Unpublished novel by Rakesh Biswas for all interested in the science and fantasy of medicine. Not about religion, but a postmodern multi genre combining elements of Science, Fantasy and Romance
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A global malignancy

 

Thanks June, for your write up but then I feel this echoes the sentiments of people who go trekking to the developing world and remark how happy the people are without really striving to know if they would like to be happier. You can’t insinuate that we NGOs leave our work of caring for the poor. I don’t think you are justified in glorifying poverty unnecessarily. India needs to have the opposite of what you proffer now that it’s steadily making headway into the global market. Simi

Dear Simi,

I wasn’t glorifying poverty. I am also not against the need for continuing to care and relieve the squalor which abounds in the developing world. I am sure all of us who work in the so called developing world are attempting to do just that. However I wanted to see and make others see things from a slightly different perspective. It isn't the viewpoint of a traveler who remarks how happy the poor are in such and such a country. Poor are never happy in any country. My point was to try and see why and whom do we call poor. Why have people become poor? There is possibly no remote village left in this world now, disappointing as it may seem who have been left untouched by our civilization. Our civilization in its present form has engulfed all these places, infiltrated and stifled their cultures and has become a single malignant tumor mass. Living within that mass our thoughts are easily molded to think that "The "developed" world has a duty to serve the poor and not worsen their conditions, little realizing that its the coca cola culture which comes attached with the service is what kills us. We are averse to returning to those so called miseries now because we have seen and experienced a different world of comforts but what of those people who do not( again we do not know whether they exist but as soon as we meet them we would have easily spoilt them). William Osler was a great physician practicing 100 years back without any antibiotics or ability to thwart death (which we have been able to achieve with modern medicine?).We have definitely developed the ability to add on a few more years to our life expectancies and yet why do our miseries increase exponentially with our advancements? Where is the way forward leading us to? Another future culture where the comforts are doubled, nobody dies or becomes old? Is the way really that linear? Going by the ravages we have inflicted in this land mass of Earth our future can only lie in Mars. Again that too will be for a chosen few. In conclusion, does it mean animals that live in the pristine wild, who are as yet undomesticated and still able to take their own life and death decisions, are much better off than us with our lap tops and idiot boxes? They don't seem to fall ill that often or even if they do we label that as a part of the ecosystem and are wary of disturbing their natural life and death cycles. Why did we have to tamper with it in case of our own species?  

 

 

 

 

 

 

A bad dream

 

June continued to visit the old age home particularly the old Nepali who wouldn’t allow her to lose touch of her fluency in the language although she was aware of how poor her Nepali grammar was. At times Abhay accompanied her and June suspected Simi knew of their relationship although she never let it show on her face. She seemed contented at her own work. Once Abhay said it was her inability to have children that made her so very aloof from her. They had been married 7 years now. June assured him it couldn’t be the reason rather it was Simi’s natural instinct to help others rather than revel in self indulgent poetry. Abhay was offended at this last bit of spontaneity but quickly changed track to “What if…we could marry…”June swerved back with lightening speed. “Abhay, my marriage to Abraham was only necessary to experience what marriage is once. I definitely don’t fancy doing that again with all the load of unnecessary hassles of divorcing in between. Also our romance shall end as soon as we marry because marriage is all about love and love is the blandest thing on Earth imaginable. ” One of the old men who June had assumed deaf suddenly broke into their conversation in between the shaving foam. “I agree with you lady, it’s too much of a hassle and dead boring at that too.” “I beg your pardon!” June cried out in alarm. “Don’t worry I won’t tell your husband. He’s a nice man, did my coronary bypass recently. I am going to meet him today to show him the operative scar, which itches a little.” June separated his shirt with a tremulous hand. “Let me have a look. It’s a keloid. I shall give you an ointment.” “Thanks, people call me Sutra. My surname is Dhar. I even knew Samsara your father and was present at his funeral although you wouldn’t have noticed at that time. “Well it was nice to know you,” said June with a voice that was trying to muster all the warmth it could after recovery from the shock. Sutra continued unfazed. “I am writing a biography of a woman physician who died of HIV. Would you care to go through it some day?” June felt a very uncomfortable shudder down her spine and Abhay who had finished shaving his old man said he was ready to go if she was and both of them left quickly without exchanging another word between them.

Sutra looked up and wiped the blood from his cheek, a careless scratch of June over a thick brushstroke. “Tsk-tsk, now imagine if she’s as careless with her intravenous needles.     

That night June was sleeping alone as Abraham had this long OT case that had started in the evening. She felt feverish and started having unformed visual hallucinations which in her medical jargon she may have labeled photopsia. Eventually she felt someone reading out a letter. Someone who appeared like a tiny dot that was so tiny as if all the light it reflected was getting sucked into a black hole. Its voice and email was however audible and readable.

Dear June, as a species we chanced into you a few million years ago. Some say we evolved from organisms that were present before we arrived but no one's still clear as to how they originated. All we now know is the pre-historic dinosaurs had been wiped out and we quickly learnt to use fire, invented the wheel and subsequently the computer. We still carry our evolutionary ancestors within our body either in the form of bacteria in our guts or bacterial DNA in our mitochondria. We have been recently inflicted with a dreaded virus (just as we chanced on you, once upon a time).

Trees: like receptors in our body

Where we were before entering your body (like a virus) is open to speculation... maybe somewhere in Neptune? Whether it was a sexual encounter you had with her or it was the same needle which pierced into both of you, is debatable but whatever it was our ancestors had arrived and meant to stay for a long time.

I’ am one of those virus species plaguing your body. I live in one of its relatively backward areas labeled the third world. However you may not appreciate our viral economics and the place where I live in Nepal may be closer to your heart. It is one part of your enchanting body, which contains one of the best walks one can have on your surface. On one such walk through the outskirts of a village on the way to Jomsom, I came across some paddy fields.

You have as many receptors in your body as we have trees on Earth. Trees...scores of them dot the landscape green, absorbing your daily quota of food from the sun. We learnt to adjust our food requirements by tampering with your receptors and cultivated a substantial part of your body into paddy fields for our survival.

Now get ready for another visual hallucination, a formed one. As I watch the lush green, fluttering in the wind against a dark cloud, I hear a distant rumble of thunder and suddenly notice a few white cattle egrets fly past in the midst of it. On the ground below I find a farmer tilling his land, along with two malnourished cows, which are barely able to shoulder the wooden plough. There are so many species of viruses & bacteria in your body, yet we spent a considerable amount of time trying to unearth newer species alien to this Earth.

Definitely, there must be many of our brethren occupying other bodies as much as we are sure of the other Planets in this Universe. Recently you discovered a new species of bacteria, plaguing your stomachs. We had been using it to plough our fields for centuries. These spiral earthworms were a boon to our fields before we went into full scale mechanization and built earthworms with artificial intelligence that wreaked havoc with nature. One fine day we discovered a harvest of metallic receptors with concrete fruits, unpalatable and unfriendly. This was apart from the erratically dug out ulcers they created in your stomach antrum. It’s good that you have decided to eradicate them but what will you do with us.

 

 

 

 

Apoptosis: perishing great civilizations

I am aware, we are the present scourge of mankind (in this universe) and I won't pretend any thing in our defense. Call us names. HIV or whatever code words you’d like to, sound an AIDS alert. The fact is we are doomed along with you. Off course it’s not your fault, we brought it on ourselves. You might feel guilty about your casual affair with Neptune, but we were only looking for a means to survive. We landed on your virgin soil enchanted but not entrusted with a power to see the shape of things to come.

As I look up from my vantage point near these green fields I also become aware of the surrounding mountains, tall green giants preparing to see off a pristine sunset. CD4 cells you call them. Few of them have signs of habitation. A lot of trees have been chopped; the virus must leave its mark. I wonder what will happen one day when all the trees are chopped off and the mountain is fully occupied by our fellow HIVs living in concrete jungles. You know what will happen, they'll simply crumble to dust. Great civilizations, which once twinkled atop dark mountain silhouettes, will perish. You label it apoptosis; I find it a colossal waste. You feel we are invaders destroying your CD4 citadels and we are perplexed at the way things are turning out. After all we were innocent viruses looking for shelter.

With the CD4 Mountains having been squashed, the death knell has been finally dealt and not before long you'll be symptomatic. Alien beings some of us were tirelessly searching will suddenly appear in a distant night sky, huge flying dinosaurs, glowing in the dark, spitting fire. They'll land on our cities, drink all your water, uproot all trees, dig up the whole place and finish off the ozone layer till you freeze into an ice age.

Opportunistic pathogens you call them, for us they are the end. We were a peculiar race from the very beginning, thinking, and innovative, fun loving on one hand, fearful, destructive and full of hatred on the other.

All said and done, it was fun while it lasted. We pass our last days now in exile, in whatever jungles and caves spared by our brethren and the dinosaurs. Places such as this where I am standing now, on the way to Jomsom and as I stare into the firmament, Venus starts peering over the white outline of Dhaulagiri. It's a pity; most of our viral economies are tuned to measure our wealth in terms of our concrete acquisitions.

A person who lives in a cave or hut is poor by most of our standards. We simply have to acquire more and more, more TV sets, computers, washing machines, as ads selling soft drinks proudly proclaim, "Gimme more". As the sky darkens and Venus becomes increasingly dazzling I wonder why her beauty doesn't turn you on. Virgin Venus, no concrete, no dinosaurs, only lush green forests, running streams, a harmless ecosystem. Like your past. Each day I sleep with dreams of you wooing her to bed. We'll be more careful with her, it's a promise.

Very Truly Yours, Sutra (HIV-man) or if you prefer, Death-the storyteller

 

 

Cremation-Incinerating junk 

 

As the population of the city mounted, people realized that trees were not dying at the same rate as people. They were not being born at the same rate either. It was wise of the city dwellers to devise a different method to dispel its dead. One, where the dead one’s next of kin wouldn’t have to watch the firewood flames by the river going up in smoke for a long time. It was time that was more important as most people continued to have less and less of it. The electric chimney came as a convenient solution. The dead bodies were brought into it in an assembly line and when your turn came all your kin could see was a sudden glow as your body caught fire and poof! That was it as the iron doors slammed shut. A few hours later your relatives would be handed your ashes in an urn. The precious remnants of silicon molecules from your charred laptop… June had watched Samsara’s body burning by the river side for a long time. There were no electric chimneys in their town then. Maya had been telling June about a swelling in Samsara’s right lower limb while June was in her hostel busy preparing for her post graduate entrance exams. The exact nature of the swelling was not discernible on phone and when she inspected it on the weekend Samsara’s right leg was like a log. June rang up her professor of medicine who agreed it was likely to be a femoral vein thrombosis. Samsara required urgent ICU admission for infusion of heparin molecules that June would handpick from their hospital garden. It would have prevented the thrombus spreading into his lungs, a kind of secondary prevention strategy important nevertheless, considering the life threat it would pose once it reached the lungs and blocked its circulation. Samsara didn’t want to go to the hospital he loathed all his life right from his MBBS days. He didn’t want to lie there helpless on the hospital bed with his batch mates lording over him as topnotch consultants. He called over his Baul friends and asked them to sing his favorite ‘Kaalia’, the lila of Radha-Krishna, Jivatma and Paramatma. A vivid portrayal, he believed of the interaction between the individual and the universal.

As June watched Samsara’s body burning she could feel the molecules of carbon, nitrogen and oxygen ascending into the firmament. She figured they were accumulating in the clouds and would one day burst forth as rain. Samsara would burst forth on their little town once again or maybe further away from them who knew…Abraham didn’t have such time for introspection about June whose body had landed up in the city chimney. He had a busy OT list the next day. Thank God for the work-alcohol that lets us forget the past without harming our livers or our careers.

 

 

 

 

 

 

 

 

 

 

 

 

Epilogue

 

Resurrection: Reassembling your lost PC 

 

That was the story of God’s laptop right from creation to cremation, assimilation to incineration. It was the story of our nerd God and his laptop body as his sole source of existential sustenance on an Earthy plane. Now that his body is no more you can see him going around like mad over hills and vales shouting yoo-hooooooo! June…Are you there? I understand if he wants to re-assimilate it he shall have to begin somewhere in the clouds. That’s where most of June’s molecules may still be stashed up in the upper reaches of the Earth’s atmosphere. We leave it for God to decide. S/he is not of this Earth but from a different plane altogether where PC assembling at a micro-molecular level is supposedly child’s play.   

 

 

 

 

 

 

Acknowledgements:

 

My partner Trinket for her conditional support, my child for being what she is, my parents, sister and brother (both in and out of law) for not getting to read my novel yet. June, Cecil, Bonnie, Curtis, Jeanne, Trevor, Paul, Angelee for their valuable contribution to this novel. Partha, Barun, Utpal, Dada, Laltu, Pranab for being an inspiration.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bibliography

 

1) Longmore M et al: Oxford handbook of clinical medicine, 5th ed. Oxford,Oxford university press, 2001

A fantastic read with great chapters that give us a lot to think in medicine. I have used quite a few quotes from it in this book. Unfortunately in this multi-author team write up I can’t exactly pin point the authors responsible for the quotes.

 

2) The decision tree:

 a) Lipsitz L.A, Gold Berger AL, Loss of complexity and aging: potential applications of fractals and chaos theory to senescence. Jl Am Med Asso 1992;267:1806-9

b) Goldberger AL, Non-linear dynamics for clinicians: chaos theory, fractals and complexity at the bedside. Lancet 1996:347;312-14.

 

3) Letter from a virus

 a)  Loefler IJP, microbes, chemotherapy, evolution and folly. Lancet 1996, 348: 1703,04.

b) Sleisinger & Fordtran, Gastro intestinal and liver disease 6th edition, Vol2 :1132

c) Acharya S.K. Mechanisms behind hepatitis B virus persistance: the search continues, Indian Journal of Gastroenterology Sept. 1998, 17: 76

d) Ando, K, Guidetti, LG, Corny A, Ishikawa, T, et al CTL access to tissue antigen is restricted in vivo J. immunology 1994, 152: 3245-53.

e) Thomas HC, Foster GR, Slumiya M Mutation of gene for mannose binding protein associated with chronic hepatitis B virus infection. Lancet 1996; 348: 1417 – 9.

f) Nagaraju K, Naik SR, Naik S, Functional implications of presence of HBs Ag in the T cells of chronic HBV carriers. JI viral hepatitis 1997; 4: 221 – 30.

 

4) Biswas R, Always a medical student, Student BMJ (UK) vol 11, feb 2003, pg 41

 

5) Cranky irritable bowel

a)Lindell GH, Celebioglu F, Graffner HO. Non-ulcer dyspepsia in the long-term perspective. Eur J Gastroenterol Hepatol 1995;7:829-33.

b) Parkman HP, Cohen S, Heartburn, regurgitation, odynophagia, chest pain and dysphagia. In: Haubrich WS, Schaffner F, Berk JE Eds., Bockus Gastroenterology 5th edition, Philadelphia, WB Saunders company, 1995; 30-40.

c) Lipp RW, Schnedl WJ, Hammer HF, Kotanko P, Leb G, Krejs GJ. Effects of postprandial walking on delayed gastric emptying and intragastric meal distribution in longstanding diabetics, Am J Gastroenterol 2000 Feb;95(2):419-24

 

6) Biswas R, The birth of poverty, British Medical Journal (UK), 2002;325:51

 


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Unpublished novel for all interested in the science and fantasy of medicine. Not about religion, but a postmodern multi genre combining elements of Science, Fantasy and Romance