the freedom fighter

“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?
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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.

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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.

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!"

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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!"

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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."