tag:blogger.com,1999:blog-20270310126723464762024-02-07T11:08:03.931-05:005HTWhen to write is to get a surge of 5 hydroxy-tryptamine...that is fun,that is free association!Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.comBlogger204125tag:blogger.com,1999:blog-2027031012672346476.post-1501018827140755872021-10-06T22:40:00.009-04:002021-10-06T22:42:24.168-04:00THE VITAL RESET<p> <br /><span style="background-color: white; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;">As the Tsunami of COVID cases in the Indian subcontinent shows signs of finally receding, what us</span><span id="rmm" style="box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;">e</span><span style="background-color: white; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;">d 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</span><span style="background-color: white; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;"> </span><a class="dy hn" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773971" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;" target="_blank">survival and outcomes post hospitalization</a><span style="background-color: white; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;"> </span><span style="background-color: white; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em;">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.</span></p><p class="gn go gp gq b gr hi gs gt gu hj gv gw gx hk gy gz ha hl hb hc hd hm he hf hh dn fy" data-selectable-paragraph="" id="2fae" style="background-color: white; box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em; line-height: 32px; margin: 2em 0px -0.46em; word-break: break-word;">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 <a class="dy hn" href="https://www.theatlantic.com/international/archive/2021/04/india-covid19-moral-failure/618702/" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit;" target="_blank">deeply pervasive inadequacies and inequities of healthcare system in India</a>.</p><p class="gn go gp gq b gr hi gs gt gu hj gv gw gx hk gy gz ha hl hb hc hd hm he hf hh dn fy" data-selectable-paragraph="" id="20c8" style="background-color: white; box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em; line-height: 32px; margin: 2em 0px -0.46em; word-break: break-word;">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 <a class="dy hn" href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09107-4" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit;" target="_blank">rural</a> and <a class="dy hn" href="https://pubmed.ncbi.nlm.nih.gov/23213162/" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit;" target="_blank">urban Indian people</a> .</p><p class="gn go gp gq b gr hi gs gt gu hj gv gw gx hk gy gz ha hl hb hc hd hm he hf hh dn fy" data-selectable-paragraph="" id="d8ed" style="background-color: white; box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em; line-height: 32px; margin: 2em 0px -0.46em; word-break: break-word;">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. <a class="dy hn" href="https://pib.gov.in/PressReleasePage.aspx?PRID=1710629" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit;" target="_blank">Reports</a> at different times estimate that there are around 80,000–100,000 ICU beds and approximately half that number of<a class="dy hn" href="https://cddep.org/wp-content/uploads/2020/04/State-wise-estimates-of-current-beds-and-ventilators_24Apr2020.pdf" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit;" target="_blank"> ventilators i</a>n 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?</p><p class="gn go gp gq b gr hi gs gt gu hj gv gw gx hk gy gz ha hl hb hc hd hm he hf hh dn fy" data-selectable-paragraph="" id="26fb" style="background-color: white; box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em; line-height: 32px; margin: 2em 0px -0.46em; word-break: break-word;">Resident doctors who provide most of the clinical care at government run medical college hospitals. They are often re <a class="dy hn" href="https://indianexpress.com/article/cities/mumbai/in-second-year-of-pandemic-resident-docs-on-covid-duty-rue-academic-loss-7261832/" rel="noopener ugc nofollow" style="-webkit-tap-highlight-color: transparent; box-sizing: inherit;" target="_blank">overworked</a>, 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.</p><p class="gn go gp gq b gr hi gs gt gu hj gv gw gx hk gy gz ha hl hb hc hd hm he hf hh dn fy" data-selectable-paragraph="" id="ac66" style="background-color: white; box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em; line-height: 32px; margin: 2em 0px -0.46em; word-break: break-word;">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.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVVGM9x5W1Q0y54rFIdMIGM-ohYY72OFYy3DKtYm2c55n5lcgqAohexxGWCsbUswZYL4v-0Or6VA98kUHZ_x6VTtOGtHA03EPKtjZFc0ulwwkNvuvNylNMAVcJr-YiPHiF1aNvvGtmFN4/" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img data-original-height="1412" data-original-width="1050" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVVGM9x5W1Q0y54rFIdMIGM-ohYY72OFYy3DKtYm2c55n5lcgqAohexxGWCsbUswZYL4v-0Or6VA98kUHZ_x6VTtOGtHA03EPKtjZFc0ulwwkNvuvNylNMAVcJr-YiPHiF1aNvvGtmFN4/w197-h265/image.png" width="197" /></a></div><p></p><p class="gn go gp gq b gr hi gs gt gu hj gv gw gx hk gy gz ha hl hb hc hd hm he hf hh dn fy" data-selectable-paragraph="" id="9ca2" style="background-color: white; box-sizing: inherit; color: #292929; font-family: charter, Georgia, Cambria, "Times New Roman", Times, serif; font-size: 21px; letter-spacing: -0.003em; line-height: 32px; margin: 2em 0px -0.46em; word-break: break-word;">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.</p><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-89582443584991865222020-01-18T13:17:00.000-05:002020-01-18T13:17:30.355-05:00Peregrination Diwali 2019<div dir="ltr" style="text-align: left;" trbidi="on">
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Random Observations for posterity: India trip 10/22-11/4/2019<o:p></o:p></div>
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This was an India trip after 8 years. In some ways it was an eye re-opener for me. I had quaint ideas of how things might be despite the build up of expectations before the trip, and did
not realize my ideas and expectations were quite amiss. Quite often we get stuck in a snapshot of what things
should be like and do not realize that times and rituals change, and our frame
of reference has not. However, I found this trip quite refreshing and instead
of getting stuck on lingering on the memory of the moment, due to the constant
sensory overload, I made an attempt to experience the moment and move on. This
was also because I had limited time and my attention was divided between family
in India and checking back on family in the US. This is a a set of random
observations that I have tried to document in no specific order or pattern,
taking things as they come.<o:p></o:p></div>
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One very striking thing that hit me the very moment I
stepped out of the airport was the sense of needing to define our space and
time you occupied that space as a vehicle driver or pedestrian on the road. It
was that few inches of space and for those few moments that belonged to you. You
had to move to let another person occupy it or else you would be colliding into
each other. It was as if I was the culprit if I did not move in this Brownian
movement of orderly chaos. There was no anger at being pushed out or being
honked at. It was an understood transaction with implicit rules, that there
were no rules! And for this reason, somehow, strangely, everything seemed very
small. This is hard to explain- it is as if the streets were smaller- the
landmarks you grew up with looked petite sized and stunted. Because their being
big was defined by the moment being longer. With so many people on the road,
the moment was smaller, shared.<o:p></o:p></div>
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Driving in India was something I looked forward to, but
riding on the a rickshaw, I began to feel a sinking pessimism about the prospect.
My days in Mumbai I had relished at being able to get on my bike and get to Regal
Cinema for a late-night show or BTC for a sinful lunch or the Worli Seaface or
Bandra for a breather at the spur of the moment. However, there are so many
more cars and 2 wheelers, and so much lesser space on the road, with the Indian
penchant for the elastic waisting of the underbelly, the disregard for traffic
rules and order in street is not unexpected. Driving on 2 lanes is not frowned
upon. It is a way to claim your space. <o:p></o:p></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWdhz_oiifXV3TG4FlzZC9rpxNSVSwgpeF8ANXuOKpEYNY7XBC7C0CTfsvLcT27RtiDC8HSIDYJAVsXdqDLGqifk5OOwBeeNOUBKLN9CG8GpCf6eNwfF_cCaFXoTMyI3Lx9JmWu22OYo8/s1600/map+Thane.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1057" data-original-width="739" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWdhz_oiifXV3TG4FlzZC9rpxNSVSwgpeF8ANXuOKpEYNY7XBC7C0CTfsvLcT27RtiDC8HSIDYJAVsXdqDLGqifk5OOwBeeNOUBKLN9CG8GpCf6eNwfF_cCaFXoTMyI3Lx9JmWu22OYo8/s200/map+Thane.jpeg" width="137" /></a>Uber, especially Uber rickshaw became my go to way of
getting around. In some ways it is such a democratic equalizer. I fell in love
with the ease of being able to summon a rickshaw without having to deal with a
dismissive “nai” for your pleas of “rickshaw aata hai kya?”. It is also less
displeasing to allow the driver from ‘8 drivers nearby’ to refuse your ride through
the app without you seeing it as a dismissive brush-off. <span style="mso-spacerun: yes;"> </span>There is no haggling over fare, demand for
return fare, or meter “nahi chalu”,” kab chalu kiya”. The security feature is an
important addition and most welcome. <o:p></o:p></div>
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I was also impressed at how good google maps was at locating
the best route to your destination despite landmarks being random/non-orderly
like the Maruti mandir on your street corner or near the chakki mill en route
to the talao. <o:p></o:p></div>
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Getting through a day of work with many distracting demands of
your attention can often make you frustrated, unfocused. I would imagine the
job of a bank teller clerk would be an example of such a job profile. Many people
of diverse backgrounds, profiles and interests making demands, asking
questions, trying to eke a shekel extra here or there. On a humid hot day we were
witness to a bank officer at the SBI branch at Thane be the epitome of imperturbation.
She was quite being harassed at around closing time on a Saturday afternoon at
the bank. The air conditioning was off, the room was hot and sweaty. A novice
businessman kept demanding that she process a transaction which seemed poorly defined,
or detailed. Another rotund pan chewing hombre wanted his transfer of money
done before Diwali. I wanted an internet banking password reset. An elderly
gent needed his withdrawal approved. This lady seemed able to attend to
everyone, without losing her patience, in a Buddha like calm. It was as if the
travails of demonetization had given them the inner peace of being able to
dissociate the affective response from the work to be done. Within those few
moments I learnt a lot about how one can decide how much the environment around
them affect them negatively by making a conscious choice about how to react. Eventually
we will get from point A in time to point B. It is all about what state we are
in when we arrive at point B.<o:p></o:p></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjF5-hjuGTWK6kgH8m7CSWq87Tcrx6CHarv2NdLeYxruzpyMJ5hEbTDXsN5vuu2t1-0iHSDk5TBMd8d3f1K9r8XWZXDG-bQbwgy8I5tCSUA6eg5p5-1SWrNDxwTTRfSm31vy5WYH5nWaTk/s1600/Menu.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1202" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjF5-hjuGTWK6kgH8m7CSWq87Tcrx6CHarv2NdLeYxruzpyMJ5hEbTDXsN5vuu2t1-0iHSDk5TBMd8d3f1K9r8XWZXDG-bQbwgy8I5tCSUA6eg5p5-1SWrNDxwTTRfSm31vy5WYH5nWaTk/s200/Menu.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sample of a menu from a vegetarian restaurant in Thane</td></tr>
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If it’s India trip you have to talk about food. Of course it
was Diwali, but still, I kid you not, in a street in Thane, which is less than
500 yds long, there are 11 pastry/sweet shops. Sugar has sweetened the tongue, fattened
the underbelly, raised the A1c, and expectations, enhanced the creativity and
the appetite of the Indian middle class. I would like to propose that like
hoarding gold, pigging on sugar can be called a defining characteristic of the
Indian middle class. <o:p></o:p></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYowwyO_YqpWGZ123Prtff-Lkvi12wQ1N8YC5zeUFf-5OkM5Ic2OhBs3tN4eFucPILAASngi9jaShLR_3Y2aUlYGngVjbhOQN3SS6jV59rYqhjrhKBmdHOFZYf7az-5bZidXVm5HX5Xpo/s1600/frenz.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="822" data-original-width="920" height="285" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYowwyO_YqpWGZ123Prtff-Lkvi12wQ1N8YC5zeUFf-5OkM5Ic2OhBs3tN4eFucPILAASngi9jaShLR_3Y2aUlYGngVjbhOQN3SS6jV59rYqhjrhKBmdHOFZYf7az-5bZidXVm5HX5Xpo/s320/frenz.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Meeting with friends at a barbeque style restaurant in Pune</td></tr>
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I had thought that I would run amok on treating myself to Indian
culinary treats this visit, but strangely found my appetite for Indian food lacking
and in need of some juice. Maybe it was the concern of calories or maybe my gastrointestinal
tract has become more blasé and unadventurous with age and lack of stimulation.
All said and done, I tasted everything I wanted to, but thankfully did not pillage
on the offerings.</div>
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<o:p></o:p></div>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd68MRTPazSPO74K0Eg4ZVyhRXxf4BaQJc-jrHyzcAkbaLpgB6pM21cRzHogGz6E6fMkk6A8KHeI7gnVHPHVmw-s0KBLeoJ6lO5mT8wlVmOKIlOUKOO2_BB9mkRjfua0r3BNzbuURQ8UI/s1600/Road+to+Pune.jpeg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1452" data-original-width="1511" height="191" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd68MRTPazSPO74K0Eg4ZVyhRXxf4BaQJc-jrHyzcAkbaLpgB6pM21cRzHogGz6E6fMkk6A8KHeI7gnVHPHVmw-s0KBLeoJ6lO5mT8wlVmOKIlOUKOO2_BB9mkRjfua0r3BNzbuURQ8UI/s200/Road+to+Pune.jpeg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Before Lonavla</td></tr>
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I had quaint memories of riding on the expressway from
Mumbai to Pune on the Shivneri buses from my days in Mumbai. I thought that
with the October rains, the wholesome weather, my ride through the ghats would
be memorable. I think I let my expectations rise too high. </div>
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The romance of the
ghats was lost on me. It was like an orgasm that did not come. There were signs
galore- ‘India’s biggest amazement park’, ‘ baghtoys kaay raagana, linen
ghatlay vaghana’. Big FM was playing on the car radio- “Jaadu hai nasha hai”. </div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUnSJ40UZGpHMlWpcVm5r5EcYQIx8ifYr__mY9lbOAmFN62C5nzUOkfI37oK9B6gwIjeO_dU9MlnUshLv_SfyS4TrVssSw9RhMqiO1XL21NTWSvb1AFznetcrFtFs3BhUGFJVJcZsHMBA/s1600/road+to+Pune+2.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1195" data-original-width="1505" height="251" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhUnSJ40UZGpHMlWpcVm5r5EcYQIx8ifYr__mY9lbOAmFN62C5nzUOkfI37oK9B6gwIjeO_dU9MlnUshLv_SfyS4TrVssSw9RhMqiO1XL21NTWSvb1AFznetcrFtFs3BhUGFJVJcZsHMBA/s320/road+to+Pune+2.jpeg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">After Lonavla</td></tr>
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The
clouds covered the mountain tops, the weather was misty, the mood languid and
peaceful. But the magic wasn’t there. I cannot explain it- maybe it is the same
idea- we get caught up in a frame of reference but the frame itself moves.</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3DZjnFiDpHuRkkm74TH7ps_fWfjdQAs67nZAkAv7D_YxQDDlOy2Cl9d3sBk9egYbewpss6AnIwEK2-5ix1XiXidwPkBzXoEgNhLtSS8flmxS0jkkzQIh4h4xldW6mu_OtzqYNdVqPppY/s1600/upper+deck+lonavla.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="764" data-original-width="858" height="177" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3DZjnFiDpHuRkkm74TH7ps_fWfjdQAs67nZAkAv7D_YxQDDlOy2Cl9d3sBk9egYbewpss6AnIwEK2-5ix1XiXidwPkBzXoEgNhLtSS8flmxS0jkkzQIh4h4xldW6mu_OtzqYNdVqPppY/s200/upper+deck+lonavla.jpeg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The road to Pune is littered with banners like this</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVxtdgBH-LYslojItNA66wa33Slf4qMDpLuVfo5yBEPBM3fV25bP0ReCQ3GL_6J74jaElhPy-szw5dwtEY0Azwh2onxhIV3_ToszI8v8HHLxasEiPGWkaZhCrbnGV8U4ikN8jNhfuIkl0/s1600/ghats.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1531" data-original-width="1471" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhVxtdgBH-LYslojItNA66wa33Slf4qMDpLuVfo5yBEPBM3fV25bP0ReCQ3GL_6J74jaElhPy-szw5dwtEY0Azwh2onxhIV3_ToszI8v8HHLxasEiPGWkaZhCrbnGV8U4ikN8jNhfuIkl0/s320/ghats.jpeg" width="307" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Ghats</td></tr>
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70 Mercedes cars booked on Dhanteras!. So the papers
screamed. There were Porsches, Range Rovers and Ford SUVs on the Pune roads.
However, there is no space for all these cars. The traffic exchanges are
torturous, especially in evenings when the vehicle traffic is heavy. There is a
heavy diesel odor which dries up your throat and makes you want to rinse and
gavage when you get home. People wearing surgical masks while driving solo on
their 2 wheelers is ironic! I will still drive and contribute to the pollution,
even if I have to wear a mask for it. It is like a fat man not cutting down on
intake and taking an obesity pill for weight loss.<o:p></o:p></div>
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Despite the pollution, the concept of an evening stroll is
something which I cherish and thoroughly miss in the United States At 9 PM I
can get out of the house and find people getting some tea at a local
amrutatulya shop, shopping at a grocery store or pharmacy or visiting the local
Ganesh temple, or just taking a stroll. Life shuts down on the streets in the
US after 8 PM, at least in the residential neighborhoods. The streets in India
are buzzing till late. The day begins late – 9 AM is when people saunter into
their offices, the senior staff afforded the luxury of arriving even later- and
ends late. I can put on my Hawaii chappals and go gallivanting around at 9 PM
and have a lot of post Sylvian stimulation. This is something I sorely miss and
will miss.</div>
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The biggest revolution IMO in India is of mobile telephony
and the deluge of mobile data. I get a puny 4.5GB per month and a Jio customer
in India pays a tenth of what I pay and gets 10 times more data. It was mind
blowing to be able to do video calls on the go, not being tethered to a Wi Fi
zone. Or to use Google maps to get around, Whatsapp to call/text/communicate.
Data lines have walked over voice telephony with heavy boots. You can call
anyone anywhere anyhow. You can be a vadari hanging on to a Local train door
bar, watching Bhojpuri hits on YouTube or keep your kids occupied on the
backseat while you drive with Netflix streaming on data. The whole concept of
limits has been blown to smithereens. It was unlike anything I expected. The
opportunities out of this data revolution are so infinite, that it is
benumbing.<o:p></o:p></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjj7iXHkUZ5TBIueTndQSV8s3E_bRaE3IFuatj2AhSGBOmN8Ctct0e4zLEK-KVqa7wQlzArAA45Bdsmwm8Mr4FHgfbyhUV8TrGsfOosHe1cQKwm9ROIP6IIVqqCdmQOSlmXNpaRX6Q2Xg/s1600/diwali+2.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1467" data-original-width="1521" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjj7iXHkUZ5TBIueTndQSV8s3E_bRaE3IFuatj2AhSGBOmN8Ctct0e4zLEK-KVqa7wQlzArAA45Bdsmwm8Mr4FHgfbyhUV8TrGsfOosHe1cQKwm9ROIP6IIVqqCdmQOSlmXNpaRX6Q2Xg/s200/diwali+2.jpeg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Diwali killa</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMucyvURXR2F_6MVVqrsL-cvC9dyokzMvoWCuGLIEQZMfZYPgOra8uzXvqOAuQ6WvFcM5g-B6vOqkBzetoxXslsqmhO8uu98Z9MDm9InX51HNcFDy-pDmOVKJdE1YFKdzhghxWYAM3L3s/s1600/Sinha+1.jpeg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1400" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMucyvURXR2F_6MVVqrsL-cvC9dyokzMvoWCuGLIEQZMfZYPgOra8uzXvqOAuQ6WvFcM5g-B6vOqkBzetoxXslsqmhO8uu98Z9MDm9InX51HNcFDy-pDmOVKJdE1YFKdzhghxWYAM3L3s/s320/Sinha+1.jpeg" width="280" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sinhagad on the way up</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggz8wYbVJHMppNydxg64cc5LmnUW-yUbjXOwimnJWeeKhI40x4rUAgxyWvaD8Lc48niWYgW6WKn-dWSBINqzQbQSQTjkkPH9HWLOWXL0Ovaktr9R-jq41zGLEp2WNwIB7h49Le2Nt618Q/s1600/SInha+4.jpeg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1314" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggz8wYbVJHMppNydxg64cc5LmnUW-yUbjXOwimnJWeeKhI40x4rUAgxyWvaD8Lc48niWYgW6WKn-dWSBINqzQbQSQTjkkPH9HWLOWXL0Ovaktr9R-jq41zGLEp2WNwIB7h49Le2Nt618Q/s320/SInha+4.jpeg" width="262" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sinhagad on top</td></tr>
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All this packaged within 2 weeks was all I could ask for. I
was happy-sad to be back with family, but we live life based on the choices we
make. Being an immigrant is a hard one and every immigrant can relate to this.
There is a cognitive dissonance about where home is. People say the longer you
stay away from where you grew up, this ego-dystonicity dilutes into a hybridoma
you yourself evolve into. You cling to cultural things, glitzy Diwali/garba
functions locally, dressed in gaudy ethnic wear, cooking imitations of your
mother or grandmother’s best confections, that help you remind of what you grew
up with. The childhood friends age into their own routines of domestication , your
parents age into fading resemblences of what you remember them as- diffident,
with physical frailties, hoarding like they themselves want to cling to
memories of when you were with them, with opinions which seem strangely
extraneous to your priorities and values, though they helped shape some of
yours. There is a languorousness to the cold snowy Saturday afternoons which
were foreign to you but you have allowed to become part of our life, just as
you have allowed things you grew up with you drift away from your time and
space. That’s why such trips are refreshing, and you need to cling to them like
a warm hug and enjoy it while it lasts.<o:p></o:p></div>
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<div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-64537099912251855402016-11-28T20:18:00.000-05:002016-11-28T20:28:27.171-05:00INFECTIOUS DISEASES AND MORTALITY<div dir="ltr" style="text-align: left;" trbidi="on">
<a href="http://jamanetwork.com/journals/jama/fullarticle/2585966">Infectious Diseases mortality trends</a><br />
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<span style="font-family: "georgia" , "times new roman" , serif; font-size: xx-small;">Crude
Mortality Rates (per 100 000 Population) in the United States Over TimeThe
x-axis and y-axis scale is different for each panel. In panel D,
vaccine-preventable diseases for which vaccines are routinely provided in the
United States include measles, mumps, rubella, varicella, diphtheria, tetanus,
pertussis, polio, Streptococcus pneumoniae infection, hepatitis A, hepatitis B,
and meningococcal infection</span><span style="font-family: "helvetica"; font-size: 12pt;">.</span><br />
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' Action without reflection is mere experimentation'. This timeline encompasses the time when we entered medical school- 1996. HIV mortality was at its peak and witnessing this peak period of so called medical helplessness had influenced me profoundly with respect to what I wanted to specialize in eventually. Much has come to pass since, and now we learn about an ab and an ib every week in the ever increasing advert pages of once venerated journals. HCV is the NKOTB but for those who have seen the pestilence of AIDS and associated OIs, Kochs included, the munificence of payors for Harvonizepatierepclusa seems too generous, considering that companies make a 1000% profit on these. The lumping of all infections is an oversimplified agnosia and does little justice to individual conditions, just like 'cancer' is not one condition and terms like cancer moonshot and 'beat 'cancer' a la CTCA seem as spurious as they are naive. However snapshots like these give opportunity to reflect - they are like a K Park's PSM perspective to a reading of Harrisons. One without the other is going to leave you either a myopic or an out of context Frequentist<br />
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Ref<br />
<span style="font-family: "georgia" , "times new roman" , serif; font-size: x-small;"><span style="background-color: white; color: #333333;">Hansen V, Oren E, Dennis LK, Brown HE. Infectious Disease Mortality Trends in the United States, 1980-2014. </span><em style="background-color: white; box-sizing: inherit; color: #333333;">JAMA.</em><span style="background-color: white; color: #333333;"> 2016;316(20):2149-2151. doi:10.1001/jama.2016.12423</span></span><br />
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<div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-39195680941265228812014-09-06T02:23:00.002-04:002016-04-11T18:56:56.262-04:00Pratikriya<div dir="ltr" style="text-align: left;" trbidi="on">
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Everyone is the sum total of his reactions to prior experience. As your experiences expand and vary,, you become a different person, your perspective on things evolves.. Every reaction thence is a learned conditioned one; every significant experience alters your ability to reflect/react and shape your next esperience. . This is a perennial and iterative process, until perhaps dementia sets in. ( प्रतिक्रिया ही जीवन है और जीवन ही प्रतिक्रिया - वोह प्रतिक्रिया है जिसने चम्पू को दीन , गोकुल को धूर्त , और बंशी को विद्रोही बना दिया )</div>
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So it would seem foolish, to adjust our lives to the demands of a goal we see from a different angle every day? How could we ever hope to accomplish anything other than becoming neurotic idiots who serve our neuroticism with to do lists, and a skewed frozen perspective which defeats the freshness of perspective.(दास्वीदानिया movie देखी ?)</div>
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Goals hence are meaningless. They make you arrogant when you achieve them, or restless when you stray. They give a linearity to a frame of learning which ought to me more circumferential or spiralling. They stunt life into meaningless non-memorable routines.Life actually happens to us in between getting from point A to point B. We laugh, cry, tense up, let go, sigh, exult and go through various other consuetudines of existence. In the interim we build various comfort zones to ward off solitude- family, love, career, hobbies. We mistake these to be life, yet when the gray cells age and company and productivity abandon us to solituide, we fear it instead of accepting it as the way you entered this world. All alone, naked and unendowed of anything but the ability to observe, react and evolve. </div>
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<div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-71296229927839547162014-09-01T05:21:00.000-04:002014-09-01T05:21:16.245-04:00Review of systems<div dir="ltr" style="text-align: left;" trbidi="on">
Gen: hot and cold. Like ants in my brain. I am chill.lets see I lost weight when I was on a diet. Then I<br />
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ate and regained. What's the difference between malaise and fatigue? </div>
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HEENT: stop the nose, it runs. Away. I hear a symphony, not ringing in my ears. Does an itch in my ears count? I hid a babycorn in my nose when I was 3 and it just came out. Bad breath. Well, I fart the wrong way, will my mouth not be sore?<br />
Eyes- when the joints creak, and vision fades,and calcium deposits in the arteries, a fine arc forms around the eye, want to see?</div>
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Cardiovascular: chest pain?- huh sometimes- fit me in your diagnostic model; palpitations- you mean heartthrobbin? ; yes, always with 3 pillows under my head; nah woke up to pee, not to breathe; If I don't breathe I expire, ain't I? If I do, I inspire?<br />
Respiratory- Smoker's cough- always do, more of a hack I call it , sailor; blood - why would I have any blood in it; 2 blocks? I stay in the countryside; Nah , my cat wheezes......yeah shit she does....asthmatic feline<br />
Gastrointestinal- Whaddya say? Noshia? Where are you from? No, I mean originally....you ain't born here were you? WTF is reflux? Heartburn? no, I get a sour taste sometimes. Lots of gas!!! Like I need to fart or belch. I like to have a 8 inch turd every 2 days or so. Not black, I make green shit. I wipe really carefully.No blood. Pooptube- nope, don't want one. Why don't you get one instead. Yellow eyes? Won't I look like a zombie?<br />
Genitourinary- Quite a lot. I take an hour sometimes.No I don't have accidents, but wear them depends just in case. Burns in the tip. I shoot small and slow.I am pissing razor blades outta my pecker.Yeah, wake up 3-4 times to pee.<br />
Musculoskeletal- Yeah my L4 and L5 is shot. Knees hurt when I run.Yes I have some disc problem. Spondolysis something. Yeah I got plates and screws in my back<br />
Endocrine- Hot flashes, no I don't have them since I manopaused.I get hot and cold all the time. I eat like a pig. Don't drink as much I think. I am always getting dehydrated.<br />
Integumentary- Have some sun spots. No lumps or bumps. No no...<br />
Neurologic- I get migraines. I get numb, like my feet are asleep. No they feel numb. Isn't it the same- tingling or numbness? Yeah, I forget. No, I don't forget , I am pretty sharp.<br />
Psychiatric- You think I am mad? Yes, I get anxious when I am taking a test.NO I am pretty upbeat.<br />
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<i>Now why are you asking me all these questions? I just came with a urine infection.</i><br />
<i>You mean you want to cover your ass?</i><br />
<i>You mean you will miss things? I better get another doctor</i><br />
<i>I think you are very thorough. </i><br />
<i>I think you ask too many questions. </i><br />
<i>Why does everyone ask so many questions? I am tired. Let me sleep will you.</i><br />
<i>What? </i><br />
<i>Everything hurts!! EVERYTHING hurts... period...</i><br />
<i>Jiyara ghabravat hai....phadphadavat hai, udat hai, magaj ma jhunjhunaut hot hai</i><br />
<i>Kaleja ma meetha dard hota hai</i><br />
<i>Kachu samajh nahi avat babu....bada ajeeb sa lagta hai....tum daktar hai na, pata lagav ke kahe hot hai</i><br />
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<div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-17514678453209303692013-07-14T01:05:00.001-04:002013-07-14T08:48:42.013-04:00Haazir hoon............The VA on weekends can be eerily desolate with hardly a soul in its vacant corridors. You could get mugged and no one would know till hours later maybe. I am making my way to the fellows' office hearing my own squeaky shoes as I trundle more than walk, unsure of what to do next , except carrying out the ritual that i have unfailingly indulged in every day. Unfailingly perhaps out of meekishness, and fear of the unfamiliar if I did not. <div>Of looking up labs, heading to patient rooms to see tired, unfrustrated veterans who have resigned to what may happen, almost fatalistically, also thankfully that they get healthcare amongst a paucity of other privileges. Of heading back to the office, reading the NY times, dreading a page for a new consult in the minutes before I decide to drive back home. What gives? </div><div><br></div><div>I trundle, unplanned for the unplanned. If a UFO crashed in my path, I may not recognize the need to run to safety. <i>Oh really! You critters are aliens. How bout that , eh. Mind if I get along? </i></div><div><i><br></i></div><div>A new batch of interns, on the floors below, performs in Brownian randomness. Some misdirectedly over enthusiastic, some glad not to goof up. They are learning the right wrongs from their peers, speaking the phraseology, diuresing the dry, walking troponin plateaus, smelling the diabetic feet, getting high on nebs and vanco, smiling goofily at strangers who look on as they run athletically gracefully for code blues, in scrubs, green pixie shoes and dirty loaded lab coats and all, thinking for the moment , that <i>this is it.....what I became a doctor for. </i></div><div><i><br></i></div><div>Invariably, the final year resident/fellows are a more pessimistic lot. They have known the shibboleth, learnt from mismanaged codes and perfectas gone snafus, raked through piddleshit, got scutted out, had an inspiring encounter, and an insipid one, lost and redeemed themselves over and over. They know to locate the vocal cords, the subclavians, Mr Babinski's erection, flutters with 2:1, spectra of beta-lact-amazes, the right words to discuss end of life care, SIRSies and dopies. And this becomes a learnt exercise. Notes become less verbose, patients become lists, time off becomes more important than time on, and the present gives way to planning for future. </div><div><br></div><div>They were once interns. </div><div><br></div><div>The current interns will be residents and fellows later. This cycle goes on. At least for the observer. For the passenger on this conveyer belt, this training time will never come back. What started as passion becomes a profession. Notes become codified billing sheets, processes become bulletted problem lists, pathogeneses become DRGs, recoveries become hospital stays. Families expand, priorities change, anxieties are decentered. The angst at aimlessness is now felt to be a wasteful frustration. </div><div><br></div><div>Get off the gas, clutch, lower the gear, drive on.</div><div><i><br></i></div><div>Times of changing gears are weirdly surreal. The knowledge of going into an unknown time mass feels like someone deafferented your gracile and cuneate nuclei. I am sure all the interns felt this way leaving med school going into the real world. When I moved out of home, bag and baggage into the mosquito infested room in the KEM resident quarters where 9 tired house men bodies competed for aedes aegypti lullabies and dry bath towels, among other things, I was as just as random, kibitzing around. I made my mistakes. I learnt. </div><div><br></div><div>Times of change are good for stress testing a growth reserve as well. It is a good stimulus for the senses also. I think this country offers the opportunity to do this. At some point, you can clutch, raise your gear , and drive on. Along one of the long interstates.....someplace else.</div><div><br></div><div><br></div><div>Btw "htiu#" : that was the text of my 14 month old daughter's first tweet. Figuring out what it means...<br><div class="separator" style="clear: both;"><div class="separator" style="clear: both;"><br></div><br></div></div><div><i><br></i></div><div><i><br></i></div><div><i><br></i></div><div><i><br></i></div><br><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjulddPbKW8N6AMLEV7VeCmqao8a7I954t8pT0VAwg_bDfGjkZbXVZURy1EWVt1NVAHxwUE7P9AsdV98pWsHzaZY4vb7bOAZiMB5eXuXJyL0p5Dj3QZmq3u_qNrgSi3UJ9azvj6s2MEwT4/s640/blogger-image-273575538.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjulddPbKW8N6AMLEV7VeCmqao8a7I954t8pT0VAwg_bDfGjkZbXVZURy1EWVt1NVAHxwUE7P9AsdV98pWsHzaZY4vb7bOAZiMB5eXuXJyL0p5Dj3QZmq3u_qNrgSi3UJ9azvj6s2MEwT4/s640/blogger-image-273575538.jpg"></a></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-71063504246080985922013-04-21T19:11:00.001-04:002013-04-21T19:11:43.748-04:00Random phraseology, that colored my growing up with pati<div dir="ltr" style="text-align: left;" trbidi="on">
In no specific order. Am decanting here from memory, lest these were to disappear from recollection.No one would know what they mean, without having heard them uttered/seen.....<br />
<br />
<i>Aing oyang....</i><br />
<i>Pillapapiah / jemmy doctor</i><br />
<i>Balakka</i><br />
<i>Lalla won Kulla enakku taa</i><br />
<i>Summa irukkaya swaroopata kattama</i><br />
<i>Pant doctor</i><br />
<i>Melleril/ Largactil/ serenace in a red white Fargo lantern box</i><br />
<i>Marwadi sainyam</i><br />
<i>Rajanna/Bebanna/Mani anna</i><br />
<i>Thanga taatha</i><br />
<i>Nandiyaal thelu</i><br />
<i>Aise chandrabhaaga aise bhimateer aisa vithevaara "Devakottai"</i><br />
<i>The swinging hips dance</i><br />
<i>"Jaala setthu poi lorry le eduthindu poghara"</i><br />
<i>"Kudu"</i><br />
<i>"Ennadhu idhu"</i><br />
<i>The times Poona taatha would drop in at 3 PM to read the TOI and paati would make tea for "Maama"</i><br />
<i>"Mookannadi vizha terunjiduuuu"</i><br />
<i>Mriganayani</i><br />
<i>Aadivaram aviyal chestaana</i><br />
<i>Oosipullaaan</i><br />
<i>Madaraas ki jao</i><br />
<i>Mischief rascal</i><br />
<i>Nallavan kadai</i><br />
<i>Torchlight and all other small collectibles</i><br />
<i>Aadum maadum kolam kolam, amayaar paati um kolam kolam</i><br />
<i>Deepa Jyoti parabhrama..... </i><br />
<i>Ucchipulayaare mahaganesa</i><br />
<i>Durgalakshmisaraswati thaaye</i><br />
<i>Chidbambara ragasyam</i><br />
<i>Chakravarti thirumaghan</i><br />
<i>Poooo....malaaaii....pottu kalyanam</i><br />
<i>Ungalukku ellam ennai mami.....neenga ellam romba jolly aha iruppel</i><br />
<i><br /></i>
The last I heard of her, she was a frail shrunken form of her previous self...staring into the webcam on Skype....muttering unintelligibly like a child , trying to sing her remarks....the image quality was not very good, she did not recognize me I think......<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIdKJ5T1K8xRjM7q04Kex1Ri_iak5KfRzNipN-ehM1q5u8rX79SPURkWg6JjIxtrErwA63pMzlBZev8oFUPhbz8XJ9V3knQ20t4_x1WzEQZgQi-aae8PPCK0hlqSHizZak7mFwyZSYHXs/s1600/FAmily.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="211" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIdKJ5T1K8xRjM7q04Kex1Ri_iak5KfRzNipN-ehM1q5u8rX79SPURkWg6JjIxtrErwA63pMzlBZev8oFUPhbz8XJ9V3knQ20t4_x1WzEQZgQi-aae8PPCK0hlqSHizZak7mFwyZSYHXs/s320/FAmily.jpg" width="320" /></a></div>
This was the last grandparent of mine who was alive.<br />
A generation has passed..........</div>
<div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com1tag:blogger.com,1999:blog-2027031012672346476.post-83471143788412639312012-10-09T23:16:00.001-04:002012-10-09T23:16:22.319-04:00Lime and lemony Limca!!!!<div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjgNnIytpmyF6z0TSmhRQGgiM209CeOEagi6vBz7XZOa-sobNoH2qnqjCi1G8IkU8SMH30QpISKHGpXlnqjkt8f4WfW3btCPqNRkOaZ-cKCUGhzLWpdL06ulrT12XubjKAeFrqQ1xkSkc/s640/blogger-image-757962318.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjjgNnIytpmyF6z0TSmhRQGgiM209CeOEagi6vBz7XZOa-sobNoH2qnqjCi1G8IkU8SMH30QpISKHGpXlnqjkt8f4WfW3btCPqNRkOaZ-cKCUGhzLWpdL06ulrT12XubjKAeFrqQ1xkSkc/s640/blogger-image-757962318.jpg" /></a></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com2Elkridge Elkridge39.19317 -76.746909tag:blogger.com,1999:blog-2027031012672346476.post-26180925232537731182012-02-08T17:18:00.001-05:002012-02-08T17:18:10.954-05:00Consumption<object id="flashObj" width="404" height="436" classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=9,0,47,0"><param name="movie" value="http://c.brightcove.com/services/viewer/federated_f9?isVid=1" /><param name="bgcolor" value="#FFFFFF" /><param name="flashVars" value="videoId=1432221248001&playerID=1813626064&playerKey=AQ~~,AAAAAF1BIQQ~,g5cZB_aGkYZXG-DCZXT7a-c4jcGaSdDQ&domain=embed&dynamicStreaming=true" /><param name="base" value="http://admin.brightcove.com" /><param name="seamlesstabbing" value="false" /><param name="allowFullScreen" value="true" /><param name="swLiveConnect" value="true" /><param name="allowScriptAccess" value="always" /><embed src="http://c.brightcove.com/services/viewer/federated_f9?isVid=1" bgcolor="#FFFFFF" flashVars="videoId=1432221248001&playerID=1813626064&playerKey=AQ~~,AAAAAF1BIQQ~,g5cZB_aGkYZXG-DCZXT7a-c4jcGaSdDQ&domain=embed&dynamicStreaming=true" base="http://admin.brightcove.com" name="flashObj" width="404" height="436" seamlesstabbing="false" type="application/x-shockwave-flash" allowFullScreen="true" swLiveConnect="true" allowScriptAccess="always" pluginspage="http://www.macromedia.com/shockwave/download/index.cgi?P1_Prod_Version=ShockwaveFlash"></embed></object><p>Awesome video...look at the hungry ants come in their bellies empty and then slowlydistend with the red sugary stuff.....!!</p><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com2tag:blogger.com,1999:blog-2027031012672346476.post-14306548505724020142012-01-14T20:04:00.000-05:002012-01-14T20:05:01.979-05:00I am piqued at myself saying this...<div dir="ltr" style="text-align: left;" trbidi="on">
There: "Pair tuta hai na baba....dard thoda to hoga ....sahan karo abhi"<br />
<br />
Here: "It is not acceptable for you to have pain...please let us know if your pain medicines are not adequate"</div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com1tag:blogger.com,1999:blog-2027031012672346476.post-80612793790996623232011-12-30T06:48:00.000-05:002011-12-30T06:49:37.820-05:00This post has been deleted<div dir="ltr" style="text-align: left;" trbidi="on">
<br /></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-70171346524909702112011-12-29T22:18:00.002-05:002012-02-08T17:11:09.584-05:00So much love...!!!<div dir="ltr" style="text-align: left;" trbidi="on">
<br />
It seemed that he had gone into a persistent vegetative state after a routine surgery. There was no identified toxic/metabolic/anatomic/structural/infectious/rheumatologic cause identified from results of a slew of extensive and sophisticated tests based on every possible near/far fetched hypothesis that could be tossed in the diagnostic process. His brain looked structurally normal with normal electric activity.But he continued to just stare blankly into the recesses of his room, like.... all hope of purposeful life had been sucked out of his existence, as heart continued to pound, blood flowed, lungs bellowed. But... to what end? What caused his neurons to be so benumbed... no one knew. I felt like I wanted to enter into his hippocampi /medial frontal area and tickle and see how they responded .<br />
<br />
Only one thing stuck in the story : he had lost his wife to an acute illness a few months before.<br />
<br />
I shivered at the thought when I heard the detailed story for the first time. I found it hard to picturize in my mind the fact that <i>this man</i> had slept beside the dead body of his wife for three days without alerting anyone of her death . They called him crazy and schizotypal, but he had been a 'normal' guy before her death plunged him into craziness.
<br />
<br />
There was incredible sadness when one entered his room after hearing this story. Like he was one with his wife at last, and we were no one to intrude in to this seeming oneness of two persons. I knew then that he would die soon. I had seen my grandfather shrink into this absurdity of purposelessness without my grandmother had passed. All their lives they had been so passive-aggressive to each other, but in the death of another, the unmanifested love had played out like a gutting <i>opera tristis a la Ivan Illych </i>gradually stenosing all life.<br />
<br />
I asked Psych- <span style="font-size: x-small;">"<i>Could this be catatonia?"</i> </span> They said, <i><span style="font-size: x-small;">" <b>NO</b>, please rule out an organic cause." </span></i><br />
<br />
I thought, "<span style="font-size: x-small;"><i>yeah, sure!!! </i></span>"<br />
<br />
I felt like asking, <i><span style="font-size: x-small;">" could the diagnosis be Sadness? "</span></i><br />
<i><span style="font-size: x-small;"><br /></span></i><br />
They would have called me crazy, I know.<br />
<br />
<br />
<span style="font-size: xx-small;">Disclaimer: The details of the above mentioned situation are a figment of imagination only.</span></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com3tag:blogger.com,1999:blog-2027031012672346476.post-32412648749698953042011-12-29T21:21:00.001-05:002011-12-29T21:21:53.720-05:00The Ritual by Abraham Varghese<div dir="ltr" style="text-align: left;" trbidi="on">
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Am so amused by some of the reactions in the comment section of this video.<br />
<div>
<br /></div>
</div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-31539355697010679662011-12-28T22:47:00.000-05:002011-12-28T22:47:16.968-05:00The busyness of being busy<div dir="ltr" style="text-align: left;" trbidi="on">
I have always struggled with when lack of novelty threatens sustaining interest in activity. I remember Louis Aledort's comment at MBA's Hematology CME, when I first attended this in Mumbai. Somehow his comments stood above Mammen Chandy's ode to Lorenzo's Oil. They stuck in my impressionable mind. He had alluded then that the redeeming moments during boredom ridden midlife/after-midlife crises are often an interesting patient, a serendipitous catch, a renal bruit you picked, an opening snap that others overlooked, an anion gap you chose to investigate that turned out to be the real thing, that reinforced your way of thinking. That maybe you should just do your thing, give 2 hoots to what people say, write, recommend. Because you are the one who is doing things in circumstances which surround you.<br />
<br />
It is important to ask yourself a question, to rejuvenate the juices or the physical exam skills, to sharpen your skill of diagnostication,to invent a way. You could be very good in adhering to guidelines and doing things systematically. But boredom/ lack of engagement will elicit an error in you if callousness or lack of conscientiousness towards the culture of safety does not.<br />
<br />
I think it is important to be busy. But it is also important to decide what you wish to be busy with.
</div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-32599601401205303102011-11-07T16:16:00.001-05:002011-11-07T16:27:46.541-05:00Culture Shock..........<div dir="ltr" style="text-align: left;" trbidi="on">
Date Nov 07, 2011.<br />
This was one of the no real planned agenda routine days on my trip to India this Diwali of 2011. The noise of the crackers had died down and the triglycerides had peaked at 260+ , waist fattened on sweets of all kinds, plenty of rice and dollops of ghee and left over chocolates.<br />
<br />
What it turned out to be was a revelation.<br />
<br />
I am one of the innocent few of my flock trying to cover my naivete in thinking I would be able to return and practice in India as an Infectious Diseases physician with braggadocio, patriotism, thinking big, an exercise in philanthropy, or say what you may. Every time I think <b>this</b> ought to be my punch line for my future SOP for a Fulbright scholarship application or a motivating <i>Carpe Diem</i> kick on the rump when I am too stricken by porn pestilence or Facebook fetish to indulge in useful activity. And I cannot imagine a <b>this </b>picture/<b></b>situation where I can fill myself in.<br />
<br />
MSF- 8 months away from DW?!; WHO- lack of clinical work?!, Consulting with McKinsey- same lack of clinical work which equals intellectual rust; health concerns; frailty of resolve; concern that mutabilities of time might change priorities in life the way it has from say 5 years back to till now. All these play on the mind.<br />
<br />
This was supposed to be a trial for what might be.<br />
<br />
My friend is an Infectious Diseases Consultant in Pune. Having done an Infectious Diseases fellowship at Hinduja Hospital, he has established a reasonably successful ID practice here in Pune. I accompanied him on one of his 'routine days' hospital-hopping across the city seeing various consults requested of him. My debilitated motorcycle served me well. The weather was bearable, I had relearned all the tricks of 2 wheeler driving in Pune traffic.<br />
<br />
We started at <a href="http://www.inamdarhospital.com/">Inamdar Hospital</a>, in <a href="http://maps.google.co.in/maps?oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&q=Inamdar+Hospital&fb=1&gl=in&hq=Inamdar+Hospital&hnear=0x3bc2bf2e67461101:0x828d43bf9d9ee343,Pune,+Maharashtra&cid=0,0,2479307023361050303&ei=ESS4Ttu9HNDtrQfMtbXCAw&sa=X&oi=local_result&ct=image&ved=0CAgQ_BI">Fatima Nagar</a>. This came as a real shocker.For one, I thought this might be some small apartment-converted-into-nursing home type gharghuti affair. But the scale of this hospital awed as much as the in-expertise of the nursing staff and lackadaisical manner of things appalled me. The usual sort of ID cases, but drugs missing from the med list, doses and names botched up, a blissfully unaware BHMS type of registrar, nitpicking nursing staff. It may be my limited view of things, but I was unimpressed by the usual Indian/Puneri way of acknowledging and satisfying a need while glossing over the details. The <i>paan</i> stains will come........I thought.<br />
<br />
I remembered my friend Jason, from Baltimore, reasoning why we give leucovorin while treating Toxo. How I wished he were here to see this- our land of plenty. Plenty of people, plenty of disease, plenty of infections, plenty of doctors, plenty of money, plenty of poverty, plenty of misery, plenty of inequality, plenty of diversity, plenty of toxo...<br />
<br />
A long drive to my birth place. <a href="http://www.kemhospital.org/">King Edward Memorial (KEM) Hospital</a> in <a href="http://maps.google.co.in/maps?q=kem+hospital+pune&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&hq=&hnear=0x3bc2c05d24b57a01:0x38e2994f0446c50,KEM+Hospital&gl=in&ei=sCy4TqbhGobLrQeUoszoAw&sa=X&oi=geocode_result&ct=title&resnum=8&ved=0CFsQ8gEwBw">Rasta Peth</a>.I have quaint remembrances of doing my medicine internship here. Of course residency was at the bigger, dirtier KEM in Mumbai, but this KEM was where I thrombolysed my first MI patient on a semi-floor bed naive to the concept of reperfusion arrhythmias, did simultaneous and tandem ascitic taps on noon calls, and had to suture my first bone marrow puncture site which I over-enthusiastically converted into an incision. It was where I diagnosed my first Addison's, and ran my first code on a renal transplant patient spilling OKT3 on my apron, already smelling of NAC. It was where I got my Hep B needlestick, panicked first and then got wiser from the situation. (I don't know if it was the HBIG though which made me wise). It was where I got my medicine mojo.<br />
<br />
Fever with rash is always a sticky wicket to play on. Fever with rash in the ICU is even more tormenting. From the days of the Lepto epidemic in Mumbai, I have had hypotheses of scrub/tick typhus, Hantavirus, Crimean Congo, immune storm pathophysiologies to the <a href="http://www.bmj.com/content/335/7633/1295/reply">FART( Fever Associated with Rash and Thrombocytopenia) and FUNDAY ( Fever UNDiagnosed As Yet) </a>phenomena. I admit I had to refer back to Ananthanarayan's textbook of Microbiology to refresh my details on the Weil Felix reaction.<br />
<br />
Drug rash we opined- like is usual, ID physicians are first to pick up on even non infectious etiologies because of the general housekeeping sort of job one does in this role.Of course we fornicated on Lepto/Dengue and all those usual culprits, besides typhus, spotted fevers etc.<br />
And continued Tygacil and Meropenem!!! Bloody jaat ka baida maru.........<br />
<br />
OPD at <a href="http://www.dmhospital.org/">Deenanath Mangeshkar Hospital</a> at <a href="http://maps.google.co.in/maps?oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&q=Deenanath+Mangeshkar+Hospital&fb=1&gl=in&hq=Deenanath+Mangeshkar+Hospital&hnear=0x3bc2bf2e67461101:0x828d43bf9d9ee343,Pune,+Maharashtra&cid=0,0,9905763384357252343&ei=dje4To3TBYj5rQe1zqXLAw&sa=X&oi=local_result&ct=image&ved=0CAgQ_BI">Nal Stop</a> came with it's bushwhack of the day. An otherwise healthy old lady of mid 60s or so, walks in with her nephew with symptoms of dysuria.No antecedent antibiotic exposure, no prior hospital stay or urethral instrumentation. Some 30-50 pus cells i the urine with an ESBL E Coli in the culture!!!<br />
<br />
" This is very common here", my friend explains. He mentions of another friend's mother who grew an ESBL in the urine in similar circumstances. He blames this on the blatant abuse of higher antibiotics and the "spiraling empiricism" among sub-specialists with the authority to prescribe, but no knowledge to guide such prescription resulting in Zosyn or Meropenem being a first line antibiotic for maybe an SBP, Colistin being a staple drug in the ICU, and double and triple Gram neg coverage being a common phenomenon. I am scared at the disconnect between what is taught and what I am practicing now and this mirch masala type of practice.<br />
He reasons that this community acquired ESBL UTI phenomenon is close to 70% of the UTIs he is seeing. He has no data to back this statement apart from his recollection of experiences which he says is not biased. He reasons that this maniac empiricism might be causing the prevalence of ESBLs in the community to be so high that people might be spreading it to each other. We discuss that we should prove/disprove this theory by possibly culturing the stool of these 2 patients or the water supply at their homes.<br />
<br />
Our 60 year old lady gets Ertapenem for a week.<br />
<br />
A few HIV, and TB patients follow.<br />
<br />
But this question keeps nagging. So the NDM scare stories are for real? This really will be a tainted shit hole of MDR bugs,the bugbear of ID physicians of the world? Will we be the biggest prescribers of Colistin the world, like we are possibly for Amphotericin? Will we sink into the grave our GPs have dug? <br />
My naivety suddenly was more apparent than ever before.I had wanted to return to India because I always thought that there was so much opportunity for an ID Physician to carve a niche into, to work to establish norms, to educate, to improve upon. But now it seemed to be like the same plot was a bit trepidatious, even quixotic.Organized chaos might work in business models, but what butterflies are created in this unholy, free for all kaccharpatti, and how they may evolve is something I cannot imagine. ID specialists might be in demand due to ESBLs and KPCs proliferating everywhere, but with neither the drugs to manage them, nor the epi wherewithal to prevent them, we might just be practicing this abhorred empiricism at a higher level.God save us from that anarchy !!!<br />
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Small hospital in Parvati zopadpatti area. Few simple TB cases ( so relieved to see pulmonary TB after what seemed like a drought of TB across the Atlantic) and Crypto Men ( Amphotericin again!!)<br />
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My fears were confirmed at the <a href="http://www.sahyadrihospital.com/">Sahyadri Hospital</a> ICU in <a href="http://maps.google.co.in/maps?oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&q=sahyadri+hospital&fb=1&gl=in&hq=sahyadri+hospital&hnear=0x3bc2bf2e67461101:0x828d43bf9d9ee343,Pune,+Maharashtra&cid=0,0,16546699890160607115&ei=dEO4Trj9KsXVrQfXz6XqAw&sa=X&oi=local_result&ct=image&ved=0CAgQ_BI">Erandawane</a> . All three patients we saw had MDR organisms in pleural fluid, CSF and blood respectively. Colistin, Teicoplanin, and Micafungin were running like tube feeds. It dawned to me that it was likely we would lose this battle against the microbiome faster than other countries would. Unless we could export these bugs to a more developed country, there would be no more new drugs to fug these bugs.We would be back to the old days of good air, nourishing food and sanatoriums for the very resistant bug illnesses. Or surgery for recalcitrant infections. More radical or modified radical abscessectomies/ infectionotomies for more or less virulent infections.Maggot therapy, hot coffee therapy.<br />
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'<i>Kya aap Acinetobacter positive hai?' </i><br />
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<i>" I am MDR positive, please don't hug me" </i><br />
<i>" MDR- Jaankari hi bachaav"</i><br />
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<i>" No, you don't get NDM from mosquito bites" </i><br />
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The funny thing was that there is no hospital epidemiologist allied to the ID physician. I guess the incentive in a pay out of pocket system is in people staying longer in hospitals or ICUs. And so no one takes this seriously. Possibly with development of the health insurance system, shorter stays would be the norm with physicians whose patients develop nosocomial infections getting a rap on their knuckles for poor performance. The opportunity would then arise for educating these numbskull surgeons, by disincentivising poor performers.<br />
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I really hope that day would come.<br />
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Nahi to <i>andher nagri chaupat raja, takiye ser bhaaji, takiye ser khaaja</i>.<br />
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<br /></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com2Pune, Maharashtra, India18.5204303 73.856743718.3999798 73.6988152 18.6408808 74.014672199999993tag:blogger.com,1999:blog-2027031012672346476.post-26480365152651196042011-07-10T01:39:00.001-04:002011-07-10T10:05:00.796-04:00This or thatThis was part of a long drive conversation with DW. I have worked in two healthcare models, one of the developed world, and another barely sufficing to meet needs of the developing ( whatever that word means) world. We manage to scrape the surface back home. Manage the one single basic issue really well. But if anything is screwed, complications arise, or things become more complex than diagnosis and treatment of one issue, we step back, become fatalistic and let things take a natural course.<br />
<br />
Which is not to say that the plentiful bounteous healthcare dollars available to the American healthcare system have created a mannaland here. Problems of treating a populace that expects too much, and believes itself to be immortal, and a force ready to appease this hunger, are not easy to solve. You would say, what's wrong with that? This is an individualistic society that values the achiever who pushes his chances to the maximum, be that his fight with fence sitters, backscratchers, depression or pesky irritants that threaten his longevity. But, do we need a geriatrician to tell us that one day it is going to all end, and to accept this is not a defeat of the generation?<br />
<br />
Are we then better off in the developing world setting, where too much healthcare has not intruded itself into interfering with the daily issues of life, or becoming a part of it? After all, would I care what goes into the making of my TV as long as I am able to watch stuff on it? Or is that a sense of acceptance that since we cannot shape our lives with the limited monies and resources we have, we have to accept what life deals to us, be that the fatal realizations of the frailties of our own bodies?<br />
<br />
To be truthful, I do not know. If it were me, I would want the best, ain't I? But, are the countless visits to the doctor's, tests, venepunctures everyday, some numbers thrown against my profile, pills, chills and psychic overkills really the best? I cannot seem to decide without a P<0.05<div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com3tag:blogger.com,1999:blog-2027031012672346476.post-19931437961120942632011-05-08T22:45:00.000-04:002011-06-20T09:32:48.253-04:00Homeostenosis<div xmlns='http://www.w3.org/1999/xhtml'><div trbidi='on' style='text-align: left;' dir='ltr'>I met a 83 year old, who once would lift 250 pounds in one snatch,<br/><br/>Now, age, the passing of his significant other, severe heart failure,<br/><br/>I know not which more, makes em puff and sigh so hard,<br/><br/>In 10 pound dumbbells he finds his match.<br/><br/><br/><br/><br/><br/><br/><br/></div><div class='blogger-post-footer'>Astra Castra Numen Lumen</div>
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</div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com2tag:blogger.com,1999:blog-2027031012672346476.post-11202810757588107542011-04-14T16:31:00.002-04:002011-05-08T22:46:16.067-04:00Echo<div dir="ltr" style="text-align: left;" trbidi="on"><div xmlns="http://www.w3.org/1999/xhtml">My Q waves wonder why they are there, While,<br />
Physiology, respiratory variations or my lardaceous midriff<br />
Do not explain whether the cold water I drank,<br />
Inverted the Ts in the same views<br />
Of my presenile heart, which must now be viewed<br />
Or so they say!! <span id="BB_SIGN_BEGIN"> </span> </div></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-90752691509715407622011-01-31T01:38:00.002-05:002011-05-08T22:47:24.346-04:00Iphone secrets<div dir="ltr" style="text-align: left;" trbidi="on"><div xmlns="http://www.w3.org/1999/xhtml">I am also surprised as to how well my Bluetooth headsets work with the iPhone. Earlier on with the windows mobile handset , it was a task trying to her the headset to sync with the handset. Listening to the classics on piano by Richard Clayderman..... Soothing with no sound breaks. Wish I had waited for the Bose Bluetooth headset. But the Motorola is good enough. <br />
<br />
Tomorrow is a new day. <br />
Hope , I hope is on my way<br />
<br />
Shivakumar <span id="BB_SIGN_BEGIN"> </span> </div></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com1tag:blogger.com,1999:blog-2027031012672346476.post-68733603971209270312011-01-29T23:38:00.002-05:002011-05-08T22:48:26.786-04:00Moblogging<div dir="ltr" style="text-align: left;" trbidi="on"><div xmlns="http://www.w3.org/1999/xhtml">This is my first post from the iPhone blogging tool. Blogger has become an old thing in some ways what with twitter and Facebook. But I prefer freetext to click and enter. Having the iPhone handy is also useful when the thought strikes and pen and paper are not handy, nor is a computer screen.<br />
<br />
I have to figure out how to insert an embedded hyperlink in text with this device.<br />
<br />
Meliorix<br />
<br />
<span id="BB_SIGN_BEGIN"> </span> </div></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com2tag:blogger.com,1999:blog-2027031012672346476.post-4248771427196718602011-01-28T11:27:00.000-05:002011-01-28T11:27:31.534-05:00Interview questions and answers tips<div>This is for future reference:</div><div><br /></div><a href="http://www.makeuseof.com/tag/8-websites-give-tips-job-interview-questions-and-answers/">8 Websites That Give You Tips On Job Interview Questions and Answers</a><div><br /></div><div>Motivator: "Tell me something about yourself"</div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-89977832517305047962011-01-27T23:40:00.003-05:002011-01-27T23:45:34.212-05:00Bodypainthing ...circa std III textbook<div><span class="Apple-style-span"><span class="Apple-style-span" style="font-size: 11px; line-height: 16px;">Thought I would never find this ever....</span></span></div><div style="color: rgb(102, 102, 102); font-family: Verdana, sans-serif; font-size: 11px; line-height: 16px; "><br /></div><span class="Apple-style-span"><span class="Apple-style-span" style="line-height: 16px; " ><i>Okee Pokee crack me crown<br />King of the island of Gulp 'em Down<br />Was thought the finest young fellow in town<br />When he dressed in his best for the party.<br /><br />Okaa Pokaa Ching Ma Ring<br />Eighteenth wife of the mighty king<br />Loved her Lord above everything<br />And dressed him up for the party.<br /><br />Satins and silks the queen did lack<br />But she'd some red paint, that looked well on black<br />So she painted her Lord and Master's back?<br />Before he went to the party<br /><br />Crowns and stars and ships with sails<br />And flying dragons with curly tails<br />And so dressed Okee Pokee, without a coat or a vest<br />But yet, in his best for the party..</i></span></span><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-92210305417045896902010-12-04T23:49:00.000-05:002010-12-04T23:49:01.832-05:00Let us put the dialysers out of business<div>Never occurred to me why when we talk of Heartmate 2 and all that chutzpah, is there no such implantable device for the kidney. </div><div><br /></div><a href="http://medicaldesign.com/engineering-prototyping/artificial_kidney_2202/">Cleveland Clinic gets $3 million to create artificial implantable kidney</a><div><br /></div><div>Maybe there might be an implantable MARS system for the lliver too!!</div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-91684660215428861062010-12-04T23:17:00.002-05:002010-12-04T23:28:42.942-05:00F.D.A. Studies Band Surgery for Less Obese - NYTimes.com<div>Interesting read about bariatric surgery in the NYT.</div><div><br /></div><div><a href="http://www.nytimes.com/2010/12/02/business/02obese.html">F.D.A. Studies Band Surgery for Less Obese - NYTimes.com</a></div><div><br /></div><div><br /></div><div><img src="http://www.toplessrobot.com/fat_bastard.jpg" /></div><div>Think of the symptomatics-anyone who is obese and has symptoms- OA I guess is symptomatic obesity, or OSA- which everyone will have. So then suddenly 1/3rd of all Americans, including all those brobdignagian American football stars will qualify. Of course there is no debating the lack of a middle path- weight watchers and surgery are 2 extremes. One often feels stuck when managing obese patients who have no quick fixes than disciplining themselves. <i>Lifestyle change</i> often is a <i>life changing </i>event and not many want or are able to do that.</div><div><br /></div><div>We know about the effect of bariatric surgery and the resultant weight loss on not just medical problems- I mean imagine coming off diabetic medications-, but also factors like <a href="http://books.google.com/books?id=0bCtTO7rxgYC&pg=PA181&lpg=PA181&dq=gawande+bariatric+surgery&source=bl&ots=md_x-DxCV2&sig=-SGXTC6gA3nLLK0QCH6z0dKd33I&hl=en&ei=IxP7TN3IOMGclgeH34iqDA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBYQ6AEwAA#v=onepage&q&f=false">mood</a>- improving depression, as well as paradoxically, <a href="http://www.amjmed.com/article/S0002-9343(10)00574-7/abstract">an increase in suicide</a> risk!! But have you read the fine print in Love Bailey on dumping syndromes and other miscellaneous post gastrectomy complications?!! People do not appreciate how dramatic the weight loss can sometimes be- I have taken care of people who eat 1 cracker for breakfast, 2 for lunch and a few sips of juice for dinner which consists of a few raisins!!!! And lose 1o0 lbs or so in few months. One of my colleagues once presented a case of Wernicke's encephalopathy in a patient after bariatric surgery- aptly titled as "loss of weight and loss of gait" because the patient would just not eat anything at all. Surgical complications exist of course, and quite often the obese with COPD, OSA, CAD, CHF are poor candidates for surgery anyways given all the end organ damage which has already set in. One is stuck thinking as to where to start to remedy this lardaceous mess. I guess addressing it before it assumes gargantuan proportions is an option....but then...suddenly everyone's in. It is tricky ground..one has to loop before taking this leap of faith.</div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0tag:blogger.com,1999:blog-2027031012672346476.post-8613613241914031462010-12-04T22:47:00.001-05:002010-12-04T22:47:59.993-05:00Technology Can Get Freaky | MakeUseOf.com<div>Wonder what wireless fidelity might be?!!</div><div><br /></div><div><img src="http://main.makeuseoflimited.netdna-cdn.com/tech-fun/wp-content/uploads/2010/12/wirelesstech.png" /></div><div><br /></div><div><br /></div><a href="http://www.makeuseof.com/tech-fun/technology-can-get-freaky/">Technology Can Get Freaky | MakeUseOf.com</a><div class="blogger-post-footer">Astra Castra Numen Lumen</div>Shivakumarhttp://www.blogger.com/profile/10610452606946724261noreply@blogger.com0