Thank you doctor !

We get visiting consultants from abroad every now and then.

Few weeks back, we had a very senior consultant  visiting our hospital. He was a famous endocrinologist  from one of the leading facilities in Europe. He was in his sixtees. A very handsome man for his age,  he was very friendly and  always kept us comfortable, never  giving us a feel that he was an authority. His manners were impeccable.  His lectures were examples for us, how to deliver information, and to titrate the levels according to who were listening to him.

We have a dedicated diabetes clinic at our hospital. We take all efforts to see  the diabetics regularly trying to help them to bring the condition under control. But never have been appreciated for any of the work done there. On the contrary, receive only criticisms.

We were in the diabetes clinic  for a week, seeing patients and reviewing their treatment protocols. He had some strict standards about patients. Following the advices and sticking to the regime was one of them. Most of our diabetics are poorly controlled. Majority do not follow any advices given to them. We educate them on  the diabetic diets, life style changes and treatment options and finally give them a suitable  protocol to follow.

The clinic was crowded with diabetics. They had heard of a visiting diabetes doctor and came for the ‘’cure”  he was to offer, not what they had to do.

The lady in our story was middle aged, and morbidly obese. She had diabetes  for over a decade and had never got it under control. She never followed a diet, and never  took her medications regularly.The only exercise she ever did was probably at the time of eating,when she had to move her hands. If she had followed any of our advices, her condition would have been controlled so easily.  I always used to think that the lady had some problems, because she often looked unhappy and was never shy to express that. I introduced her to the consultant and gave the full history of her treatment. Looking at her medical records, the consultant was obviously amused and then, irritated. She had never taken any medicines, or followed any regimes and then how was he supposed to help her?

He was clearly not interested in giving any new suggestions. He had a hearty laugh,  made a joke of the whole issue and simply told her to take her previous medicines and attend the clinic regularly. We would not have taken more than few minutes to sort out her issue. The woman didn’t understand any of the comments he made about her as well.

The final day of his visit, we were winding up the clinic and  was about to leave, when I found the same lady waiting outside. She wanted to see him for just few minutes. I was surprised when she walked in, and like a conjurer,  produced a  gift from somewhere  under her burkha. It was very stylishly wrapped, with a pink ribbon and a flower to match the wrap. She obviously had good tastes. The consultant was a bit surprised, when she handed over the gift, with a big “ thank you” and left.

After she left, the consultant, who was obviously confused , winked at me and said.

“ Thank you, for what? For making fun  ?”

A Horse Story

It was one of those days when  I decided to take a walk at the corniche. I was on call and had to be around. Dr Hannan is a perfect companion for a walk, because he has a lot many stories to tell. His stories are usually captivating.  The weather was cool and a gentle breeze was blowing. We were immersed in our story when we heard the squeak of tyres  and then, the Police sirens. Ahead of us was  a  U turn, and a crowd had already gathered and many cars stopped on the highway with their hazard lights on. We hastened our pace and reached the scene as well. It was a pathetic scene. A horse was lying on the ground. It was hit by a car at the U turn, The horse had broken his legs, was in agonizing pain and trying to get up on his broken legs, in vain.

Dr Hannan had no hesitation. His  compassion had already worked on him and was visible on his face. He knew some of the policemen at the scene, and they gave a mocking look when Dr Hannan was trying to touch the sick horse. They mockingly asked him in Arabic

“ Since when did you start treating horses, doctor?

Their irony didn’t stop Dr Hannan.  He sat down beside the horse, and gently stroked him, as if to soothe his pain. He examined the horse in no time and declared that both ankles had broken. It had sustained some other external injuries. But the broken legs were obvious. The pain  was visible in the eyes of that animal. It looked at everyone around with painful eyes, asking for help. Its eyes appeared to be searching for some one, I thought he was looking for his master. Soon a young man in sports jacket moved in. He talked to the policemen. Apparently ,he was riding the horse when the event happened. He was looking quite fine. The horse probably went down first and received the jolt, thereby saving his master After satisfying their curiosity, many onlookers had already left. Dr Hannan tried to make a conversation with the owner of the horse. He suggested that they call the veterinary service. Dr Hannan suggested to him that there was an Equine Hospital on the way to Sharjah, and they are probably available. The boy was not much interested and was talking on his mobile. He was calling a pick up or trailer to remove the horse. Dr Hannan asked him what was his plans. 

He was cool in replying.

“ Oh, I just asked some people come and take him to the mountains”

“ To the mountains !! what for?”

“ They will take him there and shoot him to death”

His laborers had already arrived  at the scene.

Dr Haanan appeared shocked and looked pale. He pleaded with the boy in his broken Arabic to save the horse.

“ What is your problem, doctor, he is my horse” was the reply.

I  forcibly took a reluctant  Dr Hannan out of the scene. He was not in the mood  to continue his walk. So we decided to settle down under a tree facing the sea.It was a weekend and the sea side was crowded with families. Children were happily playing on the seesaws. It took some time for him to recover and then we continued our talks. I tried to take him away from the subject,  but he was stuck to horses and we talked about horses and races and  on horse movies and so on. 

To most of us, horses are fascinating.  They are powerful animals and are worth millions. Probably the most expensive animals.  Millions are spent on rearing them and training them to make them in to racing horses. Not all can become race horses. Pedigree, power and  training are all important. Our discussion  wandered around the richest horse race at Dubai and the Derbies. We discussed the pride and glory they bring to their masters, when they win races. The prize money, which are often to the tune of millions of dollars. The horses are transported in air conditioned carriages, and are flown in special flights. Their attendants and trainers are paid more than doctors and the jockeys make millions as well.

But then, at the end, if they are injured or hurt, they are put down.

Later, at home I was feeling uncomfortable about the whole event too. Being doctors, seeing people brought in after accidents are familiar scenes for us. But we don’t practice euthanasia. We don’t think about killing someone if they are badly hurt or sick. 

Someone can argue that prolonged treatments of an injured horse only extends its suffering.But isn't it the same about human? How can someone who was riding the horse just moments before,can cruelly make a decision to kill it, when it is injured?

There are not enough explanations for killing an animal you have love fully brought up.I believe that bringing up an animal is something akin to an adoption. They cant decide on anything and don't have choices.They are at the mercy or cruelty of human.They cant talk or argue for themselves. These animals trust us with everything. Humans have the brains and the capacity for a worldly trait known as compassion. Let us use it.We are able to comprehend others suffering.
It is because of this, that we disgrace ourselves by continuing to inflict suffering on to others while knowing it.


I was also thinking of the paradoxes in life. Every living being has a glorious time, animals and human alike.Bit when that time passes who cares? How easy it is to fall from heights. The glory and honour, all become stories in seconds. There are lessons we have to learn. Life is a challenge.No matter how privileged, successful, rich, pampered, admired or beloved we are, some days are better than others. We hit walls we cant dig under or climb over.


 Ever looked at a seesaw? I mean,seriously looked at it? It is one of the simplest pieces of equipments on the play ground, but one of the most complex to operate. Without the proper balance on each side, the darn thing is useless. Much like a seesaw being weighted down by the big daddy on the play ground..life...without the even weight distribution, or some people call it " an even keel"  can be tilted out of whack.

The concept of a well balanced life,filled with ups and downs, is a simple notion,but some of us find hard to grasp. Too many of us let too many things upset our balance.Instead of being happy and healthy and joyful and blessed, not too up, not too down.

Every aspect of life is a series of ups and downs. You have summer and winter,day and night,work and play. You get a job,and you may lose it. You fall in love and may fall out of it. One day may be full with energy,the other day,you may not get out of bed,being weak and tired.One day you will be in prime health,to be sick on an unexpected day.

Successful people are those who find the silver lining behind every cloud. They have understood that happiness does not depend on their circumstances,but their attitude towards the circumstances. Attitude decides the Altitude.

Once King Solomon,the wisest king ever lived,was asked a question.

The secret for true happiness.

His answer was

" Remember,this will pass away"

He realized the truth of life, and the key to happiness.

Neither happiness,nor sorrow, are permanent.
The path of life is simply a frame of mind.

Learning to say " No "

It was  really a difficult day.But then, I  found I was making it difficult for my self.


Start doing things for others, and then the trouble starts. People take things for granted.And soon,they learn your weak points and try to take advantage.
Today for example, I was not supposed to do the regular clinics.But then, they know, if the clinic is left alone,patients would start yelling ,and then someone has to go and see the patients. Who else?


We often live life in a dream,from which we never  wake up.We are submerged by our feelings,by our loves and hates,by our ideas of good and bad,beautiful or awful. We are probably incapable of growing beyond these ideas and feelings.


I often used to yield to the requests of others,often putting myself in to difficulties.The funniest part is that no one reciprocates,leave that, they tend to forget they ever received any favors.Some of those who came up with all my efforts and supports, keep away now.They probably do not like to be reminded of their beginnings.These are painful lessons.
Do you habitually give in to others,because you cant stand the thought of upsetting them? Do you put your own needs to one side for the sake of others?And then find that he or she is the least grateful? Then you are probably in my group and can be called "people pleasers"
It is time to shift the focus from others to ourselves.Stop being martyrs  and start caring for ourselves. Don't we need some attention too?


There is trouble ahead when we live only for the approval of others,saying what flatters them,and doing what indulges them.Popularity contests are not truth contests.Our task is to be truthful,not popular.Isn't it?
It is noble to help others.But it is something you should do because you want to do, not because you have to.
The greatest acts of kindness are  those done by choices,not out of fear or feeling of guilt.If you are doing things for others,because you would feel bad,if you didn't, is it a genuine action?And if you are doing it neglecting your needs,is it really wise to do so?


Sometime or other you have to learn to say " No".


To things you really do not want to do.Suppose your friend asks you attend a party, and you know there are people whom you cannot tolerate or wouldn't like to meet, isn't it wise to a polite "No". Sorry, it is not my scene,than to go there and undergo the torture of entertaining those whom you didn't even want to meet?.The world is not going to collapse if you don't attend that gathering, the party will go on its way,and you can peacefully go on with your life and time,with whatever you wanted to do.


I am not against sacrifices. But is this the time and place?No one will come to remove the chalice of venom from your lips,if you voluntarily choose to drink.


Assertiveness is something one has to learn and by doing so you will put a limit in the middle,so that you will not be mistaken for someone who is always willing to say "yes". In life we must learn to say "No" if we know we are not up to something or at par.Don't just try to fulfill someone else's dreams just because you want to please that person.Instead,think of matters in the long run,if you cannot really do it,and especially if you know that thing is wrong,don't do it at all.
You might be afraid that  no one will like you,that someone will leave you,or that you will be left alone.This is a prison you have trapped yourself in to,and it is time to unlock the doors and walk out.People around may be used to your compliance.But if they are not willing to accept that you have your own needs,are they really worth having in your life?


Dont let yourself being a doormat for others.Instead,be the doors to let them see the world in the correct perspectives.Let them learn that life is not just taking,but giving as well.

True Love

This picture by Hindustan Times Photographer Himanshu Vyas has won the IFRA Gold Award for News Photography.General News.

Vyas had heard about an orphan fawn being looked after by a Bishnoi woman near his home town Jodhpur.  At the mud dwelling,he noticed the fawn playing with the children.
When hungry,the woman breast fed the fawn and her daughter simultaneously.Wildlife activism is published around the  world.But this connect between man and nature is unparalleled,he says.

The art of healing....Not any more

I am looking at the world a bit differently these days…not as a physician,but as a husband whose wife had a brief, dramatic encounter with the health care system, and as a father who had an ailing daughter in law at the hospital. Our experience started me thinking:  How did we get in to the point where the driving force in medicine  is the bottom line, where a system supposed to give care and compassion  to the suffering has deteriorated in to something of a money spinning business.

Hospitals have mushroomed in our places  over the last few years. Naturally it is commonsense knowledge to assume that investing millions in to  a hospital is done because it has become lucrative, and their purpose is not simple service. Many of them look as good as five star hotels with designer lobbies, and charming receptionists dressed up like flight hostesses. Once you are admitted, the scenario changes in to an extraction business. Doctors are too busy to talk to patients. You see them walking in and out of ICUs, as if they are doing great life saving procedures ,never bothering to look at the faces of those waiting anxiously outside.

While waiting as an attendant outside the ICU, I also realized how ignorant our public are about common medical  conditions, and how easy it is to mislead them giving half correct information. For someone at the height of stress having their dear ones kept  unseen, and not knowing  what is happening to them, money matters become of no concern. They will pledge what ever they have to save the lives of their dear ones. Human relations transcends all money matters, and it should be that way.

My wife had an attack of chest pain at the middle of the night. While she was in the emergency  room, my wife informed the doctor that her husband is a physician and would like to know some details.

I introduced my self and started off the conversation. He gave me his name and said

“ I am the cardiologist here” and went in to explain that my wife had an attack of unstable angina.

“ We need some one to sign the consent” he said

“For what “ I asked

“ For angiography’ he said “ The senior cardiologist will come only if you sign the consent for angiography”

I was surprised and said” But  how does he know she needs angiography without seeing her?”

“This is the policy here” was the reply.

I called a classmate of mine who was working as consultant cardiologist at the same hospital. From the history and ECG findings he said “ It is not that urgent to do  an emergency angiography, and can be done electively, but I can’t see her today officially because I am not on call today” he managed to postpone the procedure temporarily. I took the earliest flight  the next day morning. By the time I reached the hospital, they had already managed to get a consent from my son, and done the procedure. He said the doctor frightened himself and his mother so much, that they requested the doctor to do the procedure. What can we call this  other than ‘ emotional blackmailing ‘? When doctors are paid incentives for the procedures they do, the number of procedures increase in proportion. I met the doctor to whom I had talked over the phone and found that he was a junior doctor in the department.

I work in a hospital where we deal with heart attacks on a regular basis. In fact, our most common emergencies are related to ischemic heart disease. In the last five years, we had the  need to send very few patients for an emergency procedure. Most are treated conservatively and sent home, and we reassess them for further treatment options. There are no studies to show that the emergency interventions benefit the patients in a better way, except when carefully chosen. But, they are the main source of income for hospital and doctor alike.

“Hi Tech Hospital” is the term used to describe hospitals now. “ Super Speciality” is another terminology. Even small hospitals at the road side  display big boards written “ Super Speciality hospital and Research Centre”. Research of what? I am yet to see  the results of any studies or researches coming from these kind of hospitals. Ther are no more ordinay hospitals or ordinary doctors.

Technology is not what matters to the patients. They want to know someone will look after them and tell them what is going on. They want an assurance that their medical team is focused on their well being. Through words and actions they want to be told , “ we care about you”

It is ironic that with all the advances we’ve made in medical science, the thing patients remember  is the one-on- one ,human side of medicine.

Everyone in a hospital helps deliver health care, from the security guard to the registration clerk, cleaning staff and cafeteria workers. They set the mood. Similarly physicians and nurses cal alleviate patient apprehensions with a few extra moments of personal time. A touch of hand or a pat on the shoulder can ease a worried mind and send a patient’s confidence soaring. If a physician simply sits down in a patient’s room, it makes a big difference. Patients sense  you are focused on their problem. You’re not peering down at them.

         Few weeks back, I was called to the resuscitation room in the E R. A young Indian man was being resuscitated. He was unresponsive and had shown no signs of life when brought in. The story was that the man was coming out of a travel agency and suddenly collapsed at the road side. The ER doctors had attempted a resuscitation which was unsuccessful. I often find it difficult to stand and witness such events even after years and years of experience. It was  while I wasx trying to get some history of the event that the cell phone in his trouser pocket started ringing. The loud rings were annoying in the  bleak silence of the room. We had no option other thn to extract the phone and answer. At the other end was his wife from India calling to inform that they will reach the airport in time to receive him. Also that his new born child was anxious to see her father. I could hear the sweet  cries of the baby  at the other end. I couldn’t talk to the lady for long and was relieved when some of his  relatives arrived at the scene.Now is’ it inhuman to produce a huge bill form somewhere at that juncture ? I know of incidents where the dead body was not released for lack of payment!.

There are times when I think whether I should have chosen this career. Some times  I worry that  I have become part of a system of well planned looting of patients. I had no doubts when I started off as a young doctor. I believed I could do many things for people. I thought I had learned everything in medicine to heal  the sick. Over time, I regretfully realized how wrong I was. Now I know, the very  little  I can do for them. Only those who destined to live reach the hospital. Roughly one third of patients with serious heart attacks die at the time of attack. And what if one developes  it  at the middle of no where, while travelling, or when alone without assistance to reach hospital?  If the best of treatments could prolong life, the richest would have lived longer. But does it happen so? I remember having read in the Oxford Hand Book.  There is a total disarray of deaths in nature. If nature had followed norms, the oldest should die first, and the youngest should live longer. But does it happen so?  As doctors, it says, our only role is to bring some order to this total disarray of deaths. How true !

 On the other side, everything loses value, if given free. It applies more to the services you offer free. I never refuse if someone asks me to bring a relative or friend to my clinic. The rules at my work place make it mandatory for patients to pay some fee for consultation. But then, there are many poor people who cannot afford to pay even that. But the sad part is that  the person often doesn’t realize the value of the service. A doctor who sees the patient immediately, probably has no value. He becomes important when the patient waits for him for hours to get his turn to see the doctor.. And then, his value  increases along with the cost of medicines he prescribes.

I don’t think there is any other profession which has been so much commercialized. With the result, medicine has lost the human touch. We do key hole surgeries ( and often do not care what is left behind. It is more money than open surgeries and apparently attractive) and even robotic surgeries. There are medical programmes  now, which gives you diagnosis and treatment, if given sufficient data. And the time is not far, when an educated patient can do it himself with the help of a computer. The gentle, emotional tie between the doctor and patient is already broken. And that is why more and more of litigations and manhandling happens in the medical field. The profession has changed in to a business, like anything  else. Some people invest crores of rupees to   transform their incompetent children to doctors, and then more to make them specialists. It is not surprising that they see the career as an investment and try to reap the returns at the earliest.

There is all the more reason to include in the education the acquisition of” human touch”. One can always argue that however  kind a doctor is, the patient will die if he lacks knowledge or skill. There is also the danger of too much emotional involvement of the doctor. Such considerations do not justify the doctor treating the disease, and not the patient. Because of the pressures of today’s medical education, nothing is demanded of the student than to acquire masses of of information, with little thought for integration and correlation. I have always thought, “ every one learns the same books ,but then how come some are good doctors and others not? I had often argued with my friends that medical field is something which does not need much intelligent people. What is needed is simple hard work. And it is the application of knowledge which makes some doctors good, and others bad. Some of the best students in my batch, were never able to practice clinical medicine, because they failed at practice. Some of the so called ‘chronic additionals’  became popular doctors and built up their own hospitals and businesses.

There is a factor which transcends all specializations and involves virtually every person in the medical profession..human personality, one of the most useful tools in the  therapeutic arsenal. I could say a doctor is guilty of negligence if he neglects his own personality as a therapeutic device, leaving the “ human touch’   to the relatives or some of those prayer group members who are waiting to jump on to them. “ The most human of all arts”  is becoming not an art at all, and degrading in to  nothing other than a money making business.

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