Not-so-smooth transitions make good life lessons

Before returning to India, Ram perused a few R2I (Return to India) blogs- there are many out there, explaining which schools to target, where to live, whether to rent or own, which cars to buy etc. He was especially taken with the lists that people would make about what to get and how to get it. There are people who planned every step of their move back and who wrote about it.

Somehow for our return, I didn't plan as much as I normally do. I assumed that things would sort themselves out some time. We had some grand visions (my dad called them "unreasonable and half-baked". Turns out he was right) while still in Pittsburgh about what we would do in India, but those didn't pan out quite as we had envisioned. Maybe I'll type out the details of that venture at a later point.

But we made some mistakes and took some wrong turns, but thankfully turned back before committing to anything drastic. This was our lowest point, as a couple and as a family. Had we continued on the wrong paths, we would have compromised on a lot of things, including integrity and happiness. Our mistakes did cost us a lot financially, but hopefully, that's only temporary. I still think that things are in the process of sorting themselves out and that we don't have to worry too much or plan too far ahead. And so far, my belief has been correct.

I'm in the process of a pretty big change in terms of career paths. I've spent the last 10 years (14, if you count my undergrad days) training to become a basic scientist. Now I'm changing gears to become a childbirth educator and counselor for pregnant women. Would I have committed to this choice, if we hadn't gone through a period where we questioned our beliefs and actions? I think not... I tend to be a chronic ditherer and I would have probably continued dithering. But somehow, something has worked out and I have been offered a opportunity of a lifetime. There's not much money in it, but there's the promise of fulfillment and meaning.

Similarly, Ram too has chosen his workplaces with care, making sure that these offer him something more than just clinical revenue. His work at an HIV clinic and at a charity hospital enable him to function by being true to his core.

It takes time to settle and to find the right spot to settle.... I wonder if all the other people who write those R2I blogs also felt the same, or if they jumped into work full swing right away.

These days, I end every day by feeling grateful to whatever higher being is controlling our lives (if there is such a one), for the opportunities given to us and for the support we have from our parents and extended families and friends. It's good place to be.

Ani's First Fancy Dress Competition

Ani's school handed out some advertisements by Big Bazaar to a fancy dress competition. On a corner of the advertisement was a picture of the Avengers, which thrilled Ani to bits, who imagined a whole bunch of kids dressed up as various characters from the Avengers.

So yes, of course we had to go. He decided that he wanted to be Ironman, so that's what we went with. I made a mask, painted it and inserted some ties. Then stuck a white circle to a  red T shirt (that's supposed to be his heart or something.... can't remember what it's called) and tada! My job was done.

Tracing out the Ironman face

 When we reached the competition, we realized that nobody, but NOBODY, else was an American superhero, let alone a character from the Avengers. Instead, they were all the ultimate Indian superhero, Krishna.

Ani in his costume at the competition, very upset at lack of Avengers characters

Other kids: a million Krishnas and Radhas

 Ani stared aghast at what his contemporaries thought of superheros. I stared aghast at the sheer effort expended by the moms. Some of them had even trained their kids to sing Krishna bhajans!
Yes, moms of India, I bow down to you- there is NO way I can compete with that.

One of the Radhas. Observe the hair! How much time did this kid's mom spend??

 There was a non-Krishna boy, who jumped up on stage and did some Hrithik Roshan+ Michael Jackson combination dance moves.

The only non-Krishna guy, other than Ani. 

Main lesson learned from this experience:
My Ani does not know (yet) how to discreetly shove his way to the front of any line.

So, all parents had to leave their kids by the side of the stage. By a stroke of good luck and some anticipatory moves on my part, I left him at the front of the line and expected that he would be the 2nd or 3rd kid on the stage and we could leave early.
I hadn't counted on the sheer experience of other kids when confronted with a queue. Before long, what seemed like a hundred kids went on the stage and Ani still hadn't showed up. So I peeked backstage and realized that this poor guy was expecting the other kids to let him on the stage, but didn't know how to just get up ahead and go. He was waiting to be asked to step up! My heart melted a bit there... my poor little baby, with no experience with a whole bunch of dress-up crazy, competitive, expertly shoving kids.

Note to self: practice with kids on how to shove ahead.

Doctors and their choices

I never understood, until recently, why in India people revere doctors so. To "get into Medicine" after 12th std is considered to be a pinnacle of success (on par with "getting into IIT"). Now I wonder if I ought to have tried harder, at 18, to get one of those Medical seats. But the choice between Engineering and Medicine requires some amount of firm decision-making. For chronic ditherers like me, an engineering seat in Biotechnology forms the perfect compromise of getting an education without having to choose a camp. 

Now, since the big return, I'm seeing the benefits of being a doctor. Red carpets are rolled out, people are begging you to take their money and are willing to let you ride roughshod all over them. It's insanely easy, if you're a doctor, to make choices that are very beneficial to you personally, but may not be in the best interests of anybody else. When a whole culture of medicine is like that, with doctors willing to cut corners or make decisions that benefit them financially, the trust between patients and doctors erodes. This is true even in a big city like Bangalore, with a hospital at the corner of every block, and presumably, that many doctors. Patients go from one doctor to another, hoping to find two opinions that are the same or similar, to reassure themselves that they are not being taken complete advantage of (the wording here is deliberate: I think nearly all patients are aware they are being taken advantage of, but they are willing to fight for how much).

Doctors almost never write notes on their patient encounters, keeping other doctors (even other doctors who may be involved in the care of the same patient, within the same hospital system) in the dark about their thinking. Is this some kind of self protection? Or just plain laziness? Can this same doctor recall why they made certain decisions with regards to a particular patient a few months down the line? How can they, with the numbers of patients they see? In which case, where is there any opportunity for longitudinal, continuity of care? The onus of keeping track of prescriptions, of what the doctor said during the visit lies wholly with the patient and heaven help him if he gets muddled or forgets something that the doctor said! 

On the shoulders of the doctors and the choices they make is a whole industry of middle-men, agents whose sole purpose is to help a doctor make "cuts", from the referral fees that a hospital pays doctors to refer their patients for additional treatment,  from prescribing certain branded, non-generic drugs, or from ordering additional tests or drugs to be procured only in certain establishments.  

This is an ecosystem without any kind of oversight or accountability. 

In the US, health insurance companies are considered to be the "bad guys" who limit payments, who force doctors to choose one treatment over another, who push for outdated practices and who are easily influenced by rich lobbies. But I am appreciating the other, more crucial role they play- that of keeping a doctor accountable for his or her choices and actions. 

The insurance options in India are fairly limited, especially if you happen to be middle class or poorer (which encompasses, what, about 95% of the population?). The government has multiple schemes for the truly poor (and it makes these truly poor people jump through hoops to prove that they are truly poor) and there are other schemes for inpatient admissions. Nothing exists for continuous, out-patient treatment for chronic diseases.