Thursday, February 26, 2009

Taken for a ride?

Mine is a fee for service kind of practice where after each consult the patient pays. There is no fixed fee and this was truer in the early years of my practice than in the later years. There were many patients who by intention or othewise succeeded in making me believe that they were of poor means and thus got away with out paying my fee or paying much less than my usual fee.
My main difficulty then and occassionally now was to find out the capacity of the patient to pay my fee.

Narayanappa was an infrequent visitor to my clinic. His asthma was mild and seasonal and like many of my patients, he self medicated, often using my old prescriptions and was none the worse for it. He was another of my many misjudgments. Whenever he came he could be found wrapped in an old torn kambal [blanket] with a dirty muffler around his neck, wearing his standard off white pajama and kurtha that had seen better days. He also came unaccompanied and I had not met his family members. I came to know that he very well off only by sheer accident. One can make out which part of the country a patient came from, by the way one dresses or by their accent or by their attitude but not their ability to pay. Sometimes I could make out by the questions they asked. For a Keralite his daily bath is important than any thing else in life, so he would ask me if he can have a bath, A Tamilian would ask me what should he eat and what he should avoid and a Kannadiga how much rest he should take off from work but this didnot help me in assessing their monetary status.

Narayanppa was an unusual Kannadiga, on one occasion when he was about to go he asked me whether he can drink kaach. This for a moment had me wondering, before it dawned on me that my poor indigent patient was asking me weather he can drink his usual tot of Scotch whiskey at night! When his doctor is struggling to have his weekly mug of beer, here is a patient who is asking him whether he can have his daily dose of Scotch whiskey. I did not grudge this travesty of justice and his whiskey but the many occasions that I took no money from him thinking that he is too poor to pay! I told him he can drink but refrained from asking for what ever he owed me, as I keep no track of the free service I do. But next time he came he paid double my usual fee and then on till he stopped coming, he paid more than others with out a whimper.

Sunday, February 22, 2009

Closure of a bookshop

Premier bookshop located off M.G.Road and Church street closed operations a few days ago. With this an era of selling books came to an end.

35 years ago, in the early years of my general medical practice, I made little money and had lots of time. This time I spent in reading. The only places where the books were available cheap were a lending library located some distance away and second hand bookshops off M.G.Road. The bookshops that sold new books were many but the one that drew my attention was premieres. I would first visit the second hand bookshops and then go over to Premiere. The books I took home were generally from second hand [used] and thus cheap. Even these were bought far and between. But I liked the feel and look of new books and loved reading them. So I frequented premieres.

Unlike other bookstores in that area, Mr. Shanbhag of Premiere was a book lover himself and he and I soon discovered each other for what we are. This is how it happened. I would go and stand there in front of the rows of book shelves and select a book and start reading. Time would go by and I would shift from one leg to the other. After some time I would stop and then go home with my used book either borrowed [lending library] or bought from some other shop. On one such occasion seeing my shifting from one leg to the other, Mr. Shanbhag came to me with a stool and requested me to sit and read. Thus I could continue for an hour and from where I left the previous visit. But this was not an ideal arrangement and his book shop was not meant for itinerant book lovers like me. But the man’s heart [or business sense] was large. Another day while I was busy reading he came and said,’ would you like to take it home and read?’ Would I? As long as I brought the book back in the same condition that I took it, it was OK with him.

This relationship between us which began with no profit to the owner, blossomed and I began buying books when I could afford. This continued for many many years till access to MG road became difficult and frequency of my visits to his place became less. But of the many persons who have shaped my character and life, Mr. Shanbhag the book seller and book lover must take a prominent place.

Advice unsolicited

I used to have an elderly lady as a patient. She suffered multiple chronic illnesses like severe diabetes, heart disease, eczema and she managed her life with these disabilities fairly well. She was a good patient in that she kept her appointments, followed my instructions and paid me well.

She lived alone with a helper but had a large number of relations living in the city, country and abroad and was popular with all of them and they frequently visited her.

Once, she came to see me and I could see that she was very agitated. I asked her what the matter was. She said, ‘Doctor, my nephew told me that I have Parkinson’s disease. I went to the Internet and what I read there has got me very scared, how can I manage with this terrible disease now?

I could sympathize with her as Parkinson’s disease is an illness which can be very disabling. The sufferer gradually loses control over muscle coordination and becomes stiff and rigid. Worse there is no proper treatment or cure in sight. But she did not have Parkinson’s disease and how could she believe her nephew? I asked her. She said, ‘no doctor, he is a neurosurgeon living in the US and when he saw me shuffling, he told me that I have this disease and I should take treatment’

It took me more than half an hour to convince her that merely a shuffling gait is no evidence of this disease and lot of elderly men and women take small steps but have no other signs and she has excellent gait and movement. She went convinced.

This is a problem that I frequently face in my practice. Unsolicited advice given on the spur of the moment like this neurosurgeon did. One look at his aunt’s shuffle and he diagnoses Parkinson’s disease. If he had that much concern he could have called me and expressed his concern instead of needlessly frightening his aunt out of her wits. I would have tried convincing him. Weather I would have succeeded or not is a different matter.

My patients receive this kind of unsolicited advice from other doctors at casual social meetings and cause me no end of problem afterwards. I also get asked questions and opinions like this from persons who are not my patients. I have a stock answer. I tell them to see me in my clinic if they are unhappy with their own physician. This usually shuts them up and sometimes ends the conversation which is to my advantage! Because I like to be left alone most of the times!

Monday, February 16, 2009

The Amte family

Baba Amte

Prakash and Vikas Amte

Prakash Amte, his wife Mandakini Amte have been awarded the 2008 Ramon Magsaysay Award for community leadership. "In electing Prakash Amte and Mandakini Amte to receive the 2008 Ramon Magsaysay Award for Community Leadership, the board of trustees recognizes their enhancing the capacity of the Madia Gonds to adapt positively in today's India, through healing and teaching and other compassionate interventions," the board of trustees of the Ramon Magsaysay Foundation said while naming the couple for the award.

"Prakash Amte grew up in Anandwan, an ashram and rehabilitation center for lepers in Maharashtra founded by his father, the renowned Gandhian humanitarian Murlidhar Devidas Amte, or Baba Amte. Prakash was busy with post-graduate surgical studies in Nagpur when Baba Amte called him, in 1974, to take over a new project among the Madia Gonds. In a leap of faith, he and his wife Mandakini abandoned their urban practices and moved to remote Hemalkasa," the citation reads.

This is a remarkable family. Baba Amte died last year at the ripe age of 94.This extraordinary man lived the last 40 years of life as a virtual cripple ridden by the illness, ankylosing spondylitis. His indomitable spirit and ability to work hard never died. Drs Prakash and Vikas are his sons. They, along with their equally dedicated wives, are carrying on the legacy of Baba Amte.Those of you who have lost faith in human spirit and what it can achieve should do a Google search and read about his family.

Secret of success

Everyone wants to be successful. How is success measured? Is it by the accumulation of wealth and material pocessions or is it by what one has achieved in his or her chosen field of activity or is it simply by the way he has lived?.There are no clear cut answers and the definition of success thus depends upon how one looks at it from his point of view. I look at it this way. If one has led a life in which he has helped more and harmed less, is contented in what he has done or doing and has learnt to forget and forgive, he is a success. Often, success has nothing to do with school or collegiate education. It could be a way to show you how to succeed. This reminds me of a story told of an Oxford don [professor].

The faculty and students held a dinner to honor this don who had produced many successes in all walks of life. He was asked his method of evaluation of his students. He said, ‘I tried many but over the years I found one method which never failed. He stopped to take a breath. The eager audience wanted to know what this method is. The Don continued,’ I took the answer sheets to the top of the stairs and placed the bundle there and gave it a kick to scatter the sheets. One year I gave maximum marks to those which fell on the top of the stairs and next year to those which fell at the bottom’.

The audience was mute.

The message here is: Success doesn’t depend on formal education.

Thursday, February 12, 2009

Slum dog Millionnaire and White Tiger

I saw the movie, slum dog millionaire. This movie shows vividly the human depravity in all its nakedness. This is abundant in all societies and my country is no exception. Had the movie been made keeping only this in mind I would have rated this movie much higher than I did or do now. If you show filth and scum and try and vicariously titillate the audience [both Indian and western] and win plaudits for having done so, I don’t much care for it. This is one such movie and that it won so many awards shows that we want to hide behind the depicted shame and get some satisfaction by awarding the moviemakers who I am sure will not lift one little finger of theirs to improve the conditions of life depicted in the movie.

The much acclaimed novel, White Tiger, is more realistic but follows the same theme. Arvind Adiga, the author of this novel tries to bring the reality of India in this novel and he does a much better job than then the movie slum dog millionaire does. The writing style is also unique and one has to get used to his style to really appreciate the depth of the novel. The brutal reality of the unsuccessful India which we try to hide stands exposed in this book. It is a must read not because it is on the best sellers list and has won the award but for the realism.

Incidentally, Mr Sainath, journalist, writer and social activist and author of the much acclaimed book ‘everybody loves a draught’ has refused to accept the Padma Shri award by the Indian Government, befitting reply to the official hypocrisy, I thought.

Sunday, February 8, 2009

A music concert

This incident occurred more than 30 years ago at a small town in coastal Karnataka. A small group of music enthusiasts had formed a body to promote classical music. As the people who reside there have an ear of Hindustani classical music [a form of classical singing which is different from that of carnatic [south Indian classical] music, this is the form of music that they were organizing every month. It was not easy. Organizing a concert meant raising resources and the music lovers were high in their love for music but low in finances and generally, it was cheap local talent that was available, and they had to be satisfied with this.

On one occasion, on the day of their anniversary, they decided to get Bhimsen Joshi. Bhimsen Joshi even those days were famous but gettable [recently the nation has honored him with the highest civilian award, Bharath Rathna]. But it meant spending upwards of 25,000 Rs, a lot of money those days. Without a sponsor it was impossible to get Joshi.

The richest man in the town was businessman Ganpathi Kamthi. Ganpathi was known to donate funds for worthy causes. A delegation of music lovers went to meet Mr. Kamthi. After the preliminaries Ganpathi asked the secretary of the organization a simple question. ‘Does this Joshi fellow sing devotional songs [Bhakti geeth]? Joshi is well known to sing these [Abhangs] though he did it in classical style which is very different from the usual form of rendering devotional singing by the uninitiated to classical form of music. There was enthusiastic,’ yes, yes, he does’ from the group which was from their point true. Ganpathi agreed to sponsor the meet. But a problem arose. As the chief guest he was expected to speak. Ganpathi’s knowledge of music was confined to occasional hearing of Hindi or Kannada film music and devotional songs. The organizers told him that they would prepare a written down speech which he can refer to when he was asked to make his speech.

On the appointed day there was a huge gathering of music lovers and Ganpathi Kamthi was well received and obviously he enjoyed all the attention he was getting. He was profusely thanked and was asked to speak. Ganpathi may not have knowledge of classical music but he knew how to impress the audience, having spoken at many business meetings. Referring only briefly to the written speech, he extolled the virtues of Hindustani classical music and its evolution and praised Bhimsen Joshi and thanked him for agreeing to give the concert. He got the deserved applause. The secretary escorted him to the front row where he sat in high expectation of listening to the maestro.

The concert began with rag Malhaar. A single line of a Marathi [another Indian language] abhang [devotional song] was taken and Joshi elaborated this in this raag for over an hour. There were several times thunderous applause and when he stopped there was nonstop clapping for more than five minutes. There was five minutes break and the secretary came to Ganpathi and asked him Kash asa [How is it going?]. Ganpathi gave a noncommittal smile. He was just having the beginning of a raging head ache. The devotional song he expected had not even begun. After this one hour of torture, he could not understand the ecstasy of the audience. There was no escape as the next session of the programme began.

Joshi selected the first line of another song and began rendering it in rag Malkauns. Malkauns is a popular rag in Hindustani classical music and it is like watching a slow flowing river and there are not many highs and lows in it. Joshi spent another hour in exploring the intricacies of the rag. He did not go beyond two lines of that song to the utter disappointment of Ganpathi whose head ache by now was raging. The musician was in his elements and seeing the audience so appreciative and the bond between the performer and the listeners was so intense that after he finished this piece he took another raag without a break and this time he chose to sing in Bhairavi. Bhairavi is raag when sung with intensity and emotion can bring ecstatic tears to the eyes of the listeners. Seeing so many crying, Ganpathi thought that here must be something very sad in what this fool of a singer was doing. Upset, he called the secretary over and asked why they were crying. He was told that they were tears of joy and not sorrow. Ganpathi’ s head ache now was at a crescendo. He sat with his head held in his hands and the onlookers mistook it be of intense involvement.

At last the concert was over and the audience gave a standing ovation to Joshi. After the formalities of seeing the performer taking his leave, the secretary came over to Ganpathi and in all sincerity asked in Konkani, the language of Ganpathi Kamthi,[Kash laglo] how was it?. Ganpathi brought all his pent up emotions to the surface, ‘you ask how was it [kash laglo, kash laglo mantha], that son of a wh----e pulled and pulled [thantha, thantha] and pulled, it is a surprise his throat did not split and if you ask me another such silly question I will break your head, bloody waste of money’ he said this with venomous intensity and walked away, leaving the poor secretary dumbfounded.

My friend Gnandev Kamath told me this real life story in Konkani and I am afraid the translation does not bring the same flavor of the original.

Thursday, February 5, 2009

Appreciation of art and adding meaning to life

One way of assessing maturity or positive progress of any civilization is to look at its achievement in the various art forms

This may be music, literature, dance, sculpture and painting. It is not enough if there are performers in these fields. There should a larger participation of lay persons in that civilization who know how to appreciate and enjoy these art forms.

Not all of us are fortunate to be exponents of art forms. It is reserved for the privileged few who have the perseverance, talent and single-mindedness to pursue these interests often at great personal sacrifice. But if we don’t have the talent or perseverance, the next best thing is to develop a feeling for appreciation of art. Everyone has eyes but few can appreciate a work of art or the abundant beauty that is around us. To give one personal example. I must have seen the painting of Sunflowers by Van Gogh at least a thousand times. I am still not tired and can see it again with the same pleasure many times more. It simply dazzles me. Same is true of the painting of water lilies by Claude Monet. What is this feeling which so uplifts my spirit that is contained in these paintings? I cannot say it; it has to be experienced and cannot be easily described.

I have seen and heard musicians performing. The expression on their faces is one of intense pleasure. They are so involved that they are oblivious to their surroundings. To experience of listening to some of the great musicians is the same as one gets one views a great painting. I can say the same with dance forms.

I recently had the pleasure of viewing a recorded performance of Bharathnatyam [a form of classical Indian dance] by a young relative of mine, Mithila Ballal [Mittu, as she is known to us]. I sat transfixed for more than one hour watching and listening. It was a soul filling experience and I felt I was in the presence of a great talent.

Our lives can often be boring because it consists of many repetitive acts. Some of these are necessary to live and some we are forced to because to live we have to do these. Our humdrum lives can become interesting and meaningful if we develop interest in one or other form of art. This is true for all ages but especially so when one grows old!

Monday, February 2, 2009

Manmohan Singh

Many many years ago, we had a prime minister called Lalbahadur Shastri, who had all the attributes of a leader. He was honest, efficient, noncorrupt, and humble and knew how to delegate responsibility and remain calm in the face of adversity. He was the last of the true Gandhians.

The present Prime minster of my country is a gentle Sikh called Man mohan Singh. He like Shastri became the prime minister by default 4 years ago. He belongs to the ruling party whose moral antecedents have always been suspect is another matter altogether. He speaks less, has no personal charisma, his oratory skills needs much to be desired, diffident and has no mass base. Why is it then he has captured the hearts of many like me who have a gut dislike for his party?

It is because the way he deports himself in public and personal life. Never makes it an issue that he was the chief of London school of economics, that he is responsible 20 years ago for the country’s economic turnaround, doesn’t mind if others hogging the limelight and the credit for the work he has done and is doing, and more than anything else, his behaviour when he fell seriously ill a fortnight ago.

He has had a coronary artery bypass graft surgery done 15 years ago and a stenting procedure few years ago. Investigations revealed that the grafts had blocked and he was in serious trouble and needed a redo surgery, a highly risky procedure. In this kind of circumstances what would an Indian dignitary do? He would scout around the world and would land up in some institution in the US or UK. The Indian public is used to such health jaunts by our politicians and other bigwigs. But Dr Singh did nothing of that kind. He chose a government institution called all India institute of medical sciences and an Indian cardiac surgeon called Ramakanth Panda to do the redo surgery. The surgery took 15 hours and was successful and today, after only seven days, a beaming prime minister was seen shaking hands with the team of doctors before leaving for his home.

By this act this prime minister has sent a message to all Indians. That we have the best medical care and please make use of it.

Foot note. This is true we do have the best. But one must know where the best are. Health care in India is like a haystack with needles. The needles are the excellent professionals. To get to know who are these and where are they working is important and the prime minister was lucky in having found an institution and Dr Ramakanth Panda.

Sunday, February 1, 2009

Moral policing

There have been reports in several of parts of the country of acts of coercion against women for acts which the conservative [bigots, extremists, fundamentalists] elements take exception to. These include not following the prescribed dress code, being seen and friendly with men, going to pubs and parties and in extreme cases even going to schools.

For a person who is steeped in the belief that all humans are equal [some times women even better than men], I find these acts abhorrent to say the least. Sex and its ramifications and interpretations and beliefs of purity etc related to sex are the root cause of these problems. Women are not property of men to be traded and victimized at their whim. Unless human beings treat sex as another desire and keep it in its place, this kind of nonsensical and deviant behaviour will continue. All women and all sane men should use all the means at their disposal to counter these elements in our societies.

This is the worst form of cancer that has afflicted our social fabric.