In pursuit of......

Slideshow on statistics of happiness from slideshare, thanks.

What do we know about happiness

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In conversation with Dr Terry

I was telling him about the Taj Mahal hotel and the latitude comparisons of Florida and Mumbai. How snow happens here, but its a day or two in Shimla in India. How people who lived here for long enough imbibed the American efficiency and thought it was birthright and made similar demands from the system in India when they chose to make the return journey; only to return again to the US and feature neo-enlightened in NYT write ups on the 'reverse brain drain.'

Invariably conversation shifted to how medicine differs in India as compared to the United States. There weren't many moments that allowed, outside the bronch suite, waiting for the patient to be wheeled in. But I wished to tell beyond how health insurance does not exist, and hence people save money for a 'rainy day' and healthcare is separated into government hospitals for the poor and private hospitals for the rich and tourists.

I wished to mention how one system cannot be flawed for being hopelessly inadequate because the demands it makes on it's country's exchequer are miniscule as compared to the Brobdingnagian other; the needs it tends to are so disparate and basic that trying to rein things in seems like a colossal case of Balint's simultagnosia- missing the forest for the trees and doomed to failure like the many Malaria programs we learned of in PSM classes. I wished to mention how micromanagement and backfoot play has become the bane of American medicine- so it seems to someone who has worked in both systems; how people become lists of past medical issues and ideal setups for iPatient scenarios that Abraham Verghese describes again in the BMJ this week; how it is still plausible for a patient to have 17 surgeries and both hips and both knees and shoulders replaced and still crib when the age for beginning mammo screening is moved from 40 to 50; how patient does not know she is on opiods for pain -denies she ever had pain- doctor does not know why pt is on opiods for pain- pt comes in confused and drowsy-screaming-'oh she must be in pain' and pain gets treated as the fifth vital sign of course- and patient is in and out of the hospital, on and off narcan drips, treading the papaver somniferium way to doom.
I also wished to say how I find it odd that everything including duration of hospital stay, courses of illnesses, prognoses can all be stuffed- fitted- normalized according to mandated standards, that deviation from the rule can be scorned upon, hence everything be slotted in some protocol or other and dealt with that way and that insurance and not intelligent thought dictate what approach to take.
Lastly, I wanted to tell him that I would never want to die in a nursing home/hospital, with no family in sight- they got so used to the NH to hospital shuttles ,they did not bother to come see-while some resident desperately dials numbers to find what the code status is, and finally locating a DNR sheet, throats a relieved "allow natural death."

There is chaos here as there is chaos there. Questions need to be asked.There cannot be a Ultimate Turing Machine truth or an answer 42 for all questions.

"You are responsible for your own experience", so the Buddha tweeted.

Knowledge speaks, Wisdom pretends to listen

Yogi Berra says when you come to a fork on the road, take it.

I am trying to develop a lateral view to things I see and feel everyday- it may involve keeping a distance from all the shindig to develop a 'broader' perspective of things. So I see everything as it happens, feel everything like it should but am not there in participative mode. I am 6 inches above the ground in a holier than thou gear fornicating with my Quasimojo. In this mode, even probing questions can be skillfully deflected with a "depends , on your point of reference" flick off my sleeves- dhamaal invincibility.

I could write nothing for a 100 Q paper and claim it to be my POV, whats my fault, I am diagonally parked in this parallel universe.

You might call me ch#*ya....I could call you something else...but thats besides the point. Somebody has to be the broad boy- and call Carpe diem. If Windows 7 and Ubuntu Linux have to cohabit, someone has to be the wise one.

Because all the world's a stage, and all the men and women are merely players. Each one they have their exits and entrances, and one man in his time plays many parts

But................................ Sheikh Ispiar to ek hi bana na......jo tangdi taang ke je tamasha dekha

And there was one Jesus who said, "God forgive them, for they know not what they say/do"

Abhi ch#*yon, jao chalo karo ch#*yagiri.....

When I should be writing my PS

I bore through two and half hours of West Side Story and Arundhati Rao's Come September and another reading of 'The Howl's eli eli llama homosexual rantings.

Is it good or bad to be impressionable- each one is affected differently by what is crap for one, kitsch for another, spur to someone else? Is it a harm to be enthusiastic? Should one pretend moral superiority and lose the innocence of the action reaction spiel, and be deliberative and not get the high of now and done- whats next?

I have been trying to think. But conventional ramblings keep me busy.

Dr Druker's interview with the NYT

Dr Brian Druker was awarded the Lasker science award for developing Imatinib mesylate with Charles Sawyers from MSK and Nicholas Lydon from Novartis.

This is about the magic cancer bullet

With cold coffee at an unearthly hour, after a looong time...

I always thought writing a paper while doing residency in India was tough and that you would never find the time in the midst of all the emerg/post emerg/pre emerg cycle of actiwitty. I never thought handling 80 patients and seeing consults, doing procedures rat-a-tat-tat-tat was ever an issue then. If yo get free time, you would rather spend it on watching a movie at Sterling or Regal and fine dining at Crystal or Cafe Mondegar or Bhagat Tarachand. And why not wake early, not to do schlolarly activity, but to go to the railway ground to run a couple of three kilometres every now and then, coz you could always take a siesta by the side room after you do the routine ward work.And so when push comes to shove with your theses, you run to DP Singh at TISS or try out trial versions of SPSS really trusting your acumen and luck with the games of trial and error and hoping your p value works out.

I thought writing a paper while in the US would be easy- especially with the fact that residency would not be such a pain in the derriere, time would be at more surplus since management questions wont take forever and clicks of the finger that underlined pages after pages of Harrison would make ailments vanish.

Alas, here 10 patients tire you out. The greatest task at hand seems to be jousting against all the data thrown at you wondering what is relevant and what is non necessary, trying to figure which among the past medical issues needs more digging and which is just another episode in the unending treadmill test that healthcare is viewed as in this developed world.

Not staying in campus- why call it residency then?- cuts you off from working when you like to, and residency becomes a stretched out 8-5 routine where you do a bit extra in form of calls, signouts and all that.

The task of the day is writing a note in the first year, dispo in second year, dispo and managing the census in a smart alecky way in third year. Abraham Verghese's i-patient is very much existent on a busy day when time is at premium and as vitals and I/O are available on COWS- confessions from interns! Work becomes "work" in the true Dilbertamerican way; people judge you, and you need to be mindful of their judgements aware that they have a right to judge you in this 360 degree assessment cumulonimbus thats so pervasive. Uniformity is encouraged as it means productivity, lateralness is frowned upon, protocols are gospel truths.

So when do you sit and analyse what you saw and write abut it? I guess that comes when you do bench work research and stay poor, for the smart ones are seeing more patients in 15 min encounters and making more money!!

Some of my friends who never did clinical work in India do not feel that the emperor's clothes aren't there at all. I guess working in different scenarios gives you spectacles that you can choose to wear or toss, for quite too often WYSInotWYG.

Have a weekend off after some time. Will try to submit something I have been sitting on for some time. Again, I also need to enjoy - when will I have a weekend off again!!

Whats going on.....

Just like that ek post dalna tha

Presented a case from KEM Hospital in Mumbai which we took care of- a case of difficulty weaning which was due to an empty sells syndrome with panhypopituitarism- at the rheumatology challenge at GSH. There was some malaria for lazeez fare and DRK management for laissez faire, chloroquine and artesunate which is like stibogluconate and eflornithine for the C difficult audience.
Was a decent presentation I thought. - gives me some free time now since I am free. Left me with an estomago dolor though, with Chow baba snoring away and food too plenty to eat. I thought of it as a break from the MRSA VRE fluid overload story of daily grind.
Gonna try and keep ready for elective time, long drives and traffic, new places, new people and working towards that letter of recommendation.

I dream meanwhile of the rains in Pune, the greenery of malshej ghat and the beauty of Varanda at its summit, Karjat ghat ,the Bhugaon exit from Paud road and its lustrous wet green vallies and circuitous roads and small hamlets, getting drenched in the waters near the Temghar dam, eating bhaji and chaha on Sinhagad, the bumpy ride to Panshet backwaters- of being able to get drenched and dry your clothes in one single motorcycle ride to Bhatghar dharan, pedalling on rotten pedal boats in sunkissed mist- kya maza hai yaara!!!
Kabhi apna wahan ghar hoga. Mukunda Mukunda Krishna Varanda Varanda