I was in India recently to do my elective terms in Indian hospitals. Whilst in Bangalore, i lost notebook in which i had been keeping a journal of sorts, jotting down my experiences and suchlike. So i am going to attempt to recall what was lost and write about some of the patients, who for some particular reason or for no reason at all, i can still remember.....
The first patient who comes to mind is a little boy, or to be exact, his mother. Just as i was beginning to see this child, something else came up that i had to sort out (for a previous patient), so one of the doctors offerred to see this boy. But the mother would have none of it. She insisted that they would wait for me: "aap hee dekh lijiye, hum theherte hein". They had come all the way from Shiliguri, in northern Bengal, to NIMHANS, Bangalore, for specialist treatment (obviously i wasnt the specialist, i was only the preliminary guy who saw the patients first). In the few minutes that i did have with them, i asked a few questions about Shiliguri, it being a place that i wanted to go to (only as a transit to Sikkim, but still...). And for this little bit of curiosity, that lady was willing to wait an unknown amount of time, to have her son seen by me. I felt touched by this episode. I hadnt really done anything for them, but they wanted to wait for me.....I often think about that kid; how's he doing; is he still alive (he was quite sick with very severe epilepsy...).
The next patients that come to mind are these two kids who had a condition called SSPE, which occurs in kids who have had (and recovered) from measles. It is the most devastating diagnosis to have to give to parents. SSPE causes a slow, inexorable mental deterioration that always lead to death within a few years. First, these kids start having random jerks which make them fall over. Eventually, they get more of these uncontrolled movements as well loss of mental function until there is nothing but a shell left. The first of the kids that i saw with SSPE was end stage. He had the barest minimum of brain function; his father and brother had taken him to all kinds of doctors and finally decided to come to NIMHANS after being told the same thing by everyone else. When asked what they wanted, the brother simply said "treatment". The father was in tears....The second kid was an only child in a poor family. He was extremely bright- he'd been awarded various scholarships to top schools in Bengal. But a few months ago, he began to jerk and lose his 'intelligence'. Desperately, the family came to Bangalore, only to be told the diagnosis of SSPE. I have never seen a person as devastated as tha
Friday, 26 May 2006
Monday, 22 May 2006
Day 1 in emergency
Today was my first day in the emergency department (or ed, NOT er). As a student, u wait for this term right from first year, coz its cool and glamourous yet grisly and full of blood. By the time you actually get to do a term in emergency medicine, you're only thoughts are of final exams, but still, its an exciting time....
For those of you whose only exposure to the world of medicine apart from asking your local gp to fill out a sick leave form is from watching er, gideon's crossing, house, grey's anatomy and god forbid, scrubs, you will be interested to know that i DID NOT "bag" or "tube" anyone, crack open a chest, put in an umbilical line or do any of the things that ur average tv doctor does in the course of an average shift. Here's what really happens in an ed:
1. we see the end results of human stupidity- the moron award for the day has to go to one of the following-
- the woman who snorted cocaine and came in with a seizure- very, very lucky not to have a brain haemorrhage, heart attack or other nasty things.
- the woman who managed to stick a fishbone into her thumb, press it in deeper by trying to extract it with a needle, yes a sewing needle, went to the gp after 3 weeks, and then got referred to us coz her thumb was "infected".
- the genleman who grinds metal for a living, feels some irritation in his eye, and waits till the iron filing in his eye had RUSTED before he figured he needed to see a doctor.
2. we see the real impact of the obesity epidemic- no! there's no exclamation marks around obesity to imply that there some doubt about it, nor is it preceded by a "supposed" or "so-called". its real and we see it, or hear it, or not hear it to be exact. stethoscopes were designed in the 19th century before the obesity epidemic- hence they cannot cope with 10-15 cm of fat between the heart/lungs and the sound-conducting membrane.
3. of course, there's plenty of "real" medicine as well- the heart attacks, strokes, pneumonias, gallstones etc.
4. there was also the unfortunate old lady who fell over on the pavement and fractured the orbit ( thats the bony socket in the skull in which the eyeball sits). she forgot her son's phone number and got really worried as to how she was going to get home....these are the people who you really feel sorry for. a small crack in the footpath, most of us think nothing of it- but to old people, especially frail little old ladies, it is a big deal.
so there u go, my first day in emergency!!
For those of you whose only exposure to the world of medicine apart from asking your local gp to fill out a sick leave form is from watching er, gideon's crossing, house, grey's anatomy and god forbid, scrubs, you will be interested to know that i DID NOT "bag" or "tube" anyone, crack open a chest, put in an umbilical line or do any of the things that ur average tv doctor does in the course of an average shift. Here's what really happens in an ed:
1. we see the end results of human stupidity- the moron award for the day has to go to one of the following-
- the woman who snorted cocaine and came in with a seizure- very, very lucky not to have a brain haemorrhage, heart attack or other nasty things.
- the woman who managed to stick a fishbone into her thumb, press it in deeper by trying to extract it with a needle, yes a sewing needle, went to the gp after 3 weeks, and then got referred to us coz her thumb was "infected".
- the genleman who grinds metal for a living, feels some irritation in his eye, and waits till the iron filing in his eye had RUSTED before he figured he needed to see a doctor.
2. we see the real impact of the obesity epidemic- no! there's no exclamation marks around obesity to imply that there some doubt about it, nor is it preceded by a "supposed" or "so-called". its real and we see it, or hear it, or not hear it to be exact. stethoscopes were designed in the 19th century before the obesity epidemic- hence they cannot cope with 10-15 cm of fat between the heart/lungs and the sound-conducting membrane.
3. of course, there's plenty of "real" medicine as well- the heart attacks, strokes, pneumonias, gallstones etc.
4. there was also the unfortunate old lady who fell over on the pavement and fractured the orbit ( thats the bony socket in the skull in which the eyeball sits). she forgot her son's phone number and got really worried as to how she was going to get home....these are the people who you really feel sorry for. a small crack in the footpath, most of us think nothing of it- but to old people, especially frail little old ladies, it is a big deal.
so there u go, my first day in emergency!!
Saturday, 20 May 2006
Secularism in India
The legislative assembly of the State of Rajasthan recently passed the religious freedom bill, which would enable the judicial system to prosecute, fine and jail people for attempting to convert people to a religion against their will. However, bowing to pressure from Christian missionaries and Muslim interest groups, the state Governor, Pratibha Patil has refused to sign the bill.
The Christian and Muslim groups claim that this legislation would be discriminating against them and impinge on their rights (to forcibly convert people). This protest is understandable, since these groups have enjoyed these rights for centuries. Converting people through brute force, money, extravagant promises and intimidation is nothing new to India. But what this incident highlights as far as I am concerned is the deep-seated negationism that pervades mainstream India. Everyone knows what happens in rural India, yet people choose to ignore it in the name of secularism. This immaturity arising from the desire to be a secular state has led to this particular incident in Rajasthan. The insipid mainstream-Hindu BJP party has attempted to raise the issue of forced conversion (which effects only the Hindu population- no one would dare try to convert a Christian or a Muslim, thats a violation of the rights of minorities) through the legislative assembly, but has once again failed to achieve anything but negative publicity both in India and internationally. In the world media, this incident has been portrayed as a Hindu fundamentalist (drawing comparison to Islamic fundamentalists in the middle east and neo-nazis/christian fundamentalists in europe and america) government abusing the rights of religious minorities (that the bill was designed to discourage forced conversions is soon forgotten).
The official view is that forced conversion does not occur, and has never occurred. Of course, support for this view from influential institutions like the JNU (Jawaharlal Nehru University) and the Congress party helps. What helps even more is the ineptitude of those not under the spell of negationism in not being able to properly present the issue on a national or international stage. As such, books like Romila Thapar's Penguin History of India, are what is presented to the international community as "Indian History" with their denial of all unpalatable aspects of the Islamic and Christian invasions of India. Conversion is only one of the things amongst mass slaughter, pillaging, sex slavery and grossly discriminatory laws that is denied in this book and others (Communalism and the Writing of indian History by Thapar, Harbans Mukhia and Bipin Chandra). This latter book actually claims that these accusations were made by "Hindu fundamentalists" in the 20th century to create communal disharmony. For the Congress party's contribution, we need look no further than this statement by the National Council of Educational Research and Training: "Characterization of the medieval period as a time of conflict between Hindus and Muslims is forbidden." This was the committee that had the responsibility to guide the schools of India in setting their curriculums. Negation of history was given its official seal of approval.
The Christian and Muslim groups claim that this legislation would be discriminating against them and impinge on their rights (to forcibly convert people). This protest is understandable, since these groups have enjoyed these rights for centuries. Converting people through brute force, money, extravagant promises and intimidation is nothing new to India. But what this incident highlights as far as I am concerned is the deep-seated negationism that pervades mainstream India. Everyone knows what happens in rural India, yet people choose to ignore it in the name of secularism. This immaturity arising from the desire to be a secular state has led to this particular incident in Rajasthan. The insipid mainstream-Hindu BJP party has attempted to raise the issue of forced conversion (which effects only the Hindu population- no one would dare try to convert a Christian or a Muslim, thats a violation of the rights of minorities) through the legislative assembly, but has once again failed to achieve anything but negative publicity both in India and internationally. In the world media, this incident has been portrayed as a Hindu fundamentalist (drawing comparison to Islamic fundamentalists in the middle east and neo-nazis/christian fundamentalists in europe and america) government abusing the rights of religious minorities (that the bill was designed to discourage forced conversions is soon forgotten).
The official view is that forced conversion does not occur, and has never occurred. Of course, support for this view from influential institutions like the JNU (Jawaharlal Nehru University) and the Congress party helps. What helps even more is the ineptitude of those not under the spell of negationism in not being able to properly present the issue on a national or international stage. As such, books like Romila Thapar's Penguin History of India, are what is presented to the international community as "Indian History" with their denial of all unpalatable aspects of the Islamic and Christian invasions of India. Conversion is only one of the things amongst mass slaughter, pillaging, sex slavery and grossly discriminatory laws that is denied in this book and others (Communalism and the Writing of indian History by Thapar, Harbans Mukhia and Bipin Chandra). This latter book actually claims that these accusations were made by "Hindu fundamentalists" in the 20th century to create communal disharmony. For the Congress party's contribution, we need look no further than this statement by the National Council of Educational Research and Training: "Characterization of the medieval period as a time of conflict between Hindus and Muslims is forbidden." This was the committee that had the responsibility to guide the schools of India in setting their curriculums. Negation of history was given its official seal of approval.
Friday, 19 May 2006
Deep ravines, rocky outcrops and mustard fields
The beauty of Madhya Pradesh (MP) took me by surprise; so much so that it never even occurred to me to take photos. Of course, i can only comment on what i saw from the train (i went from chennai to haridwar and back). But indian trains stop often enough to give you ample opportunities for taking in the wonderful sights and sounds of the countryside.....
I had always thought that MP was a nondescript desert, a poor cousin of Rajasthan. The Deccan plateau is already largely dry, semi-arid country with areas of rocky desert. So i thought it would be little different on the northern side of the Vindhya ranges. But i was completely wrong. On the way north, i woke up to find the train crossing the Vindhyas, and what a sight it was!!
The train was speeding through hilly country- the sun had yet risen but the sky was blushing orange in anticipation. The fog swirled down from the hilltops into the deep ravines. The rain gods had been generous during the monsoon, even though the lifegiving deluge was delayed by a month or so, hence the creeks and rivulets were overflowing with water. The forests of the Vindhyas contained only a loose sprinkling of trees with an abundance of grass, wildflowers and low bushes.
The train rattled over countless small bridges- the depth of the gorges is incredible. The railways tracks built through this sort of terrain are quite an achievement I think, architecturally and aesthetically. There are also several tunnels in the Vindhya segment, which always mean lots of fun on Indian trains; the lights often dont work, you might be in the tiolet, the kids are screaming.
As the train screamed north, it slowed down...The terrain also flattened out, but not completely. We entered some sort of a transition zone- there was enough flat land for agriculture, so there small fileds whereever there was space, with little dwellings scattered in the hills.There was the odd train station now- these stations hardly deserved to be called that actually. There is no platform or station building (except for a little shack which i presume is for the stationmaster). Just a signpost nailed into the earth with a name on it. I wondered what purpose the stationmaster served. He simply stood there holding his green flag. There was no one else to seen within kilometres. He would just live in that little shack and hold out flags to all the trains that pass by....
By the time we got to the plateau of MP, it was nearing sunrise. As beautiful as the forests were, there something uniquely charming about the plateau. MP is the mustard growing capital of India- the plateau is full of lush green mustard fields studded with bright yellow flowers. There are also rice, wheat and vegetable fields, but the distinct sparkling green of the mustard really stands out.
The land is relatively flat but still undulating with some small hills and the occasional rocky outcrop. These areas, which are agriculturally useless, are crammed with houses. The miniature peaks all appear to be bursting at the seams with residences, i suppose the farmers dont want to waste precious arable land for housing. It was over one of these villages situated on a massive chunk of rock that sunrise happened. There was just enough fog and winter haze in the air that sunrise was seen clearly- not too bright like on a clear morning and not too dull like on an overcast day.
The sunrise had an enlivening effect on the other passengers; people became extremely chatty and active once the sun began its ascent. I spent the morning reading 'Zen and the art of motorcycle maintenance', intermittently gazing out at the idyllic landscape of rural MP. As we went further north, the population became denser and the agriculture more intensive, the villages and townships larger and the train stations looked more like 'normal' stations. The tibetan refugees sitting in my section of the train began chanting their prayers with their japamalas. The kids started to laugh and play. The group of young tamil boys headed for work in a Haridwar factory started their game of cards, taking over where they left off the previous day. In short, the train woke up!!
I had always thought that MP was a nondescript desert, a poor cousin of Rajasthan. The Deccan plateau is already largely dry, semi-arid country with areas of rocky desert. So i thought it would be little different on the northern side of the Vindhya ranges. But i was completely wrong. On the way north, i woke up to find the train crossing the Vindhyas, and what a sight it was!!
The train was speeding through hilly country- the sun had yet risen but the sky was blushing orange in anticipation. The fog swirled down from the hilltops into the deep ravines. The rain gods had been generous during the monsoon, even though the lifegiving deluge was delayed by a month or so, hence the creeks and rivulets were overflowing with water. The forests of the Vindhyas contained only a loose sprinkling of trees with an abundance of grass, wildflowers and low bushes.
The train rattled over countless small bridges- the depth of the gorges is incredible. The railways tracks built through this sort of terrain are quite an achievement I think, architecturally and aesthetically. There are also several tunnels in the Vindhya segment, which always mean lots of fun on Indian trains; the lights often dont work, you might be in the tiolet, the kids are screaming.
As the train screamed north, it slowed down...The terrain also flattened out, but not completely. We entered some sort of a transition zone- there was enough flat land for agriculture, so there small fileds whereever there was space, with little dwellings scattered in the hills.There was the odd train station now- these stations hardly deserved to be called that actually. There is no platform or station building (except for a little shack which i presume is for the stationmaster). Just a signpost nailed into the earth with a name on it. I wondered what purpose the stationmaster served. He simply stood there holding his green flag. There was no one else to seen within kilometres. He would just live in that little shack and hold out flags to all the trains that pass by....
By the time we got to the plateau of MP, it was nearing sunrise. As beautiful as the forests were, there something uniquely charming about the plateau. MP is the mustard growing capital of India- the plateau is full of lush green mustard fields studded with bright yellow flowers. There are also rice, wheat and vegetable fields, but the distinct sparkling green of the mustard really stands out.
The land is relatively flat but still undulating with some small hills and the occasional rocky outcrop. These areas, which are agriculturally useless, are crammed with houses. The miniature peaks all appear to be bursting at the seams with residences, i suppose the farmers dont want to waste precious arable land for housing. It was over one of these villages situated on a massive chunk of rock that sunrise happened. There was just enough fog and winter haze in the air that sunrise was seen clearly- not too bright like on a clear morning and not too dull like on an overcast day.
The sunrise had an enlivening effect on the other passengers; people became extremely chatty and active once the sun began its ascent. I spent the morning reading 'Zen and the art of motorcycle maintenance', intermittently gazing out at the idyllic landscape of rural MP. As we went further north, the population became denser and the agriculture more intensive, the villages and townships larger and the train stations looked more like 'normal' stations. The tibetan refugees sitting in my section of the train began chanting their prayers with their japamalas. The kids started to laugh and play. The group of young tamil boys headed for work in a Haridwar factory started their game of cards, taking over where they left off the previous day. In short, the train woke up!!
Ganga Dhyan Part 5- Why the Ganga flows from Shiva's matted locks
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| After failing to reach the Neelakantha Mahadev temple, i decided to head back into rishikesh to watch the evening So i headed to triveni ghat with about an hour to go before the aarathi time. From the concreted space, sort of like a picnic area, which has stautes of various gods as well as the standard gitopadesam, one gets a fine view of the As the crowd built up, i sat down on a rock, ganga kinare, to observe events as they unfolded. People walked to the Ganga and offered their prayers, splashed themselves with the holy waters (symbolizing a ritual bath) and then offered those little cups made of some sort of leaf filled with flowers, sugar and of course, burning camphor. Offerings to the gods (Ganga is the favourite goddess of the foothills) form a very important part of indian culture- as krishna explains in the gita, the basic offerings are leaves, flowers, fruit and water (patram, pushpam, phalam, toyam). Fire is the symbol of cleansing and purity, hence the camphor. As i sat there basking in the setting sun, an old man came and sat on the rock next to mine. He closed his eyes and began doing pranayama and went into some sort of meditative state. He sat perfectly still (apart from his fingers doing the pranayama) for almost an hour; time during which i took some photos of the gorgeous sunset. During this time, there was a swan hunting fish in the After about 45-50 minutes, the old man stopped meditating and got up to go. But as he turned around he saw me and gave me a look of surprise which quickly softened out into a smile. I think he wasnt expecting to see me still sitting there after nearly an hour. Anyway, he said to "aap bhi ganga dhyan kar rahe hein?" (were you also meditating on/by the ganga). Now, thats a reasonable question, one that i should have been able to answer quite easily. But i just sat there, unable to say a word. You see, while i can speak reasonable hindi, spontaneous conversation just does not come to me. Its been fourteen years since i've spoken hindi spontaneously..... So i just shook my head and mumbled something. It didnt bother the old man though, he sat down again and began talking to me about how beautiful the He asked me if i wanted to hear a story about the |
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