The ex(f)iles

It was somewhat ironic. The fact that on my recent trip to my hometown, Delhi, I happened to be reading about its history. I was reading 'City of Djinns', a book about Delhi and its history, as seen from an Englishman's eyes, set in the 1980s, and there I was in Delhi, seeing it through an expats eyes in 2012.

The City of Djinns explores the history of Delhi and is testimony to the city's constant evolution, the way it has changed with every civilization, every empire, every race that has ruled or inhabited it over thousands of years. What I continue to notice, on every visit back home, is how it continues to change, to adapt over much shorter time spans and how Delhiites, continue to change with it.

I grew up in Delhi, before I left for med school in 1999 at the age of 18. Since then I've of course, made several trips back home and lived there for a couple of years in between med school and moving to the US for my residency.

Things change, no matter what. You leave home and home changes. You change. Nothing stays the same. What is more resistant to change, however, is your perspective of home. You want it to stay the same, you try to cling to the happy memories of it that you have. You don't live there anymore, but you dislike the fact that other people are moving in there and making it their home. You build a life and career elsewhere but you don't want to miss anything that happens back home.

Its a strange life, once you're transplanted. You begin to experience this disconnect in time and space. I've physically been in several places, far away from Delhi over the last 13 years, but mentally when I go back there, I feel like its 1999. I want it to be 1999.

I've often noticed how many NRIs get stuck in this 'time warp'. Their perspective of home gets stuck in the era when they leave. They may or may not continue to evolve and be progressive in the community and country where they now live, but the ideas and values they apply to their homeland tend to stagnate and I'm not sure how others react to it, but my reaction to it happening to me is one of bemusement and mild annoyance. The people who are clearly not from Delhi, but are seemingly more comfortable than me driving on its streets, annoy me. The girls who wear these really short shorts, which would not be out of place at all in an American mall, shock and scandalize me (and make me wonder why I left in the first place). The heat that I used to play tennis in now feels almost intolerable.

Now that I feel it happening to myself, I feel a certain degree of inevitability about it and still don't quite understand why its happening. Is it a voluntary mechanism to try and stay connected? Is it just that impossible to progress with the country once you've left it? Is it that one can only adapt to one changing culture at a time? I'd like to fight it, but I'm not quite sure how. I'm not even sure if its that much of an issue and if it bothers other people as much as me. Looks like for now, every trip back home is going to be a mild culture shock, from my own culture, which seems to be moving at breakneck speed and is not going to be easy to catch up, or keep up with.

Home? Shanti? Home?

So, as another year comes to an end, and the usual cliches abound about if having sped by so fast I decided it was time to revive my blog which had been dormant for far too long, the reasons for which are many. I have been busy living the life of a Neurology resident, and am busy aspiring to live the life of a neurovascular fellow. I have also gone through a rather prolonged phase of indifference towards most things the world has to offer(when Manchester United loses and it doesn't affect me, it's probably time to worry) the reasons for which I still seek.

I have also had several failed attempts at writing a post which I considered good enough for my blog over the past few months, and if it hadn't been for a friend who happens to be an accomplished writer giving me some very sound advice this post might also not have seen the light of day.

So what has been happening with our chronicler over all this time, is I believe what the avid followers of this space are wondering. Life has, in general, been dawdling on rather slowly, and yes, in spite of that I too, will wonder in a week's time how the past year flew by, just because its what we do. I have been surviving this godforsaken land as best as I can, having a few moments of fun thrown in between several of boredom and serious introspection, essentially precipitated by having far too little to do and having nobody to do it with.

Its incredible how some of us take to a foreign country like a European to beer, including many of my friends who now live in the US, while some of us struggle to make any place other than home, home. I first moved out of home when I was but a young lad of 18, heading to Ahmedabad to med school. Since then I have had several visits back to Delhi, and several departures from home, and I have to say, they do NOT get easier. I have over the last 10 years, never really, truly felt 'at home', ironically enough not even during the brief period that I was home, perhaps because I knew it was just a brief stay, in transition to my next destination. I don't know if thats something thats wrong with me, whether I am holding on too tightly to an idyllic place from childhood that exists in my head to accept my new surroundings as home or whether this is something that every immigrant, every re-locator goes through.

The definition of home has now become amorphous. Is it the supposedly 'nice' apartment in downtown Cleveland I share with a friend? Is it my parents house in Noida where I have lived just a few weeks since they moved? Is it the overcrowded yet beautiful streets of Delhi? Is it mainland India in general? Or is it a concept, rather than an actual place? A fairy tale place I seek perhaps, like the end of the rainbow, that I might never be destined to find? (This is probably right where my mom would jump in and tell me to get married and 'settle down' but I'm not sure thats the answer. In fact, I'm sure that its not) What I can be absolutely certain of at this point in time, is that its NOT my apartment in Cleveland, and its never likely to be, no matter how much I call it 'home'.

Well, on this rather introspective and melancholic note, I wish everyone a happy holiday season and great 2010. May we all find our respective ends of the rainbow, or be at peace with not finding them.

An Ailing Enterprise

Webster’s dictionary defines Hospitals as “institutions where sick or injured are given medical or surgical care”. This definition truly falls short in many respects, especially when viewed from the perspective of the medical fraternity. We, who spend most of our waking hours in one or more of these “institutions” come to look upon them as this, and much more. They are our teachers for the best part, there are times when they are our friends, our shelter, and of course there are occasions when we can barely wait to get out of there. Hospitals are in a number of ways like living, breathing entities. They are born when they start functioning, they grow over years as they develop with the changes happening in the world of medicine and in some occasions, for different reasons, they one day cease to operate, or die.

I have been associated with a hospital that is, unfortunately in such a situation, where it is fighting to stay alive and to put it bluntly, the prognosis doesn’t look too good. In such circumstances, it is natural for all the people associated with the institute to be very worried, and the instinct for self preservation takes over. Perhaps we should take some time out and give a little thought to the hospital itself. Having been around for over a hundred years, having been over a thousand bedded facility in its heyday, having been a premier center for health care and research, for the institution to see this day, to be, metaphorically speaking, on its knees, having stood tall not too long back, is indeed a sad, sad story.

These, however, are also signs of the changing times, when we realize that a hospital is not merely what the lexicon defines it as, but are also financial concerns, with medicine and health care being the multi billion dollar industry it is today, and we also must unfortunately accept that if it is not financially viable for an organization to keep running, it must shut down. If we take a moment though, to reflect on the parallel I attempted to draw between humans and hospitals, I wonder how the hospital would feel at the state of affairs, having witnessed many events in its time. It has seen glorious discoveries, it has trained fresh moldable minds into competent physicians, many of whom are at the forefront in their chosen fields. It has served the changing community for over a century. It has been a part of their joys at the birth of their children and the recovery of their sick. It has been a source of strength in their times of weakness, and a silent sympathetic spectator to their grief. In short, it has done its part and a whole lot more.

Everywhere you go in the premises of the hospital at this point in time, you come across snippets of conversation about the impending fate, and while most of these circulate around how it is going to affect the lives of those associated with the organization, there are underlying emotions which are quite perceptible. There are those who feel angry and frustrated, partly because of the concern for their own futures and careers, but also because they can do little to help the hospital, their home away from home, in its time of need. There are those who feel despair and disgust at the way their workplace is being snatched away from them by financial reasons and constraints that they don’t even comprehend, and there are some who still feel pride at having been associated with an institution that in its day shone like the sun in the world of medicine, leading the way in research and clinical practice. If I may speak on behalf of my fellow workers, it is largely a combination of all these emotions that most of us feel.

Many of the employees, past and present, have been associated with the hospital for a large part of their careers, and declare with pride, “I will go down with this ship”. It is this attitude, perhaps that also reflects what the hospital would feel at this time in its life. Pride, at having accomplished so much, and the will to continue to fight, no matter how dire the circumstances. As for the employees, patrons and other people associated with the hospital, life will carry on, here or elsewhere, but I hope that the mixed feelings of anger and despair will eventually give way to a feeling of pride. Pride, in staying in the fight and not throwing down their arms, pride at performing their duties to the optimum even under the most strained circumstances, and pride, for coming through testing situations which are being witnessed far too often in the American health care system today.

(Written in tribute to Michael Reese Hospital, Chicago)

The Code

Suddenly it was all over
And everyone looked at me
As I looked at my watch,
Said “time of death - 4:53”

After all the frenetic activity
A squalid pall had descended
For, on ICU bed 3
A code had just ended.

(also a piece deemed unworthy by the Annals)

Life, death and that post call feeling

The last 4 months have been a bit of a blur. The last 3 weeks even more so. Since moving to Cleveland in June, lifes been either ridiculously busy or ridiculously dull. No real in-between moments. The last 3 weeks I've been in the Neuro ICU, (One more week to go, and its been really, really tiring!) which if one has the time is the kind of experience that will make one reflect on life, on death, on dying, and also on that incredible thing we call the post call feeling.

It will make one realize how fragile life is, as indeed many of our daily experiences do, and how a small blood vessel popping somewhere in a persons head can bring an end to what might have been a long and happy life. It will reiterate the belief that dying might actually be a lot harder on the loved ones of the patients rather than the patients themselves. It will bring a relative, in some cases an absolute lack of emotion dealing with death and dying, which is unfortunately, and in an ironic extreme, a part of life.

Coming to that amazing post call feeling, I'm not sure if there is any non-medical parallel I can draw for the more fortunate folks amongst us who were smart enough not to go to med school. I could liken it to running a marathon, somehow getting through it, and then seeing the finish line, the home stretch, but then I dont know too many marathon runners either.

You spend almost 30 hours at a stretch, working like the devil, getting almost no sleep. Somewhere about 20 hours or so into the call, it really hits you hard, but you keep going and around 24 hours into the call you get a second wind, which is the beginning of the post call feeling, even though you're technically and physically still there, still answering questions, presenting cases, and sometimes unknown to the ACGME, doing procedures, you bask in the knowledge of having successfully completed a call, in anticipation of the comfortable bed and undisturbed sleep that await you at home. Trust me, it is almost euphoric, as is the feeling of actually hearing those hospital doors slide shut behind you and the half asleep drive back home.

I still have over half a year of calls every 3rd or 4th day and I expect that like everything else this too shall pass. At least on every call day I have the post call feeling to look forward to.

The "Graduates"

Michael Reese Hospital celebrated the graduation of its last ever class yesterday. It was a great occasion. A happy one. A sad one. A proud one. A beautiful one.

As part of the outgoing intern class, I was perhaps amongst the people with the briefest association with MRH at the graduation party last night. The gamut of emotion that many were going through was very palpable to me nevertheless, the open bar not withstanding.

As all of us leave Michael Reese, we all take with us a small part of the institute, a small part of each other, the people we worked with, and the people who were friends, practically family for the last 1 year. We also as a corollary, leave behind a small part of ourselves with this place and with these people.

Its been pretty much a roller coaster ride during my internship - I apologize for using such a cliche. There've been times of joy, times of sorrow; Times of sheer frustration and agony, somewhat outnumbering the times of ecstasy (its a residency - thats about par for the course); Times of nerve wracking stress (I never, ever want to hear the words 'business' and 'lunch' used together again.) and times of complete relaxation (the last couple of months have been pretty easy).

As the party came to a hesitant end last night, after all the music and dancing (yours truly danced as well - most people who know me well know that happens even less often than a sighting of the Halley comet - to underline how special the occasion was) one could tell that many of us were reminiscing on such moments (the open bar was a help this time around). Everybody looking back on the time they spent here, with each other, lasting memories they would have of each other, of themselves, of the hospital. The education they received here, which would of course serve as the foundation for most of their careers. The relationships they forged. The laughter they shared. The quarrels they had. The things they shouldn't have said but did, the things they should have but didn't. (I know thats what I was doing, at the very least.)

Now that the serum alcohol levels are tending towards zero, I can think clearly and realize that I was thinking pretty clearly last night anyways. In about a week, all of us will move on to our lives at other programs and hospitals. The hospital, too, doesn't have too much long left in terms of operation. At this point in time I would just like to thank everyone I've had the pleasure of working with over the last year and wish them the very best of luck.

If any of you guys are ever in Cleveland, give me a shout out. It'll be great to catch up.

Nightcrawler

As the night passes by I think thoughts that I am sure many have thought before me, and many will continue to think for ages to come. These thoughts pretty much range around causing some sort of bodily harm to my pager, perhaps flinging it far into Lake Michigan. It is my first day - rather, night of my night float rotation. I haven't slept a wink as the minutes tick away and the clock shows 3:36 AM. Still 4 long hours to go. The lack of sleep is partly due to the job description of an intern and partly due to my complete inability to sleep on the on call bed or couch(As my resident just told me, I'm going to be in a lot of trouble if I can't learn to do that). So I use some minutes of relative silence to pen (type, really-but that doesn't sound too authorly - i know thats not a word, before any of you smartasses correct me) my thoughts and break what has been a pretty long silence for my blog. I think I'll have to send emails to all my readers reminding them of its existence.

The news from my end is that I survived the first 2 months as an intern and the better news still is that so did all my patients. Whether that represents my skills as an internist, or those of my residents/attendings, or just plain old good luck is anybody's guess. Residency has had its moments thus far. Some good, some bad, some funny, some exasperating(yet funny), some easy, some rough but almost none dull. The people here are a very eclectic mix and make for some very interesting company. (I know everyone expects it but I shall refrain from saying anymore. If I was a 16 year old girl it is at such an occasion perhaps that I would draw a smiley)

As for the city of Chicago, I have unfortunately not been able to see much(the job description of an intern again, can rather come in the way of that. "Patients before Sears tower" is my motto) but I have no complaints (this is a rare magnanimous mood where I refrain from airing my complaints. Even those against USPS) as I have 3 (what promise to be really long) years here before life figures out where it shall take me next.

I think I shall stop this midnight sleep-deprived ramble here as it dangles precipitously at the point of getting philosophical and finish on the note that I'm doing fine and think I'll manage to survive the Year of the Intern, including this month of 'the nightcrawler'. Besides, as one of the Indomitable Gauls of Michael Reese, my only fear is that of the roof falling on my head one day.

Scrap That Scrap

Over the last year I have gradually evolved from being an extremely reluctant and somewhat nonplussed semi-computer literate who was quick to dismiss the invitations to join this blessed thing called 'orkut' sent by many relatively more social and computer savvy acquaintances to a rather frequent 'orkutter'. If you cant beat 'em, join 'em, I figured.

What is really amazing about orkut (and the like - I believe there are other similar services that I have not yet subscribed to) is how people get hooked to it and how it offers complete strangers a window into our as yet very personal lives - which, oddly enough, nobody really seems to mind. Orkut is like a telescope you put in your window and pretend not to peep into other peoples homes. 'Orkuting' and 'Orkuter' are words that have become commonplace and I suspect might find their way into the Oxford lexicon at this rate. Another semi-medical term I propose is ' Orkutitis' - A condition that may result as an overuse of one's orkut account.

The diagnostic criteria I propose for severe Orkutitis are as follows:
(2 Major or 1 Major and 2 Minor criteria are required to establish a diagnosis)

Major Criteria
1. If you have over 2000 scraps in your scrapbook(chronic orkutitis) or receive/send/exchange over 20 scraps a day (acute orkutitis)

2. If you have over 10 photos in your album in all OR
If you have less than 10 photos but one of them is of a baby(yours as a baby, your baby, your niece/nephew, random baby pic - the prognosis gets worse in that order)

3. If you have greater than 2 video links on your account

4. If you change your profile name with every changing phase in your life (exams coming, exams over, getting admission, getting a job, getting married etc etc)

5. If the last meaningful conversation you had was in 'scraps'

6. If said conversation did not contain any vowels.

Minor Criteria
1. If you meet more people through orkut in a week than in real life.

2. If you check your scrapbook more than 4 times a day for new messages.

3. If you update the pictures in your album more than once in 2 months.

4. If you belong to greater than 25 communities.

5. If you have over 200 friends on orkut.

6. If you have mastered the art of typing alternate letters in CaPiTaLs

I'm still working on a possible management regimen of severe orkutitis. As of now I can only recommend controlled exposure. Prevention is better than finding there's no cure. For more developments, watch this space.

Our Cup Runneth Over

Its over. Or almost so. At the time of going to press, Bermuda could still beat Bangladesh and India could still go through to the 'Super' 8 (Yeah, I know, NOT happening, but i did get an award for optimism in high school). When the WC pools and fixtures were announced, nothing seemed so 'super' about the eight teams that would make it to the next round. It seemed terribly obvious and the pools were laughable to say the least. Yet, now it seems that a super effort was required, which of course our team rarely delivers when needed. We flex our muscles and show off our might against poor Bermuda and we bow down meekly in front of the ever competitive Sri Lankans.

Murali, Vaas and Jayasuriya continue to be thorns in the collective Indian side(pun very much intended). The number of times Murali has beguiled the Indian side and made them look as confused as Mika would be at a Beethoven recital or Rakhi Sawant in an art film(i.e. as clueless as a child in a topless bar) is perhaps just fewer than the number of man hours wasted in India over all these matches. Hence we have the number two batsman in the world, Mr Dhoni trying to cut an offspinner bowling around the wicket (Either the victims of the reported heart attacks during the game were of weak heart, had a lot of cash riding on the outcome or were real cricket purists and could not stand such blasphemous flouting of the cricketing manual) and we have Sachin, the Boss, the Master Blaster, the man closer to being God in our country than many of the gods themselves being bowled through the gate for the umpteenth time in his career. The above mentioned Lankan players are going to give many die hard fans nightmares for a while to come, and they'll probably still be playing 15-20 years later and give our kids the same nightmares too.

In an earlier post(Just Not Cricket) I had compared global cricket to a circus and Indian cricket to a masala movie. This current WC goes well beyond these descriptions. Its a soap opera, a whodunit(It really is tragic about Bob Woolmer. Nobody should lose their lives over a game. Unless its football.) full of drama and suspense, but sadly devoid of good cricket. (Thus far, at least)

So what happens to the Indian team now? Is it the end of the road for Sachin, Rahul, Saurav and Kumble? Do we get a radically overhauled team? Does BCCI do what the South African Board did after the last WC, and appoint a captain out of nowhere - Kaif or Raina, perhaps? Chappel of course, has to go.(An SMS doing the rounds suggests we give him away to the Pakistan team) Not for his coaching or management, but for his arrogant press conference after the Lanka game. I agree that he is not employed by the junta but he should have the grace, the dignity and the humility to accept his faults and responsibility in this debacle rather than come out swinging at the reporters and appearing like a petulant 10 month old who's all day sucker's been taken away and is throwing toys out of his pram.

As a corollary to this question, what happens to the Indian fan? Do we forgive and forget? Do we stop the unreasonable business of the yagyas, sangeet mehfils, and prayers for these random 11 people who are 'not employed by us, but are employees of BCCI' (which in a way makes them the BCCI XI and not 'Team India')? Or do we still continue to shower our adulation at them also making them targets of our spite when they fall short of our exacting standards? Do we still continue to say "Match fixed hai, these guys are selling the country" just because its easier than admitting, even to ourselves, that maybe, just maybe, we weren't good enough?

To quote an old classic song, "The answers my friends, are blowing in the wind". Till then I switch my support to the Irish team for the 'Super Eight'. May the best team win.

Love...Actually?

Its that time of the year again. Everything around me is pink or a slightly less nauseating shade of red. Everything that could have has had its original shape contorted into that of an anatomically incorrect heart. You can run, but you can't hide. If you're one of the few single people on the planet February 14 is a curse that you can neither fight nor escape.

Over the last few years I've tried some different things to battle this horrible day (Yes, I've been single on ALL the Valentine's Days I've survived thus far. Initially it was a battle, which has now evolved into a mere quest for survival). It started in school where veritable score cards were discussed at the end of the day ("X got 3 cards and she didn’t accept any!", "Y gave 4 cards this year"). I was always one of the people discussing these news makers and thought I'd probably figure out this bizarre concept of arbitrarily picking one day of the year to profess your 'love' for some random guy/girl just because Tom, Dick, Harry, X, Y, Z, Chunnu, Munnu, Teena, Meena, Bunty and Babli(I really wanted to name names here, and I mention it so my restraint can be admired by all) were doing it, when I grew up and went to college.

I went to BJMC Ahmedabad and I didn't figure it out. (All fellow BJites give me a "Hell, Yeah!"). In college the numbers for both X and Y came down to one, and I was blessed (or cursed) with a group of friends as nonplussed and incompetent in this department as me (all members of the gang, give me another "Hell, Yeah"). Bottom line, I still didn't get it (the concept and/or a valentine-take your pick).

I've tried going out with my friends, ‘Stag' is I believe the (im)polite word for people like us. What ended up happening was a collective frustration forum ("Dammit.. Look at THAT guy, how’d he end up with THAT girl?????!#@!?##!$" and the like..) I’ve tried staying in all day and studying (Thank you, Gujarat University for conducting the exams in February) but my solace was invaded by radio and the newspapers carrying commercials for lots of places in the city that had special valentine evenings planned for “couples only” which were pinker than Steven Tyler’s new obsession and carried more hearts than my med schools pathology museum. The worst thing a single 20 something year old guy can do on V day though is to go out for dinner with his parents (I know its supposed to celebrate love in all its forms and in all relations, and I love my parents very much, but the heart shaped balloons on the ceilings, soft candlelight and a restaurant full of couples did NOT make for a comfortable environment).

After losing so many battles I have reconciled myself to a life of peaceful coexistence with the devil that is 14th February. (Kudos to the Shiv Sena for continuing the relentless rage. I have, on many occasions considered joining their moral police for this one day of the year but I must admit, burning greeting cards just wont do it for me. Making guys do sit-ups because they were with their partners in a park does promise to be fun though.)

There is actually a variant of 14th Feb that is celebrated by my single brethren, and me and is called ‘Singles Awareness Day’ (Ironically enough its acronym is SAD), which is a humorous and self-deprecatory take on the more conventional celebration of the same date. So to all those who share my views on the subject, I wish you a very Happy SAD.

What makes everybody celebrate Valentines Day? I agree that there’s probably not enough love in this world to go round, but if it’s that realization, lets do it every single day! I guess expressing love, or pretending to express love on a regular basis is just too much of an effort. In that case are the millions of cards Hallmark sold this week, the millions of roses that were plucked for no fault of theirs, the thousands of red heart-shaped soft toys destined to go into a closet for life and the tons of money spent on dinners and gifts symbols of love…actually?

Reality Bites

One of the incredible things about home is that no matter how long you were away, 5 minutes back home will make you feel like you never left! I landed at IGI about a fortnight back and have since spent the most relaxed two weeks ever, making the occasional trip to Delhi from NOIDA(after much procrastination), eagerly lapping up all the soccer and cricket action on TV having missed these like crazy in the US, and meeting up with family and friends.

Needless to say, it feels great to be home. I also think I got back at the right time, else I would have missed all the excitement about Ms Shetty conquering the world and then some(my hearty congratulations to all fellow Indians. We might not win the world cup this year, but we already have Big Brother). I would have missed the furore over Mr President and his Baal Thackeray and the critics universally panning and proclaiming a complete lack of ishq for Nikhil Advani's Salaam. On a more serious note, I would have also missed Manchester United thrashing Spurs 4-0 and Sachin giving a 100 of the best to the hapless West Indians.

Coming back to Big Brother and reality TV, I must say, I really don't get it. Talent hunts seem to have sprouted up exponentially in the six months I was away. Every channel from A to Z(ee) has got one-or more. Every one from Palash Sen to Pooja Bhatt is a judge. Pooja Bhatt judging an acting contest is one of the great ironies of life. Who knows, next we'll probably have Rakhi Sawant playing quiz master(or is it mistress?) on Master Mind India!

This whole business about Big Boss and Big Brother(I know one of them has more g's than the other but I don't bother enough to find out which and how many) left me quite nonplussed as I didn't even know they existed till very recently. The firang version which created a 'rang' controversy that even 3 year olds who can't count know about was apparently intended as a celebrity episode. How Shilpa Shetty could be considered an international celebrity then is also beyond me, not to mention the rest of that motley crowd comprising the Goody, the Bad and the Ugly. The desi version of the same packed in a bunch of dysfuntional(or in some cases, malfunctioning. Right Ms Gracias?) also rans and losers like my favorite 'actress' Ms Sawant(I don't mean Abhijeet), Deepak Tijori and the eventual winner(I am still obstinate in my allusion to him as loser) Rahul Roy. The forced drama, the manipulated results, the crocodile tears are there for all to see, yet there seems to be this perverse streak in a global audience that compels them to not only watch the trials and tribulations of these random people locked in a house, but to also get involved and vote for or against some of them.

I considered adding this whole concept to the list of things I would never understand(Women, Money, Computers...) but i figure this is nowhere near important enough to make it to the list. My only advice to 'Reality TV' people is - Guys, get real.