Thursday, July 30, 2009

Keeping fit

Many have complimented me on my fitness. Some who see me after a lapse of years say they see me the same except for the hair which has more grey than black when they last saw me. I really have not worked very hard for this fitness and actually loathe physical exercise for the sake of exercise, though I dish out copious advice on the benefits of physical exercise to my poor [not in the economic sense] patients. It is the same with diet. Though I am not a big eater, I eat everything that is edible provided it is cooked well and is tasty. I also enjoy an occasional mug of beer after my golf.

Then how is that my weight has remained around 65 kgs for so many years?

The answer is the game of Badminton. I started playing this game 50 years ago and more or less have done it all along these past 50 years [though not with any distinction]. Next to Squash, Badminton provides the most exercise in the shortest span of time. The shuttle keeps coming back at you before you have had time to recover. Not only are your muscles in action but also your reflexes. As the game involves lots of stretching and reaching, the muscles of the body don’t get big unlike in doing weights but they remain strong. As one would imagine the game is hard on joints especially knees and ankles. Through the years I have been fortunate in having excellent playing partners who have shared my joy of playing this game and like me love to play and not merely to win. Lately however Golf is taking precedence over Badminton and I have reduced my badminton outings to two times a week. This has not been well received by my playing partner [opponent] Suresh James. Both of us love singles play which is far more strenuous than doubles [more popular] play and when I am not available he finds it difficult to get another opponent who plays like I do [not for win but for the pleasure] and constantly reminds me that I have deserted my first love Badminton for my second love Golf. As a matter of fact he reminded me the other day, after reading my writings on golf that by not writing on the game [Badminton] which has kept me fit, I am being unfair to the game, a point well taken.

Racquet sports have their own attraction. They are not like Cricket, Hockey, Base ball or Soccer where more than four players are involved. In racquet games it either one to one or as in doubles it is two against two. Thus there is some privacy and class that is missing in group games. These are also games which can be played at your leisure time [early morning or evening/night] and thus will not disturb your professional life. Another advantage is that one can play these games till one is pretty old [I am the example]. One must also be lucky in not suffering injuries that will put you out of the game as I have found it has done to many of my friends. I have been lucky in not suffering any major injuries and having indulgent friends like Suresh who don’t mind playing with and occasionally losing to an old man.

Watching the seniors

I watched with great relish the senior British open. The greats of the past like Greg Norman, Sir Nick Faldo, Mark O’Meara, Ian Woosnam, Sam Torrance, Tom Watson, Larry Mize, Tom Kite, Fred Funk [what a name!] and the ultimate winner Lorraine Roberts were in view. What made the viewing these past masters at such a pleasure? It may be the nostalgia of having watched these players in action many years ago or it may be the easily felt and seen camaraderie amongst them when at play, or the undiluted quality of the game which these have managed to retain for so many years, it is difficult to say.

gain, like in The Open in which Stewart Sink came from no where to snatch the Jug away from the leader of the four days, Tom Watson, in the senior open too, Lorraine Roberts, with a burst of scintillating golf, snatched the trophy from the two contenders who led the leader board for four days, Mark MacNulty and Fred Funk. Unlike the British open loss of Watson which made us all feel sorry for the veteran; the win of Lorraine Roberts was well taken for the manner in which he won and by sheer quality of play and the ability to hold his nerve when it mattered.

Golf is a strange game. Perhaps it is the only game where you can watch the 50 years plus players in action with the same enthusiasm with which you watch the younger players. As a matter of fact there is a classy Newzelander called Bob Charles who is 73 years old who plays the senior circuit with distinction. In no other game you can watch old men at competition play as you can in golf. In many ways like I described above, senior golf is more enjoyable than the open golf.

Tuesday, July 28, 2009

Death of a Doyenne

Gangubai Hangal died few days ago. With her death a chapter in Hindustani Classical music came to an end. I feel compelled to write about her and her music. Classical music of this country has evolved over the last two thousand years. Though there are structural similarities, the music that evolved was different in south and the north of this country. Strangely some of the giants of Hindustani [north Indian classic] originated form a small region in the north of Karnataka which is in South India. Gangubai came from this part of the country. Classical music has derived from many sources such as tribal folk singing and devotional music. Spontaneity of the tribal and the devout singer has been channelized into a format which grew into an art form over many centuries. Many schools of music which are called Gharanas took up some aspect of the music and specialized without deviating from the original structure of the raga [melody] and tala [rhythm]. Kirana Gharana is one of them and Gangubai was the outstanding exponent of this Gharana’s music.

What is it about her music that makes her so special? It is very difficult to define the character of classical music. It has to be felt and in her music one could experience the power of Indian classical music. She did not have a great voice unlike her much loved daughter Krishna who died young due to cancer. In fact, her voice sounded neither male nor female and can even be termed harsh. It is not the voice that held you but the special quality of rendering which though well inside the structure of the Raag, transcended the limits and went beyond, which lovers of classical music came to appreciate. She also was one of those who refused to compromise. For her concerts of limited time was an anathema. To elaborate one raga one often needs more than an hour and she would not accept any invitation which were time bound. She therefore gave fewer performances than others and it became even less after the death of beloved daughter Krishna Hangal.

Honours came to her aplenty. There were no less than five hon. doctorates conferred on this simple woman from a small town. But Gangubai remained a simple woman at heart but allowed her music to rise to great heights.

She will be missed.

Saturday, July 25, 2009

Definition of honor

Honor is a much used word. This can be interpreted as self respect, self esteem, a feeling of being correct and the like. It also depends on what the society at large perceives a quality as honour.Two separate incidents that occurred a few days ago made me think of these definitions of honor. An official of BBMP committed suicide by hanging after it was found out that he pocessed assets disproportionate to his known income. A case was booked by the state’s anti corruption bureau against him some time ago. BBMP stands for Bruhth [big, extended] Bengaluru [Bangalore] Mahanagara [huge city] Palike [governing body]. Bruhth can also be interpreted as unwieldy which it certainly is. Bengaluru is the vernacular version of the rather nice name of Bangalore. With the city going berserk with the huge and rapid expansion, the work of the already existing rather inefficient and corrupt civic body has enormously increased and so also the scope for corruption.

In today’s India, it is socially accepted and even honorable for one to be corrupt. Till recently it was so, as long as one remained undetected. Now it has come to be accepted and even applauded if one is caught because it indirectly proves the man’s worth! If another government agency thinks that a particular officer is worth investigating does it not mean that he gets official recognition of his worth? It should not come as a surprise to see so many known offenders going about as though it was a privilege to be investigated! That more often than not they are let off after lengthy and fruitless court proceedings only adds a kind of vicarious glamour and aura to the concerned persons. It is like gentlemen exhibiting their sternotomy scars after undergoing coronary artery bypass graft surgery by leaving the top two buttons of the designer shirt open. Getting coronary artery disease and more so getting operated by a famous cardiac surgeon has become an honor. So corruption is like a prestigious disease and the investigating agency is like the society cardiac surgeon. The same news report said that his fellow officers sympathized with him saying that he [the concerned official] had asked for voluntary retirement [so that he could possibly go undetected with his honor intact!]. Even the chief of the investigating agency expressed his sympathy for the now dead official. So all round sympathies for a person who killed himself instead of going about with his head held high and may be after a few years get all the charges dropped for lack of evidence! So this was indeed a rare individual who felt guilty for having been found out! Indian society has been reduced to this miserable state of defining honor.

In the other incident a couple was killed by the villagers because they dared to marry. What is their crime? They belonged to different castes and thus committed a crime and the villagers felt honor bound to kill them. You don’t believe that this happens in a country which claims to be developing and in due course wants to be a super power! Caste and communal identity is primeval, especially in rural India. It is cursed bond between individuals and families which is held sacred and anyone who violates this goes against this bond. For persons like me it is difficult to understand this mindset but I have known persons who if not indulge in such acts, speak sympathetically. Much like the colleagues of the corrupt official who committed suicide. This scourge is one major factor which will not allow India to become a super power. Have we done nothing to overcome this? We have on paper. The constitution guarantees every one the right to live with dignity. But how can one if the social fabric is like this? In our own time there have been persons like Dr Ambedkar and M.K Gandhi and some years earlier reformers like Sri Narayan guru and Jyothi rao Phule who crusaded against the evil of castiesm but as one can see it there has not been any sweeping success and this primordial disease is slowly destroying the country. So the honor for these villagers is to keep and safe guard their identity. They are not much worried about inefficiency, bad administration, corruption, sloth, dirt etc which is all around them. Even if these worry them they donot excite the same fury as the caste transgression does.

Next come the honors that are periodically bestowed upon individuals and organizations by the other organizations and the government. Here the definition of honor is recognition. Next only to power is this need to be recognized. Whether one deserves to be recognized is not important, as long as the stamp of recognition comes from appropriate quarters. Indian government both at the centre and state honours every year, persons who have rendered service in various fields of activity. Politics is one such activity and beurocracy comes only next to it in vying to get the honours. The nation’s highest honor is called Bharath Ratna [jewel of the nation]. This honor has been so misused that not so long ago, to appease one provincial government, it was given to a long dead chief minister of that state! Similar is the affairs at the state level. One of the persons I know who was a social worker came to know that the state government was considering honoring him. He became so depressed that his name will be associated with so many undeserving persons if he accepted the honor. He heaved a sigh of relief when his name was found missing from the list.

Many professional bodies too indulge in this. Sometimes they do it to buy favour. If they need a big donation it is natural to catch a wealthy person and entice him with an honor. Or if there is a trouble maker buy his support by honoring him with a false citation. The recipient in most cases will not object to the nonsense written on the citation and the memento.

So my friends, in my today’s India, honor has many and varied definitions and explanations.

Thursday, July 23, 2009

Miracle cure

Dr.K.S.Hande is a general practitioner like me and also like me, has gone through difficult times in the early years of his practice. When patients are few and far between, one has lots of idle time. This time sadly has to be spent in the clinic, as one cannot afford to be elsewhere for the fear of losing even that occasional patient. While my pass time was reading, his was to stand outside his clinic and watch the humanity go by. One day some 35 years ago, he was indulging in this favourite pastime of his, and to his surprise saw one of his patients who had visited him a few days earlier pass by cheerfully waving a greeting.

This patient really had no business to be walking so cheerfully because when he had visited the doctor he was a very sick person with X- ray confirmed pneumonia. How then he got so well? Why did he not turn up the next day as advised? Did he go to another doctor and got better? Did I do anything wrong? Was my fee too much that drove this man away from me? These were the worrisome thoughts that the doctor had. He got the patient to come in and asked him what had happened to him and why did he not turn up the next day? ‘What saar[sir], you gave magic injection that day, next day my fever went, second day my cough went and yesterday I ate well and felt fit and now I am on my way to work. I did not come because your one injection of that magic medicine cured me, thanks’ the patient said. A quick examination revealed complete clearance of his lungs!

Dr Hande had given the patient 800,000 units of crystalline penicillin. That was how the drug acted in those days!

We have now made a mess of treatment of infections by indiscriminate use of antibiotics and the germs have developed resistance to most commonly used antibiotics and the society is paying a heavy price for the physician’s folly!

Tuesday, July 21, 2009

Lost and Won

The recently concluded British open golf tournament was memorable in more ways than one. Till recently it used to be British open and aptly so as it was held in the British Isles. That it is being held continuously for over 100 years is also true. Then why did they change the name to The Open? Several reasons. When Americans have their Augusta and the US open, the British have their British open. By this in what way they are better than the Americans? So they called it The Open. They may have scored some brownie points over the Americans. But what makes the British open, sorry, The Open championship unique is that it is played on a links course. Links is the name given to golf courses which are built on the seaside property and these courses have an entirely different character and to play them one needs special skills. For one there will be no trees lining the fairways. It appears bare and barren. There are howling winds which will make shot making and club selection very tough. There are also a large number of sand traps which are better termed as death traps. These have vertical banks rarely seen in the normal courses. This year’s open was made more difficult by the rough grass which was tangled and left unattended. A wayward ball going there was virtually unplayable as evidenced by the many who took penalty drops which meant loosing a stroke and distance. Therefore even the comparatively short four and five pars were unforgiving to say the least. That the likes of Tiger Woods could not even make the cut speaks of the special talent required to play the Links golf.

So much for the tournament. Now coming to the man who won and lost The Open. Tom Watson. Tom is now 59 years old that means he is running 60. He was the oldest competitor and the youngest was 16 year old Italian amateur who teamed up with Watson on the first two days [he made the cut]. Walking nearly ten kms daily under these conditions and playing competition golf of the highest standard for four to five hours every day for four days requires great stamina and fitness. That a 59 year old not only did it but almost won The Open is going to go down in the record books as one of the greatest golf tournaments ever played. Normally seniors [those above 50] don’t compete in open tournaments and if they do it is for the sake of the thrill and pleasure and sometimes they don’t want to turn down the invitation for such a prestigious event. But Tom Watson is made different from the usual senior players. He not only competed but almost won! He led from the front and was leading on all the four days and when the claret Jug was his for the taking; he gave it away to the winner, fellow American, Stewart Cink. Millions of viewers must have felt like I did that a thief surreptitiously snatched the prize away from the real winner, The half smile on the face of Watson which was present on all the four days of intense struggle became a bit rueful when he lost the cup on the extra holes that were played, but there was no bitterness what so ever.

A story is told of Watson, when under his leadership the US team lost the Rider cup to the Europeans some years ago. Rider cup brings out a lot of emotions as the national honor is at stake unlike the other majors where individuals compete. The whole team especially the rookies were in tears and there was great sorrow in the locker room. But where was the captain? No where to be seen. Concerned players went around looking for him and ultimately found him on the balcony of the club house sitting with a cigar in one hand and a glass of whiskey in the other with the now famous half smile on the face. He appears to have gently admonished the losing Americans,’ loosing is not important but the way you played is, and for me you guys played well and that is why I am celebrating, come and join me. Whether the players joined him or not or the story itself is true or not I don’t know. But it reflects the man’s extra ordinary character. Like Bobby Jones, Tom Watson too will be another legend in the golf lore of the future.

In the end what did he say? I will be back next year!

Monday, July 20, 2009

Deaf and Dumb Narayana

Many many years ago, a young and harried mother used to bring her ten year old son to see me. The boy was an introvert, performed poorly at school, frequently fell ill and adding insult to injury was a very poor communicator. The father was a bank employee and had two other sons who came up to the family’s expectations in developing the required social skills and scholastic performance. They belonged to an affluent and high performing family with a large number of wealthy professionals and businessmen and thus suffered by comparison. Therefore it was an all round stress managing this boy whose full name was Thumbe Narayana Shetty. Mother called him Gadde and I called deaf and dumb. Why his mother called him a Gadde [which means swelling] I never asked but my calling him deaf and dumb had reasons. Whenever a question was asked his response was a blank stare as though he never heard you and therefore will not answer. That he understood was clear the way he opened his mouth when asked to and his response to my other such requests. But speak he will not. My attempts to humour him too used to fail and I had never seen him smile in the years that his mother suffered with him and I saw him. To put it in a nut shell he had all the makings of the family’s forthcoming disaster. More to humour his mother than the boy I used to give many examples of such apparently dull children [like Einstein] becoming highly successful scientists and even gave an example of one my own class mates who could not understand basics of physiology going on to become one of the famous nephrologists of the country. But she was rightly skeptical of my optimism.

This community to which the boy belonged to goes by the clan name of Bunts. There are many famous Bunts. Our own Dr Deviprasad Shetty is one and the famous beauty Aishwarya Rai Bacchan is another. That the community has also produced several leaders of the underworld is a different matter altogether. They are a gutsy people and usually excel in whatever they undertake to do. Our deaf and dumb Narayana was going to be an exception, so we all thought.

Some months ago I had a visitor who sent in his driver who gave me a card and said his boss wants to see me. The card read Narayan Sanjeev Tumbe and gave a fancy address at Pune. I had to make the gentleman wait for some time and after I did with the waiting patients asked him to come in. In walked a man in his late forties, class reeking out of every pore of his body, and asked me,' how are you doctor, you have not changed much since the time I used to see you’. Seeing my blank expression, he said,’ you called me deaf and dumb Narayana’. Memories of the deaf and dumb Narayana came flooding back at me and looking at this handsome successful man I just could not believe it is the same boy who now so confidently stood in front of me.

I was curious to know why he had come to see me. He was obviously not sick. He said,’ I just felt like seeing you, you were one of the few persons who believed I would be successful [the stories of Einstein and others I told his mother!]. I asked him what he has been doing since I last saw him. He said he owns a chain of bar and restaurants in towns and cities of Maharashtra and jokingly said he had changed his name to sound Maharashtrian! I asked about his parents. ‘Father is dead but my mother is with me’ he said. I then asked about his academically bright brothers. ‘Oh, they both work for me’ he said.

He said good bye, leaving behind a basket of fruits and a huge flower bouquet. I went out to see him off. He got into chauffer driven limousine and drove off.

Tuesday, July 7, 2009

Easing out

I lost a very good friend few weeks ago. She was past 70 but had a lot of life still left in her. She was active and wanted to do many things when cancer claimed her. This had me wondering what more I want to do in this life than what I have done or already doing? Surprisingly, I found very little that I want to do before I die. There was however one thing that I wanted to do more often. Don’t be under the impression that I want to see more patients. That desire to see more and earn more has been dead for a long time. So what is that I wanted to do more often? Not surprisingly [at least for those who play golf], it is to play more golf. That means talking another half day off. This I began doing two weeks ago. What about my patients and their reaction? One quality I have come to appreciate in them is their stoic acceptance of my maverick ways. There was not even a grumble. May be they think by allowing me to play one more day, they expect me to improve my clinical skills and thus give them better service? Whatever may be the reason, I am now free to play on Tuesday afternoons in addition to my other two regular days.

What is it in this game that makes me go over and over again, week after week, spend four to five hours, whacking a small white ball around? Why this little white ball sitting on lemon green grass is so inviting to hit. I cannot think of any valid explanation. Of all the games golf is probably most addictive and most soul satisfying. May be it is so because in golf the real opponent is not the one who is playing against you but the course itself. As a matter of fact you are playing against your own self and the mistakes you commit, you cannot blame anyone else but yourself. Thus even when you are playing with three others you are left to yourself most of the time to think, ruminate, plan and then with all that get into a trap and curse yourself. Occasionally or more often [in case of a good player] the ball does what you want it to do and you do the hole in regulation. The joy of seeing the ball disappear into the hole or hearing the chuck sound of the well struck ball and seeing it soar high and long is something out of this world.

Playing good golf is really having a good life and now I am playing to a handicap of 15 which is not bad for a 68 years old. Today is Tuesday and in a short while I am off to my game. Cheers.

Wednesday, July 1, 2009

Doctors' Day

Today is doctors’ day. I was bit overwhelmed to get so many calls and SMS messages from my patients. It is in the fitness of things that I remember few doctors who really lived up the oath they took to serve the people.

The earliest was my own GP Dr Shanbhag. My memories of this doctor go back to over 60 years. I was a very sick child prone to many respiratory illnesses. It was a rural set up that Dr Shanbhag practiced in. His wife was his assistant. He handled all ailments and I remember an episode when I was unwell with whooping cough when he sat with me when I was racked with paroxysms of cough. He was overworked, was paid poorly by his patients [they could not afford], he took no precautions to remain fit and died in his fifties with a heart attack.

It is surprising that I came across none who really is worth remembering during my medical school days. But one who deserves to be remembered is Dr Sarosh Patel about whom I have written in this blog some time ago. There were a few seniors and colleagues who lived up to the Hippocratic Oath. They too died before their time. First of them was Dr Manjappa Gowda who came from a farming back ground and remained a simple farmer at heart till the end when a fatal heart attack claimed him. Unlike others Dr Manjappa served in the government health service as a genera surgeon. His skills under adverse conditions of work were legendry. He was known to act as anesthetist and also as a surgeon with help from assistants whom he had trained. This he did in places with primitive facilities in rural and semi urban setting. His personal life was full of tragedies which he bore with great equanimity. His solace was tobacco which probably contributed to his early death.

Next is Dr.M.R.R.Rao who again was unfortunate to have been born with polycystic Kidneys which ultimately took his life though he had some extension of life because of a successful renal trabsplant.He was one of the first who returned to India spurning offers of a very lucrative carrier in the US 35 years ago. He was way ahead of his times and was brilliant in whatever he did. He pioneered use of endoscopes and tried doing arterial grafts. Many of us who got our patients operated by him remember him for his skills and commitment.

The last one to go [a week ago] was Dr Malathi Rao. A specialist surgeon and a gynecologist, she too returned to India giving up a very promising carrier in the US. She too like M.R.R.Rao was a pioneer. She trained scores of doctors in the use of laparoscope. She was also the first o introduce endoscopic uterine procedures in this city. Lately she was doing excellent work in the field of infertility. Sadly she fell victim to cancer and died fighting the disease.

There are a few others who are still alive who are practicing true to the oath they have taken [ I am reluctant to write about them because they are still living!] but the large majority for various reasons are not and this is not the occasion to write the why and what of it. There in one thing that was common in the lives of all the doctors whom I have written above. They all placed the interests of the patient above that of other considerations and were prepared to pay a price. None of them made a lot of money though they could have and none went after recognition or status. They lived up to their own set of high standards and were worthy examples for others to follow.