india trip, post 4

Sunday, September 6, 2009; Day 14-15: India; 12:30 AM

Just got back from the nursing home.  Nani is going to be discharged home tomorrow, rather, later today this afternoon.  She will essentially be complete nursing care.  I’ve been given charge of monitoring vital signs, oxygen, q2h feedings via NG, accuchecks, insulin, q8h IV antibiotics and IV care.  The lady I mentioned a few days ago, Shaheen auntie, will manage all the other aspects of care.  The doctor was a little wary of sending her home, and I think it was out of genuine concern of whether we could manage her, rather than trying to make a few more dollars, or rupees, out of us.  Ultimately we decided to do it, and have a low threshold to re-admit if necessary.

So over the remaining weeks I’m here, I will start to delegate all of these things and train a few people.  My mom was reminding us of how everyone in the family knows how to establish IV access, and administer Factor VIII for my younger brother.  Even my dad, who’s very much removed from healthcare and the medical profession.

I had some local haleem today, from the neighborhood.  I also had some haleem from a very large and well-known restaurant yesterday.  Guess which one tasted better?  The local one, hands down.  The one from the restaurant was too bland, uber-slimy, had a dull diarrhea-gray color to it, and had bits of bone in it.  I was told that this is the way the “best” haleem sells.  It has to have bits of bone in it so the people will be sure that it’s from goat.  Goat meat is more expensive here versus cow meat.  Beef haleem is cheaper, and doesn’t have bone (because cows have much larger bones…hmm, I should really stop all this commentary and just tell you the story).  Also, the grayer and slimier the haleem, the better it sells.  When we make haleem at home, it’s much thinner and has larger bits of meat.  I’m not sold on restaurant haleem likely due to my bias and familiarity with the thinner version.

I remember in nursing school, I met a vegetarian who also only ate organic food.  One day I was eating cheese doodles (before all this cheese, rennet and whey arguments were known to me) and offered her some.  She tried it and spit it out, commenting on how it tasted like chemicals.  Almost 10 years later, I finally understand.  In Chicago we have both an ice cream maker and bread maker.  We also make a lot of cakes from scratch and obviously all of our Indian and many American dishes are from scratch.  My little sister started all this and after we started, we never looked back.  Now I can taste the “chemicals” in Wonder Bread, and the preservatives in ice cream.  I still like cheese doodles though.

Monday, September 7, 2009; Day 16: India; 1:47 AM

The trick to writining in a blog or a diary is to force yourself to do so, even when you lack inspiration or energy.  I am deficient in both right now.  Ramadan has taken a toll on my exercise, which has dwindled into 50 pushups every few days or so.

A bit of good news: my nani jaan came home from the nursing home yesterday.  I told you about the discussion we had with her physician on Saturday night about setting things up at home.  He also discontinued the IV fluids and switched all IV medications to oral (via NG).  But, on the discharge summary he wrote, “Please discharge patient Against Medical Advice.”  Why would he do that?  Because, doctors don’t make much in India as it is, and they cannot afford lawsuits from silly Americans who think they can wield power in Indian courts.

One of the DMO (Remember this?  It stands for: Duty Medical Officer.  It’s the moonlighting physician, typically a 5^th year medical student doing his internship or a recent graduate who is writing exams) physicians told me he makes 7000 Rupees a month.  He works 7 days a week, and 10 hour shifts at night.  He’s hoping to do post-graduate stuff either in the UK or USA, then come back to India and open a mini-hospital.

Every time I took a shower in St. Kitts, it would take about 5 minutes to get all sweaty and smelly again once I stepped outside in the heat.  It’s similar here.  Everything has a mild dampness to it because of the rainy season.  I just took a shower and it feels good.

I just learned that the haleem we make at home is not haleem.  It’s called kidhr.  Or something like that.