Thursday, May 6, 2010

Another homage to India...

They say that the caste system in Inda is a thing of the past.  It is tough to judge the voracity of this claim in the United States, where most of the Indian immigrants, historically, have been those of means, and heavily weighted of the Brahman caste - whether Gujarati, Bengali, or Punjabi.  Most of the custodial work and service jobs here are conducted by some of the middle and lower eschelons of southwest Asia - not local Central Asians, for concerns of safety. 

Many of the folks have been here for 5 years and never been home.  They mop floors and clean the hospital for low wages, but the contracts are always vast improvements on their home salaries, were they to have them, and they eat for free here.  I am not sure of the arrangement they have made for lodging, but I hope it is reasonable.  All said, they make their nest eggs here, and send most of it home to children they never see for years at a time.  Like sailors of the old age, or soldiers gone for a decade of battle, their lives are made away, to make better lives for their own at home.

Funny thing happens, however, when the simple Sri Lankan who mops the floor meets the Indian-American physician working here, seemingly the owner of the American dream.  These workers maintain decorum and great respect for all of us, but they tend to keep a professional distance from me and most of the white/black/hispanic Americans.  My Indian-American physician friends, however, they approach with a keen sense of brotherhood, or adoring-younger-brotherhood, if you will.  They bring nightly curry dishes to these folks, and constantly ask what special favors can be done for them.  They treat them respectfully, even honorifically.  They provide easy access to the kitchen and supplies. Most curiously, they rely on their higher society Indian-American brethren for advice, and respect their words for true finality. 

We had a contractor recently in the hospital for a heart condition, and I spent 2 days working with him, and explaining the disposition to he and his friend and boss, another Indian man, Rakesh, who had been dutifully at his bedside.  Not 30 minutes after my last and most complete debriefing, one for which I was particularly proud of the logic and efficiency by which I had made a plan clear to the patient, I found Rakesh speaking with my Indian American physician friend and colleague.  I found that curious, but was on my way to some other task so did not inquire just then.  Before I had an opportunity to ask him why he was talking with the radiologist (after all, he had no radiographic studies at all), I had the chance of walking past a group of the Indian custodians talking together in mixed Hindi and English.  All I could make out, at the end of a busy conversation was, "...and Dr. Raj will take care of this problem." 

Speaking to my radiologist friend Raj later in the day, I was told that one of the custodians had brought Rakesh to him in order to get his care expedited as best as possible.  At first I was incredulous, and a bit miffed, that I was circumvented on the disposition of my patient, and this man thought that the radiologist who is completely disconnected from this part of the patient care process could make it happen more efficiently or quicker. 

I am not sure if this is a vestige from the caste system.  And it does remind me of the way things work in New York City, especially among more recent immigrants, where the only way to get things done is to "know some guy."  All I know for sure is that my buddy the radiologist is like a king to them.

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