Sunday, August 29, 2010

Looting the public

We are a poor nation with rich people. With a teeming population of over 100 crores of people even a small percent say 5 percent rich is like having the whole of Europe living in India. The other side is people who live below the poverty line, so abject poor that they have not enough to eat, leave alone other necessities of life. These people periodically elect their regional and central representatives to govern the states and the central government. They are called legislators and parliamentarians or MLAs and MPs.

These representatives of the poor gave themselves a salary hike of 300%! I don’t think this kind of self indulgence by so called public servants has not been heard of anywhere in the world. But my country is special. Anywhere else there would have been violent protests and chaos. Here we accepted this gross and open looting of public money without even a whimper of a protest. They even gave themselves a sumptuous pension!

Looting the public has long been a pastime of those who ruled this country. From the days of Rajas and Nawabs to the rule of the company [East India Company] and later the British, all have done it. We have become so used to this kind of indulgence, extravagance and often sheer waste that it has even become a part of our life! I have on one occasion written about a friend who spent Rs 500,000 only on flowers during his daughter’s marriage! This kind of ugly extravagance is being seen more and more in most of our public and private functions, particularly so in Indian weddings.

Not so long ago there lived in this country a man called Mohandas Karamchand Gandhi who in addition to fighting the British get us Indians freedom, but also tried to teach us the virtues of simple life by personal example. Instead of following his advice we promptly made him a deity and called him Mahatma Gandhi [great soul!] and as quickly forgot him. He must be turning in his grave many times over.

There have been volumes written on M.K. Gandhi. But a quaint little book on some persons who have tried to follow Gandhian way of life and worked to better the lives of their fellow suffering humans, came my way some time ago. I strongly recommend you all to read it. Name of the book is ‘Bapu Kuti’ and the author is Ms Rajani Bhakshi.

Monday, August 23, 2010

Mind over matter

Many illnesses are directly linked to brain activity. Two patients who came one after the other illustrate this. This happened just a week ago.

This patient who is on blood pressure medication records her pressure at home and more often than not it is within the normal range. But whenever I take her pressure it is way above normal. I tried consoling her that this is a well known phenomenon and we have even coined this as white coat hypertension. She was not convinced and said,’ I am a calm person, I have known you for many years and there is nothing here to get excited about [this is true!], your measuring instrument is showing wrong reading’. I have learnt not to argue with some patients and this is one of them. I said, ‘right then, you bring your instrument tomorrow and we will check the pressure with both the machines and see which one shows the correct reading’

She came next day. I don’t know which one of us was more anxious! She took her blood pressure which showed even higher reading than the previous days! Then I took her pressure using her instrument first and then mine. The readings were actually less than hers! She was convinced but wanted to know why the reading done by me was lower than hers. ‘The excitement was already over when I took the reading, therefore the figures were lower’ I said. I presume she will have more faith in me and my equipment henceforth!

The Swoon and after
I have heard and read stories of persons collapsing and even having a heart attack sometimes resulting in death when they hear distressing news. In my 40 odd years of being a doctor and having broken unpleasant news to many of my patients and having watched their agony, I had not come across anyone who has swooned, had a stroke, heart attack or who died. That is till a week ago, soon after the above mentioned patient [lady with high BP] left.

This 50 year old Mrs. P came in with a young man; Mr S. Mr S is a house guest with Mrs. P and will remain with her till he finds an accommodation. The reason why she brought him is that Mr S had fever since the past three days and felt very dizzy the previous night and with difficulty prevented a fall. She made fun of the youngster saying how little resistance the modern youngsters have when compared to people of her age and gave her own example of good health and how infrequently she saw doctors. In fact she asked me,’ when was the last time that you saw me?’ I really did not know and in fact her face was just vaguely familiar, if she had not told me I would not even think she was ever my patient. I told her truthfully that it must have been long time ago. ‘See, what did I tell you?’ she said looking accusingly at Mr S, as if by falling sick he has committed some form of crime.

There was not much wrong with the young man except for lower than normal blood pressure which combined with his fever must have caused some momentary dizziness. I reassured him of the nature of illness which would probably limit itself and he should be alright in couple of day’s time. Mrs. could not help saying,’ I told you it is nothing to worry, but you would not listen, see now doctor too tells you the same’. The tone clearly indicating that it is waste of time coming over to see me.

She would not leave. ‘Doctor, she said, will you please check my blood pressure also’. This kind of free additional consultation is part of the game and I don’t mind doing it these days. I proceeded to check her blood pressure and to my surprise this super fit [her assumption] had pretty high blood pressure. I told her so and get back in the evening for a recheck and take a note for some basic tests before beginning the treatment. She did not answer; instead she said she is feeling giddy. I made her sit in the waiting area and proceeded to see the next patient. Few minutes later comes Mr S and says,’ doctor come and see her, she is not talking’ I went out and found her head had rolled to one side. We put her down and she threw a fit [convulsed]. Soon after that she opened her eyes and obviously surprised at finding herself on the floor instead of sitting on the char. By now I had again taken her blood pressure which had dropped to near normal levels, heart rate and rhythm were normal and she seemed to be fine.

She wanted to go home having profusely apologized for creating a scene. I would not let her. A person with high BP who swoons and had an observed fit and BP drop could have had a heart attack or a stroke or even a tumor in her brain for all one knows. I had explained why it is necessary for her to go to a hospital. My suggestion that I call an ambulance was vetoed by her. By now she had recovered well enough to call a friend to come over to take her to the hospital. The friend duly arrived and the prostate lady was slowly moved to the car and taken away.
The drama took over an hour of my time. I went back to work. After half an hour Mr S comes in and asks,’ doctor do you know where Mrs. P lives? They have left me here and have gone to the hospital. I don’t have her phone number or her address. I don’t know how to go back!

Now I am faced with a new problem. How to get this man home? I did not know where MRs P lived except somewhere nearby. I told him that he has options of sitting in the waiting room till such time MRs P and or her companion realizes that they have left him behind or go over to the hospital and chase them. Poor man’s face fell, faced with this daunting task. He quietly returned to the waiting area.

I went out an hour later and found that he had gone.

The consultant from the hospital called to say that the lady’s BP was normal and her ECG was also normal and they are waiting for the brain scan reports to arrive.

It is nearly a week since the incident; Mrs. P came to see me with all the reports. All were normal. It only confirmed that what she had was indeed a syncopal fit on hearing the bad news!
She has reluctantly agreed to begin taking medications for her raised blood pressure.

Impressions 4

My friend asked me what I missed most when I was away. I said without any hesitation,’ my morning newspaper’! Don’t be under the impression that our newspapers carry some earth shatteringly important news that we cannot do without. It is not that. It is just a question of habit. It reminds me of an elderly patient of mine who was admitted to the hospital and became constipated. Moving the bowels daily for many is the most important ritual of the day and if unperformed will ruin their day. He made such a big issue of this that the girl who was in charge, made preparations to give him an enema. He would have none of this and he made her call me and he spoke to me. He said,’ please tell this stupid girl to get me Hindu [a popular daily of South India], it will act better than this enema business.’ Why did not you ask her’ I said. ‘I did and she laughs at me’ he said. I made him give the phone to the nurse and asked her to get him the paper even if it is against the hospital rules. She did and my patient took the paper and sat on the commode. Lo and behold, the job was done!

Though I had no such dependence the habit took some time to get over. Americans unlike us don’t miss their daily that is if they have one. Most are virtual rags giving bizarre local news like some ones dog missing or someone having a social evening or what the local school boys did when they took a trip to another state or the local Rugby team did against a visiting team. Ask them what is happening in the next state unless it is a major shooting spree they wouldn’t know! Even the TV coverage is I believe very sketchy [I did not have the opportunity to watch TV as my hosts fortunately or otherwise did not have the connection! To get the news of the world I had to go the internet but it is not the same like getting it from a newspaper.

Even small towns in the US now have centers that teach Yoga and meditation. The teachers are generally trained locals but have a generous sprinkling of Indians. It is common to see advertisements especially in the media [ specially meant for Indian readers] announcing visit of that this or that Swami or Guru who teaches yoga/meditation/ makes astrological predictions/performs rituals for ones’ wellbeing in the true traditional Indian style. The consulting hours and the fee charged are also given in the true American style!

I visited a fair on a week end that was held in the town’s main street which was closed for traffic for the day. In the nearly kilometer stretch, the road had at least 200 tents displaying all sorts of goods and crafts. The road and the footpath were chockfull of people with their families out to have fun. The area has a sizeable Indian population and I found very few of them. When asked the reason why I was told they tend to use holidays to visit each other or spend time goading their children to study! There were many Chinese and compared to my last I found many more of them. At this rate of Chinese immigration soon California will be renamed Chinafornia.

Thursday, August 19, 2010

Impressions 3

My friend asked me what I missed most when I was away. I said without any hesitation,’ my morning newspaper’! Don’t be under the impression that our newspapers carry some earth shatteringly important news that we cannot do without. It is not that. It is just a question of habit. It reminds me of an elderly patient of mine who was admitted to the hospital and became constipated. Moving the bowels daily for many is the most important ritual of the day and if unperformed will ruin their day. He made such a big issue of this that the girl who was in charge, made preparations to give him an enema. He would have none of this and he made her call me and he spoke to me. He said,’ please tell this stupid girl to get me Hindu [a popular daily of South India], it will act better than this enema business.’ Why did not you ask her’ I said. ‘I did and she laughs at me’ he said. I made him give the phone to the nurse and asked her to get him the paper even if it is against the hospital rules. She did and my patient took the paper and sat on the commode. Lo and behold, the job was done!

Though I had no such dependence the habit took some time to get over. Americans unlike us don’t miss their daily that is if they have one. Most are virtual rags giving bizarre local news like some ones dog missing or someone having a social evening or what the local school boys did when they took a trip to another state or the local Rugby team did against a visiting team. Ask them what is happening in the next state unless it is a major shooting spree they wouldn’t know! Even the TV coverage is I believe very sketchy [I did not have the opportunity to watch TV as my hosts fortunately or otherwise did not have the connection! To get the news of the world I had to go the internet but it is not the same like getting it from a newspaper.

Even small towns in the US now have centers that teach Yoga and meditation. The teachers are generally trained locals but have a generous sprinkling of Indians. It is common to see advertisements especially in the media [ specially meant for Indian readers] announcing visit of that this or that Swami or Guru who teaches yoga/meditation/ makes astrological predictions/performs rituals for ones’ wellbeing in the true traditional Indian style. The consulting hours and the fee charged are also given in the true American style!

I visited a fair on a week end that was held in the town’s main street which was closed for traffic for the day. In the nearly kilometer stretch, the road had at least 200 tents displaying all sorts of goods and crafts. The road and the footpath were chockfull of people with their families out to have fun. The area has a sizeable Indian population and I found very few of them. When asked the reason why I was told they tend to use holidays to visit each other or spend time goading their children to study! There were many Chinese and compared to my last I found many more of them. At this rate of Chinese immigration soon California will be renamed Chinafornia.

Tuesday, August 17, 2010

Evaluating success

An old oxford don was being felicitated by the alumni for having completed 50 years of academia. After the dinner, over a glass of sherry one of his admirers asked the old Don,’ Sir how come so many of your students have done well in life. How did to value their dissertations?’

‘In the early years I used to take lots of time and trouble to evaluate the papers. But in my later years I found a foolproof method. I placed all the files on the top step of the staircase and gave the pile a kick and gave maximum marks to the ones that fell nearest to me and the ones falling farthest got the k least marks. Gentlemen most of you are products of this system’ He sat down amidst stunned silence.

In life what matters is individual enterprise, creativity, using or making opportunities and not book learning.

Did you know?

This interesting material was sent to me by good friend and relative Sheena Hebbar

Where did Piss Poor come from?They used to use urine to tan animal skins, so families used to all pee in a pot & then once a day it was taken &Sold to the tannery..... ..if you had to do this to survive you were "Piss Poor"But worse than that were the really poor folk who couldn't even afford to buy a pot......they "didn't have a pot to piss in" & were the lowest of the lowThe next time you are washing your hands and complain because the water temperature isn't just how you like it, think about how things used to be.

Here are some facts about the 1500s: Most people got married in June because they took their yearly bath in May, and they still smelled pretty good by June.. However, since they were starting to smell Brides carried a bouquet of flowers to hide the body odor. Hence the custom today of carrying a bouquet when getting married.Baths consisted of a big tub filled with hot water. The man of the house had the privilege of the nice clean water, then all the other sons and men, then the women and finally the children. Last of all the babies. By then the water was so dirty you could actually lose someone in it.. Hence the saying, "Don't throw the baby out with the Bath water!"Houses had thatched roofs-thick straw-piled high, with no wood underneath. It was the only place for animals to get warm, so all the cats and other small animals (mice, bugs) lived in the roof. When it rained it became slippery and sometimes the animals would slip and fall off the roof. Hence the saying "It's raining cats and dogs."There was nothing to stop things from falling into the house. This posed a real problem in the bedroom where bugs and other droppings could mess up your nice clean bed. Hence, a bed with big posts and a sheet hung over the top afforded some protection. That's how canopy beds came into existence.The floor was dirt. Only the wealthy had something other than dirt. Hence the saying, "Dirt poor." The wealthy had slate floors that would get slippery in the winter when wet, so they spread thresh (straw) on floor to help keep their footing. As the winter wore on, they added more thresh until when you opened the door, it would all start slipping outside. A piece of wood was placed in the entrance-way.Hence: a thresh hold.(Getting quite an education, aren't you?)In those old days, they cooked in the kitchen with a big kettle that always hung over the fire.. Every day they lit the fire and added things to the pot. They ate mostly vegetables and did not get much meat. They would eat the stew for dinner, leaving leftovers in the pot to get cold overnight and then start over the next day. Sometimes stew had food in it that had been there for quite a while. Hence the rhyme: Peas porridge hot, peas porridge cold, peas porridge in the pot nine days old.

Sometimes they could obtain pork, which made them feel quite special. When visitors came over, they would hang up their bacon to show off. It was a sign of wealth that a man could, "bring home the bacon." They would cut off a little to share with guests and would all sit around and chew the fat.Those with money had plates made of pewter. Food with high acid content caused some of the lead to leach onto the food, causing lead poisoning death. This happened most often with tomatoes, so for the next 400 years or so, tomatoes were considered poisonous.Bread was divided according to status. Workers got the burnt bottom of the loaf, the family got the middle, and guests got the top, or the upper crust.Lead cups were used to drink ale or whisky. The combination would sometimes knock the imbibers out for a couple of days. Someone walking along the road would take them for dead and prepare them for burial. They were laid out on the kitchen table for a couple of days and the family would gather around and eat and drink and wait and see if they would wake up. Hence the custom of holding a wake.England is old and small and the local folks started running out of places to bury people. So they would dig up coffins and would take the bones to a bone-house, and reuse the grave. When reopening these coffins, 1 out of 25 coffins were found to have scratch marks on the inside and they realized they had been burying people alive... So they would tie a string on the wrist of the corpse, lead it through the coffin and up through the ground and tie it to a bell. Someone would have to sit out in the graveyard all night (the graveyard shift.) to listen for the bell; thus someone could be, saved by the bell or was considered a dead ringer.And that's the truth....Now, whoever said History was boring!!!So...get out there and educate someone! ~~~

Sunday, August 15, 2010

Impressions 2

I am fortunate in having my daughters and their American husbands as nature lovers and sharing my love for outdoor life. Americans with rare exceptions love sun and exposing their skin to sunlight, a feature which I don’t share. California is a sun drenched state and when I was there the mercury often touched 35 degrees [c] and more. I with my ankle length trousers with full sleeved shirt and wife with her saree made a striking contrast to the hordes of minimally attired Americans who were out to enjoy their sun. The motto appeared to be less clothing you have on your body the more pleasure you get. This is not only with the young who have well proportioned beautiful bodies to show but also the fat and the elderly with sagging bellies and bottoms. That excess of sunlight exposure positively harms and the publicity given to skin cancer is more than offset by the sales promotion and use of sun screen lotions! Having played golf in the afternoon Indian sun for over ten years and having my forearms burnt to the extent that the skin appears like a thin wrinkled parchment, I have become wise and use only long sleeved shirt whenever I go out in to the sun and during my California sojourn I did the same, but could not help wonder how these people manage to avoid the effects of sun exposure. Indians living in the US especially in places where there is limited months of sunlight seem to suffer more from Vit D deficiency in contrast to the native Americans [I don’t mean American Indians] I have had two young women in the US who had to be given D supplements!

The shopping malls are thriving given the penchant for shopping. I can understand if one were to shop for what is necessary. But buying for pleasure is something I fail to understand. In my country too there is this illness but it appears to be widespread in the US. The whole culture is aimed at consumption needed and not needed. I found large displays of storage houses. Americans move about a lot and it is understandable that they need to store their belongings when they are away. But part of this storage is used to store unwanted purchases made for want of space in their own homes! If I buy a shirt I tend to use it till it frays and then it goes to someone else as a donation or it is used as a mopping cloth. It will last for years and I rarely get bored with it. Not so in the US. Dress trends keep changing and one buys to keep up with the trend not for utility. The economy survives on conspicuous consumption! The Automobile industry is suffering because they no longer change their car every two years. So are the manufacturers of golfing paraphernalia. Americans no longer change their sets every two years!

Sequoia tree and our night out
Sequoia and King canyon national parks are located in the Sierra mountain range, four hours drive from Los Angeles. These trees grow at heights ranging from 5000 to 10,000 ft. The oldest tree [named after Gen Grant] is more than 3000 years. Its height is over 250 feet and the diameter is more than 100 ft. It is still growing. There are hundreds of these matriarchs in that splendidly maintained park where we were privileged to stay. Imagine that they have existed even before the civilization as we know began. The Pheraohs’ of Egypt when they were building the pyramids, these trees were already there! I could not help but give a respectful homage to these ancients who have managed to survive god knows how many natural calamities. They would not have survived humans but for the timely intervention of some naturalists [J. Muir] and others like President Theodore Roosevelt who enacted the natural park laws. This is also the natural habitat of bears and there are frequent encounters between humans and bears without much damage to either. My younger daughter and husband decided to camp in the open to see the star lit sky in this bear infested mountains. I love animals alright, but this outing with lurking danger, that too at night is one I am unlikely forget. With their programmed GPS aids they could locate all the planets and the stars and I had not seen so clear a sky with that kind of display of stars ever before in my life. This and the constant threat of bear invasion made that an eventful night, to say the least!

Thursday, August 12, 2010

Impressions

Every time I travel out of India and return I feel good and also bad. I feel good because I am made to feel good by my patients and friends who genuinely miss me and make me feel needed. To be back in your own home, sitting in your favourite chair and doing what you are best at, in your own set environment which you have struggled and built over so many years, has its own charm which nothing can replace.

But for a few days I become very depressed. This is not because I have left behind those who are very dear to me and possibly will not see them for another year or two, or because of the effects of Jet lag, but because of what I see here and what I have seen abroad and despite the knowledge that comparison is bad I cannot help doing it.

The first thing that strikes me is relative absence of squalor and dirt. By this I don’t mean absence of poverty, but sheer human degradation that is present here. The other is our lack of historical sense and appreciation of beauty. We have plenty of places which are worth preserving and showcasing but have no sense to do it and thus allow our own extra ordinarily beautiful heritage places and sites to degenerate.

Americans have developed some new habits since I visited them last. One is the extensive use of bottled mineral water and it is common to see water being supplied to households periodically. This I felt was unnecessary in a country where supply of clean water is the norm and only adds to the recycling burden. I also noticed many carrying metal water bottles instead of plastic ones when they are out of their homes. The habit of drinking gallons of thin and tepid coffee seems to have grown. They also seem to be taking to drinking more wine. I found on my drive from Los Angeles to San Francisco thousands of acres of newly laid vineyards and my comment that they are converting precious water into wine was well taken.

Universal use of tissue paper for cleansing from top to toe has only increased. I used to see few still using handkerchiefs in my earlier visits. This time however I found none. How many trees are sacrificed to meet this avoidable habit? But unlike here I found none who threw the used tissue on to the road side. The roads are thus free of litter which was a joy.

America is heaven for dogs. They come in all shapes and sizes. There were many I just couldn’t identify and walking their dogs is fast becoming the most important pastime for most Americans, at least to the retired community. The locality where I lived there is a club of dog walkers. They start from their homes at the same time and stop at a large public lawn and gossip while their pets do their job and run around [leashed]. The dogshit is carefully picked by the gloved hand of the owner and placed in a plastic bag for later disposal. Here I pick up arguments with such walkers who think my home front is ideal place for their dog ablutions!

One car, one driver mentality persists despite wide appeals for car pooling. But a greater number of smaller cars are on the roads. Four lane high ways are becoming six lanes and the lessons of reducing dependency on this wasteful mode of transport don’t seem to have sunk into the heads of these people. We here are heading towards disaster if we continue to allow the cars to congest our narrow roads. America can indulge in this folly for some more years, but we cannot.

We never seem to learn some basic lessons. Or are we by nature arrogant that we just don’t want to?

More when I write next.

Wednesday, August 11, 2010

Holiday Time

I was away for nearly two months and did not write in my blog. I promise you will get to hear from me regularly hence forth.

God fearing

Some years ago I used to get help from a surgeon who lived and practiced close by. The set up he had was good for minor procedures but not major surgery.

One morning I saw a patient who was in severe pain around his anal area which made him sit on one half of his bottom. And seeing me smile looking at the way he sat he said,’ you are laughing, you don’t know what it means to have pain there,’ pointing to his posterior. The smile was quickly replaced by concern and I made him strip and had a close look. The man had a small abscess [collection of pus] next to the anal margin, an extremely painful condition. What he needed was a simple procedure of draining of the pus.

I sent him with a note to this surgeon requesting urgent help.

An hour later the patient came back. I was happy with such prompt attention and thought he has come to thank me. Instead the patient said with irritation in his voice,’ Please doctor send me to some other doctor, your friend is no good, he spends more time doing his prayers than attending to patients’

I agreed to send him elsewhere but was curious to know what had transpired. I asked him. He said, ‘I went there and waited in his waiting area with other patients, your friend came, went to his room and came out with a burning joss stick and proceeded to perform a ritualistic prayer to each of the gods photos he has hung in the waiting area, I got cheesed off, he should be attending to us first and do his prayers at home, I lost my patience and confidence in that man and decided to come back here’

So he went to another surgeon and got the abscess drained.
The surgeon in question became a drug addict and alcoholic and died few years ago!