Sunday, July 26, 2015

A Different Speciality....

My first seven years of school  were spent in a system where something called the Senior Cambridge Board was in operation, and for some reason, somewhere in Class 6, I heard about the Pharynx, Larynx, Oesophagus, and Epiglottis.  ( Throat, Voice Box, Food Pipe, and Flap-that-keeps-food-from-getting-into-the-windpipe, respectively , to those bothered by fancy nomenclature). 

And I was hooked.

Since then several doctors, and unsuspecting friends have been at the receiving end of surprising diagnoses.

I remember the time I  was around 11 and had this swelling in the throat as children usually do, my voice had alarmingly changed, and my mother was on the phone to our family doctor who lived in the next building, when I wildly gesticulated and told her to tell him the pharynx was inflamed . He was vastly amused and immediately asked her to start me on gargles and steaming and he would stop by later to check.

He was the beginning of a large set of doctors , to whom, I asked (and continue to ask) all kinds of questions about anatomy , and who patiently answered , every single time, without letting on what they really thought of me.

I changed schools in class 8, and joined another school that functioned under the Maharashtra School Board. This meant  that I traveled by a specific bus across the city everyday at a fixed time to make it to school, and it was just providence that the school was next to the B.J.Medical College in Pune. The same bus used to be taken by lots of lady students of the college, with very thick black bound volumes called Gray's Anatomy.  This book had countless pictures , particularly of the skeleton, and I used to pour over these books during the ride, giving me a nodding acquaintance  with tibias, fibulas, femurs,thorax, scapula and so on.

But a separation was on the cards. Report  cards , that is. Somewhere in the second year of college, we had to choose between biology and maths. I was very good at both, and ended up choosing math. Since then , I have moved further and further away from formal biological learning, but once I was free of academics , I got back to my old interest.

I read books, and then the Internet happened. To me , it was a Khul Ja Sim Sim moment.

Long, long, before Google happened, we used to use something called Lynx  at work , and it would display search results; when you clicked on a specific one, it would actually show you the bytes loading one by one in the left lower corner, till the actual site appeared; it was almost like counting each and every chana dal grain while eating a PuranPoli.  

I  searched for a family member's knee symptoms, and came up with Chondromalacia.  The only other person who had said that word , was his doctor ! And so folks were amazed.  I also found treatments , but was a bit more quiet about that. 

Then Google came on the scene.  Articles and books became available.  You could see graphics and diagrams of all kinds of stuff. You could join all kinds of interest groups, and wonder about coming across someone from Kansas having the same problem as you did, and what worked for them .   

There were of course some embarrassing episodes, where a friend was describing her lower leg pain consequent to a back trauma, and I searched and found out about "claudication".  I also learned about the possibility of someone listening to your femoral artery (in the legs) sounds with a stethoscope, and looking for flowing river sounds to ascertain about blockages.  This friend and I immediately rushed to our gynaec friend at our hospital , who by then was used to these learning situations. She humoured us by doing the blood flow sounds, and allowing us to hear (not that we could tell anything) , and then told us that claudication was a serious thing, and one didn't go traipsing around like this if so afflicted.  So my friend didn't have claudication, she was relieved, I learned something, and the doctor probably had a big laugh.    

Another time, I had some knee problem, very painful after a fall.  Naturally, an appointment with the hospital orthopaedic person was advised , X-rays were done, but I googled till then to find out just what was going on, and discovered the Anterior Cruciate Ligament. The orthopaedic doctor had me lie down, and move my leg in various ways to ascertain pains vis a vis movements.  No one could figure out why a lady in pain would be smiling so much after the doc mentioned the Anterior Cruciate Ligament. I was just thrilled to bits. To this day, I think the quick healing had a lot to do with this attitude of respect and recognition accorded to the ACL.  

Late in the sixth decade of my life, facing some extreme gynaec issues, it was like doing a course on Uterus 101.  I had a lot of questions about some anatomical constructions in the region, and the purpose behind making things so difficult. I was now on backslapping terms with endometrial lining sizes, OS, laparoscopic methods,  unnecessary hysterectomies,  anemia, hypothyroid, and other friends. There was an element of "mind over uterus"  with all the treatments, and I even dreamed a certain size of endometrial lining  once, only to have the radiologist on duty give me a high five when she found out the identical lining size the next day during a sonography session.  Science be damned, but I think I brought a few moments of entertainment in the lives of the busy doctors.  That the entire issue got solved later as an amazing example of a different "mind over uterus"  is something that even my doctor will agree upon, and is actually material for a separate post or conference paper.

Which leads me to the belief that there are cells that "think" all over our body.  That there is a brain branch in our gut is well known.  But I am talking about the sort of "cell thinking"  that is aware of what I am thinking otherwise.  Every living tissue of consequence probably "thinks". And is aware of the mind, per se.  There is the heart, that endlessly beats to the tune of Nishkaam Karma; there is the Liver, that is so busy releasing and storing stuff into and from our blood  for difficult times ahead, that it ignores itself, and shows weakness only after it is 80%  gone , to the dogs, as they say.  

And so you are smitten by the anatomy, the brain, you delight in correct diagnoses, and you develop an immensely huge respect for medications  and pharmacy formulations. You have great admiration for those who take the trouble to explain pros and cons of certain medications, in the face of popular treatment protocols.    And you have immense respect for a cardiac interventionist , who kept a straight face when you noticed copious urine in the ICU bag, and asked if the kidney was throwing out all the "blood thinner" medication  stuff .  And you applaud those who actually draw diagrams and explain to you what is happening,  when you ask stupid questions. And a recent episode where I jumped to multiple sclerosis after the doctor mentioned Myelin, will be kept in reserve for another post.

Sometimes though, you make anatomical poems, and some doctors are shocked. Never Mind. 

Possibly, some of my interest in  run-of-the-mill interpretations of serious things, has been passed on to the next generation.

The daughter, several years ago, single digits in age,  explaining her pain to the dentist, said she had a heartbeat in her gums.  (I think he missed a beat)

The son, again in single digits of age, listened to his grandma explain why she wore footwear in the house, as she had diabetes and needed to protect her feet from wounds, as they might heal slow. He routinely heard talk about high and low "sugar" then as his grandparents were diabetics.  The one fine day, he tells his diagnosis.

The medicines for the foot wound , would be reaching there late , mixed with the blood, as unlike other non diabetic folk, grandma had slow moving thick sugar syrup style blood  flowing all across.  His grandma, who was treated by the country's leading diabetes authority had never heard such a fun diagnosis.

 One of my doctor friends once mentioned that I could still go in for formal medicine training; medical college , that is.  She thinks I am really cut out for it, since I already exhibit certain second year  MBBS signs, of suspecting that I have the disease symptoms, that I  am actually reading about.

The only problem is, I am not sure , that even though I hold a Masters degree in Physics , that I will be able to make it through today's  complicated  XII Boards......  


( In the meanwhile, I can almost hear collective sighs of relief, that I am not likely to be a doctor; Ph.D or otherwise....) 

Thursday, July 16, 2015

Death : Digital and otherwise

1956. I must have been seven years old then, and I often wondered why my mother was spending so much time at her brother's place, and why , this time, my paternal aunt downstairs was now involved in organizing my birthday.  I might have been considered too young to understand.

My maternal grandfather was sick, bedridden, and sinking. The family rallied around, spending time with him, trying to communicate with him, even though he didn't seem to be responding. My first encounter with a death, was when we were all taken to my uncle's place, to do namaskars to my late grandfather.  We grandkids, of a certain age , took a bit of time understanding what had happened, and learned to accept that people gradually fade away  and become a memory.  Those children who stayed in that house, saw the ebbing away of a life in detail, and unconsciously learned a lot.

There were no ICU, ICCU's and fancy hospitals.  Yes, specialists were there, and they came on the request of the family doctor,  in consultation with the immediate family.  There was a certain sense of respect.  Perhaps for the patient, perhaps for the inevitable unfolding of a life stage, and for the immense knowledge and advice of the doctors.  Elders of the family often knew the signs , the breathing, perhaps the last glow of a tired flame, and life, as we knew it, quietly tiptoed around.

It has been my honored lot to assist at  bereavements in my late adult life, a few , in hospitals, when near and dear ones were in ICU's. 

And I have often wondered whether death had now become digital, a war of numbers, finally, unequivocally, asymptotically,  visually, going to zero. Or perhaps , even infinity. 

A sick person, in clinical isolation, intubated, catheterised, wired and masked, struggling through flashing numbers, and beeps.  Periodic visits by impersonal nurses /ayahs and doctors on rounds, and a glimmer of life around through sedated eyes. No family allowed in. Sometimes drastic electrical treatments to revive a sinking, and shocked family sometimes seeing the struggle through small windows.

Some are hard fought victories,  an ode to the brilliant medicine being practiced, and people go on to several more years of  a slightly more disciplined life.   Some are, humble acceptances of the inevitable, after having tried one's best.

But what bothers me in this new protocol, is when patients are kept artificially alive for days together, and decisions for "switching off life" per se,  are left , to the immediate family.  There are counsellors, there is gentle prodding.  and many times, a hitherto quiet spouse, child or parent, shows immense strength of mind and takes a  tough decision.  (While some others, make it their business to ask traumatic questions that trouble the immediate family).

What , strangely,  does not bother me so much, is the possibility of transplanting working anatomy to another needy person, perhaps young, perhaps a child, to give a gift of life, where no hope exists.   

Perhaps, its a sign of age or life stage, that one tries to find a golden mean

There have been deaths , where at home, a quiet shutting down of systems was noticed,  some typical breathing was noted.  A doctor in the house was at the bedside . Family gathering around.  And the lady who spent more than half a century with the patient, mentoring the aforementioned family , accepting it all with stoic grace. Asking her son to sit by, and take his father's head in his lap, as  is the custom.

A quiet respectful passing away. An even more quiet phone call to the eye bank, and the uneventful arrival of its personnel. Ten fifteen minutes behind closed doors, and they leave quietly with gratitude, as the patient lies, as if in sleep, totally unaware of his amazing gift of eyes to someone.  The family converges once again around the just departed, thinking about how life has changed.

There have been situations where one was the sole person watching life ebb away from a close relative with a terminal situation, and one stood holding his hand, watching and trying to decipher moving lips, and  perhaps , involuntary hand movements; perhaps a last brightening of the mind, before the shutdown, and one wondered what must have been going through his mind, while one tried to calm one's troubled mind, trying to wish away what was happening. Then doctors, relatives, and the kicking in of a social system that keeps you from dwelling solely on your loss as you deal with visitors, phone calls, and yes, the eye bank and skin bank people.

Sometimes, it takes a perceptive doctor  to see you through the toughest moments.

A very close relative, a lady , was rushed to our local hospital ,  after what was later diagnosed as a massive heart attack.  The lady was very alert, smiled at the doctor, asked me to get her glasses and shawl from her bag, so she could see what the nurses and doctor were up to. Lots of intravenous stuff being initiated, BP being tracked, and  one suddenly noticed, a closing of eyes, and a twitching of the mouth , happening with much frequency, and pointed it out to the doctor, who immediately stuck fingers in the patients mouth . One noticed a  way to contribute in the proceedings, and immediately freed the doctor by offering to sit with one's fingers in the patient's mouth, while alternative treatments and arrangements were effected.

The patient had actually passed away then, nails turning blue and all, and to this day, I remember the force with which the teeth had clamped down on my fingers.  I slowly climbed down from the big high trolley bed, and went to stand with family that had gathered outside, still coming to terms  with what had happened  in the space of an hour. .

Much after all the formalities were completed, and we brought her home, the doctor came by to visit the next day,  and comforted the family saying, that in the last moments it was as if I had "offered my lap" , so to speak .

There is much to be admired in the advance of medicine and treatment techniques. There is much to be  admired in the capabilities and efficiencies of doctors. 

Somewhere, it occurs to mind, that  it has to be more than numbers. More than a straight line implying the stopping of a heart.

Somewhere, perhaps inexplicably, the departing may sense a family wishing him farewell. Offering a lap, holding a hand, giving a drink of holy water.....

Life is , and has never been  a straight line.  There is no reason that death should be one.   


Saturday, July 11, 2015

Perils of a Synesthesized Society.

Ever heard of Synesthesia ?   No ?  Ah well, at the outset , let us just say that it has simply nothing to do with a similar sounding Anesthesia.

Turns out,  Synesthesia is a condition  , where stimulation of one sense in a human, automatically evokes a "perception " in an unstimulated sense .

For many years I marveled at the way all our senses are "managed" in our brain. Touch, sight, hearing, taste , smell,  all developing to the level they do as we travel to adulthood, from a single fertilized Ovum.

Sensing is the easy part. Perceiving what it is, involves some smart work by the brain.

Synesthesia is what we call it when we see folks looking at numbers, and see them in various colors; there are people who hear sounds when they smell things; there are people who get a certain taste when they read words; there are people who see colors when they look at , say calendars, and everyday of the week has a color.  They may even hear sounds, for each day of the week in the calendar.

This appears to be a fine example of senses intruding into each other, in the "management area"  in the brain. (Reminds me of certain Municipal Corporations, but never mind.)  Which, to someone , who needs to work with computers , sounds like a hardware fault.  This is found in,  say, 1 out of 25,000 people, and more women seem to be prone to this

This seems to be a case of some brain circuits connecting to other brain circuits , maybe even shorting,  possibly due to  genetic reasons , when they actually should be independent.  

Software wise , precisely because of this capability  to "perceive" and understand , the brain often develops something called neural plasticity, which means ,one or more of the senses chip in , in a constructive way, to help out with a sense which is not working any more for some reason. And so you often see visually disabled folks having an amazing sense of, say , touch,  through which they learn much more than us ordinary folks.

This situation, unlike Synesthesia, is like a program being tweaked to do something additional in the brain. This "plasticity", generally positively enhances   things for the specially abled person.  

Which brings me to my pet theory, that our society and anatomies mirror each other. Clearly, anatomies came first and societies later.  

And typically, the societies learned nothing.

Synesthetic societies. With messed up social and power circuitry.

We have people, who sense colors , like green and orange, when they see people, and immediately jump to conclusions and set alarms.

We also have people who feel depressed when they see black, and are over the moon when they spy white.

We have people, who hear imaginary words, when they taste certain foods.

There are also people,  who smell something when they hear the jingle of something in someone's pocket.

I have known people who can smell something around dark people, and this affects their sense of touch. 

I know folks who see red when they are confronted with certain sounds at certain times of the day.

And of course, we have people, who see money and think "black" .

Unfortunately too, there are those who are forced to tolerate a sense of touch, and they shout red everywhere, but are surrounded by those who whose sense of sight  is on mute.

Some folks can smell a rat when they hear some words.    Some folks can "see" a lie being spoken.

The question is  whether we do anything about it.

On the other hand, a society with a predisposition towards neural plasticity , will tend to multitask, or train people to multitask.

Using a sense of reassuring touch to those who see green and orange colors where there are none. Sharpening one's sense of hearing in addition to reading and sighting things that could endanger the peace in the community.  Using the sense of sight and smell, to bring some security to what we taste.  It is all about being flexible in the common good. You become a good watcher, even though you cannot hear well.  You develop a sense of analysing taste, even though your fingers do not sense anything ; and sometimes, you suspect something, cannot see anything, but keep your ears sharp to listen , and  save something disastrous from happening.

The trouble is, anatomically, the Synesthetic folks are about 1 in 25,000 people. There is even research happening that says such folks may be creative .

On the other hand, today, our society is full of  misguided Synesthetics,  being encouraged by power hungry folks and being used by them, for their own benefit.

If our brains acted like our societies do,  they would experience fits and seizures. Which is actually a danger indication from the brain.  Sometimes , the human body listens.  And treatments are provided to right the situation.

But our societies, are yet to listen.  Or watch. Or smell the danger. The seizures are all by those, "seized of the matter"  and so powerful.  So many act mindlessly, as if in a fit. And cause more damage. You just need to read the daily newspaper to understand.

When I first heard about Synesthesia, I thought it was a cousin of Anaesthesia.

It should have been.

Then there would have been a solution to quieten all those noise making social circuits in society, with a hefty dose of something.....