Making a shift from blogger to word press. Just so because of the cosmetic appeal of the latter.

Just back from a back breaking, skin tanning overindulgent trip. Savored every bit of it except an occasional migraine. Needed something close to hold on to before I take the social lemming- jump into the Indische Ocean across to starting a residency in being non- resident- of- India. So IInd Class sleeper berths and state tourism bus travel was a blessing in disguise. Suddenly I felt like an Amitav Ghosh mated with William Darlymple type of person with a wanderlustful Pico Iyer thrown in for good measure. And the mood, waiting on the fly infested Pune railway station to embark on the “Dadar express” was deliberately Rubaiyat like “ah my beloved fill me the cup that clears….”- I wanna wanna sinfully indulge myself this time like this trip were a juicy hapooos amba that I shall never get to eat again.

I had been reminded some time back by a cousin from a nouveau- riche background that my parents were second class citizens who would never travel by car even if they were to buy one. For once I seemed to be happy with that statement.What with no chakks on the train, lots of laddus and Banganapallis – larger, sweeter and cheaper than the over rated Devgad hapoos- to get softishunderbellied on, backpacking with a Bhavnagri plastic bag through toasty dusty hot AP…….ekdum jhakaasmaal!!!!!!

Some snaps…….

Snap of the main temple at Tirupati. With my 1.3 MP cellphone camera!!!!!!

The sky is my roof, the earth is my playground.Astra Castra Numen Lumen

This is a shot from a distance of the same temple gopuram and the promenade around where folks camp day and night.
The one really great thing in this snap- no, I am not referring to the golden dome inside the temple- is the verdant greenery in the background. If you feel claustrophobic amidst all the sweaty taklu crowd, you can always choose to cool off in the hills around the temple area.

Pushkarni.

Watching the people do their rituals here I thought I got some idea as to why the bathing ghats at Benares are such a draw for folks all and sundry. What could be so interesting about people dunkin themselves in water? Well….come and watch…..

The train rambles along, stupidly, trying to catch up with the sun, as the tracks wind around- sometimes west, running directly into the sun as it arcs into the horizon; sometimes north, disadvantaged bytrigonometric inanities of resultant vector and all that stuff.

Life and Times are playing out their parts outside windows with railings like Pozzo and Lucky, while one watches listlessly inert,like an Estragon, as the scenery evolves from verdant green to burnt sienna to orange and magenta to finally pitch black. Only an amber signal light flashes in the distance somewhere.

I am taking a break…………

Not many posts this month……..

……amidst hours spent on Mahabus and the rambunctious BEST no 66- front seat upper level, in Ruby hall Poly OPD and Nair Hospital Anand Bhavan flat 19, wandering through quaintly unfamiliar- now KEM corridors and the disorderly forums on immihelp.com, soothing gadolinum thrombophlebitis and sore Latissmus dorsi, fixing houses and spouse grouses, cycling through Kalyani Nagar Koregaon park Kawde Road Keshavnagar and Kharadi and other heterosexual streets of Pune listening to Enigma, Eagles and Simon and Garfunkel’s sweet Mrs Robinson, pushing my petrol budget with experimentations based on the quench effect and 4 stroke faith while the heat burns me amber and pop goes the diesel, doing paper work, more paper work and still more f@#$ing paper work, shopping lemon squeezers, tea strainers, roti belans, kadhais and neck ties, rounding on Kochs, more Kochs and still more f@#$ing Kochs, deciding and undeciding about wasting some time on IPL and finally giving way to inertia , only to be plagued by the guilt of art being long and time fleeting and the muffled drums beating couch po-tick-tack-toeishly…………….

I didn’t get time.

Hope cries
While a moment dies
And time flies
Amidst existential lies

A yoga teacher had once instructed me to just observe my patterns of breathing while performing ADL, and doing so I had been surprised as to how we take for granted the inflow and outflow of air out of our lungs to occur like it were an irrefutable absolute truth- like it is as true as I am or you are. We exist because we breathe. Since our existence is not doubted, so also that air will move in and out, this cannot be impossible.

To me the COPDs were always the hukkahwallahs, who never went to the chest med OPD despite repeated ‘warnings’, came shamelessly again and again to the EMS bearing with the grudging and abuses of the EMS staff…..for they came there to regain the ability to breathe. Not all were smokers- a large proportion was of patients with byssinosis- not their fault, some post Kochs bronchiectasis- again not their fault, one with Kartagener’s-who cried helplessly, I remember, at being told that his sperms were all dead,some Cushingoid with years of steroid abuse, one mama who said, “kabhi to marna hai, beedi peekay aish karte marenge, kya galat hai”. I had never imagined or associated any emotion with them…..a few nebulisations, an antibiotic if needed…and they’re off…..till they get an exacerbation again. What could you do anyways? “Fefda kharab ho gaya hai…….kuch nahi kar sakte……dum to lagna hi hai……..sahan karo….” The worst I had faced myself till then, was a blocked nose……extremely frustrating. But nothing compared to this- from an article in the NYT.

Ondine’s curse was a theoretical entity for me till I managed organophosphorus poisoning patients, whom we had to fight with all night to remind them that they had to breathe if they wanted to live. Neurology registrars laughed at me when I made a diagnosis of central hypoventilation in a patient with recovering Lance Adams. But when the patient died, undiagnosed, I was surprised how they could digest their inability to point to specific reasons.The very thought of needing to remember that one had to breathe, and knowing that if I sleep I shall not breathe, and hence die was too ghastly to imagine in real time. Shaila Vartak was embodiment such a curse, and getting her off the ventilator was an achievement we shall ever be really proud of.

“Myasthenia hai”…..the neuro registrar seemed cock sure.I felt something was amiss. She was middle aged Konkanastha brahmin, middle class, coming with a history of fatigue, diplopia and recent onset of weakness. No thymoma, RNS not conclusive enough. Electively intubated and steroid, Azoran and pyridostigmine upped to max levels…….no response. Should we do plasmapheresis? We decided to redo the EMG……and repeat EMG revealed that Shaila was suffering from a muscle dystrophy. So while leptospirosis patients with ARDS waited for ventilator vacancy, we fought with Shaila, fiddling with SIMV, pressure support, low tidal volumes, postural variations, 2 ventilator associated pneumonias, progesterone, acetazolamide and analeptics, countless trials of weaning and sheer desperation. Shaila could walk, but she could not breathe. She could even AMBU herself if someone was busy with some other patient.I never talked to her as she was on trach for a loooong time. But finally when she was weaned off onto a nocturnal BiPAP support…after 2 long months in the ICU, we felt jubiliant that we had achieved the near impossible.

” Jor jor se saans leti hai isliye haat paanv tedha hota hai aur fit aata hai”………me,explaining carpopedal spasm to a histrionic teenager’s relatives in the EMS!!!!!!

How difficult it seems then to think of a thought, to form a sentence in English, to translate each word into Spanish based on a presumedly instantaneously accessible vocabulary databank, to check for grammatical correctness and language specific plausibility,to string them together in right order, and to vocalize, all this while maintaining collective stream of thought in a conversation.!!!!!!!

Some more stuff ..I believe from the BMJ…..continuing from an old post – medical short forms.

The ass: placed equidistant between two equivalent piles of hay, the ass could not make up his mind as to which to choose to go towards first and feast on, and thus starved himself to death. Had there been just one pile, he would have lived.Don’t blame him. He was just being perfectly rational. There was nothing to choose between the two piles in terms of size, quality of hay or the distance they were from him to the smallest measure.But the result was that our rational ass could not make up his mind as mounting hunger kept clouding his ability to do so, and finally died of starvation.

Buridan, had he been there: Above all, it was irrational to starve himself to death. Thus although it would be irrational to choose which pile to feast on based on just one turn of pitch and toss, the ends justified the means in this case.So Buridan tossed a coin, and based his decision on the result of the toss. (Let us say it was a pile of bread, for Buridan is no ass.)

How do we choose which path to take when we know nothing of where either leads us to? Simple. Na?

Amidst the bedlam of the IID course coordinating chaotic case discussions and listening to cute Italian accents, a once in some time incident like the one below provides for much humor as much as it sets you thinking.

“Doctor, मला ना कुत्रा चावला. मी दोन इंजेक्शन घेतले.”

“कुत्रा कसला होता? आजुन कुणाला चावला का?”

“नाही हो, घरचा कुत्रा आहे. Palmolin कुत्रा आहे.त्याला पण वाईट वाटला असेल, म्हनून दोन divasa पासून कीव कीव कर तोय. मला ना दोन तीन diwas झोप नही लागली“

” अहो घाबरु नका, इंजेक्शन घेतला ना तुम्ही, कही नाही होणार तुम्हाला”

“ मला कसला काय होणार, tya कुत्र्याला majhyapasun HIV झाला की माझा भाऊ रागाव्णार mhanun मला भीती“
!!!!!!!!!!!!!!!!!!!!!