India Trip: Monkeys Among Us

FROM 1/9/08:

Much as many cities of the United States are riddled with chipmunks and squirrels, the cities of India are swarming with monkeys. Although informed of their presence upon our arrival, we did not actually see any until yesterday morning when about a dozen of them commenced to migrate from one group of trees to another to do whatever it is monkeys do. We were also told not to try and befriend them as as charming as monkeys may seem, to some people at least, these are actually thieving monkeys. And they bite too. Or so the rumors go. Who knows what they're actually capable of, but I will keep my distance unless one of the little guys forces my hand. Until then, live and let live.

Speaking of monkeys, though, I myself am about to start throwing poo at some people after two days of my Internal Medicine II service. We created our schedules Monday, but it seems that is about as deep as the organization goes in this elective as I have been only given a sheet of paper with times and locations and nothing else. While that may seem sufficient, and I myself would normally be inclined to think so, I must also add that many of the activities are missing, many of the activities I am in fact not intended to go to, and when I do show up I have no idea what, if anything, I am supposed to do. That last statement goes double for the residents as whenever I ask them where I should go or what I should do I can just about guarantee I will get two different answers from two different people. Confusion was mildly frustrating but acceptable on my own in Dubai when I wasn't supposed to be doing anything in particular. Now that I am it is getting rather annoying. I would not care to only attend rounds a few hours a day, and they are quite nice rounds, but at least say that that is all that is expected. Asking too much? Quite possibly so.

Since I briefly mentioned that I am the Internal Medicine II service I will go ahead and post the rest of my clinical schedule for the next three weeks.

This week (07 Jan - 12 Jan): Internal Medicine II
Plain old internal medicine and rheumatic disease (like arthritis and lupus and stuff.)

Next week (14 Jan - 19 Jan): CHAD [Community Health something or other]
A community outreach program that takes the clinic to the surrounding areas.

Last week (21 Jan - 26 Jan): Internal Medicine I
Plain old internal medicine and infectious disease (hurray!)

Back to rounds, though, they are generally the only real education packed parts of my day, and they are generally over with in an hour. They occur just like rounds in the states but typically with much worse pathology. We go from bed to bed with the residents and the attending (or registrar as they seem to be called here) and briefly discuss each patient and the plan. Although I frequently do not hear much of what is said during Grand Rounds (all the teams together), as they speak rather softly, and I frequently do not understand much of what is said during normal rounds, as I just cannot seem to deal with the India accent sometimes, they are interesting. Where else would I see bacterial endocarditis, malaria, scrub typhus, typhoid, and organophosphate poisoning? And only in two days at that. They almost make up for the fact that I usually then spend the following two or three hours sitting around the hospital reading or staring until the next random activity.

As I am on the topic of medicine I will also just pause to say that the CMC Hospital is amazing. It's like an entire medical compound. Imagine a dusty, 1950s looking version of the Houston medical center. There are a few really nice, modern facilities, but most are fairly old and jam packed with desks, beds, and people. On the ward I am currently on there is about 3 feet between each iron frame bed and easily 12+ patients along each side of the wall separated only by what appears to be a shower curtain. There are a few more private rooms and obviously some isolation rooms, but by and large the amount of space allotted to a patient and his visitors is about the size of many small apartment kitchens. It seems they expect and are used to such conditions, however, as I am not aware of any complaints, but it is definitely medicine as I envisioned it being practiced about 50 years ago at least in regards to the facilities. The quality of the care, on the other hand, is, as far as I can tell, amazingly high in light of the undoubtedly few resources available. India for all its growth is still a poor country and the needs are ever many so the fact that they can provide top of the line medicine, CT scans, chemotherapy, and the like in such a setting is something I feel worthy of envy. CMC is an amazing place and I cannot wait to share some photos when I am able to load them back in the good ol' USofA.

And while I am on the topic of amazing things I will add the CMC campus itself. Amazing may perhaps be too strong a term, but it is quite lovely. Very green and pleasant. I know I discussed it briefly earlier as a camp setting, and it is, but it is kind of a early 1900s British colonial India camp setting. Lots of old stone buildings with thick panes of glass separated by slightly overgrown gardens. In as much as the legacies of empire can be a good thing, this is a nice place.

Meanwhile life goes on. Rachel and Rebecca moved from their roach infested squatter's roost to a much larger and nicer place similar to mine and Paul's. Luggagewise, Paul and Rachel have both finally received theirs and Rebecca is expecting hers tomorrow. There's a 50/50 chance her toiletries will be missing. No signs of traveler's diarrhea or typhoid as of yet. No histrionic longings for home. No trips to Indian jail.