Recently, a junior colleague, Prakash complained bitterly about the step motherly attitude meted out to him in a surgical oncology unit where he went to train. As a maxillofacial surgeon he was interested in oral oncology and considered himself competent to be trained in cancer surgery in the maxillofacial region. Prakash was politely reminded by the surgical oncologist that as a dentist he was not equipped to handle the complexities of cancer surgery. The sleight and put down, not withstanding, Prakash proved himself and earned the respect of his trainers. Many medical specialists look down upon other specialties as being less glamourous. Most clinicians tend to look down on colleagues involved in the less sought after para-clinical persuasions of medicine.
Unfortunately I too have ridden the high horse of being a surgeon. Somewhere during training and practice we come to believe that there is superiority in our calling. It perhaps comes from the adrenaline of working directly with blood and danger. The general public too may carry these impressions created by perceptions borne out of dramatization in books and movies. The truth is often understood by an actual patient seeking treatment for his disease. A patient with Psoriasis needs a dermatologist not a neurosurgeon.
My father, a dentist, had practiced his profession for nearly 50 years. He was particularly adept at prosthetics. He made excellent dentures. I never realized how much he was appreciated for this until a month after his recent death. I had operated on a patient with a tumour in her upper jaw a couple of years ago. It required a fairly major surgical procedure involving the removal of part of her upper jaw. After the tumour was successfully removed, I never thought much of it. She was asked to see my father for some kind of prosthesis. In fact I saw her only when she returned for her reviews which included routine inspections of the large defect. She removed her dentures to show me the defect and put it on again. I did not even pay much attention to the prosthesis. She came to visit following my father’s death. She broke down and cried inconsolably. She confessed that she was so desperate after the ablative surgery that she did not even want to live. The anguish of an young woman with a hole in her mouth. My father had apparently comforted her and painstakingly built her an obturator and denture that improved not only her appearance but also her ability to speak and eat. I understood that she felt a greater obligation to my father who restored her function with some good dentistry rather than to the snooty surgeon who removed her tumour. It was a humbling experience which reminded me that every person has a place in the healing profession.
Tuesday, February 3, 2009
Where were we!??
Every adult who was alive in the US when John F Kennedy was assassinated will tell you what he/she was doing when they heard the news. I was not alive when the Mahatma was assassinated, but I certainly remember what I was doing when I heard about the assassination of Indira Gandhi and Rajiv Gandhi. I don’t however remember my disposition at the time of Pokhran 1 or 2 but I certainly remember where I was when the twin towers came down and the Babri Masjid was destroyed. I guess we benchmark these occurrences based on how much they mean to us or how deeply we have been affected by them. Today with the TV channels ‘Breaking news’ every 10 minutes, it is perhaps a difficult exercise.
I will never forget the 26/11 terrorist attack. I was in Delhi with a senior journalist friend. In fact I was staying with him. It is always a pleasure talking to journalists because they have such a bird’s eye view on the happenings in the country. This particular journo is one of the best defense reporters in the country. All you have to do is ask a stupid question and you can get some terrific insights into the complexities of their specialty. As a peacenik, I asked him if he ever foresaw the possibility of India being in a situation where there would be no need for a standing army and a significant part of the defense budget being used for development- education and health in particular. He was amazingly prescient when he said that he did not foresee such an eventuality. He predicted that conventional inter-national war will be replaced by intra-national conflict!! The arms dealers will never be out of business, he promised. Terrorism and internal strife will keep our army busy. I retired early to bed. My friend arranged for me to sleep in his extensive library- filled from floor to ceiling with books-mostly about war, terrorism and other conflicts. I was tired yet mellow from a couple of drinks and went to bed in the company of voluminous tomes about war and terror.
When my friend woke me up at midnight I was not sure if it was a dream. Terrorist Attack! Terrorist Attack! He said. I was confused because reality morphed into a dream like trance of battles, guns and grenades. It was surreal. The whiskey did not help matters! I was ready to run out or jump out of the building (8th floor I think). My friend quickly pointed to the TV screens showing repeated images of the TAJ, CST and the other sites. Still groggy I went back to sleep. When I woke up in the morning, surrounded by books of war and the faint memory of some visual action, I was still not sure if it was a dream or reality. Another benchmark etched into my memory reminding me where I was when it happened!
I will never forget the 26/11 terrorist attack. I was in Delhi with a senior journalist friend. In fact I was staying with him. It is always a pleasure talking to journalists because they have such a bird’s eye view on the happenings in the country. This particular journo is one of the best defense reporters in the country. All you have to do is ask a stupid question and you can get some terrific insights into the complexities of their specialty. As a peacenik, I asked him if he ever foresaw the possibility of India being in a situation where there would be no need for a standing army and a significant part of the defense budget being used for development- education and health in particular. He was amazingly prescient when he said that he did not foresee such an eventuality. He predicted that conventional inter-national war will be replaced by intra-national conflict!! The arms dealers will never be out of business, he promised. Terrorism and internal strife will keep our army busy. I retired early to bed. My friend arranged for me to sleep in his extensive library- filled from floor to ceiling with books-mostly about war, terrorism and other conflicts. I was tired yet mellow from a couple of drinks and went to bed in the company of voluminous tomes about war and terror.
When my friend woke me up at midnight I was not sure if it was a dream. Terrorist Attack! Terrorist Attack! He said. I was confused because reality morphed into a dream like trance of battles, guns and grenades. It was surreal. The whiskey did not help matters! I was ready to run out or jump out of the building (8th floor I think). My friend quickly pointed to the TV screens showing repeated images of the TAJ, CST and the other sites. Still groggy I went back to sleep. When I woke up in the morning, surrounded by books of war and the faint memory of some visual action, I was still not sure if it was a dream or reality. Another benchmark etched into my memory reminding me where I was when it happened!
Saturday, January 17, 2009
Travel Stories- Almost a Vietnamese. Almost!
My work as a volunteer dentist in the Philippines required me to spend the better part of the day at the Vietnamese refugee camp. The Palawan First Asylum Camp was a docking station for Vietnamese refugees (boat people) who were trying to get out of their country in the aftermath of the US departure from South Vietnam. My lunches at the Vietnamese restaurant inside the camp were a new culinary adventure. The camp dished out authentic Vietnamese home food replete with their amazingly spicy sauces. Even my brave South Indian tongue turned red at their potency. One gets used to the food in a short time but the journey from the bowl to the mouth was an arduous one. The Vietnamese are a proud people, like most Orientals. They are also finicky about their table manners. Chopsticks are ‘de rigueur.’ In the early days, they often looked at me pathetically as I struggled with a fork to discipline the slippery noodles, which were distinctly different and certainly more difficult than the user- friendly Chinese variety. At least the one’s we ate in India. A significant conversation, a few days later with Van Phuc Trinh, my translator and chopstick coach, told me that I should learn how to use their tool if I must earn their respect. Trinh and I were dining at the canteen a couple of days after I started work. Trinh leaned forward to interrupt my futile attempts to trap the noodles, which seemed to have a mind of its own. I could not, for the life of me, believe that you could actually tame these slippery spools of wormy noodles with two sticks that were perfectly smooth.
“Doc, do you know that the Filipinos have no eating manners!?” She whispered
“No” said I, distracted and struggling with the two sticks whose tips would never come together. I had always sensed an undercurrent of silent hostility between the Vietnamese refugees and their hosts, the Filipinos.
“They do not know how to eat properly,” she announced with a trace of condescension.
I had this strange feeling that she was hinting at my ineptitude. Orientals have a way of being round about in their conversations.
“They cannot eat with a chop stick…” she hesitated realizing that I had stopped my fervent attempts and the noodles were smoothly unwinding back into the bowl. “ or even forks…” she trailed away, seeing the look of guilt and embarrassment on my face. She then leaned forward as if to reveal a terrible secret and said, “I have seen Filipinos eat with their fingers…!” She waited to see the horror on my face. She obviously did not know that Indians, particularly south Indians, not only used their fingers but their whole hand. Licking streaks of curry or curds from their wrists or even forearm was considered perfectly good manners in Tamilnadu, my home state. However, I decided to show significant alarm at her revelation. It was clear that her issue was with the Filipinos and she did not care about my chop stick expertise.
“Don’t tell me…..” said I, in mock revulsion.
She nodded sagely while I got back to my struggle with the chopsticks.
Over the next few days I learnt to pick up large chunks of food with my chopsticks. My eyes had grown chinkier. Hell! I almost became like them. Well almost….. My real test came a week later. Here goes!
The cook at the Vietnamese camp was a celebrity of sorts. He was an important cultural link to their homeland. So when he had a toothache it was a real emergency. He was allowed to jump the queue - to have his tooth extracted by me. No one complained. The next afternoon, the cook, now relieved of his pain decided to honour me by making a special appearance in the service area of the canteen. He came to my table, which I shared with my interpreter, Trinh and an American intern George Davendorf. In his hand was a plate of meat, which Trinh (who obviously knew that I was being honored) explained, was courtesy the cook. He put the plate of meat in front of me and bowed low saying “Doc”
“Thanks” said I and dexterously picked up a piece of meat with my chop sticks, whose use was becoming more familiar to me. While Trinh my interpreter joined me in eating the rather delicious meat preparation, George, my other table- mate politely declined. After having eaten a couple of pieces, I asked Trinh what the meat was.
“Doc” said she.
“What is the meat?” I asked again, thinking that she had not heard.
“Doc” came the reply.
Seeing my puzzlement the American intern George clarified for me. “Dog” he said. “ It’s a delicacy they reserve for important people,” he laughed.
The chopsticks slipped from my hand as my interpreter went on to explain how a wayward dog had found its way to my table and my stomach. With increasing revulsion, I listened as she explained how the dog had created a ruckus the previous night and the cook had it killed and served up for lunch. Last night’s nuisance became today’s gourmet lunch! Two birds in one shot if you like. The cook who understood no English stood by smiling proudly at his accomplishment. “It was kept a secret” she said sotto voce. The Filipinos like most people did not find the idea of killing dogs for dinner a friendly eating habit. More importantly there would have been a stampede amongst the Vietnamese, for dog meat was a delicacy in great demand at the camp. I tried to say something appropriate to everybody around. It came out sounding like a bark. I motioned to Trinh and asked her to share it with her people at the next table. I could never look a dog in the eye….. ever again.
George
April 1990
“Doc, do you know that the Filipinos have no eating manners!?” She whispered
“No” said I, distracted and struggling with the two sticks whose tips would never come together. I had always sensed an undercurrent of silent hostility between the Vietnamese refugees and their hosts, the Filipinos.
“They do not know how to eat properly,” she announced with a trace of condescension.
I had this strange feeling that she was hinting at my ineptitude. Orientals have a way of being round about in their conversations.
“They cannot eat with a chop stick…” she hesitated realizing that I had stopped my fervent attempts and the noodles were smoothly unwinding back into the bowl. “ or even forks…” she trailed away, seeing the look of guilt and embarrassment on my face. She then leaned forward as if to reveal a terrible secret and said, “I have seen Filipinos eat with their fingers…!” She waited to see the horror on my face. She obviously did not know that Indians, particularly south Indians, not only used their fingers but their whole hand. Licking streaks of curry or curds from their wrists or even forearm was considered perfectly good manners in Tamilnadu, my home state. However, I decided to show significant alarm at her revelation. It was clear that her issue was with the Filipinos and she did not care about my chop stick expertise.
“Don’t tell me…..” said I, in mock revulsion.
She nodded sagely while I got back to my struggle with the chopsticks.
Over the next few days I learnt to pick up large chunks of food with my chopsticks. My eyes had grown chinkier. Hell! I almost became like them. Well almost….. My real test came a week later. Here goes!
The cook at the Vietnamese camp was a celebrity of sorts. He was an important cultural link to their homeland. So when he had a toothache it was a real emergency. He was allowed to jump the queue - to have his tooth extracted by me. No one complained. The next afternoon, the cook, now relieved of his pain decided to honour me by making a special appearance in the service area of the canteen. He came to my table, which I shared with my interpreter, Trinh and an American intern George Davendorf. In his hand was a plate of meat, which Trinh (who obviously knew that I was being honored) explained, was courtesy the cook. He put the plate of meat in front of me and bowed low saying “Doc”
“Thanks” said I and dexterously picked up a piece of meat with my chop sticks, whose use was becoming more familiar to me. While Trinh my interpreter joined me in eating the rather delicious meat preparation, George, my other table- mate politely declined. After having eaten a couple of pieces, I asked Trinh what the meat was.
“Doc” said she.
“What is the meat?” I asked again, thinking that she had not heard.
“Doc” came the reply.
Seeing my puzzlement the American intern George clarified for me. “Dog” he said. “ It’s a delicacy they reserve for important people,” he laughed.
The chopsticks slipped from my hand as my interpreter went on to explain how a wayward dog had found its way to my table and my stomach. With increasing revulsion, I listened as she explained how the dog had created a ruckus the previous night and the cook had it killed and served up for lunch. Last night’s nuisance became today’s gourmet lunch! Two birds in one shot if you like. The cook who understood no English stood by smiling proudly at his accomplishment. “It was kept a secret” she said sotto voce. The Filipinos like most people did not find the idea of killing dogs for dinner a friendly eating habit. More importantly there would have been a stampede amongst the Vietnamese, for dog meat was a delicacy in great demand at the camp. I tried to say something appropriate to everybody around. It came out sounding like a bark. I motioned to Trinh and asked her to share it with her people at the next table. I could never look a dog in the eye….. ever again.
George
April 1990
Travel Stories- No Habla Espanol! No Habla Inglis!
Language guide books teach you nothing. I landed in Guatemala city armed with just one sentence “ no habla espanol” (I don’t speak Spanish). The problem was that I could say it so well that most people wouldn’t believe me. It did not help that I looked a little like them. Come to think of it most Mayan Indians look like Asian Indians!!
A quick conversion of the Quetzals (local currency) into dollars (and then of course into rupees) told me that I couldn’t afford more than one drink at the paid for business hotel I was put up in. I decided to take a stroll to find a liquor shop. I stopped every friendly looking guy on the pavement to enquire in English about where I could find a liquor shop. I hated myself for not having learnt the useful words. They would smile and indicate that they did not understand English. No habla Inglise. I tried different strategies and words. I tried ‘Rum’. No chance. Beer? A cock of the head and a slow shake. Whiskey? Blank. Finally I stopped an elderly man and did a mime of drinking and then lolling my head around like I was drunk. He glanced curiously at me. When he showed interest, I repeated the act once more and added a few staggering steps to indicate drunkenness. He now looked at me with great interest his hands on his hip like he was watching a street play. He watched for a while then shook his head sadly and said something before walking away. I thought it was loco. This time I understood him. I also understood that it was a hopeless adventure. I went to my room and slept off the jet lag in absolute sobriety.
Paul Smyth was a lanky guy with great uncombed curls on his head and a scraggly beard. His ill fitting pair of jeans looked like they would slip down any moment and trip him at the ankle. He looked straight out of Greenwich Village in the sixties. Paul introduced himself as the parish priest from the Parroquio San Antonia. Padre Pablo as he was fondly called by his parishioners had come to fetch me. I was to be transported to a small sub-urban community in the Barrios district on the Caribbean coast. The Fronteras was eight hours away from Guatemala City. I had volunteered to be a Rotary Volunteer dentist for the Quiche’ Indians who lived in the villages (aldeas) nearby. I almost grabbed Paul’s hands when he spoke English. We obviously shared more than a common name. That was my first conversation since I arrived in the city the previous day. I toyed with the idea of asking him about the liquor shop and decided it would be inappropriate to ask a catholic priest. We drove in silence through the streets of Guatemala City on our way out. I looked out at the numerous shops and almost pointed excitedly when I saw what I thought was a shop selling some kind of alcohol. Now! I am not an alcoholic, but the prospect of living in a strange place with a bunch of priests definitely cried out for some entertainment. The stuff found in the bottle was convenient and uncomplicated.
Two days at the Parish and I was bored and thirsty. Father Smyth was the only other person who spoke English. In fact he was the only other occupant of my living quarters, if you excluded the extended family of cats and kittens purring in every room. I am distrustful of cats and for that matter all kinds of pets. I finally picked up the courage to ask Fr Paul Smyth if I could find a place to buy some beer. He laughed aloud and took me to his refrigerator (run on gas). It was stocked up with bottles and bottles of beer. He thought I showed no interest because Indians had some serious issues with alcohol. I didn’t ask him because I thought the Church had issues with alcohol. In any case I got myself a drinking buddy for the next one month. My Spanish vocabulary on that front improved to discover that beer is called ‘cerbeza’, whiskey is called ‘scotch’ and rum is called ‘ron’. No wonder I had a communication problem
The problem of the drinks was solved pretty easily. Food was a more complex issue. Alicia, was a pleasant young woman with a ready smile. We had long smiling conversations. Not a word spoken. She was our cook and she took her job very seriously. I should have been happy, considering that my most adventurous cooking was the making of a boiled egg. I was capable of botching up even that! I was therefore completely at her mercy. And she had a job to do. Make me eat Pasta morning, noon and night. She was some kind of pasta angel. I can digest an occasional pasta meal. But Pasta for a month was too much. I suspect that she never did know to make anything else. So it was Pasta! She made this very good looking pasta, yes! Only good looking, topped with some kind of grilled meat and plenty of tomato ketchup and cooked in olive oil. I am not a fussy eater but the olive oil really had me. Every forkful of the pasta was a painful process. I would somehow clear the plate with Alicia hovering at my back. She would then lean towards me and ask me in that sensuous way of Latinos “Beuno?” (meaning “Good?”). The only word opposite to ‘beuno’, which I knew, was ‘mal’ and that meant bad. Oh! I was caught in that terrible disposition between losing that smile on good Alicia’s sensuous lips and the indignity of throwing up on the plate. My language disability precluded using a complex expression such as “ its good but thank you” or some such thing. I would roll up my eyes and make funny noises to express my hesitation and would end up saying without enthusiasm “ Si, Beuno….”.and try to cover the plate with my hands. It never worked. She dumped all the pasta she made. This went on day after day with only Sundays for holidays, when she went to church or maybe torture her poor husband with her pastas. Why did she not just make regular Guatemalan food like tortillas and beans or Enchiladas or Tamales?
One weekend I decided that I would cook myself something to eat. Alicia, as I said, did not cook for us on Sundays. I looked at all the canned food in the pantry. The names in Spanish meant nothing to me. It was food alright….and it couldn’t be worst than Alicia’s pasta. Finally, I settled on a can with a picture of a smiling fish on it. Underneath it was written “Por Gatto”. It looked friendly enough. I opened the can and smelt its contents. Definitely fish. The smell was a little too fishy but then this was Guatemala. I put it into a frying pan and generally heated up the contents. It was just about edible- slightly better than Alicia’s Pasta.
That evening over a bottle of beer (cerbaza), I told Paul Smyth that I had cooked myself a lunch. I then showed him the empty tin with the picture of a fish. Father Smyth, in his cool English manner told me with a wry smile that “Por Gatto” means “For the Cat”. I looked at the tin in horror. Yes I had cat food for lunch. The only lunch I had cooked myself! The fish on the can’s label really was smiling!
A quick conversion of the Quetzals (local currency) into dollars (and then of course into rupees) told me that I couldn’t afford more than one drink at the paid for business hotel I was put up in. I decided to take a stroll to find a liquor shop. I stopped every friendly looking guy on the pavement to enquire in English about where I could find a liquor shop. I hated myself for not having learnt the useful words. They would smile and indicate that they did not understand English. No habla Inglise. I tried different strategies and words. I tried ‘Rum’. No chance. Beer? A cock of the head and a slow shake. Whiskey? Blank. Finally I stopped an elderly man and did a mime of drinking and then lolling my head around like I was drunk. He glanced curiously at me. When he showed interest, I repeated the act once more and added a few staggering steps to indicate drunkenness. He now looked at me with great interest his hands on his hip like he was watching a street play. He watched for a while then shook his head sadly and said something before walking away. I thought it was loco. This time I understood him. I also understood that it was a hopeless adventure. I went to my room and slept off the jet lag in absolute sobriety.
Paul Smyth was a lanky guy with great uncombed curls on his head and a scraggly beard. His ill fitting pair of jeans looked like they would slip down any moment and trip him at the ankle. He looked straight out of Greenwich Village in the sixties. Paul introduced himself as the parish priest from the Parroquio San Antonia. Padre Pablo as he was fondly called by his parishioners had come to fetch me. I was to be transported to a small sub-urban community in the Barrios district on the Caribbean coast. The Fronteras was eight hours away from Guatemala City. I had volunteered to be a Rotary Volunteer dentist for the Quiche’ Indians who lived in the villages (aldeas) nearby. I almost grabbed Paul’s hands when he spoke English. We obviously shared more than a common name. That was my first conversation since I arrived in the city the previous day. I toyed with the idea of asking him about the liquor shop and decided it would be inappropriate to ask a catholic priest. We drove in silence through the streets of Guatemala City on our way out. I looked out at the numerous shops and almost pointed excitedly when I saw what I thought was a shop selling some kind of alcohol. Now! I am not an alcoholic, but the prospect of living in a strange place with a bunch of priests definitely cried out for some entertainment. The stuff found in the bottle was convenient and uncomplicated.
Two days at the Parish and I was bored and thirsty. Father Smyth was the only other person who spoke English. In fact he was the only other occupant of my living quarters, if you excluded the extended family of cats and kittens purring in every room. I am distrustful of cats and for that matter all kinds of pets. I finally picked up the courage to ask Fr Paul Smyth if I could find a place to buy some beer. He laughed aloud and took me to his refrigerator (run on gas). It was stocked up with bottles and bottles of beer. He thought I showed no interest because Indians had some serious issues with alcohol. I didn’t ask him because I thought the Church had issues with alcohol. In any case I got myself a drinking buddy for the next one month. My Spanish vocabulary on that front improved to discover that beer is called ‘cerbeza’, whiskey is called ‘scotch’ and rum is called ‘ron’. No wonder I had a communication problem
The problem of the drinks was solved pretty easily. Food was a more complex issue. Alicia, was a pleasant young woman with a ready smile. We had long smiling conversations. Not a word spoken. She was our cook and she took her job very seriously. I should have been happy, considering that my most adventurous cooking was the making of a boiled egg. I was capable of botching up even that! I was therefore completely at her mercy. And she had a job to do. Make me eat Pasta morning, noon and night. She was some kind of pasta angel. I can digest an occasional pasta meal. But Pasta for a month was too much. I suspect that she never did know to make anything else. So it was Pasta! She made this very good looking pasta, yes! Only good looking, topped with some kind of grilled meat and plenty of tomato ketchup and cooked in olive oil. I am not a fussy eater but the olive oil really had me. Every forkful of the pasta was a painful process. I would somehow clear the plate with Alicia hovering at my back. She would then lean towards me and ask me in that sensuous way of Latinos “Beuno?” (meaning “Good?”). The only word opposite to ‘beuno’, which I knew, was ‘mal’ and that meant bad. Oh! I was caught in that terrible disposition between losing that smile on good Alicia’s sensuous lips and the indignity of throwing up on the plate. My language disability precluded using a complex expression such as “ its good but thank you” or some such thing. I would roll up my eyes and make funny noises to express my hesitation and would end up saying without enthusiasm “ Si, Beuno….”.and try to cover the plate with my hands. It never worked. She dumped all the pasta she made. This went on day after day with only Sundays for holidays, when she went to church or maybe torture her poor husband with her pastas. Why did she not just make regular Guatemalan food like tortillas and beans or Enchiladas or Tamales?
One weekend I decided that I would cook myself something to eat. Alicia, as I said, did not cook for us on Sundays. I looked at all the canned food in the pantry. The names in Spanish meant nothing to me. It was food alright….and it couldn’t be worst than Alicia’s pasta. Finally, I settled on a can with a picture of a smiling fish on it. Underneath it was written “Por Gatto”. It looked friendly enough. I opened the can and smelt its contents. Definitely fish. The smell was a little too fishy but then this was Guatemala. I put it into a frying pan and generally heated up the contents. It was just about edible- slightly better than Alicia’s Pasta.
That evening over a bottle of beer (cerbaza), I told Paul Smyth that I had cooked myself a lunch. I then showed him the empty tin with the picture of a fish. Father Smyth, in his cool English manner told me with a wry smile that “Por Gatto” means “For the Cat”. I looked at the tin in horror. Yes I had cat food for lunch. The only lunch I had cooked myself! The fish on the can’s label really was smiling!
Friday, December 26, 2008
Ram Bahadur
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!
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!
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.
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