Res Ipsa Loquitur

Some real events methinx are stranger than a Marquez's fantabulous imaginativeness.But just as shit happens, things happen.As you can see.


Stranger than a village becoming collectively amnesic? Yeah, maybe....maybe not.But anyways...( ok Gabriel you re King)

Whoever would have thought:
- That I leave for Vellore in the night of yesterday and am back home today morning. Did I cut across a time vector and travel like Marty McFly in a time machine?
Nein, I just lazed my legs wherever I could get some space in a Warsaw ghetto like Pf No 1 on Pune Railway Station trying to catch some 39 winks, my already syringobulbic neck contorted into a Cartman like immobile stiff painful wry thing with only lateral eye movements possible, mumbling Cartman like filthy f**kin foul fluff at the Indian Railways, the rain, the irritating f**kin flies, the overpriced Comesum menu and at anything in general, stayin awake on syrupy tea and soggy vadas, walking back home at 5 am after fighting and again abusing the gold digger rickshaw wallahs who want to take you for a ride to nowhere else but your own home; watchin BJ at 5am- hell I have seen BJ at 2 am , 3 am, 4 am.....not 5 am- thats zzzzz time.


- That I would pick the porn DVD that some hopeless, helpless, worthless male species left at the Railnet Cybercafe- and even try playing it on my desktop without bothering to run a virus scan. Gosh....the things boredom does to an otherwise sane mind.

Anyways thats done. Am stil waiting for my train to arrive and for me to say arrivederci to Pune.Everywhere I look I see people. Until now I was under the delusion that there are too many vehicles in Pune. Now I believe there are too many people that drive those vehicles.My mind goes back to sitting at South Station in Boston for 4 hours on an October night chatting about accents with an Iranian at an Au Bon Pain eatery and guzzling dunkin a donut in a coffee for the first time.Was so much more peaceful.But then in being crowded this is at least safer than a NY/Philly subway station! Small joys, kiljoy!

Other stranger things: How one hour of rain can cause 12 hour delays,Kaka quarreling with me and me having the temerity to give him a piece of my mind,Kakrani's ego and impulsive impishness,his pathetic attempt to kick me where it hurts;where all the money we pay for Dean's signatures go to,...and hell...hold...I am revealing too much methinx. Mea culpa, maaf karo.The Boss is always right! Right?

For memory is fickle!

Let me jot down what DRK told me. I respect the man for what he taught us despite never teaching us in the literal sense of the word.I value my postings in his unit as the best I have ever had ...with DRK, Andy, Salil, Maithili ( and even Sabsi- she taught me the most important lesson in medicine, perhaps unknowingly to herself)- I owe these guys a lot.I feel guilty for not having been in touch with Maithili after all the help she provided me after the tough time I had in my second year what with my grandma's illness and death and my disillusionment with medicine.I feel even more guilty for having never having expressed my thankfulness to her.

Anyways:
1) Look at doing something that would benefit me in the long run and not run of the mill stuff.
2) For a third person to know how good I am, what I have in my name- namely publications count.No one will take notice of you unless you show them the wares.
3) Present what you got.It might not be spectacular , but show it to the people around you, if not the entire medical fraternity. Present my thesis at a MAPICON or something like that.
4) It dosent take time, it just takes an idea.'Lack of time' is something we have invented to save our skins.
5) Money is important.
6) Being a small fish in a big RCT ain't so good as getting a decent publication from anywhere else- be it BJ or anywhere.
7) You are 28- don't waste time.

Also :
a) A certain Avinash Patwardhan- UMass /Wisconsin....confirm
b) Dr Gandola , endocrine, Buffalo.

Dentimental

I have been reading Denty's posts over the last week.
I was reviewing my own postings.I realised what an oblique way we really react to what circumstance deals us.Denty dried up....I started this blog giri( I really don't know the technical details of it all still, how no one screams COPYright when you copy and paste from somewhere else; thought RSS was Rashtriya Self Server and wondered how the hell Google gets money out of it if there arent no ads?!)

I started off when I was wasting time in the US...searching for obships, waiting for interview calls, accumulating rejects - my grotesque ego trying to seal off puncture after painful puncture.I had a rethought of whether I really wanted to do this.And I felt that if I try and escape not thinking about what I wanted to do I would never get to what I could be.
Juggie started his blog just then. And then I thought....if Jaggu can find time from his schedule and put finger to keyboard then I can do so too.I don't even remember what I started with.But I felt good.Just random thought, some introspection.I saw this as an action ...if you were to argue that actions speak more than words.

Actions are driven by thought.Period.

Dont trust me: here's some karma cola-
1)keep doing without expecting fruit says the Geeta.

2) Again we are taught that as we sow so shall we reap.

Aint there a contradiction, a counter intuitive logic here?Karo karo karo- kya karo- arre goli maro. Aur galat karo to maro, sahi karo to hero?


Everything we do in life is for an incentive.

In its most primitive form this incentive might be satisfying the id.I do something because I FEEL GOOD about it.Thats Freudian logic....sex and violence.Basic stuff we crave for, live off.

Then we bent over our spines, put fist to chin...and began an activity that Rodin sculpted into form so beautifully-THINKING.Super ego/ prefrontal lobe ityadi concept bana.We realised that we have to satisfy our 'conscience' or 'ego ideal' to feel good. We aspire for something, or are afraid of something.I felt good that I was using empty time to think on things I would have never thought of otherwise. And if I dont think of them, I shall never feel the need to even consider their existence.So much in life not experienced.

I post as meliorix- to improve. To refine thought process.I think that is the ultimate motive behind life, job, career whatever you look at as an end result; your quail and manna, your Forrest Gumpian time on the bench where you chat with some nobody about the success of Bubba fishing company or your angst ridden hippie girl you loved so much or your run across the United States of Life while 'shit happened' all around.Your successes, failures are all about wht you were after those successes and failures.
I might not be successful...but can I give it rational thought to a situation and be richer from the experience?If I can...then hell....I am successful.I do not pretend to be fashionably opinionated.I leave that to more visible people.I am just my small personal self.And this is my own personal selfish lego . I shall build upon.

Mumbai tomorrow, Vellore later in the week.Might be some time before I can post again.
Fedex shall emulate Borg methinx.Repeat finals as last year. Five sets this time.Vamos Rafa. Go Fedex.

Flick on my Hay

Amma( my mother) just passed 58 years. If it were as per old rules she would have 'retired' from service at this age!

Appa ( dad) is 66. He falls into the 'elderly' category now,in medical parlance at least!!

I am almost half way to where amma is!!!

I have crossed the stages of 'hope', 'will', 'purpose','competence' and 'fidelity' as Erik Erikson chooses to analyse and stage human psychosocial development into.( Or have I?)

The only stages that I have to cross to reach where amma is are: LOVE( intimacy vs isolation) and CARING ( generativity vs stagnation)

Or so Erikson says.

Astra Castra Numen Lumen

Pee for paregoric

It rained yesterday
And the miseries of first failure, an unsure liaison,
the subservience of entry 9 am, exit 5 pm
Were all washed away!!

A tear...for Priyanka

Priyanka might not mean anything to anybody. She might not mean much to me too if and when I am seeing more patients, if and when I am more busy. She might be among the many we see, manage, talk to briefly, touch and get touched by, chat nonsense with , palpate spleens and lymph nodes of...say how one is rubbery and the other hard,poke needles into, draw blood from, administer a whole load of tablets to and follow just up to they are gone. Away from our lives. We away from theirs.And they might remember us more than we might remember them.
But Priyanka died. She died unseen in a crowded medicine ward at 2 am..when all were asleep. She died an orphan..all of 14 years.. of HIV/AIDS...or that is what we suppose. No one dies of HIV really. They die of complications associated with HIV. We could never figure out how she died. When my junior resident got a call at 2 am, she was motionless, no pulse, no BP, no heart sounds. He dutifully entered these in his death notes and went back to his room to catch some sleep. The only one who shed a tear then was her grandmother who doted on her grandchild. She had shown us photos of Priyanka when she was prettier and healthier...a mere 6 months back. Dressed in pressed and pretty navy blue school uniform with hair oiled and smile on her face. " Kashi hoti.....kashi jhaali!" ..she chokingly exclaimed to us as she pointed to a wiry girl with scraggly hair with herpetic lesions over forehead, cheeks and neck. I could imagine her making a trip from her village with luggage bundled into a potli, a sick Priyanka to console, traveling a few hundred kilometers to make her grandchild better.In hope she would be able to attend school again, healthy and cured.

Final diagnosis at death: disseminated herpes simplex infection with bullous impetigo,abdominal tuberculosis,AIDS.Immediate cause of death: we don't know.

I first got a call from skin dept on my Sunday emergency at 10 PM about a patient with disseminated herpes with "poor GC" for transfer to medical wards. My resident was reluctant to take her. " Sir, woh skin ke patients bahut gande lesions lekar aate hain....mat lo transfer", he said. I was in two minds really when I went to see the patient. But then she didn't have extensive skin lesions. She was looking sick when I saw her, lymph nodes everywhere, abdomen distended, coughing.I decided to take her to our side.When I learnt her story...orphaned with only a grandmother to care for her, and really not 'unsalvageable' I wanted to send her home healthy.She wasn't poor GC for gossakes.And everything was goin well. She wanted to go to school. Her favorite subject was 'ingraji'...so we talked to her in ingraji....and she would smile knowing she wasnt game to this type of ingraji.

So when my CR told me over lunch that " woh to gayi"...I felt a paw dig into my throat, words escaped me and I could just whisper nothings ...for a moment my mind was blank. How? When? Why? I could probably some time get answers to the first two interrogatives. But Why? I had no answers to that.Cmon...what was I arguing against. She had pulled on for 14 years...thats good for childhood HIV/AIDS. Statistical true lies stared against my hope to get her going.She had to die. Sometime now or later. That was fated for her....not her decision to make but something that her parents had slapped her with when she was born.Given her a death sentence at birth.
I thought there might be hundreds of Priyankas that I might not see, never hear who might even not come to a Sassoon and die uncared for febrile and consumed by pestilence and cytokines.

We are taught that a physician needs to be affectively neutral. He cant be sentimental and needs an emotional distance from the sorrows and mania of his/her patients.That will not cloud his judgment, his rational/analytical thought and diagnostication.But what does that make us? Wooden emperors with scepters to mete and dole diagnoses gloomy or good, mechanistic, stoic,comforting, omnipotent almost. But are we so? Who made us so from normal carbon based homosapiens that look and think the same as those we treat? Should doctors not cry? They do.So says a book compiled by a sensitive thinking resident from AIIMS.But who proclaims they shouldnt?
Why shouldnt a Dr Bawaskar shed a tear when he sees a mother die while feeding her newborn child who innocently suckles at her breast while she gasps for breath from left ventricular failure...as the sun dawns , and dies despite the doctor toiling the night trying to salvage her with the limited resources he has at hand. What could be more poignant!!

There are so many instances where lack of time and more pressing problems have stopped us from getting more attached to our patients.There are many more stories that will ever haunt me.I can remember three more. I do want to chronicle that...so that later I may feel what I felt then...so that I dont become that affectively neutral 'ideal physician'.I admit one will become emotionally drained if one sheds a tear for all the sad stories that people who sit and cry outside a hospital MICU will have to tell you.But should that deter one from feeling closer to the ones we care for?
But till then we move on, there are more people who will come sick and dying.There will be more stories of how people sold their houses for chemo,Dickensian stories of how daily wage earners lifted loads in the daytime and brought all their wages and gave them to you in the evening to buy that darned acyclovir, ate vada pav afternoon, evening and night because 50 rupees was all they had,travelled ticketless and were arrested and policemen played good samaritan bringing them to the hospital, died waiting for anaesthetic fitness, camped outside hospitals after discharge because they couldn't travel home and come back for the scheduled DSA appointment a week later,begged at a helpless resident to do what they could to save their kin, watched husbands die a couple of beds away, admitted with the same illness...so many more.



The shortest verse in the Bible is : " Jesus wept"

Sivaji - ad nauseum

So sayeth Rajini:
--"En vazhi – thani vazhi."
"My way is a unique way."

Every one's way is unique aint it.If only we realise that. unfortunately as I have commented in an earlier post:" what the eyes do not see, the mind does not perceive"
There are only so many things we can imagine. We cannot imagine what 5th dimensions might be. It took us so much time to understand 4 dimensions...and that time is a dimension. It took us so much imagination to imagine molecular motion, the disco of atoms and parabolic vector.It took us so much time to understand that there is a different way to understand.Non conformity is shunned.Clusters happen.Trends get established. Newspapers splash on what is in and what is out.IT becomes hot, then biotech. The IT again.Septran goes out,Teicoplanin and Daptomycin make way to Septran again when we have exhausted our resources.

So where is this thani vazhi.It a imagination fuelled Dorothy's yellow brick road to Emerald city.Its about people like Paul Farmer, all the guys who populate Po Bronson's book that I so liked because it was so non judgemental.You may be right.You may be be a classic case of ignoratio elenchi.But you dared to take the thani vazhi.
Again what is right or wrong is a relative term. It might be right or wrong for someone. But for oneself...to ask oneself...." did I do right?" is a hard task. And all answers have to be to self.One cant judge oneself based on what others tell him/her what they are. If one can ask oneself what one is....thats a huge battle won.



"Andavan solran. Arunachalam seiran."
God says Arunachalam does.

Thats a way of shirking responsibilty. That God is responsible for everything we do or dont do.I used to read Erich Von Daniken's books on what we call God with great interest. About how Gods might have been androids...or "jadoo"...which our ancestors witnessed. A lot of that was bunkum...like the books which questioned the existence of the HIV virus or Neil Armstrong's landing on the moon as being false.But no one has seen God. Or no one who has witnessed God has told us what the form, characteristics of God are. We have given Him forms...Corcovado, krishna, ice lingam, Khandoba and so on. We have invested faith of the 6 billion that populate this earth....so that when we have nothing to fall back on ...we assume God is there ...he will help. We refuse to question Him....because we fear His wrath. We have thus been policed by this faith of ours. It has civilised us, created some hatred, given us hope, again created conformity.It has straightened vectors,made clusters.

But then ...if your path is a thani vazhi.....why do you listen to Andavan?

Where is the music

Wonder sometimes- and feel as to why I wonder just sometimes- where do the violin strings playing tequila mockingbird snap off when I am at a mundane brainless moment and want to push a patient away because I feel hungry and its lunch time, when I see a fly infested vagabond lying to nature's mercy at the gates of Sassoon and wonder when and howhe will die.
Wither the purity ?No it aint purity...its just plain sanity.Not giving a person his honor in illness, when he is dependent on another person who is all he can trust at that time is insane.
Why is getting into a Ruby Hall Clinic and a plush Renault more a priority than putting Harrison into common sense practical implementation. Why isn't an Ipod playing songbird in blithe bass tones when I have to say that "if he isnt getting an MR let him f**k off...I cant treat him."

I have learnt the formulae and algorithms...I need to fit every dysfunctional human body I see into a heuristic pattern I know to recognize and remedy...if it dosent fit, I feel uncomfortable. My discomfort is channeled into venting my frustration onto patient, relative, hospital, staff nurses, juniors.Thats noise break, thats disharmony.Adaptive learning is something we never want to venture into. Because everything has to be standardised, dovetailed to protocol- the issues are legal many times..but also to ensure conformity in data,standard of care. But again in an attempt to homogenise method of care, the individual patient is lost in the numbers.A note is lost in the harsh background noise of a relentless drum.
We have our lives.True. We have our aspirations.Also fair. But we also have our moments of inspiration. Pity these moments flee us the moment the Ipod is off our ears and the harsh screech of the ward sister wakes us out of our slumber...there are lines to be put and blood to be drawn, a miserable JR to admonish,a prissy Unit head to please, a girlfriend to humor...what a frickin life!!

A wooden flute sends melodious notes wafting through the squalor of the overcrowded wards...it harmonises dissonant emotions -the helplessness of the ill, the frustration of the resident, the passivity of the doctor, the angst of the baba staff,the apathetic- abulic punctiliousness of the nurses and gives new cognate sense to the whole process of care giving as it were.

Wither the flautist!!?!!
Wither the exclamation ....are we to endure with question marks and commas and full stops?

To stretch a boner:
1)"When you breathe in : you INSPIRE, when you dont: you EXPIRE".
2)And to stretch the analogy:
" Life is not the number of breaths you take but the moments that take your breath away"

So stretch, take a deep breath, imagine nights in white satin playing into your ears and INSPIRE .....

Pisstilence, filth and coronaries, 43 degC

The best way to waste time...listen to a bhojpuri learned man regale his men of lesser achievement with tales of the world....they have a fatalistic theory to everything, a karmic sentimentalism, filthy tobacco stained mouths that never tire of emitting absurd but entertaining guttural sounds of abuse and lust,an opinion even if knowledge is limited and a fervent desire to preach, to influence and change minds of the 'gandu bacchas'..to make them better sons of the world.
" Bambai naseebon wala shahar hai"......(sahi hai bade babu...sabki khul jati hai wahan jane se)

"Mayawati to pradhan mantri ki kursi ki shaan hogi"....( arre Laloo chodega tab to)
" South ke logon ne chawal khake dimaag badhaya, hamara to chana khake pichwaada badha bas"..........( Some nod, some dont)

" Ab to aise hi hoga, jisko rejarveshan hoga usiko seat milegi,chahe train ho ya kaam ya sarkaar".........( sahi hai babu......abhai Gujaron ka kaa kasoor...unko bhi milna chahiye...sabko milna chahiye)


Luckynow was tiring, uncomfortably HOT ( I mean heat, not the trial...that answer I got right)and in between providing amusing opportunities at TP as detailed above I had to encounter the uncleanliness of the people that populate Amitabh Bacchan's land...they so mess the area they sit on while traveling...if a beggar boy cleans up and asks for alms for his service they will quibble" humne thodi poocha tumko karneko";
Kids piss out of the train window to avoid the inconvenience of going to the toilet..fathers tell them to make contact with the window railings and direct the stream downwards!!........
If Ur train does not stop at the station U want to get down at....STOP TRAIN PULL CHAIN...its so easy....make Ur escape before the TC comes searching. Even cops do it. I was witness to an amusing scene of a railway cop chasing a policeman who had pulled the chain to alight at a small station where the train did not stop.

Havent quite drunk so much water so frequently and still felt so dehydrated. Maybe its the water."Pyaas bujhi nahi, lagi......paani bujhaye nahi pyaas... no bakwaas.Water tastes like a 9V battery applied to ur tongue.Sweat pours out of every pore, the dust of the ruinous roads that every truck, tempo, cycle rickshaw suffuses the air with ,sticks like a coat of Sultani mitti; and the Vaishno bhojan U ate with Ur grimy sweaty hands seems to float and tickle the fundus of the stomach and come periodically as oily belches that suffuse the air around Ur nasi with smells of the grime, paneer tadka, 9V battery water and the sublimated vaporous talk of the bade babu.

SGPGI is a mirage in the desert. Its Central Govt splurging, Gandhi family's appeasement to the peoples of the Raibarreily.Its full to airconditioned..even the loos!!It is the ultimate possible aberration in the most populous bimaar state of India....no generalists, only specialists; no direct admissions, just referals. No free treatment, all paid for...an appointment system in this land of hodgepodge disorganisation.I didnt get a chance to see and meet everyone....but twas impressive ...better than the places I have worked at till now. Of course, bricks and mortar dont make a place what it is. It is the men who run the place which constitute IT. I havent seen any of them/that. "Lets see"


Zor ki baarish dekha, Makes me wonder,
Is this what they call, Taste the thunder?