The Casualty

The Casualty in a Delhi hospital is what an Emergency Room (ER) is in a Glendale hospital. Patients walk into casualty if they are too sick to go to the OPD or if the OPD is closed. Doctors in Casualty treat some, refer some to OPD, and those who need to stay are sent to either Medical or Surgical Emergency. The patients are treated in Medical Emergency and then either sent home or more commonly transferred to the Medical Floor the next day.

If you want to see the widest variety of cases there is no better place then the Casualty of Irwin Hospital. But you need a strong stomach. I was in Casualty only for about three hours. A patient was brought in with tetanus. I do not remember ever having seen tetanus in my life. Her whole body was rigid like a wooden board. I could hardly bend her elbow or knee. She gave a history of a splinter in her hand. After about two weeks she developed difficulty in opening and closing her mouth (lockjaw). She came to the hospital about five days after  the start of tetanus. By now her body was stiff like a board. You could hold her leg and lift the whole body.

I had read about tetanus in books. The tetanus organism grows in untreated wounds. The bacteria releases a toxin that causes muscle spasm. Even if the bacterial infection is cured by antibiotics there is no way to remove the toxin which is already bound to cells. But in my heart I did not believe that a small splinter could cause that kind of wound for the bacteria to grow. Now I know better. In future I will treat splinters with respect. Even without a splinter I will get, and give to my patients, that tetanus booster every ten years!

Another young woman came in with wild movements of her head. She brought back memories of seeing other patients with conversion reactions (called hysteria in the past). You never see such gross/obvious conversion reactions in USA. There patients, under similar stress, develop Munchausen Syndrome or other disorder (Please do not quote me on this, I am not sure about the psychopathology of these disorders).

There were times when it made me very sad to see some of the deficiencies of simple equipment, like wheelchairs and stretchers.

Satish – Is he American or Indian?

In response to my blog on “Medical Emergency” and others, I heard that there have been comments like, “Satish, he grew up here. He worked on these floors. How can he say things like that?” and I have received emails saying, “Are you not trashing India?”

In response to the first comment, I plead guilty. I grew up here in India, but I spent only five years of my adult life in India and have spent thirty-seven years of my adult life in USA. If one is not influenced by his environment in thirty-seven years, he is not normal. I remember working here in Irwin Hospital. The more I stay here the more the memories are coming back. I am sure if I stay here a year or two, I will see it the way I used to see it. But right now, I am just writing what I see and feel.

Trashing India is not the right description of my blogging. India is so big, there are aspects of India that are admirable and others that are deplorable. If you read the blog carefully you will find that I have never said anything derogatory about people. I love the people here and that is why I am here. But when some conditions are pathetic, I write about them the way I see them.

The Medical Floor Revisited

Today I went back to the medical floor that I described on my November 3rd post, titled “Jump in the Ocean.” Most of the patients had been admitted on Monday, that being the emergency day for this unit (patients are admitted to the various units in rotation). Today being Friday, a lot of the patients have been discharged. So many of the rooms now have only one patient per bed. Oh what a difference it makes. It looks like a new place, calm and serene!

I remembered some of the patients I had seen on Monday, described in my “The Medical Emergency” post. The middle age patient with an acute heart attack had survived. He was transferred to the Coronary Care Unit the next day, even though he did not have any money. It was so nice to hear that.

There was another patient with viral encephalitis I had seen last week. He was comatose and in catatonic state. I had given him no chance of survival. He appeared better today. He still has ways to go. Another patient with cirrhosis and vomiting of blood looked good enough to be discharged today. There was a patient with hemorrhage in his brain. He looked a lot better. It is amazing how resilient human beings are. With whatever meager resources they had, the resident doctors had made the patients well and got a lot of them discharged. I was told that two patients had died. That was a lot less then what I was expecting.

The Medical Emergency

I headed to the Medical Emergency ward on the fourth floor. The signs on the fourth floor were non-existent. So I wandered into a patient care area. The stench was piercing. This was different then the usual stench of human excreta in the streets. I knew the smell but could not identify it at first. I sniffed and sniffed. Yes the old memory cells woke up. It was smell when there is copious flow of pus. I had entered the surgical floor.

The medical floor was flooded with human beings. I could see some harried resident doctors working. The residents had worked all the previous day and the previous night too. Their tired faces had total resignation written all over them. I asked them to ignore me and carry on with their work.
They were eager to do that. I just stood there near the nurse’s station and watched. Patients were wheeled in by relatives on stretchers. The stretchers were the same I had used here in this hospital about forty years ago. The paint was chipped. The wheels never went where you wanted them to go. The steel bed was as uncomfortable as it could be. Most patients had I/V bags attached. The relatives were holding the I/V bags by hand. Their hands were tired at times. The I/V bag would go down and blood would flow from the patient to the I/V tubing.


The I/V stands were also the same I had used forty years ago. The stands were on wheels. The base was very heavy to prevent tipping. The wheels were crooked, small and had lost lubrication. Some stands had six I/V bags hanging on one stand. The bags were going to two or three patients. One patient fell out of bed and tipped a stand over. There were six bags on the floor. Some I/V lines came out of patients’ arms. There was I/V fluid all over the floor. I can just visualize the poor intern starting the I/Vs again. That part of internship is still fresh in my memory. Starting I/V in an emaciated and dehydrated patient is no piece of cake. You stick the needle again and again. The patient is cringing in pain and you have gone thru and thru again.


A middle-aged man came in clinging to his chest. I was told he had acute chest pain starting about two hours back. The EKG showed acute myocardial infarction. The resident doctor hurried to give him everything this place had. Oxygen was ordered but the orderly could not start it. Morphine was given promptly. He was to be started on streptokinase. After fifteen minutes the patient was still in severe pain. If the patient was rich he would have been in cardiac cath lab. But if he was rich he would not have come to this hospital. Even if he wandered in here by mistake, he would have been transferred to an intensive cardiac care unit.

There was a shouting match going on between a doctor and an orderly. The doctor had asked that oxygen be started and the orderly had ignored the request. There was not much the doctor could do but to scream. The orderly shouted back.

The evening rounds by the attending physician started. The attending went over each patient quickly. The attending told me he felt he was keeping the residents from taking care of the patients, so he wanted to spend the least amount of time on rounds. I left the floor with the attending. We headed to a roadside shack for a cup of tea. I was exhausted. I had spent only two hours in the medical emergency and had done nothing.

The Medical OPD

The day started with a visit to the medical OPD (Out Patient Department). Anyone can walk in there to see a doctor. The waiting area was wall-to-wall people, pushing and shoving. A sick person had no business being there! The Delhi Police was busy guarding Obama, who is in town today. They were needed in the waiting area. A few street-smart dogs had also taken residence here.

The patients then enter the doctor’s consultation room. It was about twenty feet by fifteen feet. There were five doctors seeing patients. There were about thirty other people in the same room. The mobile phones (cell phones) were producing different musical melodies from Bollywood. People had selected the melodies as ring tones. Sometimes they belonged to the patients sometimes to the doctors. Everybody answered their phones and carried on.

There were no signs of any nursing personnel in the neighborhood. There was a guard at the door. There may have been another orderly. The doctors took patients' blood pressure only when needed. There was no thermometer anywhere that I could see. There was a six by eight foot room in the back with a bed. A patient could be examined there in privacy. That room was not used during my stay in the area.

Business was brisk. Doctors would ask four to ten questions and would prescribe something or the other. Several patients were sent for lab or X-ray. The average time per patient was under five minutes. The doctors had spent the previous night in the Emergency Medical Ward. To say that the doctors were tired would be a gross understatement.

In a back room senior doctors were seeing patients. The pace here was a little slower. Only patients from the front room, who needed a second opinion or other special patients were seen here.

A well-built patient (that means he must be at least middle or upper middle class), in his fifties was next. He was complaining of lower backache. The doctor inquired about his back and then started asking about the rest of the body systems. The patient had severe symptoms of prostate enlargement, had difficulty in breathing on exertion, bronchitis off and on for years and significant recent weight gain. I am glad the doctor stopped asking questions at this time otherwise the patient would need a whole body transplant!

Drug representatives with huge backpacks also came in to pitch their wares. They handed out their cards and drug information but did not hand out any goodies. The doctor patiently listened. The girl you see standing with a backpack graduated from university two months back. She has a bachelor's degree in Medical Technology. She started working as a drug rep right away. After one month of training she was pushing her stuff flawlessly. American corporates ideas had arrived in the medical OPD!

Cyber Cafe

This hole in the wall is called a cyber-cafe because it is next to an internet cafe. The internet cafe has no food only the internet. This place has food but no internet. It is owned and operated by four brothers. They grew up in Raniket, an area in the foothills of  the Himalayas. Their father is a farmer. There was not enough land for the brothers to farm. All of the four went to school. Some finished high school. The oldest came to Delhi and soon the rest  followed. They all work in the café. One of them is always there. The work starts at 4:00 AM with a visit to the market for vegetables. They finish after 11:00 PM with the cleaning of the kitchen. They all are married and have either one or two kids. They live together in a small house.

The restaurant employs five others. Most of them are migrants from other states. The rent for the space is Rs. 7000 per month and the electric bill is about the same. The workers make between Rs. 3000 to 4500 per month. The restaurant used to be very busy with people waiting in line at lunchtime. But now the hospital has opened two other eating-places. These are government run and subsidized canteens. They have taken a lot of business away from the Cyber Café. For the past six months the café is merely breaking even.

It took me a while to feel comfortable there. Everything looks awfully dirty. They clean everything every day, but it is all very old, broken, stained, and rusted! After eating a few times I realized that my stomach was not complaining. There was no Delhi belly. So now I feel okay in there. The bread is fresh out of oven and is very tasty. Today I saw the oven and took some photos. I wish I had not seen how they make it! It is not going to taste that good anymore.

I am on a crusade to teach the cook how to cook. My omelet was plain. So I asked him to sauté some onion. When the omelet came I could not see any onions. He had chopped the onions so fine, it was like onion powder! So the next day I went into the kitchen and chopped some onions and bell peppers myself. I told him to sauté it before putting it in the eggs. He threw the stuff in a pan, with some oil, and turned on the burner so high that the flames were going all around the thirteen-inch pan! No wonder he burns everything. Maybe that is why I have not had any Delhi belly so far. After appropriate instructions he made a decent omelet. Tomorrow I must teach him how to make scrambled eggs.

For photos of café click here.

Dewali

Dewali is to India like Christmas is to USA. People decorate their houses, give gifts to others, light firecrackers and of course everybody overeats.

I took the Metro to a station close to Amar Nath’s place and Mukesh came and picked me up. His house was full of children as usual. After prayers we ate. By this time it was getting dark and people were using firecrackers outside. Amar Nath told me that because of education by the government, people are not using as many firecrackers as they used to. It was still too loud for me. This started at about eight o'clock and went past midnight. There was never more then two minute’s reprieve. I took some video of people lighting firecrackers. I am sure, the day after Dewali, everybody in Delhi is deaf!

The houses on the street were decorated in lights, just like Christmas in US, only more so. It looked like everyone was participating in a game called “I can do it better then you.” It was very festive. The adults were having as much fun as the kids.

Next day I took the metro back to my place. I decided to take some photos of the metro. I took some photos from outside the station. Then I went inside and took one photo of the information counter and map. There was no one inside this counter. All of a sudden a Sikh policeman appeared from nowhere. He yelled, “What are you doing, Sahib?” I was a little taken aback. I told him I was taking a photo of the map. He took my by my arm, very gently, and showed me a signboard far away. The signboard said that photography was strictly prohibited. Then he took me to another information counter. He asked the employee inside for a map. He took map and gave it to me. Then he asked if I could delete the photo I had taken. I deleted the photo. That was it. What is going on in India? Another government employee who is doing a good job!

Since I told everybody two things that I do not like about the metro, I must tell two things that I really like about the metro. First is the signage. The signs are as clear as they can be. Inside the train they have a drawing of that particular metro line with all the stations marked. There is a little light that tells you which station you are on and which is the next station. The second great thing about the metro is the loudspeaker system. You can understand every word of the announcements. Try that in a New York subway.

Later in the day I took the metro to Goel’s place. I had nice time there. Lucky for me, it was the time and day for Kapil to call. He called exactly on time on Skype. It was nice to talk to him.

Pre-Dewali Day

Today is the day before Dewali. There should be little work being done today. Everybody is looking forward to tomorrow.

In the morning I paid another visit to the Delhi Medical Council. If you remember, this is the place where I sat down in the reception area and stared at everyone, daring them to make eye-contact with me! (see blog of Day Four – Busy day) This time I walked straight up to the receptionist and interrupted whatever she was doing!

After making me wait two minutes, she took my application, looked it over, and consulted with her colleague to see if the passport photos I had brought were too large or not. Then she handed me a computer-generated receipt for the application fee of Rs. 1,000/-, and told me that my registration will take about a month. She said I could come back and pick it up or they can mail it to me. That was it. No hassle, no hint at any hanky-panky, the whole thing was not what it was supposed to be. It was an Indian Government office. They were supposed to hassle, find some problem with my application for sure and offer to expedite if I was nice to them. Nothing like that happened. I am disappointed!

Then I went over to the hospital OPD (Out Patient Department). I passed by the medical clinic; it was chaos in there. I went to the ENT clinic and walked right into the room of the senior most doctor. No one asked me why I was there. It is surprising what you can do, if you are dressed right and appear confident. The senior ENT surgeon was seeing patients and I was observing. After all the patients were finished, all the junior doctors came in for a mini-meeting. I asked them how they treated ENT patients who had nasal and sinus problems due to allergies, after there was no response to sinus surgery. The chief doctor explained that there is no cure for allergies and that allergy tests and allergy shots are useless since they do not work. He said he tells his patients to live with it since it is not going to cause any serious complications. He said sometimes he sends them to Yoga, and Yoga works much better then allergy shots. Well, well, well, all my life’s work was trashed in two minutes.

In the afternoon I went over to Suneeta and then the two of us went shopping for sweets in Chandani Chowk. This is the main bazaar in front of the Red Fort of Delhi. The bazaar has been in continuous operation for almost a thousand years. There are descriptions of the bazaar in many old books. It was wall-to-wall people,  all of them moving in some Brownian fashion. As Meenu explained, they have moving sidewalks in Chandani Chowk. Just get in the right place in the crowd and crowd propels you forward, without any effort on your part!

I bought sweets at Haldiram’s shop. When I walked out with a bag of sweets I felt what athletes must feel on winning gold medals. I had triumphed.

Jump in the ocean!

I am glad I had a day of rest yesterday. I needed it today. Just watching the other doctors do their jobs made me tired. Dr. Richa Dewan, the head of the Department of Medicine, told me that I was welcome to jump in the ocean. There was so much sickness that everybody was welcome to do what they wanted to do, in terms of learning medicine and/or providing medical care. It was like jumping in the ocean. You could do all the swimming you wanted to do. After a round of the medical floor I understood.

First Dr. Dewan introduced me to her staff of residents. Here they call them post-graduate students. The senior resident is someone who had finished post-graduate. The medical floor was divided into cubicles. Some had four beds others had six. The beds were slightly smaller then a typical American single bed.

The senior resident took me on a round of the floor. The first bed had a very sick looking patient with a diagnosis of new onset of paralysis of all four extremities. He was improving so there was hope that it was some kind of self-limited demyelinating disorder. There were about three to four people on or near that and every other bed. I was about to move to the next bed when the resident interrupted me to talk about a person who was sitting on the bed of the patient. I thought he was a relative of the patient. No, he was another patient! He was very sick too, with pneumonia on top of his underlying chronic bronchitis. He was on oxygen. Then I remembered that Dr. Dewan had told me that there were two patients to every bed. It does not sink in, until you see it.  I wonder how they sleep. Do they take turns sleeping one by one?

Every patient had one family member staying with him or her. The family members provided most of the nursing care. There were family members everywhere. Since some patients are from out of town, the family sleeps in the courtyard areas. They take turns one by one, staying with the patient. Only one family member is allowed inside the medical floor at any one time. The nurses were there just to dispense medicines and take vital signs. The nurses were overwhelmed as was everybody else. There were more doctors working on the floor then nurses. There were no nursing assistants. Without a family member you are really out of luck. Thankfully, meals are provided by the hospital. I saw a child who was a ward of state. The state had provided for a caregiver for him. This caregiver was taking care of the child in a very professional manner. That kid was getting the best care on the floor.

We got to another patient who had hypokalaemic periodic paralysis. He was getting potassium by I/V infusion. It is a very rare disorder but fortunately I knew a little bit about HPP. I had seen one patient in Chicago in 1975. I asked the senior resident why the patient was getting potassium. She said since the patient had low potassium, he was getting potassium. I persisted but why give him potassium, is it going to clear up his paralysis? She did not fall for the trap. Very calmly she replied that there is no good evidence that giving potassium will help the paralysis. She had passed the test!

I was relieved that the residents did not ask me any medical questions!

Day Ten

In the Bible it says “and then he rested on the seventh day.” In my case it was the tenth day.

I had a delicious lunch with Kamal Goel, another classmate of mine, from my medical school days.

In the evening, Suneeta brought me a home made dinner. I had a good time with Suneeta and Mahesh sitting in my room. They sat, talked and watched while I ate dinner. They were going to go home and eat. They eat dinner at 10:30 to 11:00 PM (which is normal for Indians).

Just another day

In the morning I met Dr. Hira. He is head of the Respiratory Medicine Department at Irwin Hospital. He showed me around his pulmonary lab, which included a sleep lab, a spirometry suite and a bronchoscopy room. He performed two bronchoscopies while I watched and video recorded one of them.

He said he used to do allergy skin tests but two patients had anaphylactic shock from the testing so he stopped doing them. We made a quick tour of the Respiratory Intensive Care Unit. It has about twelve beds. One patient had acute intermittent porphyria and could go into respiratory failure at any time. She had an oxygen monitor hooked up to her. It displayed the blood oxygen saturation on the monitor next to her. I asked Dr. Hira if there was a central station to monitor her oxygen level. He pointed to the medical residents and said they were his central monitoring stations!

The staircase going to the medical ward is lined with tiles. At strategic locations they have four decorative tiles, one showing Christ, the next one a Hindu deity, another one is a Moslem symbol, and finally one for the Sikhs. Dr. Hira explained that people had been spitting on the tiles. So they put up these tiles and now no one spits here (you cannot spit on Gods, after all). Unique problems call for unique solutions.

In the afternoon I visited office of Public Citizen Research Foundation. It is run by Arvind. The office was humming with the sounds of computers and people. There were about a dozen people, mostly in their twenties. I interviewed about seven of them and took their photos. I want to write a photo essay of the office. I belong to a group called the India Friends Association (IFA). This group supports some of the people recommended by Arvind. So I want to show IFA what the organization PCRF is like.

I don’t like two things about the Delhi Metro. First, they frisk you when you go there. A guy dressed as a security officer runs his hands all over you. There is a women policeperson to frisk the ladies. I do not like getting frisked by men. Second, is that on two occasions when I was travelling, young men offered me their seats. A sign above the seats said, “Please offer your seats to the old and disabled.”

Sundays are for Golf

Today was golf day. I reached Delhi Golf Club at about 11:00 A.M. It is a huge place with hundreds of people milling around the clubhouse and restaurant. After a little effort I found my way to the Pro Shop and bought myself a nice cap with the local logo on it. Then I walked around and saw the course. It looks so beautiful. Inside the course there are various ruins of tombs from the Mughal period. The tombs look very pretty in their red and yellow colors contrasting with the green around them.

Where in USA can I say that I played golf teeing off from the porch of beautiful tomb made before Columbus discovered America? The fairways are totally green and lined with dense row of trees on both sides. The trees are of various kinds, mostly acacia and related varieties. The whole place is in sharp contrast to what is in Delhi outside of the golf course. I felt like I was a criminal taking advantage of all that while outside the golf course miserable people worked like slaves to make two bucks a day.

Prabhat Singh came right on time and introduced me to his group. There were eight people in the group, it was very hard to remember people’s names. We made a small bet and started playing. We had four caddies. When we tee off, the caddies will go to the middle of the fairway and watch for our balls. It was uncanny to hit when there were four people right where you were supposed to hit. But they had sharp eyes, they moved when the ball came to them.

On the greens they had women, in bright orange sarees, sitting and fixing the greens. They were wearing hard hats! They would take out any weeds from the greens and put sand in any ball mark divot. Then they would smoothen out the sand with their hands.

I started out good but pretty soon my game went down. The golf course looked prettier when I was playing well. I ended up posting an awful score and loosing all my bets.

Day Seven - Visiting Dad

I had talked to a cab driver yesterday and fixed with him the rate and time for the daily hire of a cab for a visit to Dad. Today I called the driver at 9:00 AM and he was not answering his mobile phone. So I waited and tried again. No response. Finally I called the radio Cab Company to see if they had rental rates by day. It turned out they had good plans; you can rent by four, six or eight hours. So I called for cab and waited. The cab driver had no idea of any of the Delhi streets. It turned out he was driver for someone and had no experience as a cab driver. The cab company hired him, gave him two days of training and put him on road. He had been a cab driver for ten days when he showed up to pick me up.

For the first time I was giving driving directions to someone in Delhi! Fortunately I had a very detailed map in a book form. However the book was a few years old and they have made so many changes that we ended up in the wrong street. Finally we got to my dad's.

He was sitting in the lobby of the building, waiting for me. When I approached him he could not recognize me. His eyesight is very poor. He recognizes people by their body appearance and the sounds of their voice.

He appears very frail and needs a lot of help in walking around but he was in good spirits (not bad for 100+ years). We went to a local restaurant for lunch. His living place was unchanged from the last time I visited. We talked a little bit about the past, mostly medical things that happened when I was young. He told me that I had suffered from malnutrition and looked very skinny. He took me to a indigenous medical person who cured me in a week!

He also told me that one time Prakash (my oldest brother) was admitted to a hospital in Bombay. Dad went over there and found out that the doctors wanted to take out his blood and replace it, because there was something wrong in his blood. So Dad had called me. I was in Chicago, so it must have been between 1973 and 1976. I told him to get Prakash out of hospital as soon as possible. I prescribed some medicine and Prakash got better! I had forgotten all about it. Even now I do not remember much about that incident. But I do remember that Prakash never paid me for that consultation! So I am going to call him and demand payment of principal and interest!

In the evening I took the Metro to Amar Nath’s place north and west of Delhi. The Metro looks like something transplanted from some other place in the chaos of Delhi. The Metro is on time, efficient, clean and the signs are so good you do not need to ask for directions. I almost miss the human interaction when you have to go someplace; normally you have to ask for directions three or four times. There are separate cabins for ladies. No more groping and fondling the women in the crowd. In the men’s cabin, the scene during rush hour has to be experienced. If you can breathe comfortably then there is too much empty room, at least two more skinny Indians can squeeze in the cabin.

Day with Arvind Kejriwal

Today was my day with Arvind. He is a social activist that I met in Los Angeles about three years back. Since then we have been in touch, irregularly. Initially he has hired an attorney to work along with him on RTI cases (India’s version of the Freedom of Information Act). The India Friends Association (IFA), based in the Los Angeles area, was helping to defray the cost of the attorney. I am a member of IFA and was in touch with the attorney on a regular basis.

Arvind held a press conference to denounce the poor investigation of corruption that occurred during the Commonwealth Games. He was joined by Kiran Bedi. She is well known personality in India. She has retired from police force. She was the highest ranking woman in the Indian Police. She was strongly against corruption which so irritated her superiors that they posted her to the infamous Delhi Tihar Jail as warden.  That is one of the least desirable positions in the Delhi Police. The jail was built for something like three hundred prisoners and now holds about three thousand. Prisoners get lost inside the jail. Even the jailers could not find them! There were stories of prisoners who were ordered released. But someone misplaced the order and the prisoner spent another five years in jail! (Please do not quote me on these conditions of jail since there may be a little embellishment here and there.) She took on the challenge and started reforming the jail. Soon she was getting accolades from the inmates, the press and the public. She had to be promoted. After her retirement she is busy in social work.

There were about a dozen reporters. I say that because I think that was the number of microphones on the table! There was a lot of excitement all around. New charges of mismanagement were leveled at the government and everybody seemed to agree that the government is trying to white wash the whole affair.

After the press conference, Arvind drove me home and we had a long and fruitful talk while we were stuck in traffic.

It was about 7:00 PM and I was thinking of skipping dinner. Suneeta called to say that her husband is going to drop off a pillow and some other stuff she had bought for me. She wondered if I had eaten. When I said no, she insisted on also sending me a home cooked dinner. Mahesh brought an old style “tiffin box” with four small cups, each holding some part of the dinner. It was delicious. For the first time since coming to Delhi, I went to bed at a decent hour.

Day Five

I had breakfast at the usual joint. It is a hole in the wall place. The menu is on the wall between the eating-place and the kitchen. The menu covers the whole wall. For a small place the menu is quite varied. I have not had the courage to try the entire menu yet.

Hey your bank balance is larger than mine
How did that happen?

I went to the bank to see if my account was open and if the traveler’s checks had cashed. It took me only 45 minutes to walk out with forty bills of one thousand rupees each. Wow I am rich! I had almost one thousand dollars in my pocket.

While at the bank, their version of a Brinks truck arrived. Out came two young men holding what looked like shotguns. Then came two other men carrying a large trunk which could have been the original trunk used sometime in WWII by the British, in the deserts of Egypt to carry cash.

I wanted to show how it is done, in India, to Brian the Banker. So I took some photos, sitting behind the cashier, as he is handing out cash to the customers. Security is so lax here that I could have easily taken a video of him punching in his password on the computer. I could see the balances of his customers. But that is no big deal. Anyone expecting privacy should stay out of banks. To see more photos of the bank and the Indian Brinks, click here.



Banerjee came in at about 11:00 AM in his official car. Wow, it was impressive. An old Ambassador! With emergency lights, curtains in the windows, and a smartly dressed chauffer. Everybody around the parking lot became silent and watched. It was like royalty coming in.  We drove to the Dean’s office about 75 yards away! Banerjee told me that his official driver feels bad if he does not use his car. But I think Banerjee just wanted to impress me! He was successful.


The Dean of the medical school is a big man! He was very polite and asked me what I wanted to teach. I told him about my interest in medical law and ethics. He said he would schedule a meeting of the people in charge of the teaching program and who would listen to my proposal. Since Dewali is coming and everyone is in a holiday mood we set up the meeting for the week after Dewali.

We walked over to the hospital stopping in the Nursing School dorm on the way. Banerjee is principal of the school, by default as he says. The nursing program is four years, including one year of internship. Three girls were waiting for us. The leader of gang was Deepti. Banerjee said she was the head of the hostel. I told her she could not be head of anything since she was only forty kilogram (about eighty pounds). She corrected me, “I am forty-two kg”.

We inspected the kitchen. The girls were complaining of inadequate staffing in the kitchen and lack of equipment in kitchen, game room and TV room. The whole place was so bare, I felt like I should buy them something. Reminded me of a movie I saw about Gestapo prisons. The kitchen in the movie was better equipped.

The girls were a lively bunch of giggling and happy girls. Since out of six kitchen employees, only one was available, they had prepared the meal themselves. They wanted us to eat there. We had just eaten so we passed on it. My camera gave me an error message and refused to take photos. I was so annoyed, that I could not take any photos of the place and people. Maybe I will go there tomorrow and take some photos.

Later on I met Dr. S D Sharma, who is in charge of quality improvement at the hospital. He is very sincere young man who wants to make a difference. He is holding a training seminar in two weeks for about thirty others, teaching them about quality improvement. The hospital is trying to get accreditation by a national quality control group, something like Joint Accreditation of USA. I am going to participate in the panel talking about the some of the process, as it happens in USA.

Evening was spent with a friend of friend, Prabhat Singh, who is going to be my golf buddy here. Again I tried to blend in!

The Rickshawalla

His name is Mohammed Firozalam. Pretty impressive name for a fellow who is about five feet tall and weighs ninety pounds at the most. He says he is 28 years old and came to Delhi from his village in Bihar at the age of eight. His parents stayed behind. He did odd jobs and saved money. After ten years he went back to his village. He said he made a house for his parents. I think he is talking about a hut. Anyways, later on he got married and now has two children, one son and a daughter, ages five and three. He goes back to his village, to his wife and kids, about three times a year. There he works on farms. In Delhi he makes about Rs. 300 a day. He sends most of this to his wife.


By this time we had reached our destination. His fare was forty rupees. I took a photograph of him and gave him a hundred rupee bill. He made no attempt to give me change. I told him to keep the change and he left with a big grin on his face.


hummm.... was that a good story or what? Well, there is skeptic in me, who says trust no one. Let me see, there was this fellow on my last big trip to India, who was our guide. He was telling Brian that on weekends he goes to tribal village and takes gifts for the local poor people. He also said he had a masters degree in Mathematics. Made me a little suspicious. Why would a person with masters in math work as a tour guide. There is a shortage of math and science teachers in India. There is no custom of city people going to tribal villages taking gifts with them. The story was a hoax. He had tried different stories on tourists and came up with the one that allowed him to take money from the tourists to give to tribal poor people.


I need to check out the story of my rickshawallas. Next time I will ask two or three other rickshawallas the same questions. If they all give me the same story, then I will know.


P.S. I tried another Rickshaw today. The guy was in his forties/fifties. He was a farmer from Bihar. He came here two years back. No other heroics from this one. Okay Mohammed may be legit. But the skeptic in me is not convinced yet. I have to catch rickshaws two more times even if I do not need them. So I can get stories from two others.


 P.S. Well today I talked to two other rickshawallas. They had very different stories. So I guess Mohammed Firosalam is legit. My skeptic side has to accept him.

For more photos of other Rickshawallas click here

Day Four - Busy Day, Conquered the maze, had fun, etc. etc.

Banerjee called and invited me to a party that he is going to tonight. He said something about the camera. I told him to bring the camera to the party so I can show him some of its features, as I was familiar with it. He said he did not need me to show him the features. He had stayed up till 2:00 AM last night trying everything out. He downloaded the manual from the internet and looked up the features that he could not figure out! Just like a kid with a new toy.

I had a breakfast of Aloo-parantha at a different hostel canteen. I picked up the common hall newspaper and was eating and reading the paper. I put the paper down next to my plate on the table and was chewing. A student came in and sat down across from me and picked up the newspaper and started reading it without blinking his eyes. So Wade and Kristina, next time you accuse me of my bad manners you know where they came from. Actually that student was not doing anything unusual. He was a friendly chap who even made eye contact with me and smiled, not a common thing here. You do not make eye contact and smile at a stranger.

After breakfast I went for a walk. This time I decided to tackle the dreaded maze. I walked right on, crossed the hospital from south to north and came out on street, without making a single U-turn. I must have looked like I knew where I was going, since no one offered me advice. I am so proud of myself!

Later in the morning I paid a visit to the Delhi Medical Council. I did not tell Banerjee about it, so that he would not call them. I wanted to do this on my own. I do not currently have a valid medical license in India. So I wanted to apply for one. I went to their office. It was a large room with a clean floor and lots of seating in front of the reception area. There were three people sitting behind the counter. Two were on the phone and a third one looked pretty busy on his computer terminal. So I waited for a few seconds and when no one said anything I sat down and waited. Now I tried to make eye contact with them, one by one. They kept avoiding any eye contact and tried to keep looking busy. This went on for over five minutes. I wanted to see if this could go on for an hour. I was enjoying myself. It was getting hard to suppress a smile. I had to look serious and keep staring at them. After about seven minutes a bunch of people barged in. They all headed to the counters and interrupted the fellows behind the counter. Now I realized why the three people behind the counter were so uncomfortable with me. They are used to people barging in and firing away their questions. When I came in and waited for them patiently, they did not know what to do with me.

For lunch I invited myself to Suneeta’s place. She is the daughter of my sister, Kanta. Her house is within walking distance from my place. But it is a long walk and you have to know your way. It is another maze of narrow nameless streets. Over there asking for directions would probably get you more lost.

Mahesh, Suneeta's husband, picked me up in his car. His car cannot go all the way to his house since the street is too narrow. He has to park his car outside this network of alleys. These "streets" were probably laid out before the time of Shah Jahen, the builder of the Taj Mahal. They were pretty short-sighted people since they made the streets for two legged and four legged animals, they did not see the coming of two and four wheeled animals.

Suneeta had prepared a big meal. Then she asked if I needed anything for my room. I needed clothes hangers badly. So we went shopping for hangers and other things. Then Suneeta kept adding stuff for me to bring to my place. By the time we were done I had two big bags of stuff. Suneeta just could not do enough for me. She seemed so happy. Mahesh is a charming man. It was great to see them both so happy.

Goel called me. He is down with a high fever and body aches. Let us hope it is not dengue fever. Banerjee had to work late so his party plans were cancelled. But things somehow work out over here. Sood, another classmate of mine from medical school, called me at about 6:30 PM. He had talked to Banerjee and found out my cell phone number. He said he was going to a surprise birthday party for Poonam, another of our classmates. He wanted me to come too. I told him to go ahead by himself since it was getting late and I did not want to hold him up. He said he was not planning to leave for the party till about 8:00 PM. So I dressed up and called a cab. We reached Poonam’s house at about 8:30 PM. We were among the first to show up. As is the routine, all men drank scotch. So did I. I want to blend in, who knows after a month of scotch and soda I might get to like it!

Poonam came in at about 9:30 PM. The food was served at about 11:00 PM, some guests were still coming in! Poonam and I had spent six months together in Irwin Hospital as house-physicians. We were in the same unit. I had a great time at the party.

I went to bed at about 1:00 AM and got up at 5:30 to the sound of noisy birds and someone praying on loudspeaker. I could not tell if it was a Hindu or a Moslem praying! God, please, bless them all! And God please ask them to pray without loudspeakers, since there is nothing wrong with your hearing.

Day Three - Nothing happened or at least nothing that I remember

Banerjee came in at about 9:30 AM, and I spent the morning with him. I gave him a pocket camera that I had brought with me. He was thrilled. We went over to the bank next door. This time was different, the bank was just opening, and Banerjee went over to the branch manager and introduced himself to the new branch manager. Everything went smoothly after that. I did not have to wait in any line.

The rest of the morning I sat with him in his office while he tried to patch things up on a dispute between two senior doctors. It was a very tiring, laborious job requiring a lot of patience. I am glad I am not a hospital CEO.

I met Tejinder Singh at noon. He is my classmate from the good old days and is now head of the Department of Pathology. There was an unexpected opening in the lecture schedule for third year medical students that  afternoon. He asked me if I wanted to fill in and give a lecture today. So I gave my “Introduction to Medical Ethics” lecture. At my request, Tejinder had placed a staff doctor in the room to see how the lecture went. I have yet to receive her feedback.

Goel came at about 4:00 PM to pick me up to have dinner with him at his house. I was so tired that I told him some other time. Later on I called him to apologize. He had come all this way but I was like a zombie.

I went to sleep at about 8:00 PM and got up at 2:00 AM, no Xanax tonight. At 2:30 AM I called home. It was a good time to call.

Second Day

Last night I was ready to fall sleep when I heard the dreaded buzzing of a mosquito in my room. I had visions of me getting malaria the next day. Goel had told me that keeping the ceiling fan on drives away the mosquitoes. So I turned on the fan on low. But at that setting the fan’s noise output exceeded its air movement output! So I had to turn it on high, then I think the increased air movement and the increased noise output were evenly matched. Now there was the problem of me going to sleep. So after half an hour of turning and tossing, I turned to my good old friend Xanax. Then I slept peacefully.

In the morning I had not received my lost bag yet. The airline had promised to deliver it to my place, so I called the airline and was told that the customs had refused to release it. The customs officer wanted me to be there personally at the airport. I took a cab and went to the airline office at the airport. After another round of several forms, filled out, signed and stamped, I got my bag. Then I found out that the reason they had refused to release my bag was that I had declared its value to be 20,000. I had done it at the advice of the airline staff. She had told me anything under Rs 25,000 is not a problem. The custom official saw that I was a US resident and so he assumed it was US $20,000. Therefore he had called me there to check my bag in my presence. When he saw me and found out it was supposed to be 20,000 Rupees, he released the bag without asking me to open it.

I took a walk around the campus at lunchtime. Practically all the boys/men were carrying a backpack. During my medical school days there were no backpacks. I never carried any books, just a notebook. The backpacks are nice and look very useful.

The girls have heavy shoulder bags or backpacks. Over half of the girls are wearing jeans. Jeans are so much more convenient then the traditional Indian clothes. And the girls definitely look better in jeans. Most of the girls are so skinny they make Lindsey Lohan look fat.

Another thing about the dress of the girls is that they are not wearing any Dupattas. A dupatta is a piece of long narrow cloth very much like the popular silk scarves. The girls are supposed to wear them around their necks, the front part comes down to the chest to cover the breasts. I think the idea of the Dupatta was that the boys would not be distracted by the sight of female breasts and could concentrate on their studies. Goodbye Dupatta, you were a total failure at your job anyway!

During lunchtime I went to the local bank to open an account. It was wall-to-wall people inside the bank. I did not have the nerve to get in a line. It might be the wrong line! So I left and went back at 3:00 PM, well past the lunchtime. It looked like the same scene again. I took a video for Brian the banker. The video shows throngs mobbing the few employees in sight, this is what is missing at Wells Fargo Bank. I left again without getting in any line. I think I will try again after a few days, after gathering some courage.

Afternoon was a good time for nap. In the evening I decided to explore the neighborhood. I must have walked three miles or more. Most of it was because I could not figure out the path between the buildings. I kept walking around them. Based upon yesterday’s experience I did not dare to enter the corridors!

I have decided that I am not made for walking fast. Most other walkers, men and women, kept walking past me! Some of them were half a foot shorter than me. I play racquetball for an hour three times a week. I should be able to keep up with these little Indians!

First Day in Delhi

Sculpture in airport
Made by another Satish Gupta

October 24, 2010
My first day started in the Delhi airport. The new terminal is huge. You have to walk at least half a mile to get to the immigration line. The airport is spotless and looks like any other major international airport. My plane was late taking off from LAX so it was about 30 minutes late getting into Bangkok. A stewardess was waiting to take us to our connecting flight. We had to walk fast/run to the new gate. It was at least a mile away. I made it to the connecting flight but one of my two bags did not make it. The baggage people at the Delhi airport knew it and told me it would come on the next flight. The process of filing out papers and getting it approved from the government official was a long one. I did not know my address in Delhi so I gave Goel’s cell phone number to the person filing out my papers and asked her to call him to get my Delhi address. She said she did not have a phone. It was such a lie, I almost lost my cool. It is such a common thing in Delhi to speak without giving a full explanation. She should have said, I can not call your friend because the rules forbid me to call outside. She had a cell phone in her pocket.

The drive from the airport to the Medical School was all freeway and a nicely landscaped road. There was not a beggar or a roadside slum to be seen. If I did not know better, I could have been easily fooled.

The guest house in the medical school has a large very impressive sign/billboard. Inside it must be a very neat hostel with nice big rooms, marble floors, attached bathrooms and plenty of closet space. However, time and poor maintenance has taken its toll. Anyway the room is spacious and the location is great.

Goel and I went to a small cafeteria next door for lunch. It was opposite the boy’s hostel, where I had spent five years of my life. I could not recognize the hostel at first. The trees around it have grown tall and hide much of the view of the building. There is new parking lot in front. During my time, that area used to have two or three motorcycles. Now the parking lot had about twenty cars and forty motorcycles.

For dinner I went to a 24-hour kitchen in the hospital. I could not eat the potato-peas, it was much too spicy. They do not ask if I want my spices mild, medium or hot. I guess I better get my tongue trained. I have been to the toilet three times already. Hope I am not coming down with Delhi-belly. This is only my first day here!

In the evening I took a walk to the hospital. The hospital has several buildings connected with covered walkways. They are like corridors except that there are no walls on the sides, just screens. They have added so many new buildings here and there that the corridors have become a maze. I think the overall design of maze was done by a woman. Once you enter the maze you cannot come out without asking for directions. I was not about to ask for directions! After a while some guy looked at me and asked me where I wanted to go. I must have looked lost. He gave me directions. Then I had to ask for directions one more time before I could get out of the same door I had entered. Real men do not ask for directions, except in the maze of Irwin Hospital.