Report of 31 May 2020

Good evening!

All is well here and hope the same with you.  I have just eaten a cold mango - one of the joys of Chennai summer - and my mouth is very happy.  As am I.  I have not been in Chennai in May-June for many years and missed mango season completely.  Not this year!  I have been eating mangoes, sometimes as a meal. 

The Banyan is great.  I turned 57 last week and the B had a most delicious cake for me.  I was actually going to slink in and slink out, but Leela - our head nurse - asked if I could hang around for a bit and the cake was brought.  She also gifted me a very pretty sari.  One of the patients bought me a purse and a wallet that the vocational training unit made; these are lovely things and not inexpensive.  I appreciated all the thoughts in my direction and had a splendid day. 

We went to Writer's Cafe - now open for takeout - and bought some treats.  We came home and spoke to friends and family, and had a good day.

The B has all manner of preventive measures in place - sanitizer, checking temperatures, hand washing with soap and water - and we continue to hope that we keep COVID at bay.

Last week, we stopped at our favorite coconut vendor.  He and his wife also used to sell "koozh," which is a porridge made of hearty grains and rice.  They cannot sell this any more during COVID times, thus money is tight.  We had coconuts, bought "nungu (palm fruit)" and tried to buy as many of their wares as we could.  The man also had an accident in January, breaking his clavicle, thus cannot cut nungu all day.

I was privileged to see Vandana and get a short chat in on my birthday.  I also talked to my sister, father and our children, and enjoyed all the conversations.  Our children sent me very nice recorded and written wishes, and I have looked at/listened to them multiple times. 

29 May was the birthday of our younger child.  They (1 of 2 preferred pronouns) made a public announcement that they are now trans-woman, named "Natalie."  Nat had told us of gender dysphoria, the counselling process and decision to come out, and we support all of it.  She is happier and I expect her to kick some a**.  Of note, I do squats and lunges and take the stairs until I am huffing and puffing - all in the quest for some decent leg muscles - and along comes Nat, 6' woman with 5' slender legs.  Life sometimes is not fair :) but that is okay.   

My father and I had a long chat today, primarily about Nat.  He did not quite understand the process or the decision at first - and transgenders are a mightily ostracised population in India - but we spoke at length and I mentioned how much happier Nat is, that we did not go through any trauma, that we support the decision, that Naren has been very protective and supportive of his sibling, and at the end of that, my Dad said, "Tell Navin (former name) I support this 100%.  You cannot hide from what is within you."  That was lovely  My Dad was quite a trailblazer in gender reassignment surgery, doing complicated surgeries as far back as 50 years ago. 

We have been catching up on movies, I have been doing Continuing Medical Education (CME) including one on transgender medicine, and exercising.  We were fortunate to speak to both our children twice last week and had a riotous conversation on 29 May, singing to Nat on her "rebirthday."  We spoke and shared and laughed.  We are lucky to have brave, strong and inspiring children.

Unw -

R

Report of 25 May 2020

Good evening!

Eid Mubarak!  May Allah's choicest blessings be upon you and yours. 

Much of our furniture on the balcony is piled up on itself as we swept and mopped this morning.  India has a plethora of hired help and many households have assistance with cooking and cleaning; with the lockdown, no help is coming - appropriately - and so we are doing all of it ourselves, as many in other countries do.  It is meltingly hot - 41 degrees celsius or 105 degrees fahrenheit on 1 or 2 days - so we hurry up with the chores before the sun unleashes its midday glory.

I do appreciate having the sun, though.  Many of us are in robust good moods because of the abundance of sunlight.  I have lived in grey areas and been miserable, thus I appreciate getting into the sunlight.  Just before I left for the U.S. for the first time, my father said, "Take a good look at the sunshine.  You won't see it for another 2 years," and he was almost right. 

We are well.  Scott shaved his head last week with my help, as no barbers were open.  He feels that by the time his hair grows back, a barber or 2 might have resumed the trade.  I gave him an initial haircut and was very pleased with it myself, but the shave was the ultimate destination, so off went the hair.  My late mother used to say that not everyone can be bald, that some folks have head-shapes that cannot rock baldness - I might be one of those.  Scott, though, looks good and cool and comfortable.

The Banyan is good.  I was at work last week and handled lots of cases, both patients and staff.  With the heat, we are seeing many skin conditions - prickly heat, rashes, etc. - and all have to be treated.  I tend to liberally prescribe the panacea, coconut oil.  I also gave a talk on tuberculosis and COVID-19 (a repeat); folks from other sites joined us online and it was grand fun.  The staff at the B are unfailingly eager to learn and are a joy to teach; Scott is perennially envious.   

The bed that our late dancer used to occupy is now occupied by someone else.  My eyes tend to mist up when I see that bed: I remember Ms. X, her lack of enthusiasm for my curls unruly; her love of old film music; her easy use of obscenities; her initial chattiness about her family; her asking if I was married (considered a rite of passage for women here, with spinsterhood viewed as a grand curse); and most especially her dancing.  As I said during a talk once, I am heterosexual and happily married, and yet when I saw Ms. X dance, I perceived a happy sensuousness about her. 

We grow with our patients.  We grow old together, our hair greys, we acquire spectacles, and sometimes, we employees cremate or bury our patients.  We miss them and I am grateful that they were with us, to give us all the joy of a well-placed obscenity or a mesmerizing dance.

Kovalam is also fine.  I had to take a phone call today about a patient who has a pelvic fracture.  We try to prevent falls in our patients with diet and exercise, and are not always successful.  We are grateful that SMF Hospital's orthopedic surgeons are available to help us. 

We spoke to our children during the week and that was nice.  During one call, it was morning for them and there were plenty of yawns plus staying in bed; it reminded me of old times, when both children were little.  That time flew.  I also spoke to my Dad.  There was a COVID fatality in the next street and he is being doubly careful.

It is, ultimately, a good life.  We have done what we can.

Unw -

R

      

Report of 17 May 2020

Good evening -

The Muttukadu bridge is quiet - no traffic.  We will likely enter lockdown no. 4 tomorrow.  Our number of cases continues to climb and it strikes me that management here is a flail.  We are not testing enough, the Government (free) hospitals are full and now the Government is urging that private hospitals also make provision for treating COVID cases, with separate entrances, isolation wards, etc.  The Government had initially wanted all COVID cases to go to the Govt hospitals. 

We are well.  I went back to the B on Thursday and that was nice.  I had forgotten the distance to Adaikalam - about 52 km or 33 miles - and was glad of the airconditioning in our car, to help cope with the drive.  Also, where would we be without music?  So, the music played and I drove, and saw patients.  I ate a meal at the B, which I always love - hot food, made by someone else, served with love and care.  The patients were well, perennially looked after well by the staff.  I headed home early and was happy to eat lunch with my husband.  We do shower these days as soon as we enter after having been outside, a practice that my Dad said his surgeon father used to do: enter the house, go straight to the bathroom, finish a bath, put on non-hospital clothes and then gad about.

I have not yet been to Kovalam as the project director there prefers telemedicine; that is fine by me.  We are managing the patients thus. 

We spoke to our children yesterday morning, their time - they were groggy but otherwise well, thank goodness.  I wonder about the wisdom of living here while our children live there, and that is a decision we have to balance daily.  I spoke to my father today and we discussed the pandemic, hygiene measures, etc.  It was a very nice chat. 

It is my hope that all are nicer to each other when we finally have a vaccine and life is back to restaurant visits, or grocery store trips, or haircuts.  That may take a year or 2, of course.

Until next week -

R

Report of 13 May 2020

And then there was a gas leak.

As though the pandemic were not enough, an LG plant leaked styrene gas over a village to the north of us.  Actually, the safety valves functioned as they ought, and leaked gas out of an overfilled tank, otherwise the tanks would have exploded, much more gas would have been released and many more deaths would have ensued. 

While I thought COVID was the great equaliser - afflicting rich and poor alike - the poor in India have suffered more.  Many leave their home states to seek work elsewhere.  After work got suspended due to the pandemic, salaries were non-existent, food unprocurable and so, the migrant workers started walking home.  Some sporadic efforts have been made to take the folks home, but they are mostly stopped and asked to return from whence they came, getting housed in quarantine centers.  These centers are of variable quality, as is the food and drink - if any.  A group of migrant workers - to escape these checks and stops - followed railroad tracks and fell asleep one night on said tracks; 16 of them were run over by a train which tried to alert them and tried to stop. 

Thus is COVID and styrene gas, and poverty.  It has been long seen - especially on airlines - that those who could afford less got less.  Sad, I thought - at one time, airlines served everyone who got on the planes.  Will we see a kinder, gentler world after COVID?  I see a bit of it already on roads here: fellow drivers are more considerate and pedestrians more patient. 

The lockdown eased up this week and I returned to work yesterday at the Banyan.  One of our patients, Ms. X, died last week.  She had had a urinary tract infection and was variably responding to the antibiotics.  She ate sometimes and did not eat sometimes.  On her last day, she was taken for a bath and uttered obscenities, as she sometimes would; after the bath, she lay down and was pulseless and without any measurable blood pressure.  The staff tried to resuscitate her, to no avail.  After 15 minutes, I suggested - over the phone - that they stop.  I was immensely mollified at the obscenities; she was her usual self until she died.  No suffering, no pain, no umpteen tubes in her body. 

Ms. X was a beloved patient - passionately fond of old movie songs and dancing in perfect rhythm to them.  She was a wonderful sight to behold.  She was also the patient I feared most if I entered with a fancy haircut.  I have mentioned this before.  It was fine for the salon to tell me "Get this gel in your hair and shake your hair about, not 1 comb should touch your hair;"  If I walked into Adaikalam thus, feeling so fly, Ms. X would peer at me, gesture to me to come over, reach under her pillow and produce her comb, and tell me to comb my hair.  After a different patient, now a beautician, experimented with my hair - with my blessings - and gave me a very nice haircut, one of the former nurses asked what Ms. X thought of the haircut.  Ms. X was that legendary.  May her soul rest in peace. 

I had thought during the lockdown that I was ready for retirement: I enjoyed having days at home with Scott - exercise, breakfast, make lunch (often healthy), read, study, do continuing medical education (CME), eat lunch, watch a movie.  Then I returned to work yesterday and am re-hooked.  See patients, treat them, have them get better, get smiles, see good health - all very addicting.

We hung out with both children on Mother's Day and they were sweetly indulgent, allowing the lengthy chat with utmost geniality and good humor.  I spoke to my father and that was also fun.  I give lectures in Tamil at the Banyan and he wanted to know Tamil words for some medical terms.  He was pleasantly thunderstruck at the aptness of some words, e.g., the Tamil word for vital signs is "life status signs," which vital signs truly are. 

Scott is convinced he will get - or has already got - COVID.  As am I. 

Hope all of you stay well and safe!

Unw -

R 

Report of 3 May 2020

Good evening!

"Blue Jay" - a movie not to see.  My friend, LaDonna, used to say after a terrible movie, "That's 2 hours of my life I won't get back."  This movie, Blue Jay, had been so well-reviewed, blah blah, we kept hoping it would improve.  It did not.  Fortunately, only 1 hour and 20 minutes irretrievably gone.

We are well.  The Banyan is wonderful.  Telemedicine, keeping up with patients, trying to ensure they stay healthy.  The staff is diligent and wonderful, some of the staff are "users" of our services themselves, i.e., they are patients who have had mental illness treated and are now functional enough to help us as staff.  All of this makes for a nice, therapeutic environment.

One of the Adaikalam calls was about a patient, Ms. X, who stopped eating.  The Doctors Healey, geriatricians extraordinaire, told us during residency that we must check for pneumonia and urinary tract infections (UTI) in older patients who did not "act right."  So, I checked and there is a flaming UTI.  The patient is undergoing treatment; she still has a fever off and on, but her appetite is improving.  Small triumphs, very large in our world.

Kovalam is also fine.  The patient who had to be hospitalised last week is recovering slowly and vomited today.  We are keeping a close eye on her. 

The lockdown in India has been extended by 2 weeks.  Some restrictions have been eased; we will see in the coming week what has been eased.  Doctors are apparently allowed to return to the clinics.  Some restaurants have been open for take-out, not to eat-in. 

Our extended family got together on Whatsapp yesterday to talk.  It was nice.  There was a lot of "Say that again" as audio connections got strained, but all in all, a fun time. 

We spoke to our children and they are well.  Lots of laughter and chatting.  They are also locked down in NYC and Philly.  I spoke to my father and he pointed out that we were fortunate to go through the pandemic instead of merely reading about it.  That was a different opinion and I mulled it over; truly, it has been an experience going through it and much of it is good learning.  I am immensely sorry for the deaths.  Nature is loving the decreased human presence.  Science is coming to the fore with possibilities of vaccines and cures.  All in all, a fine learning time. 

Unw -

R