Sunday, December 25, 2016

The season.

I just said goodbye to a friend and I feel sad.Max is my junior doctor.A quiet kid who when he joined us looked like he would prefer to disappear from the usual welcome and farewells that go on.For the past two years he has been like a shadow supporting and helping me through the inconsistencies of my personality.I have raved and ranted,he has silently been there....a ready help...one with Divya ,supporting me when I have been at my weakest.
I took my time getting to know Max.Anyone can tell you that he is an introvert.Divya and myself often take time to rag him ,he takes it sportingly.He is the junior who has patiently painted the dustbins in the campus,designed the annual report cover for two continuos years,counted the tiles in the acute care unit umpteen number of times,defibrillated patients,done amputations,studied basic medicine with us ,just filled in whenever we have felt out of our depth.
I have never seen him loose it,,In the middle of getting picked out for something I have often wondered what must be going on in his mind,a blank look with fleeting shadows is all that we get but there is no carrying over.
It has been a blessing having him here.
The world is just so big and there are goings and comings all the time.
This was one going I felt ,acutely.Kudos to the kid.

Friday, December 23, 2016

Making Christmas memories!!

Made a quick trip to Lalitpur to see my friend Sheba and her family before I dash out of EHA ,'Kent'ward bound.Doing the MP highway at 100kms per hour,from a distance of about half a kilometre we saw a motorbike struggling to cross over.He seemed to be an amateur .Kamlesh tried his best to control his car while I prayed hard.At the last moment the man slid his bike right in front of us.Things could have turned tragic but for our Lord's mercy.We hit the pillion ,both the men were thrown out of the bike onto the road but the car made a smoothe stop so the men were safe ,just the light at the back was broken.
Out of nowhere a policeman landed up and a crowd came in.Things can turn ugly on the road. Two gentlemen, both of whom looked dignified, just appeared in the crowd and took control of the situation ,kept reiterating that it had not been our fault ,made us pay for the backlight and made way for us to leave the spot.Talk of guardian angels!
The morning when we started off from Laknadon ,I noticed when I prayed that I did not ask for protection,only to be a blessing whereever we would be.I did not change the wording wilfully because that was the way the prayer went.I had just been talking to Kamlesh about the things that matter half an hour earlier.
Once in Sagar,I took the bus from the private bus stand.It was an educative process,the entire thing.The first bus which was to leave Sagar at twelve-five got cancelled because there weren't enough passengers.We were put into the one o'clock bus.The bus did start at one.The distance would have been one and half hour's journey but the bus happily took four and a half hours.Initially my heart sank at the numerous detours to the village roads they were making and the stops every fifteen minutes but soon I caught on that the bus was meant for the local villagers.I sat back on my seat and enjoyed the ride.Thankfully the driver was sensitive enough to keep the music at a low volume throughout the journey.
When leaving Lakhnadon one of the staffs had quickly pushed a siver foil with some snack into my hand.That came in handy during the journey.While returning from Lalitpur another saintly woman pushed a plastic with her hand-made snack into my hands.I felt blessed to have a taste of God's providence in these small journeys of my life.
It was amazing two days spent with Aunt Christa,Andy Sheba,Asha ,Enoch,Benjy and ofcourse Leela di .Fragments of Christmas and pre-Christmas memories I will carry with me especially little Enoch's ready coffee and Horlicks which finished one large packet of milk in a single sitting and the warm breakfast, made to order.
Tonight we get-together for a time of Potlluck with my surrogate family in Lakhnadon.
Another seven days and I will be homeward bound.Will meet up my cousin and her children after a couple of years,will have the privellage to spend time with the family post-Christmas before I start the next phase of my life.The journey continues ......till I am safely 'Home' someday.

Sunday, December 18, 2016

One step more..




I am slowly but surely winding up my stuff from Lakhnadon.As usual I take a rough survey of my belongings and decide what I really want to carry with me.I have managed to collect a fair share of kitchen items ,thanks to my sunday cooking to feed the twelve youngsters.I never realised I liked glass so much as when I started filtering through my stuff only to find my weakness for the cutleries made of glass.I have a terracotta black pot which I have managed to put into a cardboard box.Apart from that I have an oven ,a coffeemaker and a blender I would like to carry with me.
I have two or three boxes of books some of which have lived through my various movements around the country,many added to the collection in Lakhnadon..
Strangely enough,I don't have much clothes and anyway none that I covet.Bulk of my beddings were bought when I had visitors in Herbertpur,most of which I am not planning to lug around and ofcourse I have two or three files full of papers which seems to be the only necessity if I want to be legally viable.
Three years of my life.....that's it...I'll only know in eternity.

Friday, December 16, 2016

These days..

The last week has been strange to say the least,I had to travel to Raipur for my IELTES.I had three days in hand in a strange town.Divya booked a place for me in the pastoral centre which fed me with the tastiest putta I have had in my life.The cost was unbelievable ,just two hundred rupees per day.
The written and the spoken were in two different places which were a rickshaw ride away from the place where I was staying.The first day an old rickshawpuller seems to have fleeced me of fifty bucks extra.The next day I decided to partly walk and caught a rickshaw halfway.What amused me and touched me also the next day was the reaction of the rickshawpuller to my ten rupees coin.He blankly refused to take it from me.
Just a day earlier I was catching up with my juniors on current affair.One of them commented that one rickshawpuller had committed suicide because he could not feed his family,but he further added that it was his own fault because he had an old one thousand rupees note in his person when he died.Much to the chagrin and discomfort of my junior I felt extremely hurt by his comment.and I gave him a sound dressing down as he looked helplessly on.As I often do ,I mulled over why I actually lost it.I realised it was the realisation that he was oblivious of how the dynamics worked in the lives of the people who live in deprivation.They already have so many battles to fight in their lives and to add to it when they are unable to spend their hard-earned money I cannot even begin to think of the toll it would have on their person.It does not take much to trigger off suicide in a person who has the inclination.I remember two adolescents admitted in one of the hospitals, had tried deliberate self harm in reaction to a fight they had had over a remote control of a television.
I had a lot of time in hand in Raipur so I picked up a biography of Che Guiverra which made a fascinating read.On my way back, the frontline had series of articles on Fidel Castro so I was full up with latin American politics of the fifties and the sixties .
I see a vast improvement in the railways in the last one year or so.The facility was very convenient and the TTs seem to be of another brand from what we were used to in Bengal.Not only are they extremely cordial,thay are also not corrupt and have no qualms about upgrading our RACs when there are seats available.I have not travelled through Kolkotta in the recent years so am not sure how things are in that part.
The ATMs were all non-functional.The card payments could not be made in most places because of link failure.One of the staffs who had borrowed some money from me sometime ago paid back half the sum so I had some money to see me through the Raipur trip.
My journey continues from day to day...doing what needs to be done and what can be done....it is going to be a hectic farewell to 2016 .......I have a lot of travelling ahead of me.

Wednesday, November 30, 2016

A day unlike any other !

Today was unlike any other day for me.
Driving through the ins and outs of the village roads I saw a lone elder ,barefeet...in his seventies with basic minimum ,building God's house brick by brick with his bare hands .Not only was he the only labourer for the day ,he had demarcated the land from the portion of his own property.All I could do was hug him .He beamed a heartwarming smile and bent down on his knees to pull out barbed acens (weeds)from my woollen skirt .It brought tears to my eyes.
I saw an old lady hunched ninety degrees, washing her face in a puddle of muddy water bring out her first fruit of around half a kilo rice  and offer it .It reminded me of the widow's mite.
I saw a congregation of saints barely able to discern the inheritance, in faith, pray for healing.
I saw a man paralysed with most probable congenital fusion of the cervical vertebrae lying in bed,stutter his greetings in the Lord with so much of joy.One could just about discern what he was saying.
I saw a man ,depressed to the hilt ,walk up to me just to greet me in the Lord.
Looking at their poverty ,my first instinct was to push some money into their hands but age has made me wiser,I refrained from it.My money is worth nothing .Their lives,their simple faith,their generosity and just their testimony humbled me and  made me realise how small my life is .
I had requested the visit to see if there was a burden the Lord would give me,I came back with the realisation that I have done very little of the hardwork that goes into building God's kingdom.
Forgive me Lord .

Tuesday, November 29, 2016

A simpleton's thoughts on the current situation.

The first few days of the demonitisation period was a swell.It felt nice to have no penny in one's pocket and yet not have to struggle with the chaos every where around.The problem slowly began to dawn on us when we had to start interacting with banks which were trying their best inefficiently to work out the clog.Every transaction became a herculean task and somewhat irritating.
Today one of my colleagues commented ,'Soon the government will decide what one is going to eat in the afternoon meal'.
The rumours that float around don't make things better.
Another colleague of mine tells me that the RBI governer is Mukesh Ambani's brother-in-law.
That does not give me much assurance because at the end of the day the brand 'Mukesh Ambani ' shouts loud ,'profit'.However after some net research I conclude this may not be true.
While the common man struggles with the nitty gritties of everyday living,struggling,dying in some cases,queing,confused about what is happening one does not hear about too many sharks falling into the net.The affluent are unusually quiet and continue with their business of hosting flamboyant parties.One does hear of occasional loans being written off.
For the last one month,the only money I have been able to withdraw is one new 2000 Rs note from the only ATM that seems to be working.I have travelled to three states in the last one month!
I cannot even begin to fathom what the others are going through because I stay within the premises and protection of a campus and an organisation which looks to my basic needs.
The government owes the people of India a clear explanation.
While travelling in a train ,I needed to go to the toilet past midnight .I heard a youth standing with a ticket collector who was clearly in a hurry to get his job done comment,-'Can you imagine Dr Manmohan Singh ,being such an educated man ,is giving such dirty gaallies at the behest of the congress?'
I thought that was taking politics to another level.
If Manmohan Singh is really doing what this man is saying he is ,that should worry the common man.

Monday, November 21, 2016

Boundaries!




Sitabai (name changed )has been working with us since the founder’s time.Her dedication ,sincerity and efficicency is matchless.I have watched Sitabai excel in her work and yet have been almost a silent spectator to the family struggle she flaps around with.Her husband ,a ganja addict and an alcoholic has been to all eyes a thorn on her side.He has not earned a penny to my knowledge but has been a steady siphon sucking out all her savings on imagined and actual ailments,thanks to the bad habbits.


Every now and then Sitabai used to update us about her hubby’s headaches.It used to keep the entire family awake.Much to our chagrin she would take prescription analgesics and as would have it one fine day he started developing abdominal pain.

He perforated and presented with a serum potassium of 6.5 .We reffered him to a hospital in Jabalpur where he had a laparotomy.Fourteen days into the surgery he was still pouring out pus fro m the wound.

One day I took Sita Bai aside to alert her to the fact that her husband had not had a single day of headache the entire time he had been engrossed in the new ailment.Even as we did the dressing for him I observed Sita Bai and the loving way she treated her husband, like a little child ,even as he groaned while the dressing was on.

It set me thinking hard.What had he done in his life to deserve the loyalty,the love and everything that was being put into his life then.We owed him nothing but we owed Sita Bai everything we were doing because she deserved it and it was part of her staff benefit,but her husband….

Was there an issue about boundaries as far as Sita Bai was concerned because of which she was having to suffer all her life.The community she comes from ,there are no ‘till death do us apart’ vows.

I am reading a book on ‘Boundaries’.

It talks about the illustration of the good samaritan.

The questions raised in it was what if the wounded man had begged the good samaritan not to leave him at the hands of the other strangers but to stay with him till he got better?

It says ,perchance the good samaritan complied to the wishes of the wounded man,his business would have suffered and deep within the resentment at having missed out on his business would stay with him.

Sita Bai defies all this logic.She suffers with her husband in this pain,she suffered with him in his headaches,she suffered through his addictions and wayward ways,but at the work front she continues to excell.

I am at a loss to come to conclusions.

Thursday, November 17, 2016

In the passing...

It has been a strange few months or rather half a year for me.
I can see some transitions at the door and yet strange peace prevails ,peace that passeth all understanding...
Every nook and corner Romans8 vs 28 bombards me...I believe the promise because it has come to me from five or six definite places..from posters sent to me by prophets, to embroidery made on casement, mounted and brought as a gift by praying friends.It has been thrown down from the pulpits and from the inscriptions on the pages of the old books I have not opened since I passed my first professionals.Just how much assurance can I expect from a friend who has called me His kin.
It strikes me how fragile our lives are .....and so are the things that we think we do .
Our time and our back is in our maker's hand .
Sometimes we take on too much in life ..in terms of responsibility,opinions,stands, and we play God,we judge,we crib,we come to quick conclusions......God in His mercy is teaching me to stand back and chill and know that He is God.
He is teaching me to cry out to Him in my need and to trust Him as I take faltering steps forward in faith......but mostly to let His assurance really sink in that ,"all things work together for good of  those who love God and are called according to His purpose."

Saturday, November 12, 2016

Modiji's demonitisation drive,Divya's appams and Max's insight!


 Winter months in Lakhnadon are slow to say the least.
Max and Divya ,my colleagues are away,Max for his post-graduate entrance exams and Divya to help our neighbouring hospital in Chattarpur with the obstetric load.So here I am on my own for the next one week or so trying to go juggle my work with Modiji's demonetisation drive.I am cashless for a second day in a row feeling absolutely light and nice and yet am heavily involved in the imbroiglo of making it through the system while the patients pay the bill.
I am doing a bit of experiment with regional foods of India and it is fascinating to say the least.The other day Divya sent a tiffin with fluffy appams with egg roast for lunch.I loved it.I sat with her one afternoon and wrote the recipe down.She had made it with an appam mix I decided to try making it the traditional way with ground coconut.It took me close to fourteen hours to put it on my plate but it was worth it.The weather has taken a turn with the temperature around 15 degrees so even after a night the appam mix did not rise.We climbed the hospital terrace to catch the morning sun and by the afternoon the mix had doubled.
We loved the result with hastily made chutney for tea and a  traditional stew later for dinner.
She also taught me how to make chettinaad chicken.
Two weeks earlier I had lunch with Muani for her birthday and she treated me to those deliciously masala less fish curry and vegetables with herbs.I get fascinated by the subtle flavours of the herbs the mizos use in their curries.We are cooking mizo food for lunch tomorrow.
CNN ,ABC and all the leading newspapers in America  and the pollsters got it wrong but not my junior Max.I quiz him often with the current affairs because he is in touch and often clears my doubts.Some polls were showing 70% chances of Hillary winning but the exact words Max used was ,'These are just polls with very small fraction of people represented.There are so many people around the country who love the idea of America as it was...they will vote for Trump..so Trump will win.' Max was right he did win.
Vijay( Kant) was here for three days .We had a retreat of sort which was a blessing.He got me started on a more disciplined bible study mode.
In between caeserian sections,low profile laparotomies,hysterctomies ,geriatrics,wonderful colleagues and dipping temperatures, winter is here for sure..sweaters creeping out from the trunks,everyday a grace from God.
The book of Hebrews says,'Today,if you hear His voice ,do not harden your heart.'
My tomorrow is in my maker's hand.I only answer for today.




Friday, November 4, 2016

Live ,love and pray!

         Came back from home ...everyone seems to think I was away for long but it has been just a fortnight.For me it was a fortnight of another world altogether..climbing the hills and the valleys with a cousin who has taken a sabbatical from her stint in the Down under...spending time with mom helping her with exercises to strengthen her quadriceps....catching up with siblings and just trying to get past the freshness of the farm food and fruits...and the quality of life back at home.....even watching football matches with my brother and keeping up with my mother's past times.I made pickles,learnt to make wine with guava and pessimon..ate exotic vegetables like the orchid flower,asparagus,water cress,nettles,avacado,..I took time to visit parts of South Sikkim...went fishing in the river....drove to the site on the opposite hill  where a whole chunk had fallen into the sea. I prayed with my cousin on the spot.It was an amazing experience.This time, I sort of understood why Sikkim is labelled 'green'.
I fell in love with the landscape and the river in the wild all over again.
I became greedy ...and embraced with abandon every moment.....the spa from the rocks in the mountain,tete-tete with my aunt who was visiting us for a few days,indulging on Hero our tibetain apso.
I woke up most days close to mid-day.....and did my own thing.
I saw an aunt who is in her seventies bike the hundred kilometres through the tough terrain..I pray I may be able to do that when I reach that age.I saw my father who is eighty-six about his daily rythemn,I observed my mother who is eighty with a bad knee drive to school,manage the kitchen ,participate in the enthusiasm with more energy than I had mustered for the past two years.
I think I need to come home more often to get past my mid-life crisis....
I come back refreshed,...now I look  at the paraphernalia around with a lot more compassion...I am a lot more geared,...I will try harder...I will work smarter...I will commit myself to understand my speciality better...I will pray sweeter...I will trust more.. ,risk more....,live more and love more.
Cheers to this age in my life......I am loving it!

Friday, September 30, 2016

Just when I thought I had seen it all!

Just when I think I have seen it all and done most things in Lakhnadon,Alok Singh is wheeled into the OPD.He has a history of injury to the heel which was treated in Seoni .Since two days he has severe spasm in the neck and is unable to swallow anything.
I last saw a case of tetanus ten years back in Jharkhand .Here was Alok who went into a severe bulbar spasm as soon as I put my spatula into his mouth.
I had to go through the tedious experience of explaining the natural history to the  bystanders who were already very difficult to communicate to.
Just how do you treat diseases like tetanus in the current scenario?We have long stopped stocking Tetanus anti-globulins.Brought to mind Dr keith Sander whom I had the privellage to meet for lunch during my time in England.he had done some work on tetanus during his stint in Ruxual ,and I am talking about the founders of the organisation !
I remembered our escapades in Oddanchattram where day after day Dr KV during his rounds used to show us different ways of examining the well-being and progress of such patients with such patience.
The incident that stands out is of a patient from one of the Panchalur hills who was brought to Oddanchattram with the full-blown disease.The patient had to be sedated ,kept in a quiet room and had to be bagged with an ambu.We did not have a ventilator then.The tubes started clogging on the third day so a  tracheostomy had to be done.
Every day Dr KV would go through the vitals to look for features of dysautonomia,palpate the abdomen to make sure he was sedated adequately,scan the diet sheet  and go through the routines very calmly while we tiptoed around so as not to wake the patient .
One fine day the relatives decided that they had had enough and they wanted to take the patient home.
When persuasion did not work we sent the patient home with a spare ambu-bag .
A month later  my senior Alex came chuckling into the out-patient.
Much to our amusement and joy the patient had walked into the OPD all the way from Pachalur bagging himself with the ambu.
He must have recovered some time back but had been too afraid to disconnect or do anything about it.
That was good news.
However,managing Tetanus is hard and I often find that the support staffs are not trained or adequately equipped to manage such cases.Add to it I travel out of lakhnadon tomorrow and will be away for more than a fortnight.
I feel tired even as I explain the logistics to the patient and the bystanders.
He is with us tonight.Tomorrow they might have to make a more feasible arrangement.
Just how do we treat diseases like tetanus in this day and age?Sigh!!

Saturday, September 24, 2016

The Concert.

Yesterday we attended the ‘Yeshua ‘concert in Jabalpur.
It  was a group of young boys leading  the  worship with songs which have blessed so many in the 
present generation.
There was a lot of  technical snag I believe (Joseph ,our muscian dentist noticed but  so did he notice the much needed  dental work the lead singer needed,so I don’t know?) because the unpredictable rains ensured a change of venue at the last moment.I, for one ,did not notice anything because I was caught up in the worship.
The concert started with a salute for the king-all of us stiff people were asked to stand in absolute
attention with our salute for the King of kings.
There were banters,there was worship,there was an altar call.My heart’s cry was for the youngsters
on the stage to be broken individually for God to a greater extent and to be poured out even more for
Lord Jesus’ glory.
At the end of the worship all of us were on our knees ,with our eyes closed worshipping with the
team even as the CNI pastor gave the benediction.
It was a ‘Jesus’ show all the way.
I was blessed.

Wednesday, September 21, 2016

Preaching by Mr Ekka in the prayer meeting in my house today.

We are called to be the sons and daughters of the living God.
We are called to purity.'be thou Holy even as I am holy.'
We are called to grow and be lifted up in Christ.
We are called to be taken up in Glory with our savior.

Tuesday, September 20, 2016

Just a day in a mission hospital.




Ashish Ram literally hobbled into our casualty supported by his relatives.His complaints were severe palpitation and giddiness.His heart was racing as was visible from his carotids and his pulse was hardly there.We fitted a cardiac monitor stat and there was a ventricular tachycardia on the run.This fortyfive odd years man had walked with that VT from God knows where?
We traced out an ECG ,got our defibrillator into our casualty and I got my colleague going with the
machine even as I got the settings in place.The nurses were quick in getting the consent from the relatives.The man was sedated quickly and shocked.He reverted to normal sinus rythemn by God's grace .
The second ECG we traced out showed a nice WPW syndrome,the earlier ECG also had a prolonged QTc which had normalised in the second one.The electrolytes which were quickly done through the ABG showed significant hypocalcaemia so we gave him the slow calcium gluconate intravenously with our eyes on the monitor.
To make sure that the VT would not revert we had to put him on bolus amiodarone and mantainence for the next twenty-three hours.
Ashish Ram responded very well to the emergency treatment ,but now the definitive management with all the expenses loomed in front of him.The least I could do for him was put him on a protective treatment till he could make the necessary arrangements.
I sent a quick facebook message to my friend Amos in Cardiff who is a cardiologist with special interest in VTs.Amos was a colleague from our Oddanchattram days.He had come to ODC as a student elective from Malaysia.An extremely God-fearing and humble individual,I don't ever recall Amos not smiling.He was an active member of the junior doctor's fellowship.
In between putting his little baby Annie to sleep ,he was quick in responding.Flecainide was what he suggested,with an alternative of digoxin and beta-blocker carefully.
Flecainide ,we did not have.Since we had already started him on tapering doses of Amiodarone ,he suggested going with it for the next three weeks and then changing over to the above drugs carefully.
The next morning ,when I went for my rounds Ashish Ram  was happily sitting up in bed eating an apple with such gusto that he looked different.
Ashish Ram would not understand what had gone into saving his life.
Lizi,our dentist having left Lakhnadon, sent me a message from the US saying that she wanted to facilitate buying an equipment for our hospital .Being a physician ,I shuddered each time a myocardial infarction patient landed at our doorsteps,praying hard that the patient would not go into a life-threatening arrhythmia .
Predominantly a surgical unit,I remember sitting in the OPD and praying for patients,the immediate response as soon as we finished praying was an old couple who came huffing and puffing into my OPD with chest-pain.They were poor but they were an answer to our prayer.She had an anterior wall MI. We treated the patient with a lot of gratitude in our hearts.We are friends and greet each other with much happiness whenever we meet.
Lizi helped us buy the defibrillator.
DVN made arrangements for us to buy a cardiac monitor and helped us build the ACU.
Amos gave me the assurance and the support I needed then.
Ashish ram got the gift of life.One never knows the the extent of impact of one's genorisity.
The beauty of it all is Ashish ram is oblivious of it.

Monday, September 12, 2016

Hail the Lion of Judah!

Eight o'clock in the morning while we were having our morning prayers,a patient with chest pain came to the casualty.The young nurse during the ward prayer prayed that not I, but Christ would come through to minister to all the patients.
The patient was in severe distress with pulses hardly palpable.Max had done the prelimanaries and by the time I reached, the ECG had just chugged out from the machine.the patient had extensive anterior wall myocardial infarction.
I started barking orders as usual.The monitor showed a sinus rythemn and the blood pressure was just about holding.We went ahead and thrombolysed the patient.
The streptokinase was in ,the analgesics were in and so we expected the patient to settle down,but suddenly he started sweating profusely and went into a ventricular tachycardia,following which he became extremely restless.
The man who had so far been relatively controlled gave a blood curdling scream and I thought that was it.I haven't seen too many men with chest pain who scream like that, live.
My hands tied, we started him on Amiodarone and called the staff and the relatives and asked them for permission to pray for his healing.They gave us the permission albeit a little dubiously.
We prayed,and the man settled.It was as simple as that!
No chest pain after that ,he calmly slept like a child and his four hour ECG showed a reversal.We sent him off to Nagpur for intervention(Angio,etc).They could afford it.
All of us in that room knew the Lord had come through for us.In His mighty compassion He had come through for all of us the patient,the staffs,and the relatives..
I could only marvel at His compassion for everyone in that room.

Thursday, September 8, 2016

A season of blessing indeed.

What an amazing season of reaching out to women especially mothers, it has been.We had our women's conference in the last week of August as scheduled.Thirteen ladies sat at the Lord's feet like Mary with our two senior resource persons who have been through it all but carry that 'precious wonder' in their heart which touched our lives in different ways.I find myself so much more calmer and rested and more in touch with myself these days.
The vocational training centre has ten women from different walks of life being taught sewing by our very own Mrs Zakir who not only excels in the craft but gives 101% of herself to the task.
Since yesterday thirty strong ladies from the village,namely ASHA workers are being trained in the campus in different government modules and will be here for the next three days.This is just the first batch this season and it fills my heart with joy to see these mothers take time off from their busy mothering schedule to attend classes and just hang around in the garden .They start chirping around in the park in front of my house from five in the morning.A little unusual for a person who likes the quiet the first thing in the morning but nevertheless we feel extremely privellaged to host and train these women folk from the villages.Some of them have children and so are accompanied by their mothers who look after the babies during the sessions.
We feel blessed just to have this opportunity to be part of the process of involvement with the cohort which actually may define the future of our families,of our villages,our institutions and our country.
Thank you Lord!

Doing the math with my patients.

Prashant was ill when he came ,required intensive care.He recovered albeit slowly but surely.The father realised how ill he was and requested me to do all I could do,his words were ,'Don't worry about money'.Needless to have said that because we never worry about money when we treat a patient.
I was away when it was time for Prashant to go home.There was no usual asking for charity here.The father quietly disappeared and appeared one fine day with half the sum.We wrote off the rest.He had arranged for six grands.I wondered how?He showed me the papers.He had leased out his land to another person for a year,sealed,stamped and approved by the local tehsil.No interest ,nothing.
Considering how uncertain it was for farmers anyways I thought it was smart.
Shitiiz brought in his mother to the out-patient.He went to the local Sahu ,left his mother's silver anklet and got a fifteen hundred rupees for her treatment.He has to pay an added interest of fifteen rupees per month.If he goes to Nagpur or Jabalpur to work,he and his brother would earn around six hundred rupees between them.I do the calculation and he says it will take them a year to release the anklet.I am not sure how the calculation works because I thought a week should see them out of the debt.The market price for the anklet is twenty-five hundred I am told.
That is a way of life for Prashant's and Shitiz's of the world.that is how their world ticks and there is a certain amount of dignity in the way they go about it.Especially the poor,they will never ask for charity.

Thursday, September 1, 2016

Forgetting Shyam!

I had been in a woman's conference for two days and then in Lalitpur to see my good friend Sheba.Coming back to work ,it was ward  rounds with my juniors as usual.In the male ward ,a young boy gave me an unabashed heartfelt smile and told me 'my father is coming today'.I was taken aback wondered if the boy was a little behind in the growth milestones?
When I asked Max to update me the history,I realised it was Shyam.How could I possibly not have recognised him.
On one of my duty days he was wheeled into the casualty cold and clammy ,unconscious with a heart-rate of thirty beats ,ECG showed a complete heart block and a barely recordable blood pressure.
I thought we had a case for pacing but just a dose of atropine saw the heartbeat returning to normal sinus rythem and that gave us some time for some history and basic bloods.His ABG was nothing to write home about.
Shyam had followed a truck driver to Mumbai was what the father said.The truck driver had dumped an unconscious Shyam into the government facility from where the father had picked the boy up in that sorry state and brought him to our hospital.He had no other history.
His counts were as low as can be with the total counts in hundreds and the platelet at thirty thousand with borderline renal failure.The boy had a GCS of 7/15 which did not revert with correction of hypoglycaemia.We hit him with antimalarials , covered for sepsis and arranged for a fresh pint of blood to be transfused.I was a little concerned he might have bled into his brain but there was no knowing since the bystanders were not happy to take him for a CT scan .
From then onwards it was a slow but a vigilant recovery.
Over the next four or five days Shyam's GCS improved and he started responding to our queries albeit a little unclear.I would make it a point to call his relatives inside just to strike a conversation with him.He mumbled umpteen number of unclear words much to the chagrin of his relatives.His maternal grandmother was the only person who could get through to him.
One day two sturdy men entered the ward and Shyam's face brightened when he saw them and he raised his hand in greeting.The feeling was mutual.
My hunch was he was on the way to recovery.Four days I was away I presumed he would have gone home.
I was overjoyed to see him so well ,he looked much younger now that he was sitting up and swinging his legs from the bed.I asked him if he recognised me and he shyly nodded his head in an affirmation.I asked him the other question all of us were dying to know.That was if he remembered what happened to him and where had he gone without informing his family?
He said he remembered everything and he had gone to Punjab to pick apples?On his way back he had fallen sick.
Little do our patients know how much joy they bring into our lives when they give us beautiful surprises the way Shyam did.
Doctoring has it's heartaches but it has it's own share of wonderful rewards,like an unabashed heart-felt smile from a patient who has been through hell with you and back .

Wednesday, August 31, 2016

The last few days.

Ok what have I been doing in the last few weeks.
I have had my hands full organising a women's retreat in lakhnadon .
Twelve beautiful ladies took time out from their hectic schedule to sit at the Lord's feet with Mrs Renuka Sanghi and Mrs Pushpa Waghmare.
Mrs Renuka  took us through the Garden of Gethsamane and the Garden of resurrection poetically,lightly,gravely and impactfully whereas Mrs Waghmare made us travel through the current scenario in missions making us think through and surprising us with questions we have never been aware enough to ask ourselves.I found myself in tears often enough.
Following the retreat I made a quick visit to Lalitpur to see my dear friends.
It was a restful two days . 

Monday, August 15, 2016

In my weakness you take my hand and lead me on.

Every once in a while in my responsibilities I feel extremely over-whelmed and there are times when you feel out of your depths and unable to move further.This has happened to me in the past.During my tenure in Satbarwa,I used to have a group of officers around me who used to literally carry me.It was a team ,earnest and never questioned me but stood through times when I felt it was just too much.I have often felt like that in Lakhnadon.Yesterday was one such night.The government hospital was all into mucking up simple cases and pushing them into our hospital.At one o'clock at night one previous caeserian section case given a trial labour and failed was pushed into the casualty.Much like any other caeserian case we posted her.The bystanders were insistant that she be steralised.We started the surgery well enough with an inexperienced assistant.Her haomoglobin was all of 7.5gm percent.She was bleeding from all over and inspite of all our efforts medically even after she was sutured up one corner would just not stop oozing.It was serious oozing.We finished three vicryls trying to stop the bleed ,but to no avail.I had to wake Divya up,get Harshlata to scrub and we decided to do a sub-total hysterectomy.We asked the bystanders to give blood,none of them were compatible.
We continued with the surgery with my able assistants.
By the time we were done it was five in the morning.By God's grace the lady coped very well inspite of less blood.The baby whom we were much concerned about because the foetal heart rate when the mother presented was below eighty was hale and hearty and cried vigourously at birth. I lost heart so many times during the surgery.These stellar ladies  quietly by their presence,just carried me along.
Thank you Lord Jesus for these blessings.
As I write this ,'Good shepherd of my soul....in my weakness you take my hand and lead me on' ..the Bethel group sings.

Sunday, August 14, 2016

The shepherd's heart.

I was dreading the last three days in the hospital with its unpredictability in the patient load.The last month or so have been hectic to say the least.I had allowed one of my juniors to take the much deserved leave for ten days and Divya was in her community stint.I could always call her if I needed her but I was alone for all practical purposes.Even when three of us were there,every evening I would come home by eight or so and I was severely sleep deprived.Whenever I could I would catch up.
By God's grace in the last three days,I could actually fill in on my sleep except for sunday when I was at it the day and the whole night.On fifteenth August I could get to my bed only at six in the morning.
On thirteenth of August evening as usual I came back from work at five and then without wasting time I decided to catch some sleep before I got the next call.
At seven forty sharp I got woken up by a spiritual nudge and an intense pressure to pray for Djongu.
Djongu is the hill opposite my hometown ,the place where my erstwhile people the lepchas live.I knew there was somekind of landslide going on but I thought it was the usual monsoon hullobullo that takes place in the hills.Lepchas are simple people,animists by faith and they worship nature in it's manifold forms.I was up wide awake and wondered why but immediately did what was bid.
At seven fifty I got a message from my friend Sheba that her father in law uncle Ray had been raised up in glory.
Now I had been accompanying the Eichers in my prayers throughout the journey and so the first question that came to my thought was how come the nudge was not prayer for them especially when they were going through that momentous event just at that exact time.Why Djongu?
I went back to the net to get an update and realized that the landslide in the area was serious and the people were actually being evacuated and shifted to safe areas.
More than that it was the heart of the shepherd that left the ninetynine sheep in the fold to go after the hundredth that was lost.I am sure uncle Ray would have wanted me to do the same too.

Friday, August 5, 2016

Coming through.

In my short time in the new region where I have worked I have wondered often how people meander about the paraphenalia with all it's implications to be effective in their ministries.We know they are effective because we see the fruits.Everytime our goodman came to the out-patient he always had a most wretched patient brought in for medication.It would be a destitute,a lunatic,a schizophrenic.Everytime he would have a positive report about the well-being of the patients often attributed to prayers.
One day he was in the out-patient giving us an update about his work.I had had a busy night and the day was busy.I was impatient but was trying my best to curb my baser instincts and practise politeness.Suddenly a gentleman entered the out-patient with another patient who had fever.
Our man was greeted with effusive  enthusiasm.When the patient had been dealt with and the duo left ,our good man shared how he knew this gentleman.Apparently he was one of those village practitioners.He had heard of our good man and therefore had one day come searching for him.His son who was apparently well qualified was not landing a job so he wanted our man to pray for him.Our goodman  put it in simple words.We prayed and he not only got a job but also came first in the interview.I was deeply touched and reminded of the three men in the book of Daniel who were put through fire and how Nebuchddnezzar saw the fourth man ,'the son of man ' is how he puts it.
I have often wondered how these good men and women were getting through fire unscathed in the field . I realised that 'the Lion of Judah ' was coming through for them .

Sunday, July 31, 2016

The widow's mite.

One busy out-patient morning I found Max examining one tribal lady with a high grade fever who looked toxic.In the passing ,I told Max,just keep her in the wards for the day till her fever subsides and then she can go home in the evening with her family.I became busy with other patients.When we went for rounds in the evening at around five ,she was sitting up in bed.Her husband was nowhere around.
When I asked after her husband she told us that he had gone home and had not returned.She had not eaten her lunch so I requested Geeta Bai to give her some food from the mess which she promptly did.I was on duty that night and it was a busy duty.I did not get a wink of sleep and so missed the morning rounds.Suddenly mid-morning the lady and her husband with a little kid bounced into my out-patient.The lady was very excited about the fact that we had fed her and looked after her and was narrating it to her husband.
The bill had gone up to Rs 2000  .The husband did not have a single ruppee on him .He excused himself saying that his kid would not let him alone so he could not make it to collect his wife the previous day.So we wrote off the bill seeing that he had paid four hundred ruppees for the medications on arrival.Both the husband and wife seemed a little short on attention.
Half and hour later much to our amusement,the husband entered my OPD and pushed a hundred ruppees note towards me.
This is a common phenomenon amongst the poor.
A few weeks ago we laboured with a young girl who was brought into the emergency unconcious with a high grade fever and a haemoglobin of 2 gm.The bystanders quietly arranged for blood.Seema regained conciousness the next morning but rapidly went into ARDS.We put her on high flow oxygen,gave the bystanders a bad prognosis but by God's grace she started making a dramatic recovery from the fouth day.
To cut long story short, she was discharged in another day or two with oral medications.A fortnight later they came for a follow up visit.Both the mother and daughter seemed extremely grateful .After examining her I had just bid her farewell when her mother caught hold of my hand .I thought she was going to shake it but I realised she had slipped a fifty ruppees note into my hand.I thanked them for the money and explained why I could not take it.They told me they would come again just like that, to see me.
Another time an extremely poor man slipped a ten ruppees note to me to express his gratitude.
We are so grateful to God that the poor come to us.

Saturday, July 30, 2016

This and that!

It has been a month of activity in various forms.It is raining cats and dogs.Thank God for that.
The flowers are blooming bravely through the rains.I am enjoying spending time with the plants in the morning.I remember trying drip irrigation for my roses through the summer heat.The plants have survived so many summers and brought so much of joy to our hearts everytime it beats the heat to brighten the paraphernalia and our days.
The hospital has never been so busy.We had almost ninety percent occupancy for a day or two and we also had some very sick patients.There were times when I have murmered ,'Oh Lord when will it end ' only to guiltily ask for the Lord's forgiveness for we have prayed for patients and He has sent them .
My juniors always tease me about how various very sick patients seem to respond only to my queries about their health during the rounds.One palliative care patient with stroke would start weeping as soon as I started talking to him and gradually as he recovered and started talking, he graciously mumbled that he felt nice talking to me.Divya ,keen and observant ,told me ',actually mam, you are the only one who talks to them'.
Now, why do I take pains to talk to these apparently non-functional patients?
The credit for it goes to a teacher I had in my post-graduate studies,Dr Luke Mathew.
In the high action ACU in ODC with Dr Luke trying to feed us with all the latest medical information and keeping us updated with the facts and figures,one afternoon, he called us altogether for a chat and made one of the visitng interns from the US read an article aloud to all of us.
I ,for one, can never forget that article.
The article was a write up on the various struggles, besides the apparent medical issue ,a patient faces when they become indisposed.I think there is a chapter in Harrison on it,I never read it and I have never suffered because of it.
Take for instance a middle aged man ,incharge of the family,suddenly having a stroke.
He could be the head of the family making all the decisions and overnight everything  changes.He has to depend on everybody else for everything.He has uncertainities about the finances,uncertanities about the family support .Suddenly he has no control over his family life ,he finds everyone else making decisions for him,what he wll eat,what he will wear,which doctor he will see ,etc.
To top it all,noone seems to address him directly anymore.Everyone seems to talk over him and about him '.He is de-humanized in a way.
Our Indian medical system do not have ethics and patient rights as an important curriculum.
Even if it is a curriculum in any of the elite institutions I, for one, have never heard of any doctor being taken to task for such insensitivities unless the patient has a voice .
Talking of the rights of the marginilised we have a long way to go...
I am greatful for all the great teachers who have taught me things I carry deep within me as a legacy and I deem these the most precious lessons I have learnt..

Sunday, July 3, 2016

'LISTENING-A SPECIAL GIFT FROM GOD'.

It's five in the morning.I pull my deck chair to the verandah of my quarter to take in the cool ,fresh monsoon air of the morning.I tilt my head to listen to the sound of the nature,the bird in earnest conversation,the rustle of the leaves,dew-drops quietly tiptoeing to settle into the grass in the lawn,the lone birdling singing away to glory.My senses alert, I do not take it for granted anymore.It has been some time since I have been able to really listen ,to the nature beyond the voices of my own head and the manyfold noises of the paraphenalia and the constant tinnitus in my left ear.
It is a beautiful morning ,it is a beautiful day and it is a beautiful life.So much to be thankful to God for.
We are working towards a women's workshop in August in Lakhnadon ."Women-a method of God"-Two stellar ladies Mrs Renuka Sanghi and Mrs Waghmare have agreed to guide us through various topics.We are sincerely praying for the right candidates to attend the conference.
God just wants us to pray.In the cacophony that surrounds us, he wants us to retreat to that sanctum sanctorium, to commune with the Holy of Holies .To listen to Him...Whatever it takes for Him to get our attention.
May our steps be firm ,may our ground be the solid Rock ,may our beacon be the Eternal Light and may Christ come forth in glory to stand before us in all that we say and do because we have listened.
If so, then 'If Christ be for us who can be against us?...'

Monday, June 27, 2016

The Quiet place.







Every once in a while you want to carry on through the corridor ,stroddle the two steps onto the bridge but stop just ten yards before the cafeteria into a heavy door on the wall which reads ‘Quiet room’.In the action filled acute medicine setting it helps to spend a portion of your lunch break beyond that wooden door.It is a chapel of sorts,a room to be exact.Carpetted but with very sparse furniture.A lectern with a bible,a side table which holds church addresses,brochures for church activities,small booklets on various subjects like bereivement,etc.
As you scour the place what really strikes you is the board .It has flaps of tiny hand-written prayer requests,cards ..people who have just poured their hearts out to ‘you will not believe ,who?’.It is letters to Jesus.
One of them reads , ‘Dear Lord Jesus,please be with my eighty year old mother who is having a hip replacement.She has never been to a hospital before.Please look after her and help her to heal.’Sam
Another one reads,’Dear Jesus,I have lost my son John to a road traffic accident and it is extremely difficult for me and especially my wife to understand why this has happened.Please help us as we go through this sad time.Please help my mother who is devastated by this loss.I feel helpless.’James Thomas.
‘Dear Jesus,my wife and I have been blessed with a tiny baby girl who decided to be born premature.She is fighting to breathe well and in an incubator.Please keep her safe. Love Jerry.
Dear Jesus,I want to thank you for blessing my sister with a lovely baby girl.I love U.Tabitha .
Then there are others addressed to God.
Dear God ,I lost my temper with the staff in the ward no ...today.I thought they were careless in the way they handled my son’s linen.Please help me not to get angry with them and help me to forgive them.I am sorry.Rita.
Dear God ,Thank you,thank you thank you..so much........for looking after Herbert through the difficult surgery.Muah .....Liz.
I kneel down on the carpet and say a prayer for Liz,Rita,Tabitha,Jerry,James and Sam.

Friday, June 3, 2016

travel writing in 100 words-Phew!

We hitch-hiked the himalayan route we had often driven through .
From Mangan, we had to fend for ourselves through the steep mountain tracks ,beautiful wisps of water-fall,reflecting the rainbow .
We  mercilessly hacked our way past civilisation,innocent smiling faces,army settlements,labourers with loads.
We walked with the river companionably beyond our second breath.
The wooden cottages in Lachung beamed with spots of snowed roof and carpets of vibrant primulas .
Sweet slumber ,with rice and chunk of meat with lard completed our day.
It had been well-earned.

This and that.

The heat seems like it is here to stay.One can hardly put any food in the mouth and yet the scales are unforgiving, not a dip to the right or left.A colleague tells me it is going to rain on Monday.We just went through a water crisis of sorts for a few days but we are back on our feet, on track ,surprisingly enjoying the unmeritted grace of God in big and small things.
Patients?what about patients.As usual the hospital is as unpredictable as it gets.Somedays are busy to the hilt and some as quiet as a monastry.Our collections however have been steady by God's grace.
The coolers are on every hour of the day at work and those of us who are fortunate enough have air-conditioners to keep us sane.Just sitting in the OPD with cooler at full blast for stretched hours make one feel nauseated so you can imagine what would happen if we had an out-door job.
The patients are a study at impractility .One often ends up doing all the math for them so that they can save maximum money. We have a lady with ILD,a young nineteen years old, she also has recurrent pneumothorax for which she had had a tube in Nagpur but was reffered from there for home oxygen therapy.Here we found that she had developed another pneumothorax so we put in a chest tube again.She is mantaining 88-92% saturation with minimal O2.We are planning on a pleurodesis and are going through a last minute pros and cons checklists as well as getting a second opinion from experts.Tetracycline was what I had personally seen used in my short stint in the UK but my friends from the CMC tell me they use betadine instead which is a lot less painful.She needs home oxygen and as usual Indian medical systemn has no arrangements for deviants like this.They can't practically think of keeping the patient in the hospital forever so we are seriously thinking of renting them our oxygen concentrator,not sure how practical it is.Apparently the government guys have told them to get her admitted in the hospital,seriously, for LTOT?
Mohan came with the good news that the government set up in Seoni has put in a test which detects extrapulmonary tuberculosis.It brought so much of joy to my heart that I felt like distributing sweets .That is the sort of burden I carry in my heart for this cohort.
Like I was telling Devyani today ,life is 'avoiding the heat exhaustion at any cost these days',and it somehow seems to work like a clock work..

Sunday, May 8, 2016

Malnutrition-different faces of it!

I have been dealing with a lot of mallnutrition cases overtly.
There are the usual ,obvious cases that glare at you from the paediatric out-patient and then there are others which are there because they have not been eating due to other reasons.
We get a lot of cases of starvation.There is a common myth in the villages which says that patients who have enteric fever have to be put off food.
So a vicious cycle resumes.Patients are not given food ....and then later their stomach shrinks over time and then they lose their appetite.
We had a twenty five year old cachectic lady come in with a history of  fever.
We screened her for everything one could think of in a cacechtic person and she came negative except for enteric fever.She had clinical features pointing towards the diagnosis.She had been treated with various antibiotics so we put her on Multi-drug therapy for enteric fever and her fever crashed by the second day.However her blood pressure continued to crash inspite of adequate hydration.So we put her on pressors and supported her with steroids.
However she continued to have the ups and downs.
We transferred her to the ACU and one afternoon the patient looked like she was going to have a funny turn.
I walked up to her and she told me she was having palpitations.We attatched her to the cardiac monitor and she was having intermittant VTs, it looked like torsades pointes.
I immediately started her on magnessium drip.
Twelve hours later she looks a different person.She sat up and started eating the high nutrition pack dalia which our community health people have made.We have stopped her pressors.
I thank God for ways in which the Lord helps us to deal with cases which can be found only in the peripheries.

Wednesday, May 4, 2016

Reality





When there is no rain ,there is drought,
There is no food .Two square meals ..what is it?
Life becomes tougher,struggling for that two pots of water.
Cycling  at four in the morning
To the community well .
The water is receding,
The doctor talks about clean,sanitized water ,
We want just water,water to drink,to wash ,to cook
when there is food.
Will the rains ever come?
I can hear the thunder
In the distant sky.
Are our prayers heard?
Yes the rains will come and with it
Malaria,acute gastroenteritis and ofcourse ,
The snakes will be out to enjoy the respite…
Lalli has been bitten ,
Will she survive?
The drought,the starvation,dehydration,
The fever ,the  snake-bite
Or the doctor’s bill.