Indeed an Emperor!

How many of us have seen greatness flicker in the face of an adversity,how many of us have found ourselves succumbed to pressures of life.

I took my own time in reading emperor of all maladies….I dint assign myself any time period which I agree isn’t a very good habit but I picked it up in college days…..however emperor isn’t one such book….there were days when I'd read as little as three pages and would suddenly become aware of this numbness surrounding me ….I found myself exhausted and consumed by the words….and then there were other days when I would imagine myself sitting in the conference room listening intently to halsted while he is delivering the lecture on radical mastectomy until and unless words jolt me back into reality 'I find myself inclined to welcome largeness'.

Cancer has always been the most devastating of all illness….the most harsh of all challenges that we face is the diagnosis before the appearances of symptoms because by the time symptoms appear it's too late…..the transforming medical research has seen some landmark discoveries….we have come a long way…protooncogenes- sis ret fms her2neu are some growth factor and growth factor receptors then signal transduction proteins and NTP RAS tumor suppressors ,genes for apoptosis and dna repair genes…I am enthralled by the way these discoveries has led to the cure of cancer…recently we lost Hugo Chavez to an undisclosed form of pelvic cancer…Steve Jobs to the most aggressive pancreatic cancer….Steve jobs donated an unprecedented sum to the john Hopkins fpr more advanced research into pancreatic cancer and its cure ….he was so enthused by the way it was developing  and growing that he also made  a media statement saying that either he will be the last one to die of it or the first one to be cured of it…that brings us to cure and chemotherapy…the problem that is looming large in the face of all of this is the cure now….recently bayer's kidney cancer drug nexavar was in the news for all wrong reasons…I was flabbergasted to see the price that bayer's quote for nexavar an exorbitant Rs 2,80,428….Nexavar is sorafenib which is a tyrosine kinase inhibitor …is useful both in renal cell cancer and hepatic cell cancer….it's side effect profile describes hand foot and mouth syndrome….at this price not many can buy it…cipla currently is selling it at Rs 30,000/month…however government has given its nod to natco pharma for making and selling its generic version which though of inferior quality but will be available at cheaper price….which itself throws at us the question of drug's potency and efficacy.

 Such questions are extremely unsettling …it reminds me of that in love at the time of cholera Dr Juvenal Urbino had observed and believed that scalpel is the greatest proof of failure of medicine.

Scalpel today has redefined cure and life expectancy of cancer patients…while medicine is all about instincts , surgery is show time….surgery is about conviction…in today's time they are hand in gloves for a successful cure.

As Novalis said "every sickness is a musical problem"

"and every cure a musical solution" - W.H. Auden

 lemme write my music.....i still have a chance....to heal and be healed!!

As Paul Ehrlich said , “life is a....chemical incident”!! What I am sure of is I never wanted the description of my life to be easy , smooth ,fun  else why would i choose to become a doctor.
Medicine is all about handling failures....in all its forms!! You will be assigned more work than can be managed ,more to learn & read than probably can be remembered...enough is always less for us. It’s  emotionally and physically gruelling and no I am not complaining here. I, probably, only by now have a partial glimpse of my life ahead....tip of the iceberg and I won’t even call it a struggle. Struggle is what people do against their disease in hospital....rest everything is overrated! There are things that we are told and things we discover!As an intern when i was assisting my resident in suprapubic cystostomy ,he pulled me aside and said “Emotions are funny and weird, Keep them aside”. I now know emotions are neither funny nor weird,  expression is!! When I put my first suture I realized how precision with which a task is done so much more important than it’s mere completion. I know medicine to be either consuming or evading. There’s a midway, it’s just not for me!! As Sidney Farber said “for progress we don’t need full solutions of all the problems”.....I agree. For  progress, we need patience!!
At  the end of the day, you just have to compete with yourself, you could either be optimistic or delusional and There’s just one thing that can’t be cured...it’s impatience!!!

NARENDRA MODI AND THE HALF TRUTH

            It's been a while now…I used to either start my day with suryanamaskar or a cheese slice….but this morning in particular has been really lazy….all I needed was to catch up on some sleep…I don't exactly remember what I was thinking about when my roommate slammed the door and thrusted a mug of tea in my hands….she was muttering something, well I 'm blessed with selective hearing and vision loss early in the morning.

however it was in my best interest to pretend I was listening to her,I asked her to pass me

the newspaper….she hurled toothpaste towards me,"doc, it's all about coalgate…go brush"….i wish I had complied with the orders!!

I came across an article…what a bummer seriously….flip newschannels…go through newspapers....it really takes Indians a great deal of time to move on….kudos to our media

Talk about misrepresentation of facts, talk about bending the truth….talk about being selective in bringing facts to lights…oh wait facts,is it??media's recent brouhaha about Narendra modi's interview to WSJ…. In the concerned interview,Mr Modi also spoke about girl child education,upliftment of poor…which was very conveniently not reported….while you lodge this war of attrition against Mr Modi,

you are devoiding us of truth.And probably noone ever told you but  A half truth is no truth, you see unlike gossip truth follows an all or none law!!

But what really took me by surprise that while everyone jumped on to the conclusion of the chief minister being callous sinister and bla bla,even the self proclaimed genius saviors of our society failed to acknowledge the difference between malnutrition and low birth weight or underweight…..malnutrition is just one of the cause of LBW!!

As a doctor I understand the importance of nutrition during the nine months,it plays a vital role in determining the birth weight of the baby…but overall health of mother is equally important!!

let's look at it this way…..we have been always told that the performance on the day of the exam is really important for delivering good result but can we ignore the preparation that we need to do for an exam which will affect the performance on the day of exam…likewise pregnancy is an exam,it's a responsibility!!

You need to prepare yourself for it….emotionally mentally but most important physically….Nutrition is always prophylaxis ..it can never be the treatment!!

And anorexia has really become rampant in our society….girls in early 20's do diet excessively…and certain losses can never be covered up for!!!That is also the reason why a 19 or a 20 yr old girl always deliver a LBW baby….it's important to note that nutrition has an additive effect!!a malnourished mother cannot usually cover up for the lost nutrition and can never deliver a healthy baby!!this underweight baby contracts infection like pneumonia which takes a toll on it's already dwindling health and it indirectly adds to our screwed up stats!!

this brings me to question that why do we always talk about problems,are busy in dissecting statements…..what about the solution….LBW has plagued India!

we have been talking about the conflicts,its time we let truth prevail…..it's time we talk about the cause!!

Debates only form opinions….it's the best way to hoodwink the society while doing absolutely nothing about the problem!!most of the media reports are based on these opinion!!

As and when such reports flummox us…here's a thing

opinion resides in everyone's mind but truth ,it's always lurking in our hearts!!

three cups of tea

 Just finished reading "three cups of tea" by Greg mortenson and  David Oliver relin

I have always been lucky with books I read and people I meet…just when the time is right for a particular story in my life…… for beginning of a new chapter or end of a loss

Three cups of tea is an exceptional book….we know several such books and incidence where in someone's courage, their story  became our inspiration…and then there are books about realizations....by the end you would always smile…..silence would seem better than music… my realization through this book is what I have always believed….there are just two kind of people …. A- those  who always wait for the right opportunity or time to take a decision and B are the ones who go ahead with their decision and conviction and would do everything possible to make it right….latter will have  two outcomes…either they  will succeed or they will know the limits of their existence but they probably will  never loose….because  just where we thought was the end, life begins … and at the limits we know the significance!!

Sometimes it isn’t about winning or losing, right or wrong , acceptance or rejection……sometimes it's just about taking a decision and finding the truth about yourself!!!

by the way tea has such a therapeutic effect....it has seriously become a companion!http://www.threecupsoftea.com/

The Royal Road

Books have been lying all over my bed since morning…pages flickering.

I've read so much since morning….I have been in alpha rhythm for sometime now….I thought it would be good to write…..yeah I know today is doctor's day….and I have to confess it was in prefinals of bachelor's when I fell in love with complexities of female reproductive system and later complexities of brain took a part of my heart….former anatomy,latter ofcourse physiology!!

We live in such a world,a world of paradox….so when you meet a women or a mother who asks you "hey doc,tell me about pain free labour ,or how can I get a pain free labour?" you chuckle"I am afraid maam but that's  an oxymoron….how can labour in any form be pain free and I know delivery as the most difficult labour"!!     oh dnt give me the crap of science progression and C  section…..it's not that I m against Csection….and I am pretty much aware of all the indications for the same….fetal distress maternal stress PIH h'agge bla bla…..my point here is….why do we resort to C section so often …..why do mothers give up just in time??why do families want their babies to be born on some silly date which they consider is auspicious and rush to clinic to book  a date for operation??

Normal labour is the most divine and miraculous physiological process designed for human body….when a fetus is sure of it's capacity to be able to sustain life on it's own ,it drives it's way out of the womb…..it releases hormones ,initiates muscular contractions and squeezes it's way out......the fetus has a powerful brain which co ordinates all these activities between it's skeleton n muscles …..and twisting and turning in that tiny space isn't pain free for baby too…..Csection and analgesia have several risks….and when you resort to them….you deprive your baby of the very first struggle it undergoes to come to the real world, the very first time baby's brain initiates a process…..and you deprive yourself of the very pain for which u were born as a woman…..learn endurance…..if it's going to be amazing, it's not going to be easy!!
The road with maximum resistance is always the royal road!!!

In the darkness

When the night fell,

            Out of sheer exhaustion I lied down.

All I wanted was my peace

I frantically searched for it.

            Hurried gazes. . .some here some there.

How would I ever know where?

I closed my eyes yet I could see,

Flurry of thoughts flood my brains.

Why did I ever think I'd be forgiven,

And when my inner voice grew louder,

I shut my ears and ran for shelter:

To a place where I could hide my tears.

Seconds later. . .

As I was standing beneath the eternal sky;

Its vastness and its greatness made me realize:

It was all temporary. . .everything that ever was. . .that is. . . and that ever will be.

I was assured that "Someday, I will rest in peace".

TIME

I seldom wonder about time and how it has always been so harsh on me, about how time changes a thing of joy in the past to that of sorrow in the future, about how at certain point, it would first take away my pain only to return so much more.

We've all been played in the hands of time. Time has an amazing way of sneaking up on our lives just when we think everything's going fine. Just when things start making sense to us, time interrupts us and gives us its own verdict.

They say time changes everything and everyone. There are many of us who are racing against time just to save some of ourselves and probably, some of our time. But I, in particular, have always, always lost to time. It has been the masterpiece of my life.

Now when I look back in time, I wonder how I lost my innocence, my dreams, my pleasures, my love to it. Time ruined it all and changed me to the core of my heart.

There is responsibility.

There is conflict.

There is fear.

There are questions unanswered.

There are worries, complexities, uncertainties.

And then, there is time…

So one such evening, I decided to give up. As I sat by my window side, staring at the dark sky wondering why is it so that the beauty of the brightness of stars can be fathomed only against the darkness of the sky. I let a tear trickle down my cheek and wondered, what is that one thing that would stand tall against all atrocities of time, that one thing that time will never ever be able to steal from me??

I was lost in deep thoughts trying to understand the malleability of time, listening to the silence of the night under the limitless sky and twinkling stars, when the ring of my cellphone jolted me back to life. Reluctantly I answered it. It was a call from emergency and I had to rush to the hospital.

In almost a time, I forgot all else. A life is so much more than any amount of loss or pain. I reached the hospital and attended to the patient. Once things were under control and patient was doing fine, I returned back to my hostel with a smile on my face.

When I entered my room, I just fell on my couch too tired to lift myself up and dozed off. What happened next, was either a dream or a hallucination of a tired mind, but here's what I shall always remember it as henceforth. I had an actual conversation with time and here is what it said:

"Dear One,

I hope you got my answer. It's you and only you who would always stand tall against me. I'll never ever be able to steal you from you.

Innocence is always lost either to wisdom or arrogance. I took away your innocence.

Your actions, now, will determine which one you gained from it.

Love is always lost to patience and what on Earth can love alone achieve? Love makes you vulnerable.

A patient mind can, however, achieve whatever it conceives. Patience alone can teach you perseverance which is a matter of attitude in life.

You ought to break some rules when you are playing, bound to make mistakes. You will be ridiculed by some, wronged by others, judged more often than not, criticized often and applauded seldom; by people sitting within their boundaries. But then you know so much more than these people. Your mistakes not only give you an insight, but also help you examine your life.

You were wasting me on so many insignificant things in life. I hope you, now, remember what your father told you when you were 15."

As I awoke the next day to an exceptionally bright Sun and blithe birds with a soft smile playing at my lips, I realized that there was something monumentally different about this day. I didn’t have to strain my memory too hard to remember what my father had said when I was 15:

"Daughter,

Time will teach you everything that you refuse to learn otherwise. What I wish to teach you today, someday you'll hold them as morals of your life. I hope its not too late by then."

I found myself reaching for my phone and doing something corny. I called my father and said, "I hope its not too late".

As I put on my watch and stepped out, Time was with me again and this time around…I have a lot more faith!