why should I care?

All my life, I have looked after myself first and now that I am in a pickle, I moan that others do not care about the injustice inflicted upon me. Now that I have known what it feels like to be treated as an undesirable and expendable element in a community, I understand what it must be like (not fully, but atleast partly) to be helpless and poor and weak and illiterate and trod over. I cannot quench the self righteous rage that fills up every now and again, I cannot believe that the whole world is not saying 'Let us make Unni's life better, he deserves a better chance'. Then, in a brief moment of clarity, I realise that till now I was one of the 'have it, care not' bunch. Now that my life is difficult, I have started making noise about the unfair system. Maybe I should list the people I never cared about who I feel a kinship to now:

The poor - in general
The beggars
The illiterate
The mentally ill
The unemployed
The homeless
The orphans
The handicapped

the list goes on
Not that I was ever cruel or disrespectful to anyone, but I NEVER ever cared!

It has taken a significant extent of personal insecurity for me to even 'waste' time thinking about other people. And yet, I am still to do anything selfless to help these 'other people'.

Yes, I went into medicine to help others, but now I realise that the small print in my 'mental contract' said:
'I want to be given the knowledge and skills to make my life comfortable and make me happy and then to help others'

I also realised after I started my research that I am more anxious about my project than I ever was about any of my patients. I have never been rude or unprofessional or indifferent to patients, but the scale of anxiety is just not the same. I wonder whether it is just me who is this selfish!
The way I worry about my blood samples and my RNA and my data and my project grant - makes me sick that I never worried about the people I looked after to this extent, even though at the time, if someone were to ask me whether I cared about my patients' well being, my answer would have been a resounding yes.

I think the whole future of the British health system is in danger. I maybe one of the casualties of the current battle - but like in any war, the damage to an individual casualty pales in comparison to the damage to the system. Somewhere along the line, doctors have forgotten what they are fighting for, forgotten the face of their fathers, as Roland would have said (apologies to S King). The profession's shift in focus from 'high quality training and service' to just 'service and opportunistic training of variable quality' will turn out to be a death blow, when people look back at the current situation in 10 years time, wondering what went wrong. And through all this, the senior medical colleagues are silent - they have the attitude that I had about the homeless and the less fortunate - ' why should I care? '

This is nothing new. About 300 years ago, Edmund Burke said:
'All that is necessary for the triumph of evil is that good men do nothing'

More relevant to my profession, the great William Osler, who was not just a physician, but a great thinker summed things up very eloquently:
'By far the most dangerous foe we have to fight is apathy - indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self satisfaction'

The three reasons he gives for apathy sound uncannily prophetic, as if he has visited us in 2007 and seen the mess we are in as a profession.

I am sad, very sad, not just about my future, but about the crumbling system. It is akin to the sadness you feel when you see cobwebs and cracks in your childhood home, the same sadness when you see someone dear grow old and weak and confused.

And then I realise, all around me the world is rushing forward to meet tomorrow, with an attitude no different to mine when it concerns someone else:

why should I care?

circling the drain

it is all very grim
there is an all pervading feeling of inevitability

how has it come to this?
- a prescriptive government in denial
- leaders without concern or vision
- a community infused with apathy
- a lack of professional cohesiveness

...the list could go on

I went to an interview last week
the job was desirable, competition was stiff and the future was at stake
somehow, the whole approach reflected that of the current government
- treating people like 12 year olds
There were a lot of things I wanted to say, some of which they asked,
some they skipped and some I would never say in any interview.

maybe this is where I say the latter

how have you demonstrated commitment to your field?
to me working in cardiology is like living with the ideal life partner. I have fallen completely in love with cardiology and I cannot help it. There is nothing else that I can think of doing that will not seem like work. When I work in cardiology, I feel guilty about being paid - after all, they are paying me for doing what I want to do and love to do.
For 20 months I used to drive down from Liverpool to Aylesbury at 3:30 AM on a monday - to get to work by 8:00 AM and then finish the day at 7:00 PM. Never ever did I feel that this was a problem. As I crept down the M6 behind a mud splattering lorry, I was happy that I was driving to a place where I can learn and do some cardiology. In the three and a half years of marriage, my married life has been squeezed into my weekends and at no point did I feel that I could not carry on, for I was working in cardiology.

I have confidence in my enthusiasm for the subject - to the extent that I can make others fall in love with it just like I did.

commitment, can it be measured by experience and knowledge alone? what makes the 'bog-standard' answer describing the clinical and research achievements in the field a better measure of commitment?
To me, commitment comes from the heart, where as knowledge comes from the brain. A commitment at a mere cerebral level is not the same as a heartfelt feeling of desire and love for the subject.

If I were to categorise my reasons for wanting to work in cardiology, I would have to say:
1. cerebral reasons: intellectually engaging, requires lateral thinking, needs quick decision making
2. limbic/hippocampal reasons: love, desire, enthusiasm
3. autonomic reasons: a quickening of pulse, a pounding of heart, a nostril flare, a buzz

there is nothing else that makes me feel this way, which is why I want to do cardiology

Imagine saying that at an interview! I would have to provide complimentary sick bags to the panel!
Moreover, I can never convey my genuine feelings when I say this out loud. Which means the panel will always get the 'bog-standard' answer.

Anyway, coming back to the point - the interview process used to be a fun experience, as it was an opportunity to display the candidate's character and an opportunity for the panel to assess this. Not anymore, now it is a list of blinded, validated, politically correct psychometric analyses which according to 'experts' is the best way of assessing a person's capabilities.

I want to grab hold of the bright spark who thought this up, give him/her a good shake and say:
'snap out of it you idiot! if you want someone who just does a job,you will get that someone and the same someone will just roll over and die when you bring in the next reform which will be the death blow to the field.
However if you want someone for whom this is not just a job, but a vocation, a spiritual calling, someone who will stand his ground and guard the field he loves, someone who will inspire future generations to love the field, someone who is not just a worker bee, you are making a very big mistake'

Then I stop myself, for I realise why they want this new method of selection. Yes, the same reasons I said are their reasons, they know exactly why this is the best way forward. They want to clone sheep!

like I said, it is all circling the drain

electric blue

an ECG in front of me
all spikes and squiggles
patterns emerging in static
I close my eyes and see...
dark brown muscle
and waves of electric blue-
-current flowing through,
across and down the chambers
I wonder how this power surge
keeps the incessant pump ticking over
like clockwork, never missing a beat
(well, only occasionaly)
and I know
I just know
that I LOVE Cardiology

an ode to the mitral valve

She works away incessantly
ever compliant
without a murmur of dissent
this most unique and intricate figurine
at the centre of my heart

She dons a delicate filigree
While her oval face -
gently curved and delicately dimpled -
smiles as she endures
the onslaught of the brutal ventricle
whilst her maternal instinct
guards the little atrium

I think of all the millenia
spent in evolution
as Nature (God to some)
sculpted her to perfection
And I wonder how many
were enchanted
before her beauty
swept me away

car

crisp winter morning
my boots scrunch snow
like fresh apples underfoot

walking to work
the holly bush reminds me
of last year's Christmas cards

afternoon sun
a water droplet sparkles
clinging to my pipette tip

the tossed coin stops...
...in mid air
pensive?
it has a long way to go
and it is all downhill

multitasking for men - an idiot's guide

Adult learning, according to experts is based on experience. So rather than list out the various theoretical aspects of the above subject, I will illustrate by example using real-life scenarios and expect my adult readers (excluding my brother) to make their own conclusions and 'take home' messages from this short learning exercise.

The scenarios are divided into parts 'a', 'b' and 'c'. 'a' denotes extreme multitasking - while , 'b' denotes usual behaviour and 'c' is a useful suggestion which may help to achieve a stable middle ground.

the characters depicted in the scenarios are in no way fictional and bear an exact resemblance to living, breathing (sometimes halitotic) people

Scenario 1a:
My wife is filling out a tax return form while chatting to my brother on the phone - I walk in and ask her for her internet banking access code and she rattles out the 10 digit number, hardly acknowledging my presence and slips smoothly back into conversation with my brother while filling out Section 10.24 on the form

Scenario 1b:
I change the TV channel while having dinner, but momentarily stop chewing when I press the button on the remote

1c: train my wife to change the channel so that I can continue chewing my food without interruption

Scenario 2a:
we have invited guests for dinner and my wife does a bit of 'conveyor-belt' cooking - she starts with chopping some green stuff for one dish while boiling something else and simmering the third, at the same time, asking me to stir dish number four

Scenario 2b:
I skillfully stir the soup till the ringing phone diverts my attention and I drop the spoon in the soup

2c: convince my wife to prepare soup the night before so that she can stir it herself and then heat it up on the day, after she has finished with all the other things

Scenario 3a:
my wife continues to watch TV while I desperately try to set up a romantic evening, till she finds my antics 'cute', gives me a pat on the head and goes back to watching TV

Scenario 3b:
fume, double fume, personal thundercloud (go stuff yourself, multitaskers)

3c: the best made plans of men and mice...

bad moon rising

the world is caving in - shapes have collapsed, north has died, colours have forgotten their names, numbers dissolve into nothingness, above and below are vague memories, cannot make out light from dark - does it matter once you are blind?

what does a blind man see?
darkness or all encompassing light?
how would he know?
how would you know?
what do I hear?
is it white noise or deafening silence?

desolation

desperation

depression

the landscapes are all grey, barren and cold. Hope struggles upward through darkness and is born - battered, bruised and bleeding, only to be ripped apart by bitterness - feral and hungry.

the seeds, filled with innocence and eternal (?) hope, still dream, but they know not what waits above, for the dead tell no tales

I still have her and I still love her, so maybe I will not wake the dreaming seeds

giving in to beauty

there are very few things that make me want to close my eyes and give in to overpowering beauty

it may be something from a book or a poem:
Kahlil Gibran writing about death
William Golding in the closing lines of Lord of the flies
Samuel Shem in that final breathless nonstop flourish in House of God

it may be music:
Barber's adagio for strings
Tracy Chapman - the most beautiful and perfect voice ever
the twisting and turning soundscapes brought to life by Counting Crows

rarely it may be a movie:
that final scene from Edward Scissorhands
Donny Darko, especially when Gary Jules sings in the background

OR

what I saw today, arguably the best movie I have seen in a long time:

Pan's Labyrinth

I won't spoil it for anyone

but it is so perfect and beautiful and fantastic and imaginative...

rrrespect maan...

Lines from books that are just so perfect that I wish I could have written them (I hope this list will get longer with time):

''So I got older, till being grown was no new thing but just ordinary''
- Peevay, in Matthew Kneale's 'English Passengers'

Saying it as it is

'I have, for years believed that a man should be thoroughly educated or not at all. The middle way ... produces anonymous competent mediocrity, enslaved to technology and efficiency'
- Neville Cardus (the greatest cricket writer in history)

I think I should elaborate on this. There seems to be the danger of reading this out of context which may seem insufferably snobbish.
When I came across this, I felt it summed up a problem that I am very concerned about and which is likely to have a far reaching knock-on effect on society. These lines, written more than half a century ago seemed uncannily prophetic - about the current state of medical education.

falls, scabs and scary balls

I think I can summarise my childhood physical activity in to the above phrase.
I was never good at any sport, ever in my life - not even going down a children's slide. For inexplicable reasons, I would somehow manage to hurt myself and walk around like a sacrificial lamb who has been briefed regarding his grim future (yes, ok, my mother should not have paid so much attention). Take the slide for instance. I remember going to Lion's park in Calicut and getting stuck on the slide (usually I just freeze up at the top and gingerly go back down the steps, but that day there was one of those scary looking boys - freckles, missing front tooth, evil snigger, you know the type - breathing down my neck, so I had to at least pretend that I was planning to go down the slide in the near future). I remember lying down on the slide (when I sat up, the ground looked too far away and the slide looked too steep) and hoping for the best.
The slide was one of those fashionably curved ones and with me lying down, which the poor guy who designed the slide had not anticipated, I got stuck in the curve. So there I was, lying down on the slide, stuck about 2 feet from the ground while the boys behind me were getting more and more impatient by the minute. As I had closed my eyes at the point of departure, it didn't dawn on me till a few moments later that I had not touched the ground and that the ordeal was not over yet. I also realised that I did not have any momentum left to make my way down.

I calmly weighed up the options in my mind:

1. try and keep my eyes open for longer, look around me (and maybe even look down) and decide whether:
a. I should jerk myself loose by wiggling my bum
b. I should try to sit up and move down the slide
c. I should swing my leg over the side and chance a fall (yeah right!)

OR

2. listen to the advice +/- threats from the impatient boys waiting behind me such as:
a. 'curl up into a ball so that I can kick you down the slide' (very kind, but please don't trouble yourself)
b. 'stand up and run down the slide' (really guys, if I could do that, would I get stuck in the first place? honestly!)
c. 'get out of the way or I'll kick your head in' (hmm... that was clear enough)

OR

3. cling on to the sides of the slide, screw my eyes tight and cry out at the top of my voice till someone 'responsible' comes running

Strangely enough option 3 seemed the most sensible thing to do, so I did not waste any more time.

The end result was:
1. the boys above got frustrated and jumped on to the slide so that three of them bounced off my head, two plunged to the ground straight off the curve while the third rolled over me and cannonballed down the slide
2. I donated a significant portion of the skin from my palms and forearms to the slide trying to hold on for dear life
3. I lost one shoe and half my shirt pocket
4. Being of reputable character and of a friendly neighbourly disposition, the slide repayed my generosity in full, so that the whole of my back had a respectable coating of the slate grey top layer of the slide to replace the skin I had lost

The amazing thing was, all of this took no more than 48 seconds.

Like I said, it is all inexplicable

So I never bothered to attempt any sport whatsoever, but as my friends all liked sports, I HAD to go out and play in the evenings. It was only later (when we bought a TV) that I realised that there is no 'back goalie' in football or 'second wicky' in cricket. The truth was, knowing how 'good' I was at sports, my friends had devised a way of making me useful.

During a typical evening's play I would:
1. retrieve the football after a goal has been scored. The goal post was usually the space between two big boulders and the top bar of the goal post was an imaginary line above the goal keeper's head which is deemed reachable by the oldest boy in the group. This meant that if a goal is scored, the ball would shoot off into the undergrowth and then it was upto me to retrieve it (back goalie)

OR

2. retrieve the cricket ball if it goes wide and is too far for the wicketkeeper to reach (second wicky)

I must say I cannot blame my friends, for all kinds of balls scared me. I used to field at mid-on once upon a time (when I first moved into the neighbourhood, before my friends knew me), but I remember turning around and running away when the ball went up in the air and then came down straight on top of me (i.e., a catch). The football being bigger, you can imagine my response.

Nowadays, I just don't bother. I am quite happy sitting in a corner and picking my scabs.

do indians dream of white terrorists?

Feeling quite bitter. I am trying my best to separate my ego from the whole issue, but it is easier said than done. Two things happened last week that has brought back the sense of unease I used to have a year or so ago.
1 AM on tuesday in Liverpool. My wife is on-call. There is a difficult case and she asks for senior help. One of her senior paediatric surgical colleagues, an Indian who also happens to be our friend is on his way to assist her. He stops at a traffic light when a police car pulls up beside him. The lady officer asks him to pull over and step out of the car. He complies and shows her his NHS ID card and explains that he is going to the children's hospital for an emergency surgery. Her only response is 'I am glad you are not operating on me'. He asks her why she wanted him to stop. She says it is because she saw that his car was beginning to move forward when the light was amber, a few seconds before it turned green. He apologizes and says that he did not do this intentionally. She starts walking around the car as if inspecting it. He offers to bring his car into the station the next day and reminds her that he is on his way to help in this surgery. At some point in the conversation he addresses her as 'madam' and she latches on to this. She says 'in my language madam is someone who runs a brothel'. He recognizes then that this whole incident has racial undertones. Quietly he apologizes again and says 'I am sorry I do not know your language as well as you do and I am sorry if I caused offence without intending to' (he has only been in the UK for about 12 years, so I guess he is still only starting to pick up this strange language). After about 45 minutes of this he is finally let off. He asks for a receipt as a record of the 'offence' he is supposed to have committed, but he is simply asked to go. In the meanwhile, my wife has asked one of her other senior colleagues (English) to help her who arrives in a few minutes and they finish the case. He says he was stopped on the way for speeding in a 30 mph zone, but was waved on when he flashed his NHS ID. After they finish the surgery, my wife meets her Indian colleague in the doctors' room when he tells her what happened and why he could not be there to help her. It is ironic that all of them were trying to help a two year old child (need I say English) survive.
The next day I am making my way from Liverpool to Leicester. It is a two hour train journey. From the station, I get on the hospital shuttle that takes me to my place of work free of charge (provided I have my NHS ID card). I have two pieces of luggage with me, my shoulder bag and another bigger one with all my laundry and my food (long story - I work in Leicester, but I have a house in Liverpool, which means I get to see my wife and do my laundry and do the cooking for the working week over the two days I spend at home in Liverpool). Anyway, the bus is packed, so I pop the big bag in the luggage rack and stand leaning on a nearby pole till the next stop. People get off and I get a place to sit, so I take my small bag with me and sit down, till I get to my hospital. As I make my way to the front of the bus to get down, I notice the commotion at the front. I hear a lady frantically point to my bag and say 'I saw this asian get on the bus with two bags from the station. He got off at the next stop, but only took one of the bags with him. This other one is here and it all looks very suspicious'. The driver (an Indian) tries to reassure her saying that he is positive that the 'asian' in question has not run off without taking his bag. The lady does not listen. She repeats 'I am telling you, I saw this guy get off without taking his bag. This is all very suspicious'. While this is going on, I quietly take my bag from the luggage rack and slip off the bus without turning back. My immediate response (not verbal, but in my mind): 'go on b****, judge everyone everywhere based on their skin colour'. Then I think more rationally and I accept the fact that I cannot blame her for being suspicious. After all, 'asians' have not been at their best behaviour recently in the UK. Nonetheless, how convenient that asians are the new bad guys, for it helps people to develop and nurture their latent racism. I wish people would think from a slightly different perspective. To an Indian in India, a German and an Irishman and an Englishman all look the same, so how would the Englishman feel if he is blamed for the Nazis and the IRA? What if someone walks up to him and says 'when will you apologize to us for the CIA torture centres and Guantanamo?' I can see him seething self righteously and saying: 'I am not American or Irish or German, can't you see I am English?'. Well, how does he expect the Indian in India to differentiate between them? They all look white!
The only difference is, the Englishman's story is hypothetical, where as the Indian's story is real. I hate terrorists even more than the English, because I am as likely to die if a bomb goes off (strangely enough explosives tend not to discriminate on skin colour) and the rest of the time, I am a suspect. How I wish there were non asian terrorists so that people understand that it is not just asians who are the bad guys. Really, I do sometimes dream of white terrorists.