India Archives

Namaste India!

August 12, 2024 No Comments

We’ve been in India for a week now. I had hoped to post about all my previous travels on here before even getting here but the reality is, I have essentially no disposable time ever.

I am starting to write this post while Mäuschen jumps around in my arms and Mausi is playing in the indoor playground we are now visiting for the third time this week. The heavy monsoon rains aren’t exactly inviting for outdoor activities. That hasn’t stopped us from undertaking trips but they are not the easiest to manage.

JOURNEY TO INDIA

Our flight was 7h30 long and a daytime flight from Frankfurt to Delhi. The other flight options were inconvenient timing with kids. With one child, I preferred red eye because Mausi usually slept most of the flight. This flight however had us arriving in India when the local time in Germany was just a bit past bedtime and I figured we could acclimate quicker. This did however also mean that I would have to entertain two kids on the plane for most of the journey. Or so I thought.

About 2 hours into the flight, the announcement came asking for a doctor onboard. I was just finishing up in the lavatory with the kids when we rushed out to see how I could help. Surely I wouldn’t be the only doctor onboard this huge plane headed to India.

I was. At least I was the only one that responded to the announcement.

MILE HIGH DR. HASSELHOF

The passenger was having an allergic reaction with watery/red eyes, nasal congestion, and difficulty breathing. There was a language barrier but from what I could gather, he started having symptoms after eating lunch. The flight attendant informed me that it was a shrimp dish. Ah-ha! Our likely culprit.

INITIAL ASSESSMENT

He was already wearing oxygen when I arrived at his side. The flight attendants brought over a kit with medication. The only antihistamine available was an unknown dose of loratadine. Neither the folder nor the blister pack said what dose it was. We started with that.

Meanwhile, Mausi was running around the cabin and Mäuschen was screaming bloody murder while another flight attendant swayed back and forth.

After having given the passenger the loratadine and checking vitals, I wanted to check the medical suitcase to see what other medications were available to me in case things escalated.

PREPARING FOR THE WORST

I sat on the floor breastfeeding Mäuschen next to a flight attendant while we looked through the medical suitcase. I was on the lookout for an EpiPen. Unfortunately, there wasn’t one. Only a vial of adrenaline. Thankfully, there was a literature that explained how to mix the right proportions for IV administration. We tore open the IV bag to get all the supplies we needed for me to place an IV should it come to this. We discussed how we would mix and dose the medication if needed.

All while passengers were squeezing past us to get to the toilets on the lower level. A medical emergency was no place for modesty and I was boob full out breastfeeding to manage Mäuschen and simultaneously get medical equipment ready. Priorities.

MONITORING PHASE

We moved the patient to a stretcher in the back of the plane to make him more comfortable and more accessible to us.

We continued to monitor his vitals which included elevated blood pressure (not surprising given the circumstances), stable oxygen saturations, stable blood sugar, and a slightly tachycardic pulse of 103 (again, no surprise there).

His symptoms had improved in regard to the allergic reaction. After about an hour, I took him off of the oxygen to see how he managed.

The guy was obese with supposedly no medical issues or chronic medications. Off oxygen, his saturation started falling again. When I asked him to take some deep breaths, his O2 sats shot back into the mid-90s.

Eventually, he fell asleep (sort of an upgrade to business class for him since he got to sleep lying flat) and we continued to monitor. While asleep on his back, his O2 sat fell to the mid-70s. The altitude likely wasn’t helping but I presume he lives in a hypoxic state at night at home too.

Since we were monitoring him though and seeing that mid-70s number, I decided to place him on O2 again. The lowest dose available was 2L. And almost immediately, the O2 shot up to 98%.

DECISION TIME

A while later, the flight attendant informed me that we were nearing emptying 2 bottles of oxygen and if we were to use a third, the airplane wouldn’t be able to return to Frankfurt because they wouldn’t have the minimum required oxygen bottles on board and they don’t get replenished in Delhi.

It was time to discontinue the guy’s semi-business class experience and I had him sit up instead of sleeping lying down. I monitored him for another 15 minutes off of oxygen while seated and awake. His O2 sats were absolutely fine. He was released back to his original seat.

WRAPPING IT UP

Throughout the process, I kept him and his wife informed of what we were doing. A flight attendant was trying her best to keep Mausi entertained by reading books, playing games, and providing snacks. I had strapped Mäuschen to my back after the breastfeeding session so I could move around more freely.

One other person had responded to the announcement initially made. A respiratory therapist. Luckily, we did not require their particular skill set for this situation. I can not say enough how happy I am that this passenger did not have a full-blown anaphylactic reaction.

The entire crew was very appreciative of my assistance and offered me drinks and meals. This was not the first medical emergency I’ve responded to but it was the first I was offered compensation for. Although completely unnecessary, I was grateful and happy to accept the offer.

All in all, everything worked out. I gave the patient and his wife a summary of what occurred on board to provide to a primary care physician (which I recommend he start visiting). Furthermore, I strongly encouraged him to have his blood pressure rechecked and discuss having a sleep study done looking for sleep apnea. I also strongly encouraged him to avoid shrimp and maybe see an allergist and get a prescription for an EpiPen.

And with that, we landed in Delhi just a short while later.

DELHI TO JAIPUR

We arrived in Delhi at 1 AM. By the time we were through customs and got to our hotel and into bed, it was almost 3 AM local time.

The next morning, I had someone come to the hotel to do my FBI fingerprinting for my medical license. A nice thing about India is that you can arrange a lot of services to come to you!

A few hours later, we were back at the airport to catch our flight to Jaipur.

The whole travel day from Germany to India was less stressful than the short trip from Delhi to Jaipur. Mausi was on one… probably due to a prior travel day. Tantrums, not listening, etc. It was a lot to handle. I am empathetic that the kids go through a lot with me sometimes and am sympathetic when it all gets a bit overstimulating.

We did eventually make it to our AirBnB. Our host had the fridge stocked with a few basics so we were able to eat some toast before heading to bed.

JAIPUR

So now we’ve been in Jaipur for a week. On all my previous India visits, I didn’t have to worry about day-to-day operations. I was either on a fully planned itinerary or visiting people I knew who took care of it all. There was a learning curve to managing the basics as well as acclimating to the Indian surroundings again.

Our AirBnB host has been so incredibly helpful in many situations. I try to be as independent as possible. I bought an Indian eSIM in the hopes of obtaining an Indian number. Many of the apps require but was only able to find data eSIMs that don’t come with an Indian number. The host said he is happy to order food, groceries, etc. on my behalf so I don’t have to obtain a physical SIM card. If I happen to pass a SIM store, I might still get one to gain some more independence.

It is still monsoon season in India and I think it has rained every day so far. Yesterday there were heavy rains. This hasn’t stopped us from leaving the apartment though.

Thankfully, we found this indoor playground. It is filled with things to play with, climb on, slide down, jump on. The first hour is 500 INR ( approx. $6) and every additional half hour is 150 INR (approx. $1.80).

OPEN TO OPPORTUNITIES

I have a list of attractions I’d like to see while we are in town over the next few weeks. I’m not putting a lot of pressure on myself to see something daily. So many factors affect the ability to do things.

One day, we headed towards Jantar Mantar, which is a large area filled with large astronomical instruments. I was looking for a place for Mausi to run around and get some energy out while also seeing something.

We were approached by a driver outside of the entrance. He inquired if we were going to Jantar Mantar. After sharing that this was our plan, he suggested an alternative itinerary. Since Jantar Mantar is best visited in sunny conditions given many of the instruments require the sun. For just 400 INR ($4.75) he offered to drive us to three sites. He explained that the royal tombs were also a great place to run around, were beautiful, and had an entrance fee of only 50 INR ($0.60).

It sounded like a good plan to me so we went for it.

GAITOR KI CHHATRIYAN

Not so much the royal tombs as advertised by Ali, our driver, but rather the royal crematory and cenotaph of the royal family of Jaipur. Nonetheless, it was a beautiful location indeed and the drizzle made it seem even more mystical.

For just 50 INR for foreigners (the kids were free), we were able to run around and explore.

We quickly encountered a group of Indian women in beautiful, colorful saris. I offered to take pictures of the group as one woman was always out of the group taking pictures of the others. Mausi wanted to take a picture with them which they were happy to do.

(If you want to feel like you are traveling with a celebrity, travel to India as a foreigner with a small child. I constantly have to tell people not to take pictures of the kids or touch them.)

We continued to explore the grounds.

MEHNDI

After we were through, Mausi and I had mehndi applied to our arm. Convincing a preschool not to touch their arm for 20 minutes while ensuring they don’t get henna all over the car or themselves while also having one arm full of drying mehndi and a baby on your other arm is no simple task. But we managed. And now we both have a lovely mehndi design on our arm for a few days.

Then it was off to see Jal Mahal, the lake palace. With the aforementioned drying mehndi, the rain, and the crowds of people, it was all a bit much for me. We just popped out to snap a pic and then got back into the car.

HAND BLOCK PRINTING FACTORY

Many drivers will take you to a shop/workshop to see local crafts as well and hope you’ll buy something. I’m certain the driver gets a commission on sales made from the tourists they provide. In this case, I didn’t mind as I intended to visit a block print workshop/store anyway.

A man greeted us at the door and started by showing us how block print is done. This was not my first rodeo. It was nice that Mausi was able to learn how it is done and was able to help block print an elephant design. Afterwards, we were led into the shop. I was given a masala chai and Mausi was given some chocolate and water.

They were about to present us with finished block print products for purchase but that wasn’t what I was interested in. I asked them to take us to the block-printed fabrics to make tailored outfits.

Mausi quickly picked out a multi-colored elephant print for a dress before running around the shop and entertaining the other workers, playing soccer with them, and chatting them up in German.

I proceeded to choose two fabric designs for my dresses, two designs for pants for Mäuschen, and a pair of pants for myself. The tailor came to take our measurements and I took pictures of the various block-printed fabrics to send to my mother.

All in all, 2 adult dresses, 1 pair of adult pants, 1 preschooler dress, and 2 baby trousers all tailor-made cost 11,700 INR ($140). I paid half as a deposit and was told they would be delivered to my home in two days at which time I would pay the rest.

I will share the results once I receive the goods. Without seeing the fabric printed before your own eyes, there is always a hint of doubt, about whether or not the fabric is truly block print or a good screen print rip-off.

We then headed back home after a day of adventures with two tired children.

I was so happy that the day unfolded in such a positive way.

I took the driver’s contact info and he drove us the next day to run some errands and visit the elephant village.

ELEPHANT VILLAGE

Going to the Elephant Village rather than Elephantastic was a recommendation from our driver. Since I want to experience many different activities in Jaipur, I decided to give his recommendation a try. The website made it seem like the less pricey option compared to other elephant experiences in Jaipur without listing exact prices. I really should’ve known better to follow up on pricing before agreeing to go.

Two years ago, my mother, her partner, Mausi, and I visited Elephantastic in Jaipur. We had a lovely day getting to know the elephant, feeding her, painting her, washing her, and walking with her. We were provided a snack and at the end of the experience, were provided a home-cooked Indian meal. Overall a great experience and cost about $80 per person.

At the Elefant Village, which I was told was a project from the government to get the elephants out of the city and into a more calm location for them, was significantly pricier. I was offered the “combo” package which included petting, feeding, painting, washing, walking, or riding the elephant for $350 per person. No, thank you. Since we had already made it to the location after getting through the flooded streets and spending well over an hour in the car, I at least wanted to feed and paint the elephant. I wasn’t confident the children would be up for much more than that. For Mausi and I, these two activities cost me $130. So, not a great deal. Lesson learned. I’ll graciously accept recommendations but do my research before blindly following those recommendations.

I’m still happy we got to spend time with such a beautiful creature and it was Mäuschen’s first encounter with the gentle giant. Mausi had equal fun with the elephant and playing in the muddy puddles.

EXPERIENCING JAIPUR

Learning more about block print is what inspired me to choose Jaipur as our location for an extended stay in India. I didn’t fully take into consideration the monsoon time. Luckily, we are on the tail end of the season. I am trying to get Mäuschen to take a bottle so that I can partake in some workshops and hire a babysitter.

There are so many incredible hotels, restaurants, cafes, and bars in Jaipur. Having two small children which includes the energizer bunny and without additional help, it is hard to try to experience them. I’m determined to at least visit a few of the hotels as sight visits so I have an idea of what the places are like. Let’s see what I can achieve. I’d like to share a guide/itinerary to Jaipur after our trip.

Now our two hours in the playground are almost over and I was able to finish the first draft of this post. Yay!

Proofreading, editing, and adding pictures will need to wait until the kids are in bed.

mfg

Happiness, Locum, Travel

Cows, Water, Flights & Family

November 30, 2022 No Comments

Dairyland

I’m into my last three weeks of work at my assignment in Wisconsin. It certainly hasn’t felt like 5 months altogether. This may be due to the fact, and I’m sure this won’t surprise regular readers, that we were quite busy. If we weren’t off to a different state or country, we were spending weekends visiting friends in Madison, Milwaukee, and Chicago.

I work in a rural family practice with another physician and a nurse practitioner. As a locum, my schedule tends to fill up on the day of or a few days out. These visits are often same-day complaints, pre-op evaluations, ED follow-ups, and such. Things people would ideally see their primary care provider for but they are both essentially booked out for months! It is a different mind game seeing these sorts of visits on a regular basis vs typical primary care follow-up visits. I have a few patients I’ve seen on a regular basis, but the majority of patients are new to me every visit. It is all part of the gig as a locum, however, and I don’t mind it. Keeps things interesting!

I work with two medical assistants I’ve gotten to know quite well over the past few months. The rest of the staff consists of really lovely nurses, medical assistants, radiology techs, lab techs, and front desk workers. The feeling of familiarity amongst the staff was evident from the first day there. We have many laughs throughout the day.

The substitute teacher of doctors

Many patients have asked if I would consider staying. The administration did that same early on. I make a conscious effort to be clear that I live a nomadic lifestyle and that keeps me sane. The physician I took over for, left primary care to work in urgent care for more of a work-life balance. There is another locum coming in after me to cover the first half of the year before their new hire starts permanently. I feel the era of having the same family physician for 20+ is over but you can still find the occasional doc that has stayed in the same practice over decades. There are a lot of factors that contribute to this trend. Burnout is a big problem among them. The locum lifestyle definitely helps me avoid burnout because I always have a new adventure to look forward to!

Time: A man-made construct

Mausi has done astoundingly well for all the time zones I took them through over the past few months. There have been no “up all night” or “sleeping all day” despite time differences of 12 hours. The kid is made for traveling and I am pumped about it. We’ve also visited the cock pit of two of our flights and run up and down airplane aisles countless times.

September

We started the month off in Waupaca, spending labor day with family and friends. Mausi even went down the water slide a few times…with my help, obviously. The following weekend, Mausi and I hopped over to Cleveland to see my mom and partake in my citizenship interview and civics exam (aced it). By the end of the month, my mother came to Wisconsin to hang out for 9 days.

Took a lake cruise to see some of the estates

Wisconsin kiddo with cows and Oshkosh B’gosh overalls

October

The first weekend of October, Mausi and I flew down to New Orleans to visit our dear friend and former Eugene nanny and her two boys. At that time, she was far along in her pregnancy and I helped get stuff done around the apartment to prepare for baby number 3’s arrival a few weeks later. Mausi was ecstatic to see her two friends again. It was a quick trip but filled with fun.

The following weekend, I was lucky enough to witness my best friend from middle school/high school get married. I missed a lot of my high school friends’ weddings because I was in medical school in Germany. Then I missed a lot of my med school friends’ weddings because I was in residency in Ohio. I’m so happy I was able to partake in his!

I officially became an American citizen! The judge presiding over the ceremony held a very beautiful speech about the importance of immigrants in a country like the USA. Lovely to hear, especially after the rhetoric of the previous president and his administration.

Personal record

Toward the end of the month, Mausi and I went on our longest airplane ride together. It was a direct flight from Chicago to Delhi, India. The outbound flight lasted about 13.5 hours, and the return flight about 15 hours. On the way there, I was given a new seat assignment during check-in with the hope that I would have a whole row for us. Unfortunately, when it came time to board, we ended up having someone seated in the aisle seat.

Mausi, being their usual curious self, was all over the place; pulling anything that moved, pushing all the buttons, and climbing on the tray table. The travel busy board and busy cube I had purchased the week prior provided a few solid minutes of entertainment. Mausi did end up sleeping for a good 6 hours. I laid them across the two seats we had and tried to position myself around them. That was minimally effective and quite uncomfortable. After trying that for 4 hours, I eventually just laid down on the ground and slept for 2 hours. That was enough for me not to feel like a zombie when we landed.

India – Delhi & Diwali

We were met at the airport by my boyfriend and his son. At their place, we were lovingly greeted and welcomed to their home by his parents and the house staff. We ate delicious home-cooked food and I got a proper nap while Mausi explored the house and had many willing eyes watch her. That evening, we all went to a neighbor’s place for a Diwali celebration.

Diwali is the Indian festival of lights. It’s celebrated by many religions and is one of the most important holidays in Hinduism. We got all dressed up in traditional Indian outfits and ate way too much food. Mausi met a few children at the party and played with them essentially the entire night, just coming to check if I was still around from time to time.

India – Goa

The next day, following our Puja (prayer) for Diwali, my boyfriend, his son, Mausi and I were off to the airport. We caught our flight to Goa. Goa is a coastal town about halfway down the west coast of India. Portuguese architecture is prominent due to the Portuguese history of colonizing the place. My boyfriend’s sister, brother-in-law, and nephew joined us in Goa. Our routine for the next several days was simple; wake up, get ready, go eat a delicious breakfast, and then spend the rest of the day on one of the various beaches.

I even drove us home at night three times. For those who don’t know, they drive on the left in India. They also drive like crazy people! Very different driving culture than in America or Germany. We survived, no cows were hit (they like to just stand in the middle of the street sometimes), and no traffic tickets were issued.

After five days, it was back to Delhi. We only had the last day to run a few last-minute errands because our flight left at 2:15 AM.

Paging Dr. Hasselhof

While at the airport, it took forever to get checked in. I made it to the border control officer at the time boarding had started. And I arrived at the airport three hours before our flight time. Three stalls down, a man started having a seizure. Luckily, two others caught him and lowered him to the ground. I saw this all unfold and told the border control officer that I am a physician and should go check on that man. The officer was not impressed and told me to wait. Again, I pressed that time is of the essence and that I need to help keep that man safe. The officer continued to be unimpressed.

Finally, someone in the security line shouted out “is there a doctor here!?”. I raised my hand and exclaimed that the officer wasn’t letting me pass. Finally, a supervisor came and waved me through. I lifted Mausi out of the carrier and handed them to the supervisor.

How to help someone having a seizure

The main goal in taking care of a seizing person is to keep them safe. That means ensuring the area around them is clear, cushioning their head so they don’t hit it on a hard surface, and protecting their airway by positioning them on their side. Do NOT wedge something in their mouth. We quickly laid coats under the man’s head and positioned him correctly. I tried obtaining some medical history from his travel companion. He mentioned issues with low blood sugar but couldn’t tell me if the man was diabetic. Eventually, a paramedic came with a suitcase filled with medical supplies. At this point, the man had stopped seizing and was slowly coming to. He was still very confused, as was expected. He was surely even more confused when the seemingly only caucasian person at the airport was now hovering over him asking him questions.

Gotta go!

I stayed long enough for the paramedic to check that his vitals and blood sugar were stable (I had sent someone to fetch apple juice after the comment about low blood sugar in case we needed it). Vitals and blood sugar were good. Then it was time for me to go catch my flight. Luckily, the supervisor had me expedited to the front of the line at security but I still had to run, with a toddler strapped to my chest, to make it on our flight.

November

We were home for a mere 12 days before hopping on a flight to Germany. My cousin turned 40 and the whole family was coming together to celebrate. The week flew by because there were so many people to see. Anytime I am in Germany, there are a number of people I must see every visit. In the town I went to medical school in, there is a group of 6 people I do my all to see while there. Once again, I saw them all! The second half of the week was especially busy because everyone was arriving for the festivities. It was a good time.

Breakfast is my favorite meal of the day in Germany

My older sister came with her husband and kids. None of the extended family had met her kids before. Her youngest and Mausi are only ten days apart in age and are like two peas in a pod when they get together. Pushing them around in my sister’s double stroller made it look like I had twins!

The week involved family complexities I won’t go into detail on this platform. But, I will say, I think it was a very successful week for my family overall.

Now, we are back in Wisconsin and I have been busy over the weekend packing and organizing. The following two weekends are already planned out before we have the last weekend to do the final packing. Then it’ll be off to Ohio and Rochester, NY for Christmas before we head back to India for a three-week vacation with my mother and her fiance.

So, where to next?

It’s official! I will be headed to Molokai, Hawaii for 6 months starting in February! I’m beyond excited about this next assignment. If you have any tips for the island of Molokai or any of the other Hawaiian islands, please send them my way. I plan on spending the majority of the time on Molokai and just enjoying island life. However, one weekend out of the month, I’d like to hop to one of the other islands. My younger sister will be joining me for three months to be Mausi’s nanny. I’ll have to find someone local to take over once she leaves, or open it up here for applications for a three-month nanny stint 😉

I hope everyone in the States had a lovely Thanksgiving with family and friends.

Stay healthy!

mfg