Restoring faith

After my post yesterday, where I rant and raved about deadbeat coward dads who beat little kids senseless, I think the Lord knew I needed some therapy.

So, the first 3 patients in my schedule were it. Now, keep in mind that apart from a new last minute changes, some of my patients, especially those coming in for complete physicals have been scheduled months in advance.

This morning, one after another, I got to do physicals on relatively healthy, young (in their 30s to 40s) wonderful men. They had jobs or ran their own businesses. They took care of their health, eating sensibly and exercising. They were married and faithful to their wives. They were loving, protecting and doting fathers. I could not help but tell them that I appreciated their stepping up to the plate and fulfilling their role as men, husbands and fathers. One of them gave me a quizzed look. He probably wondered why I was making so much of what he just did as a matter of fact. If only he knew...

The 90s

Yesterday was a strange day. Med-Peds makes for some interesting contrasts. I went in to see a 93 year old. She still drives, lives alone and is quite healthy, other than some arthritis. I once joked with her saying "I hope that when I'm 90, I'm as healthy as you and still practicing medicine. She came back with "And I hope I'm still your patient."

The next patient was 2. He was, well... 2... running around, playing and talking.

The next patient was 96. He came with his daughter. Apart from swelling in his lower legs, he was doing quite well, thank you.

The next patient was another 2 year old, a girl, this time.

Thank you, dear patients, for bringing joy and hope to my life.

To those of you who still live in the past (when people who died in their 70s had 'lived a long and good life', it is time to update: we CAN live into our 90s and enjoy a good quality of life.

Needed: a few good men

If you're not in the mood to hear me rant and rave, don't read this post...

Nothing tears your heart up like child abuse does. When a child feels guilty for turning in his father or step-father that is abusing him and his younger siblings, you want to grab him by the shoulders, shake him and tell him that he's the victim, the abused. It always amazes me that despite being beaten badly, thrown across a room, physically abused and made to feel like trash (wish you were never born, you're not my son), a child still misses his dad.

Oh, for a few good men. Men who earn a living and provide for their family. Men who protect their children rather than beat the living daylights out of them. Men whose children feel they are big and strong and inspire confidence and a feeling of security, rather than make them cower in fear. Men who inspire their children to run home to them when they are afraid, rather than their children being afraid to go home to them.

I thank God for the many fathers in my practice who love their kids. I even appreciate the ones that hover over me when I examine their child, or yell at me, frightened and helpless, to do something, when their child is sick or in pain. These are men.

Not the cowards who use their strength to beat up a little one, who hurt and dissappoint.

And through all the fear, bruises and being put down, these children still miss their dad and want to make them proud. Go figure.

Be vigilant. Stamp out child abuse. Join me in affirming and assuring children that if they are being hurt, they can talk to you and you will do something about it. Show these little ones what adults can really do. Speak positive things, affirm, praise, reassure and cheer up a child.

ER over Christmas

I love my family! From December 1 to 15, I got to go home. I saw my Mom, brother, his wife and my nephew. We did not do anything special... just hung out. It was great to eat home-cooked food, and just to spend time with my family. When we're together as my mother often says, it's birthday, anniversary, Christmas, New Year...every special day. I agree completely.

So I returned to good 'ol Marshfield refreshed and ready for action. I volunteered to work extra shifts in the the ER over the Christmas holiday, Saturday through Monday. Here's a sample:

Cow kicked man in thigh. Man got mad, kicked cow back...sprained ankle.

Sewed up the foot of a 3 year old that stepped on a Christmas toy. Despite numbing up the area, he cried through the whole thing, even with rubbing gauze on an injured portion of the foot. Oh well, put the stitches in and got out of there.

Finally, I saw Jesus on Christmas. Well, I mean Jesus was an infant with gastroenteritis that I got to see in the ER. Still...

I love my job!

Beware the Vampire Chipmunk!

It was a normal clinic day. I had to do a well child on a 4-month baby girl. Mom, Dad, brother and sister came with. To keep the other kids occupied, we have learned to give out pictures for them to color. Since I can run late sometimes and families can be in a room for a while, it helps. My patient's 7-year old big sister was doing a great job coloring a picture for me. When we were done with the visit, she proudly handed me the picture. There was a spot of red painted near the mouth of this charming printed picture of a chipmunk. Curious, I asked what that was. She proudly told me:

"That's a vampire chipmunk! That's blood."

And smiled like an angel.

I asked her what she had dressed up as for halloween. She had been a vampire hippie. Of course, the teeth hurt after a while, so she switched to just being a hippie.

:-)

Here's the picture

4-year old philosophy

Sometimes even little children can teach you the lessons of life. It was a well child visit for little brother of this 4-year old little girl, Charlotte. I love visiting with this family because when I enter into the room, I get greeted enthusiastically and rewarded with the best hugs, nothing held back. Little Charlotte calls me 'Vijay', like we're old pals. (Remember, she's 4). Well, this time she drew me this beautiful picture and wrote a word of wisdom for me. It's fun watching your patients grow as a doctor. I see the entire family and have seen them when they come in for well child visits, illnesses, injuries -- the lot. Charlotte must be just learning to write and like many 4 year olds, she inverts some of her letters.

As I struggled to read what she wrote, I could recognize only one word: 'poop'.

'This should be interesting' I thought.

I asked, "Charlotte, sweetie, this is beautiful! Can you read to me what it says?"

And here's the words of wisdom, one of life's truths. Are you ready?

"Everybody poop and that's the story."

Deep, isn't it?

The stool sample

One of my 70-something year old patients had an appointment with me. As mostly happens, she came with her husband. As I walked into the room, he looked at me seriously and said, "Doc, I brought in a stool sample." My forehead creased as I tried to figure out what was going to come next. One of the things with being a doctor who sees entire families is that often, you get to address the health concerns of a family member that was only accompanying the family member you are actually scheduled to see. No problem. It comes with the territory. My mind was racing with differential diagnosis: gastroenteritis? Blood in the stool? Diarrhea? Colitis?

And then he handed me the bottle. I didn't get it at first, until I opened the bottle and emptied out the 'sample':

Falling...

An 80-something was escorted into the room by his wife and son. He was full of jokes.

"Doc! I have something for you!"

"Okay..." I say not knowing what to expect.

"If you fart in church, you'll have to sit in your own pew!"

He breaks out in a mischievous smile as we all laugh.

And then we get down to business. I had seen him before for a complaint of frequent falls. In his 80s, I suspected a gait disturbance, orthostatic hypotension, arthritis, a large prostate (necessitating him having to get up at the odd hours of the night to urinate). I had tried to address each of these, but his symptoms persisted. What was going on?

The falls were getting worse. I had him stand in the room with outstretched hands and his eyes closed, prepared to catch him if he fell. He was to stand that way for 30 seconds. Within 10 seconds he began to sway and fall. I caught him. The test was positive. This test is called the Romberg test and we use it to assess cerebellar function. A chill ran down my spine when the thought came to mind as to what this might be.

I needed an MRI of his head to be sure. I got the study and here is the result below:

The bright white spot in the cerebellum is a cancerous mass. We admitted him to the hospital. Over the next few days in the hospital, he became more confused, sometimes agitated and sometimes somnulent. His wife sat by his side and knit to pass the time.

We discharged him from the hospital to home hospice, anticipating that he would die within months. I fought back the tears as his wife placed 2 little cup mats she had knitted in the hospital into my hands and said,

"Thank you for everything you've done, Doctor. I want you to have these so that you'll remember us."

I am this patient's hospice doctor. I do not think I will ever forget him or his family. The mats are in my office.

Addendum on December 5, 2011....

While out of the country, I received news that this patient died this weekend.

What did you do this weekend?

An 80-something year old was in for an office visit on a monday morning. He walked without a cane and did not wear glasses. While I was doing my exam, to make conversation, I asked:

"So, Jim [not his real name],what did you do this weekend?"

"Well, Doc, my daughter, son-in-law and me went hunting for bear."

Surprised at this answer from an 80-something year old, I asked,

"So, did you get anything?"

"Oh yeah! We killed two bears!"

"No you didn't" I blurted out before my brain could intercept the words to prevent them coming out of my mouth.

Later that day, I received this picture from him. He took the picture so he is not in it.

Grrr...

Okay, I'm pissed and I want to get this out of my system...

The other night, I was on call. I was covering a patient signed out to me by another one of the ward teams. He was a large (575 pounds) gentleman in for cellulitis. His blood pressure had started dropping and he had continual fevers of 102 and up. The team had transferred him to the ICU and told me to keep an eye on him.

As the night progressed, Mr. Jones (my favorite 'patient name') continued to spike fevers and drop his blood pressure. He was going into sepsis. His urine output dropped. I reacted: we started more antibiotics, added a second agent to lower his temperature and a cooling blanket and began giving him fluid boluses to keep his pressure up.

He had only one small IV and nurses from the floor, the ICU, the transport team and a tech from anesthesia had tried to get a second IV in without success.

Normally, I would have put in a central line myself. I've done enough and do not need supervision. But Mr. Jones was such a large guy that I could not get any reliable anatomical landmarks to guide my approach. Furthermore, I had never put a line in someone this big and did not know what size needle I would need. The risks were greater: if I collapsed a lung in him (even without the sepsis) it would not go well.

I decided to call the experts. I called Anesthesia first. The anesthesiologist came on the phone and politley told me that per hospital policy first call goes to the Vascular Surgery service and that if they could not do it, they would consult him. So sorry...

I called the resident on Vascular Surgery. He told me that I would have to have my Attending call his Attending who would then tell him to place the line. My eyebrows rose as he said this. Whaaa? We had helped each other in the past: he had supervised me putting in my first lines. I had helped him manage pain in his pediatric patients (surgeons are not pediatricians and sometimes don't know the dosages and regimens for kids).

I briefed my Attending (who did not know either the patient or the situation with him until this time). He was surprised that we had to call the Vasc. surgeon. He made the call. The surgeon told us that because we had one IV and did not need pressors (yet), he would not allow his resident to place a line. If we lost the IV, he would send a resident to put in a femoral line (goes in the groin).

Whaa?! First, if he lost his IV and continued to drop his pressure, the patient could die. Second, have you even seen a 575 pound patient's groin. I'd pay money to see someone even attempt put a line there, not to mention that

The Brothers Mayo and their Institution

In July, I got to go to Rochester to attend a course in Internal Medicine. It was summer and beautiful. I had never been to Rochester. Rochester, Minnesota is best known for the world-famous Mayo Clinic. All these years, I had read its name in jounals, studies and the popular press. I finally got to see the place for myself.

What impressed me most of all is the vision of the Mayo brothers. Here they are (maybe it's just me, but don't they look like they're made of chocolate?)

The plaque near the statue is shown below:

I have a brother too. I love that neither of them ever wanted to claim credit for themselves, but always spoke humbly of themselves as a team.

The vision of these two surgeons and their father led to an institution that put Rochester on the map and created many notable medical breakthroughs.

Here is the entrance to one of the older buildings called the Plover building. It is named after one of the first physician-scientists that the brothers hired to part of the 'Mayo Clinic'. He went on to win a Nobel prize. The rest of the building is shown below. My lack of skills in photography limit me from doing justice to the beauty of the building.



Here is an elevator in the building. Wow!

The main clinic building is in the next two pictures shown below:

The Brothers Mayo believed in education and also build a medical school:

The moral of this story: vision can accomplish great things.

Camp Angel Summer 2011

It's summer!

Once again, Angel On My Shoulder (http://angelonmyshoulder.org/) put on its summer camp for kids experiencing cancer through a loved one. Who comes to these camps? Boys and girls, ages 8 through 12. This year, we had 45 camper and 11 counselors. What's so special about these kids? Well, just for samplers, one has a brother with an inoperable brain tumor, 3 of them a mom with lung and brain cancer, 4 more have moms with cancer, several have brothers and sisters with leukemia and a pair had their mom die from cancer just within the last week. Kids deal with these tragedies in different ways. Often the illness casts a deep and dark shadow over their childhood. Here at camp, they can be kids again. The camp was held, as it is most every year, at Camp Luther (http://www.campluther.com/). This is in northern wisconsin just north of Rhinelander and Three Lakes. 

I arrived late this year. Clinic was VERY busy and I only got in to camp at about 9:30 pm at night. Camp was rather uneventful from a medical standpoint (the way I like it). I treated some cases of heat exhaustion, abdominal pain and one little girl with whom the dialog went something like this:

"Hi! I'm Dr. Vijay. What's wrong?"

"My tummy hurts and (sniff), I'm homesick!"

On Friday evening when the campers arrive, we have icebreakers (to get everyone to know everyone else). They then report to their camps -- rustic camp sites constructed and named 'The Tower', 'Fort', 'The Ark' and 'Treehouse'. The Camp Luther's website (link above) has pictures of these camp sites.

Once settled in, the campers came back down to the main center for dinner. After dinner, there was a special visit from the Northern Harley Club. These bikers give their time to visit the camp and let the kids oogle and pose on their shiny Harley Davidson motorcycles. Campers went on a scavenger hunt after that, and then headed back to camp for the night.

The next morning before breakfast, campers were out on the court playing 4 Squares and shooting hoops. I learnt to play four squares last year. There is a square divided into four with a player in each sector. The goal of the game is to bounce your ball into another square. There are by-laws like 'chicken feet' and 'black magic' to modify the rules of the game.


4-Squares - black magic and chicken feet

I learnt a new game this year: Ninja. Players stand in a circle and after bowing to each other,

Ninja -- yyyyyaaaah!

strike a Ninja pose. Then each person is sequent has a turn. The player tries to touch another player on the hand or wrist. If they succeed, that player is out. Of course, that player can move their hands out of the way. It is great fun to play and to watch. Here are some pictures.

After breakfast, we headed out to Eagle River for a ride on a Pirate Ship (http://eagleriverpivates.com/). This year, before getting on board, Captain Steve's daughter, gave us all a class on hoola hoop dancing. The kids loved it.

Captain Steve's daughter teaches the Hoola

Can you do the hoola hoop?

We saw the ship come in

Pirates returning from a trip

and climbed aboard for a fun ride on the channel. Our ship was piloted by Captain Steve and his first mate, Steve-O.

Captain Steve and Steve-O steering the ship. Aarrhhh!

While on board, we ate popcorn, drew on white t-shirts which we got to take home,

Drawing on the T-shirts

and saw cool things like this eagle's nest (check out the eagle sitting above it),

Eagle Nest -- can you see the eagle sitting on the branch above?

a giant red chair on the shore near someone's house,

The Giant Red Chair

and a duck and her duckings in a row.

A duck and her ducklings. Ahoy, mateys!

There was swashbuckling sword duels with bubble swords (see picture)

(Bubble) sword play with the Captain

and listened to Pirate songs (like "My name is Roger the Pirate and my favorite letter is R(arrrrrhhh!").

We came back to camp to a barbecue cook out, then spent time in the water, tubing, swimming and doing crafts.

Tubing behind a jet ski. Hold on tight!

Some kids went fishing and I hear, we caught 20-odd bluegill and other fish. Some were as big as my arm (okay, not really). As I do every year, I got my painted rock. This year, I chose a penguin. No, I did not paint it myself. (see picture).

After cleaning up. in the evening, we had dinner and DJ Dan brought out his music system. We had fun dancing

Dance Revolution

, doing the Tonga and seeing how low we could go under the bar (of course, some of the little kids could just walk underneath with no bending needed (see the picture).

How low can you go?

Sunday morning, after more games of Ninja

A final game of Ninjas -- the Masters at work

and 4 squares, campers boarded the bus to go back home.

Time to go back

It was fun. Campers could forget the seriousness, tragedy and pain of home for a while and just be kids. Volunteers (counselors, cooks, fisherman, helpers, doctor, face painters, jet ski-ers) all came and helped out.

We'll be back in Winter for another camp.

See you at camp in winter 2012!

Julia (not her real name)

I first met Julia when she brought in her newborn son, Caleb for a well child visit. She seemed thrilled with her new baby and doted over him as moms do. During the course of getting a history, I discovered that Julia worked as an exotic dancer. She was not entirely sure who the father of the baby was but thought it was her 'agent'. She told me that she planned to have nothing to do with him.

Over the next few well child visits, Julia seemed to be coming unglued. She complained that the neighbours were teaching Caleb to say vulgar words and that she had caught him saying them (he was about 2 months old at the time). Her speech was rapid and she rambled on not giving enough pause for me to interject a word in sideways.

Julia established care with me since she did not have a doctor. Reviewing her medications, I noted she was on medications for bipolar disorder, ADHD and anti-psychotics. I asked her about her psychiatrist and she told me she saw him regularly.

After several strange phone calls to the nurse line, a social worker was sent to Julia's house. Someone had expressed concern for Caleb's wellbeing, although at every visit, Caleb was gaining weight, meeting development milestones and always looked clean and well cared for.

Caleb was taken away from Julia by the court.

Julia's mental health seemed to worsen. She told me that her psychiatrist and counselor had 'fired' her for noncompliance with treatment and missing scheduled appointments. This was confirmed by a letter to me by the psychiatrist that said very little other than that they would no longer see Julia.

One day, Julia came in claiming that someone had come into her house, cut her hair and stole her ADHD meds. She wanted an early refill on them. I politely told her I would not refill the meds until she either brought in a police report documenting what had happened or showed me proof that she had established with another psychiatrist. She lost her temper and stormed out of the office, after telling me that she no longer wished me to be her or Caleb's doctor anymore.

After being rejected by other physicians with whom she tried to establish care, Julia called my office again and asked for an appointment with me. She mentioned that she was told that until she had taken her medications and was more stable, no-one else would take her on as a patient.

Julia still does not have a psychiatrist. She has not regained custody of Caleb. She continues to have good days and bad days and alternates between being flirtaeous and threatening.

Has the healthcare system failed Julia?

Privacy

I was chatting with a colleague at a birthday party the other day. This physician said something interesting. His wife added to it. They mentioned how he does not list his telephone number in the phonebook. He tries to avoid going to the grocery store at peak hours. He chided his wife because she bought some tobacco at the checkout counter. She was buying it because someone had suggested putting it around her plants to make them grow better. She wanted to try that out. He was afraid of being recognized and what people might think.

As I finish my second year in practice after residency, I am beginning to understand. Being a doctor is a 'full-time' job. It is however, more than that. One's patients view one as someone with whom they can share their suffering, pain, fears, depression and the medical problems that may be the cause of the result. Often, people are inclined to run a medical problem by you. Family and friends count on you as their go-to person for medical problems. Even if they don't, as a medical profesional, one feels obliged to pitch in and help. Slowly, one's identity in the eyes of many merges with one's profession of being a physician.

As a person, one may want to protect some time 'away' from this identity. As a medical student and resident, I often wanted to be known as a doctor in public so I could help if it was needed. I often wondered why older physicians tended to be more discrete about their identity as doctors. I misinterpreted this as their unwillingness to step up to the plate and help if needed. I now know that this is not true. I have seen doctors quietly come forward and do what needs to be done. I guess I understand now that sometimes a doctor wants to just be a regular person and not feel the weight of being the reliever of suffering or the sympathetic listener or the ...doctor. Most physicians struggle with guilt, as it is, that they are not doing enough for their patients or they are not sympathetic or empathetic enough. So this is difficult to talk about. It is an internal conflict between the desire to be there and make a difference and the need for recharging one's own reserves. I think this is why doctors are private people. My number is still in the phone book.

Cystic fibrosis

One of our beloved physicians retired. He used to (single-handedly) take care of the cystic fibrosis patients that come to us for their care. After he left, we decided that the kids would be cared for by one of my pediatric colleagues, while I would take over the care of the adults.

I had taken care of CF kids during residency. I thought I knew what I was getting into. I had never been involved with taking care of them as adults.

Cystic fibrosis, for those who do not know, is a genetic disease cause by a mutation in a gene that codes for a chloride transport protein. It manifests as increased, thickened mucus in the lungs, sinusitis, diarrhea (from destruction of the pancreas, so it does not make enough digestive enzymes) and often sterility. Because of its genetics, there are often multiple members of a family with the disease. They need frequent hospitalizations -- at least twice a year -- for intensive antibiotics, chest physical therapy, oxygen therapy and pulmonary therapy.

The first patient I got to care for in the hospital was a pleasant 40-something female. Her lung function tests indicated she was advanced in her disease. In the 'old' days, CF patients would die before reaching adulthood. They are living longer. However, by the time they reach their 40s, they die if they do not get a lung transplant. Studies focus on pulmonary function tests (PFTs) and have correlated FEV1 (measured in percentage of predicted) with life expectancy. A FEV1 of less than 35% indicates a life expectancy of less than 3 years generally. When I admitted her for her bi-annual CF 'tune-up', we got a PFT. Her FEV1 was about 25%. That meant that without a lung transplant she would die in a year. I could see the terror in her eyes. There was no hiding her fate from her. She knew her disease, had watched siblings die and knew the end was near.

Fortunately, she was put on the transplant list and received her lung transplant in time. I had the pleasure of taking out her sutures in the office a few weeks ago and listened to clear lungs.

Another CF adult I inherited was a wayward 20-something. He had had the misfortune of having a childhood cancer, in addition to being the only one of several children in that family with CF. This young man was not very interested in CF bi-annual hospitalizations. He had not come since he was 16. In the years that followed he developed a dreaded lung infection with a bacteria called Burkholderia. This organism is so deadly that CF patients with it are not allowed to attend Cystic Fibrosis meetings for fear that others with CF will contract the infection and may die from it.

I did his PFTs and they had declined from the 70s to the 50s in the space of 4 years. I had to sit him and his parents down and have a hard conversation. I pointed out that at his rate of decline and with Burkolderia, if he continued to live as he did, he would be dead in about 5 years. I had his parents in tears, while the patient looked stoically on.

Fortunately, he stayed the length of time in the hospital and we got his PFTs up to the 80s by intensive antibiotics and much needed pulmonary therapy, with which he cooperated and complied. We pushed death back, I think.

With kids with CF, it was bi-annual CF tune-ups and antibiotics. With the adults, there is watching the PFT decline predictably and waiting for death. I had not expected to be dealing with that. Still, I will care for them -- encouraging, goading, exhorting, doing whatever it takes to extend life.

Time off - part 4

Here is Piyali, Simon and me at the exit of the cave.


The next day, Piyali took me to see Marshall University. We drove around Huntington and she showed me the stadium (of 'We Are Marshall' fame). Here she is in front of the Marshall University buildings where we going to see Simon and her labs.



It was a true 'vacation' for me to 'forget' medicine for a while and immerse myself in science. Simon patiently walked me through his research. He works on cell communication in Drosophila. Here he is in his lab, 'posing' for my photo -- looking at his beloved Drosophila.


After we finished with his lab, we went over to the medical school and checked out Piyali's lab. She showed me her research work. Here she is at her lab work bench.

We had a wonderful tirpanyaki lunch at a Japanese restaurant down town.

It was a short break, but lots of fun.

Time off - Part 3

Stalagtites and stalamites join to form pillars, here's one :

Our next stop in the national park was a natural bridge. This is -- as the name suggests -- a bridge over a river or stream that formed naturally. Here it is:

The ceiling of this bridge was spectacular. Here it is:

At the end of that day, we all came home and slept well. It was a fun day.

Time off - Part 2

Huntington, West Virginia is at the edge of the border of West Virginia, where it joins Kentucky and Ohio. In fact, downtown Huntington is at the edge of the Ohio river and one can stand on the bank of the river and see Ohio on the other side. This is me standing with Ohio in the background.

The second day of my trip, Piyali, Simon and myself drove to Kentucky to the Carter Caves. This was the entrance to cave we went into and our guide. I LOVED the accent of the Kentucky folks!

The cave was beautiful with many natural formations related to the process by which caves are formed. Here is one.

Caves are formed by stalagmites and stalagtites -- limestone dissolving in the water and forming extensions of the ceiling and floor, respectively.

These are stalagmites.

The photo below shows a large stalagtite.

Here is Piyali and Simon inside the cave.

More in Part 3

Time off - Park 1

During the Memorial Day weekend, I had time off. So, on Saturday morning, I jetted off to visit a friend I had never actually met in person. Piyali Dasgupta have been friends for about 10 years now. We talked on the phone and emailed each other through the years -- she living in various places in the U.S. pursuing her career and me going through medical school, residency and now working here. She recently bought a house and invited me to visit. I was looking forward to meeting her in person. Both she and her boyfriend are professors at Marshall University, so a side treat would be to visit their labs and learn about their research.

Piyali has a beautiful house in Huntington, WV. She told me that the state bird of West Virginia. On her back porch, she has a bowl of birdseed and practically all day, I could see these beautiful birds come to feed. They were very shy so photographing them was difficult. This is the best I could do.

This next picture is taken through the netted window.

More in Part 2

Don't look now, you've turned into your dad...

I just finished a week on the teaching service in internal medicine. I have now been in practice a little over 2 years. During the week, there were a number of times when I caught myself thinking "wait... I sound like the attending I had as a third year medical student!" It wasn't a bad thought. But it felt like looking in the mirror and seeing your first grey hair or catching yourself thinking 'I sound like my mom or like my dad!'. I guess as one goes through the medical education process -- from the third year medical student doing his or her first clerkship to the time when you are the attending physician, one changes. I felt comfortable in my role. I supervized procedures, stepped in when the resident or student could not get it, and led patient care decisions. I thank God for all my mentors and teachers through the years that have enabled me to step into this position prepared. I pray I will impart and train the next generation of physicians as I was trained.

Rejection

I suppose that if you practice long enough, you will have this experience. My appointment scheduler came to tell me that one of my patients -- a 2 month old was switching providers. I may have lost patients before, but been blissfully unaware. This time, I knew. Strangely enough, just a week before I had answered a phone call from her mother, weeping on the phone that the baby was not doing well. I lost no time getting in touch with a specialist to weigh in on the problem and called her right back. I thought we had things settled. Apparently not. While I do not resent this mother wanting to take her baby to another doctor elsewhere, it does leave me wonder what I did wrong. I cannot think of anything (that's scary too, no?). Well, I hope the mother and baby do well, and receive the care they merit. I will miss not seeing little one grow up in my practice.

Epilogue: Help us build a hospital in Coatepeque

Northridge Church has been sending a team yearly for at least the past 9 years. Each year we do something like what I’ve described above. It is a drop in the bucket. King’s Castle (Castillo del Rey) has a beautiful campus. It also has a full-time doctor (Dr. Boris, who comes out with our and other visiting medical teams), and now about 5 nurses, mostly from the U.S. who are full time missionaries there year long.

Here is a photo of Dr. Boris and me (drinking coconut water)

One of the frustrations of our short visits was diagnosing patients with diseases like diabetes, hypertension, hyperthyroidism, chronic medical and surgical problems like cataracts, chronic skin breakdown and infections. It is impossible to treat this with a single doctor’s visit. They need ongoing care. Many of the older population had cataracts, pterigium and other eye problems that are easily corrected surgically. A cataract operation could take as little as 10 minutes in an equipped operation room with appropriate post-operative care. The people that live in the mountainous (altitude of about 600 meters) municipality of Coatepeque (population of 48,544 living in 126.85 km2). To the best of my knowledge, there is no clinic accessible to these people. The closest hospital is in the city of Santa Ana which is about 15 miles away. Since the population is poor, something more accessible is needed. There are concerns regarding parasites (worms and amoebae) in the drinking and bathing water, high levels of arsenic in the water of the lake. There is a great need for treating injuries, infections and acute health problems before they become chronic. There is an inherent mistrust of hospitals. Most people think that if they go to the hospital, they will never come back alive!

We NEED a hospital in this area. Over the past years, Northridge church and other concerned groups have been donating money and bringing down construction teams. The results are what you see below:

The inside looks like this:

Of course, there is no floor and when it gets hot, the horses on campus come and sit inside. $ 16,000 will allow us to put a tiled floor inside, plumbing and doors and windows.
The hospital is about 120 feet long and 60 feet wide. It will have two floors and an access road.

The next step is to raise about $ 20,000. This will give us a floor and plumbing. Once we have these, we can begin to put in windows and doors and set up electricity. With another $ 60,000 we should be able to get the first floor up and running as a functioning hospital. This will include inpatient beds, an operating room and outpatient areas. King’s Castle has housing where visiting medical faculty can stay. We have a number of physicians, surgeons, nurses and therapists willing to come down for periods of time and donate their services. This is, of course, if we have the hospital up and running. I am picking up this vision and shall be working locally (that is, in Marshfield, WI) to raise funds and support for this project. If you would like to help, email me at aswani.vijay@marshfieldclinic.org or aswaniv@hotmail.com ).