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.