Friday, December 17, 2010

The Epilogue

I thank all of you for taking the time to read my blog. Those who are reading it for the first time, it would be best if you click on "October" in the Archive section. Then you can read from the beginning to the end.

The journey has come to an end. I had so many questions.

The first question was if I would be comfortable living here in the old Delhi. It can be easily answered with an emphatic up and down Indian nod :) I had a one room accommodation with hot and cold running water and electricity. The room was spacious and the surroundings were really good for long walks. The food was not the best at the local eatery. But there was always Suneeta nearby :)

The second question I had in my mind was if there was any way for me to make a useful contribution to society. That question was answered in the negative. It was not the answer I was hoping for, but it was expected. So I was not all that surprised -- a little disappointed yes.

On the medical front I found that I could not provide a long term meaningful teaching and learning experience for the residents and myself. I had a good time on the medical floor which was staffed by hard working residents. They were lucky to have a very competent of department head teaching them. Other floors and departments were not so lucky. The young men and women were of the highest caliber everywhere. The problem is that the system that does not promote inquisitiveness, leadership and talent.  The emphasis here is on rote learning and passing examinations. Independent thinking, discussions, self-study and group projects are on nowhere in sight.

The medical school has one of the most concentrated areas of highly educated and intelligent people in Delhi. Even here a culture of incompetency, grandiosity  and/or  inferiority complex predominates in the people who are in power.  Without the cooperation of the highest level of the administration of the medical school, there is no use of me going back.

On the social service front, I spent a lot of time with people working on the anti-corruption crusade. They are a bunch of dedicated people. I worked on the legal proposals that they are putting forth to establish an independent body to investigate corruption.  However they already have enough competent and experienced people working on it. I did not feel that I was able to make any difference. The important thing for me was that I tried. All you can do is try. Sometimes you succeed sometimes you fail. The destination is not everything but the journey is.

Red Traffic Light Means Go

Thursday, December 16, 2010

Photos from New Delhi

I have placed some photos from the New Delhi on Pacasa. Please click on the following link to go to the site.

Thanks all for the comments and encouragement.

Satish Steve Gupta

Sunday, December 12, 2010

Last day in Delhi

Yesterday was pretty depressing. Today it is different. I am looking forward to getting home. There is excitement and anticipation, mixed with sadness. I have already packed two suitcases. Tomorrow I will be leaving early in the morning. The flight is at noon.

While walking past the college building I realized how the building looked so nice! Just a month back it looked like such a piece of junk. Human beings are so malleable. The building certainly will be declared uninhabitable by any western municipality. The electric wiring is pathetic. The number of working toilets is far below the minimum required by the building code, the fire exits--the less I say the better. But here in Delhi it is one of the better buildings. After spending six weeks here my perception has changed dramatically and I did not even know it. After another month I will be making statements like the ones made by one of ministers, “Delhi is a world class city!”

Second to last day in Delhi

Today is second to last day here in Delhi. There is certain sadness in leaving this medical school with the knowledge that I will not be coming back any time soon. I was hoping against hope that I will find some “connection” that will bring me back every year. I was hoping that I will be invited back. That is not going to happen. There is no room or field for me to make any positive contribution at this time.

Today is also the day to say goodbye to Dad. This is likely to be last time I will see him. It was good to see that he is such a good physical condition. He can walk pretty good. He can hear everything. He eats really well.  When I first came here I took him out for lunch. He did not like the food. Next time he had food made for me even though I had told him that I will take him out to a different place. I did not want to eat there. Anyway I ended up eating there. Next week the same thing happened. He would say yes when I told him that we were going to go out, but when I got there he would refuse to go. So the next week I picked up “Chole-Bhature” from Haldiram Restaurant and took it with me. Dad really enjoyed the chole-bhature. So I asked him whether I could bring the same next week. He said fine. I was so relieved. The chole-bhature is easy to carry and stayed pretty good for the one hour that it takes for me to pick it up and take it to dad. This week I called and told him I was coming over with chole-bhature, he said, “I cannot have chole-bhature every day! Bring something else!” Now I have to figure out what to take that will taste good after one hour of picking it up from shop. He can be a pain in the back. Well at least dad must be feeling good since he is himself again!

Dad is very sharp on some things but some things he is making up. It happens in old age and the medical term of this is confabulation. When a person cannot remember he makes it up. I know my daughter will say that her dad has done it all her life!

After lunch I said good bye to day. He asked when I was going to see him again. I said when it is the wish of God. He knew it is probably the last time he will see me. He had tears in his eyes as we said good bye.

Friday, December 10, 2010

Last two lectures to the Medical Residents

In the last two days, I gave two lectures to the residents. One was about medical malpractice law and related issues. The other was about my experiences in India. There were about thirty doctors for the medical malpractice talk. It was based upon a hypothetical patient who came to hospital in a very poor condition and later expired. The talk went well, everyone was very attentive and the discussion was good.

The talk about my experiences in India did not go as well. I told them that the most frequent question I had been  asked was,"Is it better to go to USA or stay in India?" I answered that medical doctors would be better off in USA unless they had strong family ties or obligations or if their families were very wealthy.

Then I talked about how the residents kept complaining about the poor facilities and lack of basic equipment. They were right in their descriptions but I told them that they were not doing all that they could do. They could still make things better by their own actions. It was not right to say that you are not going to do the proper thing just because others are not doing it. I think I got a little carried away and it did not go well with the audience:(

Respect -- sometimes welcome sometimes not

When I first saw the security officers at every gate, I was a little worried. They might check every person's ID and I had none that entitled me to get into the hospital and college campus. I had asked the Dean to give a letter of introduction, that he had approved, but it never materialized. However, soon I learned that if I walk confidently and carry a stethoscope, I could go anywhere in the campus. Most of the time the security officers would get up from their chairs and salute me. I liked the respect they showed.

But there were times when the respect was not welcome -- like riding in Metro and the young men getting up to offer me their seats because the seats were reserved for "old and disabled"!

The other time when respect was not welcome was when strangers, sometimes in their forties or fifties, called me “uncle.” With utmost respect they would ask me, “where is the bus stop? Uncle!” Whatever little hope I had of looking like a young man have been dashed forever. Coloring my hair and mustache was not fooling anyone. I guess there is no use coloring my hair anymore. But if I do not color my hair I end up with a same statement in USA. They say it differently but it means the same. In office patients have asked my three or four times, “You are not retiring anytime soon? Are you?” On the golf course other golfers have asked me, “You are retired. Aren’t you?” This has always happened when my hair and mustache were as white as Santa Claus’.

Wednesday, December 8, 2010

Last Few Bites in India

Today I found out that I am going to be here in Delhi for only five more days. (My travel agent informed me that my return flight is booked now, before I did not have a definite return reservation.) So I have decided to eat plenty of what is not available in Los Angeles. See how my mind works :) I have decided to live on a balanced diet. I am going to eat plenty of fruits and then balance them with plenty of sweets! I have already described the sweets. Most of the fruits here are plentiful in Los Angeles like mango, watermelons, cantaloupes, apples and papayas. But there are some that are not available back home.

This is my favourite, Gauva. It is of a consistency somewhat firmer than an apple. Normally you eat the skin but I am peeling off the skin, just in case. It is not very sweet, just enough to make it delicious. The grapes are just to give you a perspective.

Cheekoo looks like a big kiwi fruit. But it is nothing like a kiwi. The inside is brown, my favourite color, just like me :) It has one or two large black seeds and the rest is delicious. You have to peel the skin.

Orange looks like an American orange but it peels off like a tangerine and is sweet like an orange. They have American style oranges too, they call them Keenu here. When I was here these were called Mousambi. Who knows when and why the name got changed.

I faintly remember this fruit Sitaful. It has outside appearence like a pineapple. Inside each piece comes off like pieces inside of a pomegrantes. Each piece has a large seed. There is hardly any pulp and the pulp is slimy and very sweet. No wonder I do not remeber this fruit. It is not my favourite.

Tuesday, December 7, 2010

A Night at the Movies

I wanted to see a Bollywood movie while in India, the Indian style. So I had asked Suneeta if she would like to go to movie with me. She had not seen any movie in a theater for over a year, so she was happy to go. Her husband works so late that we left him out. So it was three of us, Suneeta, her teenage son and me. We gave the task of choosing the movie to the teenager.

I want to give a little background for those who do not know my experience with Hindi movies. When I was in High School we used to live in an Army Camp. There was an open air movie theater just for the army families. My dad paid a monthly fee and we all could go as often as we wanted. The theater was about two hundred yards from our house. The theater showed three different movies every week. It would screen a Hindi movie four times a week, an English movie once a week and another regional Indian language movie once a week. I used to write down the title of every movie that I saw there. I still have the list. When the list went to 150, I decided to quit. All the Hindi movies had one story, the same story in all movies. A man falls in love with a woman. The villain comes in between. There is fist fight and the hero gets his woman. (They were supposed to be boys and girls, but the parts were played by over-thirty actors.)

So in the last thirty years I have not been able to sit through many Hindi movies. I think I have seen one, because I was with my brothers and their wives in New Jersey.

So I was expecting another one of those boy meets girl and triumphs over the villain story. It was a pleasant surprise to see this movie about a quadriplegic man who is asking the court to allow him to end his life. There was not much of a story line but it was very well done. It had only a few songs at appropriate times and no fist fights! The movie lasted only two and half hours. Not the usual four hour movie with thirteen songs.

Monday, December 6, 2010

Teaching the Residents

Today I gave a presentation to the ENT PGs (as residents are called here). There about twenty five doctors, about half staff and half PGs. I talked about Allergies of ENT. The talk went very well. The faculty members asked several questions and the PGs none. Then the chief and a few senior faculty left and I talked to the PGs. They were very interested in doing allergy testing and learning more. I had earlier thought that they were not showing any interest because they do not see allergy patients or they are missing the diagnosis. But the PGs told me that they see hundreds of allergy patients every week. But they do not have any way of testing for allergies or giving any allergy shots. In the present situation the allergies take a low priority. Anyway I told them that if they get their Department Chief’s permission and they get some patients together, I will show them allergy testing.

It was nice to see that young doctors are interested in learning. I am finding the same on medical floor. I have been a little more vocal about the medical problems and they appreciate the information.

Sunday, December 5, 2010

An Atheist Who Prays Every Morning and other random observations

ATHEIST: I am an atheist but it does not stop me from praying every morning. In New Delhi, there are Mosques, Temples and Gurudwaras behind my room. They are pretty far but every morning at 5:30 AM, I wake up to the sounds of prayers. So I join them. Here is my prayer:

“Oh God, bless all of them, Hindus, Muslims and Sikhs. They are all fine people. Please, please bless them and tell them not to use loudspeakers since your hearing is not impaired.”

DELHIWALLA: There is certain charm in the hustle-bustle of Delhi. I could live here if I had a good,  meaningful job. There is never a dull moment if you go on the road. There are people walking, riding bicycles, rickshaws, sometimes riding horses or camels, motorcycles, tuk-tuks, small cars, imported luxury Mercedes cars, and screeching past them are the huge buses and trucks. They all used to belch thick heavy smoke trails, the men puffing cigarettes and the machines giving out diesel smoke. Now no one smokes and all buses, tuk-tuks and a lot of the cars run on CNG, so there is no smoke trail.

TERRORIST: I traveled on the Metro yesterday and my train went past a school. It was a spacious school with children playing soccer on a neatly groomed, large playground. It reminded me of the Delhi Public School --  one of the most expensive and prestigious schools in Delhi. The DPS was here when I used to go to a government school in Delhi. My school had few teachers, let alone a playground.

I used to walk past an officer’s club. They had beautiful grounds and even a swimming pool. My father was a private, so we were not allowed in there. I could not understand why the government would spend so much money on them and not on us. They were already getting paid enough. They could afford to pay for their own recreation. Privates' salaries were low so I thought the government should pay for them to belong to a club.

Social injustice was as rampant then as it is now. I could feel it even when I was ten or eleven years old. I remember during Junior High, one of my fervent desires was to have a few nuclear bombs. Then I could detonate them over India. I believed that only after the whole damn place was destroyed could a new India  be born, an India with social justice for all. I am sure with some encouragement and proper, or improper, depending upon your point of view, guidance I could have been groomed into a suicidal terrorist.

Looking at that school brought back those memories from forty five years ago. I guess there may be a “sleeper terrorist” some place inside me! But that person is happily in deep, deep sleep :)

Retirement Home for Cows

Today I visited a “Retirement Home for Cows”. It is about 25 miles from Delhi. There are several of these around Delhi. They are run by Non-Profit Organizations. People respect cows and donate money to take care of them until they die of old age. Most of these cows were abandoned by their owners when they were no longer useful. As you might know, cows cannot be killed in India. They are considered holy. My cousin Amar Nath donates money to this place so we went there to donate the money and take a look.

Amar Nath Giving Money

The Retirement Home

The home has about 1420 cows. Only about 12 of them produce milk -- the others are non-productive. Cows live about 20 to 25 years. They give milk for about nine months after delivering a baby calf. One of the keepers told me these facts. He said a cow may get “married” about 10 to 15 times during her life and after giving birth to calf can give milk for nine months each time. Unlike American farmers, they do not use any hormones to keep the cows lactating. Most milk in India is produced not by cows but by water buffaloes. The milk of a water buffalo is higher in fat and the milk output per water buffalo is much higher than from an Indian cow.

They can go inside the shed or wander around
 The volunteer managers and their 22 employees take good care of the cows. Both the facilities and most of the cows are washed twice a day. There is plenty of space for them to roam around. There is a big farm in the back to grow cow feed. The workers are all from Bihar. The whole of Delhi and neighboring area depends on migrant workers from Bihar to keep going. The Biharis are to Delhi what illegal Mexicans are to USA.

This very holy blind cow has an OHM on his back

Progeny of the very holy blind cow

These four were posing for me, like saying please take our photo

Friday, December 3, 2010

Teaching the Medical Residents

I have given up on teaching the medical students. They told me that their main interest is to pass their examination. After passing the M.B.,B.S. (as MD is called in India), they become interns and then they have to study even harder to get good grades in their Pre-Entrance Examinations for post-graduate slots. All the examinations are based on your ability to memorize and regurgitate. There are no meaningful clinical examinations. So unless the method of entrance to post-graduate courses change, there is not going to be any interest to learn something that is not going to be on the exam. They are absolutely right. Until and unless medical ethics and law become part of the examination they are not going to show any interest in it.

So I have decided to go ahead and concentrate on the post-graduate doctors, as they are called here. In USA we call them interns and residents. I gave a ten minute talk on Monday and one on Thursday. The Monday talk was on the importance of getting patient consent and how to get it. The Thursday talk was about the need to keep proper medical records and I added a five minute lecture on the need to follow the rules and regulations, like wearing white coats and carrying medical diagnostic equipment with them. The second part did not go over very well with some of them. Next day I got an earful of how bad the working conditions are and here I was insisting on them wearing white coats!

I am thinking of giving a talk on communication next week! Kristina will say, “and what do you know about it?” The basic things that we take for granted in USA are missing here. So I do not have to be an expert. All I have to do is talk about some very basic needs of a hospital. We will see how it goes.

Fine for Loitering

Sign in the Hospital
I am glad no guard fined me for committing offense number six!

Suneeta and Mahesh

The phone is glued to his head
Suneeta is the daughter of my late sister Kanta. Suneeta lives about a mile from my place in Delhi. I walk to her home from time to time. At other times I take a rickshaw. Suneeta calls me every day about seven o’clock in the evening to invite me for dinner. She does not take no for an answer! Her cooking is adding to my waistline. Her household consists of her husband and her son. Her daughter is in Dallas studying computer science. Her husband, Mahesh, is a charming man who keeps the conversation going. Both of them have a great sense of humor and I feel completely at home there.

Mahesh has a degree in auto engineering. He is working as an independent claims adjustor. He is very busy working almost seven days a week. Suneeta runs a pre-school for kids for four hours every morning. Their son has finished high school and is applying for admission and hopefully a scholarship some place in the USA.

They live in not too far from the Red Fort of Delhi. This area was first inhabited at least a thousand years ago. It has been in continuous use since then. The streets are not wide enough for autos. Mahesh has to park his car about half a mile away.

My sister had a sad and tragic life and died of cancer at the  very young age of about 55. When she was born there was some problem. I am not sure what happened but it caused her to have borderline mental retardation. She could not walk until she was three years old. Then she could not read and write no matter how hard she tried. At the age of eighteen she was married. Naturally she could not fulfill her duties competently. She was expected to cook, clean, take care of her in-laws, husband and children. Here she could hardly take care of herself. It was very tragic for her husband too. There was no divorce in India at that time. Kanta had four daughters and one son. They are all married and are well settled. Her grandchildren are going to graduate and post-graduate schools. Kanta would have been so proud and happy.

Sweet sweets :)

I love Indian desserts. After spicy food, a sweet dessert dish is the perfect way to end the meal. I found this place called Haldiram. They have dozens of varieties of desserts. I have tried about 15 different ones, so far. They are all good, some better than others. Between the desserts and Suneeta’s cooking, I have put on ten pounds! My pants do not need a belt to stay on me, any longer!

Wednesday, December 1, 2010

The Barber Shop

While on a quasi-purposive walk today I saw a saloon in Connaught Place. So I decided to have a hair cut and some highlighting of my hair. The barber looked like a kid. He was moving fast thru my hair with his scissors making a lot of noise. It went on and on. I am not usually in the habit of watching myself in the mirror. I usually close my eyes and relax. After a while I got a little worried. Was he cutting one hair at a time? Even that would not take very long since Keane has told me that my hair count consist of only two digits. Well he was being very careful. I think he would cut one hair, one tenth of an inch and then later on cut it again! Then he trimmed my mustache. This was the first time in my life someone other then me, had trimmed my mustache!

He made some horrible smelling stuff and covered my head and mustache area. I looked awful, like someone in between Groucho Marx and Adolf Hitler. After fifteen long minutes he washed it off. He washed my mustache and his fingers rubbed my lips. I did not like it. A man touching my lips. I must be homophobic or something like that. He was just doing his job. Now came the bill for Rs. 460/- I told him that Rs. 460/- was for a full head of hair. I asked for 50% discount since only 50% of my head was covered with hair. The result of all that hair chopping and slopping came out really good. I was very pleased so I left him a big tip ($2.00) !!

Quasi-Purposive Walking

I love walking around. It is usually with some faint or unimportant reason. But to me it looks like I have a purpose. I call it quasi-purposive walking! I was once asked what is quasi-purposive? I was in my third year of medical school. I used to read before going to classes. I knew we were studying neurology so I read the chapter after the one the teacher had talked about the day before. The chapter was on Sydenham's chorea. When I entered the room in the hospital, I was very late. All students were sitting down and Lecturer Patla Srivastava was teaching. We had two Srivastavas. One we called Patla (thin) Srivastava and the other we called Mota (Fat) Srivastava. There was a patient next to him. The patient's hands and legs were moving here and there. Srivastava asked me to describe what I was seeing. I told him it was Sydenham's chorea! Srivastava's jaw dropped. A third year student diagnosing an extremely rare disorder. Fortunately for me that was the only abnormal movement disorder I knew. He asked me to describe the movements. I had just read the book. So I repeated the text, “Sir, the patient has involuntary quasi-purposive movements.” Then he asked me what was the meaning of quasi-purposive? I had no idea!

Now I know what is quasi-purposive! Around Connaught Place I walk around as if I am shopping. Rarely I buy a thing or two. I must look lost today because a very fine gentleman told me that I was walking too slowly while crossing the road. He told me that the cars will not slow down for me. I thanked him for the information. Then he told me where I was and asked me where I was going. I had to tell him that I knew my way around. I just did not know where I was going:)

A day full of promise

The day started out full of promise. I had two interesting appointments. I was so see the working of a Consumer Court at 10:00 AM and later at noon I had an appointment with an official of the Max Hospital chain.

My contact for the Consumer Court had sent me an email listing the address of the court as Room 4 Floor 8, Oil Bhawan (Name of building) on JanPath Road. So I took a cab and headed for JanPath. The traffic was horrendous. It should be a five minute drive. It took twenty minutes. Once on JanPath, we started asking people for the Oil Bhawan. No one seemed to know the building. After three tries, I called my host. He said he was late and was driving so he could not talk much. He said it was not in Oil Bhawan but in  “Janpath Bhawan” on JanPath next to the courts. Now we headed to the courts, which were easy to find but once again we had to ask for directions to the right building. After we found it, there was no sign as to how to get inside.  So after another two inquiries I got inside the building and got in the elevator. The elevator had signs only for seven floors. So more inquiries followed. I had to get off at the fifth floor, cross to the other side of the building through a maze of corridors and then take a second elevator to the seventh floor! This time another fellow accompanied me thru another set of corridors to stairs and I climbed one more floor to reach my destination.

In the USA, I am going to miss all this human interaction! I talked to fifteen people today to find my way to the Highest Consumer Court of the land.

Inside the court room there were two commissioners. They did not have to be judges, but one of them was. All the people doing the talking were attorneys for the people. Here I was under the impression that Consumer Courts were made so that people could argue their cases without attorneys!

The commissioners were all business. They seemed to know the cases and the law very well. The arguments and outcome was more like a regular court! The same problem too! All three cases I sat through, ended up being continued. My host's case was filed in a local court seven years back :( His opponent carried out the same old trick, he sent a junior attorney who pleaded ignorance of the case and asked to postpone the case. It was postponed for three months.  It was getting late for my next appointment so I left at 11:15 AM.

It was noon when I got to my next stop  at the offices of the Max Hospital chain. This chain has several very posh hospitals in India, and is aggressively promoting medical tourism in USA and Europe. This official was interested in starting an allergy specialty department in the hospital.  Once inside the office building, it was like I was in some big law office in Century City. All leather sofas and an ornate waiting room. The guard showed me to the waiting room and informed my host. I was glad to be there on time. The problem was that only the building was western not the people working inside. The staff was Indian and they were on Indian Time! After waiting for 25 minutes I left. On my way home the official called to apologize. She blamed it on her assistant and miscommunication among them.

Banerjee's Head on the Chopping Block

Banerjee carries the title of Medical Superintendent (CEO) of this hospital but a better title would be the Hospital Firefighter. He runs around with a fire extinguisher tied to his back, dousing the flames here while another fire starts elsewhere.

The latest disaster to strike the hospital is the news report in the photo. A poor patient was injured in an auto-accident. He was taken to a nearby hospital but the hospital refused to admit the patient claiming they had no ICU beds available. He was rushed to another hospital which was  supposed to be a trauma center. They refused to admit him saying that they did not have an ultrasound machine and the patient needed an ultrasound. They probably have developed a sophisticated system of refusing all the poor patients with one reason or the other. The patient was then brought to this hospital where the newspaper says he was refused admission because he did not have the correct papers. The patient died in the parking lot.

The chief minister of Delhi has promised a full inquiry and punishment for all of the people responsible for the poor care given to the patient. So I am sure Banerjee is going to have to see the chief minister and make a statement to the press, to douse the flames.

I do not know what happened in the Casualty of this hospital. The initial newspaper reports are frequently misleading in India because the reporters are so untrained. They do not even try to get the  facts from both sides. They just print what one party claims. It is possible that the patient died in the parking lot of this hospital before anyone had time to see him.

But on the other hand, the training of the doctors in the Casualty is pathetic. They only have MD degrees and one year of internship as the required qualification. The internship in India is more like externship of medical students of USA. So essentially a Casualty Medical Officer may have no emergency training at all. There is no advanced training programs in Emergency Medicine in India. When I was in Casualty I saw some real sub-standard care by the doctors. They also appear so unconcerned with the pain and suffering of the patients. I guess prolonged exposure to extreme conditions desensitizes you otherwise you will not last.

Anyway Banerjee's head has been on chopping block several times. One of these times the axe may not miss!

Chair chairs everywhere,... even for beggars

Here was this beggar in Connaught Place sitting on this chair and begging!
His chair appeared better then the one I was sitting on in the hospital!