The Last Breath

I became close to a couple a few years back when the wife was undergoing cancer treatment while her husband was her closest advocate.  They were working their way to their 62nd wedding anniversary.

They made it to their anniversary, and a few months later a wish of hers was fulfilled magically via Twitter.

She unfortunately passed away a year ago last weekend to the day.

He carried on, living in their mobile home they had once shared filled with many memories.

I used to visit him whenever I could. We would sit hug, sit down and chat.  A lot of the conversation was how much he missed his wife.  

It was heartbreaking.

Last week a nurse came to let me know that he had been admitted for breaking a leg.  I immediately went upstairs to check in on him and he was telling me how he accidentally fell.   He was discharged after surgery..

This past Monday I got a phone call from his daughter.  She was in tears.

"Krupali, he was re-admitted for pneumonia and he isn't looking too good.  I know you would want to see him."

She called me at 10am.  By 11am I had picked up my father, who also had met him a few times and drove to the hospital.  He was having difficulty breathing with an oxygen mask and as he was gasping for air, I held his hand and told him how much I loved him.

"I want to be with her when I go," he gasped.

I visited him yesterday, he looked a lot better, I talked with him as he responded underneath his mask.

Today, at lunchtime I went up again, just having a gut feeling that I needed to go upstairs to check on him.

As I walked in, I saw his daughter, son, and granddaughters.
They had red eyes.
I looked at him.  He was still gasping for air, but something did not look right.

His daughter said, "We are turning off the machines, he is not getting any better, and that is what he had written in his requests......" as she cried tears.

The pacemaker was turned off.

I stood their stunned.
I went to him, held his hand and prayed, and told him how much I loved him, but that his wife was waiting for him too.

We all stood around him as he took his final breaths of life.
Tears streamed down my face.

I cry as I type this.
It's never easy to say goodbye to anyone.
Especially those who you become fond of and love.

I am just grateful to have this wonderful couple come into my life and changed me.
Change me hopefully for the better.
They taught me a lot.

What did they teach me? 
So much.

They showed me how a couple sticks together through the thick and thin.  I can still hear his voice from the first day I met them.  "Doctor, she is sick and she was there with me when I went through all my heart surgeries.  I have to be there for her...."

They taught me more about love.  Although they had a small home, they had the biggest and kindest heart.  They always welcomed me into their home and into their family.

They both taught me so much, it's too hard to put into words.

Both of them are gone now from this world.
It hurts.

The only consolation I have is that I know they are both with each other now, dancing, laughing, and smiling.  They both had lovely smiles, smiles that will forever me etched in my heart and memory.

Thank You Mashable

This morning when I got up, my phone was buzzing with new emails. When I checked, I had over 50 new @twitter followers. I didn't know why, and hence I asked since I thought I was being spammed like mad.

Warren Wong (@warrenwwwong) replied: mashable!

Mashable is social media website filled with news, musings, tech info.

I was stunned. My jaw dropped. What did he mean?

Then he sent me this link.

Again. Jaw dropped.

I was the top doctor to follow on Twitter on a list of 11 other professionals. 
The list was incredible, Politician Cory Booker, to Journalist Anderson Cooper, it's a bit overwhelming and incredibly humbling.

I thank those who I guess found me and mentioned me today.
Thank you again for this honor.

All I can hope for is to use this social media platform to work even harder and to share more stories. My patients and people I meet inspire meet, and I hope that they inspire you too.

Hugs & Smiles,
Krupali

A Simple Hug

I hug patients.
This simple act transforms the patient.

A simple hug.
This act conveys so much.

A simple hug.

---

I recently met a 70 year old woman who looked angry the first time I met her. She didn't want to have cancer, she didn't want to come in daily for 6 weeks for radiation therapy, she was OVER it. I understood.

I read her eyes.

I addressed her anger.
I asked her if she was upset...then I gently asked if she was scared.

She shuddered, and I saw her eyes.
Tears were forming.

Instead of talking to her, I simply asked if I could hug her.
She softly said yes.

We hugged. I didn't let go until she did.

She softened up a bit.
I actually saw a smile.

We talked for a bit and discussed how to fight the disease.

---

She started her treatment the following week.
After her first treatment she wanted to see me.

I saw her, and she said she had a gift for me.
'Oh thank you but I don't need anything,' I told her.

She said, 'No, this is for you.'
Inside a bag was a gorgeous poem inside a beautiful frame.

The poem was about hugs.
A poem for those who like hugs.

My eyes filled with tears after she said these words,
'In my 70 odd years I have never been hugged by a doctor, and I just wanted to say thank you.'

---
Hugs.
They matter.
A lot.

Dying Alone

Death. We all face it. Nobody is immue. To die alone is one of the saddest things I've ever seen. Watch this beautiful story about the VA promise to never die alone.

How Doctors Die

I think this is a very important, eloquent, and great article to read. I'd love to know your thoughts.

The Phone Call

**All names obviously have been changed, as in all blog posts if I do mention a name**

"Dr. Tejura, Brandy's sister is on the phone, she wants to speak to you," my nurse told me.

My heart sunk.
It actually plummeted.

I knew what this phone call was.

"Hi Irma, how are you?", I asked.
"Hi Dr. Tejura, I'm hanging in there. I just wanted to call to say thanks for visiting Brandy last week at home. I wanted to let you know she passed the very next day....."

The rest of the conversation we talked about the rest of the family, how everyone was doing, including the newborn child, the other children, brothers, sisters, and Brandy's mother.

Just last week, a stranger had emailed me asking about her and how she was doing.

Why a stranger was emailing me about Brandy is a beautiful story in itself.

---

I met Brandy a little over 6 months ago. She was in her late 30's. She had just delivered a baby, but while pregnant she was diagnosed with breast cancer.

She wanted to delay treatment after the baby was born. Chemotherapy immediately began. Unfortunately by that time, the cancer had spread to several parts of her body.

Could she have stopped the cancer from spreading if the therapy had started earlier? I do not know. That was Brandy's choice and we must respect it. And honestly, that's not the gist of the story.

I treated her palliative to an area, and she did well for a bit. She returned less than 2 months ago for treatment to other sights.

She was progressing more rapidly. You could feel the fatigue, you could sense the decrease of energy, you could see her eyes which were full of sadness.

She was going through so much physically, emotionally, and personally. So much other things were going on in her life on top of this cancer that honestly, I didn't know where she garnered the internal strength to fight. It was truly admirable.

We both found out we had attended the same high school in different years, we had a kinship. I grew close to her and her family members who brought her for the therapy. We talked, we talked about everything. Life, lifespan, hope, her kids, and what the future held.

The conversations at time were difficult and not very easy.
The conversations at time were things I didn't want to talk about, but knew it would be important for her to hear.

She knew it was difficult for me sometimes to talk about certain things. Her response was always, "I know this is hard for your but I appreciate you being honest and caring for me. I love you Dr. Tejura."

During one of the visits I asked her if she had any crazy dream or wish.
She responded fairly quickly with this response, "I would love to go to a cabin near the mountains for a few days and spend some time just with my family, the kids, brother and sisters, my mom...."

I looked at her and her sister Irma and told her, "I'll figure something out...I don't know what will happen, but we'll make it happen."

I knew the time was short.
This dream would have to happen after her last radiation treatment.

I went online, cabins ranged from 2000 to 3500 dollars for the week.
What could I do?

I asked a few people that I spoke with at INTEL. Many were generous and agreed to raise the funds.

But then, magic happened.

That same afternoon I asked Brandy about her dream, I met a nurse Bob that I work with that afternoon and I asked him if anyone he knew had a cabin in the mountains nearby. I told him I needed it for a patient.

The next morning he handed me a piece of paper with a name and a number.

"This is my friend Cathy. She has a cabin where you are looking for....I told her about your patient and she doesn't mind the patient and her family using it... call her," the nurse said.

I called Cathy.

"Hi Cathy, this is Krupali Tejura, I know Bob and he mentioned you have a cabin that you don't mind a patient of mine using...."

After figuring out logistics, she was generously offering her cabin to my patient the following week, a day after Brandy finished radiation.

I told Brandy and her family. They were ecstatic.

They went to the cabin, and by sheer coincidence, it happened to be Brandy's birthday the Saturday they were there. They got to celebrate it together.

They returned from the cabin, and Brandy was hospitalized. She was then sent to home hospice. She passed away peacefully a few weeks later.

----
I have yet to meet Cathy in person to say thank you. Cathy was the person sending me the email asking me about Brandy last week. I sent Cathy & he family a gift and a note of how generous it was to open her home to a stranger's patient. That her gift and kindness and trust was truly remarkable. It was inspiring. It was magic.

As I was leaving Brandy's house last week, I saw pictures from the birthday celebration that she had in the cabin, I saw the cake, the candles, and the smiles.

The smiles.
I will always remember her smile.

Strength, Courage, Hope

Yesterday I got a call to see a patient with SVC syndrome. They were in their 60's, a longtime smoker, and no prior diagnosis of cancer.

The CT scan showed the large tumor invading her lungs, encroaching upon the superior vena cava. It was ugly. Pathology was pending, and a brain MRI was too.

Both came back positive.
Cancer.

Lungs and brain, making it a dreaded stage IV.

I met the this patients daughter and sister today.

I gave her the results and wanted to start radiation therapy to possibly relieve some of the pressure of the tumor, shrink it, make it better for her to breathe, and hopefully slow the tumor growth.

When I walked in, I saw fear as I started to talk. Nobody had told her the results. When I started to give her the information, I told her it was cancer and that it had spread to her brain.

"So what does that mean?"

I told her it was stage IV, and as gently as I could tell her it was not at the 'curable' yet we would do the best we could to give her the best and longest quality of life she could have.

I heard some crying, her daughter got up and left the room.

As I finished talking to the patient, I told her I was leaving to find her daughter. My patients words were, "She's going to need help... I just lost my husband to cancer last month."

I had no words.
I had to bite my lip to stop from crying.
Internally I wanted to yell at how unfair this was.

I found her crying in the hallway.
I held her hand and then we hugged.
She did not let go.
She cried and it was so hard not to shed tears with her.

I can't even imagine the pain she is going through.
I can't even imagine.

If you can, please send this family some love.
Some strength.
Some courage.
Some hope.

Hope.
I truly hope and pray that my patient fights to the end and she is here for the longest possible time.

I hope.
I pray.
I wish.

I Need Help

I saw a patient and his wife recently. The husband had a horrible cancer that was growing through the chemotherapy. He had been sent to me by the medical oncologist to see whether or not I could radiate and palliate some of the pain that the tumor was causing.

We were going though the history and physical examination and then I sat down to go over the treatment plan with them.

As I was speaking I looked over at the wife. Her eyes showed something that unfortunately I have seen too much of.... her eyes were full of fear and sadness.

I asked her, 'Are you okay?'

Tears welled up in her brown eyes, and were running down her cheeks under her glasses.

'I need help. I need support. I don't know what I can do anymore...' as she said these words, I went and grabbed her shoulders.

'Can I give you a hug?' I asked.

She held onto me for minutes. I didn't want to let go until she did.

'Take some deep breaths.... breath deeply' I mumbled.

After she let go, she held my hand, 'I haven't said that in the past 2 years we've been going through this....I'm sorry for crying...'

'No need to apologize, and I'm glad you did. It can be overwhelming, and really difficult. I don't and can't even imagine how you're feeling right now....' I said with tears in my own eyes.

I gave her the number to the American Cancer Society which runs support groups for spouses and patients in the area. I told her if that didn't work to come back and I would give her more options.

I told her husband that he was indeed lucky to have this woman by his side, as his rock and anchor to help him through the treatment. He shrugged, and sadly smiled... not knowing what to say.

I told his wife to come daily to me for a hug and that if she needed anything we'd try to help her though this difficult time.

The tears the worry in the eyes the fear and the sadness.... emotions that cannot be hidden by the eyes. The eyes truly speak the truth.

Gift Cards of Hope

A few weeks ago I met a woman who was being treated with radiation for cancer. She was suffering from side effects of diarrhea secondary to the fields we were treating her with. I sat down with her talking to her about diet, and to avoid certain food (fibrous) to try to slow the side effects along with some medications to help her.

She got quiet all of a sudden when I asked her what foods she was eating.

"Well we are in the process of losing our home, and right now food is coming from the local food bank...," she said softly.

A lump rose in my throat. She was eating whatever she could receive from the food bank, and here I was making restrictions on what I recommend her eating.

I looked at her and said, "I'll help figure something out.." not knowing exactly what I'd do.

Later that evening I went to the grocery store and got a gift card for her. I placed it in an envelope and gave it to her.

Afterwards I put on my Facebook status:

Just met a patient who is terminal, losing their house & goes to a food bank. They can't afford the proper diet to help the side effects from the radiation I'm giving them, need gift cards to grocery stores if anyone is interested in contributing. Let me know, thanks!

The response from this was overwhelming. A friend put it as her status update and she got several responses as did I. It was very heartwarming to know that people wanted to help.

Every few days I'd either get a check or a giftcard in the mail with messages telling me 'thanks for allowing me to help'. I mailed the cards to this patient. I recently got a letter from her saying she and her husband ate a few meals that they both had been craving. Some of the cards were from people who I didn't know and had never met. For them to give and trust was truly remarkable. Kindness was pouring through.

Little things like this have helped this particular patient throughout this difficult time not only mentally but financially. It was a beautiful way social media yet again has helped someone.

Thanks to all who contributed, and thanks to those who sent their wishes and kind words. Being kind matters, it really does.

-Krupali

Celebrating Life

I've been getting slammed with new patients, most of them with newly diagnosed with terminal disease. Today was no different.

I received an urgent phone call to see a patient who was admitted last night and having difficulty with memory. A CT of the brain showed lesions that should not be there, tumors which were growing causing pain and swelling. Scans were done of the rest of the body and there were tumors all over the place.

I went upstairs after reviewing the scans, a biopsy of an area to get tissue for a diagnosis was still pending however I wanted to introduce myself.

I went upstairs, met the patient and their lovely family. They stared at me as I explained what was going on, and what we were likely planning on doing for his probable cancer.

'So doctor am I cureable? How long do I have...' asked the patient as the family watched.

It is always so hard to tell someone and their loved ones that no, they are not curable and that we are fighting to keep them comfortable for however long they have.

When I said no, that this was likely not curable, tears started streaming, from the spouse, and then all the children....the patient himself was stoic. They had more strength emerge then I had ever seen in someone.

I took the family outside and to hug them....as I spoke with the spouse and met several of their kids I found out it was their twins 20th birthday they day before when there dad was admitted to the hospital.

I smiled, and internally I was crying because I know that this would be likely the last time they would celebrate a birthday with their father.

I left the floor and headed back to see other patients, but I had a plan already in my mind.

After my last patient, meetings, and finishing charting, I went to the grocery store. An ice cream cake was bought along with forks and other shenanigans to celebrate a birthday.

I went back to the hospital, by that time over 30 family members were waiting in the waiting room, and I smiled as I walked in, asking them all to come in. The twins were surprised, I handed the cake to the patient and told him that he needed to celebrate the birth of his kids with his family.

To see 30 people sing their hearts out in a hospital room, smiling beneath tears was an incredible moment for me... not as a doctor but as a human being. I got to meet every single person and tell them what an honor it is to treat their loved one as well as celebrate a happy occasion (despite the pain).

Caring makes a difference. Caring as a friend, a stranger, a caregiver, and just a neighbor. Remember, people are people.

I hope that this family finds strength in numbers and can fight this battle with grace and love. I know that they can, I hope they know that too.

Needs YOUR Help

Imagine having a child undergoing therapy for leukemia and then having the mother diagnosed with a brain tumor, unable to afford surgery.

Nightmare?

Unfortunately it's reality for a local family.

Here is their story.

They need YOUR help.
If you can, please send whatever you can, every little bit counts.

Thanks,
Krupali

Frustrating

I recently saw a patient who had a cancer that needed chemotherapy and radiation for possibly a cure to their tumor. They had just seen the medical oncologist and refused chemotherapy. The patient was then sent to me for possible radiation treatment options.

I was quite blunt with the patient.

"What do you want out of life?," was a question of mine. "What is your end goal?". They had a sibling going through the same cancer and didn't want to "look sick". I urged them to go back to the medical oncologist to once again go hear the chemotherapy options.

The medical oncologist and I did a pow wow session, where we both know that if this patient refuses the chemotherapy that their chances for the cancer to recur were sky high. It was a no brainer. A no brainer.

The patient again refused the chemotherapy and came back to me. I told them the facts, and said I could give the radiation alone but the treatment would not be as effective.

They agreed to the localized radiation.

Treatment started, and five treatments in, they called to say they didn't want anymore radiation because it was causing deformity in their skin (something I refuse to believe as five treatments would not cause this).

I called the patient to talk to them.

"I just want to make sure that you want to stop radiation therapy. What are the reasons?" They said their skin was getting 'deformed' and that they cried all weekend. I again urged them to come in so we could talk about it. They refused.

Some patients get diagnosed when they are incurable, and they have no choice of all doors open to them for potential cure. Some patients don't get this choice to live. When people who do have all the options available but refuse, it makes my heart hurt.

This patient has children. This patient has a family. This patient is a human being that I want to help.

It's extremely frustrating when they refuse, because I, along with everyone else who has tried to help and treat them, know what is likely going to happen sooner then later.

It is their life, their body, their choice.
No doubt.

However, I still don't understand, and I don't know if I ever will.

July 1st

My first tweet this morning was this:

It's July 1st. Stay away from hospitals. Interns start today :)

This tweet brought back a flood of memories from my first day intern year. It was a memorable, full of ups and full of downs. Learning how to deal with all types of people, from the nurses on the floor you were on that month to the residents you were working under to the auxiliary staff, and of course first and foremost with the patients themselves.

My morning that first day as an official 'doctor' was surreal. It was at the county hospital and we had a meeting early in the morning at 7am. I walked into the little room, it was filled with 30 other faces who looked just as scared as me. "What am I doing, I am supposed to have the answers...yet I KNOW NOTHING!" was running through my own head.

People were sitting around the table waiting for the Chief Resident to give us pearls of wisdom and a pep talk before we headed out to the 'big bad world of medicine.'

I saw a friend who had an empty chair next to them, they motioned for me to sit there. I grabbed the chair and sat down.

THUMP.

The chair was a broken chair, legs collapsed and my ass was on the ground. No simple or kind way to say it.

I couldn't stop laughing.

The thoughts running through my head were, "My ass starts on the ground the first day, this year... can only get better, right?"

People laughed, as someone helped me up.
Seriously. Really? Could it get any worse?

Oh... good times awaited me that day.

On my white coat I had 2 pins on it, one from my undergrad and one from my medical school. I was a proud CALIFORNIAN, and being in a different state was 'foreign' :) (Those from California understand).

I met my resident and the other intern who was going to be my partner in crime for that month. We were the lucky ones who were not only starting that day on the wards, but we were also on long call, and had to admit patients. (See how lucky I am?)

My resident looked at me and my pins and said, 'Oh you already want to go back, eh? From now on you'll be known as California girl.'

I gave him a weak smile. Yeah, I missed the beach, my friends, my family.

I went to go see my first patient. An elderly gentlemen admitted for chest pain a few days prior. I wanted to introduce myself and examine him. "My very first PATIENT!" was what I was thinking.

I told him who I was and timidly began to ask him questions. He was a Rastafarian, dreadlocks, seemed happy, and was just 'hanging out' in the hospital bed at 8am. I began to listen to his heart and lungs, and then I felt for edema on his lower extremities. He was wearing jeans, and while examining him, I felt something along his left leg.

I lifted up his jeans. There, stuck to his leg, was a can of beer. A can of beer.

I said gently, "Um sir, I don't think you're allowed to have beer in the hospital on the floor as a patient."

He glared at me.

I repeated to him that I didn't think he was allowed to have it.

What happened next was surreal.

"F*ck you, who the F*CK do you think you ARE? It's MY BEER and I'M GOING TO DRINK IT RIGHT F*CKING NOW!"

He grabbed the can out of my hand, cracked it open and started chugging it. I ran outside the room looking for my resident.

"Mr. X is chugging a can of beer, is this allowed," (boy was I naive!), he laughed and followed me into this mans room.

"Now Mr. X, it's Dr. Tejura's very first day as a doctor, and you're her very first patient. You know there is no beer allowed on the floors...and stop cursing at her."

I walked out. I felt like a complete failure. I had no idea what had just happened or transpired.

That was just the beginning of the long day which was to follow.

It's July 1st.
July 1st.

Welcome to the 'big bad world of medicine' interns. I wish you all the luck, laughs, development of thick skin, and perseverance in the world. You will get through it. You will look back on the year and the very first day with laughs. It will and can only get better.

Promise.

Questions

“Life is full of ups and downs. The trick is to enjoy the ups and have courage during the downs.” - Unknown

Many people with many stories have walked through my clinic doors. Every single one impacts me in some way, shape, or form. One of the cases that has recently impacted me is of a young mother of a newborn that was recently diagnosed with stage IV incurable cancer.

How do you tell this mother of a 1 month old that she may only have a few months to live? How do you tell her not to lose hope or faith? How do you give her a timeline of living each day to the fullest and not to leave any stone unturned?

How do you react when she is crying, saying, "I wanted to at least see my baby be 10 years old..." How can your own heart not break?

How do you go over lab and imaging results which give more horrific news? How do you remain realistic yet wanting to give them hope? How do you not break down yourself?

How can you not feel their pain, their fear, their sadness, their anger? How can you not feel their strength, courage, hope, and spirit?

I don't have answers or responses... just questions.
Lots and lots of questions.

Generosity

A few days ago I tweeted how my heart aches when I see some patients undergoing cancer treatment alone. Some cancers are a bit harder to fight then others, and seeing someone alone during this difficult time makes me sad.

Well I got a response from Kelly (@craftyb on Twitter) who said she would love to have her kids make a card for a patient. I was overwhelmed. Really? I told her the gender and age range of the patient, and that was it.

Today I get the amazing, yes AMAZING card in the mail. Her kids, Wyatt, Chloe, Avery, & Morgan sent one of the most beautiful cards to a stranger. I must be honest, I wanted to keep the card for myself :).

Ironically this patient was admitted to the hospital last night, so when I went to see them today, I took this kindness card with me. Let me tell you, it lit up their face. I placed it nearby so that they always will remember that there are people who care about them and are pulling for them.

The timing could not have been better.

So I say this:

Dear Kelly:

Thank you for reaching out with kindness, and teaching your kids that doing something for a stranger can and will make an impact. What a beautiful thing to teach your kids and what an impact they left on me and a stranger who they will likely never meet. They are little heroes in my book and you as their mother are the most amazing teacher.

With Love,
Krupali

Music Until The End

These past few days have been hard for me. My 'Music of the Heart' patient was placed in hospice a few weeks ago, and yesterday out of the blue I gave her a call. Her daughter answered saying, 'Mom isn't doing too good.' I told them I would drop by after work.

Before going, I had my staff who knew and loved her sign a card, and I bought some Easter lilies. I went to her home after work. When I walked inside, her loving husband said, "She's so excited that you said you were coming, we told her this morning and she perked right up!"

Tears were shed before I entered her room. There she lay in a hospital bed, oxygen tubes in her nose, but there she was, I entered and she smiled.

I smiled right back.

Immediately I went to her and hugged her and gave her a kiss.

"I love you," she said.
"I love you too Miss," was my reply through a mess of tears.

She asked about my mom who she met at the Andre Rieu concert in December. I immediately called my mom and asked her what she was doing. I then looked at my dear patient and said, "well forget about asking about her, how about I go bring her to see you personally within an hour?"

I immediately left their home and drove the 30 or so miles to pick up my mom. We both entered the house 90 minutes later. We each took a hand, smiled, laughed.

I knew she hadn't been eating much, but I knew how much she loved a particular food. Last October I surprised her and her husband on their 62nd wedding anniversary with a large chocolate cake. She couldn't stop talking about chocolate cake for weeks aftewards.

I held her hand and asked her if she craved anything. She thought a little bit. I said, 'What about chocolate cake?' Immediately she smiled and nodded her head and said okay with a grin.

I asked her husband where the nearest grocery store was. I left my mom holding her hand and went to the bakery of the store and got a gorgeous cake and inscribed it with the words "We love you".

She took a look at the cake when I got back, and smiled. Then we cut her a large slice. My mom and I and her granddaughters and daughter all fed it to her until she finished the entire piece. It will be a moment I cherish forever.

As we left, I promised her that I'd be back tomorrow. I smiled as I told her to stay out of trouble and behave for me until I returned. She laughed as did I.

---

That same evening I emailed a violinist Robert Gupta who plays for the LA Philharmonic. I have never met them, but knew of them via a friend. I explained the situation and asked if they would be so kind as to play for my patient via the phone/skype/etc. He replied with enthusiasm that he would love to. I knew that she was critical so we set up a time the next day in the early evening for him to play for her. It was quite kind, and I was excited to share this with her the following day.

----

The next day I went to her home with my phone in hand, wanting her to enjoy the music. As I entered her granddaughter said to me, "The priest already came...she's taking her final breaths...go in."

We all cried...as I walked in, she wasn't alert...she was taking breathes. Her family invited me to hold her hand, and I held it and prayed.

I got Robert the phone and he played for 5 minutes, 5 beautiful minutes via speaker phone for all of us to hear. Gorgeous notes played from the heart who's sounds touched every single person in the room who surrounded her then. All of us took joy mixed with solace at the music being played for her.

She then, took her final breaths.

---

I cannot put into words how precious this entire journey has been for me personally. It reinforced for me how important love is, how incredible family/friends/people who care (even if they may be people you have never met). So many amazing people came together for my patient--so many people around the world sent their love, thoughts, prayers, kindness, and strength.

Late last night I received a text from Robert, the violinist. It said this: "Krupali, Today changed my life forever. Thank you."

To those words I humbly say this: thank you to everyone who changed so many peoples lives with this story--changed them for the better, changed them for good, and changed them with kindness.

With Love,
Krupali

Happy 5th Birthday Twitter

It's the 5th birthday for Twitter. Here are some interesting insights into the history of how the entire concept got started by one of the founders, Jack Dorsey.

After reading his tweets, I wanted to share my 5 reasons why I love Twitter. Sure, Twitter wasn't easy for me to understand the first few years. (Twitter isn't intuitive, it took me a few years to finally get a handle on who to follow, what to say, and how, and get a read of what was going on.)

So, here they are. 5 reasons to celebrate the 5th birthday of Twitter:

5. Twitter for me is a platform to the world (If, of course you aren't private). Your voice gets heard all over, from people who you know, to people who you don't know. This is much different then Facebook which for me is purely for people who I know and have met in person.

4. It's an amazing way to receive news feeds and updates from stories that are happening in the 'now' rather then waiting hours to hear updates via TV or even the radio. I first came across the usefulness on this front during the 2008 Mumbai terrorist attacks. My parents were traveling in Mumbai at the time and getting updates via tweets from people on the scene, news agencies was quite helpful. I was reading tweets on one screen, having IBN international news online on another. The tweets were at least an hour, if not more, quicker with the information then any TV station.

3. I use it to share information about life, thoughts, and just randomness. I follow people who are funny (@rainnwilson), people who share insights about their struggles, triumphs, people who inspire (@corybooker), and people who are just simply 'people'. I love to learn, and perusing interesting feeds (@breakingnews) just keeps my neurons in check. I get to share my feelings of the world, ongoings, life, and musings as well. To have the interaction with your followers is quite profound at times.

2. It has been an incredible platform to share my blog posts and make dreams come true for several of my patients, and other people around the world.

1. I have 'met' incredible people on Twitter that have sometimes transpired to amazing in real life friendships. (@padmasree, @caroline, @ed, @om, @ktraphagen, @anandc, @nilofer, @jeffjarvis, @jeffpulver, @jessicagottlieb, @monkeycageuk) I am sure I've unintentionally left a few people out (please forgive me!), but these are just some of the incredible people who have become great friends. These are spheres of people that I don't obviously have a connection to (aka most are in tech, other industries, quite far removed from medicine and what I do, yet we all connected as people, which is beautiful!). It has also helped strengthen friendships with people who I knew off Twitter who I follow as friends (@desinole, @saketvora, @trel, @chhabs, @sree).

The past 3 years for me on Twitter have been in one world: awesome. I hope that I get to share in many more birthdays!

I Will Miss You

This week was extremely rough in clinic. Many dear patients are slowly losing the fight against cancer.

One couple came to me, she in a wheelchair, and he pushed her in the room.

'How are you doing?,' I asked.
'Not good....I fell today...,' she said. I noticed bruising up and down her arm.

'When can we stop therapy? I'm tired,' she said, with a look of sadness in her eyes.

Her scans were not good. Prognosis was dismal.

'Whenever you want. I want you to be comfortable,' I said while holding both her hands staring into her eyes.

She had tears and she said, 'You are so awesome, you got me this far. I am going to miss you so much when I'm gone.'

I started crying as she said this. I couldn't stop.

She looked over at her husband lovingly and said, 'He cleans the floors and things since I can't do them anymore.'

I smiled and said, 'They don't make them like that anymore.'

As we both wiped away our tears, we chatted some more.

When hugged our goodbyes, her husband said, 'Thank you for being my crutch for this entire year, I don't know if I could have done it without you.'

They left, and I came into my room and just bawled.

This week has been extremely rough....it's never easy to say goodbye. Ever.

It's Hard

Today I passed one of my favorite colleagues in the hallway of the hospital. We usually catch up on politics, life, and the going ons of the world after a good hug.

Today was different, I read their eyes after my hug and instead of a sparkle, I saw a dull sadness.

"How are you," I asked.

"Sad," they replied.

I found out that their best friend had cancer and was now in the final stages. They were having seizures, from the tumors in the brain. The response was dwindling, and he knew that the end was near.

"We started work at the same time, we're the same age, and it's so hard for me to see them this way," my colleague said. "It's so hard on his wife, his family......." they continued with the story.

All I could do was hug them harder.

I told them to talk to me whenever needed and that I was sending their friend and the family my thoughts and love.

Cancer.

It affects everyone.

Everyone.

Interview

After my TED You talk this past week, I was invited to do a radio interview. Here is the link to it.

Hugs not Handshakes

Hugging patients is common for me, hugging people just is a nicer way to interact then a simple handshake.

This past week at the TED conference I hugged several people. My new motto became, Hugs not Handshakes, which led to this new 'idea worth spreading'

TED 2011

In the next few weeks I'm going to be attending a few special conferences. One is the TED conference, a week long conference with people full of amazing and inspiring ideas, and those who make me think. I attended last year, and it was life changing. It's my brain candy.

This year I'm giving a 3 minute talk to the folks at TED Active in the TED You series. Very excited and nervous to say the least.

----

Update:

I'm currently at TED, and loving every minute. My talk for TED You is done. I've received lots of input, and kindness. Overwhelmed.

You Were Always My Hero

This afternoon I was in a business meeting with my staff, and the front desk nurse popped her head in and said, "Dr. Tejura, a patient who passed away this week, her husband is here to see you."

I immediately excused myself. I knew who this patient was. She was a kind woman, a woman who was well known to me. A woman who had battled cancer for over a decade. A woman, despite the pain the cancer was causing her, always showed up smiling with her hair done, make-up on, and dressed to the nines.

The last time I treated her was a little over a month ago. I remember talking to her husband as she was getting treated. We talked about how they met, to how many children and grandchildren they had, to what they planned on doing next.

"She was my first and only date," he told me. "We married at 17 years of age, while still in high school, and here we are still strong as ever." I remember hearing these words in awe....what an amazing story of the strength, and their power together.

-----

Today I saw him, I saw a few tears in his eyes. We hugged, and I started to have a few tears coming down my face.

"Dr. Tejura, I wanted to come by today to let you know that your hugs and the last time we talked really meant a lot to me, I wanted to say thank you. Thank you for caring. People and other physicians need to learn from your example."

I was stunned. I muttered "Thank you" under my breath.

We hugged again.

"I have no regrets, we both did everything she wanted to do. Our bucket list is complete. No stone left unturned."

They had traveled, gone on cruises, been fortunate to get a dream home which she had the pleasure of decorating all of last year.

"I truly know what it means 'in sickness and in health' after this experience, and I am so lucky to have chosen her...." he said.

I started tearing up again.

"In the last month when she was in home hospice, I spent every waking our with her, getting only 2 hours of sleep if that...."

I asked if she left peacefully.
She did.

"Her last words to me before she passed, "You were always my hero."

I could not stop crying after that.

----
This man shared a life with an incredible woman, a woman who was taken from him by such a horrific disease. He stood it out with her, took her to every therapy, they tried everything she wanted, and both of them never gave up.

He was her hero....and she his.

Both of them are some of my heroes. They have taught me a lot about life, and will continue to do so.
----

May we all be so fortunate to find our heroes, our backbones, the people who truly understand the words 'in sickness and in health.' May we find people who make us realize what is important. May we find people in life who make us aware of what really matters.

Happy Birthday

A few months ago, I saw a patient in followup. I asked her, 'What are you doing for the upcoming holidays?'. Her response, 'Nothing, I'll likely bake my birthday cake. I was born on Christmas you know...'

My heart broke when I heard these words. I knew she was a widow and was alone. I learned she didn't have family nearby. So I told her, 'I will bring you a cake and we'll celebrate together.' I learned her favorite flavor of cake and we laughed.

I then asked her what, if any, dream she had.

'Well, I am likely too old for this, but I've always dreamed of having a surprise birthday party. You know where I'm really surprised....'

I laughed with her and said, 'Yeah, you're likely too old for that but that's a great wish....'

My wheels started spinning as I said those words...after she left the appointment I went to my nurse and staff and said, 'We're going to throw this patient a surprise birthday party...'

They all laughed....because they knew it was going to happen...and of course they would also be involved.

That afternoon on Facebook I said these simple words in my status update:

"Next patient dream is throwing a patient a surprise birthday party."

What happened next really made my heart smile. A friend from Atlanta, someone I hadn't seen for a few years sent me a message saying she'd like to donate some money to offset the cost of the party, even though I didn't ask for anything. It was kindness and something she wanted to do.

Then I got a message from an elementary school friend, someone I hadn't seen in over 20 years. She lived nearby and bakes professional cakes as a hobby. Her message to me was, 'I'd love to bake the cupcakes/cake for the party, just let me know what you need...'

I was overwhelmed with the support of friends, some so far away yet wanted to contribute to the joy.

That same week we decided to throw the party, I was asked to speak to a few classes at a local high school. I talked about science, medicine, and emphasized the need to care for people. I then threw it out to the the kids in the audience, I told them, 'I'm throwing a patient a surprise birthday party in a few weeks, if anyone wants to come, be there for cake & pizza, please do...'

The response was overwhelming. I got bombarded with emails from students and teachers about wanting to help.

We finally figured out a date for the event, but how was I going to get the patient there?

I called her up the week prior and told her, 'Remember the cake date? Well thats going to be on December 9th, is that okay with you?'

She was stunned. Stunned that I had remembered and that I was calling... I asked her, 'Whats our favorite flavor of cake....whats your favorite color' (As I needed to tell my baker friend these details). My patient didn't know how to respond. She was too shocked that I had called her.

Earlier this week she dropped off a note for me, saying 'I don't feel too good and don't think I can come December 9th....'

My heart sank and I went into panic mode, I didn't know what to do.

I called her and said, 'I got your lovely note, but you have to come, I'll bring you medicines and we must get you there. One of the therapists is coming too, you can't let them down!'

She agreed....and the next day I went to her house to make sure she was okay. She was okay. Stunned that I now was at her house, but she was OK.

-----

I got her to the location of the party, a local family operated pizza parlor. When she entered and I took her to the location, people yelled surprise. She was a bit frazzled as she didn't know who it was for...then she saw her cake with her name on it, and was completely and utterly overwhelmed.

I had never seen her smile so wide and so bright. It was joy beyond words.

20 high school kids had come, current and former patients were there, friends, family, and friends of friends had come. Doctors, nurses, therapists, all had come to wish her a happy birthday. The high school kids had made her a wonderful birthday banner.

'I didn't know I had this much family,' she said.

I told her she was loved, she mattered and we cared. She was important to me and the rest of the people here.

For us to watch her open her gifts, her cards, cut the cake, and mingle and meet her family was such a gift. As she spoke, tears came down her face.... and tears came down our faces as well.

'I will never forget this as long as I live,' she told everyone. As people said goodbye at the conclusion of the party she refused to say 'goodbye' to them, only, 'see you later'.

Words cannot properly express my gratitude for everyone who came, sent their wishes, love, and thoughts to make this persons dream come true.

It was magic.

Pure magic.

Full Circle Moment.

Last night, my "Music of the Heart" patient Thelma (read the link for the backstory) and the man she's been married to for 62 years, Jim, attended the Andre Rieu concert. She made it and fought for 6 months, despite the terminal disease that is affecting her body. Watching her and her lovely husband at the concert brought joy to my heart like no other. Their eyes were wide, their smiles large, and their excitement palpable.

Andre Rieu read my blog post above, and gave her CD's, DVD's, VIP tickets to the concert, and graciously offered for all of us to come meet him backstage aftewards. It was something that we had arranged 6 months ago when she was diagnosed with the terminal cancer, and a moment we all hoped and dreamed would come to fruition.

Before the show, we all went to dinner, along with the patients daughter and son-in-law. It was nice catching up during a meal, talking about life, making jokes, and just being happy that she was here to attend.

If you recall the patients very first words to me from her when she was deemed terminal from the cancer, over 6 months ago, were, "Doctor, will I live long enough to go to the concert in December?"

She made it.
She did it.

Not only did we get to see the concert from amazing seats, but after the great show (if you are near a city where Andre Rieu is performing, it's a must see, go go go!), we went backstage and hung out with the orchestra and finally we all met Andre!

Andre was very kind to her, helped her walk to get a picture taken and walked her back. He joked that she needs to listen to his CD daily and waltz with her husband, and he said he can't wait to see her again next time he's in town.

She was overwhelmed with joy. Her husband was overcome with happiness. All of us were truly for this moment to have come to fruition.

I cried during the concert when "Amazing Grace" was performed. It was grace that kept her here, it was grace that made her fight.

For those who sent their love, kindness, prayers, well wishes, good thoughts from every corner of this planet, I cannot thank YOU enough. It's your support that helped carry her through.

People matter.
People care.
People will come together.
What happened last night is a true testament of this.

Thank you, thank you, thank you.
Nothing else I can say.

With Love,
Krupali

Steelers!

This weekend a dream is coming true for a patient.

Earlier this year I overheard that a colleagues terminal cancer patient had a wish to take her husband to see the Pittsburgh Steelers play. They had been longtime fans but had never seen this NFL team play live. When the nurse mentioned this dream to me, I told her we should try to make it happen...we didn't know how, but had an inkling that if we tried, that it could be possible.

As they say, timing is everything, and this May, I spoke about this dream the #140conf in Los Angeles held at The Comedy Store in Hollywood. Magic happened.

Jeff Pulver donated flights, Yahoo donated hotel rooms, others contributed money for transportation, and the attendees of the #140conf that night raised $400 for spending money.

All that was missing for them were tickets to the game.

A colleague who works with us, knew someone, who knew someone in the NFL. The story got to Lynn Swann, a NFL Hall of Fame Football Player, and a former player for the Steelers. He graciously gave 4 tickets to see the Home Opening game for the Steelers this weekend in the Heinz Suite.

Incredible.

You have to understand that this was not my patient, I didn't even know their name when I mentioned this dream at the #140conf. This was a stranger to me, who had a dream, that I wanted to try make happen.

When I first called this patient, after consent, with the news, they were in shock, as they didn't know who I was.

Them: "Who ARE YOU?"
Me: "I'm just someone who heard about your dream from a nurse and wanted to try to make it come true."

We met later on that week so that we could hug and meet face to face. It was truly an amazing moment.

The dream for this patient which seemed so far fetched and almost impossible is coming true this weekend.

Pittsburgh or bust.

Thank you to everyone who contributed, gave, shared, and most importantly made a family believe in the power and kindness of strangers.

Every act makes a difference. Each act is like a ripple. in the pond of life...when these ripples multiply, amazing things happen.

-Krupali

Tony Hawk!

This morning I saw this tweet from Tony Hawk the world famous skateboarder . Tony is a long time tweeter and every few weeks or so, he leaves autographed skateboards for fans to pick up in random locations around the world. In front of signs, to in bushes--no place is too random for him.

I've followed his tweets with wistful humor. Although I'm not a skateboarder, I have always admired him and what he has done for the sport. I was super excited last year when I was in the audience for a taping of NPR's show 'Wait Wait, Don't Tell Me', and Tony Hawk was the special celebrity guest. He was not only funny, but just plain awesome.

So to my utter SURPRISE I saw the tweet with the skateboard location was IN MY TOWN! I ran out from my house and booked it, yes booked it to the Lexus Dealership trying to look for a man named John. I ran into the dealership asking to speak to John. The lady in the information booth paged him and asked me why I was there... I babbled on and on about Twitter and Tony Hawk.

John came down, and we walked to his desk. He pulled out the skateboard from where he had kept it. I yelped in GLEE :), I could NOT BELIEVE IT!

In my hand was a signed skateboard from TONY HAWK! I had got it via his Twitter game. The odds? I have no idea, but it was such a treat. Seriously I am still smiling.

John and I talked for quite awhile as I shared the magic of Twitter and how it has made dreams come true of my cancer patients to the patients we had just treated last week in the free medical camp in Uganda, East Africa. I told John to tell Tony thank you if he ever spoke to him again.

John was happy. He was glad it went to me. I am glad to have it.
I will cherish it always and smile.

Dear Tony Hawk: You don't know me, heck I don't even skateboard, but I admire you as a person and what you have done for the sport and people in general. You are still having fun, and are taking your fans along for the ride. Many thanks and hugs, Krupali :)

-----

UPDATE :)

Tuesday August 24, 2010, Tony Hawk Tweeted this message:

We are live right now... Call in 1877HEYHAWK but be nice. Or not.

So, I called in and TALKED to him to say thank for the skateboard.

How amazing is that? :)
Still stoked!
YAY!

More Safari Pics :)

Murchison Falls, UGANDA

A Few Safari Pics--Murchison Falls!

Some of the AMAZING animals we got to see while at Murchison Falls!

Umbilical Hernia

Today we got to see an interesting case, a child with an umbilical hernia. We gave her mother money to go to Kampala to Mulago Hospital for proper surgical care.

Elephantitis Update

Jaffar is doing better. Leg is surgically removed. I visited him today and brought him lunch. I'm leaving tomorrow and so this is my last day to see him. His spirit and smile are much better than when I met him the first day of the camp. We are working on placement and other such things at the moment with another physician who is working at this camp who is from Canada. Let's hope the plan works.

The Pharmacy at the Medical Camp

So this is the pharmacy for the medical camp. It's a room full of medications. Common ones include cough medications, malaria pills, fever reducers, and ring worm eradication. Oh yeah, least we forget iron tablets/vitamins/and iron syrup for the babies. Some of us take shifts counting tablets and packaging them, some are runners to and from the place outdoors where the people are waiting, and some are bagging. Everyone helps out. No job is too small. No job is too big. Everything needs to get done.

Kid with Cancer

Our last patient today was a 5 year old kid named Daniel. The cutest thing with a large mass on the right neck. He came with his concerned parents and paperwork.

He's been to Kampala, he's had these lymph nodes biopsied, but they came back negative/non-diagnostic. An abdominal ultrasound showed mesenteric lymph nodes. To top it off, his mouth was full of oral thrush--common with immunocompromised people/cancer patients with poor immune systems.

This kid has cancer. I know it, the biopsy shows nothing.
They need to get to the hospital again to get another biopsy.

They don't have the money.

We're trying to gather the $1000 or so dollars to get them back to Kampala to have it looked at again, get more tissue, get more work up done.

It smells, looks, and breathes lymphoma to me.

-----

His parents are truly concerned. I could see tears in his fathers eyes which make me and made me cry then. Cancer's a bitch, but to have it as a child hits me the hardest. To have it as a child, sans the right diagnosis/treatment, stabs me like a knife.

I really don't have much else to say.

Day #5--107 F Fever

Day # 5 of the medical camp started off with helping out in the pharmacy, but it then became busy shuttling sick patients to the hospital. We took the pediatric patients to the Childrens, and the adults to Jinja General.

The most remarkable case that I saw today was a 6 year old girl named Caroline. This young thing had a fever of 107 F, (normal body temperature is around 98-99 degrees F). 107 is CRITICAL.

My dad literally took bottles of water and threw them over her head, I ran to find more water, and her mother undressed her and we just kept on pouring cold water over her body, and her head trying to cool her down.

My dad luckily had gone to the local pharmacy the night before to buy some personal supplies including antibiotic injections---for high fevers. He ran to get it, and he injected her with the drug.

Her fever came down to 104 F, and I held her hand, as I tried to also make her drink some water. Her eyes were jaundiced… her body was shuddering….yet she smiled at me.
Her mother Margaret followed along as she came with me to the van to take her to the hospital.

I walked into registration, and told them the case, I was immediately taken to the back where the admission doctor was.

I introduced myself, and told him the story. He immediately wrote a lab slip and told them to come back.

I had to leave them there. Hopefully I’ll get to visit her tomorrow in the hospital.

Oh dear Caroline… I hope you get better… your tender smile despite the horrendous temperature and other things that may be ravaging your body… showed me inner strength and spirit…. Although you are only a 6 year old child… you truly taught me a lot.

Sunset at Bujagali Falls

The Source of the Nile River

Baby needs Help--Omphalocele!

Update from Paul via email on 10/30/10:

Young Solomon is now home with his mother and father here in Jinja and doing quite well under the circumstances. He is eating and gaining some weight. He will need further surgeries next year after he grows a bit, but for now he is keeping strong and free of infection.

For the incredible story, read below:

August 9, 2010




Yesterday evening our guest house phone rang,--a man was waiting to meet us. I had no idea who it could be, as nobody, besides the other international doctors that we’ve been working with, knew we were staying here.

Downstairs was an American man named Paul Gibson & with him were a man and a woman. Apparently they came to thel medical camp but it had closed, and they had begged to know where the doctors were staying.

Paul runs a foundation here in Jinja, Uganda taking care of 700+ kids. One of his employees who has been married a little over 1 year just had a baby 3 weeks ago. A baby boy named Solomon.

Unfortunately Soloman is in desperate need of help. His abdominal wall muscles never developed and now his intestines are coming out of his stomach area--it's known as omphalocele. The hospital in Kampala, Uganda, where he is now, doesn’t have the ability to do the surgery.

They wanted to know if we had contacts in Africa elsewhere to see where this complex surgery can be done. It would require intense pediatric surgery along with plastic surgery to rebuild the skin/grafting/etc—I’m guessing.

I didn’t know of anyone here (as I'm just volunteering in a medical camp for 10 days here in Uganda and am a radiation oncologist) but I told him that I’d blog and Twitter his plight, because as I’ve found out, the world is your platform on Twitter, and you never know who may be reading. I’m sure someone out there knows what/where/what they can do.

Here is the plea:

Does ANYONE out there have contacts anywhere in Africa, whether it be South Africa, or other places that could offer advice/help/input? If so, please contact Paul. His email is: paul(at)childrenofgrace(dot)com. His group’s website is: www.childrenofgrace.com.

Any help/info/input would help.

Thanks,
Krupali

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Update: Sunday August 8, 2010 9:15pm Uganda

Just got a tweet from Paul Gibson a few minutes ago, he said they found a doctor in Kenya for Baby Solomon and are leaving Wednesday from Uganda.

Incredible.
Amazing.

Thank you everyone for your help, tweeting, helping, and spreading the word. You have just helped someone save their child. You--together have come through to save a life.

Kudos.
Hugs.
Smiles.

Thanks again,
Krupali

Day #4 of the Uganda Med Camp

So today started off filling prescriptions...but immediately it went to a sick child dehydrated from malaria... right when we were putting the child and the mother into the van, my dad ran to get me because another child needed admission. A 2 month old child with severe pneumonia...as we placed this child into the van to go to the Children's Hospital, another child was needing admission.

After going to the hospital and buying 60,000 shillings worth of medications we ran to the Adult Hospital to take the amputated man his lunch. While there, the phone rang, we needed to get back to the Children's Hospital as 2 more kids needed admission.

One had severe malnutrition and one had severed dehydration.

I took someone along with me this time to experience the hospital conditions. I had shown them a quick video I had taken yesterday of the wards in the Children's Hospital, but when I took him there in person today he was in utter shock.

Him, "I know you showed me the video, but the video doesn't do this horrific place justice."

I just nodded silently, understanding everything he was trying to say.

The smells, the cries, the sounds, the conditions: HORRIFIC.

Back to work, lunch just ended. Counting pills, running around, seeing the kids, and the people.

Uganda Medical Camp Day #3

Today started off busy, with one of the first children having a case of hydrocephalus. 2 years old, cute as a button, but not as talkative as a 2 yo kid should be. Treatment includes having a shunt put in the brain by a neurosurgeon. We gave the mother money to take him to Mulago Hospital in Kampala for him to be evaluated by a neurosurgeon.

After that, I was called to take a 18 mos old with pneumonia/malaria to the hospital. The grandmother brought this child as the parents were dead. Right as we were getting into the car to drive to the childrens hospital, another patient was needing admission. This time a 20 yo woman with pulmonary tuberculosis.

Prior to us getting to the hospital, we made a pit stop so I could buy them and the amputation patient lunch. We packed it into plastic containers and then we were off.

After dropping the two patients for admission, I made my way around to see the amputation patient.

He was still lying on the floor, but this time attendants were changing his stump dressing. He smiled when he saw me. I told him I brought food, although he doesn't understand or speak English, he smiled. We both understood---and that was all that mattered.

This afternoon I've been working in the pharmacy counting medications and putting them in little bags. The most used drugs include paracetamol, metronidazole, ibuprofen, amoxicillin, vitamin B, multivitamin, folic acid........

Counting away.... trying to be useful wherever I can.

I think we're going to beat our 1004 patients that we saw yesterday, I think we'll go way above and beyond that.

Exhausted.

Amputation, Malaria--Day #2 Medical Camp

Uganda Medical Camp Day #2 we saw 1004 patients.

This morning started off a bit hectic as a 18 month old was extremely sick with malaria, dehydration, and high fevers. I accompanied him and his mother to help him get admitted to the Childrens Hospital--which was an adventure. Prior to admitting this child, we had to buy IV fluids, IV instruments, syringes, IV Quinine, and other medications for them. Yes, you BYO medications/supplies and food. Yes, there is no 'check what you'd like to eat for breakfast' here. It's whatever your family/friends provide you.

Afterwards I went to go see the man who we admitted for elephantitis.

He had his right leg amputated this afternoon.

This evening after the camp, my parents and I went to a local pharmacy, bought pain medications, IV fluids, IV instruments, syringes, IV pain meds, alcohol swabs, antibiotics, and other sundries to give to the nurse who would administer the medication.

The next thing on our agenda was food. We went to see him. He was on a dirty matress on the floor covered in a bloody blanket. He was at the entrance of a medicine ward which housed approximately 50 patients and their families. Families sat/slept on the ground, on the 'bed' with the patient or wherever they could find space.

When I saw my amputee 'friend', he was sprawled on the ground, no family or food around him. The only thing next to his bedside was a water bottle I gave to him this morning when I saw him sitting outside.

I asked him if he was hungry. 'Matoki, soda!', 'Matoki, soda!'. Matoki is a local banana cooked in an African style. Soda, well is soda.

We went around town to find this--found food, but no plates/tupperware. Hunted down two food containers, bought them, a large bottle of soda, and then filled the containers with matoki and posho--another African dish. We then bought crackers/cookies so that could be his breakfast tomorrow morning.

I will go everyday with food at noon and hopefully at dinner. If not, this man will eat nothing. He has no family, friends, social support.

Seeing him there, on the ground--broke my heart.
Having to bring your own medications, while admitting the 18 month old child--broke my heart.

I saw things I had never seen. I smelled things I had never smelled. I felt things I had never felt. It was an eye opening experience. I don't have answers. I don't have much else to say....