I have been sitting on this entry for months. It’s a little out of context in terms of the date but I still wanted to post it….

3 years ago, I lost my Uncle to lung cancer. On some level, this wasn’t unexpected. Jetu Kaka had been diagnosed with Stage 4 lung cancer with metastasis. After hearing the initial diagnosis, we as a family, rallied and made more of an effort to spend time together. As a first year medical student, any time that I had off was spent visiting LA. After rounds of therapy, Jetu Kaka’s cancer continued to progress.

I remember being in class when I got the phone call from my dad. I immediately left and rushed home to pack my bags for a flight to California that night. As one of the last family members to arrive, I didn’t know what to expect. How was my family taking this? How were we spending the next few days together? What was next?

Sitting here, three years later, my family has made it through this misfortune. In some sense, we were lucky that we had so much family around for help and support. And since that day, we have all found a way to keep moving forward and keep celebrating life. Although, like most families, we have our disagreements and “drama,” I can’t imagine going through this type of situation alone.

During my third year of medical school, I met many patients fighting their own battles with cancer – some were new diagnosis, some had won and some were in the interim. In some cases, concerned loved ones surrounded these people.  In other cases, support was provided by the oncologists and nurses involved in a patient’s care.  Although many of these situations were inherently tragic, the saddest thing I’ve seen in medical school occurred when I was on my OB rotation.

More than half way done with 3rd year, I had gotten a good sense of my role as a student. On OB/GYN, knowing what to do and doing it was essential in getting along with the residents. After the 3 weeks of GYN, OB was a nice change of pace. Meeting happy parents, excited and scared about the bundle of joy that they had been waiting for was rewarding. While most of the births I had seen were “normal,” occasionally a problem would arise which required further attention. Whether it was failure to progress, fever, fetal distress or a number of other pregnancy-associated problems, we always ended up with happy parents and healthy babies.

One of the nights that I was on call, an Indian family had arrived in active labor. The woman (TS) was 22 years old, married with her first child on the way. She had come with her husband and an older woman who I gathered to be her mother. From their last name, I could tell they were south Indians. In my usual fashion, I introduced myself, spoke to the nervous family and wrote down some numbers from the chart. This particular patient was being followed by one of the family medicine residents (also Indian) so I reported to her for the rest of the night.

For much of the time I spent up, this patient’s progress was quite slow. With each passing hour, TS looked more exhausted and the vibe in the room became increasingly strange. TS’s husband seemed quite uninterested each time we entered, staring out of the window while we performed physical exams. The mother seemed quite un-affectionate and unconcerned about TS. We would leave the room and the resident would grow more furious with TS’s family. She had gotten to know TS well over the last few months and grown attached to her. TS was newly married and newly immigrated to the States. The older woman in the room was not her mother, but her mother-in-law.

Late into the night, TS spiked a fever. It was likely chorioamnionitis. Despite treatment, her fever continued and we grew concerned about its effect on the baby. After conferring with the attending, we decided to go to C-section. As we told TS our plan, the disappointment in her face was obvious. She translated our words to her mother-in-law and a sense of failure overtook the room. As TS’s husband tried to argue with our decision, I couldn’t help but notice how alone TS seemed.

Moving to a new country, barely speaking the language, and living with a still unfamiliar man seemed like enormous obstacles. Adding pregnancy complications to that list, it’s hard to be surprised at how alone one person can look in a room full of people. It felt like her inability to have a natural birth was a reflection of her worth as a person. In what was supposed to be the happiest place in the hospital, TS seemed devastated. Looking at TS, I couldn’t help but think of my mom. The resident and I grew furious at TS’s husband and mother-in-law. Despite their disappointment, we proceeded with the C-Section and TS gave birth to a healthy baby boy.

In my short career, I’ve encountered many sad situations. I’ve seen numerous patients walk into the ER with a simple illness, get diagnosed with a metastatic cancer, and get told that they have months left to live. Why this remains one of the saddest things I encountered in my third year of med school  is simple. We had failed as providers. Instead of creating a supportive environment and acting as advocates, we stood by as TS lost hope. Although things turned out alright for TS, I am reminded that I am lucky to share these experiences with my patients. With that privilege, I hope to provide my patients with the same support that my uncle received in the face of adverse situations.

With that, I’d like to share Dr. Robert Lowe’s BU School of Medicine Commencement Speech. Congrats to all those “Docs”  surviving the beginning of their intern year!


Adorable Little Girl

Adorable Little Girl, originally uploaded by Jainy Savla.

Little kids love cookies in every country.

My Kutchi Friend

My Kutchi Friend, originally uploaded by Jainy Savla.

Meet my friend! When I met him, he was hanging out at the ENT clinic with perforated tympanic membranes. Because of the size of the perforation and previous operations, the surgeons required additional equipment to see him. As a result, he was hanging around, waiting, for several days. In that time, he made it his goal to improve my Kutchi…

Awesome guy.

Little Girl at ENT Day

Little Girl at ENT Day, originally uploaded by Jainy Savla.

What I also learned…little kids either LOVE cameras or get super shy. Either way, it was a great ice breaker with the majority of the people at the camp.

What was a little sad was the number of syndromic looking kids we saw.

ENT Exam

ENT Exam, originally uploaded by Jainy Savla.

Since I’ve been editing my India pictures and slowly uploading them with my bootleg internet connection, I figured it was time to share some photos again….

In the ENT camp, Grace and I shadowed a few of the Indian docs with some medical students fro Mumbai. What I learned? Head lamp is important. Very important.

Passing Time

It never feels like that much time has passed between posts..and then I look at the date. Despite being on a “year off,” times seems to pass by extremely quickly.  I suppose that is what happens when every weekend is excellent. A few months ago, I spent an awesome, sleep-less 3 days in NYC with some good friends from California. Not only did I spend time with amazing people, I also spent the weekend doing touristy things intermixed with things that could only happen in NYC.

While we were there, we had the opportunity to tour Donna Karan’s Urban Zen Foundation (THANKS DHRUMIL!). As I understand it, the Urban Zen Foundation is inspired by Donna Karan’s husband Stephen and his battle with lung cancer. Having first hand experience with patient care, Donna focuses on the fusion of western and eastern medicine. While we were touring the center, the foundation was hosting a large training session for yoga instructors involved in patient care. Because of Dhrumil’s natural charms, we had the opportunity to sit down with Rabbi  Stephen Robbins, a kabbalist and psychologist.

Sitting down with him, he recounted numerous encounters with patients dealing with emotional and psychological barriers. While medical school makes me very skeptical of non-traditional, little researched forms of “medicine,” I do believe attitude and mood play a significant role in patient outcomes. After all, we are often told about the importance of hope and having the will to live.

The half hour to forty-five minutes we spent with the Rabbi were incredibly interesting. While I am still skeptical at his ability to improve outcomes for concrete diseases with a known pathophysiology, I do see how his work could benefit people whose state of mind affects their disease. On my psychiatry rotation, it was pretty clear that there was a fine line between sane and crazy. In many cases, there was some significant trauma or a sustained external factor that would often push an individual in one direction versus another. As one of my preceptors would say, “we all have the potential for crazy, we just need the push.”

If I had one patient that I could send to the Rabbi for treatment, I would have to pick a patient that was on my service on medicine. Having to switch to a new team in the middle of a rotation was always difficult. New attending, new residents, new interns and new patients with their own set of problems. This particular patient on our service stuck out…in a good way. He was incredibly nice. He was understanding of delays. And, he was constantly showering our team with unnecessary praise.  As a recovering addict, he had been on long-term methadone treatment. He was admitted for palpitations and EKG changes that were side effects of his treatment. Our plan for him was to wean him off Methadone and switch him to another form of treatment. On his last day in the hospital, he thanked our entire team for our hard work. He even left with the name and business contact information for the intern taking care of him, vowing to return to clinic to see her.

A few days later, while rounding, we saw him again. He was in a hospital gown being followed by a nurse.  As he walked by us, he started at us as if he had never seen us before. It was almost eerie to see the lack of recognition in his eyes. While we wondered why he wasn’t bounced back to our team for treatment, an interesting story  emerged. He had been taken to the emergency room after dunking his head into a fish tank in an Asian restaurant and spitting water at the diners. Upon arriving at the hospital, he was admitted under a different name….one that was in the system….one that he had used in the past. He had no recollection of his previous hospital stay or even the person he was just a few days earlier. After several attempts to escape the 6th floor through a small open window, he was transferred to a psychiatric hospital.

It’s one thing to hear about “Multiple Personality Disorder” aka Dissociative Identity Disorder (DID) but another thing to meet someone who has it. To have no recollection of an alternate life you have created for yourself is really an amazing and scary thing. Genetic predisposition aside, I’ve often wondered how jarring the inciting event would have to be to result in the development of multiple personas.  Considering that DID is thought to be caused by physical/sexual abuse during childhood, it’s no surprise that this disorder predominately occurs in women. As you can imagine, therapy is critical in merging the different “alters” that are created to process the trauma.

So while I don’t ALWAYS see a place for “eastern medicine” in daily practice, meeting patients like this one is a reminder that western medicine doesn’t always offer concrete solutions for the complete spectrum of human disease. In many cases, alternative treatment strategies can complement traditional western medicine in providing patient care. Perhaps there is a greater place for those lessons in medicine that have been passed down from generation to generation (hardar nu dood anyone?).

On a side note, I’ve become obsessed with this song. Hope you enjoy it as well!

Bidada Camp

Due to lack of access to an appropriate internet connect, posting this was delayed. I’ll definitely update with more photos in the next few weeks…but here is what I had at the time:

Today marks our last day at the Bidada Medical Camp. For the last week, Grace and I have seen a lot of cases that we’d rarely see in the US, met some incredibly friendly Indians, checked out both my mom’s and dad’s home villages, visited the homes of people we don’t even know, and spent a lot of time hanging out in the wonderful Kutch sun.

Overall, the experience has been eye-opening. The hospital was much nicer than I was expecting and the amount of patients they are able to treat in these 3 weeks in incredible. Being a medical student with a limited ability to speak the language, I felt fairly useless in terms of actually helping..but I did learn a lot. I also became the unofficial camp photographer….at a minimum, I hope the pics muster  up some donations so the good work continues

Enjoy some of the snaps: