"Are you dying?"

My office is cold. Cold enough that I wear a jacket at work and have given up on the white coat. I have tried to get the temperature raised but have given up. My patients do not want to get undressed and today one of my patients asked me as I felt for neck lymph nodes- "Are you dying?" I answered "Of course, I am. Aren't we all? Some quicker than others." He smiled as he told me that my cold hands are not quite compatible with life.
This reminded me of another time when one of patients insisted that I could not be a healer- "A healer does not have cold hands". Luckily, I know many of my patients would disagree. Although, a healer is not how I would classify myself.
Many years from the original incident - after a disconcerting, surprising move cross country, across time zones and growth zones, I am still wondering how I see myself.
As a primary care doctor who has worked almost exclusively in the hospital for the past few years, I want to be seen as a competent clinician, a decent diagnostician, a thoughtful human being with a good bedside manner and jargon avoiding teacher. I know all of that is quite the mouthful, despite my concern of avoiding jargon.
What a move does- is shake you up; as does a new job. New place, new people, new routines and a new culture of work with the loss of old routines can be traumatic even when desirable. I have wanted this move mainly for spousal career enhancement and in my own way I wanted a change, an improvement in my life and work. Now, what I feel is a dose of regret- at least, this morning after a sleepless night.
I want work that brings me satisfaction, helps people, improves me as a physician and as a human being. That is not a tall order but seems to need a bit of crafting a different way of living and working.

Death Valley- A drive-through weekend

Death Valley happens to be the largest National Park outside of Alaska and a weekend simply does not do it justice; but a weekend we had- so we piled up the kids, ourselves, assorted snacks into our dinky car and hit the road. We tried to visit a part of the southern end of the park.We drove through most of the park but we did do a few beginner's hikes. We were hamstrung by having to carry a child on our back, as the picture indicates.

Luckily, we had chosen a relatively cool time to go- we even found some ice and made the smallest snowman ever.
The first evening we were there, we hiked a little off the main road to look up to old gullies on the hillside and trudge over spongy waterladen sand. It was a no pressure hike limited only by the approaching sunset, like the novices that we are, we had not packed a flashlight with us.

The next morning after a carb laden breakfast we drove all the way to the actual park with the first stop being at the Emigrant pass. Here is a a much more professional view of all the amazing geology of it all.http://www.teachersdomain.org/asset/etv08_vid_etvgeology/

Our most challenging hike has to be at the Zabriskie Point where we had to go down to the old river beds to get a better view of the rock formations and the river bed. The children complained but drag them down we did. We were rewarded by otherworldly sights. Our next stop was the badlands area which happens to be the lowest point in the western hemisphere. There has been recent rainfall which has lead to this area being wetter than usual

Inspiration

We were very lucky to have grand rounds by Faith Fitzgerald who was a great speaker and kept us very engaged with her magical medical mystery tour. Later on as we talked, I was extremely taken with her charm, authenticity and her love for the practice of medicine. It is so rare to find an Internist who retains their love of medicine and the patients who come to them.
One thing she said really resonated with me- I am paraphrasing but she said something like, if a hungry man goes to a grocery store and asks for food because he is hungry and the manager refuses to give him any, nobody bats an eyelid- the man runs a business and a business cannot be giving away its goods. Similarly, if a homeless man goes to a builder and insists that he be given shelter, nobody feels that he ought to be given a house. However, if a sick person goes to seek succor to a hospital and he does not get care, all of us are mortified and feel ashamed somehow.
This is why medicine cannot be a business.

Journey back

I returned about a fortnight ago from Kolkata, where I grew up, went to medical school and where my family of origin still lives. It was a difficult trip home, with two kids and a husband in tow, revisiting after the death of my father from complications related to diabetes, while he was only 64. Like most children, I have things that I feel guilty about- not keeping in touch, not being there for my family and feeling that now, I will never get a second chance for a do-over. It was so good to be home, hold my mother who feels so alone now, and talk to my brothers who had to do all the work and go through all the stress of having to take care of a seriously sick parent. Apart from spending time with my family, I enjoyed walking the crowded streets, teeming with people. I drank tea in an earthen ware container, called a 'bhar'; went on a local train, on a ferry, visited Belur Math and Dakhineshwar. Went on a road trip to Gangasagar with the children to say goodbye to my father. My kids, brown and American were freaked out by the crowds and the begging naked children and the younger one who is two, bawled out "Never, ever, ever again".I took this to mean, he was not enjoying the ferry ride.
Inspite of all this and maybe even because of this,it is always good to go back home, especially when you can go back to your usual life soon enough. Calcutta has amazing energy, the streets are crowded, people are milling about, there is no sense of personal space; people jump ahead of you in queue all the time- and so would I if I were there all the time.I went to College Street Coffee House; I visited our 77th medical school reunion, a school that my father also went to. I dragged our kids everywhere. I wonder what my children think of India- I know that they are interested in the language and the music which is great, but what else do they learn? I will find out soon. Hopefully, I will be listening.