Sanctuary

Sanctuary basically means a safe haven. In history religious shrines have mostly figured as places where violence was prohibited. The oppressed or people in any kind of danger would flee to the church to escape attack or even justice. Like the safe place in a game of tag, they could not be molested here. Nowadays people in danger of deportation sometimes seek refuge in churches, a reminder of the sanctity of the church.

I wonder what might figure as a sanctuary in our everyday lives? Hospitals now seem to function like an assembly line factory with time limits and legal constraints. So bewilderingly large and complex are they with prohibited areas, endless corridors and a million people. There are also financial bills attached.

Yet they are sanctuaries from some angles. Here the infectious people need not fear reprisal for their disease nor neglect. People infected with HIV are often ostracized and people with chronic diseases like tuberculosis and cancer face impatience and frustration of family and friends because of financial burdens or added responsibility. The treatment may be faceless with numerous changing doctors and nurses but several burdens are lifted as patients do not have to fend for themselves. Also as injuries and diseases are cured people get a new lease on life from hospitals, for example people with cleft palates usually have a speech impediment that influences their lives. Then consider psychiatry cases like depression etc., their problems are often intangible to others but receive proper attention here.

Another place I would consider a sanctuary would be home. Home is basically a refuge from the world where we should be happy. It is a repository of our dreams, our good times and bad times, our wishes, our freedom, and our responsibility. Sometimes I feel as if time soaks into the walls so that rooms take on peculiar characteristics and associations with memories. But time might as easily cling to something else, a saying, a scene like light on a window, something like a polished door or wicker furniture which forever remind us of home or childhood. Most homes fulfill the condition of physical safety but what about mental serenity? The thing is that homes seem now to be just as demanding as a full time day job. Whether it is to keep up our image in our own eyes or our social circles people go all out to have a thoroughly inconvenient home strewn with expensive clutter. Some homes are dominated by one person who orders around everyone else, while others are marked by neglect and indifference.

True homes should be a breathing space, peaceful and dependable. Consideration is a major part of the foundation of such a home. I was taught that when anyone returned tired from work or school, they should not be greeted by “what went wrong today” news nor should errands or chores be recited. They should not find the bathroom occupied and so on. Such small actions make a home comfortable and a sanctuary from a demanding world.

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ghosts in my books

When i open my books a thousand ghosts rise out of them and if i am under no pressure to finish the chapter i leave today and join them in a timeless world. Here i listen to tales as ancient as our existence. Their awed fascination is communicated vaguely to me until what is to them fear, mystery and obscurity is to me fear, mystery and obscurity. There are countless pictures of patients in my books, all unnamed. What happened to these people? What did they do? What were they like?

And the doctors who toiled endlessly in forming the compressed residue of the chapter i read. There are the lucky, like William Beaumont who knew a man St Martin, whose gunshot injury in the stomach left a fistula which provided him with enormous insight into gastric physiology. And Alexander Flemming who discovered by accident the first antibiotic.

There are also countless examples of almost fanatic research in common illnesses like malaria and ingenious breakthroughs. These ghosts forgotten and unforgotten together are memories of a younger world when teachers were few and questions were many. Stories written between lines of books until they are almost lost to sight. A passing mention of the name attached to the subject, the Bainbridge reflex, the Wolff-Parkinson-White syndrome, the Bohr effect and a hundred other trifles which tell ancient tales which are, yet, woven like a pattern in the fabric of time for only recently was the Watson-Crick model for DNA published and the brugada syndrome described.

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Bits of life, a moment in time

Anne had been staring at the laptop screen for a long time, lazily sitting up in bed. Her bored gaze travelled over another facebook album. It was late night and there was silence in the house, everyone in their own rooms and quiet.

The door opened and Cathy, her younger sister entered.

” I think it’s going to rain.” She said, sitting on the floor and leaning against the side of the bed.

” How’s keats ? finished? ” inquired Anne, referring to Cathy’s homework assignment.

Cathy nodded. ” What are you doing? Facebook?” she glanced at the screen. ” Why do people put up all these silly pics. All of them look alike, if i have seen one mug shot i have seen a dozen, and I’m sick of seeing my friends twirl in a dress like they’re taylor swift or something.” Critical essays usually left the prosaic Cathy sarcastic. Anne was eighteen and quite mature for her age. Cathy to whom she was a fascinating big sister had already acquired a lot from her serious nature at sixteen. Though the girls liked pretty things, they also liked variety, and had a remarkably incisive reasoning.

“Vanity, dear Cathy, just vanity. ” Anne replied with the patience of explaining the obvious.

” Ever since Jane got her new phone, she barely talks; she just pouts at it and uploads photos all day, even in class. And because i didn’t comment on them, she said I must be jealous. ” said Cathy in disgust. It was evident Jane would soon be demoted from friend to groupie.

“A picture is worth a thousand words, especially those that people take themselves. You get to see into their minds with them. Their weak points, and their desires. Look at this.” Anne pointed to one of her friend, cooing over her cousin’s new born baby. “That tells you a lot.”

” A thousand words,” said Cathy with the iron clad conviction of one who knew what she was talking about,  “is a lot of words.”

For the first time a spark of interest came into Anne’s bored eyes.

“It could write a fair essay. Maybe one of those children stories, too.” , considered Anne.

” Words,” said Cathy, delighted to find Anne taking her seriously, “convey a lot more than pictures, i think, because they are more, … more firm and concrete and … and  they make sharp definitions, you know.”

” And they tell characteristics, and hidden meanings and a variety of scenes. They crystallize situations and people and explain a lot more than a stern attitude and frown might in a picture, like Heathecliffe in Wuthering Heights” , said Anne, much struck. She and her sister were avid readers.

”Pictures have no explanation or conclusion, you can’t understand them without reading something about them, of what was in the person’s mind or something. Like that picture of Jack with his motorbike, you would never guess it was three summers’ worth of yard work unless it was captioned. ” said Cathy, “not to mention the paintings that dad has hanging downstairs.” 

“Pictures have subtle explanations and conclusions.”, retorted Anne. “We haven’t seen enough to learn the language.”

Cathy opened her mouth wide, outraged.

“Besides if you are a witness at a crime scene, pictures can capture detail in a way a written report never can.” ,said Anne.

“Elementary ,my dear Watson. “, said Cathy.” But you might think that in that picture of your friend with the baby, that its hers and not her niece. Not enough explanation. A story with a picture, it is just a symbol of a story or a reference.”

“Words do form stronger links, and give backgrounds and there is a wider scope.” ,conceded Anne. “But pictures are visions of life, and to most people more interesting than words. Besides its hard to condense everything you see in a picture into words, that’s why descriptive writing is such an art .We don’t understand everything about life anyway, you know ,maybe that is the point of pictures, that there are things we don’t see or hear that are there all along.”

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the Paintings in the Stairwell

It was early and hushed in contrast to the normal brisk activity. There were three of them, one on each of the half landings in the hospital. I was quite alone as i climbed the stairwell and was faced by these paintings after each flight. There was a subtle undercurrent to their arrangement that i could not immediately catch. A whimsical idea slowly formed as i stood getting my breath at the top.

I wondered if they had been arranged so on purpose by some thoughtful person or it had been by accident. They showed the various facets of a doctor’s professional life. They seemed to be a chronicle for those who had grown old in this profession and at the same time suggestive for the fresh doctors. A door slightly ajar, as it were.

The first showed a doctor bending solicitously over a decidedly grumpy patient reclining on a luxurious couch. The doctor was well dressed and in a coaxing attitude. It clearly denoted the leisurely calm of everyday practice. There were no surprises, the cases tomorrow would be just the same as today and a hundred yesterdays. The doctor would learn many practical skills needed to deal with every eventuality that could possibly arise. He would observe human nature in all its forms as patients come and go. He could assure every patient truthfully that he would do his best for them and easily put in as much effort daily as he wished to. There would probably be small rivalries and challenges, failures and victories.

On the second landing a doctor stood doing an operation with several other people, in an attentive circle around him. A depiction of an alternative to practicing medicine, ie research and teaching. Most aspiring doctors may discover an overwhelming interest in the basic sciences of medicine and branch off very early, while others may always research along with practice. This facet shows a world within a world where doctors engage on diverse subjects to develop new techniques, instruments, automation, and drugs. Other subjects like physics, statistics, information technology, biology and others mingle to form vast new horizons for which humanity races.

 

 

Teaching is an art and in medicine where so much depends on experiential learning, an exceptionally important one. For instance when a doctor puts the stethoscope on your back and asks you to take a deep breath he is listening for one of four sounds. All the eloquence of angels cannot explain these sounds in words recognizably, a teacher has to make the students listen, explain their significance, explain the course to follow. It requires patience but some people may find it more rewarding than practice and most teachers claim that they learnt more from their students than all their time in college. Some have a natural aptitude while others are a student’s worst nightmare. It is important also to make well structured evaluation tests because here you need to not just know the facts but recognize signs and symptoms when you see them. For some it may be simply a change of pace. A passing on of skills to people who impress them with potential.

The third painting depicted the doctor in his harshest element. Three doctors stood among a row of patients lying on the floor. It was the scene of war or epidemic. The doctors have to work beyond all imagination, there are huge number of patients, limited resources and no rest. The doctor here will wonder bitterly where the medical supplies go? He will not be able to reassure them that he would do his best for each because there are so many of them. He will get cases beyond all human aid and watch lives slip away. He will consult seniors only to get hopeless answers. He will have to make tough choices and work beyond the limit of his strength and go through the depths of anxiety, despair and struggle. He will also see a callous side of human nature, self pity, selfishness. But he will also see some miracles. Here previous everyday worries seem trivial and life a grim business. People will amaze with their hardihood and patience and understanding in the face of adversity. And he will never be the same again.

Those paintings were really windows into possibilities for the prosaic white coated cogs in the machinery of the hospital. A rainbow released from a raindrop.

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battle of the titians.

 

It is universally granted that anyone with the grit to get admission in medical college has to have besides reckless disregard for sleep, a pretty lively bunch of gray cells in the crown. So what happens when these medical students get a test. The title says it all. These kids are smart with lists of all sorts of accolades under their belt from highschool on. They have a reputation to protect and they are not going to give an inch.A Scanning Test - From http://www.sxc.hu/photo/517386

When we got feedback for the class quiz which was unofficial ie the marks wouldn’t count towards the final the results showed the level of competition.

In the test a hundred students had given the difference between the top and bottom marks was only 20. Even a difference of .1 changed the percentile by two or three places. And best of all there was a question on the test that only one student got right. That student was Chinese.

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how to speak in a new life

During my observership i went into the spinal cord ward where patients with spinal cord injuries learn to live a new life with some different rules. I guess such injuries push people back to their beginnings as children. They need to learn new skills, strengthen them by practice and accept someone else’s help.

At this time what people say can and does make a huge difference. And if the patient requires long term treatment you must remember how to approach them in the many facets of interaction which include coaxing, forbidding, informing, and sometimes arguing. That is because long term treatment seldom shows quick results. There are many approaches that i observed in the doctors that seemed most at ease. These doctors command the patients respect because they know most of the time what the patient wants to hear. That does not mean they are conciliating. All patients respect decisiveness in the doctor they consult, whatever their mood.

Some patients, mostly the new entries are quite sensitive. With them the doctor encourages them to talk and doesn’t say much because they require sympathetic listening and tact. People tend to overdo sympathetic ‘reaching out’ sometimes so patients are soothed by unembarrassed audience.

The old patients, that is some of them, accept their condition so completely that doctors’ approach border on indifference to errr finer feelings. Not indifference to their well being, simply a tactful jocularity. These greet people happily, are curious, and in general out going. One such patient cheerfully allowed my facilitator to do examinations on him to teach me the sequence of procedures. He even corrected me as i did them over under my facilitator’s eye. Doctors rib these patients sometimes but always maintain mutual respect. Not all patients are like that though and some have to be handled with gloves literally. Some also exaggerate and complain illogically. These patients require the most patience, sympathy and firmness.

Strangely, pity really has no place in PM&R. it is a dynamic field that does not condone crying over split milk or pessimism. The doctors i saw working with cerebral palsy patients were jubilant over improvements, critical of inattention or neglect to follow instructions, or concerned for the patient. I believe they would have been irritated if someone had exhibited distress over their job or the children they dealt with. Perhaps they know that pity may lead to parents and patients giving up. And that is discouraged by the unquestioning acceptance of limitations of the disease and the attitude ‘ what are we going to do about it?’

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genes and life?

Today i want to write about something that i have been thinking about for a while. Mainly how genetics and PM&R ( physical medicine and rehabilitation )compare. What their practice seems to symbolise of the human psyche.

Genetics is the search for perfection, the nirvana we have been dreaming about since the beginning of time. The complete solution to all health problems. Fixing at the cellular level many health problems that are inborn like cystic fibrosis, and sickle cell anemia by manipulating genes. Such genetic diseases also terrify and irk us all the more because there is no magic elixir that we can drink and recover. No pills, no medicine and no therapy in fact offers the complete solution held out by genetics to conditions you are stuck with. Genetics plays on fear, like insurance companies when it extends to cover risks. Certain genes are associated with heart disease, with cancer, with diabetes, with hypertension. You can get fixed, you can protect your children or you can resign yourself to a bleak future. That seems like admitting defeat, doesn’t it? What about the fighting it? Beating it?

PM&R is the other side of the coin. That is, the main concern of PM&R is salvaging from the wreck as much as you possibly can. To function at the optimal level with the limitations of disease. It is not the vision of a starry eyed utopist but contact with the harshest reality. What could go wrong, has gone wrong, beyond reversal. It is the life after being beaten, being defeated. But it is for those who are not broken. Amputations, neuromuscular diseases, spinal cord injuries, chronic pain management; all the trauma people don’t think will ever happen to them. PM&R is accepting it , and living with it.

Genetics is a sprint race, it demands more and more speed. There is always a new horizon, a new goal. No one is satisfied for long with one result. There are a dozen more intolerable things to work on. And always the perfection tantalizes us. Custom made babies with the height, hair color, eye color of your choice. Intelligence, long life, talents, less sickness are all desirable.

PM&R is an endurance marathon. It is too busy just trying to finish the race to worry about might have beens. It is an exercise of will to get up again and keep going with the end seldom in sight. And it is along this harder path that people are truly made. Some drag happiness out of the struggle, some discover new wells of strength and broader vision of themselves and the world. And some are hopelessly lost in repining and bitterness.

There is cynicism and awe in PM&R because you cannot guard against tragedy, humiliation or defeat. These patients are proof of the delicate and in exorable nature of life. A vivid painting of how life goes on always bringing new dawns even after stormy nights. It is about accepting limitations, compromising on your desires and always making up your mind to stay happy without any conditions. Just as helen keller blind and deaf was happy, she said “i have found life so beautiful.”

There is an illusion of control and a fairytale-ish dream ending in genetics.

That of having an edge over the rest of humanity, of avoiding misfortune like disease, of greed for admiration and or just acceptance in an unforgiving world. Between hopes and desires reality becomes a little vague. Perhaps that is the secret of the popularity of genetics. The amount of research on aging is evidence that man still dreams of conquering death which really shows how unwillingly we accept oblivion of our dreams, existence and importance. A competition that you get so caught up in that you have little time for anything else. And such a lot of conditions before living life in every facet.

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