Trials and "Trails"

I've been trying to spend most of this first rotation with a particular junior attending (all the senior attendings turned me down when I asked to observe them), named Dr. Krishna (many people go by first names rather than fathers' names), mostly so that someone recognizes me. It's been great though, the more he gets to know me, the more he fills me in on the patients we are seeing and talks to me about culture and asks me questions about America. We discussed Breaking Bad in English while he was working up a Tamil patient. He's only on season two and loves it. He noted though that, "it's easier to be bad in India" and I don't doubt it--the police are great (not really) with bureaucratic paperwork but not so much with law enforcement, not to mention the corruption in all levels of police and government. Maybe I should start a meth business here! It would be quite lucrative.

I also saw in outpatient that some patients were paying full price for labs and medications and some were paying only 25% or nothing at all. I asked who pays when the patient doesn't and apparently this not for profit hospital gets much of it's income through donations from the US and the rest from reinvesting their profits. When I asked if there was any health insurance, he laughed and shook his head saying that people here hardly have enough income to eat let alone afford some luxury like health insurance. I asked about government health insurance and he said there was none-- they deal more with provision of food and shelter to the poorest of the poor.

Many of our outpatients have TB as well and I saw really advanced manifestations (for you med people--Potts causing cord compression and miliary TB with a snowy diffuse infiltrate on chest xray--things I'd only ever read in textbooks). They also see a ton of neurology complaints even as internists--tons of people with headaches and strokes (although unlike the US, many of these people must've had the stroke months ago rather than hours which is too late to do anything..). We saw a patient who was prescribed antipsychotics for depression by her cardiologist aka malpractice in amurrica.

(Speaking of TB I bought some N95 masks and have worn them in the isolation ward despite the funny looks and head shakes I get from the Indian doctors.)

Also, religion, particularly Christianity, plays a big role at this institution. I was surprised when on Monday our day started with devotion--reading out of the bible with discussion and long, uncomfortable pauses for reflection. Also during devotion, I had my big water bottle on the table. A resident asked for some water so I had no intention to drink out of it after (germs!) but she never even offered it back, just drank the rest of it. A random girl on the bus a day later also asked for some but I was so thirsty I had to turn her down. I don't know about you, but I've never asked a random person for some of their water.

After work (and soccer!) we stumbled upon a banquet and concert on campus for a hematology symposium being held that week. Despite being sweaty and dust-covered in American athletic apparel, they ushered us in. There was a live band performing rock style Indian music and by the end everyone was up and dancing. They taught us a line that we shouted out in unison and in rounds despite not knowing how to pronounce it correctly or what it meant. Turns out it was a mantra praising god, but it was catchy and stayed in my head through the following day. Then they invited us to join the delicious feast of chicken tikka, ginger fish, tater tots (technical term), vegetable fried rice, some corn based salad, some spicy soup thing you put rice in, dosai with coconut sauce, a cole slaw type thing, and honey ice cream and coconut juice for dessert.

I had ventured into Vellore that day with all it's hustle and honking cars and exhaust (I typically try to avoid this and just go back to campus after I leave the hospital) that day to get 5 simple items, and after 3 separate miserable attempts at 9am 11am and 3pm I gave up because either A) there was no store carrying the product B) the store was closed each time I attempted C) the ATMs were shut down due to a strike and no one would take plastic. It's the little annoying things like this that wear and tear on you.

The next day a huge group of us Americans went for a hike up the bigger mountain behind campus. We had to walk down the dusty, dirt road, a private driveway, past sweaty workers on a roof, through the dust of a quarry rock grinder thing, and up a "trail." I put that in quotes because it kind of was a trail to start and maybe there was a trail because we kept finding and losing it but 95% of this hike was scrambling up rocks, between tall brush with pricklers on them that got stuck to your clothes, and ash that turned all of our legs and arms (and face when we touched it) completely black. Not to mention it was 100F and humid and late afternoon. The group was also really wide ranging in hiking abilities and we quickly got split up.

A girl Alex and I followed what most looked like a path, preferring not to go up farther on an ashy rock slide, because the way down is always worse. We turned on the jams on my phone and hoped for a random helicopter to come save us and journeyed alone along this path that obviously wasn't always there to guide us as the sun started to set. Needless to say we made it down safe 3 hours later and hitched a rickshaw back to campus... Hopefully we didn't encounter any scrub typhus in our journey, but I'll let you know when I know in about two weeks.

Last notable thing pre-New Delhi trip (get excited for the next two posts!), was that we admitted a patient with rabies! Agh!! He's 22 and came in already with brain involvement (hydrophobia mostly for med people) and was agitated and quickly moved to the ICU. He plays with stray dogs and doesn't even remember the bite. Only 8 people in the world have survived rabies treated at this stage, so we really don't have much evidence to go on and are just hoping for the best. He's still in the ICU now (almost a week later, sorry, I'm a bit behind in my posts) and hopefully it will be an exciting outcome instead of just terribly sad.