Ram Bahadur was referred to me with a large growth in his cheek. When I first saw him two months ago, he was in pain. This gentleman was obviously not from these parts. Ram Bahadur was a Nepali. His features confirmed that fact. The rest he told me in his clear unaccented colloquial Tamil. He came to Salem as a young man and became the security guard at Rajendra Mills, one of the leading cloth mills in Salem. Gurkhas were always in high demand in the security business. Some years later he got married to a local girl and settled down in a friendly locality, most of who worked in the same mill. Over the years he had completely integrated with the community. Although they had no children of their own, the Bahadurs adopted all the kids in the street as if they were their own. Ram Bahadur eventually retired. His wife died. The street adopted the old man. He was now 70 years old. Bahadur was the quintessential relic of urban goodness. The common grandfather. He played with the little ones, many of them the children of boys and girls whom he had cared for as a young man. He worshipped at the community temple and visited the Church of St Anthony every Tuesday. Bahadur’s life was certainly not lonely. At least not until he had this tumour bulging angrily out from his cheek. When I first saw him it was threatening to burrow out of the skin. It was not a pretty site. Ram Bahadur was concerned and it showed in his feigned nonchalance. He was brought to my clinic by two young men whom he had carried on his shoulders when they were little boys. They were barely employed young men struggling to make a living. One of them, Veerapan, worked as an unskilled office boy in an office which belonged to a good friend of mine. Unlike his infamous namesake, Veerapan was a docile self effacing young man who was genuinely concerned for the Nepali Thatha of his street. He asked to speak to me privately and went on to tell me that he and his friends had decided to take care of all the expenses that they could afford. I explained that Ram Bahadur had a tumour that was too far gone. He had nodes in his neck. He was unlikely to survive long even with surgery and radiotherapy. My silent concern however was whether these young people would indeed look after him if he needed prolonged convalescence. Even close family sometimes experienced fatigue and disgust in these situations. After getting a positive biopsy I anguished over the decision to operate. On the one hand there was the futility of a long operation and a very long and turbulent period of healing. There would be significant impact on his quality of life. On the other hand who was I to make a decision for treatment based on his social situation. I admitted him in the charity hospital of which I am the medical director. That night Ram Bahadur rebelled. He hallucinated and the devil of loneliness got to him. He lashed out against the nurses and showed significant signs of psychological instability. We calmed him down with anti-depressants and two days later I made my decision. In consultation with a psychiatrist and considering his advanced disease we decided that surgery would be inappropriate. He was discharged. Ram Bahadur was given pain and anti-anxiety medication. Veerapan and his friends were assured that it was a non communicable disease. Indeed, the whole street was apprehensive. They however stood by him. They bore the stench and fed him for two months. When it got too much they brought him back to the hospital. He was given three days of palliative care at Sharon. He died one morning in absolute peace. Veerapan and his friends took him home and gave him a grand farewell.
A week after the funeral the young men of the street found that Ram Bahadur had Rs3 lakhs in bank deposits. There was another Rs13,000 in cash. There were no relatives. There was no nomination. The young men refused to take a single paisa as compensation for the money they spent for their Nepali Thatha. They finally came to me and asked if I would accept the money to help other poor people at Sharon. Goodness dwells in the heart of the poor!
Friday, December 26, 2008
Wednesday, November 5, 2008
Should Radha's Sacrifice be Rewarded ?
Last week I had written the sad but glorious story of Radhakrisnan’s supreme sacrifice. I would like to bring to it a new dimension.
To understand the realities of life in the aftermath of sacrifice, let us go back to Radha’s story. Radha was a married man. In fact his first wife passed away after bearing two of his children. He remarried and has a 10 month old baby. His first two children are technically orphans, though I am sure his second wife will take care of them just like a real mother. The little one will never know the pleasures of a father. Radha’s wife now has the unenviable task of feeding, clothing and educating three children as a single mother. The economic burden is real. Reality comes when the TV crews have packed up and gone home, when homilies have been preached and paeans have been sung, when the public have clapped their palms to soreness. At the end of it all there will remain only the penury of a widowed woman and her three children. We need to examine what the family got out of all the publicity and praise. They got Altruism. Altruism is a nice word. Unfortunately you cannot eat or pay for groceries with it.
Yes! I am suggesting that his family should be rewarded. And why not? When you consider that the woman who received the heart transplant is a dollar millionaire and the recipients of the Kidneys and Liver are probably rich too. They will, hopefully, live meaningful lives because they could afford to pay for a transplant service. At the end of the day we must also remember that all these transplants cost money. The money goes to virtually everybody in the chain. The hospitals, the ambulance owners, the immunologists, the doctors, the surgeons and multiple small beneficiaries all make some money as professional or service fees. The drug companies in fact have a lifetime commitment from these patients with all kind of drugs. The immunosuppressant will ensure a steady prescription of long term medication. In all of this, only the donor or his family is expected to exercise the ‘noble’ virtue of altruism. In the transplant scenario, compensation is a bad word when it comes to rewarding the donor or his family. They are expected to be altruistic. Any benefit accruing to them would be stamped as being unethical, undignified and avaricious.
This question has been often addressed in the context of live voluntary donors who make up a significant number of kidney donors in our country. In this context I would like to address an issue that is different from Radha’s sacrifice. Adult voluntary donors should have the choice to donate their kidney or any organ which will not compromise their own lives. If this is legitimized it will cut out the criminal elements in our system. Malek, who teaches economics at San Jose State University, in an Internet post, questions the noise being made about paid transplants. He says “If money is the catalyst that relieves shortage, and if the money/organ exchange is voluntary, then why prevent this transaction? Obviously, I want the money more than an (extra) kidney, and the sick person wants the kidney more than the money. This is a mutually beneficial exchange.” Contrary to popular belief, these open transactions will cut out the middlemen and the benefits go to the donor and recipient (and of course, the hospital) only. Frank Adam et al., in Contemporary Economic Policy, April 1999 and William Barnett et al., in the Independent Winter Review 2001, ask the same rhetorical question “Who owns my body?”.......I hope it is clear that the answer is not, and should not be, the Government! The argument that the poor are incapable of taking decisions is a specious one. The same with the argument that there are surgical risks to the donor. Malek questions governmental concerns with, “-- but should Government legislate risk taking? Would driving a car be illegal? What about flying? Bungee Jumping? Roller Coasters? Where would it stop?” People may argue that health is all about welfare and ethics, but it is impossible to leave out economics. Henry Hazlitt’s ‘Two main points in economics in one lesson,’ tells us that “bad economists look at the short term, not the long term, and they look at the effect on one group, not all. In other words, good economists consider the unintended consequences of public policy legislation. Obviously, our policy makers do not have good economists advising them, or, if they do, they are ignoring them.” A well made out argument in favour of an open market has been suggested by Nancy Scheper-Hughes of Berkeley, California. She has personally visited and worked in 12 countries and collaborated with national governments to end trafficking of human organs. She argues that ‘everyone under the current system benefits, except the donor’. The patient gets a new kidney. The hospital and physicians are paid. The drug companies get to sell life long drugs. Why should only the donor be governed by altruism??”
Coming back to our present discussion we need to ask if Radha’s family should be compensated. I am certain that Radha’s family should benefit. It would be peanuts for the dollar millionaire to fund an educational scholarship for one of the kids over the next ten years. The same with the other recipients. The Government could chip in with a Government job for his wife. They do it all the time when it brings in votes. If somebody is listening, it might actually mean that Radha’s sacrifice will not only be meaningful to the men and women who got a new lease on life but also to Radha’s family which has been impoverished by the loss of an earning member and a loving father and husband.
George Paul
To understand the realities of life in the aftermath of sacrifice, let us go back to Radha’s story. Radha was a married man. In fact his first wife passed away after bearing two of his children. He remarried and has a 10 month old baby. His first two children are technically orphans, though I am sure his second wife will take care of them just like a real mother. The little one will never know the pleasures of a father. Radha’s wife now has the unenviable task of feeding, clothing and educating three children as a single mother. The economic burden is real. Reality comes when the TV crews have packed up and gone home, when homilies have been preached and paeans have been sung, when the public have clapped their palms to soreness. At the end of it all there will remain only the penury of a widowed woman and her three children. We need to examine what the family got out of all the publicity and praise. They got Altruism. Altruism is a nice word. Unfortunately you cannot eat or pay for groceries with it.
Yes! I am suggesting that his family should be rewarded. And why not? When you consider that the woman who received the heart transplant is a dollar millionaire and the recipients of the Kidneys and Liver are probably rich too. They will, hopefully, live meaningful lives because they could afford to pay for a transplant service. At the end of the day we must also remember that all these transplants cost money. The money goes to virtually everybody in the chain. The hospitals, the ambulance owners, the immunologists, the doctors, the surgeons and multiple small beneficiaries all make some money as professional or service fees. The drug companies in fact have a lifetime commitment from these patients with all kind of drugs. The immunosuppressant will ensure a steady prescription of long term medication. In all of this, only the donor or his family is expected to exercise the ‘noble’ virtue of altruism. In the transplant scenario, compensation is a bad word when it comes to rewarding the donor or his family. They are expected to be altruistic. Any benefit accruing to them would be stamped as being unethical, undignified and avaricious.
This question has been often addressed in the context of live voluntary donors who make up a significant number of kidney donors in our country. In this context I would like to address an issue that is different from Radha’s sacrifice. Adult voluntary donors should have the choice to donate their kidney or any organ which will not compromise their own lives. If this is legitimized it will cut out the criminal elements in our system. Malek, who teaches economics at San Jose State University, in an Internet post, questions the noise being made about paid transplants. He says “If money is the catalyst that relieves shortage, and if the money/organ exchange is voluntary, then why prevent this transaction? Obviously, I want the money more than an (extra) kidney, and the sick person wants the kidney more than the money. This is a mutually beneficial exchange.” Contrary to popular belief, these open transactions will cut out the middlemen and the benefits go to the donor and recipient (and of course, the hospital) only. Frank Adam et al., in Contemporary Economic Policy, April 1999 and William Barnett et al., in the Independent Winter Review 2001, ask the same rhetorical question “Who owns my body?”.......I hope it is clear that the answer is not, and should not be, the Government! The argument that the poor are incapable of taking decisions is a specious one. The same with the argument that there are surgical risks to the donor. Malek questions governmental concerns with, “-- but should Government legislate risk taking? Would driving a car be illegal? What about flying? Bungee Jumping? Roller Coasters? Where would it stop?” People may argue that health is all about welfare and ethics, but it is impossible to leave out economics. Henry Hazlitt’s ‘Two main points in economics in one lesson,’ tells us that “bad economists look at the short term, not the long term, and they look at the effect on one group, not all. In other words, good economists consider the unintended consequences of public policy legislation. Obviously, our policy makers do not have good economists advising them, or, if they do, they are ignoring them.” A well made out argument in favour of an open market has been suggested by Nancy Scheper-Hughes of Berkeley, California. She has personally visited and worked in 12 countries and collaborated with national governments to end trafficking of human organs. She argues that ‘everyone under the current system benefits, except the donor’. The patient gets a new kidney. The hospital and physicians are paid. The drug companies get to sell life long drugs. Why should only the donor be governed by altruism??”
Coming back to our present discussion we need to ask if Radha’s family should be compensated. I am certain that Radha’s family should benefit. It would be peanuts for the dollar millionaire to fund an educational scholarship for one of the kids over the next ten years. The same with the other recipients. The Government could chip in with a Government job for his wife. They do it all the time when it brings in votes. If somebody is listening, it might actually mean that Radha’s sacrifice will not only be meaningful to the men and women who got a new lease on life but also to Radha’s family which has been impoverished by the loss of an earning member and a loving father and husband.
George Paul
Friday, October 31, 2008
Radha's Last Diwali Gift
I was called in to see a patient on the day before I left town for the long weekend before Diwali! The young man in the ICU had multiple facial bone fractures. He also had a serious head injury and was on a ventilator. I glanced through the neurosurgeon’s notes which gave him a grave prognosis due to a bad brain stem injury. In fact my opinion about the facial fractures was superfluous. The Glasgow Coma Scale at less than six indicated that he was unlikely to make it. I was writing down my notes when the duty medical officer who was looking over my shoulder asked me if I recognized the patient. I had not. I suddenly felt greater remorse when he told me it was Radha (short for Radhakrishnan) a theatre assistant in the same hospital. Someone I knew well. The doctor told me of how he was involved in a hit and run accident on the highway near Salem and of how he was left untreated in a large corporate hospital for six hours before his colleagues went over, put in a breathing tube (intubated) and brought him to Kamala hospital. He was unrecognizable due to his facial injuries and the tubes. I told his wife that I would see him again when I returned on Tuesday, although I knew that he was unlikely to make it.
On my return after Diwali , I learnt that he had created magic over the weekend. Dr K K Rajagopal the owner and Director of the hospital, in consultation with the neurosurgeon had decided that Radha was brain dead. He convinced Radha’s wife on the benefit of an organ donation since he was well perfused on a ventilator. A young boy’s parents had made a similar decision a few week’s before and the media had covered it well. The public were waking up to the benefits of this good media coverage about organ donation. Dr Rajagopal contacted Dr K M Cherian a Cardiac Surgeon at Life Line in Chennai. It turned out that there was a very sick lady with dilatory cardiomyopathy waiting for a heart transplant. Within the next 24 hours Radha was transported to Chennai (6 hours away by road) still hooked on to a ventilator. Even as he arrived at Life Line the adjacent operating room was prepared and they had the lady who needed a new heart on the table. After going through the necessary compatibility tests a team of doctors removed Radha’s heart, liver, two kidneys and corneas. While the heart was plumbed in to the lady waiting with her chest open, the other organs were harvested by doctors from other hospitals in the city. Within fifteen minutes the organs were transported under special conditions to the respective hospitals while the lucky recipients were already readied to receive them in the shortest time possible. The police had cleared the traffic to allow the Ambulances to go unimpeded through the otherwise snarled traffic. Finally a team of plastic surgeons from the Stanley Medical College removed sheets of skin for the skin bank and a team of orthopedic surgeons removed his bones for the bone bank at Kilpauk Medical College. The lady patient was off the ventilator the next day, Radha’s heart ticking away in her chest. Two patients with end stage renal disease got a new lease on life with Radha’s kidneys. One very sick patient with liver failure was given a new and healthy liver. Two persons will shortly see better with Radha’s corneas. His banked skin will probably save the life of a critically ill patient with severe burns. Radha’s bones after being appropriately prepared will replace lost bone in some accident victim and help him move around. Radha himself was subject to a post mortem (autopsy) to record the events of his great sacrifices before he was declared dead. Well! not really. Radha will go onto live a multiplied life in others. These are the real heroes of our lives. Radha gave the ultimate Diwali gift! The gift of life.
On my return after Diwali , I learnt that he had created magic over the weekend. Dr K K Rajagopal the owner and Director of the hospital, in consultation with the neurosurgeon had decided that Radha was brain dead. He convinced Radha’s wife on the benefit of an organ donation since he was well perfused on a ventilator. A young boy’s parents had made a similar decision a few week’s before and the media had covered it well. The public were waking up to the benefits of this good media coverage about organ donation. Dr Rajagopal contacted Dr K M Cherian a Cardiac Surgeon at Life Line in Chennai. It turned out that there was a very sick lady with dilatory cardiomyopathy waiting for a heart transplant. Within the next 24 hours Radha was transported to Chennai (6 hours away by road) still hooked on to a ventilator. Even as he arrived at Life Line the adjacent operating room was prepared and they had the lady who needed a new heart on the table. After going through the necessary compatibility tests a team of doctors removed Radha’s heart, liver, two kidneys and corneas. While the heart was plumbed in to the lady waiting with her chest open, the other organs were harvested by doctors from other hospitals in the city. Within fifteen minutes the organs were transported under special conditions to the respective hospitals while the lucky recipients were already readied to receive them in the shortest time possible. The police had cleared the traffic to allow the Ambulances to go unimpeded through the otherwise snarled traffic. Finally a team of plastic surgeons from the Stanley Medical College removed sheets of skin for the skin bank and a team of orthopedic surgeons removed his bones for the bone bank at Kilpauk Medical College. The lady patient was off the ventilator the next day, Radha’s heart ticking away in her chest. Two patients with end stage renal disease got a new lease on life with Radha’s kidneys. One very sick patient with liver failure was given a new and healthy liver. Two persons will shortly see better with Radha’s corneas. His banked skin will probably save the life of a critically ill patient with severe burns. Radha’s bones after being appropriately prepared will replace lost bone in some accident victim and help him move around. Radha himself was subject to a post mortem (autopsy) to record the events of his great sacrifices before he was declared dead. Well! not really. Radha will go onto live a multiplied life in others. These are the real heroes of our lives. Radha gave the ultimate Diwali gift! The gift of life.
Friday, September 5, 2008
Railway Toilets-Use and disuse
Traveling, in fact the thought of traveling, triggers off a major shut down in my lower gastrointestinal system. This protective mechanism has served me rather well except on a few occasions.
Despite the fact that toilets in the Indian Railways have improved significantly in the last decade, it is still a bit of a gut stopping experience and that is literal!. One, of course, has a choice between Western and Indian ‘styles’. Do not take the use of the word style too seriously. There is nothing ‘stylish’ about both. The western ‘style’ usually comes without a seat. This is a frightening proposition particularly for some one with a narrow hip and waist, say a child or an anorexic fashion model. On the other hand, the few that have a seat are invariably soiled. Men, as we know, do not care to lift the toilet seats before using it. I know of one friend who carries a newspaper which he expertly cuts and uses as a protective barrier between his butt and the seat. On the few occasions when I have needed to sit/ squat, I have shown immense patriotism by choosing the Indian ‘style’ which consists of two platforms to place your feet on while you squat. Between the two platforms is a metallic receptacle that has a gradient leading to a hole which empties on to the railway tracks. If you look carefully, there is usually a tap in front of the seating arrangement which has a pushing device to dispense water. I have seen no use for it except as an anchor to hold on to while you go about your business. How one effectively uses the water that comes out of it is beyond me. Of late the Indian Railways has provided a mug chained to the tap (or to some contraption at the side). This chain is about a foot long and one cannot expect to use it meaningfully for anything. A longer chain would no doubt have dragged itself over so many undesirable areas making it a messy business. Not having a security chain will understandably result in some one taking it home. My advice is to use toilet paper or carry your own mug if you cannot manage without water (as is the case with most of us Indians). The flush works half heartedly, and certainly does not do its intended work. The Railway however urges you to flush before and after use. The Indian Railway also requests you to not use the toilet while the train is stopped at a Station. It certainly is a reasonable request to prevent passengers at Railway station platforms from having to see unsightly heaps on the track while waiting for their train to arrive. On the other hand it is an unreasonable request on the toilet user. Aiming for a 4 inch hole while the train banks from side to side needs quite some experience. If you are squatting on an Indian style toilet the chances are that you will not only miss the target but may end up soiling your ankles as well.
I have heard of all kind of things going down the chute of the toilets- wallets, glasses and cell phones. A most bizarre story was recently reported in the Indian newspapers. A woman delivered a child and she chose to do so in the toilet of a running train. The mother watched aghast as the new born disappeared down the toilet chute on to the tracks. Hearing the distressed mother, the train was stopped by fellow passengers, who pulled the emergency chain. They found the child on the tracks a kilometer away, a little soiled but without a scratch- alive and kicking. Happy endings are common in India!
George
Despite the fact that toilets in the Indian Railways have improved significantly in the last decade, it is still a bit of a gut stopping experience and that is literal!. One, of course, has a choice between Western and Indian ‘styles’. Do not take the use of the word style too seriously. There is nothing ‘stylish’ about both. The western ‘style’ usually comes without a seat. This is a frightening proposition particularly for some one with a narrow hip and waist, say a child or an anorexic fashion model. On the other hand, the few that have a seat are invariably soiled. Men, as we know, do not care to lift the toilet seats before using it. I know of one friend who carries a newspaper which he expertly cuts and uses as a protective barrier between his butt and the seat. On the few occasions when I have needed to sit/ squat, I have shown immense patriotism by choosing the Indian ‘style’ which consists of two platforms to place your feet on while you squat. Between the two platforms is a metallic receptacle that has a gradient leading to a hole which empties on to the railway tracks. If you look carefully, there is usually a tap in front of the seating arrangement which has a pushing device to dispense water. I have seen no use for it except as an anchor to hold on to while you go about your business. How one effectively uses the water that comes out of it is beyond me. Of late the Indian Railways has provided a mug chained to the tap (or to some contraption at the side). This chain is about a foot long and one cannot expect to use it meaningfully for anything. A longer chain would no doubt have dragged itself over so many undesirable areas making it a messy business. Not having a security chain will understandably result in some one taking it home. My advice is to use toilet paper or carry your own mug if you cannot manage without water (as is the case with most of us Indians). The flush works half heartedly, and certainly does not do its intended work. The Railway however urges you to flush before and after use. The Indian Railway also requests you to not use the toilet while the train is stopped at a Station. It certainly is a reasonable request to prevent passengers at Railway station platforms from having to see unsightly heaps on the track while waiting for their train to arrive. On the other hand it is an unreasonable request on the toilet user. Aiming for a 4 inch hole while the train banks from side to side needs quite some experience. If you are squatting on an Indian style toilet the chances are that you will not only miss the target but may end up soiling your ankles as well.
I have heard of all kind of things going down the chute of the toilets- wallets, glasses and cell phones. A most bizarre story was recently reported in the Indian newspapers. A woman delivered a child and she chose to do so in the toilet of a running train. The mother watched aghast as the new born disappeared down the toilet chute on to the tracks. Hearing the distressed mother, the train was stopped by fellow passengers, who pulled the emergency chain. They found the child on the tracks a kilometer away, a little soiled but without a scratch- alive and kicking. Happy endings are common in India!
George
Tuesday, September 2, 2008
Strange Names, Strange Places, Strange Professions!!
My name is George Paul. I am a Maxillofacial Surgeon practicing in Salem. It might actually occur to some that this is some weird guy with two first names (and Christian ones at that) practicing an ominous unpronounceable profession in Salem. Since Salem (Massachusetts) is historically linked to witchcraft I would not be surprised if people thought that maxillofacial surgery was in some way related to that dubious craft. So let me explain. Maxillofacial Surgery is a surgical specialty of Dentistry/ Medicine and Salem is a ‘witchless’ city (I believe) situated in Tamilnadu, India. But first, the business of the unusual name.
I do not know of any place in the world where people have two Christian first names. It is a unique practice amongst the Syrian Christians of Kerala in India (where I was born). In fact I know a young man who had the not unusual name of M.M. Mathew. Indians in the South of India often prefix their name with an initial. Therefore the name is not unusual until you got him to expand his initials. It turns out that this gentleman from Kerala is indeed Mathew Mathew Mathew. So George Paul is not too bad. I am now a naturalized domicile of Tamilnadu. The name George gets a bit of a battering in these parts. For some reason most people cannot spell it correctly. Those who can, sometimes pronounce it wrong. This is again surprising when one considers that the official seat of Government of Tamilnadu is housed in a building called the Fort St George (a carry over from the British East India Company). In any case I get by with being spelt as Jorge, Gorge, Geroge and other such combinations which invariably involve the addition, deletion or replacement of some vowel or consonant. The only time I was actually offended was when I ended up being spelt as Garage in a hotel register.
Most people (anywhere in the world) would find it difficult to even pronounce ‘maxillofacial surgery’. It is therefore unfair to expect them to know what part of the body gets chopped up by the practitioners of this unpronounceable surgical specialty. In fact the specialty is a fairly complex one- at least as complex as its origins. The Wikipedia, and for that matter most authoritative sources, call it a surgical specialty of dentistry. Dentistry its self has a rather tenuous origin. It branched off from mainstream medicine (and surgery) a spot earlier than it ought to have and established itself as a separate specialty of the teeth (and later the mouth and jaws). Most medical specialties have gone through the mainstream of medicine and then separated out. If you ask me why Ophthalmology or Otolaryngology did not go the way of dentistry, I have no reply. We can only call dentistry an anomaly of medical history. The Maxillofacial region was annexed to dentistry by adventurous dentists who moved their surgical ambitions from the teeth to the gums to the mouth to the jaws and finally laid claim to a good part of the face. This insidious expansion is best captured by the evolution of the specialty’s nomenclature. It went from being called dental surgery to oral surgery to oral and maxillofacial surgery. Here it must be mentioned that the military violence of the two World Wars and the subsequent violence of high speed motoring and bar brawls, with heady ‘spirits’ as a catalyst for both of the latter, contributed to its establishment as a sound surgical specialty. Today maxillofacial surgery involves facial trauma, pathology, oral cancer, cosmetic surgery and more. At the risk of sounding morbid, I must admit that it is a good livelihood in Salem. The chaotic (and often spirited) traffic and the average motorist’s disdain for any protective gear keeps me and my family well fed. Today Oral and Maxillofacial surgery requires a double qualification (dentistry and medicine) in many parts of the world due to its complexity. Thank God, we do not need that as yet in India!!
Now Salem. This Salem that I live in is in Tamilnadu. It has nothing in common with the many other Salems around the world. I know of two major cities/ towns in the USA and there is one little Salem that I whizzed past in Jamaica. Of course Jerusalem has an etymological connection with Salem (Shalem). Other Salems include a popular brand of cigarettes, a rock band in Israel and an accused terrorist who for some reason spells his name as Salem (Abu Salem). Our Salem is a sedate city of a million people. Nothing dramatic happens here. No earthquakes, no floods, no terrorist bombs, no witchcraft (as in Salem Massachusetts); in fact it has nothing that merits ‘breaking news’ kind of publicity. It is relatively clean by Indian city standards. It has better than adequate facilities on nearly all fronts (relative to Indian standards again). In fact it has a surplus of hospitals, eateries and more recently educational institutions. Other surpluses include trucks, HIV/ AIDS and other unpleasant stuff, but we will pass those. The food is unique in these parts. The famous non vegetarian joints serve up some real mouth watering, spicy and biologically suspect food from small innocuous looking joints. The hospitals do good business, thanks to two national highways which intersect here, the chaotic city traffic and its central location, fed by numerous smaller towns and villages. The teaching institutions range from fly by night operations to highly rated professional institutions.
On a personal front my interests range from reading, writing, traveling (I hope there was a way of getting to places without the drudgery of car, bus, train and planes) and surgery to weekend appointments with Bacchus. Thanks to a recent qualification in law and ethics, I have a new interest in medical ethics. I also like talking. That’s right, talking. If I cannot find anybody I just talk to myself. Crazy? Well maybe a little bit of that too!
George
I do not know of any place in the world where people have two Christian first names. It is a unique practice amongst the Syrian Christians of Kerala in India (where I was born). In fact I know a young man who had the not unusual name of M.M. Mathew. Indians in the South of India often prefix their name with an initial. Therefore the name is not unusual until you got him to expand his initials. It turns out that this gentleman from Kerala is indeed Mathew Mathew Mathew. So George Paul is not too bad. I am now a naturalized domicile of Tamilnadu. The name George gets a bit of a battering in these parts. For some reason most people cannot spell it correctly. Those who can, sometimes pronounce it wrong. This is again surprising when one considers that the official seat of Government of Tamilnadu is housed in a building called the Fort St George (a carry over from the British East India Company). In any case I get by with being spelt as Jorge, Gorge, Geroge and other such combinations which invariably involve the addition, deletion or replacement of some vowel or consonant. The only time I was actually offended was when I ended up being spelt as Garage in a hotel register.
Most people (anywhere in the world) would find it difficult to even pronounce ‘maxillofacial surgery’. It is therefore unfair to expect them to know what part of the body gets chopped up by the practitioners of this unpronounceable surgical specialty. In fact the specialty is a fairly complex one- at least as complex as its origins. The Wikipedia, and for that matter most authoritative sources, call it a surgical specialty of dentistry. Dentistry its self has a rather tenuous origin. It branched off from mainstream medicine (and surgery) a spot earlier than it ought to have and established itself as a separate specialty of the teeth (and later the mouth and jaws). Most medical specialties have gone through the mainstream of medicine and then separated out. If you ask me why Ophthalmology or Otolaryngology did not go the way of dentistry, I have no reply. We can only call dentistry an anomaly of medical history. The Maxillofacial region was annexed to dentistry by adventurous dentists who moved their surgical ambitions from the teeth to the gums to the mouth to the jaws and finally laid claim to a good part of the face. This insidious expansion is best captured by the evolution of the specialty’s nomenclature. It went from being called dental surgery to oral surgery to oral and maxillofacial surgery. Here it must be mentioned that the military violence of the two World Wars and the subsequent violence of high speed motoring and bar brawls, with heady ‘spirits’ as a catalyst for both of the latter, contributed to its establishment as a sound surgical specialty. Today maxillofacial surgery involves facial trauma, pathology, oral cancer, cosmetic surgery and more. At the risk of sounding morbid, I must admit that it is a good livelihood in Salem. The chaotic (and often spirited) traffic and the average motorist’s disdain for any protective gear keeps me and my family well fed. Today Oral and Maxillofacial surgery requires a double qualification (dentistry and medicine) in many parts of the world due to its complexity. Thank God, we do not need that as yet in India!!
Now Salem. This Salem that I live in is in Tamilnadu. It has nothing in common with the many other Salems around the world. I know of two major cities/ towns in the USA and there is one little Salem that I whizzed past in Jamaica. Of course Jerusalem has an etymological connection with Salem (Shalem). Other Salems include a popular brand of cigarettes, a rock band in Israel and an accused terrorist who for some reason spells his name as Salem (Abu Salem). Our Salem is a sedate city of a million people. Nothing dramatic happens here. No earthquakes, no floods, no terrorist bombs, no witchcraft (as in Salem Massachusetts); in fact it has nothing that merits ‘breaking news’ kind of publicity. It is relatively clean by Indian city standards. It has better than adequate facilities on nearly all fronts (relative to Indian standards again). In fact it has a surplus of hospitals, eateries and more recently educational institutions. Other surpluses include trucks, HIV/ AIDS and other unpleasant stuff, but we will pass those. The food is unique in these parts. The famous non vegetarian joints serve up some real mouth watering, spicy and biologically suspect food from small innocuous looking joints. The hospitals do good business, thanks to two national highways which intersect here, the chaotic city traffic and its central location, fed by numerous smaller towns and villages. The teaching institutions range from fly by night operations to highly rated professional institutions.
On a personal front my interests range from reading, writing, traveling (I hope there was a way of getting to places without the drudgery of car, bus, train and planes) and surgery to weekend appointments with Bacchus. Thanks to a recent qualification in law and ethics, I have a new interest in medical ethics. I also like talking. That’s right, talking. If I cannot find anybody I just talk to myself. Crazy? Well maybe a little bit of that too!
George
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