Shades of Gray

I am back in Pondy, reflecting upon yesterday’s voyage, as Brian foreshadowed. Also, I uploaded some posts I had been working on when I did not have internet access over the past couple of days here and here.

I spent Friday in aunt’s house in Nellore. Nellore, the last major city in southern AP before one hits Chennai in Tamil Nadu, is the ancestral home of my mother’s family, and is where my mother was born and spent some of her formative years. I had not been there in 16 years. I spent about 18 hours with my aunt, including the night stay. Saturday morning, I awoke and bathed. Upon exiting the bathroom, I immediately perceived that the door to my bedroom was now on the floor. This was not entirely surprising, since my aunt had complained on the previous night of the white ant problem in that door frame, and I had already ascertained that the door was had been staying affixed to its frame primarily by the adhesive properties of the white paint on its exterior. I cleaned up the shards of wood, saw none of the offending termites, who had presumable headed off long ago to greener pastures, and, after a quick breakfast of pongal, proceeded to the Nellore YRG CARE clinic at about 11am. I was then apprised of the first of a series of unfortunate events.

Sunil had not come. Although his presence was not required for the tour, which was to be conducted by Krishnan and Vasu anyway, it was essential for my return to Chennai that afternoon. At least, it was according to the plan we had worked out 48 hours previously. Since I had an appointment with the Chairman of the Balaji Trust (the parent organization that started MGMCRI) in Chennai that evening, I rapidly became apprehensive and voiced my concern to Krishnan in a half-crazed, high-pitched tone. His eyes widened and he spoke to me very slowly and deliberately, acknowledging that I must be frustrated. This is exactly what I have been trained to say when dealing with “problem” patients and generally works extremely well. It infuriates me when I am subjected to it. Once he outlined a very reasonable course of action that would get me to Chennai by mid-afternoon, I calmed down and my pulse came back down to the low 120s, which is the baseline I achieved following my volume-depletion after cleaning up the disintegrated door frame in 90 degree weather with the ceiling fan off. Krishnan then cheerfully remarked that Americans such as myself are all so black-and-white about plans. Here in India, there are only shades of gray, but you are not used to that, he laughed, and Vasu looked up from his laptop to sagely waggle his head and laugh in agreement. Yes, I said weakly, shades of gray. Hehe. We headed off for the tour, which Krishnan conducted with supreme competence and efficiency I have now come to expect of YRG staff. I called Mrs. Asha to confirm my appointment with the Chairman. She seemed rather surprised to hear from me, even though she had asked me to call at exactly that time on that day. She asked me to call her back in the afternoon, when she would divulge the particulars of the meeting venue and time. We dined at Murali Krishna’s, a fantastic restaurant serving typical Andhra fare, and tried to call Sunil to gloat but he was not available. Then they dropped me off at the bus stop. I left my water bottle in the car.

I boarded the bus to Chennai and payed about $2.80. My recliner didn’t work, and I was too exhausted to find a different seat. It was 1PM and the heat was unbearable; I could barely wait until the driver started off so that we could turn on the A/C and the TV. Sure enough, within five minutes, we pushed off, and I realized that there was no A/C on this bus and that the TV did not work.

We made about 15 stops in Nellore and picked up about 4 people. The last was a man on the outskirts of the city. I don’t know where he was going, but the driver charged him 10 rupees compared to my 114 fare, so I decided it couldn’t be that far. The man was barefoot, dressed in a blue short-sleeve shirt and a darker blue lungi folded at the knees. He held a basket against his hip and spoke in a gravelly baritone very deferentially to the bus driver, ending all his sentences with “saar”. After paying, he stepped into the main part of the bus and began to hawk his wares in an unbelievably shrill voice, walking up and down the aisle several times before realizing that none of the eight of us passengers was a future customer. For whatever he had in that basket. So he sat down and demanded that the driver turn on the TV, not taking no for an answer. The driver yelled something back at him and he quieted down. Meanwhile, my shirt was slowly being steeped in sweat as we rarely got enough wind coming through the windows, what with the frequent stops. My mind started swimming, just a bit, and I began experiencing mildly paranoid ideation. Specifically, thinking a bit about lungi-boy’s abrupt change in behavior, I imagined that the driver and he were in cahoots and that they would perpetrate some heinous act upon us once we were in a more rural setting. I felt a sharp tap on my left shoulder and looked back to see lungi-boy gesturing to my watch. I started to take it off and then thought briefly and said 3:15. This seemed to satisfy him and, after a while, I managed to fall asleep.

When I awoke some 20 minutes later, sweat was dripping off of my brow and streaming down my face. I reached for my water bottle which was safely in the back of Vasu’s car. My kidneys began to shut down for the afternoon. I realized that there was an argument going on. The driver and lungi boy were yelling at each other. Initially, only the driver was yelling, and lungi-boy was trying to plead his case. The driver felt that he had taken him 10 rupees worth of road. Lungi-boy wanted to go a bit farther. Then lungi boy started screaming. He was agreeable to getting off, but he wanted 2 rupees back. He felt that he had only gotten 8 rupees worth of transport. Some of my fellows passengers suggested that lungi boy get off, so he asked the driver to step outside. They would handle things behind the bus. The driver eventually assented, and they stepped off the bus. 10 seconds later, lungi boy came back to put his basket on the bus. Confidence. 5 seconds after this, the driver came back and left with the basket. Then we heard the argument continuing outside. I craned my head to see across the bus, but to no avail. The villagers were gathering to witness the proceedings, and I began to ponder the potential outcomes of the altercation. For my money, the driver could have taken lungi boy. But what if he couldn’t? Could I drive the bus? Don’t they have gears you need to shift? Would my head stop swimming? Fortunately, the driver came back and we headed off. I relaxed and reached again for my water bottle, which continued to be in the back of Vasu’s car.

I called Mrs. Asha to get the details of my appointment with the Chairman.

Yes, Mr, Gopal, you have to get to Ashok Nagar as soon as you get off the bus.

OK. Then what?

But how will you find Ashok Nagar?

Excellent question.

You do one thing. You call me back in 10 minutes.

I did not understand why finding Ashok Nagar was not on the problem list 4 days ago when we planned this meeting. I also did not understand why Mrs Asha had a phone that could apparently only receive calls. I called back in 10 minutes.

Mr. Gopal the Chairman has left for the day.

Really? He left? This is what transpired in the last 10 minutes? HE LEFT? Was it because of the Ashok Nagar dilemma? Really?

Yes. Really. Can we schedule for Monday?

No.

I have fixed an appointment with him at 9:30AM on Monday, OK?

No.

I will see you Monday. The Chairman wants to meet you. You bring your students. Bye.

I called Krishnan to let him know that I no longer had an appointment with the Chairman, and I would just go to Sunil’s house, as we had discussed. Umm, Gopal, there has been a bit of a change. Sunil’s dog is sick. He cannot meet with you. You can go to our guest house.

I want to go back to Pondy.

Yes, yes, that makes much more sense. My driver will meet you at the bus stand. He will put you on a wonderful bus to Pondy. More gray, hah? Hehehe.

Hehehe. Cough cough. I reached for my water bottle. My kidneys began putting their affairs in order. Talk to you later.

We pulled into Chennai at 6PM, where I was to meet Krishnan’s driver. Krishnan called. Hey Gopal, can you do one thing? Can you find the bus to Pondy on your own? It is just that the driver is waiting outside the stand, and he would need to park if he would come to help you.

Sure. Sounds great.

You can’t miss the bus, Gopal, it’s very easy. Go to Enquiry and ask. OK?

Sure. I eventually found the platform with the buses going to Pondy. All ten of them. I got on one. The one with four conductors waiting outside. Or it could have been two. Or one. I ran my bone-dry tongue across my cracked lips, brushed some uremic frost off my arms, put my backpack down and reached for my water bottle. Then it hit. An epiphany. An inexplicable moment of clarity. I ran off the bus and bought a bottle of Aquafina. The bus took off, I downed about half the bottle’s contents, and took stock of my new vehicle.

It wasn’t as fancy as the other one, but the TV worked well enough to blare a 45 minute tape of Ilayaraaja‘s selected hits repeatedly over the next four hours. We made about 10 stops in the city of Chennai and the bus was packed by the time we hit the east coast road. There was standing room only, and not much of that. I fell asleep (lost consciousness) for some 10-15 minutes. When I awoke a blurry toddler was staring up at me from the floor. I stared back at him through my dry, opacified contacts. He was wearing a shirt, nothing below, and lying in his mother’s lap. I then realized that she was sitting on the floor of the bus, breastfeeding him. She glanced up at me and glared. I jerked my head up violently to look in another direction. Any direction. My head hit an object behind me and to the left. It was a man’s posterior. He was sitting on my left shoulder. This explained the excruciating pain just left of my spine. I straightened up and heard something crack in my spine. I glared at him much in the same way the lady on the floor continued to glare at me. He smiled broadly and started singing along to some of Ilayaraaja’s greatest.

This continued for 3 hours before I saw the familiar mien of the Pondy Chief Minister on a billboard. I had had intermittent contact with my aunt and with Brian via text message. The team was waiting for me at the Ajantha hotel. I got off the bus at the Pondy Bus Stand at 9PM and hailed an auto. The trip to Ajantha took another 10 minutes. The team waited patiently for me as I consumed my dinner and brought them up to speed on my activities. We walked out of the restaurant, Satsanga, and saw two autos parked outside. We quickly agreed on a price of Rs. 250.00 per auto and set off for MGMCRI. Tim, Alicia and I talked in our auto about some slum related issues. Then it stopped. The auto did. It just stopped. No petrol?, I asked the driver. He gave me a winning smile, produced a Sprite bottle with an amber-colored liquid, and disappeared behind the vehicle. A minute later, we were full speed ahead. Until we go to the edge of town. Then we stopped again. This time, he had no extra bottles. Fortunately, his friend up ahead realized we were not right behind them and came back. As they conferred with each other, 3 dogs approached us. I proposed that we hitch our auto to these sturdy specimens, but the other auto driver then pulled out his own sprite bottle and we were off and running again. until we were well into the dead space between Pondy and the campus. The first auto came back. There was no backup any more. The three of us joined Brooke and Brian in their auto and we sped off again. My muscles had already adapted to unusual postures thanks to the man that sat on me for 2 hours. Brooke, however, lost feeling/circulation in her right leg after a few minutes. This proved to be reversible once we arrived at the hostel, and the only thing left to do was explain to the auto driver why we would not be paying him 500 rupees. This only took about 20 minutes and was assisted by translational help from the security guard, who spoke only Tamil and no English, and two student passers-by, who spoke a lot of English and Malayalam but little Tamil. That went almost as well as one would predict and we settled on a sum of 400 rupees. I left the driver muttering to himself, no doubt planning his revenge. Some 13 hours after I set out from Nellore, I walked into my room. Never did I expect to be so pleased to see that place. I called home, spoke to Toohie, heard Geethanjali’s voice, and the gray lifted. I slept well.

Peektures!

I know you want pictures of mustaches (and ladies, let me tell you, they are something to marvel at!) But no one has their camera connector here at coffee dot com today. We will definitely get you some mustaches to look at in the future, certainly, so be patient and enjoy what I have below:

This is a cute picture of us on the back of the bus, on our first bus ride out of MGMCRI & RI, notice how empty it is. This was a misleading view of bus rides as all subsequent rides have involved mild panic attacks from claustrophobia. You might note my sweet adventuring hat that also serves to keep the 12 degrees latitude Indian sun off my pasty Irish flesh. Cute, huh?

Ah, home sweet home! You may note the partially constructed dorm that we are currently living in. They are working hard to complete it, though, and do something involving hammers from approximately 5am – 10pm every day. The insides are nicer and we very much appreciate the air-conditioners.

The previously referred to cow, Betsy. As you can see, Tim is trying to get a closer look and she is giving him a very wary stare.

Random Thoughts from Day #2

1.) Sorry KBA, no “mother’s milk” (vanco/zosyn) here. Empiric antibiotic of choice is Ceftriaxone alone.

2.) India has a pay-for-performance health care system. The patients pay upfront and then then they perform the lab/procedure/imaging.

3.) The second two bus trips have not been as pleasurable as the first one.  I have never been so hot/sweaty/claustrophobic at the same time.

Coffee.com

We are all blogging from a fantastic coffee shop/internet cafe/restaurant called coffee.com. We left MGMCRI via the commuter bus. Fortunately, we ran into Niharika, one of the med students we met at the conference, at the bus stop. She and her friend were going into town as well and guided us on the bus. All went well until the bus came to a screeching halt at the bust stop and Niharika’s friend slammed her trachea against the seat in front of her. She is ok, though, I think.

The bus ride was fantastic. It was a slower pace than the 80km/h preferred by our taxi drivers, and afforded us the luxury of looking at the roadside as we made the 20km trip into town. We passed rural sections, marked by paddy fields, neat rows of coconut trees and banana plants; interspersed with partially constructed houses and small, roadside shops. There was no closed sewage system between the college and the city, so we were treated to open sewage canals ranging from one foot to 10-12 feet in diameter. Tamil filmi music blared from the radio next to the bus driver’s seat, and the atmosphere was fantastic. The bus was not as packed full as one would see in the big city, so we were able to look around and enjoy ourselves.

Paras gave a lecture today on organophosphate poisoning. This led to a spirited discussion on research priorities. He observed that the vast majority of funding (>99%, I would estimate) goes to prevention research for things like sarin poisoning. Bioterrorism. This is despite the fact that people in developing countries get OP poisoning from either accidental exposure or as suicide attempts. Treatment research, which is what these patients would benefit from, is almost non-existent. As Tim pointed out, this merely reflects the priorities of the countries best positioned to do the research (resource-rich countries). It was an interesting discussion, and it was nice to see talk about global health issues beyond infectious diseases.

Finally, the baguettes here at coffee.com are as good as the ones in Paris. I know that may sound sacrilegious, but it is true. And the barista is conducting her business in 4 languages: English, French, Tamil and Hindi. I am impressed. Even though she yelled at me. We are now headed to the French area and then the beach. Tomorrow with the dawn of the work week, we hit the hospital.