Sunday, July 3, 2016

Travelling Home

The mind is a powerful thing.  For about three weeks, I watched a woman who had been in a car accident and fractured bones all over her body, who had been admitted unconscious with a brain stem contusion, and who could not eat anything for two weeks, gradually improve.  After the first week and extensive surgery, she was moved to the IMCU.  Later on, she was transferred to the general wards.  She was eating, moving, and speaking.  Her tube feeding was removed. She was getting better and could have probably gone home in the next week or two.  Then, she found out that she had accidently and tragically killed her son in the car accident that put her in the hospital.  By my second to last day, she had become so depressed that she had ceased all eating.  She dropped so much weight that she was placed back into critical condition and is now laying dead-faced in the ICU.  She is receiving IV fluids again.  The prescribed diet is a soft diet with mild foods like milk, idly, rice, soup, and juice.  I will not be there to see it, but if she continues on like this, she will be placed back on nutrition support.  For two to three weeks, before the depression fully set in, this woman’s body knew what to do to heal itself.  Physically, she was recovering just fine.  When she fully realized what had happened, her mind took over her brain, and she is in critical condition, again.  This is amazing to me.  You can teach nutrition students all of the theories, guidelines, disease states, advanced nutrition sciences, among any other topic, but handling patients’ psychological needs is something not taught in school.  For me, this is too difficult.  The hospital to me became a symbol of disease and sadness.  I love to talk with the dietitians, and we have become friends by now, my last day.  However, the job of any hospital worker includes being around people who are suffering, crying out, coughing, spitting, screaming, and gasping for breath.  In many cases, they are totally dependent on you. In cases where they are not, they often do not listen.  Additionally, I know that I love food science.  I love watching Madhan make the breakfasts and dinners (I am not here for lunch to watch him make it).  I love trying new fruits and vegetables and hearing the dietitians explain why you eat certain foods in which ways.  I love reading research articles.  I also love looking at the body and how it works, including in hospital care.  However, the hospital environment is wrong for me.  It is good to find this out now. 

The only other patient I wish to mention that I saw is one who I have also seen everyday for the last two weeks.  He was admitted after a traffic accident and had a bad head injury.  At first, his diet was hugely artificial.  He was receiving 28.5 kilocalories and 2.1 grams of protein per kilogram of bodyweight, much higher than the necessary 23 kilocalories and 0.8 grams of protein to maintain a healthy human.  Despite this high input, the patient was admitted with a BMI of 22 kg/m2 and ended up at 16.8 kg/m2.  This means he dropped from a healthy weight to being malnourished.  He is now receiving 40 kilocalories per kilogram of bodyweight and the same amount of protein as before.  Besides milk and porridge, his diet is 100% artificial.  He is being given three different supplements several times each day to maintain a high intake of energy and protein.  There are two reasons for his drop in weight.  After having been moved to the wards, his food intake was not monitored as regularly as in the ICU.  So, he was not receiving enough energy.  Additionally, he continued to develop minor infections, so his body was expending huge amounts of energy to fight these on top of having to rebuild after a head injury.  He developed hypoxia and could no longer efficiently use the food he was taking.  Now, he will remain in the ICU until the hospital can boost his weight.  In the USA, there would be a major investigation to discover why a patient was allowed to become malnourished after admission.  Many times, US dietitians document patient condition heavily when they are admitted to ensure that there is no malnutrition present beforehand.  The hospital and dietitians would be liable to a lawsuit for mistreatment.  I am not sure if there will be an investigation here, but it seemed like Gayathiri was not worried about it. 

The hospital was checking the oxygen lines in all of the critical units today.  Because the oxygen lines run behind the beds of the patients, the staff moved, literally, every single patient from these units to these super cramped, makeshift critical care rooms.  The difference was shocking.   The makeshift rooms were very crowded, super hot without any air conditioning, and really loud.  Workmen were removing and replacing tiles on the walls (which is pretty much an everyday occurrence all over the entire hospital), so there were all sorts of noises.  Also, there was hardly any equipment.  In the ICU, there are clean tables, several medical machines, filing cabinets, etc.  In the makeshift rooms, there were dirty tables, and that was about it.  Normally, these patients receive very careful care and attention in their units, but these rooms were awful.  I have also noticed that the power goes out more frequently, here.  It only happened on two days while I was at the hospital, but it continued happening during the length of the whole day.  Hospital workers have to deal with a lot of unfortunate external problems; infrastructure does not support them.

Technically, yesterday was my last day of training at the hospital.  At the end of the day, the dietitians brought out a cake, we took many selfies, and we all wished each other the best.  Today, I went back just to hang out.  I was only there for about three and a half hours compared to the usual six.  At any point, one of the dietitians stayed in the office with me to chitchat.  Gayathiri made a lot of jewelry for my wife as a gift to me as I go.   During these three hours, she spent two of them working on finishing all of the jewelry.  Some she had made during the last week, like the four really nice, deep red bangles.  Today, she made several pairs of super cool earrings out of only glue and paper.  It sounds silly, but they look really awesome.

Now that I have finished everything, we are going to celebrate our last night in India!  I do not think I have mentioned it, but another student from Appalachian State randomly showed up in the mess hall this week.  He is a botany student, and is totally new to India, like Jess and I were four weeks ago.  We are going out tonight to show him around, shop, and party!  I cannot believe the past four weeks are already gone.  It blows me away.  


One last thing I want to mention, which I am sure I will mention again in my last remaining blog posts to come in the next week, is that the culture is so different here.  People know English, but it is a different English.  I was asking one of the dietitians who is married about what her husband does.  He is an accountant with four years of experience, making 15,000 rupees ($230) each month.  This dietitian, though, does not speak English well.  I asked her in four different ways about her husband’s salary (sometimes I do not ask people, but she was open with me about her own salary).  I asked “Does your husband make a lot?,” “Are you guys well off?,” “Does his job pay well?,” etc.  English here is very specific; some things are only said in one way.  Before I asked in the only way I figured she would know what I was talking about, I hesitated because the question could be construed very differently back home. Finally, I asked “Does your husband have a large package?”  Her eyes lit up with understanding, and she reported about his 15,000 rupees.  I felt so awkward asking that in a room full of women in a country where women have fewer societal rights where they are much more prude.  However, the only thing any of them heard was “how much money does he make?” in an innocent way. 

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