Wednesday, October 31, 2007

Eating Out Gujarati style

The Gujarati festival of Diwali is approaching, and with it the streets of Mumbai are lit up with colorful paper lanturns and electric lights adorning the buildings while the doorsteps are decorated with diyas, or small earthen lamps. Diwali is known as the Festival of Lights, and reminds be quite a bit of how Christmas and the New Year are celebrated back home. This will be the first time I get to celebrate Diwali here in India, and I can't wait!

Since I'll be going to Akola with my parents for Diwali, Mama and Mami decided to treat me to an authentic Gujarati thali dinner before I leave this Sunday, and it was quite an experience. We sat down at the table that was set with large thalis that each contained 4 or 5 smaller bowls, and within moments the waiters began serving how dinner. The menu was fixed, and for the next few minutes each waiter came with serving dish in hand to offer us rotis, vegetable shaaks, curries, daal, khadi, dholka, fruit salad, and chaas.

We all tucked into the feast and our plates were kept full by the very attentive staff. Despite Malan Mami's warning that the waiters will keep serving you until you say no, the food was too good to refuse and I ended up eating far more than I normally do. As my cousin Adit told me, your thali should look messy at the end of the meal, because there is no way you can finish all the food they give you!

Here's an example of a traditional Gujarati thali:

For anybody planning on visiting Mumbai, this is something they have to try, it's wonderful.

Friday, October 26, 2007

An Indian-American in India

It’s always an interesting experience coming to India because despite my appearance it is fairly easy for people here to tell that I am an American. The accent is a big giveaway, especially combined with my limited ability to speak Gujarati and Hindi. And I probably look at everything from the vegetable vendors to the sometimes crazy traffic with an interest and curiosity foreign to the average Mumbaiker.

It also doesn’t help that I stand about half a foot above the average Indian woman, and I often have at least an inch or two on many of the men. I’ve grown fairly accustom to the stares I receive on the street, and whenever I am introduced to someone invariably one of their first comments is on my height. Ba and I must make quite an interesting pair during our walks around Thakur Complex, with me standing over six inches taller than her. She even commented once when I accompanied her to an afternoon garba dressed in a punjabi that several people were giving us (mostly me probably) double-takes as we walked by.

It all reminds me of one of my favorite quotes from Barbara Kingsolver’ Animals Dreams, whose main character is a woman about my height. She says that, height isn't something you can have and just let be, like nice teeth or curly hair. People have this idea you have to put it to use, playing basketball, for example, or observing the weather up there. And if you are a girl they feel a particular need to point out your height to you, as if you might not have noticed."

Still, by in large I don’t really mind it; height does have its advantages, like making it easy to look over the nurse’s head in the OT or grabbing a long pass in ultimate frisbee. Then of course there was the waiter at an Indian restaurant in Amsterdam, who upon seeing me stand up wished me good luck in finding a man. Sigh.

Another interesting part of being an Indian-America here, are the questions I’m asked about America, like whether high school is really like what they see on US TV shows. But those are the easy questions. More often I’m asked, especially by the doctors I’ve observed, about the average salaries of different professions, what the most popular majors of university students are, what the sub-prime meltdown in the US was all about (thank you Mom for explaining that to me or I would have had no clue!), or how many patients do doctors there see in a day. I answer them as well as I can, but I’m often left feeling rather ignorant of my own country.

Granted I’ve probably pestered Samir Mama, Malan Mami, and others in a similar way, asking lots of questions about the festivals I’ve seen here, how many patients come to their clinics, how much are the maids usually paid, and even how late the banks stay open. Mama often laughs at the questions I ask, but it helps make things seem a little less foreign if I understand them a bit. Still, I don’t think I’ll ever quite understand why people here do not keep separate bathtub in the bathroom, getting my feet whenever I brush my teeth gets quite tiresome!

Thursday, October 25, 2007

The head bone is connected to the neck bone…

This past two weeks I’ve been going to Sarodev Orthopedic Surgical Hospital run by the Dr. Haresh Ratanpal, a very good friend of Samir Mama. Dr. Ratanpal is a quite friendly and intelligent gentleman who is a fount of information, orthopedic or otherwise. It has been great fun to talk with him not just about his experiences in his 15 years of practice, but also the human aspect of practicing medicine. He also maintains a very friendly relationship with his patients, one reason being that his patients will often remember his instructions better if they are given as a joke rather than an order.

Dr. Ratanpal was one of the first orthopedic surgeons in India to become qualified to do laparoscopic spine surgery after training in the US with some of pioneers in the field. He also came to the US for training in joint replacement surgeries, which he continues to perform at his hospital in Kandivali. During his OPD, as Dr. Ratanpal is examining his patients, he also explains to me what symptoms he looks for in his clinical exams and how he comes to a diagnosis about his patient’s condition. I’ve learned quite a bit, like how to differentiate the symptoms of rheumatoid arthritis from osteoarthritis, or how to determine if the back pain is neurogenic, muscular, or skeletal in nature.

The most common symptoms his patients present with are back and neck pains, also known as PC syndrome because they are usually office workers who have to sit in front of a computer for several hours every day. The treatments are often quite simple, first relieve the pain with pain relievers and muscle relaxants, and then prevent future pain through physiotherapy and posture adjustment.

I also got to see Dr. Ratanpal perform a couple of internal fixation operations. One was on a mother who received a compound fracture of her tibia when a delivery boy hit her with his bike as she got down from a rickshaw. Using screws and a surgical steel plate Dr. Ratanpal properly realigned the bone with no complications, which was great for the mother since her daughter was getting engaged that weekend.

The other operation was much more difficult, with the patient being an 86 year-old woman with a fracture in the neck of the femur that also extended down to the shaft of the bone. She had further complications of anemia and diabetes, and the hip fracture had left her completely immobilized. If the fracture was not repaired then she would never be able to get out of bed. The operation began well, but as Dr. Ratanpal began to screw in the plate, the brittle bone began to chip badly. Eventually he and the doctor assisting him were able to get a good fixation, but it will still be at least two months before she’ll be able to get out of bed.

Orthopedic operations are a quite an experience compared to the other surgeries I’ve seen, with the OT often resembling a mechanic’s workshop. My anatomy professor once told me that orthopedic surgeons operate with a tool belt, and he is quite right. In addition to the scalpels, forceps, and clamps used by all surgeons, Dr. Ratanpal’s bench had a variety of screwdrivers, pliers, wire cutters, and of course a drill. If you only looked at the doctors’ hands and not at the patient on the table, you could almost believe it was a machine they were repairing and not a human being.

Sunday, October 21, 2007


We celebrated Dassera today, which is a festival during Navratri where machines and equipment used in the workplace as well as children’s school books are decorated with flowers and pujas are performed to ask for blessings of these objects.

We had an early start this Sunday, performing pujas at both clinics and at home. I've posted pictures on my facebook account, but for my Mom who's dying to see me wear a sari, here are a few pictures:

There ya go mom, enjoy! :)

Friday, October 5, 2007

Matters of the Heart

I saw someone’s heart today, and not in the metaphorical sense. This past week I’ve been going to a hospital in Malad (W), a 20 minute rickshaw trip from home, where I’ve been shadowing a cardiologist Dr. Venkat Goyal who is a friend of Samir Mama’s. The hospital he works in is very impressive, the largest I’ve seen so far and the most high-tech, which makes sense since it’s a cardiac center. The main ICU has about 20 beds and a central station where the doctors can monitor every patient’s ECG, oxygen saturation, and blood pressure.

This past week I have gotten to see several angiograms, where the doctor inserts a catheter into the radial artery and threads it within the lumen of the arteries through the arm and across the chest until it reaches the aorta. Then while taking X-rays he injects a liquid that allows him to see the flow of blood through the coronary arteries that feed the heart. It’s pretty amazing to watch the doctor thread the catheter to the heart since he cannot see the vessel the wire is moving through, a bit like driving without being able to see the road.

If the angiogram shows major blockages in the coronary arteries, then the doctor can perform an angioplasty to remove the blockage. To do this, he uses the catheter as a guide to correctly place a balloon at the site of the blockage, and then inflates the balloon to make a whole through the plaque. To keep the vessel open, the doctors puts a stent over the balloon. The stent is a small cylinder of metal mesh that is often coated with a drug that keeps plaque from building up again. The whole procedure takes about 20-30 minutes and the patient can go home after a couple of hours.

When I arrived at the hospital today I was told that a bypass operation was in progress, so I quickly changed into scrubs and hurried into the OT. The doctors had already opened the chest and begun to graft the small sections of arteries taken from the thigh into the heart’s vascular system. It’s a bit of a surreal sight to actually see someone’s heart beating inside of their chest. It’s also not very common for bypass surgeries to be done on beating hearts, they usually put the patient on a heart-lung machine during the surgery so the doctors can work on a still heart. It makes it easier for the doctors to operate, but the damage the heart-lung machine can do to the patient’s blood can mean a longer recovery process. Operating with a beating heart requires much more skill and confidence on the doctors’ part, since much more can go wrong. But thankful everything went well today and after the three bypasses were completed, and the site checked for other bleeds, the doctors stitched up the patient, using stainless steel wire to suture the ribcage close.

As exciting as it was to watch the operation, I don’t know if I would have the confidence to literally hold someone’s heart in my hands as the doctors did while they grated the bypasses. Hats off to all the cardiac surgeons who do that on a regular basis, they’re an amazing group of people.