udderly bored...... some divine bovination from the Holy cow!!

If you breathe in, you inspire.......If you don't you.... expire

A yoga teacher had once instructed me to just observe my patterns of breathing while performing ADL, and doing so I had been surprised as to how we take for granted the inflow and outflow of air out of our lungs to occur like it were an irrefutable absolute truth- like it is as true as I am or you are. We exist because we breathe. Since our existence is not doubted, so also that air will move in and out, this cannot be impossible.

To me the COPDs were always the hukkahwallahs, who never went to the chest med OPD despite repeated 'warnings', came shamelessly again and again to the EMS bearing with the grudging and abuses of the EMS staff.....for they came there to regain the ability to breathe. Not all were smokers- a large proportion was of patients with byssinosis- not their fault, some post Kochs bronchiectasis- again not their fault, one with Kartagener's-who cried helplessly, I remember, at being told that his sperms were all dead,some Cushingoid with years of steroid abuse, one mama who said, "kabhi to marna hai, beedi peekay aish karte marenge, kya galat hai". I had never imagined or associated any emotion with them.....a few nebulisations, an antibiotic if needed...and they're off.....till they get an exacerbation again. What could you do anyways? "Fefda kharab ho gaya hai.......kuch nahi kar sakte......dum to lagna hi hai........sahan karo...." The worst I had faced myself till then, was a blocked nose......extremely frustrating. But nothing compared to this- from an article in the NYT.

Ondine's curse was a theoretical entity for me till I managed organophosphorus poisoning patients, whom we had to fight with all night to remind them that they had to breathe if they wanted to live. Neurology registrars laughed at me when I made a diagnosis of central hypoventilation in a patient with recovering Lance Adams. But when the patient died, undiagnosed, I was surprised how they could digest their inability to point to specific reasons.The very thought of needing to remember that one had to breathe, and knowing that if I sleep I shall not breathe, and hence die was too ghastly to imagine in real time. Shaila Vartak was embodiment such a curse, and getting her off the ventilator was an achievement we shall ever be really proud of.

"Myasthenia hai".....the neuro registrar seemed cock sure.I felt something was amiss. She was middle aged Konkanastha brahmin, middle class, coming with a history of fatigue, diplopia and recent onset of weakness. No thymoma, RNS not conclusive enough. Electively intubated and steroid, Azoran and pyridostigmine upped to max levels.......no response. Should we do plasmapheresis? We decided to redo the EMG......and repeat EMG revealed that Shaila was suffering from a muscle dystrophy. So while leptospirosis patients with ARDS waited for ventilator vacancy, we fought with Shaila, fiddling with SIMV, pressure support, low tidal volumes, postural variations, 2 ventilator associated pneumonias, progesterone, acetazolamide and analeptics, countless trials of weaning and sheer desperation. Shaila could walk, but she could not breathe. She could even AMBU herself if someone was busy with some other patient.I never talked to her as she was on trach for a loooong time. But finally when she was weaned off onto a nocturnal BiPAP support...after 2 long months in the ICU, we felt jubiliant that we had achieved the near impossible.

" Jor jor se saans leti hai isliye haat paanv tedha hota hai aur fit aata hai".........me,explaining carpopedal spasm to a histrionic teenager's relatives in the EMS!!!!!!

And I am learning Spanish......

How difficult it seems then to think of a thought, to form a sentence in English, to translate each word into Spanish based on a presumedly instantaneously accessible vocabulary databank, to check for grammatical correctness and language specific plausibility,to string them together in right order, and to vocalize, all this while maintaining collective stream of thought in a conversation.!!!!!!!

Medical shorthand

Some more stuff ..I believe from the BMJ.....continuing from an old post - medical short forms.

Buridan ka gadha

The ass: placed equidistant between two equivalent piles of hay, the ass could not make up his mind as to which to choose to go towards first and feast on, and thus starved himself to death. Had there been just one pile, he would have lived.Don't blame him. He was just being perfectly rational. There was nothing to choose between the two piles in terms of size, quality of hay or the distance they were from him to the smallest measure.But the result was that our rational ass could not make up his mind as mounting hunger kept clouding his ability to do so, and finally died of starvation.

Buridan, had he been there: Above all, it was irrational to starve himself to death. Thus although it would be irrational to choose which pile to feast on based on just one turn of pitch and toss, the ends justified the means in this case.So Buridan tossed a coin, and based his decision on the result of the toss. (Let us say it was a pile of bread, for Buridan is no ass.)

How do we choose which path to take when we know nothing of where either leads us to? Simple. Na?

On a lazy sunday afternoon......

I was leafing through the first few posts of this blog.

I had also happened to buy the Times of India today after a long time and , starting from the last page as usual , I happened to stop by a snap from a later page of a lagoon in Costa Rica which was supposed to be azure blue due to some chemical reaction between CaCO3 and sulphur in the waters. Now the catch was that this snap was printed in black and white.

Which means:
- The lagoon could really be azure blue and this was a printing error, the TOI put up a b/w snap by mistake.

- The snap was a wrong snap, it really was not azure lagoon in Cosat Rica but some murky green one with moss and weeds in the east.

- If I am color blind to blue, how would I really have made out.Would it have mattered to me anyways?

All these three situations are possible reality situations. The ultimate reality is the existence of the lagoon . But hardly anyone who reads the TOI Pune is going to go to Costa Rica to verify.So all these are realities in their own sense.

We support our inferences in a realm of stochastic determinism of things.The qualities of things is determined by the known quantities that they resemble. The lagoon is blue because it resembles the color of the sky which is known to be blue. But if we come to know of something that does not resemble anything we already know of? Like ..... describing how fortification spectra of migraine look like without really seeing them, or ...something that you will ever have to guess but never know for sure....what does a patient with Wernicke's aphasia think of or dream of if he never understands the environment around him??!!??

Reality is a bit like Heisenberg's principle.
Electrons jump back and forth, atoms and molecules change, the thoughts that are formed of long term potentiation due to molecules at the CA1 region in the hippocampus should mutate if the basic structure of those molecules is relative to the observation moment.

When I surf through the phonebook of my old cellphone handset I am randomly presented with names of people I had known but whom, for lack of presentation to my sensory apparatus had' forgotten'- Chandu, Vilas AKD, Geeta staff, Ankur, Nilima, Sayali, Shridhar, Sunanda, Sushil , Suyash, Varsha Shevgan. As I scroll through, I can conjure the faces, how we interacted, the scenes of interaction, the circumstance. The palette fills in gradually.

We change so much over time- is a cliched reality. But we change relative to what?

It is like alluding to the question of the ship Theseus. When a new ship was recreated from components of the old ship, and a reconstructed old ship stood beside, which was the original Theseus?The new one made from components of the old, or the old one which was the original, but had innards which were all replaced.

Am I the me who cycled the lanes of Rasta Peth on a Tobu cycle at 10, or the random medical student who was trying to romance KD Tripathi and the hernias of other people at 20 or the person I am now? Can I be like a Beautifully American Kevin Spacey shot in his temples visualizing his life from his childhood to his tragic demise in the last few moments in a flashback(or more pleasantly like a sit like a Forrest Gump on some bench in some park at the end of his eventful soiree of a life) and point out that this, whatever it is, was/is my baseline?

Time is potent, and memory fickle. Surfing through older pages of your blog, you will wonder....did I ever really think like this? Why so? And if you never happened to visit those pages, you will never get the answer.

Being aware of all possible situations- the blue lagoon, the mossy green lagoon, and the blue lagoon in black and white makes me more comfortable. Maybe

Innocents aboard

Amidst the bedlam of the IID course coordinating chaotic case discussions and listening to cute Italian accents, a once in some time incident like the one below provides for much humor as much as it sets you thinking.

"Doctor, मला ना कुत्रा चावला. मी दोन इंजेक्शन घेतले."

"कुत्रा कसला होता? आजुन कुणाला चावला का?"

"नाही हो, घरचा कुत्रा आहे. Palmolin कुत्रा आहे.त्याला पण वाईट वाटला असेल, म्हनून दोन divasa पासून कीव कीव कर तोय. मला ना दोन तीन diwas झोप नही लागली"

" अहो घाबरु नका, इंजेक्शन घेतला ना तुम्ही, कही नाही होणार तुम्हाला"

" मला कसला काय होणार, tya कुत्र्याला majhyapasun HIV झाला की माझा भाऊ रागाव्णार mhanun मला भीती"
!!!!!!!!!!!!!!!!!!!!!