It's Friday morning in Vellore. I left OKC last Friday afternoon. I know it's actually not quite a week that I've been gone from home due to all the time-warping-traveling that involves flying to India, but so much has happened in a week. In one week I have come to love this place so much, and feel so comfortable here.
The rest of the week in the ICU and on tropical medicine rounds has again been fascinating, emotionally difficult and taught me so much. Both of the young women I wrote about earlier died on Wednesday night (the woman with puerperal sepsis and the one with peripartum cardiomyopathy). They were too gravely ill to sustain despite all of the efforts put forth to save their young lives. Rounds yesterday were pretty sobering. Dr. Victor had obvious guilt on his conscience. He walked briskly into the ICU stating that the team was missing things. That rounds needed to be diferent. More thorough. "You always wonder if you could have done something more?", he said to me. That sentiment rang true to me both here in India, and in medicine at home. When I have had a patient die, I go back through my mind to think of every possible thing that could have been done differently. I know it will be even more of a mental battle when I am a resident and attending physician myself when my patients have unfortunate outcomes.
I saw several medical "fascinomas" on tropical medicine rounds. A CMC biochemistry professor with Madura foot was particularly interesting. It presented about 10 years ago with an insidious onset of swelling in the left foot, and has progressed over the past several years despite anti-fungal treatment, so he was schedule for surgical debridement in the upcoming weeks. Dr. Libman explained that Madura foot, also simply named mycetoma or maduromycosis results from innoculation from a scratch or abrasion from any number of fungi. Since the majority of Indian people walk barefoot in the rural areas, Madura foot is an extremely common entity, and acquired its name because it was firist reported from the region of Madura in southern India. The fungal infection can remain latent for a long time as the professor's had, but as the fungus proliferates the subcutaneous tissues swells and can even break open or form sinus tracts or invade deeper. Such an interesting disease that I have never seen back home! There were several very interesting cases in the HIV patients-cryptococcal meningitis, disseminated histoplasmosis and the largest brain abscess I have ever seen in a woman with focal neurologic signs. I saw the most textbook head CT of a toxoplasma infection as well. Another new disease I've learned about here is melioidosis. It's caused by Burkholderia pseudomallei which is found in soil and water and is endemic to India and several other Asian countries. It can cause both acute and chronic infections in almost every part of the body! We saw a 23-year-old boy yesterday who presented with a 20cmX20cm splenic abscess that communicated with the body wall. The culprit? Melioidosis of course. Causing disease ranging from pneumonia to osteomylitis it's a bad mamma jamma here in India. Luckily you can hit the patients with wopping doses of 4th generation cephalosporins and carbapenams and they do quite well.
I really enjoy spending time at the hospital. There are always the most intersting people to meet. I've started going to the patient cafeteria at the YWCA with Luella (my Aussie buddy) and Michael, and we have made several friends. One woman insisted on giving me her omlette since I hadn't tried that yet in India, gave us a recommendation to her favorite restaurant in Vellore, than proceeded to invite us to her family's mountain home outside Vellore. So kind. Her son was a vascular surgeon who did his residency at CMC and was now in the UK, and her daughter was a business executive in Cupertino, California. The pride in her eyes was as obvious as how much she missed her children when she spoke proudly of them. She was so happy to hear that we were enjoying India so much.
On the non-medical side of things, the four Oklahomans have been having an excellent time in Vellore!!! The week has been full of activities! On Wednesday evening Jules and I rickshawed it to Gandhi road to shop for some kerthas for work (kerthas are the long, shirt-like tunics that all of the woman physicians wear at the hospital, as well as many Indian women in general wear if they don't wear a sari. Kerthas are a bit more modern, I guess, and less conservative). Gandhi road is a bustling frenzy of activity at all times of day with all the kiosks selling food and the endless blocks of stores. Jules and I bought some fun attire and then headed to the Darling Residency to meet the rest of the international students for dinner on the rooftop terrace. Each Wednesday, all the international students meet at Darling's for dinner and this one was no exception. There were at least 30 of us and it was tons of fun. I talked to the Swedish students for much of the dinner, and we swapped travel advice in our own countries and compared medical training. I explained the residency match to one of them, and she was open-mouthed during most of it and commented that it sounded "so dramatic!" I told her she was completely right.
Yesterday the girls and I hiked College Hill right outside of campus to catch some stunning views of Tamil Nadu and Vellore. It was quite peaceful up there, and though you could still hear the mad honking of transportation below, we felt like we had found a little peace of heaven. There are quite a few large hills to climb around here and we plan on exploring more. We headed to the Darling Residency for dinner, and ate in one of the vegetarian restaurants on the lower levels. I think this was my favorite meals so far! The vegetable kofta curry was the most delicious dish I've had in India! The restaurant itself was quite entertaining with the flat screen TV playing Tom and Jerry as the waiters watched in rapture, and of course the electricity went out twice. It only added to our enjoyment. We took the city bus home, which is another experience in itself to describe. In the evenings they are much less chaotic then during the day, in which it's standing room only and you can barely draw a full breath from the crush of people around you. The ticket collector sneaks up on me every time because I can't make him out from the swarm of people around me as he sticks out his hand to collect my three rupees. The buses are generally old and rickety, and take the turns at such high speeds you feel as if they'll tip and spill you onto the road! Julie actually screamed yesterday as we took a particularly hairy turn, and the whole bus broke out in laughter at her as we stayed upright and continued on our journey home.
This afternoon Julie, Cristine, Michael and I head to Pondicherry (or Pudcherry in Tamil) for a weekend of adventures and relaxation. We will take the 4.5 hour bus for 46 rupees and arrive this evening, ready to enjoy the former French colony. It's quite an interesting place, actually. The town is divided into two sections, a French section and an Indian section, and from descriptions it sounds like a colorful blend between current day India and old France. I'll make sure to write about it when we get back!
Missing everyone at home, but fortunately Landon and I have gotten to talk a lot since I bought a cell phone. I can't wait to meet up with him in Singapore and travel together. I'll write more about that later. Much love to you all.
The rest of the week in the ICU and on tropical medicine rounds has again been fascinating, emotionally difficult and taught me so much. Both of the young women I wrote about earlier died on Wednesday night (the woman with puerperal sepsis and the one with peripartum cardiomyopathy). They were too gravely ill to sustain despite all of the efforts put forth to save their young lives. Rounds yesterday were pretty sobering. Dr. Victor had obvious guilt on his conscience. He walked briskly into the ICU stating that the team was missing things. That rounds needed to be diferent. More thorough. "You always wonder if you could have done something more?", he said to me. That sentiment rang true to me both here in India, and in medicine at home. When I have had a patient die, I go back through my mind to think of every possible thing that could have been done differently. I know it will be even more of a mental battle when I am a resident and attending physician myself when my patients have unfortunate outcomes.
I saw several medical "fascinomas" on tropical medicine rounds. A CMC biochemistry professor with Madura foot was particularly interesting. It presented about 10 years ago with an insidious onset of swelling in the left foot, and has progressed over the past several years despite anti-fungal treatment, so he was schedule for surgical debridement in the upcoming weeks. Dr. Libman explained that Madura foot, also simply named mycetoma or maduromycosis results from innoculation from a scratch or abrasion from any number of fungi. Since the majority of Indian people walk barefoot in the rural areas, Madura foot is an extremely common entity, and acquired its name because it was firist reported from the region of Madura in southern India. The fungal infection can remain latent for a long time as the professor's had, but as the fungus proliferates the subcutaneous tissues swells and can even break open or form sinus tracts or invade deeper. Such an interesting disease that I have never seen back home! There were several very interesting cases in the HIV patients-cryptococcal meningitis, disseminated histoplasmosis and the largest brain abscess I have ever seen in a woman with focal neurologic signs. I saw the most textbook head CT of a toxoplasma infection as well. Another new disease I've learned about here is melioidosis. It's caused by Burkholderia pseudomallei which is found in soil and water and is endemic to India and several other Asian countries. It can cause both acute and chronic infections in almost every part of the body! We saw a 23-year-old boy yesterday who presented with a 20cmX20cm splenic abscess that communicated with the body wall. The culprit? Melioidosis of course. Causing disease ranging from pneumonia to osteomylitis it's a bad mamma jamma here in India. Luckily you can hit the patients with wopping doses of 4th generation cephalosporins and carbapenams and they do quite well.
I really enjoy spending time at the hospital. There are always the most intersting people to meet. I've started going to the patient cafeteria at the YWCA with Luella (my Aussie buddy) and Michael, and we have made several friends. One woman insisted on giving me her omlette since I hadn't tried that yet in India, gave us a recommendation to her favorite restaurant in Vellore, than proceeded to invite us to her family's mountain home outside Vellore. So kind. Her son was a vascular surgeon who did his residency at CMC and was now in the UK, and her daughter was a business executive in Cupertino, California. The pride in her eyes was as obvious as how much she missed her children when she spoke proudly of them. She was so happy to hear that we were enjoying India so much.
On the non-medical side of things, the four Oklahomans have been having an excellent time in Vellore!!! The week has been full of activities! On Wednesday evening Jules and I rickshawed it to Gandhi road to shop for some kerthas for work (kerthas are the long, shirt-like tunics that all of the woman physicians wear at the hospital, as well as many Indian women in general wear if they don't wear a sari. Kerthas are a bit more modern, I guess, and less conservative). Gandhi road is a bustling frenzy of activity at all times of day with all the kiosks selling food and the endless blocks of stores. Jules and I bought some fun attire and then headed to the Darling Residency to meet the rest of the international students for dinner on the rooftop terrace. Each Wednesday, all the international students meet at Darling's for dinner and this one was no exception. There were at least 30 of us and it was tons of fun. I talked to the Swedish students for much of the dinner, and we swapped travel advice in our own countries and compared medical training. I explained the residency match to one of them, and she was open-mouthed during most of it and commented that it sounded "so dramatic!" I told her she was completely right.
Yesterday the girls and I hiked College Hill right outside of campus to catch some stunning views of Tamil Nadu and Vellore. It was quite peaceful up there, and though you could still hear the mad honking of transportation below, we felt like we had found a little peace of heaven. There are quite a few large hills to climb around here and we plan on exploring more. We headed to the Darling Residency for dinner, and ate in one of the vegetarian restaurants on the lower levels. I think this was my favorite meals so far! The vegetable kofta curry was the most delicious dish I've had in India! The restaurant itself was quite entertaining with the flat screen TV playing Tom and Jerry as the waiters watched in rapture, and of course the electricity went out twice. It only added to our enjoyment. We took the city bus home, which is another experience in itself to describe. In the evenings they are much less chaotic then during the day, in which it's standing room only and you can barely draw a full breath from the crush of people around you. The ticket collector sneaks up on me every time because I can't make him out from the swarm of people around me as he sticks out his hand to collect my three rupees. The buses are generally old and rickety, and take the turns at such high speeds you feel as if they'll tip and spill you onto the road! Julie actually screamed yesterday as we took a particularly hairy turn, and the whole bus broke out in laughter at her as we stayed upright and continued on our journey home.
This afternoon Julie, Cristine, Michael and I head to Pondicherry (or Pudcherry in Tamil) for a weekend of adventures and relaxation. We will take the 4.5 hour bus for 46 rupees and arrive this evening, ready to enjoy the former French colony. It's quite an interesting place, actually. The town is divided into two sections, a French section and an Indian section, and from descriptions it sounds like a colorful blend between current day India and old France. I'll make sure to write about it when we get back!
Missing everyone at home, but fortunately Landon and I have gotten to talk a lot since I bought a cell phone. I can't wait to meet up with him in Singapore and travel together. I'll write more about that later. Much love to you all.
Sara dear, I'm so glad you included that bit about Jules screaming. I love these blogs!
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