srizzle

one day soon

2010-08-09T22:41:00.000-07:00

one day soon

for shwe

one day soon
i would like
to lie in an open plain of grass
with you
and watch the open sky above

on that particular day
i would like
to do nothing but that.

in silence
with you next to me.

the clouds
full puffed up boats of gray
or
wisps of near disappear
make their way across the blue canvas

the yellow light whispers
sings loudly off key
stretches like a yawn
blue into sleepy yellow
at midday
then

slowly

birds chaperone
the light off to the west
orange
like
a fire in the hillside
a flame panting then
falling into a manageable
breath

each passing hour
subtle marking of time
until finally
light drips
off
the ledge of our viewing

darkness
like a blanket
pulled over a head

all of my days
going forward
(like we watch the sky)

i would
like to watch the
landscape of your face
as laugh lines form slowly at the corners of your lips
or
soft creases form at edges of your eyes
the marking
of the passing
of our time together.

ss
7/12/2010

burundi to sargur(rural karnataka)

2010-05-07T04:20:00.000-07:00

burundi on top, rural karnataka below.

Eventually Burundi spills into Karnataka spills into Haiti which spills into so many places where people crouch next to roofs slightly higher than than their head and come out of the darkness into the Sun. A Sun that blares belligerent onto any forehead but can’t seem to get into the space inside the house. The house is for lizards or rainwater to drip in damp but not the sun. The deeper into the forest of southern Karnataka the more it looks like Sub Saharan Africa. There are a good amount of tribal folks here. In the hospital all the patients have a weather worn appearance. A spine that protrudes. Skin like it is slapped in between ribs like paper mache, skin like chappati dough roled too thin that a hole is going to emerge if stretched a centimeter more. The diseases are the same. The malnutrition is less here, especially among children. And there are far more doctors in India, but they are still overwhelmed.

I am currently in rural South India with a local NGO trying to support the organization by seeing patients and going into the field, connecting the social-economic impacts of health with classic biomedical treatment of diseases of poverty.

The thing I find impressive about this organization is that in a mortality conference when someone dies, they look at why they died, ie if all medical decisions were timely and appropriate. But they don’t stop there. They ask if a community health worker could have identified the 6 year old girl with malnourishment long before she developed disseminated TB. They look at potential government policies that are not being implemented and could be a source of intervention. The root cause, the root cause is the mantra. So simple, but so far different than most of us docs have been trained.

brecht and prof hayes

2007-09-25T19:29:00.000-07:00

Strangely enough, I have been thinking alot about health care lately. I am out of school and finished with training next year and thinking about what I am going to do. I think most of in the doctor world are not agitators so many times there are very few mentors who are excellent physicians and at the same time asking hard questions about race and class and poverty and gender. And big money and pharma. I came across this poem that is so right on and obvious but strikes me as really profound because we don't really get trained to think on these terms. Check it out.

A Worker's Speech To A Doctor

We know what makes us ill.
When we are ill we are told
That it's you who will heal us.

For ten years, we are told
You learned healing in fine schools
Built at the people's expense
And to get your knowledge
Spent a fortune.
So you must be able to heal.

Are you able to heal?

When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.

The pain in our shoulder comes
You say, from the damp; and this is also the reason
For the stain on the wall of our flat.
So tell us:
Where does the damp come from?

Too much work and too little food
Makes us feeble and thin.
Your prescription says:
Put on more weight.
You might as well tell a bullrush
Not to get wet.

How much time can you give us?
We see: one carpet in your flat costs
The fees you earn from
Five thousand consultations.

You'll no doubt say
You are innocent. The damp patch
On the wall of our flat
Tells the same story.

- Bertolt Brecht

There is this prof at UC Berkeley, Dr. Tyrone Hayes who has studied a particular pesticide, atrazine and its effects on amphibians. And his findings have shown that a very small amount,(a smaller amount than is allowed to be in the water by the EPA) effects amphibians sex organs drastically. And he was attacked by the big pesticide company Syngenta who sells atrazine to farmers at a considerable profit. And he was villified. He is a black man tenured at 32 and an excellent scientist and he could not be bought. His work and story is testimony to the lenghths industry can go if your work, your science becomes a threat. http://www.mindfully.org/Pesticide/2003/Syngenta-Tyrone-Hayes31oct03.htm

And I wonder what would happen if doctors in addition to studying AICD's (Automatic Implantable Cardioverter Defibrillators) studied the damp. What would happen if we spoke out, in mass, about the damp? It dawned on me, so late in my training that evidence for what we do and why we do it as doctors is often based on who puts up the money.

and there is no money in studying the particular toxins that may be linked to black women and cancer, for example. There is no money in studying the damp, or treating the damp. But those who do, and there are some.. like Dr. Tyrone Hayes can maybe lead the way for us clinicians who have a ways to go.

on silence and medicine

2007-06-21T19:46:00.000-07:00

At Vipassana:

I recently spent 10 days in silence. Absolute silence. With 30 other folks. no glances. no speaking. 12 hours of meditation a day. until your leg aches and your ability to be even minded is broken. I was a little scared to spend my short vactation in residency with hours rolled out long as a airplane runway. Waking up at 4 am. And I had just come off 80 some odd work weeks and dying people. The wards in a county hospital. Six of my patients had died over the last month and no emotion really came through until ten days of silence. It wasn't that I sobbed or broke down or anything but I realized at some level my absence of any emotion was not respectful of those lives. I got to thinking that maybe why the American health care system spends so much money on end of life care, is that most of us aren't very comfortable with death. And for someone to become DNR(do not resuscitate) has something to do with their world view and the way they see life and death.
And moving from death, there are so many things American medicine gets wrong or not quite right.
In those meditation hours I got pumped about Cure this. I want to feel after I leave a long day at the hospital and walk into Whole Foods(on those super bourgeois days) that the person behind the counter doesn't have more to do with health and healing than I do. All those startups in the tech world because of their littleness and creativity on the fringes can innovate and come up with new paradigm solutions for old problems. Or charter schools dealing with super low income kids and really breaking ground. What is possible on the fringes of medicine that can be creative and radical? Simple and successful. small or big
A new American medicine. Or international medicine. Can we organize off this website, brainstorm, redefine ourselves, our direction? What we came to the table for as doctors or nurses and what piece of the pie we expect as patients.

As JJ says:
Its on. you and me, the both of us. the all of us. We're on.
It was wierd how many things come up in 10 days of silence. One sit, I heard JJ's laugh clear as a bell. over and over. so many things stored up inside all of our heads.

baby boy born at dawn

2007-02-12T12:07:00.000-08:00

the three of us traveling made a deal to come up with a poem by the end of the World Social Forum in Nairobi. still working on one inspired by the WSF but here is one from working in a rural clinic in tanzania. The mother died of AIDS and even though we got together money for formula for her five month old son, he died right before we left. Me and Monica saw the grandmother and grandson in clinic and payed the 7 dollars a week to get him along for a bit. he is pictured above. he was swimming in those shorts. We didn't even find out his name. A poem seems so useless but it was a long plane ride after finding out the son had died too.

On AIDS in Tanzania
(Loose emulation of JJ's "Focus in Real Time")

Something as simple as a pill in the palm of her hand

This Tanzanian woman
Sings as she breast feeds

They say it was the rain
But it was always my tears and sweat
Which brought up the maize

They said the railroads
Will bring a new day
But it was always diamonds going
with the sunset
The other way

And now she dies and is dying

Something as simple as a pill in the palm of her hand
This Tanzanian woman
Brilliant orange head wrap
Red African mud between her toes
Any pill
Anything close to healing
She does not hold in the palm of her hand.
her left breast sags in
the sun.
ribs exposed
continuum with the spine of her too large wooden chair
she resembles the chair
both of them frail
twigs
ready to snap

a pill
something as simple as a pill in the palm of her hand

her hands scathed
rough as maize husk

she dies and is dying
her 5 month old
baby boy born at dawn
suckles at her dry left breast

he suckles ashes from her left breast

something as simple as a pill in the palm of her hand

Who owns this pill?
What plant or human genome extract gave birth to it?
Who cut the compound, packaged
into compact cure?
In which boardroom, what lawyers patented it?
Blue suits and leather suitcases
tucking death into the space between fine print

Who keeps the cash?
Which markets rose while she fell?
Which corporate graph will track her demise?
Who will clench their fists one over the other as she opens her hand?

This Tanzanian woman
Her baby boy born at dawn

Who will began to ask for a moratorium on their death penalty?

Something as simple
as a pill in the palm of her hand

Who will join this standing up?
A reach to claim the pill
demand the pill
And place it in her hand
Something as simple
And good
As healing
A pill in the palm of her hand

Sri
2/10/07

2007-01-30T09:58:00.000-08:00

from east africa:

in tanzania the children refer to their elders with the greeting "shikamoo." It means "I will hold your feet while you are shackled" or "may you not be beaten too severely" The kids say it lightly and with lots of energy. Most of the folks don't remember the literal meaning. Alot of Tanzania is like that, intensity and struggle which is so woven into everything that folks deal and smile and are so warm and keep going.

We were in a little town near Lake Victoria called Sota. A village. One red mud dirt road. Huts and Huts and people that make their lives outside and migrate inside only to sleep or fetch something. There is this doctor trained in the US that has lived there for 25 years- married a Tanzanian. She just opened a little clinic and our job was to try to survey the community. Try to hit up a thousand hut households, walking from house to house. We had a swahili translator nurse come with us. The kids in each house would set up little chairs for us to sit in and when we went to the next house they would pick up the wooden chairs and follow us. So many children curiously peering at us. We would get a list from the head of the household of everyone that lived in the house. Some men had up to 8 wives. And 16 kids with some of the wives. Most had 2 or 3 wives. And once you started getting the list of kids and 6 of 10 have died of malaria or 4 of 11 you realize this is where your medical school textbook is talking about when it says flippantly 1.5 million folks die of malaria each year.

The survey punched a bunch of holes into so many taken for granted kind of things. The water had schistosomiasis and families didn't boil their water. then you figured out that two days wage is the cost to boil water.

We organized a day for vaccines since so many of the kids don't have their vaccines up to date. All the mothers lined up, but the maternal-fetal health folks did not.

You realize that poor health is the outcome of poverty. They needed roads and jobs and clean water and then maybe we wouldn't see all the end results of the lack there of.

between a clinic and a well, you gotta choose a well. but of course there should not be that choice.

after working i went to climb kilimanjaro(which was amazing!!!) and headed to the world social forum in Nairobi and river rafting in uganda. it is amazing how the world is carved up by race as you go to the tourist things. Kili only had australians and white south africans and canadians and europeans and americans. the brown folks were immigrants from these rich countries and maybe some koreans and folks from japan.

Slowly, slowly i am trying to write to remember for myself and keep myself committed.

Sri
Sri

Sri

diagnosis

2006-12-13T21:08:00.000-08:00

i read this women describe a potential devastating diagnosis like this:

it is either
a maniac with a knife
or the wind

David Jewell

30 day experiment

2006-12-01T19:58:00.000-08:00

Inspired by experiments in truth part 2 by guri(she is definitely an inspiration in many ways- see link on my page) I am going to make my own experiment. Push my boundaries. I am on a 80 hour work week schedule this month. calls every 5 nights for 30 hours. today was the first day.

i am going to make a committment to not complain this month. I try not to complain much but the culture of medicine is to complain. It is almost a bonding ritual. A way to create comradarie. But it is not healthy.

I remember a few years ago when I hung out with a couple that used to work with Cesar Chavez. He would go over the day at 6 in the morning and then ask the couple when they would want to meet at night. When they said, "We have kids, we gotta get them to sleep." He would say "Okay, lets meet at 1 am at this coffee shop and organize tomorrow for the farm workers" And when folks would complain he would tell them that no matter how hard they worked, or sweated or suffered it was not comparable to the plight of the farmworker.

I think of that alot in the hospital. I am healthy. That should be a source of gratitude. And the hospital should remind you of that. No matter how much I struggle for my patients in this county hospital- from so many inefficiencies and lack of adequate resources and frustrations of being a doctor in the county it is nothing compared to trying to navigate a health care system that counts you as a number when you are sick and poor and not knowing where the hell you are going to find the money to pay for any of this care but you are sick and poor. and really sick. and maybe pretty young and an immigrant. That reality I don't know and hope never to know.

But this month it will be the awareness of the tongue. The counting of the complaints that rise from the back of my throat.

Sri

2006-11-27T23:59:00.000-08:00

today a patient died. my patient. came into my clinic. 62 year old chinese man with decompensated heart failure. talking and walking and saying doc i can't walk as many blocks as i used to three weeks ago. a nice slightly stoic chinese man. and i sent him upstairs to get labs to decide what to do with him. admit him to the hospital. or send him home with more water pills. after getting his blood drawn he slumped over and died. i told him i was worried about him. i was the last doc to see him alive. alive at 11:44. dead at 1:15. walked into the room, skin blue as a pale sky. but less vivid. and more depressing. played over scenario and scenario of what imightacouldadone.

teared up a little and drank tonight. tipsy still...

gotta work early tomorrow...

Sri

HIV

2006-10-24T21:18:00.000-07:00

I have been on HIGH FIVE as they call it HI-V or HIV all month. Everybody who has HIV in the hospital we hear about it and help take care of them. Everyone who has never been diagnosed and comes in sick and they run a rapid HIV test on them that comes back positive we go and see. in the ER. It is just me and the Infectious disease fellow and we have anywhere between 9-14 HIV patients at a time.

It is so interesting and devestating and inspiring, all at once. the reaction of people. so many reactions for hearing the same news. We have told about 6 or 7 people this month that they have HIV. The big black man with corn rows and a skull cap who who doesn't look at you. Absolute stoic. No questions, just waiting for you to finish. The 33 year old sweet Cameroonian woman who starts crying. Who won't touch your pen because she thinks then you would not want to touch it again, because she now has HIV. She is so straight edge she knows(or you think she knows since she won't tell you) it could only be her husband who has cheated on her and given her HIV.
The gay man who has been in denial and finally gets sick, gets tested and is positive. His reaction, the man, damn it caught up with me. He cries too.

The 50 yr old black woman who lived on the street for two years and turned tricks to get by. Just for a little while, just to get by.

the thing about it is in the states, HIV is a little forgiving. there is redemption. there is some treatment. a chronic disease. something you can live with and stomach. which is not the case for so much of the world. and its fun to watch people who were sick, get on the right meds and bounce back. Yesterday I was shooting the shit with this Puerto Rican guy who was kinda sick a couple weeks ago in the hospital. and he comes in to clinic yesterday in his Sean John t-shirt and baggy jeans, his hair all styled and we talked about NY coffee and People's park in berkeley and the Bay Area record stores.

and then there is this 34 year old man from Honduras who wanted to stay alive till his brothers came from Honduras. And he died today. cancer everywhere and AIDS. and we pulled the tube out and made him comfortable. and his wife was there, but not his brothers. they were caught somewhere between homeland security and honduras consulate.

sri

this is a cool blog

2006-10-14T11:52:00.000-07:00

lots of beautiful brown people- as the blogger says a counterpoint to all the other mags full of white folks

brownpeople

full into Fall

2006-10-04T20:35:00.000-07:00

i have been sick for weeks. kinda feverish, chills a whack cough. and on call. and on call. shivering sleepless through the night. i keep looking at how sick my patients are and dragged myself to work for the last week and a half. and i feel better now. but it is freaking hard to motivate when you are feeling so sick. to compare the sickest person you see and realize that you are not even close to being that sick is useful to a degree.

my world shrunk to the walls of the hospital and the walls of my bedroom. the call room and my bedroom. for a month.

anyway i am stalling because i am supposed to be writing something for Michelle's wedding or reading about HIV- told a man he had HIV today. he started sobbing. That must be such horrible news to hear. I find myself wanting to promise things i cant hope to deliver. An undocumented mexican man wanted to leave the hospital even though he was really sick and likely had cancer eating into his bones. he wanted to leave because it was too expensive. I felt like saying, Don't worry, Money is not an obstacle. We got this one. But i told him let the state charge you and charge you and make sure that you don't have any dependents they can come after.

a Palestinian man who got shot in the 1967 war in Jordan was my patient and he was so freaking awesome, this guy. So nice. and he kept asking me, doc this procedure i need is taking so long in this county hospital, should i use my life savings to pay out of pocket somewhere else? 2000 bucks- 65 yrs old and all you got is 2000 bucks to your name. and a lifetime of scraping by. and you an American citizen and nobody has your back. The floor has got to raise. what we are willing to accept as the lowest level of care.

anyway- that was a tanget. i am trying to write a poem for the wedding and i came across this... this is the beginning of my inspiration. where all inspiration starts... RUMI...

The minute I heard my first love story
I started looking for you, not knowing
how blind that was.

Lovers don't finally meet somewhere.
They're in each other all along.

What else is there to say?

Sri

tecate

2006-08-19T21:12:00.000-07:00

just got back from Tecate. A little border town 55 miles in from San Diego. Some UCLA latino union undergrad students set up a clinic there every 3 months. They get some family med folks from Harbor-UCLA to roll. I rolled this time. A 6 am until 9 pm day. but pretty fun, eating breakfast with folks on the way there and stopping at a mexico taco stand on the way back. (a side note. we noticed everything in the taco stand was coca-cola. red coca-cola chairs and tables and the awning and they only sold coca-cola products and the doc we were with said that coke comes out all through mexico with these and gives the little taco stands fridges and tables and chairs as long as they only sell coke. so thats how they get their product everywhere...)

of course i only ate cheese quesidillas since there aint nothing for no veggies down there really.

when we got to the clinic there was this guy in a beat up pick up truck with megaphones announcing we were coming. there were all these women and children lining up. young women with their kids. hardly any men.
the UCLA students brought clothes and rice and beans and the Harbor pharmacist have stockpiled all these meds that she brought.

it was fun. seeing kids. and their moms. real easy medicine with shitty social factors which makes it hard medicine. improvise everything. this guy's blood sugar was through the roof and the medication that i wanted to give him usually needs follow up on liver tests. i was gonna just tell him if he gets yellow go see a doc but is that responsible? but what else can you do?

they need the so called wrap around medicine where you have to cover transportation cost and food cost and so much other stuff in order to make medical treatments effective and work.

this day reminded me of the tibetan refugee camp in karnataka where i was sitting as a med student with nuns and scared and not really knowing if i was doing anything useful for them. me and ani dichen(the head nun of the clinic who had such a dope vibe about her who was around my age...) and ani dichen would bring the nuns in one at a time and they would be so so shy. i was often the first guy who have ever touched them in their life. you got to see some brilliant smiles and giggles and I knew I would never be let into their private woman nun world(which i guess is rather obvious) but just from some of their smiles you could tell they were so cool and you would like to get to know them better but never would.

anyway, i felt a spleen on a nun back then and i didn't know what to do. What does that mean? feeling a spleen. i knew it wasn't good but not much else.

now i know. i know how to work it up and what the serious stuff of a palpable spleen is. and i now how to try to figure out what is causing it. in the United States.
the sad thing is it probably doesn't matter in parts of Mexico or India. if i had known in india it probably wouldn't have made that much difference.

learned so much in a couple years. but its still the access, stupid. that gets the patient every time.

at the AIDS conf in toronto this past week heard alot of stuff about people trying to draw up a blueprint for universal access for HIV meds. past the rhetoric. everybody from your mama to big pharma says thats a goal. but some folks are talking about ways to get there. gotta learn more about that.

sri

little poem

2006-07-24T23:58:00.000-07:00

just trying to write more... hot summer days. i played basketball until i was drenched...

a poem i wrote based on something solmaz had sent me.

Sunday night blues

say this city has ten million souls
aint none of them is you.
i said this city has ten million souls
my dear
aint none of them is you.

they say you come back
may turn to june
even the peonies down the steet wait that day to bloom.

Sri 5/21/06

june in harbor

2006-07-24T00:00:00.000-07:00

so we are well into July. I started second year. Last month was probably one of the hardest of my life. I have been cruising along for so long, eventually life is gonna make you struggle a bit. and so many things came into perspective.

AF, my patient on the wards. a Philipina woman, 73. she had chronic pain and i didn't know how much to give it credence. i hate the gatekeeper roll. i feel like i am always deciding, who is in pain and who is not. who deserves disability and who doesn't. who is addicted to IV dilaudid. AD told me today on the phone that she thought i have the personality of someone who would give in and prescibe pain meds to a patient who demanded and begged for it.

i disagreed. it is a tough line between being compassionate and not being soft. being aware but not cynical. there have been so many patients this year who i present to my resident as a warm great guy with a supportive family and when the urine tox comes back positive for coke, the resident asks me if the patient also smokes crack with his beautiful family. i know everybody has their sufferings but i am not trying to be a sucker.

so anyway, to the point- my patient was here to be placed and i saw her Hgb had dropped a point and a half since the day before. she had just came in. maybe dilution i thought. the next day, i saw on my computer that she had been discharged. i was surprised somebody had found a place for her to stay after i left.

then i ran into the senior resident. she said my patient had coded overnight and died. bled into her belly. i should have picked it up. maybe. the only way to describe it is similar to those you love who leave your life. like a kick in the stomach. a sinking feeling that stays for days.

sri

Dr. V

2006-07-07T23:46:00.000-07:00

Pavi emailed this morning, Dr. V passed away.

one of the true heros. He is one of the doctors we should make mandatory study for all of us in medicine. One of the people you want to bring up in nearly every conversation and pass the word like GOOD NEWS. If anybody is around LA or anywhere, you should watch a documentary on him called Infinite Vision... by Pavi. I am going to show it to the residents in a couple weeks.. We can get you copies...

SOUTHERN NEWS - TAMIL NADU

Jul 8, 2006
Aravind Eye Hospital founder G Venkataswamy passes away
Saturday July 8 2006 00:58 IST

MADURAI: Renowned ophthalmologist and founder of Aravind Eye Hospital Dr G Venkataswamy passed away at his residence here on Friday after a brief illness. He was 88.

‘Dr GV’, as he was affectionately called, was conferred Padmashri in 1973.

Born in Vadamalapuram in Thoothukudi district in 1918, he graduated in medicine from Stanley Medical College (SMC), Chennai. He had served in the Indian Army Medical Corps during the British regime.

He began his career as a tutor in ophthalmology at SMC in 1955 and later became the Vice-Dean of Madurai Medical College.

Post retirement, Venkataswamy, chairman of the Aravind Eye Care System, founded Aravind Eye Hospital in Madurai in 1976 and subsequently established a chain of eye hospitals in Theni, Tirunelveli, Coimbatore and Pondicherry.

A pioneer in conducting free eye camps, he had helped lakhs of cataract patients regain vision.

He was honoured with numerous national and international awards, including the Helen Keller International award, American Ophthalmic Association International Award, the Hall of Fame Award from the American Society of Cataract and Refractive Surgeries and the B C Roy Award conferred by the Medical Council of India in 2004.

Venkataswamy, who remained a bachelor and dedicated his life for the cause of the visually impaired, is survived by his sister Natchiar, also a well-known ophthalmologist, and two brothers, Nallakrishnan and Seenivasan.

The body has been kept for public homage in his residence at Anna Nagar in Madurai. The cremation will take place on Saturday afternoon.

uncle x 2

2006-05-18T17:04:00.000-07:00

May 18th... My sister had a baby today!! a baby girl...6lbs. Going to see her right now...One day before my birthday...

unnamed as yet but we can conjure up so many ways this little life is going to come into full fruition. There are many examples of phenomenal women, determinations and imaginations to follow. here is one of them.

from a Peace lecture in 2004...by Arundhati Roy

So what does peace mean in this savage, corporatized, militarized world? What does it mean in a world where an entrenched system of appropriation has created a situation in which poor countries which have been plundered by colonizing regimes for centuries are steeped in debt to the very same countries that plundered them, and have to repay that debt at the rate of 382 billion dollars a year? What does peace mean in a world in which the combined wealth of the world's 587 billionaires exceeds the combined gross domestic product of the world's 135 poorest countries? Or when rich countries that pay farm subsidies of a billion dollars a day, try and force poor countries to drop their subsidies? What does peace mean to people in occupied Iraq, Palestine, Kashmir, Tibet and Chechnya? Or to the aboriginal people of Australia? Or the Ogoni of Nigeria? Or the Kurds in Turkey? Or the Dalits and Adivasis of India? What does peace mean to non-muslims in Islamic countries, or to women in Iran, Saudi Arabia and Afghanistan? What does it mean to the millions who are being uprooted from their lands by dams and development projects? What does peace mean to the poor who are being actively robbed of their resources and for whom everyday life is a grim battle for water, shelter, survival and, above all, some semblance of dignity? For them, peace is war....

But remember that if the struggle were to resort to violence, it will lose vision, beauty and imagination. Most dangerous of all, it will marginalize and eventually victimize women. And a political struggle that does not have women at the heart of it, above it, below it and within it is no struggle at all.

march at harbor

2006-03-22T10:36:00.000-08:00

on call:

people walk around with so much. heavy-ness. carry it and tuck it away.

it is one in the morning. My last patinet for the night. A tough black woman. 60 yrs old. sweet but tough. short gray hair and a quick smile but a smile like she been working so long without a break. her lungs are kinda shot. she has smoked for so long and wheezing now. wheezing so much you can hear it when you enter the crowded, noisy ER room. she had a Laker hat on and a Laker blanket and I started chatting with her about how the Lakers suck right now and you could tell she had been watching the Lakers for a long long time.

It is always great to talk about Cooper and Byron Scott and Magic and showtime. That itself makes the day. So after examining her, i tell her she will have to be admitted upstairs.

She got all freaked out and said "I don't do elevators I am closterphobic and I can't ride an elevator" Her sister is with her and says "She don't get on no elevators-She scared of them closed space. Her sister leaves and I say we can sedate her but she will have to take the elevator.

All of a sudden she starts to shake like a leaf. Her right hand shaking and she starts to cry. Not a sad cry, a scared spontaneous cry.

I squat down to look her in the face since her Laker hat is blocking my view as I stand over her. I tell her I can walk her slow up the stairs if she wants but "what's up- Why are you so scared"?

She says she doesn's tell anybody this but when she was seven, her uncle locked her in a closet and raped her. and she hasn't taken the elevators since. not once. she is 60 now. She said her aunt died a few years back and she went to the funeral and she brought a gun to kill that man. That uncle who had raped her. and sadder than seeing the aunt dead in a casket was finding out that that uncle had been dead for two years. She said she wanted revenge- for that man who broke her to the point that she couldn't have kids. she can't pee without keeping the bathroom door open. She was never married.

There are certain things that are a Fuck You in the moment but don't make you feel any better. I told her that her life, her leading her life healthy and standing still without fear, without a running away is the biggest Fuck You to that man. That dead man who had raped her fifty some odd years ago. I felt like telling her that without forgiveness for that man her own heart would be affected. but it felt contrived and what do I know of rape and a trespass of something so sacred that you can never feel safe in your skin.

so i was getting paged and paged and a man was dying upstairs and i had to go... but i told her I would be back to figure this out with her and make it upstairs with her.

the man dying upstairs is another story- i shocked him with paddles. it took till 4:30 am to stabalize him. my DNR/DNI patient died at 2:30 in the morning and the family was bedside and I didn't make it there until 5 in the morning. to sign the papers and talk to the family. and the daughters in spanish said doc, you abandoned us. you took care of our father for so many days and his body has been cold for two hours and where were you? and my spanish is okay with a capital OKAY and i mustered something not very convincing.

i kept getting paged by the ER and I called back and they said you have a patient here who will not be taken upstairs until she talks to the doctor. it is now 6 in the morning and i have not slept and I run downstairs and my patient says doc what happened to you. You abandoned me. and I tell her what went down. and ask her if i can walk her slow up the stairs.

she says No. She will take the elevator. And I ask if she is sure. and she says she is.

And I go to round on her in the morning and she is on the third floor and she tells me like a kid who has just hit the winning shot in march madness. she made it up the elevators.

sri

hybrid

2006-03-07T00:14:00.000-08:00

i have been thinking about jhumpa lahiri's article in newsweek. my stomach dropped when I read this.

She writes:
"I feel Indian not because of the time I've spent in India or because of my genetic composition but rather because of my parents' steadfast presence in my life. They live three hours from my home; I speak to them daily and see them about once a month. Everything will change once they die. They will take certain things with them—conversations in another tongue, and perceptions about the difficulties of being foreign. Without them, the back-and-forth life my family leads, both literally and figuratively, will at last approach stillness. An anchor will drop, and a line of connection will be severed.

I have always believed that I lack the authority my parents bring to being Indian. But as long as they live they protect me from feeling like an impostor. Their passing will mark not only the loss of the people who created me but the loss of a singular way of life, a singular struggle."

I have never connected being indian strongly with my parents. I haven't contextualized indianess with a relationship . A relationship that legitimizes and defines you. But there it is. And it rings so true. And there is an insecurity in the construction of identity hinged on parents. Maybe that is why so many of us tangle ourselves with work in India, bind ourselves in other ways to the subcontinent. And an emphasis on a indian partner starts to make so much sense.

Sri

pharm

2006-01-21T23:43:00.000-08:00

Pharmaceutical Giants
‘There were times not long ago that drug companies were merely the size of nations. Now, after a frenzied two-year period of pharmaceutical mega-mergers, they are behemoths, which outweigh entire continents. The combined worth of the world’s top five drug companies is twice the combined GNP of all sub-Saharan Africa and their influence on the rules of world trade is many times stronger because they can bring their wealth to bear directly on the levers of western power.’ (Guardian, 26/06/2001)

christmas eve at Harbor general

2005-12-24T16:30:00.000-08:00

on call in the ICU- Christmas eve:

Here is an extract from a poem by Pablo Neruda, 'I'm Explaining a Few Things':

Treacherous
generals:
see my dead house,
look at broken Spain:
from every house burning metal flows
instead of flowers
from every socket of Spain
Spain emerges
and from every dead child a rifle with eyes
and from every crime bullets are born
which will one day find
the bull's eye of your hearts.

And you will ask: why doesn't his poetry
speak of dreams and leaves
and the great volcanoes of his native land.

Come and see the blood in the streets.
Come and see
the blood in the streets.
Come and see the blood
in the streets! *

ER

2005-10-28T00:33:00.000-07:00

I have been in the ER this last two weeks at County UCLA

I keep hearing the lines
from suheir hammad's poem on the louisiana floods in my head:

"who says this is not the america they know?
what america do they know?"

and Barbara Bush's

"And so many of the people in the arena here, you
know, were underprivileged anyway, so this--this is working very well for them."

The poorest of the poor in LA come in to our hospital.
Only those without insurance. The working poor, the
undocumented, the homeless. They are almost without
exception black or latino. And it is not working out exceptionally well for them.

Just yesterday two folks with gun shot wounds to the
chest came in. A 19 year old girl. she died. A
black man, 34 years old. he died. before we
pronounced him dead i cut into his chest to put a tube
in and massive amounts of blood came pouring out. the
bullet had filled his lungs with blood. and his eyes
were so lifeless. I keep thinking that the bullets
just finished them off. there is a destitute
hopelessness that brought him to the point that
bullets were just the final blow.

my friend was telling me that violence is a chronic illness. if you get shot at 18 or 19 and survive there is a ridiculously high chance you will be dead by 35. and she takes the time to tell them that bluntly.

and it is this America I am getting to know well.

sri

it was also blog quake day so help out
blog quake day

los angeles hip hop

2005-10-21T13:03:00.000-07:00

i am on the ER shift right now and i had a day off yesterday and dont have to go in till 4 today. My aim was to read medicine some but I basically went swimming in the morning and looked up trips to cuba and yellowstone or yosemite for my break coming up since Cuba doesn't look like its happening. Then at night I headed out to this awesome underground hip hop music club. it was 5 bucks to get in and this is the first time outside the hospital since i have been back in Los Angeles that I have felt that LA is an amazing city.

The place was packed with a mix of so many black white asian folks and it had none of the I'm a thug and gonna front like i'm hard. no dress code. the women were super fly not over dressed very little make-up- very around the way women that would just dance with you if you rolled up to them with no pretentions. reminded me of the I-house at berkeley. where everybody just wants to dance. period. and everybody could move. there would get to be a spontaneous circle and then a guy would roll in and start breakdancing. amazing. little japanese guys, big old black guys, big old japanese guys, mexicans, white dudes. 21 year olds 35 year olds. i never seen breakdancing like that. it looked like what every corporation is trying to artificially pull off in there ads. (speaking of which MIA, the new sri lankan artist who is off the hook just did a honda add and i couldnt help feel a little dissapointed but...) or what real comradarie between races is supposed to look like. it was beautiful. there was supposed to be no breakdancing so this bouncer would break it up every once in a while and then the circle would inevitably form again and the breakdancing would resume. it was like it was the job of the bouncer to break it up and the duty of the breakdancers to resist.

at 2 am when we left- when i left actually since everybody i came with had to work early and had already left a bunch of guys were kicking it on the corner rhyming. out of nowhere this guy had a beat up boombox with writing all over it and real run down and he looped the same song back and everybody on the corner just rapped and the rest of us listened and bobbed our head and danced a little. i left at 3 in the morning. every thursday night. i'm gonna try to go as much as my schedule allows---

gotta head to the 4pm to midnight shift.

sri

new orleans

2005-09-12T00:31:00.000-07:00

yo i am on the end of my neurology stint. thinking like everybody else in the country probably about New Orleans and Sept 11th. seems like with internship you sink into a ahistorical, timeless warp where the news ceases to exist. only the patient in front of you and whether she will improve or get worse and running the list on your patients and figuring out what needs to get done for them before you leave on your 30th hour and what will get you out by that 30th hour. i guess it makes sense that the sick's world shrink considerably to self preservation and taking care of them there is a tendency to move in that direction.

and it is the first time i have watched television in a long time and seen images of Katrina. I just listen on the way to work and read articles on the web when i can. there is so much to say about this country and the direction it is taking. the levee broke and the market didn't figure that one out. seems like the capitalist market doesn't work when the good being provided is for one and all. you can't make a levee for just the rich. it has to protect the rich and the poor so it doesn't get done.

In the heart of uninsured Los Angeles we see health care workers tell patients if you dont like the wait, get health insurance. There is a disconnect in this country on priorties and what every person should have a right to. Where are the links between big companies not providing health insurance to their workers or the lack of any decent national health care plan?

In New Orleans, I hope there is more discussion on race and class and what the market fails to provide. and the uses of development. who should decide how New Orleans should develop. it should be the poor, the displaced, the black. not the Red Cross and FEMA and power whose priorities are skewed and usually irrelevant for the majority of the suffering.

there are so many pandits out there and the best i have heard so far is Kanye West.

Saw Kanye West say Bush doesn't care about Black people. What a gutsy truthful statement. I love that guy. His album is great too. I heard it two nights ago for the first time.

ss

gay pins and toothaches

2005-08-09T17:12:00.000-07:00

i am in the library post clinic.

i have been wearing this little pin on my white coat that db gave me. it is a redorangegreenyellow snakes around the medical staff(which is actually not the real symbol of medicine). The caduceus(which is the one on the pin) was the magic staff of Hermes (Mercury), the god of commerce, eloquence, invention, travel and theft, and so was a symbol of heralds and commerce, not medicine.

the World Health Organization use the "correct" and traditional symbol of medicine, the staff of Asclepius with a single serpent encircling a staff, classically a rough-hewn knotty tree limb- anyway there is some way cool history about the staff and how it became the symbol of medicine. supposedly the worms that swim in the skin just below the surface were so common place and you could see them on a patient that a doc would cut the skin in front of a worms path and have a little stick ready so the worm curled around the staff. and docs would advertise their services by showing a worm around a stick... i just learned that.

so back to the pin
i vaguely remembered that it was a gay people in medicine pin, the thought was swimming in a recess of my mind but i didnt think about the consequences or the political statement... it was all colorful I thought i would wear it and shooot i thought i was comfortable with my sexuality:).

been meaning to get some "health care for all" or some more clever medicine slogan pin but i had this really nice one so i wore it and i thought nobody else really actually knows what that pin means. and i had no idea that people were making mental notes to try and figure out if i am gay. and turns out everybody knows what that pin means. and some people are clowning me for it. and now i am making sure i dont fold and take it off. there are some things that are so ingrained that they come up and jab you when you least expect like a trick knee or an ali punch. and so does the boy machismo of my playground middle school days. but the pin will stay.

more stories...
this one woman came in yesterday crying. toothache. bad. like really bad. i talked to the OMFS clinic(oral-maxo-facial surgery and they said it is not urgent and give her an appt in two weeks) and when i told her it wasnt serious and she would have to wait two weeks she was devestated. and started crying big time. and i told her we would get her to USC tomorrow to have her tooth pulled but she would have to get there crack of dawn early and she could take the pain meds i give her tonight.

she said she had no money. this happens so much. people say they dont have 6 dollars for medicine. i asked her again if she could afford 5 dollars worth of pills. she said no. and she was crying more and more. and so i fished out ten dollars and handed it to her. she was elated. she jumped off the stool and put her 60 year old arms around me and got so happy smiled broad enough before she remembered the pain in her mouth.

sri

last call of 1st month

2005-07-19T19:30:00.000-07:00

post call- just slept for a couple hours. always like to wake up before the sun dips down so i wont go two full days without the sun.
i took a walk and am back at the library. still no net access.

there is something about standing over a woman and compressing her chest wall repeatedly for 1/2 hour that drains you. I think i got drained because she ended up dying. her eyes were so hit you in the belly fish like. i didnt look much.

At 2 am when you hear the Code BLUE 5 EAST ICU. CODE BLUE 5 EAST ICU your blood starts galloping and running down the hallways you start to feel like a somewhat superhero that could bring back somebody like now. and i stood over that body and cracked some ribs and you could hear them crack(but that is normal)and after shocking her a few times and getting a pulse and losing it and after some electrical activity and losing it I walked back to the CCU feeling like an unincredible zero. it was a bummer. but process process process- there is a time to die and i don't like compressing somebody who will code again tomorrow and the next day. but this woman was supposedly the most alert in the ICU 5 minutes before. confused but alert.

anyway... gonna walk back home. tomorrow is the last day of my CCU month. i have weekends off now on med clinic.

took the fam out for dinner friday. it ate 1/2 my first pay check. 10 dollar martinis that people were downing...ouch:) it was fun though.. a sheeshy indian restaurant...

gotta go this comp is gonna boot me,

Sri

brief notes

2005-07-12T17:53:00.000-07:00

i am in the library in redondo beach. got no internet at home. the days are tough, if you let it hit you it would be emotional and sometimes you can but alot of times you can't. the moment isnt right or you got to hold it together in front of a patient and then the moment passes. i had a dream a couple nights ago that the man who was on a vent for so long and who we took off and who died was sitting up and talking to me. and his daughter who sobbed so much and told me a bit about him, he was like that in my dream. and it was kinda wierd because i kept asking him, shit dying aint that bad, huh? you look great and he was laughing. i have never seen this guy remotely alive. just connected to tubes. and i was so excited in my dream.

anyway, i wrote my first death note yesterday on call. an 80 yr old black fiesty woman who was dnr(no cpr), dni(do not intubate), and no pressors it bummed me out a bit but she went quickly.

i met the mayor of LA couple nights ago. very friendly. i finished talking to him and called resh and she gave me a list of things i should have spoken to him about, policies and meetings he should come to and stuff. i felt like i dropped the ball, i am not in a strategy mode and i guess i should be more often. he was in the ER because a cop got shot.

got my vacation schedule. 2 weeks in oct. thinking i might climb mount whitney or go to yosemite. maybe sit for 10 days if the dates coincide. we'll see

writing an essay on india and the tibetan refugee camp. reading maxine hong kingston- she is off the hook.

anyway, i get my first pay check friday. i am taking the family out to dinner. 10 folks. got to find a good restaurant.

sri

friends blogs

2005-07-08T12:38:00.000-07:00

collection of blogs

on call number 2

2005-06-30T11:29:00.000-07:00

"Healing may not be so much about getting better, as about letting go of everything that isn't you - all of the expectations, all of the beliefs - and becoming who you are"- Rachel Naomi Remen

i realize that i am not naturally fearless. i am unsure of my skills as a doc. i care if the attending thinks im an idiot even though i dont want to. i think before i stop rounds and make sure the 70 year old spanish speaking only man understands that a cardiac catherization is dangerous sometimes and he shouldnt sign the consent unless he understands that fully. but i got a translator for my booty spanish that doesnt carry the intricacy of 50 words for scales of danger and vitality post surgery.

32 hours on and sitting down for a total of 45 minutes is draining. yesterday i got called for two chest pains that could be heart attacks, admitted 5 very sick cardiac patients, talked to three families about their loved ones chances and pulled the ventillator on a brain dead patient. a patient was crashing in the ER and i kept getting paged that the patient's family in the cardiac intensive care unit wanted to talk to me. i couldnt get up there in time. i am trying to get used to being pulled in so many directions and saying no. i am not that good at saying no. i dont know why. at the bottom of the stairs was a young mexican woman who was in tears and she asked me if i spoke spanish and i said yes and she asked if i could help her find her grandmother who she thinks might be dying and urgent care hasnt seen her yet and could i talk to urgent care. and i was so behind for the night and i had to see a patient that was crashing in the ER and i couldnt. i talked to her for a couple minutes.

finally i got up to the 4th floor and walked behind the curtains to see the family of my patient on the vent. there were 15 people in that little area around the bed. two boys at the head of the bed, their heads shaved, about 22 years old crying for their father. and when i walked into the room i apologized for taking so long. and i have realized in a week that patients are so hungry for some communication and the medical field in general and acute, highly skilled specialists in particular are so bad at sitting down and talking to patients for a couple of minutes. and there is so little time in LA county hospitals but it has to be done and it isnt being done. and patients are ridiculously grateful for honesty and a brief minute.

so i walked into that room and explained we would pull the vent and start a morphine drip if they agreed. and they wanted to. what is crazy is that the most intimate, crucial stuff the best stuff of being in medicine never shows up in rounds. like robert horry whose stats the next day are not that great but you know he won the game for his team with all the hustle and the little stuff.

so the stats the next morning are all that is important and they are mostly numbers.
and i am trying my damndest to keep doing stuff that will never show up in rounds and i think most of the other interns at harbor are too. but the fellows dont for the most part and the attendigs, rarely. i cant remember when i have been impressed by an attending bedside chat with a patient. long time, i think.

today i am off. i need to set up my place. we got it painted yellow and red. i went to home depot and got the colors mixed the way i wanted. it has a little spanish villa feel if you stretch your imagination:)

the roofs are low and it is this little one bedroom hideaway less than a five blocks from the beach.

sri

internship day one.

2005-06-26T12:17:00.000-07:00

internship day one: today is recovery day one.

i had the most awesome, difficult, hectic, frazzled, crazy day on the fist day on. i volunteered to be on call. i wanted today off for krishnas wedding. viral and gurm and hash will be in town. 32 hours. no sleep. none. my patients are sooooooooooo sick. i dont know much. overwhelmed is a good word. nervous is another. but it is such a sacred space to witness all of this stuff. in one night two patients coded. they were both my patients. 10 minutes of pumping on the chest and pulses coming and going, flat lines. they put me in the cardiac intensive care the first month. fifteen patients are super sick. breathing machines and tubes and swan ganz chaths. a 24 yr old drug adict with tubes and on ventilation and crashing. she had tatoos and was in septic shock and bluish. red hair, tatoos everywhere. she looked like the posterchild of death but maybe it was because so young or i could picture her struggling with drugs or being touch but i was emotional to see her about to die. and my name is first to call for the nurses if anything happens. and i am first to call to talk to the parents. it is really a trip to click on a patients name and have your name come up as the doc taking care of her.

there was once a poet(it has now been a full three years since she died) who said it is hard to keep a white shirt clean(and i was in india and a little tibetan kid squirted some blood from his nose onto my white kurta. and as i took off my white white shirt and washed it by hand in that bathroom bucket i was reminded of that phrase it is hard to keep a white shirt clean and i thought of that poet and something swept over me emotionally and i almost started to full on cry.)

but anyway it is very hard to keep a white shirt clean and before i left NY trevor told me to keeping a white shirt clean means that you have to put yourself in positions to get it dirty, really freaking dirty. you cant just chill at the laundry room and be happy that your white shirt is clean. so the point being, i am spent after last night and i feel like i am about to fall on my face and get my shirt bloody but at least i am in that place.

i was in on the decision whether to stop treatment on this patient. i signed the DNR. i talked to the family. this whole figuring out how to be real and still a doctor. both the codes were still alive when i left the hospital.

the hospital is chaotic and awesome and my patients speak mostly spanish. there was five women- age 16 to 55 praying loudly around 2 am. standing up and crying in a circle, raised hands and praying in spanish. it was beautiful and sad. tears rolling down their cheeks. and i am running to replace magnesium on my patinets and try to make sure everybody lives through the night. so many lives are being played out it is crazy. and i am responsible in some part for some of these lives. lucky the residents and the fellows hold your hand a bit.

i got off and drove home to my parents house and slept. woke up and ate. and slept through the night. this is going to be a hard year. exciting, i think but so hard. every intern looked liked they were drowning and frazzled. first day, two of my patients coded. tomorrow. day two.

today, a wedding.

sri

orientation

2005-06-23T00:46:00.000-07:00

into third day of orientation for my new residency. people are super cool and bright. start friday in Coronary critical care unit.

found a place to live... redondo beach, few blocks from the beach. it is this little bungalow behind a single mom and her two kids. a hideaway. want to try and paint it tomorrow before friday starts. there has been a lurking feeling that this country and medicine are misguided, drastically. in so many ways. we just got told yesterday that if a patient vistor comes to the hospital and collapses it might be better not to touch the patient for liability reasons. in a plane it might be better to say you arent a doc... pretty misguided.

been reading krishnamurti a bit... always challenges the kind of cookie cutter approaches to life that i can fall into. puts into question what is worth living for and priorities and what is the measure of success that everybody is striving for without really pressing the underlying reason for that seeking... why do we get more conservative as we get older and joy seems to leak out and slip away from the older and older folks.

my uncle had a heart attack on monday night... been back and forth to orientation and the hospital... last week so much partying for b's wedding. this week life turned on a dime.

s

WHO india

2005-06-06T21:43:00.000-07:00

more wedding stuff every day. this is good exposure on how to plan what you want in a wedding. what to leave out. what to include. a house full of women. b dressed up in her wedding stuff yesterday. grooms fam comes in tomorrow. pick ups and drop offs and drama and kids running all over. this is a topsy-turvy household if there ever was one:)

here is something that steph actually read and though it might bore you faithful one or two readers i thought id post it. To the WHO rep in INDIA.

Dear Sir or Madam,

My name is __ I am a United States based physician who had the opportunity to travel to South India and work at the the Tibetan refugee colony in Bylakupee, Karnataka. During nearly four weeks in April/May, 2005 I lived and worked on site at Tsepal Tobkyed Hospital in Bylakupee, fourth camp. The hospital aims to serve over 3000 monks and 600 nuns of camp four and lay persons in the surrounding community. While I was there, however, there was no doctor on site and no doctor had been present for quite some time.

During my stay at the Tibetan colony, I was able to meet with Dr. Gopinath, the government doctor located at first camp, in charge of overseeing India’s Revised National Tuberculosis Control Programme (RNTCP) in that area. I was deeply impressed that high quality, first line medications were being distributed for no cost. While the treatment and objectives of the program were strong, there were no health workers present to diagnose tuberculosis and no oversight and regulation of TB drug administration. No one in that area was trained in recognizing harbingers of tuberculosis and recommending sputum Acid fast bacilli tests.

During my short month at the colony, one monk was in St Johns hospital for spinal TB and two others were undergoing treatment. A preliminary assessment of the community, especially the adolescent monks, revealed numerous previously undiagnosed and untreated cases of tuberculosis. The ones who were being treated did not have adequate oversight and follow up to ensure that a complete course of medications was administered.

As you are aware, Multi Drug Resistant Tuberculosis in the Tibetan community is documented in the medical literature. The very high quality of the drugs being used mandate that treatment be more regulated than currently standards in order to not cause an even greater increase in the number of MDRTB cases.

Many cases remain altogether, undiagnosed. In a population where many of the monks in the colony I worked in were sleeping 14 to a room, and often 75-100 per classroom tuberculosis is present in epidemic proportions. In my opinion it is necessary to:

To place a government health worker at Camp 4 to stay on permanently. Isolation of sputum positive patients must be stressed.

Formal train a few Tibetan monks and nuns to recognize the symptoms of TB in order to increase the amount of sputum AFB's being done. The need is present and the trained monks and nuns will be on sight, long term in continuous direct contact with the patient population.

An experienced government lab scientist deployed to train Camp 4 Lab technicians would help ensure accurate diagnosis of contagious sputum positive TB patients.

A periodic evaluation is necessary to determine There is currently no way of evaluating the incidence of patients with TB or the success of the RNTCP with such little oversight of Camp 4.

living in LA

2005-05-29T00:33:00.000-07:00

I moved home today to LA. We are in this transition house until b's wedding is over.
Packed up all my stuff for the last three days. Boxes and boxes. I thought I wasn't a consumptionist but had to come to terms with living simply might mean a whole lot less books and random clothes. 4 boxes to UPS and 5 big bag of clothes to good will later I used my full 3 bag quota for jet blue and came home. Since I dont have a car I carried big boxes 6 NY blocks. one at a time or maybe two. The only ones to stop were these decked out guys in suits. They offered to carry the boxes for me. They were mormon. It seems sometimes that the religious folks get stuff right. Yeah, they busted out their pamphlet but you could see that they were sincere about helping me out. I thought they were pharm reps at first in their crispy blue and gray gear.

everything has moved so fast. getting back from india and moving to LA and going to NY in the last 10 days i havent had time to transition back to the states. I think LA felt a little wierd for a bit. couple weeks ago i was waking up at 4 or 5 from jet lag and running and nobody was on the streets and so much of life is lived behind doors or in cars. india was filled streets and knocks on doors to visit and kannada hanging in the air, phrases i had heard at home my whole life repeated in bakeries and shops. ny more closely approximates india reality. little corner shops where you can barely walk in cuz of the lack of space and slightly rude store owners and crazy traffic and a hum of life that surrounds and swarms and will engulf you in chaotic vibrancy .

but i am lucky in that everything feels like home. my two year old niece ran up to me today as i walked though the door. a good coming home if there ever was one. and in NY this last past weekend i feel like it was a continuous celebration for 7 days and i was just happy to be present much less have folks celebrate me graduating.

i had graduation at carnagie hall on monday. 14 folks rolled out. uch and trev and lamb and hash and gurm and beena and bhav and pat and sherry and bob and my folks and my aunt and uncle. the best part was hearing all the families cheer for their son or daughter being called doctor for the first time as we got out diploma. my mexican friend brought 42 folks and said that "shoot, if my relatives could cross the damn border they sure as hell can get past the security guards at carnagie hall":)

it was super fun. the dinner after. a little pizza joint. the topic was marriage i dont think any of us have laughed that hard for god knows how long. there was alot of relationship exp in the room and some insightful stuff. i'll detail later.

going to sleep on the west side.

sri

2005-05-16T00:24:00.000-07:00

in tibetan refugee colony with the monks last month