The Old Photograph

Cleaning my drawer sometime back I chanced upon a colored photograph of my departmental colleagues from the time I had just cleared my post-graduation in orthopedics.  Below the photograph was a type written note gummed to the cardboard mount of the photograph, bearing the names of the people in the photograph in all the rows, left to right, sitting and standing. What a neat method, I had thought to myself, for making sure whoever sees the photograph knows who is who.

That was face tagging as we know it now, and it was before digital photography came to help us mark people for posterity. Well I was happy for this photograph and the memories of the experiences it conjured for me.

By coincidence, the next day, a cousin sent me by email a scanned copy of an old group photograph, a black and white, with the identifying note below the photograph missing.

In a Manner of Speaking.

If you get the inflection of an "alright" right then you can tell whether the NRI speaking to you is a product of a Gujarati family from Idi Amin's Kenya or she is an immigrant with roots in Saurashtra. What one speaks shows where one comes from. However some chirps are more ominous as can be seen from the following -harmless-in-after-thought- communication. But at the time it transpired, it shocked me.

Doc Get Me Some Sleep!

One of the principal reasons a person goes to a doctor is that the ailment he is suffering from does not permit good sleep. Such a patient asked me one day, " Doc what is that I can do during the day so that I can sleep well at night?" I appreciated the fact that he hadn't asked for a sleeping pill. Also, the question struck me as being at once practical as well as profound.

Coincidentally, the next day I received an email from WebMD with a link to a slide show on how to sleep well. It is here.

However the question kept on reverberating in my mind and I thought that there has to be something even more to getting good sleep. I started with some hands on research and found that some measures indeed helped getting better sleep.

A unique and yet paradoxical finding was that there is some evidence that altruism (helping someone without expecting anything in return) helps in getting good sleep. On one hand the understanding is that you help without expecting anything and yet here you are expecting peace of mind and good sleep! Putting it another way, I thought wouldn't an altruistic act a day be a good thing irrespective of its benefit to the doer?

Another interesting finding was reading the scriptures in the original script (alright, with the translation thrown in as well) as the last thing during the day. Try it and you may find that there is no better sedative.

It is said that Dr S. Radhakrishnan, the second president of India, during his tenure as India's ambassador to the erstwhile USSR, walked out politely from a state function citing his routine of retiring to bed at 10 pm daily.
Maintaining a regular schedule turns out to be important- yes that important!

Then there are foods that can help or harm your sleep just as there are jobs that can wreck your sleep.These links are worth a look.

Perhaps, just as important as these factors happen to be for a good sleep there is also the even more important factor of what you happen to have done during the day that affects your conscience. If your heart is heavy as you hit the bed, it is unlikely that you would sleep well. This does not require any double blind studies, only blind practice.

The Fat Farce.

Jealousy, I had always been confident, was other peoples' domain. It would have remained that way but for a chance meeting between a friend and myself.

To our care givers- Doctors' real colleagues

As a wannabe doctor, a junior medical student dreams of operating upon a patient or ordering a test or writing a prescription for his future patients. It is with great aspirations that one fantasizes about these things, including but not limited to passing orders to those reporting to oneself when one thinks of being in the doctor's position. At that stage there is a vicarious pride in visualizing such a situation. For such a medical student, the sense of anticipating great personal power is there but the same is not true of the irrefutable accompanying responsibility at that nascent stage in one's career.

Well, most doctors-in-training ultimately do mature and there are very few conceited doctors that are still evident beyond a certain age. Yet, even at this mature stage, doctors are rarely, if ever, involved in administering continuous care to patients under their supervision. Doctors hardly have to administer injections or nurse their patients. Rightfully there is a support staff to do these duties. Even if once in a while doctors have to take up the role of their support staff, it is momentary and perhaps gratifying. It is considered as a feather of virtuous humility in the doctor's virtual cap.

Any parent who has nursed a sick child through the night will testify that such care giving is extremely draining. Now try to visualize that situation happening over and over again during every day you report for duty. Just how awfully exhausting could it be for the minds and bodies of the support staff. If you have ever had such a demanding situation at home, you will gladly exchange any other professional role in the hierarchy of health care for that of an immediate care giver. It is amazing to see nurses, assistants and attendants smile and greet doctors on rounds, often in quick succession, through the day.

Two groups of people should spare a kind thought for the support staff involved in any long term care facility: the doctors and the relations of the infirm. For the patient, meaningful life is restored as a result of the daily caring and loving ministrations of the support staff and not just the doctor's wise orders. Next time a nurse smiles at you, smile back to her for this reason alone. It will be a different smile, both, yours and hers!

Choosing a Residency program

Recently a senior medical student requested me to help with the decision making about the specialty to choose for post graduate training (residency). There are some people who are lucky enough to face this dilemma while quite a few are forced to make do with whatever is available after others have left with the meat.

Because there are many people in this predicament, I thought it appropriate to post this email, suitably modified for public reading, without in any way diluting the contents.This is what I had to say:

Why Do I remember Eid at Every Diwali?

The trip was progressing better than our expectations. We felt that our travel agent had planned for and arranged a nice itinerary. Though there was a last minute change in our dates, he had gone to the extent of offering us a customized tour without any extra charge at all. We felt grateful to him at every step of the trip. We felt that our trip was worth the full advance we had paid him.

The second leg of the trip was Singapore. We had to reach there by a train from Kuala Lumpur. All of us felt that Indian trains, third AC coaches onward, were better than the thing we were booked on. There was a major difference, however; smartly dressed lady ticket checking officers were doing their job professionally; it was a night train.

We arrived on Singapore railway station at about 9 am and seeing that other tourists were being escorted out by their travel agents'  local representatives, we were expecting someone to approach us with our names written on a placard. Indeed before the others were out of sight, a man in his late thirties approached us with my name on a sheet of paper in his hand.

i-fast

After the company whose name rhymes with maple came up with a series of products beginning with the first person singular pronoun things have gotten complicated: when last heard of, a contraceptive pill manufacturing company was considering a name-change for one of its hot selling troubleshooters because the small little i in their product’s name rendered itself to being perceived as an offering from the gadget behemoth. So readers are forewarned that this piece has nothing to do with gadgets or speed or abstinence from food. And, it has nothing to do with the first person singular either, though it has a lot to do with the Self.

Ten Seconds Flat

Can anything that's fun and interesting happen in ten seconds?
Well I am referring to quirky everyday events that add some flavour to a day in just about ten seconds.

The best place that I know of to get your fill of events of this import imprinted on your mind is the road in a busy city. Here's a small selection of  what has amused me.

Quick Bite:
A portly gentleman whom I have known for sometime now has recently upgraded from a two wheeler to a car with shaded windows. He has consulted me in the past for painful knees and I have a distinct remembrance of advising him to shed some weight. Well, it seems he leaves for work at (presumably) the same time that I go (occassionally) for my morning walk. The purpose of shaded windows is to prevent peering eyes to see what is going on inside. But that still leaves the front glass- the wind screen- for curious eyes to have their share of peeks. The other day I chanced upon this man deftly handling the steering wheel with one hand while helping himself to a generous portion of what seemed like a pizza from something in the seat next to him. At that very instant our eyes met for a fraction of a second and then he whizzed past. Heaven only knows whether he swallowed the pizza or whether he choked on it! Needless to say, I enjoyed it- the scene!
Total time: much less than 10 seconds.


Pleasure with Duty:
In my city there is a squad of traffic assistants, boys and girls just past their teens, who assist the police in directing the traffic at important junctions. They have no legal authority but most times their signals to stop and proceed are respected by the populace. On this particular day, as I approached a turn-around I noticed two of these boys manning the circle, one each on two successive exits of the circle. There was no noticeable traffic to monitor then.
At about the same time as my car approached the turn-around another vehicle, driven by a very beautiful young lady, approached the circle from my right. I had expected to be stopped for the girl had reached the circle a split second earlier than I had. To my surprise, the traffic assistants waved her to a stop, and bade me to proceed, with a naughty smile. My curiosity was piqued. In the rear view mirror I saw that the two boys were taking their time to wave the beauty to proceed further along the exit. It must have been a good five seconds before they signaled her to go. I was too further away on the road to see the lady's reaction in my mirror, but from what little I know of these, it must have been a vigorous shaking of her head from side to side.
Total time: A generous 10 seconds.


How's he doing?
There are some small but busy and yet unmanned traffic spots where nature- mother and human- slug it out for the best way forward.
At such intersections vehicles jumble up at the junction from all sides leaving no room for anyone to go anywhere. In this heady cacophony some kind souls backtrack or shift a little to make room for vehicles nudging in from all other sides and soon the spot is cleared of the madness.
I found myself in the middle of such a mess one fine evening. With the intention of guiding vehicles on both sides of my car, I opened the car's windows. Just as I was done with firm suggestions to my fellow drivers, a familiar face peered in on me. The face smiled and without meaning to, I did the same. The fellow asked, "Hello Doc, how are you? Remember my father?" In that situation, perhaps even the most devout would be forgiven if they could not possibly remember the Father, leave alone someone's big man. I was hard pressed to go further along the junction on one hand and on the other, I had to blurt out, "Oh, Hi, how's he doing?"
"He came out fine from the hospital" the guy responded.
Someone honked a nasty one from behind this fellow and he mumbled, "Excuse me, Doc, See you later."
Excused indeed, I said to myself-of myself.
Any corporate big boss would have been proud of the time-management displayed by my friend.
Total Time I was tried for: ten seconds that seemed like a decade.

Undue Consultations

One day just as a man walked out of my office, a general practitioner walked in,coming to consult me for her daughter's issues. She noted the man who had just walked out, and asked me in a hushed tone as to how I was connected to that man. Making an exception to the professional confidentiality clause, I told her that he was the son of one of my patients. She sighed and narrated an experience she had with this man, a young autorickshaw driver. A few months prior to this visit of hers to my office, that young man, she said, had started dropping by in her clinic every few days complaining of a marriage not consummated. Maintaining her professional courtesy this colleague had heard the man the first time but had firmly asked that he bring along his wife thereafter. Seeing that he had not followed her instructions she was forced to be rude to him and warned him of the possibility of reporting him to the police for indecent behaviour. At this point I told this colleague that as far as I knew of that man, he was unmarried. I could see disgust on her face for that man as she left my office.

Three Men and a Mannat

Many years back I had set up my practice as an orthopedic surgeon in a small town. Looking out for staff, I hired a young man for the night duty.His name was Razzak. He was recommended by the local government official I had come to have some acquaintance with. He had clearly mentioned his religion to me and asked whether that was alright for me. I brushed it aside and asked him to join my team, asking him to feel as comfortable as he would in any other place outside his home.

Surprisingly, the very next day one of the town's leading merchants sent his staff to me and conveyed that I was to remove "that man" from my staff right away, if I wanted to practice. My instantaneous response was that I would never remove Razzak on my own, except if he committed an offensive act against a patient or another human being. The incident simmered away after a while. But, it continued to surprise me that I defended Razzak in a firm manner. He was not in any way dear to me. So, what was? The answer remained elusive until I could correlate the following incident from my infancy; it was told to me during my years of  growing up, long after it transpired.

As an infant, I had remained unwell for an extended period of time, long enough to lose a good deal of precious baby-weight. After some concerted efforts from many people that went on for a few months, including my parents, grandparents and others, I finally came on to the road to health, much to the relief all my family members.

Soon after my health was no longer a concern, three young unmarried men staying in the neighborhood came up to our door one day and asked permission from my parents to take me to a Dargah (a muslim shrine) to offer namaz as a thanksgiving in return for the health bestowed upon me. They said that they had a mannat ( a solemn resolve) that should I become well again, they would take me to the Dargah they had faith in, to offer prayers and thanks at the shrine of a holy man buried there.

By the grace of God I have remained away from serious or life threatening illnesses ever since. While I am certainly grateful for the good health I continue to enjoy, I am especially thankful to those (then) young men. They demonstrated by their deeds that humanity is beyond religion and beliefs. They also sowed in me seeds of something very valuable. I now know that those young men could have least cared what happened to a hindu infant; but they cared. Not only that, they cared enough to see that, in their belief-system, a spell of disabling  ill-health would not afflict me again, and for that they went out of their way, rising up against the fear of potential ridicule and rejection from people they did not know (my parents).

For the better thereafter, I haven't been able to discriminate against a person because of his religion.  That's not to say that I don't have likes and dislikes about people I interact with, but just that a religion different from mine is no deterrent to a decent relationship. For this Value, I shall forever be grateful to those three men and their mannat.

What’s Not in A Name?

How do you like the name Schiklgruber?

You may not care to have an opinon on that but the person named as that did not like it one bit and changed his name and perhaps thereby changed quite a significant part of human history, dubiously.

Not On Oath!

This is literally, a tale of two cities with a twist. More correctly, these are two tales from two cities with two twists. And, this is not fiction. Let’s find out.

A family, known to us, shifted to another city as the elder son joined his new job there. The senior, the boy's father, had just retired and was looking forward to some relaxed time with his wife and family in the new city.

The Business of Pet Therapy.

Mahesh* is a 49 year old former site foreman in a road construction company. He is well built and handsome. He came to the clinic as a part of his annual check up. From his looks he didn't need any.

However his past medical history was a shocker. One harsh summer afternoon, seven years back, he was found comatose at a  road construction site by his colleagues.

Dr. Machine, M.D.

The other day I met with a professor who teaches computer chip design amongst other things. He is from a generation who has also lived comfortably in an age without the internet and mobile phones.

The professor was a multi-disciplinary person and his interests were thus wide ranging. He wanted to inquire about how doctors take to technology in their professional lives. 

He asked me if I was comfortable using more and more technology in my practice, and if so how far I would go with it.

Why is the patient a patient?

The answer to the question in the title of this post is almost always very evident as soon as one sees the patient. He or she is sick and needs help to cope with the sickness or illness and get on with life.

There could be other reasons as well: fear of suffering, seeking relief in a manner better than what is being offered now (second opinion), seeking reassurance and so on. Almost always there is a child like need that has to be addressed by the doctor when seeing a patient.

In being a patient, it is assumed by the doctor that the patient is not there to increase her suffering. It is also inconceivable that the patient has any malicious intent in presenting to the doctor.

An exception to such a generalization is any work-related health issue: here there is some psychological game playing going on,sometimes subconsciously. I have rarely seen any malicious intent in a domestic setting.

Sometime back a lady in her mid forties started consulting me

Lovely Ambitions!

Ask any child in the preschool age what he or she wants to become when grown up, and the usual answer is to be like one of the parents. The parent is the child’s ideal. It is a magical world for the child to be like one’s parent. But then, during school age the ambitions change, sometimes twice a day.

As doctors, to get the child’s confidence and cooperation for the examination, we often engage the child in such talks, and before the child knows it the quick examination is done and we can then get on with further management of the child’s illness.

On the other hand, these questions can be quite a needle prick for the parents, because once the child is relaxed, heaven only knows what he or she will blurt out. So you are never quite sure which way the question, “What do you want to be when you grow up?”,  will lead.

Recently a family brought along their three year old daughter

Sample Coincidence.

Medical Representatives (M.R.s) and Doctors share a relationship that evolves over a period of time. Most times it is a professional relationship with all its protocols intact. When a M.R. visits a doctor, he does so to promote his company’s products. As a part of this process he is asked to leave behind him some samples, which are a reminder of his products. It is supposed to help the doctor remember the brand when prescribing a medicine.

A newly recruited and fresh M.R. is not expected to leave behind much, and he does not generally stand a chance in most doctors’ chambers till he has put in quite some efforts in convincing doctors over and over again of the value of his products. Thus, to perform (make the sales figures rise) he has to resort to gimmicks

Symbols are not just symbolic.

Symbols stir up something deep within you. Gestures are also symbols. The 'Namaste' gesture, or the Thumbs-up and the Correct mark in a student’s class work book are all powerful symbols that evoke emotional responses without there being much choice on the part of those coming to experience or receive the symbolic gesture .

A Deceptive Rip Off

Sometimes we fail to realize that we have been conned; but when we do, after the initial dismay, we are on guard not to be fooled again. But what if we stubbornly refuse to do the needful and willfully get fooled again and again?