Report of 26 July 2020

Good evening!

The sea is blue, as is the sky.  Sunlight is on the entire vista.  At about this time yesterday, we had pouring rain, which I also enjoy. 

Rain is a big deal in an agrarian country and in a farmer family.  My mother's family still grows rice and coffee.  Some adventurous sorts have diversified to pepper, cardamom, lychees, but the main crop is still coffee.  Conversations - even long distance - revolve around rain and my mother's first question to anyone on the phone used to be "Did it rain?"  That became a standing joke for my sibs and me, to ask of anyone, "Did it rain?," and then laugh uproariously.  The question used to come to me from sibs even when I was in the U.S.  Still, rain is a big deal here. 

We are well.  I was at the Banyan last week and was beaten by a patient.  Ms. X had come to me conversationally earlier that morning, and asked if I knew why she was beating people; I said I did not and she said it was because she wanted to go to the beach and play.  Scott and I had tried to drive by the beach the previous week and knew for a fact that access was barred, so I could tell Ms. X honestly that no one was allowed on the beach, that the B would take her when access was allowed, and to not beat people.  She agreed.  Later that morning, as I was defusing a crisis and typing on the phone, she came up to me and beat me on the upper arm twice.  I raised an alarm, a nurse distracted the patient and then we were left alone again.  The second time Ms. X came up to me, I stood up and told her that if she beat me, I would hit back.  She hesitated, I said it again, louder, and a health care worker came and took Ms. X to the isolation room.  There was some issue in the isolation room and then Ms. X came back at me again; I had really had it by this point and stood up and told Ms. X that I would take her teeth out if she tried anything.   

Later, I asked the staff what they did if a patient beat.  They said they were to hold the patient's hands and ask why she was beating.  I discussed this with Vandana over phone messages and Vandana said that mentally ill patients rarely beat - she and Vaishnavi had lived with the Banyan's patients for 8 years and such incidents were rare, she said.  She said the converse was more frequent, that mentally ill citizens were often subject to beatings.  This is true.  We also know that staff who beat patients at the Banyan are instantly terminated and I told Vandana that if she wanted to terminate me (for the threat I issued), she could. 

There is a survival instinct in most species, isn't there: we do what we must to stay alive.  I was the lone staff in the Medical Care Unit (MCU) when Ms. X came at me, and had to keep from getting beaten.  The staff are discussing this issue, including the need to not leave the MCU - or any unit - unattended.

So that was the excitement.  I am very glad I work out, thus could ward off the blows and state quite firmly that I would hit back if beaten. 

We spoke to both children and they are well.  Both have nice roommates whom they are grateful for.  Both are also cooking more, which is nice to see. 

Scott and I ventured out yesterday for our weekly shopping expedition.  We bought the essentials and headed back.  Folks were out in full swing, masked and sanitised.  Cases continue to climb in India, and a dear friend and former classmate lost his 48 year old cousin last week to COVID. 

To get some of the population healthy, I have a health challenge: I issue a suggestion weekly and if followed for a day or a week, I ask that the doer contribute Rs. 50 - Rs. 100 (about USD 1) on Friday to a charity of their choice.  This week's suggestion is: no sugared beverages.  If you'd like to try it, please do. 

I will shortly go talk to my father.  That is always fun. 

Unw -

R    

Report of 19 July 2020

Good evening!

I am trying to stay awake long enough to get on a Zoom call with school friends in about 1.5 hours.  Losing battle.  Some people love Sundays to hang out.  Sunday is a working day for me. 

Hope all are well.  The number of COVID cases in India is increasing.  Some areas are very successful at handwashing, physical distancing and mask use; many of these success stories are headed by women.  Other areas think the worst is over since the lockdown is over.  I understand the U.S. is struggling with leadership and citizens who think the pandemic is interfering with their rights. 

I had to take a phone call the other day from a friend's friend.  Their colleague had had fever and a COVID test done and awaited results.  The symptoms sounded like the test would be positive.  The fever had not subsided and the patient was anxious; we talked and I urged Paracetamol (Acetaminophen) every 4th hour and lots of fluids.  The next morning, the patient was better.  Later that day, the test came back positive and the patient went off to get admitted, which I endorse: history of high blood pressure and obesity, which add to risk. 

The Banyan is well.  I was at work on Tuesday after hanging out with our children that morning.  I did get dosais and then had many, many patients to see.  The patient diagnosed with pneumonia had a slow recovery: when I was there, she refused to eat and looked puny.  The program manager came to get me and we went to see her; she did not converse and I told the nurse to start IV fluids.  A guava was produced and the patient immediately grabbed it and started eating, which was a sight to behold.  She has continued to recover and I am still grateful to the specialist who prescribed the antibiotics.  Last week, the patient even ate some chicken; we cannot afford to give chicken to all the patients, but those who are sick get what they need, which is the joy of the Banyan. 

I was stricken to read of the death of Fahim Saleh.  Successful innovators who do for their impoverished homelands in brilliant endeavors that alleviate poverty are few and far between, and Mr. Saleh's employee/murderer has stopped a visionary and marvellous thought process that - were it to have continued - would have helped many more millions of people. 

We spoke to both our children and they are well.  Some sassiness and snark did emerge during the call, but I remember my mother's advice never to curb our children's honesty.  They are dealing with much: I know I never had to deal with a pandemic in my 20's.  I spoke to my Dad this evening and we spoke of much, including the British surgeon who served in his village in the 1930's and how my father thought the surgeon was his uncle - not knowing any color or race distinction.  It was a gentle and humorous conversation, full of nostalgia. 

Stay well and safe, folks!

Unw -

R 

Report of 13 July 2020

Good evening!

My late mother's birthday today.  She went out of the way to make each family member's birthday memorable and grand.  On one day of the year, we felt special and indulged, and she had a rule that no one could say nasty things about the "birthday baby" on the birthday. 

It's only after folks pass away that we fully realise how fine they were, no. 

We are well and hope the same with you.  I had to punt my workout today as I felt a bit unwell.  Lying on the sofa helped matters and I managed to do my continuing medical education as well as language lessons.  Some German words sound harsh when spoken, but not in classes. 

I was at Adaikalam last week and promptly had 2 dosais for breakfast.  After that, I saw patients and staff.  One of my favorite patients had been hospitalised with low blood pressure and then developed a fever, so the hospital looked at her lungs with a CT scan.  There is something suspicious there, but the patient recovered so well the hospital discharged her and we were to follow up with a lung doctor in an outpatient visit.  One of the city's lung docs looked at the report of the patient's CT scan and has diagnosed pneumonia.  The patient is now on 2 antibiotics and is slowly on the mend.  I absolutely love it when specialist colleagues help us with our patients.  As I told this doc, I am not a religious sort, but certainly feel a divine hand when I am at the Banyan. 

We spoke to our children last week and it was nice though they were sleepy - whether it was late night or early morning.  It was good to see them and get updates.  I spoke to my Dad yesterday and it was the nice conversation it usually is.  The corporation health workers had gone to check on the household in Madurai and the folks who assist my father had dismissed them; the health workers were to return and I told my father to speak with them as they monitored homes with citizens older than the age of 60.  He readily agreed; both he and I appreciate the battle that the health workers wage in this time of the pandemic. 

The virus continues to rage and we continue our own battle to keep our patients safe.  Maybe the divine hand will continue to guide us.

Unw -

R  

Report of 6 July 2020

Good evening!

Dinner has been completed, and there was a cold mango afterwards.  Any meal can be traversed through if there is mango at the end of it.  Like a carrot and stick.

We are well.  The Banyan is wonderful - good, dedicated employees; resurgent patients; fun environment. 

Regretfully, we lost a patient last week to COPD (yes, COPD, not COVID).  Ms. X's lung function had become worse and she had had frequent exacerbations, necessitating multiple hospital visits.  Most recently, she had been evaluated at a Government facility and did not improve.  When the lung deteriorates to a great extent, there is very little that can be done to help the patient through yet another exacerbation.  This did not prevent me, however, from wondering what else I could have done.  The patient's oxygenation had dropped the previous night and the nurses had quickly put her on oxygen - exactly what would have happened in a hospital.  As providers, we try the least invasive means first, and they were appropriately tried at the B.  The patient did okay during the night, I got an update in the morning and gave some orders for medicines.  Later in the day, I got the news that Ms. X took a deep breath at one point and life peacefully passed. 

I was upset with myself, thinking we should have transferred Ms. X to a hospital; this is a risky maneuver in these times of COVID, Scott pointed out.  I agreed, but could not shake the thought that I had not done enough.  Ultimately, it is for the best that Ms. X died surrounded by love and care, and passed away peacefully, instead of being in a scary hospital and having tubes rammed down her throat. 

The other patients are fine, and telemedicine is a good way to address issues.  Nothing compares to actually examining the patients physically, but these are not times of laying hand/stethoscope on a patient.  So we do the next best thing and the Banyan colleagues are expert in giving me the info that I need.

4 July was an occasion to celebrate and Scott and I got takeaway from our favorite restaurant.  We spoke to both our children and they seemed well and happy, touch wood.  I also spoke to my father and we shared observations on COVID and much else, also getting a few chuckles in.  My extended family and we had a Zoom call and that was fun. 

Stay safe and well!

Unw -

R