Part I: What should a doctor dream about?

images

To the fresh, eager young faces who were beginning their journey as doctors, my focus this year was to make a distinction between a dream and an aspiration, between the joy of perception and the burden of chasing a market-driven ambition.

This thought stemmed from a post I had put up some time ago on Facebook:

Whatever you choose to become tomorrow- a parent, a practitioner, a teacher, a writer, your ultimate objective of that role should be to bring about a transformation in the lives and minds of the people you touch- your children, patients, students or your readers. I say this because profits, expansion, competition– these are the words that govern the modern world. Aspirations are built on the foundation of these words. Do not fall prey to these. True happiness comes only from a positive transformation of the world in which you live. Touch lives and live on in the minds of the people you have touched. There is no greater joy than that!

To which one of my students asked:

But what should a doctor dream about? For instance, I am the first in my family to have taken up this profession. I am now already in my second year, but I do not know what I must focus on. Should I just focus on studying and building concepts? How do I plan my future? What defines a dream? If I wish to set up a hospital, would that be a dream?

This question, I realized, was the question of the hour- the unasked question that nevertheless hung heavy in the minds of all the young people in the profession. While a large segment of society believes that the problem lies with the students who make an entry into this field by paying a huge capitation fee while they are not suited for the profession, my experience with them has been different. Like the student who asked me this question, there are many who are here to explore and to learn. In fact, entrance toppers have often been a disappointment in this regard because more often than not, they are good performers and not true learners. Many are only masters of a formula that works when it comes to delivering in Indian entrance exams- an evaluation pattern that seldom assesses the creative application of the knowledge acquired.

So what must a doctor dream about? 

When I worked in the Medicine Department, we had a doctor by name Rosamma. Rosamma ma’m was a middle aged lady, and she only had an MBBS degree. My room was adjacent to hers and I could hear her conversation with her patients. On many occasions, I have wished I could work as an apprentice under her.

She talked to her patients

About their illness, about medicines, and about numerous other things that no doctor would bother to explain. I remember her telling her diabetic patients:

You can eat just the same. Fill up your plate, but reduce the quantity of rice to a cup, and increase the vegetables. That way, your stomach is full, but your calories are low. You could perhaps divide your meals into six small meals, instead of three large meals. You could substitute your snacks with salads and fruits. It is alright for a diabetic to eat a little fruit. Go down on the rice and the starch, but increase your dals and fish, so that you are not hungry. Steam or bake your fish, instead of frying it. Most importantly, keep giving yourself a change of menu so that you are not bored of the same diet. Once in a while, after your blood test, if your glucose is normal, you can treat yourself to a sweet.

She maintained a holistic approach to all kinds of illness. She had these little non-drug prescriptions for all kinds of illness- common cold, asthma, abscesses, diabetes, hypertension, heart disease.

Instead of jogging, you could do gardening. Since you enjoy gardening, you would be more motivated to pursue it, as opposed to jogging or other physical exercise‘, she would tell some of her obese patients.

Rosamma ma’m was very particular about the follow-up of her patients. She would ask relevant questions on follow-up and listen attentively as her patients let out details of progression or regression of the disease, and I realized that she had acquired most of her wisdom from such attentive follow-up. There were many occasions where she was able to identify things that many specialists missed. Some were simple things. For instance, an infection that failed to abate because her patient had stopped the medication midway- a fact that the patient considered irrelevant to mention. Or self-medication with antihistamines that suppressed a throat infection. She had also learnt to differentiate between brands of a medicine; she was aware of which brands were cost-effective and patient-compliant. When prescribing a new brand, she always made it a point to check with the patient if the patient had experienced any particular difficulty.

In effect, Rosamma ma’m was a very happy and content person, unlike all the specialists in that department. She had built a patient clientele, and had gained their confidence. She demonstrated a deep involvement with them, and that was the reason for her ‘success’. This deep involvement was possible only because she kept her clientele limited. At the time, she had no private practice unlike the specialists who filled up all their time with practice.

Her calm, content face was a striking contrast to the frustrated faces in the department.

Rosamma ma’m quit this hospital a few years ago. She is now happily settled in a little village called Kelakam where she runs a clinic and enjoys the simplicity of rural life. She has a beautiful house with abundant garden space, and she enjoys tending to her garden. She grows her own vegetables and rears a couple of hens on her farm.

I think a dream is defined by breathing life into what has touched us. I am sure we all have our stories of encounter with disease and of how it has touched us. In the dark alleys of disease, one often discovers the most powerful stories of human life.

Perhaps it is these stories that the young doctors have to search, within themselves. It is in these stories that they shall discover their dreams- the dreams that define their role as a doctor.

(to be continued….)

 

 

 

 

What is the color of fear?

theyyam

 

With the practised strokes of an artist, he adds final touches to the mural. The mural is of a fiery-eyed, bloodthirsty demon. 

‘The car is gone’, speaks a voice at his doorstep.

He turns around. It is his neighbour, an adolescent girl whose eyes are still that of a child. She peers at him, terrified of something she has witnessed.

‘When I see that man, I am terrified’, she says. There is the inexplicable fear of the unknown in her words. The abrupt exposure to a world that the child doesn’t understand, but that her instincts mark as ‘dangerous’. 

Sadayam was a film that I was never comfortable watching. I was in school then, and I remember it as a rather disturbing film that left me feeling weak, turbulent and helpless-

The feeling of being stifled, when you actually wanted to scream.

I remember how that film was played once in the bus while we were travelling. I remember forcing myself not to look at the monitor. And yet, I couldn’t run away from the dialogues that sent a chill down my spine, and the background score that knocked louder at the doors of my mind.

That there were women out there, standing all alone, standing naked to the brutal forces of society, was a chilling revelation to my young mind. That I lived a life of dignity while there were women out there who surrendered their spirits to the sheer adversity of their circumstances, opened my eyes to the horrors of being a woman. It struck me that I was bound to them by the commonality we shared- I was a woman too. More fortunate, perhaps. But I couldn’t shed away the fears that crept into my mind when I confronted on screen the brutal experiences that my gender had to confront in life. These women on the screen were my own faces in a different context. This realization was the magic of writers like MT. 

‘What is the color of fear? Is it blood red?’, asks the artist.

The young girl is perplexed by this question.

Those words lingered in my mind. MT’s signature script. Haunting.

sadayam
Mohanlal in the film ‘Sadayam’, directed by Sibi Malayil

‘Are you a communist?’, asked my mother.

That is always her question when I wear red. It always makes me conscious. I go and take a second look at myself in the mirror. And somewhere, I feel a little uncomfortable.

Perhaps red is the color of fear. Or of violence. It is the color of blood…of bloodshed.

There is always a certain discomfort I feel when I regard the color of buses in Kannur. They are painted in shades of red and orange and yellow. Like buses that have caught fire. They speed through the traffic, desperate and chaotic, with no regard for all other life.

Theyyams are indigenous to Malabar. They are colorful and vibrant. But in them is an uncomfortable portrayal of violence too. They embody the prominent characteristics of primitive, tribal, religious worship. The costume of the theyyam artists is blood red.

These artists go into trances and transform themselves into forest and ancestor spirits, mythical heroes and flamboyant toddy-consuming gods who leap through fire, roll on burning coal, and accept blood sacrifices of live chickens.‘, reads an article on this folk art:

http://www.natgeotraveller.in/coming-face-to-face-with-keralas-fierce-gods-and-goddesses/

It seemed as if the entire village around the Theyyam artist as he danced in a corridor of wild fire, screaming and kicking flames in every direction; he seized full control over the crowd around him, leading the villagers to scream in ecstasy into the dark night sky as he performed the ancient rituals. There were moments where the artist’s helpers thought he had lost control and would try to stop him from stepping into the fire, but he would violently push them away, throwing himself again and again into the eye of the fire, determined to complete his transformation and embody the God.

http://www.svidensky.com/blog/the-chained-gods-of-india

I have often seen a similarity in the violent expression of the theyyam artists in Kannur and in the political bloodshed here or the violent tones in which the labourers in these parts reciprocate to the more elite. A palpable insecurity governs the life of the common man in these parts- an insecurity that is skilfully utilized by politicians. There is a palpable suppression in Kannur, and that suppression is chronic. It is this suppression that the theyyam artist perhaps liberates in his violent expression. A suppression rooted in casteism. Kannur is populated by people belonging to the Thiyya community- a community lower in the caste hierarchy. This is contrary to the scenario in the more central and southern parts of Kerala where the upper castes are dominant.

The article sheds light on the violent expression of Theyyams:

Ironically, the Theyyam finds its origins not just in the worship of ancestors and forest spirits, but also in a polarised society which once allowed only higher castes to enter temples. This forced people of the lower castes to employ other means with which to engage with their gods. Since participating in a Theyyam is open to all, it created an egalitarian space for the oppressed. They discovered a powerful voice with which to narrate to their feudal persecutors stories of injustice and exploitation. This transformation from man to god that began during the post-paddy sowing month of Thulam (October) also initiated a dramatic status reversal within prevailing social hierarchies.

Somehow, the suppression has trickled through the generations and despite the fact that the caste system has dissolved, the insecurity generated by this suppression appears to have been rooted and passed on. Today, Kannur has become the land of red. Red that is violence for some, and fear for others…

Red, the color of blood that appeases the Gods in these parts.

Cinderella’s private life

Youthful…zealous…passionate…inspiring…bubbly…full of life…compassionate…picture of happiness.

These are the adjectives my students have often used to describe me.

You have an aura that makes one instantly fall in love with you!‘, a student once said to me.

My students have seen me on the dais, teaching Physiology. They have seen me outside of the classroom, in the moments that I have interacted with them on a more personal or casual note.

The lady who drives a black Santro‘, they say.

And now the author of a book!‘, they add with pride.

A few days back, one of my students turned up at my house, unannounced. There was a look of shock and dismay on her face as I ushered her in, and I could see that she was in conflict. I was tired and exhausted from a day’s hard work, my clothes were soiled and sticky, my hair was disheveled and grimy, and I bore no resemblance to the person she had seen in college. I could very well have passed for a housemaid. Any day, my maid was more presentable than I was at this point in time. My mother appeared, and I could see my student’s confusion as she regarded this thin, frail and fragile woman.

My mother‘, I said to her.

She was silent for a while.

Do you both live alone? Is there nobody else?‘, my student asked.

I could see that she had expected a lively and cheerful house, brimming with people, with noise, and with optimism. A house where maids bustled about and where chauffeurs opened doors of limousines for people to be driven around. And here we were, a mother and daughter, living a life on the edge. A house that was filled with silence and loneliness. She was quite taken aback, and she left shortly, the conflict in her mind unsettled.

My mother gave me a knowing smile. We have often talked about this malady of our lives. The illusion that people have of my life. Cinderella’s private life! Behind all the adjectives that my students use to describe me, they are unable to fathom the circumstances that surround me- the private moments that characterize my life. Not just students, but a lot of people. Somehow, there appears to be no connection between my public moments and my personal moments.

Last evening, when I got back home, my mother did not answer the doorbell immediately. I panicked for a moment. Then the door opened, and I was relieved to see her. But her face looked pale. It was only when I stepped in that I noticed her limping. Only then did she tell me that she had slipped and fallen. As she narrated to me the details of the incident, I felt a little giddy. Immediately after the fall, my mother’s first thought had been me. What if she had broken her leg and had to be taken to hospital? What if it was a fracture and required admission to hospital? Weeks of hospitalization? My mother couldn’t imagine my predicament. With not a soul to turn to for help, how would I manage?  Her first instinct had been to try and see if she could manage to get up. She was relieved when she realized she hadn’t broken her leg, and she had cried with relief. I couldn’t help dwelling upon the helplessness that characterized such moments, but I didn’t want my mother to know how I felt. So I heated up some water and applied hot packs to the swelling. Then I went about the household chores while she gave me verbal instructions. When I had a few moments to myself, I cried all the tears I had bottled up until then.

The peripheral elements of society- beggars, destitutes, orphans, prostitutes, lunatics. There are others too. Single women, divorcees, children from broken marriages, victims of child abuse…even celebrities. Some are alienated from society because they have nobody. Others are alienated despite having everybody. Every day is a struggle to belong. Belong to that gross order that they call society. A struggle to prove to oneself that one is worthy. Worthy enough to be wanted. Worthy enough to belong. The whole world can admire you and yet not want you. It is therefore not surprising that many celebrities have resorted to suicide in the lonely moments that characterized their lives.

It is perhaps these helpless and vulnerable moments that have connected me to cinema. My mind attaches itself to the vulnerability and helplessness of these characters in cinema. I experience the companionship of these characters who walk my paths, and this companionship comes in as a welcome respite- a ray of hope in the dark solitude of my life. It is these moments that liberate me from my vulnerability and transform me into the Cinderella that the world loves.

 

 

 

 

 

Mind to Mind

My mother is not a bad person. I don’t hate her and I don’t want others to hate her. She suffered and that suffering caused her to live her life on her own terms. My only sorrow is that another man is robbing me of my moments with her. I am unable to accept the fact that she prioritizes this relationship over and above me. I am unable to come to terms with the fact that I am not her priority‘, she said.

I sighed.

Fundamentally, there is no bad in any human being. There is always a reason to all the bad in us, and when we rationalize bad from that perspective, we realize it is so human. Your mother is a good person. But she has run away from her role as a parent. It is her absence in your life that has left behind an unfulfilled void in you‘, I replied.

She said nothing.

What is a bird’s dream?‘, I asked her.

To fly?‘, she replied, unsure of what my question implied.

To fly. A bird is happiest when it can fly. That is its instinct. It is this instinct that propels it forward until the day it can fly unbridled across the skies, reveling in this flight. Take away its ability to fly, and you have taken away its soul. So what is the role of the mother bird?

She looked at me, aware of the point I was trying to make.

To feed it, care for it and to guide it towards its dream. The mother bird teaches the baby bird to fly. And when the baby bird can fly independently, the mother bird’s role in the baby bird’s life is complete‘, I said.

She was silent.

So what is your dream?‘, I asked.

I have no dream‘, she replied.

That is what concerns me. Everybody has a dream. That dream is one’s motivation. But one must uncover this dream that lies dormant within. At an age when you should have experienced a mother’s presence, affection and care, you were lonely. Her absence in your life almost caused you to question your worth- a feeling that there is perhaps nothing in you that makes other people like you or want you. Now, at an age when you should have been emotionally secure and building your dreams, you are struggling with worthlessness and a lack of motivation‘, I replied.

She lowered her eyes. There were tears in those melancholic eyes.

Do you love your mother?‘, I asked.

Yes I do…I don’t hate her‘, she replied.

What is love?‘, I asked her.

She was quiet, perhaps wondering how one spells out an emotion.

You love your mother, no doubt. You miss your mother, you crave for her presence, and you perhaps do many things to make her happy. It is a child’s love for her mother- a child’s need for her mother. But given the nature of your circumstances, you must try and give this love a more mature dimension. When you really love someone, you must set them free. You can continue to love them, but set them free. Your mother has made up her mind with regard to the relationship. That is what she wants because she believes that the relationship will make her happy. If you love her, set her free. Don’t rebel, don’t protest. Let go. Let go because you love her so much that you wouldn’t want to be the cause of her unhappiness. People are also able to love back more when you set them free. Your mother may really appreciate this step on your part and it may even cause her to be remorseful of her act. That her daughter could make a sacrifice for her when she couldn’t make a sacrifice for her daughter, may change her perspective. Rise above the rebellion, anguish and denial that your circumstances have seeded in you. That will cause you to look at your own self in new light, and even change your feelings of worthlessness. After all, how many people are capable of such an act?

By now, she was crying.

A long time ago, somebody told me- Don’t make me the sun of your solar system’. I didn’t quite understand what they meant at that time, but I am repeating those words to you now. Relationships and people are a necessary element of our lives, but they are not our goals…our destinations. Our dream is to fly. Relationships must only help us fly. If you wish to fly, to find your dream, you must outgrow this dependence on relationships. You must overcome this fear of losing people.

She had wiped her tears, but her eyes were red.

You are important to me and I care about you. I would ideally like to check on you every now and again, meet you and make sure you are okay. But that is often not possible, given the nature of my circumstances, and given the pace of the modern world. I worry when I realize that I am your motivation, and that most of your life is centered on something concerning me. As a teacher and otherwise, I am happiest when I can work on my students and make them independent and help them discover their dream. I am worried when they grow dependent on me and start weaving their lives around me.

She sat listening to me and a certain numbness had taken over.

As long as I am here in this place, I will be in touch. I am not going to abandon you or disappear. We will do many things together. Things that you will enjoy and things that will help you discover who you are and what your dream is. When you discover your dream, it will not be difficult to shift your emotions towards your dream. They call it transference in psychiatry. You transferred your emotions for your mother to me, owing to her absence in your life. Similarly, you will outgrow your dependence on me only when you transfer your emotions for me to your dream. Also, you must probably allow yourself to feel the negative emotions that flood your mind when you fear losing someone. Fear is often our resistance to feelings we wish to avoid. I will absent myself from your life for brief periods and you must allow yourself to feel the negative emotions, unless they are too difficult.‘ I concluded.

The human mind…

There are occasions when the mind refuses to rise above its misery, despite the innumerable helping hands that make attempts at reviving it- a reminder of our powerlessness over our minds. And then there are occasions when the mind displays its potential for the extraordinary, despite the negativity of the circumstances that it must confront, and despite the solitary battle that it must put up. Indeed, it’s all in the mind!