Clowning around

Today has been a relaxing day thus far. I got to work in time to go on rounds for OBG. I tend to not really understand what is going on because everyone talks so softly and fast, which makes for a confusing several hours. But I pick up bits and pieces and I did get to examine the belly of a woman with a 24 week gestation that measured 36 weeks due to a fibroid. I got to see the usual post-round episiotomy which had a larger than normal tear secondary to inadequate perineal support by the nursing student. Ouch. And the good news is the girl twin (the maid's granddaughter) got out of the NICU and gets to stay with her mommy in the postpartum room. She is so tiny and sweet. Unfortunately both of the babies are septic and are on antibiotics for 15 days (I finally got a hold of their charts.) They look very tired.

I decided I would spend more time on the gyn wards today. I didn't know exactly what to do, but I started reading charts in the pre-op room where there were about 10 patients waiting for their operations. The women had all sorts of operations needed, from rectovaginal fistulas secondary to cervical cancer, vulvar cancer, a 20 year old just admitted with urinary and fecal incontinence, a young girl with a missed abortion (a miscarriage) waiting for a d&c, and so on.

While I was reading the charts, I decided it was time to try and communicate. I basically sat next to the patients' bed and smiled and pointed to my name. Then I said "Kannada or Hindi?" and then they'd tell me what they spoke and I would say "sorry no Kannada/Hindi", point to myself and say "English." I would somehow ask about the woman's children or husbands. One of the patient's son (who was in his 20s) and his wife were infatuated with me and kept taking pictures and video recording me. Some of the other patients would point to a stool and want me to come meet them after my conversation with another patient was exhausted (which happened rather quickly.) I almost felt like I was a clown coming to visit little kids on the peds ward. But you know what, ill be a clown any day if it makes someone who is in the hospital with a yucky diagnosis, smile.

Some other things of note
- the babies stay in the dormitory style rooms (30 beds in one room) with their mothers. There is not a nurse who helps take care of the babies the first several days of life. Usually the mothers or mothers in law are there helping out.
- informed consent is signed by family members (and it appears to be mainly male family members)

Ale and I are going to Hampi this weekend with Vaibhav (Ale's sister's boyfriend's friend since grade school.) We take an overnight sleeper bus Friday night and then spend one night in the town and then come back on another overnight sleeper on Sunday night. It sounds a little ridiculous, but I'm very good at sleeping. Last weekend we did this and I was fine. Ale on the other hand didn't quite sleep on the bus ride back and so she has been a tidbit grumpy all week. Needless to say, we will be taking a bus with actually beds this time instead of seats that go back 150 degrees. Ale without sleep is like my sister without food- the Loch Ness monster.

Here is a picture of our breakfast (the idlys are bottom center and the coconut chutney is the cream colored circle in the center) and then one from outside the hospital

Barbecue nation

I'm full and it is midnight. We just got back from a restaurant, Barbecue Nation, that was quite ridiculously good. And it was a buffet I think. Ale might have to roll me into Bed. The appetizer alone was all sorts of meats and vegetables that are grilled in front of you on a mini grille. Then there is a very large spread of all sorts of Indian dishes: chicken Bryiani, Butter chicken, etc etc. and then is the best part, the desserts. We had such good gulab jamon and a rice pudding.

This wasn't even the best part of the day! So yesterday afternoon, Ale and I tried on like 10 different saris of Mrs. Thacker. Should wrapped us all up and we danced around the house. We each picked out several to wear to the wedding festivities since saris are one size fit all! Then today we went over to Vishal's fiancées house and she had us try on more saris and some Indian dresses. I ended up picking one of Amoolya's saris for the evening dance the night before and then one of Mrs. Thackers for the morning ceremony. Then Amoolya brought us shopping down the street from her house to find blouses to fit us. Blouses are not one size fit all, and originally we thought we could borrow Amooyla's blouses, but turns out Ale and I aren't Indian girl thin. Shocker. So off we went to a store for some ready made ones to match the saris. Now this was not necessarily our most favorite activity, as standing in front of bright mirrors trying on short blouses that show off your newly growing belly isn't exactly my cup of tea. But fat jokes aside, it still was fun playing dress-up. The ladies at the shop loved dressing us up. They were draping the sari on me and all crowding around. Amoolya was laughing and answering their questions about who we were.

We also got to do a little shopping and looking down the street. There were all these beautiful flowers that are used in weddings, to wear and decorate their houses with. Next week, Amooyla is bringing us shopping at Commercial street for bangles, shoes, and more. This just keeps getting better!

Besides for this, I went to clinic this morning. Nothing too much to write home about. There were the usual PCOS (polycystic ovarian syndrome) causing infertility, prenatal visits, abnormal bleeding, etc. Oh I met three Swedish med students who are here for several weeks in Obstetrics. They were very sweet and we got to compare and contrast our medical systems. I find it so fascinating. They do 6 years of med school, then 2 years internship, then 6 of residency. If I'm remembering correctly. This rotation in India is also their first exposure to obstetrics.

In regards to our other meals today, Mrs. Thacker made dosas (our first time trying hers) and a semolina upma for breakfast. Lunch was aloo parotha (potato stuffed bread deliciousness.) Needless to say, I'm getting pretty good at reading at Indian menu. Ale and I sometimes reflect on the fact that we will never be able to eat at an Indian restaurant again in the states and not feel like we are missing something. I can't even eat in some here. For example, the pickles (not american pickles but pickled vegetables to eat with veg meals) are just nothing compared to Mrs. Thacker's pickles. My friend Vikram used to act like he was too good for the Indian restaurants in Gainesville and Liz and I would make fun of him. I can now understand where he is coming from.

Lets see. In other news, Ale and I got a 2 hour nap this afternoon. Life is very taxing here in India.

Pictures: a)Ale and I in Amooyla's closet b)at dinner c)a wall of saris

Around the hospital

Today started off with a new breakfast treat: upma- a semolina dish and some sapota (a fruit.) Ale and I were off to work a little late today. We got in a rickshaw, and within 1 minute it puttered out. To be honest, we have been on plenty of rickshaws that sometimes putter out, and every rickshaw turns off whenever we are stopped (which is often due to traffic.) But this one kept puttering. And then the driver would jump in the back with us and jostle with the petroleum tank. In the midst of the puttering, our driver consulted us about his sore throat. Since he did not speak much English, and we do not speak any Kannada or Hindi it was not our best patient visit. 2 almost doctors from the states in India does not at all equal one real doctor. We recommended nothing since we decided it was viral based on a very through history and physical. With the caveat: seek medical care in 7 days if this has not improved. America had taught us to cya (cover your ass.) We somehow got to work, albeit late due to our rickshaw. We had to walk the last block since the rickshaw might have met its last ride.

I went to clinic again this morning. Clinic is fun for me, because I usually get what is going on by reading the chart and the prescriptions and what is being ordered (all upside down while the doctor is seeing the patient and writing everything). There is much less patient physician communication, so it is much easier to follow. And since it is usually me and a 2 doctors (1 consultant, 1 intern or resident) the me:doctor ratio is much lower than rounds, so I can ask lots of questions if I don't get what is going on.

I also got a chance to see the Thacker's maid's grandchildren today. Her daughter, who is 21, was pregnant with twins and went into St. John's on Thursday of last week because of preterm labor. She was at about 34 weeks on 1-26 when she delivered the two babies- a boy and a girl. The boy was only 1.5 kg and the girl about 2 kg. Since only the parents had been in to see the babies, Mrs. Thacker and the maid wanted me to go see them and keep them updated. Keep in mind, there isn't too much communication between doctors and patients, so the maid and her daughter knew very little. Had this been two weeks ago (guess what- today is our two week anniversary to arriving in India!), I would have been like "umm you want me to go into the NICU where I don't work in India?" But by now, I was quite comfortable flashing my name badge and getting in anywhere. Operating rooms, patient rooms, NICU. You name it, I'm in.

So I found my way to the NICU and asked around for the "Smith" twins (I'm trying to keep some patient privacy.) I asked one of the pediatricians if I could see the "Smith" twins and he of course showed me where to wash up. I scrubbed extra extra well because I knew I'd probably be having the little 34week boogers thrown in my arms. One of the sisters showed me where "Smith" boy was. I walked barefoot into the NICU and then washed my hands another time and got to see the little fella. True love. He was so tiny but so adorable. He was breathing fine on his own, had a feeding tube, and was under lights because he was a little jaundiced. It was a little odd that he was laying on plastic and not on any blankets, but I decided getting his poopy diaper changed was more important at this moment. He had on an adorable little eye mask to protect his eyes and they use these adorable cloth diapers that make me want to just wear them myself. He was so sweet. After a few minutes, I then asked to see "Smith" girl. She had a little more meat on her bones and was in the less critical NICU. Also under light in her eye mask, she was a little sunbathing queen. She was also quite adorable and I enjoyed holding her tiny little hands (rewashed of course) and rubbing her little baby belly. She was luckily on some blankets, but again Sister had to change her dirty diaper. Apparently for 8000 rupees/night, frequent diaper changes are not included.

Which brings me to my next point, these babies were staying in the NICU for 8000/night each. How long will they stay? The family had no idea, so I asked the nurses and physicians. No one was really sure. I asked if the girl would be released first since she was healthier than the boy but "oh she will go with her brother." The maid, their grandmother, makes no more than $50 per month. 8000 rupees is $160. The mother also is a maid and goodness knows what her husband makes. So many hospital bills. And this was a result of an infertility drug. And I'm sure the parents were not counseled on the risks of infertility meds and the risk of multiples and preterm labor. Oy. I guess when it comes down to it, the babies are absolutely precious. So what more can you ask for?

So after loving on the babies, I walked out with "Smith" girl to go see her mother. Just kidding. This NICU was quite the contrast to the US where every baby has an alarm bracelet on.

Some things about clinic:
- the lights turn off several times randomly throughout the day and no one thinks twice
- the women get on and off the examination bed and the sheet is never changed. ObGyn entails pelvic exams by the way.
- patients admitted to the hospital who need to see another speciality, make their way down to the outpatient clinic (OPD), instead of in the US where the physician goes to see them in their hospital room.
- we saw a patient today, 19 yo who was married 9 mo ago. She was complaining of burning and pain for 6 months and she had been to two other hospitals. Her exam was obviously very painful and the doctor just says "relax, relax." It's almost like it Is their right to examine the patient. And the patients just suck it up and still thank everyone after. It's a very different interaction than the US.
-Language barrier. I don't speak Hindi (the language of some of Northern india) or Kannada (the language of Karnataka, the state we are in), but most of the physicians and nurses speak English. Most of the patients, though, only speak their native language. So I definitely feel a disconnect with the patients. There are so many times I just want to put a hand on a patients shoulder, but since none of the doctors do this and I can't say any words of comfort, I feel lost. I appreciate that I can show affection to patients in the states.
- I was looking at some of the info sheets of the patients we were seeing, and written in for income was between 5000-10,000 rupees/month. Some of the charges: 30-40 rupees for each doctor visit, 350 rupees for a pelvic ultrasound. These seem so cheap, yet comparing it to the incomes, how can these people afford to live, let alone bring babies into this world?
-An incident from Thursday during a vaginal delivery: As the mom was pushing, all the sudden amniotic fluid went flying all over the place. It would have been semi-fine, except for the fact that no one wears eye protection or face masks or hats. I avoided getting close to either of the doctors doing the delivery the rest of the day.

In other news, Ale and I visited fabindia again today (pic 1) We had another delicious dinner of roti and pabbad, a potato/cabbage dish, a yogurt curry, and pickles (see those blue containers in the second picture.) It was followed with a trip with Mr.Thacker and Vishal for Jalibe (a dessert) made on a street in old Bangalore (last 3 pictures.)

We got registered!!!!!!!

Today was a funny little day. After taking the bus back from Madikeri, we got completely ripped off by our rickshaw driver. Mr Thacker told us we would have to pay 1.5 because it was early morning, but the driver insisted we pay double. And then the meter went faster than any meter we have ever seen. We refused to pay him double, instead paying him 1.5, but when we talked to the Thackers about it later, they told us some drivers mess with the meter and we should have gotten them to come outside to yell at him when we got to their house.

Ale had not been able to sleep more than 20 minutes, and I had woken up a few times, so we got back in bed for a couple hours when we got home. There was a surprise in our bed though. Pam! She had thought her flight was later than it was, and found out her friends in Delhi wouldn't be going to work on Monday, so she called The Thackers when her bus got to Bangalore and they welcomed her with open arms. We told her that spending a day with The Thackers definitely beats out laying in a hammock all day, given she doesn't get to live with them for a month. For real. She even got to go to FabIndia today and eat Mrs. Thackers pani-puri. Luckily, one extra person in bed did not effect my sleeping and before I knew it, Mrs. Thacker was waking me "your tea and idlys are getting cold." Mmm, I was seriously missing some coconut chutney and idlys. She also made vada and samba. It's so nice being home!

I also got to take a hot shower for the first time since Thursday night. Since I'm in the mood to be honest ...There might have been dirt in the water dripping from my hair.

Ale and I went over to work, knowing what was soon to come. We had another trip to the FRRO (I finally saw what the real name is... Foreign Regional Registration Office.) This morning I went to clinic. It is absolutely amazing how much more efficient these clinics run (minus the total disregard for HIPAA.) we got through like 30 patients in 3 hours. It is very interesting to me the physician-patient interaction. The physicians tend to be a little bit rough and not so warm. The patients are very thankful and appreciative, which is odd because if patients in the US had physicians talking to them like this- it would not go over so well. After clinic I went to the canteen with the physicians I was working with. It seems to be a theme because every time I go to clinic, each team goes to the canteen after together. Nothing like free coffee and treats! It reminds me of the attendings in the US who always pay for lunches for the team. It is very sweet.

So after the sweet little coffee break, I grabbed Ale and we headed off for our last ever FRRO trip! First we stopped offf in the phone shop where I had boughten my Nokia and SIM card, because my phone had yet to start working and it had been more than the 4 days. Long story short, the paperwork was rejected, goodness knows why, so I get to bring back all my forms again tomorrow. Another girl from the states was throwing a tantrum about how she had been through 3 sim cards and I just internally laughed thinking about how much worse the FRRO was.

After that, Ale and I got in a rickshaw for what would be our last ever trip to the FRRO. And actually when we got to the FRRO, we were in and out in about 20 minutes. But that of course would be too easy, when we told the rickshaw driver "foreign registration office on double road, by ESI hospital" like we had done 100 times before, he said "yaya." We verified "you know where that is, right?" "Yaya." And then I even asked again when he made the wrong turn, and I asked again "are you sure you know where 55 double road by ESI hospital is?" And he said "yaya." Needless to say, an hour later with a lot of stopping to ask other rickshaw drivers and pedestrians, we learned there are two "double roads" in Bangalore. Of course.

So once we got into the FRRO, we walked straight to the second floor and handed over our little token sheets. Since we were at different counters (I was B, Ale C) we had to deals with different people. Ale got her new registration sheet in 2 minutes, while I had to fork over my passport that she put a big stamp in and wait for what seemed like an eternity. I tried to stand by the desk because she had my passport, but she kept saying "sit, sit" and there were no seats nearby. So I had to sit without my passport in sight, worrying about the stamp she had put in my passport that would say "Do not let leave country. Put in Indian prison if departing" circa Brokedown Palace. Finally, hours later (ok fine it was 20 minutes) "Lauren Rose" was called and I got my registration paper and my passport with a cool new visa stamp that Ale didn't get. Well worth the panic attacks. Ale and I hightailed it out of that joint as fast as we could. We really expected to be super excited after finally being legally allowed to stay in India until our flight was to leave, but we were just annoyed.

Luckily, Mrs. Thacker was home to melt away our sorrows with pani puri. Mmmm. We also starting working on planning our trips. This weekend we will be going to see ancient ruins at Hampi with Vaibhev and Vishal. The following weekend we are going to Kerala to lounge in the backwaters of this southwestern state. Then we get back to Bangalore in time for our first Indian wedding. We have officially been invited to the Thacker's friends wedding. The invitation even came today saying "Mr. and Mrs. Thacker and family and friends." We are the friends, in case you couldn't tell. We are each picking out one of Mrs. Thacker's saris and getting a traditional top tailored. Needless to say we are soooooooooooo excited.

Pictures: the first is from our final time in the FRRO. Please note the man in front of us was not posed. The second is how Ale and I keep pollution out of our faces in the rickshaw.

A visual from Coorg

Here are some pics from Coorg... Our tent, some hammock time, and the sunset at Raja Seat (this picture does it no justice.) Please don't judge the fact that Ale and I prioritize relaxing over keeping our room clean.

Coorg

This past weekend we got away from the noise and pollution of Bangalore and went to the "Scotland of India." One of Ale's friends from undergrad, Pam (who is in her last year of internal medicine residency in Maryland), joined us. Pam is in Delhi for a month doing a similar shadowing medicine experience. She took a flight down to Bangalore and met us at The Thackers around dinner time on Thursday night. Mrs. Thacker made a delicious meal of okra, "drumsticks" (a vegetable), daal, and baby eggplant.

Mr. Thacker drove us to our bus around 1030 pm, and we were very thankful he was there. There was so much traffic and the bus was on IST (Indian standard time) so it came 20 minutes late. He not only found our bus, then a place for us to pee, but he walked us on and made sure we were okay. It's nice to have a set of parents in India. The bus was dirty but luckily the seats reclined to about 150 degrees, so I laid back and literally woke up 7 hours later in Madikeri (the city we were arriving to in Coorg.) Ale also slept pretty well, but Pam unfortunately did not have the same bus experience.

When we arrived at the bus station in Madikeri around 6 am, a rickshaw was waiting for us. We then took a 25 minute drive up some crazy roads to the middle of the hillsides and were greeted by one of the owners. I was praying we didn't crash as we barreled up these windy, tiny, poorly paved roads/dirt, Ale was praying we weren't being brought to the wilderness to be raped and murdered (Since I had picked this place, I knew it would be in the middle of the hillside. She did not.) We hiked about 5 minutes up some hills and got to our tent. It was really adorable, not in a cute and clean way, but in an "at one with nature" way. The tent had a double and a twin bed. So it wasn't too rugged or anything. We took a 2 hour nap and then trekked down for breakfast. We had some dosas (which were obviously delicious) and met a few of the people staying there, all tourists.

After breakfast from 10-1 everyday they have a trek, so we joined. It was beautiful. It reminded me a lot of being in Peru. The climate is very dry here and it's pretty hot during the day but pretty cold at night. We got some awesome views of the hillsides and saw some coffee plantations. We only saw 2 people the whole trek, who had a little home with chickens and cows. It felt wonderful to finally be moving my body after eating 10x more per meal for the past week.

Afterwards, Pam and Ale went down to the common area for lunch, but I stayed by our tent and read in a hammock for a couple hours. Pure bliss. Then we decided to venture into Madikeri because Pam needed a bus ticket, we wanted to go to Raja Seat, and Pam and Ale had found out our meals were 300 rupees each at lunch (which is grossly overpriced for veg food. 300 rupees is about $6, but it's all about principle.) We were glad we went into Madikeri, because we also set up a driver for the next day which was 1500 rupees instead of 2500 the owners were charging. A little fishy Rainforest Retreat. But really, the area was beautiful and we loved our tent and the food was good, we just don't like being ripped off!

We explored the little town, and headed up to Raja Seat, which is where it is claimed the most beautiful sunset in India is. It really was beautiful. It happened to be really crowded with Indian tourists since Saturday was Independence day for India, but it was still neat to be the only foreigners in a sea of Indian tourists seeing a beautiful part of their country with them.

Afterwards we had a very yummy dinner. We didn't understand why no one else was at the restaurant (was it bad? Vaibhev had recommended it since he is from Coorg), but as we learned the next night, most people in India eat dinner after 8 (hence why we eat dinner at the Thackers around 830/9) and not 6. We called our rickshaw driver, who conveniently would come drive us whenever we wanted. He even let us stop for snacks and drinks and we became fast buds. There is nothing quite like speeding up the hills in the dark in a rickshaw with the wind blowing at your face and PitBull blaring on the radio.

Both nights, we giggled ourselves to sleep in our tent. There might have been some food fights with gross Indian snacks and some henna gone wrong on Ale's foot.

On Saturday, we had a driver pick us up at 730 am. It was a little rough, but it meant we'd be to the Dubaru elephant Sanctuary in time to watch them be bathed and fed. It took a little under an hour to get to the entrance from our tent in the hills. Our driver dropped us off and then we took a jeep to a boat to an island with elephants. Pam and I rode an elephant, but it was kind of a lame ride. There were five of us on our elephant and we literally went in a circle on a dirt path. But despite that, the elephants were still pretty adorable. It was a really pretty island, just lots of Indian tourists. Again, we were glad that at least we were vacationing where the Indians vacation and not just with a bunch of foreigners. We had some coconuts which had the most amazing juicy pulp inside. We got back in the boat and then on a jeep but halfway back, there was a traffic jam so we had to walk the rest of the dirt road to the main road where our driver was waiting. When we got to the main road it was even more jam packed with cars and buses. We found our driver and got in the car but we couldn't even move for 15 minutes and then it took another 30 to get out of the mess. In India, all the cars pass each other and go in the opposite lane of traffic so somehow the road got so packed, and then the jeeps and cars on the dirt road got backed up and it was a mess.

When we arrived at our next stop, we thought it was The Golden Temple but it was instead a big park (there was a rather large language barrier between the driver and us.) We decided we would still go because we like parks. It definitely wasn't like a park in the states. There was bamboo everywhere and dirt and very little grass. You could easily spend hours walking around it. We found a little gazebo and sat next to an Indian family having a picnic. I was smiling at the grandmother when she goes "You like chapati?" I told her I didn't know what it was and then the entire Indian family decided to feed us. Chapati (a bread) and rices and chutneys started piling a plate. Each time we almost cleaned the plate, they would add more things to try. Luckily we had gotten used to eating ginormous portions at the Thackers, so we smiled and ate even when we had been stuffed to the brim. I must say, I thought Jewish moms like to feed people, but they have nothing on the Indian moms.

After our eating adventure, we found our driver again (which is quite amazing since we had no reception and couldn't call him and this was a very busy holiday) and he brought us to the Golden Temple. It is one of the biggest Buddhist monasteries in India and unlike the temples I've seen in Thailand, this was a large complex where all the students and monks live and study. There were also several beautiful temples on the property and very lovely gardens. Outside the complex, there was even a little shopping. It was late afternoon by the time we left the Golden Temple and we decided to head back to Madikeri for dinner. This is when we found out nothing opens until 7/8 pm and we had to have tea and dosas until any of the restaurants opened up. We had a very delicious dinner and then called Bashkar to bring us back to the Rainforest Retreat.

We had another silly night in our tent and finally got a little bit of decent rest. We slept in, had some dosas and tea and then it was time to send Pam off so she could get back to Delhi. After, I went on a little trek to a nearby river with our guide and a nice couple from California/Paris. I joined Ale in the hammocks by our tents afterwards and had a very lovely afternoon lounging in the rainforest. Ale and I even took our first shower from the spout. We had been avoiding this for almost 2 full days (and lots of sweating and being gross) and decided it was time. I had a freezing cold sponge bath while Ale went all Indian and used the big, dirty plastic bucket with a little pitcher to scoop water out. It felt really good to be semi-clean. We headed back to town for a traditional Coorg dinner and then headed off another night bus back to Bangalore.

First world problems

Since today included a trip to the FFRO, it is safe to assume today was not a fun one. We decided we should go in the afternoon as we really prefer going to the hospital vs the FFRO. So I went to the labour room in the morning and went to rounds and then after rounds yet another woman was being wheeled into the delivery room. The woman pushed for all of 3 contractions before -shocker- they did an episiotomy. I decided it was time to verify my worst fears and talk with a resident about this whole episiotomy thing. I confirmed that 90% of the women in this hospital delivering vaginally get episiotomies. News flash, Lauren, you are in a third world country. Maybe it's that Indian women are so tiny, not because St. John's isn't up with the literature? But really, they don't even give these women a shot. It's like 5 minutes of pushing and out comes the local/scalpel combo.

Speaking of third world countries. We left work around noon to make it over to the FFRO. We got to wait for about 3.5 hours before making it upstairs. I'm a very patient person, so I really enjoyed this. When they finally get to my token number and I go up and show my papers, the scrutinizer takes one look at my bonafide certificate and says "No. This is not good enough signature" and shoos me off." The dean had signed my certificate over my attached passport picture. I get Ale to show her certificate proving this is the right signature, but he again shoos me with his hand. So I do what I do best when I get frustrated. In the sea of legit Africans, Southeast Asians, and Middle Easterners, the lone white girl starts crying. #firstworldproblems. (Looking back, perhaps the scribbled signature on my picture that was glued onto the certificate might have been questionable.)

Luckily Ale, with a much more sound mind, barks orders to me. "Lauren go back to St. John's and get a new signature. Sir, what time does she need to be back by?" I was to be back in 55 minutes before the office closed and I would have to come back and wait all day long again for a stupid token. Given that every time we need something signed by the dean, it takes about 2 days minimum, this was no small feat. I went running (with tears down my face), downstairs, out the FFRO and into the rickshaw of an Indian about to profit off of my despair. "400 there and back?" Apparently this wasn't the first time these rickshaw drivers saw a desperate foreigner run out the door in panic. And so I ended up paying 4x more than I should have (a whole $6 extra). Somehow 40 minutes later, 2 rickshaw rides, 400 rupees, 1/2 mile of sprinting later, and by the grace of god the dean being in his office, I was back at The FFRO. The scrutinizer scrutinized my papers and they were accepted. Of course, though that's not the end of the story. Since it was already 430, the registration paper wouldn't be ready that day and so instead of waiting until 515 when Ale's paper was ready, we got out of there as fast as we could. Lucky us get to return Monday to hopefully (knock on wood) pick up our papers. Fifth times the charm?

Luckily, since then we have been fed, showered, and Interneted by now, so today is but a distant memory. Mr. Thacker had gotten us a little pre-dinner snack of things he wanted us to try when we arrived home. We each had 2 Indian burgers (1 fried potato and 1 fried corn/cheese thing on a bun), cheese gulab (a dessert) and jac fruit (cue image of Ale and Lauren plus 50 lbs.)

Tonight we take an overnight bus to Coorg and spend 2 nights in a tent. We then take an overnight bus back to Bangalore on Sunday night. We will be relaxing in the hillsides of Karnataka in an Eco-friendly coffee and cardamom plantation. We will be trekking, taking photos, and maybe meeting some elephants?

Until we have Internet again...

The usual

Today was a nice day. I felt comfortable at the hospital and learned a lot. I got to stay another day at The Thackers. Ale and I got new bonafide certificates (third times the charm, eh? Lets just not think about another day at the FFRO). The Thackers helped us plan our weekend trip to Coorg (we found a tent to stay in, in the hillsides of a coffee and cardamom plantation.) My friend matched into the very competitive urology speciality at his first choice, University of Minnesota (Go Vikram!!)

In food news: Mrs. Thacker makes the best freshly made coconut chutney to go with idly. I tried baht today at the hospital cafeteria when I got coffee with the doctor I was shadowing. It was like a sweet idly mash. yummy.

Today at work I had a horrifying experience. If you thought the episiotomy the other day was bad, well I walked into something worse. After lunch today I walked into the delivery room and saw the aftermaths of an episiotomy turned forceps delivery (yup- apparently they use forceps here.) Since I had eaten, I did not feel faint. I only vomited in my mouth. Just kidding. I watched the repair and decided I would never ever get pregnant. So many stitches, so much blood, and so many screams from an unanesthetized woman.

And now it is time for bed. Congrats, Vikram!!!!

Our first bad day

Tuesday could have been better. After leaving work a little early to get our student visas registered at the foreign registration office , only to arrive at the office and be told although we had an appointment for Monday by 4, the office closes at 2, we set out tuesday am to the office to get there nice and early to get our token to then get registered! See we got student visas, not tourist visas because we thought that would be the appropriate visa. Actually I think we originally applied for a different visa way back in November but were rejected and told to do the student visa after we spent $50 mailing our passports to Houston. But back to today.

So after waking up to chai (chai = tea in india and it is the most delicious tea ever) and idly with home made coconut chutney (love Ms. Thacker), ale and I headed off in a rickshaw to the FFRO (foreign fools registry office). We arrived at 855 and got in the line for tokens. We got our tokens and then were told to wait until 930 for our token numbers to be called. At about 950 we got called and got in another line to show our documents, but then were rejected because we needed a cover checklist. So we got the checklist from a different line, got back in the token line, had our documents looked at and then were told to go upstairs to wait for our number to be called. If you are confused because you thought our numbers had already been called, ya so were we. So then we waited for our respective token numbers to be called and after a while we each had our documents scrutinized. Then they wrote noon on my cover letter. It was about 1030. Why were we to return at 12? Again your guess was as good as ours. So we ventured out to get some random things we needed (tweezers, tissues, hand sanitizer).

We returned by noon and then were told to wait for 15 minutes. So we waited and went to the counter again and were told to wait. This continued on until about 1 pm when our numbers were again called and we finally got an official document for our registration. And then we were done. Just kidding, turns out our registration only lasted until we were done with St. John's which is the beginning of February. But our flight home out of Delhi is on March 9. So we asked the people e,long us what to do and they shooed us away - "go get tourist visa in US" and shooed us away. Defeated, Ale and I left and decided to go back to St. John's to get a new certificate stating we will be here until march 9. Which, needless to say took some more back and forths and waiting. We put on our sad faces and hopefully will have a new certificate by 2 pm Wednesday. Meaning Thursday we get to have another fun filled day at the FFRO!

And you know the best part? All the other elective students just got tourist visas and don't have to register at all. #whatyougetwhenyouarehonest

But to cheer ourselves up, ale and I came up with a list of what we are thankful for:

1. The Thackers
2. Chai
3. Ms. Thackers delicious meals
4. Hot showers
5. A be
6. Fabindia
7. Wifi/Skype/iPads
8. Being in India
9. Living in the USA where paperwork is online
10. The Thackers maid who makes our bed and cleans our clothes
11. All our family and friends
12. Our health

Taken

I forgot to document a classic helicopter parent story.

My parents called me for the first time on our Indian cell (which the Thackers had given us) on a Saturday morning but it was while Ale and I were at the pharmacy. I told them to call me back in 5 minutes and thought it was weird they hadn't 5 minutes later or even an hour later, but assumed they were having some technological difficulties (nothing new). We cant make calls to the US anyways so we went on with our day. It wasn't until dinner later that night, that we got a concerned call from Ale's sister, Adri, making sure we were okay. Apparently my parents had tried to call back but accidentally put in the wrong country code....

Dad: hey Lauren
Random Indian woman: blah blah blah in native tongue
Dad: Lauren? Sorry wrong number?

So then he tried again...
Dad: Lauren?
Random Indian woman: blah blah blah in native tongue
Dad: what have you done with Lauren. Why do you have her phone?
Random Indian woman: blah blah blah in native tongue
Dad: who are you and what have you done with Alejandra and Lauren? You have taken my daughter and Ale? What have you done with them?

Convinced ale and I had become the real life version of Taken, he called Ale's mother (which I had given them the number for in case of emergency!) who then called Ale's sister who then tried to call us. Meanwhile Ale and I were in lala land probably stuffing our faces with dosas and missed the call.

Ensue panic. By the time Adri had finally contacted us many hours later, I think everyone had dropped a couple years off their lives.

Moral of the story: Don't watch Taken.

Here's to Monday

Monday was quite the day. In the course of 8-2 I saw quite a lot of obgyn!

We had moved into the Thackers on Sunday, and Mr. and Mrs. Thacker were still in Calcutta. Vishal had welcomed us into his house with open arms and we had feasted all day and night. Ale and I went to bed with visions of fairies and sugarplums, and the best was only yet to come (Mr. And Mrs. Thacker).

(Don't read the next paragraph if you don't like blood and guts and female organs. And if you don't find medical talk interesting probably ignore a lot of this post.)

Monday morning started off with a rickshaw to the hospital. Within several minutes of my arrival to the obstetrics floor, a woman rolled in in labor. What then happened was horrific. In the next 20 minutes, I heard she was "6-7" followed by her being rolled into the delivery room. With her legs wide open, some local anesthetic was being drawn up in a syringe. I was confused as to why local was being used (they don't get epidurals in this hospital and I had never heard of local being the anesthetic of choice in childbirth) and then I saw a scalpel come out. I have only gotten nauseous and almost passed one time in a medical setting. In third year during my Obgyn clerkship, I started feeling cold sweats and nausea when I saw a woman's perineum tear during childbirth. Well the second time came then. I could feel my stomach turn upside down and the sweat heading on my forehead as I saw a scapel slice through her perineum and hear this woman's screams. I could not even watch the repair, I was so faint.

It's interesting to me that I can easily slice through the skin and fascia of a human being in an operating room, I can watch IV's be placed, I can dissect a cadaver-- a person that has died, and yet to watch the perineum tear in an un-anesthetized woman is what gets me. I better learn to get used to it given my career choice of obstetrics and gynecology. Episiotomies used to be very common in the US, but as far as I know, they found that the damage was worse when a cut is placed versus a natural tear. I have never seen one done in the US (and I've seen a good 50 plus vaginal deliveries) but I'd suspect vacuums and forceps would be used before an episiotomy nowadays. I can not be more thankful that whenever I choose to have babies, I will be doing so in a country with so many resources.

(Queasiness over.)
After that morning shocker, I went on rounds. I still only understand 5 percent of what everyone is saying, so I've come to glancing at the charts after we go over each patient so I can at least get a concept of what is going on. At the end of rounds I found myself following one of the doctors into a semi-OR (like an outpatient procedure type of facility) and I saw a d&c done for what I presume to have been a miscarriage (St. johns doesn't do elective terminations as it is a catholic hospital.) The procedure was done, but with one dilator and I'm not sure how the curettage fit in because it was bigger than the dilator.

Next up, I knew there was an elective cesarean that should be going to the Real OR (called Operating Theatre in India) so I decided that it was as good a day as any to figure out how to go into the OR. I asked a lot of people where and what to do until I somehow got changed into scrubs, put on some OR flip flops (my sneakers just would not suffice but luckily I kept my socks on) and was directed to obstetrics OR. The room I was told to go into turned out to be a laparoscopic cystectomy and not the cesarean, but it was still so interesting to see this done in an Indian OR. Although the room was unairconditioned and everyone was in flip flops, the surgery was completed done like any other I have seen.

After this operation, I decided it was time for lunch so I found Ale and we ventured out for a little break. On my return to the hospital, before I even got into the obstetrics ward, I spotted the team heading into the elevator with an emergent cesarean for a breech delivery. I ended up in the right cesarean OR this time and got to see my first Indian cesarean. I am so in awe of watching every little move and comparing it to the US. I wonder how much we must waste and yet how much we must gain from our wealth and resources.

The baby was pulled from its mothers womb and was such a beautiful little munchkin. If you think babies in America are cute, you must see a freshly born Indian baby! Cuteness.

As the cesarean wrapped up, I had to excuse myself to go meet Ale so we could get our visas registered at a foreign office in another part of town. Which is a whole 'nother adventure I will talk about in the next post.

We got home around 3pm and waited for Mr. and Mrs. Thacker to get home (aka we were glued to our iPads and had delicious chai the maid prepared for us.) Once the Thackers came home, we were captivated by the saris she had boughten in Calcutta and the stories they were telling. And soon it was time for dinner. The cook had prepared a meal for everyone (Mrs. Thacker usually makes all the meals but has help for when she is out of town or needs a sous chef) but Mrs. Thacker was busy making the delicious bread right of the stove so it would be hot for us (we are spoiled) as we devoured the goodness. We had daal and a carrot coconut dish and pickled mangos and lots more. If you see Ale and I in the States in 2-3 months, please ignore the additional 50 pounds we each have gained.

Things to love about India: Norah Jones, Fabindia, and The Thackers

Ale and I spent our first night in the Thackers house last night and we are oh so happy!

We went to Fabindia yesterday after waking up and eating some neer dosa (coconut dosa yum yum). Fabindia is amazing. I was in heaven. It is basically anthropologie but better and cheaper in terms of home linens and accessories. There is a huge fabindia clothing and home store about a ten minute walk from the hospital and it has the most beautiful things from all over India. I literally could have bought linens for everything in my house and to wear. I picked up a couple Kurtas, a purse, and some shoes and I could have bought so much more!!! I'm planning to stock up in Delhi (where I fly out of India). Also, speaking of Delhi, ale and I are officially going to a Norah Jones concert in Delhi on March 5. I am out of this world excited!!! And speaking of music, the Swedish house mafia concert got canceled yesterday because the band had some airplane trouble coming from Indonesia. It was quite unfortunate. Even more unfortunate, they rescheduled to tonight and would not refund our money. Ale and I have work today and tomorrow and we have to get our student visas registered and The Thackers came back from Calcutta so we did not want to go tonight! But can you believe that- in India they reschedule a concert to the next day and do not refund your money!!! Norah better not disappoint!

Back to yesterday. So we walked to fabindia and then Vishal (ale's sisters boyfriend's little brother) picked us up and brought us back to our dorm so we could move out!!! We went back to the Thackers house to move in. We love the Thackers! They are such a wonderful family! Vishal shared the meal his maid had made for him - daal and some "gravy" as he calls it- potato masala deliciousness and lots of parantha (heavenly bread) and then we ordered some green, red, and white (malai-cream) kabobs. Yum yum! Vishal even taught us how to eat with our hands so we could fit in in South India. After lunch, ale and I were pooped so we went to our room to rest aka get on wifi like we'd never seen the Internet before. We had been existing on Internet cafes since arriving in India and that was getting old. Hello Skype/Pinterest/aimlessnothingness

Well I'm heading off to bed now! Happy Monday everyone in the USA. It was a good day for us, will have to tell you all about it tomorrow.

Bangalore Weekend

It is Sunday morning right now. This weekend we have been in Bangalore, exploring the city and getting more acclimated to India.

I was feeling really congested with a pounding sinus headache Friday night and Ale hasn't adjusted to sleeping here, so we went to bed early. Saturday morning I woke up feeling just as bad and Ale then got nausea and vomited. Ale and I decided it was time to visit the pharmacy. It was awesome. We stocked up on sinus meds, anti-nausea meds, ibuprofen, and some cipro (just in case of traveler's diarrhea) all without seeing a doctor. And it cost about $6 for all those pills, which was the same cost as 6 tabs of cipro in the US. I realized, if my sinus congestion doesn't get better, I can just go get myself some antibiotics! <3 india.="india." p="p">
Although we still felt like poop, we weren't going to ruin our first full day without work in Bangalore. We got on our first rickshaw and set off to MG Road. Mahatma Gandhi Road is a big shopping area where tourists like to rendezvous. We stopped in one of the first shops we saw and of course I fell in love with a $1000 rug. I know nothing about rugs, but I learned silk is better than wool and the more knots = prettier and more expensive. Ale's sister's boyfriend's friend, Vaibhav, met up with us there and showed us around and where to actually shop. Sadly, the rugs I like were still just as expensive. We went to a microbrewery in town with him and had some lunch. Then he brought us to a mall and we got to go to FabIndia which is amazing. It has all these really pretty kurtas and tops that Indians wear. We are going again today to a different one, because FabIndia is so pretty. We also stopped off at the Bangalore Palace, UB City, the High Courts and Parliament. We got home around 730 pm and then Nirmal's brother, Vishal, and his fiance, Amulia, picked us up to go out to dinner. They brought us to an amazing Indian restaurant and we got to try all sorts of delicious foods.  Heaven.

Which brings us to today. We are going to a different FabIndia after we finish with the internet cafe, and then Vishal is picking us up so we can move into the Thacker's house! We are very excited. Then this afternoon we are going to a concert- the Swedish House Mafia. It is some techno dj group and I have no idea who they are. Vaibhav invited us to go with his friends and him and we decided to go, "when it Rome Bangalore."

Interestingly, the areas we were in yesterday were a lot more westernized. A lot of  the girls are wearing shorts and short skirts and ale and i were confused. We were convinced we couldnt show any skin in India so we barely brought any american clothes. We were planning to wear full body bathing suits and cover our ankles and necks like 24/7. Vaibhav told us that was silly and that Lonely Planet is a little dated. Still, I dont think we will EVER wear shorts or anything when we arent with the family/friends from here. Especially in Delhi. Vybav and nirmal's brother, Vishal, might come with us on a couple weekend trips so that will be helpful as well. Overall so far everything is way better than I could have imagined!
 

Oh I got a cell phone, it was like $20 and is going to be super to cheap to call anywhere in India or the US. It takes a couple days to start working. It was actually pretty hard to get. All I needed was a letter from st johns stating we were residing there for studies, but apparently tourists cant just get phones. Even people that live here, have to show proof of residency.

Off to FabIndia...

A little less overwhelmed

Today was the second day of work. It was a lot less overwhelming, luckily. I went in at 8 am to the labour room and then was in the OPD (outpatient clinic) for the rest of the day.

The morning started out with a precipitous delivery. I saw people heading to the delivery room (there is one "sterile" room off the labour room where the vaginal deliveries occur) All I could see coming out of the vagina were these little beads on a string and it took me a few moments to register that those were toes of a foot. I guess they do breech deliveries here. And then the baby came out and it was really tiny, so I realized this was a preterm delivery. And then I remembered I was in India. They brought the baby to a resuscitation room and I saw them intubating the tiny thing and trying to set up an incubator. I have no idea what happened to that baby after they wheeled it away.

Things to note about Indian hospitals
1. Everyone working in the hospital wears flip flops.
2. When watching a resident do an arterial line in the ER, Ale saw no alcohol swab used as the resident attempted repeatably on the wrist to find the artery. The resident got a little blood, but not enough, so she squirted the excess blood on the floor and tried again (without a swab.)
3. Flip flops are worn in the Operating Theaters. You take off your shoes before entering and then put on a pair of "OT" flip-flops that god knows how many people have put on their feet.
4. When seeing patients in clinic, each doctor has a set clinic room. They call the patients to come in when it is their turn.
5. Epocrates, uptodate, and iphones are not used to diagnose and treat patients. 

Clinic goes much quicker in India. And procedures get scheduled quicker, too. One patient we saw had gotten an ultrasound earlier in the week showing a fibroid uterus. She came to clinic with the results and the doctor sent her to the outpatient medicine clinic (the same day) to get cleared where she would then be admitted to the Gyn service for a hysterectomy (maybe tomorrow).

In other news, Ale and I have eaten dosas (pancake filled indian goodness) many times in the past 3 days. We found a little restaurant across the street and we have been eating Leer Dosa, Onion dosa, rava onion dosa, rava onion masala dosa, paper masala dosa (and the list goes on) since Wednesday AM. We have branched out a little bit by getting pea paluv, naan, and some other things, but we really like our dosas.

Also, I have officially gotten a cold from the pollution in Bangalore. I started using my nose spray because I had such retched postnasal drip and a sore throat and it has improved a tiny bit.

First day of work

I just finished my first day of work. I wouldn't exactly call it work, more like confused shadowing. I went in from 8am to about 230 pm. .

I was told to report to the labor room at 8 am. The physician who is in charge of the department told me she would meet me there, but she was not there. I started talking to the different interns and residents to figure out what in the world was going on. I had lots of questions. Rounds started at 930 am and lasted until about 11 am. We went to all the different rooms. There was a labour room, antenatal room, PIH (pregnancy induced hypertension) room, post-op room, postnatal room, and several eclampsia rooms on the obstetrics ward. There are about 5-10 beds in each room. The gyn ward I have yet to figure out. On rounds, I really could not understand what anyone was saying, even though they were speaking english. Fail. After rounds, I was still confused about what I was to do. I was not sure what I was allowed and not allowed to do, which made me really uncomfortable. Luckily there were a few interns around who were not doing anything who answered a lot of my questions. They said I could go read charts and examine patients, so I began doing that. All the charts were paper, which I rarely have seen at UF. During one 2 week geriatrics rotation in a nursing home at the beginning of 4th year, I had to read paper charts and it was a challenge. No one's handwriting is legible and I never knew where to look for the list of meds or surgical history, etc. So I got to experience that again. In India.

I found an interesting patient who was 17 weeks and had a hetertopic pregnancy (one baby in the tubes and one in the uterus). She had a ruptured ectopic (the one in the tube) at 6 weeks and an emergency cervical cerclage was placed because the cervix had funneled. Here she was 11 weeks later with her intrauterine pregnancy. This is pretty rare in the US, so I was excited to lay eyes on this. I also met a patient at 29 weeks with Lupus, gestational diabetes, antiphospholipid syndrome, evans syndrome, + hypertension whose AFI was at 4. This is low and usually we would deliver this patient in the US. I asked if she would be delivered and the intern said "No, she is not viable until 30 weeks." I was confused because we say 24 weeks is viable in the US. And then I remembered I was in India.

At about 1130, I decided I need a break. I went to find Ale in the ER and we went to lunch for dosas. She also agreed she was confused, but was definitely not as distraught since she said she expected it. It made me feel better and when I got back from lunch, I talked to a couple of the interns who weren't busy and they expalined a little bit how things work. Tomorrow they said I can follow them in outpatient ob. Even though I barely worked 8 hours, I'm pooped.

Getting adjusted

Ale's sisters/bf's family (The Thackers) came by around 5 pm and showed us around the city. They exchanged money for us, got us fruit, gave us a mobile phone to use, showed us where we can eat and walk around, and brought us to their house for ginger tea lattes (sort of like chai tea but ginger) and fried tapioca sticks. They are ridiculously warm and welcoming. They offered for us to stay with them during our month at the hospital, and we might take them up on the offer. It is still close to the hospital but they have WIFI, a phone that calls for free to the US, "domestic help", etc.  And we would get to eat good Indian food everyday (or so we hope.) They are very nice, it makes it a lot nicer to be here knowing them :) Mrs. Thacker said she would help us make our vacation plans, so that will also be nice. For right now, Ale and I are sharing a room. The hospital and internet and everything are all within a "complex" type of place in the center of the city. Everything is about a 10 minute walk away. We are also going to take up yoga at a place Mrs. Thacker takes yoga. There is a 6 am, 7 am, 8 am, 6pm and 7pm class so we have many options. It is a $1 rupee rickshaw ride away, at a rate of $1 US dollar/ 54 rupees aka 2 cents.

Overall I'd say we are adjusting.

We have arrived.

Ale and I are sitting in an internet cafe on the campus of our new medical school. It is a really beautiful little bubble in the bustling city of Bangalore. There are lots of trees and flowers around and random buildings.

I arrived at the Bangalore airport around midnight and then waited about 5 hours for Ale to arrive. It was actually not that painful. I had slept most of my flights, so I read on my kindle during that time- Cutting for Stone and then some Ob/Gyn Case Files (I am a little rusty!) Ale was of course one of the last off her plane, so when I met her at baggage claim outside of customs, I had already gone through every scenario of what had happened to her and how I would find out and get to St. Johns/fly home. Wifi was not as accessible at the Bangalore airport as it was in Paris. Also, we thought we would have wifi in our dorm, but alas no luck.

Ale's sister's boyfriend's family lives in Bangalore and they had just traveled through India the month before, so Adriana had set a car to pick us up. It worked out perfectly and the boyfriend's mother even called us on the taxi driver's phone to welcome us. I felt good about that, given my recent viewing of Taken (thanks, Marshall.)

We got to the dorm around 7 am and proceeded to find a cafeteria, which was closed. Then we went looking for internet, which was closed. We decided everything must be closed, so we decided it was time to nap. At 10 am, we met the elective secretary and then did about 5 hours of  paperwork/errand running. We had a lot of random things to work out- like wifi (still not sure where we access that or why we are filling out that form), paying the dorm, paying the medical school, getting photos of ourselves for various badges, and photocopying papers. None of which could be done in the same location. It is quite amazing how easy it is to get things done in the States compared to here.

So now I am in India. It's kind of surreal. Not sure when we start working in the hospital, but I am certain it will be quite the experience.

Paris

Wish I could say I'm eating croissants beneath the Eiffel Tower, but
I'm just in the airport. First leg turned out to only be 8 hours which
was a pleasant surprise (I probably would have known that if I read my
itinerary.) The tv didnt work until an hour in and then I could barely
hear with my earbuds or the planes. So I went to sleep. Uneventful I
know.

Jetting off

I've got mixed emotions right now as I head off on a 2 month trip to India. The first month I will be working at St John's Medical College in Bangalore doing an elective in Obstetrics and Gynecology. The next month I will be backpacking from the south of India up to Delhi. I'm going with a friend from med school, Ale, so I won't be doing this on my own. We aren't taking the same flight out there because she will be stopping in Madrid on the way back - which makes the next 24 hours a little less fun. But with a kindle, a lonely planet, tv, and my incredible talent to sleep anywhere anytime, I'm looking forward to relaxing (since I've really been lacking that in my fourth year of med school.) Ill be taking two 10 hour flights with a layover in Paris, and then I'll be waiting in the Bangalore airport for 5 hours until she arrives. Sounds crazy, but unfortunately I've had much worse (re: Australia to Malaysia to Korea to NYC to Miami)

We have both had our fair share of backpacking before, but this just feels different. I'm not going to Europe, or on a medical outreach trip with 30 people to Ecuador. I'm not diving the Great Barrier Reef or trekking to Machu Picchu. I'm going to India to experience another medical system in a third world country with so much poverty. And then yes I'll be visiting the Taj Mahal and being a tourist.

When I get back I'll be finding out where I will be going for residency in Obstetrics and Gynecology for the next 4 years. I guess this is where the transition from medical student to doctor begins.

See you on the other side!