Where does resilience come from?
In my last neurology posting I had this female patient, a young patient, who came with complete right sided hemiplegia. In normal words, complete right sided paralysis. She was in the hospital getting all the treatment that there is for the stroke. She seemed to be improving gradually. Physiotherapy was initiated and she started regaining some function at the end of almost a month and a half. Everyone was planning to discharge her. That was when i picked up the case. Two days after i joined neurology, her condition worsened. Everything was the same. It was decided that a new MRI would be advisable. So we got it done. She had developed a second infarction. A second ‘brain’ attack (similar to a heart attack). We intensified the nursing care and the physiotherapy. The additional tests that we did showed a blockage, a clot, at a supplying artery. This clot was acting like an icecap in the approaching summers. It was slowing breaking, piece by piece, sending small icebergs into the system ahead. These icebergs were blocking the arteries when sizable enough and thereby sinking the Titanic wherever they got stuck.
The patient’s treatment was started again in view of the new findings. She was now a critical case. The number of possible complications in such cases is high. And once complicated, the treatment becomes much tougher. The management in order to avoid the complications, though simple, are very tedious for the patient in a poor general health. The physiotherapy, the lateral position nursing, the feeding by the naso-gastric tube, no oral intake at all, everything was easy to prescribe and easy to follow. But for a patient who has been in the hospital for two months already on a similar regimen before, the things would be cumbersome. And she had no means of telling us her problems anymore.
She recovered slowly again. While I was in the neurology posting, I could follow her progress daily. She seemed to be progressing again. Very slowly she was able to start her limbs move. Her voice was still gone, but soon she was able to indicate to us that she was uncomfortable. And then I was gone. The area was hit by a disease at epidemic proportions, and I was pulled into the emergency managing those patients. I did go and follow up her progress occasionally but not as frequently as I would have liked to. Her progress was slow and steady.
And then finally four months from the day she suffered her second stroke, she ‘walked’ out of the hospital, with a perfectly normal smile on her face.
What gave her the energy to face an ordeal like this? What told her to keep persisting and keep on trying her best to get better? How many of us could have really suffered such a fate and not have become depressed, especially on being afflicted by a second stroke?
What was it that helped her persevere? Her personal strength? Our inspiring talk? Her family? The hospital staff and their care? The fact that this patient was a part of the religious sect and was therefore probably supported by the divine intervention?

I thought I knew what love meant. And then I met her.

Love! What exactly does one mean by the word?

Caring? Thinking of someone? Obsession? Passion?

I thought I knew what love meant. I discovered I had no idea what love meant. Not for a long time. Not till something special was lost to me.  And a special talent in me went silent.

And yet I distinctly remember how it all started. How could I not? It was the first time ever that I had fallen in love.

It was during my internship. I moved to a new hospital. I immersed myself thoroughly in all the work that could possibly be laid my way. I had one vow. I would never say no to a patient, even if it meant going an extra mile for that patient. Usually it meant that I would be working beyond my prescribed hours trying to help those that were around, whether it was my co-interns, or the patients.

One of the reasons I joined the new hospital was to get back home, get back to my family, and get back to the routine that I had before I left home to the hostel (not that I am complaining about my life cycle in the hostel). Fate had other plans. Soon after I moved to the city, my folks had to shift to a new city. And once again I was left alone, this time in a megacity.

And then I tried to study for post graduate entrance exams. I went to the library, instead of going home. I loved being there. It had become my routine to come to the library early in the morning. Sometimes I would be waiting for the librarian to open the doors. The library had relatively less number of chairs to be occupied then there were people interested in coming to the library for their studies. So it was usual for us to occupy any vacant seat, even if someone had been there a while ago.  I usually did not mind the trend. Till I returned to find my seat occupied by someone napping in my place. Yet I did not have the heart to wake her up and pick up an argument, a gauntlet that was just there waiting to be picked up. Her wild curled hair covered her face completely. So I simply collected the books of mine and moved couple of seat up to displace someone else. She was still sleeping when the librarian finally rounded us stray sheep to close the library.

I soon met the sleeping person through a couple of mutual friends. In a closed society like the medical staff in the hospital, and an even more select subset like the interns, one always find out about each other sooner or later, whether they like it or not.

During the one year of internship, all of us were meant to do 15 CMO duties. I intended to finish the fifteen days worth of duties within 9 days. The first couple of duties I managed to do with my friends. But since they were in no mood to do back to back duties, the third night would probably be like a blind date. It was the girl with the curly hair. She was as aggressive around patients as I was. And that was comforting. I hated compensating for others.

And then came the night. As usual the CMO left us in charge and went to sleep. We decided that we would take turns sleeping. Now it was entirely not my cup of tea to wake up in the middle of the night (that meant 3 AM and not midnight in the emergency setup- I still dislike that scenario). So I asked her to go to sleep first. Of course since the CMO was in the room, she had to try to relax right there, sitting in the chair. It was a quite kind of night, with only a few patients trickling in after midnight. And I ploughed on, awake, reading my class notes or writing some case notes when the patients arrived. Eventually 3 AM came by and went past, and I kept doing my notes. Finally at dawn she woke up. And demanded an explanation as to why I did not wake her up. I heard myself utter the dumbest excuse that I had ever heard- because she looked so peaceful and relaxed while she rested, and because her hair was so nice.

“Her hair is nice?” I asked myself all the way home. I had no idea what had made me say that. Especially because I knew I preferred the long straight hair.

I suppose we started talking somewhat regularly after the CMO duties ended.

They say the time flies when you are enjoying. The internship surely flew past. The day came when I was to say goodbye to everyone. I had to return to my family. It was time to return to normal life, once again. And yet, this time something was amiss.

The flight was to take off at 1635 hours. I got a call at noon that she was getting a CAT scan. She had some severe dyspnea and bloody sputum. And the senior most chest physician in the hospital had advised the CT scan. From the intern’s point of view, that information added up to something drastic. I rushed to the hospital. There she was in the waiting room scared, yet trying unsuccessfully to pretend that she was in complete control of herself. I could almost feel the fear vibes in the air. She walked in and the scan was initiated. Once the scan was completed, she was given some intravenous dye to complete the study. And that increased the frenzy with which the alarm bells rang. Two minutes later, the scan was completed, and she was brought out. We were told to stand by while the radiologists took a look at the scan in case they needed to repeat a sequence. Having seated her, and leaving some friends by her side, I moved into the CT scan room to badger the residents with my question, one last time again.

Five minutes later, my watch and mobile alarms constantly reminding me that it was time to leave for the airport, I walked out of the reporting room. I had just met the radiology consultant. This was more than I had bargained for. I had walked in expecting to force them to show the CT scan to the SR at the very least.

I walked up to her and quietly whispered into her ear that I had to leave now. She nodded. As a parting gift, I told her that the CT scan was absolutely normal and she could go back and dress up.

Of course I would leave before she would come back. I didn’t mention that to her. I left the city that evening, and lost one of my most prized talents. 

That was the last time I saw her for many long years to come.

My mom has always been my favourite person, or so says my dad.

My dad did not hail from a rich family. He was a good student, a good athelete from what I hear. And a caring person. My dad started his career as the most junior person in an Indian enterprise. A hard working chap, he advanced fast in his career. He became the youngest Vice President ever of the same enterprise. Of course there were Ups and Downs. But he went through it all. He is the toughest cookie I know that way. He has weathered it all.

Today, hunting for a picture for another blog of mine, I came across the snap I added for this blog. That snap, is not mine. It is the imagination of someone else. But it reminds me of what my mom told me. This goes back to the days when I was not yet four years of age. I do not even remember if I was in the play group by then. The house had a veranda with a grill. The ground floor flat faced the road and I used to hang on the grill for hours together. The other kids were way too old for my age, but not old enough to make sure that I would not meet with an accident. So I was in the house till my mom could be free of her household work (work that was usually increased by my activites- but thats another story) and take me out to the nearby park where I could test my young muscles against the giant strength of Mother Earth. Dad was of course an essential part of the trip. I after all needed to drive the giant bike to my satisfaction. Mom says that I could predict two minutes in advance when my dad would be home, even before the bike was visible across the bend (I guess it was the better hearing of a child's ears that detected his bike's characterstic rumbling). Once in the house dad would just say my name once and I would jump off the cliff (well that is what three feet height felt like at that age). And he never dropped me.

Someone once said "Only those who go too far know how far they can actually go". Dad did not usually stop me from anything. I could do anything on Earth cause I knew I had dad backing me up. I knew he would catch me in time. Always. And he did. Always. He did till things were finally not completely under his control.

I am a decent swimmer. I used to swim for hours. And dad would sit there for hours watching me swim. He is the best swimmer in his part of my family. I have seen him beat my older cousins who were twice my age. He would always let me win though. Occasionally of course he would speed up ahead so that I had to pull in everything I had to catch up with him before he finally let me win. Of course, as I grew up, the day came when the table turned and I slowed my stroke to let him win. I guess he understood. Cause we have never raced since. And I miss that.

I always have wondered- what is his inspiration to keep going? What keeps him ticking at the hours when I am still sleeping? What keeps him awake at night when I am drowsy and just trying to get done with my homework? What keeps him at work when I am desperately desperate for a break? Upto a huge part of life so far, I have always heard the typical adjectives used for him- workaholic, hard working, type A personality. The lingo could extend endlesslessly. I always believed it was his thirst to prove himself as the best that there is. And then I thought of another answer- Me.

Today when I am on the verge of starting a professional career of my own, once again, and once and for all, I wonder what could keep me going? I know initially it would be to prove my worth. To state to the world that I have arrived. But would that be an inspiration to keep me going through life? I think it would be the thought of my kids, their dreams and needs that would be it. Of course I have had a much more comfortable childhood as compared to my dad. The protected experience that I have gained with him is something that he did not have. But I suppose there is no end to reaching perfection. There are things that I feel I missed out upon that I would like my kids to have access to. I think that is how it always works.

As a child, I often did not understand dad's busy schedule. As he progressed the steps in his career, the work pressure increased. His responsibilities increased. He had to put in longer hours at work. And by the time he came back home, there would be no more time for the park. The park was slowly replaced by the small lawn our new home had. Mom was always around. Not dad. He had work to do. I missed his bike. But he now had a car and I loved the feeling I got when he would let me feel that I was driving the car. The occasions to drive the car were less frequent.

Years later it was dad who finally taught me how to drive a car. The banter during that time is a legend in the house. Mom rode with us only once during that period- it was that bad. I would always want to go faster. I had to be the speed king as fast as possible. He insisted that I learn how to drive slow first. Who ever wanted to enjoy the slow magic when you had the thrill of speed? And the geometry and trignometry of negotiating curves was more than enough for me. But he had his way and now years later, when I drive the highways alone, he just leaves me with a word of caution- ' Drive Safe'.

Whenever I got an injury, dad would get upset. He would scold me. His favourite statement was, "Do you think I am a doctor?". I never understood that statement. I mean its the birth right of every decent football player to get hurt. Right? I hated that dialogue. I guess he probably became upset because as a non medico he could not pull me out of pain as quickly as he would like to.

I fell seriously ill twice in my life so far. You know the kind of illness you remember. The rest of course come and go. Both the times dad was not in town. He was on a tour. He however always interrupted his tours to return to me. And it was always a relief when he arrived. After all, before he left, he would always leave me in charge of the house. "Take care of mom and the house while I am gone. You are the man in the house", he would say. You can imagine the strain on a five year old, who is seriously ill, and is in charge of the house. Yeah, it was always a relief to see him back. I could return to being naughty when he returned after all.

When I was young, I hated Sunday afternoons. My parents would go for their siesta. I would play with my toys for sometime, till I became restless. Then I would go and check on my parents whether they were actually sleeping. Since I did not have a eeg machine at hand, I used the next best method. Open their eyelids and look for changes. Somehow, I never found any changes. They were always wide awake as soon as I opened their eyelids. With mom the tecnique was safe. She would get up and play with me. Dad was another matter. He would envelop me in his bear hug and go back to sleep. I would try to get out of the hug. But always failed and finally got tired enough to go to sleep myself- a good Sunday afternoon wasted. It took me eight good years to finally manage to break out of his bear hug. Of course I had stopped my "sleep changes" experiment long before.

I always thought that I was a good bicycle rider. I always wanted to show him how fast I could go. He was never there during my playing time- he would be travelling home. And mom would always ask me to drive safe, not fast. Well she seemed to be right about that on only one occasion- the day I could not brake in time and landed in a cactus bush. I thought that the cactus bush had some kind of fungal alopecia. Why else would it shed so many thorns at once? Of course I cursed the bush owner too, espeacially when she tried to act smart and blame me for the damage done to her bush. Mom did not like it one bit. I must have been thorny cause she could not do it herself and had to call in the neighbour to pull out the thorns. I guess she would have fainted if she had to pull out all the thorns herself. It had taken almost half an hour to pull out all the thorns, and I had pulled out about thirty thorns myself before mom had arrived home. That night I slept in dad's bear hug.

Yeah I love my old man. And I know that deep down he knows how much I love him. And noone knows more about it than my mom. Cause it was always my mom who reminded me how much dad loves me.

Who doesn't have trouble in life? Who at some point of time has not felt as the most terrified person on Earth? Or the most troubled person on Earth? And yet, are you the worst affected? Is there no one here who is not in a worse shape?
I felt this ever since my internship. My very first posting was in the pediatric department. having joined the internship as one of the most unhappy persons on Earth, I had entered the internship program with some grudges, and some distress. I did not like kids. I could not bear the noise they made. And I just was not happy with the way my life had turned. In short, I was not a happy person, unlike most of those who had started internship by my side. I would rather be elsewhere doing something else. But options were few. And I had to do what I had to do. In simple words, life was not looking good.
And then pediatrics happened. The first few days were not good. After all that was the first time I was doing a job on my own, in a fashion that someone else wanted me to do that job. It took me sometime to learn the strings, the ways the things are done. It did not help that I was unhappy. In retrospect, looking at the amount of experience I gained later in internship, I could probably have been a better intern had I been relatively happier. Once I got comfortable with the type of work I was given, the kids in the pediatrics ward helped me out of my gloom. I don't know whether during that phase it was I who was helping heal the kids in my ward, or was it the kids who were helping soothe my nerves, helping me improve the person that i was, helping me see that i was not the worst affected on the planet. Those young souls were there, active and happy when not feverish and low and inactive when febrile. But somehow they never let go of hope. They would always have those bright eyes, dulled by the pain of their illness, but with the hope that the good doctor could always give them a tablet or a sweet syrup that would help them come back to the play table again. And there they were always ready to smile when they had the strength to do so.
And then came in the admissions that I could not help. They were the kids that could not be helped, because there was no therapy for their illness, or because their parents had no further financial capacity to treat them. Or simply because they were brought in too late. And yet the reserve of the strength in them was vast. Some of them seemed to face life better than i could. They seemed to know what would eventually happen. But they had learnt to fill the days with the quality that a human deserves. They had learnt so early in their young lives to Live.
It started making me happy. It became a routine for me to visit the pediatric ward even when I was not needed. I would go to the library after the evening round, reading for the residency programme. I didn't realize it at the time, but I always took the seat that faced the pediatric ward. I could always keep looking at what those kids were doing. And everyday I would visit the pediatric ward after the library hours before I went in for dinner and bed.
I gradually started interacting with the children. Playing with them, painting with them, singing with them, trying to teach them new games and skills. Skills that were mine to share with them. I would personally make sure that all of them had slept. I would bother the resident if the kid was not comfortable or could not sleep. (That was the phase I was not allowed to prescribe. Frankly, I would still avoid prescribing to a child. They are so delicate). I tried to make the hospital ward a play ground. I did what I could while I was there.
I still don't know whether it was I helping them, or whether their reserve of strength kept drawing me to the ward, and that I got addicted to the strength. All I know is that I needed to be there, to play with them, to see their happy and laughing faces, and to feel happy with them.
I never was a believer. I never was a non believer.
I became more of a believer because it was obviously God's gift that I got the posting first, I got the posting first when I was not happy. It was a posting I did not wish to come to me first. It was probably His way of healing me. His way of telling me that maybe i was wronged, but it was time to move on.
I became more of a non believer. How could He let these young souls suffer? What was wrong with Him? These kids had not even started seeing the beauty that is called Life. And some of them never would. Why did he give kids to those who didn't want them? Didn't appreciate their existence? Didn't understand the magic that the kids brought? Why did He make the life of those young magicians hell? Yes, many of you would tell me its not our place to question His decisions. Some of you would sink to telling me that it was their misdeeds of some other age. I ask you- Who is suppossed to be the correcting entity, the forgiving entity? And if they are just facing the repercussions of past deeds, why can't they have a normal childhood? Why can't they face the repercussions later in life? And why give life at all to a soul, when you just intend to take it away giving the child a painful non treatable disease?

The kids gave back to me the happiness I had lost.
Thanks to all of them.

Posted in neurology these days. Its amazing how much one can learn. And i am not talking about just the subject. I am talking about life in general. You get so many people around you every day. If one simply listens to someones story nicely and patiently, its amazing how individuals can teach each other.
Today i had a grand round. Sir is really regular with these rounds. There i was, standing at the bedside of the patient and facing my teacher and my guide, trying to face the volley of his questions- answering some. The rest were bouncers (there is simply no other suitable term). And he told us how a simple mistake might have slowly caused the patient to have deteriorated from a very small condition, to the large syndromic disease he is now admitted for with us. The learning to most of us was the history, examination and management of the patient. My mind unfortunately also kept registering the kind way he tried to keep soothing the patient, the lost art in medical sciences- the art of 'touch'. And i could actually see and feel the comfort on the face of the patient whom i had treated just two hours earlier trying to put him out of his misery, and failing drastically. The cramped time schedule did just not allow me to think about the artistic part of my training. No painkillers, no sedatives, no antibiotics could have brought the relief that i saw at that time. It was trust that one man had in another. A trust that one man would do everything in his power to help the second man. I have felt that our patient himself knows some how that he cannot hope to improve to his pre disease 100%. Yet he seemed relieved, satisfied, and content. How could one man inspire confidence in another without having said a word? I know from the training I recieved from the great man that the patient would never fully recover. There is ample data that says that the medications, the prescription I wrote out two hours earlier was perfectly suitable. And yet I had failed, and my teacher had relieved the patient without having said a word.

What did I learn besides the clinical parts, including the importance of art of touch?
TRUST.
Trust those that ought to be trusted.
It leaves you peaceful.