CMC - Day Nineteen

It would appear that my encounter with the horse - which i've been advised, in one of several supportive emails, that i should have bitten back - was merely coincidental in its timing in relation to the flu-like illness that felt so disabling yesterday. Today i feel better - less feverish, less weak - and i've ventured into the hospital to prepare for a talk i'm giving this afternoon on pediatric asthma treatment guidelines. I won't bore you with the details. There is a quotation often (and apparently mistakenly) attributed to Ralph Waldo Emerson and the last line of wich goes something like this: ..."to know that even one life has breathed easier because you have [lectured]. This is to have succeeded." Surely, to lecture on treating asthma is a way to find success.

Today is Hospital Day at CMC and the campus is abuzz with this annual showcase of the hospital and its departments. Set up under three massive and brightly coloured tents in a large parking lot across from the hospital are no fewer than 60 booths displaying the departmental displays, in addition to carnival type games, food stalls, and hospital-associated vendors. The women from CODES, the COmmunity DEvelopment and Society group, a project jointly coordinated by CHAD and the communities to create disposable income for families, are there selling their handicrafts. Reprentatives from the leprosi hospital, Karigiri, are selling their printed fabrics. A large section is cordoned off where medical students are giving free health check-ups for the public. The festive atmosphere and this great display of informational public health lifted me right out of my lethargy.

The department of Pharmacology had a busy and crowded display of posterboards, dioramas, and models depicting pharmacuetical classes, tips for travel and appropriate storage, adverse effects, and routes of administration. A large foam-board image of the front of a man had an inhaler stuck in his mouth, several needles stuck into the foam body, indicating subcutaneous, intraveinous, and intraosseus (into the bone) routes of administration. The adjacent poster depicted a less fortunate man from behind with a large needle jutting out of his painted pink buttock (intra-muscular) and a suppository pushed into his foam bum (rectal). A large foam house diorama sat beneath a foam archway that read, "Keep drugs away from children." Inside the house various acts of accidental ingestion were taking place by little child dolls. Plastic bags of toxic substances surrounded the house, labeled for recognition.

A display at the Obstetrics and Gynecology department depicted the Desert of Gestational Diabetes Mellitus (GDM). Small yellow foam footprints headed in the direction of the road to management, each representing a symptom of GDM: weight gain, hyperglycemia, excessive thirst, and excessive urination. They were placed to aoid the small green foam cacti that represented GDM risk factors: maternal age greater than 30 years, family history of diabetes, recurrent abortions and obesity. A sign in the middle said "Decide Your Path? Which Way?", and signs pointed in the direction of "management" or "complications." On the road to the oasis of management were signs outlining the appropriate steps to monitor GDM - "visit 15 days once till 28 wks, then weekly to term;" "maintain good personal hygiene;" "adequate fluids." Inside a cool blue pool at the end of the management road, surrounded by foam palm trees, one could find "scans" and "drugs" and "investigations." Taking the other route, one found the pyramid of complications, a large Egyptian tomb labeled "macrosomia" (big baby), "congenital malformation," "still birth," "infection/UTI."

One large poster in the background showed the male reproductive system pre- and post-vasectomy. I learned at CHAD the other morning that vasectomy is basically a non-option for Indian males. Not even the women want their husbands to have vasectomies, so powerful is the perception of that certain display of male virility. The hospital is trying to promote it more and more as women are rushing after one or two childbirths to have "tubectomies." This wouldn't be seen as problematic except that so many of the women requesting them are in their early early 20s.

The Department of Cardiology's Planet Heart had row upon row of coloured diagrams depicting the flow of blood through the four chambers of the heart. The Nephrology Department displayed glamorous glomeruli lit up with chains of flashing lights indicating the flow of blood and then urine. The pathologists had their rows of microscopes out for the public scrutiny of various tissue samples. The anatomists had a remarkable display of fetal crania. The dentists had dentures and a smile contest for kids. The operating theatre had a foam diorama that looked like a scene out of "Team America:" a team of puppet size dolls were in the middle of a C-section on a doll that was about a third of their size. "The patient seems awfully small," a young girl pointed out in a beautiful Tamil lilt, before giggling.

A voice interrupted the music: "The 9th grade students of the Ida Scudder school would like to dedicate a song from the film 'Arrop' for their beloved teacher Padmini."

I turned around to see a poster of a women being set on fire, perhaps by her angry inlaws. Such incidents are surprisingly and unfortunately common, even today. The Department of Plastic Surgery depicted how people became burned, the complications of such burns, and photos of their successful repair of the damage. A sign warned in four languages: "No loose and flowing clothes while cooking;" and "never keep the oil lamps and candles near the cot (or) curtains at home when all are sleeping." Next door the department of radiology had a large poster that said, "RADIATION: Friend or Foe?" Flanking this question was one photo of a man being hugged by a large white tiger and, on the other side, a man pointing a gun towards the reader. Not sure what they were trying to get across.

A rather progressive display came from the women of Waste Management, the girls in green saris that can be found on every campus collecting refuse. They had a bucket full of warms displaying thier composting techniques, plastic bags displaying each type of trash collected, and a poster asking us to do our part by not using that plastic bags that are ubiquitous in every aspect of shopping. They are, i'm afraid to say, ahead of their time in India.

Perhaps the most impressive display was a large papier-mache mountain decorated with temples and cities, farms and villages, each depicting a component of the endocrine system. The hypothalamus, a large electricity tower at the top of the mountain, connected to the pancreas, a city full of pizza huts, soda fountains, and ice cream shops. The parathyroid gland - "This is the area of moans, bones, and groans," i was informed by the eager attendant - was a cemetary. Two villages, side by side, represented the hyperfunctioning and hypofunctioning thyroid gland. In the former, skinny farmers rushed about through lush rice paddies. In the latter, lazy farmers and fat cows wallowed around unkept fields.

I've been struck, in the past few weeks, at how alienating it must sometimes feel to be a patient at CMC, the doctors interviewing in the native language but always discussing the cases in english in front of the patient. In medicine we do so much to distance ourselves from patients, from wearing white coats to speaking a language no one understands. To see such a massive outreach to the public in the form of such earnest and elaborate educational tools - in English, Tamil, and other languages - was quite heartwarming. People were learning about what they could do to improve and maintain their health, what the hospital could do in the event that they didn't succeed, and they were having a ball. This was something everyone seemed to be proud to be a part of.

Maybe we need a hospital day back home?