for nature. 

We went to buy vegetables and essentials today.  We were stopped by the police 3 times and then permitted to continue.  I like this diligence. 

Please stay safe and well.

Unw -

R

Report of 22 March 2020

Life in the times of Corona, said a headline in our newspaper.

At the Banyan, we have had to cancel clinics, stagger staff schedules, prohibit visitors and cancel all outside activities.  A residential facility becomes a petri dish in times of virus transmission, and our staff are being hyper-vigilant about symptoms in patients and staff.  The staff really are exemplary in what they do.  It makes it possible to work from home - sort of - though, of course, my pulse races when the phone rings. 

Scott and I have had to cancel our plans for U.S. travel.  The week before last, there was an announcement about the conference of the American College of Physicians being cancelled.  Usually, I try to get to the U.S. to attend the conference and with the cancellation, there is no need to go bolting there.  Especially in times of corona.

Last week, clinics at Kovalam were triaged, with a huge phalanx of staff triaging outside and directing patients inside.  Before clinic started for outpatients, I had to see several inpatients - making wait times longer for those waiting outside.  One of the outpatients said - during her visit with me - that I had taken too long to see patients.  I yelled to one of our community workers and asked her to take this lady to the waiting area, requesting her to clue the woman in on what/what not to say to the provider and to bring her in after I'd seen the next patient.  Much ballyhooing ensued, but the patient was taken away.  The next patient was one of my favorites, a local fisherman, unfailingly appreciative of what we do: as I apologised to him for the wait, he said, "Oh, that's okay," and it was like salve.  Were we a huggy nation, in huggy times, I would have hugged him. 

We got through clinic and then I had to give a lecture on coronavirus.  I enjoy teaching and we had a good session.  I went on to my private practice, found no patients and went home. 

The next day, I had to give the same teaching session at Adaikalam and the room was packed, as staff from all departments were urged to attend.  Scott is always envious of how willing my colleagues at the B are to learn, when his students are often not motivated.  The session at Adaikalam was lively and fun and engaging, and I am hopeful that the message went through.

By Wednesday, I was on the prowl to see if our residential facilities could get testing done on the premises, instead of our having to ferry our patients/staff to the very places where transmission could be high - testing labs with patients waiting.  I have no answers yet, but am hopeful that someone will consider our case.  To be poor - anywhere - means being left out of many therapeutic interventions.

On Thursday, senior leadership and I had a meeting on the severity of the situation and several measures - prohibiting visitors, staggering staff schedules, checking temperatures on all - were put in place.  I was relieved to see instant understanding from the team. 

We spoke to both our children and they are working from home.  It was lovely to see them, to hear of their days and their interactions with each other.  I asked that we talk regularly, as not seeing them in person is one unpleasant side effect of not travelling to the U.S. 

Scott is a good person to go through this crisis with.  He reads out online news, to my great benefit.  I only read the newspaper - finding lengthy exposure to the computer and phone a big strain on my eyes - and news in the paper might not be comprehensive.  I incorporated some of what he told me in my lectures and my meeting, and we are hoping all are spared the worst of this crisis. 

We hope you stay safe and well.  No hugging. 

Unw -

R

Report of 8 March 2020

Happy Women's Day!

I hate everything about everything today.  I swam this morning and was full of bonhomie and gratitude earlier, then I posted on the Society for Hospital Medicine exchange and am now thinking the post was idiotic.  Thus, the blahs set in.  I made a dish for lunch and Scott does not like it.  I was not going to eat it, but tasted it and quite loved it, so have had 2 bowlsful.  It is made of a sprout and ragi (a millet) and some dhal; I had tried for years to make an Irani dish called orsh and this approximates it, so that should make me feel better.

We are well.  The Banyan is its usual nice self.  Responsibilities have changed based on distance from residence and I now go to Kovalam twice a week instead of once a week - exchanging the former Kovalam schedule for Adaikalam's; it is nice.  Last week, we had to tell some people from a nearby home for elderly that they have to access care at the Government Primary Health Center (PHC); they were not happy.  Our services have to be cut for financial reasons and urging people to go to the PHC is the way to go for now: at least there *is* a Government clinic nearby, unlike in many countries.  The Kovalam clinic is routinely slammed on Mondays, with upwards of 40 patients to be seen in half a day - and that is with reduced services. 

One of our adult patients came in with a blood test for diabetes and it showed her illness was out of control.  The student interning with us came in with the patient and proceeded to tell me that the patient really *was* trying to manage her illness, when all evidence pointed elsewhere.  When I said that, the patient - also on medication for mental illness - snatched the paper out of my hand and said, "Well, that's plenty!  If you are not going to give me the medicines, I am leaving," and stomped out.  We have resources to educate our population; they have to be willing to be educated.  The next week, her father - also one of our patients - came by and we mentioned this little altercation; he gestured, sighed and said, "Leave it.  If a person cannot speak with respect, they need not be treated," and we did not belabor the point. 

Adaikalam is fine.  We had an HIV positive patient return to see us; she is emaciated and concerning.  I ordered a ton of blood tests and found she had kidney failure.  She and her husband were eager to return home - about 10 hours away - and so, we asked that she follow up there.  She did go see the nephrologist and I was pleased.  It is quite, quite lovely when patients do as they are told.

My private practice is also fine.  We have several young patients come in with persistent cough.  With the new affluence in India and the plethora of Information Technology (IT) jobs, many employees sit in 24-hour airconditioning, to the detriment of their lungs.  I have had to try varied remedies and then hope for the best. 

We talked to both our children and they are well.  Movies are being released, job situations are being addressed and both are making a difference in the world - knock on wood.  That is all we want of our children. 

We attended a Hip Hop performance by a local band called "Black Boys."  It was good.  They emulate another band called "Casteless Collective," and sing about pressing local issues.  We also attended a couple of markets of female entrepreneurs and enjoyed them.

Unw -

R