random thoughts about life in general and mine in particular
Cicero said that if a man has a garden and a library, then they have a complete life. Well, we painted the walls of our unused room dark red and put up a wall of shelves and now we have a bona fide library because I have always had an eclectic collection of books. It was great to discover multiple copies of Calvin & Hobbes so now, I can share with my friends.
It is lovely to have a dark, cool place to read
Traveling is wonderful & now that I have it out of the way..I can complain about the heat, the worry, the noise & the snoring & the weird bedtimes & of course, the flights where one is made to feel like a cow being lead to slaughter.
When I get home, each episode during my travels will be like a smooth pebble that I will feel in the palm of my hand, remembering the pleasure of being elsewhere & not quite oneself.
The fall of Kabul reminded me of strange, long forgotten things.
When I was a child in Calcutta, going to school in a school bus and noticing everything around me. I remember huge men in pastel colored salwar kameezes, bearded and so much taller than local folks in West Bengal. They were known as Kabuliwallahs who brought dried fruits from Afghanistan and someone told me that they would usually be waiting near the factory gates to collect debts from the workers. There were at least three huge factories that I crossed on my way to school-- a cotton mill, a jute mill and a ship yard. Only the shipyard survives.
I used to accompany my grandmother to radiotherapy for her breast cancer to a radiation unit in Calcutta. I must have been eleven years old and I remember an Afghan man who may have had oral cancer and whom no one understood as he seemed to only spoke Pashto. It was heartbreaking then and even now, it strikes me as sad not to be understood. I still think about him sometimes.
One of my colleagues in residency for whom Medicine was a second career, told me that he had backpacked in Afghanistan, so very long ago. I was jealous of him as I imagine it is a beautiful country. In the few hours of history I learned in school, it was said Babar missed the gardens of Kabul, where he is now buried. The inscription on his tomb in a garden in Kabul, is said to reads "If there is paradise on earth, it is this, it is this, it is this!" For us in this millennium, we can only think of the destruction of the Bamiyan Buddha.
More recently, I was waiting for my takeout at an Indian place, another patron shared that she was stationed in Afghanistan and loved the unleavened bread from a tandoor, one of the foods she got used to during her deployment there.
For all of us, faraway places feel closer when we understand the people who live there. I saw a movie called The Breadwinner on Netflix a few years ago which told of the struggles of people living under the Taliban. It touched me deeply then and as I think about the people in Afghanistan today, I hope better days are ahead though I worry that life under the Taliban will be much, much worse.
One of the parts of my job is holding the triage phone. This is not something I enjoy. It feels like folks call me for a way to reach other folks and finagle transfers to our teaching hospital. I am not at my best on the phone and phone tag is irritating.
My first conversation with the outside hospital doctor started with bare bones introductions before she asked me if I was a nephrologist because she wanted an expert opinion on whether her patient needed hemodialysis. Now, this was a woman with lots of comorbidities who had heart failure which was responding well to diuretics but her creatinine has creeped up. We discussed her care and decided that there was no indication for urgent hemodialysis.
My very next call from another outside hospital was for another person with newly diagnosed congestive heart failure with a prior history of chronic lymphocytic leukemia. Now, here even before our introductions, the doctor blurted out, asking me if I was an oncologist. I told him that I was a primary care doctor working in the hospital. We reviewed the details of the patient's history and concluded that he needed management of his shortness of breath before looking at further oncologic management.
It is shocking to me that generalists don't seem to trust their own clinical judgement. Care for a patient often degenerates into a consult-a-palooza where a lot of specialists opine about diagnosis and therapy without a leader of care so that therapy may not always be in the best interest of the patient. This is a common scenario which plays out daily in our hospitals and reflects poorly on our internists.
