Despair.

She was middle age, sitting up on a hospital bed. She was still like a statue and very disheveled. She was trying to appear strong but the flow of tears were a dead give away. Maybe her inability to control her emotions was compounding her despair and frustration. 

She was again admitted with another suicidal attempt. When we started to talk she opened up and said "I always felt the desire to end it all" she paused for a second like she was trying to find the right words then she said very softly,

"when I was 8, I used to take cold baths in winter and stand outside the house, hoping I may catch pneumonia!. 

Just imagine, 8 years old and so much pain to bear! 

"I love walking in the rain, 'cause no one knows I'm crying" 

Unknown.

Blog you later.

About the picture: I shot this inside Doge's Palace. To me it depicts despair.

Dante’s Inferno.

Nine Eleven.... always brings a feeling of dread, though it has been a decade now. 

In Dante’s Inferno, when Dante along with Virgil started to descend deeper into hell (Inferno), they observed Contrapasso, best explained as symbolic punishments, best suited for one's sin. A kind of a poetic justice. 

.

For example a con man in hell would be reassured that he will be served a full meal, when he would become hungry, he would be served with putrid and rotten food. A murderer will be kept alive for eternity, where he would only wish every second for death to relieve him from his agony.

If there is hell, what would be the punishment for our deeds? Let’s assume if we are not …..Umm….. not adequate. Not just adequate but negligent, if I may say so ... pernicious to others! So those guys who crashed the planes, what should they get in Dante's Inferno?

I have been in a hiatus, working on my book, busy with work etc and ... OK, have you ever come across a situation when someone calls you after a long time and you try to provide some lame excuse of being really busy? And when they ask you what you have been up to? You reply sheepishly “nothing much”.  

Well, I will not give any excuses, I will stop while I am ahead.

Just some random thoughts...

PS: I wrote few words last year on Nine eleven here. Took this picture around the same time.

Snooki Or Not To Be....

To be or not to be---that is the question. Whether ‘tis nobler in the mind to suffer. When Shakespeare penned these words in Hamlet I am sure, that he was not thinking of Snooki.

I am not sure how many of you are familiar with the infamous Snooki, the star of “Jersey Shore”. She has made quite a name for herself in so many ways. To top it all she wrote a new book too.

I read this most interesting news the other day; she was invited to be a guest speaker at Rutgers University. Now the amazing thing is that she was paid $32,000. She was voted by students to get an invite.

During her talk she was full of wisdom and insight regarding this perplex thing we call life. She pondered on various subjects from fist pumping to laundry and tanning. I will take the liberty to quote one historic pearl from her speech,

                              “Study hard but party harder”.

When you Google Rutgers University, the first hit you get about this esteemed New Jersey University is

Rutgers, The State University of New Jersey, is dedicated to advanced learning, creating knowledge and contributing to the growing vitality of the state…….

Great……….

All jokes aside it is fine and dandy that you want your students to have all kinds of exposure. In all fairness the next speaker is 1993 Noble Laureate in literature , Toni Morrison. She will be speaking to a jam packed stadium audience.  She is known for her eloquence, role of black women in society and her contemporary style.

The only problem is she is getting paid two thousand dollars less than our party hardy girl. I think our Beloved is getting the short stick…. again!

Blog You Later.

About The Picture: That is JFK at a monument in Tampa, not to be mistaken for a Snooki quote.

Monro-Kellie Doctrine And My Father.

Alexander Monroe hypothesized in 1783 that brain resides in a confined box. Total volume of the brain remains constant and it is incompressible. Any time there is an increase in the volume of this box it will directly increase intracranial pressure and will compromise either one of the three contents; brain, cerebrospinal volume or blood.  Later George Kelly confirmed this observation in 1824.

Our memory is like that too. We only have a finite memory, our recall is limited. We only remember the most pertinent things. Stress plays a major role in memory loss, sustained stress cause damage to hippo-campus, which is essential for learning and memory. When we forget essential details during stress, that is due to Cortisol, which may also cause confusion in trauma and crisis. Maybe after delivery mother's develop some short term memory loss.... otherwise women may never want to be pregnant again.

My father taught me so many things. He practiced Medicine for almost 50 years, a very astute clinician.   When I was growing up, I had to wear a tie even in 1st grade. It took me a while to master the knot properly but he never gave up on me. My parents were visiting me some time ago and we were going out  for dinner. My mom came to me and asked me to help my dad. I went to his room and I found him standing in front of the mirror holding a tie with a look of confusion. I asked him what is wrong. He said I don't know how to tie a knot. I looked at him and remembered all the times when I had the same look when I was young. I tied his knot and we went our way.

They are visiting me this month. When I look back, I wish I be as caring and a good father as he has been to me all my life.

Blog you later,

About the picture: Still going through the museums.

Music Is In The Silence Between The Notes.

Music is in the silence between the notes.  Just imagine even the most renowned symphonies would be just noise if there was no pause between the notes. Life is just like that. If there is no sorrow, joy would not mean any thing. If there is no tragedy, happiness would be meaningless. 

If some one would remain euphoric all the time you would call him insane, if someone is always sad, you would think that he is "depressed". Life requires balance, that could only be achieved if you experience both spectrum. Sometimes it requires a touch of the other side to cherish what you have. Some people only realize what a blessing good health is, until they come out of an illness.

There is a short Urdu story by Azad. There was this man who found out that there is a place where you can go and trade ones worst problems. He went there and traded his chronic colic pain for bad arthritis. On his way back he realized how difficult it was for him to walk with this new ailment. .He had no choice  in the end but to return and get his old ailment back. They say that no one gets more than their share of bad luck, not an ounce more than they could tolerate, I guess it is true, maybe it is adaptation or I just hope that it is not  Karma! 

I write this because in the past one week I admitted two patients, both with foot pain. One person got an amputation the other had a simple infection. Surprisingly both were stoic. I made it  a point to ask both of them today how come they never had a complaint. They both said it could have been worst! 

Blog you later.

About the picture: Curves and different shades caught my eye in this frame as I was walking towards this building in DC. 

What If Walls Could Talk?

What if walls could really talk? Would you be scared? Would you really want to listen? What stories would they have. If walls talked would you be appalled, overjoyed or disgusted with their sordid tales. You could hear the resonance of  soft whispers among lovers and their promises to each other.

These fortifications may divulge your stories and secrets, stories about you, things you do not want anyone to know. On the flip side you may hear a hearty laughter from your childhood days.  full of fun as a child, sound of your innocent and pure laugh, not yet corrupted by social obligations.

Maybe you will cover your ears, as you can no longer bear to listen to these atrocious stories. Or maybe you will listen just a tad bit more to satisfy you innate curiosity.  You may not like yourself when it will remind you of the unkept promises and blatant lies. It may show your lack of integrity, gold standard test for integrity is not measured on the basis of our social interactions but by what you do when you are alone.

Or maybe it may remind you how much you are needed and what you have done for others.

 PS: I have been lazy about writing blog lately as I have not been feeling well.

About the picture: Field Museum, Chicago

Hatred. Tyler Clementi.

Pablo Picasso said once about abstract art “Many people say they don't like my art because they don't understand it. Well, I don't understand Chinese, but that doesn't mean I don't like [it]”. 

We all fit somewhere in the spectrum of life, dull, bright, dark or translucent. Just because we do not understand something, it does not mean that we should disregard it or show contempt, unfortunately we do. We tend to dislike things which are different, some more than others. Our degree of contempt accelerates, depending how different the polarity is.

Things which are not comprehensible to us, start to plague us. Not so surprisingly our level of disapproval starts to grow depending how different something is. Our fear from darkness seeds from the sole reason, our inability to see in the dark. In darkness we are still the same, objects around us stay still but our fear of unknown and loss of control make us anxious. Our demons go away as soon as we turn the lights on. As usual when we can not perceive, we succumb to fear. 

Alien ideas, actions and concepts induce different reactions from everyone, some are not affected at all and some shows extreme agitation and some become phobic. It is so easy to detest something, much easier than trying to understand or rather accept the differences.  It requires no effort to go with the flow, however, accepting contrast need a conscious effort.  So, we decide to follow the same old route lets hate, let’s hate other faiths, beat the gay guy, make fun of how you look, and in fact hate anything which is different. 

Recently I read about Tyler Clementi, a promising musician at Rutgers University. Tyler jumped off a bridge after he was targeted for being gay. Clementi was one of many who are bullied everyday for being different. I took care of a victim of hate crime once and it was not pretty. Please spend sometime and view this link, this was sent to me again by my friend from Italy who earlier sent me this post too. Gays and lesbians are one of the many groups who are targeted for being different. History has taught us we do not discriminate in our hatred like we do for our affection.

I am not trying to make a political point nor is this an attempt to undermine any religious belief. My point is the human aspects of this tragedy. Someone lost a loved one just because he was different. You can not harm someone just because you like red and he likes blue. Millions of people are suffering because they either not look like you, worship a different God, have different facial profile or a different skin color.  Next time if you decide to go with the flow, take a hard look at yourself and see how different you are from the person next door. It is not about being tolerant; I think this is about acceptance…….you do not have to be like me, I like the way you are.

About the picture: Colors of life.

Is Compassion A Mutant Gene?

When we are young we are full of countless ideas, not yet corrupted by the world. I had a childhood friend, very smart guy, now a remarkable mathematician. We use to debate about things, some of those we were not able to comprehend and some we did, but lost it with time to the sirens of reality.

 

He would make a case that people are bad by nature and if some one is good than it is against our intrinsic nature. He was a total cynic. “So you think goodness is a mutant gene” I would counter him. We would debate to and fro and go around in circles. He would try to support his hypothesis by theorizing evolution.

 

He would say “Darwin’s theory is it about survival of the altruistic or is it about survival of the strongest? We are what we were. Since we started to walk upright we have been fighting over food to land and everything in between. What do you think natural selection or survival of the fittest is? It is exactly what it sounds like; YOU TAKE WHAT YOU GET”. He would add “compassion is a trait we have just started to learn, merely for few thousand of years, do not bet on this newbie”.

 

I would argue “if you truly believe in evolution than compassion and empathy is a gene in evolution. Maybe after struggling for so many thousand of years some of us are now fortunate enough to get the better end of evolution. We may be evolving into a higher beings”.

 

But when I see character like the one I mentioned in my earlier post Predator I start to doubt myself. On the other hand the people like the lady I met who volunteered all her life to care for homeless people, affirms my faith.  Amongst us live people who have ascended to a higher level of living; but there still those primitives; who prowl in the murky nights for prey.

 

We may not have control over what genes to pass but we can at least learn to modify our behaviors.

 

About the picture: Phoenicopterus/Flamingos are not genetically pink, they turn pink after taking high carotene diet. Shot at Busch gardens.

Female Is A Woman Not An Electric Connector.

Somehow we are seeing more females and males in the hospital rather than women and men…. I hope you catch my drift. There is a subtle difference between the two. These days I come across a lot of History and Physical (H &P) which refers to the patients as 54 year old female or 43 year old male. I find it a little peculiar. It strips vibrance off their personality. There is no denying the fact that they are male and female but so are electric connectors and dogs.

I was rounding once with an intern and he was presenting a case, he said “This is a 54 year old male who presents  ...” I stopped him in the middle and added “well he looks like a man to me”.

My point is; it is important to put things in context. If you keep on referring to your patients as male and female; you may loose the point that we are not treating a thing but we have some one’s father, brother or sister. It makes it personal.

Maybe it is a frivolous thought, but sometimes it is the small prints which matter the most.

About the picture: I took this picture in a small village in Pakistan, this lady shied away as soon as she realized I was taking her picture which embarrassed me a little.

Predator.

You can not judge a book by its cover, nor can you be always correct about first impressions. You are also expected not to judge a person. You are also taught to give a second chance. This is all true but we are humans after all and we all are guilty of doing everything opposite of what I just said. The argument would be that the intrinsic potential of a person never changes, an eagle would always be an eagle and a vulture would be a vulture. Can you change the true nature of a person?

I often see inmates at the hospital who are brought to us for various problems. I have seen some who have swallowed blades so they can get out of jail for few days to people who have sliced their hands with broken door handles. You deal with them just like you deal with any other patients as per Hippocratic Oath. Along the same lines I always try not to find out what brought them to the slammer in the first place.

Few years ago I saw inmate in the hospital. He was shackled to the bed with two guards around him. He had an ovoid face, wrinkled skin far beyond his age. He had gentle and deep eyes; he was taller than most and touching mid sixties. He was dressed in not so ever modest hospital gown. Ironically his handcuffs and ankle restraints appeared to be brand new.  I found him civil and pleasant to talk to. He appeared to be well versed and informed about his condition. I got a sense he must be a college graduate the way he was able to formulate his thoughts with the use of  proper lingo.

I saw him for couple of days before I was informed by a staff that he was incarcerated after being found guilty of raping a 6 or 7 year old and then choking her to death. The girl was a kin!

Being a father of 2 girls; it is difficult to isolate your emotions in these situations. I saw him the next day with a straight face. I asked my patent question “Sir is there any thing else I can do for you?” I discharged him in the next few days.

I have a vivid memory that just before discharge he complained to me about neck pain, it was an effort for me not to ask him “Sir, do you think your pain is more than the girl you choked, is it more than what she must have endured at the last few seconds of her life”.

I have always believed that nothing is absolutely bad nor anything is absolutely good. This incident is one of the times when I questioned my philosophy. What do you think?

About the Picture: I took this shot of Tyrannosaurus rex, largest land predator of all times at Field Museum, Chicago, however, man maybe the worst.

Time.

Someone inquired the other day, how do I find time to write these blogs. I pondered for a moment and quoted John Maxwell “Each human being has exactly the same number of hours and minutes every day.”  We have no more or less time than George Washington or Gandhi. Money can not buy you time nor can you borrow it from anyone. You have to make time Period.

Of course I am not in the same league as these great people, but I try to utilize my time the best way I know. Now suffering from chronic insomnia has its advantages and disadvantages. For the most part I survive with 5 hours of sleep.  Anything less makes me cranky.

Isn’t it funny when some friend calls you after a long time. Usually their excuse for not calling sooner is that have been very busy. But after a while when you ask them what they have been up to; their response usually is “nothing much, same ole’ boring life.”  So much for being busy!

Time is relative. Not as in the theory of relativity, but as how we see time. We have a very sharp perception of time when we are at home or at work, everything in our surrounding reminds us of time passing by. You are subconsciously aware of time as events happen at certain intervals. You know it is 7 AM because this is the time you go to work, few minutes elapses before the coffee  brews, lunch happens at 12 pm, meetings at 3 pm, going back home at a certain time, you exercise for an hour and an hour worth of TV program in the evening etc. etc. However, if you are outside on a beach or in the wilderness our perception is very poor. With no distractions or constant reminders times passes at an exceptionally slow rate. There are no milestones to remind us of the passage of time, maybe just the sun going up and down.  

The same thing happens when you are healthy and have no ailments. We experience no reminders of sands of time as long as we are healthy. No back pain after waking up, no prostate problems and no heart attacks. But with age nature starts to call on you with subtle reminders. You start experiencing more headaches, ankle pain, menopause and the list goes on.

Again these are subtle reminders, on the other hand people who suffer from terminal illnesses do not have reminders; they have alerts at the last moment. I have known patients who have asked me this question, do they have another month to live. Just imagine that a person has made peace with themselves that they will not see November 1^st, but they want to live till October 15^th. They can cram their whole life in one month. You can learn the value of time from them. They do not want to waste any time as they are acutely aware of the time wasting them.

Well I had a day off today so I had a lot to think about. I spent a whole afternoon at the library most of the time reading Kissinger by Walter Isaacson;  that was not a waste of time.

About the picture: Allegedly the biggest clock there is, but it was out of order that cloudy day. 

9/11 Nine Eleven, 8:45 AM. A Minute Before Impact.

“I remember looking at their faces when they walked in the church…… their faces were so blank almost like a deadened look on their faces. But after a while they talk, and eat, and sit and you’d see them leave smiling”.

Tara Bane

Victim’s wife and volunteer.

 Sometimes I wonder what do we have to show for. Is it really all about getting a good education or making few more bucks or collecting some more "stuff" in your life. 


What is our contribution?  Have we made a difference in someone's life.... if we have than I hope in a good way.  Let''s start small, let us make a change in just one life. 
Let's talk .....

I wish at 8:45 AM, someone could have talked to them.

About the picture: Badges of workers and volunteers at ground zero on my last trip to New York.

# 7 Life Is Good, #6 "Ciken" Wings.

This is a detailed account of what I mentioned in an earlier blog My Teachers.

Not so long ago after a busy and tiring day I came back home quite late. We usually sit down with our two daughters at dinner time and either do some fun activity or watch some TV together. Their favorite show is America's Funniest Video. Both my daughters 8 and 6 years old love that show. 

When you are a child you are easily amazed, unfortunately it takes more and more as you grow old. I think wonder never cease to exist,  however we loose the ability to appreciate it as time fogs our vision as we grow old. It is a precious gift to watch a child laugh for no reason at all. 

 So as we were watching the show, my 6 year old asked me, "Baba, can we make a funny video too". I asked her why. She said, "If we make a funny video maybe we can send it to America's Funniest Video". I assured her we can do it but why should we need to do that. She said, “If they like my video maybe we can win TEN THOUSAND DOLLARS" 

"Wow that is a lot of money, what are you going to do with it" I said. She thought for a moment and replied solemnly "I will give it to your hospital". I was surprised because I was thinking she will probably ask to buy some gifts or dolls. Still bewildered I asked her, "why would you do that?"

What she said next would stay with me for the rest of my life. She said ,“Then may be you can spend some more time with us". The decisions I made after that were pretty obvious.

"Nobody on his deathbed ever said, I wish I had spent more time at the office" Unknown.

About the picture: My daughter wrote this note about our family.

Message In A Bottle

Somebody asked me today “why a blog?” I countered “why not”. He said “what if no one reads it”. I replied “so what, think of my musing as a message in a bottle, I almost have no expectations that anyone would ever find it, probably it will be lost in the sea. It may also smash against a rock or maybe it would land somewhere on a castaway island never to be found. But if I won’t float the bottle, it will never reach its destination”. He got irritated and walked away.

I assured my self that at times people do find it; it can not be a total waste of time. People do find tales of joy or maybe tragic moments, sometime maybe a nudge to move on or perhaps someone’s life narration. They may learn to avoid the same mistakes the other person made or discover about things they can relate to. On the other hand if nothing is done then sum of zero is …….

Finally I moved away from the front of the mirror and walked away too……

About The Picture: Lake around my house.

My Teachers.

I have been blessed with great teachers. They showed me horizons which I thought did not exist. They had an array of personalities and professions. Not all of them were strictly in the academic settings. They varied in age and things they had to offer, at different stages of my life. Like my high school teacher Ms. S, who taught me time management and brought out the best in me. My father, who showed me being a doctor, is more than billing a patient.

My little 6 year old daughter, who taught me what is more important in life, when she asked me to donate money to the hospital I work at, I asked why. She said “so that you can spend more time with me”. My teacher at Beth Israel Hospital/Harvard Dr. Ferris Hall, who taught me that you can not ask for respect, you earn it.

My “singing heart” patient who taught me that you have the power to brighten someone’s day. My supervisor at the carpet cleaner company where I worked in Chicago during my first year in America, who taught never to treat anyone the way you don’t want to be treated.

Our janitor Julie, who spent decades at University of Massachusetts, taught me never to ignore people who help you, with what you do. She said "I feel invisible, people pass by me all day long but never seem to notice my presence". Indeed, she was right when I saw her next day working, she was….invisible to everyone.

I cannot forget my senior resident Kirk MacNaught, who told me once during my intern days when I was in a hurry to make a decision about a patient, “You should never treat a patient like you would not treat your own family member”. Then he continued in his soft voice “can you please stop running around the hospital like a chicken with its head cut off and get back to work”.  

I sometimes still run like that. I never claimed that I was the best pupil, I was just lucky to have great teachers. Most of all my patients are the best teachers, who teach me things I could have never learned in any school.


About the picture: I think this does not require any explanation.

Boys Don't Cry.

He was in his mid twenties, I think. His face, as pale as snow, was partially covered by his hand holding a phone. He was lean, tall and stooping forward a little. He was standing rigid at the corner, across the elevator. He was speaking softly on the phone like he was trying to assure someone on the other side, something which was beyond assurance. Tears were rolling down his face but he was not making any attempt to wipe them off. Somewhere at a distance I could hear a woman’s mournful cry.  However, this man was oblivious to everything like his goal was to mend the other person over the phone. His despair was very private and required no solace. I glanced at him while I got in the elevator and the doors closed.

Just another day in the hospital.

About the photo: Gloomy day in Tampa.

Cut, Burnt and Poisoned.

“I have been cut, burnt and poisoned” said a friend of mine who has been recently diagnosed with esophageal cancer. He has gone through surgery, radiation and chemotherapy.  He is merely 40 years old. He has lived a very good life, successful in his career and married with two little daughters who are my daughter’s age.  I can relate to him on so many levels because of   many similar traits in our personalities and among our families.

 

We used to go out a lot before he was taken by this ailment. We have shared some good laughs and enjoyed some great times. I remember going out once for a snorkeling trip. There were at least fifty or so people floating around us.  So here we were snorkeling up and down the river, we would come back up to our canoe and move to different spot.  It started to rain and we continued to do what we were doing. After a while I come up and notice there is no one in the river any more. My friend realized it too. I asked him where did everybody go. He said possibly because it is raining and, after a pause he said ……lightening too. We suddenly realized that we are sitting in an aluminum canoe. Moment of panic struck us at the same time. It was an open invitation for a lightening bolt to strike us. We both paddled for our lives and reached the shore on record Olympic time. Once we were safe we laughed at our stupidity for a very long time….. We still do.

 

We would also meet on the weekends where my 6 year old daughter would go for karate class. His daughter was just too good despite being the same age as my daughter. I was afraid she may break someone’s arm or leg. One day he told me how he taught her daughter to throw a perfect punch, I envied him because even I don’t know how to throw one. I thought well maybe I can teach my daughter not to throw a perfect tantrum.

 

Sometimes I wish we can have that time back. I wish he can get better like this has never happened before. I asked him how come he is so brave, I would tap out so fast. He replied I am as brave as any father would be. I am doing this for my daughters.

 

After he received his first cycle of surgery, radiation and chemo he waited for a month before the CT chest and abdomen were repeated. He was very optimistic, doing everything right and embracing any therapy available for this disease. He was even getting imported Japanese herbal tea which can help with cancers. Then came the results of the CT scan which showed that there was no remission, in fact there was progression of disease with lymph node involvement.

 

I remember the day when I found out. I had a tough time sleeping that night.  But he did not flinch and started the process again with chemo. I asked him how it feels. He said “It is like you prepare for your tests and work really hard, you sit at the day of test and do really well. But when the result come out you find out that you got a F. That’s how it feels like”. I was speechless.

 

His courage, dedication and strength is inspirational. We met few days ago and during our conversation he told me casually that he sold one of his cars just in case if he is not around things would be simpler for his wife. To come in terms of one’s mortality is not an easy thing to do. His wife who is a physician too puts up an act so convincing that it is hard to figure out what is going on behind this veil of bravado.

 

I read a book The Last Lecture by Randy Pausch, a computer professor who stood in front of 400 people at Carnegie Mellon University in Pittsburgh and frankly talked about his fight with pancreatic cancer with few months to live. Later in the lecture he did some push ups followed by a lecture about how to achieve childhood dreams. He writes in his book “We cannot change the cards we are dealt, just how we play the hand”.

 

I think my friends have played it well. Sometimes I feel guilty that in the game of life the dice coughed out the wrong numbers. Sometimes I have trouble looking straight in his eyes thinking he may discover that I fear for him. But there is never a time when I don’t envy his strength. I wish I could have been a better friend.

 

Anyway my friend I just want you to know we are here for you always and I hope we are stupid again to snorkel during thunder and lightening soon.

 

Blog you later.

 

About the picture: I took this picture at our house but my daughter provided me with the ketchup.

PS: This is a follow up.