Sweating it out

Ok, so I haven't blogged in a while and have some catching up to do! The past few days have been good, but hot. And by hot, I mean hot. Our hostel dosen't have a/c, which is pretty typical of most accomodations in India. But for some reason this week I am really feeling the heat. I think I am also underestimating how much fluids I am losing through insensible losses, ie sweat. I think beacuse I haven' t been drinking enough water, I've been feeling more tired than usual. So I need to be good about drinking LOTS of water so that I don't pass out.



Let's see, where did I leave off? On Friday, I went to internal medicine rounds at the hospital. It was a little better than the day before because I could hear better and get a better sense of what was going on. But it is STILL hard to hear people here! I like to think that I'm used to what "Indian" English sounds like, but people here speak so quickly. And throw in loads of medical jargon and it becomes worse. This time I went to rounds in the ICU. Again, not too drastically different from what I'm used to in the U.S. The actual number of beds is smaller, and there aren't separate encloures for rooms like back home, so it's more of a "ward" type feel. But they have all the latest in terms of equipment, like ventilators, crash carts, etc. They also, for the most part, use the same antibiotics as we do back home, only they have different trade names because they are marketed through different companies. Because I was in the ICU, I got to see some pretty sick patients, many of whom were intubated. Although the medical issues of the patients was pretty similar to what I'm used to back home, what struck me was how the attending interacted with the family members of the patient. After seeing each patient, my attending would pull the family member into the room and would talk to him about the patient, standing up, surrounded by the entire team. He would tell the family member (usually only one person, designated to be the spokesperson) that their relative wasn't doing well, that the prognosis was dim, and that they needed to start considering how long they wanted to keep them alive via artificial means. He would also ask them if they thought it was worth as much money as they were paying to stay in the ICU. This is definitely something I'm not used to back home. Conversations between doctors and family members are usually done privately, and they are not nearly as blunt or suggestive as far as what should be done with the patient. And another difference here is that patients and family members are so grateful for whatever opinion the doctor gives. It's amazing how much respect doctors command here. In many ways, the doctor-patient relationship is very paternalistic here and patients blindly follow whatever advice they are given. This might be due to the fact that many of the patients seen at CMC are represent very low socio-economic classes and have very little education. But I'm sure this is what it used to be like in the U.S. back in the 60s and 70s, in the era before HMOs, malpractice suits, and having patients self-diagnose themselves on the internet.

This weekend our whole group went on a road trip to Pondicherry. Our trip to get there was an adventure in and of itself. Eight of us crammed into an SUV that was probably meant for 5 people, and our luggage was strapped down to the roof of the truck. And the road to get there (it's about a 4 hour trip) was bumpy, narrow, and poorly paved. Which is the case for most roads in India, but when you're with a driver who is swerving constantly at speeds that are twice what is safe to drive on such a road, you can't help but start to fearing for your life.


Pondicherry is a small city which was a former French colony. And it attracts many western tourists who come there to medidate because of a famous ashram there. There's really not much to do there, except to go medidate or sit on the beach. Neither of which are my sort of thing to do. So a bunch of us basically went shopping. But I didn't find anything I really liked because I didn't think they had a very good selection. Later that evening our group went to dinner at an overpriced restaurant which was not good either. But at least the company was good.

Yesterday and today I've been working at CHAD clinics, which stands for the community health and development program here. Yesterday I was at a family practice clinic, so we saw people of all ages. Jen and I saw one little boy who presented with new onset headaches and vomiting. After MUCH debate, they finally decided to get him a CT scan. In the US, this wouldn't even have been a question. But it makes your realize that finances really do play a role in determining the level of health care people get.

Today I went to the TB clinic. TB patients, in India, are considered "bread and butter" cases. Far from the case back home. Many of the patients had dormant TB, but one woman I saw had MILIARY TB. I'm not kidding. The doctor had pulled up her chest x ray, and said "that's miliary TB." I've never seen a chest x ray like that- it looked like somebody took a pen and just made little dots throughout the film. I assumed it was one of his patients outside of the clinic. But then, this patient walks in and sits down in front of me and I realize that SHE is the one he's talking about! I was amazed that somebody in her condition was even walking around.

The other crazy patient I saw today was a 19 year old woman who looked absolutely emaciated and pale. She probably weighted at most 80 lbs. And there was a good reason why. The doctor pulled up her CBC on the computer and she had a hemoglobin of 4.5! I couldn't believe it. She was basically about to go into high output cardiac failure as a result of her anemia. She had horrible oral ulcers, and pedal edema from her heart failure. She waited this long to come in because she couldn't afford treatment. And today she was in such a bad state that she needed to be admitted. Craziness.

Anyway, this week I'm continuing with CHAD. More stories to follow....