my thoughts

Cult of violence

2012-02-13T19:17:00.001+05:30

The incident of a 15 year old student stabbing his school teacher to death should come as an eye opener to most of us. While not condoning the student who was driven to this, one should consider why he did this. The teacher who was concerned with the poor performance of the boy reported it to his parents who in turn took the boy to task and the enraged boy took out his frustration on his teacher. For many students, the present day schooling and the methods of learning are worse than spending time in jail. A society which puts scholastic performance as the acme of achievement places enormous pressure on parents and indirectly on school teachers who in turn pass on this burden of performance on school going children.

In post independence India there have been two primary casualties. One is health and the other is education. The government has gradually withdrawn its responsibility of providing these two to its citizens and has allowed the private players to enter the field. I wrote some time back on corporatization of health and the aftermath. The same is happening in the field of education. All sorts of player whose motive is to make money are entering this arena across the board from primary education up to post graduate level. This has not come cheap. These institutions are prohibitively expensive education shops. A situation has arisen in this country where in an average parent is finding it difficult to foot the education bill of his or her children. I know of many who are either stopping at one child or not having children at all for this reason!

Those who do send their children to these privately run schools are under considerable financial strain and to get a report that their ward is poorly performing and thus a poor return on investment must be indeed galling. They will vent their anger on the child and he in turn will resort to violence either on himself or on others, in this instance on the hapless teacher. Suicides are not uncommon during exam time and at the time the results are made known.
To add fuel to fire is the general atmosphere of violence in which we are living. Our media, TV serials and movies, Computer games that children play, glorify violence. A child who grows in this kind of atmosphere can easily justify violence [a la Taliban].

In this land M.K. Gandhi. We are slowly and inexorably slipping into a land of himsa [violence].

Wodehouseana

2012-02-02T17:40:00.000+05:30

I first read P.G. Wodehouse when I was in school. Both my knowledge of the language and the society in which the characters created by Wodehouse lived were rudimentary. I only read them to please my English teacher and never understood a word of what he wrote. I read him again when I was in college and the results were a bit better. I must have read and re read them many times since then and now his books are my refuge. Whenever my moods turn sour which is often, I take recourse to his books and return refreshed.

Many have told me he is a farce. Of course he is. But he makes me happy. He created a new world of farce based on characters drawn from pre Second World War British society and the characters have stood the test of time and have never become stale. The stories written 75 years ago can still make you laugh. One doesn’t have to necessarily go back to that era to enjoy his works. There is no need to imagine the scenario as it is vividly described when the characterization is done.

Wodehouse was an avid golfer. Another reason for my liking him. He once famously said,’ I wasted the first fifty years of my life because I began playing golf only after’. All golfers will whole heartedly agree with this sentiment. Our lives will be barren and purposeless [exaggeration?] if this game is taken away from our lives. He created a character, an elderly retired gentleman who no longer could play golf but who nevertheless waylaid the unwary in the clubhouse and told them stories recalled from his memory. The stories told by this oldest member [Sage] is available as golf omnibus and these too can be repeatedly read without loss of flavor.

The outstanding characters are of course that of Bertie Wooster and his valet Jeeves. The related uncles and aunts, friends and acquaintances, churches and clergymen, country houses and city clubs fill his books. Some characters are outstanding such as the pig lover Lord Elmsworth and the genteel poor PSmith.

At present I am reading another of Wooster stories and how he is being helped to get out of or prevented from entering holy matrimony yet again. It is fun reading.

Those of you, I am sure, who get occasionally depressed, given the dismal environment [at least true in India] will surely benefit if you take up reading him.

Happy reading

Conference

2012-01-23T17:11:00.001+05:30

This for us medical men and women means meeting periodically to learn, update and exchange ideas. In short, it means learning so as to ultimately benefit our patients.

To conduct a conference we need several requirements. These are: a suitable place, an organization to oversee the conduct, participants, delegates and speakers. One needs money to take care of the hunger and thirst of the speakers and delegates for the period of time these worthies hang around in the memorable cause of learning.
Over the years it has become a custom to hold these conferences in hotels. Depending on the reputation of the organizers the hotels are selected. If it is lowly paced general physicians it may be in three star hotels and if it is a super specialty conference it may be in a seven star location.

The concerned body of doctors will start working months in advance advertising in the specialist media as to this meeting and we begin getting mails giving the details of the topic and the registration charges. The higher the hierarchy the higher is the registration fee.

Now it will be interesting to know who will be the delegates [listeners] and who the speakers? Delegates are supposed to pay the entry fee which will cover their lunches and dinners and other expenditures incurred by the organizers in hosting this conference. The speakers are specialists in their fields who will have either paid for their coming or they will have been sponsored by the research grants to present their views. In reality none of this is true. The delegates are there because someone would have picked their bill of travel and stay. And speakers would have been taken care of by the companies or firms interested in high lighting their research to boost their sales of a particular product or devise.

In a major conference which drew 1500 delegates on the subject of advances in diabetes there was no registration counter! This means there were none who paid and came as delegates! Diseases like diabetes, hypertension, and heart disease afflict the rich more than the poor. Drug companies are interested in selling their products related to treatment of these diseases. They know that here is a huge market for drugs used in the treatment of diabetes and India is emerging as the diabetic capital of the world and here lies the truth of this mega conference where in an estimated 2 crores of rupees were spent. How appropriate it would have been had this money been spent on funding research on a vaccine to cure malaria [essentially a poor man’s illness]

Let us assume there are still doctors who don’t want to be sponsored and would like to pay and attend and learn. This foolish class is rapidly dwindling and if things are going as they are they may soon disappear! These doctors are generally honest professionals and therefore unlikely to be rich and cannot afford the travel and stay expenses of going to another city or country and therefore are forced to stay back. What about their learning? I asked a friend of mine who attended this hyped up sponsored conference on diabetes as to what he learnt new? He said,’ very little of practical importance.’

There is still hope for this class of doctors. Internet has come to their rescue. Most advanced research of practical importance gets published in journals and subscription costs of one or two standard journals is sufficient to keep one updated. These journals have very interesting and novel teaching methods which I find far superior to the didactic delegate’ speaker method of learning/unlearning.

What is the future of these conferences? As I see they continue to thrive but the quality is likely to come down. There is going to be major changes in learning methods and these will be more and more web based and my worry is that here too drug companies will play a role [as they will have to spend less!] and this will leave a set of unhappy doctors who are denied of their free travel , food and drink!

Communal feasting

2012-01-18T17:40:00.001+05:30

My balcony overlooks the backyard of another home. Here grows a Sapota tree. Sapota or Chikoo [Manikara Sapota] is a fruit bearing tree which originated from Brazil and has spread all over the tropics and in India Chikoo is a major horticultural produce. The tree fruits twice a year and a well looked after tree bears fruit in thousands.

The owners of this tree are old and cannot reach the upper levels of the tree with ease and thus lots of fruits remain unplucked and I am ever grateful to them for their unintended generosity. Twice a year the tree fruits and it becomes veritable bird watcher’s paradise. I have on a previous occasion written about a family of squirrels who has laid claims to the fruits and how jealously they guard against predators, mainly the birds. It was a pleasure to watch the mostly futile attempts of these small animals trying to chase the birds away.

This year they seem to have found that it is waste of time to chase the birds away especially when there is plenty of food for all! Another new feature I noticed this year is that all the birds have begun feeding at the same time unlike previous years when they took turns. The green barbets came first and the others followed. This year I am able to watch all of them feeding at the same time. I had not noticed Mynas in the earlier years. This year there are at least ten of them. Most fastidious and elegant of all the feeders [according to me that is] is the Koel. This big bird perches next to the fruit and elegantly pecks without disturbing the fruit or letting it fall. The worst of the lot is the Parakeet. Not only is he very noisy [I tolerate his screech only because he is a bird, good looking one at that!] but also he is very wasteful. Parakeet’s beak is curved and designed to open pods and eat the seeds and not really to eat ripe fruits .In attempting eat, he ends up in dislodging the fruit which falls to the ground only to be eaten by the crow. More I see the crows, more I am impressed with their intelligence. Earlier I used to see them eating the fruit still attached to the branch. Now they wait below for the half eaten fruit to fall to the ground. They unlike the other birds are unafraid of us humans and can risk doing this, their easy way to get at the fruit.

Parakeet [Rose ringed] till recently was a visitor. Now he has become a resident. I was wondering at the unusually prolonged presence of this bird around my home when I discovered his nest! The preferred nesting site is a tree with a dead branch or one with some holes in the trunk. There is a dead coconut tree some 100 yards away and this dead tree stands some fifty feet tall. This is an ideal location for the parakeet’s nest. I have begun watching these birds sallying to and fro and by the way they are behaving there sure to be hungry chicks in there.

Chikoo is a not a fruit where one sings paeans of praise unlike Mango where people go crazy in their praise. But it is a great fruit not only in the abundance of yield but in taste and structure. There is very little wastage in this fruit. The skin is thin and the seeds are few and the rest is delicious flesh. No wonder I and my avian friends like it so much.

Going back to dark ages?

2012-01-08T17:17:00.000+05:30

It was in the twenties of last century that antibiotics were discovered. First came the sulfa compounds and then came that remarkable antibiotic penicillin and then many more. In less than 90 years the microbes have learnt to live and occasionally thrive in the presence of these antibiotics. The last shock of the discovery of ESBL [Extended spectrum betalactamase resistant] was some years ago and now comes the report not of multi drug resistant but all drug resistant Tubercle Bacillus which causes tuberculosis. This is like icing on the cake or to be more precise adding insult to injury.

This means that in the near future if you get tuberculosis there may be no drug to cure you and in likelihood you will die. How you will die depends on the organ that is infected. TB germ can infect all organs from head to foot.

Human arrogance that he is the sole lord and master of this earth is responsible for this state of affairs. Microorganisms have been in existence for many millions of years before multicellular organisms AND other forms of life including humans evolved. They are self contained remarkably efficient life units who have learnt to survive in extreme adversity. We, primarily doctors believed that we can win the battle of infection by using these antibiotics. We used these liberally and indiscriminately and are still using them. Most infections are self limiting and antibiotics are redundant. But it has been common practice to use these in all infections trivial or otherwise. To give two examples. One is Staphylococcus. This is the germ which causes the common furuncles and abscesses. These, left alone will burst and heal or can be drained by a simple cut. But we routinely use antibiotics and now this organism has developed multidrug resistance. Another one is a germ called E-Coli. This one has a special liking for our urinary tract [especially women’s].This one too has become multidrug resistant. These two have become major headaches for us doctors and now are no longer simple germs that got killed by one or two doses of antibiotics. They have become killers.

If one considers one out of one hundred Indians have TB, then imagine the havoc this all drug resistant TB germ is likely to cause?

We are heading towards the dark ages of pre antibiotic days and we may have to look up and see how the physicians of those days managed their patients!

Awareness of self

2012-01-06T17:21:00.001+05:30

When I wrote the story of Mrs A, I said I would write about two of them. This one is the other which I meant to.

She has been my patient for many years and must be in her mid sixties now. With a strong family history of cancer and heart disease she is extra careful with her health and gets her tests done on a regular basis and keeps her twice a year visits to me without fail. Living with another sister who keeps indifferent health adds to her worries. Let me call her Ms M.

When Ms N came to see me when she was not due to see me, some three months ago, it was for another reason. She had severe back and hip pains of few weeks duration. Ms N is a frail vegetarian and when I found that her back and hips were generally tender with no specific localizing signs, I thought she has osteoporosis with add on Vit D deficiency, this despite her taking calcium tablets and a drug named alondrenate which is given for osteoporosis.

Vit D is manufactured by our skin only when there is sunlight exposure. Modern living and fear of sunburn makes people become Vit D deficient which can give rise to many signs and symptoms and aches and pains are some of these. Vit D deficiency was virtually unknown in the earlier years of my practice. Now I see this quite frequently for reasons mentioned above and also easy availability of tests to detect deficiency.

Mrs N was asked to do these tests and come back. The bone calcium density was not bad but her vitamin levels were low. I thought there you are! You have the diagnosis and the treatment is easy. Just give her Vit D supplements and get her to sit in the sun and her pains will disappear in a month or two. Thus reassured, Mrs N went her way.

She came back six weeks later, in acute distress. She was in such severe pain that she had to be assisted into my clinic by her brother. Instead of getting better she had gotten worse. I really cannot blame her for having gone to a specialist doctor in rheumatology [illnesses related to what is loosely called connective tissue]. This doctor had done a large number of tests to detect antibodies against her own cells. These were negative.

Here I must explain the basics of this fascinating aspect of life. We are each of us, unique, in the sense our cells [the ultimate functioning units of our body] are our own and there is an elaborate mechanism which allows our cells to recognize each other as belonging to one person and this mechanism has the ability to recognize something which enters our body as foreign. After this recognition there is an elaborate system of defense [major research area] to counter these invaders. This recognition of self from non self is fundamental to life. Occasionally, for various reasons, some understood and some still to be understood, this intricate system of recognition fails and the resulting clutch of disorders, go by the name of auto immune diseases.

Like we all have a life span [bible limits it to three score and ten, meaning seventy. I should be dead by this time going by this!]. Our body consists of various organs which perform various functions. Each of these organs is made up of millions of specialist cells. And all these cells too have their own life span and it is not threescore ten. Cells lining our mouth have a shorten life span than that of cells of our brain. When a cell dies the innards are released and these find their way into our lymph and blood stream. This dead material when once it comes out of the cell should be quickly disposed off. Or else these become potent antigens [foreign] and the our immune system begins to fight these by forming antibodies and the resulting fight takes place all over but when it occurs in our connective tissue it becomes painful and the illness too is widespread. Connective tissue is the one which binds the various structures and gives shape and structure to us. The resulting plethora of illnesses is called auto immune disease. I have given a rather simple explanation and I may be pardoned by my specialist friends for any error.

Ms N had one of these illnesses. Which one was the issue? The rheumatologist too must have been in this quandary and therefore had given her a non specific drug and wanted to review her after she tries it for few weeks. Why then she got back to me when my earlier treatment gave her no relief?

Sometimes we doctors stick our necks out and sometimes it is to benefit our patients and occasionally we get hung by! This is what I did. While reading about another problem I chanced upon this condition called Polymyalgia Rheumatica and the symptoms and signs fitted to what Ms N had like a glove. It occurs rather suddenly to only those above sixty, three times more common in women, large muscles of the spine hip and shoulders are preferentially involved, and markers of inflammation CRP and ESR will be very high. All of these were true in Ms N’S case.

I made bold to call her. I knew her name and the locality she lives and finding her number in the phone book was not tough. She must have been taken by surprise at my request to see her as soon as possible and she agreed and thus the present consult.

I explained to her the possible diagnosis and treatment. It took some convincing for her to agree to the treatment as it meant taking small dose of steroid [compared to what is given for other allied conditions]. Another motive was the dramatic freedom from pain she is likely to get if the diagnosis is right [sticking my neck out]
She agreed and three weeks ago took the initial shot of long acting steroid followed by oral tablets. Even I was surprised by the result.

When she came ten days ago, she came on her own could move all parts of her body, could bend, sit up, walk all without pain. Both her CRP and ESR which were sky high had returned to normal!

Practice of medicine is indeed rewarding. Don’t you agree?

Cure or Kill?

2012-01-01T20:18:00.002+05:30

My fading years of practice still provides me with patients whose problems test my skills, patience and occasionally my knowledge. Experience gained over 40 years of practice and occasionally sheer serendipity comes to my rescue. The month of December saw me solving two such problems with the help of a combination of the factors told above and I consider them as the best New Year gifts received even before the old year ended.

It is required that I take permission to tell their stories, especially when they are alive and kicking as in these two instances and I have done so and I must thank them for permitting to do so. Let me begin with the first one, Mrs A.
Mrs A is mother in law of a close friend of mine. She is a well built lady in her mid eighties and spends time living for some months with each of her children and for a long time she was my patient until her elder son retired from the army and came to live in this city 5 years ago. Since then she is being cared for in the army hospital and in a private hospital whenever an emergency arose. With another son living abroad money is not an issue that came into the picture as far as care is concerned.

As it often happens with us GPs, patients leave us to what they think or what their children think, for better pastures, which often is true but not in this case as later events proved. Fifteen or so years ago, when she came under my care, she was an obese, hypertensive, seasonal asthmatic and had fairly well compensated heart failure due to leaking heart valves. She was also severely arthritic with painful hips. Averse to any form of regular exercise and fond of food it was no surprise she kept gaining weight and her hip pains only became worse. We took a risk and got one of her hips replaced and the cardiology opinion was that she was a high risk patient and ideally have her heart valves replaced and the surgeon felt it was not worth doing it considering she is being fairly well managed medically as far as her heart failure was concerned.

Four years ago, when she was not under my care she got her other hip replacement done! She had a stormy post operative period but made good recovery and now she has both hips replaced and was pain free. One would have thought she would exercise and get her weight down but as I said earlier she did not and her weight remained as before and when I occasionally saw her socially [as she is my friend’s mother in law] I felt her weight had only increased. Since last one year her health seemed to worsen and she has been in and out of hospitals for one reason or the other.

Six weeks ago, she was taken to a nearby hospital [with corporate ethos] and was admitted as she was complaining of weakness and was short of breath. Given her heart condition the diagnosis was obvious. She was in heart failure due to leaking valves. The cardiology team of that hospital is good and most of them are known to me but as I was not involved in her care I did not personally check with them as to the details of the treatment. What her son in law and my friend told me was that the cardiologist felt her heart failure was under good control and he advised her increased activity and she was discharged home.

This time the home she came to was the daughters. She continued to be unwell and kept telling her relatives that her end is near, so bad was her feeling! One evening, the son in law [my friend] came to my home and asked me to come and have a look at her before they took her back to the hospital.

I went with him to see her. She was lying flat on bed, a slab of pale flesh with deathly pallor. She looked very ill. She had constant feeling of nausea and was off food for the last week and was barely able to keep fluids. She also felt it impossible to even to get up and sit and the daughter was having a hard time nursing her. Quick examination showed her blood pressure under control, but her heart’s beating was irregular. Her feet were swollen and her lungs showed few abnormal sounds suggesting beginnings of fluid accumulation. She complained of discomfort in the pit of her stomach.

I wanted to see her records. The record keeping had stopped in the year 2006 when she was under my care. Rest were all hospital discharge summaries and prescriptions. I saw the latest prescription. This had 9 drugs. One to stabilize the heart, another to remove the fluid from her lungs, yet another to keep her blood pressure under control, a different one to prevent clotting, another to prevent the possible side effects on the stomach because of all these drugs and the usual masala of vitamins.

Digitalis is a time honored drug and has a fascinating history. The plant Foxglove from the leaves of which the steroid glycoside Digoxin was extracted, belongs to the family Sacrophulariaceae, was time honored native medicine in Europe for many centuries. It came to widespread use due to an accidental discovery by the 18th century English physician William Withering. A patient of his was very unwell with Dropsy [old name for fluid accumulation all over the body]. After visiting her, Wuthering came back home leaving her to die, so hopeless was her state. Few days later the patient, now recovered, visited him. The surprised Withering found out that she had consumed a concoction made out of the common garden plant, Foxglove! It to his credit that he published his meticulous observations and extract of foxglove, digitalis, came to be used universally in heart failure patients and has with stood the test of time and is in use even to this day.

This wonder drug however, has one major problem. The margin of safety between the therapeutic dose and the toxic one is thin and if one is not careful the drug can become from a life saver to a life taker!. This is especially true when used in the very young and the very old. The toxicity is on the stomach and worse, on the heart. In the stomach it causes severe gastritis manifested as loss of appetite and severe nausea and on the heart with irregular to very fast beating leading to failure, the very illness for which it is given!

Madam A had classical Digoxin toxicity! The drug was stopped and it took 48 hours for her to eat her first solid meal in three weeks. Her heart’s beating returned to normal and the deathly pallor was replaced by a cheerful expression. She began moving around the third day and was able to walk up and down the stairs of her home. Yesterday she made a long car journey to her other son’s place to a town some 6 hours away!

Mrs A escaped from certain death [if she had continued with digoxin].

This story has taken too much of time. Will do the other one sometime next week.

Remembering Bhutto and Thanks giving

2011-12-30T18:11:00.001+05:30

I don’t know why I began calling him Bhutto, after that famous India hater Zulfikar Ali Bhutto. Those of you who are interested in the recent history of India and Pakistan will remember that he was Pakistan’s able representative in the UN and later became the country’s prime minister and later was hanged by the military. He excelled in debates and was an effective counter to our own Krishna Menon in prolonged and effectively boring speeches. In one of these speeches he called us Indian Dogs! And this infamous or famous statement must have made me call him Bhutto when he first adopted me as his friend and my home as his. Had I known what a wonderful being he turned out to be, I certainly wouldn’t have called him by this name. But call I did and the name stuck. After all what is in a name, the person is important. So it proved.

Bhutto was a stray dog and must have been a two year old when he came into our home. He was of indeterminate pedigree and as mongrels go, a good looker. He never got fully domesticated and would visit us when his mood took him to do so. He was essentially a street urchin and the street in front of my home was his territory. He never was short of food as he had many friends like me who fed him. But I felt he had a special liking for me.

Deepavali is a noisy festival with nonstop sound of crackers bursting. These days were dreadful days and he took refuge in our home. He would neither eat nor drink and my dislike for the use of crackers as a method of celebration, be it a festival or a wedding goes back to those days when I saw him in absolute dread. He would not leave the house for a few days after and only did so when there was no more of this noise.

Being a street urchin it was not possible to really get him to a Vet to get him immunized but I did try once and he jumped out of the car and ran away. But strangely, when he fractured his leg and was hopping on three legs, I with the help another dog lover friend of mine managed to take him and this time he gave no trouble at all! But the Vet told me that there is no point in attending to him as he would not allow the leg to mend and the cast he is going to put will not stay as he would tear it apart. He felt Bhutto’s days are numbered as he would not survive as a lame dog in the streets. He reluctantly applied the cast and I couldn’t believe that a dog could be so cooperative when the procedure was being done! Even the Vet was surprised. I kept him home for a few hours till the cast dried and after wards let him go.

Next day he came back with yards of plaster of paris smeared bandage trailing his lame leg. He had tried his best to chew the nuisance off and wanted my help to get rid of the remaining. This I did and put a bit of crepe bandage instead. Even this did not remain long. He hopped about for a week or two and then began bearing weight on the lame leg and in a month became normal. Another of my beliefs,’ leave it to nature and often you will see miracles happen’ proved right.

Another time he came when he was ill and took refuge inside the house. He would not eat and only drank water! I opened his mouth and found it full of small eruptions and when I asked my friend he said it was a common viral infection and gave me some pills to try. With great difficulty I managed to get him to eat these pills and in a week’s time when I forced open his mouth there was not a trace of this infection! He was also going out and eating grass and someone told me that dogs do this as a way of healing mouth sores! I don’t know which one did the trick but he became normal and resumed his antics.

He was fond of fried dosa and would know by the smell that this was being made in the house and invariably come to the dining area and sit on his haunches with an expectant look on his face. My old mother who was alive then and who was no great dog lover just could not resist liking him and would feed him one dosa after the other.

For a street dog he was clean, but I felt he needed a bath once in a way. He would have none of these and my attempts elicited a howling response. I gave up using water and would use a brush once in a way but surprisingly did not find much dirt on him despite all the mud he came in contact with on the streets.

Being a street dog, he would get into fights with other dogs especially when the females were in season. Again it was my job to treat him. Many an occasion he would report with injuries and allow me to clean and apply antiseptics and never once did he object and would lie down quietly often licking my hands or giving me small bites when I was cleaning his wounds which must have been quite painful. He knew that what I was doing was for his good.

I remember one day morning when I woke up late, only to see him sitting with an upturned anxious face. Normally he would not come into the bedroom but this time he did and was sitting there god knows how long. None of my family even knew he was there! No sooner I woke up his anxiety vanished and before I could touch him he ran down the stairs and disappeared down the street. Did he think, I wonder, looking at me sleeping form that I was dead and thus the anxiety on his face?
He lived a charmed life of may be seven or eight years and died after eating some poison from the street corner dust bin. He came home one evening vomiting blood. One look at him I knew he was too far gone to be saved. He died a few hours later and we buried him inside our compound.

Normally when a human being dies some rites are performed, priests are fed and poojas are performed to send the soul safely to the other world. The evening when he died, we put some flowers on his grave and lit some joss sticks and stood in silent prayer for a few minutes, just then an elderly man unknown to us came and asked for help. He did not look like a professional beggar. It is considered auspicious to give to charity and no one deserved it better than what I thought this emissary of just departed Bhutto,

Another year has gone by and we are entering 2012 and I thought the best way to usher in the New Year is to pay homage to a soul which left me some 20 years ago, but whose memory is still fresh and even after all these years I still miss him!

Like I did last year this year too I thank all of you, my patients, family and friends who have kept me going and for all the love and affection that you have given me.

Fire test

2011-11-30T11:51:00.003+05:30

Our revered epic Ramayana has an episode where in Lord Rama tests his wife's chastitiy by making her walk through fire [even in those days there was no need to test the male's chastity]

So this was considered to be the best way to separate the noncorrupt from the corrupt. The first ones to be tested were the ruling party memebers. One by one they were made to walk through the fire pit.

The first to emerge unscathed by fire was Antony. Next to emerge was Manmohan singh holding his backside which was singed but not burnt.After anxiously waiting for a while Antony tells Manmohan,'I donot think we should wait any more, there is a lot of work that we both have to handle' Manmohan says, ' You go, I will wait, I am sure next one to emerge will be madam!

At the time of writing he is still waiting!

Hazare and the whip

2011-11-26T17:25:00.000+05:30

I imagined the scene where Gandhian Anna Hazare is going around the country with a whip in his hand looking for persons who like their drink. What would I do if faced with this spectre? I would humbly request him to taste thimble full of wine before he takes up his whip. I am quite confident of winning him over.

Why is he so anti wine? Easy to understand. He has seen addiction to drink ruining families and thinks flogging is the answer. While not advocating that one should take to drinking, I am totally against this kind of thinking. This kind of puritanical attitude is going to draw people away from his movement to eradicate corruption. Instead he should advocate moderation and educate people not to become alcoholics. There is overwhelming medical evidence that small doses of alcohol is good for health!

The question is how small is small?

Nature’s culling

2011-11-24T09:41:00.000+05:30

Authorities in national parks allow hunting of wild life if they find one form of life exceeding the limits. This is called culling. This however doesn’t apply to us humans. We are at liberty to breed and multiply and test the resources of mother earth. This over populating the earth is in a way insulting nature. If you go by this yardstick human life is the most dangerous form of life ever evolved. Is there a scheme of things behind this profligacy? I wonder. There are different theories for the disappearance of earlier life forms. For example the Dinosaurs and the Woolly Mammoth. The dinosaurs became extinct after major upheaval die to meteor hit and the woolly mammoth because of rapid advance of ice age. If we are to believe there is an in built wisdom in nature which is not conditioned to safe guard human life, then I am afraid we are in for some form of correction which may well mean disappearance of humans. From the point of view of mother earth nothing much will be missed by the disappearance of this none too attractive a species. How will this be brought about?

Many centuries ago Rev Malthus propagated a theory that natural calamities like famine, fire or floods will correct the balance and the population gets naturally culled. This may still happen if you go by what is happening in Ethiopia where millions are dying or going to die if the rest of the world sits back and watches. A more likely event will be mutation of a run of the mill virus into a killer with widespread deaths uniformly spread throughout across all nations. Next possibility is nuclear explosion which will kill selectively and therefore unjust!

Going by the life span of stars and planets, earth has few more million years left before it gets blasted to smithereens. Therefore when doom is inevitable why worry? Get on with our wasteful ways and hell with coming generations of life forms.

Corporatization of health

2011-11-21T17:04:00.001+05:30

Indian government seems to have washed its hands off of providing health care to its citizens. Going by the evidence of measly allocation of funds in the budget for health and its acceptance of corporate hospitals to provide health care to its employees, the trend is firmly set that we are going the American way. What then is going to happen to the existing health infrastructure, the vast network of primary health care centers and secondary and tertiary care hospitals? If the present trend of encouraging corporatization of medicine continues it is inevitable that these institutions will gradually go to seed and one day will altogether disappear. Imagine the situation where in excellent institutions like AIMS [Delhi] PGI [Chandigarh] NIMHANS and Jayadeva at Bangalore deteriorating and becoming places where only destitute go!

Nations are spending a considerable percentage of their GDP on providing health care. As the population ages health care costs are going to go up and India is no exception. But neglecting government run institutions and encouraging private clinics and hospitals run by corporate and health management funds is the right way of providing health care?

Far from it, it is the worst way, especially for a poor country like India. Some you who are not Indians may wonder when I use the word poor to describe India. What you read or hear about India in the news and electronic media is all about the doings of the 5% of Indians who have done well for themselves.

This 5% is what the corporates are interested in. This 5% consist of the upper middle and the rich. Our politicians [even the grass root ones], beurocrats belong to this class. These are supposed to use the health facilities of the government. Hardly anyone does this and all of them with rare exceptions make a beeline to corporate hospitals when they fall sick or even for their routine health checks. If the top echelons of the government have no confidence in their own institutions how can one expect the ordinary citizens to have any confidence? They too will and have to go to these privately run institutions.

With increasing play by the private sector, falling ill has become a risky proposition. Let me explain. As the private players are mostly businessmen/venture capitalists/health management funds, the end point of their venture is to make money. They are not doctors who are supposed to think of patients welfare first and money next [many doctors too are becoming money first and health next thinkers]. They think of maximum and quickest return on their investment. If the investment is on building they will look at how much a square foot of the building will earn, if it is bed how much a bed will earn, or if it is human in the form of a doctor how much this doctor will earn for them. That is how they look at each item as money earners. Let us say the expected return on a bed is x amount in a year and the year end sees that bed earning is less, then the hospital administrator is pulled up and he in turn will pull up the doctor. The doctor who is so pulled up for not providing the hospital with enough business will either has to quit or adopt methods which his famous Hippocratic oath forbids him to. Most doctors are not in the real sense businessmen to begin with but they become one due to this kind of pressure. So what happens is this. When a patient goes to a corporate hospital and sees the doctor the first likely thought that comes to the doctor is how much I can get out of this patient and not what might be wrong with the patient. This attitude I am sorry to say is widespread and leads to lots of unnecessary investigations and procedures and needless hospitalization.

The sucker is the hapless patient. If he belongs to middle or lower income group, these institutions will make them feel that death would be preferable than the torment of raising sufficient resources to meet the expenditure that a hospital stay brings on.

This fear has led to the mushrooming of health insurance industry. This is another sordid story. Between corporate hospitals and insurance companies there appears to be a cozy relationship. It is not uncommon to hear the hospital reception asking the victim whether he is insured or not. If he is uninsured the smile of the receptionist is likely to be replaced with a frown. This is because you are likely to opt for less paying bed and at the time of discharge haggle, ask for concession, create a scene or as it happens occasionally, simply abscond!

So what is the solution? May be in the next write up.

Ganpathi Bhat Hasanagi

2011-11-09T16:09:00.001+05:30

There are some who strike you as brilliant at first meet. Most don’t. Meet could be personal or distant. In music, art, sport, it could be distant. I have written about personalities whom I have met personally and those whom I have not but have close relation through their work and performance. One such field where though I lack personal knowledge I have gotten close is in the field of classical music. I have had occasion to write about Bhimsen Joshi and Gangubai Hangal [both of them no more]

Another such who is still relatively not so well known is Ganpathi Bhat. I am no exponent of Classical music. My knowledge is primitive but what I know is heartfelt. Many brush Gangubai off as singer with shrill voice. But to me she was manifestation of great talent and her voice played a minor role when I listened to her. When I first heard Ganpathi Bhat some ten years ago it was like a shock wave of pleasure hitting me. He has a rich voice, brilliant control and the variety he brings in without much ado is breath taking.

Those of you who love Hindustani classical music must listen to his music. It will be a divine experience.

Parsimony

2011-11-02T20:05:00.002+05:30

I got trained in the old school of thought as far as patient care is considered. There were several dos and don’ts that were dinned into our heads. Some of these were, don’t prescribe an expensive drug when an alternative cheaper one is available. The other is don’t investigate unless absolutely necessary. Always listen to the patient then proceed to examine and always try and come to a clinical conclusion. If you have to confirm do the minimum lab and other tests. When you are in doubt get another opinion.

These principles have stood me and my patients in good stead over the years and saved us lots of head ache and money. But occasionally it has backfired, to give an example or two.

I am against routine annual medical examinations and investigations to all and sundry and with valid reasons. I consider these a waste of money. But when there is a definite indication to screen a high risk patient I do order the required tests. In this case the Youngman’s company does many tests as a part of the employee benefit and an electrocardiogram is one of them. He knows that I am against routine screening for heart disease in low risk groups and the youngster was one such. He reluctantly came and apologetically asked me to have a look at the reports. The company and done many tests which included an ECG.

The ECG was abnormal. Though the rhythm was alight the rate was very high. Even if one gives margin to the fear of doctors and machines many have with the resulting increase in the heart rate, this kind of increase was a cause for concern. The report just said sinus tachycardia and the physician who signed it had not bothered to see the patient. There was also a marginal increase in the levels of thyroid hormone.On talking to him I realized he had lost weight, had been having some diarrhea and when I examined him he had a heart rate of 130 beats per minute. A repeat test for thyroid function revealed he had increased activity of thyroid gland and this was duly treated. Had he not done the annual tests would he have come to see me? Probably not immediately but would have because he was concerned with his loss of weight. He would have come much later when treating him may have become tougher than it did.

Another patient this time a friend of mine, who by nature a thrifty sort of a fellow [there is a very thin line between thrifty and miser].He tries his best avoid consulting me [read paying me]. He also treats himself with some success. He had symptoms of hyperacidity a year ago and as his usual antacid failed to help he sought my attention and I advised him to take a course of different class of anti acid drugs and get back after six weeks. He got better and did not get back to see me. When I met with him on the golf course he said he was well but once in a way he has to take the medicine. This worried me as at his age one should not have recurring symptoms like this. As the golf course is not the ideal place for a professional consultation, I asked him to see me in my chambers. This he did when his wife came to see me, he sort of hitched a ride.

I found he has been taking the medication prescribed and managing. Though there was nothing much detected on physical examination I told him to get an endoscopy done to have look at what his stomach looks like [this meant going to the hospital and getting a flexible tube thrust down the throat right up to the stomach, a not very pleasant procedure but was needed]. He said alright and went away. He did not go to the hospital. He came three months later with worsening of symptoms. I had no doubt about the diagnosis. He had cancer of the stomach and further tests including the endoscopy showed the cancer had spread all over. He does soon after.

Looking back I feel guilty for not having insisted that he get the tests done. I could have told his wife and she would certainly have succeeded in getting the tests done. Would he have survived had the tests been done six months earlier? Yes he would have.

There is a saying that you can take the horse to the water but you cannot make it drink it. Sometimes it is difficult to force the issue. But difficult or not I should have done it and he would have probably few more years of life. Now I am carrying this burden and it will be with me and his face will keep coming to haunt me, may be, till I die.

Another patient and another time. This person was a medical shopper. He saw many doctors and I was one of them. He had painful sensations on the skin of his thighs extending down to the calves. Only sensory involvement of pain sensation carrying nerve fibers may be due to many causes and cancer is one of them. He was a smoker and on testing he was found to be a diabetic. I was happy because diabetic neuropathy is very common and good control of diabetes will help. He was told the diagnosis. He appeared happy that a cause was found and went with the diet sheet and prescription. For three months I did not see him. When he did come he had with him records of three other doctors, one of them a homeopath. His diabetes was under control but his neuropathy [pain] had worsened. A neurologist who had seen him had done a scan of his spine and brain with no abnormality. Now he also had weakness and loss of weight which was attributed to diabetes. What is this patient’s illness?
I expressed my worry about cancer to the patient and told him to get a PET scan [an expensive test but will reveal cancer activity] of his whole body. After much deliberation and visit to another doctor [fortunately he too advised the same] this test was done. A tumor was found in the patient’s intestine [ceacum]!
Though nearly six months had elapsed from the onset of pain in region far removed from the place where the cancer was, it was found to be operable. The patient lived few more years but died due to recurrence. Here again if we had forced him to do this test and the diagnosis had been done early, may be, he would have lived his normal span of life. All of us [many doctors whom he went to] thought that diabetes is the cause when all the time it was cancer. This episode too has remained in my memory but does not haunt me as the other one does.

Despite this experience I stick to the principle of investigating only when necessary. But as you can guess, I have started forcing and even threatening them with dire consequences if they don’t follow my advice. Once bitten twice shy, that is what I have become.

Medicine is, in many ways, a cruel profession. You may be right 99 times out of 100 but you remember the 100th because willy nilly, you were responsible. And to the patient who suffered it is 100 percent.

Blood sport

2011-10-26T19:21:00.001+05:30

In ancient times Romans would set humans against animals and watch the resulting gore from specially built stadia. Next came the era of gladiators who fought against each other to the merriment of the audience. That tradition is even now seen in the form of bull fight. The bulls don’t fight; they are killed after getting them so tired chasing a red cloth being waved by the modern day gladiator called a matador. Bulls occasionally behave in a wayward manner and succeed in attacking not the red cloth but the matador. This element of danger is what interests the audience and the ultimate killing is done by piercing the brain of the animal. One of the most brutal of sports practiced in modern times is this so called bull fight.

Next in order is boxing where two humans fight each other. Elaborate rules and gear makes this less bloody than killing the bull but fighters can get killed or maimed for life. The famous Mohammed Ali suffered such severe brain damage that he became a cripple in his middle age. But the sport is quite popular and even Olympic games have this and that too in many categories depending on the weight of the participants.

Next comes car and motor cycle racing. I just cannot understand the popularity of this sport. If impending death is what one wants to watch and call it sport you have a perfect example of this in motor racing. The recent tragic death of two young men, one in motorcycle racing and another in car racing seemed to have heightened expectations and popularity. In our country, the land of ahimsa, a huge track has been built in Noida and we are going to have this bloody sport pretty soon. The likes of Tendulkar, Yuvraj Singh and co seem to think that this s sport they should support by buying teams!

Horse is wonderful animal. In grace and bearing I don’t think there is any mammal which is as good looking [including humans] as a horse. What have we done with this animal? We train it to race with a man sitting on the top and urging it to run faster by beating it’s haunches with a specially made strap. And thousands throng to watch. Society women use this as an occasion to show off their costumes and head gear. But again the popularity is partly due to the element of danger where in, the horse as well as the rider may come to harm.

Of course there is an element of injury risk in most sports except probably in table games. Most sports need skill, stamina and fitness and provide pleasure of a different kind. The pleasure is that by taking part in the sport you are actually experiencing pleasure which is based on skill and stamina. The perfect example of such a sport is Badminton. One should watch the likes of Dan of China and Wie of Malaysia playing against each other. It is impossible to believe that a human being can be so fit and agile. There is hardly any threat of someone getting killed playing Badminton, ping pong or Tennis.

As sport loving people we should stop watching motor racing, horse racing and boxing and shift to watching other sports even if it is twenty twenty cricket !

Nostalgia

2011-10-26T10:40:00.002+05:30

I miss lot of things of yester years. I wrote about the joy of cycling without the fear of being run over. We could go to concerts and plays without worrying about the traffic, parking problems and the hassles of returning late in the night.

The concert in my very young days was a kind of musical dance drama called Yakshagana. The characters would dress in the gaudiest of colors and costumes with elaborate head gears. They would have bells tied to their ankles.There was an accompaniment of song and storytelling with the beat of drums. The performance would begin late at night and go on till early hours of next morning! It combined elements of song, dance, theatre, music and storytelling all in one show. It was superb and held us enthralled for more than 8 hours! The truncated from is still widely prevalent in the coastal districts.

The same applied to classical music, it would start late and end may be six hours later. The singer and the audience were one in appreciation of each other. Such spectacles which were common 50 years back have virtually disappeared now. Modern day classical concerts last not even three hours and in one performance some time ago the artist Amjad Ali spent more time tuning his instrument rather than playing it! I thought with the advent of MP3 CD I would be able to get music which lasts for many hours. By this I mean, a single or two ragas elaborated over three to four hours. My search so far has not succeeded.

Foot paths were foot paths then. They were even and one could walk on them. Now they are either used to park vehicles are dug up and we have to walk on the streets and run the risk of being run over. Many, especially the elderly are forced to stay home and rot. Even the simple pleasure of a walk is denied to them.

All this, we call progress and this consumerist economy is driving this society crazy.

Unsafe Nation

2011-10-26T10:10:00.000+05:30

A senior police officer, who was a patient of mine, once told me how easy to hoist a case on any citizen in this country. He even told me how. ‘Suppose I don’t like you and want to trouble you, I will tell my subordinate to book a case of traffic violation on you, that you have not even taken your car out is not the issue. To prove that you did not violate the rule you will have to prove this in front of a magistrate and the case cab drag on for years’. Worse still, he said, he can get me involved in more serious cases of violation of civil and criminal law and the onus of proving innocence is on me. Therefore most people don’t want to even remotely to get involved and if they do they will some have to pay a heavy price in terms of money, time and mental torture.

This is what is happening to Arvind Kejriwal, Kiran Bedi and co who are fighting the UPA government. Swami Agnivesh, who I thought was a man of character, proved to be such a disappointment. I liked best Anna Hazare’s statement,’ you cannot get a bunch of roses without the thorns’

I hope the vilifying propaganda by the likes of Digvijay singh and likes will not succeed and the common man will, when the time comes to cast his vote against the UPA.

But then who will he vote for?

Rural hell to urban hell

2011-10-18T18:58:00.001+05:30

I remember the days when I could cycle from one end of Bangalore to the other end in 15 minutes. That was 50 years ago. Today I cannot do it at all by the bicycle. At this rate of monstrous growth, this city is going to kill itself in another twenty years. It will be impossible to provide the basic civic needs to this large number of people spread out in 50 km radius by our none too efficient civic body, the BBMP.

Many so called people of vision see the inevitability of our towns and cities growing bigger because of migration of people from rural to urban locales and they even recommend an urban based economy. These include the likes of Nandan Nilakeni and the illustrious Narayan Murthy. This inevitability is due to ambitious youth whose numbers make 70% of our population. These young men are migrating to towns and cities in search of better living and more opportunities.

What is the result? Our towns and cities are becoming quagmires of dirt and decay. Our rich and the powerful are hiding behind huge fortress like compounds with security guarding their privacy away from the environmental muck that surrounds them. Most migrants end up as labourers of one type or the other serving these powerful few.

Is this what we want for our country? Is there no way to prevent this migration? Or is it inevitable or even desirable that people move out?

I am not an economist or a town planner. I only write about what I see and observe. I observe the development of a greatly demeaning society because of this migration. My gut feeling is that if we don’t reverse this trend, our towns and cities will die due to lack of resources and poor management.

How can we reverse this? There are some thoughts. These may not be original ones but they keep on occurring to me whenever I think of the rural poor. The minimum wages must be guaranteed as it is being done in the cities. Increasing the job opportunities in the villages will help to reverse the trend. This can be done by major changes in our agricultural policies. The farmer must not suffer and farm produce must get the right price unlike now where the middleman gets most of the money. Rural overpopulation leads to migration of excess labor. Limiting numbers must be our relentless drive. No one in right sense will leave a comfortable rural life to a life for a poor quality urban life merely because of the so called attractions of urban living. They are coming to the towns and cities because our rural economy is failing to provide jobs.

They leave and make the rural economy suffer and clutter and destroy the cities. Bangalore is one such prime example how this can happen in one's life time [mine]

Relevance of Gandhi

2011-10-03T20:20:00.001+05:30

Yesterday was Gandhi’s birthday and country celebrated it the usual way. Another holiday to the burgeoning list, no alcohol sold, processions, speeches, garlanding of Gandhi statues and the like. Came evening all were back to their typically ungandhian ways of living.

If there is one country where Gandhian values are practiced least, that is present day India. Let us take one by one. He preached nonviolence as the credo of his life. We have become violent and growing more violent by the day both in verbiage and action. Our movies preach violence and our politicians condone it. Mafia dons and Goonda bosses are given tickets to contest elections by major political parties.

Next in the line of importance of Gandhian teachings was communal tolerance and harmony. He gave his life for this cause. Many are not aware that he was a deeply pained man at the time of Indian independence. He did not want this kind of independence where men of different religious faiths butchered each other. Now not only this intolerance exists but has extended to different sub sects and languages. The major political parties, in Gandhi’s name are actually fostering this and today the country is deeply divided on communal cast and language lines.

He preached minimal needs and manual labor. What do you see around now? Conspicuous consumption and possession of materilals.No one wants to use his hands which include all classes of people. Everyone wants a white collar job. Man who walks wants a bicycle, a cyclist wants a two wheeler, a two wheeler guy wants a car, a car owner wants two of them and better ones. Same applies to money, clothing, jewellery, house and what have you. He advocated spinning yarn as the best mode of providing millions of jobs. Today who wears Khadi? It has become a dirty word as our politicians wear it to show off!

He did not believe in going to temples to prove his piety. But he led the socially oppressed to gain entry into our sacrosanct temples. Untouchability still exists if not visibly but in the mind of people.

Gandhi’s dislike of alcohol was more to do to its capacity to destroy and degrade human life and not because it was bad [it is bad, like too much of food]. In fact his close followers, Maulana Azad and Pandit Nehru were not averse to an occasional tot. Where are we now? every nook and corner we have a liquor shop and Hooch is freely available.

He advocated personal and environmental hygiene and practiced it and preached. We have the worst sanitation and environmental pollution in the world.

Of course he had his quirks. The major one was his advocacy of celibacy as a method of limiting family and was against family planning methods. I am sure he would have changed his views had he been alive.

He probably would have agreed to industrialization where ever it was absolutely required. He would certainly have objected to the loot of our natural resources. Had he been alive he would object even to the export of stones, let alone mineral ore.

So, year after year we celebrate the birthday of this man and venerate him. But follow his teachings, we shall not or will not. As one of my good friends said half in jest and half mocking my stupid idealism,’ he is irrelevant in today’s world’

Élan

2011-09-28T18:12:00.000+05:30

This is the only word that aptly describes Mansur Ali Khan Pataudi. The title nawab sat lightly on him. I remember him as a cricketer and gentleman who taught Indians to fight to win. He groomed the likes of G.R.Viswanath and helped them become great cricketers. He did not know how to play politics and could never do zee Huzoor to anyone. He had this in built flair and style and it showed in his cricketing and personal life. I don’t think he did any work at all after he left playing cricket and our board which is busy politicking did not find it necessary to make use of his services. Not that Pataudi minded.

His passing away brings to an end an era of gentlemen playing cricket.

Shot that pleased golf gods

2011-09-27T20:37:00.000+05:30

Each year the US PGA golf tour culminates in Federal Cup, the richest prize money event in golf. This year it was for a purse of ten million dollars [How much it is in rupees? Fifty crores?]. It is not the money that provided the excitement but the way the final holes were played. When the 18 holes were played out there were two players who tied at minus 8. Hunter Mahan and Bill Haas. They had to play a sudden death playoff. The designated holes were 18th and the 17th. It did not matter if Hunter Mahan won, he would get the cup but not the money, but it mattered to Bill. If he won he would get the cup and money as the accumulated points would put him in the first place.

The Drama began with the first playoff hole; the 18th is a long and tough three par. Bill was first to tee off and his shot went right to the right side of the green behind a bunker and landed in light rough. Mahan was next. His shot too went right into a bunker. Both hit great shots and parred the hole. They walked [buggy ride really] to the next playoff hole 17th. This is a difficult par four with water on the left and bunkers on the right. Bill’s drive found the right side bunker and Mahan’s long and perfect drive found the fairway and he was just 100 yards from the green. Advantage Mahan. Bills shot from the sand hit the sloping green and rolled over the edge to sit in water, half of the ball visible. Bill only knew that his ball had gone to the water and maybe he would have to take a penalty drop and thus lose the match and everything else. Mahan’s shot ended some 20 ft from the pin. Both players walked to the green and Bill to where his ball lay.

He now had a shot some twenty feet to the pin. The ball is sitting half in and half out surrounded on all sides by water. Facing him, a steep up slope and then five feet of green and then the pin. He now had to play one of the most difficult shots in golf. Even to get it up on to the green would be considered a great shot. Bill went down with one foot in water and the other just out, hovered his club face and then hit the water. The replay showed a sheet of water propelling the ball up and out in a beautiful arc and landing two feet away from the pin and stop dead. He got his par and so did Mahan and then in the next play off Bill got his par and Mahan a bogy and thus Bill Hass watched by his illustrious father Jay Hass won the trophy and prize money.

I have seen many great golf shots but this one is probably the best I have ever watched.

Full Circle

2011-09-21T18:39:00.001+05:30

‘No, it is not he, it is I who wants it’, she said. A statement of bare fact which took my breath away though this was uttered 35 odd years ago when the age of permissiveness had not as yet set in. I thought then [now I know better] that it was the boy who wanted it more than the girl. So I asked this 17 year old that does she know the consequences. She replied,’ yes I know. I have to have it. I think of that day and night and it is interfering with my sleep, my studies and I am snapping at everyone around me, and I don’t want to become pregnant’.

So this teenager has come for advice on contraception and not to listen to stupid moral advice. Like a good lawyer who accepts briefs with the belief that all are innocent till conviction, I too offered her the advice. She went beaming.
Miss K is from a fairly orthodox Iyyer Brahmin family and they were my patients for some years then. A few months later Mr S father of Miss K, came to see me. He was obviously was very worried. Though I could guess the reason for his coming to see me, I kept silent as to the meeting his daughter has had with me. Doc,’ I am very worried about my daughter, she is into bad ways’. I thought the next thing that he will tell is that she has become pregnant. Instead he said she is moving around with a Christian boy.

Patients come to us doctors not necessarily for medical advice. Often we act as counselors to the family. I knew then that Mr S has two worries. One is that his daughter may land in trouble and second is that the boy is a Christian, a major disaster for an orthodox Brahmin [vice versa is also true].’ Is he a bad person,’ I asked him. ‘No doc he is nice and well mannered and we all like him, but she is too young for this sort of thing’. ‘What sort of thing? I asked. He kept quiet. I wanted to reassure him that there is no possibility of her getting pregnant but did not want to let the cat out of bag, so kept quiet. He requested me to talk to his daughter about the danger and after getting an assurance from me, he went his way.

Couple of months ago a middle aged lady traditionally dressed, came to see me. She could make out that I did not recognize her. She said.’ I am K. daughter of Mr S, we used to see you many years ago, remember’. Of course I remembered. Obviously she had not married that Christian boy [I could make out by the typical Hindu style of her bearing]. Still I asked her. She said,’ that useless fellow, he had no guts, I did well to break that relationship’.

I did not ask any further questions about her past. After a momentary pause she said.’ I have a teen aged daughter, who is going around with a boy, and I want you to give them advice as you did for me, it was a great help’. Unlike her father, K had not a bit of worry on her face.

I became a witness to a full circle of similar events.

The problem is food

2011-09-04T18:55:00.001+05:30

Man domesticated animals and plants [animal husbandry and agriculture] between five to ten thousand years ago. Till then he did not know where his next meal was and when. Most of the food needs were met by gathering wild fruits, edible leaves, flowers, tubers [edible roots] small life like ants, flies, moths and bigger life like fish, birds, rabbits, deer and occasionally bigger animals. At that time the food was eaten raw. Cooking was the earliest form of food processing and probably it came into being only about 20,000 years ago.

Till the advent of Industrial revolution man ate more or less unprocessed food. Gradually over the past three hundred years the food that we eat has undergone a gradual change from unprocessed mostly cereal based diet to mostly meat based diet. This is true to western nations and not so much in eastern nations. The idea that meat based diet is healthy and cereal based diet is not healthy has taken deep roots in our thinking.

If you look at historically how the chronic diseases like diabetes, hypertension, ischemic heart disease, cancers and autoimmune illnesses have evolved, one can see a more than casual relationship to these changing food habits. In societies which eat more grain based, mostly vegetarian diet, the incidence of these illnesses is much less. Even in these societies one sees these more commonly in the affluent sections than in the less affluent. Take one example. Breast cancer. I have seen breast cancer rarely in a poor woman, whereas I have seen this in many in mid and high income group.

Why are we facing a sudden epidemic of diabetes in our country? Answer is in the changing food habits. There is a sudden increase in the consumption of processed, ready to eat food. People are also eating more that what is needed for them. 40 years ago, seeing a fat youngster was a rarity. Today every other boy or girl is fat. Too much food is poison.

Adding insult to injury there is hardly any exercise. We are obsessed with the scourge called automobile. Our life revolves around this ‘convenience’. That wonderful mode of transportation, bicycle, has almost disappeared from our roads. Even the poor no longer cycle to work. Even they are becoming victims to chronic disease and diabetes is not uncommon in the urban poor. In the earlier era when men walked or cycled to work, and women spent time washing, cleaning, preparing food without any mechanical aid, they kept good health.

There was no television then and people did not sit staring at TV [aptly called idiot box]. Those who watch TV should be called idiots.

Instead of changing our dietary habits and going back to grain based occasional or no meat diet with little or no processed food we seem to be hell bent on increasing our intake of ready to eat food. Food industry is a major player in keeping our bad habits growing. Ads for wafers, oils, butter, spreads, cheese and meat burgers, pies, biscuits and confectionaries, beverages, health drinks etc , bombard us day in and day out. Even us doctors don’t spend time in trying to change the dietary habits. We are more interested in treating the illness after it occurs than preventing it. Preventive medicine and epidemiology has hardly any takers.

Therefore my friends, if you want to remain healthy and enjoy life, change your eating habits. Eat a lot of fruits and vegetables, whole grains, limit your intake of diary and meat products, take an hour’s exercise daily and avoid watching television.

Attacks of sophistication

2011-08-30T16:50:00.001+05:30

‘Doctor, I have sophistication in my chest,’ she said pointing to the middle of her ample chest.

I have realized in my rather long life of patient listening, not to interrupt. ‘They come and attacks, I cannot work, I feel my legs arms die, I shiver and shake and I no get sleep’ she stopped. I was about to ask her for some details of this weird set of complaints, when she said, ’han, I also have bumps here pointing to a bit lower part of her chest.

I found her to be recently married and she was being treated for polycystic ovarian syndrome. For the past twenty days she has been taking 500mgs of Metformin daily. Metformin is a drug given to bring the blood sugar down in type2 diabetics and also in women who have polycystic ovaries. Though dietary measures, exercise to reduce obesity are better and more successful methods of treatment, doctors are wont to prescribe this medicine instead of the laborious process of counseling to get the weight down which is the culprit.

All her complaints were due to the blood sugar lowering effects of metformin. Her suffocation [sophistication], dying of legs and arms, shivers, bumps [belches and a sinking feeling in the pit of the stomach] were all due to hypoglycemia [low blood sugar levels]

Fortunately she was not fasting like Anna, that would have been a disaster.

She became normal soon after she stopped metformin and her attacks of sophistication and bumps disappeared.

Anna's victory?

2011-08-30T16:22:00.001+05:30

Amidst the din of euphoria following Anna Hazare breaking his 12 day old fast, if one looks closely one would realize that the civil society has not really won its battle. Its demand that only their version of the bill be passed was not agreed to. Their demand that the bill be passed without reference to the standing committee was also not acceded to. So also was their bill to include the PM. All that the government did was to agree to consider the Jan Lokpal bill along with the other versions and then bring in a comprehensive bill which will be placed before the committee and then before the parliament to make it into a law. The demand for a time frame too was not agreed to.

Then what did the movement and Anna Hazare’s fast achieve? It showed the government that the people of this country are indeed fed up with the poor governance and the indifference that they are being treated with by the beurocracy and politicians. That is what made the likes of Manish Tiwari and Kapil Sibal disappear from the scene in a hurry.

I was witness to the JP movement which Madame Indira Gandhi ruthlessly suppressed in the seventies. Popular sentiment was against her and she lost the elections. Then what happened? The stalwarts of the JP movement took the reins of power [Janata party rule]. Within two years they proved to be worse and Indira came to power again. Hopefully we will not have that again.

Having said this I don’t want this anti establishment [anti corruption, effective delivery of services, electoral reforms, decentralization of power] movement to lose its tempo and die down.

Aside: How is it that Anna with hardly any resources, managed to get so many followers? It is because of the congress spokes persons. Every time Manish Tiwari spoke 20,000 volunteers joined, when Kapil Sibal spoke, 50,000 did and when Ambika Soni spoke 100,000 joined. Saving grace was that Jayanthi Natarajan did not speak. Otherwise the whole country would have been on the streets!

Anna's fast

2011-08-25T20:38:00.002+05:30

Occasionally it gives me great pleasure to be proved wrong. It has happened in the past like when, the huge lump I felt in a patient’s abdomen was proved non malignant or when the patient with a strongly positive treadmill test had normal coronaries [arteries that supply blood to the heart]

When Anna Hazare began his fast, I felt it will not succeed because the masses of this country [aam admi] are so emasculated by the 60 years of stifling rule by the Kalas [to use Anna’s famous words, Gora gaya Kala aya]. It is the 10th day of this remarkable man’s fast and it appears as though he is succeeding in achieving his immediate goal of getting the parliament to debate his Jan Lok pal bill. When the bill becomes a law I am certain it will not be the same as his version.

The Kalas [meaning beurocrats and politicians at all levels] who are enjoying the power of corrupt rule and feel safe with the prevailing regulations not able to get after their ill gotten wealth, will move earth and heaven to prevent an effective deterrence to corruption. It is not just this, there are so many more. Delivery of health care, basic sanitation and water supply, conservation, building and maintenance of our roads and rails and host of others. It is just not enough if one is honest [a la Man mohan Singh]. One has to be efficient and decisive, qualities sadly lacking in the present day rulers.

There is a long and hard struggle ahead to change the basic character of the people of this nation.

[Gora is the Hindi term used for white and Kala is for black. What Anna means is when India became Independent whites left and blacks took over and the country has remained suppressed, now by blacks [Indians]]

Frightening

2011-08-22T17:12:00.000+05:30

‘Doctor, one new problem’, she said with a beaming smile as though she has won a trophy. ‘What new problem,’ I asked with concern that must have been visible on my face,

‘Don’t worry, it is just a little BP’, she said. She had found it out when she went her doctor in the neighborhood for having felt dizzy.

Esther Nirmala is now a 50 year old grandmother. She is 5’2” and weighs 90 Kgs. Unlike other obese women she is solid and carries this weight with unusual grace. I first came to know her when she was a schoolgirl 35 years ago. She belongs to a family which has a mixture of Hindus and Christians. Her parents were Hindu, her uncle and aunt Christian, her elder sister Christian, brothers Hindu and she married a Christian, Magnus Chetan. Nirmala herself is more Hindu and becomes a Christian when circumstances so demand. Like when her child should get admission or when she has to go a hospital. Most of the good schools and hospitals in the city are run by Christian organizations and she gets preferential treatment. But in day to day life she likes to be a Hindu. She usually wears bright red colours and on her forehead a circle of red kumkum [trade mark of a married woman]. This dual existence comes easy for her as it is a very mixed community she lives in. Once I had asked her about the church taking objections to her way ward behavior. She dismissed me with one word, they understand.

She could not finish her matriculation and soon enough found Chetan, another mix like her. After a few years Magnus alias Chetan moved away to gulf [where he still lives]. Nirmala lives in Bangalore and for years they have been meeting twice a year. This has resulted in two children.

35 years ago as it is now, the parents would get worried if the girl did not menstruate at a given age and it was a concern for the mother that at 16 Nirmala had not menstruated. Those days we did not have Ultrasound to diagnose but we could clinically recognize polycystic ovaries as the cause in fat girls. Nirmala was one such and I had cautioned that if this continues she may have problems. This bothered the mother a bit but not Nirmala. She went ahead and married her friend Chetan and even before the year was over became the proud mother of a baby daughter and in the course of next 5 years produced a son. Marriage causes problems for many but it corrected the errant ovaries of Nirmala.

She became a diabetic some 15 years ago. I don’t think her diabetes was ever under control. Her philosophy was very simple, go to the doctor when in trouble, Blood sugar readings mean very little to her. What she felt was more important. When I asked her what her blood sugar was. She said it was o k. knowing her I insisted, what is ok? 200 she said with a coy smile. [Meaning 200 mgs percent, way above normal but not threatening] I told her it is abnormal. She said a week ago it was 380! This is her usual defense, things could have been worse. Her whole attitude to life has been like this and I have given up trying to make her see reason. That she has lived 50 years without any major disaster is itself a surprise. But her wayward attitude worries me and whenever she comes to see me my heart beats a bit faster because I expect her to have some serious problem, given her background.

Now she is here with blood pressure. Raised BP and uncontrolled diabetes complement each other to destroy one health. I told her that and asked her to get some tests done. She had them already and showed the lab reports. They were not good. When I told her she should take additional drugs and diet more seriously, she conceded reluctantly. ’ alright, I will give up sweets’ she said as though she is making a big sacrifice for my sake.

Did it also mean she was happily eating sweets all along? You will never know with our Esther N.

Not once she showed any concern or worry and took my leave saying, you will see I will be alright in two weeks time’

This I felt was more to reassure me.

I wish I could have written all this in Tamil, the language between us, that would have been so much more fun.

Adithi Ashok

2011-08-22T16:05:00.004+05:30

Some time ago I write about our ace tennis player, Rohan Bopanna [Thursday,sept9,2010]. Now it is time to write about another special talent, her name is Adithi Ashok and her sport is Golf.

Golf unlike many other games is a game played against the course and sometimes yourself. It is also a game in which it takes many years to become a mature and complete player. This is because mastering the game, according to me is extremely difficult and needs lots of time and practice. Added to this, golf course designers are building courses which are more testing then ever and these are also playing much longer than ever.

Given this background Adithi’s performance is astounding. She came on the national scene just a year ago when she won the national amateur championships for all age groups. Two days ago she competed against the top professionals of the country and almost won. She lost in a five hole sudden death playoff. The pro tournament was held in one of the toughest championship courses in the country, KGA Bangalore, and I was one of the privileged witnesses to this remarkable performance.

Why is it so remarkable, it is so, because Adithi is only 13 year old, thin built, waif of a girl.

My reckoning is, if she keeps on like this, she will play the world’s ladies PGA when she comes of age and turns a Pro. I hope when that happens in 5 years time, my faculties will be sharp enough to appreciate her feats.

Pregnant women and exercise

My friend Sunder sent me the following one and my fellow golfers will understand and agree with the man, but other readers, I am not so sure.

The room was full of pregnant women with their partners. The class was in full swing. The instructor was teaching the women how to breathe properly and was telling the men how to give the necessary assurance to their partners at this stage of the pregnancy.

She said "Ladies, remember that exercise is good for you. Walking is especially beneficial. It strengthens the pelvic muscles and will make delivery that much easier." Just take several stops and stay on a soft surface like grass or a path.

She looked at the men in the room, "and Gentlemen, remember - you're in this together - it wouldn't hurt you to go walking with her".

The room suddenly went very quiet as the men absorbed this information. Then a man at the back of the room slowly raised his hand.

"Yes?" answered the Instructor.

"I was just wondering if it would be all right if she carries a golf bag while we walk?"

This kind of sensitivity just can't be taught.

It kind of brings a tear to your eye

TV Brainwash

2011-08-18T10:16:00.001+05:30

Ordinarily if you are watching any TV programme you are spending [wasting] an equal amount of time watching commercials. These try and sell products which we may or may not need in day to day use. I sat through a three hour programme and counted commercials which advertised absolutely necessary products. Don’t be surprised, they formed only ten percent. Most were unnecessary and some positively harmful.

Let me list the harmful ones. The pride of place goes to food products. These range from soft drinks to chips and chocolates. All contain refined sugar and fat or sugar alone with additives. Packed with easily absorbable calories they are tailor made to get you to become obese and if going by available evidence predispose you to cancer and cardiovascular disease. [The China Study: Colin and Thomas Campbell] Packaged foods, ready to eat mixes, frozen preserved meats are no good for health when compared to the naturally available fresh food. These are rarely advertised. Have seen a cabbage or cauliflower or tomatoes being advertised except when on display in a supermarket? There the ad is for the chain of supermarket and not for the product.

Next in the list are the body lotions and sprays. Human skin produces sweat and this secretion has antibacterial properties. The smell is odor is unpleasant is a phenomenon that is culturally motivated. Of course you don’t want it to crust and irritate the skin, so periodically one has to have a wash. But removing the sweat and worse spraying the skin with deodorants and scented chemicals [with a flock of woman rushing after the sprayed man] is positively harmful. This may cause skin allergies and invite other organisms like staphylococcus to colonize and cause furuncles and abscesses especially under arm. There was a time when one shot of penicillin would make these disappear but now this common garden variety of germ has become a killer.

Whitening the skin creams take the pride of place in commercials. This is specially targeted at women. Why is it considered that a woman with pale skin is good looking beats me. Again it is culturally driven and the ads only help to keep this myth grow. It is nauseating to see this advertisement. So is hair growth and conditioning tonics. Mostly useless. But look at the number of men and women buying these products. As one senior marketing executive once told me that he can sell even a packet of saw dust with the right idea and image. This is true for most of these products. Saw dust is innocuous but I cannot say the same with these products listed above.

There is an obnoxious advertisement for skin itch in the groin area. This is usually due to a fungus common in the groin area. Though difficult to eradicate it is easy to treat with antifungals. But to advertise like this is positively in bad taste.

We are blessed with abundant health giving sun light and dark skin to counter the effects of excessive sun exposure. We are not satisfied with this nature’s protection. We are forced to use sun protection creams. Except when one has sun sensitivity or when there is danger of sun burn, one should not use sun screens routinely as it will stop production of much needed vitamin D. As it is we are seeing vitamin D deficiency syndromes in many office going men and women especially those who live in apartments.

When you have a perfectly working vehicle why do you need a new one? You need it because the TV ad tells you that your neighbor has one and your wife is goading you to buy one.

This list can go on and on.

My take home message to you is, if you have a gadget which deletes all the advertisements from the programme you are watching, please use it. Even better don’t watch TV at all. It will do your mind, body and pocket, a lot of good.

Return of Anna

2011-08-13T18:14:00.001+05:30

Anna Hazare is a rare human being. Such men and women got us our freedom from the British who knew that they have to leave sooner or later. British rule was for the benefit of Britain and not of India. The design and purpose of rule was to exploit the country’s resources. The institutions they built had one single purpose, which was to serve the mother country. This they did with active connivance of us Indians. Indians never in their history thought as one nation. There was no unifying force or a common cause which united us against the three hundred years of British rule. For majority of Indians it was just another ruler out to exploit them. That some good came out of the British rule is not to be denied. We got the railways, unified system of currency, Banking, an administrative machinery, survey of the country and records, a system of revenue and judicial administration, thanks to the British. All this was done in reality to benefit not Indians but the British. History is replete with examples of how methodical and ruthless this exploitation really was. But they were helped by our own people. The person who was financing the East India Company in its early years in Bengal was Marwari called Omi Chand [considered to be the richest person in the known world those days]. If one reads the well researched book, ‘Sea of poppies’ [author: Amitab Ghosh] one will come across innumerable examples to support this fact of Indians helping the British. Why did they do it so willingly? The answer is that they have done it since time immemorial. British were for them no different from others who invaded this country.

What this has got to do with Anna Hazare? What he is trying to do is what Gandhi did in the first half of last century. Make us think as one nation and object to exploitation. Corruption is one form of exploitation. Gandhi used communal harmony and nonviolent civil disobedience as unifying forces. Anna is using corruption. Is he going to succeed? Is it going to be a mass movement and change the politician and the beurocrat?

I very much wish this will happen. But my gut feeling is that it will not succeed. This is because corruption has come to be accepted by most that matter. These form the top ten percent of Indians. The rest are so emasculated that they are incapable of rising against the rulers just like it happened when the British were ruling us.
Still it is good thing that we have left in this country a few persons who have the gumption to fight, even if it is a losing cause.

Cricket Ignominy

2011-08-13T17:36:00.001+05:30

As I write this Indian team is on its way to its third humiliating defeat in the four test series in England. Most of us cricket lovers who enjoy watching test cricket are dismayed with this kind of pathetic, dismal performance from a team which boasts of five world class batsmen and quality swing bowlers. Why did they fail?

Among other reasons, the main one is that there is no hunger to win. As I have written on earlier occasions, fat cats don’t fight. These players are a pampered lot with all the fame and money showered on them. There is no need to win when you are guaranteed a fabulous income. The Indian cricket board has used these players to make money is the common complaint, but then what about the players? Should they not object to this too much cricket? Why do they acquiesce to the unreasonable demands of the board? They do so because of greed.

These defeats should make the board and players realize that they cannot take us, the viewing public and patrons of cricket, for granted. The first step would be to stop the silly form of game called the twenty twenty cricket. This is destroying the true format of the game which is test cricket. Players who play twenty twenty cricket will not know how to play test cricket or if they do know then they will soon forget. This is what has happened to the test cricketers.

Injuries are a part of any sport. The more you play the more injuries you suffer. The greed makes them hide their injuries or declare them too late. This is why our bench strength is so thin.

I, though unhappy with the defeats, see a silver lining. This should make the board sit up and take notice of the deterioration of standards and the reasons why. I hope the paying and viewing public will boycott cricket matches and teach both the board and players a lesson.

Eventful afternoon

2011-08-11T09:29:00.005+05:30

It began with a game of badminton played with [against really] my regular partner Suresh James. Normally we play two games of singles and lately he has been winning. Getting beaten by a better and younger player is no shame if the games are well fought.But surprisingly this noon the story was different in that I played such a nice game that I ended up winning the two closely fought games lasting wellover 45 minutes.

Soaked to the skin with honest sweat and on a high [happens after a gruelling bout of excercise],I came home and casually switched on the sports channel,just in time to see Saina Nehwal playing against an Irish girl in the world Badminton championships.In two superlative games she comprehensively beat her opponent.This added to my high.

Went upstairs to the room to have a shower and change. Heard a rather strange fluty song. My bay window over looks a slender flowering tree with a crown of leaves and branches laden with flowers.This provides me with a daily dose of pleasure and today on it sat the singer, a Bulbul. I had written on an earlier occassion of my sighting and hearing the song of a Bulbul.But this one was different both in song and appearence. It had side red whiskers and a red vent with black brackets below the whiskers. This veriety of Bulbul is called the Red Whiskered Bulbul not ordinarily seen in urban areas.What a pleasnt surprise! My wife has been telling me that she has been seing a multicolored small bird hopping around and wanted to know it's name. Thinking that this was the one, I went down and called her to come up quietly and have a look. The bird was still there preening himself. Though fascinated, she said this was not the one she had seen.[I wonder if it is the common warbler that becomes coloured during breeding season, that she had seen?]. All of a sudden his mate [less colourful] appeared and both of them flew away.

Savouring this fantastic sight which added to my already high mood we went out and sat on the terrace to watch a display by a flock of pegeons which had landed on the terrace.She said,'there is so much we humans can learn from birds'. In one sentance she summarised the essence of bird watching.

This done, I did the set of muscle streches to ease the aches in the tired muscles and had the much awaited hot bath.

Topping it all, fixed a large single malt Scotch and listened to Bhimsen Joshi singing Rag Kedar for an hour.

Who is that fool who said life is not good?

Sonia and her cancer

2011-08-11T09:25:00.000+05:30

Sonia Gandhi is the most powerful person in India today. For those of you who don’t know who she is, she is the president of the ruling congress party and thus effectively the ruler of the country. She is also the wife of the erstwhile Prime Minister, late Rajiv Gandhi. In a country where your family antecedenents matter often more than ability, whether it is by birth or marriage, it is no surprise to see the rise of Madam Gandhi in the congress hierarchy. As I said ability apart, her son Rahul Gandhi is being groomed to be our next PM after the term of the stooge PM Man mohan Singh comes to an end.

She was diagnosed with cervical [uterus] cancer some months ago at Lady Gangaram hospital in New Delhi. This hospital is considered as the best in our capital and world class care is provided here. Then why did Sonia and her retinue choose to go to Newyork for the surgery and subsequent therapy?

There by hangs an unsavory tale. We have still not gotten out of the bias in favor of anything foreign is superior to what is available here. Be it a simple cataract surgery or an ordinary removal of uterus, we rush to US or UK for attention when these are done in our hospitals by the hundreds every day. In fact advanced care in all super specialties is available in out hospitals both in public and private sector. Sonia’s choosing to be treated in the US not only reflects poor national character but also is an insult to our doctors especially those who treat cancers.

What surprises me is that not one institution, political party, doctors organizations have criticized her!

My letter to the newspapers was not even published.

Cricket watch

2011-08-07T19:23:00.000+05:30

As I write this, the number one test team, India has suffered two comprehensive defeats from the English in England. I watched the matches. There were several reasons for the dismal performance. As captain Dhoni put it, the team was jaded with too much cricket and injuries to several top players. This is true but not entirely. The reason why is that Indians do not know how to play the raising fast delivery that goes up above the left shoulder next to the left part of the head. It is difficult to leave the ball and sway the head away from being hit. The only way is to duck under or hook it. To duck under is ugly but can be done if the ball is seen early and the batsman is quick enough. This we did not do well and some like Yuvraj Singh got hit and became non players for the series.

Next option and an elegant one at that, is the hook shot. To see the shot played to perfection is a rare treat not available in international cricket these days. The last batsman who was an effective hooker was our own Mohinder Amarnath. I remember way back in the early seventies when the West Indians toured India, there was a batsman of Indian origin called Alwyn Kallicharan. In the Bangalore test played at the makeshift Chinnaswamy stadium, I was sitting way up in the built up stands behind the fine leg. I don’t remember who was the hapless Indian fast bowler was [they were not really fast]. What I remember was the hooked six over the fine leg and the way it was done. Kallicharan went down on his knee and the next I saw was the ball coming towards where I sat. The shot was also played by swiveling on the left foot when the ball came up shoulder high. Another West Indian who hooked the ball was Cammie Smith. Smith’s carrier was cut short in an automobile accident. The great Garry Sobers too was involved in this accident but survived to play for many more years.

One does see a semblance of this shot played occasionally and the one who did play this recently was again another West Indian, Chris Gayle.

Kallicharan kept visiting Bangalore in later years, not to play cricket but to see Sathya Sai Baba!

Watching Cricket

2011-07-25T13:19:00.000+05:30

Experience of watching a cricket match is very different from that of watching any other game. In other games the excitement is constant as the players constantly strike the ball and thus the watcher too shares the excitement. In cricket the excitement is watching and waiting for something to happen. When that happens once in a while say once in a hour or sometimes once in a day when there are two set batsmen t who refuse to get out, the audience is left to fend for themselves. That is the secret of watching a cricket match. How one does it. Different nations do it differently and the ones I like most are the West Indians. For them it is fun time. Let the cricketers do what they want in the centre here we will have fun is their motto. As dance and music comes natural to them this is what they do and to see them swaying to music with a drink in their hand with happy grins on their faces is indeed a pleasure. Next best are the British. For them the waiting is in itself fun. I watched with fascination two women sitting with a contraption in front which held a bottle of Champagne and two glasses, oblivious to the others around. No jumping up and down or screaming for them. When a good shot is played the best they do is to mildly clap, that is, if the hands are free.

The worst, you have guessed right, are the Indians. They suffer the game. When their team is batting every run scored is cheered and when a four is hit they fall over with excitement. When the opposite side does well and scores there is deathly silence. Only an Indian can score well and play cricket and the others are there to provide opposition.

Sri Lankans too enjoy their cricket and are parochial but not as bad as Indians
I have not said anything about Pakis. They are even worse than Indians

Printer's devil

2011-06-21T13:09:00.001+05:30

We Indians love ostentation and pageantry. I have written about this on earlier occasions. This love is across the board. Poor people if unable to have the artifacts that make up the show would like to watch the wealthy and powerful decorated in them. One has to only look at the bejeweled Indian bride or Indian army general in his full regalia or a person about to receive a diploma from a university to appreciate what I am saying. The stage set for these ceremonies too reek of vulgar ostentation [vulgar to my eyes, of course].Talking about degrees and diplomas; there are two verities of these. One variety is that the person who is getting them deserves it because he has slogged and worked for it and passed rigorous examinations and has thus earned it. The other is that he has been awarded one. Those who belong to the latter class are interesting persons. They need to have one single qualification. That is they should have the proper connections, preferably political. Most vice chancellors of universities and each state has several universities, are political appointees and are thus amenable to pressure.

Let me give an example. Mr B is a two bit poet. But he thinks that having published few poems in the local daily and having given some lectures on the place of poetry in modern day life, thinks that he deserves to gel a hon. doctorate. He has his classmate, Mr C, who has become the state’s education minister. So he pesters the minister to recommend his name. For The education minister, this probably is the least troublesome request. He gets many more which are very tough to oblige. This one is too easy. So he shoots of a recommendation to the vice chancellor who is beholden to the government. So among the many, Mr B too is given a Hon Doctorate [D’Litt]. On the appointed day, an emotional Mr B accompanied by the admiring family and few friends goes to the venue. He is made to wear a ornamental gown and a head gear and the chancellor makes laudatory remarks on the literary achievements [speech written by an underling], calls him over to receive the scroll. To register the momentous occasion photographs are taken from many angles.

Mr B, then on becomes a firm believer in his literary merits and makes it point to drive home this to all and sundry who cares to visit him. His conversation begins with,’ you know when I was awarded to doctorate---.’ We have a flood of these doctorates. Film stars, politicians, social workers, artists and even professionals have become doctors of literature or Philosophy, and proudly display [prefix and suffix] these ill gotten letters with their names.

Some years back, a well known social worker’s name was recommended for an honorary doctorate. He was an exception to the rule; in the sense he really deserved it. He came to know of this. Instead of being happy he got worried and wrote to the university to please not to honor him. Those close to him told me that he felt that the work he is doing gets downgraded if he accepts this award!

Talking about earned and unearned degrees, we doctors are no exceptions. We know a large section of our clientele get impressed with our qualifications. We also know that hardly any one checks what the letters in front or before the names really mean. Usually, M.B, M.D, M.S D.M, MCh, DNB, PhD are earned qualifications in India. M.B. MRCP. Phd are earned ones from the UK. In the US one’s qualifications are rarely displayed. For them a simple MD will do. But here we can get any number of degrees and diplomas by virtue of being in the profession for some years or by paying a fee. FRCP,FCCP. MCCP etc .etc. Some doctors have a penchant for acquiring these hon. diplomas in addition to their real earned ones.

35 Years ago I was an office bearer of the local medical association and we had a president whom I will call Dr P. This doctor P was a well qualified specialist with both Indian and foreign [earned] degrees. But he like the others also had a string of other diplomas next to the ones earned. These letters occupied the top line of his letter head.

We organized a major conference and I was the organizing secretary. We had to get some stationary printed giving the conference details etc. Those days printing was primitive compare to the present day. Composing was a laborious process and was done by hand. Based on the recommendation of the president who used to get all his work done by a particular printer, I went to see him with my order. Before placing the order I wanted to see samples of his work. He knew I had come with recommendation from Dr P. So he began showing the samples and the first one he showed was Dr P’s recent letter head. It read, Dr P………….M.B.B.S, M.D, M.R.C.P, [UK] F.R.C.P, F.C.C.P. F.U.C.K [UK] F… etc etc, occupying the whole top line. Intrigued, I asked the printer what these letters F.U.C.K meant. He said.’ I don’t know sir, I have been doing work for doctor for many years and don’t know the details, you should ask the learned doctor, he has so many of these.’

After a few days, I had to meet with Dr P in his chambers in connection with the conference work and I asked him about this special qualification of his, that too from UK. Taken aback, he took out his letter head and there it was for all to see, F.U.C.K [UK]. How many years this printer’s devil had gone unnoticed, even the good doctor did not know.

I leave it to your imagination what followed.

Recollecting this brings on a smile even after so many years.

Female feticide

2011-06-15T12:21:00.001+05:30

Readers of my blog are aware of my irritation whenever a mention is made of my country is progressive and is going to be a super power in the years to come. I have often written the reasons for this. One more addition to this disgust.

Couple of days back the newspaper carried an item of finding ten dead female fetuses. Imagine this scene where a mother agrees to kill/abandon her own baby just because the baby is female. Ten mothers must have done this at one time and apparently it must have been from an institution based facility. This attitude is not confined to economically and socially poorer section of the society but is spread across the board. The rich and well off resort of feticide in utero by getting the sex of the child determined by sonography. The law does not permit determination of sex this way. But who cares for the law in this country?

Why is it so? The reasons are mainly economic. The girl child is a burden as she is not going to be economically or educationally empowered. She will remain illiterate or semiliterate and will await her marriage [ultimate doom or salvation].The rich too feel the female child a burden because of the same reasons. They spend enormous amounts of money in getting the girl married and often even educated girls are victims to this malady.

What is the solution? Economic empowerment and a movement to boycott ostentation in performing marriages is required. Women should learn to say no and should not consider marriage as an end all of life.

The best example of social empowerment of women is seen in Kerala. Matriarchal society, women’s education and employment have resulted in their social and economic emancipation and there is no reported case of female infanticide in Kerala.

There is already a skewed sex ratio in the BEMARU states. If you take the census of younger people it must be worse. There may come a time when like Draupadi [one of the main characters of Mahabharata] a woman may have to manage many husbands. Worse still is the scene where like water wars, women wars may be fought amongst men. Will the status of women get better then?

I wonder.

Reminisence-4

2011-06-06T18:02:00.001+05:30

It is nice to write about nice things and events that happened in your past. But it is not so when you write about unpleasant events. Also one has to be dispassionate which is difficult if have witnessed them and also suffered the consequences of such events. Most of the years between 1966 and 85 have been years of suffering for us Indians. When I say Indians I mean law abiding, taxpaying ones. The one person who is most responsible for this suffering was Indira Gandhi.

I have vivid memories of many of her misdeeds. The outstanding one was not her declaration of emergency but of my old mother standing in the long queue for daily necessities such as soap and tooth paste in front of the so called fair price shops. She coined many catch words which she used liberally to hood wink all of us. One of her favourite one was called garibi hatao. Garibi hatao is a Hindi sentence for removing poverty. Who wants to be poor? So when she said that all the poor persons, and their numbers were much more than it is now, felt here comes a savior who is going to get them out of their misery. They even went to the extent of calling her Indira Amma [mother]. But what this amma succeeded in doing was to spread the poverty and not remove it.

She considered that ends are important and not the means. This led to wide spread corruption and probably she was responsible for institutionalizing corruption and what we see today as the greatest danger to our lives began during her regime. Another scene that haunts me is the hordes of slogan shouting hired persons [hooligans] ferried to where ever she was speaking. The going price then was ten to fifteen rupees. Now I believe it is two hundred! This paid crowd gave an impression of her immense popularity. Our entrepreneurs, businessmen soon realized that only way to survive and prosper is to tow the line which strengthened the license and permit raj and a pliant corrupt beurocracy helped her do what she wanted in the name of socialistic progress. A fledging business house which knew the ropes managed to import an entire factory as scrap metal and get away with it. Many who had no scruples prospered at the cost of those who could not or would not do this. Many of the big names in Indian business today owe to the policies of the then Government of Madame Gandhi for their success. The beurocrat and the politician ruled the roost at the cost of common man. Poverty was visible everywhere. It was common to see nearly naked people going about [less common now].Nutrition status was worse than it is now [even now it far from satisfactory]

Was there no one who protested? There were and the frustration of the people took the shape of Sarvodaya movement under an old Gandhian and erstwhile friend of her father called Jayaprakash Narayan, It succeeded in ending her rule but her rule had so emaciated the opposition that no sooner they came to power they forgot their objective of good governance and began fighting with each other. Can one imagine, the JP experiment lasted two years and the people chose Indira Gandhi once again to head the nation? We were back in square one.

Indians have been good sycophants. This was so under the Hindu Rajas, Turkish Sultans, Mogul Nawabs, and the British. It is easy for us to say yes than no. When we say yes it may mean no as later events prove. We also are very prone to bribery both in giving and taking. This has deep roots in Indian Psyche. It was common in the past to go with a gift when you went to see a dignitary. The raja then reciprocated with some reward. It may a gold coin, a necklace, a bangle or a piece of land. This gift giving and taking has continued over centuries and got institutionalized even when the gift taker is being paid handsomely by the government. It reached its zenith under Indira Gandhi [some who are keen observers of present day politics may say it is worse now]

The name congress I is not to be confused with Indian national congress. It actually stands for congress Indira! The old Indian national congress was killed by madam and her supporters in a very undemocratic coup and the present generation of congressmen are not bothered about history and behave as though they are the inheritors of Indian national congress.

Was there nothing right with Indira Gandhi? Of course there was some. Like her father she was non communal and very brave. She also took some historic decisions with far reaching consequences. One such was sending troops to liberate East Pakistan [now Bangladesh].This she did despite the threat from the US not to do so. The other was nationalization of Banks. Today if you see banks at every nook and corner of the country, the credit should go to her. That certain degree of inefficiency too came in with nationalization is another matter.

The most unethical of all actions was probably was abolishing the privileges [privy purses] of the erstwhile princes. A solemn promise made by the constituent assembly was undone by an act of a puppet parliament. That they any way were an anachronism in a modern society and would have vanished in the course of time is a different matter. But the act was unethical to say the least. To her what mattered was the end and means really did not matter.

What we are witnessing today in the political scenario where the powers are afraid of enacting a law to get hoarded money back to the country is the direct result of those policies of license Raj. The beneficiaries who have stashed away their ill gotten wealth have direct links with this generation of businessmen, beurocrats and politicians and therefore the reluctance.

Master check up/Annual medical/general physical and such other frauds

2011-06-04T18:25:00.002+05:30

Screening for disease is big business. When one needs screening? Does one go and screen the general population? And if so what ailments you screen them for?
These are important questions not only from the point of people’s health but also from the larger issue of economics of health.

Let me illustrate this by a case story which motivated me to write this piece.
He was a 34 year old man whom I will call Mr S, who came to see me two days ago.
Mr S said without any preamble. ‘Your friend, Mr Y asked me to see you,’ he said. This friend of mine is an unavoidable evil [wrong metaphor to use, matter of fact he is very good human being]. He continued without interruption,’ I have liver disease and also high fat in my blood and doctor wants to put a tube down my throat’

I could see he was very agitated and very anxious. Just to put him at ease I asked him who is the doctor who has said so and asked him for some details.

‘Sir, I went Hospital M for my annual medical examination and they found out I have these problems. And they want to admit me. I know Mr Y, your friend and he asked me to see you before getting admitted’.

I went through the annual medical examination reports.

The following tests were conducted. The reports were all in an eye catching folder with all the details of the hospital’s virtues prominently displayed on the envelope.
Complete blood study, ESR, CRP, Chest X-Ray, Abdominal ultrasound scan, Urine analysis, Liver function tests, Blood urea and Creatinine, Blood lipids, Sugar both fasting and after food, EKG, Echo cardiogram, Lung function tests, Audiometry, Eye examination, A physician’s sport and a dieticians consult.

The liver function test showed a marginal rise in blood bilirubin [1.6 instead of 1.4] and his cholesterol levels were marginally high. I found no need for him to undergo and endoscopic procedure, neither a need to take any cholesterol reducing medication as advised by the physician. What he need was a regulated diet with an hour’s exercise and a redo of liver function after 4 to six weeks. Most of the tests that were done on him were unnecessary to say the least. What was the hospital’s screening programme was trying to do?

The answer is very simple.

It was designed to create patients and also is easy pickings. The patient had spent a packet on these tests.

Then was there nothing wrong with the patient? There was something wrong. He had bilateral Hydrocele [collection of fluid around his testicles].This might need surgery at a later date. How was it that it was missed in all this gamut of tests?
Again the answer is simple. None bothered to pull his trousers down to check his genitals!

So what is the lesson to be learnt? Is screening for disease absolutely unnecessary? I would not say so. It is unnecessary in the sense it is not cost effective and detects very few treatable illnesses. Instead there should be what is called selective screening. Let me elaborate. Cancer breast has a strong hereditary bias. If there is a strong family history then the screening for breast cancer in the siblings is worth the effort. Doing mammography for all women is astronomically expensive. Other examples are Heart disease and diabetes. If there is a positive family history then the children should be screened periodically. Probably the most cost effective tests are a blood pressure check and a blood check for diabetes. All others are waste of good money. A normal lipid profile [blood fat study], liver, kidney, lung, eye, ear function will remain so for many years. Then what is the rationale of doing all this, year after year?

The answer is again simple. Keep this farce of a programme gong and create patients whenever it is possible.

What is the final line?

Screen for disease in the susceptible and leave the rest alone. They will be better off without our interfering.

Rajiv Gandhi

2011-05-28T16:47:00.000+05:30

Most people, including many Indians think that Rajiv Gandhi is son or grandson of the founder of the independent India, Mohandas Karamchand Gandhi [Mahatma Gandhi].In fact Rajiv is no relation of M.K. Gandhi. He is the first son of Indira Gandhi, Indias prime minister [nemesis?] for 15 long years. Indira was the only daughter of our blue eyed boy, the first prime minister of independent India Jawaharlal Nehru. Then how did Rajiv become a Gandhi? Indira Priyadarshini Nehru [Indira’s full name] married a Parsi called Feroz Gandhi. Feroz and Indira could not get along and the marriage did not last long but succeeded in producing two boys, Rajiv the elder and Sanjay the younger. So by a different route both the daughter and grandson of Jawaharlal acquired the sir name Gandhi. This no doubt did them some good as many ignorant Indians thought them to be old man Gandhi’s relatives and so can do no wrong and thus voted for them!

Indira Gandhi was assassinated 25 years ago and bereft of leadership the congress party roped in Rajiv Gandhi who was then a happy airlines Pilot, and made him the prime minister. For few days after the assassination, the country was in chaos and that is the time when the country was literally burning and Sikh’s were being targeted and murdered [Indira’s assassins were Sikhs], Rajiv made the now infamous statement, when a giant falls the earth tremors’ meaning that the riots were a consequence of the giant[Indira] falling. I have not come across a more stupid statement to make given the situation in the country. I still remember the shock I went through when Sikhs who have done so much for this nation being murdered in cold blood by the mostly Hindu riff raff. And here was an important person, future PM of the country making such a stupid remark.

It is twenty years since the fall of Rajiv Gandhi. He too was assassinated. This time the dastardly act was done by Tamil militants whose case Rajiv stoutly and rightly had opposed. I had admired Nehru and he was my child hood hero. History made me revise my opinion. His daughter came to power when I had grown up and began my life as an adult. I went through the pains as a result of her terrible rule and came to dislike her and that dislike still stands. The dislike was carried forward to his son too and I took to looking anything that Rajiv did as a prime minister with suspicion. Now with 20 years gone since he died I have come to believe that he was the best of the three Nehru/ Gandhi’s in prime ministerial performance. He was not exceptional but was better than the mother and grandfather who did nothing to improve the country and in fact steadily took the nation down the economic slide. My generation bore the brunt of their policies and therefore the grudge.

His freshness at looking at problems helped in his performance, He was unlike his mother and grandfather, not taken up with socialism and had a healthy respect for enterpreunership.He knew that he country can only progress if the economy opened up and the beginnings of what we see today started when he was the PM. Nevertheless his tenure was none extra ordinary and he could not shake up the ponderous and corrupt beurocracy and was forced to get along. He also made some blunders and the one which ultimately cost him his life was the unwanted interference into the affairs of SriLanka. Sending Indian army to fight Tamil tigers was his worse blunder. The other was the stink of Bofors gun deal. That it helped his Italian relatives is public knowledge though successive governments have tried hard to obliterate the traces to keep the Gandhi honor going.

But when he lasted he was different especially when compared to his mother.

Pulled tooth and the eyelid droop

2011-05-25T18:48:00.001+05:30

If you ask anyone what is required to live one would normally answer air, water and food. If you were to ask me I would add one more item, gossip. For many, gossip is even more important than the first three. Without gossip they would not be able to spend their time. The communication revolution has greatly contributed to the spread of gossip and has become a very important aspect of our lives. While most gossip is innocuous, some can cause lot of problem. Here is a real life example.

My friend Dr Ravi Rao, practiced dentistry for four decades and recently gave it up and went back to work for his first love, Moral rearmament movement [MRA]located at Panchgani. This incident narrated here involving Ravi occurred many years ago and as the main actors are dead and gone it is safe to tell the story.

There is a fairly large Syrian Orthodox Christian community settled in Bangalore. Originally from Kerala, they are now fairly prosperous residents of this city. They trace their origin to Thomas, one of the first disciples of Jesus. [For more info go to Google search].Their ancestry is not important to the story but the closeness of the members of the community is. They are concentrated in the east Bangalore where Ravi Rao’s practice was located [incidentally mine too]. They have their own church and this acts a centre point of all their activities and needless to say also to share information related to each other, in short gossip.

Mr Joseph George and Sophia were important members of this community. Joseph held an important position and was influential and Sophia was a social bird. They were my patients and needed my help frequently. Sophia was nearing sixty when this episode occurred. She came to see me with a pain and swelling near her upper lip and I found it to be due to a root abscess of one of her teeth. I called Ravi rao and fixed an appointment for her. She went and got her tooth extracted and then after a course of antibiotics she became normal. Just about this time when she was returning to her normal self, she noticed that her left eye lid was drooping and she was not able to raise it. Right eye was normal. This was investigated by a neurologist and a CT scan of the brain showed a tumor pressing on the nerve which had resulted in the drooping eye lid. She underwent successful surgery. But the droop did not completely go. This became a talking point in the community. The conversation began like this between Aleamma and Sosamma, two important women members of the community. Aleamma phones Sosamma, ‘You know Soosi, what happened to Sufeee?’ Sosamma knows all about Sophie’s surgery but feigns ignorance and says no.’ You know that dental doctor Ravi rao, ‘Yes, yes, I know’ replies Soosi. ‘Sufee went to him for tooth pain and you know what he did to her?’ Now properly excited, Soosi replies earnestly in the negative. ‘He pulled her tooth out and along with it he also damaged the nerve that keeps her eye open.’ This piece of anatomical knowledge of shared nerve supply between the tooth and the eye was avidly shared and Dr Ravi Rao was branded as someone who did great wrong to their dear Sophie. ‘That is not all, she continued, they had to go in and operate on her brain, all because of some simple tooth pain’ she stopped.

This conversation took many shapes and turns and went round the community and reached my ears by another patient of mine. Joti sees me once in three months for her diabetes and blood pressure and when she came this time she asked me if it is true that my friend Dr Ravi Rao did this to Sophie? Should she continue to see him for her teeth problem if one were to come up? I was taken aback by this stupid accusation. I had to tell her that the nerve to the tooth and eye are differently located and even if he had tried hard out of some hidden anger against Mrs Sophia Joseph he could not have done it. These two are different events which unfortunately got connected by the twine of gossip. I asked her where she heard it and she told the name of another Syrian Christian woman. I told her to do me a favor. I asked her to make calls to ten of her woman friends and tell them the real events as they occurred and thus start a reverse gossip to exonerate my friend.

Later, much later, I came to know that the culprit was Sophie herself. She would begin the conversation with her visitors with a, ’you know Dr Ravi Rao, the dentist, he took my tooth out and after three days I got this trouble’ and proceeded with her other details. The listener would put two and two together and tell her own version to another friend.

Of course, such stories do little damage to professionally competent doctors and Ravi Rao’s practice did not suffer in the long run but when the rumor was on it did cause considerable embarrassment to me as I was the one who referred the patient to Dr Ravi Rao!

Global warming

2011-05-22T17:03:00.002+05:30

My friend H.S.Jayaprakash is a prolific forwarder of mail.Most of the time it is below the belt junk.But on occassions he does send some nuggets.The following one is one such!

ENERGY SAVING/global warming

In the line at the store, the cashier told the older woman that she
should bring her own grocery bag because plastic bags weren't good
for the environment.
The woman apologized to him and explained, "We didn't have the
green thing back in my day."
The clerk responded, "That's our problem today. The former
generation did not care enough to save our Environment"

He was right, that generation didn't have the green thing in its
day...........................

Back then, they returned their milk bottles, soda bottles and beer
bottles to the store. The store sent them back to the plant to
be washed and sterilized and refilled, so it could use the same
bottles over and over. So they really were recycled.
But they didn't have the green thing back in that customer's day.

In her day, they walked up stairs, because they didn't have an
escalator in every store and office building. They walked to the
grocery store and didn't climb into a 300-horsepower machine every
time they had to go two blocks.
But she was right. They didn't have the green thing in her day.

Back then, they washed the baby's diapers because they didn't have
the throw-away kind. They dried clothes on a line, not in an energy
gobbling machine burning up 220 volts - wind and solar power really
did dry the clothes. Kids got hand-me-down clothes from their
brothers or sisters, not always brand-new clothing.
But that old lady is right, they didn't have the green thing back
in her day.

Back then, they had one TV, or radio, in the house - not a TV in
every room. And the TV had a small screen the size of a
handkerchief, not a screen the size of the state of Montana. In the
kitchen, they blended and stirred by hand because they didn't have
electric machines to do everything for you.
When they packaged a fragile item to send in the mail, they used a
wadded up old newspaper to cushion it, not Styrofoam or plastic bubble wrap.

Back then, they didn't fire up an engine and burn gasoline just to
cut the lawn. They used a push mower that ran on human power. They
exercised by working so they didn't need to go to a health club to
run on treadmills that operate on electricity.
But she's right, they didn't have the green thing back then.

They drank from a fountain/Water-Tap when they were thirsty instead of using
a cup or a plastic bottle every time they had a drink of water.
They refilled their writing pens with ink instead of buying a new
pen, and they replaced the razor blades in a razor instead of
throwing away the whole razor just because the blade got dull.
But they didn't have the green thing back then.

Back then, people took a bus and kids rode their
bikes to school or rode the school bus instead of turning their
moms into a 24-hour taxi service. They had one electrical outlet in
a room, not an entire bank of sockets to power a dozen appliances.
And they didn't need a computerized gadget to receive a signal
beamed from satellites 2,000 miles out in space in order to find
the nearest pizza joint.

But isn't it sad the current generation laments
how wasteful the old folks were just because they didn't have the green thing back, THEN ??!!

Reminisence-4

2011-05-20T13:05:00.000+05:30

Difficult to stop when one starts writing about Nehru. So much was he responsible for what we are today, both good and bad. That there is much bad and less good is again a fact of history, but when it was happening, few of us were aware of the fact that we were heading for the kind of disaster [disasters] that we were to experience so painfully later on in our lives.

Nehru liked persons who spoke well, looked well and dressed well. Some names that did a lot of damage come to mind. Top of the table was Krishna Menon. He was our ambassador to the mother country, Great Britain. When he was so placed he did his best to sour the relations between the two countries. Arrogance seeped out of all the orifices of his body, principally out of his mouth. Such a foul mouthed man this country is unlikely to see again. The famous spat between Krishna Menon and Kushwant Singh who was then our press attaché took place when Menon was the ambassador. Nehru chose him to be our representative in the UN to plead our Kashmir case. This he did with such inefficiency and boredom that he antagonized most of the western countries and nearly lost our case. Then, adding insult to injury Nehru chose him to be our defense minister. In this capacity he was an unmitigated disaster.

Another of Nehru’s choice went by the name of Sardar Panikkar. This chap was a not a Sikh but a Malayalee like Krishna menon, and excelled him in stupidity. He was our ambassador at Beijing. Chinese were building up troops at our border and all the time saying that they and we were brothers. Panikkar kept sending rosy reports despite advice to the contrary by the army generals, most notably, Gen Thimayya. Nehru believed him and when the Chinese gave us a bloody nose, the folly of Nehru stood exposed. He had to drop his friend and nations curse, Krishna Menon, very reluctantly. What happened to Panikkar I don’t know. Nehru died soon after the Indo Chinese war. Some say he never really recovered from this disaster. But the nation was so taken up with this man, that most of us did not realize that he was the principal culprit.

But there was one Malayalee who contributed a great deal at the time we became independent. Mr [Sir?]V.P.Menon. The two Menons were not only unrelated but also were poles apart. This Menon rose from the ranks to become one of the finest civil servants the country ever produced. He was primarily responsible for keeping the country united and bringing the 500 odd small and big princes under unified India. He did this with some charm, bit of diplomacy and good deal of threat and once by actual army action [Hyderabad]. Though the credit goes to Sardar Vallabhbhai Patel [then home minister], it was Menon who did the spade work. It was also this Menon who helped in drafting the Indian constitution. If anyone deserves Bharat Ratna to be given posthumously, V.P Menon deserves it most.

Reminisence-3

2011-05-15T19:47:00.001+05:30

Jawaharlal Nehru was our hero. When he became the first prime minister of Independent India, we thought our savior had arrived. He was our blue eyed boy and our night in the shining armor. He could do no wrong. I heard him speak twice. Once when I was in school and next time in this city of Bangalore. Both times it was with unbiased admiration. He had charm, charisma and mass appeal. People were eating out of his hands. He could have done anything he wanted. As later events proved, he was a very poor administrator and intolerant of criticism and also very naïve. He liked people who agreed with him and persons with more knowledge and experience in managing the country like Rajagopalachari had to part company. When told that he should get citizens to limit their family by no less a person than J.R.D.Tata, he had replied that the nation’s strength is in its numbers. Indians, then, would have agreed to anything this man said. He could have made us adopt the small family norm which even now we are unable to. The strength in numbers belief has made this country so over populated, that it is virtually swallowing up all the resources and we are going to be the laborers for the rest of the world and not leaders.

But the man did something the nation will not forget. He had not a shred of communalism in him and he was personally non corrupt. If we are confident today that we can never be a theocracy, the credit should go to Jawaharlal. On the flip side he was also directly responsible for the license permit raj type of governance which has made this country one of the most corrupt in the world. All this is in hind sight, but when I was growing, he could do no wrong.

Reminisence-2

2011-05-14T18:21:00.000+05:30

I am aware that what I write about recollected past is not of much interest to readers of my age group, but I hope it will be for the young. What was life like 60 years ago to what it is now is indeed interesting to know. When I was around ten, I saw my first motor car. It is not that there were not persons wealthy enough to own a car, but none felt the need for one, I remember the person who was the owner of the car was in all kinds of trouble. Forget it being the cause of his neighbor’s envy; it was a problem for the owner. First of all he had to face the daily nuisance of us children assembled in front of his house to see him take the car out .That was in itself was a sight. His house abutted the main road. The road carried all sorts of traffic which is mostly bullock carts and cycles with an accessional bus. When the bus was on the street there was no place for any other mode of transport to use the road, it was so narrow. Occasionally the bus would get stuck in the melee of pedestrians, cyclists and bullock carts all jostling for space. Into this chaos the owner had to reverse his car. It was easy to drive into his portico from the road than reverse into. So when he had to drive out he had to reverse on to this busy road. We [pedestrians, cyclists bullocks and bullock cart owners] had no idea of the space required for this contraption to move. So we stood gawking giving the owner just enough space to maneuver. Irritation writ large on his face he would shout in kannada,’ you idiots, do you want to die, you want to rot in police station’, and to the owner of the bullock cart, ’your bullocks have more sense than you have’ This was true because, to get a better view, the cart man had left his cart on the road side thus obstructing the car’s path, and had joined us. I also remember joining a crowd which was helping him to extricate his car from heavy and wet mud. It must have been just six months that the car stayed with him .He got rid of it at the earliest opportunity.

Most walked. Some cycled. Pocessing a cycle meant you were reasonably well off. Those who had Raleigh bicycles were considered upper class. Many of my class fellows walked miles to come to school and few cycled from nearby villages to reach the school. When it rained it was very tough to even walk let alone cycle. I remember there was a locally made umbrella of sorts with a fixed canopy made out of coconut leaves. This was not made to last and one had change these every other month. It was so unwieldy that it had to be kept out doors. Raincoats were unknown. Most of us did not have any special protective clothing and when we got soaking wet, which was quite often, we just took off the sodden clothes. Drying the wet clothes was another big problem. Those days washing and drying machines were unknown and one depended on the Sun to dry. And during rainy season it rained days on end and we went about clad in semi dry clothes! No wonder we suffered so much of ill health during rainy season. The kind of rains I saw as a child I have not seen since. It was so heavy that one was not able to see what is in front 3 feet away.

I had not seen a privately owned telephone in that town or I don’t have the memory of having seen one. Postal services were efficient and postman was one person every one welcomed as the only connection with the outside world. News papers arrived one day late and that too not always. Some had Radios and I remember when I was in high school listening to the Radio Commentary of the cricket matches. This was despite the fact India always lost the matches. There was a Station located in Ceylon [now Sri Lanka] which broadcast Hindi film songs which was very popular.

Tipper Topple

2011-05-11T18:36:00.001+05:30

Yesterday in the wee hours, a truck carrying a load of whiskey cartons had a burst tyre. Trying to avoid hitting the meridian the driver swerved to the left and lost control of the vehicle. The whiskey laden truck toppled and came to rest on its side. There was a spill and several cartons split open and some bottles broke spilling the golden brew on to the road.

The first to smell the opportunity were the morning walkers. They made way with carton each on their heads. The reek then reached the houses nearby. The occupants came out and saw the waiting bonanza. The carried what they could. Then came the flood and these men and women had to make do with shared contents. They would not even leave the half broken half full bottles, these too were taken away and some consumed on the spot. All this happened in an hour!

What was the hapless driver of the truck doing all this while? He was stuck with a fractured leg and was screaming at the crowd at the top of his voice to get him out. What did the gentlemen looters do? They waited till the looting was over and then, only then, they extricated him and took him to the nearby hospital for attention.

Those who took him to the hospital smelt strongly of alcohol!

Moral of the story: Only when drunk will one goes to help others.

Reminiscence-1

2011-05-10T16:04:00.001+05:30

In a couple of days I will be seventy. Reaching the biblical allowance of three score ten, without major health and other problems is indeed a blessing of sorts.
On this occasion what are my thoughts?

The earliest recollection of my life is just before India became independent. I was six years old then. I participated in a procession carrying national flag [these were called Prabhat Pheris] shouting little understood pro freedom slogans. I also remember the procession abruptly ending with some Khaki clad men asking us to go home. Why do I remember this one occasion? I don’t know. It is possible that the desire for freedom had percolated to the level of young children of my age. Another reason may be is that my father was freedom fighter and congressman belonging to the old school of Gandhians. The other incident I remember is of our neighbor breathlessly announcing Gandhi’s death. The whole house hold went into deep mourning and fasted. That is the kind of reverence the people had towards this one man.

The small semi rural town I grew up is nestled in hills with thick forests around. It rained almost nonstop when it did which was frequent. I remember only two seasons. Rains and Sun. The rain brought in its wake, myriad of illnesses and the one I remember and suffered most, is attacks of disabling asthma.

Sun brought in some relief not only to us children but to all sorts of life which included, dogs, cats, snakes and other small life to go out to have fun. Snakes were aplenty and lived in cozy relationship with us. Often they were found in the rafters looking for rats. I lost my fear of snakes very early in life thanks this exposure. Go five to ten kilometers in to the country we could still sight wild life like leopards and occasionally tigers. Elephant sightings were uncommon. On a visit ten years ago I found no trace of the once verdant forest! The land was full of lantana and parthenium weed!

School memories are mixed. The best feature of schooling was that it existed at all! It was a kind of free for all place. Primary and secondary education was not serious and you passed any way. High school was better with some teachers being really good and took trouble to teach. Best of all was that the education was virtually free, being run by the town municipality! Because no one really forced you to study, one did because of few exceptional teachers who kindled the search for knowledge.
In that humid rainy season illnesses were common place. I remember suffering from Whooping cough, Diphtheria, Malaria and Typhoid to name a few. I seem to have had fever as a constant companion. Most of these went only when I left home at 15 to do my college.

The overall impression of child hood is not one of pleasure, but one of illness, uncongenial home and social life. But then unpleasant experiences have a way of staying in one’s memory more than the pleasant ones. And I am no exception. Let me stop at this and reminisce further after my birthday!

Death of The Baba

2011-04-24T13:55:00.000+05:30

Sathya Sai Baba was at last allowed to die. He was the most famous of all spiritual Gurus that India has produced in recent times. Millions of his devotees will mourn his death all over the world. He was in addition to being a spiritual teacher, a performer of weird acts of bringing out objects from nowhere [like wrist watches made in Switzerland], of producing copious quantities of ash from his hands. Many rationalists were able to repeat these acts and thus debunk the Baba’s so called miracles. But for the devotee, he was the reincarnation of God. He did do many good deeds. He founded many hospitals and educational institutions, provided drinking water to many districts in the state of Andhra Pradesh. All his services were provided free. Therefore his death at the ripe old age of 85 is a loss from this point of view that he was an extraordinary social worker.

Did he reform the society? The answer is no. Corruption, inefficiency, class and caste distinctions have all increased during his life time and he did not actively campaign against these evils of society. He may have been a spiritual guru to the believer but by no stretch of imagination he was a social reformer.

He was seriously ill and was on life support for the past twenty odd days. His devotees [including the doctors who were attending on him] could not or did not believe that their Guru is going to die. Even god men must leave this body, did not occur to them. The last twenty odd days of torture that he went through was due to this blind faith! Poor man,[Godman] he had to suffer his followers who would not allow him to go in peace!

Unusual Family

2011-04-22T20:45:00.003+05:30

Many, many years ago, Mr Zafer Fateally, nephew of the famous ornithologist, Salim Ali decided to make Bangalore his home. Zafer, in his own right, is quite well known as a conservationalist, naturalist and despite his advanced age, still writes on his pet subjects. Then, I was a fledging young doctor trying to make both ends meet. Zafer took for rent a portion of a house owned by Mr and Mrs Henry Pais. This was only a temporary arrangement till such time his own house was ready for use which was under construction on the outskirts of the city. After Zafer moved out his son Murad became the tenant. Henry and his wife and the son Prem [then a medical student and now dean of St John’s medical college] were well known to me and for a time, when Prem was abroad I had the privilege to being their doctor. Old man Henry was a very meticulous man and an avid reader and he used to lend me books. He kept track of everything he did and this included maintaining records of all the bills paid and when.

In those days, getting a phone connection was a major issue. The beurocratic strangle hold on the ordinary citizen was much worse than it is now. Therefore or for other reasons, Zafer entered into a sort of unwritten agreement with Henry that any bill in excess of the usual that was normally received before his tenancy will be paid by him. As Henry kept records of all calls he made there was no problem. All was well for a few months. Then came the trouble. The monthly phone rentals shot up. Henry was quite sure as his records did not reveal any additional calls. So was Zafer. In those days it was not unusual for errant lines men to cross connect and favor someone at your cost. Thinking of some such outside mischief, Henry went to the phone department and met the concerned engineer. They agreed to monitor his phone and catch the culprit.

It was soon found out that the reason why the phone bill shot up was due to Zai [daughter of Zafer] who had recently come from Mumbai [them Bombay] making trunk calls to Madras. The matter was thus solved as far as Henry and Zafer were concerned.
But who was she calling so frequently? Now arrives on the scene, the chief character of the unusual family, Romulus Whittaker, popularly called Ron. The calls were made to Ron who was courting her. How did these two meet and who is Ron?

Kamaladevi Chattopadhyaya, a south Indian, Konkani speaking Saraswath Brahmin woman married to a Bengali, was a renowned freedom fighter and a close associate of the first prime minister of the country Jawaharlal Nehru. Kamaladevi is also known for her bravery, good looks and for the work she did with refugee rehabilitation post partition. Later she held important positions and was primarily responsible for the survival and revival of many art forms in the country. When she finally retired she came and settled in my practice area. When I first met her she was past 85 and was pretty unwell. She died of natural causes soon after.

Kamala Devi had one son called Ram [I don’t know much about him except that he married Doris and the marriage was not successful]. Doris Chattopadhyaya became my friend and patient and I was privileged to be her doctor till her death few years back at a ripe old age. She had one son and one daughter [or two?] by her first marriage and a son by the second marriage. The male product of the first marriage is Ron.

Ron is now just past 60 and the story really begins when he was around 10 or 12 when Doris put him for schooling in International school at Kodaikanal in Tamilnadu [then state of Madras]. Young Ron even in those days had an interest in animal life and his lifelong love affair and his later profession of herpetologist began in that young age. He would befriend the wandering snake charmers and would move around with them even spending his holidays wandering all over. These snake charmers belonged to a tribal community called Irulas. These people dwelled in the forests and caught snakes for a living. They also lived a life well adapted to nature. They ate ants and honey along with some live bees and lived on what is naturally available [ there is an excellent picture of an Irula enjoying his meal of ants sitting near an anthill in the book Snakeman, a biography of Ron by his wife Zai]. Ron soon became an expert snake catcher among other things learned in this association. After school he had to do two years of compulsory military service as per the US regulations and once that was done he was back to his old ways and the city of Madras became the centre of his activity and till recently it was so. He established the famous Madras snake park in Guindy which soon became a major tourist attraction. If I remember right he even lived in the premises. A well known wild life organization [? world wild life fund] invited two representatives from the state of Madras to visit Mumbai and young Ron was asked come with another colleague.

Ron took an experienced Irula tribesman to the meeting. This natures man well versed in the ways of forest did not know the basic courtesies of urban life. He was comfortable sitting on the floor rather than on a chair. When asked the propriety of bringing this person as a delegate, Ron is reported to have said.’ He knows more about wild life than all of us put together! The organizer of the meet was Zafer and that is how Ron met Zai which eventually resulted in their marriage. This was about the time Zafer moved to Bangalore and the above mentioned encounter took place at Henry’s home.

Ron ran his Madras snake park for many years and then moved over to a place close to Mahabalipuram and established a crocodile conservation project along with establishing a very successful Irula cooperative society. Once I went there to see his work. The Irula tribals would catch the snakes and bring them over to the society. Here men trained by Ron would remove the venom [a fascinating process] and clip one of the scales [like making a mark] and get the Irula to take it back and release the snake in the wild. There have been instances where the snake is caught again and again by the same of different Irula and brought back to the cooperative. The venom is in demand for making vaccine and for other medicinal purposes and the society is run on financially sound lines. When I was there I found crocodiles everywhere and from all over the world being reared. There were so many which were surplus and the central government under the minister Maneka Gandhi had forbidden export of animals and Ron was stuck with hundreds of Crocks. He even told me that he was fed up with eating crock meat for breakfast, lunch and dinner!

Gharial is a crocodile in the rivers of north India and in particular Ganga. It had a long flat snout very different from the usual crocodile one sees. It plays an important role in cleaning up the river by eating up all the rubbish that is thrown including the half burnt dead bodies. This species was on the verge of extinction and Ron was asked to help revive them. I think his attachment to this magnificent animal began then. I think his love for the Gharial is only next to his love for the King Cobra. He camped on the shores of Ganga and managed to repopulate the reptile in its natural habitat. Gharial can be seen in numbers in his crock park at Mahabalipuram. If you rarely see the floating half burnt bodies in the river Ganga these days, the credit to some extent should go to Ron for having saved the Gharial becoming extinct.

Now coming to his fascination with that magnificent reptile The King Cobra. King Cobra needs a particular environment to survive and ideal environment is in the evergreen forests of Western Ghats and in particular the forests surrounding the town of Agumbe. Incidentally Agumbe gets an average of over 300 inches of rainfall annually. Those of you who have seen the serial Malgudi days [based on R.K Narayan’s novel Swami and his friends] may know that the film was shot in this town. Ron has now made Agumbe his home. People around don’t harm snakes and even worship them but Ron’s presence is welcome as an errant king sometimes gets into their houses and tries to stay there! Hand rearing King Cobra is not easy, not just because of its venom [enough to kill a big size elephant] but because of its staple diet is other snakes. Ron is constantly is in search of this special food for his pets. All this well brought about in his now famous documentary shot for the National Geographic on King Cobra. Having been bitten occasionally in performing his professional duty, Ron has often taken anti snake venom. Now he has become sensitive to this and cannot take it. He carries with him shots of adrenaline and steroids and when I asked him what happens if he is bitten he answered with a rueful smile,’ let us wait and see ’. For his sake and for the King Cobra’s, I pray that doesn’t happen.

What about Doris? She lived a full life studying and writing on Indian art. Ever a gracious host she divided her time between upstate New York and Bangalore and died some years ago here following a brief illness. She too was in her mid eighties when she died.

What about the Son from her Indian Husband? Neil Chattopadhyaya married Arundhaati, a well known Bharatnatyam dancer from Mumbai and has now settled here in Bangalore. Neil provides the back ground music to Ron’s documentaries.

What about Ron’s sister?. I have forgotten her name. Here is small but interesting incident. My US based daughters while on a trip to distant Seattle, on their shopping trip, saw this store selling eastern art. Naturally interested in art, they went inside and got talking to the lady owner. She was [is] Ron’s sister and knew me and was very pleased to meet up with her doctor’s daughters!

The property in which such illustrious persons as Kamaladevi and Doris lived was ultimately sold some years ago and now is a shopping mall on the 100 ft road! Often when I pass by the place, I recollect the unusual people who lived there and how fortunate I was [am still] to have come to know them.

It is two years since I met either Neil or Ron and therefore couldn’t get many more details and get whatever I have written, edited. If there are any discrepancies I own the fault. I had to write about them so that my readers get to know about this remarkable family.

Hypersensitivity

2011-04-21T10:35:00.001+05:30

We as a people seem adverse to criticism even when there is an element of altered truth in it. President Obama is a patriot and is trying his best to save US economy and at the same time provide a semblance of welfare state which will look after the poor and uninsured population. His comment that Americans should seek quality medical aid in the US and not go to India or Mexico where quality is not assured was not well received. Naresh Trehan came on the national media and declared that his results are better than the ones from Cleveland clinic. No one disputes men like Naresh Trehan or Devi Shetty who have built institutions of excellence where
American medical tourists are looked after at one tenth of the cost.

My simple question is, are all our private sector hospitals maintaining the same standards of quality? How many of them have mortuary facilities, do clinico pathological meetings where unexplained deaths are discussed, how many hospitals have facility for direct transcription of case notes as they are being made to the patient’s designated relative? How many hospitals can say with confidence that their case records are never fudged? My experience with corporate hospitals varies from utter mediocrity to excellence. It is also important to realize that the American/foreign patients who come to india are those who compete with the upper crust of Indians who can afford these hospitals and willy nilly are responsible for driving the costs of the care up.

What about the rest of us Indians? Where do they go? There are NGO/ religion run hospitals which provide excellent care at reasonable cost but these too cannot cope with the demand. The poor have no other option but to seek help at our sate run health services. That is another sordid story. So when Obama says quality is suspect he spoke in general terms and was not meaning one or two odd good quality hospitals.

Return of the super bug

2011-04-21T10:29:00.002+05:30

I had on earlier occasion written on the emergence of super bug on the Indian scene and how it has rapidly spread to the community and now comes the news that the bug was found in the municipal water supply of New Delhi. The reaction from the health authority was on expected lines and typically Ostrich like behavior. It is only a matter of time that the organism, E-Coli which is lives in the colon where it rarely causes problem and urinary tract where it causes many problems, gets into the water supply. Fecal contamination of drinking water in India is a rule rather than an exception.

In India the best way to tackle the problem is to behave as though the problem does not exist or try and discredit the authenticity of the source. This time it once again the Lancet, one of the most reputed medical journals is being discredited by being partisan. Why don’t we accept and try and tackle the menace before millions die of resistant infections? Remember, E coli is very friendly to other organisms. It will, sooner or later will make our ordinary staphylococcus [causes furuncles and boils] a super bug by donating the resistance factor. Imagine the situation when a patient with a simple abscess dies because there is no cure?

Those who want to, live like ostriches are doing the same to Shanthi and Prashanth Bhushan. They want to kill or defang the Jan Lok Pal bill. The corrupt in this country never have had it this good. Let the am janata go to hell. I am happy in the present state of affairs. I don’t want o topple this excellent apple cart. Who are these fools Anna Hazare and his team to disturb us?

Tears of joy

2011-04-09T13:01:00.000+05:30

I don’t remember to have shed tears of pleasure. This I did today watching Anna Hazare, a 73 year old Gandhian, breaking his five day old fast after having brought the corrupt [or which tolerates one] government to its knees. The Government agreed to his demands for constituting a committee to draft a Jan Lokpal [kind of Ombudsman] bill. The government also agreed that 50% of the committee members will be from the general public. After the draft, the bill will go to the parliament to be passed. That will be the first hurdle. Why it is a hurdle and any sane MP should welcome this, you would think. I will pardon you for your ignorance if you are not an Indian. Most of our MPs and many of our ruling beurocrats are corrupt. At present it is said that it is even difficult to remain in office if you are non corrupt. We have sunk to such a pathetically low moral state. These vested MPs will fight tooth and nail to see that the bill is stalled. Anna has anticipated this and that is what he has warned the multitudes who have rallied behind him, that this victory to get the government to agree to introduce the Lokpal bill is only the beginning of a long drawn out struggle.

Not that we don’t have upright men and women in this country. There are but they were feeling helpless under the corrupt machinery of governance. The massive eruption of support to Anna showed how fed up the people are. The suggested names of Kiran Bedi, Sahnti and Prashanth Bhushan, Swami Agnivesh, Justices Santosh Hegde and Verma are persons of impeccable character and if they were to head the machinery against corruption and the young people of this country who came out in such large numbers to support and who will hopefully be the beneficiaries of an efficient, non corrupt governance in the future.

A small aside. Wife and I decided to fast as long as possible. We did not last even 24 hours. I became hypoglycemic and irritable and wife became weak. We broke the fast. Anna Hazare, even after 100 hours was up and about and looked and acted fresh. There were 100 others who fasted with him. I wonder where the strength came from.
When he broke his fast unto death, he saw to it that his followers first brake the fast and then a little girl [future of this country] gave him the glass of fruit juice to end his fast.

I have rarely been so happy. There is yet some hope for this nation.

Genteel poverty

2011-04-05T19:21:00.002+05:30

When the call came for a house visit I was very surprised. Normally one doenot get a call from a patient who last saw you 20 odd years ago. My initial reaction was to refuse, but on second thoughts I felt obliged to see him. This is because these were the persons who had helped me to build up my practice and I felt duty bound to see him despite the fact that for his own reasons, he had chosen some other physician.
So I went.

I had some difficulty in locating the house. The area had changed so much with multi storied buildings all over the place. The house was the same with no additions and located in the centre of a fairly big piece of land. I made a mental calculation and came up with a figure of 8 to ten crores! Mr S is sitting on a gold mine. When opened the gate and went inside, there was evidence of decay everywhere. There was over grown shrubbery with trees gone wild and leaves all over the ground heaped up. The house must have seen a coat of paint decades ago. The house and the surrounding garden I had seen 20 years back was immaculately maintained and what I was witnessing was pathetic to say the least. I pressed the bell and after few minutes an old maid opened the door and on finding who I am made me take a seat and went in to inform Mr S. I had a look around, inside of the house was no better.

Mr S came in and profusely greeted me and talked for a few minutes about old times. He had grown old like I have, but then he is much older than I am. Must be in his eighties I thought. Then he told me about hi s complaints. They were the usual one of old age. I examined him and asked him the treatment details. He gave me a list of medications. Some were needed and some not so. I told him what to do and then wanted to take leave of him. He would not let me go. He said,’ after so many years you have come to see this old man, I cannot send you without giving you a cup of tea’. He called out a name and the same old maid appeared. He asked her to get some tea for us.

I asked him about his wife. I remembered a gracious woman whom I used to see. ‘I lost her, he said. I did not want to ask the details. After some silence, I asked him why he called me instead of his usual doctor. He said the world that he is living in is very different from the one he lived 20 years ago when I was his doctor. This explanation did not satisfy my curiosity. As he was not forthcoming with the details I felt it prudent not to press the issue. By this time the tea arrived, the two cups were neatly arranged on a floral tray with tea pot covered in a tea cozy [all of them had seen some service]. Old man proceeded to pour and make the tea. I could see he was enjoying himself playing the host.

There apparently was no one else in the old home. I could not help remarking. I remembered he had a teen aged son. What was he doing? ‘Oh, him? What will you expect from him? He was no good then and he is no good now. That ended another conversational vein. I finished my tea and took his leave. He came with me up to the gate and thanked me for coming over to see me.

He did not bring up the subject of my visiting fee and neither did I.

Few days later, a young woman in her mid thirties came to see me. She introduced herself as the daughter in law of Mr S. She had come to clear the money that he old man owed me. She said she was sorry that it was not paid that day. I said it often happened to old persons. ‘Nothing of that sort. His memory is better than mine. He had no money to pay you. Yesterday was my pay day and today I have come to pay you’. ‘What about your husband? I could not help asking. ‘My husband, his only son, did not train to do any work and is now holding a job of a sales man in a used car show room. The only subject he knows’, she said with some contempt in her voice. Then why don’t you sell that valuable property? I asked her.’ You know my father in law, he comes from a royal family, in fact I too come from one, but my parents trained us to live with common people but the old man still lives fifty years behind times and refuses to give up the old property. Even his car is 50 years old. He spends more money on maintaining that blessed car than on food’. Her use of the word common people made me think even this lady thinks she is royalty but has learnt suffer common people [like me for e.g.]. Obviously the husband too is not very keen on selling but she feels that he will be forced to do when the time comes.

'When will it be?, I asked.

'When the old ----- [unprintable]dies', she said and took my leave.

Black tape

2011-04-04T16:53:00.000+05:30

I am sure you have heard of red tape but not black tape. Black tape is the word [coined by me] to describe a combination of red tape and black mail. Much publicized incident of black tape occurred recently at the Bombay [Mumbai] customs. The international cricket council [ICC] is head quartered in Dubai. The world cup made up of precious metal and stones was taken from Dubai for the inauguration ceremony at Dakha [Bangladesh were the co hosts] after the ceremony it went back to the ICC HQ. Now for the final it was brought by an ICC official who was told that he can bring it into the country or so he presumed. He did not know our customs [read my earlier post on them]. They would not let the cup in unless a hefty duty of 22 lakhs is paid. The ICC version is that the customs official demanded 200 free tickets to release the trophy! So the trophy that the winning team went about kissing was a replica which had made the rounds all over the three countries prior to the events!

Whom to believe? I believe the ICC because I know my Indians. It is said that an Indian custom official demanded a bribe from his own mother!

Here was thus a combination of red tape and black mail. Black tape is the apt description and I hope it will go and enrich English language as yet another unsavory contribution from us, Indians.

India wins the world cup

2011-04-04T16:51:00.001+05:30

Indians won the world cup by defeating Sri Lanka in a closely contested match. The country was gripped in mass hysteria which is not possible to imagine for a non Indian. We, only we are privy to the secret of going into a frenzy of jubilation and also the opposite, to the depths of severe depression. The frenzy was for all to see, thanks to the electronic media and the whole country erupted in one great burst of joy.

I have on earlier occasion written about a small town youngster called M.S.Dhoni. He is the Indian team’s captain. This one man was primarily responsible for the win. The fearless exhibition of leadership is worth emulating by our politicians and beurocrats. After hitting the, where did he go when his teammates were celebrating? He went to get his head shaved to keep a vow he had taken!

Of course it was a team effort, there were many heroes, but much hyped Tendulkar was not one of them. It did not matter, the country and the team love him and they all dedicated the trophy to the veteran cricketer. Our politicians are very free with the tax payers’ money. I read and saw that each player will be richer, by rough estimates, by ten crores of rupees. This is for a team that is already rich beyond ones imagination. I don’t say effort should not be rewarded but this kind of largesse is vulgar in a country where most people are poor and other sports are severely hampered for want of resources. Who would want to be a basket ball player when there is no money or prestige? So is with Hockey which was once considered as our national game. We were once unbeatable in this game. Today we don’t even make the qualifying rounds. Is there dearth of talent? Far from it, we are ideally suited to play this game. what is lacking is the support base and the talent pool which is drifting towards cricket.

Having said this, what did I do? I watched the game. It was a great pleasure watching batsmanship of highest standards by two. One from SriLanka. Mahela Jayawardhana’s chanceless century almost took the game away from us. It was an innings of rare class. Next to it was from our own Gautham Gambhir. He fell short of his century by three runs. It was another innings of class and character. Small built men go unnoticed. Both Jaywardhane and Gambhir are short men. Why is it that it is so much pleasure to watch them? Most of cricket history’s great batsmen in terms of correct batsmanship have been short. They rely on technique and timing and not on brute force and that is the reason why it is such a pleasure to watch. In my younger days there was this great batsman called Gundappa Viswanath. He faced the fearsome fast bowlers of that era without wearing a helmet. One would not even see the ball which sped and crossed the boundary when he hit it. Then there was Gavaskar, then came Tendulkar [who is s till there after 21 years of international cricket!]. Now we have Sehwag, Gambhir and Virat Kohli. The all time great, Don Bradman too was short.

But the man who took the award of man of the match was none other than the captain, Dhoni. He came to bat at a crucial time when the game was tilting towards SriLanka. India were three wickets down and the captain chose that moment to promote himself and did not send Yuvraj Singh who normally came in to bat in that position. Dhoni was not in the best of batting form and to come in at that juncture was pure madness or so some thought. But he had his own reasons. May be he thought he could stand the intense pressure better than others. How right he was. In the next hour he had taken the game away from SriLanka and in the end remained unbeaten. His innings did not have the class of Jayawardhane or Gambhir but it had great character. Only when it became certain that India will win, that he went for his strokes and the last fifteen minutes we saw his power hitting.

The winning stroke was a massive six with the ball disappearing into the stands. I can never forget the expression on his face when he followed that ball. It was one of pure pleasure.

Now comes the serious job of living up to the reputation of world champions. Let us watch and see how they do it.

Cricket

2011-03-31T13:47:00.003+05:30

Much hyped semifinal between India and Pakistan was finally over yesterday with India winning. The celebrations across the country made me wonder what was the achievement? They still have to win the finals on saturday against Sri Lanka.

Be that may, for many Indians and Pakis winning means a great boost to their national pride and honor. Ridiculous but true.

I have often felt Muslims in India are lucky. They are better off in a tolerant corrupt India than a begoted [honest]islamic country. It is reminder for all Indians that two of the last three crucial overs were bowled by two Indian Muslim boys, Munaf Patel and Zahir Khan.

Democracy in action for all to see!

Earth [H] Our

2011-03-27T20:04:00.001+05:30

Sent to me by my friend and one of the few young men who is doing his bit to keep the earth green. It is worth reading.

Earth (H)Our

At 8.30 pm on March 26th, as we turn off all electrical points in our homes for an hour, we could consider this an atonement, albiet a token one, for the economic runway that we have laid out for ourselves, riding on a blasphemous belief that energy – as much energy as we need - is a birthright.

Most people I know will switch off a light when they leave the room, yet this is hardly conservation; this is decency, protocol, the done thing, just as most people I know would say ‘Thank you’ when they were gifted a present. Conservation begins by questioning what could be done to change a lifestyle that is energy intensive and getting worse by the day.

A few months ago, a young journalist, Namrata Nandakumar, did a short study on electricity consumption in two urban spaces in Bangalore city. She first chose a slum which had ‘authorised’ access to electricity, a slum of three and a half thousand homes called Ullalu Upanagara, that houses about five times that number of people, during a post-monsoon month when there was no significant power cut. The monthly electricity bill for the entire colony was Rs. 2.38 lakhs. In contrast, Bangalore’s most popular mall, The Forum Mall, with a sanctioned load of 4 megawatts of electricity, had a monthly bill of about Rs. 85-90 lakhs (which included its expenditure on diesel for generators) for the energy it used with abandon, including the cooling of an enormous common areas around the day.

Recognise the sobering reality that energy is a finite resource currently in acute short supply in India. As the country’s GDP trots along, much more of it will be needed to supply basic energy needs to millions of our people as well as to meet the consumptive lifestyle of urban India. Energy comes at a cost, a cost well hidden from most of us who live in protected urban India and take planes when we travel : the costs, ecological, psychological, financial and otherwise, of displacement of people, damming of rivers, submergence of land and forests, pollution from thermal plants and carbon dioxide emissions and huge consumption of natural resources. Recognise that this is not a historical cost but a running one - for instance, the origins of the Maoist problem and the slums of urban India can be traced to our energy projects - and the true impact of the Mall’s consumption begins to emerge. Recognise, in addition, that the production of every litre of diesel needs 9,200 litres of water and 2-3% of the diesel that is imported into India is consumed in its own transportation to the consumer.

Yet, none of us would seem particularly perturbed with these numbers, ascribing them to a convenient rung on the ladder of development, for we empathise, not with the slum, but with the mall. It is a lifestyle that, though recent and foreign, is not negotiable. The biggest issue, of course, is that we – literate, well-read, well-meaning, intelligent as we are - do not connect the dots. We cannot, often do not, wish to see the impact of our actions on others. Let us then not blame the Americans for the climate mess we are in. Given an option, we have grabbed the ‘pollute’ lever ourselves for the short term gains that accrue from glamorous living.

I have in front of me, two recent articles that are very recent, yet hardly new in content. The first speaks of the protests last month against the East Coast Energy coal-fired power plant in Srikakulam district in Andhra, during which two people lost their lives, lives that were worth much more than any power plant could possibly match. This plant coming up next to a ecologically fragile wetland has, over the last couple of years, damaged the area and put many fishermen and farmers’ livelihoods in peril as the wetland is excavated and filled up in haste. The police were there, of course, to help push this private project through. This incident was merely a repeat: on July 14, 2010, in Sompeta, where the Nagarjuna Construction Company is building a thermal plant on a wetland, three persons were killed in clashes with the police.

The second article concerns a different source of energy that threatens a different species. If you make your way into the Athirapilly-Vazhachal forests of Kerala, as I have done – dense, wet deciduous forests of breathtaking beauty and surprise – you occasionally hear a loud, pitched call, a distinctive ‘tock-tock-tock’ , or sometimes a heavy whooshing sound. Look up or around (if you are by a ridge) and you might see the Great Indian Hornbill take to the air, the most beautiful, graceful, charismatic, even-tempered bird that has ever been. It is a bird that might see its habitat destroyed with a hydroelectric project proposed by the Kerala State Electricity Board that will generate a measly 160 megawatts, for the forty Forum-Mall-look-alikes that will dot the state to sell the resident Malayalee’s sole fetish: gold. The Hornbill, stunning as it is, is merely a representative species of the priceless biodiversity we stand to lose at Athirapilly, a portion of which is not even known to science as more discoveries enhance our sense of wonder at the mechanics of creation.

To set the record straight, the KSEB is hardly the first State Electricity Board to consider habitat of little use except for submergence, yet it was a pioneer in the destruction effort, with a plan made forty years ago to submerge the Silent Valley. It required the determined effort of Dr. Salim Ali and Mrs. Indira Gandhi to scuttle the project.

The destruction of forests, and the biodiversity within it, is a horrendous cost to pay for our lifestyle, yet it is a cost that few of us understand, even as the decision makers do the hypocritical act of planting the odd sapling to mark an Earth Day or a Wildlife Week. Much before additional power plants of any kind – thermal, nuclear or hydro – are planned, there is need, indeed a pressing, vital need, to use a system of incentives and disincentives to get the energy addicts (that’s us) to reduce our need for the fix. Yet, I have little faith in the Government’s ability to promote a culture of reduction and thrift and a lot more conviction in your ability to reason and conclude.

In my few years in conservation, never have I felt this alarmed at the speed of the consumption gravy-train. On March 26th, therefore, I have a request to make : please switch your lights, air coolers, water heaters and all else off, for just an hour. This, by itself, will make little difference, yet it will hopefully provide the darkness needed for a few moments of solitude.

In those moments, do think of just how you could become part of the solution, just how you could change the way you live your life to reduce, dramatically lessen, the need for energy. I repeat, target, not a 5% drop in consumption but, a 50% reduction in your energy demand. …for unless we press the brake now, the energy gravy train will run over the person on the railway track.

That person is you. And the time to heal the Earth is Now.

Warm regards,

Gopakumar

www.gopakumar-rootcause.blogspot.com

Earth hour

2011-03-27T17:28:00.007+05:30

I was out driving a friend home during the earth hour. I had to despite the fact using the vehicle too is against the green movement. I was pleasantly surprised with the response from the citizens of the city.

Most had switched off the lights and the vehicles were less on the roads. This awareness should be there all the time and at all levels. More importantly at the levels of politicians and beurocrats as these are the decision makers.

My city is being slowly and steadily being destroyed in the name of development.More roads are being built or widenied and more vehicles are allowed on the roads. Many busy roads have no place for the pedestrian and the cyclist. Moving from one part of the city to another has become a night mare. More and more trees are felled to make way for roads in the name of development. Once, the city had hundreds of lakes which were interconnected and water flowed from west to east.Now many of these are filled up and developed. What is this development? Building more and more apartments and housing colonies.

The city's population has quadrypled in less than 15 years. The water needs of the city are met with the crazy scheme of pumping water up a gradient of 2000 ft from a distance of 100kms.Where is the power coming from? build more hidel and nuclear powerplants, inundate verdat forest and agri land and invite disaster?

Gandhi, nearly a century ago had anticipated all this. He advocated minimum consumption of resources as the key to life. Is any one listening? Today's developers are taking away resources of tomorrow's generation. Who is worried?

Mr Gandhi must be turning in his grave!

Chasing the ESR

2011-03-26T06:34:00.002+05:30

We doctors order investigations when we are stumped as to what is wrong with the patient or some times to know the effect of treatment. Added to these, we also order teats to assess fitness levels. This last phenomenon which was exceptional when I began my career has now become routine. So common it is that patients themselves go to the lab and get tests done and then see us. Most often it is a sheer waste of money but occasionally it results in early diagnosis and effective management.

When tests are ordered a common one among them is called the ESR. This stands for erythrocyte sedimentation rate. In simple language it means speed with which the red cells of the blood drop when a column of blood is suspended in a glass tube. This simple screening test is very nonspecific. It tells us that there is something wrong but does not tell us where and what is wrong. A friend of mine once said you sneeze hard couple of times and then measure the ESR and sure it will be up.

Red cells are in large numbers compared to white cells. Their main purpose is to carry oxygen to the tissues and normally they circulate without clumping and when suspended they drop down ever so slowly. In disease conditions the rate of this fall is rapid. The higher the fall more serious is the disease. We accumulate willy nilly, lot of unwanted material in the blood during the course of our lives. These include among others bacterial and viral antigens against which the immune system produces antibodies, particulate materials which freely flow in our blood much in excess of the ability of our innate cleaning systems to scavenge. Some of these stick to the surface of the cells and make them not only heavy but also get them to stick to one another. Thus the cells which were once clean now become dirt laden and heavy and thus fall faster in suspension and the ESR goes up. In acute infections and in malignancies, the phenomenon is marked. And very high ESR levels are always worrying to the attending doctor.

Mrs. Y is a sixty year old woman and a true party animal. When she was with a group of friends, one of them told her that she was looking pale. Everyone looks pale in the artificial light and Mrs. Y did not attach any importance to the remark. Few days later at another party another friend remarked,’ what is the matter with you? You are looking very pale’. Remarks of similar nature on two successive days had her worried.

She took the decision to do the tests. Had she come to me I probably would have examined her and may and more likely not have got any tests done. She went to a well known lab and told at the reception to tests for her looking pale. Most labs are privately owned and clients like Mrs. Y are like a new lode of gold for them. All tests including the scans of her chest and abdomen were done. Here is something interesting. It is not difficult to find some trivial abnormality in most people and as they say half in jest, when you see a tail sticking out of a hole it is sometimes best not to pull it out, you don’t know whether you pull out a cat or leopard. The labs too have a funny way of reporting here. They put an asterisk against the slightest abnormality that is found or a value which even slightly abnormal. In madam Y’s case there were many such asterisks!

Thoroughly frightened, Mrs. Y landed in my clinic with a whole wad of papers. ‘I am very sick’ she said by the way of opening remark. She looked very fit and I said so. ‘No, no, you see these reports and then you will change your opinion’ she said. If she is insisting to be very sick, I felt I should first examine her before going through her papers. She agreed and a ten minutes physical found her in a fit condition with her basic parameters being normal. Now came the time to see her lab reports and scan reports and I could see her becoming visibly anxious. Almost all her reports including the ones marked with an asterisk were normal. There was however one major abnormality. Her ESR was very high. Normally in her age group it should not exceed 20mm of fall in an hour and in her it was 80.

This was indeed a surprise and a cause for worry. Surprise because she was fit and I found nothing which would explain this high ESR. In the absence of infection the only other cause would be occult [hidden cancer]. In women the most likely place is the breast where small tumors could easily missed. I felt her breasts once again. I could find no mass small or big. I found among her papers recent tests to exclude cervical [uterus] and ovarian cancer. Then where is it? Could this be in her blood forming bone marrow? Could this be in her colon? Lungs?

I had no option but to get a whole lot of expensive tests done. May be a better option would be to send her to an institution [an unsettling thought]. My brain was buzzing with all sorts of thoughts and idly I was sheafing through her papers and saw her liver function tests. There was a marginal increase in the globulin fraction of her blood protein. Globulins are very important componets of our immune system and special cells called plasma cells make these.

Here was a possible clue. Without telling her what I was thinking but all the same reassuring her, I ordered a test called serum protein electrophoresis in which the various fractions of blood proteins are studied, a non invasive test. She came back two days later with the report. She had a raised level of one particular fraction of her gamma globulin. I, at last, had the diagnosis. She has monoclonal gammopathy of uncertain cause. This condition is due to excessive production of gamma globulin of one variety by one clone of cells. This excess protein adheres to the surface of the red cells and thus making them heavy and drop faster in suspension. Monoclonal gammopathy is premalignant condition and in time a percentage of them go into a type of cancer called multiple myeloma. No one knows who will develop into this serious condition and who will not. I have had several patients who have carried MGUS [monoclonal gammopathy of uncertain significance] to their grave without suffering Multiple Myeloma.
I painted the picture highlighting the positive aspects. That was ten years ago. She is now seventy. The other day she had come for the usual follow up with her reports. They were all normal and she too will hopefully carry this to her grave without going into cancer when ever her time comes to go.

In search of the stink

2011-03-23T19:26:00.000+05:30

They first noticed the foul smell two weeks ago while watching television more or less at the same time, the wife first and then the husband. They thought the smell is because of a dead mouse that was seen inside the home couple of days back. They took the house apart looking for the dead mouse but to no avail. Then couple of days later the husband told the wife that he noticed the same smell in his office. They thought justifiably that he was imagining the smell!

Next day too he said the same and confirmed that it was no imagination as his secretary too smelt the stinky waft. How can the same smell be both in the office as well as home?
Realization came at last. The smell was coming from the body of the man! Wife found that it was from his navel and on close inspection she found a whitish substance in the depth of his belly button. She made him wash it thoroughly; still the smell remained though the whitish material was no longer there.

This was the time they thought it to be serious enough to seek medical advice and came to see me.

The stink was obvious even before she told me its origin. He had a navel which was deep and well hidden in the fat fold of his paunch. I could with difficulty, [I used an old fashioned nasal speculum] to separate the overhanging skin folds. There I could see something glistening! It was quite easy to pull it out with a forceps. An inch and a half of cone shaped hard rubbish was pulled out. The cavity was washed and sterilized with iodine.

That was the end of foul smell. The cone contained debris, shed skin, secretions all of which had joined together to produce this foul cone!

I asked the couple if they wanted to take it home as a memorable memento. They vehemently refused!

I then dumped it in the toilet bowl and flushed it to make sure it went for ever.

Cricket Crazy

2011-02-14T13:02:00.000+05:30

The game of cricket is confined to Britain and its erstwhile colonies. The one legacy the colonies bear cheerfully but have also excelled in. For many decades it was Australia. Australians were virtually unbeatable in playing cricket and in the art of sledging. Sledging is a term referred to acts designed to irritate and do things to get the batsman of the opposing side to lose concentration and throw away his wicket. This is a specialty of close in fielders especially the wicket keeper. Sledging identified, as some wit put it, the hallmark of progeny of erstwhile prisoners who colonized Australia! Words like,’ you want to sleep, there are better places’, when the batsmen went run less, or ‘now you can think’ when the ball thrown at the batsman hits the head [though covered with helmet]can disturb any batsman and sensitive Indians were particularly prone to this some decades back. Now I believe they too have become experts and have taken to saying so in Hindi which the hapless Australians don’t understand and worse likely to misunderstand as it happened between two volatile players, the Australian Symmonds and Harbhajan Singh the Indian. What Harbhajan said to Symmonds in Hindi was ‘Theri Maaki……’ [Your mother’s]. Symmonds heard it as you are a monkey! The two came to blows and the umpires had to intervene. The Sardar [Harbhajan is a Sikh] is not by any means a handsome fellow but Symmonds has some simian features which added color to the misunderstood ‘theri maaki!’ Good it was misunderstood as the Hindi curse has worse connotations. In the enquiry that followed, the venerable and much respected Tendulkar who heard the altercation was hard put to explain the meaning! I believe our own skipper M.S.Dhoni is a sort of expert sledger behind the wickets.

Every three years a cricket extravaganza is held and it goes by the name World cup. Over the years India has taken over as the prime promoter and Indian companies spend mind boggling amount of money on promotion. The centre of cricket and the power is slowly and steadily moving Indiawards. Going by the record crowds that attended the first match yesterday, which was a practice match and therefore does not really count, we are in for a crazy period of six weeks. Incidentally India won! 30.000 cricket fans paid through their nose for the privilege of seeing the two sides fling a ball 600 times at each other! [It is not as simple as that]

When the Britishers left India it was a complete severance. Unlike in other countries where many stayed back, In India and Pakistan none stayed. This is indeed a surprise, so alienated were they from the locals, that they had no options but to leave. The first Englishman who opted for Indian citizen was a defrocked priest called father Vernier [read the famous and well written and researched biography on father Vernier by Ramachandra Guha]. But many of their habits and institutions survived. The game of Cricket is one such. The other is our clubs. In most of urban India there are these bodies where in friends [members] gather mostly to drink in private [not really wholly true]. These clubs have their own archaic rules. Till recently one of these in Bangalore, did not allow women to become members! Even now you cannot enter some clubs in comfortable Kurta and Pajama’s. If you go in a Lungi, it is possible that an elderly member clad in suit will suffer a heart attack.

Cricket caught on like wild fire. It suited us very well. We are an over populated country with a large number of partially or fully unemployed. These found it great to spend time five days watching this game. Those days there were no limited overs cricket which ended in six hours. They could sit back relax, sleep and do nothing in keeping with our national character.
With money and new found affluence this pastime has become a monstrous obsession and addiction and the newly rich cash cows are hell bent on making all of us slaves to this game.

Sadly it includes your truly!

Drugs Doctors and Patients

2011-02-03T11:37:00.002+05:30

How did L. Leela get tablets of Colchicine without prescription? If you are a non Indian reader of my blog you are justified in wondering. If you are a reader from India then you know how and it will be of no surprise to you.

I will tell this sordid story of easy availability of drugs and the damage that this is causing to people with a real life story and follow it up with another later.

Mr C has been my patient for over twenty years, that is, when he is in Bangalore. A senior executive, he is often posted out of Bangalore and seeks attention with other doctors or self medicates. He suffers from high blood pressure and diabetes for which he takes medication and consults doctors when there is trouble. When living in New Delhi he developed pain In his back for which initially he saw an orthopedic surgeon who prescribed him a drug which belongs to a class called NSAIDS [non steroidal anti inflammatory drugs].The commonly prescribed drugs such as diclophenac, Ibuprofen, Indomethacin, paracetamol, aspirin etc belong to this class. He was asked to take one of these for five days when the pain was acute and was asked to report back. He never did go back. Instead whenever he had some back pain he took these drugs and got pain relief. Few months ago he went for his annual medical and he was found to have elevated levels of creatinine in the blood, a sure sign of renal disease. His creatinine levels were near normal when the test was done a year ago. Indiscriminate use of the pain killer had irreversibly damaged his already fragile kidneys [due to high blood pressure and diabetes] and he is now in end stage kidney disease and on three times a week dialysis. This means spending the rest of his life hooked on to a machine for over six hours, three times a week. If the drugs were not available to him and he was forced to go to the doctor this misery, possibly, would not have happened.

How then did Mr C get his Ibuprofen?

n India pharmacies are run by businessmen. The license to run a pharmacy is obtained in the name of a qualified pharmacist who is usually not the owner. Even if he is one, he would be reluctant to let go an easy custom for want of a prescription. Many of them are located near the patient and those who work in the pharmacy are friends of the patient and are unlikely to refuse a request. Old prescriptions are used with impunity and doctors too are to be blamed for indiscriminate prescriptions.

Let me tell you all another ongoing problem a patient of mine is facing. She is a seventy four year old lady who is a severe diabetic with complications and who has chronic urinary tract infection caused by a versatile organism called E.Coli. This one belongs to a class of germs who are called ESBL producing organisms. Meaning there by, that they are clever enough to survive the onslaught of most of the available antibiotics. How did this happen? We doctors to a great extent, and patients to some extent, are responsible. How did she manage to acquire this dreaded multidrug resistant strain? Please go to the website given below and read the article by Dr Chatterjee. How is she being managed? An ongoing struggle for both of us.

On many an occasion the illness especially the one caused by virus is self limiting and no drug is required. Rare is a doctor [of any variety] who says so to the patient. Almost always a drug is prescribed. This is especially so with painkillers and antibiotics. To learn more about the havoc we doctors have caused I draw your attention to an article by Dr Biswaroop Chatterjee [Turmoil over New Delhi Metallo-Beta Lactamase-1: a tale of ersatz patriotism] which has appeared in the recent issue of Indian Journal of Medical Ethics [www.ijme.in]

Have we, both doctors and patients learnt our lessons? Sadly, the answer is no and the sordid tale is continuing and I shudder to think of the future scene of resistant infections. Probably we will be back into 1930s [pre antibiotic days] very soon.

Scary isn’t it?

Another giant goes

2011-01-26T18:17:00.001+05:30

On an earlier occasion I had written about Gangubai Hangal and the loss I felt on her death [Death of a Doyenne, 28, July 20009]. Now I am writing about another maestro of Hindustani classical music who passed away three days ago. Collectively as a nation we have not achieved a great deal but have managed to throw up men and women of extraordinary talent and achievement. One such was Pundit Bhimsen Joshi.

Joshi was blessed with a rich voice over which he had extraordinary control. He would hold his listeners spell bound with his mastery over the various nuances of construction and delivery of the various ragas sung in the style of Kirana gharana. Many would be found with tears while listening to him, immersed in musical ecstasy. He was a simple man, who enjoyed life. Liked his drink, food and fast cars. Honors came to him aplenty including the nation’s highest, the Bharat ratna. Last few years of his life were not easy as he was very ill and his last performance was some four years back.

It is worth relating an interesting and unexpected encounter I had with him ten years ago at Mumbai. Four of us, all doctors had gone to Mumbai to attend a medical conference and stayed at a guest house. I was the medical advisor to the company which owned and operated the guest house. The major domo who managed the guest house was a Ghurka [native of Nepal]. When he came to know we were doctors he treated us with special attention and took lot of trouble to make us feel at home. The guest house had three rooms reserved for us for two days and we reached the guest house in the evening and made ourselves comfortable and after some light reading I went o bed. Around 1 am in the morning the major domo knocked on my door. I opened the door and asked him,’ what is the matter? Normally when a doctor is woken up at night there usually is a medical emergency. But this was none of that kind.’ Saab, [sir] some old singer [contempt in his voice] has come, says he has room booked here, office has not informed me’

I went to investigate. I saw the regal [he was a big built guy] persona of Bhimsen Joshi sitting with a glum face. There were flowers and mementoes placed on the next chair. There were few persons standing. These were his escorts who had come to see him safely home after the concert. It must have been galling to be told that the room meant for him was occupied by someone else. I was over whelmed and felt pretty bad that due to some ones error he had to suffer. Apologizing on behalf of the company, I requested him to take my room and I would move out to another one occupied by my friends. He appeared none too happy but I gave him no option and moved my belongings as quickly as possible, woke up my friend and slept on the floor of that room.

It must have been an hour or so later, there was another knock. I was barely asleep. I opened the door to find the major domo again. He said,’ that old singer [gayak] must be mad, he called some chela [disciple, friend] and he has gone away, he has asked me to get you back to the room, saab please come back’ He [Joshi] must have felt bad at disturbing me and had found alternate lodging. Not difficult for him considering the number of admirers he has all over the country. Many would consider it a privilege to host him.

I lost an opportunity of interacting with him at next day’s breakfast. But the ignorant Ghurka was full of apologies and criticism for the company which gives room to all kinds of musical riffraff and wanted me to inform the management not allow this sort of persons in to his esteemed establishment!

Counting my blessings

2011-01-20T10:48:00.001+05:30

It is not always that I am depressed, living in India. With all the faults which I have been enumerating and boring you all with, I have one major reason to be happy. I have freedom of expression. I can say what I want without fear of reprisal. I can also live the life I want to live. Being a born Hindu helps. Neither the state nor the religion forces me to conform. I can dress the way I want, eat what I like, drink what I want, visit or don’t visit a place of worship, I can criticize my gods for their follies and still live fairly peacefully doing what I want to do.

I have Muslim patients/friends who have close relatives in Pakistan. Pakistan is India’s sibling though many in both countries want to deny this fact. People share lot of common features and most of north Indians and Pakistani’s are from the same ethnic stock. India chose the democratic way of governance [or non governance] whereas Pakistan chose Theocracy based democracy. This did not work and over the years the decline of governance and domination of religion over democracy has become overwhelmingly oppressive. Descent is dangerous and nonconformists pay with their lives as it happened to Mr Salman Tasser, governor of Punjab, who was killed by his own body guard. Worse, there were celebrations and the killer was hailed as an upholder of Islamic values. Frightening, isn’t it?

My Muslim friends here are happy to be in India with all her faults. So am I, when it comes to final reckoning.

Loose motions Leela

2011-01-20T09:37:00.001+05:30

‘I am your old patient, Mrs. Leela’ the voice said at the other end of the phone line. Here old patient means not elderly but patient of some years standing. Leela is a common name and my practice has its quota of Leelas. I couldn’t place this Leela by her voice. The silence must have made the lady realize that I was finding it difficult to place her. She said,’ I am loose motions Leela’. Here what she meant was that she has had loose bowel movements which I had treated her for some time back and she expects me to remember her. This gamut too failed because I couldn’t remember any Leela who took treatment for diarrhea recently. My memory too is not that great and that adds to the problem. I said so to her.’ No, No, your memory is OK, I came to you three years ago for the problem and you cured me’.

‘What is your problem now?’ I asked.

‘Same, I have loose motions again.’ She replied.
‘Why don’t you come and see me’ I asked her. ‘You are too far away from where I live and I am afraid to travel’. This is a genuine problem. ‘Why don’t you prescribe some medication on phone which I can try?

I told the name of a commonly used drug which is given for infective diarrhea. ‘Doctor, I have already tried it, it is of no use, she said. ‘Who gave the prescription’ I asked’. ‘Dr S did one week ago’, she replied.

Dr S is a practitioner in her area. ‘Why don’t you go to him and tell him you are no better?
‘I did and he scared me, he wants me to go to hospital and get colonoscopy done [colonoscopy is passing a fibreoptic soft tube up the lower intestine and seeing the innards. Usually done when one doesn’t know the cause. In advising her Dr S was not wrong. I told her that.

‘But you cured me last time, I had the same problem’. She would not leave me in peace.
‘What was the treatment I gave you? Do you have my old case notes or prescriptions? I asked her.
She said, no and insisted that she come and see me.

She gave me no options. I agreed to see her and to see that she does not have any mid journey crisis, gave her a prescription for a bowel slowing drug and asked her to see me next day.

She came in next morning with a put on smile as though she was my long lost friend. Three years is a long time to remember a face for a person whose memory and recall is none too great. I still could not place her. Now she has got me it no longer worried her. She has been having these bouts of diarrhea which lasts from a week to two weeks and she gets better after taking medication with local doctor [meaning the hapless Dr S]. This time however she is not better despite his medication which she took for more than a week. The prescriptions she showed me had most of the common antidiarrhoeals.

Here was a problem. Could she be a diabetic and could this be a rare neuropathy due to diabetes? Sometimes these wild hunches of mine do work. She said she was not a diabetic but she has Gout and takes medications and before I asked her she said Dr M [M is a doctor who specializes in joint ailments] has asked her to take the drug for life. I asked her the name. She said goutnil. Goutnil is trade name of a drug called colchicine given for acute attacks of gout and certainly not to be taken for life. ‘How many tablets a day you are taking? I asked. ‘Three, that too when I have severe pain, when not in pain, I take one and sometimes none’. [Not really following take for life advice]

Here was the diagnosis. Gout causes severe pain and swelling of the small joint of hand/feet. The preferred joint is that of big toe. Colchicine is a very good drug to manage acute attacks but to prevent recurring attacks another drug called allopurinol is given, sometimes for life. Colchicine in many patients causes diarrhea. In Loose motions Leela’s case, likely culprit.

‘Did Dr M tell you to take it for life? I asked her.

She was silent for a while and said,’ Dr M gave me this drug to take for two weeks and then come and see him. It is very difficult to see him, he has a nasty receptionist, and getting appointment is difficult. So I asked my cousin who also has gout. He takes medicine daily and his doctor has told him, it is for life. As I also have the same problem I too thought it is for life’.

The patient who came in for intractable diarrhea ended up getting advice on management of gout. She stopped colchicine and her diarrhea disappeared.

It is six months since her visit and there has been no call and hopefully both her gout and gut are quiet.

Kidney tray

2011-01-13T17:11:00.001+05:30

Some years back, Bangalore achieved the dubious distinction of being the capital of clandestine kidney transplants. New and stricter regulations have made the procedure more transparent now. Those days the kidneys were procured for a price from poor donors. Slumlords were known to even coerce people to donate their kidneys for a commission. There was a lot of hue and cry in the press and surgeons too came in for a fair bit of justified criticism. There were widespread rumors of kidneys being removed from ignorant poor who got admitted for some other reason. This was the atmosphere prevailing then in the city, when this incident occurred in one of the hospitals. The patient was admitted for a minor procedure of draining an abscess [collection of pus].This was being done under local anesthesia in which the patient is conscious but doesn’t feel the pain in the place of operation. The surgeon after giving the local anesthetic proceeded to incise the abscess. No sooner he inserted the knife, a stream of pus welled out of the cut. To prevent spillage, he told the nurse with some urgency,’ quick, get me the kidney tray.’ The horrified patient jumped and ran out of the room. It took the combined might of three attendants and the surgeon to convince the patient that kidney tray is the name for the receptacle and it is not a tray to hold the kidney and to get him back to complete the procedure.

The word went round to all Bangalore hospitals not to mention the dreaded word in front of conscious patients undergoing procedures!

In the eyes of the beholder

2011-01-13T17:10:00.001+05:30

I have a close friend living abroad. He did not make a very successful marriage but got along with his wife. They make frequent visits to this country and used to visit me. Whenever I went abroad, time permitting, I too visited them. Often there was trouble between them and knowing my friend, despite trying to be neutral, I tended to take his side. Or so the lady thought. She may not have liked me but managed to be nice because I was her husband’s friend. On one occasion when I returned to Bangalore after spending some time with them, I got an e- mail from her, which read, ‘you were looking haggard and worried’ hope you are alright’
This came as a surprise, because I had never felt better at that time and was in best of my spirits. Then how did she get this impression? I wrote back in all earnestness, ‘looks are in the eyes of the beholder’. That was five years ago. Madam has neither seen me nor has spoken to since. My friend did see me once three years ago, but has not seen or written since then. My mails too have gone unanswered!

Irresponsible statement

2011-01-11T13:56:00.001+05:30

A gentleman who was my patient and whom I will call Mr D, suffered from high blood pressure and his exercise test for ischemic heart disease was positive at high exercise levels. Every year it was the same. We, the cardiologist who saw him and I refrained from doing any further tests on him and explained to him the pros and cons of doing an angiogram and the option of medical treatment was best for him. He came periodically for his blood pressure check and other sundry ailments. One day he developed prolonged chest pain and over the phone I advised him to seek help from the same cardiologist who had moved to another hospital which was located some distance away. Mr D decided to go to the hospital closest to him and met another cardiologist who correctly diagnosed a developing heart attack and proceeded to an angioplasty and stented the obstruction. So far so good. He did however made one remark which destroyed the relationship between Mr D and I, built over 15 years. He said to Mr D, ’you should have got this done many years ago’!

He [the cardiologist] did not bother to go through the case notes and earlier records made by me nor did he have the curtsey to talk to me [he did not know me then]. The patient who was in distress believed in what was told and not what I have been telling him. Later on, when I came to know this young cardiologist, I told him the damage his remark had caused. He of course was contrite but the damage had already been done. I lost that patient and it is three years since the incident. I came to know of the story by one of Mr D’s friends.

Cut your balls off

2011-01-11T13:51:00.002+05:30

Advertently or otherwise we cause problems to others by passing some comments or making some remarks. This happens more often than not with us doctors. Sometimes it is due to difficulty with language and sometimes, due to sheer irresponsibility and occasionally, it is due to how the patients/friends interpret the remarks.

Years ago, when I was a medical student, there was a teacher of surgery. We had a patient who had a painless swelling of his testicle. The surgeon made all of us examine the patient. We were some ten students, and all of us examined him. The discussion that followed was in the language of instruction, English. The final conclusion was that he patient had Hydrocele, a simple problem easily curable by a simple operation. When all this was going on the patient, whose mother tongue was Malayalam [language spoken in the state of Kerala] and who had no knowledge of English, was looking at us with some degree of panic. Seeing him thus, the surgeon who knew some Malayalam told him in a tone of assurance, 'don’t worry, you are going to be alright, I will just have to chop of your balls.’ What he meant was, that he will make a cut and drain out the collected water. But when he said the same in Malayalam, it appeared as though he was out to castrate the poor guy. The patient broke into a sweat and fell at the surgeon’s feet requesting him to do no such a thing and to discharge him and allow him to go home with his balls intact. The surgeon was very surprised with this show of ingratitude. He said again in Malayalam, 'my dear fellow’ why are you so worried; I am just going to cut off’ [meaning make a cut]. At this, the patient began to cry.

One of the students whose mother tongue was Malayalam came to the rescue of both the surgeon and the patient and explained the intent and the surgeon understood the blunder inadvertently made by him.

The 19th Hole

2011-01-06T19:23:00.002+05:30

The game of golf is played over 18 holes and it takes 4 to 5 hours to complete. At the end there is the 19th hole which some call the watering hole where the victors and the vanquished gather either to celebrate their victory or drown their sorrows. Many golfers value the time spent on this hole more than the time spent playing the 18 holes.

Apart from the discussion related to golf the conversation can be on a wide range of subjects and like all sports persons, that too over a drink, the pride of place is for talk that makes one laugh. There are some who are born wits and few other have a big collection of stories and jokes and they can recall and at the appropriate moment. One such is a fellow golfer and 19th hole specialist, Mr B.N.S Reddy senior.

The following is what I heard from him last week end.

The anatomy professor was taking his first demonstration for the new batch of medical students. The fresh and uncut formalin reeking body was laid in front and the prof spent time impressing the students on reverence with which one should treat the dead body which is going to give them so much of knowledge and also the importance of keen observation in learning medicine. Then he proceeded to do a strange thing. He inserted a finger into the anus of the body and put the finger inside his mouth. This act, the students thought, was his way of showing respect to the prospective dead teacher, though a bit strange. But what followed was even worse. He asked the students to do the same one by one. Very reluctantly one by one, all the students did what he prof did.

The professor said after this ceremony of finger licking was over. 'Ladies and gentlemen, as I said earlier, in medicine, observation is very important and I am sad, none of you observed what I was doing. I inserted my forefinger but licked the middle’

Cough Cure

2010-12-30T17:49:00.001+05:30

I could hear her violent bouts of cough through the door leading to the waiting room. She came in with her son who has been my patient for some years now. This was the first time she was seeing me. A well preserved and groomed lady of around 65 years, when asked what the problem is, began,’ can’t you hear my problem, this cough; I am having this since the last three months. I have tried many medicines but of no use’ she stopped to let go another bout of cough.
The list of medications consisted of three types of antibiotics, several anti allergic drugs including oral steroids and currently she has been taking copious quantities of syrup of codeine and suffered as a consequence, severe constipation.

I asked,’ where are the prescriptions’?

‘What prescriptions? I don’t need any prescriptions? I am a doctor’. She stopped at that.
Her son added,’ doc, I should have told you, my mother retired as professor of Pharmacology from Orissa few years ago and she has come here for a visit and has come to see you only because I forced her to.’

This explained a lot of things. She has been a senior teacher of Pharmacology and knew in depth all about medicines, but had no practical knowledge about diseases! Having retired she must have felt odd to seek help from her colleagues, most of whom must have been her students. She had made a self diagnosis [many] and has been medicating herself.

I was a worried man. I am dealing with senior medical personality who has come to seek help from a GP at the instance of her son. We GPs are considered as know nothings by many specialists and like many of us GPs thinking them to be doctors with blinkers on and knowing more and more of less and less. In reality both these assumptions are incorrect. I did not know what to make of this lady, a senior professor and teacher who has been neglecting a cough for over three months. But saying so will only make matters worse, this I know by experience.
For a while I kept quiet. By then she had told me few more complaints which were not very relevant like not sleeping well, dry mouth etc.

I asked her,’ have you got any tests done’? She said no but has been planning to get some done. This was like adding insult to injury. Three months of cough and no tests done!

I proceeded to examine her. But for repeated bouts of dry cough, she was alright with fairly clear lungs. I told her so and said I will have to get some tests done which included a chest X-ray, blood and sputum tests. She asked me,’ what you are suspecting? You think I have TB? Sounded more as an accusation than a statement. ‘In this country, madam, that is the first illness that I would want to exclude, though I don’t think it is TB, but one can never be sure ‘. ‘Then what do you think it is? This is another problem we doctors face. When I am not sure how can I tell her what is the problem? I told her that is the reason why I was getting these tests done. She would not leave me. You must have some idea before you asked for these tests’ she said. I had to reply. I said,’ madam it can be any illness starting from TB to asthma to cancer. No, No, No, I cannot be having cancer; I have never smoked in my life, asthma! I don’t have any breathing difficulty, it must be something else’. How can I argue with this professor that all the three diseases are still possible and why. It is simply a waste of time and prolonging the argument which was taking us nowhere.

I felt it is best o keep quiet. She said at last, ‘OK, we will do the tests and get back to you’.

Couple of days later, she and her son returned to see me with reports of the tests done.
One look at her told me that something was seriously wrong. Her face was ashen and her lips and hands were trembling. Here was a lady who was frightened out of her wits. I made them sit down. Even before I asked her any question, she said,’ doctor you are right, I have miliary tuberculosis’. Miliary tuberculosis is very serious form of tuberculosis where in the tubercular germ has widely disseminated and the patient is very seriously ill. I asked her how does she know. She showed me the radiologist’s report which accompanied the chest X-ray. It read,’ fine diffuse nodular opacities in both lung fields. Consistent with military tuberculosis. Please correlate clinically’

The X-ray reader sees and reports on what he sees. He has no clinical experience as he does not see the patient. His job is to report what he sees and that is what he has done. Strictly speaking he should have stopped at diffuse nodular opacities seen and not hinted at military TB. That is the clinician’s job. But the radiologists do commit this mistake of suggesting which they should not do. Our professor has put this finding and her cough and surmised that she has serious form of TB.

I went through the other reports. She had very high percentage of a type of white cell called eosinophil. Eosinophil developed over thousands of years to particularly attack worms [not germs] which infest our body. Especially so, those worms which tend to travel around in our tissues. Coming from Orissa the diagnosis was very easy to make. She had Filariasis.

In Filaria, after the infected mosquito bites, the released larvae of the filarial worm migrates and gets stuck in the lung tissue where the eosinophils too go in large numbers and attack them. The reaction results in small pinhead sized nodules which are seen in the X-ray. The same happens in a different way in TB where another specialist cell called Lymphocyte does the same. X- ray picture of both is near identical. The flood of eosinophils is also seen in the blood much more than what is normally seen. In fact this condition is known as tropical eosinophilia.

I explained to her in detail and also prescribed the 15 day course of a drug called Diethyl Carbamazine that will bring about a near miraculous cure.

She brightened visibly. Next ten minutes were spent not in thanking me but in giving me a lecture on Diethyl Carbamazine.

After all, was she not a professor of Pharmacology?

Ushering in yet another year

2010-12-28T19:46:00.003+05:30

A year is about to end and another about to begin and time has come to share my thoughts and feelings and say thank you.
These are:
To those of you who are my patients, a big thank you for keeping me active in the profession and for the confidence, love and affection you continue to shower,
To those of my friends, especially my golfing and badminton buddies, for having kept me happy and healthy,
To my small scattered family for continued support and love,
To the colorful plant and bird life which continues to give me so much of visual pleasure,
To readers of my Blog for the encouragement which has helped me to keep writing,
And lastly, to that mighty force which has kept me mentally fit and physically active, given me the ability to enjoy and appreciate the little things in the evening of my life.

Hope you don’t mind a bit of advice from an old doctor.

Eat less, consume less, exercise more, laugh whenever you can, help out, forget the past, enjoy the present and don’t worry about future.

These are the same ones expressed last year.I could not do any better this year.Therefore I have posted the same!

Travesty of Justice

2010-12-24T20:33:00.001+05:30

I did not know whether to laugh or weep on hearing the news of Dr Binayak Sen being found Guilty of sedition by a judge in Chattisgarh. In this country the state machinery can be used to bend justice to suit its ways and Dr Sen being found guilty is one such. It is not difficult to create documents, get witnesses to testify against anyone the state doenot like and there are any number of officials willing to cater to the whims of the state.

That he was a nuisance to the state machinery was true. His ways of helping the poor and down trodden was not to the liking of the state. He took the health and nutrition care where it was most needed, to the poorest of the poor and to their doorstep. He found by experience that these people had no voice and willy nilly became their voice in the form a human rights activist. To equate this activity as that of a naxalite is shameful to say the least and this is exactly the state government has done. It should have followed his example and reached out to people and won them over instead of giving in to the influential interests of the landed gentry.

Of course the higher judiciary will not be that stupid as the lower courts and will see that he justice will be done, but then if a person of Dr Sen’s eminence can be found guilty, imagine the plight of an ordinary citizen in this country who has been wronged by the state.

Hollow

2010-12-23T19:56:00.001+05:30

I was idly rummaging through my collection of books and came across this one. Bound in a buff cover, pages yellowing, the book had a small legend written by my hand. 25/2/77 H.A.L. airport and the scrawled signature of yours truly. It brought back memories of those years. The airport was small and served few domestic flights. Those going abroad had to go to Bombay [oops sorry Mumbai] and take an international flight from there. The road to the airport was a narrow lane with hardly space for two vehicles to pass each other. Vehicles were few and the ride to the airport was hassle free. I rode my motorcycle and would reach the airport in ten minutes. What surprised me was that I had bought that book and that too from the airport bookstall paying obviously much more than in the town’s book stores. Normally my buying was from the second hand book store located off MG road called Rao’s. Mr Rao specialized in second hand books and enjoyed his trade. He had few stools placed outside his tiny store over flowing with books for not too well off customers like me to sit and browse.

The book’s name is Hollow and late Dame Agatha Christie the author. I read the book once again. Set in the post war England where one still suffered [or enjoyed] class distinctions, in the rural countryside, it made good reading. Agatha usually kills her victims with poison but here the murder weapon was a revolver. The story meanders to an unexpected conclusion in typically Agatha way. What was interesting is that after 30 years I could still read it and enjoy doing so. I cannot say the same with some authors whom I greatly admired in the yester years. One such is A.J. Cronin. I read one of his novels and found it too artificial. Whereas, his book of stories relating to Drs Finlay and Cameron remains an all-time favorite. There was a crime writer called Earl Stanly Gardener whose books I avidly read and now I wonder how I could do so. Works of others like P.G. Wodehouse, P.D.James, John Mortimer [Rumpole stories] can be read over and over again without the loss of pleasure.

40 years ago, in the beginning years of my practice, I had oceans of time and one way of spending time in the clinic was reading and those days there were lot of way side book shops in the Cantonment area and near Majestic circle. Commuting was easy unlike now and I would be a regular visitor to these shops. It was quite entertaining in a way especially visiting Rao’s. Old man Rao passed away some twenty odd years ago and now his son [Murthy?] manages the book shop located some distance away with equal enthusiasm. Then there was Premier Book shop run by Mr. Shanbhag who ended up becoming my friend and about whom I have written earlier in these columns. In the last five years there is another bookshop called blossoms that has come up in Church street which too specializes in old books but the owners are not knowledgeable like Rao and Shanbhag who knew exactly what I would be looking for and would put ten books in front of me to choose from.

I miss them

Holding the breath

2010-12-22T14:47:00.001+05:30

That was an unusual complaint. She said every time she went for a walk she was forced to hold her breath. ‘You mean you were breathless? I asked. She said,’ no doc, I had to stop breathing for a few seconds and then I can proceed with normal breathing’. She said she had no chest discomfort or radiating pain. This 65 year old woman has been my patient for several years and not given to exaggeration though the unfeeling husband seemed to think that she was imagining a complaint! I knew that an exercise ECG and an angiogram [done for similar complaint?] two years ago were normal.

I did not like it despite her BP being normal and a regular pulse. I sent her to my cardiologist friend and forced him to do an exercise ECG. He called me from the hospital and said she had severe supraventricular tachycardia [very fast uncontrolled heart rate] and atrial fibrillation [another kind of serious rhythm disturbance] within two minutes of excercise! The stopping of her breath was due to inadequate perfusion from a heart which was in serious trouble. She was rescued with medication and another possible disaster avoided!

Tendulkar and Bradman

2010-12-22T14:27:00.000+05:30

The present generations of cricket lovers all over, including the Australians seem to think Tendulkar is better of the two. One should really not compare the two in the first place. But if you force me to do it I would place Bradman above Tendulkar. In the era Bradman played, except Leg guards there was no protective gear. One exposed the body and head to the fast bowlers. He had a phenomenal average of more than 90. He may have played fewer tests but that is not taking away from the basic facts of brilliant batsmanship. They had to design the famous bodyline attack to keep him quiet. Nothing of that sort ever happened to the well protected Tendulkar. Given the conditions of modern cricket it is possible that he is one of the greatest batsmen the world has seen in recent times. But then who am I to opine when the majority of voters are young hero-worshippers?

Update

2010-12-22T14:25:00.001+05:30

Many of you must have wondered at the prolonged period of not writing on my blog and what may have happened to the old man? Recently one of my patients took objection to my calling myself an old man. When one is old what is wrong with the term? After all the body has to get old but what is important is the feeling. If one feels good in whatever one does and keeps active then one is not ‘old’. In that sense I am not old. Incidentally I have updated my age which should have been done six months back.

Returning to the question of why I did not write for six months, is not due to my passing away or due to ill health, lack of material or sheer laziness, but because of one important factor which constantly and even now disturbs me when I take up to write. This is the thought of the state of my country. This not new and I was able to put these aside and get on with life and my writing. But lately the level to which the governance and corruption has sunk to, is so mind boggling that I am compelled to write only about this and most of you are quite bored with my constant rantings.

But then I have a reason. I was a toddler when the country became independent. We were abject poor but were reasonably administered by the British before that. Our poverty was due mostly to the siphoning of the resources and funds to our host country and to the ravages of world war which made every one poor including the British. They thought it fit quit rather than manage us and there was also the nuisance called Gandhi. So we became independent and I grew up in this independent India. We had visions of a well managed state where in every one lived in harmony and comfort. Gradually reality took over and we realized that aspiration is one thing and achievement is another. The former was high and the latter very low. The real colours of the ruling class [politicians and beurocrats] became apparent as the years went by. Corruption and poor governance which were not rampant in the initial years gradually became common and even worse it came to be accepted by the society and corrupt wealth came to be accepted and even respected! This happened at the cost of development is easy to understand and what we are seeing today is this cancer that is destroying the country and the magnitude of this illness is what the media is highlighting. Then what is this that you hear that India is an emerging economic power and is going to be a world leader? This is because we are a large and populous nation and a small percentage of this population is wealthy it is like the whole of Europe being wealthy. That is what one sees .The doings of this 5% of the population [which includes most of the corrupt]. The state of remaining is going from bad to worse leading to a frightening discordance. It is a joke that this country becoming a world leader. What is then the solution?
Radical surgery is the cure. Not so long ago, corruption was rampant in the state of Singapore. It needed one man [Lee Kon Yew] to set things right. Quick justice and accountability is what he did and you see the results. We need another Lee to save us.

Till then you have not many choices, rant and rave and be called a misfit, get into a self created cocoon [of golf, music and infrequent writing like I have done]and let the world be or become a revolutionary [which may take the country to even worse situation]

New Patient

2010-11-04T18:40:00.002+05:30

These days, as I grow older [also wiser?], I am reluctant to take new patients and added responsibility. The main reason is that I have come to value my private time much more than before. Another reason is the fear that I may not be able to give an efficient service by my own standards. Be that may, I still have to take a few because of many compulsions. One such is my own friends who bring their dear and near, and I owe it to them, so I accept. Here is one such patient.

This old lady walks in and tells me that she is a very good friend of Mr G and because of his recommendation she has come to see me.

‘You look good’ she said by the way of opening the consultation. I am used to patients telling me their complaints and not complimenting me on my looks. I sat looking at her rather confused and did not know how to respond. She must have guessed,’ you don’t know how to take a compliment’. This is true; it leaves me uncomfortable because I suspect the motive which is not really the right thing to do.

I said belated thanks and asked her what I could do for her.
She sat thinking. Few minutes passed. I asked her what the reason why she has come to see me. ‘Oh, that is because G told me to see you’, she said.

We were now back to square one. Many of us old persons are forgetful and I thought this one must be one of those who has forgotten. So I asked her,’ have you forgotten why you are here?’ ‘Common doctor, I am not that old, I remember all my problems, the trouble is that there are so many of them, I don’t know where to begin’.

This was enough to make my heart sink.

She began her complaints with unusual gusto.
Thirty years ago, I was involved in an accident and since then I have this periodic head ache. She went on to give a graphic description of how the accident took place, the number of doctors she has seen and the investigations that have been done and the medications she is presently on and the diet she has been following.

Seeing me getting ready to examine her, she said 'hold on,’ I also have diabetes and high blood pressure.’ She proceeded to give another lengthy description.
Then came the description of her knee joint pains. Then her gas in the belly,

There was a brief intermission when she was collecting her thoughts as to her next problem.

‘Ha, I also have this ache in my back and pricking sensations in my legs. Sometimes I get up too often at night and this disturbs my husband’. A description of how irritable a husband she has, followed.

You may think that I sat there docile without interrupting her. My attempts were firmly put down,’ wait a second, I will come to that, or some such comment to keep me in my place.

At last, after nearly half an hour, she allowed me to examine her. There was not much wrong with her. I was able to get her medications down from the twelve drugs to six essential ones. I thought she would be happy. Instead she said,’ but doc, I have been taking these for over ten years. A mild argument as to the need to cut down unnecessary medication ensued. She reluctantly agreed to do so.

By now, I was feeling the beginning of a small ache in my head and was having visions of my mid morning tea.

‘When should I come back? She asked. ‘Six months from now’ I said. She was taken aback,’ but my doctor sees my every fifteen days’. I said,’ see him every fifteen days but see me once in six months’.

She gave a strange look, thanked me and went. I heaved a sigh of relief that I don’t have to see her for six months.

Red Herring

2010-11-04T16:56:00.003+05:30

Often we doctors go astray chasing the wrong diagnosis and causing avoidable distress to our patients. This is one such story which happened in my practice recently.

I am now treating the fourth generation of Pillays. The old man Pillay who came to Bangalore from the state of Kerala some 60 years back died many years ago. The young man in question is 25 years old Mr S is the grandson who is employed as an engineer in a private company. He suffers from stone disease of his kidneys and every now and then develops pain in his back and down the track of his ureter [the tube that drains the urine to the bladder] and ends up either with me or at the nearby hospital’s outpatient department.

He developed one such episode of severe backache and ended up in the hospital and a scan of his abdomen revealed Kidney stones though none was visible in the ureters. Going by the past story he was given pain killers and asked to come next day. He did not get better and developed urinary urgency and frequency and constipation. The physician thought the urinary symptoms to be due to possible infection and suggested a urine study. The patient’s complaint of constipation was attributed to taking painkillers and his feeling of tingling sensations in his legs to anxiety. Pending urine study he was given antibiotics and sent home.

He came over to see me next day. His pain back was localized and on both sides. He had abnormal pain and touch sensations and improper control of his bladder and was unable to evacuate his bowels. Examination revealed grossly abnormal neurological signs in both lower legs and there was bladder and bowel involvement. I was dealing with a serious illness called Transverse Myelitis which needed urgent expert management.

Myelitis is a general term used to describe all inflammatory conditions that affect the sheath [cover] of the nerves and nerve cells. It can be due to infection or immunological insult. The latter was the case with this young man and he was saved the dire consequences of possible paralysis of his body from navel downwards by massive doses of steroids and only a week’s hospitalization. At the time of writing the story he is near normal.

He still has stones in the substance of the kidney but sitting quietly for the present.

India Today

2010-11-04T16:53:00.000+05:30

Whenever there is talk or writing about India’s great strides as an emerging superpower I get upset. A patriotic Indian likes to hear and read this so called greatness of ours and you may not like what I write. The sheen of prosperity one sees is mostly confined to metropolitan India. The shopping malls, eating and drinking places are full of well dressed young people spending freely. These are not our people. The Indian I talk about has not set his foot in any of these places and he forms the majority, some sociologists put this percentage to be 90 out of 100.This must be 98 out of 100 in rural India. But this 10 percent is what the other world sees. It also sees the Indian who is more visible and successful abroad and many make the mistake of his success as his country’s. These expatriates are runaways and escapees from the real India.

The real India exists in utter misery. It is malnourished, disease stricken, poor, and roofless with no body to look up to for help. The delivery mechanism of our so called welfare state is virtually nonexistent and the benefits that should reach these people generally end up lining the pockets of those who are supposed to deliver. Our primary and secondary health care systems are in shambles. We have no social security worth the name. We have no food reaching the needy and malnourishment is rampant. And these poor children end up as stunted adults. The politicians and beurocrats who are supposed to get us out of this morass are busy in participating in one type of scam or the other and care a damn as to what happens to the 90%.

The silver lining is some Individuals like the Drs Amte [many such], business houses like the Tatas and other NGOs. But the work that is being done by these is a drop in the ocean for a vast country like India.

So please stop talking about the country’s progress.

Rohan Bopanna

2010-09-09T20:21:00.000+05:30

When I first met Rohan he was a thin gangly 11 year old. His father Prabha [Bopanna] is the younger brother of Raja [Nanjappa] who is a very dear friend and neighbor [also golfing buddy of over twenty years!].’Doc, look at this boy, he wants to play tennis, how can he ever with his eating habits’ Prabha said pointing to the grinning boy. ‘What eating habits’ I asked. He likes only bread and honey and occasional glass of milk the father said. This worried statement made both of us laugh and I don’t remember exactly what advice I gave the boy then. Kodagas [Coorgs] like their meat and no meal is complete if there is no meat dish preferably pork and naturally the father was worried about this bread and honey eating boy.

Then on there have been many occasions when I met Rohan either as a patient or when he came to stay with his uncle [Raja]. His build makes him Injury prone and his whole carrier is bedeviled by many injuries mainly to his right shoulder [serving arm]. As a matter of fact with his ability and character he should have achieved much more as a singles player but for his injuries. Rohan is one of the most self effacing boy [man] I have ever met. Success sits very lightly on his head. He is the same Rohan whom I met for the first time some 15 years ago.

He met Aslam [Qureshi] about ten years back and they have started playing doubles together some five years back when Rohan shifted his priority from singles to doubles and the pair began making history. Their reaching Wimbledon QF and now US open final has made all of us very happy and proud. So much so, despite winning today’s golf match and the bet of beer, Raja did not allow our opponents to buy and celebrated Rohan’s victory by buying drinks for all of us!

It is very big news for us In India and many like us I am sure in Pakistan,to see these two men who have shown how the two countries can get along and as Aslam rightly said,’ leave religion and politics behind and play tennis!’

Not their cup of tea

2010-09-06T15:28:00.000+05:30

I read with interest two news items, one recently and the other some time ago. The one I read a couple of days ago described the travails of the dean of a government medical college. This dean after a lot of struggle had succeeded in building a state of the art mortuary for his teaching hospital and wanted a dignitary to inaugurate this building. In India no public function is complete without this formality and generally the preferred dignitary is a politician of some standing, usually belonging to the ruling party. Thus the first choice was the chief minister of the state who declined and the next two were the health and the medical education ministers. They too refused. The number of ministers in each of our states is sometimes equals that of the legislators. This is to accommodate as many of the winning legislators as possible and give them some status and power. This in turn leads to massive corruption is every ones guess and no one’s concern. So after many ministers refusing it was the turn of beurocrats. The dean met with the same kind of reluctance. At last he was driven to inaugurate the building himself accompanied by few of his trusted staff.

Obviously those who refused to do the honors believed that by doing so they may end up in the morgue before their time is up!

The other news item is about a constituency named Chamarajnagar. Since last twenty odd years no Chief minister has visited this place. Do you know why? In the earlier years those who did lost their chief ministership with in a short time after the visit. So the place is stuck with this taboo and no one has dared to break this voodoo!

We humans are strangely superstitious. It is all over but we Indians must take the cake. We have a right time and a wrong time to do anything and everything. There are Pundits who prepare almanacs giving the exact good and bad timings each day. No auspicious function is held without consulting these experts. I have known many daughters who have remained unmarried because of some blemish in their horoscopes [birth charts]. Strangely there appears to be less stringency where sons are concerned! I have on an earlier occasion written about my not being able to find a friend’s home because he had changed the entrance to the house following such advice. My friend who is an architect tells me that he has to use all his ingenuity to satisfy this belief and also make the house look good and livable!

Looting the public

2010-08-29T18:16:00.000+05:30

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.

Mind over matter

2010-08-23T08:25:00.002+05:30

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

2010-08-23T08:23:00.001+05:30

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.

Impressions 3

2010-08-19T17:51:00.001+05:30

Evaluating success

2010-08-17T08:35:00.000+05:30

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?

2010-08-17T08:31:00.002+05:30

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! ~~~

Impressions 2

2010-08-15T15:31:00.002+05:30

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!

Impressions

2010-08-12T17:27:00.001+05:30

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.

Holiday Time

2010-08-11T13:32:00.000+05:30

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

2010-08-11T13:30:00.001+05:30

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!

Lump and Ache

2010-05-17T12:43:00.001+05:30

New patients are naturally wary of the doctor. They don’t know what they are going to get in the consult. It may not be a pleasant experience for both parties. Who knows, in a worst case scenario, the doctor may not hesitate to pass a death sentence on the hapless patient.

This patient who gate crashed [came without prior information] into my clinic had severe anxiety writ large on his face. I asked him to sit and try and relax. He sat on the front of the chair and I could see the hands tremble. He was perspiring. I waited for him to begin.
After a minute or so he said, ‘I have a tumor on the lower part of my back and it is hurting me’
Normally patients don’t say tumor, they say swelling or lump. If someone says tumor I am certain he has already seen another doctor and has borrowed the terminology. We doctors as a tribe don’t know how [or don’t want to] to put our diagnosis in simple lingo. We have to say myocardial Infarction instead of heart attack, Cholecystitis instead of infected gallbladder. Sometimes when we don’t know how to describe an illness appropriately enough with a high sounding name, like when one has vertigo due to vestibular disease then we call it BPPV which stands for benign paroxysmal positional vertigo which in real terms mean a benign form of vertigo which comes in paroxysms related to position of the head!

So this tumor word had me worried because it connotes a growth of some type and could be serious especially when it is also causing back ache. After getting the history that the swelling was noticed several years ago and the pain from the last two months, I asked him to undress and lie down on the couch.

This is what I found. He had a small mobile lump and he had a stiff lower back. The lump belongs to group of fibro fatty innocent tumors called fibromas/ lipomas. The rigid back needed to be investigated. I told him so and assured him that he two are unrelated. He said he has already been extensively investigated which included an MRI scan. He proceeded to take out as sheaf of papers from his sling bag. The MRI showed slightly indented cord but not serious enough to have caused his back ache. His other reports were normal.

What this young man needed was posture correction at work and a set of exercises to stretch his low back. His lump needed no intervention. I told him so.

‘Doctor, are you sure’? He asked.
‘As sure as one can be, going by the evidence’, I said. Then he took out another set of papers in which a surgeon had advised admission for removal of the tumor and surgery for the disc prolapsed!

I sat in silence for a while not knowing what to do or say. I told him, ’you have come to me for an opinion and advice, according to me you need no surgery, try out these exercises and get back to me after six weeks, we will review you back problem. The lipoma needs no removal, not now and not in foreseeable future’.

That was two months ago. He came to see me few days ago. His back ache was very much better and his much feared lump didnot seem to bother him.

Fat cats don't hunt

2010-05-13T11:13:00.001+05:30

I am one of those who never liked the 20/20 version of cricket. It is more like a slam bang jamboree rather than real cricket. Indian version of this is called IPL and it was over about two weeks ago. Just after this the team went to West Indies for the world cup of the same format. It came as no surprise to me that the much hyped team India got a through drubbing. This was mainly due to what commentator Ian Bishop aptly described as spineless batting.

On docile Indian pitches even the fastest bowler is rendered innocuous and our heroes are used to this and away it is a different story. The ball comes at you at an uncomfortable height and you should be quick on your feet and eye to either ward off or hit the ball. Our players did neither and preferred to get out! They were such a jaded and faded lot after the hectic IPL that even a child could see that they were an unfit lot. Adding insult to injury there seemed to be no pride representing the national side. This is entirely due to the fact that there is so much more money in domestic IPL than world cricket and our team full of fat cats were not hungry for a win. As the legendry Imran Khan commented that there may come a time when players may prefer to stay away from representing their country and prefer to play for their club!

Now coming to the sordid affairs of the IPL. When money, glamour, business and politics become bedfellows, it is foolish to expect honesty and straight forward deals. The high flying commissioner of the league, Mr Lilith Mody was found wanting on many counts and was summarily booted out, few tears were shed by the viewing public. Few were indeed shed for another IPL casualty, the articulate blabber mouth, Sashi Taroor.

I consciousness

2010-04-11T19:00:00.001+05:30

My friend, patient and reader of my blog, Dip Ghosh dropped in to see me the other day. He made a chance remark as to why I write so much on matters concerning the evening of one’s life? This made me laugh and also had me thinking. What is my contact with young people and their lives? [morning of life], except when they come to see me as patients. What I know and hear about their lives is so far removed from my own that writing about it can only be second hand. I am also not well qualified to write about young people even those whom I know. I don’t understand their craze for modern Gizmos, their spending spare time wandering and shopping in the glitzy malls, their way of eating out at fancy places paying unacceptably large sums of money on unacceptable food. When they come as patients I sometimes tell them but their attitude is one of bored listening to an old man who is out of tune with the modern world [this is true]

I have on the other hand firsthand experience of the evening of life. Many of my patients are old and in their sickness and other wise I understand them better. I often wonder how our own I consciousness wanes slowly as we age and becomes hazy because of lack of recognition by others. I am I because others see me as I. When others see me as one who is on his way out, this recognition and feeling of real or contrived importance recedes. But does it die entirely? Sadly it will not and the recognition of its lessening importance is occasionally galling to the ego. When does it do and what happens to it? The development of I consciousness begins early in life when the child begins to understand the body limitations and begins to develop and understand language. The skin cover of the body tells the brain the limitation of the body in relation to the exterior and the senses tell the brain who it is visa vi the external environment. But for all this there must be original something to develop. This is I. When I die what happens this my I? Is it kept in suspended animation? Does it have some sort of structure that we don’t know of? Does it consist of some special form of intelligence which doesn’t need senses to be appreciated? I have no answers to these questions.

The belief that this I consciousness is transferable after death gives some meaning to existence. But truth eludes us and the proliferation of God men and women is a proof to this quest to know. Some glimpse of understanding will come to you if you read the book,’my stroke of insight’

Like it sometime happens, I begin with something and end up with something else . This week end happens to be one of those where in I have been having these recurring thoughts and felt that I should share some of them with you.

The Little Green Barbet

2010-04-10T20:51:00.002+05:30

Eleven years ago I did a study with the help of an expert bird watcher, of the birds that are found in and around our golf course. Recently I was asked to do so again. This time however I needed no expert and I know by heart, sound [call] and sight and flight the number of birds that still survive and thrive. There are still 40 varieties of them seen in the last one year out of the 50 odd that were listed ten years ago. Some have disappeared and the numbers of many has come down drastically [Rosy Pastor]. Some however continue to thrive like the common Myna and the Crow both the house and the jungle.

But what drew my attention was the surprise missing of Little Green Barbet seen in such profusion now but not mentioned at all in that list made ten years ago. How can this be? We, or at least not the expert who was with me [refer: birds and others, Sunday, Nov 25, 2007] could have missed seeing this bird or at least listening to his call?

Some time ago I wrote about sighting and listening to the call of the Red vented bulbul in my backyard. Any time a new species arrives and thrives in new ecological environs, it lifts me out my gloom. The profuse sighting of the green barbet in recent years is one such event. This bird which is smaller than a Mina is colored green with rufus and white mixed front and a beak with bristles. Its flight is like an arrow shot from a bow. The call is a staccato cuttroo cutroo repeated over and over. Perhaps this is one of the early callers in the morning that wakes you from your slumber. I have often wondered how such a small bird can produce such a loud sound.

From the tenth green we walk to the eleventh Tee box and next to this path there stands a dead tree awaiting the axe. The trunk of the tree abruptly divides into three branches. At this cleavage is located the circular entrance of a Barbet’s nest. It is so well located; one can only see it from one angle. All others are hidden out of sight. What is even amazing is that despite the almost continuous walk of golfers within a few feet of the tree, the bird has managed to dig a hole for its nest. How is it possible? One day I took up a position and watched. Between one batch of four golfers leaving the putting area [green] and another batch coming there is an interval of ten minutes. That is when I saw the birds do their job of nest building, cleaning, feeding and what else. Remarkable is not it?

I did observe one pair of Sand Pipers coming into the course every summer and they still do after ten years. Are they same? I wonder. I used to see Rosy Pastors, Yellow wagtails and Wood Mynas in their hundreds, but I see a measly few now. All around the course there is so called development [concrete jungle] How much time before they convert the golf course which is the only refuge for these birds into some government sponsored monstrocity?

Golfing woes

2010-03-28T13:30:00.001+05:30

Mr S is a fellow golfer and also my patient. He took to golf when he was past fifty and I have been observing his progress [or regress?] since then. Even when he began he was not very good, as it often happens when you take up a new sport at that age. Except for the walking that is involved in golf and swinging the club attempting to hit the golf ball squarely, he does no other exercise and as he has grown older his never very good golf swing has become shorter and stiffer. This is because he finds it difficult to turn his body fully and shift weight from one leg to the other. Though this is the lot of most of us ageing golfers and most of us have come to accept this as another aspect of ageing process and still continue to enjoy the game [more observant amongst my readers may have noticed that my handicap has gone up from 15 to 18].

This is not so with S. He cannot accept that his bad golf is because of his age and stiffness. He came to see me the other day and his opening remark was, ’Doc,’ I am giving up golf’. I kept quiet. On many a bad day I too have felt like doing so, but have gone back to play. The infernal game is like that. No other physical activity [with the possible exception of sex] is as addictive and frustrating as golf. ‘ I am not able to strike the ball, and when I do it, it is a slice [the ball taking of to the right in an ugly arc], I have become abusive and ill tempered, no caddy is prepared to carry my bag, my partners barely tolerate me and when I go home, I am so irritable that wife doesn’t even want to speak with me’ he stopped.

He sat quiet staring at me. I can understand the turmoil he was going through. Golf is one game where maximum consultations are done with sport Psychologists and in their absence my friend has found me to help him. I know that telling him that he has become old and it is natural that his game will deteriorate will only depress him more.

‘What you want me to do’ I asked him.

‘Give me something that will make me less irritable, I don’t want to lose my temper on the golf course’ he said. ‘But then, how will it improve your swing? Have you gone and seen the club’s pro?’ I asked him. ‘Yes I did. Took two lessons, He wanted to correct my twenty years swing, impossible at my age, it was a bloody waste of money’ he said.

Any way you have decided to give up golf, why then you need medication to quieten you’? I asked. I want to give it a last try, He said. I gave him a prescription for a minor anti anxiety drug to be taken half an hour before the start of the game. I also told him it might cause some drowsiness. He took the prescription and left.

Couple of weeks later I met with him on the golf course and asked him about his golf. He said, ’I am much better, I have stopped using my driver, 3 wood and long irons[ less forgiving of the 14 clubs a golfer is allowed to carry] and my slice is now much less though my handicap remains the same’. ‘How is your temper?’ I asked him. ‘I am paying my caddy twice the amount so that he can put up with me’ he replied. This meant he was bribing the caddy to accept his short temper [I will tell the caddy’s version in another story]. ‘So the medicine is working’ I asked. Yes, he said but not while playing golf, I take it at night with my evening drink, doc let me tell you I never had a better cocktail, I have never slept this well, you should recommend this to your other patients’ he said.

Demand from the drunks

2010-03-26T18:04:00.002+05:30

The Citizens of the city of Bangalore are now in the throes of selecting their ward representatives [carporators] who will administer the city for the next five years. This time over there are two hundred of them. Normally one would expect the contestants to be educated with a flair for social service with administrative ability and leadership qualities. Going by the newspaper reports and what I have seen and heard these candidates on TV, a large percentage of them appear to be slum lords, gangsters and extortionists, undercover dons who have come over ground only to contest the elections. Many of them have the additional qualification of being school drop outs. Their sole qualification in getting nomination from the major political parties is winnabllity.

Most are locally well known in their respective wards not for any acts of gallantry or for social work, but because of creating nuisance such as extorting, creating ruckus during festivals and taking out processions, boot legging and it should come as no surprise that many are rowdy sheeters registered with the local police stations. But they all have one additional qualification, that is money. This enables them to hire unemployed youth from the slums and shanty towns of the city where majority of voters live for doing election work. One TV channel showed these young men having a good time after the day’s electioneering, sitting in happy groups drinking and dancing. The electioneering involves visiting the voters with hands folded during day time and clandestine visits during the evenings to distribute goodies like clothing, kitchen utensils, cash and the prince of all gifts, alcohol.

Hooch is the term commonly used for illicit liquor sold without license. This city is in love with alcohol. Many years ago when prohibition was introduced [driven down the throats of people] all over the country, Bangalore was the only city that was spared. This city has many legacies left over by our erstwhile masters, the Britishers. One of them is the habit of drinking. Depending on affordability and class, there are three types of drinking men [and women]. The first are economically well off who drink the high end of spirits [scotch and other imported stuff], the second are the not so well off who drink what is called IMFL [Indian made foreign liquor] and the last are the weaker sections who drink the cheapest available that includes illicit alcohol. It is not uncommon to see many dying after consuming this illicit brew contaminated with methyl alcohol. But across the board we Bangaloreans love our drink and come election time we give free vent to this love of ours.

Alcohol users form the majority of voting public, and this time they have put forth their own demands to the prospective candidates. Stop making impossible promises like providing nonstop water, electricity, clearing the clogged drains and the like and work towards meeting the following demands.

Provide shelters near liquor shops where inebriated persons can spend the nights instead of on the footpaths and roadside as it is done now.

In case one was to be found sleeping off in the above unacceptable areas, see that they are not disturbed by the police and the good Samaritans who pass by. This applies to street dogs also.

When we are zigzagging our way back home late at night, passing vehicles must slow down and allow us to go our way. We should have the right of way and not these crazy drivers. Policemen should leave us alone and not drag us to the police station and disturb our sleep and pleasure.

Wives are a major problem. They don’t seem to understand the importance of alcohol in our lives. They scream and shout at us when all we want is to get our well earned sleep. Often we are made to sleep on the door steps of our own homes. This must stop.

Last but not the least; we are the major revenue earners for the government. Excise levy on liquor forms 40% of the state’s revenue. It is therefore the duty of all the future carporators to work to reduce the duty on liquor and all of us then can afford to drink quality liquor and need not risk our lives drinking illicit hooch.

Maya's garlands

2010-03-21T18:19:00.000+05:30

Indians are immune to the news, both visual and written, giving details of corruption in public life. If there is one single reason why we have progressed much less than what we could have, is because of this. I have written on several occasions on this and how we have come to accept and even appreciate the corrupt.

The latest is the felicitation ceremony of the corrupt politician queen, madam Mayavati. This scion and savior of Dalits [name given to the socially and economically backward section of Indians] is ruling the largest and the most populous state of the union called Utter Pradesh. On the occasion of the 25th anniversary of the birth of her party, she was profusely garlanded by her party men [sycophants].The garlands were made up of currency notes of 1000rupee denomination. The garlands were huge and were engulfing the diminutive Mayavati and they [garlands] had to be supported by her faithful. Was there any sense of shame or remorse on her face? No fears. There was a glow of great pleasure. Obviously there is no need to account for this money that must have come by some sort of coercion, when it is collected by politicians. There was an interesting TV discussion on this question of acceptance of money in this manner and one of the participants defended her saying that she has the guts to do it openly in contrast o others who do it under hand!

God save this country.

IPL 3

2010-03-21T17:52:00.001+05:30

The slam bang cricket jamboree that goes by the name of 20/20 [twenty twenty cricket] is back to haunt the likes of me. For the next two months there will be no other news or sports show on our TV channels and I have no option but to watch it. Having said I prefer the longer version of the game, I am not averse to watching it. But the kind of entertainment this provides is aesthetically less satisfying compared to the game played in other formats. But that is not the younger generation thinks and feels. The stadia are full of young people watching [if you call making lewd noise as watching]. The viewer is bombarded with commercial clips not only at thee end of the over but even between balls!. Commercial interests have completely taken over this game and we are witnessing the death of real cricket.

Most of the viewing and paying public is young. This generation has grown up in a frenzy of change. They are used to loud sounds, lewd language, explicit sex, no leisure, traffic snarls, violence in real life and on the screens, corrupt private and public life and the IPL in its third successful season, reflects all this. Sad but true.