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Saturday, October 16, 2021

Collective Unconscious and Collective Conscious

 In defining “Collective Unconscious” Carl Jung is quoted as saying that ‘The form of the world into which [a person] is born is already inborn in him, as a virtual image’. There are volumes of papers and books on this topic by Carl Jung himself and other scholars. This is a theory to explain one aspect of human behavior, particularly behavior common to all humans from different cultures and lands.

Is there a “Collective Consciousness” also? This must also be inborn, an awareness of one’s own mind and of the “minds of others”. May be, “collective unconscious” is the same as “Collective Conscious” but Carl Jung used it for a different purpose and emphasized the absence of being consciously aware of our behavior.

Those were my thoughts when I was reading a pictorial essay on the “aerial acrobatics” of swarms of starlings. I have seen those swarms too (called murmurations according to the article in the National Geographic magazine). Obviously, each bird in the swarm knows the “mind and direction of movement” of its immediate neighbors and all of them interconnect so that they have a collective “mind”. Can it not be called a component of the collective consciousness of the starlings?

The same thought occurred to me when I was watching a group of birds flying alongside our boat for almost 15 or 20 minutes when we were sailing between islands in the Galapagos. They were flying in formation with two birds in the lead position. Periodically, two birds will move from the end part of the formation and take over the front lead position. How did they know?

Several years back, I watched an osprey couple raise their brood on the banks of the Choptank River. It was amazing to see the male and female taking turns watching the eggs. The female and male will take turns bringing “food” for the chick. The female will teach the chick how to fly and she will not leave the nest for good till the youngest one can take off on its own. How did the mother know it is her responsibility?

Is it not acceptable to call all this “collective Consciousness” of the species – built in and inherent in their body, brain, mind, and psyche? We, humans, certainly have a collective consciousness if only we know how to touch it. In addition, humans also have language which makes it possible to have a meta-consciousness, an awareness of awareness (in backward loops). Awareness implies a subject and an object. Taken to its origins, it is a state which ends in a Pure Subject. This is what the Advaita philosophy calls the Brahman.

How can we touch these states when the emphasis is always on the “I” and the “me”?

(Thanks to "Kannan" for a key suggestion)

Friday, October 8, 2021

Forces and Patterns (slightly revised)

 How does variety come out of limited numbers of basic units? There are only certain number of particles. Yet, the entire cosmos and our bodies are made of these particles. There are only 20 essential amino acids. Out of them come the entire varieties of viruses, bacteria, fungi, birds, amphibians, plants, animals, and human beings.

Patterns of arrangement of limited number of particles/units and “forces” acting between these particles make this universe happen.

We are told that three forces namely Electromagnetic, Strong and Weak forces and three particles, namely electron and  two kinds of quarks account for most of the universe (gravity is not on this list). Two “up” quarks and one “down” quark with a weak force make protons and neutrons and matter in general. Protons and neutrons acting with strong force relate to heat. Electrons and protons acting in the realm of electromagnetic force account for the light. 

Patterns as forms can be seen. The forces cannot be seen but inferred.

Is there a similar pattern to life on earth? As varied as life is, its material base is DNA made of the same 20 amino acids. Patterns weaved with combinations of amino acids and the sequence of arrangements of these same 20 amino acids give the codes for varieties of life forms we see. Form appears to have been explained.

But how did life and awareness appear? After all, most of the universe is made of inanimate matter. And, why life at all?

Defining life is a difficult task. We know it depends on and is based on active exchange of energy. Awareness is a puzzling emergent property of living organisms. This property is active exchange of information, which requires energy.

Just as we cannot see, but only infer, electromagnetic, strong force, weak force and gravity, we can infer “life energy” and “awareness energy” but cannot see.  It appears that the material forms are the relationship between a potential state and an emergent or manifest state requiring information and heat. The potential state can be inferred.

Material-to-life relationship (or inanimate to animate) is based on “life energy”, which operates in an individual life form and can be inferred from the existence of several life forms. From individual lives we infer a collective energizer.

Material-to-awareness relationship also needs an energy like an illuminating light. It is the meta-awareness, an invisible, emergent property of living organisms. Just as light gives illumination and, also lights up everything else to be seen, meta-awareness as an energy makes us aware of ourselves and of our own thoughts and of the universe that we live in. This can be experienced and inferred but cannot be seen. Neuroscientists will call it  an emergent property of neural networks. It has to be. But it is a property that cannot be seen.

Gravity, EM force, Strong force, Weak force, life-force and awareness force require matter to act on. Why these forces at all? We just have to meditate on them in awe and with humility. 

Oriental philosophers will say that these invisible forces cannot be described since they do not have “forms” and, also because they belong to a category on the basis of which we describe what we see in this universe. However, they can be “known” through our intuitive powers. Hindu saints say that they have experienced these invisible powers in deep meditation when they see their individual “self” merging with the universal “self”.

Our ancestors, in their primitive times and magical thinking started using metaphors and symbols to depict these invisible patterns and forces, since it was not possible to describe these forces. One of the best examples in Vedas is light equated with Sun and, also with consciousness. It is because the Sun shines on its own and makes everything else visible. So does consciousness (awareness) which by its presence reveals itself and, also everything else.

To understand symbolism of forms and forces in the Vedic literature, one should read the Upanishads and some passages in the Rg Veda. It is not obvious in a casual reading. It is unfortunate that our scholars did not develop tools to understand these metaphors, with a few exceptions such as Adi Shankara. Most of them developed systems of thought  and points of view (darshana) requiring unquestioning faith.

Here are some books which helped me to learn about the origins of these metaphors and symbols. Interestingly, all these books are by western scholars. The Artful Universe by William Mahoney, The The Golden Bough by Sir John Frazier, The Elementary Forms of Religious Life by Emile Durkheim.  For easy reading, there are many books on this subject by Joseph Campbell. Among the scholars from India, Sri Aurobindo's writings were helpful and more from the Indian context and with understanding of the culture, but sounded more like justification than explanation. If the readers know of Indian scholars who have dealt with this subject, please share that information in the Comment section.  Thank you. 

Saturday, October 2, 2021

Life's Lessons - Who taught me What? (15)

 Who taught me what after coming to Cokesbury?

After coming to the Cokesbury Village, two individuals influenced my thinking the most. I cannot even give the initials of these two gentlemen for privacy reasons. But I wish to write about what they taught me.

One of them is no more. He is no more because he lost the desire and the will to live. He taught me how to die gracefully. He was close to 100. His mind was sharp but, the body was worn out.  When this happens many in this age group lose their desire to live.  

I had the privilege of sitting and talking with him twice just before his death. It was a humbling experience. He spoke with calmness and assurance. There was no self-pity. He was saying “good-bye” in his own terms.

He told me that he became an atheist when he was around 23 or 24 following an accident in which he almost lost his life. Events around that accident made him realize the impermanence of life and life’s lonely fights. He had no regrets about the way he led his life. He also recommended that I read a book with the title “This Believing World” by Lewis Browne. I read it and learnt new ways of looking at religions in general.

The other gentleman is over 100 years old . He is my role model for growing old gracefully. He taught me that one way to live long with a sharp mind is to be socially involved, help as many people as possible, as many times as possible and lead an active, engaged life.

Lessons from Three Habits

Reading habit: During my five-year stay in US between 1958 and 1963, I was afraid of forgetting my mother-tongue and Sanskrit. Therefore, I made a habit of always reading one book in Tamil and one in Sanskrit throughout those five years. I am reaping the benefits now. The other reading habit was to always read one non-medical book, since so much of my time was taken up reading medical books and journals in those days. (I plan to write a series on Reading Skills soon)

Journal (diary writing) habit: This started when I was in Loyola College. I do not remember why I started it. It was not a list of what I did that day. I wrote only when something of significance ( at least what I thought at that stage in life to be significant) took place. Since my life for the first two years in Madras(college years) were stressful and unhappy, I used writing journal to express my disappointments and frustrations. I have lost most of my earlier notebooks. But I saved a few pages from the final years of medical school before coming to US. After that I have saved all my journals from the 1960’s. Some of the thoughts I have expressed in my blog site (www.timeforthought.net) are based on my daily journals (diary).

Meditation habit: I started daily meditation in early 1972 or 1973. Initially, I learnt basic ideas from my brother and later from Ramaa’s dad. I also got initiated into the TM style. But I followed my own path and inner direction. Therefore, it kept changing. But, after I attended the first week-long session with Thich Naht Hanh, it became steady.

I have meditated consistently for over 40 years now. I do both silent meditation in the Vedic style and insight meditation as in Buddhism. Meditation has been a great source of relaxation and mental stability and has helped me look deeply into myself and into events around me. Without meditation I could not have survived the year Ramaa was critically ill and the years since I  lost her.

My brother, Adi Sankara, Buddha, Ramana Maharishi, Thich Nath Hanh and Tolstoy are probably the most significant figures who influenced the direction of my meditation and spiritual journey. 

End of stories!

PS: In 2006, I shelved this project since it is self-centered.  I asked myself: “Who is going to read this anyway?” Few years back Sheela said that she wanted to interview me and make a recording.  Pranav also started interviewing and recording me. Therefore I decided to complete this and completed it on June 11, 2021. 

Thanks for your interest. Hope there were a lesson or two you found useful. 

Saturday, September 25, 2021

Life's Lessons - Who taught me What? (14)

(continuation of lessons from travels)

 Speaking of air travels, two co-passengers who sat next to me in two different flights taught me remarkable things. I have communicated with one of them and have saved his thoughtful response.

One was an actor in the London theater. We were talking and he said: “You are very relaxed”. I said: “ Yes, what made you say that?”. He said: “I am an actor. I know when I am acting with someone who is new on the stage. They are so nervous that their mouths get dry. Therefore, when they say certain words, I know they are new on the stage because of the way their tongue sticks to the roof of the mouth”. I have used this observation successfully in my practice when I speak with mothers. On many occasions I was able to recognize they were very anxious and that made it possible to help them better.

The other one was an insurance inspector for the Lloyd’s of London. He specialized in investigating fires in airplanes. We were discussing how he investigates fires as to their origin, the spread and possible causes. I shared with him how we investigate origin of symptoms and causes in children. He taught me that it is all based on astute observations followed by systematic logic! Just like Sherlock Homes. We agreed that the process is the same whether we are investigating fire in a physical structure or disease in a human being!

Ninety-nine dollar tour of USA: During my first trip to US, I stayed for five years. At the end of the 4th year (May – June of 1962), I wanted to travel through USA and see the country before I went back to India. At that time, my intention was not to return to USA. My resources were limited. (The monthly salary at the Children’s Hospital of Philadelphia was $50.00 and free boarding and lodging. And, at the University of Chicago, the salary was $120.00, without boarding and lodgings) When I was thinking how to make my dream come true, I heard from Jim Johnson of Binghamton NY(I have mentioned about him earlier), as if he read my mind. He asked what I planned to do for vacation. I said: “what can I do with the money I have?”. Jim must have sensed my frustration. He sent me a check for $200.00 and said that I should travel around the country and enjoy. He also said that I need not return the money because he intended to write it off as unpaid bills in his practice!

It also so happened that I knew one Mrs. Updegraff in Philadelphia. She worked for the Greater Philadelphia Council of Churches. She was a missionary in in a village near Pune in India at Pune and knew Dr. Malathy Jadhav of the Christian Medical College, Vellore. She said that she can give me contacts in several cities where I can stay with families who had grown up children in the adolescent age group. The only condition was that I have to speak about India at the Churches these families attend. I agreed.

In those days there was a special ticket for $ 99 in Greyhound . This allowed one to travel anywhere around the country as long as one does not retrace the steps. In essence, it was a around-the-country travel. I travelled mostly during nights to avoid hotel bills. The contacts given by Mrs. Updegraff was useful in several cities, but not in all. Therefore, in some cities I stayed at the YMCA hotels for  $3.00 for a night. 

During this trip, I saw for myself the size and beauty of the country. During day-travels, I enjoyed the beauties of nature. I experienced the friendship of people in small towns and villages. I found how helpful they were to strangers like me. I became friends with some of the people I stayed with. They taught me about various aspects of life in America.  Mr. K of Portland, Oregon taught me about dairy farming. He owned a dairy farm and even took me with him one early morning when he went to milk his cows. (One of his cows won the competition for the most yield of milk in that county and I still have a photo of that cow!) 

The C family in Klamath Falls, Oregon exposed me to logging in the Oregon area and made me visit Klamath Falls which is one of the most beautiful, mystic and spiritual places on earth. Of the many places I have visited, I will add two more to this list - Kuai Island and Bali. 

 The most enduring friendship was with Jim and Lucy in Colorado Springs. Later I visited them with Ramaa and Bama once. We visited them once more with Bama, Hari and Sheela. By that time, Jim and Lucy had grandchildren. Bama, Hari and Sheela had a wonderful time with them and  experienced life in a cattle ranch and countryside, which included hayrides. Sadly,  Lucy and Jim are no more. But I had communicated with their son until recently.

 I learnt a thing or two about life-long friendship across cultures from these visits. 

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

 

 


Saturday, August 14, 2021

Life's Lessons - Who taught me what? (8)

          (Just a reminder that although the focus of this series is on the lessons learnt, I may elaborate on a person or an event to set the context and relevance. Quotes within parentheses carry the main points even though not in the exact words. Italicizes parts are for extra interesting details.)

Doctor Lewis Coriell (teacher, mentor, father-figure)

Doctor Lew Coriell was the first physician-teacher I worked with at the Children’s Hospital of Philadelphia (CHOP). He was the Director of the Municipal Infectious Disease Hospital at Camden, NJ. (The hospital has closed since then. In the 1950’s Camden was a thriving community. Its economy was driven by New York Ship Building, RCA and Esterbrook Pen company. The Courier-Journal was considered the best small-town newspaper in US. The Polish ethnic neighborhood was a great place to live)

Doctor Coriell took to me at first sight – I do not know why. From that moment, he has been  a father-figure, teacher, mentor and cheerleader.

He was outstaged by Mrs. Coriell (Esther) with her kindness and care. Mrs. Coriell just took Ramaa under her care like a mother would. The Coriell's did not have a daughter and I know that Ramaa was that missing daughter to them. She taught Ramaa every aspect of home-life and family living in America. When we said: “Thank you for your kindness” , her response was “Kindness is meant to be passed on”.

Mrs. Coriell gave Ramaa some simple items such as a toaster, a griddle, and empty cans and canisters to store grocery items. This was very helpful to us when we moved into our apartment.  Ramaa learnt this lesson and used it to help newer families who came from India after us. She helped them get started with simple, mundane but useful things.

Mrs.Coriell also taught Ramaa several small “do”s and “don’t” about living in USA. Ramaa was a great student and picked them all up – such as how to be frugal and yet do not cut corners in daily purchases; how to cook Western style; how to set the table etc etc.

If I have to list the lessons we learnt from the Coriell’s, I have to respond by asking “What is it we did not learn from them?”

Dr.Coriell taught me how think critically, how to disagree without being antagonistic, how to be firm and gentle at the same time. He taught me how to plan and perform scientific experiments. He taught me how to write medical articles with attention to details and how to edit scientific manuscripts. (I helped him edit one of the early editions of the Red Book for the American Academy of Pediatrics. He went over it for accuracy, clarity and thoroughness and edited it over 20 times before it went to the printer)

There is  one other incident to remember. Through this experience I learnt two lessons. One was about caring for others and helping them when needed. That was the lesson from Dr. Coriell. The other was from the owner of an auto-body-shop in Norfolk, Va.

We (me, Rama and Bama) had gone to Williamsburg, VA for a long weekend by car. The valet of the hotel we were staying in got into an accident with our car on his way to the parking lot in the next block! When the police called me to report this incident, I did not know what to do. As usual I called Dr.Coriell and asked him. He said that since I had nothing to do with the accident, he suggested that I give my details to the Police and collect all the information from the Hotel and take a flight back. I did just that. But, when I landed at the Philadelphia airport, I was surprised to see Dr.Coriell waiting! When I asked him how he knew about my flight (since I had not called him), he said: “There is only one flight a day from Norfolk and I took a chance”. The story does not end there.

The car did not get fixed for several weeks, because the insurance company for the hotel and my insurance company were arguing as to who should fix it and who will pay for what portion. Nothing happened for almost 2 months. When Dr. Coriell heard about it, he wrote a letter to the President of my insurance company and the car was fixed within the next 2 weeks.  I do not have a copy of that letter. But I read it. In that letter Dr. Coriell did not criticize or attack. He just stated the facts and told them that one of them should “fix” the car and then argue, not argue for ever leaving the customer without a car for several months. I learnt how to write with tact and diplomacy, how to complain without pointing finger at anyone – in other words how to get things done and not vent your anger!  This is still not the end of the story.

After the car was fixed, I had to fly to Norfolk, VA to get my car. When I reached Norfolk, a big surprise was waiting for me in the form of the owner of the garage who repaired the car. I wish I remember his name. He taught me a major lesson in life. I learnt that he is not just a garage owner or a car mechanic. He was passionate about cars and their maintenance. It was evident from the way my damaged car looked after he laid his hands on it. For one thing, the car was better than new, if that is possible. In addition, I learnt that one can be an “artist” even with car repairs.

He was animated when he talked about how he fixed my car. In addition, he spoke about his passion and about the many other cars he was repairing. We went around looking at them. It was obvious that he did his work for more than making a living. He took pride in his work. I forget everything he said. But the gist was this. “It does not matter what work you do. You should do it with passion and with perfection. It should be done in such a way that when someone looks at the work you have done, they should be able to see “your stamp of excellence” on it. If you can do your job well, you do not have to worry about making a living, whatever the trade or profession. Even when there are several people in your town doing the same kind of work you do, people will seek you out”.

Later I realized that this is also a definition of excellence. Knowledge, skills, attitude, creativity and values.

Saturday, August 7, 2021

Life's Lessons - Who taught me what? (7)

 What did the process of choosing a profession and field of study teach?

When I decided to enter medicine as a profession, it was based on desire, faith, emotions and a role-model. I had no facts or knowledge to base my decision on. My 5 years in medicine taught me several things. Therefore, my later decisions had more solid grounds.

In the process of choosing pediatrics, later choosing pediatric rheumatology and in deciding to come to USA for training, I learnt several things. First, one must know why one wants to choose one path or one decision over another. That requires a reasonable amount of information - not necessarily everything, about the choices. In other words, knowledge about the choices. That, in turn, requires efforts to gather knowledge by reading, listening, observing and if possible, through experience. Next comes, a logical analysis of the pros and cons of the available choices. Finally, the final choice or choices have to be checked with one’s own “heart” to make sure one can live with the decision, even if not able to enjoy it. That decision should be compatible with one’s values and personality.

This learning and a desire to share this with others was the motivation for my book (with a co-author) on Thinking Skills for the Digital Generation in which I have summarized these thoughts.

Experience during my first visit to the USA

When I came to US in 1958, I came as a rotating intern at the Binghamton General Hospital at Binghamton, NY. During that year I learnt many things about personal and professional life in USA.

The first person I got to know and work with was Dr. James Johnson. How fortunate that was! He died recently at the age of 96.

He initiated me to the ways of medicine, particularly pediatrics, as practiced in USA. This footing helped me immensely in my learning how to be a good house officer and how to acquire knowledge by observing and doing. It also helped me obtain great residency positions at CHOP and at the University of Chicago. I applied to 50 Departments of Pediatrics and Dr. Johnson sent letters of support to all of them. This was in those days when there were no copying machines and every letter had to be typed. (I still have a copy of the letter he wrote)

One other person who helped me in the process of acculturation was Mr. Herman Darkins, who was a Speech Therapist at the Hospital. He taught me how to pronounce English alphabets correctly! He showed me how to position the tongue and the lips to produce various sounds. (Later I could relate his teachings to what has been written by Panini on how to use the tongue, lips, teeth and roof of the mouth to pronounce Sanskrit alphabets. There is a similar section in Tholkappiam on pronouncing the alphabets in Tamizh).

Mr. Darkins was an Afro-american. During my trip to Pittsburgh with him by car, I also learnt first-hand how segregated things were at that time. We had to sit in a separate counter at a diner!

Then there was the family of Clifford and Peggy Thomas of Greene, NY. They introduced me to how a typical American family lives in a village. Peggy also introduced me and Ramaa to pancakes and maple syrup and to strawberry shortcake!

The next stop was at the Children’s Hospital of Philadelphia, affectionately known as CHOP – and what a stop! That was the beginning of my career in Pediatrics. Who are some of my teachers at CHOP who influenced me?

Doctor Milton Rappaport was one of them. He was a giant in knowledge and in stature. He read medical journals in five different languages. He was a pioneer in several new fields in pediatrics. He taught me (he did not ask me to notice; but I noticed how he did) how to hold newborn babies safely, without any risk of dropping them. (When I was demonstrating this method to students at Chennai later, they were all scared that I was going to drop the baby!) He taught me the importance of expanding my horizon in reading. He insisted that I read far and wide and develop other interests. 

Doctor Stokes was a gentleman and a statesman. We rarely see such gentleman in medicine as Chairman. When I interviewed with him for residency his first question was about cricket in India and not about pediatrics. I learnt later that he did not like intimidating students and this was how he helped his students and colleagues to relax.

Later he taught me how a professor or any one in a high position can come down and just be human. Here is one of the  most touching incidents in my life to document what I mean.  After my second stint in US, I was getting ready to return to India for good and set up a research project at the Egmore Children’s Hospital in collaboration with CHOP. At that time, we were living in a one bedroom apartment in Camden, NJ and both Bama and Hari were very young. Hari was hardly 3 months old. 

Dr.Stokes had just returned back from Denmark after being honored by the King of Denmark for his work during World War II. He wanted to see me before I left. I offered to come and see him. He said: “You are probably busy packing up for your return home. Besides, Ramaa just had a baby. Let us come and see you”. He drove from Chestnut Hill, outside Philadelphia to Camden NJ with his wife and visited us in our tiny apartment. Just a day before we left for India, Dr. Stokes drove to Camden to my apartment, with his wife. (I still have a picture of him sitting in my apartment and with Hari as an infant on Mrs. Stokes’ lap).

During the conversation he said: “I am 70. You are going back to India for good. I do not know whether I will get a chance to see you again. That is why I came”.   I have tears in my eyes as I write about this episode. True enough, he passed away before I came back in 1970.

The main lesson is that even if you are a “big shot” or a Professor or a famous person, you must have concern for others, give respect to others irrespective of their position in life and treat everyone with dignity.

The next most important person who influenced me at CHOP was Doctor Lewis L. Coriell. More about him and what I learnt from him in the next post.

Saturday, July 31, 2021

Life's Lessons - Who taught me what? (6)

 My special older sister: (Nagammal) She taught me what love for a younger sibling is and how to show it.

My children (Bama, Hari and Sheela)

My children taught me to loosen up, although I probably did not come to their expectations. I was somewhat rigid and orthodox in my thinking about many things. They changed me with Ramaa’s help and through her.

Teachers in School, College etc

There were many teachers in my school (Rajah”s High School) who were simple gentlemen from my hometown. They showed me what dedicated teaching means and why one takes this profession for such meager salary.

My time at Loyola College was essential for my further development and entry to medical school. Other than quality broad education, what I learnt during those two years were about life in general and growing up into an adult. I learnt about taking care of my own needs. I learnt to play sports. The most important experience was that of making some life-long friends (Peter Fernandez, “Rangs”, Chandra and Meenakshisundaram). They are still friends after 60 years. 

Medical School (Madras Medical College)

Who were some of the most influential people in medicine and how?

Top on the list is Dr.K.V. Thiruvengadam (affectionately known as KVT by all his students) with whom I was in contact until his death, sadly one of the victims of the COVID pandemic. I learnt from him what it is to be a clinician, how to be compassionate, and how to be soft and gentle with people. For bedside manners, he was my role model.

For social justice, Dr.K.S.Sanjivi set the standard for me.

Dr.S.T.Achar was responsible for creating in me an interest in pediatrics. He was another role model for my clinical skills.

While at Wadia Hospital for Children at Mumbai known at that time as Bombay, Dr. S.M. Merchant showed me how to make observations, interpret them and use clinical logic.

Above all, these role-models of mine treated everyone with compassion and kindness. They treated the rich and the poor with equal respect.

One other great experience while at the medical school was probably responsible for sowing the seeds for my interest in scientific inquiry. This was a visit by a WHO team who taught at my medical school for several weeks. I was fortunate enough to attend talks by Sir Alexander Fleming and Dr. Heymans (Both Nobel Laureates), Dr. Samuel Levine (Bellevue Hospital, Neonatology), Dr.Charles Aub (cardiologist, Harvard) and Dr.Leo Rigler (radiologist, University of Minnesota).  

Saturday, July 24, 2021

Life's lessons - Who taught me what? (5)

 Father (Hariharan)

My father was not as influential in my life as my elder brother was. The most important lesson he taught me, and my mother was the importance of forgiveness. (Rev. Thich Naht Hahn taught me the “how” - namely “how to forgive” - through his guided meditation on forgiveness)

Two other lessons he taught by example are: keeping promises and keeping trust.

My father’s mother had a much greater  influence on me and taught me more. That was my grandmother.

Paternal Grandmother (Chellathammal)

My paternal grandmother was an amazing lady who became a widow when she was very young and raised her two sons, one of them my father. She was a tough task master. But she was also full of love. She used to say: “The hands that punish you will also hug you”. That was true of her.

She showed me that wisdom has nothing to do with formal education. She did not have any education. But she was able to make wise decisions. How else could she have raised two boys as a very young widow and a single mother in the late 1800’s and early 1900?

Another lesson she gave me:  “Just because you are poor, you do not have the rights to take someone else’s belonging”.

She was old-fashioned enough that she did not encourage educating my sisters. But she insisted that “the only out of poverty was education” and supported the boys in the family – her sons, me and my brother.

She taught us Honesty. People in my street trusted her to do what she said she will do.

Although she was orthodox in her ways as a Brahmin, she treated everyone warmly and giving them due respect.  By her actions she taught us how to treat people with dignity whatever their social status. Here is one great example.

During the war, when rice was rationed, she will ask some of the poor folks to come at night (we were not supposed to give food?) and she will feed them. Therefore, I have seen them being loyal to her and come any time to help her, if asked. One such person was a poor lady who used to live selling yogurt. My grandmother will feed her every day.Therefore, the yogurt-lady was a loyal family friend. She was so loyal that when my middle sister became sick and was alone, that lady came from her village, stayed in our house and took care of my sister for a few days till someone else from the family could take over the care.

A local Priest (Sri. Narayana Bhattar)

Sri. Narayana Bhattar (we used to call him “bhattar mama”) taught me Sanskrit when I was 5 or 6 years old. I resented going to the class at that time. But am glad my family insisted on it. I did not know how much that Sanskrit knowledge will help me when I grew up.  Fortunately, I kept it up and now can boast of having read several passages from the Vedas and Upanishads in their original and even some Sanskrit classics such as Sakuntalam and Malavikagnimitra.

That experience taught me something about curriculum-setting in schools. There are some subjects which students would not like to learn because the subject is “dry” or they cannot see any point learning it. For example, in medical school, many students will not like anatomy or organic chemistry or statistics. That is  because they do not know of their usefulness in the future. People who have gone through the training and who are in practice should insist that some subjects should be learnt even if the student does not “like” it. The idea of students setting their own agenda/curriculum or taking all subjects as optional is questionable.

Srinivasa mama (“Dr”. mama)

Srinivasa mama was responsible for motivating me to become a physician. I need to write a few words about him so that the context (medical care in India in the first half of the 20th century) is clear.

He was NOT a doctor. He went to medical school for a year or two and was forced to leave for family reasons. He took a job in a Government Office. But, at a time when there were extremely few doctors and most of the care was provided by indigenous practitioners and ayurvedic doctors, it was common for “compounders” to practice medicine. Compounders were laymen who made up “mixtures” and “powders” (there were no prepackaged medicines in those days. Doctors mixed various medicinal chemicals in proper proportions. These were called the “mixtures” and “powders”) and ointments for doctors who practiced western or allopathic medicine.

During my high school years, I became sick with typhoid. There was no antibiotics in those days. I was so sick one night that my mother thought I will not survive as she told me that several years later. During recovery I was taken care of by Srinivasa mama. This was a defining experience because, this to my memory, was the beginning of my interest in becoming a doctor.

He not only sowed the seed for a desire to become a doctor, he also set a model of a compassionate physician for me to look up to.

Srinivasa mama worked in that capacity as a compounder with the limited knowledge he had acquired during his time as a medical student. But he was considered a full-fledged doctor by the community. More important, he was a compassionate human being who practiced the noble qualities of a physician better than many other doctors I have known. He listened and understood the needs of the people. He took care of “the entire person”. People consulted him on every aspect of their lives, from choosing a college to choosing a bride. Most important, he knew when to send them to a bona fide doctor. (May I add, he played a major part in my marriage too!)

He certainly inspired me to become a doctor. I learnt humane approach to medicine from him and, also how to take care of the whole person with a disease, not just the disease.