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!

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.

Dassera

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! :)

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.

India Wins Twenty20 World Cup!!!

Living here in India, it’s impossible to escape the cricket craze. The streets are empty, shops close down, and students abandon their studies all to watch their Men In Blue bat and bowl their way to victory.

I admit I had only a faint idea of what cricket was about when the World Cup in South Africa started a couple of weeks ago. But in the absence of other sports to watch, I became intrigued, and then enthralled by the game. Granted the T20 is a faster version of the game, designed for modern-day short attention spans, but the momentum swings, explosive plays, and nail-biting moments are all still there.

For those who haven’t had the chance to watch much cricket, here are the basics: In the center of the cricket field is the dirt pitch, 66 feet long, with a wicket at each end. A wicket is 3 upright stumps (sticks) embedded perpendicular to the ground like |||. The batting team has a batsman at each wicket, and the other team has 10 fielders positioned around the field and 1 bowler. The bowler’s job is to bowl the ball from one end of the pitch to the other and try to hit the wicket.

The batmen have to defend their wicket, using their bats to strike the ball a bit like the batter in baseball. To score runs, the batsmen must run between the wickets, each time they run to the other wicket they score 1 run. Or they can hit the ball so hard that is goes beyond the field’s boundaries, with 4 runs for the ball rolling over the boundary and 6 runs for the ball going over through the air. The batsmen can get out when the bowler hits their wicket, a fielder catches a pop-fly, or a fielder runs them out by hitting a wicket before he reaches the wicket.

In the Twenty20 format, each side bats for 20 overs, with an over equal to 6 balls. The batting team must score as many runs as they can in the 20 overs, or until 10 wickets are taken. Since each side consists of 11 players, and each wicket must have a player, if 10 wickets are taken, the batting side has only one batter remaining, so it cannot continue batting. After the batting team posts a score from their overs, it’s the other teams turn to bat and try to chase down that score. If they can score more runs in their 20 overs, then they win the match.

Hopefully that’s enough rules to understand the basics of the game, or I just confused you further. India reached the World Cup final through a couple of very intense games. First they had to beat undefeated and home team South Africa in order to make it to the semi-final. They not only won that match, but they knocked SA out of the tournament when all SA needed was 126 runs to make it to the other semi-final. Then in the semi-finals India faced defending champions Australia, who are renowned for being great bowlers and fielders, barely letting India score single runs. But the hero of that match was Yuvraj Singh who hit 50 runs off just 16 balls, letting India run up a high target score. Australia had great batsmen, but India’s bowlers did extremely well, taken enough wickets and keeping the Aussies from getting too many boundaries to take India into the final against Pakistan.

Like any good rivalry, India-Pakistan matches are always intense battles with more than just cricket victory at stake. India batted first and the front-line batsmen started well, with Gautam Gambir leading with 75 runs before he was caught-out. But then the Pakistani bowler picked up their game, taking wickets and barely letting India get singles. Rookie Rohit Sharma saved India near the end of its overs, getting 30 runs to set a challenging target score of 157, but one that was within reach of the Pakistani batsmen.

Pakistan’s chase began terribly, with RP Singh taking the first wicket after Pakistan had made just 2 runs. He took another wicket before Pakistan could reach 40 runs, but just as things were looking good for India, Pakistan’s batting started up and soon the balls were flying over the boundaries. India took a few more wickets but they were unable to keep the pressure on Pakistan, until the 7^th wicket was taken with Pakistan needing about 60 runs from 30 balls. The match looked to be India’s with Pakistan at the end of their batting order. One of those batsmen needed to step up, and Misbah obliged, smashing 6 after 6 to get Pakistan within one shot of victory.

By the last over, India had taken two more wickets, but Pakistan needed just 5 more runs with 3 balls left with dangerous Misbah still on the field. On the third ball Misbah tried to a tricky shot to lift the ball upward to the near-side boundary for a 6 and the victory, but his ball fell just short and into the waiting hands of Indian fielder Shreesanth. That catch was the 10th wicket, giving India the victory by just 5 runs. It was an absolutely nail-biting finish that exploded in celebration both on the field and here in India. Almost immediately fireworks were going off and horns were blaring, while on the field in South Africa the Indian cricketers were celebrating a most deserved victory.

It took me a while to get into it, but this World Cup has made me into a cricket fan, though I’m going to miss watching it once I go back to the States. Maybe I can convince Dad to get satellite TV… :-D .

Adit and Aditi’s Birthday!

Dhmaal = 20 12-year-old kids in an 8 x 20 foot room during a birthday party.

My cousins, Adit and Aditi, had their 12^th birthday party today with all the usual elements, cake, games, balloons, toys, and a few dozen 12 year-olds fueled by chocolates and candies for the 5-hour party.

The group of kids was roughly half boys, Adit’s friends, and half girls, Aditi’s friends, and the differences between the two groups were numerous. Most of Adit’s friends arrived first and almost immediately began their style of WWF wrestling, usually ending with several kids piled on top of one another on the sofas. Meanwhile, the girls were quietly sitting in another room, talking about films, listening to music and doing each others’ hair. After the boys had gone downstairs to play cricket, the girls took over the main room, and with some help from Samir Mama started an impressive pillow fight, showing that girls too can play rowdy.

Mama eventually corralled all the kids together to play some games, one of which I also participated to make the teams even. Mama filled a backpack full of 40 odd objects, and then each team member took turns trying to blindly pick out the object Mama told them to get. The team that can get the most objects wins. Of course, my team won, just beating out Aditi’s team by one object. Heehee.

After I helped Malan Mami serve all of the kids lunch of pav bhaji and pizza, the kids crowded around the cake while Mama lit the candles. I had to resort to using a chair to try to get a picture of the cake, which led to all of kids throwing up their hands trying to block my shot. After cake, Mama brought in two balloons filled with small toys and confetti. One he popped for the girls and the other for the boys, but soon everyone was scrambling around on the floor going for the best toy. And, of course, the confetti got everywhere despite Mami and mine best attempts to vacuum them up. I saw some in the lift shaft just yesterday!

By the end of the party the girls were back to listening to music while the boys were playing DragonballZ on Adit’s new PS2, and by 7pm all the guests had left and the twins could finally tear into all the gifts they had been given. Adit received a ton of PS2 games along with a board game and a nice pen, while Aditi received a couple of books, a purse, earrings, and a cute music box.

A Day of Firsts

It’s been just over a month since I arrived in India and I’ve started to adjust to many of the aspects of Mumbai life; sleeping through the traffic in the morning, avoiding drinking tap water, etc. But still, all of the traveling, shopping, and such that I’ve done here I’ve been accompanied by someone who could speak Hindi and who knew what to do. Today I took a bit of a leap of faith and decided to travel by bus and rickshaw alone. Thankfully, it was in an area of Kandivali that I’ve gotten to know very well so both trips turned out fine, though I did get off the bus one stop too earlier, and gave me quite a boost of confidence that I can manage by myself here to a certain extent.

I also got to accompany Dr. Asher, a gynecologist who is a good friend of Samir Mama to his OPD at a 40-bed hospital in Malad. Dr. Asher is a soft-spoken gentlemen whose been practicing for over 20 years. He very patiently explained pretty much everything relevant about his field of practice, from the hormonal cycle that controls the release of the egg from the ovary to how to determine where the heart is by palpating the women’s belly. It was also nice to be able to place some real experiences and memories to the theoretical knowledge I’ve read in my anatomy book, which is what this sort of clinical experience is all about.

My other first started well but ended on a rather somber note. At 8 this morning, I accompanied Samir Mama a maternity home run by a Dr. Medha Vora; she is a very energetic woman who I’ve met a few times since Mama does sonography there every Tuesday. Today Mama went to do an emergency sonography and then he went to his clinic while I stayed to see a Caesarian section. Dr. Vora’s assistant Minakshi explained the steps of the procedure while we waited for the anesthesiologist to finish his work, and then we donned our caps and masks and entered the OT.

Everything went well at first and a 3-kg healthy baby boy was delivered to a thankful mother of three. It was quite amazing to see the baby utter its first cry and the joy on the mother’s face as she thanked Dr. Vora for delivering him. Then as Dr. Vora began suturing the incision she had made in the abdomen, the mother’s pulse and blood pressure began to fall until the pulse could no longer be detected. At first, I pressed myself into a corner of the OT hoping I would not get into any of the nurses way as the rushed to assist Dr. Vora and the anesthesiologist. But with some of the nurses busy with the newborn baby, I was asked to assist in small ways, closing the door, handing Dr. Vora her stethoscope, and the most unnerving part, checking the woman’s wrist for a pulse that wasn’t there.

I guess you could say that I saw a person die today. For several minutes the newly-made mother-of-four’s heart had stopped; cardiac arrest. My first code. After a while it became difficult to watch as the nurses and doctors applied chest compressions, added a new IV, and attempted to use a defibrillator that refused to cooperate. Soon the OT became crowded with nurses and other doctors so I thought it best to slip out at wait in Dr. Vora’s office, lest I get in anyone’s way.

The doctors and nurses were able to resuscitate the mother and move her to the ICU at the maternity home, but she is in a coma and with serious concerns about brain damage. The prognosis does not look good. Thankfully, her newborn son is doing well and is with his family.

As for me, it was definitely an experience I will not soon forget.