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Saturday, September 18, 2021

Life's Lessons - Who taught me What? (13)

            This post is a little different. This is not about "who" taught me, but "how" travels taught me some important lessons. That includes travels in general and specific travels.

What did Travels teach me?

Travels taught me many things about life and living.

The most important lessons were about being open-minded and flexible. I learnt that there is no one correct way to deal with daily tasks and life’s issues. There are many ways, each suitable to its place and context. For example, Chinese end their dinners often with soup or salad. The western culture starts dinners with soup. Indians mix soup with their main dish. (Incidentally, the word soup in English, Zuppa in Italian are similar to the word soopah in Sanskrit. This is an example of how travels gave me an interest in linguistics)

It is good to be prudent and plan, but not plan so much that spontaneity is lost. For example, when we (Ramaa and me) were in Turkey, we broke from our group and walked on our own. It so happened that this was near a University Campus. We stopped at a bookstore. A student who was working there wanted to practice his English. He told us many things the tour guide did not cover. More important, he introduced us to a Turkish writer most admired by Turkish people. The author’s name is Irfan Orga. We bought one of his books (Portrait of a Turkish Family) and found it fascinating.

This leads me to another lesson both Ramaa and myself learnt. Whenever we went to a new country, we wanted to experience three things – their food, their language and their music. To get these experiences, we must have an open mind and some amount of adventure. (Ramaa was more adventurous and, I had to keep her under some control for her safety) If we are going to stay within our own comfort zone, how can we understand another culture?  

We used to ask the locals what their “signature” dish (food) is, who their best author is and who their most admired musician is. Yes, we have tasted vegetarian and non-vegetarian food in every country we had visited. We have read at least one book by that country’s famous author in English translation. We often bought one tape or CD of each country’s famous musician. This is cultural education, even though that is not enough to give us a deep understanding of any culture. Ideally, we should immerse ourselves  in that culture by living among the locals for a few months. 

 I would like to share this habit, this lesson we learnt with youngsters. This will help open their minds to develop respect and tolerance to other people’s points of view and ways of doing things.

Travel with Visu: The very first travel experience without my family members was with Visu. It is one of the most memorable. I was in high school at that time. My brother made it possible, as usual. We had a marvelous time. We stayed in modest hotels and ate cheap but hot meals. Visu taught me how to find good places to eat, how to negotiate price and how not to panic, if things do not go as planned. Once we missed a train – almost. Visu’s comment: “So what? We take the next train going our way!”

The most remarkable memory was our visit to Ramana Ashram and the darshan of Ramana Maharishi. What an impression it left! I did not know at that time he was suffering from some tumor of the bone and had surgery on his arm “without anesthesia”. I learnt about that several years later. But I remember that he passed away a few weeks after we had the darshan. The peace in his presence and the glow of his body are still fresh in memory. They still influence me during my meditation times. The other lesson was: “ Ramana was also a human being. No one can escape illness and death. If a soul as serene and divine as Ramana can get cancer, what other human being can escape disease?”

The first trip to USA was a memorable one. That was the first time I travelled by plane. It was not jet age yet. I flew by TWA, “Super-constellation” and it took 3 days from Bombay to New York! It was hop - step - and - jump with several stops for refueling. It was monsoon season and naturally it was pouring rain at Mumbai. But I was so excited about the future, the present moment became exciting.

I learnt for the first time how to eat using knives and fork and how to open a milk carton. There was no one to teach, except the one in the next seat.

Saturday, September 11, 2021

Life's Lessons - Who taught me What? (12)

 Friends, again I am writing two posts this week. The first one is the continuation of the series on Life's lessons. I was "moved" to write the second one during my meditative moments. 

Books that influenced me most

“Bhagavat Gita” is clearly the first on the list. I have read the original in Sanskrit. I have read three major interpretations, one by Bal Gangadar Tilak, one by Vinoba Bhave and one by Kanchi Periyaval. The translation by Kannadasan in Tamizh, is a gem for its language and unaltered meaning of the original.

The two most important lessons I have always carried in my thoughts are: 1. Sloka 43 from Section 2. Our concern should be to carry out our duty (dharma) without looking for the rewards. I can also say I have tried to apply it in real life as much as possible. I did not do so once; that was when I saw clearly why this lesson is very important. 2. Sloka 63 in the final chapter where Lord Krishna tells Arjuna “I have shared with you the deepest of knowledge (about this Cosmos). Think about what I have said and act as you think is best”. He did not say “Do as I command”. What a way to teach?

The second most important lesson came from Sir William Osler, considered the Hippocrates of modern medicine. He says: “When you want to learn about a subject, go to the most original writing on that subject. Then, read the most recent review on that subject”. He was talking only about medical subjects. But I have used this idea for several decades not only in reading medical literature but when learning about any new topic, to immense pleasure and profit.

For example, this habit led me to read one of the earliest descriptions of tetanus in an Egyptian Papyrus manuscript (Edwin Smith Surgical Papyrus. I read it when I was at the University of Chicago). I can say with reasonable confidence that I have read the original descriptions of most of the diseases such as Mumps (Hippocrates), Chorea (Sydenham). Mongolism (now known as Down Syndrome) and the so-called Salaam Epilepsy. I have read the original descriptions of all the rheumatic diseases, particularly the one which established that connective tissue and blood vessels are part of all the organs and therefore connective tissue diseases are multi-system diseases.

This habit of reading the originals solidifies description of diseases in our memory. We learn why the original author thought this was important and what did he/she see unique which made him (her) describe it. Every time you read about the condition in modern literature, you just add new facts to that old memory unit like a “coat-hangar” and, also can visualize gaps in knowledge.

As I mentioned, I have used William Osler's advice in subjects other than medicine. For example,  searching for the source of the metaphor of two birds on a tree in the Mundaka Upanishad led me to a treasure house of wisdom in Asya Vamasya Sukta in Rg Veda. That led me to read the entire Sukta in Rg Veda 1: 164. That led me also to the source of the famous quote:  “The truth is one; learned men call it by different names”. This is also in the Asya Vamasya Sukta.

It is impossible for me to describe the value of this one lesson from Sir William Osler and how much this practice has enriched my intellectual life.

On Becoming a Person is a book by Carl Rogers. This pioneer in psychology taught me about how to listen and what the fundamentals of helping professions are. I have written about this topic in my Handbook of Clinical Skills.  I have tried to apply those principles in my role as a physician, as many times as possible.

Soon after I came to USA in 1958, when I was trying to adjust to the cultural shock, the book that helped me was “A Mirror for Man by Clyde Kluckhohn. This is a book on cultural anthropology which made me understand how to appreciate cultural differences. The primary lesson was that one should observe other cultures to learn and NOT to judge. One should not label cultural behaviors as “good” and “bad”. But one should understand what it is for, how and when it originated and what the advantages and disadvantages of those practices are. That way, we can adopt them if they are beneficial and reject them if they are no more valid under current circumstances (place and time) or not suitable for our needs.

This book has a chapter on how americans think and act. This was very helpful for me to adopt and behave appropriately in the new settings. It also influenced my tolerance for other ways of doing things. This book was written almost 50 years back. Obviously, the book is outdated and behavior of people has changed.  But  many of those observations made by Kluckhohn  are still true.  

This book influenced my sensitivity to cultural factors in my medical practice. This made me understand my own culture also better. 

What is in a word?

 Friends, again I am writing two posts this week. The first one is the continuation of the series on Life's lessons. I was "moved" to write the second one during my meditative moments. 

“War on poverty”

“War on drugs”

“War on terrorism”

Words hide passions

Wars show passions

We are praying for Peace,

Why are we worshipping “wars”?

 

Saturday, September 4, 2021

Life's Lessons - Who taught me What? (11)

 Parents and grandparents who taught me

One of the earliest experiences was with a mother who was taking care of her son with a colostomy. She knew exactly how to clean it, dress it and what ointment to use etc. But she always had arguments with the nurses – rather, the nurses were always fighting with her. During discussions with her, she taught me an important lesson. She said “ Your nurses may know a lot about colostomy in general . But I know colostomy in my son better than they know. I live with him and I know how to take care of colostomy in my son”.  Once the nurses conceded that fact and were willing to listen and care for the boy the way she wanted it done, there were no more problems.

This became a lesson for me in medical practice in general. I may and indeed do know more about a disease than the parent. But the parent knows more about that disease in her child better than I know.

Another lesson was taught by several parents on different occasions in different ways. Some families fell apart when one child was diagnosed with a chronic disease. Some families coped well and were resilient. Resilient families taught me that their strengths were in one or more of the following  areas: supportive relationship in the family, someone outside they can depend on for help, faith in some tradition or religion, trust in one person who can help guide them and someone with a sense of humor in the family.

One other feature of these parents who coped well is their desire to help other families with similar problems. They were not dwelling on their own bad luck all the time. They took care of their own children with the disease and found time to help other families. Those are the parents who started the American Juvenile Arthritis Organization which is still doing excellent work supporting families of children with arthritis.

One other experience taught me about humility and the power of faith. One five-year girl with severe lupus became comatose due to her disease affecting the brain. Almost every organ in her body was affected by the disease. We had administered every medicine available at that time. She remained in coma for three weeks. Throughout those three weeks her grandfather and grandmother took turns to be on her side 24/7. They used to tell me that they were praying all the time, sometimes holding the girl’s hand. That girl woke up one day and has been disease-free when I saw her last time in her teens. You can make whatever conclusion you want, but the grandparents, particularly the grandfather, believed that they “prayed” that girl out of coma.

There are many more stories of this kind, each one with an important life’s lesson.

 

 

Saturday, August 28, 2021

Life's Lessons - Who taught me what? (10)

 Lessons learnt from children (patients)

There are so many lessons I learnt from children, their parents, and their families I do not know where to begin and which ones not to include.

One of them had a severe illness affecting many parts of her body from the age of 15 months. The way she has fought that disease and all the things she had accomplished in her adult life are inspirational. She taught me, like many other children, about resilience and motivation. She, like many other children with similar conditions, did not give up. She did not let chronic illness control her life completely. Her experienced showed me that resilience is partly built-in and most of it depends on the family. She also helped her own parents and helped other children with similar conditions.

These attributes are true for most of the children with chronic illness. They planned for their lives ahead, not just for the disease, although they had to modify their goals and day-to-day planning. Some had to modify their career goals and field of study. Families learnt to plan for an alternate activity if the disease should flare on a day with specific plans.

All of them showed me how important family support is and how their positive approach came from their families. They taught me that one way to overcome adversity is to help others with adversity. Families of children with chronic illness were the chief movers behind American Juvenile Arthritis Organization, locally and nationally.

Another young lady had an illness associated with daily fevers going up to 105 degrees for months on end. We had very few treatment options available those days. She was the earliest one who showed me how one should plan for life and not for illness. That is what physicians also have to do - help them plan for life without minimizing their realities or giving false hopes. She did not miss school because of fever. She wanted no excuses and did well in school. She went to college, obtained a Master’s degree and became a manager. She even had energy to raise funds for arthritis research.

Then there was a 12-year-old boy whose legs never worked right. Once he told me: “Doctor A. My legs do not work. They have been working on it for years. It is still no better. But my hands are great. No one is working on them”. That is when I learnt that physicians are taught primarily to look for defects and treat them. That is as it should be. But  defects cannot always be corrected fully if at all. Physicians must also  look for strengths in patients and their families and build on them. We can prop up defects. But can build only on strengths. That was the lesson this young boy taught.

There was this 6-year-old girl with a bad disease. She and her family had a rough time. But what helped them get through was the mother’s great sense of humor. She was very funny. I realized that humor is one of the antidotes for the stresses of chronic illness. (In some, humor may be a cover-up for the internal struggles. There will be some clues such as sarcasm or inappropriate laughter)

One girl with a disfiguring chronic illness I had the privilege of caring for and, her mother taught me several lessons. They were from a very poor neighborhood.  The mother had very little education. But she gave something special to her daughter. I cannot describe it in words. It is my intuitive understanding of the way she took care of her daughter with a severe disability, which made this girl thrive, grow and, become independent. This mother also showed me that the special feelings and attitude associated with "motherhood" have nothing to do with wealth, intelligence, and education. It is a sacred feeling, only mothers can have.  

When she was 12 years old, this girl requested that one of her legs be removed. She asked on her own even though the mother was sitting there and said it with a smile on her face. She said “ Doctor Athreya. Let me have a new leg because I want to dance like other girls”. I did not know how to respond immediately but told her that I will get back to her and her mother. Her request and the way she brought it up made me think very hard. The conclusion of this episode was a happy one. She got her request and the smile on her face after her first dance with a new leg was one to remember forever.

Indeed, this episode taught me how to think through complex issues and became the template for future challenges I faced in medicine and in personal life. I was moved to share what I learnt from this experience with future generations and therefore included it as an example in my book on Thinking Skills for the Digital generation.

She went to a local college with help from our team of nurses and social workers and, also found a job – all on her own. Few years later, I was sad to learn that she contracted “flu” during the “flu” season and died. Even after her daughter's death, this mother showed her grace and nobility confirming my earlier opinion about her as a special kind of mother. 

This mother and her daughter were equivalent to a whole book on graceful living for me.  

Saturday, August 21, 2021

Life's Lessons - Who taught me What? (9)

         Friends, I am posting two units this week to break the monotony of the series. One is Number 9 in the series on Life's lessons - Who taught me what? The other is on Vedic mantras for meditation and prayer. 

 Dr. F. Howell Wright

Another great person I came to know was Dr. F. Howell Wright, who was the Chairman of the Department of Pediatrics at the University of Chicago. He taught me how a person in position of authority and respect should treat others irrespective of their positions.

After I reached Binghamton NY for my internship, I applied to several hospitals for my pediatric residency. University of Chicago (Bobs Roberts Hospital was its name at that time. The name has changed twice since then) was one of them.  One day, I received a phone call from Dr. Wright. He said: “I am travelling by Binghamton on my way to Syracuse with my daughter. I would like to stop by at your hospital and meet with you, since you may not be able to come to Chicago for interview”. I was stunned, particularly coming from India where most Professors sit on their “thrones” and look down upon juniors! He came to my room and interviewed me. Then, called my local mentor Dr. Jim Johnson and spoke with him.

Later, after he reached Chicago, he offered a residency at the University of Chicago Hospitals. By the time I heard from him I had accepted an offer from the Children’s Hospital of Philadelphia. I could not accept the offer and I felt guilty doing so. I felt so guilty that I decided to go and spend a year with Dr. Howell Wright between my residency and fellowship years at CHOP (1960-61). I am so glad I did. For one thing, I learnt many more things from him about kindness, compassion and, clinical medicine. I also learnt important differences between private practice-based medicine (CHOP) and medicine as practiced by fully paid staff (University of Chicago).

Dr. Howell Wright was a Quaker who had studied at Haverford College, Haverford, Pa. He was such a great gentleman and Statesman. He  was President of the American Board of Pediatrics for a few years.  After he retired, he came back to the Philadelphia area and lived at the Kendall (Longwood). Ramaa and myself  used to visit him often. Those visits also taught us to consider living our senior years at a place like the Kendall. Now here I am at the Cokesbury Village.

Dr. Thomas McNair Scott

Dr. McNair Scott was a great clinician and a researcher. We (me and Ramaa) used to be invited to his home during holidays. There we will meet trainees from several parts of the world and our discussions used to be very stimulating and interesting about various countries and their cultures. That is where both of us learnt why it is important to invite trainees to our home and get to know them and get educated in the process. We had many sessions in our house with pediatric and rheumatology trainees and recreated the experience we had in Dr. Scott’s house.

Once I visited Dr. Scott when he was 98 years old and was living in a Senior Home. I found that he was learning sign language. When I asked “why”, he said: “Balu, several people here do not hear well. That is why I am learning sign language so I can communicate with them”. The lesson for me was: “if he can learn at 98, none of us have excuse for not learning something new at any age”.

One other influential teacher at CHOP was Dr. Samuel X.Radbill. He instilled an interest in the history of medicine in me. He was the one who told me that the world’s first pediatrician was Jivaka, who was the personal physician to Buddha. Dr. Radbill also gave me a copy of Kashyapa Samhita in which this fact is mentioned. If you go to Bangkok, you can see a statue of Jivaka in a sitting position at the entrance to the famous Golden Buddha shrine.

Dr. Radbill’s interest was in the history of medicine. He has written several articles on this subject. (I have given a collections of historic articles written by him and some historic books on medical subjects to the Library at the Nemour’s Children’s Hospital). He also had a collection of valuable first printing (that means soon after invention of the printing press) of  of medical books in his personal library whch I had the privilege of seeing and touching.

Experiences at the Children’s Seashore House (CSSH) and Dr. Henry Cecil

Dr. Cecil gave me strong education on the grounding principles of chronic care and coordination of care. Later he helped me become effective in Family-centered, Community-based, culturally sensitive, Coordinated care of children with rheumatic diseases.

The therapists at the CSSH taught me several things such as:  In chronic care in which several professionals are involved, we need one coordinator and decision maker; Parents need one person to talk to. (That is how I started developing the idea of a Nurse Coordinator); Most children with chronic and less common conditions live far away from big cities and academic centers. Therefore, academic centers should develop outreach services. (We conducted such clinics in Pennsylvania for over 20 years); Parents of children with newly diagnosed chronic conditions need support to cope with the impact of the condition on the patient, siblings, parents, and the school system. That realization resulted in the development of Parent support groups. 

I had one bad experience at the Children’s Seashore House which taught me the difference between ambition and vision. I realized that ambition is self-centered; vision is “other” centered. Vision also needs ambition. But ambitious people are interested only in their ego and personal advancement. People with vision care about the “whole” picture and everyone around.

Mantras that Inspire

       Friends, I am posting two units this week to break the monotony of the series. One is Number 9 in the series on Life's lessons - Who taught me what? The other is on Vedic mantras for meditation and prayer.

Meaningful Passages from the Vedas for Meditation

Over the years, I have learnt several noble slokas and passages from the Vedas and the Upanishads. Here are a few inspirational slokas ideally suited for insightful meditation and prayers, since they help connect the part with the whole, historical with the universal and the ephemeral with the eternal, in both form and substance.

पूर्णमदः पूर्णमिदं पूर्णात्पूर्णमुदच्यते
पूर्णस्य पूर्णमादाय पूर्णमेवावशिष्यते   Shanti Mantra of Isha

Both the Supreme Brahman (That, adah) and the conditioned Brahman (idah, in this body) are full, infinite. The conditioned infinite arises out of the Supreme Infinite. That Supreme remains full, infinite and, unconditioned even after the conditioned infinite had been separated.

 

यस्तु सर्वाणि भूतान्यात्मन्यॆवानुपश्यति
सर्वभूतॆषु चात्मानं ततॊ विजुगुप्सतॆ Isvasya 1: 6

He who can see all beings in oneself and, can see the Self in all beings does not feel any negative feelings towards the other.

(It is interesting that there is a similar passage in the Bible. It is John 15:5 which states "  I am the vine; you are the branches. If you remain in me and I in you, you will bear much fruit. Apart from me you can do nothing") 

 

तदेजति तन्‍नैजति तद् दूरे तद्वन्तिके

तदन्‍तरस्‍य सर्वस्‍य तदु सर्वस्‍यास्‍य बाह्यत: ।।  Isvasya   1:5

It (or That) moves. It does not move. It is far. It is near. It is inside all and, It is outside all.

 

तमेव भान्तमनुभाति सर्वं तस्य भासा सर्वमिदं विभाति  Mundaka 2:2: 10

When It shines It illuminates ( makes know) everything ;  In Its brilliance everything else shines.

 

यन्मनसा मनुतॆ यॆनाहुर् मनॊ मतम्
तदॆव ब्रह्म त्वं विद्धि नॆदं यदिदमुपासतॆ  (Kena 1:6)

That which is not thought of by the mind, but That enveloped by which the mind thinks, is Brahman, not what people worship as an object.


समानी व आकूतिः समाना हर्दयानि वः |
समानमस्तु वोमनो यथा वः सुसहासति || Rg Veda 10:191

Let your resolve be one and let your minds (hearts) be of one accord.
Let your thoughts be united so that all may happily agree.

 

सर्वे भवन्तु सुखिनः सर्वे सन्तु निरामयाः
सर्वे भद्राणि पश्यन्तु मा कश्चिद्दुःखभाग्भवेत्
शान्तिः शान्तिः शान्तिः

May all be happy, May all be free from illness, May all experience everything auspicious,
May no one suffer. Om Peace, peace, peace