The Great Yellow

First, let's see what my boy Herm has to say about the color of the world. (Before you run retching into wild, please understand that I've spent the last 5 days with IRB protocols and critical care papers. Your tolerance is appreciated.)

"And when we consider that other theory of the natural philosophers, that all other earthly hues- every stately or lovely emblazoning- the sweet tinges of sunset skies and woods; yea, and the gilded velvets of butterflies, and the butterfly cheeks of young girls; all these are but subtile deceits, not actually inherent in substances, but only laid on from without; so that all deified Nature absolutely paints like the harlot, whose allurements cover nothing but the charnel-house within; and when we proceed further, and consider that the mystical cosmetic which produces every one of her hues, the great principle of light, for ever remains white or colorless in itself, and if operating without medium upon matter, would touch all objects, even tulips and roses, with its own blank tinge- pondering all this, the palsied universe lies before us a leper; and like wilful travellers in Lapland, who refuse to wear colored and coloring glasses upon their eyes, so the wretched infidel gazes himself blind at the monumental white shroud that wraps all the prospect around him. And of all these things the Albino whale was the symbol. Wonder ye then at the fiery hunt?"

Ok, so a bit superfluous but bear with me, I'll bring it home.

Today as I walked down good old Civil Supply Godown with Kalyan, on the way to the library for the 5th day in a row, I turned to him and said through the venetian slits that have become my eyes these days, "Is it just me or is the light different here?"

You see, I can't quantify or explain it, but the light here absolutely ruins my eyes if I don't wear sunglasses. I don't know if it is just me, but I think not. I mean how many green or blue eyed Indian people (kashmiris and bollywood stars don't count) have you ever seen? Obviously there is something being selected against. Perhaps it explains why my ancestors ran squinting into battle alongside Alexander only to be driven out of the Indus Valley with our togas between our legs. I mean surely Blublockers weren't invented until at least the 17th century.

However Melville would have us believe that all light is the same whether in Boston or Bangalore... made up of pure white heat, and that all deviation is merely deceit. So why would rays from mama sol here charbroil my retinas when in New York they just tickle my rods and caress my cones with their fingertips? The only explanation I can come up with is that there is a flaw in Melville's logic. The light in New York, Nantucket, and New Zealand... lands he was known to haunt on his 4 year tours.... may be pure pale fire, but as the earth warms up along its steamy waistline, here in India, it is stained with henna, turmeric and saffron. And thus, instead of painting our sallow protagonist like the slapper he yearns to be, it leaves him burnt, blind, and disoriented.

Don't believe me? Check this out:



Trust me. I'm not trying to trick you with a typical sunset passed off as midday. This was taken at 2pm! It looks like the iodine tincture of the world is going to diffuse in and stain our daintily whitewashed concrete wallpaper. Doesn't it? Er... which is to say it looks really yellow... like sticky stainy, clorox-won't-cut-it yellow.

So if you haven't seen me in a while... and you notice that my skin has taken on a certain hue... please be kind and understand... at least all of you Indian kids will understand why my right hand is stained yellow (not what you think... i do that with the other hand)

And if you're coming by the house sometime soon and think that we're not in. Just ring the bell. Odds are we're home, maintaining our natural pallors. Wonder ye then at the croconic cowardice?*

*I'll put up a normal post sometime not too far away when something other than work happens.

As I was saying....

So anyway, I'm guessing y'all are wondering what I've been up to for the past month or so since I gave you a decent blog post. Well, as most of you know, I would love to talk on and on for hours about myself however I will instead borrow a lesson from the master of daily-minutiae blogging (vidontap) and focus only on what I've been up to the past few days. Let's go.

Ok, well ...actually.... I really should start about a month ago. During the last two weeks of August I took an epidimiology/biostat/SPSS/EpiInfo course for docs/researchers run through the med school by Dr. JP, formerly of Bloomberg, who is an amazing lecturer. It was a lot of fun, though there was no A/C in the lecture hall, leaving the majority of us doing that ridiculous half-asleep head-bob thing for 3 hours after lunch. I think I learned quite a bit... or at least enough to confuse Marjory endlessly while trying to help her make sample size calculations and decide on statistical analysis. There's nothing as dangerous as a little bit of knowledge. Especially when it comes to biostat where vocabulary and logical constructs serve much like the snake charmer's waving oboe, a distraction that leaves the observer with a profound sense of confusion, impotence, and a barely suppressed desire to strike wildly at unprotected flesh.

After that, I spent a week reading papers and having meetings canceled while I tried to finally throw together something to keep me busy for the next 8 months. Despite a number of brick walls, it looks like I will have 2 ICU projects that will start enrolling patients in October, and a multi-year randomized controlled trial looking at alternative pneumococcal vaccination schedules that will start sometime in the future... maybe Jan? I'll also probably cobble together a couple of papers that I'll drag out of a giant database the TB group just finished building. Bear in mind this is completely optimistic thinking... none of this may ever see the light of day. This is India after all.

After meeting with the head of ICU research last Friday and squaring away our two studies, I was looking forward to a weekend of freedom before getting down to work for two weeks and cranking out two protocols for IRB review by Sept 19th. However my dream was crushed at lunch on Saturday when Dr. Kang (my fogarty assigned PI) told me I had to go to the Community Orientation Program with the second year med students for "at least a few days." Deciding that this meant 3 days, I embarked on an experience that was horrifying, humiliating, and yet ever so mildly rewarding. Interested parties - please read on.

COP - So the Community Orientation Program (COP) is a mandatory 20-day experience that all second year medical students at CMC must participate in. They go to a village within the catchment area of CHAD (Community Health and Development) Hospital in south Vellore. This hospital serves all of the 10 major villages and their suburbs until half way between Vellore and Thiruvanamalai (look it up on a map). Every year the COP program is in a different village, returning to each village every 10 years. The demographic/health data for these villages is so extensively recorded by people at CHAD that they serve has a 100,000+ cohort for all of CMC's community based studies. I'm talking data down to the GPS coordinates of every house, hut, and squatter's shanty. Every birth, every death, every illness... everything has been recorded in these villages for the past 30+ years. It's pretty awesome. Hopefully this will be my cohort for my pneumo vaccine study.

Anyway, each group of 3 students is assigned a ~15 house chunk of town and they spend the 20 days collecting data about the people in these houses (from simple demographic stuff to household economics, traditional beliefs, child rearing strategies, etc...) and getting to know them. Two of the people each student meets during this study will be that student's patient for the entire 5 years he/she has left of med school. Talk about continuity of care!

So to participate in this program I had to get up at 4:15 am so that I could wake up and walk to CHAD by 5 am when the bus left for our village of Chinnapallapakam. I forgot how much it sucks to get <4 hours of sleep. Seems like surgery was way more than 5 months ago. During the entire 35 minute bus ride, the boys on the bus (I of course rode on the male-only bus) belted out linkin park and queen hits at the top of their lungs. Such is the musical taste of the teenage Indian lad. We started each day with the obligatory praying, bible reading and religious singing as is a hallmark of all activities at CMC. During these times, I find it amusing to watch the faces of the 7-8 Hindu students that are allowed to enroll in CMC each year. It must be very strange to go to a school that forces prayer and religoius values on students. CMC is probably the second best



med school in India, making the decision to involve oneself in what must be an incredibly strange world easy, yet I'm sure few of these students know what exactly they are getting themselves into. It makes me think back to the dark ages when the madrassas of Samarkand, Bukhara, Kashgar, Cordoba, and Granada were the great centers of learning in the world. They attracted the best and brightest of the collapsed European empires who were forced to worship and obey the laws of Islam in order to learn about math, architecture, astronomy and medicine. Perhaps that's a bit of a stretch, but as many of you know, I have a particular fascination with Central Asia's golden age. (that pic is of Samarkand, not Chinnipallapakam).

So after prayer we ate breakfast, went out and met with our people for a few hours, went for a hike up the mountains that surrounded the village and eventually returned around 10 am for 3 hours of napping before lunch. After doing another 1-2 hours of post lunch napping, we went back out into the village or volunteered to work in the free clinic offered each day until dinner time at 630. As you can probably guess, we were all a bit angry that we had to get up so early each day when really there was only about 4-5 hours of work to do.

Monday was the worst, as the one person that had been informed I would be attending was not present. After a great deal of initial confusion I was assigned to a faculty member who went out in the morning with a few students and spent the rest of the day sleeping. Tuesday I randomly picked a group of 3 students and followed them around, mostly just asking a few questions here and there since the students weren't really that excited abut me tagging along. Wednesday was a lot better as a couple groups of 3 students figured out that I knew a bit more about medicine than they did and took me around to see their most interesting cases. I was able to do quite a bit of teaching, though my lack of knowledge about tropical diseases left me wishing I'd brought along my Oxford guide. Actually I had so much fun on Wed, there is a chance I may go back for one more day next week... taking the local bus out to the village around 9 am of course.

Anyway, I stuck to my word and called it quits after catching the bus home on Wed. As it was a Wednesday, I forced myself to enjoy the weekly dinner at Darling with all of the foreign students. So hard. It was Liz, Fran, Pat, and Coryn's (the 4 Australians who arrived in Vellore the same week I did) final dinner at Darling. So after dinner we grabbed a beer while we all enjoyed our regular game of them taking turns taking the piss out of America while I spent the time defending my silly schizophrenic wreck of a country whenever possible. Liz and Fran are the two girls second in from the end on each side in this photo (fran in the green, liz = disembodied head).

There are a thousand other things I would like to blog about, but I'm currently febrile, coughing up greenish stuff, and feeling rather crap. Perhaps I'll get around to telling you all about the magical trip to the Bombay sweet shop ("how much do you like him?" being the pinnacle line of the strangest conversation I have ever witnessed), the hand holding meatheads at Vellore's only gym, the adventures of a particular urban donkey, and my weekly butt-rock (if this is not a term you are familiar with, look it up) and cheap rum parties with the hospital interns.