At The Crossroads

 #USA

Post#23

At the crossroads:

Abhay’s fellowship was a 3 years program. It started in June 1992 and by June 1995 he was done. He interviewed at several places and was very happy when a doctor with a private oncology practice in Los Angeles hired him promising a partnership. He would have to go see patients at 3-4 different hospitals in the Los Angeles area. I had just finished my internship year and started second year residency. Our routines were more or less the same as the previous year.

When I was an intern all the new admissions on the day of the call had to be done by the intern(me). The junior and senior residents only supervised. Junior resident especially had the best deal, not much direct work and not much responsibility. My luck was such that when I became a junior resident the program rules were changed and interns could be given maximum 5 admissions in any one day. 🙄🙄 Guess who took the rest out of 30 ? 😪😪. So the year that was going to be my best year out of three suddenly became the hardest . Workload remained same as internship, and responsibilities increased. Nevertheless I had to keep going. 

 I became a senior resident in June 1996. At 30 I was one of the youngest senior residents in the program. Most of the people working under me ( junior residents and interns)were in their 40s , having immigrated from Russia, China,the Philippines, Romania and other places later in their life or if they were American citizens they had pursued other careers before joining medical school. It was difficult giving orders to these older people and I had to really gather all strength, affirm my seniority and learn being their boss. Also had to spend a lot of time teaching them and the medical students that rotated on my service each month.

During one of the general medical wards rotation the attending assigned to my team was a Hematologist who had absolutely no clue about general medicine problems  A Jewish man in his 60s who seemed miserable and unhappy about everything and everyone. It hurts to say that there are real teachers and then there are wannabe teachers!

One call night I had admitted a homeless man who was brought by the police to the hospital after being found unresponsive on the streets. He was hypothermic and completely disoriented when we got him on our floor. We stayed up all night to warm him, monitor his electrolytes, hydrate him,check on his mental status and keep him alive. By morning when the hematologist came to round our patient was completely  turned around from the night before. He was coherent when we reached his bed. He told the attending his toe is hurting. Attending told me to get an X-ray. It turned out to be a small fracture in one of his toes. It was a small thing compared to his condition when he arrived.

During the same rotation another call day I admitted a 50 something Mexican man who had come to the hospital because he had no appetite and had been losing weight rapidly, over 50 pounds in 2-3 months. My top suspicion was malignancy vs TB. Malnutrition and other diagnoses etc were lower on the differential list. I ordered a CT scan of his abdomen and a colonoscopy. In the morning as the attending entered the ward the radiology attendants had arrived to take this patient for the CT scan. The attending asked what’s the CT for. I told him about the case and my differential diagnosis. He made me look like a fool and in no uncertain terms insulted my judgment and decisions in front of my intern and junior resident for ordering expensive tests and multiple tests simultaneously. Having overruled the order for CT scan he made me send this patient to colonoscopy first.

 The colonoscopy was early next morning. By the time the attending was back on the rounds the ward staff brought the patient back from colonoscopy suite. Just a few minutes upon arriving back on the ward the patient started complaining of severe abdominal pain and before he could complete a sentence or two he collapsed. The attending instead of jumping in with us to save him in this emergency, conduct cpr etc just ran away from the scene as fast as he could like a coward. I couldn’t save the patient despite everything. Autopsy was ordered. He had died from a ruptured aortic aneurysm. The colonoscopy had done the last trauma towards an impending disaster. Had the CT scan been done the earlier day we would have the diagnosis and the man would be alive!!  I still remember the name of the patient…..Chavarria. The face of the man refuses to fade from my memory. I had failed him. 

After all this, at the end of the month this attending wrote on my evaluation that I was careless, unfit to be a senior resident,ordered unnecessary tests and had missed diagnosing a toe fracture ( he didn’t bother to mention I had saved the same man from hypothermia before he lived to tell us about his toe pain). He gave me a B on the evaluation ! It was my only B in the entire 3 years. The rule at the time was if we got B twice or more in three years we had to repeat a full month rotation before we could graduate ! I wanted to take him up on that one but let it go. All I wanted was to graduate and be with my kids. And that one unfair B was not going to do harm. If it did, I would have fought it tooth and nail.

Abhay’s monthly check had improved significantly once he took up the job. For a couple of months he got the salary promptly on the first of the month. Then the third month it didn’t come on time . He waited a week and requested it . After multiple reminders he was given only partial payment. Next month same thing . He was told to wait because there is not enough revenue, billing is pending . He was assured he would get the dues once the payments from patients came in. Another 6 months went by. He was religiously going to work daily and coming home with zero pay in those 6 months. We had apartment rent, car payments, and now 2 kids with diapers and baby sitting expenses.Abhay’s reliable fellowship income had stopped. Just my meager residency stipend was the source for survival. I was beginning to get annoyed. I told him quit the job and look for another. For over 6 months you are working for free  and we are paying for babysitting because you are gone. Even if you sit at home we can save money. He started searching for another job but at the time situation in big cities was such that there were a lot of jobs for primary care but very few or none for specialties.  

May 1996  my last rotation as a junior resident was in oncology. While speaking to the oncology fellows I mentioned to one of them that my husband is an oncologist and having a hard time finding a job. He told me he knew that Kaiser Permanente is looking to hire an oncologist in Bakersfield but they want one immediately. I came home and told Abhay to call the Kaiser recruiters. Are you willing to go to Bakersfield ? They asked. We were desperate. There weren’t any other options for us. We decided to say yes. Right away they interviewed him and accepted him for the position. They agreed to let him to start by September. No later.

Bakersfield was 145 miles from where we lived. Driving daily from there was not practical for Abhay.  If we found a place equidistant each of us would still have a good 60-70 miles drive to our respective workplace. In case kids needed help in an emergency neither of us would be close enough to get to them . I had 9 more months to complete my residency. We decided to stay apart. I would remain where I was with both kids because Arunaben was close by. He would get an apartment in Bakersfield. 

But there was a problem with that. Who would be with kids when I’m on overnight call when Abhay is away ? As I stressed over the situation one of my friends in residency came to my rescue. He had a masi who had a green card but lived in India. He summoned her right away to come and work as a nanny for our kids. I cannot fully express my relief at the time and the lifelong gratitude I feel towards my friend Gyandev as well as Kammuben ( his aunt) . She lived with us and took good care of the kids whenever I was away at work. Her family would take her home on my weekly day off.

Abhay got a single bedroom apartment in Bakersfield and started his job at Kaiser Permanente in mid September 1996. 

Despite help from Kammuben, living apart was not easy on me. Advait had asthma during the early years. When he would get some serious attacks inhalers would not work and  I would have to take him to the nearest emergency room. Invariably this would be in the evenings. I would take him by 7 pm and wait for our turn till 11 pm . Once inside,the nurse would take the vitals,the doctor would come see an hour later and put in medication orders. The nurse would take yet another hour to bring the nebulizer and prescriptions. By the time we picked the medicines from the pharmacy and got back home it would be 2-4 am and I had to leave for the day’s work in an hour or so . Many such nights are stuck in my memory. Fortunately Advait grew out of the asthma as he got older.

That December Advait turned three and Amita turned five . We had a joint birthday celebration for both in the party hall within our gated apartment community. 70+ people came including my new friends from residency, Abhay’s friends from fellowship, his old GMC friends, Arunaben with her family, Kammuben and of course Sheela tai and her family. I single handedly cooked an elaborate menu of bharli vangi ( stuffed eggplant), stuffed bhindi ( okra), masoor usal, vegetable biryani, dahi wade, batate wade, shrikhand puri , gulab jamun, fruit salad with mango juice in it and more. At that time everything seemed possible. Taking on such tasks was not intimidating. My cooking skills had come a long way since the early Chicago days. In fact I found it relaxing to cook. I still do. 

Another hilarious incident comes to mind of those days. We had served Margaritas to our guests at that  birthday party and there were leftover ingredients at home after it. Abhay was gone back to Bakersfield after the weekend.  I was again on oncology rotation in my senior year. It was an elective rotation and I could take a weekend call from home. I would have to go only if called. It was a slow day, nothing going on. My beeper was silent. 

Somewhere in the afternoon I got an idea to fix myself a really good margarita. That was my favorite cocktail ( it still is). I was a novice at all that. I added the ready lime margarita mix, some triple sec, a generous helping of tequila and ice into the blender and turned it on to make myself a nice sized serving 😜. And then gulped it down faster than I should, on an empty stomach. Needless to say,and to put it mildly, the results were quite dramatic 😂😂. It was my first personal experience ever of acute alcohol intoxication( in simple language I got drunk😀). But luckily there were several redeeming factors to save the day.

 First, Kammuben had not gone to her family because technically I was on call.

 Second, I had retained judgment enough to know that I wasn’t fit to drive if called at the hospital. 

Third, I had the presence of mind to call my friend Gyandev who was a year my junior and tell him about my stupidity and ask a favor if he would go in my place if I got called that evening/night. 

Fourth, he was a good sport, did not judge me for my actions and graciously agreed to be my backup that night. (This was his second time coming to my rescue , first when he brought Kammuben from India to help me)

Fifth, I wasn’t called at all that night. 😀

I learnt several lessons that day about what not to do 😂

The saree here is not an old one from those days. It is a very recent one. I chose this one as it represents love I have received from friends like Gyandev over the years. Just unconditional love that only gives without expecting anything in return. 

This is a Gamosa weave from Assam that originally was used as a towel to wipe oneself. From what I read somewhere it was presented traditionally to honored guests along with tamboul ( betelnut) as a token of respect. It was also used by men to tie around their heads during the traditional Bihu dance. Imagery from the dance such as the dhol( drum) , pepe ( flute made from rhino horn) and jaapi ( bamboo hat) works it’s way into the weave in the form of motifs to create its full exquisite glory. From its centuries old uses the weave has recently been applied to Mekhala sadors and sarees. A dear friend made a wild guess that I probably don’t have this weave in my collection yet and on the occasion of my recent birthday sent it via courier. With pre-done fall, tassels everything , it arrived earlier last week and was ready to wear. I am truly speechless and so is my photographer when I told him that this came as a gift from a sister from another mother across continents. I have met her mother but I have not met her in person YET and this fact is unbelievable even to me . If this is not love, what is ? You know who you are my dear soul sister. This saree will remain one of my cherished possessions. 💕💕