Cutting Music .....

I have always been curious about medicine and its practice , right from the time I was a teenager.  At one point in my late 20's  I had an opportunity to observe a Cesarean section delivery. I stood some distance away,  mask and all, behind a screen, in the OT and watched.

While I gaped in wonder at the proceedings, the cuts and use of various instruments, the emergence of the baby as it was lifted out, and the stitching up of things,  I was  marveling at how confidently the doctor went about the job.  It was a bit disconcerting to realise that there was some endless chitchat happening between the surgeon and the anesthetist, and the assistant doctors. And this chitchat had nothing to do with the patient, the incision , the blood or whatever. The entire operation went off beautifully, and the surgeon and the anesthetist kept on a running discussion on some new Marathi musical play that had come, and their opinion on the actors, and the writer of the play, some various inside information someone had heard, and so on.  This was in the 70's.

Today, the sound quality of music that is played has improved tremendously.  Numerous genres of music are there,  and music has become an important part of the environment. In its conservative piped in version, it is played in banks, malls, airports, lobbies, and so on. Recently , I  had occasion to attend to someone in the ICCU of a hospital, and they even had music, for us to "wait by",  as we stayed endlessly in the waiting area , day after day.

Music as therapy for the sick, has been researched and proved beneficial. There are surgeons , who listen to favourite music in the OT,  and patients who need less anaesthesia, when they listen to music on headphones while going under.  Possibly then,  the  music crescendos, and thrust-and-parry, of say, the late Bharat Ratna Pandit Bhimsen Joshi's "tanaas",  would co-exist in the OT, in delicate contrast to the quiet, careful, studied , detailed, careful investigation into some one's innards, a cut here, a cauterisation there, a snip somewhere else, and a slapping of tools into some one's capable hands. 

 There is new research to show, that music also improves investigative capabilities of doctors.

 I have just come across this .  And I don't know whether to be amused or impressed.

As reported on Oct 31, 2011 , it says ,"Physicians who listen to Mozart while performing colonoscopy may increase their detection rates of precancerous polyps, according to the results of a new study unveiled at the American College of Gastroenterology's (ACG) 76th Annual Scientific meeting in Washington, DC."

Adenomas(tumorlike growths )  are precursors to getting colon cancer, so anything we can do to be able to  detect more adenomas in the colon, during a given procedure, will save lives later on.

The above research suggests, in simple terms,  that the mental ability of a surgeon looking for polyps in the colon reaches a peak when music is playing.

Whether it could be better enhanced by playing Beethoven, Handel,  Yanni, Abba, Beatles, A. R.  Rehman,  Lata Mangeshkar, Asha Bhosle, Shankar Mahadevan or Lady Gaga is not clear.

That there is a connection between music and medicine has been known . Apollo, the Greek god of healing, was portrayed playing a lyre.  In a survey done in UK, it revealed that 90% of the surgeons had their sound systems playing music while operating, half of those even preferred listening to high tempo rock music, and strangely plastic surgeons played the most music, and ENT surgeons the least ! 

However, while music and surgery seems to be a win-win thing most of the time, a study done in 2008 and published in a journal called Surgical Endoscopy  revealed that novice surgeons performed less well, while music was on in the OT, because they actually thought it was a distraction.  The prospect of trying to extract a shaky mass of something from someones abdomen while listening to , say, the loud leading bars of 2001 Space Odyssey , or even a fast paced Jai Ho ! might be a trifle disturbing.   Just saying.

But the question remains.

Why Mozart ?  and why , only the colon ?  And has anyone done any experiments , playing Mozart, looking for polyps in other places , like say, the nose,  or small intestine ?  Does the outcome of investigations improve when words are put to the music ?

Research can possibly come up with so many options, specifying anatomy-music combinations. Like colon-Mozart, colon-Beethoven, appendix-tabla-percussion,  adenoids-shehnai,  stomach- dholak/drums, gullet-flute,  pancreas-harmonium and so on.

But the real fun would be when specific songs could be played for specific purposes .

Like a coronary artery Stenting  being done to the very fitting tune of Bridge over troubled Waters by Simon and Garfunkel.

 Like  Bariatric (stomach stapling) surgery being conducted to the plaintive sounds of Let-it-Be  by the Beatles.

Like a tumor being removed or excised,   as Killing me Softly , is sung soulfully by Roberta Flack.

Of course, the ideal song to be played during, say,  Bypass Surgeries, Heart Transplants and so on would be  My heart will go on, by Celine Dion.   To be followed shortly by My heart is beating  from the film Julie.

Deviated Septum (crooked nose) surgeries would be done to the tune of Himesh Reshammiya songs, encouraging more powerful straightening of the septum.

What might be considered the most intriguing use of music in medicine  can probably be attribute to consultant urologist Ben Challacombe, in Guys Hospital, London. He does delicate robotic kidney surgery. While extracting and removing a cancerous tumor from a kidney , there is a 30 minute window in which this must be accomplished.  Normally , they have someone calling out the time.  Which probably feels intimidating , so to speak. So what he does is that he has 6 , five minute music tracks playing in the OT , starting at the beginning of the window period.   The music goes along well with his surgery, and he knows at any given time where he is in that 30 minute window.

Of course there are older surgeon types, who even listen to opera while operating,  though I wouldn't want to be around there while he makes cuts here and there, as some soprano really decides to belt out high pitched arias.
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There is a lot of music in the sidebar of this blog page. One of the most popular songs of Marathi Cinema currently, has to do with a lavni dancer doing her stuff, telling the hero, in  a song that goes "mala Jaaoode na ghari, ata wajale ki bara " (= Let me go home, it's almost 12 now....).......and this song is there in the play list.

If I am ever a patient in a musical OT , I'd love to have this play as they wheel me out of surgery to the recovery room.

 

Medication and Sense

Besides enjoying writing a bit of prose, and foisting poetry on unsuspecting individuals, word got around from an ex-colleague that I also have a thyroid website. Nothing out of this world, but something that happened, because, 10 years ago, (a) I had collected tons of information about the thyroid for personal reasons, and (b) a geeky chap who sat next to me at work, inspired me to write HTML from scratch and make a website, in those, pre-blogging, pre facebook and nontwittering days. (When I retired, it shifted , along with me , to blogspot).

The reason it comes to mind, is I was stopped by someone and asked about this. Out of a sense of altruism, I asked if the person was a case of hypo or hyperthyroid, and was completely aghast to know that the person was diagnosed , taking meds, but couldn't be bothered to find out if the condition was hyper or hypothyroid, and offered to show me the test readings. Much like a person habituated to AC 4-wheel drives, professing ignorance about, say, the Mumbai buses. Naturally, I declined.

There is a similar attitude amongst those taking a variety of daily medication. They take "green pills" and "yellow and grey capsules" but are supremely unconcerned about names and dosages. And very often, the more educated the person, the more careless the attitude.

Sometimes , this careless and so called unconcerned attitude is seen , even amongst those whose vocation it is to sell medicine.

A few years ago, my father was bedridden , and my son went down to spend a few days with him before leaving for higher studies abroad. I was the sole caretaker , and was in a permanent state of travel between Mumbai and Pune, looking after two abodes, , and there were two trained attendant ladies doing shift duty, attending to my father, along with several normal house staff, including our trusted live-in help for over 50 years. During my son's visit, one of the ladies had a headache coming on, and asked and went downstairs to the chemist to buy some meds, while my son sat with his grandfather. She soon returned, and got herself a glass of water, and swallowed the pill. After which all hell broke loose.

She suddenly collapsed and slipped to the floor, and lay inert. No amount of sprinkling water, offering sugar water to drink, slapping the face etc, elicited a response, and so my son organized help, got the car ready, and bundled the lady off to the hospital after checking with her parent agency (that sent her to us ). My father did not use a car, and it was providence that my son was there, with transport, so that the lady got immediate help. The agency people also landed up there, and we were wondering the next day, what was happening, when the lady herself, comes up the stairs!

Turns out that she had asked the pharmacist for some headache meds, there were many people at the counter, and she probably picked up something meant for someone else. Maybe a diabetic medication, who knows. So much for careless dispensing. But what if it was psychotropic medicine, what if it was blood pressure medicine, anything could have happened.

But when things happen due to meds given by the doctor himself, things get a bit serious.

Two days ago, my household help, S., about whom I have blogged many times, came to work, coughing away, eyes red, with a splitting headache, and a body racked with pain. She often asks me for paracetamol(tylenol), but this time she had been to the doctor the previous evening and he had given her some yellow capsules. Everytime she took one, she said, she felt as if her head was vibrating. Things were getting alarming. I offered her some hot nicely sugared tea with milk and a fresh chapati thinking, maybe, she had taken stuff on an empty stomach, asked her to take the day off and she left.

Next thing I heard was that she had just managed to cross the heavily trafficked road outside, before she simply collapsed. People ran, someone called her sons, and someone else offered her sugar water, after which she revived, and was helped home.

The story turned out to be, that sundry general doctors, near where she stayed, were routinely prescribing something called levofloxacin, a fluoroquinone, ( for a population that was suffering from some infectious disease), that was known to have side effects, like red eyes, cough collecting in the chest, and lowering of blood sugar. No one had told her that. No one even checked her sugar levels. There was no written prescription, as the doc himself counted the capsules and gave them to the patients. I told her son about this, and instructed him to go tell the doctor about this. She also now carries a bottle of glucose water with her on her way to work, where she must walk in the summer sun.

But think of those who will collapse in the middle of the road, or have some other problem because of this blatantly given medicine, and have no one to help.

I recently read in the paper the story about an old man, a tailor, the only earning member of his family, who was prescribed , on paper, a blood pressure medication. The pharmacist gave him methotrexate, a cancer medication. Two days later, the poor man broke out into a deadly rash, collapsed, and died on admission to a hospital.

These kind of things are not just India specific. A pregnant lady in Colorado, USA, was prescribed methotrexate, which she took. It causes non-surgical abortion, , but she continues to be prgenant, and no one knows what is happening.

Fingers will be pointed, people will blame doctors, their illegible writing, the super busy pharmacist, the urge to sell a more expensive drug, the patient's simple , educated but non-medical mind, and the tendency to regard pharmacists as next in line to doctors.

But the problem is us. We do not respect our bodies. And we are careless about what we put into it. Food, drink or medication. The patient being educated has nothing to do with it. The doctor could either improve his handwriting, or start typing the prescription on a computer system. The patient needs to come back and confirm with the doctor about the medicine. When medicines are being handed out by the doctor himself, like in S's case, just 5 minutes more explaining the possible side effects would change a life.

We do not have a system or , even a habit, of reading ingredients of a medication. Or checking the dosage. So many of us just blindly take the medication from the shiny strips. I wonder how many of us read the little paper that often comes inside a medication packaging that tells us where the medication should not be used, or should be used with caution. Everyone has a cell phone, doctors have several, but no one wants to call the doctor , when in doubt, before buying, what could be a wrong medication. And all this holds for "educated people" too.

And so I often get the feeling that we as a society , have taken a huge leap somewhere, much like someone earning a huge lottery. We forgot the learning that happens, when life progresses at a natural slower pace. And we then tend to try everything new immediately.

In each strata of society this attitude manifests itself. The higher class educated types, reveling in the ignorance of minor things like their medications, think it infra-dig to worry about their bodies, and leave it to the n-star hospital doctors, something that enhances their status in their own myopic view. The pharmacy folks , probably carelessly read things in the big hurry to maximise sales; possibly even employ untrained folks in the shop.

And doctors serving large populations, let patients like my household help, stagger through their drug side effects, and only providence allows them a life, as they cross an arterial heavy traffic road, and then collapse .


But it is worrisome. What use is science , and learning, and having a large pool of technical talent, if communication abilities are non existent ? And nobody has the time to listen ?

So typical of Mumbai, where we are now the third most expensive city in the world, (real estate wise) , but have infrastructure that is at least 25 years behind. Inefficient communication channels.

And the knowledge vehicle goes further and further, speeding....

To oblivion ? Who knows ?

Hello Hippocrates !

When I was in the 6th grade, I went to a school in Pune that subscribed to, what was then called "Senior Cambridge" school board. It was affiliated with something in England, the things we learned were slightly different than those prescribed by the local State board, and we had a favourite subject called Physiology and Hygiene, where we learnt lots of anatomy names.

I used to love this, and it so came to pass that one day, when my mother was on the phone with our family doctor consulting about my non healing sore throat, I told her in a hugely hoarse voice to say that I had an "inflammation of the pharynx". She got a bit alarmed and handed over the phone to me. Doctor Uncle was completely amused, and he continued to be immensely amused even many years later, when I took my children to him on my trips to see my parents.

It also helped that I went to school by the municipal city bus, and that my school was very close to Pune's well known B. J. Medical College. The bus would be full of lady medical students , in sarees, holding thick books , we became friends, and I absolutely enjoyed leafing through their Gray's Anatomy's, and marvelling at pictures of bones and skeletons, something we were learning in class too.

I actually did marginally better in Biology than in Maths in college, but the system then allowed us to choose one or the other, and it was more or less expected that I choose Maths. Which I did. I wont say the world missed out on a decent doctor, but since then, I have had an abiding sustained interest, in all things medical and anatomical, to the immense disgust , wonder and surprise of not just family, but also some doctors.


Fortunately or unfortunately (depends on who is thinking), I have had doctor friends from across the age spectrum. I recently lost one who was in her mid-eighties, another is almost my age, and never complains about being treated as an encyclopedia, and even being questioned . Another friend , is the above mentioned Doctor Uncle's grandson, who is my son's age, but did home visits for my (late) ailing father, every alternate day, simply because I requested it, and was bombarded by lots of troubled questions by me when I was witness to the marvellous fight back capacities of a body, when faced with a terminal slowing down.

Over the years, I have come to the conclusion, that the best doctors are those who explain things to you, don't glare in a superior manner when you ask questions, and appreciate the fact that you want to know, and possibly learn something. It's your body, so the attitude should not surprise anyone. I suspect , that those that brush away your questions rudely saying "how is it your concern", are actually insecure about their knowledge or about communicating it to a layman.

Many doctors of the old school love getting questions. A close family elder, who was diabetic had just had surgery, and I was posted in his room, while others went downstairs to attend some paperwork and stuff. A nurse suddenly appeared with an injection. I asked her what it was , and she told me it was a maintenance dose of insulin.

I got alarmed; I had been a close witness to this relative getting into an hypoglycemic (low sugar levels) coma once, because he didn't reduce his dose corresponding to his reduced food intake during a digestive infection. Prior to surgery his intake had been very light. I knew the signs of a coma first hand, and I appealed to her to give that injection only in the doctor's presence. An argument ensued, and went on till everyone returned with the doctor, a very respected senior name in the field, now no more today.

He heard me out, asked us to keep a banana ready along with some fruit juice, and the injection , as prescribed was given. Within moments, the words became slurred, eyes kind of unfocussed, and the doctor , who was holding the patients hand , noticed the signs even before me, and asked us to give him the juice. The patient was able to stand the insulin dose needed post surgery, and the great doctor, smiled, patted me on my shoulder, nodded at the nurse and left.

Many times it has been a skirmish for knowledge, in a dicey health situation. Skirmish, because , very clearly, some doctors don't like to be asked. It has become a habit to ask details about any medicines that someone recommends that I take. Sometimes one has read something about a particular medicine, and has some questions about safety.

Caretaking of elders of the willful type often needs a different interaction with the doctor. I once did this for someone who was the type who threatened to do what he liked after prostate surgery , like cycling , and lifting luggage up the stairs.

The urologist surgeon was totally amused to see me with a chart, listing out do's and dont's , contraindicated Yoga postures, and instructions for medications , all written in large letters for someone with a cataractic eye. I thanked him for his suggestions to my questions, requested him to sign at the bottom, and had the hospital office put a bunch of stamps there. This particular doctor had a lot of geriatric patients and he even asked me for a copy of the chart !

When the elder in question, lifted his bag on reaching home , and pooh-poohed my suggestion, I whipped out the chart. And no further words were required. Even the rickshawallah who transported us was amused.

This tendency of asking questions , has somehow seeped into the anatomy. I have had general anaesthesia given to me for various things in my lifetime, and the one noticeable feature has been that I always tend to come out of it before anyone expects me to.

While science sometimes says, that it has to do with the amount of fat in your body , that can absorb a particular type of anaesthesia, I think it's the tendency to question stuff that is embroidered in the DNA, so to speak, that keeps something ticking below all that anesthesia.

And so I can fully understand the irritation in the voice of the surgeon, who was helping to wheel me out into a recovery area after an investigative procedure, and had me suddenly asking him , from under heavily lidded but desperately trying-to-open eyes, as to "What he found ...".... I was politely told to rest .

While the Internet has been a gift from the Gods for someone like me, who likes to check out her own diagnoses with the doctor's, not many doctors are thrilled about answering questions, starting with "Why" . But some are amused.


The knees started to pain a couple of years after I had a fall that fractured the ribs in 2005. I poured over pictures of muscles, ligaments, tendons, and read related articles on the Net. Finally, I was convinced about the ligament (Anterior Cruciate ligament) that was not behaving itself. I went to my doctor friend, who was not surprised at all this, and possibly agreed with my discovery, but she advised X-rays, and a consultation with the more experienced Orthopaedic expert.

And so there I was lying on the examination table. My doctor friend had come along, as this was in the same hospital premises where she worked. The orthopaedic expert had me move my legs, bend them, and then did some twisting and turning of his own , eliciting some occasional painful exclamations fro me. He then turned to my friend , muttering, something-something of the Anterior Cruciate Ligament, and proceeded to write up something in my file.

To this day he cannot figure out why a bad injury should have brought a wide smile on my face, and why I barely stopped myself from hi-fiving my doctor friend, who was trying to hide a smile. He advised some knee caps and physiotherapy etc, which was duly followed.

But to this day , he always smiles when he sees me otherwise.

And then there was the time, I was waiting for the aforementioned investigative procedure, and suddenly the nurse turns up to ask about the next of kin. The husband had stepped out to make a call. It seems they needed his signature to say that it was OK to put me under anesthesia.

This was too much. I wasn't invalid,was in my complete senses (though some folks tend to disagree occasionally), this was my body they were discussing and if anyone was going to give permission to put me under, it would be me. The nurse looked stricken at hearing this. Such things were not done. They must have a finger to point at someone who signed and gave permission, in case something happened to me. She disappeared to return some time later with the doctor

The doctor came, took one look at me, shook his head, and allowed me to sign. If I was well enough to have a surgery, my vital signs were fine, and this was a minor procedure, then I should be qualified to sign . That's what I thought. The doctor actually just wanted to get over with it. :-) ....


This post came about after I read this blog post. About maintaining secrecy about the patients treatment file. About the nurse mentioning how the particular doctor did not like nurses to see it too.

I have always thought , that the file or chart for the patient that is maintained at the bedside , lists chronologically the treatment he/she has received, the recommendations of visiting experts, and instructions for modifying doses etc. I don't see why nurse cannot see the stuff. In fact, they must.

Not that it is legible or understandable, but It possibly makes sense to keep the stuff confidential from relatives who visit.


But just think of how the this problem can be solved, if the doctor could quietly explain the stuff to the attending relatives, in addition to writing it down. There would be more confidence , less doubts , about what was going on.


Its about your body. You need to ask questions, and demand answers.

And so, it hurts when one sees, those who spend enormous amounts of time getting technical about cars and cellphones, talk about taking "red pills", and "white pills", and "green capsules", without finding out what they do.

Maybe it's time for some senior citizen lady type to tap them on their shoulder, smile a toothy smile , and ask how their Anterior Cruciate Ligament is doing, or why their Bundle of His in their heart , is twitching so much .....

And enjoy the look on their faces......:-))