Friday, December 28, 2012

For 100% Success Rates....

I went to a wedding last week in chintadripet. Nothing surprising about going to a wedding you might say, but it was a one – off occasion for me because it was the wedding of a former patient of mine. Now, I am someone who firmly believes in keeping his professional and personal lives separate. I have rarely; or rather never socialized with patients, despite the wedding and other invitations I get on a frequent basis. Why I cannot say. Its not because I think that I am special or it would in any way not be the right thing to do. Its just that, I prefer not to think of patients and their problems in my personal time. Not that I dont. But I do try to keep it down to as minimum as possible. Or this job will suck you down. Being constantly around sick people, being around people in pain and being able to do nothing about it most of the time is as soul destroying as any other job but also has the added risk of  not allowing you to tune your mind off other peoples worries and concentrate on your own problems.  Hence, most doctors refer to patients as cases not as people to see if thinking in the abstract helps keep the mind of them. But still statistics show that doctors are in the high risk group for depression and doctors are some of the most vulnerable people to heart disease. Not that I am afraid of any heart disease or anything, for physical fitness has turned as important a part of my daily life as eating or sleeping.

Anyway to come back to the premise of the post, the reason I choose to attend this particular patient wedding was because I was proud of this girl. Or rather proud of my treatment and its successful outcome. When this patient had first come to me, I had turned her down like every other doctor she had been to recently. There was nothing I could do to help her in my opinion. And I would have stuck to “no” had not this been a VIP case. Yes, this patient had come to me with a recommendation letter, referred by my mom. The mother of the patient worked as a domestic servant in the household of a close colleague of my mother, the family was poor, they couldn't afford to spend any more money for treatment, the girls wedding had been fixed and the date was fast approaching and the family was in desperate straits and despite the fact that this patient would have to be treated free by me, if I knew what was good for me I would not turn down the patient and face my mom’s wrath at home (and probably get put on a bread-only diet). 

The reason my instincts had screamed to decline this case on first examination was that the patient had already undergo multiple surgeries before coming to me and most of them had failed to cure her basic defect. Plus the previous surgeries had removed whatever useful bone and other tissues which were available on her body (as grafts harvested to be used in a different area) and had used them in a failed cause without achieving anything. So even if I had wanted to, there was nothing there left for me to use to make her better. But sometimes when you are forced to improvise, you surprise yourself. Or at least I did. Once I decided that the usual treatment protocols would never work with this patient, I thought up a different way to treat without treating (kinda zen- but I like describing it that way). I even thought up a fancy sounding name for it (to bamboozle other doctors who ask) but the idea was to do the minimum required with the minimum available to last her till her wedding. And mission accomplished. The little treatment I did for the patient worked like a charm and the patient and her family were very happy, grateful and insistent on my attending the wedding and hence I made an exception just this once.

Anyway, I have often thought about how reluctant doctors (or at least surgeons) are; to accept cases which others have treated before them. It’s not just a matter of not being able to see the original condition of the disease before someone else mangles it in a botched surgery. It’s not exactly about pride at not being consulted first, not being the first choice so to say. The real reason, I would say is that doctors keep score. Just like any other professionals, they worry about their success rates. The higher they rise, the more they worry about their success rates. Their reputation demands that every single patient they treat turn out to be a success. To achieve that kind of consistency they turn down cases which in their opinion have even a marginal risk of failure. It’s like a batsman cutting down all risky shots to make sure that he scores a century every match And that means they stick to only safe cases and turn down the demanding ones, the difficult ones and also the interesting ones. I guess they have a right to, but sometimes this is carried to the extreme. If every single doctor decides only to treat those patients he can guarantee a success, what will happen to others who need it as bad but are also risky to treat. This is what I used to think myself and this was what brought me a lot of trouble in my younger days.

For instance, in my younger days when I was just dipping my feet in the profession (at Tanjore Medical college hospital) and had absolutely no clue to what I was doing, I was caught in a bind once because of my over enthusiastic (plus compassionate) mindset. Once during a late night duty period (when the mind is half asleep) a colleague from the ENT department managed to pass on a terminal cancer patient (someone who is at the end stage of the disease and about to die) to me with the improbable story of their wards being full and no place for the patient (plus the seductive story that this was something which was in our specialty and we could treat better) and as our beds were free could I shift the patient over to our ward? It shows just how much of an innocent babe (greenhorn) I was that I managed to swallow this story hook, line and sinker and admitted the patient in our wards. Until the next day, when my chief came for the ward rounds and caught on to the swindle immediately. After a barrage of bad words at high pitch delivered at me (must have gone on for atleast half an hour non-stop), my chief asked me what the hell will we say at the 3-M? And that’s when it struck me what a fool I had been.

The 3-M for those who don’t know is the Monthly Mortality Meeting where the death cases from each department are discussed every month. Every single department has to explain about patients they lost that month and what they learned from the experience to prevent it from happening again. This self flagellation will not prevent the other departments from pitching in with their own expert analysis of the in-competencies of the doctors and about what they did wrong. It sometimes degenerated into all-out slugfests where insults were traded openly based on what the other group had said at the last meet. And my chief was sure that the sanctimonious ent doc who had cleverly passed on the patient to us, would be the first one to roast us alive when the patient died despite him knowing very well that there was nothing we could do at this stage (the last stage) for the patient. But hey, he had got it off his hands didn’t he? So he could have a go at us with clear conscience. Anyway, the story ended with my being given a punishment posting at the fracture clinic – re-fracturing improperly set (half healed) fractures for re-setting properly, in other words a bone breaking job, plus a job which meant that I would always be delayed for lunch, which meant that the mess would have just empty vessels being washed when I turned up for lunch. Even after all this time, I still remember that month I survived majorly on bananas and biscuits. And I remember that my chief somehow passed on the patient to general surgery and got me off the hook.

The lesson I learned from that episode was that people will be merciless in taking advantage of you if you are innocent. And also that I was too young and inexperienced to take risks without proper guidance. But after all these years I have learnt to trust my own judgment rather than others opinions. To take a risk or two, if I judge I can pull it off.  And I have also made it a habit of predominantly picking up revision surgeries (which is not as grotesque as it sounds) but which means doing a second surgery to correct any surgery which did not come out right the first time (for whatever reason). I have learned to work within the limitations, I have learned to lower my expectations (and the patients) and I am not fazed by the occasional failure. It is kind of liberating to treat patients when I don’t have targets to maintain and for whom I can do my best without worrying about my success rates or about doing something spectacular all the time. Sometimes not having a big reputation, being junior, does have its perks, doesn’t it?

So tell me, do you think that doctors should be always infallible and have 100% success rates? Or do you think that doctors should be ready to do the best they can, even if the results are not going to be spectacular? Which kind of doctor would you prefer to be treated by?

(P.S. I really enjoyed the wedding as I got to hear for the first time certain native musical instruments like daalaku, dhol and dappi which are never played by mainstream orchestras)

Tuesday, December 25, 2012

Film Review –Needhane Enn Pon Vasandham – A Realistic Take On Urban Love.

I happened to catch up on the movie NEPV recently. After all the reviews bashing the film, it was a considered decision on my part to brave the critics’ scathing opinions and go see for myself. I had always considered Goutam Menon as one of the very few directors (along with SJ Suryah) who had a clear realistic take on modern day city based romance. And it was a welcome relief to watch an urban centric movie after a long time, the recent trend in Tamil films being a surfeit of rural romances with bearded, scruffy, dirty heroes, clad in lungis, brandishing sickles and threatening village belles to fall in love or else “you will see the macho side of a man” kind of thing. And Goutham Menon doesn’t disappoint.

NEPV is a neat little movie, showcasing urban relationships and male female dynamics in the modern world. All natural and nothing contrived about the story. There are no goons going around in a dozen Tata Sumos, threatening to kill the couple but allowing the puny hero to single handedly bash them up in minutes. In fact there are no villains as such in the movie and only circumstances play the villain as in real life. There is no hero introduction song with village women showing Mangala Aarathi to the hero and praising the hero as the savior come to rule the land as chief minister in the coming elections. The first song is actually sung by the comedian/second hero of the movie- Santhanam, who does a neat job as usual.

With such a refreshing beginning, the film had a great potential for turning into a entertaining hit. But what lets down the movie are the screenplay and the music. The screenplay sags a bit after the interval and I am astonished that as accomplished a director as Goutham Menon wasn’t a bit more ruthless at the editing table. And as for the music, the less said the better. After the highs of VTV, when GM combined with AR Rahman to create a blockbuster album, NEPV with Ilayaraja helming the music comes as a sad disappointment. There is not one single hummable song (like the eminently likeable Hosanna from VTV) and the music score is completely forgotten by the time we walk out after the end credits. A failed experiment musically and I hope GM goes back to ARR for his next film.

The story as such is simple, boy and girl meet, fall in love, have a misunderstanding and break up. After a suitable time interval boy and girl again meet, rediscover feeling for each other and continue their love, till again a misunderstanding crops up and they break up. Repeat/Rinse for half a dozen times till you come to the climax. At the end the boy decides he has had enough from the girl, no point in waiting any longer and goes in for an arranged marriage. And girl walks in on the day of the wedding to wish him. There is not much novelty to the story if told blandly like that. The difference is in watching the performances, for both the actors Jeeva and Samantha have performed creditably bringing the personalities of the characters alive. The second pair of Santhanam and new introduction Vidyalekha have some of the best lines in the movie and provide welcome relief with their comedy act, especially the spoof in the second half on the directors own earlier hit movie VTV.

A few scenes especially stand out for the deft touch of the director. Like the scene where the hero shows off his brand new car to the heroine (bought from his first job) and asks her why she hasn’t yet changed her old car. This despite the fact that earlier throughout the entire movie the heroine is the one who goes around in a car and the hero borrows it from her and drives around without any compunction treating it as their common property (in Tamlish- Osi Gaji adikaradhu). In that single moment of gloating, the director shows us all a different aspect of the hero. The depth of his inferiority complex about his financial state which he had hidden from the heroine (and us) all along the movie, allowing her to spend lavishly on him and pay for everything, till he finally reaches a state of financial independence when he shows up his true feelings about their mismatched financial backgrounds. For too long Tamil films have perpetuated the myth that people can fall in love despite vast differences in financial backgrounds with the hero being a slum dweller who falls in love with a millionaires daughter and when the heroines father objects to it, the hero in the space of a single montage song becomes a business man who has makes enough money to buy out the girl’s father and humiliate him and teaches him the value of true love over money.

Unfortunately, such things don’t happen in real life. Almost all the mismatched relationships in real life end up in tragedy. Girls who elope with auto drivers and bus conductors end up regretting their stupidity sooner rather than later when the love of their lives turn into parasites who prey upon their earnings while lazing about.  Only real achievers who are comfortable with their own lives (sans ego) can bridge over any such mismatched financial backgrounds. The rest will definitely exhibit inferiority complexes and try to take out their frustrations on the very person who loves them. Don’t believe me? Ask any celebrity woman achiever and you will learn the truth about how male ego demands that the woman’s status always be lesser than the man’s ego can bear, even when the woman is paying all the bills.

The next scene which shows the typical Goutham Menon punch is the terrace scene just before the interval, when the hero informs the heroine that no, he would not be marrying her as he had decided to go for higher studies to improve his career prospects. And when the heroine goes all clingy and desperate and talks about sacrificing everything in her life for his love he shows a bit of contempt for her and advices her to find something else to do with her life, get a career or an outside interest like him. This is so true to life but till now has never been shown in any film. When men chase a girl, they put aside everything else and concentrate only on the chase. But once they are satisfied that the girl is indeed theirs (all opposition vanquished), then they slacken off and start considering all the other work which has been put aside till then in the heat of the chase. Suddenly all the lavish attention which was enjoyed earlier seems to be smothering and they want space (this is a universal truth known to all men). So they end up giving unwanted advice on how to find a career or a hobby or something which will allow them to moderate the time spent together to manageable levels. In defense of the guys, it is because they don’t think over much about anything in the initial euphoric phase of love and only when the girl is firmly attached that a guy starts thinking about the next part on how to settle in life, how to earn enough to support the girl with him and suddenly time seems a premium and career or education becomes all important.

The outstanding scene of the film for me is the climax scene where the heroine comes to the hero’s wedding reception and sees him standing with a different girl beside him and realizes the extent of the folly of her ego when she finally realizes that he is not hers any longer, even to fight with or to show anger. Too many people in relationships let their ego ruin things by not realizing that circumstances can change anytime and time waits for no man or woman. They mistake the trees for the woods and forget the big picture and are intent only on punishing their partner without realizing that sometimes they may push away the other person beyond an irretrievable distance. So every time anyone in a relationship feels that their ego is hurt they should just imagine their person of choice standing beside someone else at their wedding reception. Just picture this in your mind and see whether the issue at hand seems as big as before. Fighting is all very well but only when there is someone still left to fight with. That for me was the take home message from the movie. Something which Goutham Menon has nailed in his inimitable style.

So my verdict is NEPV's a movie worth watching at least once. And if you haven’t till now, better head to the theatre before it’s taken off.

Tuesday, December 18, 2012

Leave the Kids Alone

A few years ago on a hot afternoon, under a burning sun, I saw something which I will never forget, on Broadway (now known as Prakasam road), an old bullock cart overladen with sacks being pulled along by a single bull, straining against the load, eyes rolling in their sockets, mouth foaming, but still pushing gamely on. I remember the same scene whenever I happen to see kids in school uniforms gamely walking along laden with back packs which seem to be twice their body weight dragging them behind and causing them to stoop forward to balance the weight on their backs. I see the same look in the kids eyes that I saw that day on the bullock, a look of this is my lot in life and what can I do except accept it. There have be a dozen educational committees formed at the center and state levels  to study the problems of overburdened kids and report after report have been produced (a lot of balderdash) on reducing the academic pressures on school kids, but the reality is different on the ground. Kids still are treated like beasts of burden and forced to go to school daily carrying a backpack which will challenge even seasoned mountaineers. And if that were the end of the story, I would stop right here.

To add to the kids trauma, parents nowadays are not only competing with their neighbors in acquisitions for the house, but also in the achievements of their kids. Every single parent wants their kids to be the next super singer, or junior master-chef or the next prabhu deva. Kids are not allowed a single moment of free time when they return from school, but are hurried on to painting class, music class, swimming class and foreign language class. Parents want their kids not only to be super smart at school work but also in all arts and accomplishments. The poor kids are not given a single minute of free time or a free day with even Sundays being jam packed with classes on extra-curricular activities. With all this being forced on to a child (who has often no interest in it), no wonder kids are rebelling and more and more kids are being seen by counselors nowadays for “disciplinary” problems.

The fact that a six or seven year old requires psychiatric counseling seems strange, but it’s a fact. Child counselors are mushrooming everywhere and to justify their existence they keep diagnosing kids with attention deficit disorder or hyperactive disease and prescribing strong drugs to dampen the kid’s natural energy and enthusiasm. Is it so unnatural for a child of six or seven to be bored by lessons and have its mind wander away? Kids have strong imaginations and most of them can easily move between reality and fantasy roles. Even adults do it often in computer games, for example in role playing first person fantasy games like assassins’ creed, or doom or prince of Persia. When something is boring like hell it’s a natural tendency of anyone to lose interest. It happens throughout life, in school, in college and at work. That’s not attention deficit disorder and it’s wrong to single out kids for that. And almost every normal kid has an unbounded enthusiasm and energy for life and we can’t label that as hyperactivity and start dosing them with drugs to make them artificially passive.

Parents and teachers are abandoning their traditional roles of taking responsibility for the children’s behavior and instead of guiding them along the right paths; they are shifting their responsibility onto child care counselors and obscure diseases and syndromes and over dosing the kids. At this rate, no one will be responsible for their own actions or decisions, for we will find a psychological reason for everything. Shift all blame to society and disease. I shudder to think of what kind of society we will be left with in the future if this continues. Maybe schoolroom shootings will become common here too- and we will blame it on a harsh word said by some teacher a decade ago, which caused so much mental trauma that the shooter had to kill a dozen kids after ten years just to ease his mind. I woulnt be surprised if this reason is soon trotted out too.

So what do you think? Am I crying wolf? Before it comes? Or am I talking through my hat?

(P.S. the idea for this post came from a conversation with my friend Vidya Dev who blogs there. Thanks Vidya)

Friday, December 14, 2012

Film Review: The Hobbit - 3D, Dec-2012

Disclaimer: Spoiler Alert. This Review contains complete Story details and discussions. So do not read if you are planning to watch the movie soon.

For those, who have watched The Lord of the Rings series of movies- LOTR, The Two Towers And Return of the King, the Hobbit is a must watch movie. And not just because it’s a prequel to the LOTR series and provides a lot of background to the story of how the One Ring was acquired by Bilbo and Frodo’s Journey to Mordor, to the Mountains of Doom to destroy it. And even if you haven’t watched the LOTR series till now (because you have just landed on planet earth in your flying saucer), you should watch The Hobbit because it’s a damn good movie on its own and worth watching for not only the fantasy story but also the special effects, especially when seen in 3-D. The Hobbit has released in 2 versions- the 3-D version and the 2-D version. Please, please skip the 2-D version even if you get free tickets, free snacks and the company of a pretty girl thrown in besides. On second thoughts take the pretty girl with you and go see some other movie, and reserve the hobbit for watching only in 3-D. Because this is a movie worth watching only in 3-D. I got to watch the film, first day/first show at Escape theatre in EA Mall in 3-D with a sound system boasting of Dolby Atmos- the latest in digital sound technology. And I am still reeling with the effect of the movie. It’s as if I am walking around middle earth, expecting goblins and orcs to leap out at me at every turn.

To start at the beginning, if you have read the LOTR books, then I am pretty damn sure you would have read the prequel “The Hobbit” too and formed your own idea of how Mirkwood would be, or how Smaug would look like. If you haven’t read the book till now, here goes the story. Bilbo Baggins, a quiet little hobbit is spending his life, having meals and smoking pipes, when the wizard Gandalf who is passing by his village in the shire, decides to give Bilbo a taste of some adventure. He makes a mark on his door labeling it as a burglars place and a group of dwarfs who are looking for a burglar to accompany them on an adventure barge into his house and make merry. This has a great little sequence (courtesy the director Peter Jacksons quirky twist) where Bilbo looks at the pile of dirty dishes after the feast and wonders who will wash it, when all the dwarfs join in a song (fantastic music/tune btw) and simultaneously do the dishes, juggling them from dwarf to dwarf without breaking but leaving them in a gleaming pile. When they finally broach the topic of the adventure which involves traveling to Erebor, the dwarf kingdom under the lonely mountain to kill the dragon Smaug which lives there, Bilbo to everyone’s amusement, faints.

The next day, Bilbo, to his shock finds that he really wants an adventure in his life and rushes off to join the dwarfs and Gandalf on their journey. On the way to Erebor, they run into a lot of trouble, like in all adventure stories. From Trolls, Wolves, Orcs and all sorts of creatures. One of the best scenes of the movie is when they are climbing a mountain, only to find that it is a rock giant come alive and do battle with another rock giant, with the adventurers clinging on to the moving rock. Azog the Orc king, hunts them with his wolf band, because of his old enmity with Thorin Oakenshield, the leader of the dwarfs and the only living prince of Erebor. But in a cinematic moment (with cinematic licence) Bilbo saves Thorin’s life when he is about to be beheaded by the Orcs ( something which is not in the book) and Thorin apologizes for the rough treatment of Bilbo till then.

And then comes the highlight of the film, Gollum’s entry (the claps/whistles in the theatre were equal to any seen in a Rajnikant movie). When the dwarfs and the hobbit get separated during a flight from the chasing orcs, Bilbo gets lost in the deep dark subterranean cave  where Gollum lives and has lived on for centuries preying on everything living, with the help of his magic ring “my Precious” which makes the wearer invisible to everyone’s eyes. The ring somehow (magically) falls down from Gollum’s hand and is found by Bilbo who then has a nasty encounter with Gollum where they ask each other riddles (instead of fighting), the wager being, if Bilbo wins, Gollum will show him the way outside, but if Gollum wins, he will eat Bilbo. Bilbo manages to win that contest by asking “Guess what’s in my pocket?” which Gollum cannot answer even in three tries. Gollum treacherously refuses to accept his defeat but instead searches for his ring to wear (become invisible) and then kill Bilbo. That’s when he realizes what Bilbo has in his pocket and with murderous rage, chases after Bilbo. Bilbo manages to avoid him by wearing the ring on his finger and becoming invisible and Gollum takes him straight to the cave entrance, thinking Bilbo will have to pass there somehow. This Bilbo does, by taking one long, clean jump over Gollum’s head and rushing off outside to join Gandalf and the dwarfs waiting for him. And that’s how the one ring comes to Frodo in the start of the Lord of the Rings.

There are a lot of guest appearances in the movie from the LOTR series, Frodo is shown early on, as are Elrond and Galadriel the Elf lord and lady. Even Saruman the white is shown as a good guy before he turns to evil later on in the Two Towers. But the best new character has to be Radagast the Brown another wizard, who goes about in a chariot drawn by a dozen rabbits and who, though he looks like a comedian in the beginning, shows his stuff by going alone to Dol Goldur where Sauron, the dark lord lives (called as the necromancer in this movie but shown as the Burning Eye in LOTR) and battles to death a dread lord of Angmar, before escaping with his sword as evidence. Something which even Gandalf doesn’t do in any of the books. 

The director Peter Jackson has indeed brought alive the book as a well made film (one book into 3 films) and has left me salivating for part 2. And oh, the last scene of the film shows the Dragon Smaug opening his eyes and looking angrily at someone making a disturbance outside his house. With more to follow in the next part. To be released sometime in June, 2013.

P.S. On a related note, I really should grow up and stop behaving like a teenager. I really should stop acting first and start thinking later. And really, really stop jumping into things given the smallest opening or slightest chance. And although I am feeling like a god and grinning all over, courtesy all the adventures I had today on my quest to watch this movie. Its time I stopped pulling rabbits out of the hat, time I stopped charming, charming little ladies and time I stopped dicing with fate to do things I had set my mind on. It’s really past time I grew up and started acting my age. Like Bilbo Baggins I should write about my own adventures someday later on and leave you with just this review of The Hobbit.

(Images Courtesy: Google Images)