Look Before You, Uh....Cuddle...

Look Before You, Uh....Cuddle...

Can you tell the difference between something which is let’s say bony hard and something else which is stony hard? I mean how hard bone is and how hard a stone? Can you tell the difference by feeling with your hands, just your finger tips, eyes strictly closed? Well if you are able to do so, congratulations you just passed the general surgery paper. Hold on, wait a minute, before you start throwing things at me and let me explain the above example. Contrary to what is generally believed in surgery- treatment is only half of what you do, the other half- shall we say the better half- is diagnosis, the finding out of facts and deciding whether they are worthy of being operated on or simply require drugs to cure. No one wants to undergo unnecessary surgery do they? And that’s the reason learning diagnostic skills plays such a large part in medical training. If you can see it- you can kill it (probably) a concept which predates drone warfare

But there are diseases and diseases- some common place, some rare enough that you read about them only in text books and suddenly remember a particular line from the book staring at your face when quoted by a patient to you out of the blue. Your mind goes "oh wait, i know this, I know, now where did i read this? Which subject? Which book? Was it in so-and-so textbook? Yep I think so. So let me confirm it by going along that path and asking more questions". And that’s how the diagnosis for most of the common diseases gets done. But sometimes, rarely, no one knows what the actual disease is but we can still identify the symptoms and treat the disease without putting our hand on which specific organism actually causes the disease till the lab results come out positive and then you go "Hold on, oh shit, this one? Isn’t this a zoonotic (animal) one? How did it ever.....?" And based on those test results you start asking the patient specific questions like "how many pets do you have at home? Do you ever pet wild and rabid animals on the street out of the goodness of your heart?" and the answers finally make some sense.

So the story i am about to tell you started a couple days ago when i was a referred a patient for opinion on her enlarged lymph nodes in the neck area.  In India any enlarged lymph node is automatically (and rightly) suspected of being tuberculosis. But identifying Mycobacterium, the organism which causes Tb is fairly easy - you just need a chest x -ray or like i said in the first para if you can put an hand on the enlarged lymph node and press it down and it feels rubbery firm then you can suspect TB and go on to order blood tests. At the risk of repeating myself diagnosing mycobacterium tuberculosis is  easy but treating Tb is a different kettle of fish- that mycobacterium is one tough sonofabitch and doesn’t die easily.

Anyway to return to my story once you rule out TB as the cause of enlarged lymph nodes the next obvious suspect is a cancer - lymphoma, thyroid cancer and stuff like that. And again as I said in my first para, if you start pressing the enlarged glands and find them to be stony hard and fixed to a point -then you scratch your head and wonder how you are going to break the news to the patient that they "might, just might" have cancer pending further tests to confirm. But for this particular patient the diagnosis of cancer was ruled out because the doctor who had seen her just before he sent her to me had taken a CT scan which pretty much ruled out cancer as a possibility. He suspected an infection and he sent her to me.

I suspected an infection too- a chronic or longstanding infection - but like all the other doctors who had seen her before me I just couldn’t pin her down to which infection. So as i always do when in doubt, i went back to the beginning. I sat her down in front of me and asked her to tell me the whole story right from the beginning and assured her that there was no hurry and we had all the time in the world as if she was my only patient for the day. And that’s how i got my first glimmer of a diagnosis when she talked about her initial flu-like fever and a few weeks later developing those swellings and as she went on and on I suddenly noticed the profuse white hairs scattered all over her black salwar dress. The patient before me was in her mid-20's and still had most of her hair on her head and i could no way think of any reason why she should have so much hair fall in a single day- besides her hair (even if dyed/colored) was still black while the dress was covered in white hair. Voila...the violins sang somewhere and I had cracked the case in my best Hercule Poirot style.

"Do you have any pets at home" I asked interrupting her long story of how she hated eating only bread due her fever. "Yes" she said, "I volunteer with the animal adoption drives on facebook" she said and then continued "I have two cute little kittens at home, they very cute and playful animals doc, they can never be separated from me, they even sleep on my chest at nights" at which point I removed my spectacles (TV doctor style) to peer at her and then i wagged my finger at her (couldn’t resist) and said  in my best i-am-the-expert voice "Ah, Ah, You have a zoonotic disease passed from animals to humans. It might be Ebola- in which case you should be dead by now, might be Crutzfeld-Jakob - in which case you will go mad before you die. Anyway let’s send you for a blood test for the most commonest cat disease- Toxoplasmosis" and then i wrote her a PCR test for Toxoplasma gondii- a parasite which usually lives in cats but sometimes infects the cats owners too.

The rest as they say is history - the PCR test came back positive and we started her off on Clindamycin and Pyrimethamine- all good solid parasite killers which can take care of a little parasite called t.gonddi without breaking a sweat. And I sent her back with a warning to stop cuddling with those cute little kittens all the time (especially at bedtimes) and instead get a man to keep her bed warm at night (actually I didn’t say that outright but sorta implied it). I further pontificated generally on how dangerous animals are to human beings who don’t recognize the truth and gave a few examples like - bird flu, swine flu and HIV all of which had come to us humans (mostly to single ladies) courtesy of those cute little animals.

And that’s the point of this post. Actually there is no point to this post, but if you are still reading this the take home message is - stop cuddling animals and go cuddle with other humans.

The Curious Case Of The Judge And The Intern.

The Curious Case Of The Judge And The Intern.

Disclaimer....Although this looks like a long post do bear with me and read on for the juicy parts come right near the end. Releasing for the first time on the Internet the secrets of the casting couch and candid confessions.

Every evening when i return home from work i switch on the TV to relax a bit before sleep. I mostly avoid watching news channels as they tend to be repetitive and loud- all of them dealing with the same "breaking news" issue and screaming people on TV is the last thing i want to watch after a stress filled day at work. Last night I accidentally switched over to an English news channel and as i passed over all the news channels in rapid succession they were all screaming and pontificating on the same issue- no, not about Salman Khans miraculous virginity- the news was about the complaint filed by the former intern of a retired judge who has accused him of sexually harassing her during the course of work. As I watched disinterestedly all the media persons were screaming about stringent punishment for the retired judge for rape which only proves that the talking heads on national media are poorly educated and cannot differentiate between workplace harassment, sexual harassment and rape- each one of which is a completely different issue.

Now, workplace harassment is one of the most commonest things we face (everyone faces) in employment- - it includes sadism, favoritism and outright abuse of power sometimes. And the thing about workplace harassment is you can take it on the chin, bitch about it and still continue to work there. But sexual harassment is an entirely different kind of fish. Any sane person’s first response to sexual harassment at work is to flee from there - career prospects notwithstanding. After all if you are intelligent and talented and believe in yourself- no single job is necessary for you to survive - you can always explore alternate options rather than submit passively to the worst kind of torture. No job is more important than individual dignity and self respect and sanctity of your own body.

But if you make the choice to continue in the job despite the harassment then it means only one thing - that you are willing to compromise for your career. No amount of bleating about it and complaining later on - in this case after more than two years- is going to change the fact that at the crunch time- you made the decision to put your career ahead of your dignity and opted to adjust rather than complain. To complain later on about rape- when you no longer need that persons help in your career - is an insult to all those honest women who put their self dignity above any temporary advantage in their careers and took a principled stand against harassment. Is an internship which is an unpaid, voluntary, not explicitly required part of a degree worth all the pawing and fondling for months together? I just don’t get it- maybe i am a different breed. But who am I to complain about the farce of it all? The media has decided that the girl is right to raise it now (after all these years) and the all-powerful media is never wrong is it? I just hope that real feminists who fight against real harassment do take note of this. Such selfish behavior is what spoils the entire fight for justice, doesn’t it?

The reason I am so worked up about this issue is I had an almost similar experience when I was a young stripling looking out for some off-college practical training. The medical profession in India is almost like the Sicilian mafia- you have to be born part of the family to belong. As a first generation entrant to the profession i found that the lack of pedigree/influence meant there were no takers for me even when i volunteered to work for free. Almost all of my course-mates had a family member (fathers) in the same profession and they just had to pick up a phone and make a call for their children to win internships. And as an outsider i had to depend on pure dumb luck to land one. And so when I heard about an opening with a famous lady surgeon in Anna Nagar, I promptly turned up (at the break of dawn- early bird gets and all that) to beg for an opportunity to train under her. The only time she showed any interest in my interview was when i mentioned that my hobby was dance and I was proficient in salsa and other Latin forms (remember- I told you this was in long bygone days).

Anyway after assisting her for a couple of days i had a weird experience on my third day at work. After the work day was over and all the patients sent home and i had cleaned up and got everything ready for the next day, my boss who i had assumed would have left for home by then came back inside the operatory and locking the door behind her she switched on the music system with a personal CD and then dimming the lights, started swaying and gyrating in front of me as if in a trance with her eyes closed and her body moving provocatively. As I stared flabbergasted and unsure how to react, she moved closer to me and said "you told me you were a dancer too, come dance with me" and she held out her arms to me.

Orders are orders and when your boss asks you to hop to it and dance you just dance with no qualms. But i had not bargained for such an intimate dance as my boss held me close to her and bumped and grinded her body with mine. Remember that I was barely out of my teens back then and I didn’t have much of a mental control over my raging hormones and so I should be excused for the immediate reaction of my body to this close intimacy with a female body. I was a raging bull in seconds and the fact that she was actively encouraging what was going on (responding equally) very nearly made me lose my control and only the sudden remembrance that this was a woman who was old enough to be my mother brought some much needed sanity to my hot blood. And in that moment of sudden clarity I thought through what this meant- I may be an unpaid servant but if I gave into her wishes I would just be her kept man - the equivalent of a male whore. That sobering thought cooled me off instantly and I hurriedly disengaged from the salsa embrace and protesting "Ma'm its very late, I will miss my last bus home" I ran away from there without a second glance- as if the devil was after me. I never went back to her after that- even though whenever i pass through Roundtana and look at the name board of her clinic i sometimes wonder which unfortunate guy is dancing to her tunes now.

To tell the truth- the casting couch is not really limited to the film industry. It is quite common in India- happens in every profession and to everyone- both female and male. It is sometimes considered as the fastest and easiest route to professional success and there are people (some few) who actively look forward to persons in power with a roving eye to notice them and then plan to utilize them as the much needed elevator while others take the stairs. Sometimes you can’t but wonder how far you would have come up in life professionally if you had not kept your zip locked up tightly. And at other times your pride re-asserts itself and you are glad you didn’t sleep with someone who tried to use you just because they were in a position to do so. And at such times you can look at yourself in the mirror with quiet pride- knowing the truth that you never compromised for anything.

Which is why i say that the time to protest sexual harassment is the very first time it happens and not years later. But if you keep quiet, accept things, finish your internship, get the internship certificate from the very same person, get recommendation letters from him to prestigious US universities, (as reported in the very same media) get free admission/fellowship/scholarship from US universities based on those strong recommendation letters obtained by keeping mum to the harassment and then after you have used up all he gave you and the old lecher had retired and is no longer of any benefit to you - to complain then after two or three years means that you are  not really serious about it and never were. To use a well worn cliché- it’s not Cricket.

So what do you think? do you think the intern blameless? (Like the media does clearly -for you must have noticed that not a single media person has asked her about either the delay or those recommendation letters) Or do you think both of them are equally at fault? One for exploiting his power and the other for exploiting his weakness? And whoever is to blame do you think that all this hysterical media-lynching is justified? Doesn’t the national media have any other worthwhile issue- like the state of the nation, its economy, the Chinese aggression on the border to report? Why do they look for soft targets and beat a dead snake? Is this issue worth 24/7 coverage on ALL CHANNELS? Do let me know your thoughts.

Why Blame It On Alcohol?

Why Blame It On Alcohol?

There is a rule in psychiatry called McNaughton rule. This rule applies to anyone who is accused of committing a crime and then claims that he was mad or insane when he did the alleged act. This rule was first introduced almost 150 years ago in England when a guy called Daniel McNaughton tried to kill the then British Prime Minister Robert Peel but instead shot dead the PM's private secretary Drummond whom he mistook for the PM. When the assassin's lawyer later claimed that he was mad and hence should not be hanged but sent to a hospital for treatment- the McNaughton rules was formed. These are a bunch of criteria which determine whether someone is really insane or just feigning insanity after the criminal act. It includes criteria like checking to see if the criminal was already undergoing treatment for his condition before the crime or if it is just a newly developed condition (thought up after the crime) to escape justice.

I am not a psychiatrist and I don’t remember much of the rules (refer to Wikipedia for full details) but suffice it to say that the rule in McNaughton helps in preventing false alibis and avoiding responsibility for crimes committed. The general public in India is very familiar with McNaughton's rules (even if they don’t know the actual name) because we are used to seeing our politicians get sick (mostly of heart disease) whenever they are accused of a crime and are about to be arrested. Almost every single politician immediately suffers from chest pain and gets admitted in hospital doesn’t he? And by the time they get discharged from treatment the initial media scrutiny goes away into yet another “breaking news" and so they are never held responsible for their actions and crimes.

Likewise there are a lot of people out there who do things knowingly and then get away easily by blaming it all on alcohol. As far as I know ethyl alcohol when ingested in large quantities degrades fine reflexes, causes loss of balance and impaired (double) vision - which is why drunk drivers cause accidents. But alcohol in no way encourages crime- crime which was not previously in the persons mind before- to say so otherwise is to lie. Alcohol provides an alibi for doing many things, things which people lack the courage to do so but always want to do. It’s like the guy who is always afraid of his wife’s stinging tongue coming home drunk to beat up his wife and then blaming it all on his drunkenness - even while secretly enjoying getting even with her abuse.

                                                                                                         

It’s like getting inside a lift and cleverly pushing all the buttons of the lift to make sure that it does not stop at any single floor and then going down on your knees in front of a girl young enough to be your daughter (daughters classmate in this case) and after forcibly lifting up her skirt and pulling down her panties indulging in cunnilingus (oral sex) with her despite her attempts to escape from your grasping hands and your probing tongue violating her body. When it is such a difficult sexual act to perform for even sober men is it scarcely believable that a drunk man could do it with ease all the while physically controlling (with brute strength) a struggling girl? And how does an intelligent man expect other intelligent people to believe that it was all done in a state of drunkenness? If alcohol had a voice of its own it would be screaming in its defense. (And as a side point I wish someone would explain to me what real purpose is solved by the police insisting on a potency test when it was not a question of erection or penetration but oral sex? I know rules are rules but do they have to be applied so blindly all the time?)

Anyway the point of this post is that when people get drunk and do certain things - they do it clearly and soberly knowing what they are doing and enjoying the act of doing. In fact they may have even planned it and fantasized about it for long and were just waiting for the right set of circumstances to do it. Blaming alcohol for their actions is like pretending to be mad after assassinating the prime minister. Doesn’t wash. There are no drunken crimes- there are only crimes. And all of these crimes are committed by cowards who use alcohol as an excuse. So the next time someone blames alcohol for their actions- it means they are not brave enough to admit that they enjoyed what they did regardless of the consequences. And not because they were drunk. So any number of apology letters blaming alcohol for causing and I quote “ a temporary lapse” is just splitting straws and throwing chaff. Even without alcohol this one was waiting to happen given the right circumstances and it finally did. Isn’t that the truth?