Friday, June 29, 2012

Different reading habits

After my stroke, I got books on religion and spirituality. For eg., there was a book called 'How to find God everywhere'. I wonder how people read these kinds of books from cover to cover and bawl for more. (To be fair, that is also what many people say when they see the kinds of books that I do read. They are hardly bookspam but peole seem to be underwelmed.) I would be more interested in reading about The Most Astounding Fact About The Universe than God's blog.

For the first couple of years after my stroke, I used to listen to the budget speech of the FM. This was because I was supposed to nod and smile intelligently when people talked to me about taxes, duties and stuff.(MBAs are required by law to listen to the Budget speech and pontificate about it afterwards.)  The papers will be full of acronyms like GST, DTC (apparently it is not Delhi Transport Corporation), MODVAT etc. I gradually lost interest in these things.There used to be lively discussions even in my halcyon days about how much I really knew about these things. I am now more interested in things like NS, RGD, PE, etc. Take that you finance freaks!

(Using acronyms is a good way to illustrate profundity. For eg.:
  1. Ads use them all the time. Some paint has no VOC while some drink has DHA. What do they mean? Your guess is as good as mine.
  2.  When I was in Bajaj Auto, I was told that 'RTZ' in the bike name Kawasaki RTZ  doesn't stand for anything. It just sounds cool.
  3. I was looking at a problem in Sujit's notebook regarding congruent triangles when I was baffled by the last line - 'By c.p.c.t.c.' I found the explanation in his textbook - 'The Corresponding Parts of Congruence Triangles are Congruent is represented in short form as c.p.c.t.c. Hereafter this notation will be used in the problems.'
  4. You often come acroass internet acronyms like LOL, IMHO, FOAF, etc. (Have you heard of this study on LOLcats?) IHTOASMTIATCOTYHABYWABOL.)
My heroes these days are not guys like Bill Gates or Steve Jobs. They just do normal things a bit better than others. Now it is people like The Man Who Dreamed He Was A Beetle or Al Gentry:
Al Gentry, a gangling figure in a grimy T-shirt and jeans frayed from chronic tree climbing, was a botanist whose strategy toward all hazards was to pretend that they didn’t exist. At one point, a tree came crashing down beside him after he lost his footing on a slope. Still on his back, he reached out for an orchid growing on the trunk and said, “Oh, that’s Gongora,” as casually as if he had just spotted an old friend on a city street.
I just completed reading The Making of the Fittest by Sean B. Carroll and I loved the tales about the icefish, fossil genes, convergent evolution, etc. I like reading about say, the chicken-eating cow. Or about why manta rays need forests.  Or about how snails cross continents by flying inside birds(At this point, I am sure you are thinking, 'Of course that is the way snails get around. What was this guy thinking?') Here are some things I find interesting.

The kiwi has the largest egg relative to body size among all birds, being abouta quarter oj the female body weighht. (This will end soon, I promise you.) In Bully for Brontosaurus, Stephen Jay Gould writes:
A study of the general relationship between egg size and body size among birds shows that average birds of Kiwi dimensions lay eggs weighing from 55 to 100 grams (as do domestic hens). Eggs of the brown kiwi wigh between 400 and 435 grams (about a pound). Put another way, an egg of this sixe would be expected from a twenty-eight-pound bird, but brown kiwis are about six times as small.
The obvious question, of course, is why?
This the kind of essay I like to read while many people will think that I should spend more time pondering over Pascal's wager. What to do, I am like that only (sic)! Perhaps they didn't whisper enough into my right ear. Or do you think it is the fault of a parasite?

PS: While on the subject of eggs, I can't resist quoting from The Canon by Natalie Angier:
The largest egg in the world, and thus the largest cell in the world, is the ostrich egg, which measures about eight by five inches and weighs three pounds with its extracellular shell, two pounds without. (Interestingly, the ostrich egg is also the smallest bird egg relative to the size of its mother, amounting to only 1 percent of the female ostrich's body mass.  The she-birds most deserving of every mother's pity are the kiwis and hummingbirds, which lay eggs that are 25 percent as big as they are - the equivalent of a woman giving birth to a thirty-pound baby.
You must be getting 'eggsasperated' with my 'eggcentricity' so I will sign off without delay.

Friday, June 22, 2012

Hospitals as corporate entities

There was a program in Satyamev Jayate regarding medical malpractices. It reminded me about various such stories that I had heard.
  1. When I was admitted to the hospital following the stroke, we had to purchase medicines and consumables like cotton from the hospital medical shop. When I was discharged, Jaya found a wholesale shop nearby which sold the items at upto 1/3 of the hospital prices. We could make out no difference in quality. I don't know the costing and obviously retail prices will be higher than wholesale prices but  will it be 3 times as high?
  2. It seems that in some hospitals, the doctors are given revenue targets so they have to prescribe various irrelevant tests in order to meet those targets. Doctors who meet their revenue targets are close to the management. Doctors who are uncomfortable with such practises and don't meet the targets run the risk of being transferred to a department that they don't fancy, akin to the punishment postings that bureaucrats get when they don't toe the line of their political masters.
  3. When I had been in hospital for about 6 months, a doctor friend told us that I could have been discharged 2 months earlier and that whatever was being done in the hospital could also be done at home. When Jaya asked the hospital management about discharge, she was told that it would be better to continue in the hospital since any emergencies can be dealt with easily. We were offered a room at concessional rates to continue to stay in the hospital. We finally bit the bullet and got discharged and there has never been an occasion where we felt that we would have been better off in a hospital.
  4. When in the hospital, I used to hear nurses talk about how low their pay was, from 1000 to 1300 rupees per month which was low even by the standards of the day especially considering that they had 12 hour shifts. And I was hardly admitted to a hospital renowned for charity work.
  5. Rs. 50-60 lakhs have to be paid as donation for a seat in many private medical colleges. (I heard that in PSG Medical College this year, it is 70 lakhs.) If that kind of money has to be paid for getting a seat, doctors will obviously charge more when they set up practise in order to recoup their costs. They will set up practise in the richer sections of cities thus leaving many areas under-served. Also, in their quest for turnover, doctors don't spend much time with the patients. 
  6. Apparently, there is something called a 'basin test' - a perfectly normal person is asked to do a blood test and is charged for it. He is given a normal report and the blood is thrown into a basin.
  7. Since ICU charges are higher, I heard that a dead patient was kept in the ICU and the attenders were only informed the next day.
  8. I heard that the  head of some hospital conducts pujas to get more patients if there were unoccupied beds in his hospital. Can you beat that for hypocrisy? 
The problem is that the increasing healthcare costs will not affect a person like me who can afford to pay the bills, who has access to different sources of information and who is probably looked at through a different lens by many medical personnel compared to other people who have not had the same privileges. As it is explained in this post, there are 3 major reasons why patients are not consumers:
  1. Health care is generally not a refusable or elective service.
  2. There is an asymmetry of information
  3. Purchasing power is concentrated in the hands of a very small number of "consumers".(I don't know the figures for India.)
The widespread distrust of doctors means that self-medication is widespread. People consume antibiotics as a preventive thus exacerbated the problem of antibiotic resistance. I saw in the news that doctors were demanding Aamir Khan's apology for some inaccuracy in the program. They are missing the wood for the trees. The perception of medical malpractice is widespread and if I  had got the idea of writing this post a couple of years ago and kept notes about everything that I had heard, I would have had a much longer list of malpractices. Why blame the mirror when the face is ugly?

PS: A TED talk by Atul Gawande: How do we heal medicine?

Wednesday, June 13, 2012

I am a credit risk

The older members of my family tend to mention my stroke to everybody while Jaya picks and chooses to whom she can speak about it.  I am temperamentally more inclined towards the latter approach but there is a practical reason for this apart from the one I had mentioned earlier.

When people first hear about my  stroke they are shocked.  Then, if there is a business transaction to be concluded (say, a house to be taken on rent or an item to be purchased on credit), the person will switch to a more practical mode and start wondering how we will settle our obligations if no one is working .

A recent incident illustrates this point. My mother was staying in a rented house not far from here. When she had initially negotiated the rent, the landlord had said that she could stay as long as she liked, she just had to renew the agreement every year   and that the increase in rent will be marginal. After a couple of years, the landlord asked her if she could vacate the house as he had decided not to give the house on rent any more. He said that he had built the house for his son who had now decided to settle down in Coimbatore and was going to stay in the house. So my mother took another house on rent nearby.

Jaya immediately told me that this must be some tall story designed to get my mother to vacate the house. Perhaps the landlord was feeling awkward about increasing the rent. Perhaps he had doubts about her ability to pay if he did increase the rent. Anyway, it was no surprise when he let out the house to someone else after a month, presumably for a higher rent.

This is why Jaya prefers not to bargain using my name. Being a privileged guy, I have not faced major problems because of this line of thinking but it must be causing problems for people a lot less lucky than me.

Sunday, June 10, 2012

No. 1 fear

While scouring the Internet for information regarding a future post to be inflicted on you, I came across a quote that fits me to a 'T':
According to most studies, people's number one fear is public speaking. Number two is death. Death is number two! Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy. - Jerry Seinfeld 

Wednesday, June 6, 2012

Himalayan triumph of the human race

While reading Here Be Dragons, I saw a paragraph whose sentiment I agree with completely:
If an extraterrestrial were to land in my backyard and ask to be taken to the most significant achievement of the human race, I would very likely lead the alien not to the Louvre or to Giza or to London or Manhattan, but to my bookshelves, and I would hand him On the Origin of Species. So colossal in its significance, so sweeping in its explanatory power, so painstakingly erected upon countless empirical facts, On the Origin of Species stands as the Himalayan triumph of the human race.  But, unfortunately, the bright glare of Darwin's masterpiece tends to obscure the importance of Alfred Russel Wallace, who had independently discovered the theory of evolution but whose name, like Elisha Greay, the co-developer of the telephone, is ever consigned to foot-notes and parentheses.
I don't think I had heard of Wallace before my stroke. And, like Sherlock Holmes refers to Irene Adler as the woman in A Scandal In Bohemia, I refer to Darwin as the man. I came to know of an amusing incident regarding On the Origin of Species in this book review:
When he received the manuscript of The Origin of Species, John Murray, the publisher, sent it to a referee who suggested that Darwin should jettison all that evolution stuff and concentrate on pigeons.
I think too little importance is paid to evolution in the school syllabus. I had one chapter on evolution in Std. X and never heard of it again although I had Biology till Std. XII. I think evolution should be introduced much earlier and regularly referred to throughout the course. Otherwise biology is a collection of facts with nothing to tie them together. Evolution is not only to satisfy intellectual curiosity but also has practical applications.

PS: You had a welcome break for a couple of weeks because my mother-in-law had knee replacement surgeries so Jaya was mostly in the hospital and now has many additional responsibilities.