The last week in Vellore has been a hectic and tiring one. The day starts at 8 in the morning and we finish evening rounds by 9.30pm most days. Then a quick dinner, and after a short rest in the mess, I usually join some of the other registrars to the Haematology officewhich has 24 hour computer access. Here I normally keep in touch with the world that seems so distant as well as do some background reading on cases seen. One comes to train here with only work and study in mind- it's that simple, because there's absolutely nothing else to do here. I think I would go mad if I really was training here for 4 years!
Most nights, I walk back to my flat past midnight and Vellore is a metamorphosed place by then.The dust has had time to settle, most of the human crowd has shifted indoors and auto-rickshawsare are mercifully few and far between, giving way to (relative) quiet and peace. Some chai stalls are still open and I often stop to have a sip of the treacle-sweet potion in the company of tired-looking auto-rickshaw wallahs, factory workers finishing their night shifts and the occasional insomniacs.
The sparse street lamps cast their orange glow and in their shadows a few somnolent cows munch away at the last remains of any organic (or even sometimes inorganic) waste they can scavenge on the streets. A few dogs, tamed by men, but which here have long forgotten any pleasant human contact, lie curled up here and there. There's also often another surreal sight: A half-dozen or so depressed looking donkeys, roaming about and enjoying a few hours of nocturnal freedom before another hard day at work. Sometimes, out of the blue, as if struck by some sudden existential panic, one of them will suddenly lurch forward, braying aloud, and break into a frantic run- I once had to move sideways to avoid a head-on collision! A sad sight. There's also of course the occasional huddled tired bodies on the doorsteps and shop porches, comatose after the enduring labour of the day, and by now accustomed to the conrete firmess of their 'bed'.
I have finished Naipaul's book by now. I'm glad I read it, but I would not recommed it as a first novel on India. Naipaul eloquently screams the harsh reality of India, the hypocrisy and stupidity of some of its traditions. The caste divisions he mentions are particularly omnipresent here in Tamil Nadu, and reading the book and talking to people around me has opened my eyes to some of these facets of Indian life. After almost 2 months here, the naive veil of the new and the exotic is lifting. On a brief visit to India, there is perhaps so much to digest and the colourful side of India and its exuberance can dazzle and confuse. I am only beginning to understand the complexity of this ancient land, and the customs of its people, sometimes with amazement and sometimes with shock and horror.

Hi Everyone! Apologies for the long silence. From my previous blog, some of you may have thought I was once again incapacitated by gastrointestinal trouble! Nothing like that! I've been well, but just have been very busy over the last week. Yup, I've finally managed to catch the contagious enthusiasm and workaholic traits of the doctors here- to the point of even renouncing my plans to go to Pondicherry this weekend- yes once again! So I won;t be able to satisfy requests to write about it until a little later! I'm enjoying work very much, but it does mean that I'm getting back home at around 11 pm every night after an 8am start. Once you start taking over the care of some patients, it's very hard indeed to just leave the work and go travelling. But the experience is worth it. There's a large number of aplastic anaemia patients here and it's inerersting to learn about their management. In clinic I saw some rarities this week- a case of congenital dyskeratosis and one of Kasabach-Merritt syndrome.
My registrar colleague on the ward is Rayaz. He's from Chattigarh originally and has been here for a year. He's one of the few single doctors around here- yes, most doctors get married very early just after they finish their medicine degree- He' good company!
I'm definitely going away next weekend- to Kodaikanal- a hill station not far from the city of Madurai, which has a huge temple complex. More about this later.
The Monsoon is slowly and shyly unveiling it's full face over here. There were a few nights last week when rumbles of thunder accompanied nature's display of her full electrical might - a stroboscopic display of lightning bolts like I've never experienced before. The vast parched state of Tamil Nadu seems certainly thirsty for the impending rains. The temperatures have thankfully cooled down a little lately.
There seems to have been a string of birthdays recently. Just wanted to wish Juanita a belated Happy birthday! Same to Dolan, Ali and Nish- Happy birthday guys!
I'm currently reading VS Naipaul's India: A wounded Civilisation. An eye-opener to some of the problems of Indian society and culture. His opening line is 'India is a difficult country for me. It isn;t my home and cannot be my home; and yet I cannot reject it or be indiffferent to it; I cannot travel only for the sights. I am at once too close and too far.' No other sentence can echo my feelings any better yet!
Hopefully, i'll have more interesting adventures to tell you about next time. It's evening ward round time!

My good fortune had to run out of steam at some point. Yes, my gut became the centre of my attention for the whole of about 12 hours, during which time every movement, every ripple of an unusual sensation was subject to the closest scrutiny, lest it might lead to the undesirable. I was quite ill and feverish overnight, but held off taking the ciprofloxacin that I kept eyeing intently, constantly weighing the possibilities of whether this was a bacteria, a virus or just a toxin. I am glad I reserved the tablets for some future occasion as it turned out to be one of those nasties that produces misery for only half a day. I don't know what caused it as I had eaten nothing unusual- just the normal lunch menu at the hospital canteen. I must assume from the natural course that it was some toxin, maybe b. cereus or staph.
Anyway, I am thoroughly enjoying the clinics at CMC. Dr Mammen Chandy has taken me under his wings during these and I can see the jealous looks of the other doctors when they come in to discuss patients. The breadth of haematology that I see at each of these sessions is staggering, and there's a fair bit of general medicine too to keep one on his toes, and avoid losing the diagnostic skills and flair that we tend to dismiss when we have all sorts of funky tests at our fingertips. Dr MC is just so experienced that he seems to make haematology simple and straightforward, which it is far from.
I have been reading Rabindranath Tagore's 'Home and the World' which Juanita gave me just before I left. Thanks Juani for this amazing book! Its just so beautifully written and it's theme reflects te dilemmas of life that stand true even in modern day Indian society. Tagore was a genius in his mastery of language and its lyricism and deservedly won a Nobel Prize in 1913. Mum, I'll send it to you by post as soon as I finish it.
I'll try to head to Pondicherry this weekend. It's a four hour bus journey, and you well know how allergic I'm becoming to these, so I'll see how I feel about that tomorrow. One half of me begs for a lazy weekend in Vellore doing absolutely nothing, after the hectic past few weekends with lots of travelling. There's always the mountain overlooking Vellore that I have promised to climb, and which now looks refreshingly green after the recent rains here, but due to the heat this will have to be an early morning affair. At the same time some 'haute cuisine Francaise' in Pondicherry does beckon too!

One month in India already. I certainly feel more acclimatised to this new world, where the whole breadth of human life, from its most basic to its most opulent are on constant display. I feel that my perspective of things here has certainly changed over the course of the month. I feel less somewhat less 'awed' by the amazing menial daily things that I see around me- desensitised a little, which is kind of normal I suppose. I no longer turn my head to look at the cow stuck in the middle of the road causing a traffic jam, I no longer feel claustrophobic on walking narrow alleyways jammed with people, motorbikes, cycles and animals all trying to fray a way through. I suppose I am gradually becoming more 'Indian' in my attitudes to these things too.
My trip to Mysore was a stark reminder of the rich past this country had in its previous regional Kingdoms. The Mysore Palace of the Wadiyar rulers is one of the most amazing visual display of opulence that I have yet seen here. The city itself was cooler and offered more space to breathe than most other places I have been to in India, its borad avenues lines with giant century-old trees and the city itself dotted with green areas. The skyline viewed from the top of the Jaganmohan Palace (now an art museum) offers one that romantic, fairytale image of India that attracts so many.
At Srirangapatnam, the place where Tippu Sultan built his stronghold that eventually gave in to British forces that he was valiantly resisting in the South, one can again palpate the grand historical backdrop and its associated achievements and tragedies.
At the glamorously named "Hotel Ritz' where I was staying, in one of these turns of fate, I met 2 guys from Cambridge- Jo was in the same year as me in Medicine (at Jesus College) and Simon in the year below. Simon was going to work in a village hospital in rural Kerala and Jo was just killing time waiting for her job to start at Tommies in London. They were on their way down the West coast on motorbike- a great way indeed to view India, but they seemed to have had more than their fair share of 'mechanical failures' recently! It was nice to have them as company and I was somewhat sad to leave Mysore behind- I literally ran from the Palace that was brightly illuminated with thousands of lightbulbs at 7pm to catch my train at 7.45! It was well worth the sweat!