Job to do

Steve Jobs said in his speech at Stanford in 2005, where he talks about three stories of his life,( I searched out this transcript specifically for Ramu...he might have read it already though) that,

"If today were the last day of my life, would I want to do what I am about to do today?"

And that he had read somewhere that if you live each day like it were the last of your life, someday you will most certainly be right.

I remember Dr Deshpande, our teacher in Physiology, a cute looking lady ( I detest the word, but she was ...cute) - who used to tell us, while we grappled with the weight of Guyton and Gray's anatomy on our 'guide' mo(u)lded brains, to "keep an attitude to 'studying' in medicine which is unlike what your colleagues in engineering or in any other course might have. Imagine you have an exam the next day...... everyday. For every patient is an exam, and you cannot be caught unawares or afford to fail."

In hindsight I feel thats one of the lessons that medicine teaches you which you can extrapolate( I love the word!!) beyond the corridors of the hospital.To want to do each thing so well that you want to justify the title you prefix your name with, something your engineering friends cannot do .And there are no measuring scales, no standards here....but a desire to live upto.....what- Schweitzer? Capecchi?Kotnis? Farmer? Bang? Sudarshan? Hegde? Arole?Patch Adams? yourself?

So often we fall hopelessly short of this standard!!!

Jobs' idea seems difficult to imagine. My friend told me once that " kranticha vichaar kshanabharacha asto"- a revolutionary thought stays for some time.You have to cherish it and grow on it. Those who work on it as a way of life end up as the names mentioned above( except the last) When faced with a situation where you do not know blue pill or red pill , do you play it safe, or do you aim for something more?

There is another take to it( Krishnamurti / Bertie ?...don't remember) ...many years down the line, when you sit back on your easy chair and think about how you did, beyond earning and spending, beyond loving and being loved, beyond being 'successful in life' - often in other people's opinion more than yours, think if you gave your best shot even if you did not end up the best. And a smile lights up your face when you realize you did. This is a fictitious moment.It might never come, it might never be. But can you live up to the expectation of that moment?

Just do it....

I was leafing through Tagore's Gitanjali. I have a really old copy published in the 30's that I picked form a raddhi bookshop sometime. I had made some really funny notes the first time I had read the book.Like a Nike logo next to this verse...one of my favorites.Since the book is already losing leaves, I thought I shall keep a e-note of this.

I must launch out my boat. The languid hours pass by on the shore
The spring has done its flowering and taken leave. And now with the burden of faded futile flowers I wait and linger.
The waves have become clamorous, and upon the bank in the shady lane the yellow leaves flutter and fall.
What emptiness do you gaze upon! Do you not feel a thrill passing through the air with the notes of the far-away song floating from the other shore?

I used to make mental pictures to understand poetry- figure out scenarios that would fit the words.( I had an equally funny one for Ozymandias)To remember this scenario I had created a story- in drawings - of an oarsman who had traveled across an endless Gulf to a surreal island with exotic flowers to get his ailing kid an orchid which he dreamed would cure his child of his illness. This at the cost of his daily wages he earned ferrying goods . He must locate it before winter causes the plant to lose its exuberant bloom, and its heavenly fragrance.He searches all over the island ,as fall/winter chases his footsteps, hunger gnaws at his determination.He searches out a lonely spot at the other end of the island where he finally spots the elusive flower.But winter has begun to tickle his bones..he smells the flower...it is barely what he was told it would be. He trundles hopelessly back to his boat, sobbing his heart out. He sits on the banks, watching across to the horizon as the sea stretches along endlessly, hoping that his child would not see him in his misery. In his sobs he does not hear the flautist play and the courtesans sing , as music fills the atmosphere and the chill and mist seem to vanish in the healing notes that waft through.

He cries out, " Lord, I have failed. Carry me, for I have no will to go and see my child die."

And his Lord whispers, from across the ocean into his ear....."despair not....your love has carried you thus far, and further shall you go. Launch your boat, so what if the flower has lost it's fragrance, you carry the fragrance in your heart.Love gave you your motivation till you came here, now faith will."

"Just do it dude"

The rest... of being ......or not being....

Quite as much as I sometimes regret not learning Shakespeare and English poetry from tatha while he was alive- I was weak in maths and needed my dose of Hall and Knight to kindle my left brain too , I also am thankful to some of my teachers who chose to rush through the State board books so that they could teach us some' real stuff'.

I have never met Ms Ramaswamy later, but the pains she took to etch Othello's soliloquy " It is the cause, It is the cause, my soul......" into my memory, or the para by para pauses she took while we painfully trundled through Wilkie Collins' Chandraphattar, or when she let me do my stuff when I differed from what she advised- and ended up hopelessly wrong, all, quite make her the best teacher I have had.

Was reading the rest of the lines after the most quoted lines of Hamlet. We were taught just the first four lines....and I thought that was it. I figured out that the rest was too heavy on existentialist stuff...too much for 8th graders. But then for blogPOST- erity, here goes:

To be, or not to be, that is the question:
Whether 'tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them. To die—to sleep,
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to: 'tis a consummation
Devoutly to be wish'd. To die, to sleep;
To sleep, perchance to dream—ay, there's the rub:
For in that sleep of death what dreams may come,
When we have shuffled off this mortal coil,
Must give us pause—there's the respect
That makes calamity of so long life.
For who would bear the whips and scorns of time,
Th'oppressor's wrong, the proud man's contumely,
The pangs of dispriz'd love, the law's delay,
The insolence of office, and the spurns
That patient merit of th'unworthy takes,
When he himself might his quietus make
With a bare bodkin? Who would fardels bear,
To grunt and sweat under a weary life,
But that the dread of something after death,
The undiscovere'd country, from whose bourn
No traveller returns, puzzles the will,
And makes us rather bear those ills we have
Than fly to others that we know not of?
Thus conscience does make cowards of us all,
And thus the native hue of resolution
Is sicklied o'er with the pale cast of thought,
And enterprises of great pitch and moment
With this regard their currents turn awry
And lose the name of action.

When you hear hooves...hmm....ask Google

Well, the googleblog categorically mentions that Larry and Sergey would rather not prefer that you use the word Google as a verb. I tried to mull on a PC title for this posting ....obviously the verb 'googling' was out. Putting the word in capitals as 'Google it' was softer, but all the same fiendish as a Modi.So, disclaimer: I am not cocking a snook when I write"ask Google." It is for shortage of ideas. Ask.com has a much more friendly interface, but not a 'Google scholar' or 'pages from India.' I use Scirus and Healia, but Google has not disappointed me for medical queries. They even ante dated Stumbleupon with 'I am feeling lucky' button.

There was an article in the BMJ about Google getting the answers to problems posted in Case records at the MGH from the NEJM 58% of the time. We all know BMJ publishes junk research from time to time - the romance in the ER one was a ludicrous example.But come to think of it logically, how frequently would you hit something like Muckle Wells syndrome depends on how the person who asks the query enters the search item. He has to look at the rash and fever and look for cognitive shortcuts. He has to know whats important to add to the search list and what to discard.He has to know that the scenario fits sarcoid more than amyloid. We know of this as an anchoring heuristic- a familiar point which he/she knows and builds the case diagnosis from there. It is impossible to know every bit of information that exists about every condition in medicine.Google does all that for you...it keeps your Harrison handy on your laptop, it has the mind map like circuitry, and it can put your a+b+c together like Greg House would.Some of us like to do such syndrome hunting- e+g+h is Whipple's or Prader Willi or other such Gestalt stuff. But guys, to carry French's index of differential diagnoses and Wallach for interpretation of diagnostic tests and do it manually you would waste a hell of a lot of time reaching anywhere.

I do not see using Google for this as being wrong, or as an insult to anyone's intellect.For reasons: a) The possibility that you will arrive at a wrong diagnosis seems faint given that you are entering true factual data of positive findings that you have elicited.The issue is of sensitivity not specificity. b) Since you cannot present this as Evidence based hypothesis testing, you would obviously investigate further to test the biological plausibility of the idea before choosing to intervene on a 'hit' given by Google. c) In all cases you would follow the traditional iterative process of forming hypotheses while asking history and conducting exam, use the other two cognitive short cuts- representativeness heuristic (Spot Diagnosis method) and availability heuristic (past experience), and ask Google only when you are clueless at the end of your interrogation.

There are cases of the obsessive compulsive, patients who Google too much- the recent TIME article on one such patient is a good example.I have had an encounter with an acquaintance who waxed eloquent about her not being a vaccine person what with all the "autism going around", and defended her argument saying that "the evidence is there, you cannot deny it". I hadn't seen the evidence she alluded to, and had to take a step back there.But having seen what she was referring to, I wish I could have told her then that the most viewed videos on Youtube aren't exactly what you would call Evidence. I do share Jay Parkinson's frustration when my half read misinformed relatives choose to harp on a antediluvian dichotomy of allopathy Vs homeopathy/ ayurveda, and the latter being 'holistic', 'attacking the root cause of illness' , and choose to base their ideas on word of mouth or vague search results. But do you get confrontational with such people? I would disagree. It is better to be a facilitator in care of such patients, but to care to correct them when their enthusiasm veers them into wrong directions.

Moral: Let's accept Google as a useful tool.
But then, a fool with an idea is still a fool.

Came across this assortment of postings on the use of Google in medicine on the Clinical Cases blog.

Everybody's at home

Strange stuff.....appa does not work anymore, amma is recuperating at home, my gran is too old to work, she anyways hasn't ever worked in her long life . I am not working right now. Everybody is at home. And no one is bored!!

Have you ever fed someone with your hands? It is a deeply satisfying act. I mean hmm...beyond just the act of delivering a morsel of food to someone who can't him/herself.....Beyond the neuroticism of feeling short on time all the while....and thrusting a granola bar and coffee hurriedly into your own mouths, as you feed your own ego with low cal fattening stuff, do your own job, love yourself, even love others coz you love them loving you back..quite unlike all that ersatz ......just a bit of languorous timelessness to it.
There's also a feeling of giving to it...at an individual level.Of appeasing the hunger of someone else.I guess cooking for someone is also somewhere there in terms of satisfying your Giver instincts.I never wondered when my mother would go through all the trouble of cleaning, cutting, cooking to make us a huge bowl of Sunday evening 'tiffin' while she herself ate little or none of it.Lakshmi...your khane ka khazana is no less appeasing to you than it is to us I guess?

My readings

For suckers like me: Quail and manna. List of free articles on Pubmed.

And Dale Carnegie's mantra for MRs: How they win over and influence doctors. This is from the PLoS. Particularly interesting are the tables.

And finally....a directory of medical bloggers from India. Maintained by Indian Medic.

Happy reading.

Rabbit run. Rabbit stop.

Taking a step back and observing things as they happen. Jumpy cousin, woozy aunt, crazy Dani, helpless mother, restless rabbits, pati peripatetic, wishy washy sistahs, loads of money, Kaka's antipathy, some Spanish. Go fish.

Activity beckons.

Floydian philosophy: (with my distortion.):

Run, rabbit, run
Dig that hole, forget the sun,
And when at last the work is done
Don't sit down, its time to dig another one.

For long you live and high you fly
And smiles you'll give and tears you'll cry
And all you touch and all you see
Is all your life will ever be.