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…

the soldier scholar

The soldier scholar …..

By Vivek Hande

My father served in the Indian Army for 34 long years. All who served with him regarded him a “soldier down to his boots”. He was an Ammunitions expert and had participated in the military operations in 1962, 1965 and 1971. He joined the Indian Military Academy as a teenager and having virtually spent a life in the Olive Greens, he knew no life other than the Army.

 Well, Dad has always been a very impressive figure; in many ways larger than life. One grew up on his anecdotes for every possible occasion, and it did not matter that very often they were a repeat. Somehow, each time, they did sound different and entertaining. He has always been the life and soul of every party. He has had the amazing ability to make friends. His friends have included the watchman in my school, a watch –repairer and corporate head -honchos. The men who have served under him have been loyal to him long after his retirement.  He was a competent tennis player in his younger days and a pretty bad golfer- but he was willing to try out everything. He has always spoken his mind, and stood his ground on his convictions and has often paid the price for the same. There are many things I have admired him for over the years.  He has always been a soldier and he has always plunged into everything headlong and faced everything head on. 

 I respect and admire the way he has reinvented himself. From a  hard-core soldier to a German language Professor, it has been a long journey.  From the rudimentary seeds of interest in the language, sown in him by way of an official “interpreter ship course”, way back in the late Sixties, he has come a very long way.   After retirement, he decided to pursue the language whole-heartedly.  He took all the courses in the Max Mueller Bhawan at Bangalore, and was by far the senior most student of a class with an average age of thirty! 

  Some might have sniggered behind his back but that did not deter him. He came through with flying colours. His fluency in the language and command over the vocabulary amazed everyone. His memory was razor sharp and he soaked in the language like a sponge. His command of the language drew the admiration of the locals, during a visit he made to Germany.  He was certain; he was born in the wrong country! He teaches German today, six days a week and would take on students on Sundays too, if my mother went along.  Amongst his students have been corporate executives, Germany-bound nurses and air-hostesses, as also Germans and Austrians residing in Bangalore, who have all enjoyed and gained from his teaching skills and proficiency in the language, over the last decade and more.  He is pleased as punch when he gets letters and e-mails addressed as "Professor". 

Salutations to the scholar soldier or is it the soldier scholar? Life does begin at sixty perhaps!!

the wagener- clime flavor

                                    The Wagener –Clime flavor

                               By Vivek Hande

I have always loved ice – cream in any shape, form, size, color or flavor. I could gorge  ice- cream at any time of the day and it could well substitute any meal.  A constant battle of the bulge and the fear of a generous waist line prevent me from indulging as often as I would like to. However, my eternal favorite has always remained fresh strawberry. For many many years, fresh strawberry has always been the Wagener –Clime flavor for me.  

There is a little story behind it.It was more than two and a half decades ago when I was doing my internship after medical school in Delhi. I attended the World Congress of Neurology. It was a glittering affair and it attracted leading neurophysicians from across the world. It was a stimulating week. The lectures were top grade and it was intoxicating picking the brains of the leading authorities on various subjects. In addition to the academic activities, there were a host of lavish lunches and dinners. As a very junior medico. I would at times feel a trifle overawed and a bit out of place at times. My discomfiture was noted by a white haired old lady. She was very elegant and carried herself with great dignity. She introduced herself as Dr. Wagener-Clime, MD from Copenhagen; a rather modest introduction for one of the leading neurophysicians from Denmark.

We hit it off very well and notwithstanding the difference in age of more than fifty years, we became friends. We discussed everything under the sun-Neurology, Indian customs and traditions; marriage, politics, music and cinema. She was thrilled with snake –charmers and cycle –rickshaws. The Qutub Minar fascinated her and she found the Saree highly intriguing. She found Hindi film songs pleasing to the ear. She even picked up a smattering of Hindi and I introduced her to the nuances of Kannada. She was turning into quite an Indophile.

However, come mealtime and her sense of adventure would abandon her and nothing would convince her to try anything cooked in the hotel. She showed me her suitcase full of tinned food-sausages, ham, salami, baked beans and cheese. She even had an amazing supply of Danish pastry and bottled water. She had a mortal fear of getting food poisoning and acquiring a deadly strain of Salmonella or Cholera or some other tropical infection.

With considerable difficulty, I persuaded her to overcome her fears and try some of my favorite strawberry ice-cream. She was hooked thereafter. “Indian ice- cream is so much better than back home”. The next few days she attacked strawberry ice-cream with lip smacking gusto for breakfast, lunch and dinner. She devoured strawberry ice-cream with a maniacal zest. She returned a few days later to Denmark and we remained in touch over the years. She is no more but for me strawberry ice cream can be nothing other than the Wagener-Clime flavor!!

what is in a name

                                                What is in a name ?

                                                            By

                                                Vivek Hande

What is in a name, you might ask? I talk about nicknames or pet names or whatever you may call them. These names have so much of a story to tell. They tell you often about regional affiliations, religious inclinations, musical preferences; at times about size, shape, color or even a state of mind. Well, sometimes   they convey nothing at all. Some names are distinctive of a particular region and you could almost fix a personality and a face to the name by merely listening to the name. An analysis of these names is as fascinating as the names themselves!

                     Classic nicknames like Tony, Rocky, Bunty,  Pinky , Dolly ,Sweetie invariably remind you of warm , hearty ,affectionate, energetic folks invariably from Delhi, Punjab or thereabouts. Jhumi, Tinku,  Rinku, Jhumpa, Jhumpi, Bulu , Toolu, Baapi and Khoka-the list is endless and   takes you to the Bengalis, who are one of the great masters of the nickname business. A Goan couple I knew, had their first two kids named Bunny and Sunny and when they were blessed with a third one, a little late in life , they had no option but to call the young fellow Funny!

            Chotu, a very popular name might have been alright for the kid but just seems a little incongruous when a hurly six -footer with a thick beard responds to this epithet. Also, somehow, most waiters in hostels, canteens and cafes just somehow are always Chotu. Baby, need not necessarily be of  diminutive size and delicate disposition- I have seen enough who  are neither baby-like in size or behavior. Tingu ,is more often than not a short , wiry individual. A subtle one was AB Singh ,a Sardar ,a trifle whimsical but who was rechristened ‘Ab-Surd’ for life!

       Some names, invariably transform into abbreviated names and that sticks for life. Bharadwaj almost always is Birdy; Subramanian is either Subbu or Mani. Saxena, is often Sexy(regardless of sex appeal); Venkatesh is Venky; Chopra is more often than not Chopsy; Parthasarthy is Partha and Pattabhiraman is obviously Pattu. Krishna Kant Prem Kumar is KKPK; Dayaram Naresh Arolikar is popularly DNA and   Algappa Baindraj Chellaiah Doraiswamy has to be ABCD and nothing else!

        I may get confused with the real names of some very interesting personalities in college. But their nicknames are still fresh in mind. I don’t remember whether it was their physical attributes or behavior or persona which prompted these names but they sure got engraved in memory. Bull; Gainda (Hindi for Rhinoceros); Chipku(sticky); Moti(pearl) and the trio of Aadu, Maadu and Khadu- I don’t have the foggiest idea regarding the significance or the origin of the names but these names have survived time and tide.

            Another set of interesting names are those based on gastronomic delights. One of my favorites was a set of twins, Kaju and Kishmish! Nobody can take away the thrill of calling out to Jalebi or tenderly beckon  Jamun. HS Nath became Nuts for life and is quite nutty in his own way. A little out of the usual, a passionate mango lover, who had three boys fondly responding to Langda, Dasheri and Aapus- believe it or not!

Each name has a distinct character, flavor, identity and at the cost of disagreeing with Shakespeare , Rose can certainly not smell as special  as Gulab!!

the hand that rocks the cradle

                                       The hand that rocks the cradle!!                                               

                            by Vivek Hande

                                               

It was a very long time back, in the very early nineties, when I was stationed in Assam. The thoughts of that lovely North Eastern state always evokes memories of lush green stretches of verdant forest. Rain forests, heavy monsoons, clean unpolluted air and simple ,affectionate people going about their business of life is what I remember fondly of that beautiful place. Another memory , which is inevitably linked in my mind , is a lesson in the expression about looks being deceptive and a delightful lesson in Queen’s English!

 My elder son was born while I was stationed there. After a few months , there rose the necessity of acquiring a pram for the young man. Guwahati, where I was headed  for the necessary purchase, was nearly a hundred and fifty kilometers from my location. Armed with a list of specifications from my wife regarding the pram , I reached the fabled Pan and Fancy Bazaars of the  city. It was hot , humid and dusty by the time  I reached , but I was a man with a mission. I was initially surprised and then increasingly dejected and dismayed as I drew a blank in shop after shop. I told shopkeeper after another I needed a pram. They looked at me without comprehension. I gave a graphic verbal description of what I needed ;I drew what I definitely thought, looked like a pram and showed it around and then finally an effective demonstration  of an imaginary baby in an imaginary pram being pushed by a proud father. But , inspite of my best audio-visual presentations, no luck , no pram. My descriptions produced everything other than a pram and I was offered a bed pan, a washing machine and an Idli maker , but no pram.

I had almost given up and was now scouting some of the smaller dusty by-lanes of the market. I approached a Lungi –clad disinterested elderly gent in a small shop

and launched into my well honed pitch for the elusive pram. He spat out a mouthful of betel juice, put on his spectacles, scratched his groin and peered at me through his thick glasses. He then spoke to me in an amazing baritone, in the clearest English diction , I have ever heard, “Young man, why are you making all these funny gestures and making a fool of yourself? You want a perambulator and that is  what you will get!” I could not believe my ears –that was perhaps the last time I have ever heard the word in all these years. The pram / perambulator turned out to be a Victorian relic with a lace canopy and lace trimmings on the wheels and the Union Jack emblazoned on the head rest. It was a monstrosity and no where near the stringent specifications given by my wife but it was a pram, or should I say perambulator .

Well, the young man had his distinguished carriage  and I had a lesson in Queen’s English in the most unexpected of places and incongruous of surroundings. Life never ceases to amaze!

the patient is always right

                                             The  patient is  always right!!

                                         By Vivek Hande

Having spent more than two and a half decades in contact with patients in one capacity or the other, I am convinced of the oft repeated statement , “the Patient is always right!”. Often, one may tend to disregard the complaints of the patient, if one cannot find a straight forward clinical correlate for the symptoms. One often finds the cause of the symptoms after spending much time, money, effort and considerable agony to all concerned. I have no doubts any longer that the patient is always right even though at times, the narrative of the symptoms may be bizarre , ridiculous , far fetched or improbable.  Very often what the patient tells you may be beneficial, for reasons other than clinical! The patient is always right, that is for sure…

Many years ago , when I was appearing for my Medicine Viva Voce  for my MBBS degree,  Francis , an Anglo –Indian was my patient . It was my first major clinical exam but he was a   veteran of examinations. I was desperately trying to get my very confused thoughts about the patient in some semblance of order.  Francis was rather amused with my efforts. He told me, “I am a case of Cirrhosis of Liver with Portal Hypertension. My Liver is enlarged which is not consistent with a diagnosis of Cirrhosis.  The examiner is going to ask you about the causes of enlarged liver in a case of Cirrhosis. If you answer well, he will ask you about Drugs which can cause hepatic damage. Don’t waste your time and efforts on other issues. Just concentrate on this and you will do well.”  I took a calculated risk and focused my thoughts on the matter suggested by him and put the rest on the backburner. Well, as predicted , the examiners were consistent with their line of questioning and I did rather well. Francis was proud of me and I had the fact reconfirmed-the patient is always right!

Then , there was this patient – Jagadish. He was a tall. well built strapping Jat. He cut a very impressive figure in his uniform . He used to suffer from repeated episodes of pain abdomen. He would keep coming back to the casualty and the Medical and Surgical OPDs. Each time he was evaluated in detail. The examination was always unremarkable. The investigations were always normal. He underwent repeated Endoscopies and Ultrasonographies and CT Scans and Barium  studies , but everything was always normal. Somebody though he was malingering and trying to avoid duties. He was evaluated by the psychiatrists as well, but nothing seemed to work out. He continued to be symptomatic off and on.  During the symptom free periods, he was absolutely normal and would play in Unit games and discharge all his duties well. However,  the pain would return and a couple of times , it coincided with his detailment  on temporary duties. He was branded a poor team man and nobody took his abdominal complaints seriously any longer.  He suffered from a loss of self-esteem and went into depression.He was hospitalized yet  again with pain abdomen and he was re-evaluated in detail. Virtually, every cause of pain abdomen in the book was looked up and he was evaluated for the same. He was finally diagnosed with Acute Intermittent Porphyria, a condition which does not produce too many clinical signs and shows up normal on almost all tests except the very specific Blood tests which have to be specially asked for. Jagadish was happy that a diagnosis was finally found – he was actually happier that he would no longer be regarded as a malingerer! The patient is always right!

And then there was this very astute clinician ,  much senior to me. He had a very sharp clinical mind and was rather proud of his clinical abilities. He developed a pretty chronic cough and he diagnosed himself to be suffering from Allergic Bronchitis and treated himself for the same. His cough persisted and his colleagues pointed out to him that he was losing a little weight. He assured himself and his colleagues that it was due to his strict dietary regime that he was losing weight. He was confident about his diagnosis and refused to show himself to anyone. One day , during ward rounds, one of his patients , a grey haired veteran of several hospital admissions and the proud owner of many morbidities told him, “ Doctor  Saheb, get your blood tested and get an X -Ray. You have Diabetes and I am pretty sure you have TB!”  The Clinician scoffed at the suggestion and moved on. But later in the day , when he was having his second cup of extra sweet coffee, the words of the patient kept ringing in his ear. He thought back about his symptoms and his problems. The next morning he gave his blood samples and got an X-Ray. His Blood Sugar was 385mg/dl and he had a   cavitatory lesion on the X-Ray. He responded to Anti –Tubercular therapy and his sugars gradually came under control with medication. Yet   again , in a manner of speaking , the patient is always right!

In our clinical practice we see all kinds of cases and all kinds of patients. As clinicians, it would always do us good to remember two things-Primum Non Nocere-First do no harm !  Also ,  the patient is always right!!!

no sneezing matter

                                            No sneezing matter!

                                 By Vivek Hande

                                                    

                                            

Some people are compulsive liars; others are compulsive shoppers or walkers. Well , I am a compulsive sneezer. My sneezing habits and abilities have made me a legendary figure among friends, colleagues, family and acquaintances. My fame , if I may call that, has spread far and wide. My record of maximum sneezes on the trot is likely to be verified shortly by the authorities at the Guiness Book of world Records and is going to find a honorable mention in the 2013 edition!

Some unexplained biological rhythm wakes me up at quarter to five in the morning with the first of a series of sneezes. Thereafter , as the day progresses, the frequency and intensity of my rhinological explosions goes on mounting. Neither me , nor my neighbors have used an alarm clock to wake up in the morning for several years. The neighborhood departmental store has long since given up trying to cope with my requirement of tissue and napkins. Many of the companies vie for my nose with the latest in heavy duty tissue paper and four ply napkins and try them out for performance scores and quality control before introducing them into the market. Pharmaceutical companies are invariably trying to woo me with their latest antihistaminics and try to buy my loyalty with gifts of expensive pens and silk ties. When I shift allegiance to a rival company , their stock ,inevitably soars on the share market. My friends seek me out constantly for information on ‘insider trading’.

My wife, however , has been threatening divorce for several years. My parents are on the verge of disowning me and my friends greet me as strangers when they are with friends and classmates. We do get exceptional service in restaurants and sometimes they even waive the bill, as the mangers want me to finish quickly and leave . The real estate agent has a tough time convincing folks to move into the next door flat. More often than not , it remains vacant; very few survive beyond three months. My boss finds it more convenient to promote me rather than sit across me  and analyze my performance face to face.

I have tried everything under the sun and the moon. Allopathy; Homeopathy; Naturopathy; Ayurveda( I could have bought a Honda Civic with the  amount I spent); Reiki , yoga and what have you. I have consulted rhinolgists, psychiatrists , psychologists, proctologists bit to no avail. My maid recommended a mouthful of hot chilies and standing barefoot under the sun for an hour. I developed ulcers in the mouth ; blisters on the foot; sacked the maid and continued to sneeze. I am beginning to get depressed; my patients (incidentally I am a doctor) are leaving me and my clinic wears a deserted look. I have very few friends and family left and things are getting worse by the day. I would like to appeal to readers to send suggestions/ advice/ prescriptions at hande@sneeze-sneeze.com  and bail me out of this terribly sticky situation !!

Maid in India

                                                               Maid in India

                                         By Vivek Hande

                                                           

                                                                

We are a working  couple and  have two growing sons.  Consequently , a major issue in our lives is the availability or the lack of domestic help. The Maid assumes larger than life importance in our lives. The availability of an appropriate and a reliable  maid governs our social life and several other facets of our life. With erratic working hours and ill timed visits  to the hospital on account of emergencies, the maid assumes a central role in our existence.

              What my parents could not teach me, several years of domesticity and dealing with maids of all shapes, sizes, caste, creed, temperament, religion and linguistic preference has taught me in abundant measure. Patience ,tolerance, humility, generosity, fortitude and a forgiving nature have become an intrinsic part of my  character. My mother can’t recognize me and my wife wonders where these sterling traits disappear when it comes to my behaviour with her!

               It has been a long journey and each of the ones on a very long list of maids had something to teach me. Many years back, Shantamma, who was our maid then, made it clear she would watch ‘Ramayan” in the mornings and “Santa Barbara”(a juicy American soap) in the evenings on my newly acquired TV and work had to be squeezed in between the two television offerings. Alice, a misguided spirit was under the impression that my home was the local center for “Alcoholics Anonymous”. After several trips to the hospital with her perennially inebriated husband, I became an expert on Alcohol related liver diseases but we had to march the couple on to someone more spirited than myself. Lata was very religious and that was a good omen till I realized she was serving the good lord more than us. Monday, she would want to visit the Lakshmi temple; Tuesday was devoted to the famous Hanuman mandir; Wednesday was for the Hande family; Thursday- a busy day; Sai Baba in the morning and Pir Baba at the Dargah in the evening; Friday was immersed in Chitala Devi and after some respite on Saturday, Mass at the Good Shepherd Church on Sunday was mandatory. Unfortunately our needs were more earthly and we had to let this spiritual soul drift away from us. Then came Saira; things seemed alright for sometime till I started discovering a lot of people in town wearing my favourite shirts and looking rather smart and trendy. She had to leave after depleting my wardrobe considerably. To be fair ,there have been many who have been warm and kind and affectionate and some have been sincere and honest too.

                        Needless to say, it has taken a lot of tact and patience dealing with the lot and one has learnt many lessons along the way and one continues to learn each day . I must let you onto a little secret. Knowledge of my tremendous experience in dealing with maids has reached the precincts of  the Indian Institute of Management. The various IIMs have approached  me to launch their new MBA program on Maid Management  and take over as the faculty head in view of the tremendous interest and demand for the course. Needless to say , I shall keep you posted on developments….

live another day

Live another day …

by

Vivek Hande

Happy Birthday! Happy Wedding Anniversary! That was it. Life was so simple and uncomplicated in those days. Today, one has to keep track of a whole lot of unknown people to wish. One has to wish so many  people for so many things or  forget it at the risk of offending someone and being regarded as insensitive and uncaring, anti-social  and  behind- the -times! You could become a social outcast , get ostracized or become a pariah if you don’t keep track of these ever expanding lists. I  dread each new day and wonder whom I have not wished or greeted- life has become more complicated!

Did you know yesterday was Bai Day (also called Kaam-wali Day in North India)? You are in for serious trouble if you have not given a day off to your maid and given her a new cotton Saree. She may not be there in your employ till Bai- ke- Bacche day(also called Kaam-wali –ke -Bacche day in North India ) which falls on April 20 , when you have to take the maid’s kids for Ice-Cream to Baskin Robbins. Everybody is so sensitive about these “days “. One loved ones’ parents always but Fathers and Mothers become suspicious if you don’t wish them on their respective days. I actually sneak into my sons’ rooms trying to look for my surprise gift on Father’s Day eve. Guess what ? I believe very soon , there is going to be a Pot-bellied Father’s Day and another Grey –Haired Father’s Day and sometime in May ,they are going to fit in a Left- Handed- Grandfather’s Day! Things are just getting more exciting.

Not to be left behind ,there are special days for environmental and medical and health issues. No- Electricity –Day and Conserve –water –Day  are passé and old fashioned. There are exciting new days to be recognized officially  which are right round the corner.  To mention a few , No-toilet –paper day(May24); No –toothbrush –day (June 02); No –potty –day (June09) are some of the more prominent ones. Then there are these special days to honor certain professionals – you have Doctors’ Day and Nurses’ Day and Teacher’s Day .  The politicians have not taken this well and a bill is going to be tabled in Parliament shortly . They regard their position as special and hence have recommended a  Politician’s Week . A day would , quite obviously not suffice !

Then there are these ‘days ‘dedicated to create awareness about various illnesses. Of course, there is the World Health Day .There is a Hepatitis Day and a Diabetes Day and a Glaucoma Day and the World AIDS Day and so on. However, some specialties have been feeling left out and want to highlight the sterling work they are doing in respective areas of expertise. To focus on the ailments and bring suffering patients closer, tie-ups have been made with Hallmark cards . Very soon cards and posters will be available wishing “Happy Anal Incontinence  Day” and “Happy Enema Anniversary!”   To accommodate these large number of cards and gifts being exchanged on these Days , Ikea has brought out a special range of cupboards with different sized slots – they are ,unimaginatively ,being marketed as the Day Cupboards!

To avoid confusion between these various days and to avoid overlap , a Department of Days has been created under the Ministry of Human Resources  which considers applications for new entries. The waiting period for inclusion in the official Government of India Day List is several days  and understandably ,  there is intense lobbying for the dates. Some requests have been turned down at the initial stages itself.  Some of them include, “No –Corruption –Day  “ , “ No – Cellphone- Day “ , “No –Television –Day” …

Because of the intense demand for the Days , the Department is unable to cope with the staggering demand and there is a suggestion to start marketing Nights soon . In the near future expect “, Happy Maternal Uncle’s Night and Happy Chemistry Professor Night!”

Identity crisis

                                                       Identity crisis!!?

                                      By Vivek Hande

It is a technology driven society today and being net- savvy is more a necessity than a luxury .I am a netizen too and I must confess that  I  often surf the net to seek out interesting e-mail ids. Each e-mail id says so much about the individual and gives a fascinating glimpse into the mind of the owner. Often , an address says more about the person than the mail!

lawyer.kochupillaiparthasarthy.tvs@hotmail.com is quite obviously a serious individual who is rather particular about the way he is addressed and means business. doctorjoinbones@rediffmail.com is an orthopedic colleague; gasbag@hotmail.com is an anesthesiologist and believe it or not, babies-out@gmail.com is a gynecologist friend of mine. A final year medicine resident at my hospital is waiting to go into private practice and makes his intentions clear with moneyraker@vsnl.com .

There is a bunch of sports crazy individuals on the net who carry their sporting affiliations as a badge of honour. One encounters spsdhonitops@gmail.com or vkmanchesterunited-forlife@hotmail.com   and I find prerna-dravid-ismine@msn.com interesting. A rare one –vishwnathananandgps@mac.com !

Some addresses are clearly aspirational. My son gets mail from britneyismine-rp@gmail.com and sharapova-iwant-u@usanet.com. Another of his friends is yogihasferari@msn.com .   Some make their musical preferences clear -    beethoven-u-rock@dna.com and elvis-is-king@gmail.com don’t leave much to imagination. Some addresses make it clear that the couple is much in love ; mp&rita-r-1@vsnl.com and minaraju-janamjanam@gmail.com are good examples of love on the net!

Then there are some e-mail ids which convey a social message as well; save-papersandy@hotmail.com ; saynotosmoking-vijay@indiatimes.com and conservewater-rishi@rediff.com are prime examples. Some convey different kinds of messages-      ihatemen-rina@tna.com; rksays-brinjals-r-yuck@sify.com   Some addresses give an insight into the mental state of the person    -ihatexams@hotmail.com and lifesucks@vsnl.com might need assistance.

It truly is a fascinating study and I am really hooked on to it. I would love a feedback from readers and would love them to share interesting addresses with me on my email id ubetterlikethisarticle@indiatimes.com !!