Inner resistance

Its paralyzing.
Freezing.
Crazy.

Even when the thirst for life is intense, it feels easier to stay parched. It feels easier to sit and stare at the cool stream of life flowing by very near to ones own feet, while the feet longing for a dip stay paralyzed, motionless... The mind plays the motion picture with elaborate details, however the reality stands like a still frame.

That's inner resistance. Inner resistance to healing, resistance to wellbeing.

In my practice on a daily basis I see this clearly in the multitude of faces that speak to me. They take a huge amount of trouble waiting in long queues since early morning, travelling long distances after making all preparations for the day at home, in order to reach my desk and sit opposite me, seeking a solution to the seemingly nagging illnesses that are troubling them.

The degree of resistance varies. So does the intensity of the willingness to get better. Unawares of the play of suppressed emotions within weaving an almost impenetrable web of resistance most people frantically seek a solution from the outside, a drug, an elixir that will make them feel better, at least for the time being. Most of us are not aware of the power of self healing of our human body when left alone. And that the only challenge it faces most strongly is our own self created inner resistance to healing. This invisible web decides our subconscious actions, it decides our damaging habits that we stay hopelessly chained to. It makes us want to stay pathetic so that we can seek some sympathy and make us proud victims. It even weakens our conscious choices.
Its impossible for an outsider to point out this resistance that is often the main cause of persistence of chronic and recurrent diseases and ill health. This web awaits silently for self discovery.

My inquiry into the source of this enigmatic contradiction within, leads me into a cave of deep dark pain. Pain, the origin of which is long forgotten. Its just lurking there, inside a hidden coffin. Trying to destroy this coffin is useless. No matter whether you try to burn it, or shove it deeper down, or pretend its non existent, no matter what you do with it, it stays on... albeit beating a little bit more palpably. I believe the best one can do is keep the coffin open. Sure a constant reminder of its presence can be very disturbing and suffocating, but I hope that when the pain does not feel any resistance it slowly ebbs away from the space without letting anyone know. How long it would take is beyond my scope of judgement. I stay hopeful, for one day discovering an effecting way to triumph over this enigma. 

What next

This is an interesting writeup which I wrote 8 years back just a few months after completing my MD which conveys well the uncertainty that met me then. Little did I know that the promise of the land would not last long and soon I would again find myself thrown into a more ravaging tumultuous ocean to survive and cross. I love this analogy of the sea that came to me then and I can relate to it even now.  Now its more like I have learnt sailing and have my own boat, but every moment am aware of the uncertainties and possibility of a complete change in direction of where I am headed. I try to not focus on the destiny but the journey instead. So here is my immature hopeful and confused self from 8 years back...

WHAT NEXT?

I feel the call of spirituality. I like to believe my work in this life will involve promotion of spirituality but I have no clue exactly what it is. Am open to all possibilities even the possibility of doing apparently nothing as in the real sense there is no nothing.

After the tormentous sea which I have struggled swimming last 10 years, now in the pleasant beach of this new free land am resting and contemplating my direction ahead. The sea of this life is crossed and now remains only the treading of the path on this land.  Paths are in multitude and the apparent highway which the crowd takes to, starts right from where am standing.  Its promise is tempting, am observing the jolly comfortable ride of those passing by me, a smile brightening their faces, a twinkle of hope gleaming in their eyes, hope of nearing the gold mine, of happening to discover some gold on their way. Their faces for an instant remind me of the hopeful passengers of the Titanic at the beginning of their journey in the movie we all saw. Though the promise and the contagious happy hope of the atmosphere around calls the feet, the mind knows too well where this leads.

After a lifetime of collecting and carefully carrying a heavy burden of gold through precarious paths and going through bitter experiences in order to retain and increase the load, one comes at a certain stage to a gate where all belongings have to be submitted for good and one passes through just with oneself. He then feels ill at ease at having wasted his precious time and energy carrying a useless burden. He also begins to recollect his pre-determination of not getting swayed by temptation influenced by people this time, before he had started the present journey.   But alas! Again he beholds himself at the same level where he had been many times before, every time falling prey to the same mistake and not being able to cross the level which is all too easy if only he can master his temptations.

The fellow passengers and friends who had crossed the tough sea with me have all already headed straight on this highway and as they merrily tread ahead they turn back to ask me “Hey! What are you waiting for?” So what am I waiting for? Is this just a moment of hesitation before I eventually start moving on this very path and let myself get carried by the crowd? My intuition tells me that I have done that many a times before and am stuck at this level too long though I cant bring myself to remember it now. So do I just stand here in wait of someone or some intuition to show me the direction or do I just stray randomly from the promising highway? One thing is certain though, there is no standing or waiting in this life. Where ever we stand its like a conveyor belt carrying us slowly in some direction while we become aware of the changing scenes.

So much of free air on land, feels so good to breathe. Is not it the greatest treasure to cherish? But being in sea last 10 years I have learnt to survive with minimal air, a habit which I subconsciously continue even now, having to remind myself to fill my lungs every now and then. I must heed to nourishment now and recover from the anemia of the nutrition-poor sea. For those well meaning friends who ask me what am going to do now this is all I can say, this is in fact all I know right now.

IMCU: A real life story

This is a real life story from my past, one that is so personal that so long I have hesitated to share it publicly. I have been cherishing a dream of publishing a book, a collection of real life short stories based on doctor patient relationship, something that is very disturbingly turning very hostile these days. I hope to inspire my doctor friends and also the non medical community to write and share stories that one again start weaving us together as part of the same.

IMCU

Amongst the mostly uneducated dumb poorest of the poor patients in the government hospital of Chennai where I completed my MBBS internship, she was one of the smartest and most intelligent young lady. With simple features her bright eyes and occasional smile stands out in my memory. 

I met her at the IMCU (intensive medical care unit) during my 2 week long posting. Just 2 months into my internship, I was still relatively fresh as an intern. We were the junior most doctors, the first contact of the patients whose responsibility was to provide all basic care starting from giving daily injections, intravenous fluids, maintaining the iv lines, monitoring the patients, take notes of new complaints from patients and their attendants, counsel and explain therapy etc to them, communicate to the post graduate students and senior doctors etc. 

The first thing that hits the mind thinking of IMCU is the continuous loud beeping of the life support systems amidst a disturbing silence. The moment you step through the glass door it seemed like another world far away from the cacophonous  world outside. The air conditioned super clean space accommodating about 30 beds arranged along the four walls, each separated by curtains, with a central station for nurses and doctors failed to provide an welcome change from the super hot relatively dirty crowded hospital wards outside.  The beeping sound seemed like a constant reminder of lives hanging by a thread. I also remember a distinctly different smell, perhaps a concoction of high end antibiotics, life saving infusions and disinfectants mixed with the air conditioned air. The ventilators and monitors running constantly at each unit may have added to the smell. 

Most beds were occupied by seriously ill elderly or middle aged patients, many of whom were partially conscious or in coma. The patient attendants were grave, less noisy and more obedient compared to other wards. 

Amidst this cold death reminding space there was this young couple who radiated a daft of warmth, joy and hopefulness every time I passed by them. The wife was suffering from aspiration pneumonia, a fatal condition that fills the lungs  with fluid and makes breathing difficult. She was intubated and put on ventilator to help her breathe. Because of the tube passing through her mouth she couldn't speak though she was conscious and very alert. She would communicate with her husband and the staff with hand gestures. The husband was good at understanding her. During visiting hours every morning and evening he was always next to her bed. A man of tiny stature, docile looking and quiet, he was a doting husband, something that was a not so common sight among the lower socioeconomic strata that they represented. During his visits he would take shopping lists from her that she would write. I remember Horlicks was one of the things she had listed in one such list which she was handing over to him one day as I came by to give her regular injections. 

I could say she was quite a talkative person. Everyday she would eagerly wait for me to come by her bed for the busy nurses and other duty doctors didn't show her enough patience to try to understand her hand gestures. She would ask about her progress or try to convey some complaints. I would go on guessing her gestures and replying her, giving her hope, while she would nod her head to indicate if I was guessing right. She wouldn't budge till she got her answer. The most touching thing about her was that she was pregnant carrying their first baby. She was quite worried about the baby. One day she had her ultrasound check with a portable USG machine brought next to her bed. I saw the tiny head, arms and legs as the Sonologist did the scan. After she left giving the report I reassured her that the baby was doing well. She was slowly recovering and we were expecting soon she wouldn't need the ventilator anymore. 

One early morning when I came by the bed she complained of irritation at her throat and some chest discomfort. When the post grads came for their morning rounds they decided the bronchial tube needed a change as there seemed to be partial block due to secretions. There were two of them and they seemed confident. First they called the anesthetist on duty to do it but after waiting for awhile when he didn't show up they decided to try it themselves. They warned her she would have discomfort in breathing on removal of the tube but they would have another tube inserted pretty soon. They removed the tube easily. She was quite cooperative. They moved on to insert a new tube. Sometime passed and it seemed the postgrad doc who was trying was having some difficulty so the other doc took over. Some more time passed and they were still struggling. She was gasping for breath by now and her fists were clenched. The doctors were trying very hard. At this point the anaesthetist appeared and joined them. I couldn't stand by her bed constantly though I wanted to, as I was called to attend another patient. I followed what was going on from a distance. A sister pulled the curtain across her bed so that I could only guess. When the defibrillator was brought in, I knew where this was heading. She had gone for cardiac arrest. I rushed to assist in injecting adrenaline and atropine while the seniors frantically tried resuscitating her with the defibrillator. I had to move away again. After many minutes the doctors came out from her unit. They were talking to themselves and left the IMCU soon. I think it was one of the nurses who confirmed that she was no more. I distinctly remember that moment. It was like time had stopped for a few seconds as I saw her lay lifeless on her bed. Just few minutes earlier I had talked with her and had reassured her that everything would be alright. It was completely unacceptable, she had a baby in her! I started wondering if the bronchial tube wasn't changed she might still be alive. Wondering if it was the right decision, if the post grads were competent enough or was it just fate. I cringed at the thought of her husband who wasn't there yet. 

I had to go on about my duty caring for the other patients while my mind was constantly going back to the curtain drawn across her bed. While returning from my breakfast break later that day as I reached the IMCU entrance my eyes fell on him. Far away across the corridor on my left there he sat on the floor, stooped against the wall, his head drooping and eyes fixed to the floor. He was calm, motionless like a stone. What a contrast against the storm that must be raging within! I felt like reaching out to him and giving him a tight hug, didn't know what to say. Instead I found myself pushing the glass door and proceeding on with the last few hours of my IMCU duty. I was very disturbed and prayed to God to give him strength. It was the last shift of my posting. That was also the last time I saw him and I knew that image would stay permanently etched in my mind. 

Peas I received

It was in 2012 just after completing my MD when I moved from Dibrugarh, Assam to Hyderabad that I had attended a workshop that focused on healing oneself with diet. It also opened my eyes towards the vegan way of life. I remember trying to quit meat and milk in the following one month, against hubby's resistance and then giving up. Had experimented with nut milk chai, nut milk curd and also one Sunday I had made a completely oil free Chicken biriyani which tasted great. After coming back from the workshop I wrote down the following lines which when reading now after 8 years seemed to be a precious reminder to me.

15.8.2012

Just attended a refreshing workshop called "Peas vs pills" by Dr. Nandita Shah in Hyderabad. 15th August seemed an apt date, we celebrated our independence. Independence from what? From external influence. Cant say we became independent, but sure can say that we were made aware that we can be.

The take home message for me was not turn yourself vegan for good health, for me it was "listen to your own body, it tells you better than any doctor". Ofcourse I knew it, but had to hear it to ring a bell within.

Lots of eye opening info... technical, medical, animal farming, lots of motivational videos sensitizing us to the unecessary pain we cause to sweet cute creatures, our own Earthlings... the stupidity of supressing body's cries with medicines when it is trying to tell us something... easy tasty vegan recipes, vegan alternatives for non vegan products... all that and more resources that are easily available on the net. What made this workshop more than these resources was the exposure to the vegan way for a continuous 9 hours in a group, that is interested to listen along with 3 tasty vegan meals, all this by a doctor who has been reversing diseases with dietary change since many years. It is imperative that at the end of the session all of us but one, raise our hands to say we will surely turn vegan atleast for one month.

The question that comes to an inquiring mind is that how is it that we had never earlier questioned all the senselessness that appears stark as soon as it is pointedly shown to us. It is our tendency to let ourselves be swept by ideas without questioning much. Instead of being swept away from one idea to the next it is imperative that we start using our instincts from now on, the existence of which we had forgotten long back. I feel that more important than identifying ourselves as a vegan, a herbivore, or a raw vegan, than identifying products as vegan or non vegan, than worrying over how to obtain a supposedly super food thats not available locally, is to develop the acumen to listen to ourselves over any one else, any one.  And this goes far beyond our diet, it is applicable in each aspect of our life.

All the valuable knowledge which we heard so many experts share today, are within us too. The only thing that is waiting is our readiness to tap it. Every Earthling is unique, so will be their experience, their diet, their truth. Dont be satisfied till you find your own. 

P.s. After 8 years am yet to reach any degree of satisfaction in my personal level of inquiry

Medical career

If you have gone through my previous posts where I have shared my blurred ideas and thoughts regarding medicine and health you must have gotten an impression I have regarding my medical career. It's not something specific or constant, it's a continuous evolution of the idea of health and sickness, how to help those at need. Its an exploration of all the different aspects of addressing disease in man. It's an evolution of what the role of a doctor is. The closest description that I have come across is that the The art of medicine consists in amusing the patient while nature cures the disease. Who said it? Don't ask please.. Wait.. Let me check, need to give credit. Voltaire it is.

So far I have felt paralyzed to take the first step. So life bit me so hard that I am forced to make the jump giving up my excuses. But yet still I hesitate, I look around at all the different options and I try to make the best choice, but beggars can't be choosers. Take the smallest step forward and make the most of it.

What am trying to remind myself is that I needn't be perfect, I needn't do now what I'll probably be able to do in a few months or years. Life isn't gonna end in the now, it's a continuity and I needn't focus on end results. Only by taking small baby steps will I be closer to where I'll be in future, not by time travel in mind. Total acceptance of the present is the first tiny step in my career journey. And I need to build up momentum once the first step is taken.

So far so little.

The above piece was written a few years ago when I was just starting my medical career from scratch after a break of 5 years post MD. The break was the most torturous and haunting. It was tortuous not because I wasn't working and was apparently wasting time. It was painful because I didn't know what to do. The confusion had become painful even at a physical level. Then I jumped back into medical career at a point when I had no other option. I had to earn my living and like my mother advised, I started with the only thing that I seemed to know a little bit of. The awareness of not knowing anything significant was still huge and painful. It made me a doctor with a dissent against everything I did.
I would love to learn and practice some form of alternative medicine. Being the person that I am I know satisfaction will be hard to achieve and Ill have to explore multiple subjects before I land on the one which feels like home. This feels scary. The long period of learning and struggling is not what I can jump into without a million thoughts.
So I am continuing to do the only thing that I know a little bit of, as a conventional dermatology practitioner. I am happy that this subject gives me the scope of counselling extensively in cases of chronic and also recurrent acute illnesses, the only thing that makes me feel satisfied and whole. Over the years of reconciliations and adjustments my medical related ideas and theories have matured a bit. Earlier when my focus was mostly on what exactly I was doing, what exactly I was prescribing to my patients there was a point when I had totally started detesting practicing medicine. Age does one thing good. It broadens the outlook and lets us see beyond too.  Now I understand that importance of "how" I am doing something over "what" I am doing. I understand the power of true intention and its effect. I understand the meaning of embracing the imperfectness of what is, while shifting focus from what should be. I also understand that the present is ever changing and that patience is a virtue.
Coming back to my blog and picking it up again after a few years is helping me recollect my lost ideas and to pick up the scattered pieces and with it to try to create a life of meaningful work. 

Less for health

I wrote this piece sometime about 4-5 years back at a time when I was in US and getting overwhelmed with too much of everything...

Today internet is bringing about a revolution in making us more informed to make healthy choices. Where advertisements by multinational companies ruled the mindset of people till a few years back, now internet has provided the platform for free and fast spread of awareness about the corruption in the profit oriented companies that make and promote everything we use. So man has slowly again started realising the value of natural ways of living, natural remedies and natural products of daily use after the brief phase of fascination by everything man made (read company made) and complex since the industrial revolution. Its just the beginning of the start of the natural revolution.

At this nascent stage internet is ensuring an ongoing flood of information regarding everything natural. Just googling one of these: DIY homemade recipes for personal use products like soaps or deodorants, or kitchen gardening, or homemade remedies to common illnesses, or health benefits of common kitchen ingredients, superfoods or different dieting regimens or different types of alternative treatments, is suffice to overwhelm one so much that he either gives up his ambition to turn more natural or he completely submerges himself, makes huge lifestyle changes and  grapples for more and more detailed information so that he misses nothing in order to be more healthy. Instead of simplifying life it rather makes it more complex and stressful and one wonders what he is missing to ensure even better health.

Today an idea just occurred to me. That health is in simplicity, in lesser than more. We do not need to know about all the superfoods, all the natural remedies, all the diet regimens in details, all the harmful chemical components in commonly bought stuff in order to be more healthy. All we need is less of everything. Less of artificial products, less of time spent earning money, less of stressing over future, less of medicines, less of trying too hard, even less of information. One of the first teachings of Buddha was moderation. Today for health we need more of moderation, yes, more of less, instead of craze for more in everything. Stress is the main cause of most illnesses now. Following moderation in everything would make life simpler and less stressful, thus naturally more healthy. The human body is Gods best creation and like everything else in nature this body too has the natural ability to heal itself when left alone in its natural relaxed state.

So next time when you are trying to research on some ingredient in some box you bought at the store or about the health benefits of another new superfood just ask yourself, ‘Would that time spent be really worth it, would it be worth more than just taking a deep breath with closed eyes?’ Remember, less is more… more health.

The above image is from one of the favorite fb pages "Be more with less"

Heal-Thy-Self

Coming back to my blog after quite a few years of break, I think this piece of writing which I wrote about 10 years ago is reminding me of the track which I have almost lost in this last decade. Its a good reminder and am thanking my younger self for having written it down in clear language. Here it goes...

Heal-thy-self….

What is disease? Dis-ease is the body telling that it is not at ease. And what do we do when we have a disease? We go to a doctor, empty our pockets for a prescription and gulp down a few tablets accordingly. Now what are these medicines that we take? These are nothing but us saying “Shut up” to our crying body. Wonder why?

Lets take a closer look at the science behind our life saving and peace giving conventional medicines. Say you have fever or a headache. You take anti-pyretics (Pyrexia = fever) and analgesics (algesia = pain) like Paracetamol. Paracetamol belongs to a class of drugs called Non Steroidal Anti Inflammatory Drugs or NSAIDs.  These drugs block some steps in the multi-step production of some chemicals called prostaglandins and other related inflammatory (inflammation = burning fire) chemicals by the body which are involved in production of fever and pain, thereby relieving us of the symptoms.

Say you have cold. You take Cetirizine or some other anti-histamines (histamines are the allergic reaction causing chemicals) . As their name suggests these drugs block the production of histamine in the body which is involved in mucous production among other things.

The most widely used drug in dermatology and rheumatology (joint-related-logy) is steroids. Steroids work like NSAIDs blocking some step in the pathway of inflammation (A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, as a reaction to injury or infection).

This type of treatment with anti-pyretics, analgesics, anti-histamines and steroids too (in many cases) is called symptomatic treatment. Now coming to non-symptomatic treatment or we could say direct-disease treatment. A bacterial infection causes fever, instead of suppressing fever by symptomatic treatment we can take anti-biotics. What does antibiotics do? They kill all the bacteria inside our body. Antivirals and antibiotics work in a similar way, anti-viruses working against viruses. Thus we are rid of the fever and cured from the disease as well. But to think of it why did we get the infection when our family members or other people who may have been exposed to the same amount of the same bacteria remained free? Do you have any idea of the variety and quantity of bacteria we are exposed to daily? Then why are we not infected and diseased daily? Its due to our immunity, which is the body’s own defense mechanism against harmful external agents. Why does this immunity fail us at certain days while mostly it is successful all other days? Is the infection really the disease, or the reason behind failure of the immunity the disease, the infection being merely a symptom?

Another type of disease is the auto-immune disease, diseases where the body’s own immunity mistakenly fights against certain specific parts of the body. Rheumatoid arthritis, Type 1 diabetes (the one occurring in children) and Psoriasis (a skin disease) are common examples. All medications block some pathway in the production of molecules involved in this auto-immune reaction, in other words it kills or pacifies the mistaken soldiers. None of us know and mostly don’t try to know the reason the soldiers are suddenly mistaken and over aggressive. The one that we call the disease is actually a symptom of some deeper imbalance in the body (or mind?), the real disease. So everything we treat may just be a symptomatic treatment.

Now consider your body as a baby. When a baby is hungry it cries. Consider that being intelligent and all "logy" loving that we are, we devote enormous time and energy in studying minute details of the biochemical pathway for hunger and develop a novel drug that blocks some step in hunger development while having minimal side effects. Thus we administer the miracle drug to the baby and guess what! The baby stops crying, and we are happy!