Hello from Felicia

Hello Everyone,
This is my first time blogging, so please be a bit patient while figure this out. Chris has already told you about most of our activities, so my plan is to just fill in some of the details and post some more pictures. My arrival into Delhi was mostly uneventful......aside from the hotel mix-up (which was a pain in the butt). After we both arrived in Delhi we did our tour of the city.


Here is a picture of Humayun's tomb. This was probably my favorite thing we saw that day. This building is supposed to be one of the inspirations for the Taj Mahal. It was very peaceful and grounds were beautiful.




Here is a picture of Chris and I at the tomb. I have posted this picture as an example of my inability to take good pictures. We have so many pictures that would be great if I did not have my eyes closed. Oh well, such as life.





Here is Chris at the B'hai temple. This is a classic Chris pose that I thought deserved some blog attention.











The next day we went to Agra and visited Agra's Fort and the Taj Mahal. As Chris said there were tons of beggars (both kids and adults) in Agra. I'm never quite sure how to act around them and at times they can be a bit much. However,some of them are very entertaining. After consistently telling one kid that we are not going to give him money he threatened to call the police, and walked away from us yelling "Police, Police!" It was great.




So, in Agra I was a rock star. We met so many people who could not believe that I really exist. It was great. Several Mongolians and also Indian tourists wanted pictures with me. Here is an example of one of the many pictures I took at the fort. I should have started charging for pictures. I might have made a profit on the visit

Here's Chris making a face. I'm not sure what else I can say about this. You just gotta love him.

Here is the obligatory monkey picture. So cute!

After Agra we hopped on a plane and flew to Cochin (and stayed in an area called Fort Cochin). As Chris has already mentioned Fort Cochin had its ups an downs. We had a great time with the elephants, but the weather on our first day was really not great, making site seeing no fun, and Chris was sick for a a good bit of the visit.

Anyway, here is a picture of the Chinese fishing nets that are used along the beach at Fort Cochin. Basically they use big nets to catch fish that swim by. The fishermen here also use more moder methods of fishing, but I think these are still very much apart of the fishing industry.

While we were in Cochin I also got to pretend that I am an MD, and I removed the five stitches that Chris got from the accident. Maybe I have a second career in plastic surgery......

Here are some more elephant pictures. This was an awesome morning! I had so much fun, and by the looks of it think Chris did too. At the end of this post is some video of Chris washing the elephant! Have a look.

Just in case you couldn't tell I am having a great time. It is trips like this that make almost three years of long distance well worth the time and effort we have both put in. Right now we are in Alleppey and are staying in a small resort on a lake. It is awesome.

More to come in a few days. I hope everyone at home is good. Can't wait to hear what everyone else is up to!

OK, we're back in business...sort of

Hello everyone.
Sorry about the hiatus. Its been a little wacky, but we're online (at least for today). Since we last spoke (or rather, I monologed) we have had a whirlwind last few days. So, Felicia and I met up in Delhi. Our hotel room was most entertaining. As mentioned before, we got a car and driver for a day in Delhi and Agra. Delhi was fun. Agra was ridiculous. For the first part, our driver stopped off several times during the day to take us to "museum/shop" places that were really just stores full of tourist stuff. When we got to Agra, we were hounded by people begging (especially the kids, which is tough and they know it....one of them kept calling me Uncle). Actually, Delhi was pretty bad too. Its a shame, because all these people getting in your face insisting that you buy stuff makes you a little paranoid and on edge while you try to enjoy the sights. Having white skin is like having a target on your forehead. But black skin has its own issues too. If people sometimes stared at me, Felicia was very very popular. You'd think these people had never seen a black person before. Many Indians are as dark as her, but they looked at her like she had just stepped off of a spaceship. Amusing, especially when they all wanted their pictures taken with her.




Here is Felicia inside one of the mausoleum "annexes"






So, we went to Agra. Saw the tomb of Akbar. Had lunch. Went to the Taj Mahal. It was like running a gauntlet to get through the people trying to scam you out of every little cent. I really began to feel like all Indians just want to nickle and dime you to death. I know this was just sypmtomatic of the locale, but it got old really fast.















Here is the lotus-shaped b'hai temple in Delhi. They were very nice. It was free, including shoe storage.







I think this is Akbar's tomb. Its all blurring together.












Inside of Agra Fort.










Holey Moley, I can see the Taj mhal from here!


















Yes, we are very cute.










Our hotel in Agra was ok, not much better than the one we had in Delhi. We did get a free breakfast again, though! We left early to make sure we did not miss our flight out of Delhi that afternoon. The two cities are about 120km apart, but on Indian roads that can easily take 4 hours. Our driver stopped again at the same little rest area as before, this time there was a guy with a cobra out front. So we walk over, I figure it will be a couple of rupees. He wants to put a python on Felicia's neck but she declines. He pulls out the cobra which gets all worked up and puffs up. We take our pictures. And then he demands 500 rupess. Wow. My mistake for not agreeing on a price sooner. We haggle, I give him 300 (about $10, still way too much), but he is a dirty nasty old man and I just want to get on the road.

We made it to the airport in enough time and got to Cochin with no problems. This place is so much more laid back than around Delhi. It was a little cooler, if more humid, but cleaner and less hectic. Our homestay sent a car to pick us up, for what amounted to a 1hour drive to our new home. We were very pleased with the new digs, went out to eat, then home to sleep.

In the AM, we got up early and headed over to the elephant training center, where orphaned elephants are taken in and trained, so that they can lead productive lives working for the forestry department or in temples. If you get there early enough, you can help wash them in the river!






Here is Felicia scrubbing away with a coconut shell! We scrubbed a 6-yr old female named Asha. She was very clean in the end.
Here is footage of the acutual elephant scrubbing. There are shots of me too, we'll put them up in a few days. Anyways, it was a dream come true for me to scrub an elephant. We got a ride on the big adult female too. Wow. Thats a lot of animal.

On the way home I realized that India is trying to kill me. I began round two (and by far much more severe) of my gastro-intestinal difficulties. It has been pretty rough. Felicia is wonderful, though. We were supposed to have moved on today, but we stayed in Fort Cochin for an extra day to let me be a little more presentable in public. I probably won't eat at all today, but you gotta do what you gotta do.

Tonight we'll try to see some ritual dance performances, and then tomorrow its on to Alleppey, and eventual houseboat time.

Here are a few words from Felicia:
Hey, world! Look Mom I'm blogging. The next time we get to another internet cafe I will put up a proper post, but I just want to say "Hi!" and let everyone know that I am doing well and I am having a great time. So far I have not had much gastric upset and for the most part the climate seems to agree with me, although Chris may have a different opinion. We have got to run to the theatre, so I will leave you for now. Thanks for reading! More to come!

Hello From New Delhi

Hi all,
I made it to New Delhi without incident. My flight was on SpiceJe, one of the low cost carriers here in India. It was actually a rather pleasant experience. Non-stop from Chennai to Delihi, on-time, my bags made it. Not too bad. Felica was there to meet me at the airport. There was a bit of a mess when she got in in the AM, but she got us into another fine hotel and they were there to meet me. We're staying at the Karat 87 Hotel, in Karol Bagh ( a part of New Delhi). Its actually not too bad. The place has friendly staff, great lighting, 24-hr room service, hot water, tv, and free breakfast every day.
This morning we arranged a trip with a travel agency to take us to Agra tomorrow. We had the use of a car and driver all day today, and then he'll pick us up tomorrow, take us to our hotel in Agra with some sights along the way, then to the Taj Majal and Agra Fort. Monday AM he'll take us to the airport for our trip to Cochin. Good deal actually.

Today we say the Gateway of India, a really old mausoleum that the Taj Majal is patterned after, and the giant Bahai temple which is shaped like a lotus flower. Then we had dinner on a rooftop in the chaotic Paharghang district, did some shopping, and came home. A full day already.

I'm impressed with New Delhi. The contrast between this and the dusty, filthy town of Vellore is stark. In New Delhi I see a lot less trash (although Felicia, not having seen Vellore, might differ in opinion), a lot less cows (although they are by no means absent), many more cars than motorcycles and ox-carts. The roads are paved, and I see what appear to be middle-class neighborhoods. Don't get me wrong here, there are still plenty of people living in terrible squalor and poverty. This is still India. I guess that Vellore shows me one side of this nation, how many people live amongst filth and dirt and disease, how people eke out a bare subsistence every day. I come to Delhi and see wide roads, shiny condos, and the economic powerhouse that this nation has become. It is a remarkable dichotomy, best represented by my strolls though the city this evening. Beautiful city and filthy reeking alleys with handicapped beggars wallowing in filth as cattle roam freely. This place never ceases to capture my attention.

I took a bunch of great pics today. This camera I borrowed is really getting a workout. The web -access at this hotel is crummy at best, though, so no pics today. Hopefully tomorrow I'll be able to put up a bunch from our hotel in Agra. I'm having more and more fun every day. Part of it comes from being a lot more nonchalant about stuff, as a "veteran" in comparison to Felicia. Part is also just how happy I am that she is here. Its great to see her. I've really looked forward to seeing and doing new stuff like this with her, so good times all around. Plus, I'll probably make her take the stitches out of my face in a day or two!

Awesome!

OK. Well, sorry about the pics, but like before, hang in there. There will be a deluge once I get the right kind of access.
Wish us well.

Goodbye to Vellore

Well folks,
I am about to embark on the "after" part of my Vellore - n -after trip. Goodbye shreiking giant mutant bats that wake me every morning. Goodbye crazy Vellore town. Goodbye CMC, which I got to know from a variety of viewpoints! I got to see and do and learn a lot. Some disappointments, but I'm still very very happy with my experience overall.

So now I head up to Delhi this evening. Felicia already got there this AM. She called to let me know that the hotel there we had been corresponding with regularly, which had arranged to pick her up at the airport when she got in at 5AM 1) did not pick her up 2) had no rooms available when she got there. Stupid Hotel Tara Place. You will get some bad on-line reviews from us.
The last I hear, she had found another place, but could not check in until noon, so I guess she's hanging out in Delhi for a few hours. In theory they will pick me up too.....let see what happens.

We'll spend 2 day in Delhi, and take a day trip to Agra to see the Taj Mahal. Then we fly down to Cochin in Kerala, stay there a day (hopefully wash some elephants), go down to Alleppey, back on a house boat, then down to Varkala for a night, then to the very bottom and Trivandrum (Thiruvanathapuram). From there, fly up to Mumbai for a few days, and finally head home on the 9th of May. Wow. I am going to need a vacation after this trip.

Internet access may be spotty. I'll post text whenever I can. Pics will depend on many things, but I shall try. Felicia's going to post on here too.

2 more weeks of wacky fun! Wish us luck!

Chikungunya Virus

CHIKUNGUNYA - A Problem for Vellore, Tamil Nadu, India, and the World

Overview

Chikungunya fever is a re-emerging viral disease, especially in South India, characterised by abrupt onset of fever with severe arthralgia followed by generalized fatigue, fever, chills, nausea, vomiting, lower back pain and rash lasting for 1-7 days. The disease is usually self-limiting, and rarely fatal. The virus (CHIKV) is an RNA virus beloning to family Togaviridae, genus Alhpavirus, and derived its name from the Makonde word meaning "that which bends up", referring to the stooped posture developed as a result of the arthritic symptoms of the disease.

History

There are apparently two distinct lineages in Africa and Asia. This arbovirus shows some diversity between these two strains. In Africa, the disease cycle is maintained between monkeys and wild mosquitos in the forest. In contrast, the Asian lineage cycles between humans and our old friends the Aedes aegypti (also the vector for yellow fever, Dengue, and other fun diseases. Basically, they are jerks) mosquito. These like to bite during the daylight hours.

The first recorded epidemic was in the early 1950s, in Tanzania. Shortly after that, CHIKV was noted in Bangkok, Thailand in 1958, with viral transmission continuing up until 1964. There followed a period of quiescence, a hallmoark of this disease, followed by a second period of activity in Bangkok in the mid 1970s, finally declining in 1976.

In India, there have been well documented outbreaks in 1963 and 1964 in Kolkata (Calcutta) and southern India. This 1964 outbreak was very well documented, as it was focused on Vellore (home to the CMC), Chennai, and Puducherry. As the rainy season turned to summer, moquito populations bloomed, and as temps dropped and things dried out, the mosquito polulations shrank, with a resultant decline in human cases. A small outbreak was reported in Maharashtra (around Mumbai/Bombay) in 1973. One of the most publicized ourbreaks was among several islands in the southwest Indian Ocean, namely La Reunion, Mauritius, and the Seychelles, apparently ongoing now since 2005.

In keeping with its pattern of activity-quiescence-activity, the disease has also reappeared throughout southern India since December 2005, in the states of Andrha Pradesh, Karnataka, Maharashtra, Madhya Pradesh, and Tamil Nadu (where I am right now). This outbreak continues to the present day. In June 2007 there were 7000 confirmed Chikungunya patients in southern India, and it appeares to have spread from Kerala and Tamil Nadu to Sri Lanka around this time. As of Jan 2008, at least 8 people had been diagnosed with CHIK in Melbourne, Australia, and in Singapore authorities were given legal power to detain any Chikungunya cases.

Clinical Features

As stated above, this is an acute infection with abrupt onset of fever and severe arthralgia, followed by other constitutional signs, with a rash lasting for a total of 1-7 days. The incubation period is usually 2-3 days. Fever often rises rapidly to 39-40 C, and shaking chills, with this acute phase lasting 2-3 days. The temperature me wane for 1-2 days, then return, in a "saddleback" fever curve.

Arthralgias are polyarticular, migratory, and predominately in the small joints of the wrists, ankles and feet. They usually progress in a specific order, actually. Knee, then ankle, then wrist, then phalanges, then elbow. Patients in acute stage are incredibly reluctant to move, prefering to remain in the flexed position, often confined to bed.

Patients do not exhibit any active bleeding, but do evidence hypotension and GI distress.

Cutaneously, patients present with flushing over the face and trunk, followed by a maculopapular rash, occasionally extending to the face, palms, and soles of the feet.

Other signs and symptoms can include headache, photophobia with retroorbital pain, conjunctival redness, sore throat, and pharyngitis.

Neurologically, encephalopathy is the most common sequela, with alterred sensorium and ataxia. An EEG within normal limits offers a good prognosis and decreased likelihood of mortality. CSF shows increased proteins, increased activated lymphocytes. On MRI, multiple high-density dots are seen (similar to those seen in Nipah virus). There are no spinal cord changes seen. Other than encephalopathy, the other common neurologic manifestations are myelopathy, polyradiculopathy, neuropathy (early > late), and carpal tunnel syndrome (2/2 excess synovial fluid and swelling).

Dangerous sequalea may occur in neonates, who are prone to developing meningo-encephalitis. This disease can be transmitted vertically from mother to fetus. Similar complications occur in the immunosuppressed as well.

The tricky thing is that symptoms of CHIK infection are almost identical to those opf Dengue fever, and dual infections of these two have been reported.

Prognosis varies with age. Younger patients tend to revover completely within 5-15 days, while the middle aged take 1 to 2.5 months. The elderly can take even longer.

Detection

A serological test has been developed and is in wide use throughout affected regions. This is employed via am IgM card test. There are also rt-PCR assays. The actual virus has only been isolated from CSF twice.

Management

At present, as with many viral infections, there are no specific treatments for Chikungaya fever. Luckily it tends to be self-limiting and resolve with time. Stiffness and morning arthralgia can be improved with movement and mild exercise, but heavy activity appears to exacerbate the problem. Many medicatons have been tried. IV Methylprednisone, plamapheresis, IVIg, and others, alone and in combinations, have had poor responses. NSAIDs are recomended, and Chloroquine has been reported as useful on arthritides refractory to NSAIDs.

Otherwise, one should keep infected people away from mosquitos to reduce further transmission.

Prevention

There is no vaccine currently available. A Phase II vaccine trial sponsored by the US in 2000 used a live attenuated virus and showed 85% resistance at 1 year.

Other measures recomended are the same as for all mosquito-born illnesses. Cover yourself, use DEET, eliminate breeding sites by dumping, covering, or draining stagnant water etc etc.

This might work too.

Follow-up

Why Chikunganya exhibits its active-rest-active cycle is as yet unclear. Recent outbreaks have been more severe, and sequencing indicates that the virus may have altered its virus coat protein, aloowing it to replicate in mosquitos more rapidly. The recent vaccine trials are promising, but wide-spread use has been postponed pending the outcome of long-term studies.

Hi everyone!
I'm doing pretty good, inc case you were wondering. I'm healing pretty well, the ribs still complain from time to time, but so far so good. I do, however, have some pretty bad vertigo if I move my head too fast or close my eyes. I've done a lot of putting my foot on the floor and grabbing the table to steady myself. And sometimes I walk like I'm a little inebriated. Which I should be used to (there, I beat you to the joke! ha.) But it could be worse.

I walked around the past couple to days and took some more random pics of entertaining stuff here in Vellore, in light of my pending departure, but my faithful interent cafe is closed for the day. Acutally, there has been a power cut for all of Ghandi Ave (a mojor commercial street), so a lot of people have generators running on the sidewalk. Just adds to the heat and pollution. However, I was just in a travel agent's office, and it was like a sauna in there. No power even for fans. Wow. Those are some sweaty travel agents. Anywho, I had some funny pics, but only a 50% chance I'll get them up before I head out tomorrow. I shall do my best though.

Instead, some more random musings:

1) It turns out that Anne, she off the head-holding in jerry-rigged C-collar, and I have a connection. I may have already posted this, but I have a head injury so let it slide. I went to All Saints in Manassas, VA for elementary school. I was the skinny kid in the class and my dad was an MD. The chubby kid in the class, who's dad also was an MD, was named Paul Cioletti. He left All Saints around 5th or 6th grade, and I haven't heard anything since. Fast forward a couple of decades, and I remember noting about 4yrs ago that I had a classmate named Cioletti. I just noted the occurrance, thats all. Anne and I (and Cristina and I, for that matter) never really interacted too much over the past 4 years. With a class of 200+ people, its easy to move in differerent social circles. However, since we arrived here about the same time, we started hanging out together in India. Better late than never. And guess what? She says that there is a great uncle or something like that who is an MD in Manassas, VA. Thats right, she's related to those Cioletti's. Small world, huh?

2) I'm pretty bummed about this whole car wreck thing. I was really looking forward to my Internal Medicine rotation this week. The prospect of seeing some fascinating and (to us, at least) rare infectious diseases was part of what drew me to this experience in the first place. However, I definitely have not been stable enough on my feet for a whole day of rounds. But it still stinks. I will content myself with the really neat stuff that I have gotten to see and do already. CHAD was absolutely wonderful, and Neurology gave me good insights ad to how the inpatient services are run, and what facilities they do and do not have access to here. I guess I got an insider's look at emergency medicine too.

3) I'm not sure if I've posted a picture yet or blogged about this, but it really is amazing how many people one can fit onto your average motorcycle. Minivans are for soccer teams, not families. All you need is two wheels. And really good brakes. Everyone here relies on their brakes for their lives.

4) New Foods. I have become the default "Mikey", as in Life Cereal "hey, he likes it!" Mikey. Anne and Cristina, when pondering some new thing on the menu that they want and yet don't want to try, often command me to order it. These are usually things with a title alone, no description, so we really aren't sure what it is sometimes. Yes, I am in complete control of all of my actions, but I am adventurous too....so I usually take the challenge and order it. Its pretty funny when it turns out to be really good and then they call the waiter back to try some themselves. I've definitely had more good luck with this than bad. No, I have not been surprised with a plate of monkey brains or live snakes......yet. This trip is far from over.







Here's a nice little view down one of the cool shady hallways on campus. It is really starting to heat up here. As much as I love my hostel, with no a/c, it is not cooling off at night the way that it did just 2 weeks ago. But it's still fun, especially with all the other students here from around the world. And we have a kitchen with fridge (keep cold drinks in here), hot plate, and washing machine so we can do our laundry whenever.






This is the only great funny picture I can post so far today. This is in the lobby restaurant of Hotel Surabi, probably thje priciest place here.

I'm not the smartest guy in the world, but do they have the right Indians on this thing? I'm so confused.

OK. I'll try to get my disease profile up later today.

My 1st Person Experience with Indian Healthcare (or The Car Wreck)

TO ANY FUTURE UTHSCSA VELLORE STUDENTS ---- DO NOT TRAVEL BY ROAD AT NIGHT IN INDIA IF YOU CAN AT ALL HELP IT!!!!

As much fun as we all had during our weekend in Kerala, hanging overhead was the spectre of the ride back. Our "bus" ride there had taken hours longer than anticipated, on very narrow, very scary roads. Imagine looking out the windshield, on a two lane road, and seeing four vehicles side by side coming straight at you, two of which are heavy trucks and one a large bus. No shoulders avaialble, no other lanes availablle, nothing. Imagine a similar two-lane road, where evferyone passes at all times blindly.....you are in the mountains, the road is incredible windy. You are sitting on the side opposite the driver, so on turns you can sometimes see further dowen the road than him. He tries repeatedly to pass on the outside of blind curves, where you can see there is a really really big truck coming in the other lane, and you are positive it will all be over in just a second....and all of this at night too, so add to it all the cars, carts, rickshaws that have no lights whatsoever. Anne stopped looking out the front; she just watched my face and knew from my expression the likelihood of death in the following seconds. Hmmm..no wonder everyone says "Do Not Drive at Night in India!".

But we made it. Our driver, though was very sleepy, and though it was daylight on arrival, he was falling asleep at the wheel when we finall got to the houseboat launch. We had a great weekend, and all agreed that it would be aq good idea to head out Sunday AM, so out driver had as much day driving as possible. This was way too long a drive for a single driver, so we needed to help out as much as possible.

Then we got offererred free massages next to Manish's house on Sunday....and we all went for those instead. In retrospect, my classmates and I all agree that we all still had misgivings about leaving later on Sunday, and that if one single person had made a point of objecting, they probably would have too. Instead, we all, like a herd, went together on this. Therefore, this was obviously a completely avoidable incident. We brought this on ourselves. We had the power and insight to avoid this situation and did not....please learn for our stupidity, and don't hesitate to put your foot down when you have to. Luckily, this could have gone a lot worse.

So, we head out around 4PM. We stop off for dinner around 7:30, traffic is not too bad, the driver seems to be well rested. We watch some movies on the van's DVD player. Unfortunately, it is situated in such a way that the driver can actually look up and see it, so I catch him occasioanally with his eyes off the road. It all goes OK though, and we relax. We cross into Tamil Nadu, the winding mountain roads are done, and I relax. The seats are so crapmed tobether, though, that there is no legroom, so I stick my legs out into the aisle. On the left side of the van, Cristina is in the second seat, I'm behind her, Jamie is behind me. On the right side, behind the driver, are Dinesh and Claire, behind them Anne, behind her Vida, and in the back row, Swami (aka Michael) and Kevin, our friends from Oklahoma. The movies are off, we all drift off to sleep.

The next thing I know, I here Dinesh yelling my name. there is a lot of noise, people are yelling, I hear my name a lot, and think "this cannot be a good thing". I hear Dinesh say "His pupils are blown", and people seem generally pretty worried. I am very groggy. The closest thing to this would be when I have over-indulged on adult beverages (I know, its a shock) and someone is waking me up. I open my eyes, and its all pretty hazy. I'm on the floor. Everyone is very excited, and I get the feeling we've crashed. However, I don't know why we're here in the first place. They help me up, and they all seem happy I'm somewhat alert, but I am curious "What happenned?" and "What are we all doing in this van?" seem like reasonable questions. I think we way have been together for dinner. or something. Dinesh reminds me that we were on our way back from Kerala and we crashed. This is all news to me. Kerala.....maybe.....not sure. So, we sit up, but they want to keep my C-spine stable, so Anne gets that duty. Apparently I have a nice laceration on my chin, and I'm bleeding all over her hands while she sits there and holds my head up. I tell her I don't have any funky diseases. Not sure if that helped, but its about all I can do for now. After about 5 minutes, I'm somewhat oriented. Big whopper of a headache, my jaw hurts, my ribs hurt, my thigh is killing me. I look around. Apparently everyone is alive, but apparently Swami's lage hurt, so some classmates are working on him. I have to say, if you are going to crash, having a bunch of people around you who are a few weeks shy of their MDs is a good thing.

I remember thinking how bad I wanted to get out of the van. Thoughts of fire pop into my head. But nobody will let me run around without neck support, so I sit with them. Looking around , I see the sun has just come up, and there are people milling around the back of the van. I hear that an ambulance is on its way. Cristina is sitting next to me. She apparently got banged up pretty good too. I try to crack some jokes but really still am useless and reliant on everyone else. This is not a good way to be. The ambulance arrives in what seems to be not too long. However, they have no C-collars. Really? Really. No C-collars on an ambulance. So we use what we have been using - rolled up towels wrapped around our necks. They start to get us out of the van and into the ambulance, and people start taking pictures of us. Anne has had enough of this and lets them have it. I accept it as payback for all the medical pics I have taken in my life. So we get into the ambulance (all 9 of us). Swami, Cristina, and I seem to be the worst hurt. Nobody has any obvious fractures, My leg hurts like hell but no deformities. Maybe my ribs are broken, but too early to tell. They want to take us to another CMC facility but we insist on Vellore, it is only 120Km away. We were so close to home when it happenned. As we pull away I see our driver standing in the road with a big gash under his eye. I guess he will have to take the second ambulance.

(Here is our van and the truck we hit. I was sitting in between the intact and the crumpled window on this side. Cristina was in front of me. She says she openned her eyes and just saw truck in her lap. There is a seat even farther forward that we had occasionally sat in, next to the driver. If anyone had been there for the crash, they would have died. Lucky.)

As we head to CMC in Vellore, I try to get a handle on what happenned. The driver fell asleep. We his a truck. Apparently I shot out into the aisle (no seatbelts in these things) and they found me under a seat (not sure if it was one that had come loose or not). I was completely unconscious. Snorring, even. Ha ha. But really tough to wake up. They were all very worried and happy when I openned my eyes. Out cold for 3-5 minute total. Cristina got clobbered with something in the side and chest. Dinesh got hit in the face with the DVD player. Everybody else had several abrasions, cuts, painful spots, you name it. We all got beaten up pretty bad. Luckily for you, loyal blog readers, lots of pics were taken!


Here I am holding my make-shift C-collar together in the ambulance. Cristina comforts herself with candy. Even now I know when there is a camera on me. Don't be fooled, I'm in a lot of pain, but even that won't stop me from performing. Thumbs up!

It sure is nice to have connections and a cell phone. Dinesh calls ahead to CMC to let them know we are coming in Swami's mom went to CMC, so the Chief of Medicine is alerted we are on our way as well. Still, when we get there, lights and sirens, nobody is waiting. We get dropped off in the courtyard with everyone staring at us. My leg hurts so bad, I start geting pre-syncopal (light-headed), and have to sit down on the ground. After a minute or two they get me a wheelchair and roll me in. Somebody puts a C-collar on me (finally!). I'm taken back into "Casualty", their version of the ER. Well, they take a quick look at me, no obvious broken bones but possible rib fractures, I'm alert and oriented, not about to die, so they slow thing down a little. I understand how it works. Still, they check my abdomen (no pain), I can move all 4 limbs, etc,etc. However, at no point whatasoever in this entire experience, does anyone do a proper mental status exam on me or a real neuro exam. It still blows my mind, but I guess they have thier protocols, so OK.

Here I am getting my face lac cleaned. I look at this and think, I must be acting. But then remember it really hurt a lot. Maybe I was acting a little.

At CMC, they will not do anything until you pay for it first. I am very lucky I had friends who while hurt, still ran around and got me registered, held my personal effects, and payed for my bloodwork and X-rays. Apparently from what I hear it was kind of a pain in the rear to fill out all the forms and pay and run from window to window fighting all the other families there. The chief of medicine popped in and took a look at all of us to make sure we were going to survive. Actually, that was pretty nice. He seemed to think things were going OK, so good times! Eventually, my x-rays were payed for and they wheeled me in. The view of the ceiling as they wheel you along on a gurney is wuite memorable. Now I know why its used all the time in movies and TV. So they get me in there and start shooting, with no sheilding at all for my personal bits or thryroid or any of me. Femur. Head. Neck. Chest. Shoulder. Wait....my shoulder is fine...They actually called Jamie into the room to have her pull on my arms for proper positioning. She got sheilding. I was not in my preferred attire, the position they put us in was akward, lets just say that Jamie and I shared a moment neither one of us will soon forget. Sorry Jamie! You are a trooper!





Here I am on my wat back from X-ray.

Well, you know how ERs work. Slow. In the meantime, I hear updates on everyone else. Swami is OK, Cristina's still being looked at. Some nurses come by and want to stitch up my face. No way!! Dinesh told me that when he looked he thought he might be able to see my jawbone deep in my cut. Uh-uh, we're having suregeons sew this up. So they agree to get plastics to come and do it.

Here's my laceration. Not too good a pic, but anyways, its deep, through the subcutaneous fat.

This whole time, everyone one else is being very very helpful. I am greatly indebted to Anne, Dinesh, Claire, Vida, Jamia, and Kevin for all of their help that day. They got all of out stuff sorted out, payed our fees (ridiculously cheap by wester standards), and kept talking to us. I couldn't drink until my neck films were cleared, and I was so thirsty. Then Jamie bought a bottler of water and poured it into my mouth. It was messy but so refreshing!

Here's Dinesh with his DVD player shiner.

Plastic surgery comes along and they wheel me into the procedure room. That lidocaine does burn. Yeouch! They do a single layer closure (I asked about double-layer but they said no), and tell me to leave them for 5-7 days. They tell me to keep taking Cipro (?) for the wound. (I went and got some Bactrim DS on my own just in case the unthinkalbe occurs and it gets infected).

Here's my face. I haven't shaved inseveral days now, so I don't mess up the stiches of my other abrasions, but its driving me nuts in ths heat!

Eventually, it turns out that my films are clear, I am cleared for discharge, given an NSAID and thats it. With a whopper of a headache. Actually, they offered me morphine early on, but I delined. Swammi turns out to be fine. Swami and Kevin are done with their rotations, and were planning to head out this day anyways, so Swami's uncle in Chennai sends a car for them. It is late because it got into a wreck on the way here (in daytime no less). We wait around for Cristina to get dicharged, and then I go back to the hotel with Anne and Cristina to vegetate for a few hours in a/c. We have been thinking about ordering the room-service pizza. The only pizza I've ever seen available in India. So we order it. It is not available. Of course.

Well, I made it. I have some pretty significant vertigo when moving from a supine to vertical postition, and we are now 2 1/2 days since the concussion. If this keeps up I may go see a neurologist when I get back to San Anyonio. Maybe I knocked an otolith loose or something. Its really annoying, and makes me feel like I'n drunk when I'm walking. No headaches, though. My ribs are very very angry with me; I think they are seperated. The formerly amusing rickshaw rides are now pretty brutal, as every little bump goes right to my ribs. My leg is doing great, just looks horrible, and all the other cuts and bruises are healing slowly. Everyone else is pretty similar. Anne is getting some really nice greens and blues on her temple.

Here I am, pointing to the gigantor bump on my head that you cannot see. This is what made me go into never-never land for a few minutes.

Here is my thigh. This does not do it justice, though, for the most subtle shades of teal and aquamarine have expanded out to encompass the entire thigh. Spectacular!

Our school has been fantastic about this. Dr Jones and Dr Bergren both called. They are letting us recuperate, requiring only that ID write-up (its still coming!!!). We all had pretty good travel plans after this,. and I think we are all going to continue as planned. We are tough cookies! Its actually hard to beleive that our 3-weeks here are almosy done. We are soon going to split up, travel more, and probably only see each other again at graduation. Well, I have to say, that this is a great group of people, and I am glad that I had them looking out for me. I never want them to need it in return, but I would do my best for all of them if necessary.

So hang in there, loyal readers. I have another day or two left in Vellore. I'm moving very slowly (and wobbily), trying to recover. I have never been knocked out until now, and I am not a fan. The recovery is not, for me at least, very quick. Other than the vertigo, though, I'm hanging in there. I'll have some more pics in the next day or two, and then I will be headed up to Delhi to meet my beautiful and wonderful girlfriend whom I love very much. The whole time I was really worried, all I could think about was how I was supposed to do all this stuff with her, and how I'd better not be hurt bad or else it would ruin all of our wonderful plans together (I'm talking in big picture here, not just the nest few weeks). So, I guess you could say I'm pretty fond of her. Alright, enough sappy stuff.

Tune in next time. Same bat time. Same bat channel.

A Wonderful Weekend in Kerala

Hello everyone!

Thanks to all who have been reading along with my trip and offering comments. I'm happy you like it, and appreciate the feedback.
Well, as you can by now tell, this trip
to India has been all work work work, no rest for the weary and all that.
But seriously, folks.....So, Dinesh has a friend named Manish, who's family lives in the beautiful state of Kerala, located on the other side of the Indian peninsula. He generously offered to take us all out for a weekend to celebrate our successful matches, so with much arm-twisting, we all agreed. As the trains were all booked up already, we rented a private minibus for the trip with a driver. As we headed out, we saw what is the native water buffalo in an almost-native setting: the back of a truck at a tollbooth.

Long story short, it was a very very very long drive. The bus had a dvd player, and I borrowed some dvd's I'd seen sitting in the lounge of the hostel. Have you ever seen the episode of Seinfeld where he starts recording movies illegally in a theatre with a video camera, for sale on the black market. Well, apparently that same technique was used for our version of I Am Legend. It was hilarious. There are people's heads in the way, you hear the audience cough, only 2/3 of the actual screen is visible, and occasionally a person in the row in front will get up, presumable for curry-flavored popcorn. At the end, you hear the audience in the theatre applaud. Whahahahaha!! We also had a version of Transformers dubbed in Tamil. Its pretty funny at first to see these big robots speaking Tamil, but it gets old rather fast.

When we got there, though, our journey was rewarded. We were taken out on a houseboat. For those of you unfamiliar with this kind of thing, the "backwaters" of Kerala are loads and loads of canals and rice paddies, with the most commone form of transport being boat, and many villages are isloated. With the advent of heavy trucking, a lot of the big rice barges became somwhat unnecessary. A brilliant person years ago had the idea to turn these barges into floating houseboats and charge to take people on relaxing cruises through the backwaters. Today, it is an enourmous industry, and the town of Alleppey, where we embarked, is the center of it. I was excited to be here, but felt a little guilty, as I had already planned to make this trip separately with Felicia. I firmly resolved to have as little fun as possible, so as not to ruin it for our visit in about 2 weeks.


Here is the houseboat Manish set us up with. Three bedrooms, a/c in all of them, plasma screen TV with dvd player, running water, showers. Plus a crew of 3 to cook and supply cold beverages at our request.

So we set off. FYI, I think this backwater cruise thing is on that National Geographic list of "things to do before you die". Well, check this one off. So we headed out. We had an awesome lunch of fresh fish, vegetables, cold beer. I have to say thay the food up to this point in Vellore had been rather disappointing. Lots of carbs, lots of spice, but not many veggies, and unsafe to eat any raw ones you didn't prepare yourself. (by the way, the Ciprofloxacin + Immodium cocktail = success!!!) The food I ate in Kerala was amazing! All hail Keralan cuisine! Lots of fresh seafood, lots of veggies, yum yum! And all home-ccoked helped a lot too.

So we cruised around for a bit, and then stopped off at a local "boat-up quikie mart" to pick up dinner.

This is what a large prawn looks like in India.
Seriously. It looks like it could eat a lobster for dinner. And those crazy long blue front claws. Whats up with that? Well, I bet it tastes good!

Behind the prawn shop is a rice field. Here I am. I was careful to look for snakes, but they sent a local with me just to make sure. Probably always a good idea with me.

So, we cruised along some more.

Here is a guy herding ducks. Really! Hey paddled around and they all swam together into this little canal, there must have been 100 of them. That is something I have never seen. An aquatic duck herder.

As we continued our leisurely afternoon, I was struck by the beauty of the area. Here is a view out the front of our boat, over the driver's head. Pretty nice, eh?

Still, as I had foresworn, I was having absolutely no fun at all.

Later on in the evening, we wound up in a little canal behind a rice barge still being used for its original purpose. Here is the rice guy poling it along silently through the evening. This is incredibly serene.

A nice view of the sunset from the backwaters of Kerala.

As promised, I am miserable. No fun at all. The stress is crushing me.

As you can plainly see, my classmates decided to show solidarity with me, and also refused to have any fun dancing with the crew of the boat. We were lucky to meet some med students from Oklahoma in Vellore, and they came along too. Thats Kevin in the black shirt gettin' down with Vida, Jamie, Dinesh, and the rest.

Again, no fun at all. Here we see Jamie and Michael (Oklahoman #2) so unhappy at the pressures of the 4th year of medical school that they seem to be having some sort of breakdown. From the foreground, you can tell that in the Indian heat every effort was made to maintain adequate hydration.

In the morning we cruised over to another boat-up mart to get some fresh eggs for breakfast. We passed this guy washing his cow. I wonder if this is something he does every day? Maybe it is a show cow? Maybe it was just really dirty. Either way, it is clean now.

We also passed these guys loading up rice onto another barge. I tried to not look like the annoying tourist who takes pictures of other people working really hard, while I am not. But I kind of was anyways.









Just a close-up of a hard-working Keralan man. Actually, I have been using that wrong. The state is Kerala, but the ethnicity of the people there is Malayalam, and their language shares the same name.

After we got off the boat in the AM, we were taken to Manish's family's house. His family is usually out of town, so the house-staff was happy to have someone to care for. We also got to meet his grandmother. She though we were a very attractive group of people. So wise, she is, so wise. We rested, checked email, had lunch (more awesome home-cooked stuff), then were taken to see the local sights.

Nearby was an old Malayalam palace which we checked out. It had some old artifacts, paintings, and neat woodwork.

Here I am in front of the palace. Keralan architecture looks a little more like Chinese/Japanese, with pagoda-like roofs.

An upper-level walkway in the palace, with slatted windows which look out on the garden.

Fun with black and white at the same place.

Detail from a very old frescoe inside the palace. Very vivid colors.

One of the other places we were taken was local ashram apparently very well known around the worls. Like our guy near Vellore, it was run by someone named Amma. This Amma is a smiling middle-aged woman known for spreading love and happiness by hugging everybody she meets. see www.amma.org Apparently she's been doing this for a long long time, and her ahsram is really huge. There is a 17-story apartment block just to house the people who come for stays. There were lots of Westerners there. Unfortunately, she had just completed her hugging for that afternoon when we got there, so we were too late to meet her. We were given a tour, no cameras unfortunately, and supposed to go with the PR guy to meditate up on the stage where Amma meditates. As she was not avaialble, there was just a giant picture of her, and strangely enough, a second one below that just of her feet. Hmm. Anyways, he told us that the energy in that spot is amazing, So we sit there quietly.....and some lady come over and pulls a bag of silk flowers out and starts dumping them in front of the picture. That seems like nothing much, except her plastic bag of flowers went "CRINKLE CRINKLE CRINKLE" every time she moved. CRINKLE CRINKLE CRINKLE....pause.....CRINKLE....thump.......CRINKLE CRINKLE CRINKLE...etc. This occupied almost the entire time spent "meditating". When we were done he asked us "Wasn't that wonderful? Didn't you feel the peace and energy?'. As we all tried not to snicker, Vida did her best and said "It was amazing!" I guess this made him happy. We all found it pretty funny.

Amma's ashram is right on the coast, and was hit hard by the tsunami. Apparently she paused that day, said "something is not right with the sea my children", and ushered everyone in her big hall to the 2nd floor just before the wave hit. She worked very hard to help rebuild the area, and got lots of great photo-ops with local, national, and international leaders. Even donated about $1million to the Katrina relief fund. Still, as a living god, you'd think one would have more notice about pending natural disasters. Thats not really my field, though, so draw your own conclusions.

"Wait" you might be saying. "The tsunami came at India from the southeast, and Kerala is on the west coast, how could it be affected?" Yes, you are paying attention. A very good question indeed. Now, we have all seen how the wave hit the east coast of India (i.e. Mamallapuram) since it origninated off the coast of Indonesia (also to the southeast of India), but it actually wrapped around the bottom tip of the landmass like a whip and smacked the lower west coast as well. Wierd, but I remember seeing a NOVA special on PBC that discussed this phenomenon.

Here is the coast near the ashram in Kerala. There were many homes here. Apparently several hundred people died in this area when the wave hit. The homes were not rebuilt. The palms bear many scars on their trunks, up to about waist-high, from all the debris carried with the water.

The people built a stone sea wall at the water's edge to try to prevent further occurances. I had a pic and then just deleted it by accident. Anyways, just imagine a big pile of rocks at the water's edge, running up and down the shore.

Manish lived right down the road from and Ayurvedic spa/hospital. This is traditional Indian hebal medicine. It was pretty swanky. He paid for us to all get massages. Well, it wasn't the typical; swedish massage I was hoping for. I had to strip naked and put on the skimpiest of loincloths (please please, please I hope they autoclave these things in between uses) and get on a very oily table (apparenty the same one Dinesh had just gotten off of....we all shared each other's oils...ugh) and then a swarthy Indian man proceeded to rub oil all over my body. No reall muscle work at all, no loosening up of tension, nope. Apparently this was medicated oil being appliend through the skin. A lot of oil. The whoke thing lasted 1 hour. I was not relaxed at the end, just oily. So, if you're looking into Ayurvedic massage, just bear my experience in mind. It could have been worse, though. One of the treatments their involved all of the following: herbal enema, oil enema, oil emesis (I think you drink oil and then vomit it back out), purging (what it this if not vomiting, I'm not sure and don't want to know). amd some other thing. No Thank You. I walked back to Manish's house and tried to get all the oil off. Not very successful, despite several showers.

Well, the fun was over after a very entertaining weekend.

We had a wonderful time in Kerala, ate amazing food, saw great stuff. I would like to express my sincere gratitude to Manish and his family for their generousity and hospitality. They threated us very very well, and we all truly appreciated it. This is where I put in my plug for the new medical school in St Lucia in the Carribean that his dad runs (UTHSCSA is, of course, the best ever in the US, but if you are going to go Carribean, think about St Lucia).

I was so miserable the whole time that I can barely think about how I have to come back to this paradise, just me and my beautiful girlfriend Felcia. Somehow we'll make it through. (acutally, I got to see where I'll be staying, and it looks great!)

Stay tuned for my next post. Not as happy as this, but bear in mind that it all turned out relatively OK in the end. Lets just say that I got to experience Indian emergent care from the 1st-person viewpoint. And listen to me now. I will repeat it again for any readers who may be headed to India later. DO NOT DRIVE ON THE ROADS IN INDIA AT NIGHT IF YOU CAN AT ALL HELP IT. It is all dangerous. Sometimes, unfortunately, unavoidable, It is also very dangerous in the day, too, make no mistake. But avoid it if you can.

OK. I'll have all the gory details soon.