Reflective, not reflexive

Long time since I posted anything on my blog. Getting 'settled' into the rut of things does take its toll I guess. Having got the 'hang' of things I want to look into the mirror , stretch out and relax, with my cuppa.........

Came across this delightful piece in the NEJM this week: makes me so happy I trained under DRK. His non expressive "I don't know" makes so much sense when you decide to sit back and look at the larger picture . It is like extrapolating the gestalt logic to each individual person. Like: meet Mr Paul: he has a large nose, a few crepitations down his left infraaxillary area and a few nodes in his armpit: and no, he does not have sarcoid please. Thats Mr Paul. A unique person going by that name, not a syndrome Paul but a Mr Paul.And since when did his name become some Wegener something?

Snaps .....iTrip (ati)

Just back from a back breaking, skin tanning overindulgent trip. Savored every bit of it except an occasional migraine. Needed something close to hold on to before I take the social
lemming- jump into the Indische Ocean across to starting a residency in being non- resident- of- India. So IInd Class sleeper berths and state tourism bus travel was a blessing in disguise. Suddenly I felt like an Amitav Ghosh mated with William Darlymple type of person with a wanderlustful Pico Iyer thrown in for good measure. And the mood, waiting on the fly infested Pune railway station to embark on the "Dadar express" was deliberately Rubaiyat like "ah my beloved fill me the cup that clears...."- I wanna wanna sinfully indulge myself this time like this trip were a juicy hapooos amba that I shall never get to eat again.

I had been reminded some time back by a cousin from a nouveau- riche background that my parents were second class citizens who would never travel by car even if they were to buy one. For once I seemed to be happy with that statement.What with no chakks on the train, lots of laddus and Banganapallis - larger, sweeter and cheaper than the over rated Devgad hapoos- to get softishunderbellied on, backpacking with a Bhavnagri plastic bag through toasty dusty hot AP.......ekdum jhakaasmaal!!!!!!


Some snaps.......







Snap of the main temple at Tirupati. With my 1.3 MP cellphone camera!!!!!!

The sky is my roof, the earth is my playground.Astra Castra Numen Lumen






This is a shot from a distance of the same temple gopuram and the promenade around where folks camp day and night.
The one really great thing in this snap- no, I am not referring to the golden dome inside the temple- is the verdant greenery in the background. If you feel claustrophobic amidst all the sweaty taklu crowd, you can always choose to cool off in the hills around the temple area.










Pushkarni.
Watching the people do their rituals here I thought I got some idea as to why the bathing ghats at Benares are such a draw for folks all and sundry. What could be so interesting about people dunkin themselves in water? Well....come and watch.....





The train rambles along, stupidly, trying to catch up with the sun, as the tracks wind around- sometimes west, running directly into the sun as it arcs into the horizon; sometimes north, disadvantaged by trigonometric inanities of resultant vector and all that stuff.
Life and Times are playing out their parts outside windows with railings like Pozzo and Lucky, while one watches listlessly inert,like an Estragon, as the scenery evolves from verdant green to burnt sienna to orange and magenta to finally pitch black. Only an amber signal light flashes in the distance somewhere.

To the Lord of Seven Hills

I am taking a break............

Pappu chala Pardes

Not many posts this month........

......amidst hours spent on Mahabus and the rambunctious BEST no 66- front seat upper level, in Ruby hall Poly OPD and Nair Hospital Anand Bhavan flat 19, wandering through quaintly unfamiliar- now KEM corridors and the disorderly forums on immihelp.com, soothing gadolinum thrombophlebitis and sore Latissmus dorsi, fixing houses and spouse grouses, cycling through Kalyani Nagar Koregaon park Kawde Road Keshavnagar and Kharadi and other heterosexual streets of Pune listening to Enigma, Eagles and Simon and Garfunkel's sweet Mrs Robinson, pushing my petrol budget with experimentations based on the quench effect and 4 stroke faith while the heat burns me amber and pop goes the diesel, doing paper work, more paper work and still more f@#$ing paper work, shopping lemon squeezers, tea strainers, roti belans, kadhais and neck ties, rounding on Kochs, more Kochs and still more f@#$ing Kochs, deciding and undeciding about wasting some time on IPL and finally giving way to inertia , only to be plagued by the guilt of art being long and time fleeting and the muffled drums beating couch po-tick-tack-toeishly................

I didn't get time.

Hope cries
While a moment dies
And time flies
Amidst existential lies

The vegetarian ass

As an epilogue to the Buridan's ass problem, I give you this........distilled from an argument I had with Sanjivani last week- she is an obligate omnivore, and highly opinionated about the same, and I abhor those who can suck the marrow out of a leg piece and crunch on hydroxyapatite remorselessly.

So here goes........

Suppose two people were stranded on an island, some spaceship from the Aandupaandu galaxy offloaded them there by mistake instead of discharging at the restaurant at the end of the universe. Now this is no Blue Lagoon mannaland sadly.The island is one with the bleakest of landscapes such that nothing grows there- not a weed of andropogon or a tuft of grass or even some poison ivy, no animal has ever set foot there, even the fish swim miles away from the coast of this crazy place. Let's call the island Duravida- hard life.There is just a spring which supplies fresh water, so you don't die of dehydration. Get the drift? Well then......

Now

1) Scenario 1: Person 1 is a carnivore, like my friend. He can tolerate the hunger pangs for a few days. But when desperation and hypoglycemia clouds his senses, he will not hesitate to kill his companion to eat him up.

a) Lets say person 2 is also a like minded bloke, thinks exactly like person 1. So one day both, in compos non mentis due to hunger and their unevolved, carnivorous survival of the
fittest instincts egging them on, decide to kill the other to survive. As one delivers the first
blow, the other realizes he has to fight back and machetes the other, the end result being
that both are lethally wounded and don't make it to their goal to eat some meat.

b) If person 2 were a vegetarian- It is against his .....moral gut instinct we shall say......... to kill and eat. He will never think of killing person 1 to eat him. He won't even realize whats on
person 1's mind when he delivers the first blow. Too stunned to hit back, he will eventually
be killed. If he were quick enough to realize his position and strike back in self defense, may
be he might kill person 1, but he will still not eat him.So while person 1 dies of greivious injury, person 2 dies of starvation!!!


Scenario 2) Persons 1 and 2 are herbivores by choice. So even when hunger gnaws at their very person and ATP molecules pop away into oblivion like goli soda, their determination not to kill each other, or even ignorance of the existence of such an option will send them both packing towards the pearly gates where a Mahatma awaits them.

Dulce et decorum est.........


So - what do we have..............both die, one lives, both die, both die.

Result 1-0 for the carnivores.
Shall we say this is a victory for them? Wait a min....... what happens to person 2 after he has killed person 1. There is no ship in sight, none shall ever touch shore there. Not a vulture to kill and feast on!!!!!! He shall eventually starve to his death too, (or maybe even start to eat himself up?!!!!!)

Kya jholl hai!!!!
(Sanjivani's reply: Kahi hi haan!!!!)


This is not my indignation/malafide mudslinging against those who choose to eat meat or any hosannah or piece of propaganda for believers of vegetarianism. It is just a hypothetical situation arising out of an argument. Needless to say, cannibalism, if and where it exists, is strongly condemned by the author

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!!!!!!