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On the way you meet the usual fare of red vented bulbuls, jungle babblers, robin magpies, pied mynahs, golden backed woodpeckers, spotted owlets etc…which are commonly strewn around any Indian countryside. You also meet the wag- tails, white whiskered bulbuls, bay-backed shrikes and brahminy mynahs which to your surprise and delight seem to thrive here in greater numbers than anywhere else. As you pedal along on the rusty old bicycle you are suddenly confronted by an amazing and dazzling spectacle. Both to your right and left there seems to be a stage set on the marshlands in between which great big trees arise and atop them are a host of painted storks. Scores and thousands of them painting the whole of Bharatpur red with their beautiful red heads and necks by which one can make out they are adults. Their young ones create a nerve wrecking cacophony with their relentless string of chirpings and this only heightens the excitement of the avid bird watcher as he takes up on the challenge of unfurling further the mysteries of this fascinating patch of land. Apart from these South Indian friends we also have at the same stage the black necked stork on whom you may chance upon suddenly and get a shock as you behold a grand looking bird in a peculiar posture of anticipatory attack, still and waiting…probably for fish. Also we have, snake birds and cormorants in the dozen who have a peculiar habit of spreading out their wings to dry in the sun after each and every dive probably due to a lack of oil glands in their body unlike other birds that are more fortunate. You also see the grey and purple heron as well as the purple moorhens on almost every patch of marshy land you lay your eyes on. The moorhens are strikingly purple with a bright red crest on top of their heads just like hens and the purple color of the heron can be made out only when they prepare for flight.
The people here can be immediately classified into, the already initiated and expert bird watchers with their slick binoculars and zoom lens and occasional references to Collins or Salim Ali’s and the uninitiated whom you can spot on the rickshaws…mumbling and memorizing the awful garble of bird names”….purple…purple…what was that he said!”…Moorhen! Really dad! Why do you have to be so slow…oh! It’s just the age my girl!”…Amazing rickshaw-pullers rattle off bird names and descriptions smoothly and rapidly much to the consternation of our newly inquisitive bird enthusiasts who have to really struggle to keep pace with them.
The birding resident
As you stroll along you are suddenly confronted by a sign “would you like to be born as an endangered species in your next rebirth…if not please help save the Siberian crane…”its then that I suddenly have a chance to meet the star attraction of Bharatpur. A kindly man lends me his binoculars to have a better look. A beautiful reddish beak with a large white body and a peculiar tail, as if somebody has combed his hair forward. There it was pecking at something, in all its majesty…I wonder if she knew her worth.
Now for a boat ride…you are transported through dense dark forests surrounding you on all sides and at times you get to see Indian moorhens scuttling off as your boat approaches. You are brought very near the nests of the painted storks where you can see the young ones screaming for food. You can also marvel at the open billed storks you had missed earlier on your cycle ride. As the sun sets in Bharatpur you are treated to a wondrous spectacle of an orange glow emanating from the swamp waters with the dark silhouettes of the herons and storks atop the acacia trees creating an everlasting impression: a picture that would arise from the deeper most circuits of your cerebral networks on a midsummer day, in between a busy and tight schedule of commitments and conferences, a silent and comforting oasis in the midst of an arid desert of city life.
June returned to the rigors of residency and the approaching exams for completion of her MD degree. The dissertation submission had in itself been tough as it had involved a lot of last minute changes before the dead line but once finished June had set out on this birding holiday. There were a lot of things to read for the exams. Trouble shooting humans involved having an extensive knowledge of the present technicalities, stories of the microcosm that have evolved over generations, more so exponentially in the last few decades.
The Bronchial tree
Take a look at this chest x-ray…Hmm dense forests bordering on green rice fields
A cow munching grass, lazily waving away the flies, the setting sun, and one or two clouds interspersed …Hmm looks normal-show the other one. What’s this! A giant jungle mower, Concrete new buildings-all cooped up look alike? Hey can you hear the trees crashing!
Can’t make out – over here the mower’s creating a din. Hmm see anything more?
A lot of alveolar opacities which is probably the smoke from our upcoming power plant…
Hmm the diagnosis is clear—Lung cancer. Get a bronchoscopy but the prognosis is bleak
At the most 3-6 months.
He was known as Dada to his friends. He had remarkably long hair for an Indian along with a long beard. They say he used to religiously tie it in a turban once everyday before they attacked him mercilessly one day when the prime minister died, killed by another person with a turban. That day there were countless such victims in the roads of Kolkata. It's a city where outdated Government tram-cars are usually torched by violent mobs at even lesser pretexts (the price hike in the tram ticket being one such routine stimulus). Dada was transformed that day not only because of the hideous gash inflicted on his face by a religious fanatic but strangely the whole experience made him very unkemptly irreligious in the years to come. He let his hair down like a hippie and started smoking like a chimney (smoking was strictly forbidden in his religion). Another development that was totally unlike Dada in his pre-hippie days was his fascination for poetry. He was a permanent fixture on the Presidency college campus spouting a free flowing stream of consciousness verse that would intimidate even the utmost post-post modernists.
June came to know him only as a solemn retired professor of chemistry from Punjabi university, introduced to her by the senior resident as one with interesting findings on his chest, a respiratory case that would be surely kept for her ensuing clinical exams if available at that time. Sure enough there was a bulge at the right upper part of his chest that was dull on tapping and there was a hollow sound on putting the steth. A mass lesion is the most likely morphologic diagnosis thought June. She had become quite deft in her handling of cases during her residency years.
Unfortunately she didn't have the time to read what Amrinder Singh 'Dada' had written in his diary.
Last night I discovered the fruits of bronchogenic carcinoma growing on my bronchial tree.
Ugly and slimy it tasted of blood and phlegm. This tree…had long been a source of shade for travel weary souls amidst sun burnt fields. Not any more…falling leaves, shriveled bark, ugly nodular fruits with a slimy sauce. With each and every cough it shakes from its very roots caught in a raging storm.
Evaluating mechanical trouble shooting skills
The exam was an elaborate affair. There were 4 machines allotted to each examinee for each candidate's assessment of trouble shooting skills. These were labeled as long cases possibly because of the longer time allotted for their detailed evaluation by the candidate as well as the longer time taken by the examiner to grill each candidate on the cases. They also carried more scoring points which decided the fate of the examinee. There were a few short cases with lesser marks allotted that also involved lesser discussion time. June received the usual standard fare of system problems, a young man with abdominal swelling, which June correctly diagnosed clinically as due to a blockage in the outflow of the pipes from the liver particularly as this man had prominent veins in his back (that was an important clue to his diagnosis). The examiner looked unimpressed and insisted it might still be a problem with the liver per se and may not really have anything to do with the liver outflow pipes. The second patient was a failed river pump due to a problem with its valves. June thought one of the valves was obstructed and the other leaking. Her examiner thought both were obstructed. It was all a matter of interpreting those whooshing rumbling sounds upon which the future of the examinees (if not the patients) depended. The third patient was a straight forward fibrosis of the lung and June localized it well right down to the lobe. The last patient was the one that flunked June. It was an electrical circuit problem and June found it very difficult to get any kind of localization as the story offered by the patient was very sketchy and he seemed decidedly uncooperative and even unable to follow June. She made a diagnosis of a lesion in the spinal cord particularly its ICs at the level of L1-L2. The examiner who was a lady grew wild with anger and asked June to examine the jaw jerk. To her surprise and dismay June found it was exaggerated, a vital clue that she had missed that would definitely suggest a lesion much above the ICs of the spinal generator, above the mid pons in the brain stem. June finally realized why she couldn't get a good history from the patient; it was because he was demented. The examiner also showed her a few more signs that suggested that the localization was in the frontal lobe of the brain. June's fate was sealed. She would have to reappear again after 6 months.
On failing the acid test
Three years in a superb academic institute with an exciting and rigorous curriculum. At the end of it a costly slip commands you to take the same exam again 6 months later armed with more knowledge. You always presumed this happened to other people and couldn't affect you but one day it does...and for that moment...it seems to be the end of the world as you go through the often quoted stages of denial, grief and finally...acceptance.
As the stars peep out into a desolate night you wonder...end of the world? It’s just another world amongst all those millions of shining beauties. Amongst them, reside many more countless organisms, giving birth, struggling, dying to keep pace with their species...and in one such world...somebody just doesn't make it to the finishing line. It's as if you're observing yourself from a spaceship, a tiny speck under a satellite image, racing amongst the multitude.
However as days go by, you become aware of a new status...unemployed, minus accommodation, greeted with avoiding looks. Can't help it…for 3 years the ride had been smooth...might as well savor the bumps for another six months. Once you get used to it, it isn't as bad as one would expect. There's loads of free time for contemplation as you watch your co-residents rush to work struggling with their new found burden of responsibilities, the vagaries of senior residency. You can afford to sit back and relax, share a biscuit with the baby monkey scratching your door in old doctor's hostel. You can go for long walks or read undisturbed in one corner of the library. Failure can mold a whole personality...its as if you're on an obstacle course and suddenly in the midst of a long run you discover a deep chasm impossible to cross. By the time you collect yourself, you find the rest of the herd has disappeared leaving a dust trail. You've to wait a long six months for another herd. As days go by, you press your ears on the ground straining to hear the sound of distant hooves. This time you have to make it. Each night you dream of the ever widening chasm, the unpredictable stumble over hidden stones. You must jump proper this time. Nothing should be left to chance.
Searching...searching yellow eyes
God picks up another fragment, a yellow one like an evening sun ready to set. He sees himself as Juneli, Samsara's daughter who he lovingly calls June. June has grown up into a young studious lady with plaited braids and thick glasses. In this visual before you, she's a resident fellow in Hepatology and today's her on call day.
This one's comatose. The same lady with the ruptured embankments, the rivers creating havoc in her brain. She'd been given molecules of Phenytoin, (which God himself had handpicked from the trees near the forest in his backyard) to silence the electrical sparks, the hyper-synchronous discharges in her brain. Strangely for some reason the Phenytoin molecules created havoc in her liver bed. Islands of Hepatocytes like tender rose saplings, trampled and uprooted, destroyed. The bile channels are blocked and bile backflows into the systemic circulation reaching the eyes, which stare at you like the setting sun. Fulminant hepatic failure due to Phenytoin they called it.
Hepatology on call-Any liver problems guys! Trudging daily through the hospital, searching…searching yellow eyes…Cardiothoracic surgery…intra op scares and post op yellow stares. Labor room…yellow third trimester eyes and transverse lies. Psychiatry…eyes turning yellow in someone already blue? Emergency surgery…aha! We’ll show you what we can do!
Biliary fistula due to a bullet injury? We’ll fix it proper…don’t you worry! A tube in his torn bile duct and nature handles the rest. Hmm…speaking of rest …I hope you aren’t too tired?
I wonder why the evening sun’s so jaundiced. Is night a must like death? Wait a minute…don’t push that tube into its malignant duct! Cholangitis…sepsis…you’ll give him all the works.
Let him rest in peace…jaundice or none, lets not create a faster exit for the sun.
Hepatology Ward-I have all to myself a garden of tender roses. Each day I water them and discuss management strategies for a faster recovery…all the latest works with two of my junior residents. They do most of the work off course! Each day…collecting dung, trimming leaves and so on. All I need to do is encourage them and encourage my withering roses so that one-day, at discharge they blossom and bloom. Eating well, sleeping sound and no more of the messy blood vomiting please! I have seen those varices safely banded and bile ducts surely stented. Bye for now…till another bleed, another fever or jaundice.
The train journey 1
Abraham is a resident in surgery and is one of June's innumerable silent admirers. He is nowhere as handsome as Kris or Seshu but he truly loves June knowing very well that June doesn't care much for her. He once confided in one of his friends about his love for her upon which the friend gave him an interesting advice on how to monitor her feelings for him. "Keep looking at her pupils. If they are dilated you know you have made it."
could never once notice June's pupils getting dilated in his company. Once he
tried taking a good look at her pupils on the canteen dinner table while
filling up her glass of water and found them constricted. After June flunked
her exams Abraham would join her on her long evening walks sometimes appearing suddenly
out of the blue near a crowded city intersection. One day he visited her in her
room and after talking about umpteen non specific things they started making
love in a fit of frenzy. Abraham forgot to notice her pupils this time. After
her exams, which June sailed through in her second attempt she became a fellow
in Hepatology as a stop gap. She was also considering various subsequent career
options when one day Abraham barged in with a newspaper clipping that declared
vacancies for a physician and surgeon to
4th September2002, , On train… glad to have reservations. My friend is a heavy smoker and my dread of getting caught in the habit, especially to kill time keeps me writing, scribbling making notes of whatever comes across, sometimes even what my friend relates. Abraham is a surgeon and he has pretty interesting anecdotes to share, the slip shod histories they take in the local nursing home, general one liners hurriedly jotted down in skimpy files, sometimes so very inadequate that one has to ask the patient before operating on him as to what operation he was planned for. Abraham used to be a good reader in his student days and now he just can’t stand the site of a book, any book, preferring to blow smoke out of the train window gazing vacantly at the countryside rushing by…does surgery do that to you I wonder?
Train journey 2
…the train leaves Kharagpur. Sounds of trinkets and clapping…a mental picture of Eunuchs, a vague feeling, almost a wish they may be just girls after all. As they approach us one of them keeps a hand on Abrahams head. I dish out 10/- feeling threatened with the look of fear in Abraham’s eyes.
…train window. The rain swept landscape, a black sky, green washed paddy fields and red huts with red mud roads to match.
A few rock outcrops sprouting from the green…as if peacefully grazing animals, some of them with shapes of domesticated dinosaurs, ponds which take on the color of the surrounding green and a host of kaash flowers booming amidst all these. A name to this place, station Sini flashes by…all trains doesn’t stop here. Like Kedarnath Singh I don’t wonder why then does this station exist at all. A few wet lands…marsh lands…a black elegant Santhal woman walking on the red mud road towards the village…a game of football in a large green field in progress, towns and trees suddenly sprouting in the green…a blue hill in the background, joining with a few larger ones further down and as the mountains approach nearer and nearer they start dominating the train window. The train nears a larger town, Chakradharpur. Its power station houses a few Electric poles that somehow resemble alien robots (with all its elaborate ceramic work) watching us while we wonder when they’ll come alive. On the other window a red temple top peers out from the green. The sky has reached a state where it’s breaking up into myriad colors of blue green and red.
8:00 PM, Buying water bottles lavishly each and every time we feel thirsty instead of filling it up like old times when we were students and traveling on the general compartment. It’s not always that we couldn’t afford reservations at that time but more often our journeys would be planned all at the last moment.
5th September, Woke up with thoughts on the ancient Harappan civilization 3000BC? River Saraswati dried up 2000 BC? The spinal fluid in the central canal too dries up at the age of 40. City hutments, factory chimneys, a trail of sigmoid smoke across the sky... Telegraph poles stand in a single file.8:00 AM Nagpur station: bought a newspaper…lots of beggars with cut hands and deformed fingers (? lepromatous). Ignored them like a thick skinned rhino while they carried on their incessant whining…initially extolling your virtues but as they despair at your indifference, finally leave showering the choicest abuses (which are thankfully garbled and difficult to decipher). A lot of children sweep the train compartment free lance and hold out their hands seeking compensation for their bit of work. It’s probably better than begging (which angers our traditional values) but then it encourages child labor. An old man free-lance sweeper appears. He looks like having shifted from the begging school to the more techno ideal savvy money for work school. However his demeanor is more of a beggar as he whines for his money from everybody in the compartment holding out his broom as a proof of having finished his job. There was hardly anything left for him to sweep by the earlier children who preceded him by a few minutes. You wonder if he follows them on purpose.
Train journey 3
: Talked to a young fellow passenger on the window opposite mine.
Stays and earns his living in
: The beggars of
10: Rows of crops looking like a huge kitchen garden. Abraham feels its cotton. The sun smiles pleasantly at them…not a single cloud in the sky. At it’s going to be real raving mad HOT. The train stops at a station and a beggar peers at our window. He’s thrilled as Abraham absent mindedly hands him a 5 rupee coin. Looking ecstatic, he keeps on showering praises on Abraham…a generous beggar in terms of praise.
10:20AM a blind flute player with an out of tune flute. Again begging with a flavor added. The woman with two small children lying lazily in the middle berth finally climbs down throwing nervous glances as she dangles her legs.
: Tomato soup…Abraham’s incessant capacity to keep guzzling. The price of most food items is 10/-, be it a packet of wafers, tomato soup or a bottle of water. Two stations with peculiar names Barabamboo and Retard flash by.
: Abraham’s story, an anesthetist beats up somebody and throws him off the bus and later after he reaches home gets a call for an OT case. Goes and finds it was the man he’d clobbered.
passed a few mountains looking like Mesas…nearing
On being a medical student 1
proposed to June soon after they received a sheaf of papers from
answer to Abraham's marriage proposal was in the negative. Abraham had added
that they would be the early couples in the world to get married in
June shoved an opened journal page onto Abraham’s glum hands. "Take a look at this article. I have already received an offer to work with the man who's written it.
Abraham glanced at the journal
article June had shoved into his hands. It was written by some VM Hegde, Prof
of medicine and Dean, Macchapucchare college of medical sciences,