Monday, November 28, 2016


Infectious Diseases mortality trends

Crude Mortality Rates (per 100 000 Population) in the United States Over TimeThe x-axis and y-axis scale is different for each panel. In panel D, vaccine-preventable diseases for which vaccines are routinely provided in the United States include measles, mumps, rubella, varicella, diphtheria, tetanus, pertussis, polio, Streptococcus pneumoniae infection, hepatitis A, hepatitis B, and meningococcal infection.

' Action without reflection is mere experimentation'. This timeline encompasses the time when we entered medical school- 1996.  HIV mortality was at its peak and witnessing this peak period of so called medical helplessness had influenced me profoundly with respect to what I wanted to specialize in eventually. Much has come to pass since, and now we learn about an ab and an ib every week in the ever increasing advert pages of once venerated journals. HCV is the NKOTB but for those who have seen the pestilence of AIDS and associated OIs, Kochs included, the munificence of payors for Harvonizepatierepclusa seems too generous, considering that companies make a 1000% profit on these. The lumping of all infections is an oversimplified agnosia and does little justice to individual conditions, just like 'cancer' is not one condition and terms like cancer moonshot and 'beat 'cancer' a la CTCA seem as spurious as they are naive. However snapshots like these give opportunity to reflect - they are like a K Park's PSM perspective to a reading of  Harrisons. One without the other is going to leave you either a myopic or an out of context Frequentist

Hansen V, Oren E, Dennis LK, Brown HE. Infectious Disease Mortality Trends in the United States, 1980-2014. JAMA. 2016;316(20):2149-2151. doi:10.1001/jama.2016.12423

Saturday, September 6, 2014


Everyone is the sum total of his reactions to prior experience. As your experiences expand and vary,, you become a different person, your perspective on things evolves.. Every reaction thence is a learned conditioned one; every significant experience alters your ability to reflect/react and shape your next esperience. . This is a perennial and iterative process,  until perhaps dementia sets in. ( प्रतिक्रिया ही जीवन है और जीवन ही प्रतिक्रिया - वोह प्रतिक्रिया है जिसने चम्पू को दीन , गोकुल को धूर्त , और बंशी को विद्रोही बना दिया )
So it would seem foolish,  to adjust our lives to the demands of a goal we see from a different angle every day? How could we ever hope to accomplish anything other than becoming neurotic idiots who serve our neuroticism with to do lists, and a skewed frozen perspective which defeats the freshness of perspective.(दास्वीदानिया movie देखी ?)
Goals hence are meaningless. They make you arrogant when you achieve them, or restless when you stray. They give a linearity to a frame of learning which ought to me more circumferential or spiralling. They stunt life into meaningless non-memorable routines.Life actually happens to us in between getting from point A to point B. We laugh, cry, tense up, let go, sigh, exult and go through various other consuetudines of existence. In the interim we build various comfort zones to ward off solitude- family, love, career, hobbies. We mistake these to be life, yet when the gray cells age and company and productivity abandon us to solituide, we fear it instead of accepting it as the way you entered this world. All alone, naked and unendowed of anything but the ability to observe, react and evolve. 

Monday, September 1, 2014

Review of systems

Gen: hot and cold. Like ants in my brain. I am chill.lets see I lost weight when I was on a diet. Then I
         ate and regained. What's the difference between malaise and fatigue? 
HEENT: stop the nose, it runs. Away. I hear a symphony, not ringing in my ears. Does an itch in my ears count? I hid a babycorn in my nose when I was 3 and it just came out. Bad breath. Well, I fart the wrong way, will my mouth not be sore?
Eyes- when the joints creak, and vision fades,and calcium deposits in the arteries, a fine arc forms around the eye, want to see?
Cardiovascular: chest pain?- huh sometimes- fit me in your diagnostic model; palpitations- you mean heartthrobbin? ; yes, always with 3 pillows under my head; nah woke up to pee, not to breathe; If I don't breathe I expire, ain't I? If I do, I inspire?
Respiratory- Smoker's cough- always do, more of a hack I call it , sailor; blood - why would I have any blood in it; 2 blocks? I stay in the countryside; Nah , my cat wheezes......yeah shit she does....asthmatic feline
Gastrointestinal- Whaddya say? Noshia? Where are you from? No, I mean ain't born here were you? WTF is reflux? Heartburn? no, I get a sour taste sometimes. Lots of gas!!! Like I need to fart or belch. I like to have a 8 inch turd every 2 days or so. Not black, I make green shit. I wipe really carefully.No blood. Pooptube- nope, don't want one. Why don't you get one instead. Yellow eyes? Won't I look like a zombie?
Genitourinary- Quite a lot. I take an hour sometimes.No I don't have accidents, but wear them depends just in case. Burns in the tip. I shoot small and slow.I am pissing razor blades outta my pecker.Yeah, wake up 3-4 times to pee.
Musculoskeletal- Yeah my L4 and L5 is shot. Knees hurt when I run.Yes I have some disc problem. Spondolysis something. Yeah I got plates and screws in my back
Endocrine- Hot flashes, no I don't have them since I manopaused.I get hot and cold all the time. I eat like a pig. Don't drink as much I think. I am always getting dehydrated.
Integumentary- Have some sun spots. No lumps or bumps. No no...
Neurologic- I get migraines. I get numb, like my feet are asleep. No they feel numb. Isn't it the same- tingling or numbness? Yeah, I forget. No, I don't forget , I am pretty sharp.
Psychiatric- You think I am mad? Yes, I get anxious when I am taking a test.NO I am pretty upbeat.

Now why are you asking me all these questions? I just came with a urine infection.
You mean you want to cover your ass?
You mean you will miss things? I better get another doctor
I think you are very thorough. 
I think you ask too many questions. 
Why does everyone ask so many questions? I am tired. Let me sleep will you.
Everything hurts!! EVERYTHING hurts... period...
Jiyara ghabravat hai....phadphadavat hai, udat hai, magaj ma jhunjhunaut hot hai
Kaleja ma meetha dard hota hai
Kachu samajh nahi avat babu....bada ajeeb sa lagta hai....tum daktar hai na, pata lagav ke kahe hot hai

Sunday, July 14, 2013

Haazir hoon............

The VA on weekends can be eerily desolate with hardly a soul in its vacant corridors. You could get mugged and no one would know till hours later maybe. I am making my way to the fellows' office hearing my own squeaky shoes as I trundle more than walk, unsure of what to do next , except carrying out the ritual that i have unfailingly indulged in every day. Unfailingly perhaps out of meekishness, and fear of the unfamiliar if I did not. 
Of looking up labs, heading to patient rooms to see tired, unfrustrated veterans who have resigned to what may happen, almost fatalistically, also thankfully that they get healthcare amongst a paucity of other privileges. Of heading back to the office, reading the NY times, dreading a page for a new consult in the minutes before I decide to drive back home. What gives? 

I trundle, unplanned for the unplanned. If a UFO crashed in my path, I may not recognize the need to run to safety. Oh really! You critters are aliens. How bout that , eh. Mind if I get along? 

A new batch of interns, on the floors below, performs in Brownian randomness. Some misdirectedly over enthusiastic, some glad not to goof up. They are learning the right wrongs from their peers, speaking the phraseology, diuresing the dry, walking troponin plateaus, smelling the diabetic feet, getting high on nebs and vanco, smiling goofily at strangers who look on as they run athletically gracefully for code blues, in scrubs, green pixie shoes and dirty loaded lab coats and all, thinking for the moment , that this is it.....what I became a doctor for. 

Invariably, the final year resident/fellows are a more pessimistic lot. They have known the shibboleth, learnt from mismanaged codes and perfectas gone snafus, raked through piddleshit, got scutted out, had an inspiring encounter, and an insipid one, lost and redeemed themselves over and over. They know to locate the vocal cords, the subclavians, Mr Babinski's erection, flutters with 2:1, spectra of beta-lact-amazes, the right words to discuss end of life care, SIRSies and dopies. And this becomes a learnt exercise. Notes become less verbose, patients become lists, time off becomes more important than time on, and the present gives way to planning for future. 

They were once interns. 

The current interns will be residents and fellows later. This cycle goes on. At least for the observer. For the passenger on this conveyer belt, this training time will never come back. What started as passion becomes a profession. Notes become codified billing sheets, processes become bulletted problem lists, pathogeneses become DRGs, recoveries become hospital stays. Families expand, priorities change, anxieties are decentered. The angst at aimlessness is now felt to be a wasteful frustration. 

Get off the gas, clutch, lower the gear, drive on.

Times of changing gears are weirdly surreal. The knowledge of going into an unknown time mass feels like someone deafferented your gracile and cuneate nuclei.  I am sure all the interns felt this way leaving med school going into the real world. When I moved out of home, bag and baggage into the mosquito infested room in the KEM resident  quarters where 9 tired house men bodies competed for aedes aegypti lullabies and dry bath towels, among other things, I was as just as random, kibitzing around. I made my mistakes. I learnt. 

Times of change are good for stress testing a growth reserve as well. It is a good stimulus for the senses also. I think this country offers the opportunity to do this. At some point, you can clutch, raise your gear , and drive on. Along one of the long interstates.....someplace else.

Btw "htiu#" : that was the text of my 14 month old daughter's first tweet. Figuring out what it means...

Sunday, April 21, 2013

Random phraseology, that colored my growing up with pati

In no specific order. Am decanting here from memory, lest these were to disappear from recollection.No one would know what they mean, without having heard them uttered/seen.....

Aing oyang....
Pillapapiah / jemmy doctor
Lalla won Kulla enakku taa
Summa irukkaya swaroopata kattama
Pant doctor
Melleril/ Largactil/ serenace in a red white Fargo lantern box
Marwadi sainyam
Rajanna/Bebanna/Mani anna
Thanga taatha
Nandiyaal thelu
Aise chandrabhaaga aise bhimateer aisa vithevaara "Devakottai"
The swinging hips dance
"Jaala setthu poi lorry le eduthindu poghara"
"Ennadhu idhu"
The times Poona taatha would drop in at 3 PM to read the TOI and paati would make tea for "Maama"
"Mookannadi vizha terunjiduuuu"
Aadivaram aviyal chestaana
Madaraas ki jao
Mischief rascal
Nallavan kadai
Torchlight and all other small collectibles
Aadum maadum kolam kolam, amayaar paati um kolam kolam
Deepa Jyoti parabhrama.....
Ucchipulayaare mahaganesa
Durgalakshmisaraswati thaaye
Chidbambara ragasyam
Chakravarti thirumaghan
Poooo....malaaaii....pottu kalyanam
Ungalukku ellam ennai mami.....neenga ellam romba jolly aha iruppel

The last I heard of her, she was a frail shrunken form of her previous self...staring into the webcam on Skype....muttering unintelligibly like a child , trying to sing her remarks....the image quality was not very good, she did not recognize me I think......
This was the last grandparent of mine who was alive.
A generation has passed..........

Wednesday, February 8, 2012


Awesome video...look at the hungry ants come in their bellies empty and then slowlydistend with the red sugary stuff.....!!