Thursday, March 29, 2012

Do you remember?

I saw a TED Talk that is related to my post about doctor's dilemmas.

Monday, March 26, 2012


Whatever T.V. viewing I do is when I am lying on the bed at which time I can't read books or do any browsing. I rarely watch T.V. when sitting, an exception being when there is a ding-dong battle going on between any two of the trio of Nadal-Djokovic-Federer. Most of the programs seem like prolefeed. I am from the same school of thought as Roald Dahl. Old fashioned, no? I begin the day by getting the Indian news headlines, then watch BBC for a few minutes and then usually switch to some sports or nature channel.

Once, when the nurse was channel surfing, I came across a re-run of an episode of 'We the people' on NDTV.This episode was called 'We the Tweeple' because it was about the effect of social media like Twitter and Facebook so I decided to listen to it. There was a discussion about a blog post called 'An open letter to a Delhi boy' apparently written by a girl who called herself 'Madrasan'. It seemed that the post had gone viral on Twitter and had been the subject of much discussion. I first thought that the girl had studied in a madrassa and the post had something to do with religion. But the girl (who was present in the program) did not look the orthodox type who had gone to a religious school.

I missed part of the discussion because Jaya had come into the room to ask me about something. I then heard the girl say that she had received death threats and had to go to the police. Since all too often this is the preferred method of displaying the much acclaimed 'religious tolerance', it seemed to increase the likelihood that the post had to do with religion. But there was no mention of religion during the program so I was puzzled.

When I finally managed to sit, I checked with The One Who Knows Everything - Google (you thought it was Neetu Singh, didn't you?) - and it turned out to be a fiery post that had nothing to do with what I had thought it might be about. I was on the wrong track regarding 'Madrasan'.

Wednesday, March 21, 2012

Doctors' dilemmas

One recurring thought that I had while reading The Emperor Of All Maladies: A Biography Of Cancer by Siddhartha Mukherjee was about how doctors dealt with all the sights and sounds of misery, pain and death all around them. One of the main characters in the book, Sidney Farber, is described by Medical World News thus - 'Sidney Farber’s entire purpose consists only of “hopeless cases”.' The author of the book (you can listen to him talk about the book) writes about the time when he faced such dilemmas:
The stories of my patients consumed me, and the decisions that I made haunted me. Was it worthwhile continuing yet another round of chemotherapy on a sixty-six-year-old pharmacist with lung cancer who had failed all other drugs? Was it better to try a tested and potent combination of drugs on a twenty-six-year-old woman with Hodgkin’s disease and risk losing her fertility, or to choose a more experimental combination that might spare it? Should a Spanish-speaking mother of three with colon cancer be enrolled in a new clinical trial when she can barely read the formal and inscrutable language of the consent forms?
I wonder how doctors deal with such dilemmas on a daily basis. I sometimes have to go to the casualty ward of a hospital for getting the tracheostomy tube changed and I shudder when hearing the screams of patients on whom some emergency procedure is being performed. Doctors will be encountering such scenes every day. There must be some psychological mechanisms that must be kicking in that enables them to deal with such traumatic scenes everyday. I read an interesting piece about the struggles that doctors face. Here is another piece about when a patient is ready to talk about death, but a medical student is not.

Apart from giving an account of the various approaches used to treat cancer, the book also tells about the problems faced by the doctors and patients during the early days of surgery. At that time there were two major difficulties. The first was that the patients had to endure immense pain during surgery because there was no anaesthesia. The second was the problem of infection after the surgery. Nobody knew what caused the infection. There is a description of a typical operation theatre of those days:
At Bellevue, the “internes” ran about in corridors with “pus-pails”, the bodily drippings of patients spilling out of them. Surgical sutures were made of catgut, sharpened with spit, and let to hang from incisions into the open air. Surgeons walked around with their scalpels dangling from their pockets. If a tool fell on the blood-soiled floor, it was dusted off and inserted back into the pocket – or into the body of the patient on the operating table.
That looks like a scene from a horror movie.

Thursday, March 15, 2012

Blasts from the past

While reading The Emperor Of All Maladies: A Biography Of Cancer by Siddhartha Mukherjee, I came across a few passages that reminded me of the time when I was regaining consciousness after the stroke.
In an essay titled A View from the Front Line, Jencks described her experience with cancer as like being woken up midflight on a jumbo jet and then thrown out with a parachute into a foreign landscape without a map:

“There you are, the future patient, quietly progressing with other passengers toward a distant destination when, astonishingly (Why me?) a large hole opens in the floor next to you. People in white coats appear, help you into a parachute and – no time to think – out you go.

“You descend. You hit the ground...But where is the enemy? What is the enemy? What is it up to?... No road. No compass. No map. No training. Is there something you should know and don’t?

“The white coats are far, far away, strapping others into their parachutes. Occasionally they wave but, even if you ask them, they don’t know the answers. They are up there in the Jumbo, involved with parachutes, not map-making.”
Later he writes:
The novelist Thomas Wolfe, recalling a lifelong struggle with illness, wrote in his last letter, "I've made a long voyage and been to a strange country, and I've seen the dark man very close."
I regained consciousness fully over many days - like darkness turning into bright sunlight gradually over many days. I cannot convey the gestalt of the experience especially as it was such a long time ago. I will just mention some salient points that I remember.
  • People in white dresses used to come and go and it was some days before I could distinguish between nurses, doctors and physiotherapists.
  • I had felt a couple of times that I had been wheeled away somewhere accompanied by a lot of people. I learned that I had initially been in ICU1 from where I was shifted to ICU2 and thence to the ward. Only then did I come to know that that there were two ICUs - the first one for the more critical patients and the second one for more stable patients. I had been a Lazarus risen (well, not exactly 'risen') from the dead.
  • Jaya told me about a nurse who had promised her that she would take care of me in ICU2 and keep her updated on all developments. The nurse had come to visit me when I was in the ward. I could not recognize her at all. She must have been one of the voices I heard regularly.
  • Initially, I was not sure what time of the night or day it was. Various cues - changes in nurses' shifts, sponging, time when Jaya came to the hospital etc. - helped me to guess the time.
  • I had felt many pin-pricks at intervals in different parts of my body. I realised that these were actually injections.
  • I had felt my head periodically becoming very cold. These must have been the times when I was being given a head bath.
  • I remember hearing the sound of rainfall many times. When I regained consciousness, I wondered what these sounds had been because it doesn't rain often in Coimbatore in May. I eventually surmised that they must have been the sound of water from the taps in the bathroom.
  • I could dimly hear in the background what sounded like commentary of the Cricket World Cup. But wasn't it some days away? I gathered from some conversations I heard around me that I had been in the hospital for about 3 weeks so it was indeed the the Cricket World Cup.
  • I remembered voices frequently asking me to breathe deeply while something cold was pressing on my chest. These would have been times when doctors were examining me with stethoscopes.
  • I frequently heard about something called tracheostomy. People used to look at my throat sometimes. Whenever I coughed, the nurse brought a tube that was attached to a noisy machine, near my throat. There was something in my throat but I didn't know what it was. I gradually learnt that this tracheostomy was a hole in my throat through which secretions that I coughed came out and were sucked away by the tube.
All these realisations were on a continuum - at one end of the scale, all was confusion; at the other end, it was all clear. It took some days for me to traverse that continuum.

Friday, March 2, 2012

The problem of evil - II

Is God willing to prevent evil, but not able? Then he is not omnipotent.
Is he able, but not willing? Then he is malevolent.
Is God both able and willing? Then whence cometh evil?
Is he neither able nor willing? Then why call him God?

- Epicurus

The problem of evil has exercised many people for ages, an example being this TED talk. There is even a name for this study - theodicy. Whenever there is a natural disaster, there will be all sorts of Panglossian rationalisations by the faithful about why a benevolent god had to cause so much misery in this best of all possible worlds. I searched one site - Jerry Coyne's Why Evolution is True - and found several such amusing rationalisations. All one can say is that the religious mind is very creative. In all the pious hand-waving, one never finds an answer to the question, 'What do they expect the world to look like if there was no god?'

In his book, Arun Shourie writes about when Gandhi said that an earthquake in Bihar was caused by the sin of untouchability. That untouchability is a bane in India is unquestionable and Gandhi's efforts to eradicate it were admirable (On being told that the shastras endorsed Untouchability Gandhi replied that a shastra contrary to reason ought to be burnt. “I have so much faith in the correctness of the position I have taken up that, if my taking up that position results in weakening Hinduism, I cannot help it and I must not care.”) but to say that it caused an earthquake! Gandhi said that the earthquake was divine chastisement, that a calamity happens because of our personal sins and have spiritual causes, that the earthquake is fit punishment by god for the sin of untouchability, etc. Shourie writes:
I recoil at the next proposition that we would assume that the calamity has occurred because of our sin, as this would teach us humility. It could just as well internalize unwarranted guilt. With all the hardship that he already has to bear, should my son believe that any calamity that befalls me is also because of some sin he has committed, as this belief will make him even more humble and sensitive than he already is? Such considerations weigh heavily with me.
It was this aspect of organised religions of arousing unwarranted fear and guilt that increased my negative feelings against them. They are experts at stoking guilt feelings among emotionally vulnerable people in order to line their nests. Wherever religions have the upper hand, It is bad news for women, so it is strange that they manage to recruit self-righteous women to torture other women. And society views them as normal and harmless expressions of concern and help. Harmless, my foot.

Shourie discusses extensively Gandhi's responses to the persecution of Jews in Germany. He refuses to accept that if somebody follows the same methods that he successfully followed against the relatively more civilised British, he would have disappeared in the middle of the night never to be heard of again, as indeed happened to many people. He shows the classic signs of a person of faith - he is absolutely certain that he is right and no argument from any quarter persuades him to change his mind. And he keeps advising others to be humble! Shourie comments:
And it is manifestly circular. Non-violence is certain to melt the stoniest heart. When Hilter's heart clearly does not melt, that is because sufficient numbers have not offered themselves for immolation. And when someone asks, 'But aren't six million sufficient?' the answer clearly is, 'But they did not have love in their heart.' And how do we know that they did not have love in their heart as they entered the gas chambers? From the fact that Hitler's heart did not melt...
There is a neurological problem called hemineglect in which patients fail to notice one half of their field of vision, typically the left half. It is as if one half of the world doesn't exist for them. Similarly, believers seem to neglect one half of the balance sheet. They go ga-ga over birds and butterflies but fail to notice the bedbugs. Dan Dennett says in this interview that the tendency of not blaming god for disasters but praising him for bounties is a relatively recent one. (He may be speaking about the monotheistic religions; I don't know.) In 'On The Origin of Species', Charles Darwin wrote:
We behold the face of nature bright with gladness, we often see superabundance of food; we do not see or we forget that the birds which are idly singing round us mostly live on insects or seeds, and are thus constantly destroying life; or we forget how largely these songsters, or their eggs, or their nestlings, are destroyed by birds and beasts of prey; we do not always bear in mind, that, though food may be now superabundant, it is not so at all seasons of each recurring year.
God seems to love spectator sports. He equips predators with brilliant adaptations to catch prey. He also equips prey with equally splendid adaptations to escape. Then he sets them against each other. David Attenborough puts things in perspective.Listening to Neil deGrasse Tyson, the idea of a loving, competent god is the last thing that occurs to me.

It is puzzling that most people prefer the simplistic religious explanations to the much more awe-inspiring scientific explanations. One reason could be that the latter require much more time and effort and most people are too busy to bother. It is much easier to simply accept the received wisdom of the society they happen to live in and keep getting 'offended' at the drop of a hat. Richard Dawkins rightly observed at the Jaipur Literature Festival that tradition, authority, revelation and faith are bad reasons to believe anything.

As for me, as Paula Kirby says regarding religious arrogance disguised as humility (the first two comments after this review are good examples), 'Give me the indifference of the laws of physics rather than the hubristic self-righteousness of the religious any day.' My disregard for the religious fairy tales has increased after my stroke after I started thinking about these issues a bit. Thinking is trouble for religion. No wonder priests lay so much emphasis on faith: don’t doubt - accept unquestioningly what those with a hotline to god say.