Heart Stuff

By Peter Nichols

Composing what sounds like a medical note about a patient visit, Cuckoo Choudhary, MD, wrote, “Saw a beautiful 90-year-old lady in my clinic today. … It turned out that my patient had an illness that would necessitate me placing a feeding tube in her stomach.”

The next sentences, in parentheses and italics, seem like an aside: “(Children, a feeding tube is something that can be placed in a person’s stomach if they are not able to eat. … It does not have to be permanent and can stay in for as long as the doctor thinks the patient needs it. It does not cause pain.)”

Then the medical narration picks up again: “So we discussed all that with the patient and the daughter …”

But the direct address to kids turns out to be the real point: Feeding tubes help and don’t hurt. The apparent medical note was part of a short article, “Reminiscences of a Doctor,” that Choudhary had written for the May 2016 issue of the kids’ magazine Baal Chaupaal.

Choudhary is a gastroenterologist and associate professor at SKMC. She’s also on the editorial board as executive director of the quarterly magazine, which primarily publishes the writing and art of children.

“‘Baal chaupaal’ are Hindi words that mean ‘where children put their views down,’” she explains. “Hindi is the national language of India, but the magazine publishes submissions from children around the world.” Its readership is global too. Most of its articles are in English, although some are in Hindi.

The magazine’s founder and editor is SKMC first-year student Pankhuri Jha, who happens to be Choudhary’s daughter. When Jha was still a child, she wanted to do some kind of service project. “I knew I wanted to volunteer,” she says. “I didn’t know if I wanted it to be in New Jersey [her home] or within the U.S. International wasn’t even on my radar.”

She Googled “volunteer opportunities for 13-year-olds.” There were lots of hits for summer camps, YMCAs, and “safe” places like that. Jha sent out some 50 email inquiries that started with “Hi, I’m Pankhuri. I’m 13 years old. I’m a freshman in high school.”

She got one response. It came from India.

In the summer following her freshman year, Jha traveled to Ummeed Aman Ghar, a shelter for homeless boys rescued from the streets of New Delhi. For a suburban American teenage girl who spoke little Hindi, the setting presented certain risks. “I still don’t really know what happens on those streets,” she says.

She was too young to go there alone, so Choudhary went too. “I didn’t go as a doctor,” Choudhary explains. “I went as a mom.”

With translation help from her mom, Jha tutored the boys in math and English. “There was just a lot of broken,” she recalls. “Broken pieces of chalk, broken pencils, and broken notebooks. The wood that made up the shelter was creaking. You had to be careful where you walked. A lot of ashy legs and arms, and torn clothing. A lot of hunger.”

Choudhary was struck by the enthusiasm of the children, despite the brokenness of poverty. “They wanted to learn,” she observed. “The desire to learn has little to do with what you have.” It was yet another kind of hunger that wasn’t being fed.

Jha felt it too. The boys called her “didi,” Hindi for big sister. “Pankhuri Didi, help me with this,” they would plead. After six weeks of responding to their pleas and learning all their names, it was hard to leave.

Back in America, Jha struggled to come up with a tangible way to stay in touch with the boys. She kept hearing the chorus of voices: “Didi, we don’t have a way to express ourselves.” “Didi, we want people to know us.” “Didi, I want to be a writer.”

Maybe a magazine, she thought. She discussed the idea with her mom, and together they landed on the concept of Baal Chaupaal, a kid-friendly publication by kids and for kids.

The first issue was published in 2012 with submissions from the boys of Ummeed Aman Ghar. Today, the magazine receives writing and artwork from children in many countries. Its success isn’t the outcome of some grand scheme. “It started as a mom-and-pop thing,” Choudhary notes.

“It’s still very haphazard,” Jha adds. “It was never a plan. A lot of the international submissions and things like that came by word-of-mouth. Thank God for social media. Thank God for Facebook.” Jha used to set up tables at school socials and sporting events to get the word out. Now she plans on tapping the hearts and networks of her SKMC classmates.

Choudhary and Jha are keenly sensitive to the deprivations of underprivileged children, and as editor, Jha has to find ways of mending what she calls “broken sentences.”

“The sentences are broken because those kids didn’t get the education they deserve,” she says. “Nobody ever taught them that a sentence should have a noun and a verb and a period at the end, and the first word should start with a capital letter.” She makes corrections where she can, without shaming and in consultation with the writer. But her top priority is to let the writers have their voice. The brokenness is part of the expression.

“I think it’s about being vulnerable and 100 percent honest,” Jha says. “These problems are real. If broken sentences are the way to get it across, I hope Baal Chaupaal helps.”

Choudhary works hard to help gather submissions and broaden connections for the magazine, especially now that the editor is a medical student. “This is near and dear to my heart because it’s for the children and by the children,” she says. Kids are told what to do all the time and made to follow rules. Rarely do they get a chance to be heard. and rarely do adults listen.

But it’s even bigger than that, Choudhary insists: “Children are the future citizens of the world.” In that sense, Baal Chaupaal is about all of us and who we are becoming, and how broken our future might turn out to be.

When she can snatch a spare moment in her busy days, Choudhary likes to jot down a few lines of poetry. “I have a big collection of short poems,” she says. “Many are about very small things that I write about patients and my life in medicine. This is the literary aspect of medical practice. It’s my heart stuff.”

If she were explaining it in Baal Chaupaal, she’d likely say, “(Children, nearly all doctors get the science of medicine. It’s the listening that’s really hard.)”

“The patient has to know that you’re listening to them,” Choudhary says. “They should feel like they’re the most important thing and that you have nothing else to do that day. Sometimes that’s hard advice to follow.”

Choudhary makes a point of not turning her back on patients to type on the computer during visits and often ends up working at home on patient charts.

But in “Reminiscences of a Doctor,” she breaks her own rule. “I was facing the computer,” she confides, “pretending to type my note and trying very hard to hide and hold back my tears.”

In writing about the patient visit for Baal Chaupaal, Choudhary was moved by the tender bond between the mother and the daughter who came with her to the clinic. But there was something else—something bigger than medicine but still connected with medical practice that was pulling at her.

“Many would have referred to [my patient] as old,” she wrote. “And that would not have been totally inappropriate. But to me, she …looked experienced, with tons of history written on her face. So much so that I got lost in it.”

Choudhary read the lines of that history and listened some more. She could see the patient suffered from something greater than a strictly medical malady. Then the doctor entered the old woman’s diagnosis in her patient note: poverty.