Feather-weight Words

The Visual Analogue Scale (VAS) for pain is one of the first things they teach us when start clinical rotations in med school. You ask the patient to grade their pain on a scale of 1 to 10, 10 being the worst pain imaginable. More often than not, the responses varied between 6 & 8 with the oddball 9 or 10 dropping by like a diagnostic mystery for the fresh Dr.Houses to toy with. We were naive then, & took what was told to us at face value. When we started narrating the VAS scores to our residents, they asked if we really thought their pain was as severe. It seemed a stupid question - the patient is in pain, hence with us. Why would the patient lie? The resident explained - no patient lies, they merely embellish & it is your job to take into account their dramatic exuberance. They then showed us what they meant with a thirty something mother who lay in a bed nearby. I was first asked to obtain a VAS score like I normally do, by asking, "If 10 is the worst pain imaginable, how would you rate yours?". I got a 7. The resident then asked, "If 10 was the pain during your first childbirth, how is the pain now?". He got a 3. 

Being stubborn as I was, I argued that the logic couldn't hold true for all patients and the question posed was only applicable to women who had undergone childbirth. I continued to make my case stating that a patient's memory of past pain may fade. But, in hindsight, their dramatic skills also improve with time to compensate. A few years wiser, I find not all patients embellish, but that doesn't mean the physicians let down their guard. The ones that do exaggerate have various reasons for doing so - want more time with the doctor, think they'll get better treatment, if a little medicine is good then a lot must be better, & then we had the occasional  psych references. But, you'll find there is a deeply ingrained tendency to aggrandize in all of us. And it extends beyond the confines of the examination room. 

I'm not a grand old man, I'm still going through my one third life crisis. But, I still remember a time when the spoken word was taken at face value, when hyperbole was just a figure of speech, not a way of life. Since when did we collectively decide that grandiosity is a must to be heard? How often do you hear - You HAVE TO try this place, it's got the best [fill in some obscure dish here] in town!?, She looks like a million bucks, The dog that bit me was built like a wolf, I couldn't be more depressed, God hates me & my personal favorite - I love it.

To quote the ever-articulate Snow Patrol, "Those three words are said too much, but not enough". 'Love' it seems, is a word that's thrown around the most and meant the least, which puts me in a dire predicament. How does one actually profess love without being lost in a sea of hollow superlatives? Should I take the extra effort narrating the depths of my emotion, or should I in true romantic manner, hope she loves me back enough to comprehend it easily? Ok, that sounded corny. But, I'm still in a constant state of confusion - Did I make myself clear enough? When is it ok to stop? Bearded man in the sky forbid I offer an average review of [enter anything here], I'm met with bewildered looks. Since when did calling something average become an insult? And why do women take it personally when I don't agree with their choice of restaurants? Makes me wonder if there's some women-centric restaurant mafia I don't know about.

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There's an acute shortage of words in the English language. Well, that may not entirely be true, but there's definitely a paucity of words being used. "Whatever", "like" & "you know" may not be as dramatic as the ten biblical plagues, but they're definitely heralding the death of language. Add to that this incessant need to mess with the degrees of comparison, where superlative is the new comparative, comparative the new positive & positive is a long forgotten remnant of what the truth used to be. 

Speak your mind, but make sure you mean every word you say, even if it means you speak less.

We must never forget that the highest appreciation is not to utter words, but to live by them. 

- JFK 

Averagely yours,

SS

Apathetic Spectator Syndrome (ASS) - Do you have it?

I was a wrestling fan in my formative years and like most kids, I tried out those outlandish moves with my brothers & buddies. This was in spite of the repetitive "Don't try this at home" messages, which have recently been changed to, "Don't try this at home, school or anywhere else". Like those additions would make a LOT of difference convincing kids that didn't care in the first place! Now, you can either blame the kids for being stupid enough to imitate wrestlers, the parents for not monitoring them well enough or try to bring down the root cause - wrestling! And try they did. There were awareness campaigns, discussions by NGOs and people who had time to burn. For a while there, these nervous Nellies won - wrestling deserted the airwaves for some time. Us kids though, we carried on with our play, until one day, someone got hurt bad. No child was wheeled into the ICU, no police complaints were filed, but damn that hurt! One episode of pain & hurt is a better teacher than a thousand hours of lectures & awareness campaigns. 

TV is a powerful medium. We watch, assimilate, emulate and subconsciously draw knowledge from what we see. That is exactly the reason behind the aggressive anti-smoking campaign going on in India right now. You can't watch a movie or TV show without the statutory warning gliding across the screen. A lot of people argue that it takes away from the experience, that the immersive illusion is shattered when someone tries to blur out a cigarette or an "annoying" message flashes on screen. Directors and actors have criticized the policy saying that smokers will smoke, irrespective of whether the stars they adore do so. But, they underestimate the power of the very medium which they exploit. If even one person is disgusted enough by the cancer ridden lung images to quit, the campaign is a successful one & the ministry is justified. We take home a million messages from TV & movies - what is the difference between right & wrong, I need to work out to look as good, those clothes are in right now, I want to accomplished larger goals - So, what's the harm if one walks away knowing that smoking kills, even if the message is buried deep deep within his subconscious?

We watch, remember, & therefore we do. It's a simple concept that eludes Indian movie & TV writers when they portray doctors and medicine. I spoke of the immersive illusion of television earlier. I was watching a show where a neurosurgeon was attempting removal of a Meningioma with one of his arms in a cast & shoulder sling. Single handed Meningioma surgery aside, that idiot had the shoulder sling ON TOP of his sterile surgical gown! And then the illusion goes POOF! Indian TV shows have horrific production values most of the time & I don't see a lot of viewers complaining, or even realizing this dreadful oversight. So, it's understandable that they don't show ventilators, heart lung bypass machines, & have Casualty departments with just needles for equipment. But, it's how they portray the practice of medicine & doctors that irks me most. 

A world renowned neurosurgeon (Indian shows are fascinated by brain surgeons, I think) is called in to operate on a girl with a gunshot to the head. He flies in with much enthusiasm, but when the girl starts sinking, all he does is order the nurse to up fluids & starts massaging her palms and soles in an effort to revive her. Yes, that's what 12 years of neurosurgical training teaches us - something that grandmothers do when kids faint in the sun. Then there's the ubiquitous and classic, "The condition of the pregnant woman is very serious. We can either save the mother of the child. The family must decide soon". This is followed by a never ending ethical & philosophical discussion within the family about whom to save. I doubt there is a single obstetric condition which turns into an "either-mother-or-child" survival situation so dramatically. And even if there is, no doctor can ever ask that question! We are compelled by our ethical code & the law to save the mother irrespective of the risk to the fetus, having liberty to sacrifice the latter if required. Myth debunked! 

A man is shot while walking on the street and collapses in a pool of blood. As if out of thin air, a crowd surrounds him, but nobody moves closer than a few feet to help the man. As luck would have it, a medical intern was close by and she pleads with the crowd to help her take the victim to a hospital. The response was another archetypal Indian TV dialogue, "He's been shot, it'll be a police case. We can't move him until the police gets here." The intern then proceeded to reprimand the crowd, calling them - for lack of a better term - Pussies. And so the gunshot victim got taken to a hospital. This, I thought, is a great show. For those not residing in India, the scene I've described is a common occurrence in real life. The reason behind someone collapsing isn't always as dramatic as a gunshot, but the common man is hesitant to get involved in somebody else's crap. And their apprehension is partly understandable. Government hospitals lack manpower, so the onus of admitting and transporting the patient within the hospital often falls upon the person who brought them. The police is only just becoming more sensitive to these cases, & instances of good samaritans who have been made to needlessly wait and sign declarations by the police are common too. There is an acute need to let the common man know that their good deed will not be punished. There are of course, lives at stake here. But, while thoughts of Indian television having matured were only just forming in my head, the very next scene had a police officer admonishing the hospital dean saying, "It was obviously a police case. The intern must be punished. She should have waited for us to get there before moving him". Sigh. 

I think back to us kids imitating what we saw on TV & how we all got away with a few scratches, bruises & cuts. All seems well with our approach of mimicking what we saw on the telly & figuring out our limits. But, what of the boy who faces a life in prison after accidentally killing a girl while imitating a wrestling move? Or the boy who died imitating his favorite wrestler by diving off the roof?

There may not be any statistics to report  the number of people who died because bystanders didn't offer any help - let's term their affliction 'Apathetic Spectator Syndrome' or ASS, from watching too much TV. There are numerous stories which make me wish that TV would stop with these deceitful portrayals of what happens within hospitals or events leading up to an emergency admission. I shudder to think of the number of people who would apply what they see in these shows, in a very real time of emergency. It's about time TV woke up and realized its responsibility to create awareness extends beyond a puff of cancerous smoke. 

I'll leave you with one last story. A young doctor was riding his bike to college one morning, when for reasons unknown, he lost control and fell off at a busy intersection. Nobody came forward to help this man. The police brought him to the hospital where he worked and studied, estimating he lay on the asphalt for a good 20 minutes before they found him. An hour of relentless resuscitation attempts couldn't undo the damage of twenty minutes lying on the road alone. I wish more than ever, someone would have come forward to help that morning. 

The Evolution Of Fat People

For students of medicine and biology, this is a lesson in evolution and anthropology. For anyone with a BMI over 25, this is a factual, motivational tool. 

It all started with Balpreet Kaur, a Sikh girl going about her business at the airport. She wore a turban and as per her religious beliefs, did not rid herself of any facial or body hair. As luck would have it, someone with a cameraphone found her appearance humorous and decided to share the joke with others on Reddit. He posted the picture under the 'funny' category with the tagline, "I'm not sure what to conclude from this". It wasn't long before she knew that she was the subject of discussion, often ridicule, on the social network. Her response to her detractors & critics is nothing short of a modern example of poise & dignity - "By not focusing on the physical beauty, I have time to cultivate those inner virtues, and hopefully focus my life on creating change & progress for this world". You can read more here. 

Just a few weeks later, I read about Stella Boonshoft. Stella is a girl of voluptuous proportions, who has been ridiculed by her fellow students, trainers and men of interest, because of being overweight. She shared a semi-nude picture on Facebook to show the world how proud and comfortable she was with her over-weight body. It was her emotional outburst that accompanied the picture which caught my eye. My first response, one I'm sure a lot of you would have, was - More power to you! But, then I thought of Balpreet. The similarities between the two women at first glance are great. Both are strong women with character, both have been ridiculed or questioned for their external appearance, both used social media to their strengths and were lauded for it. That is where the similarities end.

It took a moment before I started wondering - Stella isn't that great after all. She's been over-weight, & from her account, since quite some time. While she's had ample opportunity to change her lifestyle, she's chosen to  chide society for setting unreasonable ideas of beauty. She's lashing out because she's had a rough childhood. I felt for Stella, nobody deserves to be ridiculed or made to feel inferior while growing up. Adolescence is a tough age for most of us, and it's especially tough when you're made out to be an easy target because of your appearance. But, as a smart, informed adult, she missed the point by a mile. While Balpreet is a strong woman of conviction, whose religious beliefs are exactly that - HER beliefs; Stella is just another person struggling with her weight. She's adamant about her body being only her concern, but the medical mind in me refuses to accept that. Somewhere down the line, her weight will be someone else's concern too - her doctor's. 

Society's norms of beauty keep changing. They follow cyclical trends & are fairly predictable. There was once a time in Victorian England where a woman's ankles were considered far too private to be exposed, her bosom though, was let free to feel the wind. Caucasians are obsessed with tanning to get that perfect golden brown skin tone, and the already golden brown Asians are obsessed with fairness creams. Society is way tougher on women - waxing, bleaching, hair removal are all painful procedures without much merit, and a woman's life is a continual struggle to please that handsome man in the commercials. Are fashion houses and beauty product labels being unreasonable? Most times. Each time the billboards are plastered with a woman who is excessively thin to begin with and then photoshopped to look like Aphrodite, they're being idiotic. But, their idiocy is matched only by their financial success, because we lap up these perverse standard of beauty. This is the problem that Stella was addressing.

Some standards though, have withstood the test of time. A sculpted, muscular body, toned physique, smooth, supple skin, flowing hair have never been out of style. There is but one universal standard of beauty in the world that hasn't changed in thousands of years - Athleticism. The pinnacle of human endurance, agility, strength and skill, these athletes represent all that is good about the human design. They represent health in all its glory, & are universally desirable. Desirability - that's all it comes down to eventually, desirability as a sexual partner. 

One of my professors often said, "The fact that Isaac Newton's sperm never met an egg is one of the greatest crimes against humanity!". He wasn't wrong. To paraphrase Tom Cruise from Jerry Maguire - Show me the GENES! We choose our partners, on the basis of so many factors - their looks, success, wealth, potential for growth. But, that's now. Far back when we were just scavengers in the forest, we chose on basis of strength and speed. One's external appearance mattered a lot then, as it does now, because it is a sensitive indicator of someone's health & their genetic quality. Scour through medical textbooks, and there're hundreds of signs visible externally that signify internal disease. So flawless skin, hair, ripped muscles are all desirable. Its all about having the best possible mix of genes. The desire to find a suitable sexual partner, procreate and have offspring that represent everything that's good about us, is universal. So, the next time you're questioning ideas of beauty, ask yourself how much of it has been created by corporate propaganda, and just how much are we all born with.

In a lot of ways, the reason we're fat is the same reason we orgasm. A lot of people thought that the orgasm was a fortunate blip, a physiological event that didn't serve much purpose. They couldn't have been more wrong. Just imagine if we didn't orgasm at all. Would we all still be having sex if it wasn't pleasurable? Somewhere down the line, we would give up on sex & the entire human race would be wiped out, being replaced by a species that enjoys sex. So, sex is enjoyable for a purpose. It is nature's way of telling us that we must survive as a species. We may all struggle to philosophically describe the purpose of life, but a biologist knows it already - Survival. Life exists - in strictly biological terms - to continue and perpetuate.

Getting back to my original statement - we're fat for the same reason we orgasm. Fat is the most efficient form of energy storage in the human body. Carbohydrate stores last us only for a few days and protein is far too essential to our body, therefore utilized for energy as a last resort. Back when we were evolving and food was scarce, we developed a taste for fatty foods. Evolution was smart that way, it made us love fattier meals so we would seek out and completely consume them. Energy storage was of paramount importance; one never knew how far the next meal would be. Those individuals that developed this rich taste, survived more easily than those that didn't. Move into the 21st century, and we've inherited the same fondness for fatty meals from our ancestors. Except food isn't as scarce anymore, but our appetites are just as insatiable. A quality that was meant to ensure our survival, is exactly the reason for millions of untimely deaths. Maybe, just maybe, evolution screwed up.

Obesity has been rampant since the past 50 odd years, and has mirrored our growth as a species.  This progress has brought an abundance of food, technological progress, medical innovation; But, it is exactly this progress which is the cause of our collective "growth".

Medicine has finally come of age. It wasn't until 1964 that we knew the link between smoking and lung cancer. Chemotherapy didn't give results until the 1970's. And AIDS was discovered only in 1981. The questions in medicine have shifted from 'What's causing this?', to a more reassuring, 'How can we treat it?'. We live in a spectacular time because important associations between diseases and causative factors have already been made. While we improve patient care with each passing day, there arises a greater drive and focus to reduce the number of patients altogether. Preventive medicine isn't a new buzzword, its the most important one. But, a culture of instant gratification means patients are more likely to demand a magic pill when ill, rather than take steps to prevent the illness in the first place.

Almost every obese patient I've counseled has said, "I just don't know what to do". As their doctor, one tries hard to make them see reason, to make them see the trouble that awaits. As their doctor, it's my job to tell them what to do. But, more often that not, the next time I see them - still just as obese - I listen to, "I just don't know what to do". Obesity is primarily a problem of the developed world, of the affluent classes. I do not say the problem lies with a lack of intelligence or information. That clearly isn't the case, most are extremely capable of assimilating the information we provide and acting on it. The problem is, they're careless and indifferent. Having foresight is what doctors are paid for,  but we cannot force it upon our patients; we can advocate, support, counsel and fight for our beliefs, but we cannot force them.

The age when patients religiously adhered to their physician's advice are long gone. The internet has disseminated information, both factual & fictional, in a way none of us anticipated. It is every patient's right to gather information about their health concerns and question their physicians about the same. It keeps us doctors on our toes. But, when your interpretation of the statistics does not match with ours, we urge you to trust our judgement. A figure of 1% risk seems trivial, until you become the statistic itself. I will not debate the prominence of environmental versus genetic factors in the surge of obesity, they both have an important role to play. Understanding the problem isn't enough, we need to acknowledge the magnitude of change required to overcome it and go about our business doing just that! Don't tell me that you don't know what to do. Such ignorance cannot be tolerated, your life depends on it.

Evolution doesn't ensure the survival of every being. 'Survival of the fittest' - As a high school student, I was perplexed with the choice of word - fittest. Darwin explained that survival isn't guaranteed to the largest, the strongest or fastest, but the one that is best suited to the present circumstances. He who adapts best, survives longest. The grandiose, seemingly indestructible dinosaurs were wiped out after the meteor hit because their large, inefficient, hungry bodies couldn't adapt to the scarcity of food that followed. Those that did survive, were the unlikeliest of creatures - mammals, which until then were a small, insignificant part of the ecosystem. And they rewrote the history of this little planet. Just as the dinosaurs, we're at the precipice of an enormous environmental change, that of relative abundance. Those that fail to change, fall prey to evolution ensuring only the fittest survive, in a literal sense. We need to stop dragging our feet because failing to adapt, means adding another chapter to the history textbooks. Except we don't need meteors anymore, when we've got McDonald's.

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Respected Dear Doctor Dean Sir

Still cringing at the title? Yup, that was me for five years of medical college. Every damn time the dean came up on stage or had to address a gathering larger than two people, there'd be one person who introduced him as, "Respected Dear Dr. Dean Sir",and the rest (often just one) vociferously clapped. As if just calling him the Dean (which he is) or Dr.ABC (which he is), or Sir (which he is not, the Queen never called), wasn't enough. Ass licking of Grade A quality.  And every time they did that, or I'd read letters to the Dean starting off with, 'Respected sir', I'd hear the distinct high pitched voice of my ninth standard school teacher chiding us because that's grammatically wrong! Thanks ma'am, you've made me anal retentive for life. 

You'd think that after a few years, I'd begin to ignore this blasphemy of grammar, but it only got worse. And with time, I noticed that this ass licking extended to anyone in power. Not that these people ever noticed, but the minions tried anyway. I still hate the fact that so many fellow students one year my junior would call me 'Sir', because that's the established practice. It starts off in first year of med school when the freshers are "supposed" to respect the seniors, or face social purgatory. Dramatic, isn't it? In reality, not so much. The seniors may just rag on the juniors a little or refuse them help. All for what? False respect? For being born a year earlier? Yikes. Then there was our education department, where students regularly and loyally buttered up the clerks so that work may get done that tiny bit faster. Yes, ass lickers galore! If there is any difference between politeness & lunacy, the students failed to see it. 

"Hello Uncle, Aunty, how're you doing?". As a kid, this would be uttered multiple times a day. Everyone in our country is our uncle and aunt, and there isn't a damn thing you can do about it. Calling out to someone as Mister or Miss, is considered alienating them. But, the dynamics of Indian society heavily revolve around emotional blackmail and mental torture; so perhaps familiarizing yourself as family helps. We have problems with boundaries. I always felt that by giving relative unknowns more than their due respect, I was somehow belittling the relationships I already had. Having realized this, the supply of temporary aunts and uncles soon ceased in my life. 

While all these "respected" individuals and part-time uncles lead to a lot of awkwardness in our humdrum lives, it seems ridiculous when these principles start to spill over into the professional realm. From my personal experiences, relationships for the most part are extremely strained when they are between individuals working at different levels. Bosses feel superior in unjustifiable ways, and the workers, they help maintain the delusion. One knows all is not well at the office, when respect is commanded rather than earned.

While I was interning, I found I worked best under those residents who spoke freely, those who made me feel I was working with them, rather than for them. These are the sort of leaders you want at work, ones who you can speak to without fear of critical remarks, or being reminded of your place in the pecking order. I was lucky to met a few great seniors. Residents who wouldn't ever order dinner without asking where the interns were and when they'd get free; Professors who would call me into the OT just for kicks and then ask for coffee after; And people who were mostly just great guys looking for company, not an ego boost.

At the workplace, there needs to be some balance between hierarchy and equality. There isn't a building in the world that doesn't have its own version of a Power Pyramid. It is up to the people at the top to make those clutching at their trousers feel at ease. It is extremely difficult to work our way up when we are continually reminding ourselves of our place in the hierarchy, constantly projecting power to the person behind the bigger desk. We are just as much to blame for this as the person at the top. The line between respect and ass-licking is fairly large (Think large like elephants, football pitches, endless farms, Jupiter. You get the picture), and one that we continually ignore. 

One needs to be extra careful in our country, where promotions are decided more on basis of seniority & years served, than experience & expertise. Building camaraderie, not hierarchy, is important to working well together. How else will you promote competition and innovation not just within strata but between them? Make me feel like my excellence at work is foremost when it comes to rewarding and noticing me, then sit back and watch the magic happen. 

- (Just) Dr.SS

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Men Had It Coming To Them

There has been a lot of discussion in the past few months about the safety of women in India. A great offshoot, and one that has gained momentum in the past month, deals with discussing the status of women in our society. While I haven't yet come across any great article by a cultural anthropologist, this one is worth your time (Link).

While the chatter online has been positive, household & workplace discussions for the most part, are still archaic and disheartening. Why are these people still questioning why the Delhi rape victim was out with her boyfriend at night? Why are politicians still asking for skirts to be outlawed to "save" women from the fiendish eyes of men? Why must we question the integrity and morality of those women for doing that, which would be considered normal & acceptable for their male counterparts?

So in conclusion, the many recent news stories of female victims who are out drinking or traveling alone at night or showing too much leg or cleavage, have merited sympathy accompanied by that very idiotic afterthought, "What were they doing out there in the first place?"

If people think the blame for getting raped and murdered lies partially with the victim, they'll love my plan. Women, pick up your pepper sprays and batons and wait in groups outside nightclubs, pubs & descend upon any man who walks out alone, seems too inebriated waiting to be taken advantage of, or just has an extra shirt button open. Beat the crap out of him, & don't worry about the morality of it all. He had it coming to him. Why was he out in the night so late? Why was he out drinking? Obviously, men from "good" houses do not drink. How dare he walk out alone and without someone to protect him? Does he not know it's dangerous being out so late in our country? Is he not afraid of being raped or being killed? And why is he showing off so much of his chest? Yeah, he meets all the "had it coming to him" criteria that the Indian society seems to have deemed acceptable for women. 

Godspeed

Ambition

Aaaaaaaand I'm back

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In-a-body experience

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You lean against the wall, thoughts straying,
Until you can't remember how you got here.
You look across the room... & feel nothing,
The sight of your hand seems unfamiliar;
That it obeys your command, surreal.
You wonder if this body will take the punishment, this sense of freedom,
& then a familiar sense of carelessness, it comes flooding back.
Amazing how the right song and a pair of earphones
make you the loneliest philosopher in a crowded room

To Do List

Someone recently shared a picture with a To-Do List on Whatsapp that had me splitting with laughter! I take no credit for it, but thought I should share it with you!

Personal favorite: No.6!!

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Easy Living

There's been so much happening recently, I've been giving a lot of thought to what my 'life philosophy' actually is. Is everything I do as random as I think it is? The answer's so hilariously beyond me, it reminds me of the Roadrunner & Wile-E-Coyote; but here's what I think makes my days tick:

1. "That's what she said!"
   These glorious words should only be used for that spiritually enlightening game of sexual innuendo & double entendre. Using it to bitch about someone is just depriving someone of a good laugh! Not familiar with the game? You'll find the light here
   
   
2. Tell your friends just how amazing they are
   Why? Because they are! Boss making you miserable? Girlfriend won't give you head? Marks slipping? Rubbed your local mob the wrong way? There's always at least one person to help you out. If not, at least find a friend who bakes. Yumm, the sweet taste of misery
   
   
3. Go hug your mom at least twice a day
   There's an acute shortage of mothers in the world. Everyone has just one. Tells yours she's special.
   
   
4. Question everything
   What's the reason I'm here? How can I win her over? What can I do to succeed professionally? How can I make the world a better place? Why won't this itch go away? Figuring out the right question is half the battle won. 
   
   
5. Make Love, Not War
   Stop spending so much time fighting or arguing with people; & especially stop investing energy in avoiding 'mortal enemies'. Unless you have a Batcave or come from the planet Krypton, you can't afford to have mortal enemies! Stop sulking & skirmishing. Move on. And oh yeah, have sex. No particular reason. Well, you know what I mean. 

I'm sure I've missed a few important points, but you couldn't possibly handle anything longer. 

THAT'S WHAT SHE SAID!

You Chose Already, Now My Turn

Someday when you're unlucky, I'll kill you with my words. Start running away right now.

- A wise wise woman

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Dear friend with the beautiful back, 'cause that's all I see now,

I chose to write to you. The convolution of the situation was scalding me & I chose to walk away. No, I didn't admit defeat, I didn't cower, I chose to do the sane thing, I wrote. I wrote because I can always erase the hurtful words I write, before they reach the person they're meant for, I can vent without being angry. I wrote because I can't really take back the things I angrily say, that which I don't think through, mean or don't believe in. I wrote because it's difficult to be angry at a letter, because when we're at war, seeing you makes me want to sit down with you; seeing me, makes you want to run away.

If you thought I was wrong, why didn't you just say so. I would've let you shout, scream, moan, throw your arms & legs up in the air. I would've gone through it all because you were more hurt than I. Why'd you choose to walk away instead? It aches to think years together have whittled down to nothing more than distance. Before you left, you used the choicest of words. You tore the flesh from my bones, clinically dissected my mental faculty & still had some left to share with others around you. You told me of your bitterness I wasn't aware of, of problems that I thought were long gone. You chose to bring them up, because when there's that much blood spilled already, some more would surely help you vent. What's worse is you committed yourself to your words. You stood by your decisions. I'd salute your steadfastness, if only I could justify it. 

Isn't there just the slightest chance we're both at fault here? Had we deteriorated without notice? Yes, you're the judge, jury & executioner. You based our relationship on your account of that one day. You're impervious to my pleas, ignorant of the truth, & in denial of what I meant to you. You may say you're angry enough, but you're not, unless you're going to punch me. Unless you're eager to land a right-hook, there's still hope. Because when the smoke blows over, there isn't any nuclear winter, just a few people getting on with their lives. 

Its more a game of time than words right now, & too much has passed. I'm tired of writing. I'm wiser because, I finally realize that letting go has its own charm. I have many friends, none better, but I chose to fight for you. And now, I choose to walk away from you. 

Maybe someday, you'll look back at what happened & a doubt will creep in. You'll wish you'd chosen your words wisely. Maybe, someday you'll move on, not walk away; you'll remember how intimately I loved you, our time together. 

Maybe someday, I'll turn & there won't be any time for letters; I'll tear you apart with my words, except I won't be there to stitch you up again. Would you fight for me then?

Superficially Me

Its been over a year now & no, it hasn't washed away, although I did once have a nightmare that it did. I thought discussing my tattoo would only mean narrating why I got it; instead I've got stories to share about what happens during and after as well.

Lesson #1: Needles hurt. Who knew?

Yeah it hurts, but its not really pain. Its this indescribable mix of scorching heat, vibration, pressure & a couple of IMs going in at once. I'd be lying if I said I wasn't apprehensive. Thoughts of choosing between whiskey, tequila, paracetamol & Tramadol kept going through my head. Eventually, I chose a girl to hold my hand.

I have the tattoo over my upper back, a good place as the skin here is thick and from what I've read, relatively insensitive to pain. Medicine never taught me the meaning of "relative".

And yes, its not funny when the stupid machine cords start tickling your lower back & the artist thinks you're tensing up because of the pain. I don't think he bought that story; not a proud moment for yours truly.

Would I do it again? Yes!! This damn thing brings out the masochist in you.

Lesson #2: Exhibitionism is out of the question

I've always thought people get the most amazing tattoos on their wrists, or the inside of their forearms, but its forbidden territory for doctors. I wouldn't personally get one anywhere that was easily visible. Its just that every physician is supposed to conform to the layman's idea of a competent doctor. You wouldn't ever want to be in a plane flown by a pilot wearing his hat backwards, would you? That being said, this tattoo was personal & I'm deeply attached to it. I don't think about whether its visible to the world. Its very cliched to say this, but I got it for ME! My shoulders, arms & feet though are reserved for future.

Also, I'd take this moment to thank my friends, who've never refrained from ripping apart t-shirt collars to get a better look.

Lesson #3: There'll always be 'people'

I was posted in I.Med last summer & still remember beads of sweat rolling down my nose when I did my post-emerg collections. I avoided my coat like the plague. So, I'm strolling ahead of my Unit Head during rounds & she goes, "Is that a tattoo?". I just nodded and slowled my pace to let her pass me. I thought she'd stop; except, (long pause) she didn't. She then did this great impression of a National Geographic journalist interviewing the tribes of the Amazon."How much does it hurt? How much did it cost you? Does your family know? Is it safe? Where did you get it? Why did you get it? I swear if my son one day walked upto me and told me he wanted to get a tattoo, he wouldn't have a home anymore. Personal reasons?! I don't really understand your generation." I looked at my registrar amid all this & we shared a simultaneous facepalm moment.

Other nicer instances include a Gynac nurse who almost hit me on the back because she thought the halo was a bug & then proceeded to get all the nurses to gang up on me to show it to them. Did you have a facepalm moment right now too? See, we're bonding.

Lesson #4: Those lingering moments of doubt eventually wither away

Of course, there were times after I'd taken the plunge when there were genuine doubts.
Did I make the right call?
Didn't he open the needles in front of me? Damn! Should've checked the seals myself
Maybe I could've gone with different artwork
Does this seem lopsided to you?

But, I love it & am at peace with it. I would've done a million things differently, if I'd had time. But, I suppose anyone would be that paranoid with something this permanent. Eventually, I'm going to go get some white retouches done on this to add more details at the flexion of the wing. But, I'd never change its structure, or what it says.

Lesson #5: Bis Vivit Qui Bene Vivit - One who lives well, lives twice

Those are the words I chose for my angel. This was my little slice of closure over losing someone close to me. And that's the lesson I hold dearest. I read the statement in two different ways.

One should live their lives to the fullest, take in all they can, because a life truly 'lived' is worth twice one spent in vain. 

A person who's been honest & good to those around him, deserves another chance. 

Getting inked wasn't ever about holding onto a memory or letting go. It was just honouring someone, knowing I have a keepsake with me, a sliver of where I'm from and what made me.

Superficial

Did it hurt?

Is it permanent?

What's that supposed to mean?

Why'd you get it done?

Can doctors have them?

Why?!

Thanks Bill

Bill Watterson created a fantastic world with Calvin & Hobbes in 10 years. He finally decided to end the strip gracefully while he was still at his peak, not wanting this iconic strip to overstay its welcome or lose relevance. Here's the final comic that ran on December 31st 1995. I think its very apt for this particular phase of my life:

(c) Bill Watterson 

I think we dream so we don't have to be apart so long. 

If we're in each other's dreams, we can play together all night.

-Bill Watterson

Tomorrow

Beyond all our exaggerated fights & subdued squabbles, there's a better tomorrow. Beyond hunting for time & the frustration that accompanies failing, is tomorrow. There're just a few hours left today. We haven't spoken much, we haven't met; its been days since I last saw you, took in the scent of your hair as I held onto you; but tomorrow's another day, gives me one more reason to be optimistic. 

I may plan & obsess, but there's no telling how amazing tomorrow may actually turn out to be. Tomorrow, we'll be together, I'll love you just as much, maybe more, but tomorrow will be better than today and yesterday. Tomorrow we get to start afresh with a g'morning call, not knowing what course the next few hours will take. Tomorrow will be a brand new chapter in our lives together. Tomorrow, I'll make fresh promises, and break a few old ones; You'll try harder and then give up midway. But, by night tomorrow, we'll be better for having lived our successes and shortcomings. 

Tomorrows are where I live with you, there's always something better waiting around the corner. It doesn't matter if you can't care enough, I'll do that for the both of us. I'll dream intricate dreams for tomorrow, weave tales around our heads. Tomorrow I'll lay down with you once again; those impatient hands of my watch will wait for me. I'll take in the way the light plays with your curves. Your curves, I'll take them all in, like I'd never see them again. Tomorrow I'll tell you things I've hidden from you for so long, and then tell you what I can't say enough; I'll be repetitive, but I won't be boring, I promise you that. You'll want me to go on and then I'll stop, just to feel how effortlessly your hand fits into mine. I'll trace every crease of your palms, your fingers. I'll trace that arc from your toes flowing onto your feet, legs, knees, I'll keep on going. I won't stop till the wrinkles in the sheets tell our tale; of how we lived, loved, died and came back to life together. Those moments, I should hate them, they pass too quickly. There's nowhere else I'd rather be, no one else I'd rather do nothing with. That window, the fumes of coffee & passersby, all oblivious to our day to remember. Tomorrow, I'll do everything you want, I'll make sure that smile doesn't leave your face. Tomorrow, I'll make elaborate plans for the rest of the day, how I'll push aside the hair from your face, to reveal a smile. Forget my plans, these sheets have been so good to us, it'll be criminal to leave them. 

Tomorrow can't get here soon enough. Thank god, tomorrow's only a few hours away. Beyond that, another tomorrow awaits the light of day. 

What a magical journey its been, with friends from Narnia

You have just as much power over choosing your friends, 

as you do over choosing the day you were born

All I do now is look back at the series of most fortunate events. Happy accidents, that's what I'd call them. We never really chose our company, these men and women we walk with. There wasn't a grand plan at work. But, 'we' worked together. We just moved on with our lives, ceaselessly, sometimes aimlessly. There wasn't any grand plan, we weren't capable of making it as good as it turned out anyway. 

That very first day; it was filled with a lot of "Where are you from"s. Such trivial questions! It didn't really matter, we were in this together for the long haul. Five years is very long time, or so we thought. Five scorching summers, five humorous monsoons, five faux winters & innumerable days in between. We lived our lives in these seasons. 

We stepped foot into an unfamiliar, untamed land, & made it our own. It didn't matter how far it is where you were from, or how long it took you to get here. 'Here' is what mattered, & here it seems we would be together without end. Today's not a good day, but it's as good a day as any for saying 'so long'. From lengthy testimonials, short notes, status updates, blog posts to things that're obviously left unsaid; today they all seem deficient. Another day, we'll be 'here' once again, laughing about all that conspired today. How did we get so messed up in the moment? That day wasn't a conclusion to those five years. It just signaled yet another change of season.

We didn't choose one another, but let's say we did, and pat ourselves on the back anyway. We'll meet again someday, right where and when we left off.

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Taking stock

Ever so often you find yourself in a familiar place, with familiar faces, talking about things you know so well, and yet, everything seems different. The world stops, the drinks stop flowing, the words cease and you take in that scene, that familiarity, that you want to hold onto so badly. I know the blog says Megalomania in the title but I'm acutely aware of my mortality. I make it a point that those who matter know exactly what I feel about them. I often say, "My friends are my greatest investments"; I sure do feel rich right now.

Its not the euphoria after path-breaking achievements, its not the darkness in failures, that you remember. You recall the moments you thought you never would, the moments that you never thought deserved a place in the "Best of..." reel of your life. So, once again I'm looking across the table at people I never chose, those I didn't fully understand; these are the people that matter most, I hold them closest. You know that feeling of loss which you never really understood? I feel that now; except I'm not losing anything at all. You look back and miss that you never knew you shared. That barefoot walk on rocky beaches, the bad movies that chewed your brain, those high-fives that hurt so much, a broken sink, so many broken glasses, and creative drunken stories. You've left me with memories that'll take a lifetime to recall & rejoice. 

My friends, my family, I've taken stock of life. I sure do feel rich right now.

Gaze

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They met like everyone does, without any control of where and when, but what matters is that they did. He recalls that first day, a kind face amid an unfamiliar crowd. Tried to meet her gaze, in an obvious way yet trying to be subtle; very James Bond-ish. She just swept her hair and turned away. They did finally speak. Difficult not to, when you're locked in a room together for days with a dearth of good-looking, interesting people. He got friendly and ever so often, in conversations that were treading on unfamiliar ground, she swept her hair and looked the other way. 

He didn't like her avoiding his gaze. He strayed to other women, sheepishly blurting out his infatuations, she just nodded and stared into his eyes; beautiful brown eyes that finally broke away from his. Maybe she found the world more interesting to look at than his face. He tried to meet her often, but the conversations weren't the same. How could they be? Time flew past, but not time used well. He didn't wonder or weigh what he missed out on, blissfully unaware. 

Good days have a habit of creeping up on you when you least expect them, or prepare for them. Once again, he found himself moving through an unfamiliar crowd, which suddenly, effortlessly blurred away to reveal those gleaming brown eyes. Pleasantries weren't all that were exchanged; That look, of unsure yearning. This time he made sure they met again. Felt like a fresh start, getting to know each other all over again. Memories of good conversations seldom contain the subjects of conversations themselves. All they recall now is long walks, beaches and sunsets. They weren't one for cliches, but what're good relationships without them? 

The story played itself out all over again. They got to know each other again. He felt closer than ever before, treading carefully on thin ice. He dropped subtle hints, all she did was swiftly look away, her hair moving in majestic arcs. He thought and wondered of what could be, if only she'd meet his gaze. He took that plunge, asked her to be with him. She smiled, stared into his eyes, like she never had before. It seemed like he saw her for the very first time; so open, unguarded, receptive, almost naked. Those big brown eyes. 

Their relationship was stuck in a loop, starting another cycle again. Like an aged bottle of wine lying in a cellar, that's still new on uncorking it. They got to know another side of themselves. He felt like nothing could pull them apart. He took another plunge. Asked her why she always swept her hair and looked away. She smiled, then blushed; her eyes darting between him and the ground. She sheepishly mumbled, "I didn't want you to know how I actually felt. Sometimes I tried to hide a smile, and seldom that look when you hurt me. Didn't make things too difficult for you now, did I?". With that, she flashed a mischievous grin, grabbed onto his shirt, pulling him close and kissed him. "Except now, I don't have to hide my feelings anymore". This time, it wasn't her who looked away to hide a scarlet face. 

Someday

Living an enviable life is all about finding memories in moments, 
that you wouldn't otherwise remember

This is our twilight. Everyone's moving around in eloquent, beautiful circles, not knowing what lies ahead. Everyone's looking for their way out. We've been here before, albeit symbolically. That day wasn't definitive, graduation. Of course there were tears, smiles, warm hugs and cold relationships which finally thawed. Unbelievable how one abstract idea of finality can bring such an upheaval of buried sentiments! But now, everyone's finishing off this chapter at different rates. Life's like a child let loose in a playground, plucking leaves and flowers playfully, randomly; one by one, we'll all move away. 

We'll meet again some day, beyond this twilight, when separation has finally set in. You'll still be you and I'll still be me; and I hope we'll be ourselves again. We'll look back at the times we laughed hard, sitting uncomfortably in the most obscure places, not remembering what the jokes were about; Reminisce of the times we felt lower than we ever imagined we ever could; Wear smug looks thinking back of when we pulled through. We'll meet without wondering where time has flown, or where we've been. We've always been around. I'll tell you of the times I walked down those corridors again, a familiar scent in the air, but something seemed amiss; how I sat again in those chairs, on those stools, sidewalks and stairs; how I wished for those familiar faces around. We'll talk about the music we shared, where we heard it all first, how we so effortlessly changed the tune and words, yet the song still remained the same. The coffee may not be that sordid excuse for burnt milk from the canteen, but the company will still be the same. We'll still share laughs, without ever thinking twice of what the punchline actually is. There'll still be gossip, although not as bold, but then we were always creative.

Our memories are like a song that's stuck in our head for ages which finally recedes, until you can hardly remember any notes at all; until someone sings you a line and it all comes flowing back. Our company will be that catalyst for nostalgia. How we'll long for that comfort of constancy, riding a wave, knowing we're all surging ahead together. That feeling of loss, it crept upon unchecked, unnoticed, like a river swelling behind a dam, until something gave way. Somehow though, things will remain the same. We'll be so much more than ourselves then, value what we took for granted. Of course there will be tears, warm hugs and cold relationships that finally thaw. One abstract idea of mutual belonging will unearth all we hadn't felt for so long. 

We'll be so much more than just wrinkles, responsibilities, families, experiences, successes or regrets. We'll be us again, someday, sharing obscure memories we don't recall with anyone else.

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For The Graduating Class of 2006

Good afternoon ladies, gentlemen, professors, fellow interns, med students, little brothers & sisters, people who wandered in wondering what’s going on and importantly, the parents who are already screening the room for potential in-laws. My own journey with Nair started off rather funnily outside the CET counselling center when I was frantically asking people if Topiwala National Medical College was in fact Nair, because I had just filled that in the form and had no idea where I was heading! Strange how a place whose name I wasn’t sure of would become this important to me.

It’s customary for the Valedictorian to give the graduating speech, but it’s far too long that we’ve been swooning over the numero unos in this class. We only have one Nikshita, one Shruti, one Tazeen and hell, a few Ankitas for extra measure. But, it’s about time to speak up for the rest of us.

For far too long have we told people we’re pursuing medicine, only for the next question to be, “Beta, heart surgeon kabhi banega?”. Way too many people ask where we’re heading for residency, way too many seniors ask for our final year marks. Look here, being part of a crowd is a full time commitment. We may be average, but we try extra hard to stay that way! Why can’t we just take this moment to celebrate average awesomeness?

Average is the medical student who watched way too much House and Grey’s Anatomy before coming into medicine. Awesome was their reaction when they realized not all doctors are as good looking as the ones on TV!

Average is the student who knew exactly who Peter Roberts was. Awesome is not knowing who his examiners are.

Average was the student who got pulled up for low attendance in second year. Awesome were the parents who said, “Koi nahi beta, isi bahaane doosre parents se mulaqaat ho gayi”

Average is the resident standing behind the examiner who’s frantically gesturing answers in the vivas, awesome is the professor who notices but doesn’t look around.

Average are the parents who send amazing food with their kids back to college, awesome is how they always remember their kids have friends who need a little fattening up too.

Average is knowing that other colleges have campuses, while Nair has a compound. Awesome is the fact we have the one thing that no other med school has... Speech Therapy!

Average is the parent who expects his child to make them proud. Awesome is the student who fulfils their wishes and then goes the extra mile.

Average is knowing that you can’t walk through life on the Dr. Title before your name alone. Awesome is doing something that makes people add the Sahab at the end of it.

Average is knowing that life’s a struggle that you’re willing to face; knowing that in life, being just booksmart or streetsmart alone doesn’t cut it anymore, you need to own the space around you. Average is fighting for that very space you crave. Awesome is not letting anything stop you from being a part of a great tradition of medicine, where knowledge, like the proverbial torch, is always passed on. Extraordinary is that person who teaches without expecting anything in return but time and patience. You teach because you wish to be taught.

For the past five years, Nair has defined awesome. Its been way too intimate a part of our lives to serve as a stepping stone. It’s much much more than that! We don’t spend our days backbiting about other colleges. We’re proud, we’re not delusional like the rest! Let’s hold on to that quiet confidence. The average Nairite isn’t that uber-competitive nerdy medical student most others in the city are. Look back at all the years here and you’ll find that the first few months were probably just as exciting as the next few years: meeting terrific people, meeting first girlfriends, often our only girlfriends, first gut-wrenching exam failure, second gut-wrenching exam failure, third failure to finally realizing that you hate the anatomy part-exams! 

From learning how to dress up for wards, to bunking early morning lectures with shocking regularity, from befriending all the nurses, to idealizing that favorite professor you want to emulate one day, right down to his beard, from doing research projects to having movie marathons at PVR, friends we’ve made to those we’ve sadly lost. Let’s not have to remind ourselves that every little experience, every person we’ve met, went a long way in shaping us into what we are today.

It’s up to us to realize that us graduating hasn’t been a solo effort. Let’s thank our families, our professors, thank the staff, thank everyone who’s been any sort of support over these past years, people who pushed us towards medicine and those who pulled us through.

I don’t intend on ending with a “let’s go forth and conquer the world routine”. Sounds way too average! I’d rather quote Satchel Paige, “No man can avoid being born average, that doesn’t mean he’s got to be common”. Wish you all a great night ahead.

Special thanks to Aayushi for lending me her ear and words amid all the chaos that day.