Mexico city

 

Mexico is one country that gives an image of a poor country with notorious drug smugglers in powerful positions 

So in 2021 post Covid when we needed to go to US for visiting our daughter USA had a criterion for those coming to US stay in a different country for 15 days and five countries were listed .

We had visited sri lanka ,Worked in Dubai ,did not want Qatar visited Sri lanka and Maldives so option left was Mexico but mo one said a good word on it .

My daughters classmates mentioned a WA group of Indian parents going to US via Mexico .

We joined in that group 

The group booked Hyatt usually 

we too booked same but only for three days .

when we landed in Mexico city the capital city we found we were staying in city suburb called Santa fe .

Most parents stuck to thier rooms .

we went out and found bus connectivity to 

downtown areas .

There are two types bus   Rapid transport and ordinary buses .Rapid transport buses had dedicated tracks 

The city is bigger in size than New York I heard ,its in an elevation like our hill stations ,but with pleasant climate not stark cold .

 Most places I went around in the bus in Mexico city today was  neat , well planned with multilaned disciplined traffic , multi exiting flyovers ,underpasses, pedestrian bridges ,cycle paths  broad boulevards ,miles of manicured greenery ,no garbage ,no plastic covers no dust ,no filth ,and orderly traffic .

Miles of special laned rapid transport buses plied downtown areas ,with unhindered driveways  bus bays to stop .

Travel was by E card only which was topped up and was reasonable though not cheap .

Most downtown central areas are tourist heritage spots , walk only areas with vast sqaures, stately buildings, Spanish villas, and Gothic churches .

When I saw all this it was mind blowing as to my assumptions Mexico a developing country like India is a poor disorderly country and has many desperately trying to flee to USA which had  built huge walls to prevent an exodus .

Even the suburb Santa Fe looked better than most of our metro cities 

Of course Santa Fe was the silicon valley of Mecico .

It had skyscrapers lot of modern buildings

Next day morning we walked to bus stand .

Biggest handicap in Mexico is no one knows English .

We could convey our intentions by a mixture of dum sharrat and Google translate .

We learnt to reach downtown we needed to take the RTS or Rapid transport system with its dedicated lane in the center of road 

Bus stations too were in center .

One needed to buy an E Card snd top it up 

No cash accepted 

So we bought an e card each and went in comfort in the RTS 

Most bus stations had Police in battle gear very friendly to tourists .

Once we learnt the trick uding RTS we flew like we had wings .

In city we booked Holiday inn and checked in .

It was downtown and one could walk a lot since we went in fall it was getting cold .

City was spell binding ,broad huge well marked roads 

Pavements were as broad as biggest road in say Cochin !

Traffic was well regulated and people were civil and drove respecting rules .

Later we used Metro train too much cheaper than RTS and with wider coverage .

Zoccolo was city center with huge heritage churches Govt buildings etc 

Faith healers practicing Indian medicine were seen here .

Mexico city had lovely huge parks .

One could stroll through or watch public dancers or musicians 

We flew to Oaxaca for two days 

The city was unique in being mother city of Cactus based drink and Mexicos branded drink Tequila .

The city had lot of touristy spots Tequila or Mescal bars 

Schools had opened after Covid and children were gingerly stepping in .

Once back in Mexico city we did visit Teotuhican pyramids in a conducted tour and enjoyed it .

We tried Mexican street food in mexico city and many of thier dishes were spicy and vaguely reminded us of ours 

We had to get certificate showing covid negative and it involved specific clinics ,we went to one found a pharmacist who knew some english explained to him we had to fly to US 

He was used to seeing Indian tourists coming for this purpose  do he put us in slot

We had to come next day meet Dr do test get result in English and we did all thst

Mexico was truly a surprise 

Losing battles

 Sorry long post again but a glimpse to my job 

Pain should be the most feared symptom man faces .

It changes his or her  perception ,confidence ,

,attitude ,and perseverance  in life .

My professional work has been in relieving this pain not the acute short term one but the long term chronic pain ,debilitating and depressing .

By judicious use of medications to a large extent we can control this and make patient pain free .

Unfortunately this specialisation is denied its importance to an extent diluted by being clubbed with palliation ,either with or without palliation is what is achieved by pain relief .

Iam giving three examples of patients I treated recently .

 NK a 9 year old boy with an advanced soft tissue sarcoma and an angry swelling in his groin in excruciating pain ,bed riddance and swelling of his legs and groin but bearing it with the  fortitude of a saint .

He was on high dose of an opiod patch which controlled his pain to a large extenct till he left us all ,probably to be free of his pain forever .😔

Iam sure it looks very tragic to be in such a speciality

 My take is otherwise ,

I may not be in doing miracles but by relieving him his pain by my formulations ,adjusting its dosages ,adding and removing drugs so that he was to an extent pain free but also alert and wakeful Iam doing a lonely battle in makong him happier .

I did achieve that in NK s case as endorsed by his father

 ( my heart goes out to the parents of these children )

 its a fight against pain I do along with the parents or caregivers of patient .

NK is no more .

The second is a 65 year old temple priest with a sad wife the only care giver again with an angry purple swelling on his neck ,

Looking at it one can understand the pain he went through ,coupled with  his bipolar disease he was moody angry and irritable 

His wife warned me on him when she came to  my consultation room that he was a terror full of anger and frustration and would even beat her occasionaly .

He was resting in observation room ,

I went there to see him ,

Yes he was one angry man who was impatient to me and just kept repeating stop my suffering will you !

I dont need your words 

try to stop my pain 

Even with all my training and knowledge I was put off and I felt sad for his wife who bore this all the time !

I just told her to give the pain medications I started in time and also review his Bipolar disease medications with his psychiatrist .

After one week the wife came again and requested me to see him in observation room ,

she was smiling,

" Dr ippol kandal aalle manasillaavilla 

paavam aanu vedana kondaayirunnu "

ie you wont believe it he is so quiet but happy poor thing it was his pain that made him the monster you saw last week .

I was surprised at J getting up greeting me with a smile telling me he was pain free and happy,though his purple tumour had not changed .

To me that moment was like getting an award it even removed the clouds of NK loss to a small extent .

All it needed was his pain to be wiped off to make him a lamb from a vicious angry tiger .

Of course many do get their pain back and its a never ending changing doses ,medicines ,at times requesting a shot of radiation or a nerve deadening intervention management .

We use all our nuclear weaponry to fight our formidable enemy PAIN .

The third patient I saw was today 

B was a middle aged advanced breast ca with severe pain due to disease spread to her right upper arm nerves .

Neuropathic pain is unlike any other .

 we use terms like lancinating ( cutting with a sharp knife ) scalding or burning ,pinpricking or like pricking with a thousand needles ,

Even a touch or a wisp of a breeze  can cause excruciating uncomfortable pain .

She was accompanied by a cheerful most mature child for her age ,her ten year old daughter who kept and gave her medications .

How many brave people we see in times of hardness !

Poor B told me 

" Dr please relieve me of this torture ,my literally weak arm is listless ,my daughter takes care of me so well " 

I gave her the new set of pain medications explaining to both mother and daughter ,asked them to call me if needed as she was staying in Trivandrum.

She called me just half an hour back though I tell my patients not to disturb me after office hours unless its  an emergency .

Four decades of medical practice gives me the wisdom of strict timings though available to them most never misuse .

She had called as her pain had restarted after initial relief and apologised for the call .

I told her it would take a few days of adjusting doses etc but not to be depressed as I adjusted her dose .

Hopefully I can reduce her pain .

We in Palliative care and chronic pain management are not those swashbuckling dashing doctors ,

We treat desperate souls ,most who have lost hopes for cure ( exceptions there too ,some get cured and we even stop all pain medications ) 

We talk to families saddened by the plight of their beloveds going through suffering ,

Our goals are limited without glamour but genuine in its efforts .

Every minute of thier being free of pain or discomfort is a reward for us and gives us the strength to face the loss of the likes of innocent NK s .