no leaks please

                         The call of nature: no leaks please..

                                  By Vivek Hande

The victorious England team recently celebrated their Ashes victory on the pitch at Lords by answering “nature’s call” and chose to water the pitch after some feverish Beer drinking. Not quite cricket and not quite gentlemanly, one might say. But what is a leak amongst friends- when you have to go, you have to go.

Apart from some sniggers and some smirks and suppressed amusement, I doubt if this would really outrage a country like us. For us, no place is really sacrosanct. Roads, pavements, streets, buildings, garages, parking lots, gardens, parks, railway tracks and in more recent times ,even coaches in local trains – anywhere , anytime , wherever on the go :that seems to be the motto.  The truth is that in large measure, the progress of a country has to be determined by its standards of sanitation. The less we speak about the standards of sanitation and hygiene in this country , lesser is the stink raised.

It is a fact that more than fifty percent of the 1.2 billion population of the country has no access to toilets. The governments have spent more than 1250 billion rupees on creating toilets and hygiene infrastructure in the last twenty years. However, open air defecation continues to be the norm and toilets that have come up in many villages and rural areas are located unimaginatively and are used as stores for fodder and grain! These are the facts of a government conducted survey and quite literally, money seems to be going down the drain. 

There are toilets in stations and bus stops but do try using them at your own peril. It is a nightmare which may scar you for life. Roads have improved and we have some glorious highways, but there is very little appreciable difference in the standards of the loos. If you are a lady, you can be sure you won’t forget a road trip in a big hurry. Men can be men and can water plants anywhere along the road.

I don’t think we can qualify to ever be called a civilized nation or a developed one, if we can’t get the basic standards of sanitation accessible to each and everyone.  We can build satellites and nuclear reactors and be the among the oldest civilizations of the world, but we still cannot defecate and urinate with dignity.  That is the stinking truth!!!

a grandwoman of substance

                 A grand -woman of substance

                                   by 

                        Vivek Hande

There was a lot of hype recently regarding Women’s Day.  Women have established themselves and proven their mettle in every sphere of life. The Modern woman of today is second to none and perhaps better than many of their male counterparts in their chosen fields. It is something that we, as men , have learnt to accept.

But , is it really only today ,that women have come into their own ?Women have always been a force to reckon with . I think back and reflect on the life and times of my late grandmother and realize that she was a woman of substance, if ever there was one. She was married when she was eleven .  Her husband , my grandfather was only a few years older. My grandmother , Dodda (short for  Doddamma) as we called her was never formally schooled or tutored. She taught herself the ways of life and much more as she moved to various corners of the country with my engineer grandfather.

She was a fast learner and had an amazing ability for languages. She learnt to read and write with considerable fluency,  Kannada, Bengali , Marathi , Telegu and Hindi . She could hold her own in Tamil , Bhojpuri and manage a bit of Malayalam as well.  Her linguistic abilities never ceased to amaze me. She raised four children, often single –handedly ,as my grandfather had to go across the county on work for prolonged periods. She realized the value of education and encouraged her children including her two daughters to study and aspire for higher learning. She wanted to equip them better tan what she was to face the world.

  She was a walking treasure trove of recipes across the country and always willing to learn and try something new.  My wife always joked with her and told her that they ought to compile the recipes into a book and Tarla Dalal all the way to the bank! Though , not formally educated , she had an amazing grasp of numbers. She could calculate interest rates and chalk out the dividend due to her on deposits made by my grandfather. Her photographic memory allowed her to ask my  mother to send reminders on the due dates, if dividend cheques were not received on time. She was a walking accountant and calculator and a small computer rolled into one !  She just had an intuitive feel for numbers.

She read extensively in all languages and read on diverse subjects and an esoteric range of authors. She devoured her Kannada and Hindi newspapers and had strong views on every subject and could hold her own in any conversation. She was game for adventure and visited us at Bhutan and Port Blair(where I was stationed at different times) and wanted to take on what ever excitement the places had to offer. Her frail health notwithstanding , she was ready for any kind of action.

She is no more . But in many ways , she is still very much around.  Whenever I am stuck or down and out and in a fix , I think of her irrepressible spirit and her determination and her ability to be unfazed, whatever the nature of the problem. More often than not, I am able to lift myself and get on. She , most certainly was a woman of substance . A toast to the indomitable spirit of the women of the world!!

destined to go

                                                         Destined to go…

                                                     By

                                             Dr Vivek Hande

It was many years ago. I was young and recently armed with my MD degree. I felt powerful and I certainly believed I could save the world and get everyone on the road to healing ,if not completely on their feet.

Sushant was a handsome young sailor who was sailing on one of the Coast Guard ships on the high seas in the Andaman islands. He had everything looking  up for him- a bright future, doting parents ,a lovely wife ,Smita , who was carrying their first child ,back home in Patiala. Fate ,it seemed ,had other ideas.  He was carrying out some drills on the deck of the ship that bright Sunday morning. He had been feeling a bit unwell for the past two days with a bit of a headache and a slight fever. He suddenly fell on the deck and started convulsing repeatedly. His colleagues and the paramedics rushed to assist him but he had lapsed into a comatose state. He was evacuated by helicopter in very quick time from the high seas to the hospital in Port Blair.

I assessed him on arrival and found him deeply comatose and with evidence of Pneumonia affecting both the lungs ,probably on account of aspiration during the convulsions. I moved him to the ICU. I rushed through a battery of investigations . I did a lumbar puncture and drew out some cerebrospinal fluid and also took him for a CT scan. The verdict was clear –he had severe Bacterial Meningitis, an infection affecting the meninges,the covering layer of the brain.  I put him on high doses of very potent antibiotics. He was on intravenous drips and being fed through a tube through his nose. He was being monitored very closely and all his vital parameters were being frequently assessed. By late evening, he started dropping his oxygen saturation and the lungs were not functioning optimally and I had to place him on ventilator support to ensure there was adequate oxygenation . The young man was fighting for his life and was quite literally hanging by a thread.

I saw this strapping young lad, just about the same age as me, with his entire life ahead of him, reduced to a whole lot of tubes and drips and monitors and catheters invading every orifice of his body. I felt  a strange kind of bonding with him. I had to save him, I told myself. His aged parents and very pregnant wife flew down to rally around him. I kept returning to the ICU a half dozen times a day and often late at night  to check on him. I adjusted his fluids, his antibiotics, his ventilator settings and everything else that was in my hands.  I would talk to Sushant and exhort him to fight  and coax him to get back to the world. I told him we were going  to win this war. He never gave any sign that he could perceive or appreciate any of my rumblings. Every time I stepped out of the ICU, his parents and wife would look at me expectantly. After a few weeks of this routine, they started averting my gaze and started preparing themselves for the inevitable.

Was this a doomed war? I was beginning to lose hope  but somehow  at some level, kept hoping he would come out of this state ,inspite of all  medical and prognostic indicators pointing to the contrary. After nearly four and a half weeks, the tide started turning and Sushant started showing some signs of improvement. I intensified my efforts and the ICU was suddenly injected with a sense of hope .The ICU nursing matron smiled at me and told me , “Doctor, we are going to win!”  .The next couple of days saw dramatic improvement in his condition. I was able to get him off the ventilator; he came out of his coma and started moving his limbs feebly. He soon started feeding himself and in a few days was walking around. Sushant had come back, from the dead. It was a tremendous feeling and I was elated . I somehow felt I had got a new lease of life. The gratitude of the family and  the joy  and relief of the elderly couple and Smita made me feel like a victorious General ; we had indeed won the war!

Sushant walked out of the hospital, a trifle weak and scarred but on his own feet. He returned to Patiala on leave . I got regular inputs from him over the next several months on telephone. He had become a proud father. My eyes turned misty and my spectacles fogged up when he told me that his son had been given my name.  He told me his mother had distributed sweets on the happy occasion to most of Patiala! He gave me inputs about his son’s progress and his crawling and his climbing and so on.  I was happy for them..

And then suddenly a call, almost a year to the day ,Sushant was admitted under my care. His father on the line, choking with emotion and barely talking coherently, “Sushant died yesterday. He was on his scooter and had a head on collision with a bus . He died on the spot” I felt devastated. The thought ringing in my head, “What a waste of a life! After such a heroic battle , dying so insensibly; such a meaningless death”. I felt it was such a sheer waste of an effort; all the struggle and anguish for nothing at all. I got on with my patients and OPDS and emergencies and carried on with my work but thoughts of a wasted life and a wasted effort kept coming back to me.

A few months down the road, another phone call from Sushant’s father. Quite controlled and much in command of his emotions,he told me, “Doctor, we had given up Sushant for dead a year back. You breathed life into him.  You gave him an extra year- a very precious year. We have cherished his presence and thanked God and you for every day that he was with us. He was destined to go. You changed his destiny and gave him the opportunity to hold his child. You gave him the chance to enjoy his family for another year. You gave us the chance to love him and care for him for another year. We will remember you in our prayers every day”.

His words echo in my ears every time I have a Sushant. One can only try and one can do all that is in your hand as a physician, but the humbling truth is that when one is destined to go, one has to go……

kolkata driving manual : wheels within wheels

                            Kolkata driving manual :   Wheels within wheels!

                                                               by

                                                     Vivek Hande

Driving in each city in India brings its own set of unique challenges. I recently had a fair amount of driving to do in Kolkata. My father asked me the other day, “how is the driving experience in Kolkata? Is there some kind of a pattern?“  My first response was that there was no pattern whatsoever. But I then thought back and realized that there was definitely a pattern and driving in Kolkata is a unique experience and there are certain rules of the game which one has to learn and certain rules which have to be forgotten! I would like to share some of the rules I have learnt in my short diving experience in the City of Joy ….

(a). Driving on the road is always a race. You have to, have to, have to come first !

(b).You can overtake from the right but it is preferred to overtake from the left!

(c).You have to realize you are always in practice for the Monaco Grand Prix; weave in and out of traffic; keep changing lanes to hone your reflexes. It is most imperative to keep changing lanes!

(d).Try to keep your vehicle as close as possible to the vehicle adjacent or ahead of you. Try to graze the other vehicle at least once; from any side. If you fail to do so, overtake and follow rule (a) or (b).

(e).The Horn is a weapon to ensure victory on the roads. Try and keep one palm fixed on the horn and try not to stop pressing the horn, whatever the distraction or provocation!

(f). If you are a cab driver ,your license may be suspended if you do not have a success rate of at least 75% in landing a healthy dose of Paan juice on the door of the adjacent vehicle!

(g). Another weapon in your hand is the “indicator”. Use it liberally to confuse your opponents on the road. Indicate to the left and turn right; indicate to the right and turn left or indicate in any direction but don’t turn at all!

(h). Above all , remember , when you drive ,you are the King of the roads. The road belongs to you and you alone and others on the road are incidental; a necessary evil to be borne and tolerated. You are the King!!

These are some of the rules I have picked up and I am sure there will be some more as I drive along. But for those new to the city roads, assimilate these rules; these are key to survival.  Frankly, if you follow these rules, you will be the king of roads in most Indian cities. You will definitely win the race!

time travel

                                                                      Time travel

                                                       By

                                                 Vivek Hande

It was an interesting journey to say the least.. I  had the occasion to travel recently  by train  from Mumbai  to Karwar along the Konkan coast. I was to alight at my destination  at an unearthly hour of half past two in the morning . A cluster of stations had arrival times around the same time and consequently there were a lot of  people waiting to get down roughly around the same early hours of the morning or late hours of the night ,if you please. The train was running more than an hour late and losing time further adding to the uncertainty.

I , for one kept looking at my watch and could not sleep after midnight and kept peering  at poorly lit stations awaiting my destination. The gentleman across my  berth  ,had fixed alarms on his two cell phones spaced fifteen minutes apart  from two am onwards. He managed to sleep through each of the sixteen alarm ringtones and ensured that all around him were awake to keep vigil. Another elderly couple had asked the coach attendant to awaken  them fifteen minutes before their expected destination. The wife had a healthy suspicion of the attendant’s abilities to stay up and awaken them. Consequently she would prod her husband and   dispatch him every twenty minutes to ascertain if the attendant was awake and remind him of the assigned task. The attendant had every hair standing on his head and   I am sure he   would have been the happiest person on the train when the couple finally departed.

 I must tell you about another elderly  gent , who was petrified about missing his station and not being able to get off with his luggage in the scheduled two minute halt. Therefore  ,he moved with his baggage soon after midnight to the area adjacent to the toilet. The poor man was in for a rather long and smelly wait-three and a half   hours to be precise! And I must tell you about this extremely restless, obviously NRI type youngster. He was really wired in every sense of the word. Armed with his I-Pod, Blackberry and a headphone slung around his neck for good measure, he would keep darting in and out of the compartment and getting down at every station to reconfirm that it was not his destination. Finally  , he managed to find himself stranded on the platform with the train speeding away, two stations short of his destination. Kareena Kapur of “Jab We Met” fame would have applauded. A case of so near and yet so far!

Another portly bald haired gentleman, a most laconic character, if there was one- he changed into shorts; put on ear plugs; strapped on an eye patch and dug himself deep into the folds of his blanket. He told me to relax before he sank into slumber-land, “  The train is going to get another two hours late. You can sleep comfortably for five  hours !” He got his beauty sleep and alighted fresh as a daisy five hours later as he had predicted. Talk about letting sleeping dogs lie.

Well, most of us did manage to get off at our  stations , bleary eyed and battle weary; fighting sleep and the uncertainty in our own unique ways. The journey, was an “eye opener”, in a manner of speaking,   about the trials and tribulations  of time travel !

tell me , what is your problem

                               “  Tell me , what is your problem?’

                                                        By

                                                  Vivek Hande 

                             It has been nearly two decades in medical practice for me and it has been a tremendous privilege meeting and treating hundreds of patients over the years. It has been a great learning experience and I daresay it has brought rewards which money can’t buy and it has enriched me in so many ways that words can’t express. I have learnt so much from my patients and many of them have left a deep impact on me in their own special way .Many of them have been distinctive in their manner or attire or attitude or their way to deal with stress- each of them have taught me something in their own way!

                   One of my earliest patients, now a grandmother, settled in Lucknow, has tracked me through my postings and sends “prasadam” from Tirupati,each year,  after her annual visit there.   I don’t even have her postal address to thank her but she is unfailing in her largesse. For a while, when I was posted as a young doctor in the North east and would treat the local civilian population as part of military liaison, the simple folks would leave small wicker baskets containing eggs with my nursing assistant , in return for my services. At the end of the day , I had enough eggs to feed the garrison and enough goodwill to last a lifetime .Being a vegetarian, the eggs were distributed to the families in the base- it got me additional goodwill from the ladies in the station , but that is a separate issue!

            I had a patient, a retired widower; he would come every Saturday dressed in a trendy three piece suit with a jaunty flower stuck in his lapel. He would talk about vague and obscure complaints and then ramble about his son and grandchildren settled in the US. For the life of me, I could find nothing seriously wrong with him and one Saturday after several months of this social exchange, I told him, I thought he was quite well and he need not come back to me. I saw his face fall and he started talking about some fresh complaint. Exasperated, I asked him, “Tell me what is your  problem ?” He looked at me sheepishly and confessed he had no real problem and he just enjoyed dressing up and coming over to chat as I, apparently was a good listener. He told me he had no one to talk to and these visits were the highlight of his lonely week. He came  week after  week and frankly, I started looking forward to his visits and we discussed a million things under the sun.

                  I must tell you about this elderly gentleman who had a debilitating chronic illness. He was in severe pain and had frequent flares of his condition which would leave him weak and emaciated and physically broken. He was on medication for virtually every organ system of his body. He was in and out of hospital for one complication or the other. He was in constant suffering for nearly two years, but not once did I see him lose his cheery optimism. He would always have a smile on his face and he bore all the ravages of his illness with such dignity and forbearance that one could only admire his spirit. Ha passed away quietly and with the least fuss-may his soul rest in peace!

               Then there was this lady who needed to come to me for several follow up visits. After a couple of months she asked me if I were a Brahmin. I nodded and asked her how that was relevant to her illness. She told me I would be an excellent match for her neighbor’s daughter. I spluttered and told her I was much married and I had two boys. Not deterred, she asked me how old my son was and she could fix a match for him with her niece! Then there was this young girl, who had a rather well thumbed OPD notebook and I saw handwritten follow up notes from virtually every specialist in the hospital – I asked her what brought her to the hospital so often and required her to visit so many specialists apparently for myriad complaints-she told me with a straight face that she was trying to find out if there was one doctor in the hospital with a legible handwriting! And there was this lady who after getting her prescription from me for her ailment, told me as she was getting up,” Doctor, why are you so tense all the time? You must smile more often. And you seem to have a stiff back. I must teach you some Yogasanas. It will make you feel younger and you will feel better about yourself!” Talk about ,Physician heal thy self!!

                  I must tell you about this elderly gentleman who had a debilitating chronic illness. He was in severe pain and had frequent flares of his condition which would leave him weak and emaciated and physically broken. He was on medication for virtually every organ system of his body. He was in and out of hospital for one complication or the other. He was in constant suffering for nearly two years, but not once did I see him lose his cheery optimism. He would always hare a smile on his face and he bore all the ravages of his illness with such dignity and forbearance that one could only admire his spirit. He passed away quietly and with the least fuss-may his soul rest in peace!

            Then there is this net-savvy breed of patients who sometimes know more about the illness and the latest on a condition than you do. While the internet is a wonderful tool , it also provides a whole lot of information which can be misleading to the uninitiated. I had a patient telling me that a particular drug has been found very useful in experiments on Japanese rats and Australian cats and why we could not use the same with similar success on his mother-in-law!

            Well, one learns as one goes on and each day one has learnt from the patients and their relatives and attendants and it is truly been a privilege dealing with so many of them from every corner of the country. The look , the smile , the gratitude, the word of thanks ; the satisfaction of seeing a sick man walk out of the hospital is truly more gratifying than anything money can buy!!

unexpected side effects

                                               Unexpected side –effects!!

                                             by

                                      Vivek Hande

The practice of medicine revolves around the central ethos of “Primum Non Nocere” or First, do no harm. A physician’s efforts are directed towards beneficence in respect of the patient. The practice of medicine, in many ways is not science, but truly an art. It throws up many challenges and at times, rather, strange and unexpected results.

One directs therapy with a particular goal in mind and the outcomes may be gratifying – for different reasons. I recently had a crusty old octogenarian, who was suffering from chronic constipation along with other myriad ailments. After some persuasion, he consented to undergo a colonoscopy.  He was certainly not enjoying the procedure and he let me know in no uncertain terms what he thought of me and the entire procedure. He bellowed, “Doc, you have the damn tube up my backside and you are telling me everything is fine and asking me to be normal and to take it easy. You must be joking or you must be out of your mind!” Well, we got through the procedure and he got out of the endoscopy room generally muttering and cursing and conveying his displeasure most vocally. I knew we were not going to be friends ever.  I was not looking forward to his OPD follow up visit a fortnight later. I was amazed when the gent walked into my chamber with a huge grin and beaming from ear to ear. He actually gave me a bear hug and told me in his booming voice, “Doctor, I remain constipated but the colonoscopy has completely cured my chronic sinusitis.  Ever since you shoved that damn tube , I have not sneezed. I don’t have a headache and I have not taken any anti-histaminics. I have tried everything for my sinusitis but nothing has ever worked. I need a colonoscopy every month for my sinuses!”  Well, that is certainly a new one and I am trying to get see if one can add this unexpected benefit to the list of indications for a colonoscopy!

Then I had this chirpy middle aged lady who was under treatment for dyspepsia for several years. Her dyspepsia did not seem to be getting well but she would nevertheless, faithfully report every month for her quota of antacids. She would also insist on a prescription of multi-vitamins and Calcium and Zinc for her “weakness”.  After some months, she reported to me for her monthly renewal and said she was doing fine and needed only her vitamin supplements and nothing for her dyspepsia. I went along with it , happy that her dyspepsia was finally coming under control . The next month around she said, “No antacids but I need a double dose of vitamins and other supplements for weakness!”  I did not think she had significantly “weakened” and I asked her why she needed so many vitamin pills. Her answer stumped me, “My kitchen garden and my flowers are coming around excellently thanks to your multi-vitamin pills. I have been using them on my plants; the last few months are they are doing great.  I work long with my plants and my digestion has improved and I don’t need those silly antacids. Doctor, you have to keep my dyspepsia under control by helping my plants grow!” Convoluted logic, but unexpected benefits of treatment, so to say!!

I had yet another patient, an ex- serviceman, who had many gastrointestinal complaints. He was on a regular follow up and some months later told me that he had changed jobs and that was causing his eating habits and bio-rhythm to go a trifle haywire. He started developing many symptoms after the change of job and every month he had a fresh complaint. He complained of chronic headache; blurring of vision; recurrent coughs and colds; chest pain; lack of sleep and anxiety related symptoms and itching of skin and an ongoing list of ailments. After unsuccessfully attempting to sort out his problems, I started referring him to concerned specialist OPDs –ENT; Eye: Neurology: Chest ; Psychiatry and so on. Six months down the line he came to my OPD and offered some sweets to my staff and me. I thought it was in gratitude for sorting out his GI problems. He elaborated, “Sir, six months ago I changed my job and became an Insurance agent. It was very difficult to enlist new customers but thanks to you I have met so many doctors and their staff members. I have sold so many Insurance policies in the last six months. Thanks to your clinical judgment, I have met the correct specialists and I got a huge bonus today. Sir, I have this new problem – my joints are paining at night and I think I need to see an Orthopedic surgeon. Could you please refer me?” I choked on my Barfi and pushed him out as gently as I could. Unexpected side –effects, I daresay?

Each day in practice teaches you something new and the results are at times baffling, unexpected and quite out of the ordinary. I continue to learn…