Is There Another Me Somewhere?

          “Read,” I said to Sri Husband, thrusting a newspaper article at him, “About stem-cells, in-vitro fertilization, surrogate motherhood and cloning. These are Indian ideas. We knew all about them several centuries before Christ was born. It’s all written in our puranas.”

          “Was I-n-d-i-a-n written in the Devanagri or Latin script?” he asked, as always, straying from the topic at hand.

          “That I don’t know, but one scientist, he read about it,” I told him confidently. “And our Pradhan Mantriji also said so.”

          “It’s ok for you to say Pradhan Mantri without the ji,” Sri Husband said, out of focus again. “The two words are respectful enough.”

          I got the conversation back on-line: “They say the Kauravas were cloned. Otherwise how could one mother have a hundred sons and all of the same age?”

          Sri Husband quipped: “What, no daughters? By law in today’s India, Gandhari would have got into trouble.”

          It wasn’t me saying so, I was reading something a wiser and better person had written: “… a verse in Mahabharata under the chapter Adiparva describes how the Kauravas were created from a single embryo. According to the description, the Kauravas were created by splitting the single embryo into 100 parts and growing each part in a separate kund or container. They not only knew about test-tube babies and embryo splitting but also had the technology to grow human foetuses outside the body of a woman. Something that is not known to modern science.”

          Sri Husband was silent. I’d stumped him. I grinned wickedly.

          He grinned right back: “Their highly skilled technical staff could control and regulate air temperatures and humidity, no doubt, in their infection-free laboratories. Maybe, just maybe, they had good science fiction writers, too.”

          I didn’t know what he was getting at. He continued, “Did they commute to work on two-wheelers or cars?”

          “Don’t be silly,” I said, “There were only carts, then, driven by horses and bullocks. Or slaves.”

          “Ah,” he said, “But they had Pushpak Vimaans. So they had runways, but no road-traffic jams.”

“Maybe,” I said, adding, “And they had many weapons that match those that we have today. They were bright.” I was equipped with the printed word before me. It wasn’t me saying so, smart PhDs wrote this stuff.

          “So, we were a clever people,” he agreed. “Intelligent, evolved, practical and quarrelsome.”

          “Quarrelsome?” that was a googly.

          “See the number of intrigues and fights that are documented. With humanized animals and demons.”

          “But that’s mythology,” I said.

          “The technology is real and the rest is mythology? Good, good.” I know I’m on unsafe ground when Sri Husband gets extra-polite.  

          “We can’t prove the truth,” I agreed, “But can we prove they did not exist? If cloning is mentioned, how can we say for certain that it didn’t happen, that it’s all fiction?”

          “We can’t. It may well be true,” Sri Husband had to grudgingly grant me that. “Let’s say we were smart and intelligent once upon a time.”

          “Are you saying we’re not smart and intelligent now?”
          “No.”

          “Then what are you saying?”

          “That we should concentrate on the here and now. Let history-scholars dig and analyse the archives. We should be doing our duties and jobs properly, handling garbage and governance issues instead of sitting around dwelling on past glories. Good scientists don’t rule out any possibilities, true, but they move on, too.”

          Me, talking to myself: “Lecture-baazi shuroo.”

Aloud I said, “You can’t deny that Shushrut-surgeon and Charak-physician were great professionals.”

          Sri Husband: “Drs Shushrut and Charak would have moved with the times.”

          Me: “You know, there was plastic surgery; Ganapati’s head is proof of that.”
          Sri Husband: “Plastic or other surgeries for repair of cut noses and ears, and battle or hunting injuries I can believe. Our ancestors were clever and skilled. But if someone’s head was cut off, and you had the talent to reinstate it, why not use the same head? Assuming that loss of head would mean loss of life, after attaching the head back, how would you revive the person?”

          I wondered why he used ‘you’, meaning me.

I voiced a thought: “Do you think every person has a clone? Or had? Is that why there are so many Indians on the planet? There must be some method to find out. Can my clone be made with a couple of my bone-marrow cells?”

          “Another you?”

          “Yes,” I said smugly. “Would be nice. No?”

 “Nightmarish,” said Sri Husband shuddering.

         

Feedback: sheelajaywant@yahoo.co.in

The Health Check.

I enjoy sharing my medical complaints with friends, relatives, neighbours, on Facebook, and trying out home remedies before any pain/ nausea rushes to a ‘real’ doctor (= at least MBBS). Drinking concoctions of tulsi leaves or dalchini twigs, meditating before dawn, sniffing crushed neem leaves, chewing raw turmeric or the inside of a banana stem, swallowing garlic cloves and sprouted methi seeds, anything that indicates ‘saamkey natoorall’ can only bring benefit, nee? If it’s gummy like steamed bhindi or bitter like karela juice, all the better.  

My contemporaries discuss flatulence, variations in blood pressures, medicines that go with them, ‘sugar’ and ‘kiten tein kull naa, punn jivaak borem dissa naa’ (=“don’t understand what it is, but makes me feel unwell”). That vague something a patient can’t describe, which gives ulcers to family physicians. Family physicians, also called general practitioners, are members of that getting-extinct breed which tells you bluntly that your ‘stomach-upset’ is just indigestion and not a heart attack. Contrary-wise, when you take an rash lightly, (s)he chides you for taking so long to ask for help.

Kind ex-colleagues and worrying advertisements nudged me to do a preventive screening of detectable medical ailments. I am, after all, in the teatime of my life.

Going for a Health-Check is like planning a cruise to Alaska. Cheaper. I thumbed through several glossy brochures/pamphlets to choose a hospital. I had to choose the package depending on age and tests. They (the packages, not the tests) had names like Pearl, Ruby, Diamond in one and Basic, Basic Plus, Special and Comprehensive in another. I had to decide which of the tests I wanted done. Tension saamken. Suppose I chose a ‘basic’. The first test read ‘Blood Group’. Now if I were to do the same package annually (as recommended), why would I want to find out my Blood Group over again? Would I get a discount if I said I didn’t want it done multiple times?

Liver function, heart function, kidney function, bones, eyes, ears, skin, teeth, ovary: what did I want checked? Should I tick them all? The headache vanished when I decided to go by the price instead.   

Overnight fasted, udok i piyun naa, I made myself hazir and stood in line with other yawning fellow health-conscious Goans. One woman (I refuse to call an adult female ‘lady’ unless she proves herself to be one, irrespective of what the toilet labels her to be) told me she had opted for a superior package: “It has a bone density test. One thing I don’t want to get is osteoporosis.” What was the illness she did want to get? I wondered, but held my tongue. She and her companion were from Mumbai. Goans from Mumbai, they nodded at me, lest I had any doubt. I’m used to such introductions on the Mandovi Express. I nodded back understandingly: there’s an unspoken bond of sisterhood that explains “it’s cheaper to get these things done here, you know”. They hadn’t included taxi fares in their maths, I giggled inwardly, and continued (admirably for me) to hold my tongue.

We watched each other getting pricked in the elbow, our blood being whisked away in small tubes to some mysterious place. We shared time outside the ultra-sonography room, our bladders competitively waiting, hoping that the other would not fill up first.

“Doctor,” I overheard someone say, “I want a cancer test done.”

“For which cancer?”

“Means? Cancer is cancer, no? I want a test to see if I have cancer.”

“There are different tests for different cancers: breast, uterine, ovarian, cervical. We do them all.”

“No one test?”

“No.”

“Why not?”

The sound I heard next, I believe, is of hair being torn off a scalp. This must have been the umpteenth ‘why’ question the patient (if pun, then unintended) doctor must have heard that morning. “Why do you need to do an ecg if you’re doing a stress test?” “Why can’t you directly do a CT scan if the x-ray isn’t showing you all the details?” “Why do I have to wait so long for a report?” “Why is this blood test more expensive than that?” “Don’t you have a buy one get one free scheme for consultations? Why not?”

At the end of the ‘package’, each had found some anomaly. Except me. As we bid each other warm and loving ‘byes, one of them comfortingly said to me: “Never mind. Health is wealth, they say. You may have better luck next time.”

For the third time, haanve kaany mhanoom na.

So, Who’s Got My Blood Now?

          The same heart beats in every human breast: boom-pachak-boom-pachak ceaselessly for a lifetime.

The same blood (Red Gold, I call it) courses through the chambers, arteries and veins of truck-drivers and tycoons. There is no difference between their biological plumbing system. Like air and water, mosquitoes and viruses, blood does its job without bothering about who’s from communities major or minor, a scheduled caste, tribal, Jew, Palestinian or politician.

          My father was neither tycoon nor truck-driver. When he was sick and needed blood transfusions, my sister and I donated our permissible quota so he could get his.  Unlike in Bollywood, our blood didn’t directly flow through a tube into Baba’s arm.

At the blood-collection centre, I was asked my name, sex (prefer ‘gender’), and whether I’d suffered from jaundice, typhoid or malaria recently. They measured my height and weight (those were innocent days; I was excited when the needle on the scale turned to the right). A drop of blood was squeezed from a prick in my left middle finger and tested to check whether I was anaemic and my blood-group (‘O’ for ordinary).

I was made to lie down on a trolley with a mattress, pillow and sheet. Nowadays there are reclining, upholstered sofas. Still, I carry my own thin tuwaal to place my head on, because I feel icky sharing public furniture with unknown entities. I’m eccentric.

A technician came and rubbed cool alcohol (I didn’t lick it) with a swab of cotton on the inside of my elbow (that’s why I couldn’t lick it, unreachable location). The poke didn’t hurt much, but the sight of my tambdey-tambdey ragat surging through a transparent tube and climbing up to the container hanging from a metal stand hypnotized me.

Since then, every time I’ve donated, I’ve waited for that fascinating moment. And later dwelled on mera khoon kiski nassom mein beheta hoga?

Blood-banks aren’t always near patients. But one can donate blood at ‘camps’ wherever and whenever convenient. Why wait for a muhurta or emergency to save a life?

Blood-donation doesn’t take more than twenty minutes. Later, kind nurses and whoever else is present offer fruit juice and sweet biscuits. Whilst consuming them, I wonder what motivates the other donors present. Most people donate either because a friend/ colleague/ neighbour/ relative needs blood or because they are altruistic. There are those who give (specially rare groups) blood for money: India mein sub kuch hota hai. If it saves a life, que sera, sera.

Once the blood is collected from a donor, it’s tested for diseases which could be passed on to a recipient. A responsible Blood Bank Laboratory will inform a donor that may have, say, HIV. You can’t buy blood, but you have to pay for the tests and processes.

I once asked the haematologist what happened to my donated-blood afterwards. He told me, anti-clotting chemicals kept the blood from, well, clotting. He showed me one bag/ packet which he said was mine, based on the records. It looked like pale urine. “Hain kittein?” I asked him. It didn’t resemble my blood; I’d seen it myself.

“That’s plasma,” he said. “The red blood cells have been removed from it.”

He added, I gaped: “Whole blood can be transfused, but more often, blood is separated into various components and used depending on what recipient patients need. Everything’s kept in sterile conditions and at low temperatures. The blood-component is warmed before use. Some components can be preserved longer than others.” Which means the 350 ml that I donated is useful to more than one human-being! (Feeling smug.)

“A patient can donate his own blood for his own use before an elective surgery. There’s a method by which only the plasma can be extracted and the rest of the blood returned to the donor. Also, regular users (think thalassemia) are better off now than a few decades ago. Reactions, if any, to transfusions are better handled.”

Science is as close to magic as can be.

Yet, with all the rocking technology available, and money, the only factory that manufactures this precious fluid is the human body which takes just two quick days to replace the (donated) RBCs.

I’m wallowing in satisfaction: my blood has saved many a life.

Just thinking… if an aazaaree manees who has received my blood gets well enough to donate to someone who in turn donates to another donor, etc, will a teensy-weensy bit of me eventually traverse the globe? Possible with stem-cells.

(Feedback: sheelajaywant@yahoo.co.in)

         

Me and the Backache

(13 Nov 10)

            It was the third time I felt the shooting pain in the lower back, this time whilst crossing the road. Agonizing, but I managed to do something that resembled an out of step salsa sequence and got across through the horny (horning?) cars. Luckily, was on the OPD side, so decided that I must see a Spine Doctor. Unluckily, once I reached the building, I couldn’t climb those four stairs. Tried the ramp, couldn’t climb that either, because no railings there. Ten man-minutes were wasted helping me reach the glass door.

           

When I made the voucher, the girl at the counter said what I thought sounded like ‘stomach’. I chided her because she didn’t know that Dr N had nothing to do with that part of the anatomy. She looked shocked, then told me she said: “Chamak” the Marathi term for a catch in the back. The person behind me, who also wanted a spine doctor, asked me where Dr Chamak’s name was in the schedule that he was holding!! My bad.

            For one who normally doesn’t wait for a lift and takes stairs two at a time, it felt silly to say ‘first floor’ to the liftman. Someone remarked in Marathi: “She’s only first floor, we’re third” in a superior tone. I was ready to climb out but the lift skipped the first floor (someone had forgotten to press the button or it wasn’t working) and I got a ride to the third floor and back. Smirk, smirk, who’s superior now, I thought as those Marathi people walked out. 

            Next came The Wait. Doctors are always attending emergencies. A few of us patients couldn’t sit. The chairs were too low. We didn’t want to lie on trolleys. So we stood by them, our elbows and palms taking the weight of our painful backs. One wanted to go to the loo. She came back and told us that the seat was lower than the lobby chairs. Oof.

            Then came The MRI. It’s difficult to get out of a sari, fold the darn thing, put it on a hanger and change into loose, crisply laundered, tie it yourself, hospital pyjamas and tops in a 4 x 4 cubicle. I’d heard stories of claustrophobic patients demanding their money back, and was nervous about the loudness of the sound inside as well as the order “if you move, we have to repeat the sequence”. I was to press one balloon attached to a wire if I was in any way uncomfortable. Screaming and shouting wouldn’t help. The other way to attract attention of those outside the room (one is alone inside) is to wave the legs, for the rest of the body is inside the metal tunnel. Of course, the pain wouldn’t allow any movement of the legs so that wasn’t an option anyway.

No one told me how cold it would be. The blankets helped, though. The machine takes you in smoothly enough. The metal tube’s inner edge is more than 6” from the nose, so if one sneezes hard, there’s enough space to counter the move. You won’t bang and injure yourself. The drilling, hammering sound is easier on the eardrums than most car horns or construction sites. When the sound stopped and the trolley moved (with me lying stiffly on it) I believed ‘it’s over’. I was wrong. It keeps moving you, sliding you, bit by bit, every couple of minutes for what seems a very long time and is actually approx half an hour. Each time I opened my eyes and saw the white light and gleaming metal, I wondered how many brain tumour and road traffic accident cases had thus lain in here, possibly unconscious. How many lives had this machine helped save? It’s eerie, the thought that you’ve shared this little space with almost dead or dying fellow beings.

The big film with the little photos all over it showed pictures of my insides that I didn’t know existed. Between two vertebrae or discs, one tiny bit of inner lining had slipped out. A hernia. Like a little balloon. Luckily, no nerve was damaged, said the Spine Specialist; the pain is caused because the strong back muscles ‘guard’ or protect the injured area, go into a spasm and don’t allow any movement whatsoever. Nature does its thing.

Therefore, I have to lie flat (22 hours a day) I’m told, to allow relaxation. A bit of loo and a bit of keyboard won’t hurt, I think, though the doctor disagrees. What are rules for if not to be flexed at times? When I’m better, will write about what went through my mind as I stared at the ceiling day after day after day.  @@@@

Doctors’ Instinct

          Our friend fell down some steps, then couldn’t move because the pain in his hip was terrible. His wife took him by public ambulance to the closest, very new hospital, partly owned by a semi-retired orthopaedic surgeon. He gave the friend a pain-killing shot and took an x-ray. Later, the wife found him (doctor, not friend) poring over the film, palm on forehead, mumbling, “… the neck should be broken, must be broken..” She wondered whether the semi-retired doctor was also semi-stupid.

“How was I to know,” she told me later, “that he meant neck of femur (thigh bone)? To me, a neck is something that attached one’s head to one’s shoulders.”

The only way to prove the neck-was-broken was by doing a CT-scan. The closest CT machine, this was in Noida, UP, was some kilometres away, even in an ambulance an agonizing ride. Friend’s wife did some sms homework and was assured that doctor had a good ‘hand’. So without ‘photographic’ evidence, she signed the consent for the surgery. In a couple of days, the friend’s hip was fixed and functioning. Opinion-based diagnosis had saved the day.

During my recent back-pain episode, my Goan doctor DB, sensing agony in my phone-distilled voice, recommended: “Complete bed-rest.” The Mumbai consultant who saw my MRI via Picture Archiving and Communication System on Everest Base Camp, sent realtime instructions via smartphone to his registrar sitting by my bedside: “Complete bed-rest.”

When I mentioned opinion-based versus evidence-based practice to someone, this is what he said: “Without doubt, evidence-based. How can anyone say I think the patient has fever? You check the thermometer, read the value and you have proof of temperature.” (Healthcare professionals reading this, hold your giggles; that’s how lay people perceive it.)

Even the brightest physicians are thankful to ultra-sound inputs to pass judgement on ‘pottanth khubba dukhtaan’. Who might be responsible for the painful crime: gall-bladder stone/ renal colic/ appendix/ secret tumour?

Experience versus modern technology, that’s the debate. Can skills (l)earned over 18 hrs/day x 11 months/year x 25 years of practice be superior to blood tests done in a laboratory? There are times when an opinion-based practitioner won’t wait for a typhoid result, but start treatment pronto, not wanting to waste time/ lose patient.

But… in evidence-based practice there is no guesswork. Therefore less chances of making mistakes when one depends on lab-tests. Think blood-sugar levels, typhoid/ dengue detectors.

There are those who don’t believe in modern technology, who believe that doctors must use their heads and hands alone. But should the doctor made a mistake, they say: aaj-kaal beshta suvidhaa aastana kitya upyog karap na. Would they include stethoscopes and blood-pressure checking gadgets as ‘modern’ things?

(I know people who believe landline phones are acceptable technology, but mobile phones are not. It’s ok to have a fridge, but no micro-wave. No one complains about cars, air-conditioners and electricity. No one even realizes that technology goes into the manufacture of office-chairs, sliding-windows and shaving-gear. Where does one draw a line regarding ‘modern’?) 

When it comes to curing our ailments, we want both, experienced doctors with great instinct plus state-of-art technology.

Experience crawls. Young doctors lack it and benefit with the evidence-based method. What doctors of my age learned through their MBBS and PG years, the youngsters cram into a short period because the amount of knowledge they need to know is more.  Cutting-edge stuff is cold, distant, without the human touch. And expensive. If we were to depend only on it, we’d need diagnostic centres next to every other biscuit stall and even then we’d have long queues, so dense is our population.

Leave aside serious road traffic accident cases or those with bleeding in the brain, where no surgeon would touch a scalpel without following the protocol of checking on blood-clotting time, exact location of ‘trouble’, etc, there are many illnesses that can be prevented by modern methods. Dyes injected through arteries and the presence of higher-than-normal levels of creatinine in the blood can detect heart/kidney troubles. Same with some kinds of cancer.

Evidence-based practice is here to stay. To prevent thoughtless prescriptions, to know how and when to use which tests, how to interpret the results correctly, doctors will have to fall back on Experience. Those who have insights through medical humanities, who recognize the importance of the natural history of a disease, will be more accurate in their dealings with different diseases/ ailments/ injuries/ illnesses. At the end of the day, opinion-based practice will still have higher value. Doctors’ instinct develops over time.