In the O.R.

Each morning I ride to work as my cab zips through the chaotic traffic, people bustling around the streets, and markets on the side. There are intense noises and smells, people honking, yelling, and walking the streets barely dodging the cars as they whip by (today some guy got his arm dinged by my cab driver... : / ...). There is so much going on that it's hard to take it all in.

Then I reach the Hinduja Hospital. The "old building" (built in 1950) is similar to the less developed hospitals like I've seen in Nicaragua. Cement walls and hallways lead to the outside where there are  places for people to sit in a dusty area tucked between two buildings. There is a small room with a counter and some snacks. Then a bridge connects the old building to the "new building" (built in 1987). This is the side that google shows. It is beautiful, modern, and clean. It was built for physicians who train around the world like the UK and US and then come back to India to practice. There are spots to buy food- sandwiches, coffee, and snacks- just like in the states, and cafeterias. There are elevators designed with marble at the entrance and a guy pushing the buttons for you as you go up to the 16th floor. The patients' rooms are less fancy, with basic sheets and blankets, and a seat or two for family members. There are no EMRs and their xrays are actual films. They don't have computers and TVs everywhere like we do, but they have the basic needs of a hospital. Again, it is a mixture of modern fanciness and old hospital basics. People are speaking another language and I'm picking up on a few of the words and phrases. Then we head to the floor with the operating rooms.

Like in the States, we walk into the OR wearing our caps and masks. Anesthesia is at the head of the table, and there is a hierarchy of surgical attendings to residents to students surrounding the table. They have a scrub tech, circulating nurse, and most of the same surgical equipment. There are differences as well. They have cloth drapes and scrub gowns that are rewashed, slipper/sandal things that you switch into once you reach the pre-op area, cricket playing on the tv in the lounge instead of football, everyone else tilts their head side to side to communicate while I nod my head up and down, and other subtle differences. As we get ready for the case, I forget that I'm in India. It is almost the same, but people are speaking another language while Indi-pop and bollywood music are playing in the background. Then the case starts and I remember how much I love being in the OR- the lights, the focus, the precision, the anatomy- the whole atmosphere. I appreciate that medicine, the human body, and anatomy are universal. They are speaking Hindi but I know their anatomical terms. I love it- watching the surgeon's hands carefully reconstruct the human body. I forget that time is going by and I feel right at home.

Today our last case was a right sided mastectomy with a latissimus dorsi myocutaneous flap. She had breast cancer that had spread throughout her right breast and most likely positive lymph nodes. She will get radiation and chemo next. I felt sad that she had to lose her breast and go through this terrible ordeal, but at least we were able to offer a solution, a chance to be ok, and hope.

In a city with beautiful buildings, wealth beyond comprehension, gorgeous privately funded hospitals, health care access to those who can afford it, and cancer treatment for those who need it- is the same city filled with men, women, and children sleeping on the streets, making fires by their wood huts, squatting on the filthy ground in bare feet, urinating on the street next to where they puddle water to bathe their kids, and lose limbs or die if they get disease. Side by side, completely juxtaposed, are these two completely different worlds living their lives together.

My Chief/Fellow and I

Preparation of the pathology slides 

Freezing the tissue and lymph nodes from another case

Slicing...

Preparation... (apparently I get to see pathology and surgery!)

Examination.

 

My Attending

Right sided mastectomy with a latissimus dorsi myocutaneous flap and tissue expander

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"Love and compassion are necessities, not luxuries. Without them humanity cannot survive." 

(Dalai Lama)

Slowly learning how to venture out on my own

Nehru Planetarium and the cute little peanuts I was hanging out with

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This morning I went down to the hospital and had to figure out my badge situation. They were telling me that I needed an passport photo (a copy of my passport was no good). I had to have an actual photograph or else I couldn't work at the hospital. They told me I could find a photo place just down the road at "Shoba Hotel." So with no other option, I left the HR building and began walking down the little side street they pointed to. There were markets, and people walking, sitting and laying on the sidewalks. I pretended as if I knew where I was going, but after a while of not seeing the "Shoba Hotel" I stopped at one of the little stands and asked "Shoba Hotel kidthar hei?" (where is the SH?). The guy just pointed down the street and said "Oodthar" (there). Not having a clue where he was pointing, I just kept walking. After another block I asked a different guy the same question, and he had the exact same response... soooo I kept walking. This happened 3x then finally on the 4th try he pointed across the street to a building and said "oodthar." Now that I was quite a ways from the hospital, I was very thankful I had made it!  ..However...when I asked the guy if they do photos and he said no. He pointed across the street to more huts and marketing stores and said, "Oodthar".  I frog-hopped across the intersection (traffic laws don't seem to exist here), and made it to more little market stands. Finally I saw this tiny little hut that had a sign saying "20 rupees for 8 passport photos." So I asked the guy if I could have a passport photo, and he told me 50 rupees for 8 pictures- my only option. With me being stubborn, I pointed out that the sign says 20 rupees, not 50, and we started going back and forth. It wasn't the money (since 50 rupees is only $1) but that he was trying to rip me off and take advantage of me. I finally gave in and said "Teekay teekay" (ok ok). After I agreed to the 50 rupees, they brought me to a back little room, shut the door, and dimmed the lights to take the photo. I started regretting being stubborn, hoping I didn't make them mad, and that they weren't planning on killing me.... Not sure this was the best idea I've ever had, but I didn't know where else I was gonna find a stupid passport photo...  Fortunately, they took the photo and had me wait outside to process the photos. After a bit more bargaining- 50 rupees more to get photos "now", 40 more rupees to get all 8 photos, etc.- they let me go with 4 photos for 50 rupees total. Was a little freaked out there for a moment...but I survived :) I brought my photos back to the hospital and got my ID.

After I got that all settled, I met my team for lunch and they told me all the cases were canceled for today, sooo they let me go explore for the day! Another med student from Ohio is at Hinduja doing a rotation in IM, ICU, and ID (He is seeing some very interesting things! the diseases we read about but never see). He grew up in Bombay and is fluent in Hindi. (yes, I should've waited for his help in getting the passport photo... I know...) So anyway, him and I headed down to the Art and History Museum, and after he left I stayed to explore the Nehru Planetarium :) There was an elementary school field trip and they were all dressed in their little uniforms. haha they were so cute! It was me and a ton of little ones hanging out at the planetarium. So yes- I still get excited about things a first grader would enjoy... I was saddened to be reminded that Pluto is not worthy of planet status anymore. At the sky show the little kids were ooing and aahhing and giggling at every little thing. Made me miss those days. After just about 21 years of school (k-12, college, med school) and only 3 more months left, it's hard to believe I'm almost done. I think I will always be like a first grader in that sense tho... I can't help it. I simply like the ooing and aahhing, learning, wondering, and questioning. No matter how much studying I do, there will always be more to learn. (yea. I know. I'm a nerd..)

Anyway, those were my two adventures for the day. We'll see what tomorrow brings!

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Nehru Planetarium

 

My new friend from Ohio and I outside of Hinduja

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"I have no special talent. I am only passionately curious." (Albert Einstein) ..smart guy.

"Everything we call real is made of things that cannot be regarded as real." (Niels Bohr) 

[being at the planetarium made me think of this one... the infinitely large with the infinitely small. the uncertainty principle. relativity and quantum mechanics. yum.]

First Day in the Hospital

The Saifee Hospital at night!
(Where we operated on my first day- took this the night before when we were looking at the Queen's Necklace)

Well, my first day was yesterday... (I'm trying to keep up with this blogging stuff!). During my 45 minute ride into the hospital, there was always something more to see, to take in, to wonder about. I noticed that the number of slums off the main road were fewer as we got closer to South Bombay. Bigger and bigger buildings started popping up as we drove south, but small huts were still scattered between buildings. After my cab dropped me off, I wandered into the old side of Hinduja Hospital- there is an old and a new building connected by a walkway bridge. Again demonstrating the never ending contrast of old and the new. As I entered, I tried my best to ask, "Aapgo maloom Dr. Tibrewala hai?", "Dr Tibrewala kahan hai?" (where is Dr. Tibrewala), and eventually found where I was supposed to go.

I met with the medical director and he explained the history of Hinduja Hospital, the four wealthy Hinduja brothers, and how the health system works in India. I learned that despite the huge population and great need for health care, the government spends only <2% of its GDP on health care (as compared to our 17%), therefore the funding for the public hospitals/clinics is spread incredibly thin. These are the hospitals where most of the residents and students train, where patients flood in like it's a train station, where resources are used to the bare minimum, and where they see absolutely everything. Then there are private hospitals (like Hinduja Hospital and the Saifee Hospital) funded by wealthy donors, and are spread among Bombay as well. The masses of people needing adequate health care is outrageous. And again, there is the contrast of those who have money and access to health care, and those who do not have that luxury. (should health care even be luxury? I'm not sure I agree w/ that...seems like health, safety, and security should be provided by the government.. Health care should be a right, available for everyone, but without funding that's not possible.. anywho. I'm sure that topic could go on and on...) It has been interesting seeing how health care is provided in US vs Central and South America vs India so far. Wish I could see how it works all around the world- what works, what doesn't, is there a perfect health system?

Anyway- I met the surgeon I'm working with and he is great! I am very excited to learn from him this month. Our first part of the day was consults. We saw patients with cleft lips and palates, terrible burns, right hemihypoplastic facial features that needed reconstruction, breast cancer patients for breast reconstruction, and many others. Then we traveled over to the Saifee Hospital for a breast reconstruction. When I realized which building it was, I was blown away that I was actually gonna go in it! It is unbelievably beautiful. The windows look out over the Arabian Sea, the walls and floors decorated with green patterns and designs (the traditional color of Islam), and the shiny tile floors filled with color and decoration, reflecting off any light that reaches them. There are places for you to leave your shoes before you enter the Pre-Op/Post-Op area, and you switch into these shoe/slipper things that they provide. In the middle of the case they insisted that I go to the doctor's lounge for a "tea break." Normally, I would try to stay in the OR for as much of the case as possible, but definitely couldn't pass up a tea break over looking the Arabian Sea! We finished the operation, and I finally got home around 11pm.

The Hinduja Hospital (google image of the new hospital side)

View from the Hinduja Hospital

The Saifee Hospital (google image)

My "Tea Break" view from Saifee Hospital overlooking the Arabian Sea

Another view from Saifee Hospital 

(looking to the top of the Queen's Necklace where I took the picture the night before)

Annnd another view from the Saifee Hospital. So beautiful! 

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"The future belongs to those who believe in the beauty of their dreams." (Eleanor Roosevelt) 

Bombay Hot Spots

The Siddhivinayak Temple 

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Sunday was a great day. We got to sleep in, then Richa took me on a tour of Mumbai! First we took a rickshaw to Lokhandwala Market to practice my Hindi. I practiced talking to the vendors and bought a few little goodies. Next, we went to a South Indian food restaurant. I ordered "Ek idli saambar aur ek masala dosa aur ek dal fry ek roti." It was delicious- especially the dal fry! As we drove downtown in the cab, I learned about the Ambani brothers, their wealth, and the saw one of the most expensive houses in the world (in which they don't even live!). I can see now how books like Shantaram and people who have been to India talk about the stark contrast of extreme wealth and extreme poverty side by side. I learned about the different famous Mosques and Temples and some of the traditional religious ceremonies. Both the Siddhivinayak Temple and the Haji Ali Dargah Mosque were incredibly beautiful! It is amazing that there is such a mixture of everything here- the juxtaposition of Temples, Mosques, and Churches; those who are Hindu, Muslim, Christian, Buddhist, Parsee, Jain scattered among large groups of people; the drastic contrast of rich and poor; cleanliness and filth; an eclectic mixture American, European, Asian, and Middle Eastern influences in restaurants, advertisements, buildings; Hindu and Arabic calligraphy elegantly written on buildings; and smells of every sent you could possibly imagine flooding your olfactory system... I could go on and on. It's a lot to take in at first.

Next we saw the Gateway of India- where Richa's fans ran up to her asking for pictures and autographs (haha not sure what world I'm living in right now haha, defintely not like my days filled with work and studying)- so we quickly moved on to see the beautiful Taj Hotel. Next I got to experience Colaba Causeway and practiced more Hindi :), Then Leopold's Cafe with the lovely combination of Kingfisher beer, cheese cake, and kabobs. Next we ventured over to Bademiyan, and had my first taste of street food! So much tastiness. I felt like I was being brave, but apparently it's one of the hot spots for tourists. We took our street kabob rolls and baida roti to go and went to see the Queen's Necklace on Marine Drive where we ate our delectable street food, with a beautiful view of the city, the Saifee Hospital brightly lit behind the "Queen's Pearls" (lights along marine drive), and looked out over the Arabian Sea.

Simply amazing.

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The Haji Ali Dargah Mosque (this picture does not do it justice)

The Taj Hotel (rebuilt after the terrorist attacks in 2008)

The Gateway of India

Richa's fans taking group photos w/ her

Leopold's Cafe

Bademiyan ...yep. that's street food. just a lil taste :)

The Queen's Necklace of Pearls with the beautiful Saifee Hospital in the background 

(One of the hospitals we operated in today!)

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"The pursuit of truth and beauty is a sphere of activity in which we are permitted to remain children all our lives." (Albert Einstein) 

Guaca-Rita Party- in India!

Not used to taking pics next to actresses and models... definitely need to work on my tan... : /

Gauca-Rita Party- In India! 

Club in Bandra- Trying to learn these Bollywood dance moves! 

Yesterday I experienced my first Gauca-rita party in India! We made gaucamole and mojitos/margaritas for everyone.  Richa said she had to go to townside (south of here) to find avacados but no one knew what they were. They thought they were peppers because they are so rare here. It's funny that I was just in Guatemala in Oct and Nicaragua in Dec, and came to India to have a guacamole party! It was definitely tasty tho! It's interesting how certain areas like the clubs and Bollywood/Tollywood scene are so Americanized. I'm sure I will see the contrast of other parts of Mumbai when I go to work tomorrow and explore other areas here. I'm learning about how different northern and southern India are and how their cultures are different. In the south, there are four languages that people speak in addition to Hindi. I don't know how they keep them all straight! Reading my travel India book makes me want to see the entire country. There are unique things about each state/union territory, such a rich history and culture, and so many beautiful things to see! Perhaps I'll have to come back one day :) 

It has been fun learning about Bollywood and Tollywood and how the film industry works here. I love that their movies have singing and dancing. I wanna learn their dance moves! We watched the trailer for Richa's film coming out this Thursday. She has to leave to go promote it so I'll be here on my own for a while, but am so excited to go see it with her when she comes back home! Being in medicine, I feel like I live in a little bubble and am so far removed from entertainment. It has definitely been fun learning about business, entertainment, language, religion, and culture here. I have a lot to learn! 

First Day :)

Today was my first day out in the city! We took rickshaws all over to do errands and grocery shop, and Richa taught me tons of Hindi phrases. I am learning how to talk to the rickshaws to tell them where to go and other basic phrases to get around and make conversation. I have a lot of work to do... : / but Richa is a good teacher and she keeps quizzing me to keep me on my toes! I learned how to say "Haat moot luh ghaana" when the little kids are trying to sell things while we're riding/stopped in rickshaws. I don't know how to write their words very well....but that's my American attempt at writing, which means, "No touching." The little ones run through the streets as the cars/rickshaws are stuck in traffic. They have berries and little toys to sell as they reach to touch your bags and get your attention. It's hard for me not to smile at them. I just want scoop them up to take them to a safe place. Some of them are bathing in the streets. It's hard to ignore them.

I'm also trying to learn my way around the area so that I know where to tell the rickshaws and taxi's to drive to. There is a messy cluster of squiggles in my little book which is my attempt of making a map of the area... I can tell them, "Lokhandwala jaaougay?" (Do you go to Lokhandwala?), "Lokhandwala jaana hai" (I need to go to Lokhandwala), "Mei Hindi seek ruheehaan" (I'm learning Hindi), "Duhnya vhaad" (thank you), and lots of other good ones! I have a very good teacher :) ...I'll work on actually writing the words correctly, and the alphabet eventually :)

Today we had delicious Indian food for lunch and then a slice of molten lava chocolate cake for desert. So good! I am learning what foods I'm not allowed to eat (like onions, raw veggies, sauces, ice, or limes), so I don't get sick when I'm on my own soon... The food is amazing though. I want to try everything! 

It's fun riding around in rickshaws, as they drive on the opposite side of the street and quickly swerve and dodge each other on the road. There are lots of people here and little markets on the side of the road where they sell veggies and clothes. The Saris are beautiful :) I wish I was fluent in Hindi so could make conversation. Spanish words and phrases keep popping up in my head and I can't remember the Hindi word.. I don't know how people are multi-lingual. So hard to keep them separate for me! When I was ordering bottled water I wanted to say "Ek bottle agua chaiyei porfavor." instead of "Ek bottle pani chaiyei" I'll keep practicing tho! Hopefully I'll get it by the end of the month... I am amazed that Richa moved out here four years ago not knowing any Hindi and just picked it up fluently. I have a whole new respect for people who just move to a new place and pick up the language and culture. 

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"Faith is a knowledge within the heart, beyond the reach of proof." (Khalil Gibran)  

...beginning to learn how to have a little faith in the universe :) 

Arrived in India!

I have arrived in Mumbai, India!! Thankfully everything went very smoothly for my travels. AND there was no one next to me on my 9 hr flight to Amsterdam- so I got to lay down and sleep :) I've never flown over the Atlantic ocean. It was a bumpier ride than I had imagined, lots of wind. I love it when your stomach drops when the plane dips a little bit! I was reading through my key phrases in Hindi and trying to practice the alphabet... however I feel goofy when I try actually talking to people. Hopefully I get a few of the words right...

Thankfully at the airport my ride was waiting for me! I'm staying with a friend of a friend here in India. We came back to her place and I am absolutely blown away at how generous she's being :) I get my own room and bathroom! (yep- that pic is my new bedroom!) She's even letting me use a phone and will get a sim card tomorrow. Tomorrow she's gonna show me the area, how to use the rickshaw/taxi cabs to get around and go to work. She even typed up phone numbers for friends here and key phrases that will help me get around! She won't be here for the whole month so I hope she can teach me everything I need to know before she leaves in a week! 

In Michigan, it's Thursday, Jan 31st, 3:30pm. Here it is Friday, Feb 1st, 2am. It's strange how time is all relative... Well, time to go bed! Tomorrow I get to explore Mumbai :)