“In your light I learn how to love.
In your beauty, how to make poems.
You dance inside my chest
where no-one sees you, but
sometimes I do, and
that sight becomes this art.”
― Rumi

Monday, November 27, 2006

evidence based rantings

Two things happened today that made me reconsider the possibility of TV as an intelligent medium of communication. There was a program on animal testing in research from both perspectives (researchers vs animal rights groups) and there was a 10 minute feature on Neswnight on creationism vs evolution.
Both evoked strong feelings in me and the program on animal testing especially had my full attention as it raised so many issues.
I admittedly view animal testing from a skewed perspective, being a researcher (not an animal researcher, but nonetheless). But acknowledging my bias helps me to factor that in when I think about this.
To understand what happens to us humans in health and disease, we need to chart out the structural and functional features of biological systems which is a painstaking process done with the ultimate aim (not all biological research, but certainly medical research) of improving health - of humans.
What we know now to be 'basic concepts' in biology, especially the structural aspects, are somewhat easier and less controversial to study: for one basic reason - that a structural analysis does not always require intact functionality of the subject. In other words, tissue removed from humans or tissue of dead humans are adequate for a significant proportion of structural research. Moreover, society in general accepts research on dead humans as long as this follows an acceptable 'code of conduct'. However, it is easy to forget that this acceptance was not inherent to society. The gravediggers of the past who were the steady source of illegal 'research material' for anatomy scholars, now part of medical lore, is the proof of the changing attitude of society towards medical research. Moreover, this acceptance has lead to sufficient research on the 'real thing' to allow highly detailed computer reconstructions of structure, mainly because we have not mutated in the last 400 years and therefore this 'steady state' of human anatomy has allowed us to catch up with our 'cutting edge' technology. Increasingly such artificial models are used in education and training.
Functional research poses a different challenge and one of the main limitations is the inability on the part of humans to design adequate artificial functional models. This open admission of insufficient knowledge is also the most significant reason to pursue research - without observing the functional aspects of a biological system how can one 'design' a simulated model? Moreover, this inherent complexity of normal function means that alterations in function which underlie disease in humans are even harder to understand. In other words, diseases have not shown the decency to stay the same while we catch up with our 'cutting edge technology'. This dynamism is the main reason to strive ever harder, exploring all available avenues knowing fully well that all this effort may only scratch the surface of the problem.

This is where animal research comes in.
Again, from a research perspective, animal studies almost always focus on a single scientific question. It is usually not a case of mad scientists in their blood splattered lab coats fighting over a carcass and running off with various innards of the poor animal. Yes, if simultaneous studies are going on in the same lab, different researchers may use the same animal but that surely is not a bad thing as it means using less animals overall. Also, not all animals used in research are killed or maimed as there are functional or behavioural studies which do not result in any harm to the animals. There are also strict protocols to be followed when using animals in research, starting from the initial research proposal to the ethics committee review through to the publication of results in peer reviewed journals.

I get the feeling that the main reasons for animal rights groups to intervene (and in many cases, violently) are:
1. The animal is subjected to pain
2. The animal is helpless and has no choice in the matter
3. The living conditions of the animal are not ideal
4. Researchers are motivated by their vested interests (i.e., more funds, more publications, more results) and do not care about the welfare of animals
5. Just like racism, speciesism is wrong and researchers are guilty of this

This line of argument raises a lot of issues which I have been trying to figure out in my head:

1. subjected to pain: researchers follow anaesthetic procedures similar to what is employed in surgery on humans. So pain is something that is kept to a minimum.
However, this raises the question of differential response on the part of animal rights activists: why is it that there is no furore on the use of zebra fish embryos or the fruit fly in research labs? All the anger and resistance seems to be against research using mammals or primates. Why? Because they are closer to us in the way they respond to pain? Because they have identifiable body parts we can empathise with? or because they generally tend to have large mournful eyes and chubby furry bodies? Is this response really in proportion to the cuteness of the research animal?
How do we know that invertebrates or non mammalian vertebrates do not feel pain? Because they lack the pain receptors that we readily identify in higher animals? I have not seen a single species (including plants) that does not avoid a noxious stimulus. The way they respond might be different but nonetheless one cannot assume that they do not sense pain (if not pain in its human sense, atleast an instinctive response to avoid harmful stimuli). And yet, I see no animal rights activists outside high schools and colleges where non-cute cockroaches are massacred in their thousands each year.
Also, there seems to be a context to these issues. Far more rats and mice are killed as a part of pest control when compared to research. No one seems to be of the opinion that fieldmice also need to live and therefore have equal rights to the food we carefully store.

2. Issue of consent: This is difficult to address and I cannot say that researchers ask first before using animals for research. I can only say that the same justifications apply to the killing of animals for food or to improve sanitation or economy of a community. I cannot see research as something that is especially evil. On the contrary, if you compare the method of killing a rat in an trap as opposed to in the research lab, it is obvious that more care is taken in the laboratory.

3. The living conditions of the animal are not ideal: a research lab is not a safari park and it cannot function as a useful research lab if access to animals is difficult. Again animals are kept in cages which are no different to what you would use for a pet. Adequate feeding and rest for the research animal is crucial to the success of a research project. If only to reduce variability in results in a study, if not for altruistic purposes, animals are generally well looked after - maybe just like looking after cattle till they are led to the meat processing factory.

4. Researchers are motivated by their vested interests: why is it that people assume that someone in research is somehow 'different'? We live the same life with the same hopes and fears and insecurities and aspirations just like anyone else. How is using an animal to conduct research somehow worse than being a cutthroat businessman? If anything, the researcher makes less of an adverse impact on human society. Moreover, the drive for a majority of scientists is the opportunity to contribute to the improvement of health in human society, however corny that sounds. It is rare for animal torturing psychopaths to pursue a research career and I am yet to see one of these.

5. Speciesism: Very difficult. I readily accept that we are doing animal research because we are the top of the food chain. I have heard 'what ifs' about a hypothetical society: what if there was a super human race who take a fancy to us humans and decide to test their hypothesis in 'lower animals'. Imagine that you are walking down to the corner store when suddenly this superhuman race (of super furry animals? who knows) grabs you and starts sticking electrodes in your brain. How would you feel then?

Yes, good point and again I do not have a ready answer. But let me just say this. If there is a new drug which might save your mother's life or reduce the pain that your sister goes through, would you rather it was tested in your son first or in a furry little lab rat? Or would you rather not test the drug and continue to see your loved ones suffer? Or would you electronically calculate the presumed effect of the drug in a 'complex mathematical predictive model' and based on the figures adding up (or not) on the snazzy LCD screen, give the new drug to your wife without any anxiety whatsoever?

If biology was simple and straightforward like a cardboard box, it would be simple to predict how it would 'behave' in different situations. But (un)fortunately, that is not the case. The sheer unpredictability of biology is what drives research. Also it is very important to remember that for all our arrogance as a species of high achievers, we have no more than very basic information on how we function. This awareness of ignorance is what stimulates research - not the overwhelming desire to stick a knife in a helpless furry animal.

I would like to see how many animal rights campaigners refuse medication when they are ill because it has been tested in animals at some stage in it's development. I cannot ignore the fact that we test on animals because we happen to be higher up in the pecking order of evolution. That is something all researchers have to come to terms with and create their own independent moral justifications for. This is where the concept of greater good comes in and that is all I have to say about it.

Saturday, November 18, 2006

Broosli on a Laamburrtta

It is raining in Leicester.
As I drag my feet to work on a wet, gloomy morning I suddenly remember my green rain coat. When I was five, I had this green plastic rain coat complete with a detachable hood (attached to the collar at the back with a button that only my mother could fasten or undo - I used to spend hours fiddling with the damn thing!). I had to wear it to school every day during the rainy season (who was the bright spark who came up with a school re-opening day smack in the middle of the monsoons?). Looking back, I must have looked a sorry sight with my raincoat, my umbrella (yes, my mother insisted on both, the umbrella to keep out the rain drops that fell tangentially!), my corpulent schoolbag and my water bottle. I guess it helps the imagination a little if I say that at that time I was almost as wide as I was tall (or short, more to the point).
And then there were other times when I used to wear my raincoat.
At night, before my brother was born, and probably for a couple of years afterwards, my father and I used to go out for movies on his slate grey Lambretta (I used to call it 'Laamburrtta' in typical Malayalee fashion). I did not know it was an Italian company till about 15 years later.Anyway, we used to go for the 'first show' (starting at 6:30 PM). My mother never used to come with us - she did not like English movies. So my father would start up his Laamburrtta and I would tell my mother: ' Amme, going to see Broosli'
I did not know that Bruce Lee was Chinese or that his movies were quite violent or that his name was Bruce Lee and not Broosli.
So we would go and see Enter the Dragon and Fist of Fury and all the other Broosli movies. The cinema was called Crown, near the centre of my home city, Calicut (Kozhikode for puritans). The ageless, diminutive usher who knew my father from his college days would say something silly to make me laugh as he tore our tickets in half and pointed the way with his 'Yevereddy' flashlight. I would sit through the movie with my jaw hanging loose amazed by Broosli's dazzling 'nunchaku' (I had to look up the spelling on Google) stunts and his trademark feminine howl that punctuated his kicks and jabs. During the intermisssion my father would buy 'masala kadala' (peanuts smeared in masala) from the vendor near the toilets and then give me a taste of his 'Gholspot' which would make my nose run, but make me laugh nonetheless.
After the movie we would dive straight into the madness in the car park where about 12 cars and 200 two wheelers are squeezed into 25 square metres. Amidst honking horns and glaring headlamps, before we start off for home, he would ask me two things:
1. am I sleepy (for I have to stand on the footpad of the scooter in the circle formed by his arms and the handlebar for the 20 minute trip home)
2. am I cold (well, cold in Calicut is anything less than 21 degrees and that is after adding the wind chill factor)
I would say no to both and get on the scooter giving him a reassuring nod.
As we drove home with Broosli still fresh in my mind, my father would sing his favourite Hindi song, with the words 'Aanewale...something something'. (I found out 20 years later that it was the only song he knew and that he certainly, most definitely cannot sing!)
I would pretend that the speedometer was the control panel of a jumbo jet with all the various knobs and switches and the bright green light that came on intermittently (when he switched to high beam, as I found out later) and then one of two things would happen:
1. I would fall asleep and lean against his arms.
2. I would tell him that I am cold.
My father would then have to stop the scooter and open the storage compartment (which is just below the handlebars in the Lambretta, not to one side over the rear wheel - as in the Bajaj). Nestling amongst the paperwork would be my neatly folded raincoat, bright green in the fluorescent street lamps.
He would help me into my green raincoat and insist that I wear the hood, provided it was attached (if not, I would just wear the coat, for he could not attach the stupid hood to the raincoat either - like I said, only my mother could do that).

Then we would be off again:
the hum of the scooter in perfect harmony with my father's Hindi song while the flapping raincoat provided the percussion as I looked at the bright green light in my cockpit thinking about the flashing nunchakus and the commotion around my school desk the next day as I tell my friends about how I went to see ...
... Broosli on a Laamburrtta

Wednesday, November 15, 2006

Muse-sings

Last night was FAN...TAS...TIC!!!
Went to a Muse concert in Birmingham. All their hit songs performed live with a fantastic light and sound show to boot. Amazing. It was a shame my brother was not around, for I know he would have enjoyed it. They kick-started with Hysteria and went on to play Plug in baby and Butterflies&Hurricanes and Starlight and Knights of Cydonia among others. I got a free ticket at the last minute (thanks to my Prof(!), who kindly invited me to go along with her husband).
An 'almost packed' NEC, fan age range: 16 to 65 (mean probably 24, excluding outliers), about 12,000 people in all, of which I think 4 were non-Caucasian!
I was a bit apprehensive at first, for I had this mental picture of 10 teenagers with spiky hair and 52 body piercings between them kicking my head in with steel boots, shouting 'die asian scum' while the rest cheered them on.
Before the concert, near the gates, the security staff were checking bags. As I stood in line, I thought, 'Ok, be calm, don't act guilty when you are not!' followed by 'serves you right for coming to a concert where there are no other Indians (or Asians, if you will) to be seen. Now they will strip search you and bar you from the concert, because you look suspicious, just like those students on holiday who were kicked out of a plane for being Asian'. As we approached the security staff, my Prof (Caucasian) has her handbag inspected and I (complete with stubble, oversized jacket and a guilty look) was waved through.
It is embarassing to admit that I had these unfounded fears but that shows how 'integrated' people really are in a multi-racial society. Sure, there were teenagers with spiky hair and body piercings and then there was the older bunch in leather or denim jackets but all of them were there for the music. I certainly did not get any funny looks or comments from anyone, but I could see what might cause all this misunderstanding. It is about judging people at first glance.
I do not think that my feelings are far removed from those of a Caucasian at an Asian wedding or on a plane with young Asians for fellow passengers. Both sides have to recognise that the other does not mean any harm, that they are just different in superficial issues of daily life. If I had not gone to the concert because of my prejudiced view on how 'other people' behave, I would have missed a really great show and a fantastic evening.
Funnily enough, the whole thing reminded me of the title of Noel Barber's book: 'The natives were friendly so we stayed the night'

Monday, November 13, 2006

let me pick my neurosis

Him: You look uglier than usual
Me: Thanks for noticing
Him: Sleepless nights, eh?
Me: Can't get over it
Him: Surely others have been here before
Me: As if THAT matters!
Him: You cannot go on thinking about it
Me: I think I lack the capacity to accept it
Him: What's the big deal, it is just another birthday
Me: NO, it is not 'JUST ANOTHER' birthday , thank you very much
Him: Hey, act your age
Me: Very funny
Him: So what is the big deal about 30?
Me: I don't know, but I don't want to be 30
Him: Would you rather die then?
Me: Hmmmm... burn out rather than fade away, eh? No, I would rather be 29 for the rest of my life
Him: Why so?
Me: Because 29 is still related to 21 and 21 was a good time in my life
Him: It usually is in everyone's life
Me: I don't want to let go of my 20s. I am scared that I will suddenly turn all grey and old and wrinkly if I turn 30
Him: But you know you won't
Me: What if I do inside?
Him: You are making this unnecessarily complicated. Just go with the flow
Me: Do I have a choice?
Him: You can choose not to be obsessed
Me: You see, this is something I can't fix and I can't run away from
Him: Surely things in your life do not fall into just those two groups
Me: Umm... they... usually do...
Him: What is it that scares you? That you are nearer to death?
Me: Oh, don't try your psychology crap on me. It is hardly that simple
Him: Well you tell me then
Me: I feel this urge to evaluate, to assess, to score ... my life so far. To see what I have done with the youth I had, to see if I have proven the same old cliche...
Him: Youth is wasted on the young and all that?
Me: Yep
Him: And what have you found? How did you score?
Me: I don't know. I can't seem to score enough
Him: Why? Were you expecting to win a Nobel prize by 30?
Me: That would've been nice...
Him: Does 'delusions of grandeur' ring a bell?
Me: Really, so funny, you should try stand up
Him: You know what I think?
Me: No, but I think I am about to know
Him: I think you are just vain, all you want is someone to say ''you have done well to get to where you are at your age''
Me: Am I that transparent? Surely I have more needs than that
Him: Well, then tell me what is your way out of this?
Me: I don't have a way out, you see. For the first time in my life, I am facing something that I cannot get a grip on. I don't want to be 30, because 30 is the age when you lose your links with your youth, 30 is the age when you just accept that you get on with life and live out the rest of it, 30 is the age when you stop being a son and start being a father, 30 is the age when you have no more excuses for your mistakes, 30 is the age when people no longer see you as young, 30 is the age when you have to choose a different option on drop down menus, 30 is the age when your body starts to tell you that it's getting on, 30 is the age other people get to while you sit comfortably in your 20s, really, it is as if I have lived all my conscious life in my 20s and now I have to move out - no I am being kicked out, for I no longer belong in here where things are still fresh and new and exciting
Him: Well you left out something
Me: What?
Him: Looks like 30 is just the perfect age to have an early midlife crisis
Me: Who said it was early?

Monday, November 06, 2006

bereavement

I went to a charity evening this weekend. Held in memory of someone I had come to know and respect and love in the short time I had known him. When I looked at the full town hall - full of people who knew him and respected him and loved him even more than I did, I came to realise one thing. This person had so many facets - he meant so many different things to different people. We had all come together to remember him and celebrate his life. The mood was definitely not dark or glum or sad. There was song and dance and speeches and food and laughter. All through that, there was a feeling of loss deep down.
On my way back, I thought about why he meant so much to ME - someone who was just on the outskirts of his circle of friends and relatives. I thought about why I had felt the way I did when I heard the news more than a year ago, considering that I had only met him a few times, mainly in the company of a lot of other people.

I first heard of him before we came to UK - he had given my wife (who was not my wife then) very valuable advice about her career development. Then I knew more about him when my wife came to the UK - for he took her under his wing just as he would his own daughter. Whenever my wife talked about him, I had the impression that he was a person I would look up to, someone whose praise I would value.

I remember the first time I talked to him - after my engagement (after it was all 'official' and I could talk to her relatives). It was after I had passed my exams - in 2003, more than a year after I first knew about him. I still remember - we (then my fiancee, now my wife and I) were driving to London and she had called him to introduce me - I felt quite anxious, but he congratulated me on my success in the exam and he said he was glad things were slowly falling into place for me. I mumbled something inconsequential and passed the phone over to my 'fiancee'. The conversation stays surprisingly fresh in my mind - among the innumerable conversations I had over the last 3 years with mostly faceless people.

I remember the first time I went out with my wife to look for a house - we were riding in the back of his impressive and opulent Mercedes. He was joking and laughing with us - I was just drooling at the jaw dropping interior of the stately car! After he had seen our shortlist of houses, he said he liked one of them - the one I had liked the moment I walked in. Somehow that fact - that I liked what HE liked meant something to me (still does).

I remember my wife's exams - he used to conduct mock exams for her, being an experienced examiner for the Royal College of Surgeons. I used to tag along, more a driver to take my wife where she wants, hoping for good home cooked food at his house than anything else. I remember this Surgeon's prayer he had framed on his wall. We talked about it and I showed him the Physician's prayer I have had in my wallet since I first read it as a medical student.

I remember the last Christmas - almost two years ago. He was leading a 'train dance' - for want of a better description. It was after dinner at his house, there was music and laughter (as usual, when he is around) and he was weaving the 'train' in and around the furniture recruiting more 'cars' to his train by coaxing everyone including the reclining 'Aunties' to join the fun.

I remember the disbelief when I heard the news. It just could not be right. It just was not fair. I felt for his family, but I also had selfish reasons of my own. I wanted him to be there for a lot more things in MY life too. I wanted his approval and appreciation for a lot of important things I still have to do.

I did not cry then. For some strange reason, I just felt angry.

I went to his house afterwards - a few days later. I still had not cried - did not feel like it - till I saw him smiling at all of us from a photograph - he looked so happy and confident and full of life.
I didn't make a scene then - there were far more important people around whose grief was greater than mine.
I didn't make a scene last weekend either - in fact I have to confess I had fun being with so many people I knew through him, so many people I have now come to love - all through him.
I do not have the command over language that would do justice to how I feel about him and in someways, I think it is best not to try and crystallise in mere words what he meant to those who loved him.

Thursday, November 02, 2006

The sweet taste of bitterness

I think it is time to explain my title. I made it up when I was feeling very bitter. I had been working in the UK health system for about 5 years at that point, I agree it was not for charity and I did get trained during this time, but still things were happening that made me feel very bitter and cynical about the state of 'foreign' (read non-european, may be even non-caucasian) doctors in the UK. All the details are available to anyone interested for as long as Google is still around, so I am not going to bother with explanations.
Suffice to say that I felt very bitter about the attitude of the health service employers and the UK government towards 'overseas' (see above for definitions) doctors.
I guess it was all a result of the political upheaval in the UK

Asian terrorists...
Asian suspects...
Asian vs white riots...


In short Asians were the new bad guys (by the way, what does Asian mean? there is no ethnic group called Asian! This is a 'can't be bothered to know more, but gotta be politically correct' way of saying 'brown folks').

I had so much anger in me - directed at the terrorists who made my life unbearable when I was working in London. As an Indian (Asian to some), travelling on the tube was an ordeal, you are scared of all the other Asians around you, everyone else is scared of you - the potential terrorist and you cannot decide whether it would look less threatening to:
1. look at the floor all the time
2. look at other people
3. look out of the window
4. all of the above
or
5. none of the above.
I even thought of getting a T-shirt that said in loud lettering splashed across the front: NON-TERRORIST ASIAN, GOVERNMENT APPROVED but gave it up as a bad joke(?)

As these things were happening around me, I noticed one paradox - if you are a terrorist or even just a regular bad guy, you suddenly have a lot of human rights and people debate endlessly on whether you should be subjected to interrogation which may involve intimidation (leave alone torture). Also, the terrorist/bad guy gets away without paying tax/contributing to the economy/being useful etc. However, when it comes to someone who is working hard, earning a living, contributing to the economy, paying tax like any UK citizen, paying the home office all their exhorbitant visa fees and generally living a law abiding life, the system prefers to skewer him on a kebab stick, deep fry him and watch the fun.
Almost as if the official stand point is: we cannot find/punish/hold to account all the bad foreigners as they always slip through our net, so let us nail down the ones we know. So what if they are not the bad guys, someone has to pay for all the damage, right?
This attitude was reflected in the health service, where about a third of the junior doctor workforce are 'Asian' (i.e., Indian/Pakistani/Bangladeshi/Srilankan etc, but essentially non-white, non-black)
It was as if, overnight, the powers that be decided that they are not answerable to the thousands of such doctors left stranded by sneaky new employment/immigration laws - as if all the foreign doctors were expendable commodities like matchsticks or toilet paper. It was as if there was a drive to create a new and improved, well defined official pecking order, starting from the Alpha Plus White Male to the Delta - no - Epsilon Minus 'Asian'.
Well, that's me folks, an Epsilon minus in the UK, in limbo - trying hard to fit in to the society here and at the same time wondering whether I would fit in back home if (when) I am eventually kicked out.

I must admit though... all this bitterness tastes so sweet

Wednesday, November 01, 2006

From a crumpled tissue

I found this in my bag last week. I had forgotten all about it. I had written this about two and a half years ago. It was just after my marriage and we were on a houseboat in Alappuzha (Aleppy to non-malayalees). The houseboat trip was a gift from my wife's cousin (expensive too!). I was not very keen to start with. Having lived in Kerala for about 23 years before I came to the UK, I did not see the point of having a holiday in Kerala. Surely there is nothing special that I have missed. I wanted to spend that extra day at home - having had just 10 days of annual leave and facing the prospect of returning to UK in January, I wanted to make the most of my short holiday (nice going then, some might say, trying to have an Indian wedding AND peace AND quiet in a 10 day holiday!)
I will not say that I was dragged onto the houseboat by my wife, for it would be hyperbole. Suffice to say that she had to 'persuade' me like the secret police say in spy movies.
All that changed very soon.
I think I will just copy what I wrote on that piece of tissue paper (there was nothing else to write on within arm's reach on the houseboat):

To my children

You are not here yet, but then maybe I won't remember all that I have to tell you when you are - and maybe you won't have the time to listen when I do remember. It might be easier for you to leaf through this when you have nothing else to do... like me at this moment in time.
Today seems precious. I have unwound almost completely for the first time in three years. The static of thoughts and worries buzzing in the back of my brain is gone - exorcised by the beauty around me.
My own powerlessness humbles me - I am helpless in the face of such a display of grandeur. How can mere words describe the wind flowing around me with a whiff of raw rice from the paddy fields in front.
The boat sways gently as she sleeps in the wicker chair beside me - this is how she must have slept 20 years ago when I knew nothing about her existence, her 'being there' for me on this earth.
My ears suddenly open out to Nature - the sound of wind tickling the palm leaves, men talking in the fields, water sloshing against the bank, a distant motorboat, crows flapping around for leftovers - left by the workmen in the paddy fields under the hot sun near a river on which sits this boat - delicate like a piece of china on a shiny glass table.
Water...suddenly reminds me of PG Wodehouse. Lord Ickenham says 'There are wheels within wheels'. Completely out of context. But the big waves splashing against the wooden boat have hundreds of little ripples on their backs and these in turn have more little ''riplets?'' - I don't know what to call them. You would understand when you see it.
I feel my batteries recharging. A year's worth of blood and vomit, death and disease washes off me. This river has cleansed me and like the coconut trees parading on the bank I draw strength from this water.

It ends there. Maybe she woke up at that point (likely), maybe I spotted some food (very likely). I don't know. I do wish there was more.

Well. That's that.