CMC - Day Five

Wikipedia tells us that the name Vellore is derived from the tamil words "vel" and "oore", meaning city of spears. The arid land on the banks of the Palar river that would become this cosmopolitan Indian city was once a battlefield. They would leave there used swords and spears behind. The most common spears currently in use are those in very small gauges used within the walls of CMC to draw blood, give medications, etc. Surely, then, the name "city of spears" is still appropriate.

Vellore has one of the more impressive forts - not CMC - in Tamil Nadu, described as the strongest fortress in the Carnatic War in the 17th century. This sits in the center of a plain between the river and the small chain of mountains that sits to the northeast of the city. Atop the closest and highest of these hills is a small fort. After we had finished yesterday, i put on my shorts and set out to climb it. It was a challenging hike, made more so by the fact that i had no idea where i was going and therefore made an undeducated scramble up the face of the mountain. It was made more enjoyable by the presence of a middle-aged man, whose name i later learned was Athitti. He left another gentleman with whom he'd been sitting to join me in the climb and we made our way up the hill silently, gesturing to the other when either of us had found what we thought was a better route. Our route took us through and over giant sandstone boulders, under acacia trees with 3 inch thorns and the view of Vellore became more and more expansive. We reached the entrance to the fort, around the backside of the mountain, climbing gently through patches of charred grass, burnt for some reason i cannot be sure of. The fort itself was in a state of ruin, graffitied with the names of those who shall surely pay a karmic price for their defacing of what could be so beautiful. Inside the first gate was a well, perhaps 40 feet deep, which had at its base a small doorway with a staircase ascending toward the north. Hidden in the deep brush where one would expect the stairway to emerge was the top of the stairs. We peered down into the well and i imagined a tiger rushing out to get us. Vultures circling above suggested that some sort of carrion was either present or expected.

The inner gate led us to a high plateau from which one could see for 50 miles, i'm sure. The CMC campus, with it's tall white and blue-washed towers, it's greenery, maintained its peaceful appearance even from afar. I took some lovely pictures as the sun fell in the west. Athitti seemed as curious as i did about this place, which made me wonder if he was the local i'd assumed he was. We were like children, peering around walls, under arches, through tall, overgrown grasses. For much of the developed world, ruins such as these are cordoned off with safety ropes. Wooden platforms and information placards direct our movements like biped cattle, forcing us to experience these places as adults. I'm not saying it is better in India, that is, to have free reign over these crumbling walls. But it does inspire a childlike sense of wonder that we maybe lose in the process of protecting these things. This sense of wonder, of exploration, contrasted with the writing on the wall in a way that made me understand the desire to protect a heritage that is only mine in the broadest human sense.

As the sun dropped out of the afternoon sky, so we dropped down the sides of this mountain, though taking a far less directed path. Eventually we came to a clearing, with a small temple, at which a family was performing what appeared to be an elaborate ceremony, a newborn child wailing in the background. The children scrammbled to meet me and the camera i'd pulled out to photograph this small temple on the mountainside. These children, however, were not so easy to smile and, after a few moments, seemed eager to get rid of me. My mistake of not taking their offer for a photo revealed itself as not 30 ft below their position on the trail i turned, warned, to see a small rock thrown in my direction. The rock would have hit me directly in the right eye were i not wearing my glasses, confirming that there are some advantages of being a nerd. As i continued down the hill, slightly shocked at what i'd experienced, i wondered if i should have marched back up the hill, taken the offender by the arm and reported him to his parents. Athitti appeared as surprised as me, but his words fell on deaf ears. You see, he spoke Hindi but they only understood Tamil.

At the foot of the mountain was the old town of Vellore. Small alleys wound through old mud-walled homes with rounded corners and colourfully painted entryways. Some had little notches in the walls on either side of the doors and small statues of Ganesh, the elephant headed god known as the remover of obstacles, tucked inside. Above several were spectacular and elaborate carved wooden lintels. Some had small courtyards, in which i could see men watching sattelite television. Most had benches built into the outer wall, covered with the painted knotted designs that one sees outside so many doors in tamil nadu. On these benches sat old men and women, unsmiling as we passed. This was not a friendly bunch. Discussing it with Dr. Valsan today, he assured me that the people in this part of town are not used to strangers, and suspicious of them. Not even the other residents of Vellore go there. I wonder what these people thought of us, two obvious foreigners to their village, one with skin like their own but a different language, the other well-tanned (if i do say so) but white all the same.

Athitti, it turns out, is from Calcutta, his wife here for treatment at CMC. We seemed to learn a few things about each other with no common language at all, more pointing and gesturing. Truly elemental human conversation. I told him i was working as a student doctor at CMC, which he seemed to understand. His guest house was not far from mine, but when he indicated that we would separate, i beckoned him to follow me. We went to my favorite juice shop and i bought us fresh lime juice, one for each. I asked him to write down his hotel name so i could deliver him a copy of the photo we'd taken together. He did. And then we left each other, as suddenly and as easily as we found each other in the first place.

My brief time with Athitti reminded me that the most important thing about human relationships is presence. Sometimes people only need to be in each others presence to bring about comfort. I'm sure that both Athitti and myself felt comforted by each others' presence on our treacherous hike up and down the mountain. (Besides, i learned today that the fort to which we had climbed is rumoured to be a robbers den in the evening.) Anyway, we should remember this as both physicians and patients. As the former, we must understand that an answer is neither always easy to find nor necessary. Sometimes patients just need the assurance that we will be there for them whether the answer comes or not. I will encourage my patients to see me, even when they are well, for the same reason. There presence makes it easier for physicians to understand them when things go awry.

There are times, of course, when the presence of a physician is frightening. I won't forget the look of the poor child who wrestled with pneumonia in the wards this morning. His was a look of terror and i felt awful for him, faced as he was with the team of multicolor faces who were attempting to help him get better. In the process we'd stuck a tube down is nose to help deliver oxygen, we'd strapped him to a chair, and inserted our medical spears. In the war between human life and the disease that would consume him, this child had become a battlefield.

I'm off to Mahalabalapurum, and its beach, for the weekend. Enjoy yours. I'll write again on monday.

justin.

ps. it's rumoured that a tunnel connects the fort to which we'd climbed and the much larger Vellore fort in the center of town. I didn't find such a tunnel, but i'd be afraid to use it if I did.