End of Year Potluck

 

Bombay

Sorry to everyone who i left off these email lists! here are my emails from mumbai where I've been working at KEM hospital on a pediatrics rotation.

1/20/06
I spent yesterday contemplating postponing my next rotation of third year and staying in Mumbai for another month. This trip has been a godsend in so many ways. For one I feel like this city, with it's multiple lives, is a place that I would find hard to get tired of. Priya and I are continuing our double lives of slums by day and clubs by night. We have met so many fascinating people. Today I traveled to the Bhiwandi red light district to see the work done by the NGO Aapne Aap Women Worldwide. The woman who I was put in touch with in the NGO is one of the many fascinating people that have enclosed us into their lives. Mumbai-ites have a way of swallowing you whole into their lives. This women, a dental surgeon by training, is a activist of my moms generation who instead of practicing got a masters in social work and now works at aapne aap's two centers in mumbai. Her husband is a former doctor turned police officer responsible for the recent (last year) closing of mumbai's dance bars (bars where female dancers could be chosen as escorts for an ight) who also heads the cybercrime division and just flew back from a meeting in New Zealand of Interpol. He is now looking to get a PHD and just last month hosted Yale Prof Kaveh Khosnood (small world!) and may come to yale as a fellow. These people are inspiring.
Moreover, the work they do is inspiring. In this center we learned about and spoke to women sold into the commercial sex trade from villages of karnataka to work for the areas mill workers (themselves immigrants from india's poorest state, bihar). The center houses, feeds, and teaches their children to help break them out of the cycle of prostitution and pimping. I played with the most adorable children and learned about the practice of marrying women to Temple goddesses in the village and shipping those same women in the name of this goddess' temple to the city where they will service men. Sickening. We will travel out there next week after stocking up on antibiotics to do check ups for the children, and I'm working with a friends family to try and connect a doctor here who does immunizations to go out there. Moreover we have started to talk about education for HIV screening as the women are afraid to go for testing and moreover suffer from the illegal status of prostitution and are working with an infectious disease hospital here to go out next week and do the first round of grass roots education (working the way up to aids). We talked about ways the group is trying to get them on the first ladder of economic development, from starting sowing classes to purchasing a loom for the center so the women can learn skills. I for one will happily sell the stuff they make in the US, and you all will but it (right?) They want English classes for the kids so that they could potentially find jobs that will help get their mothers out of the cycle of prostitution.
This entire paradigm is shifting how I view everything from my life's work to theories of globalization. I spent every evening frantically reading about treatment of infectious diseases (often in the dusty hospital library as my books have a paragraph at most on things like typhoid/enteric fever, Protein energy malnutrition and congenital syphilis) and cycling between three books on globalization by economists jeffrey sachs and thomas friedman. we can protest GAP all we want but jobs at factories and by multinationals are the next step up the development ladder and an escape from subsistence living and extreme poverty and I am seeing and hearing that first hand. I am learning how to align my idealistic US perspectives with economic realities and trying to make ethical decisions for myself on what I believe.
Other mumbai-ites who have included us really range the spectrum and are contstantly amazed that we even take the second class train compartment to work. Priya's friend's cousin's family is connected to the Shiv Sena nationalist Maratha party and lives in opulence in the Fort area of bombay. With her cousin we hang out at coffee shops on the ocean seafront and chic bars and clubs. We debate hindu nationilist politics and the role of india's wealthy classes and castes. (ok and yes we also hang out with some of her very beautiful friends, including a very hot guy in the Merchant Marine). We drive in air conditioned cars with drivers, but then stop by the roadside to eat dosas from a wooden cart. They are planning a beach vacation to Goa (international party central) the second week of feb and have told me more than once - why dont i just stay an extra month? ah yes and then there is anjalis family friends who are in the diamond business and who in one breath enclosed us in a world of massages, facials, good food, and jewelry salesmanship.
the contrast of the extremely rich and the extremely poor living side by side is that which is India, and when our two worlds seem impossibly different and we feel like we are leading two bombay lives, we remind ourselves that this is the nature of city itself.
oh and i forgot to mention it is 70 to 80 degrees here and i've been running around in flip flops. and the most heavenly ice cream shop ever is on my street.

1/15/2006
Bombay continues to be exciting, crazy, and intense. This is the > halfway point> of my trip and I have finally started to make this place home - > only to leave> in two more weeks! Priya and I have met up with all kinds of fun > people here -> from Harvard Kennedy school kids touring NGO's to British medical > students> doing electives - and have been having a blast going out to trendy > restaurants> and bars/clubs. Last night my british friend and I spotted a famous > indian> model at a club and she spoke to him! It is an odd lifestyle - > slums by day and> clubs by night - but a constantly challenging one. We constantly > grapple with> this double life but in some ways we need both elements to stay > happy and> centered.>> This week I will be going with a women's NGO to work in the Dharavi > slum -> Asia's biggest. Priya has started working with Spark, and NGO > dedicated to> housing reform in the slums, and I will go with her one day to see > the work> they do. Being here is such a lesson in globalization and economic > reform. Even> the books at all the roadside stalls for $2 - from NY times Thomas > Friedman's> WOrld is Flat to Jeffrey Sachs The end of Poverty - inspire me.>> SO much to describe and I can barely do justice to it. Here are > tidbits -> learning about protein-energy malnutrition and trying to explain to > the doctors> here that kwashiorkor, marasmus, nutrient deficiencies, and fulminant> presentations of TB (meningitis, abdominal tb) and typhoid are > small footnotes> in our curriculum. High point being opening to the two page > nutrition section> in Blueprints peds where allergy to formula is listed as a primary > cause of> failure to thrive in infants in the western world. large open room > wards with> rows of beds where infection control involves wiping hands on pants > between> examinations. Very different here. But also sheer numbers of people > treated.> Touring the HIV clinic at the hospital and learning about pre and > post test> counseling and the free HAARt therapy provided to seropositive > individuals> through the government (wish we had that there). Considering > starting import> export business as bought doxycycline and cipro for approximately > 24 cents.> stupid drug companies. Going from the palatial homes of South > Bombay to the> crowded food markets of Parel to the slums of Dharavi...to the > designer> boutiques of shopping haven Linking road nearby...developing a > chronic cough> from bombay pollution...holding my nose as the train speeds by the > polluted> rivers....

corporate finance and romance

In an effort today to keep myself from descending into utter and complete boredom I start to read my brother's Corporate Finance Textbook.

Yes, this may represent a new low. I have to say that it was fascinating to finally get some of the terminology that has been floating around me - equity and securities, partnerships versus corporations, venture capitalism - and all that jazz. Made me think about what if's and career choices. Especially since I've been debating applying to the MBA program versus the MPH (masters in public health) programs all year, and finally decided to not to do the MBA program. It seems so useful to know about micro and macroeconomics and finance. But ultimately I think I'm too much of a do-gooder - because in the end of all of that, isn't it just all about a pile of paper bills?

Not that money isn't nice. And I'd like to have some, someday instead of this nice little pile of debt that I've accumulated. I just don't think I'm ready to dedicate my career to it. Maybe I'm foolish and idealistic and should be more finance-savvy.

I think being home for the holidays always makes me re-evaluate things. It's part of sleeping in the same room where all my childish dreams and hopes once occurred. Where did I think I would be at this age? Am I there yet? What does it say about me that I'm 24 and still returning to my parent's house for christmas and sleeping in my same bed? Nothing I guess, but I'm at that weird age where I feel like there should be something more. Maybe someone else coming home with me and meeting the parents for the first time. Maybe being able to buy christmas presents with an income of my own. It's an odd sense of delayed childhood to still be in school, still be as single as ever. I'm getting tired of the litany of questions from cousins and friends that are an inevitable part of coming home and "catching up". Maybe I should just where a button that says "YES, I am STILL single, and NO there is nothing interesting to report".

Maybe I should have become an investment banker and moved to a nice apartment in NYC with an even nicer corporate boyfriend.

That's the thing about life though - maybe I'd be in the same spot asking an entirely different set of questions.

staying afloat

So much for my attempt to keep this thing updated!

these past few weeks have been some of the most intense so far in my life. I'm on my "medicine" rotation at the VA hospital, and to give you a quick picture of whats been going on:

- I did brain surgery.
A patient on my service was going in for an emergency craniotomy and my resident asked the neurosurgeons if i could watch. They ended up being awesome - esp the resident - and before I knew it I was scrubbed in and drilling a hole with a big bone drill in this guys head. I opened his scalp, drilled three holes, and we cut a triangular plate out to expose his brain, which was completely purulent (pus filled) and infected (he had gotten infected from an open wound from a previous neurosurgery). So here I am immersed in this guys head, discussing making creme brulee with the (incidentally cute) resident...talk about surreal. On the one hand I was emotionally blown away by this guys case and his prognosis....but I'm starting to realize more and more how hard it is to constantly exist in that state of awareness/caring - its draining and easy way to burnout. I realize to do what you have to do as a doctor, it's almost necessary to detach to some degree - or at least to not take home all the burdens of your patients with you.

But i'm getting ahead of myself.

So that was an extraordinary day. Most days i'm barely trying to keep afloat amidst all the information being thrown at me. Studying this stuff in textbooks is quite different than experiencing it hands on...which gives me a new appreciation again for ER/Scrubs...cause it really is like that sometimes! The other day my patient coded (i.e. stopped breathing and they called Code 5 overhead and like 50 of us ran to his room to start the code - luckily he came to before we had to shock him) and i was reading out his med list and watching as the 3rd year resident started a central line and the intern got the machines ready to monitor his heart rythmn and got drugs ready to push and all I could think was Oh my god, i'm going to be responsible for this someday. It's an awesome amount of responsibility, which is reinforced every time a patients family comes into the hospital and turns to me as their loved one's doctor and asks for an update. Luckily I'm still at the point that I can claim student status and offer to go and get the intern to handle the front lines...but when it's Mr. T's family and I've spent all day ordering his meds and monitoring him i start to feel like I actually AM his doctor...and it's scary.

and very easy to become a workaholic.

Last weekend I was on call both nights so I had a 12 day stretch of going into the hospital with no break....made me realize how important maintaining a normal life outside the hospital is...by the end of the second week (friday) i was emotionally drained. Friday of course had to be the day all hell broke lose - I was literally running around trying to convince my demented Parkinsons patient to stay in his chair, calming down the emphysema guy who had become increasingly agitated and was convinced that he had never come into the hospital and that we were all part of some conspiracy plot against him...and trying to start an IV in my own post-code patient...doesnt help that every patient at the VA is 60something with congestive heart failure, chronic obstructive pulm disease, and diabetes, or some combo thereoff.

but i love them, and they break my heart every day. They make me think differently about tough things - like end of life care...when to pull the plug...how i would want to die or let my loved ones die...how our society views the elderly...what its like to get old and to be sharp of mind but trapped in a failing body. Like our patient who has awful contractures of his limbs so he is stuck in a contorted position until someone can come move him in the bed to a new position....but who knows so much history and is so amazing.....or the veteran who has a purple heart and was part of the invasion of normandy who is slowly wasting away from cancer and growing more and more demented by day in front of my very eyes. I know hospitals induce delirium in these patients, and It tears me apart to see them get more and more delirious by day, their arms a mess a bruises from all the IVs we've stuck in them, their families growign more and more upset by their loss of function...

it breaks my heart, really it does.
but i can either come home and cry like i did last wknd, or i can try and leave all of that at the hospital and come home and get ready in my cat costume for a drunken fest of a halloween party.

life is surreal sometimes.

Comedy of Errors

Since time is becoming scarce, this blog is an attempt to keep my friends up to date on the trials and tribulations of this year. Plus some part of me realizes this first year in the hospital is a sort of comedy of errors that I want some record of. So if you love ER/Gray's Anatomy/Scrubs...

this is not those.

Well, sort of. My life right now seems to include all the professional upheaval and funny issues minus the romantic drama of hospital TV. Because while there is lots of scandal in the hospital (neurosurgeons with mistresses, surgery residents hooking up with PA's, attendings hitting on students) somehow as usual I manage to exist completely devoid of drama. bummer.

Well to update on today -
went to work feeling slightly under the weather, and the day only got worse. It began when my attending told me to go ahead and intubate (think ER where the doctor has to stick a breathing tube down someone's throat). I managed to get the patients airway open with some difficulty, only to very carefully intubate the esophagus. Hint: the tube is supposed to go into the trachea. Wrong hole - shit.

Then I was given the simple task of drawing up a vial of medicine (propofol). Simple, right? Somehow I managed to slip the syringe out of the vial and blow white liquid drug all over the front of my shirt.

Finally, it was my turn to put an IV line in a 89 year old woman we had under on the table. Her colon surgery was going on so there I was all hunched under the drape next to her head, trying to stick a vein that seemed to keep running away from me. I finally got the needle into vein (I can't describe how satisfying it was to have that bright red blood come squirting out). I got super excited and my resident came over to say "great job, now comes the easy part, just advance the plastic catheter into the vein." So I push through and manage to drive the catheter out the vein on the other side, puncturing the vein and giving this sweet lady a nice little hematoma (blueish blood bruise).

All in a days work. Time to go dive under my covers!