Bit of thanks giving.
For having kept my senses as fresh as in the year that went by,
That I continue to appreciate the twitter of the warbler and the song of the bulbul,
The scent of the jasmine and the beauty of the rose,
The ability to wonder at the strength of the twig that holds the 25kg jackfruit hanging free,
The divine dance of the stars on the moonlit sky,
The ability to analyze, collate and come to a conclusion and not entirely rely on serendipity,
To my small family who have not taken me amiss for finding time to pursue my interests and not for them,
To my small circle of friends and a larger circle of patients who have kept me going for another year,
And to all of you [more than 4700] at the last count, who have read and are reading my blog and thus keeping an old man’s spirits high!
Now to wish all of you
A year that will bring more joy and less sorrow,
More fulfilment and less frustration,
More peace and less disturbance,
More contentment and less desire,
More pleasure to give than to receive,
And find meaning in the wonderful world and the cosmic universe that you and I are part of.
Thursday, December 25, 2008
Sunday, December 21, 2008
Craving for recognition
Someone held a spoon with a lemon on with his teeth for 47hrs and 55 seconds and has entered the Guiney’s book of records, said the daily. The mad feller went through the ordeal just get into some record book by doing this weird act is a fact that doesn’t surprise me because, I see several such mad acts committed by people around me. This craving is near total amongst us humans and is probably inherent in our psyche. If by own merit one cannot achieve this recognition then one will buy it, seems to the modern Indian credo. Some examples.
Kishendas Banwarilal is my patient and friend of many years. Banwari, as he is popularly called is a very successful business man. He belongs to a community who are well known for their business acumen and many have dominated the commercial scene of the country and one can even see them in the world scene [Laxmi Mittal for one]. On day Banwari came to my clinic with his daughter’s wedding invitation in hand. He said after the preliminaries, that I must attend the wedding which was taking place in far away Jaipur. He extended the invitation to my wife also. Seeing the obvious reluctance on my face he said, ‘doctor, you don’t worry, I will take care of the money that you are going to lose by not practicing for three days. I will also buy both of you business class tickets and fly you back’. He was serious when he said this. I had to decline the invitation despite the incentives he offered.
Banwari met with me after the gala wedding. I asked him how much he spent on the wedding. He said,’ Rs 5,000,000 [5 crores]’. The floral decorations alone cost him 500,000 [5 lakhs]! Even Rajasthan government ministers attended the wedding, he said proudly. When I said what a colossal waste of money, he replied that, unless he did that how would his community know he has succeeded and how else would his daughter get the respect from her husband’s family?
‘So, when your son gets married you will expect the prospective girl’s parents to spend an equal amount’, I asked. ‘No, more, because the cost will be more as one has to keep pace with inflation!
Banwari is not a bad man. On the contrary he is a very good fun loving helpful person, but the illness of getting the recognition from his community drove him to this irrational act [for me, that is]
C.S. Reddy is a small time contractor and politician in this locality. With some difficulty he became the member of a local club. Every year the club holds elections and elects a committee to manage the affairs of the club. The elected member is given various responsibilities. One gets to run the kitchen and another sports section and yet another bar and the like. These members in turn form what are called as subcommittees consisting of their cronies to help them. C.S.Reddy’s friend who got elected got the bar section of the club to run. C.S worked overtime to influence his friend to get him on the subcommittee. When once he was on the subcommittee he went round telling everyone he knew, about this tremendous achievement. I was one of the recipients of this information and my congratulations were warmly received. A month later I got an ornate invitation card kept inside an equally ornate envelope. This was the invitation for the marriage of C.S Reddy’s sister’s son. The envelope, in one corner had this legend. With compliments from: Mr. C.S. Reddy, member bar subcommittee, HAL Club! Needless to say I did not know the groom’s nor the bride’s parents. Reddy took it upon himself to invite the two thousand odd members of the club to his niece’s wedding!
I came across a letter head of a gentleman who went one step further. The top of the page had his name and among equally mundane accomplishments was that he was ex member of the city club!
Many years ago, I used to work for the local branch of our national medical association. The president was a well known physician of the city. We had to get some material printed and he recommended that we get it done from the printer who does his jobs. I duly went to meet with this man in his office cum press. When he came to know that I was an emissary from the doctor he was all over me with his enthusiasm and showed me several examples of his work. One of them was our president’s own letter head. The degrees this physician had ran to almost two lines! Of these only two were degrees which needed an examination to pass. All others were awards or ones that were bought for a fee. The degrees and diplomas ran like this. M.B.B.S., M.R.C.P, F.R.C.P., F.I.C.S, M IACS, FIACS, FCCP and the list ran on and on. But what drew my attention was a degree which read F.U.C.K [UK] tucked in between these many citations. Quite intrigued, when I went back, I asked him what is this special degree that he has been awarded and which was the institution in the UK? He was taken aback and wanted to have a look at the letter head in his office. To his horror all of them carried this honorary degree awarded to him by his faithful printer which our worthy doctor had failed to notice. What happened after wards is another matter but for years after I kept teasing him about this special honor received from UK. This craze for the addition of many real or otherwise honours seems once again, an attempt at getting recognition.
But there are some who want to achieve not for fame but for the sake of a purpose. You can place sports persons, adventurers, social workers in this class. They do the job for the pleasure of it and if they also get the recognition so be it. There of course are some who deserve to be recognized but go about doing their job without bothering about recognition [late Dr Achaya, TNA Perumal: see birds and others]
Kishendas Banwarilal is my patient and friend of many years. Banwari, as he is popularly called is a very successful business man. He belongs to a community who are well known for their business acumen and many have dominated the commercial scene of the country and one can even see them in the world scene [Laxmi Mittal for one]. On day Banwari came to my clinic with his daughter’s wedding invitation in hand. He said after the preliminaries, that I must attend the wedding which was taking place in far away Jaipur. He extended the invitation to my wife also. Seeing the obvious reluctance on my face he said, ‘doctor, you don’t worry, I will take care of the money that you are going to lose by not practicing for three days. I will also buy both of you business class tickets and fly you back’. He was serious when he said this. I had to decline the invitation despite the incentives he offered.
Banwari met with me after the gala wedding. I asked him how much he spent on the wedding. He said,’ Rs 5,000,000 [5 crores]’. The floral decorations alone cost him 500,000 [5 lakhs]! Even Rajasthan government ministers attended the wedding, he said proudly. When I said what a colossal waste of money, he replied that, unless he did that how would his community know he has succeeded and how else would his daughter get the respect from her husband’s family?
‘So, when your son gets married you will expect the prospective girl’s parents to spend an equal amount’, I asked. ‘No, more, because the cost will be more as one has to keep pace with inflation!
Banwari is not a bad man. On the contrary he is a very good fun loving helpful person, but the illness of getting the recognition from his community drove him to this irrational act [for me, that is]
C.S. Reddy is a small time contractor and politician in this locality. With some difficulty he became the member of a local club. Every year the club holds elections and elects a committee to manage the affairs of the club. The elected member is given various responsibilities. One gets to run the kitchen and another sports section and yet another bar and the like. These members in turn form what are called as subcommittees consisting of their cronies to help them. C.S.Reddy’s friend who got elected got the bar section of the club to run. C.S worked overtime to influence his friend to get him on the subcommittee. When once he was on the subcommittee he went round telling everyone he knew, about this tremendous achievement. I was one of the recipients of this information and my congratulations were warmly received. A month later I got an ornate invitation card kept inside an equally ornate envelope. This was the invitation for the marriage of C.S Reddy’s sister’s son. The envelope, in one corner had this legend. With compliments from: Mr. C.S. Reddy, member bar subcommittee, HAL Club! Needless to say I did not know the groom’s nor the bride’s parents. Reddy took it upon himself to invite the two thousand odd members of the club to his niece’s wedding!
I came across a letter head of a gentleman who went one step further. The top of the page had his name and among equally mundane accomplishments was that he was ex member of the city club!
Many years ago, I used to work for the local branch of our national medical association. The president was a well known physician of the city. We had to get some material printed and he recommended that we get it done from the printer who does his jobs. I duly went to meet with this man in his office cum press. When he came to know that I was an emissary from the doctor he was all over me with his enthusiasm and showed me several examples of his work. One of them was our president’s own letter head. The degrees this physician had ran to almost two lines! Of these only two were degrees which needed an examination to pass. All others were awards or ones that were bought for a fee. The degrees and diplomas ran like this. M.B.B.S., M.R.C.P, F.R.C.P., F.I.C.S, M IACS, FIACS, FCCP and the list ran on and on. But what drew my attention was a degree which read F.U.C.K [UK] tucked in between these many citations. Quite intrigued, when I went back, I asked him what is this special degree that he has been awarded and which was the institution in the UK? He was taken aback and wanted to have a look at the letter head in his office. To his horror all of them carried this honorary degree awarded to him by his faithful printer which our worthy doctor had failed to notice. What happened after wards is another matter but for years after I kept teasing him about this special honor received from UK. This craze for the addition of many real or otherwise honours seems once again, an attempt at getting recognition.
But there are some who want to achieve not for fame but for the sake of a purpose. You can place sports persons, adventurers, social workers in this class. They do the job for the pleasure of it and if they also get the recognition so be it. There of course are some who deserve to be recognized but go about doing their job without bothering about recognition [late Dr Achaya, TNA Perumal: see birds and others]
Thursday, December 18, 2008
Late Dr.K.T.Achaya
India today, 22nd Dec 08, under the caption currying flavor carried a review of a book called the illustrated foods of India written by Dr.K.T.Achaya. The reviewer, I felt has not done justice to the personality of late Dr Achaya.
Dr.K.T.Achaya was a remarkable person in more ways than one. By training he was a chemical engineer who branched out to become one of the foremost authorities on oilseeds. So much so he published several monographs on how ancient Indians extracted and processed the oil out of oilseeds. He had to consult several books, visit many temples, study pali and Sanskrit and he did most of this after his retirement. He was a serious student of Indian cuisine and made in depth study of how the foods are preserved and prepared in different parts of the country [your food and you, national book trust of India].His A historical dictionary of India [Oxford India paperbacks] is a must read for anyone interested in the origin and migration of many items of food that we take for granted. To give you a few examples. The chili that you are very fond of is not indigenous but brought India probably by the Portuguese from South America. Even the popular potato has the same origins. The story of our food is the fascinating account of various Indian foods and how they came to be cooked the way it is now and the different utensils that were in use to prepare the foods and how these evolved[universities press].His every day Indian foods [national book trust. India] is a storehouse of definition, preparation, processing and storing of popular foods of different parts of the country. So much for his talent as a food technologist, writer and researcher on Indian foods.
Now let me come to some other aspect of Dr Achaya. He was a connoisseur of classical music both Indian and western and had a collection of records which he would lovingly play on his old record player. His knowledge of musicians and their lives would hold me fascinated. He was also a very knowledgeable amateur Botanist and could name the plant if you took a pod or a flower or the branch of a tree. When I was with him, once a lady from Kerala visited him with a round green fruit and wanted to know what it was. Achaya spent next ten minutes telling her about the fruit, its uses, where it is grown and the whole works. He was also an art lover and on the walls of his flat hung paintings from many famous painters in the original.
This man from Coorg never lived there. He spent early part of his life in Madras and later abroad and after his return at Bombay and Hyderabad. He settled in Bangalore with his sister and brother in law. His brother in law was a famous Lt General [I forget he name] and his sister Sitha was a famous doctor and before her retirement was principal of Lady Hardinge medical college, Delhi. That was fifteen to twenty years ago and that was when I came in contact with him initially as his doctor and later as his friend.
Dr Achaya remained a bachelor. He was dogged by diabetes and heart disease, both of which he bore with rare equanimity. It was a privilege for me to be associated with him and look after him in the last years of his life.
Dr.K.T.Achaya was a remarkable person in more ways than one. By training he was a chemical engineer who branched out to become one of the foremost authorities on oilseeds. So much so he published several monographs on how ancient Indians extracted and processed the oil out of oilseeds. He had to consult several books, visit many temples, study pali and Sanskrit and he did most of this after his retirement. He was a serious student of Indian cuisine and made in depth study of how the foods are preserved and prepared in different parts of the country [your food and you, national book trust of India].His A historical dictionary of India [Oxford India paperbacks] is a must read for anyone interested in the origin and migration of many items of food that we take for granted. To give you a few examples. The chili that you are very fond of is not indigenous but brought India probably by the Portuguese from South America. Even the popular potato has the same origins. The story of our food is the fascinating account of various Indian foods and how they came to be cooked the way it is now and the different utensils that were in use to prepare the foods and how these evolved[universities press].His every day Indian foods [national book trust. India] is a storehouse of definition, preparation, processing and storing of popular foods of different parts of the country. So much for his talent as a food technologist, writer and researcher on Indian foods.
Now let me come to some other aspect of Dr Achaya. He was a connoisseur of classical music both Indian and western and had a collection of records which he would lovingly play on his old record player. His knowledge of musicians and their lives would hold me fascinated. He was also a very knowledgeable amateur Botanist and could name the plant if you took a pod or a flower or the branch of a tree. When I was with him, once a lady from Kerala visited him with a round green fruit and wanted to know what it was. Achaya spent next ten minutes telling her about the fruit, its uses, where it is grown and the whole works. He was also an art lover and on the walls of his flat hung paintings from many famous painters in the original.
This man from Coorg never lived there. He spent early part of his life in Madras and later abroad and after his return at Bombay and Hyderabad. He settled in Bangalore with his sister and brother in law. His brother in law was a famous Lt General [I forget he name] and his sister Sitha was a famous doctor and before her retirement was principal of Lady Hardinge medical college, Delhi. That was fifteen to twenty years ago and that was when I came in contact with him initially as his doctor and later as his friend.
Dr Achaya remained a bachelor. He was dogged by diabetes and heart disease, both of which he bore with rare equanimity. It was a privilege for me to be associated with him and look after him in the last years of his life.
Pythakaran
Babu Rajendrn and I have been friends for over 40 years. We have grown old together and lately our reminiscences include the problems we face and occasionally the pleasure of growing old. On Some occasions we get in to hilarious situations and he told this story over a glass of beer one forenoon recently.
He had been to Commercial Street on an errand. Going to commercial street which is the shopping hub of the city is no longer a pleasant outing as it used to be thirty years ago. Then we would find ample parking, do our shopping, doodle over a cup of coffee and find our way back home at a leisurely pace. Now going there, a short 4 kms away, takes 45 minutes of crawling in the traffic. Having reached there, finding a parking place close by is another major hassle. So you start the journey with a nervous heart and even before the venture you are ill at ease. So Babu was very happy and thrilled to find parking and having done that went on his errand. After finishing, he reached the place he had parked the car and found it missing!
Panic stricken, he looked for the parking attendant who was no where to be seen. What is the next step? Naturally, to go to the police. He went to the nearby police station to lodge a complaint. To the policeman at the reception this must have been one of the many cases he handles and probably one of low priority at that. He took his time which raised the heckles of my friend. Ultimately a constable was detailed to accompany and see the place where the vehicle was last seen. An agitated Babu and a cool policeman walked towards the place the car had been parked. They met the parking attendant on the way. The policeman naturally was angry with the attendant whose responsibility it was to look after the parked cars. The attendant asked whose car had been stolen. The policeman said this man’s, pointing to Babu. 'Saar, his car is here,' he showed Babu his car, which was very much there!
What happened was that Babu had, on that day, taken his son’s car leaving behind his own car. What he was looking for was his old faithful!
Much relieved and thanking the duo for having caused needless trouble, he got into the car. But he could not help overhear the parking attendant telling the Policeman, ‘bloody old mad man’ [Pythakaran].
He had been to Commercial Street on an errand. Going to commercial street which is the shopping hub of the city is no longer a pleasant outing as it used to be thirty years ago. Then we would find ample parking, do our shopping, doodle over a cup of coffee and find our way back home at a leisurely pace. Now going there, a short 4 kms away, takes 45 minutes of crawling in the traffic. Having reached there, finding a parking place close by is another major hassle. So you start the journey with a nervous heart and even before the venture you are ill at ease. So Babu was very happy and thrilled to find parking and having done that went on his errand. After finishing, he reached the place he had parked the car and found it missing!
Panic stricken, he looked for the parking attendant who was no where to be seen. What is the next step? Naturally, to go to the police. He went to the nearby police station to lodge a complaint. To the policeman at the reception this must have been one of the many cases he handles and probably one of low priority at that. He took his time which raised the heckles of my friend. Ultimately a constable was detailed to accompany and see the place where the vehicle was last seen. An agitated Babu and a cool policeman walked towards the place the car had been parked. They met the parking attendant on the way. The policeman naturally was angry with the attendant whose responsibility it was to look after the parked cars. The attendant asked whose car had been stolen. The policeman said this man’s, pointing to Babu. 'Saar, his car is here,' he showed Babu his car, which was very much there!
What happened was that Babu had, on that day, taken his son’s car leaving behind his own car. What he was looking for was his old faithful!
Much relieved and thanking the duo for having caused needless trouble, he got into the car. But he could not help overhear the parking attendant telling the Policeman, ‘bloody old mad man’ [Pythakaran].
Wednesday, December 17, 2008
Corruption
At the customs and entry counter of an international airport.
Official, ‘this passport looks fake’
Terrorist,’ yes’.
Official,’ that will be twenty thousand rupees’
Terrorist,’ last time you took ten thousand’
Official,’ last time the laws were less stringent’
Terrorist pays twenty thousand.
Official starts looking at the baggage and finds a sackful of grenades. He asks what these are.
Terrorist, ‘they are hand grenades’
Official, ‘you will have to pay one thousand each’ after some haggling they agree for Rs 500 each
Official, ‘what is this’
Terrorist,’ that is a Kalashnikov rifle’
Official,’ that is an expensive contraband, you have to pay Rs 100,000’
After a brief haggle they agree for Rs 75000.
The terrorist starts walking away. A thought strikes the custom official. He calls the terrorist back and asks,’ what are using these for? ‘Why, to kill you Indians’ replies the terrorist.
In that case, says the official, we have to stick to the original price, I cannot give you any concessions.
[The author has given vent to his imagination]
Official, ‘this passport looks fake’
Terrorist,’ yes’.
Official,’ that will be twenty thousand rupees’
Terrorist,’ last time you took ten thousand’
Official,’ last time the laws were less stringent’
Terrorist pays twenty thousand.
Official starts looking at the baggage and finds a sackful of grenades. He asks what these are.
Terrorist, ‘they are hand grenades’
Official, ‘you will have to pay one thousand each’ after some haggling they agree for Rs 500 each
Official, ‘what is this’
Terrorist,’ that is a Kalashnikov rifle’
Official,’ that is an expensive contraband, you have to pay Rs 100,000’
After a brief haggle they agree for Rs 75000.
The terrorist starts walking away. A thought strikes the custom official. He calls the terrorist back and asks,’ what are using these for? ‘Why, to kill you Indians’ replies the terrorist.
In that case, says the official, we have to stick to the original price, I cannot give you any concessions.
[The author has given vent to his imagination]
Thursday, December 11, 2008
Loyalty and truth
Jiddu Krishnamurthy, the famous philosopher, said in an interview that even nationalism is wrong. What he meant was that to feel attached to one’s country and feel patriotic in contrast to feeling that one is a citizen of this world or one of the life forms in the universe is wrong. By this definition all of us can be accused of terrible wrong doing. This is applicable to us Indians more than any one else. Here one’s loyalty begins with his own self first. Then comes his immediate family and then his extended family and then his caste and then his community and then his religion and last his country. Add to this his loyalty to the village, town, district, state, the country comes last. Then comes language. The worst kind of loyalty next only to religion in one’s love for one’s language. Sometimes the inability to learn or the lack of interest in other languages is directly attributable to this excessive attachment.
If one is attached to so many and the country comes last in her or his attachment, what are his concerns for the health and well being of the world? None seems to be bothered about becoming citizens of this world. The deep rooted division amongst us based on the many schisms [isms] described above has kept us separate from one another and has clouded our thinking and is a great impediment to intellectual progress and realization of the truth.
The truth as I see it is that this life and this planet are like bubbles of air. One will burst and die. Another bubble will form and it will also burst. This cycle will go on and on with no beginning and no end. That is the truth. You and I when we are alive, foolishly quarrel and constantly try one-upmanship.
Ridiculous, is it not?
If one is attached to so many and the country comes last in her or his attachment, what are his concerns for the health and well being of the world? None seems to be bothered about becoming citizens of this world. The deep rooted division amongst us based on the many schisms [isms] described above has kept us separate from one another and has clouded our thinking and is a great impediment to intellectual progress and realization of the truth.
The truth as I see it is that this life and this planet are like bubbles of air. One will burst and die. Another bubble will form and it will also burst. This cycle will go on and on with no beginning and no end. That is the truth. You and I when we are alive, foolishly quarrel and constantly try one-upmanship.
Ridiculous, is it not?
Monday, December 8, 2008
Power of prayer or serindipity?
Among the many positive attributes of my friend Gnandev Kamath, is his ability to tell a story. What follows is a real life incident which occurred recently in which he was involved.
There was a wedding in the family and the relatives from far and wide had gathered. As it happens everywhere, weddings and deaths will get the maximum number of relatives to come and meet with each other. One is to celebrate a life giving event and another to pay respects to a life which has departed. The former is a joyous occasion and thus much more attractive.
Gnandev’s niece was one of them who had come from Bombay with her Jewelry box. The advise that she not carry her jewelry and make do with borrowed ones from her many close relations was not heeded to. Which self respecting young woman likes to be seen in borrowed jewelry? My sympathies are all with her for bringing her jewelry with her at some risk.
Bombay is next door to us SKites [South Kanarites, Mangalorians, Mangus, Coastal Cracks]. There are hundreds of buses which ply daily from Bombay to Mangalore and the flight connections are better than from Bangalore. The Bombay party which included this young woman duly arrived in the city and from there they travelled to udipi where the wedding was to take place. The day before the wedding is the day of fun where the women have the maximum opportunity to display their person and if that is not worth it, then at least their jewelry. As our young lady in question had both, one can understand her anxiety to be ready for the evening function. She stayed in her relative’s house and at the appointed time she travelled to the venue. When she reached the venue she found her jewelry box, her hand bag with her cell phone were all missing. She had forgotten the whole lot in the auto rickshaw in which she had travelled!
All hell broke loose and the lady was inconsolable. The reasons were many. The lost opportunity, loss of jewellery worth nearly three lakhs and the ignominy of being branded as forgetful woman for the rest of her life! All these and many more added to her grief. The promise of the gathered relatives that they will all contribute and make good her lost jewelry was not well received. The only option was to go to the police. She of course did not remember auto’s number and could vaguely describe the driver.
Before going to the police why not try the cell phone which she had left behind in the auto and may be the driver will respond. Normally the first act of a thief is to remove the SIM card and throw it away. When they rang the number there was ringing tone and this reassured them to some extent. Continued tries however did not elicit any response and they were now worried that the cell phone’s batteries would die and then they would be in deeper trouble.
At this moment a thought occurred to Gnandev.He requested the assembly to close their eyes and pray silently for five minutes wishing for the recovery. Five minutes elapsed and Gnandev made a final call to the cell number before going to the police.
The phone rang only twice before it was picked up. The voice at the other end said that the jewel box, hand bag and the cell phone were with him and he would return and give all these back to the owner. It would take him some time as he was 30 kms away. It took some convincing to get him to stay home and wait for Gnandev to go there and fetch the lost and found articles. When Gnandev reached the driver’s place he found it to be in a poor locality and the anxious driver was waiting to give it all back. They found that he belonged to goldsmith’s community and knew the exact value of the jewelry in the box. Not one piece was missing. He was wondering and thinking of ways to reach the owner when he heard the cell phone call!
When they wanted to publicize his honesty he would have none of that. It took a lot of pressure to persuade him to accept a cash gift.
It was pretty late when they went back to the hotel where the evening’s party was on. The thanks giving revelry went on till the wee hours of the next day.
It is because we still have a few of these men and women [First class of humans] still present in this country, we are surviving.
There was a wedding in the family and the relatives from far and wide had gathered. As it happens everywhere, weddings and deaths will get the maximum number of relatives to come and meet with each other. One is to celebrate a life giving event and another to pay respects to a life which has departed. The former is a joyous occasion and thus much more attractive.
Gnandev’s niece was one of them who had come from Bombay with her Jewelry box. The advise that she not carry her jewelry and make do with borrowed ones from her many close relations was not heeded to. Which self respecting young woman likes to be seen in borrowed jewelry? My sympathies are all with her for bringing her jewelry with her at some risk.
Bombay is next door to us SKites [South Kanarites, Mangalorians, Mangus, Coastal Cracks]. There are hundreds of buses which ply daily from Bombay to Mangalore and the flight connections are better than from Bangalore. The Bombay party which included this young woman duly arrived in the city and from there they travelled to udipi where the wedding was to take place. The day before the wedding is the day of fun where the women have the maximum opportunity to display their person and if that is not worth it, then at least their jewelry. As our young lady in question had both, one can understand her anxiety to be ready for the evening function. She stayed in her relative’s house and at the appointed time she travelled to the venue. When she reached the venue she found her jewelry box, her hand bag with her cell phone were all missing. She had forgotten the whole lot in the auto rickshaw in which she had travelled!
All hell broke loose and the lady was inconsolable. The reasons were many. The lost opportunity, loss of jewellery worth nearly three lakhs and the ignominy of being branded as forgetful woman for the rest of her life! All these and many more added to her grief. The promise of the gathered relatives that they will all contribute and make good her lost jewelry was not well received. The only option was to go to the police. She of course did not remember auto’s number and could vaguely describe the driver.
Before going to the police why not try the cell phone which she had left behind in the auto and may be the driver will respond. Normally the first act of a thief is to remove the SIM card and throw it away. When they rang the number there was ringing tone and this reassured them to some extent. Continued tries however did not elicit any response and they were now worried that the cell phone’s batteries would die and then they would be in deeper trouble.
At this moment a thought occurred to Gnandev.He requested the assembly to close their eyes and pray silently for five minutes wishing for the recovery. Five minutes elapsed and Gnandev made a final call to the cell number before going to the police.
The phone rang only twice before it was picked up. The voice at the other end said that the jewel box, hand bag and the cell phone were with him and he would return and give all these back to the owner. It would take him some time as he was 30 kms away. It took some convincing to get him to stay home and wait for Gnandev to go there and fetch the lost and found articles. When Gnandev reached the driver’s place he found it to be in a poor locality and the anxious driver was waiting to give it all back. They found that he belonged to goldsmith’s community and knew the exact value of the jewelry in the box. Not one piece was missing. He was wondering and thinking of ways to reach the owner when he heard the cell phone call!
When they wanted to publicize his honesty he would have none of that. It took a lot of pressure to persuade him to accept a cash gift.
It was pretty late when they went back to the hotel where the evening’s party was on. The thanks giving revelry went on till the wee hours of the next day.
It is because we still have a few of these men and women [First class of humans] still present in this country, we are surviving.
Monday, December 1, 2008
Why is Indian governament weak?
Across the board of class, caste, community, creed and religion Indians come under three classes
Class 1. Honest, efficient, hard working, helpful and noncorrupt.
Class 2. Honest but can become dishonest, can become inefficient, can become lazy and can become corrupt.
Class 3. Dishonest, inefficient, lazy, unhelpful and corrupt.
Since independence, 60 years ago, there is a steady flight of class 1 out of this country. Class 2 has also gone out but a considerable number have joined private sector. Class 3 has been given all incentives to join government service and become politicians and they have done so. And the result is what we are seeing and experiencing.
Sleep cure
An Indian politician went to his doctor and requested a prescription for sleeping pills to last for six months. The curious doctor asked him why he needed this supply. The politician explained. ‘Recently I had to change my bed which had the stuffing of currency notes. I slept very well on that. I had to take the stuffing out to distribute the notes to my party workers and voters during the recent elections. Now that I have won, it will take six months to make a similar bed’.
Class 1. Honest, efficient, hard working, helpful and noncorrupt.
Class 2. Honest but can become dishonest, can become inefficient, can become lazy and can become corrupt.
Class 3. Dishonest, inefficient, lazy, unhelpful and corrupt.
Since independence, 60 years ago, there is a steady flight of class 1 out of this country. Class 2 has also gone out but a considerable number have joined private sector. Class 3 has been given all incentives to join government service and become politicians and they have done so. And the result is what we are seeing and experiencing.
Sleep cure
An Indian politician went to his doctor and requested a prescription for sleeping pills to last for six months. The curious doctor asked him why he needed this supply. The politician explained. ‘Recently I had to change my bed which had the stuffing of currency notes. I slept very well on that. I had to take the stuffing out to distribute the notes to my party workers and voters during the recent elections. Now that I have won, it will take six months to make a similar bed’.
Thursday, November 27, 2008
Distress
The city of Bombay[Mumbai] is under attack by a group of well armed organised terrorists. Why would a country like India, where people belonging to different religeons live peacefully together and has done no harm to others, be the subject of this kind of mindless violence? What this world is coming to? I feel sorry for the young who have long lives ahead of them and wish want them to echew hatred which breeds this kind of mindless violence.
Such a waste.
Such a waste.
Mistaken Identity
I have always kept records of my patients. The records are with the patients unlike other doctors who keep records with them. I make the patients keep their records for two reasons. One it helps me to conserve space in my little clinic and spares me the bother of searching for the file when the patient visits me. Those of you who have no knowledge of the working conditions here need to be enlightened. Unlike other countries most of us have no receptionist/secretary/recordkeepr/assistant that takes care of these matters. Here, in most solo practices the doctor is all in one. He is the baby sitter, bottle washer and cook cum housekeeper. At best he may have an assistant to help keeping the patients to order in the waiting area and protect the doctor from unforeseen problems. Not unlike a bouncer in a bar [I am exaggerating this a bit]. Records with the patient also helps the other doctors because our patients go shopping form one doctor to the other and the records help the other doctor in not committing the same mistake that I probably did and other details of past illnesses and medications that he has had.
This also has several disadvantages. One major one is that patients need training to bring their records with them each time they come. In a generally indescilplined population such as ours it is tough to get them to do it. In some cases they are just incorrigible and it is impossible to get these to maintain records. But it is to my credit that most of my regulars do maintain records and it is a pleasure for me to see case records dating back to mid seventies! Some do bring their records but not always. There are reasons. Misplacement and no time to search or they would have come from office and have not gone home to get the records are common explanations for not bringing records. But one who did exasperate me by not only in not bringing records but also by the regular irregularity of follow up is Mr. Jayaram.
Jayaram is a chronic asthmatic and those days, asthma was one illness which kept us literally on our toes. The maximum number of house calls and night visits were made to see patients with acute asthma. If I remember right the only inhaled drug available then with some effect was Cromolyn. Inhaled steroids which have virtually eliminated acute asthma in my practice now were yet to make their advent thirty years ago. Mr. Jayaram who is now sixty five is so well controlled that he rarely visits me. Those days he had to see me regularly and I had to meticulously titrate the drugs to keep him free from distress. But regularity was not a word in Jayaram’s dictionary. He chose his day and time which was when his wheeze became worse. When he came with breathing difficulty I used to get wild with him. The reason why I wanted him to come regularly was precisely to avoid this distress. I used to administer injection of adrenaline under the skin ever so slowly and the results would be dramatic. The patient got immediate relief but also would have severe head ache, his heart would race and often he would vomit some times on the nearest person which was I. Though I hated using this drug I used it often enough and my friend Jayaram was one of these recipients. Despite my telling him that he can avoid these if he came in for regular follow ups, he persisted in being errant. Worse, he always had a valid excuse. I held my abuse at bay till the distress was relieved and then would let him have it. Those days I was called with some justification, ‘a good doctor with a short fuse’. With age and experience and mainly due to my forgiving patients, I have now become a doctor with longer fuse but I am aware that the fuse still remains.
Jayaram has other interesting characters. He was always smiling. Even when he came in distress he had that smile. This smile occasionally got on my nerves. When I am discussing some important issue I don’t want my patient to be smiling vacantly at me. He was always well dressed in contrast to my wayward dressing methods. He sported a goatee and a moustache which were confluent and in addition had bushy eye brows. All this combined gave this small time contractor, the looks of a distinguished college professor.
So, when he came again with one of his acute attacks and after the tiresome administration of adrenaline and relieving of his attack I asked him for my file. His face was blank. He said,’ what file? ‘The file with your records which you are supposed to bring with you’ I said. ‘You gave me no file’ he said. This irritated me no end. I wondered whether his asthma attack has made his memory lapse or is he feigning? I, after numerous encounters with him could not put this beyond his capabilities. I insisted he does have the record file and has forgotten to get it with him and is now pulling a fast one on me. He said,’ really doctor, you have not given me any file, last time I came you gave me this paper’. He showed me a note which had a prescription and his name. The way he said this made me take a closer look at him. This was not my old friend and tormentor Jayaram but his look alike! Except for a few additional greys in the goatee everything else was the same, even the voice. I looked at the prescription, the name read Charan Shukla. This north Indian gentleman bore an uncanny resemblance to my errant friend Jayaram and has suffered from the same illness. The reason why he did not have a file is that I had not started one as yet in his case. How is it that I missed the resemblance last time he came over? I apologized and told him of the resemblance and wondered how I could have missed it last time he had come. He said, ‘Doctor I have grown this beard since the time I met with you last!
So a clean shaven Shukla looked different from the bearded Jayaram and with the beard they were virtually same. My apologies were well accepted and a grateful and relieved Shuklaji took my leave.
Few days later Jayaram arrived once again in an acute attack of asthma. Before administering any drug I asked to make sure that he is not Shukla, even in his distress he gave me a worried look and said, ‘ sir don’t you know me? I am your old patient Jayaram and not Shukla; I have come here so often’. Thus confirmed that there is no mistaken identity, I asked him to show me his file [after giving him the dreadful adrenaline]. As usual he had mislaid the file and did not know the dosage details of the medications he was currently on. His bashful grin raised my heckles. I gave it to him and told him to find another doctor and stop bothering me hence forth. He stood there for some time looking at me. For a change his grin had gone. I would not talk. He waited for a while and went out. I thought to myself good riddance, I don’t have to deal with this fellow any more.
I got busy with the waiting patients and an hour or so later, finished the morning surgery.
‘Sir, may I come in’ my friend and tormenter Jayaram was at the entrance. He asked me,’ sir are you still angry?’
Looking at the grinning face, I could not help but laugh. He promised to come on time next time and surely would bring his records without fail.
I don’t have to add that he remained as errant as ever. Now he rarely gets severe attacks and takes the inhalers regularly and at 65 his health is better than when he was 30, thanks to the advent of inhaled corticosteroids.
This also has several disadvantages. One major one is that patients need training to bring their records with them each time they come. In a generally indescilplined population such as ours it is tough to get them to do it. In some cases they are just incorrigible and it is impossible to get these to maintain records. But it is to my credit that most of my regulars do maintain records and it is a pleasure for me to see case records dating back to mid seventies! Some do bring their records but not always. There are reasons. Misplacement and no time to search or they would have come from office and have not gone home to get the records are common explanations for not bringing records. But one who did exasperate me by not only in not bringing records but also by the regular irregularity of follow up is Mr. Jayaram.
Jayaram is a chronic asthmatic and those days, asthma was one illness which kept us literally on our toes. The maximum number of house calls and night visits were made to see patients with acute asthma. If I remember right the only inhaled drug available then with some effect was Cromolyn. Inhaled steroids which have virtually eliminated acute asthma in my practice now were yet to make their advent thirty years ago. Mr. Jayaram who is now sixty five is so well controlled that he rarely visits me. Those days he had to see me regularly and I had to meticulously titrate the drugs to keep him free from distress. But regularity was not a word in Jayaram’s dictionary. He chose his day and time which was when his wheeze became worse. When he came with breathing difficulty I used to get wild with him. The reason why I wanted him to come regularly was precisely to avoid this distress. I used to administer injection of adrenaline under the skin ever so slowly and the results would be dramatic. The patient got immediate relief but also would have severe head ache, his heart would race and often he would vomit some times on the nearest person which was I. Though I hated using this drug I used it often enough and my friend Jayaram was one of these recipients. Despite my telling him that he can avoid these if he came in for regular follow ups, he persisted in being errant. Worse, he always had a valid excuse. I held my abuse at bay till the distress was relieved and then would let him have it. Those days I was called with some justification, ‘a good doctor with a short fuse’. With age and experience and mainly due to my forgiving patients, I have now become a doctor with longer fuse but I am aware that the fuse still remains.
Jayaram has other interesting characters. He was always smiling. Even when he came in distress he had that smile. This smile occasionally got on my nerves. When I am discussing some important issue I don’t want my patient to be smiling vacantly at me. He was always well dressed in contrast to my wayward dressing methods. He sported a goatee and a moustache which were confluent and in addition had bushy eye brows. All this combined gave this small time contractor, the looks of a distinguished college professor.
So, when he came again with one of his acute attacks and after the tiresome administration of adrenaline and relieving of his attack I asked him for my file. His face was blank. He said,’ what file? ‘The file with your records which you are supposed to bring with you’ I said. ‘You gave me no file’ he said. This irritated me no end. I wondered whether his asthma attack has made his memory lapse or is he feigning? I, after numerous encounters with him could not put this beyond his capabilities. I insisted he does have the record file and has forgotten to get it with him and is now pulling a fast one on me. He said,’ really doctor, you have not given me any file, last time I came you gave me this paper’. He showed me a note which had a prescription and his name. The way he said this made me take a closer look at him. This was not my old friend and tormentor Jayaram but his look alike! Except for a few additional greys in the goatee everything else was the same, even the voice. I looked at the prescription, the name read Charan Shukla. This north Indian gentleman bore an uncanny resemblance to my errant friend Jayaram and has suffered from the same illness. The reason why he did not have a file is that I had not started one as yet in his case. How is it that I missed the resemblance last time he came over? I apologized and told him of the resemblance and wondered how I could have missed it last time he had come. He said, ‘Doctor I have grown this beard since the time I met with you last!
So a clean shaven Shukla looked different from the bearded Jayaram and with the beard they were virtually same. My apologies were well accepted and a grateful and relieved Shuklaji took my leave.
Few days later Jayaram arrived once again in an acute attack of asthma. Before administering any drug I asked to make sure that he is not Shukla, even in his distress he gave me a worried look and said, ‘ sir don’t you know me? I am your old patient Jayaram and not Shukla; I have come here so often’. Thus confirmed that there is no mistaken identity, I asked him to show me his file [after giving him the dreadful adrenaline]. As usual he had mislaid the file and did not know the dosage details of the medications he was currently on. His bashful grin raised my heckles. I gave it to him and told him to find another doctor and stop bothering me hence forth. He stood there for some time looking at me. For a change his grin had gone. I would not talk. He waited for a while and went out. I thought to myself good riddance, I don’t have to deal with this fellow any more.
I got busy with the waiting patients and an hour or so later, finished the morning surgery.
‘Sir, may I come in’ my friend and tormenter Jayaram was at the entrance. He asked me,’ sir are you still angry?’
Looking at the grinning face, I could not help but laugh. He promised to come on time next time and surely would bring his records without fail.
I don’t have to add that he remained as errant as ever. Now he rarely gets severe attacks and takes the inhalers regularly and at 65 his health is better than when he was 30, thanks to the advent of inhaled corticosteroids.
Sunday, November 23, 2008
Dress code
Why do we dress as we do? Is it just to attract attention or there is something more to it than that meets the eye? Is attracting the opposite sex the sole motive? If that is so nature would not have made men and women different. So dress must have a meaning other than mere sexual attraction. My own theory is it has to do with hierarchy and expression of power. Well dressed person [well dressed has different connotation in different societies] attracts attention. One can go to any extent to get attention. One can deck himself with brightly colored clothing however ill fitting it may be; deck himself or herself with heavy jewelry. May even have attachments like bright feathers, caps, hats toupees and the like. Medieval rajas had a decorated umbrella over their heads and sat on ornate thrones. The desire to dress elaborately and thus be identified as different and important is not confined to the rich and the powerful. It applies even to the clergy. One has only to look at the way the clergy of different communities dress to see my point.
Are they comfortable in their preferred dresses? Surprisingly comfort is something that is often practiced. I asked a consultant friend of mine who was in a full suit on summer morning, the rationale behind his attire. His reply was that without his suit he feels naked! I would, given a choice, rather be naked than wear a suit on a hot Sunday morning. Our beurocrats too like to be suited; that they stick out like sore thumbs in most of the gatherings is another matter which does not seem to bother them.
Doctors and white coats are synonymous. Add a stethoscope strung around the neck you have the complete uniform. This is ostensibly to ward off dirt and germs? Or is it for the patients to identify the class? For many the white coated figure of the approaching doctor causes extreme anxiety bordering on fear.
Now those of you who are my patients know why don’t wear a white coat.
Are they comfortable in their preferred dresses? Surprisingly comfort is something that is often practiced. I asked a consultant friend of mine who was in a full suit on summer morning, the rationale behind his attire. His reply was that without his suit he feels naked! I would, given a choice, rather be naked than wear a suit on a hot Sunday morning. Our beurocrats too like to be suited; that they stick out like sore thumbs in most of the gatherings is another matter which does not seem to bother them.
Doctors and white coats are synonymous. Add a stethoscope strung around the neck you have the complete uniform. This is ostensibly to ward off dirt and germs? Or is it for the patients to identify the class? For many the white coated figure of the approaching doctor causes extreme anxiety bordering on fear.
Now those of you who are my patients know why don’t wear a white coat.
Wednesday, November 19, 2008
Great leader
Today’s newspaper carried two news items of significance.
One was the chaos, a political party’s election jamboree which attracted over 200,000 sons of the soil from different parts of the state, caused. These sons of the soil were ferried to the venue located in central Bangalore in every available forms of transport, mostly hired busses and trucks. A small percentage came on their own out of love for their political leaders. For most it was a sort of all found holiday of sorts. The vehicles they came in were parked anyhow and everywhere. There was absolute anarchy on the roads of Bangalore and for many it was a nightmarish experience. School children were stuck on the roads without food, water, toilet facilities for over 8 hours and many had to walk back home. Naturally many complained. The leader of these sons of the soil party has this to say by the way of response. ‘Those who complain for this one day’s inconvenience are those who don’t go and vote and the children of these non voters suffered for one day, whereas the sons of the soil who came are the ones who vote and their children have to walk many kilometers daily to the school!’ You can surmise what is in store when the leaders of these sons of the soil come to power. They will make all the children of these non voters walk to the school, several kilometers every day!
The second was a huge half page advertisement with a huge photograph to remind us of another great leader who is no more. It is her birthday to day. I remember this great leader very well. Most of my active life was spent when this great leader was in power. During this period of her rule I saw the worst kind of poverty, indiscipline and corruption in my country. We are still one of the most corrupt countries in the world thanks partly to this great leader. Yesterday’s rally reminded me of the great leader’s days when New Delhi used to witness such rallies almost daily. I dread to think of the return of such leadership which appears very possible.
One was the chaos, a political party’s election jamboree which attracted over 200,000 sons of the soil from different parts of the state, caused. These sons of the soil were ferried to the venue located in central Bangalore in every available forms of transport, mostly hired busses and trucks. A small percentage came on their own out of love for their political leaders. For most it was a sort of all found holiday of sorts. The vehicles they came in were parked anyhow and everywhere. There was absolute anarchy on the roads of Bangalore and for many it was a nightmarish experience. School children were stuck on the roads without food, water, toilet facilities for over 8 hours and many had to walk back home. Naturally many complained. The leader of these sons of the soil party has this to say by the way of response. ‘Those who complain for this one day’s inconvenience are those who don’t go and vote and the children of these non voters suffered for one day, whereas the sons of the soil who came are the ones who vote and their children have to walk many kilometers daily to the school!’ You can surmise what is in store when the leaders of these sons of the soil come to power. They will make all the children of these non voters walk to the school, several kilometers every day!
The second was a huge half page advertisement with a huge photograph to remind us of another great leader who is no more. It is her birthday to day. I remember this great leader very well. Most of my active life was spent when this great leader was in power. During this period of her rule I saw the worst kind of poverty, indiscipline and corruption in my country. We are still one of the most corrupt countries in the world thanks partly to this great leader. Yesterday’s rally reminded me of the great leader’s days when New Delhi used to witness such rallies almost daily. I dread to think of the return of such leadership which appears very possible.
Thursday, November 13, 2008
Hot tea and chest pain
Mr Ramesh is a good friend and also a patient, a dreadful combination. He came to me complaining of chest discomfort and insisted that it was due to drinking scalding tea that morning. Ignoring his diagnosis, I started asking him the usual questions we doctors ask to exclude pain due to heart disease. Where was the pain, did it go up to the neck and down the arm, was there any sweating, how long did it last, etc.
When I was asking these questions, he sat there giving me a bored look. I knew what was going on his mind. ‘I came here with some trivial problem and this fool is asking these stupid questions’. He looked at his watch twice in those few minutes I spent trying to get a proper history.
Despite his protests, I did a cardiogram. The tracing showed severely compromised blood supply to a portion of the heart. I explained the gravity of the problem, gave him a note for hospital admission, called the cardiologist friend of mine and sent him on his way.
The same afternoon I went to the hospital to see him. I went directly to the coronary care unit. I did not find him there. Then I went to my cardiologist friend to find out what had happened. Before I could open my mouth, he asked me, ‘where is your friend?’ Having made sure that he was not in the hospital and worried, I called his office only to be told by his well-meaning secretary that he was fine but in a meeting and would I mind calling him after an hour or so? The knowledge that he was alive was reassuring but all the same the worry was no less.
I went to his house to apprise his wife about the serious nature of the problem. I found her having her prized afternoon siesta. After I finished my tale regarding her husband’s erratic behaviour, she gave me a splendid piece of advice. ‘Doc, you always worry too much. He gets these pains after drinking hot tea. You have advised him to stop this bad habit [I did not remember this piece of expert advice having been given] and if he does that, he will be OK, you wait and see!’ I requested her to please send her husband to the hospital with out wasting any more time, drank the cup of tea which she had made and returned home thoroughly depressed and worried.
Are you wondering what happened to my friend? He didn’t want to go to the hospital, especially when all the pain had gone and he felt very good. He made an uneventful recovery. His subsequent ECGs showed a small scar and his treadmill test came back negative. According to his wife, he gets no chest pains now because he has stopped drinking hot tea. No credit whatsoever to the poor me who spent several sleepless nights and anxious days looking after an unwilling and, I suspect not very grateful patient! Even now he says he takes the medicines to keep me in good humour!
This true life story I wrote several years back. This episode illustrates the fact that many patients do well despite us doctors.
When I was asking these questions, he sat there giving me a bored look. I knew what was going on his mind. ‘I came here with some trivial problem and this fool is asking these stupid questions’. He looked at his watch twice in those few minutes I spent trying to get a proper history.
Despite his protests, I did a cardiogram. The tracing showed severely compromised blood supply to a portion of the heart. I explained the gravity of the problem, gave him a note for hospital admission, called the cardiologist friend of mine and sent him on his way.
The same afternoon I went to the hospital to see him. I went directly to the coronary care unit. I did not find him there. Then I went to my cardiologist friend to find out what had happened. Before I could open my mouth, he asked me, ‘where is your friend?’ Having made sure that he was not in the hospital and worried, I called his office only to be told by his well-meaning secretary that he was fine but in a meeting and would I mind calling him after an hour or so? The knowledge that he was alive was reassuring but all the same the worry was no less.
I went to his house to apprise his wife about the serious nature of the problem. I found her having her prized afternoon siesta. After I finished my tale regarding her husband’s erratic behaviour, she gave me a splendid piece of advice. ‘Doc, you always worry too much. He gets these pains after drinking hot tea. You have advised him to stop this bad habit [I did not remember this piece of expert advice having been given] and if he does that, he will be OK, you wait and see!’ I requested her to please send her husband to the hospital with out wasting any more time, drank the cup of tea which she had made and returned home thoroughly depressed and worried.
Are you wondering what happened to my friend? He didn’t want to go to the hospital, especially when all the pain had gone and he felt very good. He made an uneventful recovery. His subsequent ECGs showed a small scar and his treadmill test came back negative. According to his wife, he gets no chest pains now because he has stopped drinking hot tea. No credit whatsoever to the poor me who spent several sleepless nights and anxious days looking after an unwilling and, I suspect not very grateful patient! Even now he says he takes the medicines to keep me in good humour!
This true life story I wrote several years back. This episode illustrates the fact that many patients do well despite us doctors.
Thursday, November 6, 2008
Count Narayan Rao
Both Narayan Rao and his wife are no more. Count died many years ago and madam Rao a few years ago. They had lived not far from my clinic and as Count had many health problems, I was a frequent visitor to their home. He very rarely visited my clinic and would joke with me,’ If I came there, I would get some more illnesses with all those patients there coughing and sneezing.’ This opinion I shared with him and have often marveled at the very few times I have fallen ill considering the number of times and patients with infections that I am exposed to over the years.
Narayan Rao, when he passed away was in his early seventies. He was related to a classmate of mine and that was their reference to see me. He had retired from a corporate executives’ job, but the habits of corporate life remained with him. To look at, he was a tall fair and handsome man, with a red, florid face. He spoke with naturally accented good English. He reminded me of characters I had seen in the movies and read in Wodehouse novels and that is the reason why I came to call him Count Narayan rao. In the course of our brief association I came to call him simply as count.
I looked forward to the visits I made to his home, because I never returned without feeling good and happy after the visit. The reason was not money. As a matter of fact because of the close relationship I did not take any fees from him. The feel good factor was the man himself. He enjoyed life and wanted to share his enjoyment with others which happily included me. He suffered from diabetes, has had several heart attacks and was in early chronic heart failure. But the disease that bugged him most was Gout. I used to make fun of him that he had a rich man’s disease [Gout affects royalty more than others is the popular notion]. Narayan rao was not rich but he led a rich life. Both of them were socialites of the then Bangalore and often they would be out of home attending this party or the other, despite his sickness.
Out of necessity he had to take multiple drugs and that included anti gout drugs. Like it is now then too, the treatment of acute gout was with either colchicine or Indomethacin.Count did not tolerate colchicine so I had no option but to give him Indomethacin, a toxic drug, especially given his other problems. Naturally my prescriptions were niggardly and never more than ten tablets at a time.
Once Count became breathless and I had to rush and see him. His wife was not at home and count was alone and with great difficulty he came and opened the door for me. Then he went back and lay down on his bed. After examining him I found his lungs filling up and wanted to know how much of the prescribed diuretic he was taking. He said he did not know but directed me to the cupboard where his records were kept. I opened cupboard and found a mini pharmacy there along with my notes in one of the drawers.
After giving him an injection of a diuretic, I returned to the pharmacy. I found lots of drugs which he was taking but not prescribed by me, and also several strips of Indomethacin. How did he get hold of this many tablets and has been using them without my knowledge?
I was very worried not only with the toxic Indomethacin but also the variety of unnamed pills and tonics many of them belonging to the class called herbal medicines. The injection had the desired effect and in a short while his breathing eased off. I asked him, He not only agreed that he took the tablets liberally and stocked them as they gave him very good relief. Sometimes he took three to four of them in a day. Horror! This despite my very clear instructions to the contrary. I was so upset that I had to admonish him, out of respect for age rather gently. He said,’ it is I who gets the pain, not you’. For this, I had no adequate repartee, so I kept quiet. After a while I asked him, how he managed to get the tablets without a prescription? He said it was very easy. He tore a white paper out of his letter pad, cut out the portion that had his printed name, wrote out Narayan rao and age and below which wrote the trade name of the drug and the required quantity. Signed my name underneath! He said no druggist has ever refused him so far! He felt no guilt what so ever! This reminded of my old pharmacology professor who used to say, ‘in this country committing suicide is very easy, you just have to go to the nearest chemist’
I stopped all the herbal medicines and told him how this over dosage of Indomethacin was having an adverse effect on his heart’s condition and his diabetes. He became less liberal in the use of that drug. Whatever may be the reason, his condition improved and he lived a few more years and died ultimately at home with chronic heart failure, in my presence.
Few days before his death when I was there with him, a party of his socialite friends had come to see him. By then the news of his seriousness had spread. When they were leaving, count called me aside and pointing to one of the women, whispered,’ that fellow with her is her third husband; I hope she will not have a fourth one’. His wit never left him, so was his jest for life.
Narayan Rao, when he passed away was in his early seventies. He was related to a classmate of mine and that was their reference to see me. He had retired from a corporate executives’ job, but the habits of corporate life remained with him. To look at, he was a tall fair and handsome man, with a red, florid face. He spoke with naturally accented good English. He reminded me of characters I had seen in the movies and read in Wodehouse novels and that is the reason why I came to call him Count Narayan rao. In the course of our brief association I came to call him simply as count.
I looked forward to the visits I made to his home, because I never returned without feeling good and happy after the visit. The reason was not money. As a matter of fact because of the close relationship I did not take any fees from him. The feel good factor was the man himself. He enjoyed life and wanted to share his enjoyment with others which happily included me. He suffered from diabetes, has had several heart attacks and was in early chronic heart failure. But the disease that bugged him most was Gout. I used to make fun of him that he had a rich man’s disease [Gout affects royalty more than others is the popular notion]. Narayan rao was not rich but he led a rich life. Both of them were socialites of the then Bangalore and often they would be out of home attending this party or the other, despite his sickness.
Out of necessity he had to take multiple drugs and that included anti gout drugs. Like it is now then too, the treatment of acute gout was with either colchicine or Indomethacin.Count did not tolerate colchicine so I had no option but to give him Indomethacin, a toxic drug, especially given his other problems. Naturally my prescriptions were niggardly and never more than ten tablets at a time.
Once Count became breathless and I had to rush and see him. His wife was not at home and count was alone and with great difficulty he came and opened the door for me. Then he went back and lay down on his bed. After examining him I found his lungs filling up and wanted to know how much of the prescribed diuretic he was taking. He said he did not know but directed me to the cupboard where his records were kept. I opened cupboard and found a mini pharmacy there along with my notes in one of the drawers.
After giving him an injection of a diuretic, I returned to the pharmacy. I found lots of drugs which he was taking but not prescribed by me, and also several strips of Indomethacin. How did he get hold of this many tablets and has been using them without my knowledge?
I was very worried not only with the toxic Indomethacin but also the variety of unnamed pills and tonics many of them belonging to the class called herbal medicines. The injection had the desired effect and in a short while his breathing eased off. I asked him, He not only agreed that he took the tablets liberally and stocked them as they gave him very good relief. Sometimes he took three to four of them in a day. Horror! This despite my very clear instructions to the contrary. I was so upset that I had to admonish him, out of respect for age rather gently. He said,’ it is I who gets the pain, not you’. For this, I had no adequate repartee, so I kept quiet. After a while I asked him, how he managed to get the tablets without a prescription? He said it was very easy. He tore a white paper out of his letter pad, cut out the portion that had his printed name, wrote out Narayan rao and age and below which wrote the trade name of the drug and the required quantity. Signed my name underneath! He said no druggist has ever refused him so far! He felt no guilt what so ever! This reminded of my old pharmacology professor who used to say, ‘in this country committing suicide is very easy, you just have to go to the nearest chemist’
I stopped all the herbal medicines and told him how this over dosage of Indomethacin was having an adverse effect on his heart’s condition and his diabetes. He became less liberal in the use of that drug. Whatever may be the reason, his condition improved and he lived a few more years and died ultimately at home with chronic heart failure, in my presence.
Few days before his death when I was there with him, a party of his socialite friends had come to see him. By then the news of his seriousness had spread. When they were leaving, count called me aside and pointing to one of the women, whispered,’ that fellow with her is her third husband; I hope she will not have a fourth one’. His wit never left him, so was his jest for life.
Wednesday, November 5, 2008
Congratulations Obama
The skinny kid with a funny name has done it! Barak Hussein Obama has become the president of the Unite States of America.
The last time I remember being this happy and excited was when the low profile, utterly honest, sincere, able and who went unsung, our own Lal Bahadur Shastri , was elected prime minster of India some 45 years ago. He was probably the ablest prime minister we have had. That Lal Bahadur lived only for two years as prime minister was a major tragedy for our country.
I wish President elect Barak Obama a long and fruitful life in the service of not only Americans but all of us in this troubled world.
Lastly, to those of you, Americans, who read my appeal in my blog and voted for Barak Obama, my special thanks.
The last time I remember being this happy and excited was when the low profile, utterly honest, sincere, able and who went unsung, our own Lal Bahadur Shastri , was elected prime minster of India some 45 years ago. He was probably the ablest prime minister we have had. That Lal Bahadur lived only for two years as prime minister was a major tragedy for our country.
I wish President elect Barak Obama a long and fruitful life in the service of not only Americans but all of us in this troubled world.
Lastly, to those of you, Americans, who read my appeal in my blog and voted for Barak Obama, my special thanks.
Sunday, November 2, 2008
Watch Dog
My friend has a Doberman pet dog. He is peculiar in his behaviour. Unlike the other dogs of his breed he welcomes guests with a whine and a vigorous shake of his head and tail. When he sees any one from the house hold leaving the house he gets upset and starts barking. If you consider my practice as home and my patients as family members and I as Doberman pincer you will be able to follow what follows. Like my friend’s Doberman I too fail more often than not and the reason you will know why if you read the next few lines.
Most of you watch television and newspapers and you meet friends and relatives. Subject of health, doctors and hospitals is a favorite topic of conversation. Morbid details of someone’s illness and death make very interesting topic of conversation as the conversants are not involved. But there is a lurking fear that they would be the subjects of such conversation at a later date. Then how to avoid this fate? Many believe that periodic testing [called whole body testing in their language] will tell them if they are fit or not. Little do they realize that these tests will only reveal that the tests are normal but will not tell them if they are normal or not. Thus this rush to get annual or bi annual tests done is thoroughly uncalled for and it has become one of my primary duties to prevent my patients from indulging in this foolhardy and expensive venture. Am I successful? Sadly, no. The media pressure and the false propaganda by the interested parties are so strong that I am like a Poodle facing of a pack of Pit bulls.
The other fad is running to consult specialists. This is another foolish and unhealthy activity. We call this compartmentalized medicine. The body is divided into several compartments and each compartment has a specialist. Heart has one, brain has one, nose has one, stomach has another and the list is growing every day. As the joke goes, a patient went with a stuck cotton bud in his left ear to an ENT [ear nose throat] specialist. That specialist refused to see him because his specialty was right ear and not left. It is my lot to see these unfortunates after they do the rounds. A person with chest pain would have gone to a cardiologist and finding nothing wrong would then have gone to lung man and then to a stomach doctor [some times stomach illness can cause chest pain] and then to a psychiatrist [if there is no cause that the other specialists can find, then, there must be something mentally wrong with the patient] and then he deems fit to see if he is lucky, a family physician. He may find the cause to be an injury to the chest wall. Supposing he had gone to the family doctor in the first place, if he [family doctor/General practitioner] had not found the cause, he would at least know where to send him. He would have saved the patient lots of money and head ache.
Another is the health insurance racket. A person who has healthy habits, who takes regular exercise and eats moderately, remains healthy well into his seventies. So why does he have to take insurance? The same premium money he can save up and invest or keep it by instead of loosing it every year to keep the insurance company happy. If you are unhealthy you will not get insurance or there will be an exclusion clause any way. Older people who really need insurance do not get it as they run a high risk of illness and therefore are not profitable for the insurance companies. The whole gamut of insurance business runs on one factor. That is fear.
Recently I have had an occasion to visit a hospital and spent some time at the reception where the patients are initially confronted. One of the first questions asked is whether you have health insurance or not? Why is this question? Will this mean that you get better attention? Certainly not. It will mean you go to a separate bracket where in your charges will certainly be higher. This is my hunch. So I advise my patients to put by some money each month and invest it. When the time comes when you are ill needing hospitalization [which never comes to most as death comes unannounced for many of us who are blessed] mostly in your old age, you have enough to take care of your expenses. Most insurance companies also have a ceiling beyond which they will not pay. In this game the insurer is not the winner; the winner is the insurance company. Do I succeed? You guessed it right? I do not.
I find a large number of my patients swallowing daily, potions of vitamins, tonics, A to Z [there is actually a name like that] minerals, health restorative oils, health foods. Again all of this is utterly useless stuff. But do they listen to me? Yes, they listen but don’t follow.
What is the solution to these problems in the community? Find a good watch dog and look after him and listen to his well intentioned barking.
Most of you watch television and newspapers and you meet friends and relatives. Subject of health, doctors and hospitals is a favorite topic of conversation. Morbid details of someone’s illness and death make very interesting topic of conversation as the conversants are not involved. But there is a lurking fear that they would be the subjects of such conversation at a later date. Then how to avoid this fate? Many believe that periodic testing [called whole body testing in their language] will tell them if they are fit or not. Little do they realize that these tests will only reveal that the tests are normal but will not tell them if they are normal or not. Thus this rush to get annual or bi annual tests done is thoroughly uncalled for and it has become one of my primary duties to prevent my patients from indulging in this foolhardy and expensive venture. Am I successful? Sadly, no. The media pressure and the false propaganda by the interested parties are so strong that I am like a Poodle facing of a pack of Pit bulls.
The other fad is running to consult specialists. This is another foolish and unhealthy activity. We call this compartmentalized medicine. The body is divided into several compartments and each compartment has a specialist. Heart has one, brain has one, nose has one, stomach has another and the list is growing every day. As the joke goes, a patient went with a stuck cotton bud in his left ear to an ENT [ear nose throat] specialist. That specialist refused to see him because his specialty was right ear and not left. It is my lot to see these unfortunates after they do the rounds. A person with chest pain would have gone to a cardiologist and finding nothing wrong would then have gone to lung man and then to a stomach doctor [some times stomach illness can cause chest pain] and then to a psychiatrist [if there is no cause that the other specialists can find, then, there must be something mentally wrong with the patient] and then he deems fit to see if he is lucky, a family physician. He may find the cause to be an injury to the chest wall. Supposing he had gone to the family doctor in the first place, if he [family doctor/General practitioner] had not found the cause, he would at least know where to send him. He would have saved the patient lots of money and head ache.
Another is the health insurance racket. A person who has healthy habits, who takes regular exercise and eats moderately, remains healthy well into his seventies. So why does he have to take insurance? The same premium money he can save up and invest or keep it by instead of loosing it every year to keep the insurance company happy. If you are unhealthy you will not get insurance or there will be an exclusion clause any way. Older people who really need insurance do not get it as they run a high risk of illness and therefore are not profitable for the insurance companies. The whole gamut of insurance business runs on one factor. That is fear.
Recently I have had an occasion to visit a hospital and spent some time at the reception where the patients are initially confronted. One of the first questions asked is whether you have health insurance or not? Why is this question? Will this mean that you get better attention? Certainly not. It will mean you go to a separate bracket where in your charges will certainly be higher. This is my hunch. So I advise my patients to put by some money each month and invest it. When the time comes when you are ill needing hospitalization [which never comes to most as death comes unannounced for many of us who are blessed] mostly in your old age, you have enough to take care of your expenses. Most insurance companies also have a ceiling beyond which they will not pay. In this game the insurer is not the winner; the winner is the insurance company. Do I succeed? You guessed it right? I do not.
I find a large number of my patients swallowing daily, potions of vitamins, tonics, A to Z [there is actually a name like that] minerals, health restorative oils, health foods. Again all of this is utterly useless stuff. But do they listen to me? Yes, they listen but don’t follow.
What is the solution to these problems in the community? Find a good watch dog and look after him and listen to his well intentioned barking.
Sunday, October 26, 2008
Sahib's constipation
Before we became independent, the British ruled us. There are many opinions as to the way they managed the affairs of the nation. But it is generally agreed that they did a fairly good job of administering this large country. This is especially true of the young officers who managed the districts and talukas. These men were fresh out of their home country, after the initial training, were posted to isolated places, thrown into a culture and people far removed from their own and yet they managed to serve the population as best as they could. They also wielded enormous powers over the subject population under their care. The following story is that of one such young officer.
He liked the country and the people and enjoyed the reputation for being fair and honest. He had to work hard to know his people and to do this he had to tour extensively. Some towns he could visit in his car but often he had to go on horseback. He would start early in the morning after his breakfast and return in the evening. Often he stayed on the outskirts of a big village in a specially designed tent.
There was one blemish which often ruined his otherwise healthy, fun and adventure filled life. He suffered from constipation. Often, days together his bowels bottled up. Help from the civil surgeon who was a fellow white made matters worse. Consultation with local varieties of doctors of different disciplines too did not help. Each morning the young sahib would wake up and wonder what is in store for him that day? If he had a bowel movement, his day was made, if not he would remain grumpy till the next day and wait.
One such morning after having failed to get his bowels move, he gave up the attempt as it was getting late for his rounds, had a hurried breakfast, and left with his driver, attendant and the office clerk who carried the relevant records pertaining to the villages the sahib would visit. The attendant carried Sahib’s Lunch and other requirements. The journey began. They must have gone a few miles when the Sahib started getting strong bowel contractions. This made him feel good. He asked his driver to stop the car at the nearest water body and urged him to hurry.
Soon they reached a bridge with a stream flowing underneath. Sahib got down and having collected his all purpose mug, hurried down to the bank of the stream. He undid his trousers and sat down for the much awaited evacuation. Alas! The strong and urgent contractions disappeared as suddenly as they had appeared. This was no uncommon experience for the Sahib. He knew that if he waited long enough he would get the contractions again and his bowels would move. So he sat patiently with his trousers down. But he kept his solar toupee on to guard against the sun.
He must have waited for ten minutes when he felt a soft thud on the toupee and a splash of gluey muck which splattered down. He looked up in time to see a native hurriedly scampering down from his perch on the side wall of the bridge. Unmindful of the state he was in, the Sahib shouted,’ catch the bugger, don’t let him go, I come up and take care of him’
The witnesses to this awful spectacle, the attendant and the clerk who were sitting by the side of the car ran and were able to stop the shivering native who by now had become aware of the enormity of his offence. He begged for mercy from the Sahib’s assistants who by virtue of their proximity to the Sahib were in themselves were frightful figures.
By now, the Sahib, came panting up the slope without his toupee and shirt which he had thrown into the stream and washed off the gluey muck off as best as he could. He saw the poor villager being beaten by his attendants. He asked them to stop and went to the shaking and shivering and thoroughly frightened villager who stood with folded hands, fear and despair writ large on his face. No sooner the sahib came near him, looking at the half naked white apparition the villager was overcome with intense fear making him fall on the ground begging forgiveness. Sahib asked him to get up and said, ‘hell with your apology, just tell me how you managed to do the job so quickly’.
Rest of the story is irrelevant.
He liked the country and the people and enjoyed the reputation for being fair and honest. He had to work hard to know his people and to do this he had to tour extensively. Some towns he could visit in his car but often he had to go on horseback. He would start early in the morning after his breakfast and return in the evening. Often he stayed on the outskirts of a big village in a specially designed tent.
There was one blemish which often ruined his otherwise healthy, fun and adventure filled life. He suffered from constipation. Often, days together his bowels bottled up. Help from the civil surgeon who was a fellow white made matters worse. Consultation with local varieties of doctors of different disciplines too did not help. Each morning the young sahib would wake up and wonder what is in store for him that day? If he had a bowel movement, his day was made, if not he would remain grumpy till the next day and wait.
One such morning after having failed to get his bowels move, he gave up the attempt as it was getting late for his rounds, had a hurried breakfast, and left with his driver, attendant and the office clerk who carried the relevant records pertaining to the villages the sahib would visit. The attendant carried Sahib’s Lunch and other requirements. The journey began. They must have gone a few miles when the Sahib started getting strong bowel contractions. This made him feel good. He asked his driver to stop the car at the nearest water body and urged him to hurry.
Soon they reached a bridge with a stream flowing underneath. Sahib got down and having collected his all purpose mug, hurried down to the bank of the stream. He undid his trousers and sat down for the much awaited evacuation. Alas! The strong and urgent contractions disappeared as suddenly as they had appeared. This was no uncommon experience for the Sahib. He knew that if he waited long enough he would get the contractions again and his bowels would move. So he sat patiently with his trousers down. But he kept his solar toupee on to guard against the sun.
He must have waited for ten minutes when he felt a soft thud on the toupee and a splash of gluey muck which splattered down. He looked up in time to see a native hurriedly scampering down from his perch on the side wall of the bridge. Unmindful of the state he was in, the Sahib shouted,’ catch the bugger, don’t let him go, I come up and take care of him’
The witnesses to this awful spectacle, the attendant and the clerk who were sitting by the side of the car ran and were able to stop the shivering native who by now had become aware of the enormity of his offence. He begged for mercy from the Sahib’s assistants who by virtue of their proximity to the Sahib were in themselves were frightful figures.
By now, the Sahib, came panting up the slope without his toupee and shirt which he had thrown into the stream and washed off the gluey muck off as best as he could. He saw the poor villager being beaten by his attendants. He asked them to stop and went to the shaking and shivering and thoroughly frightened villager who stood with folded hands, fear and despair writ large on his face. No sooner the sahib came near him, looking at the half naked white apparition the villager was overcome with intense fear making him fall on the ground begging forgiveness. Sahib asked him to get up and said, ‘hell with your apology, just tell me how you managed to do the job so quickly’.
Rest of the story is irrelevant.
Sunday, October 19, 2008
Sarosh Patel
Some weeks ago, I wrote about my primary school teacher who was responsible for some of the interests I developed later on in my life. Sadly the next fifteen years including the five years I spent in medical school, none of my peers, teachers and professors included, made much of a positive impression on me. Many of them were good teachers but none really enjoyed teaching or helping us out to understand the relationship between illness and patient. May be I am biased, but it was truly a disillusionary period, those five years were, in my life. All my ideas of nobility and sacredness attached to this profession disappeared when I saw firsthand what was happening in the hospital and college. Add personal, emotional and financial difficulties to this and you realize the dismal life I led.
I only realized what a fascinating profession medicine is, when I got out of medical school and began working in the wards as a houseman, directly involved in patient care. I was extremely fortunate in having a rare human being as my mentor. He was late Dr Sarosh Patel. Sarosh was only a few years older to me and worked as a junior doctor preparing for his post graduation in medicine. He was a hugely built man, fair as Parsees go, already balding and had a regal air around him. I was reedy, pale, and ill dressed, always ill at ease and thus we made a contrasting pair. I was fortunate that Sarosh took me under his wing and taught me the basics of patient care. He was a contrast to the boring teachers who made teaching disease centric where as Sarosh’s methods were patient centric. It is from him, for the first time I learnt that the patient was not a collection of organs, that he is ill not for our benefit and that every illness had a socio psychological background to it. Punctual, hard working, he still found time to teach me, sometimes late into the night when both of us were on duty.
He had a very bright future ahead of him. But he did not live long. Within a year of my coming to know him, he died of a brain tumour. I was told even when he was a patient at the Tata memorial at Bombay he would help in the treatment of other patients. Such an extraordinary man was Dr Sarosh Patel. My contact with him was a brief one year but I rate him as one of the finest doctors and human beings I have come across, and now after a lapse of forty-five years, I still grieve at the untimely loss.
I only realized what a fascinating profession medicine is, when I got out of medical school and began working in the wards as a houseman, directly involved in patient care. I was extremely fortunate in having a rare human being as my mentor. He was late Dr Sarosh Patel. Sarosh was only a few years older to me and worked as a junior doctor preparing for his post graduation in medicine. He was a hugely built man, fair as Parsees go, already balding and had a regal air around him. I was reedy, pale, and ill dressed, always ill at ease and thus we made a contrasting pair. I was fortunate that Sarosh took me under his wing and taught me the basics of patient care. He was a contrast to the boring teachers who made teaching disease centric where as Sarosh’s methods were patient centric. It is from him, for the first time I learnt that the patient was not a collection of organs, that he is ill not for our benefit and that every illness had a socio psychological background to it. Punctual, hard working, he still found time to teach me, sometimes late into the night when both of us were on duty.
He had a very bright future ahead of him. But he did not live long. Within a year of my coming to know him, he died of a brain tumour. I was told even when he was a patient at the Tata memorial at Bombay he would help in the treatment of other patients. Such an extraordinary man was Dr Sarosh Patel. My contact with him was a brief one year but I rate him as one of the finest doctors and human beings I have come across, and now after a lapse of forty-five years, I still grieve at the untimely loss.
Thursday, October 16, 2008
Injection mania
Over the past 35 years the attitude of patients to illness has changed. Much of this is towards the better. They now realize the importance of diagnosis and don’t insist on immediate relief. They also have realized the importance of investigations in the management of illnesses. Many have taken to exercise and prevention of disease has its due place in patient care. Despite all this, one obsession remains strong. This is the love for getting injected. The belief that medication given in the injection form is better than oral form still remains strong. This is more so with the lower socio economic sections of the population though an occasional educated upper class patient surprises me by requesting an injection.
This reminds me of an episode which occurred more than 30 years ago. The middle aged man came in supported by his son. The complaint was pain in the low back radiating down the leg. Diagnosis of disc prolapse was fairly easy. Those days we made the patient’s life miserable by confining him to bed for three weeks with the additional insult of taping the leg and attaching a weight which dangled from the edge of the bed. This we thought provided the required traction and imagined the disc would slip back into place.
We also gave liberal doses of pain killers and the prince amongst these was a drug called ergapyrin [butazolidine], a highly toxic drug but quite an effective pain killer. Adding insult injury we gave this drug in the injection form which meant a house call every day. This kind of activity took most of our time. I tried to be an exception and told this patient the illness takes three weeks and he can be managed with oral medication. He would have none of this and insisted that I give him an injection to relieve his pain for the moment and later he will try my oral medication. Very reluctantly, I prepared an injection of butazolidine and proceeded to inject this into his hip. The patient stopped me and asked what was I doing? I explained. He said that is not the place to give the injection but to his leg [he showed me the calf muscle] where there is maximum pain. My reasoning that the best place is the buttock muscle fell on deaf ears. He said his own doctor always gave the injection to the part where it hurt most and it had produced the best results.
My refusals made him tell his son, ‘let us go back home and wait for Dr----- to come back’. I lost another patient. Those days I lost two patients to every patient gained because of my methods were contrary to prevailing practices. Situation since then is better but the love for injections still remains.
Taking people for a ride
I have on occasions written about the futility of yearly screening for healthy persons. But the practice is becoming more rampant as the years go by, screening must be selective and the physician should decide who should be screened and who should not be. Young fit men who have no history of heart disease are subjected to a variety of tests which includes a hemogram, urine test, Liver and kidney function tests, blood test for lipids and sugar, Lung function test, a treadmill ECG and a resting ECG, Echocardiogram and chest X-ray. Package deals are touted in the lay media and even on television. The latest gimmickry is the laboratory/ Hospital going to the person’s residence/ office to do these mostly useless tests. If you don’t come to me I will come to you seem to be the approach? In any case they will not let you go without these tests! Needless to say that there is active connivance of the medical profession and the HR departments of companies in this money wasting [making] exercise.
Screening for disease is important for some and this should be left to the physician to decide.
Going once a year to ones doctor and taking his advice is far better and cheaper way to health than getting inveigled into these unnecessary tests done by the unscrupulous investigative agencies.
This reminds me of an episode which occurred more than 30 years ago. The middle aged man came in supported by his son. The complaint was pain in the low back radiating down the leg. Diagnosis of disc prolapse was fairly easy. Those days we made the patient’s life miserable by confining him to bed for three weeks with the additional insult of taping the leg and attaching a weight which dangled from the edge of the bed. This we thought provided the required traction and imagined the disc would slip back into place.
We also gave liberal doses of pain killers and the prince amongst these was a drug called ergapyrin [butazolidine], a highly toxic drug but quite an effective pain killer. Adding insult injury we gave this drug in the injection form which meant a house call every day. This kind of activity took most of our time. I tried to be an exception and told this patient the illness takes three weeks and he can be managed with oral medication. He would have none of this and insisted that I give him an injection to relieve his pain for the moment and later he will try my oral medication. Very reluctantly, I prepared an injection of butazolidine and proceeded to inject this into his hip. The patient stopped me and asked what was I doing? I explained. He said that is not the place to give the injection but to his leg [he showed me the calf muscle] where there is maximum pain. My reasoning that the best place is the buttock muscle fell on deaf ears. He said his own doctor always gave the injection to the part where it hurt most and it had produced the best results.
My refusals made him tell his son, ‘let us go back home and wait for Dr----- to come back’. I lost another patient. Those days I lost two patients to every patient gained because of my methods were contrary to prevailing practices. Situation since then is better but the love for injections still remains.
Taking people for a ride
I have on occasions written about the futility of yearly screening for healthy persons. But the practice is becoming more rampant as the years go by, screening must be selective and the physician should decide who should be screened and who should not be. Young fit men who have no history of heart disease are subjected to a variety of tests which includes a hemogram, urine test, Liver and kidney function tests, blood test for lipids and sugar, Lung function test, a treadmill ECG and a resting ECG, Echocardiogram and chest X-ray. Package deals are touted in the lay media and even on television. The latest gimmickry is the laboratory/ Hospital going to the person’s residence/ office to do these mostly useless tests. If you don’t come to me I will come to you seem to be the approach? In any case they will not let you go without these tests! Needless to say that there is active connivance of the medical profession and the HR departments of companies in this money wasting [making] exercise.
Screening for disease is important for some and this should be left to the physician to decide.
Going once a year to ones doctor and taking his advice is far better and cheaper way to health than getting inveigled into these unnecessary tests done by the unscrupulous investigative agencies.
Tuesday, October 14, 2008
Barak Obama
After Jimmy Carter, America did not have a president who had a vision that Americans are part of this world and world’s peace is their peace. I read Senator Obama’s views on health care delivery [NEMJ] and what he would do if elected. I am most impressed. I hope the Middle America realizes what an opportunity it has second time over [first was Al Gore] and votes for him.
Health care delivery and the costs are a major problem all over the world. Only few countries like the UK, Scandinavian countries have a fairly effective health care system. Though not foolproof at least in these countries one has access in the nationalized system. In the US you have to have expensive insurance and access to such insurance is impossible for many. Unnecessary investigations and procedures, lack of organized primary care are other serious problems. No one wants to become a general practitioner! The money he makes is not even a quarter of that of a organ specific doctor[specialist] More incentives to doctors opting for primary care[Obama’s promise] will go some way in solving the problem of providing universal health care.
Reforms come at a prize. One may have to pay more taxes and doctors [super specialists] may have to accept lesser incomes. But the working atmosphere and the beurocratic control will be less and not more if Obama’s plans succeed.
You cannot live peacefully in a world where there is so much of inequality in all aspects of life. If America elects senator Obama, there is some hope for peace not only for America but also for the whole world.
Those of you Americans, who read my blog, please don’t miss this opportunity.
Health care delivery and the costs are a major problem all over the world. Only few countries like the UK, Scandinavian countries have a fairly effective health care system. Though not foolproof at least in these countries one has access in the nationalized system. In the US you have to have expensive insurance and access to such insurance is impossible for many. Unnecessary investigations and procedures, lack of organized primary care are other serious problems. No one wants to become a general practitioner! The money he makes is not even a quarter of that of a organ specific doctor[specialist] More incentives to doctors opting for primary care[Obama’s promise] will go some way in solving the problem of providing universal health care.
Reforms come at a prize. One may have to pay more taxes and doctors [super specialists] may have to accept lesser incomes. But the working atmosphere and the beurocratic control will be less and not more if Obama’s plans succeed.
You cannot live peacefully in a world where there is so much of inequality in all aspects of life. If America elects senator Obama, there is some hope for peace not only for America but also for the whole world.
Those of you Americans, who read my blog, please don’t miss this opportunity.
Sunday, October 12, 2008
Ananth Rao
Our lives are shaped by our environment. Our environment consists of both animate and inanimate. Animate environment has people, animals and plants. All these have had their influence on us and among the many people who did have a positive influence on me, the earliest one was Mr Ananth Rao.
Ananth Rao was my Primary/middle school teacher. It was a school located in a semi urban cum rural area. He taught Mathematics and English to a class of forty children of varying background, mostly poor and middle class with a few rich. Those days there were no private schools and everyone went to these state run schools. The teachers did not bother us much and occasionally when things went out of control, however, they made liberal use of the cane.
Ananth rao rarely used the cane. His teaching methods were revolutionary [I realize it now]. His teaching of arithmetic was by using examples. He would not put 8-4= 4 on the black board. He would make eight of us stand and make the rest of us count loudly the number. Then he would ask four of us to come and sit down. Then he would ask the class to count the remaining. That would be a lesson in subtraction.
Though the spoken language in that area was Kannada, Ananth rao spoke only English when he took English language class. He made all of us do the same. He would sit and correct each of us. Sometimes it would take the whole hour to correct a simple sentence but it would stay put in our minds. That was my first lesson in spoken English. It was also then I realized that speaking good English had nothing to do with writing good English.
He had another endearing habit. He would invite a few of us to his home few kms away from school. Some of us would go there after the evening game [unorganized in open fields] more to eat the goodies his wife made rather to learn. That was in the beginning. Later we got hooked to Ananth Rao’s other activities. He would keep us spell bound with stories .I had my introduction to Dickens, Hardy, Shelly, Keats, Wodehouse and Shakespeare there at his home. My interest in Hindustani classical music too had its origins there. Mr Rao had the sense to appreciate the beauty of nature and he would take us out to witness a rainbow or to see a flowering creeper next to his wall. Thus he sowed the seeds of interest in natural history, music and appreciation of colors [became an interest in painting later]
How did a primary school teacher acquire so much knowledge and interest in various fields? It is because he wasted no time and took pleasure in perusing his hobbies and more than anything else, took pleasure in introducing these to us children. He did this for the sake of satisfaction and joy and not for fame or popularity.
Sadly, despite his best efforts, he could not get me to take interest in mathematics and many times he called me muttala because of my inability to come up to his expectations of mathematical expertise. muttala is kannada version of mutt!.
But his efforts did not entirely go waste. My daughter excelled in maths and had Mr. Rao been alive he would certainly been happy.
Ananth Rao was my Primary/middle school teacher. It was a school located in a semi urban cum rural area. He taught Mathematics and English to a class of forty children of varying background, mostly poor and middle class with a few rich. Those days there were no private schools and everyone went to these state run schools. The teachers did not bother us much and occasionally when things went out of control, however, they made liberal use of the cane.
Ananth rao rarely used the cane. His teaching methods were revolutionary [I realize it now]. His teaching of arithmetic was by using examples. He would not put 8-4= 4 on the black board. He would make eight of us stand and make the rest of us count loudly the number. Then he would ask four of us to come and sit down. Then he would ask the class to count the remaining. That would be a lesson in subtraction.
Though the spoken language in that area was Kannada, Ananth rao spoke only English when he took English language class. He made all of us do the same. He would sit and correct each of us. Sometimes it would take the whole hour to correct a simple sentence but it would stay put in our minds. That was my first lesson in spoken English. It was also then I realized that speaking good English had nothing to do with writing good English.
He had another endearing habit. He would invite a few of us to his home few kms away from school. Some of us would go there after the evening game [unorganized in open fields] more to eat the goodies his wife made rather to learn. That was in the beginning. Later we got hooked to Ananth Rao’s other activities. He would keep us spell bound with stories .I had my introduction to Dickens, Hardy, Shelly, Keats, Wodehouse and Shakespeare there at his home. My interest in Hindustani classical music too had its origins there. Mr Rao had the sense to appreciate the beauty of nature and he would take us out to witness a rainbow or to see a flowering creeper next to his wall. Thus he sowed the seeds of interest in natural history, music and appreciation of colors [became an interest in painting later]
How did a primary school teacher acquire so much knowledge and interest in various fields? It is because he wasted no time and took pleasure in perusing his hobbies and more than anything else, took pleasure in introducing these to us children. He did this for the sake of satisfaction and joy and not for fame or popularity.
Sadly, despite his best efforts, he could not get me to take interest in mathematics and many times he called me muttala because of my inability to come up to his expectations of mathematical expertise. muttala is kannada version of mutt!.
But his efforts did not entirely go waste. My daughter excelled in maths and had Mr. Rao been alive he would certainly been happy.
Thursday, October 9, 2008
Quack adversary
The first few patients who come to any doctor are not the best ones. These are the ones who come either because their own doctor is unavailable, or they owe him [their own doctor] money and cannot pay and sometimes for another opinion. It is only later on that they come to you out of choice. It is thus a hard grind to build a good practice and it takes years, as any GP will tell you. When I began practice the competition was not only from qualified ones but also from the innumerable quacks around. One of these had a formidable reputation for curing all the ailments by just feeling the pulse and went by the name of pulse doctor
One of this pulse doctor’s patients was brought to me by his mother. The boy had evidence of early malnutrition with the typical protuberant belly, discolored hair, pallor etc. I spent a patient half an hour trying to make her understand the importance of proper nutrition and how to make a nutritious meal with in her means. I gave her a prescription for a cheap hematinic and a wormicide and instructed her as to how this should be administered. She listened to me with a bored expression and took the prescription and went away. At that time I did not know what a formidable fellow the pulse doctor was! This was made clear to me within the next three days.
The lady came back and began her angry salvo, ‘What kind of a doctor are you? With your medicine my son nearly died. The pulse doctor saved him in time. You are still young and may not know the powerful effects of these drugs. Here after you be careful’ she ended, panting for breath. I couldn’t make head or tale of what she was speaking. I asked her what had happened to her son? ‘What happened you ask? I gave the medicine you gave and the boy passed hundreds of worms and many were sticking out of his bottom, and I ran to the pulse doctor and he pulled them out, he told me that you are young and inexperienced [true] and without knowing gave too strong medicine and so many worms came out, he said they should be removed few at a time like his medicines do. ‘You better be careful next time around, the next one may not be as considerate as I am to you.’ With this parting threat and without waiting for my explanation she went away.
10 years later.
That was a nasty day. I had returned after making my fifth house call and dog-tired I was but yet to start my evening surgery. There were some patients but they made way for an obviously sick person who was brought in by his attendants. I had not seen him before. History and clinical examination revealed possible pulmonary tuberculosis with cavitation, which proved to be so later on with a sputum examination and X-ray.
I told the patient the diagnosis and the treatment options. I also told him how with the prescribed treatment he should get better in a year [those days we were giving one year’s treatment]. I also told him to come daily for streptomycin injections.
I wanted to enter his name in my records and asked him. He said he is Dr------, my friend and foe the pulse doctor! Later when I came to know him better, I learnt that he was a qualified doctor! After this episode he sent me a number of patients whom he couldn’t handle and remained my friend till he passed away some years ago.
One of this pulse doctor’s patients was brought to me by his mother. The boy had evidence of early malnutrition with the typical protuberant belly, discolored hair, pallor etc. I spent a patient half an hour trying to make her understand the importance of proper nutrition and how to make a nutritious meal with in her means. I gave her a prescription for a cheap hematinic and a wormicide and instructed her as to how this should be administered. She listened to me with a bored expression and took the prescription and went away. At that time I did not know what a formidable fellow the pulse doctor was! This was made clear to me within the next three days.
The lady came back and began her angry salvo, ‘What kind of a doctor are you? With your medicine my son nearly died. The pulse doctor saved him in time. You are still young and may not know the powerful effects of these drugs. Here after you be careful’ she ended, panting for breath. I couldn’t make head or tale of what she was speaking. I asked her what had happened to her son? ‘What happened you ask? I gave the medicine you gave and the boy passed hundreds of worms and many were sticking out of his bottom, and I ran to the pulse doctor and he pulled them out, he told me that you are young and inexperienced [true] and without knowing gave too strong medicine and so many worms came out, he said they should be removed few at a time like his medicines do. ‘You better be careful next time around, the next one may not be as considerate as I am to you.’ With this parting threat and without waiting for my explanation she went away.
10 years later.
That was a nasty day. I had returned after making my fifth house call and dog-tired I was but yet to start my evening surgery. There were some patients but they made way for an obviously sick person who was brought in by his attendants. I had not seen him before. History and clinical examination revealed possible pulmonary tuberculosis with cavitation, which proved to be so later on with a sputum examination and X-ray.
I told the patient the diagnosis and the treatment options. I also told him how with the prescribed treatment he should get better in a year [those days we were giving one year’s treatment]. I also told him to come daily for streptomycin injections.
I wanted to enter his name in my records and asked him. He said he is Dr------, my friend and foe the pulse doctor! Later when I came to know him better, I learnt that he was a qualified doctor! After this episode he sent me a number of patients whom he couldn’t handle and remained my friend till he passed away some years ago.
Wednesday, October 8, 2008
Sprucing up
Recently I was away on a two weeks holiday. Made use of the opportunity to get my clinic premises done up. I gave a bare outline as to my ideas of what needs to be done to my architect and friend of many years and went my way. My friends and patients know me better than I myself do and the result of the facelift was much better than it would have been had I supervised the proceedings.
You might wonder why I did spend a packet of money to do up a place which was in no real need of sprucing up. The answer is simple. I was bored looking at the same walls, colors, pictures and wanted something different to look at which would make me happy. I had bought a metal multicolored fresco to adorn the wall facing me and had got the widow glass painted with flowers and falling leaves by a professional artist. The drab off white colours of the walls were replaced with bright yellow green and orange with partial wooden paneling.
Gifted away my old unwieldy desk and big and high examination table and replaced them with small wooden desk and a low couch. My geriatric patients often found it difficult o climb on to the old table and now I am sure they will like the new set up. The floor was re-laid with dull brown sand stone.
When I came back I was faced with this brilliant transformation. A kind of mini miracle in a matter of 15 days. A dull clinic with drab interiors was transformed into something beautiful to look at and work with in. When I told my friend how happy I am, he said, ‘most of the workers know you and wanted to please you and the result is this. There is work done for money and work done for love and what you see is work done for love’
You see my friends, the advantages of being a doctor!
I am happy to be working from the new premises, but what about my patients? Majority of them noticed the change and were happy. There were quite a few who were so immersed in their problem that the change went unnoticed and there were a few who noticed the change but were a bit apprehensive and one or two of them were bold enough to ask me, ‘ doc, I hope you are not going to hike your fee’!
But let me tell you, it does make a lot of difference, if you brighten up the place, to your well being.
You might wonder why I did spend a packet of money to do up a place which was in no real need of sprucing up. The answer is simple. I was bored looking at the same walls, colors, pictures and wanted something different to look at which would make me happy. I had bought a metal multicolored fresco to adorn the wall facing me and had got the widow glass painted with flowers and falling leaves by a professional artist. The drab off white colours of the walls were replaced with bright yellow green and orange with partial wooden paneling.
Gifted away my old unwieldy desk and big and high examination table and replaced them with small wooden desk and a low couch. My geriatric patients often found it difficult o climb on to the old table and now I am sure they will like the new set up. The floor was re-laid with dull brown sand stone.
When I came back I was faced with this brilliant transformation. A kind of mini miracle in a matter of 15 days. A dull clinic with drab interiors was transformed into something beautiful to look at and work with in. When I told my friend how happy I am, he said, ‘most of the workers know you and wanted to please you and the result is this. There is work done for money and work done for love and what you see is work done for love’
You see my friends, the advantages of being a doctor!
I am happy to be working from the new premises, but what about my patients? Majority of them noticed the change and were happy. There were quite a few who were so immersed in their problem that the change went unnoticed and there were a few who noticed the change but were a bit apprehensive and one or two of them were bold enough to ask me, ‘ doc, I hope you are not going to hike your fee’!
But let me tell you, it does make a lot of difference, if you brighten up the place, to your well being.
Thursday, July 31, 2008
Himalayan Yathra
I took two weeks off and spent time visiting some of the more important pilgrimage centres in the Gharwal Himalayas. Gangothri, Yamunothri, Kedarnath and Badrinath are places to which we [mainly Hindus] have been going since time immemorial. Mention of these places has been made even in scriptures and thus it must have been nearly 5,000 years since these journeys are being made. Why and what drove them to take this none too comfortable [downright dangerous then] journey?
Yamunothri is the origin of the river Yamuna and Gangothri is that of Ganga [in reality the origins are some way further up in the Gangothri Glacier]. But the places the pilgrims can go are the farthest they can go. These rivers are the life blood of the country and the earliest settlements of our ancestors were on the banks of these rivers and worship of these rivers thus dates back to pre history. Thus the worship and veneration has gone into the psyche of us Indians.
What about Badri and Kedarnath? Both have temples dedicated to Lord Shiva and are located at heights of around 12000 ft. After an arduous climb, you reach a place where there is a kilometer wide flat land surrounded by high rise mountains with snow caps. These two are places of indescribable beauty. My guess is that the pilgrims and other seekers must have been able to reach this height and could go no farther. They must have been awed by the beauty of the land and must have felt the Devine presence and a place where even death was welcome!
So much for the history and feeling. Now to come to some real facts. At all these places the approach is narrow and made even narrower by ill placed and kept petty shops. Garbage and dirt is strewn all over. Mendicants and beggars harass the pilgrims at every step. The shrines made up of black granite are grimy because of grease and floors are slippery. There is disorder and noise everywhere. I tried imagining how it would be if one removes all these and leave just the shrines. In my mind I saw a picture which was heavenly. It was impossible to hold on to this image as realty was otherwise.
I came back with the impression that we have no respect for our heritage and treat these great places with contempt. The sad part of the whole thing is that we even don’t know that we are sullying these shrines!
The redeeming feature of the trip was the spectacular Ganga Aarthi on the banks of the river at Haradwar. The ceremony, lasting for half an hour where in ten priests pray in praise of the mother Ganga with multi layered lamps. The evening I saw this spectacle there must have been more than 5,000 people witnessing with rarely seen discipline. I believe this thanksgiving ceremony has been going on for the last 1,200 years nonstop.
I returned home with the feeling, how nice it would be if our people show the same respect downstream and stop polluting this great river which at places is nothing but a flowing cesspool.
Yamunothri is the origin of the river Yamuna and Gangothri is that of Ganga [in reality the origins are some way further up in the Gangothri Glacier]. But the places the pilgrims can go are the farthest they can go. These rivers are the life blood of the country and the earliest settlements of our ancestors were on the banks of these rivers and worship of these rivers thus dates back to pre history. Thus the worship and veneration has gone into the psyche of us Indians.
What about Badri and Kedarnath? Both have temples dedicated to Lord Shiva and are located at heights of around 12000 ft. After an arduous climb, you reach a place where there is a kilometer wide flat land surrounded by high rise mountains with snow caps. These two are places of indescribable beauty. My guess is that the pilgrims and other seekers must have been able to reach this height and could go no farther. They must have been awed by the beauty of the land and must have felt the Devine presence and a place where even death was welcome!
So much for the history and feeling. Now to come to some real facts. At all these places the approach is narrow and made even narrower by ill placed and kept petty shops. Garbage and dirt is strewn all over. Mendicants and beggars harass the pilgrims at every step. The shrines made up of black granite are grimy because of grease and floors are slippery. There is disorder and noise everywhere. I tried imagining how it would be if one removes all these and leave just the shrines. In my mind I saw a picture which was heavenly. It was impossible to hold on to this image as realty was otherwise.
I came back with the impression that we have no respect for our heritage and treat these great places with contempt. The sad part of the whole thing is that we even don’t know that we are sullying these shrines!
The redeeming feature of the trip was the spectacular Ganga Aarthi on the banks of the river at Haradwar. The ceremony, lasting for half an hour where in ten priests pray in praise of the mother Ganga with multi layered lamps. The evening I saw this spectacle there must have been more than 5,000 people witnessing with rarely seen discipline. I believe this thanksgiving ceremony has been going on for the last 1,200 years nonstop.
I returned home with the feeling, how nice it would be if our people show the same respect downstream and stop polluting this great river which at places is nothing but a flowing cesspool.
Tuesday, June 24, 2008
Head ache which was not
Mrs. R does not see me as frequently as she did earlier on. Now a grandmother pushing 60, she divides her time between her grown up, well settled daughters abroad and her husband who is here. Therefore when she did visit me the other day, after a lapse of two years, it was a pleasant surprise. Looking at her well preserved person and happy face, my memory went back to over thirty years ago when she first visited me.
Mrs. R was then a young bride married to an up and coming business executive. She came from a semirural background from Andhrapradesh, with small town lower middle class upbringing and could hardly speak English. My smattering Telugu left very poor impression. But what saved the day for us was her ability to speak Urdu with a typical Telangana accent. My Shivajinagar/Cox town patients had forced me to learn the language and thus we could make reasonable conversation and that has stood the test of time. Now she speaks very good English but the Lingua franca between us has remained Urdu!
Soon after her marriage she was thrown into a very unfamiliar and quite unsettling life. She was not familiar with the corporate social life with its own dress code, mannerisms; habits of eating and other norms of behavior which often conflicted with her upbringing. Her husband was a nice enough Youngman but expected her to fall in line, the earlier the better. Inability to speak good and properly accented English was a major disadvantage.
So, young Mrs. R started getting spells of acute anxiety associated with fear. Evenings, when other young persons look forward to, became the times when her anxiety was at its worse. This was the time when she was forced to attend parties and she would dread these outings. Her worry and the feelings of inefficiency and inability to please her husband [he did not say so] added to make her lose whatever self esteem she processed.
Her young husband made her agree to see a psychiatrist who made a prompt diagnosis of panic attacks and put her on medication. These medicines made her worse. This was the time she came to see me.
The presenting problem was frequent episodes of head ache. The history was very typical of migraine. At her first visit she did not reveal her miserable social life. That came later when we became sort of friends. It was not difficult to counsel her as to how to manage her life. With her husband’s active cooperation and her own basic ability she overcame most of her problems and in the course of her life became a fairly successful corporate wife and a hostess.
The headaches however persisted and she would suffer a day or two and get better whatever may be the medication. I even started suspecting whether she made up the headaches so that she can consult with me and unburden herself of whatever may be the problem that was bugging her at that moment. These come and go headaches persisted and both of us were happy. I with the knowledge that she will definitely get better whatever is the medication and she with the knowledge that the head ache came in handy to have a chat with her doctor.
This happy state lasted almost 15 years when her head aches took a serious turn. Her visits with the head ache became more frequent and lasted longer and the usual medications did not seem to work. I kept asking her whether she has any new stress which she has not discussed with me. She kept denying and to a good measure added that she was never more comfortable with her mental state than she is now. She also said the headaches have changed character and location.
Despite her assertion that the headaches she was getting are different it took me three months and a bout of vomiting [by her] to think differently from the usual migraine head ache. Even then, more to satisfy her than with any conviction that I would find any pathology I asked for a CT brain which had just then become available.
To my utter surprise there was a fairly large ring lesion with surrounding edema in the periphery of parietal lobe exactly beneath the area where she was complaining of ache. Now I had the rather onerous job of explaining to her that she had tuberculosis of the brain and she needed a year’s therapy. I took my time and explained over a period of an hour to her and her husband the intricacies of treatment. I could not help telling her that I should have listened to her when she told me that the aches were of a different nature and asked for the test 3 months earlier. The relationship built over a decade came to my rescue. Instead of telling me,’ I told you so, you stupid man’ [she would have been justified in calling me so] she said, ‘I must thank you for asking to doing this test which clearly showed what I am having and is curable, I was so worried that it could be cancer’
Within two weeks of therapy her head aches subsided and she went through with the year’s medication without any problem and fully recovered.
Interestingly, throughout the year her migraine headaches did not appear but they promptly did within three months of cessation of anti TB therapy!
She must have guessed, she said with a smile, ‘I have not come for head ache doctor, but to check with you this problem I am having and went on to explain, which is another story I will write about some other time.
Mrs. R was then a young bride married to an up and coming business executive. She came from a semirural background from Andhrapradesh, with small town lower middle class upbringing and could hardly speak English. My smattering Telugu left very poor impression. But what saved the day for us was her ability to speak Urdu with a typical Telangana accent. My Shivajinagar/Cox town patients had forced me to learn the language and thus we could make reasonable conversation and that has stood the test of time. Now she speaks very good English but the Lingua franca between us has remained Urdu!
Soon after her marriage she was thrown into a very unfamiliar and quite unsettling life. She was not familiar with the corporate social life with its own dress code, mannerisms; habits of eating and other norms of behavior which often conflicted with her upbringing. Her husband was a nice enough Youngman but expected her to fall in line, the earlier the better. Inability to speak good and properly accented English was a major disadvantage.
So, young Mrs. R started getting spells of acute anxiety associated with fear. Evenings, when other young persons look forward to, became the times when her anxiety was at its worse. This was the time when she was forced to attend parties and she would dread these outings. Her worry and the feelings of inefficiency and inability to please her husband [he did not say so] added to make her lose whatever self esteem she processed.
Her young husband made her agree to see a psychiatrist who made a prompt diagnosis of panic attacks and put her on medication. These medicines made her worse. This was the time she came to see me.
The presenting problem was frequent episodes of head ache. The history was very typical of migraine. At her first visit she did not reveal her miserable social life. That came later when we became sort of friends. It was not difficult to counsel her as to how to manage her life. With her husband’s active cooperation and her own basic ability she overcame most of her problems and in the course of her life became a fairly successful corporate wife and a hostess.
The headaches however persisted and she would suffer a day or two and get better whatever may be the medication. I even started suspecting whether she made up the headaches so that she can consult with me and unburden herself of whatever may be the problem that was bugging her at that moment. These come and go headaches persisted and both of us were happy. I with the knowledge that she will definitely get better whatever is the medication and she with the knowledge that the head ache came in handy to have a chat with her doctor.
This happy state lasted almost 15 years when her head aches took a serious turn. Her visits with the head ache became more frequent and lasted longer and the usual medications did not seem to work. I kept asking her whether she has any new stress which she has not discussed with me. She kept denying and to a good measure added that she was never more comfortable with her mental state than she is now. She also said the headaches have changed character and location.
Despite her assertion that the headaches she was getting are different it took me three months and a bout of vomiting [by her] to think differently from the usual migraine head ache. Even then, more to satisfy her than with any conviction that I would find any pathology I asked for a CT brain which had just then become available.
To my utter surprise there was a fairly large ring lesion with surrounding edema in the periphery of parietal lobe exactly beneath the area where she was complaining of ache. Now I had the rather onerous job of explaining to her that she had tuberculosis of the brain and she needed a year’s therapy. I took my time and explained over a period of an hour to her and her husband the intricacies of treatment. I could not help telling her that I should have listened to her when she told me that the aches were of a different nature and asked for the test 3 months earlier. The relationship built over a decade came to my rescue. Instead of telling me,’ I told you so, you stupid man’ [she would have been justified in calling me so] she said, ‘I must thank you for asking to doing this test which clearly showed what I am having and is curable, I was so worried that it could be cancer’
Within two weeks of therapy her head aches subsided and she went through with the year’s medication without any problem and fully recovered.
Interestingly, throughout the year her migraine headaches did not appear but they promptly did within three months of cessation of anti TB therapy!
She must have guessed, she said with a smile, ‘I have not come for head ache doctor, but to check with you this problem I am having and went on to explain, which is another story I will write about some other time.
Monday, June 23, 2008
Success
Indian news papers have publicized the dwelling house that Mr. Mukesh Ambani is building in Mumbai. When completed it will be the most expensive house in the world. Mr. Ambani is one of the top five richest men in the world and very successful businessman and industrialist. The house is meant for his small family of four or [is it five?]. We Indians have a tradition for ostentatious splurging and Mr. Ambani is no exception [he may not think so]. Going by the prevailing parameters Mr. Mukesh Ambani is a very big success.
I came to know Mr. Chinnappa when he was a teenager, 30 years ago. Then he was trying to get through his school final. He lived with his sister and she fed and clothed him. His own father was too poor to look after this boy. The sister’s family had just enough to manage and one additional mouth to feed was gracefully accepted.
Chinnappa got a small job as an operator in a cinema hall and also started working for me part time, to supplement his income. His duties then and now involve cleaning up my clinic and house, doing odd jobs, shopping and paying my bills. When the cinema hall became a multiplex he lost that job. He had become quite popular amongst my friends and began visiting a friend and patient of mine who has become demented, twice a week so that his [patients] wife could get a few hours of relief. He goes every other day to another elderly couple’s house to help them with their shopping and gardening. He thus makes more or less the same kind of money that he used to make when he was a screen operator. More than the money part of it, he has become extremely useful to all of us. Not very intelligent, but very honest, punctual and trust worthy, Mr. Chinnappa has not once complained about life and his lot.
I am not comparing but success is relative and doesn’t necessarily mean financial. There are many kinds of successes and my friend Chinnappa’ s is one such.
I came to know Mr. Chinnappa when he was a teenager, 30 years ago. Then he was trying to get through his school final. He lived with his sister and she fed and clothed him. His own father was too poor to look after this boy. The sister’s family had just enough to manage and one additional mouth to feed was gracefully accepted.
Chinnappa got a small job as an operator in a cinema hall and also started working for me part time, to supplement his income. His duties then and now involve cleaning up my clinic and house, doing odd jobs, shopping and paying my bills. When the cinema hall became a multiplex he lost that job. He had become quite popular amongst my friends and began visiting a friend and patient of mine who has become demented, twice a week so that his [patients] wife could get a few hours of relief. He goes every other day to another elderly couple’s house to help them with their shopping and gardening. He thus makes more or less the same kind of money that he used to make when he was a screen operator. More than the money part of it, he has become extremely useful to all of us. Not very intelligent, but very honest, punctual and trust worthy, Mr. Chinnappa has not once complained about life and his lot.
I am not comparing but success is relative and doesn’t necessarily mean financial. There are many kinds of successes and my friend Chinnappa’ s is one such.
Thursday, May 22, 2008
Crime by women against women
There is enough evidence to show that delivering the fetus by C-section [involves surgically opening the abdomen and uterus and taking the live fetus out] carries increased risk to the mother and the child when compared to normal vaginal delivery. It is also known that higher the economic status of the woman the higher is her chances of getting a C-section done. This is also true in urban set up rather than in a rural set up. The percentages vary but in urban India it is 42% and above [Madras study]
There are definite indications for this procedure. Some of them are small pelvis, abnormal fetal position, delayed labour, fetal distress, maternal distress, wrongly placed placenta etc. These constitute around 2 to 5% of the pregnancies and the procedure is life saving in these. But what about the rest? If it is medically unnecessary why is it being done?
Here are some sordid facts
Surgical delivery in contrast to normal vaginal delivery means use of operating theatre, anesthesia, and increased duration of hospital stay. All this mean more money to all the parties concerned.
The obstetrician can deliver the baby at his or her convenience instead of waiting for the natural child birth to occur which may happen at an inconvenient time [to the doctor]
It is easy to convince the mother to agree for the caesarian section.
One can thus come to the inevitable conclusion that these deliveries are done because of greed and convenience and not for valid reasons in a high percentage of cases.
Majority of obstetricians are women
There are definite indications for this procedure. Some of them are small pelvis, abnormal fetal position, delayed labour, fetal distress, maternal distress, wrongly placed placenta etc. These constitute around 2 to 5% of the pregnancies and the procedure is life saving in these. But what about the rest? If it is medically unnecessary why is it being done?
Here are some sordid facts
Surgical delivery in contrast to normal vaginal delivery means use of operating theatre, anesthesia, and increased duration of hospital stay. All this mean more money to all the parties concerned.
The obstetrician can deliver the baby at his or her convenience instead of waiting for the natural child birth to occur which may happen at an inconvenient time [to the doctor]
It is easy to convince the mother to agree for the caesarian section.
One can thus come to the inevitable conclusion that these deliveries are done because of greed and convenience and not for valid reasons in a high percentage of cases.
Majority of obstetricians are women
Sunday, May 18, 2008
Good, bad and the ugly
The dramatic entry of the twenty twenty cricket into the Indian cricket scene and the apparent success made me write this piece.
Many large cities of the country boast well built spacious stadia exclusively meant for playing cricket. The spectator capacity varies from 35000 to 100,000! Except for a few days in a year most of these facilities remain unutilized or underutilized. With the introduction of 20/20 cricket, most of these stadia have come alive with spectators jamming the stands. Imagine over 50 matches held over a three months time! It is a win win situation for the players, the corporate backers and the paying cricket crazy public. These matches have thrown open the doors of riches to many players who have had no hope of making it to the national squad and to many ex players who are past their prime and many players from other countries who for one reason or the other fine themselves free to take part in these matches, Needless to say that money plays a very important role in motivating these players to play in these matches, hereafter called as Indian premier league! India’s darling, M.S.Dhoni reportedly was bought by a corporate house for 6000,000 rupees! For those who want to know what it is in dollars, the going rate is 40 Rs per dollar. The glitz and glamour is provided by film stars and business tycoons who have made use of this opportunity to become more visible and sell their wares.
Now let me come to the bad part of the show
Test cricket as we know now, played over five days with bowlers and batsmen trying to excel in the traditional manner of play, seem to be on its way out. The days of the square cut, the drive are over. The spectacle of a fast bowler running up to bowl with three slips and a gully waiting for the edged catch, may not be available for the next gen of cricket lovers. In 20/20 there is no place for the slip, he is needed to guard the boundary to catch the lofted pull or punch. The days of Tedulkars, Dravids and Gangulys will give way to others who will master the art of innovating new array of strokes and the batsmen will rule the game. Money bags and not the discerning cricket lover will dictate how this game is going to be played and who plays it. Genuine lovers of the game will find it tough to understand the new and changed rules of how the game is played. This shorter version which is over in 120 minutes with guaranteed result and short lived excitement is prime time viewing and going by the ratings, all other channels have taken a beating. Why watch the important news channel when the 20/20 match is on?
The ugly part
The spectacle of batsman trying to scoop the ball over the wicket keeper’s head and getting applauded in the bargain! The sight of a batsman rising on his toes and coming down on a ball like hitting a golf ball with a pitching wedge! Such an ugly sight but effective stroke in getting runs! The sight of the ball disappearing over the square leg boundary from a ball pitched ouside the off stump! Blasphemy. Then there is less than acceptable sight of men and women behaving like demented dervishes, in the stands and of players spitting allover in the playing area in the full glare of the TV cameras. But then, these are changing times and who will listen to the lamentation of an old fool like me!
Many large cities of the country boast well built spacious stadia exclusively meant for playing cricket. The spectator capacity varies from 35000 to 100,000! Except for a few days in a year most of these facilities remain unutilized or underutilized. With the introduction of 20/20 cricket, most of these stadia have come alive with spectators jamming the stands. Imagine over 50 matches held over a three months time! It is a win win situation for the players, the corporate backers and the paying cricket crazy public. These matches have thrown open the doors of riches to many players who have had no hope of making it to the national squad and to many ex players who are past their prime and many players from other countries who for one reason or the other fine themselves free to take part in these matches, Needless to say that money plays a very important role in motivating these players to play in these matches, hereafter called as Indian premier league! India’s darling, M.S.Dhoni reportedly was bought by a corporate house for 6000,000 rupees! For those who want to know what it is in dollars, the going rate is 40 Rs per dollar. The glitz and glamour is provided by film stars and business tycoons who have made use of this opportunity to become more visible and sell their wares.
Now let me come to the bad part of the show
Test cricket as we know now, played over five days with bowlers and batsmen trying to excel in the traditional manner of play, seem to be on its way out. The days of the square cut, the drive are over. The spectacle of a fast bowler running up to bowl with three slips and a gully waiting for the edged catch, may not be available for the next gen of cricket lovers. In 20/20 there is no place for the slip, he is needed to guard the boundary to catch the lofted pull or punch. The days of Tedulkars, Dravids and Gangulys will give way to others who will master the art of innovating new array of strokes and the batsmen will rule the game. Money bags and not the discerning cricket lover will dictate how this game is going to be played and who plays it. Genuine lovers of the game will find it tough to understand the new and changed rules of how the game is played. This shorter version which is over in 120 minutes with guaranteed result and short lived excitement is prime time viewing and going by the ratings, all other channels have taken a beating. Why watch the important news channel when the 20/20 match is on?
The ugly part
The spectacle of batsman trying to scoop the ball over the wicket keeper’s head and getting applauded in the bargain! The sight of a batsman rising on his toes and coming down on a ball like hitting a golf ball with a pitching wedge! Such an ugly sight but effective stroke in getting runs! The sight of the ball disappearing over the square leg boundary from a ball pitched ouside the off stump! Blasphemy. Then there is less than acceptable sight of men and women behaving like demented dervishes, in the stands and of players spitting allover in the playing area in the full glare of the TV cameras. But then, these are changing times and who will listen to the lamentation of an old fool like me!
Thursday, May 1, 2008
Milky Way
I have known Fatima since her school days. Never a bright one, she struggled through school and it was no surprise to me that she couldn’t finish school. I felt she was very relieved when the marriage proposal came, not because of the forthcoming bliss of married life but at the prospect of relief from the tedium of school. I was fond of her because of her sunny nature and whenever she came, I was assured of a laugh one way or the other. Either she laughed at me or I laughed at her. She went away to distant Coimbatore and I saw less of her then on. But each year she returned to her father’s house either to a deliver a baby or to spend the school holidays. Her husband, I saw little of but the father who is also my friend a great deal, during the days when she and her children were here with him.
Not quick on the uptake [she], I used to have a hard time explaining why and what of her illness whenever she fell ill in the years before her marriage. But she was not a difficult patient and she followed instructions to the letter whether she understood the advice or not. Inevitably, during her time spent in Bangalore, she would see me, now more for her children’s sake that for herself. As to her own health she cared a damn and was becoming fatter by the month. That seemed bother no one except me. Whenever I pointed this out to her, she would retort ‘it is not healthy to be like you, thin and skinny [those days, twenty years ago, I was much thinner than I am now]!’ I had no answer to this because this misconception of health that being fat is healthy was also shared by her father and her husband and against this trio I was helpless.
Let me get back to the incident I was trying to recall. It was a worried looking Fatima Begum [Now she is respectfully married and a mother to add] who came with her two year old toddler. He looked fine to me as the boy wasted no time in attacking the strewn odds and ends that usually can be found on my table which are a child’s delight. The nakko, nakko [no, no] cries of the mother went unheeded as the boy proceeded to throw these on to the floor. Hearing the commotion, the grandpa, my friend, rushed inside only to see the grandson at his usual best [I forget his name now]. The boy became quiet as he had my knee hammer with him and he was giving it a close look.
The mother told me the reason why she was here to see me. ‘Look doctor, my son is bringing milk out of his ear since three days. This is despite my stopping milk for the last three days’ I was a bit taken aback. Without asking her any further questions, I tried having a good look at the ear. Like mother like son. I couldn’t believe a child of that age being so cooperative. Embodiment of docility. The only interest he showed was in trying to inspect my autoscope. The ear was full of whitish pus which my friend, his mother thought was milk. I was curious to know how a reasonably educated girl could believe that the milk given orally can find its way to the ear. I made enquiries and true to form, Dr Seshachalam, her Coimbatore doctor, by the way of explanation had told her that. In a way he is a better doctor than I. Dr Seshachalam did not waste time trying to explain the intricacies of chronic ear infection to a person like Fatima. She needed a simple, easy to understand explanation and he had given her one. This was not the first time he had done one better on me and I have accepted defeat quite gracefully, as his treatment[unlike his explanations] for any given ailment was always correct.
Now the difficult question, what should I do? If I agree with Doc Seshachalam’s advice, this simple woman will starve the boy each time he has an ear discharge. I asked her, ‘did Dr Seshachalam ever ask you to stop giving him milk?’ She said no. ‘He did not say that, he said only little goes to the ear and the rest goes to the stomach, it is only I who took this precaution’. I saw a silver lining and caught on to it. Told her to restart milk feeds and despite the knowledge that she will not believe me, spent some time explaining why and how of ear infection.
Out of respect and for old time’s sake, she listened to me patiently, took the prescription and snatched the knee hammer from the wailing child’s reluctant grip, placed it back on the table, thanked me and went away.
I was sure she would return again to provide me with some other form of entertainment.
Not quick on the uptake [she], I used to have a hard time explaining why and what of her illness whenever she fell ill in the years before her marriage. But she was not a difficult patient and she followed instructions to the letter whether she understood the advice or not. Inevitably, during her time spent in Bangalore, she would see me, now more for her children’s sake that for herself. As to her own health she cared a damn and was becoming fatter by the month. That seemed bother no one except me. Whenever I pointed this out to her, she would retort ‘it is not healthy to be like you, thin and skinny [those days, twenty years ago, I was much thinner than I am now]!’ I had no answer to this because this misconception of health that being fat is healthy was also shared by her father and her husband and against this trio I was helpless.
Let me get back to the incident I was trying to recall. It was a worried looking Fatima Begum [Now she is respectfully married and a mother to add] who came with her two year old toddler. He looked fine to me as the boy wasted no time in attacking the strewn odds and ends that usually can be found on my table which are a child’s delight. The nakko, nakko [no, no] cries of the mother went unheeded as the boy proceeded to throw these on to the floor. Hearing the commotion, the grandpa, my friend, rushed inside only to see the grandson at his usual best [I forget his name now]. The boy became quiet as he had my knee hammer with him and he was giving it a close look.
The mother told me the reason why she was here to see me. ‘Look doctor, my son is bringing milk out of his ear since three days. This is despite my stopping milk for the last three days’ I was a bit taken aback. Without asking her any further questions, I tried having a good look at the ear. Like mother like son. I couldn’t believe a child of that age being so cooperative. Embodiment of docility. The only interest he showed was in trying to inspect my autoscope. The ear was full of whitish pus which my friend, his mother thought was milk. I was curious to know how a reasonably educated girl could believe that the milk given orally can find its way to the ear. I made enquiries and true to form, Dr Seshachalam, her Coimbatore doctor, by the way of explanation had told her that. In a way he is a better doctor than I. Dr Seshachalam did not waste time trying to explain the intricacies of chronic ear infection to a person like Fatima. She needed a simple, easy to understand explanation and he had given her one. This was not the first time he had done one better on me and I have accepted defeat quite gracefully, as his treatment[unlike his explanations] for any given ailment was always correct.
Now the difficult question, what should I do? If I agree with Doc Seshachalam’s advice, this simple woman will starve the boy each time he has an ear discharge. I asked her, ‘did Dr Seshachalam ever ask you to stop giving him milk?’ She said no. ‘He did not say that, he said only little goes to the ear and the rest goes to the stomach, it is only I who took this precaution’. I saw a silver lining and caught on to it. Told her to restart milk feeds and despite the knowledge that she will not believe me, spent some time explaining why and how of ear infection.
Out of respect and for old time’s sake, she listened to me patiently, took the prescription and snatched the knee hammer from the wailing child’s reluctant grip, placed it back on the table, thanked me and went away.
I was sure she would return again to provide me with some other form of entertainment.
Sunday, April 20, 2008
Golfing in hell
Story is told of two persons who had committed equal number of sins on earth. When they died, going by their record, they both deserved to go to hell. But one was sent to heaven and the other was shown the way to hell. Naturally the hell bound fellow objected to this discrimination. He was told that the other man who was sent to heaven was a golfer and had already been through hell on earth every time he played golf!
But looking at my fellow golfers I often wonder how many of them really deserve to go to heaven. Take for example the conscious grave diggers. I am surprised at the furor created in the press some years ago when Shivsainiks [members of a political organization with linguistic and cultural bias] in their misplaced sense of patriotism dug up the Ferozshah Kotla cricket ground. This is located in the national capital of New Delhi where cricket matches are held. This kind of digging on a much larger scale goes on in hundreds of golf courses. To see pock marked fairways and pitted greens, thanks to unrepaired divots and pitch marks is nothing unusual. While the Shivsainiks were hauled to jail for doing what they thought was a patriotic act, golfers continue to labor digging up mini graves all over our golf courses.
Adding to this, there are gentlemen who believe that the fairway is the ideal place to throw away their empty cigarette packets and cigarette buts and the empty obnoxious sachets that once contained tobacco chew. I am forever surprised that despite having a caddy and enough storage space in their bags, these gentlemen [?] indulge in messing up our beautiful fairways.
Then there are slow torture specialists. These are those who come to the golf course, more for their leisurely constitutional rather than a game of golf. Surely, a leisurely walk in the sylvan surroundings is highly advisable and may even be therapeutic, but my objection is to their taking five hours to walk the 6000 yards when behind them are guys like me who want to do it in three hours!
One venerable group, all of them 70 plus and happily [for them] retired from active life, play regularly on our course. Even caddies hesitate to carry your bags when this foursome is ahead of you. To add to their slow play, they are won’t to get into heated arguments, during the course of which they quite often forget what the argument was all about. Playing behind them one day, I was a mute witness to a long and heated argument and met one of them walking back in a huff. I couldn’t help asking him what the argument was all about. He stopped and thought for a while but try as he did he couldn’t recollect the reason why. He suggested I ask the threesome ahead and satisfy my curiosity, but, he declared, he would not play with these characters ever again! True to character and his short memory, the inseparable four ball were in place the next appointed day as though nothing had happened on the previous occasion!
On another occasion an exasperated golfer went up to them asked them to speed up the game. He was ticked off true and proper. When he reached their age he was warned, he would probably take twice as much time and may not even be able to play the game. An irrelevant reply, but enough to silence the upstart. We at the time of writing don’t know how to handle this group. If you have any sure cure suggestions to make this foursome play faster with out unduly hurting them too much please let the writer know.
There are other golfers who think the golf course is the ideal place to have a picnic of sorts. Our club in its wisdom has provided kiosks at two places and this encourages these. There are foursomes who spend time here leisurely imbibing biscuits and beverages and discussing the weighty affairs of the world. One foursome has taken to sitting on the bench after finishing their repast and is galvanized into sudden activity as soon as they sight the following foursome leaving the putting green. On reaching the tee one is likely to see one of them teeing the ball with the club in one hand and a cup of steaming coffee in the other. No doubt the disposable cup will be thrown on the fairway causing further annoyance to the group following. As it happens at two places on the course and you can imagine the hold ups this causes on a busy week end. Instead of the suffered wait, most of us have also taken to having the not always welcome breaks.
Our club has recently set up number of toilets around the course. You may wonder why when we have a club house which has more number of toilets than rooms. But when you consider the number of golfers afflicted with weak bladders, who ever so frequently water the trees around the course and was a sight for the sore eyes, this additional provision of toilets is thus welcome. But has contributed to the delay.
Particularly offending are the golfer’s conversation at decibel levels loud enough to heard through out the course. Especially annoying are their celebratory shouts after sinking a put. While I appreciate their pleasure in sinking a long put or difficult put. I don’t believe it is a worthy enough achievement to deserve such high decibel woops. Besides I have on several occasions missed certain puts after getting jolted by these joyous exclamations on the adjacent green. Unfortunately let me remind these insensitive revelers, that golf rules don’t permit one to take the put again.
You may wonder why, despite all this irritation, I continue to torture my self every week end on the golf course. Well it is one way of reserving my heavenly berth.
This story I wrote many years ago which got published in journal devoted to golf.
On sparrows and urban life
My friend Dr SRJ in addition to being a good physician is a well known wild life photographer. His knowledge of flora and fauna is much deeper than mine. But I write on what I see around me and he doesn’t. He has commented [read his comments] on the disappearance of the sparrow from urban Bangalore. The health or otherwise of our delicate environment is often judged by the presence or absence of some forms of life. Sparrow is one such example. Sparrow and Crow are two birds who lived with humans in perfect harmony. Why then the crow has multiplied and sparrow has almost disappeared?
Here are some interesting phenomena which are linked to our changing lifestyle.
Years ago this city had many beautiful tile roofed homes [some relics can still be found in some old localities]. City also had hedges instead of cemented compounds. These were ideal nesting sites and it was very common to see hundreds of sparrows living in close proximity, unafraid and friendly. They survived mostly on grains. People those days carried grains in hessian [jute] bags and spillage was common. They also had this habit of spreading grains on mats on the verandahs to dry. Concrete has replaced the tiled roof and plastic the porous hessian.
In some pockets of the city, like Shivajinagar and Lakhmipuram I have seen sparrows still surviving!
Crow multiplied because it thrives on garbage which the fastidious sparrow cannot stomach!
But looking at my fellow golfers I often wonder how many of them really deserve to go to heaven. Take for example the conscious grave diggers. I am surprised at the furor created in the press some years ago when Shivsainiks [members of a political organization with linguistic and cultural bias] in their misplaced sense of patriotism dug up the Ferozshah Kotla cricket ground. This is located in the national capital of New Delhi where cricket matches are held. This kind of digging on a much larger scale goes on in hundreds of golf courses. To see pock marked fairways and pitted greens, thanks to unrepaired divots and pitch marks is nothing unusual. While the Shivsainiks were hauled to jail for doing what they thought was a patriotic act, golfers continue to labor digging up mini graves all over our golf courses.
Adding to this, there are gentlemen who believe that the fairway is the ideal place to throw away their empty cigarette packets and cigarette buts and the empty obnoxious sachets that once contained tobacco chew. I am forever surprised that despite having a caddy and enough storage space in their bags, these gentlemen [?] indulge in messing up our beautiful fairways.
Then there are slow torture specialists. These are those who come to the golf course, more for their leisurely constitutional rather than a game of golf. Surely, a leisurely walk in the sylvan surroundings is highly advisable and may even be therapeutic, but my objection is to their taking five hours to walk the 6000 yards when behind them are guys like me who want to do it in three hours!
One venerable group, all of them 70 plus and happily [for them] retired from active life, play regularly on our course. Even caddies hesitate to carry your bags when this foursome is ahead of you. To add to their slow play, they are won’t to get into heated arguments, during the course of which they quite often forget what the argument was all about. Playing behind them one day, I was a mute witness to a long and heated argument and met one of them walking back in a huff. I couldn’t help asking him what the argument was all about. He stopped and thought for a while but try as he did he couldn’t recollect the reason why. He suggested I ask the threesome ahead and satisfy my curiosity, but, he declared, he would not play with these characters ever again! True to character and his short memory, the inseparable four ball were in place the next appointed day as though nothing had happened on the previous occasion!
On another occasion an exasperated golfer went up to them asked them to speed up the game. He was ticked off true and proper. When he reached their age he was warned, he would probably take twice as much time and may not even be able to play the game. An irrelevant reply, but enough to silence the upstart. We at the time of writing don’t know how to handle this group. If you have any sure cure suggestions to make this foursome play faster with out unduly hurting them too much please let the writer know.
There are other golfers who think the golf course is the ideal place to have a picnic of sorts. Our club in its wisdom has provided kiosks at two places and this encourages these. There are foursomes who spend time here leisurely imbibing biscuits and beverages and discussing the weighty affairs of the world. One foursome has taken to sitting on the bench after finishing their repast and is galvanized into sudden activity as soon as they sight the following foursome leaving the putting green. On reaching the tee one is likely to see one of them teeing the ball with the club in one hand and a cup of steaming coffee in the other. No doubt the disposable cup will be thrown on the fairway causing further annoyance to the group following. As it happens at two places on the course and you can imagine the hold ups this causes on a busy week end. Instead of the suffered wait, most of us have also taken to having the not always welcome breaks.
Our club has recently set up number of toilets around the course. You may wonder why when we have a club house which has more number of toilets than rooms. But when you consider the number of golfers afflicted with weak bladders, who ever so frequently water the trees around the course and was a sight for the sore eyes, this additional provision of toilets is thus welcome. But has contributed to the delay.
Particularly offending are the golfer’s conversation at decibel levels loud enough to heard through out the course. Especially annoying are their celebratory shouts after sinking a put. While I appreciate their pleasure in sinking a long put or difficult put. I don’t believe it is a worthy enough achievement to deserve such high decibel woops. Besides I have on several occasions missed certain puts after getting jolted by these joyous exclamations on the adjacent green. Unfortunately let me remind these insensitive revelers, that golf rules don’t permit one to take the put again.
You may wonder why, despite all this irritation, I continue to torture my self every week end on the golf course. Well it is one way of reserving my heavenly berth.
This story I wrote many years ago which got published in journal devoted to golf.
On sparrows and urban life
My friend Dr SRJ in addition to being a good physician is a well known wild life photographer. His knowledge of flora and fauna is much deeper than mine. But I write on what I see around me and he doesn’t. He has commented [read his comments] on the disappearance of the sparrow from urban Bangalore. The health or otherwise of our delicate environment is often judged by the presence or absence of some forms of life. Sparrow is one such example. Sparrow and Crow are two birds who lived with humans in perfect harmony. Why then the crow has multiplied and sparrow has almost disappeared?
Here are some interesting phenomena which are linked to our changing lifestyle.
Years ago this city had many beautiful tile roofed homes [some relics can still be found in some old localities]. City also had hedges instead of cemented compounds. These were ideal nesting sites and it was very common to see hundreds of sparrows living in close proximity, unafraid and friendly. They survived mostly on grains. People those days carried grains in hessian [jute] bags and spillage was common. They also had this habit of spreading grains on mats on the verandahs to dry. Concrete has replaced the tiled roof and plastic the porous hessian.
In some pockets of the city, like Shivajinagar and Lakhmipuram I have seen sparrows still surviving!
Crow multiplied because it thrives on garbage which the fastidious sparrow cannot stomach!
Thursday, April 17, 2008
Foreign medicine
Many years ago, there was a popular quack [qualified] in my neighborhood. He was known as German doctor. He came to be known by this name because his wife was German. How this made him a popular doctor, don’t ask me. He exploited all the beliefs of patients to his advantage. One belief that exists even to this day is that medication given by the injection form is better than given orally. Most doctors sooner or later will accept the patient’s belief and come to believe in it themselves!
This German doctor would ask the patient to choose between desi and foreign make. He would subtly suggest that the desi one is cheaper but of dubious value [those days with some justification] where as the foreign one is powerful but expensive. Needless to say the patients chose the powerful one. As I was very reluctant to inject when it was not warranted, I soon developed my own reputation as a no injection doctor! As education in matters related to medicine spread, patients of the type who knew the truth or who were afraid of the injections began drifting towards me. One of these was the German wife of this doctor. She came to me with severe menorrhagia [excessive bleeding during menstruation] that her husband could not stop with his powerful injections. I had to urgently hospitalize her and after stabilization get a hysterectomy [removal of uterus] done. She became my friend and patient and in the course of time her husband too became one and would send an occasional patient to me. Interestingly, I found him to quite knowledgeable despite the questionable methods he used to keep his patients happy.
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This German doctor would ask the patient to choose between desi and foreign make. He would subtly suggest that the desi one is cheaper but of dubious value [those days with some justification] where as the foreign one is powerful but expensive. Needless to say the patients chose the powerful one. As I was very reluctant to inject when it was not warranted, I soon developed my own reputation as a no injection doctor! As education in matters related to medicine spread, patients of the type who knew the truth or who were afraid of the injections began drifting towards me. One of these was the German wife of this doctor. She came to me with severe menorrhagia [excessive bleeding during menstruation] that her husband could not stop with his powerful injections. I had to urgently hospitalize her and after stabilization get a hysterectomy [removal of uterus] done. She became my friend and patient and in the course of time her husband too became one and would send an occasional patient to me. Interestingly, I found him to quite knowledgeable despite the questionable methods he used to keep his patients happy.
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Tuesday, April 15, 2008
Celebration of life
Baisaki, Ugadi, Vishu you call it by any name, is an important festival for Indians all over the country. This day is celebrated as the day of beginning of new life and the mother earth is thanked for her bounty. This day also heralds spring and a new and hopeful beginning. This is also the birthing season for most avian life and budding season for plant life. I see this all around and this fascinates me.
Sardar Kushvant Singh writes about a tree which he planted in his back yard growing big and huge with a canopy of leaves under which he relaxes and enjoys it beauty. I observe a young pepal tree undergoing the seasonal change. A few weeks ago it started sprouting new leaves of light lemon yellow colour. These came to acquire a kind of light brown color and now have turned into a flamboyant greenish yellow and soon will be glorious dark green. All this happens in a matter of few weeks. I watch with fascination the early morning sun reflecting these colours and the tree acquires a rare beauty. Indians have worshipped the peepal tree [Ashwath] [Ficus relegeosa] from ancient times and there is no village where this tree doesn’t occupy a central place in the scheme of things. The embankment built around it acts as a meeting place and social club for the villagers and the huge crown of leaves give the much needed shade in the scorching summer sun. The abundant fruits common to all ficus tree is heaven for birds. These trees live for centuries and the other famous ficus tree Ala [Banyan][Ficus Bengaleses] grows huge and broad and lives for centuries. There are two around Bangalore who are grand patriarchs and I feel, in their presence, a sense of revered awe. The one located in Swami Nithyanand’s ashram [Dhyanpeetam] of Mysore road beyond Bidadi is reputed to be more than 600 years old.
My favorite Ficus tree remains the common Goni mara or [ficus Mysorensis]. This too grows huge but not that huge as the peepal , has some arboreal roots [I have never seen one touching and implanted on the ground like you see with Banyan] and has closely placed branches and leaves so the tree is more compact than the others with hardly any space in between. It bears enormous quantities of fruits, initially coloured yellow and when ripe a kind of orange red. It is a sort of Mecca for birds during fruiting season. These are common trees planted on either side of roads and also grow in the wooded areas. Now if you are lucky to see this tree, it looks from a distance like a green crown [leaves] studded with orange and red [fruits]
From the balcony of my house I get a clear view of a Sapota [Chicku] tree growing in the backyard of my neighbor’s home. This tree bears fruit and the owner finds it difficult to pick the fruits in the upper branches, much to my delight. There is a family of squirrels that guard the fruits against birds who try and get at them. The bird that makes the most attempts and succeeds occasionally is the green barbet! It is great fun to watch the squirrel family trying to shoo the barbets away only to find them settling on another branch. The other bird that bothers the squirrel family is the parakeet. This noisy bird when it comes to feed sends the squirrels into a nervous tizzy. Parakeets are not fastidious feeders like the barbets. Their policy is eat one and destroy ten. Such extravagant, wasteful and noisy characters. Their performance reminds me of the needless and noisy extravaganza of a wedding feast!
The only visitor who cares a damn to what the squirrels think is the jungle crow. This magnificent bird is a fearless omnivore who believes in the dictum, ‘if there is anything edible I will eat it and enjoy doing so’. I once sat on a char and watched two jungle crows fighting over pieces of insipid papad which I kept throwing at them. It is a sight to see these big birds balancing on tiny branches and getting at the fruits with the squirrel family loudly protesting from a distance!
Copper pod in full bloom
Copper pod, rusty shield bearer [ Peltrophorum pterocarpum ] is a common avenue tree in full bloom now. I t is a large well leafed tree and bears tons of orange yellow flowers arranged in clusters. From a distance the tree appears aflame with orange interspersed with green. The flower has five thin wrinkled petals beautifully arranged in a circle around a central bunch of stamens [?]. With hundreds and thousands of these flowers the whole tree looks remarkably beautiful. Right now if you take a walk or drive on double road that connects 100ft road up to ESI hospital, Indiranagar, you will see on either side of the road a profusion of this tree.This stretch the road can be appropriately named as copper pod avenue! Should be done before they name it Hanumanthappa road!
Sardar Kushvant Singh writes about a tree which he planted in his back yard growing big and huge with a canopy of leaves under which he relaxes and enjoys it beauty. I observe a young pepal tree undergoing the seasonal change. A few weeks ago it started sprouting new leaves of light lemon yellow colour. These came to acquire a kind of light brown color and now have turned into a flamboyant greenish yellow and soon will be glorious dark green. All this happens in a matter of few weeks. I watch with fascination the early morning sun reflecting these colours and the tree acquires a rare beauty. Indians have worshipped the peepal tree [Ashwath] [Ficus relegeosa] from ancient times and there is no village where this tree doesn’t occupy a central place in the scheme of things. The embankment built around it acts as a meeting place and social club for the villagers and the huge crown of leaves give the much needed shade in the scorching summer sun. The abundant fruits common to all ficus tree is heaven for birds. These trees live for centuries and the other famous ficus tree Ala [Banyan][Ficus Bengaleses] grows huge and broad and lives for centuries. There are two around Bangalore who are grand patriarchs and I feel, in their presence, a sense of revered awe. The one located in Swami Nithyanand’s ashram [Dhyanpeetam] of Mysore road beyond Bidadi is reputed to be more than 600 years old.
My favorite Ficus tree remains the common Goni mara or [ficus Mysorensis]. This too grows huge but not that huge as the peepal , has some arboreal roots [I have never seen one touching and implanted on the ground like you see with Banyan] and has closely placed branches and leaves so the tree is more compact than the others with hardly any space in between. It bears enormous quantities of fruits, initially coloured yellow and when ripe a kind of orange red. It is a sort of Mecca for birds during fruiting season. These are common trees planted on either side of roads and also grow in the wooded areas. Now if you are lucky to see this tree, it looks from a distance like a green crown [leaves] studded with orange and red [fruits]
From the balcony of my house I get a clear view of a Sapota [Chicku] tree growing in the backyard of my neighbor’s home. This tree bears fruit and the owner finds it difficult to pick the fruits in the upper branches, much to my delight. There is a family of squirrels that guard the fruits against birds who try and get at them. The bird that makes the most attempts and succeeds occasionally is the green barbet! It is great fun to watch the squirrel family trying to shoo the barbets away only to find them settling on another branch. The other bird that bothers the squirrel family is the parakeet. This noisy bird when it comes to feed sends the squirrels into a nervous tizzy. Parakeets are not fastidious feeders like the barbets. Their policy is eat one and destroy ten. Such extravagant, wasteful and noisy characters. Their performance reminds me of the needless and noisy extravaganza of a wedding feast!
The only visitor who cares a damn to what the squirrels think is the jungle crow. This magnificent bird is a fearless omnivore who believes in the dictum, ‘if there is anything edible I will eat it and enjoy doing so’. I once sat on a char and watched two jungle crows fighting over pieces of insipid papad which I kept throwing at them. It is a sight to see these big birds balancing on tiny branches and getting at the fruits with the squirrel family loudly protesting from a distance!
Copper pod in full bloom
Copper pod, rusty shield bearer [ Peltrophorum pterocarpum ] is a common avenue tree in full bloom now. I t is a large well leafed tree and bears tons of orange yellow flowers arranged in clusters. From a distance the tree appears aflame with orange interspersed with green. The flower has five thin wrinkled petals beautifully arranged in a circle around a central bunch of stamens [?]. With hundreds and thousands of these flowers the whole tree looks remarkably beautiful. Right now if you take a walk or drive on double road that connects 100ft road up to ESI hospital, Indiranagar, you will see on either side of the road a profusion of this tree.This stretch the road can be appropriately named as copper pod avenue! Should be done before they name it Hanumanthappa road!
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