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.  

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.

ॐ 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 न 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 न 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.

 

ॐ सर्वे भवन्तु सुखिनः सर्वे सन्तु निरामयाः ।
सर्वे भद्राणि पश्यन्तु मा कश्चिद्दुःखभाग्भवेत् ।
ॐ 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

 

 

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.

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.