“Obama!” my grandfather’s younger brother declared, “Obama… celebrated Deepavali last week! Eh?” He was making sure I was listening. I was sitting on the veranda on a leather recliner between the two of them, staring at a thin layer if skin that had formed on the surface of my lukewarm tea. It was my 3rd cup of the morning, having visited 2 other houses already as part of my grandfather’s full agenda for me. To refuse the tea would have been rude. As it was, my American-ness, my limited ability to speak the mother tongue and consequently smile rather dimwittedly, was all too palpable. And unpalatable.
The leather recliner should have seemed oddly misplaced in this garden straight out of a Kipling novella. But it wasn’t.
A mongoose ran across the path through the garden.
“Obama! Is a disciple of Gandhi! He said this last week!”
“Hmm? Hmm.” My grandfather nodded sagely. “Anyway it is good that America finally has a negro president.”
I cringed, and contemplated bringing up the political uncorrectedness of that statement to my 87 year-old grandfather, a former “freedom fighter” and chemical engineer. I decided against it. I mean really, what right do I have to correct the man who was imprisoned at the age of 24, for his “passive resistance” against the British in the Quit India movement so many years ago? What have I done with my life other than get flustered by the circular discourse of the theorists and the academics in the post-colonial period and my overwhelming inability to speak a cohesive sentence?
************************************
Jet lag, I soon found out, is not the same thing as taking call. Every morning, no matter how little sleep I had gotten the night before, I would get up between the hours of 1 and 3 am. I would stay awake until I saw Achappan’s light turn on and heard him slowly shuffle into the bathroom. Just as I would drift off to sleep, the radio would turn on, first the soft humming of a mridangam which would progressively get louder, followed by a charged but harmonized Vande Matharam. "I Bow to the Mother," the call to rise and revolutionize, first sung by the Indian National Congress is 1896.
A dramatic opening of the wooden doors would let the light into to my room and I would hear a soft chuckle.
My body would be stiff from the hard mattress, my legs hyperextended and locked and my elbows taut and slightly rotated outwards, causing me to wake up with a tingling sensation radiating to my 4th and 5th digits. Bilateral ulnar radiculopathy- I had managed to hit both my funny bones simultaneously each morning. I would slowly rise, pat down my hair, and greet him with a weak smile.
“At a certain point, the parents have to obey their children,” Unni Achappan lamented. That children are an investment had never occurred to me until my aunt clucked her tongue at the fact that her aging aunt did not have any children of her own. You have children initially against your better judgment, in spite of the fact that you have limited resources, because you know that once you age, if you are so lucky (or unlucky) to age, you will have no-one to take care of you.
My mother's father, however, is a freedom fighter through and through. He refuses to obey his children and is determined to stay alone in his home of the last 30 years, what was previously a coconut shed, instead of living with any of his three children.
I watch him sit across from me. A gecko scrambles across the wall. His lips are moving, constantly reciting prayers under his breath. But his mind is far from still.
*******************************************
I am watching a sparrow hop and slide across the marble floor of the café in Bangalore’s swanky new airport. And I wonder, how much has India changed in my lifetime, let alone his?
I also wonder- if we are all to aspire towards a state of silence and mind unstirred then we are all a lost cause. Because the most venerable saintly man I know is never without worry, never for himself, always for his children.
And perhaps, abstractly, for Mother India.
Saturday, October 31, 2009
Sunday, October 11, 2009
lymelight
On why a patient had a bowel resection many years ago:
"I didn't even want it any more. It was full of shit!"
*****************
On why a patient once insisted that he could not take oral pain meds:
"Why can't you understand this. I am ON METHADONE. The methadone EATS the dilaudid. It ain't gonna work!"
************************
Pulmonary attending, on listening to a patient's lungs: "You sound really junky. Do you feel junky?"
Patient, forlornly: "Yeah. I am a junky."
My attempt to suppress a tear and stiffle a laugh when I watched this encounter manifest itself as an awkward post-call snort/sniffle. I watched this puffy, blue-hued man struggle to get a deep breath in.
And I sighed.
I don't know a single resident who does not agree: Chronic pain is painful...for everyone involved. But somehow most of us have more tolerance for the chronically inebriated and addicted than we do for the ones that perhaps look like us.
A junior resident wondered aloud if we could practice medicine anywhere outside of these United States, would we find as many people suffering from chronic pain?
Perhaps they have all been infected with Lyme disease.
I wish I could say that with more authority and less mockery. Checking for Lyme is not uncommonly part of the work-up for chronic pain. But those of us who have treated pain know that it is more often than not a somatic symptom. So we pull out the cymbalta and the imipramine, drugs that have historically part of the psychiatric pharmacopeia that are now in our armamentarium for chronic pain. We compulsively sign pain contracts to keep track of every opioid we dispense. We periodically send urine tox screens to make sure that the opioids are truly in our patients' bodies and not being sold to feed their meth habits.
We remind ourselves daily that we are treating an organic disease, that pain is mediated by a complex neurochemistry that many of us are loathe to understand.
Physicians find solace in the tangible and the sometimes grotesque: a laceration, an abscess, a fungating crusting skin lesion. And things that are less tangible are rendered so with the miracles of modern radiology that can detect tumors as big as your fingernail. I'd like to think that internists are the exception, that we dissect and pontificate and analyze. We are exacting, discerning, cerebral. But in the end we are truth seekers just like everyone else, and in the end that is often our demise. The truth is more often messy than not.
Since I began residency, I have suffered terrible migraines, chronic knee pain, overwhelming fatigue and now more recently neck pain. I can rationalize each of these symptoms- sleep deprivation, inappropriate footwear climbing up and down stairs when rounding, sleep deprivation, falling asleep on the couch in an awkward position, sleep deprivation, vitamin D deficiency. (I kid you not- my vitamin D levels were nearly undetectable.)
I was LIVID when my husband, also a physician, jokingly suggested to me that I have fibromyalgia. How dare that he imply that my symptoms were not rooted in the tangible?
The organic?
But the thought of starting an SSRI has not escaped me.
And with that, I leave you with this sobering statistic from the World Health Organization.
"Depression is the leading cause of disability as measured by YLDs (Years Lost to Disability) and the 4th leading contributor to the global burden of disease (Disability Adjusted Life Years) in 2000. By the year 2020, depression is projected to reach 2nd place of the ranking of DALYs calcuated for all ages, both sexes. Today, depression is already the 2nd cause of DALYs in the age category 15-44 years for both sexes combined."
"I didn't even want it any more. It was full of shit!"
*****************
On why a patient once insisted that he could not take oral pain meds:
"Why can't you understand this. I am ON METHADONE. The methadone EATS the dilaudid. It ain't gonna work!"
************************
Pulmonary attending, on listening to a patient's lungs: "You sound really junky. Do you feel junky?"
Patient, forlornly: "Yeah. I am a junky."
My attempt to suppress a tear and stiffle a laugh when I watched this encounter manifest itself as an awkward post-call snort/sniffle. I watched this puffy, blue-hued man struggle to get a deep breath in.
And I sighed.
I don't know a single resident who does not agree: Chronic pain is painful...for everyone involved. But somehow most of us have more tolerance for the chronically inebriated and addicted than we do for the ones that perhaps look like us.
A junior resident wondered aloud if we could practice medicine anywhere outside of these United States, would we find as many people suffering from chronic pain?
Perhaps they have all been infected with Lyme disease.
I wish I could say that with more authority and less mockery. Checking for Lyme is not uncommonly part of the work-up for chronic pain. But those of us who have treated pain know that it is more often than not a somatic symptom. So we pull out the cymbalta and the imipramine, drugs that have historically part of the psychiatric pharmacopeia that are now in our armamentarium for chronic pain. We compulsively sign pain contracts to keep track of every opioid we dispense. We periodically send urine tox screens to make sure that the opioids are truly in our patients' bodies and not being sold to feed their meth habits.
We remind ourselves daily that we are treating an organic disease, that pain is mediated by a complex neurochemistry that many of us are loathe to understand.
Physicians find solace in the tangible and the sometimes grotesque: a laceration, an abscess, a fungating crusting skin lesion. And things that are less tangible are rendered so with the miracles of modern radiology that can detect tumors as big as your fingernail. I'd like to think that internists are the exception, that we dissect and pontificate and analyze. We are exacting, discerning, cerebral. But in the end we are truth seekers just like everyone else, and in the end that is often our demise. The truth is more often messy than not.
Since I began residency, I have suffered terrible migraines, chronic knee pain, overwhelming fatigue and now more recently neck pain. I can rationalize each of these symptoms- sleep deprivation, inappropriate footwear climbing up and down stairs when rounding, sleep deprivation, falling asleep on the couch in an awkward position, sleep deprivation, vitamin D deficiency. (I kid you not- my vitamin D levels were nearly undetectable.)
I was LIVID when my husband, also a physician, jokingly suggested to me that I have fibromyalgia. How dare that he imply that my symptoms were not rooted in the tangible?
The organic?
But the thought of starting an SSRI has not escaped me.
And with that, I leave you with this sobering statistic from the World Health Organization.
"Depression is the leading cause of disability as measured by YLDs (Years Lost to Disability) and the 4th leading contributor to the global burden of disease (Disability Adjusted Life Years) in 2000. By the year 2020, depression is projected to reach 2nd place of the ranking of DALYs calcuated for all ages, both sexes. Today, depression is already the 2nd cause of DALYs in the age category 15-44 years for both sexes combined."
Saturday, October 18, 2008
Saturday, August 18, 2007
The Best Medicine.
Seen and heard on the floors during my first two months in a long white coat:
Q: Have you ever used any substances such as intravenous drugs or cocaine?
A: "The only dope I've ever been addicted to is my husband!"
As several doctors and med students peer at his jugular vein to determine his central venous pressure, Mr. J remarks, dryly:
"You're so vain. You and Carly Simon."
Q: Have you ever used any substances such as intravenous drugs or cocaine?
A: "The only dope I've ever been addicted to is my husband!"
As several doctors and med students peer at his jugular vein to determine his central venous pressure, Mr. J remarks, dryly:
"You're so vain. You and Carly Simon."
Tuesday, March 13, 2007
Kindly admit to Med unit III
It has been about 6 weeks since our Air France flight landed in Bangalore. I remember peering out my window at 4 am IST, city lights aglow, making this city, this Country indistinguishable from any other. "It's deceiving," I told Dave, who was still half-asleep. "You think it's just like any other, but you don't know..."
I can safely say, that 6 weeks later, he now KNOWS. Like any other pardesi desi, he understands the congestion, the openness, the immensity, the smallness of it all. Madness.
We spent three weeks in Kerala, God's Own Country. And if you looked from above you would understand that it is true. First the hilly mountaintops lined with palm trees. Then miles and miles of flats, lined with palm trees. Then iridescent waters rushing the coastline, also lined with palm trees.
But the land and the people are changing. And with it my vision. We spent two weeks listening to the stories of sex workers in Kerala. Yes my friends, there are sex workers in Kerala and they come in all different sizes, shapes, colors, creeds. Fiscally liberal, socially conservative Kerala has a growing HIV infected population. And the women are mobilizing, forming unions, pukka communist Kerala style. They are determined. They will not become victims.
I am so proud.
It is hard not to be religious in God's Own Country. All the Hindu sex workers go to temple every morning, after "taking bath." When I see them, their wet black hair is neatly pinned back, one long braid falling straight along their spines. A red line of kum kum dons her forehead. She is a pukka Kerala beauty.
The Christian ammas don't look terribly different. In fact, most of the time I can't tell, unless they tell me their names. Perhaps they are without kum kum. Instead a beautiful 22kt gold cross falls elegantly around their necks.
The Muslim chechis wear hijab, only covering their heads, not faces. They wear saris or salwars.
It is hard not to be religious here, because there are temples, churches and mosques at every corner on every street.
But even God's Own Country is changing. Five years ago we would hear about the riots up North. But the violence is infiltrating our land and fundamentalism is making its way. Now the "Riots up North" doesn't refer to violence in Gujarat or Delhi. It refers to violence in Calicut and Kasargod.
~.~.~.~
"Bangalore has changed alot," she said as she watched her chubby 10 year-old girl unhappily complete another lap around the tennis court. "They used to call it 'The Garden City.' Pensionner's paradise.
I watched this perfectly coiffed, manicured Bangalorean mother in amazement. She had grown up here, spent her whole life in this city, watched it evolve into the congested smog-filled IT capital of the world it is today.
I saw her a couple of mornings later at the gym. I was sweating it out in my green Champion men's basketball shorts and blue High Sierra Cubs shirt which spent one too many washes in hard water. My legs had a not so flattering coating of coarse 3 week old hair.
And she was elegantly dressed in stretch pants, a tank top and coffee coloured lipstick. I was jealous because she could do a pull up, one more than my challaballa Ningileri arms could ever attempt.
I had this strange feeling that I wasn't in India anymore Toto. I think I somehow found myself over the rainbow and in Marin County, California.
Yikes.
~.~.~.~
Every admission note I see on the floors have the following (polite) instruction: "Kindly admit to med, unit III."
And in the days before match day, I find this hauntingly prophetic.
I can safely say, that 6 weeks later, he now KNOWS. Like any other pardesi desi, he understands the congestion, the openness, the immensity, the smallness of it all. Madness.
We spent three weeks in Kerala, God's Own Country. And if you looked from above you would understand that it is true. First the hilly mountaintops lined with palm trees. Then miles and miles of flats, lined with palm trees. Then iridescent waters rushing the coastline, also lined with palm trees.
But the land and the people are changing. And with it my vision. We spent two weeks listening to the stories of sex workers in Kerala. Yes my friends, there are sex workers in Kerala and they come in all different sizes, shapes, colors, creeds. Fiscally liberal, socially conservative Kerala has a growing HIV infected population. And the women are mobilizing, forming unions, pukka communist Kerala style. They are determined. They will not become victims.
I am so proud.
It is hard not to be religious in God's Own Country. All the Hindu sex workers go to temple every morning, after "taking bath." When I see them, their wet black hair is neatly pinned back, one long braid falling straight along their spines. A red line of kum kum dons her forehead. She is a pukka Kerala beauty.
The Christian ammas don't look terribly different. In fact, most of the time I can't tell, unless they tell me their names. Perhaps they are without kum kum. Instead a beautiful 22kt gold cross falls elegantly around their necks.
The Muslim chechis wear hijab, only covering their heads, not faces. They wear saris or salwars.
It is hard not to be religious here, because there are temples, churches and mosques at every corner on every street.
But even God's Own Country is changing. Five years ago we would hear about the riots up North. But the violence is infiltrating our land and fundamentalism is making its way. Now the "Riots up North" doesn't refer to violence in Gujarat or Delhi. It refers to violence in Calicut and Kasargod.
~.~.~.~
"Bangalore has changed alot," she said as she watched her chubby 10 year-old girl unhappily complete another lap around the tennis court. "They used to call it 'The Garden City.' Pensionner's paradise.
I watched this perfectly coiffed, manicured Bangalorean mother in amazement. She had grown up here, spent her whole life in this city, watched it evolve into the congested smog-filled IT capital of the world it is today.
I saw her a couple of mornings later at the gym. I was sweating it out in my green Champion men's basketball shorts and blue High Sierra Cubs shirt which spent one too many washes in hard water. My legs had a not so flattering coating of coarse 3 week old hair.
And she was elegantly dressed in stretch pants, a tank top and coffee coloured lipstick. I was jealous because she could do a pull up, one more than my challaballa Ningileri arms could ever attempt.
I had this strange feeling that I wasn't in India anymore Toto. I think I somehow found myself over the rainbow and in Marin County, California.
Yikes.
~.~.~.~
Every admission note I see on the floors have the following (polite) instruction: "Kindly admit to med, unit III."
And in the days before match day, I find this hauntingly prophetic.
Tuesday, October 17, 2006
aiyo vey
so i was trying to explain to my mother that Dave made this incredible tofu dish with soy vey. I did my best to describe this soy sauce like seasoning, explaining that the yiddish phrase "oy vey" is similar to the malayalam "aiyo." They are both articulations of exasperation, as expressed by Little Old Ladies, withered and weary. I imagine my mother will be one of those LOLs in a couple of years, if she didn't always scrunch up her nose and chuckle in playful self-deprecation, keeping herself young at 54.
Even though she is completely tone deaf, she manages to speak with the musical lilt common among Hindi-glots. Her English is precise, although my aunt in India often argues that 30 years in this country has "yankified" her accent.
But she doesn't always pick up the vernacular very well. For example, she would say something like, "take a pill" instead of "take a chill pill," a favorite expression of ours back in our gum smacking mall rat days.
And as I tried my best to explain the pun soy vey, my mother tried her best to understand: "Soya vey? Soya vey?"
I gave up after a few minutes. But the attempt left me chuckling.
Even though she is completely tone deaf, she manages to speak with the musical lilt common among Hindi-glots. Her English is precise, although my aunt in India often argues that 30 years in this country has "yankified" her accent.
But she doesn't always pick up the vernacular very well. For example, she would say something like, "take a pill" instead of "take a chill pill," a favorite expression of ours back in our gum smacking mall rat days.
And as I tried my best to explain the pun soy vey, my mother tried her best to understand: "Soya vey? Soya vey?"
I gave up after a few minutes. But the attempt left me chuckling.
Thursday, July 27, 2006
omigosh
I am officially the COOLEST 14 year old I never was.
It took me just about 13 years to get here.
"Rory" is one of my 14 year old Onc patients. We smile and giggle when we talk about our favorite WB show.
Me: "I was SO bummed about last season's finale."
Rory: "I KNOW!"
Rory's mom: "They've got to get back together, they can't break up!"
So it goes. I sail into her room, part of the entourage: attending, fellow, me. We take turns listening to heart and lungs, feeling the belly for the spleen and liver. We talk a bit about how we can get her to eat a bit more, what our options were for anti-emetics. She's a fan of the marinnol.
And then, I pipe up: "Remind me to tell you about the time my sister met Jess, whose real name I can never pronounce."
"WHAT?! you mean Milos Ventimiglia?!?"
Yup. I am the coolest 14 year old ever. For about 4 minutes every day.
I wish Nam were there to see me. When she met me, standing in line to get our 9th grade school pictures taken, I was decked out in a matching skirt and blouse set from Bradley's. I was about three months shy of getting that memorable perm.
"Can I borrow a pen?" she asked coolly.
I handed her the one pen I had, a green "sanrio" pen with a cartoonish frog that jumped up and down on a spring everytime you clicked it. "Do you like Keroppi?"
She didn't like Keroppi. Even though she was Korean.
Thirteen years later, and Nam stuck around. If only she were there to see me...
It took me just about 13 years to get here.
"Rory" is one of my 14 year old Onc patients. We smile and giggle when we talk about our favorite WB show.
Me: "I was SO bummed about last season's finale."
Rory: "I KNOW!"
Rory's mom: "They've got to get back together, they can't break up!"
So it goes. I sail into her room, part of the entourage: attending, fellow, me. We take turns listening to heart and lungs, feeling the belly for the spleen and liver. We talk a bit about how we can get her to eat a bit more, what our options were for anti-emetics. She's a fan of the marinnol.
And then, I pipe up: "Remind me to tell you about the time my sister met Jess, whose real name I can never pronounce."
"WHAT?! you mean Milos Ventimiglia?!?"
Yup. I am the coolest 14 year old ever. For about 4 minutes every day.
I wish Nam were there to see me. When she met me, standing in line to get our 9th grade school pictures taken, I was decked out in a matching skirt and blouse set from Bradley's. I was about three months shy of getting that memorable perm.
"Can I borrow a pen?" she asked coolly.
I handed her the one pen I had, a green "sanrio" pen with a cartoonish frog that jumped up and down on a spring everytime you clicked it. "Do you like Keroppi?"
She didn't like Keroppi. Even though she was Korean.
Thirteen years later, and Nam stuck around. If only she were there to see me...
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