Thursday, January 30, 2014

The reunion - I

After arriving at the IIMA campus and  freshening ourselves up quickly after a long journey (for me) we went to where all my batch mates were gathered.  Most of them had not seen me after my stroke so they were naturally unsure how to interact with me. For my part, I could take advantage of my inability to speak to take my time to put names and faces together.

There  was some comment about the fact that I had managed to retain most of my hair and most of it had remained black. This is easily explained. The hair on one's head tends to be relatively unaffected if the most taxing work one has to do is to read and  write about a fish. But when you are Director of  something or Head of something else or are managing your own firm, the hair tends to turn grey and lots vacant real estate tends to appear on your head.

The first session I attended was 'Honouring Gurus' which was about honouring various professors who had taught us. Several of my batch mates related anecdotes about various professors the most hilarious of which concerned Prof. Mote who taught us probability. In one of his classes one student fell asleep. He walked up to her, said something loudly and when she woke up with a start, he asked, 'Am I disturbing you?"

Prof. Mote addressing the alumni
The reunion was being held in the new campus which did not exist when I was studying. On the second day of the reunion. we went to the old campus which held more resonance for us. The first event was a photo shoot of the alumni at the Harvard steps. (I am reliably informed that there are  no corresponding IIMA steps in Harvard. 'Pop' goes our egos.)

Alumni Group Photo

Then we roamed around the old campus reliving memories.

With Jaya, my brother-in-law Rananunni and my batch mate Vivek Chandel going around the old campus
While passing the LKP or the Louis Kahn Plaza (which is an imposing name for a grassy lawn with a stage), I recalled the first and the last times I was there.

The first occasion was on my first day in the campus. A few of us were sitting on the lawn at the LKP introducing ourselves. One guy looked over my shoulder and said, 'Janta is playing basky.'I turned back and found that what he meant was that some folks were playing basketball. I then realised that I not only had to learn subjects that I knew nothing about like Accounts and Economics but I also had to learn a new lingo.

With Vivek Chandel, Ramanunni and Jaya at the LKP
The last occasion I was at the LKP was during our convocation when the then PM Narasimha Rao was the chief guest. It was the only time I have seen SPG security. It meant lots of cars, lots of security personnel and being confined to our rooms for most of the day. But I did manage to see that famous pout from a fairly close distance. And I don't remember a word of what he said in his speech. (Apparently this is a common occurrence.)

Above the LKP was the library which held pleasant and not so pleasant memories. I particularly remember the 'New Arrivals' section that had beautiful  hardbound books that smelt nice and had imposing titles but I couldn't get past the first paragraph. Years later, I read Why Zebras Don't Get Ulcers where Robert M. Sapolsky captures the feeling I had:

An overabundance of information can be stressful as well. One of the places I dreaded most in graduate school was the "new journal desk" in the library, where all the science journals received the previous week were displayed, thousands of pages of them.  Everyone would circle around it, teetering on the edge of panic attacks.  All that available information seemed to taunt us with how out of control we felt - stupid, left behind, out of touch, and overwhelmed.

Tuesday, January 21, 2014

Pains before a much awaited trip

Towards the end of November last year, I developed a side strain that made it difficult for me to sit. The pain used to come off and on at a lower intensity for some months. I used to feel better after ultrasound treatment and applying cold packs. This time I strained the muscle more severely than usual due to a bout of severe cough and it was not responding to the usual treatments. I was advised more rest.

Around the same time, I started developing an infection around the feeding tube which started paining.  The doctor prescribed some antibiotics and said that he would come home in a couple of days to check how I was doing. When I have antibiotics I develop loose motion and the regular cleaning meant that my anus started paining. With all these troubles vying for attention and getting bored lying on the bed, it wasn't a very pleasant time.

What made it an even bigger issue was that I was supposed to attend the reunion of my batch at IIM Ahmedabad. When the idea of my travelling to Ahmedabad was first mooted by a classmate some months back, I was taken aback because after my stroke I had not imagined travelling so far.  After I had agreed and the logistics were being taken care of, I was rendered hors de combat.  Daniel Kahneman says that it is better to be a pessimist because then one is rarely disappointed by anything so I thought it may be better not to keep hoping for a timely recovery.

When the doctor came, he found that there was some problem with the position of the tube. There was also a blood clot which was removed by a minor surgery. (Surgery is a dramatic word for what was a small procedure that was not as painful as the menacing instrument in the doctor's hand suggested.)The pain around the feeding tube reduced and I was advised to stop taking the antibiotics. The exercises advised by the physiotherapists for the back pain continued.

Meanwhile preparations for the trip continued apace whether the trip finally happened or not. The doctor's certificate for me as mandated by the airline was prepared. There was the problem of ID cards for me and the nurse. Jaya hunted down my PAN card which I  had prepared almost 20 years ago. A certificate attested by a gazetted officer was prepared for the nurse. (It was a more innocent age when I last flew when all that was required was a valid flight ticket.) We were told not to worry too much about a domestic flight which turned out to be correct.

Since a classmate of mine is stationed in Coimbatore, it eased the planning of the trip. When the tickets arrived, I found that the direct flight to Ahmedabad would take about 4 hours. A direct flight has its advantages and disadvantages -  it meant that I did not have to shift to another flight but I could not sit continuously in the same position for 4 hours. It would cause a lot of pain in my bottom which could eventually lead to pressure sores. I have to be lifted up at intervals to relieve the pressure on my bottom which was managed during the flight.

Thus it was that on the evening of 3rd January I reached the IIMA campus along with Jaya, Sujit, my brother-in-law and the nurse. A small, well fed, well stocked army is required to haul me around. If my brother-in-law had not got leave at that time, I may not have gone for the reunion. Jaya is getting on in years and would have found it difficult to provide the necessary manpower to shift me in and out of vehicles. She also often has pain in her left elbow so I was not going to take  the risk of aggravating it.

Thursday, January 16, 2014

Nursing changes - II

One problem I have when a new nurse comes is that for a few days I have to be a better statue than usual. This is because the nurses would not yet have learned my communication methods  so if I moved any part my body inadvertently, they will rush to my side but won't know how to proceed. They will ask if it is about head, legs, hands, pillow, urine, etc. but they won't understand my reply. Finally they will call Jaya who will find that I didn't need anything.

The nurses were all believers and were often told that they will get some brownie points if they took care of me which will ensure that they will go straight to heaven. I hate this kind of talk and will sit quietly hoping that it will get over quickly. Amazingly (for me) the nurses swallow this line hook, line and sinker and make the appropriate noises.

One nurse said those who didn't believe in god are goners (not the fist time I have been told about this bully in the sky). He (it was a male nurse) didn't know that I don't give a shit about any god.Unfortunately nobody said anything about my disposition in these matters thus depriving me of some blog fodder. It would have been interesting to hear what he had to say. As Christopher Hitchens said in this debate, 'You never know what they [believers] will come up with next.'

The first thing that a nurse is taught after coming here is to know when to turn the page of a book that I will be reading. The book will be kept in a book-holder in front of me and when I finish reading a page, I will turn to the nurse and blink which will be the cue for the nurse to turn the page. I had thought that this will be the easiest part of a thankless job but it doesn't quite work that way. Generally the nurses would prefer that I lie on the bed and do nothing so turning the page was an additional chore that they could have done without.

Some nurse will sometimes turn two pages and I will struggle to convey this to them. Finally Jaya will come tell them what the problem was. She will tell them to look at the page number before turning the page but in some cases this did not seem to make a difference. I suspect that those nurses were not sure about the sequence of numbers. It might have proved embarrassing to check so I didn't pursue the matter. And then there is that damn mobile phone.@#$%&!

 After one of the many instances of children dying in hospital in West Bengal, I heard one anguished parent complain that the disaster happened because the nurses were busy talking to their boyfriends on the mobile phone. After my experiences with the nurses here I have no difficulty believing the story.One nurse moaned that she was tired of life. The reason? Her mobile phone had not been activated for a week because some information had not been provided!

Most nurses are scared of touching the computer so it has been difficult to train them to do simple tasks for me.  As a result I have not been browsing as much as I used to do earlier. That is why you don't see too many links from the past 6 months in my posts. (Thank God for small mercies, right?) When I do manage to read some of my favourite blogs, I get the impression that the blogosphere is managing quite well in my relative absence. Amazing! I wouldn't have thought it possible. There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy

The nurse who had stayed for 12 years used to do quite a lot of typing work which was essential for keeping the blog going. I  have been able to continue wasting your time since her departure thanks to the neuro-headset. According to this article, most people don't make it to the end of an article when reading online so probably I am the only one wasting my time.

I noticed a curious thing in almost all nurses, whether they came from Kerala or Tamil Nadu - the way they pronounced the letter 'p'. Plug will be 'phlug', pant will be 'phant', ship will be 'shiph', apple will be 'aphle'...It must have something to do with how they are taught in schools since everybody seems to have it.

The current nurse has stayed for about 5 months which is the second longest stay ever for a nurse here. She will leave next month because she is getting married after which she will stop working. Then the whole rigmarole of looking for a new nurse will start again. As for when it will end, your guess is as good as mine. Perhaps God knows! ;-) Maybe I should just take refuge in Shelly's words in the poem, Ode to the West Wind, 'If Winter comes, can Spring be far behind?'.

Thursday, January 9, 2014

Nursing changes - I

The nurse who had been looking after me for about 12 years left  because of some domestic issues. Looking after me is a pain in the neck and during her unexpectedly long tenure, all the regular routines which I am used to now were established. She had done a great job and I was under no illusions about the difficulty of finding  a replacement for her.This was especially because we had experienced a succession of nurses before her who stayed for a few days to a couple of months. They were used to looking after mobile patients who could speak and mine is a very different case.

We tried a couple of male nurses but Jaya was not comfortable with them since she has to spend a lot of time with them explaining my quirks and communication signals. They also seemed weaker than the female nurses. One male nurse turned out to be diabetic and his hands shook  so much of the feeding used to fall on the bed. Getting a female nurse was not easy because in many places a female nurse will come only for a male patient who is above 60.

We had encountered similar issues at the time of my stroke also and the problem seems to have increased. The reputation of males seems to have taken a turn for the worse during the period. Since it is a bit difficult for me to undergo a sex-change operation or to increase my age by a couple of decades, we decided to be patient and wait for the right nurse to come along. Thus we  played host to a series of nurses who stayed for a few days to a month.

All nurses have one or even two of an instrument that I have come  to hate - the mobile phone. The phone is always engaged and the conversations often last for an hour about such vital issues like the latest movie release. Meanwhile I would have finished the page I was reading and waiting for somebody to turn the damn page. I will use part of that time trying to improve my cursing abilities and part of time thinking of the next PJ to inflict on my hapless readers (those who still survive the assault).

Slate had an article about some annoying technologies. I would have added my pet hate to the list - the mobile phone. I hope the person who invented the mobile phone goes (or has already gone) straight to hell where he (or she)  is having a gala time in the vats of boiling oil or whatever else people in the know say the place is stocked with.Your queue is my mobile phone.

Most nurses suffer from The Dunning-Kruger syndrome - the exasperating ability of many human beings to be confidently wrong about something. If I have to nominate one human weakness that I have found most difficult to deal with after my stroke, it is this syndrome. There is nothing much that can be done by blinking when you are face to face with someone who seems to suggest like Yul Brynner in The Ten Commandments: "So let it be written. So let it be done." Mine not to question why, mine but to do and sigh.

Jaya has learned through trial and error for 14 years and through discussions with various doctors and physiotherapists what would be the best way to handle me in various situations. The nurses will never have seen a brain stem stoke patient. They will try the same thing  that they had done with other patients and fail but they will keep doing the same thing even after being repeatedly told the correct procedure.

For example, one characteristic of this stroke is clonus accompanied by spasticity. One physiotherapist described this as 'velocity dependant stiffness'. Thus if try to bend my leg fast, it will become stiff as a log and you will not be able to bend it. But if you bend it slowly, it will be as limp as a rag and it will bend easily. So, to bend my leg quickly and easily, you should do it slowly. This counter-intuitive idea never seems to occur to the nurses in spite of it being demonstrated several times. They will try to bend the leg fast but will be unable to do so. They will get exasperated and will keep telling me to loosen my leg. They are unable to grasp the idea that this is not in my voluntary control.