Memories are like holding a fistful of sand, which is to say that the instinct to secure them—to close the hand, to make a possession of what was once just there—only hastens their escape, leaving only the impression of having held something once. I think, one can retain them better by keeping the palm open. By consciously pausing. To let the sand rest there, shaped briefly by the lines of the hand. The wind will take what it must, layer by layer, and what remains will settle on its own. You cannot walk while holding it this way. Nor can you lower your arm. To remember requires a quiet effort, a deliberate stillness—a choice to stand, attentive, and allow what endures to do so without force.
5HT
When to write is to get a surge of 5 hydroxy-tryptamine...that is fun,that is free association!
Tuesday, December 16, 2025
Thursday, November 13, 2025
The House That Knows My Name
On my last day in India, I lazily took a picture while speaking to my daughter on the phone to capture the moment. It was meant to be utilitarian-proof of where I was, what I was doing-but turned into something else entirely. At first glance, it could be any photograph from any small flat in any Indian city. But the longer I look, the more it reveals itself: a palimpsest of the years I lived here and the years this room has lived without me.
I am sitting in the corner bedroom, the one where the two steel cupboards-fixtures of our family since the 1980s-still stand side by side. One belongs to my father, one to my mother, a quiet marital symmetry. The other cupboards-those flimsy ones with sliding glass panes for the kids’ clothes-have long vanished, as temporary as childhood itself. But these two remain, having witnessed everything, having refused displacement.
The bed beside me is the same one on which my paati died. Even now I cannot sleep on it without feeling too alert to sleep and too tired to watch videos or read, hovering in the limbo between consciousness and memory, as though her final breaths imposed some version of Ondine’s curse upon the room. It was next to this bed that I once would sit and study, for hours on end, lost in the ADH-sapped fog of exam preparation-Guyton, Harrison, J. Park-while the world outside flattened into irrelevance. My father’s gentle knocks offering dinner felt like intrusions into a self-induced trance, something between a Tay-Sachs startle response and a muted non-convulsive status.
Above the laminated door of the cupboard still hangs that pale blue sheet of card paper, taped decades ago, with my hand-drawn staircase of ambition-my earnest, naïve schematic of how to become a cardiac surgeon. Not because I truly wanted to become one, but because, at that age, it seemed synonymous with success itself.
Next to me now is the old desktop monitor-nonfunctional, or perhaps still running Windows 7 or something equally obsolete. It once served as my portal to the dial-up world: Yahoo Messenger pings at 1 a.m., Lycos searches, Orkut testimonials written with adolescent urgency. Doomscrolling didn’t exist then, so collecting screensavers and watching progress bars fill inch by inch counted as digital fascination.
Each year I return, the room feels smaller. Maybe because my current home is larger. Maybe because I’ve grown-five foot ten is too big for this space. Too big to cartwheel without hitting a wall, too big to skid across the floor on Ponds Dreamflower talc spills, too big to wedge a palaghai as cricket stumps and bowl underarm overs. The absence of a balcony makes the room feel even smaller. And outside, what was once an open field is now a crown of tall residential towers and a multi-star hotel. The snakes and mongooses have been displaced and make their way across the boundary wall occasionally as if finding residence in the smaller apartment complex is a smaller displacement.
Inside the cupboards—especially the “dad cupboard”—time stands still. A soldering iron. My paati’s old valadhupotti, a jewelry box repurposed into a medicine box with labels-Ridazin, Largactil, Melleril-testaments to how overmedicated she was. It is now filled with rusting screws and bolts that will never be used. Old files and certificates fading into irrelevance. Mold-fringed books. A hanger rack with more hangers than shirts. Plastic sleeves holding expired FD certificates, bank statements, and passbooks. My tatha’s green blazer from his time as a chair umpire at the 1982 Asian Games, its badge missing. And a few of my own old T-shirts-clothes I would be embarrassed to wear now, though embarrassment was not a currency in the years when vanity came unearned.
I took the photograph to show my daughter the room. But now, studying it, I realize it documents so much more-like when someone writes an essay about a pencil and ends up writing about the world, or when Stephen Dubner converts it into a 90 minute podcast.
In the picture, the closest objects are the strips of pills: melatonin and Pan-D. The melatonin I bought for my jet lag has become symbolic of my parents’ obsessive preoccupation with sleep. I would perhaps cursorily call it psychophysiologic insomnia- an obsession with the lack of sleep which causes poor sleep. I explain the basics—older adults need less sleep, daytime naps disrupt nighttime rest. Go over my sleep hygiene spiel with them in quanta which are digestible to the Indian health sensibility- avoid light, phone screens, lay down only when you are tired, avoid fluids near bedtime, get sun and make yourself tired in the day time. However when knee osteoarthritis and pulmonary hypertension make tolerated ambulation distances a smidge of what they used to be, the body is not tired. And the neighborhood pharmacists hand melatonin over the counter without hesitation. The swollen prostate or osmotic load from diabetes of inactivity allow the bladder to distend enough to make this a diurinal cycle.
Pan-D lies beside it, the mascot of Indian medicine. The amount of proton pump inhibitors (PPI) prescribed by Indian doctors would make you think there is a pH pandemic in the peninsula. When I was a resident at KEM we would deploy a slightly dim plain poster called A Borkar , kokanastha brahmin cat eyes, brahminy looks and soft spoken to handle all the patients who walked in with non specific N/V ( nausea vomiting ) symptoms which AB managed quite adeptly with the prescription which is the mark of a successful practitioner, not necessarily diagnostician. This is probably because of the top 4-5 symptoms that patients present to physicians with, perhaps nausea is the most distressing. We used to condescendingly call this AB masala - a H2 blocker or PPI, reglan or zofran, perhaps a NSAID and a liter of saline. Patients were immensely happy. I don’t know what he is doing now, but I bet he has a rip roaring practice. Reflux seems to be a very prevalent condition in my family members who are immediate contacts. In most cases this is acid secretion due to spice, sphincter relaxing foods and truncal obesity/ hiatal hernia related sphincter insufficiency.
These medications lie on a Formica-paneled computer desk that once hosted the desktop,which exists like a fossil, peeling at the edges.
In the foreground of the photograph is my mother, cooking lunch. The wall clock announces that she has started early, but for her, lunch for the son visiting from America can be served anytime between 10:30 and 2 p.m. The Zoom prayer session plays on her iPhone 16, propped against a pen stand, Vedic chants filling the small kitchen. Some voices follow the rhythm, others falter. My mother likely belongs to the former. Certainly this is an activity which is of great annoyance to my dad who is not beholden to the religiosity and ritualistic mores. Perhaps she joins these prayers to escape boredom, to impose routine on the drift of days. Half their time is spent in a senior home in Coimbatore where chanting, classes, rituals are a daily event. The other half here in Pune, where independence is still within reach. This oscillation itself is symbolic of the larger struggle of relinquishing autonomy.
That day’s lunch was bhenda bhaji, pumpkin sambar- its coincidence with Halloween unnoticed-and pudina chutney. The taste is something I have tried, and failed, to recreate abroad. Perhaps my children will someday speak of our meals with similar longing. There was also leftover vathal kozhambu, a quantity I would have thrown out, but my parents’ thriftiness forbids waste. It tasted just as good, even cold, carrying the seasoning of childhood memory.
Above the stove hangs the Faberware chimney-another artifact of modernization that fulfills no functional purpose. It protects the wall from grime but does not vent; to vent it would require leaving the window open, inviting mosquitoes. So it stays in its limbo—like an inefficient employee neither indispensable nor dispensable, condemned to permanence.
The white tiles are a collage of fruits and gods. The swami edam, the god-shelf, occupies the corner. The house, like most Indian homes, is dense with gods-on tiles, in frames, in brass. God-fearing is a uniquely Indian adjective implying moral surveillance. Here, God is both male or female, human and animal, creator and destructor, living and transitioning between lives, black or white, and is a child, adult, transvestite or the elements. S/He is a stone, an animal. God is in work or so his fervent devotees say. There is not one God. Or perhaps there is, but S/He is in everything. Even the agnostic is conscripted through rituals, festivals, rites, ceremonies.
My paati prayed at the swami edam for one to two hours daily, swaying slightly-perhaps EPS from her medications, perhaps her way of channeling her thoughts away from her schizophrenic voices in her mind. Her rituals were precise: the brass bell with Hanuman on the handle, ringing for attention; the spoonful of sugar offered as naivedyam; a sweet hallucinogenic sniffing salt to tempt your God buddy to acquiesce. Swami yedam became smaller or bigger with time. When it gathered dust, she would scrub the pictures and brass idols down. When she passed, no one took this job on. The Gods didn’t mind.
My mother’s sari in the photograph gathers the morning around her. Red, but not the loud red of new cloth—rather the softened red of rituals repeated, of kumkum in small silver choppus, of years folded and refolded into muscle memory. It carries the memories of dark cool aisles of old south Indian temples, the shreds of coconut fronds, the warmth of hands that once draped.
In the steam rising from the pan, the gold border flickers-brief, like a lamp in a draught. It is cloth, yes, but also inheritance: the quiet voices of women who woke before sunrise, who measured love in ladles of kootu and dollops of oil and dutiful pleats of habit.
The big black boxy item on the left is the washing machine. It is used mostly for sheets or guests’ clothes. My parents still wash their own clothes by hand. The dripping garments that are hung out to dry on clotheslines often brush against your head as you pass. Older Indian apartments never had dryer vents, so you could machinize washing but not drying. For years, Vasanti bai and her family handled our laundry- carrying buckets to the mori on the ground floor at 326 Rastapeth ,and brush, thrash and rinse the dirt, starch and life out of the cotton fiber, wring it into small coiled serpents, shake it dry of residual water and wrinkles and put it out to dry with a colored clip to hold it in place. I am sure my father is far less efficient, but perhaps this is his act of defiance against accusations of ageing and being less capable of doing things for himself. He will often sit on the stool the telephone and pen holder lay on, and cut vegetables for the cooking.
The microwave in the background is rarely used. Food is reheated on the gas stove. Life remains tethered to Dubros cylinders-delivery still a calendar event. You plan outings around the gas man’s unpredictable arrival. If the cylinder ran empty, cooking shifted to the kerosene stove-an object equal parts utility and hazard. Stories of stove explosions were common. I once carried the stove to school to make upma and poha for a work-experience lesson. A friend caused a mini-explosion, proving its volatility. You could only pump so much, had to keep the burner primed and clog free. Our roti wali bai would come and make 20 big roties every morning at times on the stove before we graduated to a single burner gas stove. The kersnoil as tatha called it, would sit in a big jerry can. Pouring it down a funnel was an act which was given only to the accomplished. You would be tempted to sniff it, but then your head hurt. I was worried my nose hair would go aflame if I sniffed too much. As gas cylinder delivery became more regular these kerosene cylinders died their much welcomed death.
In the photograph, the kitchen looks crowded. But in this house, space is not measured in square feet but in memories which the space time continuum spans. Everything in that room felt like an inheritance I had not claimed, but could not bring myself to leave behind.
Wednesday, October 29, 2025
Diwali trip 2025
| By Mali |
| Bhajana Madam |
| Chinna Hanuman koil |
| Periya Hanuman koil |
Monday, January 20, 2025
India trip 2025
This trip has been difficult at the onset due to personal problems and I carried some emotional burden traveling with some unresolved issues from home. Sometimes we have to compartmentalise life and to leave our negative thoughts and emotions behind and as my 10 yr old says be in the moment. The past if it keeps coloring your affective immediate response to what you see will not allow you to experience the full range of response to current stimuli and sometimes makes you feel hopeless and cynical. With that in mind I will try to jot down things as I see them. Creative thought may be at an ebb, but will try what I can.
| A winter snowstorm delayed take off from IAD. |
I am getting older -that’s a fact but the physical effect of that manifests when you start noting that your body seems to show signs that you associate with aging folk. My hip, knee and back made it abundantly clear of this on a 13 some hour flight to Dubai which got delayed in Dubai due to the snow storm. I took an Uber the night earlier so I could make it to the airport. Stayed at the Courtyard in Herndon, but could not catch much sleep. Woke up unrefreshed and thought maybe I can catch some sleep on the flight . Despite the flight not being full and an empty middle seat it was hard to catch 40 winks. Ended up watching Eisenhower, a doc series on Vegas and Barbie. Felt 3 meals was a bit too much and was bloated gassy and polyuric with a throbbing subliminal migraine.
Dubai airport was kitschy glitzy and felt like a upmarket fish market with gold and expensive perfume and watches peddled in your face like fish and vegetables by expat blue collar Asian employees who try to bring their sales smarts to high end goods. Transit was an Indian bank like experience with people jostling to get ahead. 3 more hours in a middle seat to Mumbai.
The best airport in the world was crowded but no complaints. They had people asking passengers to verify baggage tags on baggage claim, which may be a need perhaps in a crowded airport like Mumbai . Travelling back to Pune by KK travels was revisiting the old journey so often taken in the past. Being so physically exhausted though I just felt the jostling of the incessant traffic and blaring cacophony of car/scooter horns overwhelmed and inhibited the visual sensory flow and were an interlude I wished would end soon.
| Traffic plaza on way to Pune at 11 PM |
We parked for a cuppa chai at the truck stop but I had no cash to get any coffee/tea or snack. The parade of trucks on the Ghat section of the highway held us up and navigating the maze of parallelly arrayed trucks made for display of some interesting driving skills by our driver and it seemed at times I was seeing a video game player wielding a joystick and not a steering wheel. Everybody is trying to get ahead but there is no blood shed or teeth gnashed if a faster car flashes its blinkers and cuts you in your lane. If it were an occasional event you would but these things are passe.
Chatted with a ISKCON devotee who was an engineer in California but left his job for what he called a divine calling and was spending time at a meditation retreat in Mayapur. As the conversation moved ahead I sensed his tendency to frame everything in a God/religion/spiritualism context and promoting surrender to the Lord. I had my differences of opinion but was not in the mood for a debate. I let Krishna be the supreme omniescient being in that second row of car seats for that time.
| Pavers on sidewalk uprooted by growing roots of trees |
This is a wheel that turns and turns. For an outside observer like me, with intermittent exposures to this place, time and its effect on space play out a drama of progressive revelation and the plot lines are linear and galloping along like bullet trains or the hyperloop and what was a snapshot in your past in this time space continuum is irrelevant now and your points of reference are always irrelevant. This is a Lagrangian frame of reference and not a Eulerian one.
Dust is like the Lord in India. It is everywhere. It is in the oil, 5G/LTE, chat cloud that sits in the odoriferous zone of the pedestrian. It is on window sills and scooter seats; it coats the leaves of the Champa tree and forms brown lines on the dorsa of your feet where the straps of the Hawaii chappal make contact, the soles of your feet when you are chappalless inside the house. It even makes your snot a dark black gob of putty . When it rains this dust becomes the earthy odor of petrichor, when COVID ravaged the country this dust carried spores of Mucorales which led to the surge of black fungus cases at the peak of the pandemic. The mother of the house sweeps and sweeps trying to control the dust but is playing a losing game. Like the Krishna the dust always has a trick up its sleeve or a place to hide and keeps coming back. The mother never tires. The post viral cough keeps persisting, the allergies don’t go away. The dusty bus spews exhaust burnt of sulfurated diesel into the suspended dust. Inside on a dusty seat I sit thinking of how to make peace. Perhaps we have already done that. The default defence mechanism is the Indian way of Chalta hai which through resignation assigns primacy to fate over action/change and engenders a passivity or subsumption to what happens around you. We have assigned the name of the object to the verb for cleaning up the object. We are formed of dust and we end in the dust.
Dust into dust and under the dust to lie…….. sans everything.
Mailboxes at H5 Mantri Aangan.
They are barely used and many of these tenants have since moved out
I have previously raved about the liberation by data revolution in India. Data is king. Data is cheap.Data is bhagya vidhata. Data has meant your Uber rickshaw wala can use google maps to take you to your destination while you look up menus of restaurants there and accept payment with no cash or cards exchanging hands and catch up on the cricket match live streaming on wireless. The elderly parent can pay bills on their phone, order cleaning supplies and WhatsApp call their children who are travelling in another country in another time zone and not worry about roaming rates. They make point of care interventions easy to deploy, text message communications efficient for implementation science and give real meaning to the idea of World Wide Web. Data in India is cheaper and more accessible with great penetration of cellphones in most urban and semi urban areas. This enables data equals knowledge and knowledge equals power process enabling social mobility. If only people stopped making TikToks !
I have eaten murungaka sambar, tomato rasam, rice( non basmati), mixed veg kootu, methi bhaji and idlis for brekkie, lunch and dinner for the last 3 days. Nothing to rave about but the contentment from eating the food you grew up with is unrivalled. I have often had arguments with my wife about where the usual theme is ‘ whose cooking is better or whose xxx dish is better-your mother’s or mine’. Get a culinary expert and they will probably rate my wife’s dish better probably. However you crave the experience of eating the sambar rasam or kootu you grew up eating, where you could fling your satchel after you got home and dig into some , that satisfied the hunger you came home with; or the pav bhaji which was awaited with bated breath on a Sunday because it was your treat and quenching the anticipation was the dominant feeling, not satiation of hunger; the water masala /bharli vaangi of Sunday morning brunches because it reminds you of the roti eating competitions with your sibling. It’s really not the taste but the experiences and emotions tied to the food. I only wish my wife would agree. I spent a significant time during my early school days at my grandmother’s place and her cooking was staple during my very early formative years , and the experiences from my time at 42 rasta peth have elevated paati’s cooking in my mind to my most craved ever. Was it unhealthy? Hell yeah. But was it fingerlickin fabulous!
Food that pleases still is also the street food of the previous years. This is bhel at Interval bhel house or samosa at Laxmi sweet home, beetroot cutlet at Priya restaurant."Aade taste irukku innum", the parents say. I don't disagree. They couldn't have improved it.
| Pune has its share of amrututulyas which dispense sugary cups of cutting chai. I would never drink such a sugary concoction otherwise |
On the many early morning walks or bike rides my companions on sparsely peopled streets were street dogs. I had perhaps forgotten how ever present they are on streets in India. Or perhaps Pune has really had an increase in their numbers. I remember them as a menace when they would chase me as I used to bike down from Max Mueller Bhavan after late night German class along what used to be a very deserted North Main road/KP with only a graveyard and ABC farms along that stretch of road then. This was 30 some years ago. The roads now are littered with tall glass faced buildings with corporate offices, hotels, fancily named eateries, tea shops, pharmacies, 2 wheelers leaning on each other for every inch of roadside space. And dogs find their space on the sidewalks. When the shops are shuttered and the bikes and bikeriders have gone, they gather together lazing around. A mother will herd her litter. When you invade their zone, perhaps a pack will follow you. Perhaps if you get excited chase you. It reminds you of the travails of trying to figure out how to avoid the pack around the graveyard near NM road years back. But they seem more mellowed to this coexistence now. Or perhaps you don’t fear them as much now. Knowing how social these animals are you want to stare back at their inquiring eyes to say yes I can speak or give you a treat, but then you also don’t want that extra baggage. Having seen how scary rabies can be and having had a scary exposure to a patient with rabies and facing prospect of a fatal illness there is a healthy measure of hesitation. These dogs aren’t rabid and seem to want to be friends, but it seems to be one of those want to can’t do things. A litter of pups play along a sidewalk on magarpatta city. I try to snap a photo, but the mother comes at me aggressively trying to check what I am doing . I walk away making peace.
One of the evenings, I visited friends at DMH hospital. Some of them were able to find time to chat with me while grabbing a snack in the hospital canteen. We also met for dinner at a roof top restaurant later that week. These discussions eventually funnel into how things were in college, which batch who was in , weird habits of teachers, funny things that batch mates did, who had a fling on whom and where we are now, whose kids are doing how, how busy life is, new acquisitions etc. These are the brief stop growing moments. During that time everyone shared a joke and a laugh, was silly a bit and then went on about their lives.
| The next day I met old friends for dinner at a roof top restaurant in Erandawane |
| Traveled to Mumbai and visited Dhiraj at HN hospital on Monday |
I finally managed to submit my application for my Aadhar card - I had to travel to Nigdi because there were limited locations which accepted new applications. I took an early morning metro and thought I would be early and be done in an hour or so. However when I get there I realize there are people who have lined up since 7 AM to be the early bird. It seems there were only 10 new aadhar cards applications accepted per day. I was number 10 in that line. I thanked myself for making it just a few minutes early, taking the earlier train, choosing a rickshaw and not walking. While waiting interminably in line, I helped a couple who were of low literacy fill out their application forms. I was killing time awaiting my turn, but felt I did my bit of service. Job done.
The first weekend I managed to take the PMT bus from Shaniwarwada to Sinhagad. Was a good trek, but the place has become something of an outing for people on the weekend and I did not realize how crowded it would be. My mother freaked out because she could not reach me atop the hill due to poor network connectivity. I touched 24K steps that day which was my all time high.
| Visuals of the metro from Shaniwarwada at dawn |
Had all sorts of company atop the hill
On the weekend we visited Bhajana madam. This was a regular on the weekly schedule growing up- either with tatha when the evenings were spent at 42 Rasta peth or early Maargazhai mornings after the bhajanai rounds singing and chanting touching base at temples around the Rasta peth area when I would be tasked with waving the ceremonial fan during Aarti and would get first dibs at piping hot ven pongal as prasad, or later in my life when ridden with angst and cynicism I would accompany my mother to Bhajana madam on Sat evenings trying to find meaning in faith while she performed archana in our names. This is a custom she carries out to date. I find peace in this small old temple that has been patched and refurbished many times over. ‘Madrasis’ who have stayed on in rasta peth make it their evening pit stop still. The locals may come for prasad or because of proximity. The kurukkal remembers me because my mother has had him perform archana in my name for so many years.
| Visited St Vincent's on an early morning before school hours |
The small narrow lanes that lead to the temple were part of my evening loitering as and felt so big then. These streets where I have cycled aimlessly, eaten street food in, found corners to hide, and scavenged for matchbox labels and ice cream cup lids for tokens, got separated from family in during Shiralsheth and palkhi, fallen over and scraped a knee or elbow. Now shoe shops abound and old wadas have been replaced by concrete apartment buildings. I met Dileep and Kumar’s fathers at Bhajana madam. They are survivors while others from their generation and age have passed away. Perhaps their faith keeps them going. They looked shadows of their original selves, scrawny limbed with atrophied muscles. Their cataractous eyes search for sensory stimuli. People they don’t recognize or cannot make out entire faces of they assign names to what seem like Rorschach blots. And when a connection is made the joy emotion is undiminished and the mirthful smile, the drawing hug is unwavering. The temple is their workplace replacement. It gives them the social connection that becomes their purpose at this age.
The answer to the ultimate question of life, the universe and everything is 42. DA was probably high on pot when he wrote this, but I am going to be a bit bold here and frame my time at 42 RP in this context. The age 5-18 defines or frames perspectives or responses to stimuli, shapes ideas, aspirations. You evolve into being an external beings from the internal confines of the mother’s embrace and father’s bracing arm. How i respond to life’s questions is influenced by how i learnt to respond when we were first faced with being in that position. We define events in life based on firsts. Many of the firsts occurred during this time. The typhoid I had affected my metabolism for ever. The scar I have on my brow I carry for life. The trauma I faced from bullies to non Marathi speaking people lingers. The most effective teachers I have had has been Mrs Ramaswamy who taught us history and English during 7th and 8th grade and my grandfather who was somewhat of a role model for me for a long period during these formative years.
My grandparents were very closely involved in nurturing us during a phase when my working parents would not have time to watch us due to work commitments and daycare was not existent. These ontogenic experiences are recapitulated again and again and form the human experience. Hence.. proven.
The later part of the week I found my joy in biking. I was initially sceptical given the traffic and bad rides but the early morning predawn time period turned out to be perfect for pedaling through the streets of Pune. You cover more distance and see more sights than when you walk and even though the potholes and uneven surfacing make riding hell, with the lack of the smell of diesel exhaust and anyone jostling for space, I often ended rides feeling rejuvenated .
Time was fleeting. I could not accomplish many things I had marked as to dos for this trip. I don’t feel stressed about it though. I tried to make this trip about quality time with my parents. We often claim our memories for ourselves.We keep a bit of what events happen around us in our own personal reference framework of things for easy retrieval. Others have their own. They may not be the same.
| 326 Rastapeth today and our home on the 2nd floor and ghasargundi |
What images and memories my parents have of what our childhood was? I wish I could tap in. My dad calls them happy days and wishes we could go back to then. The fact is we won’t , but I need to give back some of togetherness we all felt growing up. These visits are just an attempt to
Wednesday, October 6, 2021
THE VITAL RESET
As the Tsunami of COVID cases in the Indian subcontinent shows signs of finally receding, what used to be a painful routine for many US residents of Indian origin like me, has thankfully become less common. We aren’t spending long hours every night checking on loved ones on WhatsApp, or calling family members in India, scrambling to coordinate oxygen procurement, medication or hospital beds for extended families, friends or acquaintances. I would worry about my parents, who live in India and are in their 70s, fearing that one of these nights, maybe I might receive a call that I dread. I had difficulty reconciling with the fact that survival and outcomes post hospitalization are based on the assumption that access to medical care was not an uncertainty, as it had become for many people in India. We still go over extreme rituals of non-pharmaceutical interventions, including likening using a mask like an undergarment- taking it off only in privacy of seclusion. We try to estimate exposure based on who was around who else, for how long, how close, hoping details are not lost in translation. I sigh sometimes, aware that the virus is unforgiving, and I may be clutching at straws. I would feel helpless in my inability to influence things, insulated myself in a cocoon, vaccinated, surrounded by things resuming to normalcy. My 80 year old father himself, received his vaccine 3 months after I did, due to shortages in India.
I am aware that the privilege of knowing physician colleagues would have assured reasonably good care for my parents in another time. The severe shortage of acute medical care on ground made me feel more deeply aware of what a disadvantage the common folk of meagre means in India face. The reason this pandemic has become such a pestilence is because it has exposed deeply pervasive inadequacies and inequities of healthcare system in India.
The moral test for a government is how the country treats its most vulnerable. The underprivileged in India seek healthcare primarily through government run hospitals, and cannot access care in more expensive private hospitals. These facilities are chronically underfunded, plagued by poor staffing and lack of supplies and infrastructure. Yet the smartest medical students and residents train at these institutions. The National Health protection scheme seems to be focused on supporting care in private medical facilities. In India, access to care in private sector does not necessarily result in better care for a large majority of rural and urban Indian people .
India spends a mere 1% of its GDP on healthcare expenditure. The domestic government health expenditure per capita is $74 in India at PPP, and India has 0.53 beds per 1000 people. Reports at different times estimate that there are around 80,000–100,000 ICU beds and approximately half that number of ventilators in the country. With the current number of COVID infections, a simple back of the envelope calculation shows that even if a fraction of those infections ends up needing intensive care, the country is in no position to provide the level of care they need. The healthcare system was clearly duct taped and arthritic even before the pandemic. The pandemic has just pulled the plug on whatever threads were holding this creaky system together. The truth has been staring at us, but we had chosen to look away. I looked away when as an ICU registrar I was tasked with triaging ventilators in a large municipal hospital in Mumbai during a post monsoon leptospirosis epidemic. I felt thoroughly exposed as inadequate in making such vital go/no-go decisions, and the experience left me hollowed out at an emotional level. I looked away when I was unable to resuscitate a stuporous young male with cerebral malaria who coded waiting outside the CT scanner because the bulb on the only laryngoscope for a medical ward with 50+ patients did not work, while people hurried along the crowded hospital corridor during evening visiting hour. We all looked away when we were given the task of treating an unending line of patients who came in during the monsoon admission surge, willfully accepting to lay on floor beds, with family members holding an IV set when poles ran out and even bagging their intubated family member when ventilators were unavailable. How did I, and other people, allow ourselves to be desensitized to such a travesty, when we were exposed to this all along?
Resident doctors who provide most of the clinical care at government run medical college hospitals. They are often re overworked, underpaid and face enormous stressors including inhumane working hours, and patient caseloads. What I chose to accept during this period when I was a resident was that submissiveness to adverse circumstances helps disconnect from the stress of the immediate situation. Over time this becomes an ingrained habit- if we cannot change things, we become used to it.
The dramatic scenes of patients dying due to lack of oxygen remind us that there is an Infection Fatality Rate with oxygen and one without oxygen for COVID. What we have witnessed in this period of oxygen shortage is a grotesque natural course of illness revelation with system too paralyzed or dysfunctional to be able to grapple with what it was dealt with. The visuals of helpless family members and medical staff trying to do what they can, remind me however that we have been there, in smaller measures in the past.
Pandemics hold up a mirror to human beings to show who we really are. They are inflection points to reset our trajectories. Inaction at this time is accession. While the pandemic surge numbers show signs of initial decline, this is not a time to introspect deeply, and to organize and plan for the future. As physicians we need to use our position to voice our concerns, to advocate for our patients and to pressure governments to invest more into healthcare, including critical access to the most vulnerable.
I feel….
Memories are like holding a fistful of sand, which is to say that the instinct to secure them—to close the hand, to make a possession of wha...
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Let me jot down what DRK told me. I respect the man for what he taught us despite never teaching us in the literal sense of the word.I value...
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I have been reading Denty's posts over the last week. I was reviewing my own postings.I realised what an oblique way we really react to ...
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This trip has been difficult at the onset due to personal problems and I carried some emotional burden traveling with some unresolved issu...


