Wound Vac

A typical day of my internship goes something like this. Elena, get in touch with social work. We need to get that wound vac for Mr. Smith to go home with. Simple enough, right? So I call social work, page social work, hang missing person flyers and run nurses station laps looking for social work until I locate this man in a Mr. Rogers vest named Sall, who supposedly is the one in charge of getting me said wound vac for patient to go home with. Sall says absolutely we'll have that this afternoon, the patient can certainly be discharged today.
That day and the next day and the next tick by before Sall actually orders said wound vac. On this third day of discharge planning Sall states he's contacted a man named Billy, who is most definitely on his way from Hoboken, New Jersey with our treasure. I walk in early that morning to tell 94 year old Mr. Smith the great news. You'll be going home today. Isn't that wonderful? Oh, doc. He says, with those coke bottle black lenses and the wound vac awkwardly suctioning the top of his 12 cm squamous cell excised scalp. You aren't from the boroughs are you? That Billy's got to cross the Cross Bronx bridge. That'll take him til tonight. I'm thinking, yes it will. I know that bridge well. As i've accidentally taken it to New Jersey thrice since moving here. And also, he explains. Even if this Billy gets in here tonight. My son can't pick me up tonight. He's gotta be at the Yanks. The Yanks, sir? The Red Sox. The Yanks. Tonight. I mean where the hell are you from anyhow? Far far away sir. Far far away.

pain killer

get him a prescription for pain meds to go home with, make it Percocet 20.

this was my assignment. and this is how it was carried out.

i am awesome. i think to myself as i stroll toward North 7B Nurses station. Reason #1 why I am awesome: I got lost for only 30 minutes, managing to make it to work in under one hour today. Reason #2 why I am awesome: I just successfully drew a CBC. By. My. Self. (nevermind this skill was in the objectives for first year of medical school) So I walk my bomb dot com self over to an open computer and begin to find the computerized prescription pad and search "PERCOCET". uh. wow. There's like 50,000 PERCOCET choices here. ok wait what EXACTLY did he mean by 20. um, was it the milligrams. No. that is definitely not an option here. Was it the dispense number? No. that makes no sense. Hmm. I'm not sure. So as I sit there for 30 minutes debating Percocet 2.5 vs. 5 vs. 7.5 vs vs vs vs vs, I notice the patient's large scary Bronx style nurse growing increasingly agitated at my procrastination. I can't ask the resident again, I'll look like a fool. I decide to call life line. "Dad, I need to know what you give your patients for post-op pain meds." He proceeds to suggest medications they haven't offered in the Bronx for decades. Thanks. Ok, just pick something. Percocet 5. Lets go with it. And...I vaguely remember something about q4, so we'll go with that. and yeah, lets give him enough for a week...or a month? Ahhhh. Ok lets just do 30 tabs, right? Yeah ok. And hit Print and Yes. I am so awesome. I gaze over at the prescription printer and notice it seems to be printing quite a few prescriptions. I do my cool walk over to the machine to take a look at one of the slips of paper. Percocet 5-325mg q4h PRN Pain. Dispense 3,000 tabs. NOOOOOOOO...... Oh no oh no. That is incorrect. Very incorrect. I rush back to the computer to change the dosing. Ok what is happening here?Why won't it stop printing? Oh shit balls. I suddenly look down in the bottom right corner of the screen. I'd completed the task too quickly. Become too confident in my swagger. Not only was the patient going to receive 3,000 Percocet tabs. But i'd also have 3,000 copies of this prescription to offer him at discharge. Redfaced and horrified, I began manhandling the printer with my kung fu elbow punches, drawing the attention of the majority of the large scary Bronx nurses. Minutes and minutes and minutes later, the machine finally surrenders and I begin shoveling Percocet prescriptions into the itty bitty HIPAA hole. Yeah. I am awesome.
Peace out,
E

beep. beep. beep. beep. beep.

well guys... one day down, 1,824 to go...minus one for leap year. so 1,823. damn. thats a long damn time..
anyhow, my update from the Bronx goes as follows... Last week I arrived at orientation to find myself in a room full of approximately 400 Varun Khanna look alike residents. This being my own personal nightmare was not exactly the bright start to the morning that i'd hoped for. But I proceeded to fill out ridiculous paperwork and life insurance policies (turns out i'm not even worth enough to leave anything in my dogs name). So blah blah blah. That day lasted flipping forever and I was just so so ready to go home at 2pm when I got to my car and realized that due to the India style overpopulation of the Bronx borough they are choosing to parallel park hundreds of cars behind parked cars on ramps of the parking garage. As my volvo was one of these parked cars, I of course become insanely pissed and attempt to track down a parking official who explains to me that i'll just have to hurry up and wait because in order to move that nasty van blockcocking me I will have to march his ass way up into the hospital and find the owner and his keys. AARRRRRGGGHHHH. So that took 45 minutes and it was approximately 3pm when I maneuvered myself onto the Henry Hudson Parkway (my ticket back down to Manhattan). This is when the story turns super sour because this is when I realize that New York City rush hour traffic starts at 8am and lasts til 10pm. This turns out to be a superbitch. So after an hour spent in what I would describe as strikingly similar to that scene in Armageddon where everyone in the world tries to drive out of the world at the same time...I finally inch my way toward my bridge out of the Bronx. Unlucky for me I have no flipping compass in this flipping car, thus causing me to go west instead of east on this incredibly crucial bridge, thus causing me to drive 20 minutes into New Jersey before realizing my fate. And so, at 6pm I arrived home and had myself an upset martini. Balls.
And as for today, July 1,...well lets just say it started with a meet and greet welcome breakfast in the ENT department. I of course was already donning my ironed white coat (oh who am I kidding, I didn't iron it) and spiffy pager. As the attendings and residents mingled quietly in the room, all of our conversations slowly turned to the incessant sound resounding in the room...beep. beep. beep. beep.... Suddenly the chief resident points to me and my little pager and says, "Elena, uh, thats you." And thats when the whole room erupts in laughter and I exit red and hot and red and hot. Ugh. The horror.
And the day only got better as I was trailed by two medical students in yamikas who knew more about ENT today than I'll know in 1,824 days. I was reminded of this when I attempted to renew an order of Coumadin for a Mr. X on our list. Where was the old order, why can't I find it, I keep asking myself and the yamikas and the nurses? Quietly one of the yamikas leans forward and whispers, "Isn't the Coumadin for Mr. Y, not Mr X.?" Yes yamika, you are right. Thank you. And FML.
much love,
e

Big Fish

Eufaula Lake stores up a bagillion of my favorite childhood memories. One of my most cherished is fishing for crappie with my grandpa and my dad. We'd go down to the dock and stick our hands deep in this metal bucket to get these flippy slimy little minnows and then i'd stick the hook right through their itty bitty bottom lip and then we'd hurl the itty bitty fishy out into the wide Eufaula morning. I'd sit out there on that big dock, my feet hanging ankle deep in the brown water. And I remember how all my hopes and excitement were scooped up into the prospect of one day catching the Big Fish. I mean we always fished for crappie my whole entire life. We'd fix it so tasty all fried with the tartar sauce on the side. Crappie was dependable. Safe. Expected. I always loved crappie. Always Will. But sitting there with my minnow deep down in the murky Eufaula I'd think to myself...but what about the Big One. What about the 200 ton whale that you are just certain has got to be lurking at the depths of the Eufaula and what if just this once he decided to munch on my minnow? So I'd sit there dreaming about that wonderful mysterious whale and suddenly that was the exact thing that every single part of me hoped for.
Last Thursday, March 19th I held my breath and opened a tiny red box at the OU Medical School Match Day Banquet. It read as follows: Albert Einstein Medical Center, Otorhinolaryngology, Bronx, NY.

For so long I'd debated whether to rank Oklahoma or NYC as my top choice for residency. After hours of debate and advice from friends and family, I chose to place NYC on top. And so just like the minnows and the crappie and the whale, I'd cast my rod with comfort and contentment at the idea of the crappie and the flicker of excitement at the prospect of the whale. And last Thursday in that tiny red box I caught my first whale. I caught the Big Fish. The unexpected gigantic thing that even though all my wishes and hopes and excitement had been wrapped up inside of for so so long...I never really truly thought I'd catch. And so I sat there and remembered the very manageable size of the typical crappie specimen and how tasty they always are in that sauce and I wondered to myself...How the heck I'd ever reel this thing in and if I managed to do so, if I'd even like the taste? Luckily dad was there to throw me a pool net and talk me through the fiercest fish fight of my life.
So if I ever manage to get this thing in the boat, this blog of mine is Bronx bound.

Mussels and Brussels and Waffles with Friends

Goodnight India.

Thursday February 26th
I don't have time to write much today but I want to just give a few highlights from the last few days. We arrived in Delhi on Tuesday evening. At the airport we were met my a Sikh Indian man in a rather attractive Punjabi turban who was holding a sign with "Ms Willis" scribbled on it. He also had a super nice pimp my ride India Style SUV with leather interior. So we decided riding with strangers was an excellent idea. This stranger took us to the fabulous guest house that our friend Varun and his family had arranged for us. After unpacking we joined Varun's uncle, a Delhi local, for the best Indian food we'd had yet. I mean this stuff was super super good and we all ordered seconds and thirds and fourths and then went to sleep with what Varun informed us is a "Delhi Belly". (Shout out here to Varun Khanna and Anup Kackar and family. Thank you. Thank you thank you for all your help!!!!!!)
We spent Wednesday shopping for overpriced elephants and devouring McDonalds icecream sundaes. We also found a local park full of artists where we bargained for henna hand artwork at record low prices. In the midst of sundaes and henna and shopping we may have maybe just maybe forgot to see any important tourism sites in Delhi. But just maybe. It was an accident.
Thursday was our official last day in India and in celebration we hired a super nice old man driver to take us to Agra, home of the infamous TAJ MAHAL!!!!!!!! ...oh and also another important building for a guy named Akbar. So we packed our Gandhi shirts and after a too close for comfort call with an oncoming Indian railway train we safely made it to the best wonder of the world we'd ever seen. Come to find out an even bigger wonder of the world is four white girls at the Taj Mahal. When the Vellore Four cozied up for a rest on the sidewalk, an Indian family slyly placed their toddler children next to us for a family photo op. (notice female toddler with best pouting face i've ever seen) In total the Vellore Four cheesed it for approximately 5,000 photos with Indian teenage boys. (ok ok. i'm exaggerating and yes. we secretly really enjoyed it)
Our flight leaves Delhi tomorrow (Friday) morning and we are headed to Belgium for a weekend of jet lag recovery and waffles. And so I guess this is Goodnight to India. Goodnight rickshaws. Goodnight roaches. Goodnight naan and curry and inefficient travel. But most importantly goodnight to the people of this place who tolerated four lost American girls for five fabulous weeks of diarrhea, adventure, and self discovery. We're gonna miss you India.

Varanasi. VeryNasty.

Tuesday February 24th

5am is just too early for people to exist as living beings. But the Vellore Four woke up around this hour, grabbed a breakfast to-go from the “compound”, and raced through the Bangalore airport for a flight headed to Varanasi. For those of you India virgins out there, Varanasi is the town in India that’s on the banks of the Ganges River. It’s got all those stairs (aka Ghats) that people dive off of to take baths in the holiest water in the world. We decided a trip to India would be incomplete without a visit to this spiritual headquarters of the nation, so we flew north on our fave India airline, Jet Airways. During the flight I found out some insider info on the Maharajas that I mentioned in my last blog posting. I was in seat 23D and this Indian man in 23E saw me digging through souveniers from Mysore Palace. Turns out he is BFF with the current Maharaja of Mysore who is supposedly from a long line of maharaja’s with the last name Wodeyar. He gave me the dish on this Wodeyar guy who it turns out is tragically overweight, sporting a super unattractive curly moustache this season and he has royal duties which are limited to his role as president of the local Cricket Club. But everybody in town still salutes him and he throws some pretty fab parties. The unfortunate thing about the Wodeyar maharajas is that way back when, they had a horrible curse placed on them by the goddess, Chamundeswari (sp?!?!). She destined the future Wodeyar generations to a lifetime of infertility. The catch is that her curse is only cast on EVERY OTHER generation. Unfortunately the current Cricket Club prez is one of the unlucky ones. But instead of the grin and bear it method of his predecessors, he’s visited multiple infertility specialists in the U.S. and now has plans to adopt sometime next year. The other super exciting information I was given by Mr. 23E is that little did we know it but we were arriving in Varanasi, spiritual capital of India, on the eve of Maha Shivaratri, one of the largest Hindu festivals of the year. This Hindu festival is a celebration of one of two things (I’ve heard two very different yet believable explanations), Lord Shiva’s birthday extravaganza or a holiday to remember Shiva’s marriage to his wife Parvati. Either way, we were game for celebrating. I also learned that Hindu’s stay up all night long and worship Shiva at temples and near the water. All of this was exciting news and we were stoked to finally land at the Varanasi airport. This airport is smaller than the Stillwater, Oklahoma airport but with a few more tropical plants and a really funky smell. At the baggage claim in this tiny place we met a large group of white people with really impressive cameras. I asked some questions and come to find out these people are NATIONAL GEOGRAPHIC PHOTOGRAPHERS!! They are doing a documentary on India and planned this trip around the festival mentioned above. Whoa. So Awesome and crazy that we didn’t even plan for this! Of course we pretended to be completely aware of the importance of this festival, but decided to refrain from pulling out our throw-away Kodaks to do “camera-talk” with our idols. We eventually made it to our Hotel Pradeep in the heart of Varanasi and immediately took a stroll toward the Ganges. Along the way we noticed thousands and thousands of Indians lined up on the left side of the street ( see photo and Indians in a line
0. We continued walking for what seemed like miles. Eventually we reached a rather janky security screening center and the entrance to The Golden Temple. This is the most important Hindu temple in Varanasai and all of these people had been waiting 4-5 hours to enter the temple and place flowers and claypots and other offerings at the base of the statues inside. We couldn’t spot any FastTrak options for the line so we continued toward the Dasaswamedh ghat. This is the busiest ghat of all and even more so with this crazy festival action. Ok pause for quick ghat details here. The ghats are a series of sets of staircases that lead right into the Ganges River. Each stair case is known for something different, like a cremation ghat or a ghat for healing medical problems, or a ghat with really yummy woodfired thick crust pizzas. Some Hindus come to bathe in the water every morning and some come once in their lifetime. The water is purifying and is believed to cleanse Hindu believers to allow them to be reincarnated at a higher level or to reach Nirvana directly. It can also supposedly heal some diseases and according to tour guides, scientists have been unable to culture any bacteria from test tube samplings of the stuff. (Of Note: My guidebook strongly contradicts this notion and discourages all travelers from drinking the water) Many of the ghats have bamboo umbrellas with Brahmin (priests) stationed underneath to provide prayer for people. We spent the evening walking and stalking the National Geographic guys for some great photos along the steps. At the cremation ghat we stopped to observe the simultaneous cremation of four Hindu bodies. (See attached pic of cremation ghat with all the wood piles and then the big electric cremation building to the left of the wood) The stairs of the ghat went down to a flat beach type area. Only there was no sand, only heaps and heaps of ash remains. The owner of the cremation ghat (kinda like a funeral home director but with flipflops instead of the black suit) explained the process of death in the Hindu religion. He told us that they burn 100-150 bodies each day and are open 24hours/day. It is very expensive to be cremated and if people cannot afford it they can be cremated at the electric cremation facility. What happens after a Hindu dies is that the whole family comes to the deceased persons house and brings flowers and spices and puts all of that on the body. Then they wrap the person up and put them on a bamboo stretcher and carry them from the house straight to the Ganges. (This happens within 4 hours after death) There they wash the body in the Ganges and the family members pour water from the river into the mouth of the deceased to give them their last purifying drink from the Ganges. Then they are placed on the wood and cremated for 3 hours. Afterwards the remains are put into the river. There are 6 types of people that are not cremated because they are believed to already be purified by the gods and thus can be tied to a heavy rock and dropped in the middle of the river. These include kids under 9 years, pregnant women, lepers, people with snake bites or small pox, and Brahmin. At the end of the night we strolled all the way down to the Assi ghat, the southern most ghat which is known for great pizza. On our way home we stopped to watch Brahmin priests perform a ritual dance with seashell horns on the bank of the Ganges. The entire stretch of ghats was packed with people setting up candles and alters and other places to meditate and worship for the festival. The whole place looked like the biggest slumber party in history, with thousands of worshippers laying on the steps preparing for the late late show at the Ganges. After some debate the Vellore Four decided to forego our slumber party invite to sleep back at the hotel. The walk home was a bit more treacherous than expected due to lots and lots and lots of steps in the darkness with headlamps and the rancid stench of the "oh-so clean" Ganges. There is also quite a thick swarm of flying bat bugs attracted to the Ganges. I found these insects to be especially fond of flying up the nostrils of tourists. The other especially tricky part about getting home from the Ganges was dodging the Hindu Festival Parade obstacle course of small children dressed as Shiva on stilts and floats made entirely of megaphones blaring the Slumdog soundtrack track 11 on REPEAT AND REPEAT AND REPEAT AND REPEAT. Unfortunately the Vellore Four mistakenly became a main attraction in the parade train while trying to maneuver our way through a mosh pit of locals on the street. These party animals had obviously taken one too many shots of some sort of yellow yoghurt drink with a touch of a little something extra mixed in. I say that because while we were escaping the smelliest mosh pit ever, Indian men's hands began to wander toward unsuspecting lost American girls. Within seconds the Vellore Four morphed into X-men Diva Nazi Girls with special powers including Keanu Matrix style flight capabilities and Kung Fu Panda kicking ass choreography . In a flash our rickshaw getaway car appeared and we sped off into the night.
Varanasi day two was just as smelly but somewhat less eventful. We once again woke up at a time unacceptable for life on earth to exist. This time it was to catch our sunrise cruise of the Ghats. This was truly very cool and I recommend this little cruise to all of you. In the early morn lots of locals go to the ghats to do yoga and loofa their armpits and wash some socks. And so we watched that and also lit a little flower fire pot thing that we bought for 1 Rupee from a little boy. If I've got my story straight I think the flaming flowers are to symbolize a prayer that you make for something and then you put it in the water and let it float on the Ganges. I prayed to continue having Kung Fu Panda kick ass skills in the States and also that my crippled Rolly Bag would have a miraculous recovery after its Ganges bubble bath. (Rolly Bag lost her right front leg after a freak accident in baggage claim). We said our prayers and parked the boat before walking through a district of town that makes gorgeous silk on these really ancient looking wooden weaving machines. In this pic a grandpa is teaching his little apprentice grandson to weave. After a silk shopping spree we were confronted by some local cattle concerning complaints they'd had about our stench. We quickly apologized and packed our bags and hit the road for Delhi.

Girls Just Wanna Have Fun...And Eat Beef

Sunday February 22nd
Last Friday the Vellore Four successfully completed our rotation at the Christian Medical Center. We had exactly one week until our jet left for home, so we decided to attempt to tour the entirety of India before that time. Carly revealed that she might know some people who know some people in Bangalore and we quickly took her up on hunting down her snazzy connections and living it up in the big city. After a request for a “Big Car with Big Trunk for Big Bags and Big Girls” we were surprised to see Smart Car’s Miniature Little Sister Car pull through the circle drive and pop the so-called “trunk”. After teetering 8 overpacked female suitcases on the roof of the car and receiving a bonus lesson in skillful knot tying from our driver, we began the 4 hour journey from Vellore to Bangalore. Over the course of the evening our ETA was extended from 8:30pm to 11:30pm with a rather large glitch in travel plans owing to Smart Car driver being the ultimate worst male driver of all time. Imagine this…stubborn male driver in front seat and four overly opinionated back seat female drivers in a town that ZERO of the FIVE persons has visited in their lifetimes and what you end up with is THREE hours of Smart Car stuck on India’s version of the Dupont Circle from Hell. An anonymous member of the V-four eventually offered the intelligent suggestion of electing two members to hail a rickshaw operated by a Bangalore local and to have stubborn male driver follow the local, while the two elected members hang precariously out the sides of the rickshaw wearing headlamps and providing instructive hand signals to stubborn male driver. In what can only be ascribed to as an act of God, the Vellore Four arrived at Carly’s snazzy set up, a “guesthouse compound” of Amitabh, Car’s friend of a friend. I will define “Guesthouse Compound” for you now. This term means 6 stories of sheer gorgeous heaven constructed of glass and marble and security guards and personal chefs and fresh cut flowers and really squishy pillows. We were all pretty happy to say the least, and in the words of Liz, “I don’t know if I’ve ever been this happy. Maybe my wedding day. But I don’t know. This is a really close second.” On Saturday we decided to have the ultimate Girl’s Day Out and started by burning some Rupees on silk scarves at the infamous Mysore Silk Emporium. After some overpriced salads at the popular Leela Palace Hotel garden restaurant, we begged a spa joint to allow our filthy feet inside for the best pedicures of our lives. We probably should have autoclaved from the toes up before making those unsuspecting women touch our feet, but nonetheless it was wonderful. After our pedis we caught a rickshaw to the movies where we spent 200 rupees each to indulge in the ultimate chick flick “He’s Just Not That Into You”. Although entrance into the Indian Cinema involved the most violating security screening and pat down experience of our lives, the surprise allotted Intermission time during the show and the concession stand menu totally made up for it. What’s happening here is that about halfway through your movie these people are pausing the flick just so you have a chance to visit the “Hot and Savory Corn Stand”. This stand is cooking up a revolution in movie corn snacking. Boiled corn kernels, buttered and salted, and placed in a tiny popcorn bucket. Spoon included. Carly and I already have a plan for the U.S.A. branch of “Hot and Savory”. So you just go ahead and back off. After the movie it was a race against the clock to make it to Bangalore’s Hard Rock Café before close. We know, we know. It’s the ultimate pathetic tourist thing to do. But dammit, we needed some beef and it’s the only place in town selling it. Four cheeseburgers and fries later, it was back to our “compound” for a good nights sleep. Sunday was a road trip to Mysore, home of a gazillion palaces and shrines to guys we’ve never heard of. The trip was made in a minivan, the price for which we split with some med students we met back in Vellore. We scrunched 8 people into a 6 person minivan for a 4 hour car ride with the worst driver in the ENTIRE UNIVERSE. (second only to stubborn male driver mentioned above) A bunch of oncoming cars and curvy cliffs and hail Mary’s later we arrived at the tomb of a guy we’d never heard of and then we visited the same guy’s summer home. So that was memorable. We took pics. And then it was back in the car and on to Mysore Palace. Ok now this place was actually very legit. Huge. Gorgeous. Awesome. Beautiful. And, oh yeah. Sorry, they don’t allow cameras so you will never lay eyes on this wonder unless you visit India. But I’ll summarize in a nutshell for you that this is a big palace for the Maharajas in the area. It changed hands quite a bit throughout history and burned down one time after a wedding cake caught fire. But it’s here now and they offer elephant rides in the driveway and like all other tourist spots have a shitdevil monkey infestation. The best part about the palace was a gigantic Marriage Pavilion room with all these murals and arches. I would have enjoyed this area longer if it wasn’t for my unfortunate run in with the Indian police who wrongly accused me and confused me with another short white female who was photographing in the palace. The last stop on our minivan tour was Chamundi Hill. This is basically a big hill that unexpecting travelers drive all the way up to discover the only thing to see here is another monkey colony. Only these little guys are way more evolved and are actually just asking tourists for spare cash and minivans. Uh, so we left and went back to Bangalore and the “compound” and packed our bags for an early morning Varanasai flight. And we aren’t inviting any of those monkeys.

If The Shoe Fits

I have some serious updating to do...So let's timewarp back to Thursday...
As you all know we have been at Karigiri working and learning about the leprosy patients this week. Today we were invited to attend a mobile clinic with a dermatologist. This morning was somewhat like what we did with the nurses at CHAD, only this time we set up shop in an old building and the patients in the village stopped in if they had a medical concern. We saw quite a few patients who needed basic hypertension/diabetes check me ups. One of the most interesting patients was this lady here in the photo. First of all this beautiful lady is absolutely the tallest Indian I have met so far. I mean this gal's like Andrea Dillard model height type of tall. So that was crazy. But anyhow, she actually has seizures and came by to talk about medications. We noticed her prosthetic leg and asked her how it had happened. Turns out about 10 years back during one of her seizures she fell into a fire and lost her leg due to flame burns. She walks very well with the prosthesis, though. One of the best parts about the mobile clinic was getting to chat it up with the dermatologist physician. She was a super teacher and, even more important than medical knowledge, she really cleared up alot of my confusion regarding who the heck actually owns all these damn cows. So that was just oober helpful and even more importantly, she let us in on the ultimate secret. The secret the locals have kept from us for 3 weeks. Folks, the secrets out. Theres a Baskin Robbins in town and we heard they're selling hamburgers. We took the docs advice and hailed a rickshaw to the so called haven of cake and ice cream and meat. After a detailed examination of the menu, however, we discovered the small Hindi script next to the photo of the juicy delicious Hamburger. It read "AMERICAN STYLE chickenBURGER!!" And so we got icecream to go and dreamt all evening of a day when beef will be available to all and Filet Mignon will rain from the sky. We headed back to Karigiri for an afternoon in the Prosthetics/Orthotics Dept. This guy in the pic who's showing off all the stylin' footwear works in the department and he led a portion of our tour of the facility. He explained that leprosy, diabetes, and polio patients benefit immensely from the specialized footwear they make in the workshop at Karigiri. There is a ridiculously long process that all this tree sap goes through to become black leather that then becomes a variety of prosthetic or orthotic devices. So after our tour we got to looking at the Wall-O-Shoe options that they give the patients to pick from. I'm not sure if the curry is starting to affect our judgement or if the shoes were legitimately attractive but either way these guys can throw together a good looking pair of kicks. And I swear, this has to be the best bargain in town. We paid 300 Rupee ($6.50ish) for these crafty men to make us black leather sandals, specifically molded for our foot idiosyncracies. (Arch supports and everything!!) As we made our way home in our new orthotics I couldn't stop thinking that the whole operation was absolutely an Indian version of my mother's lifetime dream come true. And since I am becoming my mother, I'll admit I'm now on their mailing list.

Karigiri: A village without pain.

"Leprosy (from the Greek lepi (λέπι), meaning scales on a fish), is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract. During the disease course, skin lesions develop that are lighter than normal skin color. These lesions have decreased sensation to touch, heat, or pain and often do not heal after several weeks to months. Patients also develop numbness in the hands, arms, feet, and legs and with long-term leprosy may lose the use of their hands or feet due to repeated injury resulting from this lack of sensation. The M. Leprae bacteria often causes a "lion like" facies due to a destructive infectious process in the nasal cartilage and eyebrow area. Loss of hair, respiratory difficulties and cataracts also develop. The exact mechanism of transmission of leprosy is unknown although the most widely held belief is that the disease is transmitted by prolonged contact between infected persons and healthy persons. Treatment is with a multidrug therapy of dapsone, rifampicin, and clofazimine. Worldwide, two to three million people are estimated to be permanently disabled because of Leprosy. India has the greatest number of these cases." -University of Maryland and Wikipedia online resources.
Karigiri is a leprosy treatment and research facility on the outskirts of Vellore,India. In the 1950's several physicians from CMC developed the concept for a center for leprosy and within 10 years they broke ground in a desert area known as "Elephant Hill" and completed plans for a 200 bed Inpatient facility, operating theater and laboratory. This week the Vellore Four have had the amazing opportunity to work at this facility. On Monday morning we were given the grand tour including a video over the history of Karigiri. The hospital boasts a specialized PT/OT department where patients learn how to complete daily tasks even with their disabilities. There is also an ophthalmology center for the treatment of cataracts and other leprosy related eye conditions. One of the coolest things at this facility is the reconstructive surgery center where many orthopedic surgeons provide hand and foot reconstructions for leprosy patients. One of these surgeons is Dr. Paul Brand, an orthopedic hand surgeon and author of the book "The Gift of Pain". This book is really amazing and describes the importance of pain in the human life and the devastating consequences for leprosy patients due to the absence of pain. During our tour we also saw an extensive lab where microbiologists are performing drug resistance research on mice. The leprosy bacteria cannot be cultured in a lab requiring the researchers to inject the leprosy bacteria into the feet of immune compromised mice to grow the bug. They then use the mice to see what meds are working for the disease. Another really cool thing about Karigiri is this really big prothesis and orthotics workshop area and agricultural and dairy farms that the leprosy patients work at. This outlet provides the patients a sense of duty and also a means for making a little cash on the side to pay for treatments. (Side Note: something I really appreciate about India is that they require patients to pay for at least a small portion of their healthcare. I mean they might only make a leper pay 5 Rupees for a walking boot but somehow it gives the patient's a little respect and ownership over their care and I think the U.S. could learn alot from that.)
Today we spent the morning doing surgery rounds with an orthopedic surgeon.(attached pic is of some nursing students and this guy teaching us about a non healing ulcer) The surgical wards house about 20 people per room and are separated into male and female wards. Every patient in the ward has at least one extremity if not all four with major deformities and amputations. They are wrapped in bandages and on rounds the nurses remove countless layers of gauze, allowing the surgeon to review and make assessments and plans for treatment. One lady in the ward had the classic "lion features" With her permission I took her photo and it is above. I don't have a great photo of her full body, but basically the disease has caused her so much numbness in her hands that her fingers are completely worn off on both hands and her legs are covered in non healing ulcers and amputated to the ankle. NOTE: THE FOLLOWING DESCRIPTION IS SUPER DISTURBING AND NOT FOR THE WEAK STOMACH....The most horrifying wound we saw during rounds was a man who only yesterday presented to Karigiri. On the anterior portion of his left ankle he had a 15-20cm gaping lesion with deep creveces of necrotic tissue which seemed to me to be moving. On closer inspection his wound was crawling with at least 100 tiny white maggots eating the dead tissue. After puking up everything I've eaten since January I got my wits about me and learned from the surgeon that most patients come to Karigiri with maggots in the wounds, but this is actually a blessing as they remove the dead tissue and keep the wound clean. Yeah maybe so. But it's still disgusting. After the marathon surgery rounds we were invited to go to the operating room to watch the debridement of several cases of osteomylitis. Turns out they've got the same sexy scrub suits and communal flipflops as Vellore CMC. So that was awesome. And we took a pic. Tomorrow we head out to the mobile clinics to see leprosy patients in the villages. Should be totally amazing and I will post again with our adventures.

CMC FoTo's

These are just a few pics of the hospital in Vellore (Christian Medical Center). We spent last week at this hospital for our surgery rotation. One of the photos is of the roof of the CMC building. This is where they are doing the laundry for the operating theatre and wards. In the pic you can see all the bedsheets and surgical drapes hanging out to dry. Under the covered area are all the surgical gowns hanging to dry. After they dry the surgical items they send them to the autoclave. I’ve discovered the big theme for Indian hospitals is “Reuse”. My experiences in India have taught me a lot about the wastefulness of the healthcare system in the U.S. Another pic is of the bustling nursing students on the surgical ward.

A Three Hour Tour

Kerala is an Indian state located on the southwest coast of the country. During the V-Four’s time in India we had heard amazing stories of this faraway land. The legends told of Ayurvedic massages, white sandy beaches, and all you can eat jumbo prawns. So we booked an overnight 14hr train ride to visit this land of promise and possibility. After our crash and burn bus experience, we decided we might be better suited for train travel. It turns out that just because you have a “Class 3A Sleeper Car Beds for Four” train ticket does not necessarily mean that there won’t be at minimum 3-4 Indians already sleeping under your covers. So we decided to call it a 50 person Indian style slumber party and managed to nuzzle our way into the bunks. On arrival in Kerala we first toured Varkala. This place is a beachy paradise with delicious cocktails and fresh fish and lots and lots and lots of t-shirts with a lifesize photo of Gandhi’s face on the front. (Don’t worry. We got one for each of you.) So we spent our day at the beach and even made an attempt at bodysurfing which sadly resulted in the sacrifice of my fave blue sunglasses to the Arabian Sea. These were quickly replaced with snazzy aviators during the most intense power shopping event of all time. During this event the V-four finally gained the upperhand in the Indian bargain sector by introducing boardwalk salesmen to the puppy dog protruding bottom lip. After a Keralan feast and four Diet Coke’s (these are a rarity in Indian culture and for some reason taste like liquid heaven) we bedded down at the Kerala Bamboo house. This place is the best bargain in town. For 20 bucks a night you get your own little bamboo hut complete with pink mosquito net and a roofless bathroom with jungle painted walls. It is quite an experience to look up from your bathroom to see palm trees swaying, the occasional bird flying overhead and the constant fear that shitdevil monkeys may have migrated west in the last week. After a breakfast of crepes we checked outta our huts and bused over to a town called Alleppey. It was in this town that we boarded our “Deluxe Three Hour Guided Tour of the Keralan Backwaters…complete with tasty snacks and cool beverages…all aboard an elegant wicker cruiseliner” Ok. No no no no no. That brochure is a bold face liar and we know it. The truth is that the Vellore Four were sent on a never ending Eufaula Lake float trip with a non verbal teenage boy who, when asked if it was snack time, pulled over to the side of a canal to an establishment I would describe as “Starbucks of India Village”. This joint is run by this lady who’s making chai and onion donuts in her hut kitchen and then these two jokesters that basically just stand around and eat all the donuts. (that’s them waving at the door of the “Starbucks.”) We bonded with the locals and proceeded to experience longest float trip ever. And I do have to say that the Backwaters are actually very gorgeous and a lot like India’s version of Venice with all these little canals and villages and you should definitely go there next time you’re in India. We washed off the backwaters at our hotel which I have to give a little shout out to for providing us with a large turning point in our travel plans for the remainder of India 2009. Liz happened upon 4 inch antennas, likely belonging to biggest ever cockroach peaking out from behind a mirror, and thus..Readers…The Vellore Four are no longer selecting hotels from the Budget section of the travel book and from now on will only take suggestions from items under the bolded heading “Luxury”.
So anyways we notified the authorities and got the heck outta dodge and spent Sunday in Kochin. This town is wonderful and has a forever long row of big Chinese fishing nets where some guys climb all over this unstable wooden structure to catch fish that they’ll sell you for super cheap and then grill it up with some rice on the side. So we ate that and then managed to squeeze in a tour of a basilica, a cathedral, a Jewish synagogue, and a little Indian antique shopping. We even had time for Chinese take out before boarding our overnight train towards the east where we battled the Indians in a cruel game of freeze out and don’t give the Americans bedding. But we bundled our bodies in mosquito nets, new scarves and head lamps and as soon as the frostbite lets up we’ll carry home the gold and deposit our love letter to India in the big red box pictured above.