Dr Christiaan Barnard, the pioneer in human-to-human transplant, had visited India when I was in high school. Not sure if that was the trigger, but around the same time I developed this great interest in medicine, specifically in cardiac medicine.
Even browsed through all of Gray’s Anatomy when I was supposed to be reading Economics much to the amusement of an indulgent family doctor. As a bonus, I had this fascination for science fiction. So, save little details like studying medicine and learning surgery, my heart was set, well, on heart.
Thank God, that didn't happen! They say heart surgeons are dying out. I thought only writers were at risk. Looks like technology is set to bypass my dream surgeons, too.
According to The Economist, until “the late 19th century, surgeons were convinced that the organ was so delicate that even touching it would cause death.” When cardiac surgery emerged around the 1950s, “it quickly became one of the most prestigious and well-rewarded branches of medicine, dominated by vaunting men who gloried in their power to save those doomed to die.”
In 2008-09, heart operations in Britain were at an all-time high of over 41,000 only to fall to 31,000 10 years later. As against this, from 10,000 in 1991, the implantation of stents increased ten times to over 100,000 by 2020. Reportedly, there is ever less work to go around the estimated 250-plus consultant surgeons in Britain, a number that has remained "largely static."
What is happening? Is a ChatGPT cousin taking over heart surgery?
When Simon Akam, the writer of the article asked Dr Dincer Aktuerk, a consultant surgeon at St. Bartholomew’s about the future of the profession, the answer was arresting: “I don’t think that the conventional cardiac surgeon, as we know it, will exist in a few years’ time.”
Dr Richard Galloway, a surgical trainee has chosen to focus on orthopaedics. The rationale is more head and less heart. “Everyone’s going to need knee replacements,” Galloway told the writer. “You’re in good business there.”
Back in 1976, while in India, Dr Christiaan Barnard had told a journalist: “You can't be a heart surgeon and be tense.” Tense they are today, going by what Simon Akam has revealed.
I wonder, the next time I meet my writer friends over pints of a morale booster, and we again aver that no technology can ever replace us, will I also run into some cardiac surgeons asserting that no wire can slip through and cut the scalpel out?
Can a disaster that no one wants turn victims into villains?
An evil scientist has released a dangerous virus inside an aircraft mid-air. All are infected; many die.
Would you let that aircraft land in your country?
If you are a passenger, would you want to land?
Would you choose to be safe or want to save?
Would you describe those who deployed fighter jets to force the plane out of their country as selfish?
When you force a child to join the section of the aircraft meant for the infected because you have spotted a rash on her hand, whom are you saving?
Why is it that those safe on the ground and those dying in the air have the same question—if the plane lands, can we live?
Can humanity draw hope from the captain’s announcement before he broke all communications?
“All of us aboard this plane have decided not to land. We know what the people on the ground are scared of. We don’t resent them. It’s just that we were caught in a disaster that none of us wanted.
“We are weak and frightened humans. But because we are humans, there are things that only we can do. Now, we intend to make a decision for everyone’s sake. This decision is not to give into this disaster, and to make an honorable choice with our humanity.
“Therefore, we won’t land. For the last time, we send our love to all our families."
These are not meant to be spoilers. These are just some of the questions that came to my mind after watching the Korean movie, Emergency Declaration on Amazon Prime.
I am no expert, but this movie may not be perfect. If you decide to watch it, do not let the telling distract you from the story … and the questions it raises.
Images: From the movie, Emergency Declaration.
The fish swam at ease
Letting the ripples pass
The grass swayed
In pace with the wind
Pebbles and rocks, big and small
Lounged lazily along the shore
The mountains stretched
Unmoving, in green hues
Above all, the clouds
Were pristine white
None knew boundaries
Who made divisions
Yours, mine, they, us
Reducing mountains to buildings
Of the Cicadas’ shrill warnings
Maybe nature finds it best
To let man be
While she waits
Until they wake up
And return, chastened
To her embrace.
I saw this image on Sunday Mid-Day, and the connection was instant. Counting on the pen to work its magic. And the family confidently in tow. What follows just wrote itself.
So happy to see
Another who lives by the pen
The same family of three too
Don’t remember the little one
Resting his sleepy head on mine
But can’t forget
Falling on the road
While carrying the older
Yes, she too had followed in hope
That the pen would feed us all
Look at all those people
They all see
What we have, what we can do
But who cares
Rarely does one stop and buy
What we peddle
When we sell one
We are pumped to sell the next
What one pen can do for us
You will make it one day
It is written in our destiny
The pen shall provide
Image source: https://www.mid-day.com/mumbai/mumbai-news/article/mumbai-diary-sunday-dossier-23254015
Image credit: Ashish Raje
There is a lizard on the other side of the pale curtain. It seems happy just holding on as the curtain sways.
The old clock ticks on, loud and relentless. The sound fills every gap in the banter and laughter.
He is at the head of the dining table, most convenient to reach on his wheelchair.
“Why don’t you make some tea?” he tells the maid. She is more than a maid. She was the chief help even when his wife was around. She took over as his prime caregiver after the wife’s death and an accident confined him to the wheelchair.
A doctor who has come from a distant city checks him out. He obeys the gentle instructions. Raises his hands. Tentatively at first, grimacing at the pain. As the pain eases, a smile breaks through his white moustache and beard. As the testing and relieving continues, there is unceasing chatter, a lot of good-natured teasing between the patient and the doctor.
The wheelchair handler is called in to understand the doctor’s instructions. Soak his legs in hot water before he goes to bed. As hot as, and as long as he can bear.
As the doctor departs, so does the delivery guy from a grocer, who had been inside, stacking up stuff.
The old man puts down his cup and resumes the story he was telling. Another trip down memory lane. Like the sun filtering through the leaves in a gentle breeze, dates and names are now bright, now in shadow.
The maid signals the guests not to make him talk until he finishes the tea. Else he would again forget to sip. Again, she would have to reheat.
He tells her to shut up and go away. She does just that. Keeping an eye on him but away from his eyes. She takes her time to respond and come to him when he calls her again. There is no malice. He is smiling. So is she, despite the sulk mask.
No one who has interacted with him so far is related to him. Yet everyone around in the community is his family, tightly bound.
By ownership, he ought to be alone in that grand old house. Someone or the other, from near and far, always ensures he is not.
He is wheeled out, shouting out instructions for yet another get-together in the evening. The dogs waiting outside can barely contain their jumps and wags of glee.
The clock ticks on as if urging the lizard to get a move on. It remains where it was.
Tomorrow, more will come. So will more laughter.
She chose hand surgery because she could perform that sitting, confined as she was to her wheelchair. The Sitting Surgeon would go on to give wings to many.
Dr Mary Verghese was keen to study obstetrics and gynecology. An accident shattered her dreams and left her a paraplegic. After that she underwent multiple excruciating surgeries so that she could get better at being a surgeon, who could not stand.
In Take My Hands Dorothy Clarke Wilson tells The Remarkable Story of Dr Mary Verghese of Vellore. Here are some extracts from the book that reveal what a struggle it was for Dr Mary to recover from two spinal surgeries.
The [first] fusion operation was performed on March 14, 1955. Bone chips taken from her hip were inserted between five lumbar vertebrae, in order to effect rigidity.
[After the surgery] body encased in two slabs of plaster, either one removable, Mary was again placed on a revolving bed. Twice each day she was turned. In the morning, the nurses would remove the top slab and bathe her. Then, turning her over, they would remove the other slab and bathe her back. For two or three hours she was left lying face down. The back slab was then replaced, and the bed turned to leave her again lying on her back. The procedure was repeated in the evening.
It was for the hours of greater freedom twice a day, lying on her face, that Mary lived. Head taped and pillowed, a book lying on a low table below the open bed frame, arms resting on the table, she could read or study. Avidly she read book after book [including] volumes on the causes of nerve paralysis.
Immobile, widening horizons
Not that the longer periods on her back were wholly wasted. She used them to pray for other people and to strengthen her own spiritual life. She enjoyed the visits of her many friends. She shared the problems of students and nurses, listened eagerly to news of all the latest romances and even tried to promote a few.
Friends brought flowers every day, and one doctor even fixed a pot of blossoms under her bed so she could see it when she was lying on her face. Dr. Rambo, the American eye specialist, brought a travel poster of the Jungfrau and fastened it to the wall. 'You need something to widen your horizons,' he told her with a smile. 'This will help.' It did.
How it did! It stretched the walls to include unbelievable vistas. The pinnacle of whiteness was like a glimpse of heaven.
Reflecting life around
Nurse Effie Wallace, as ingenious as she was practical, had attached a mirror to a bar over Mary's head, reflecting not only her face but the trays of food set on her chest, so she could feed herself normally, with her fingers. Even better, the mirror could reflect objects outside the window: the big tree, a bougainvillea bush, people passing along the path towards the leprosy clinic.
The second operation was for fusion of her lower thoracic vertebrae, utilizing bone chips taken this time from her leg. Back in her room, Mary began again the weeks of immobility and waiting: the imprisoning slabs of plaster; endless hours on her back; the two shorter periods of respite each day on her face, the open book on the low table beneath her, the pot of flowers a splash of brightness on the bare cement floor; the cheering visitors; the young nurses and student doctors dropping in for advice and gossip; the praying for the needs of others; the sounds of hurrying feet; the reflections of a tree, a garden, striding figures.
[Some years later, the aircraft was ready to take off as Dr Mary returned after her Fellowship at the Institute of Physical Medicine and Rehabilitation, New York.]
The doors were closed, the seat belts fastened. The great plane began to move clumsily towards the runway, like a bird out of its proper element … or like a human being intended to run on swift limbs but doomed to lumber on wheels. It came to a stop, shuddered as if in mortal agony, then with a roar burst its bonds, mounted upward into freedom. Mary felt a kindred surge of triumph. She saw far below a huge city shrunk to incredible smallness, a blue expanse dotted with toy ships, then nothing but sunlight and clouds and infinite skies. She closed her eyes in wondering gratitude.
I asked for feet, she thought humbly, and I have been given wings.
The Mary Varghese Institute of Rehabilitation is part of the Physical Medicine and Rehabilitation Department of the Christian Medical College Vellore. The Mary Verghese Trust that was started by her in 1986 continues to conduct vocational training programs for persons with physical disabilities. In recognition of her contributions to medicine, in particular, to the field of physical rehabilitation in India, Dr Mary Verghese was awarded the Padma Shri by the then President of India, Shri V.V. Giri in 1972. She died in December 1986 at Vellore.
These days there are so many World Days. Insert a word between World and Day and there! Not all those days matter to all. Except for some. Like today.
Today, October 8, 2022, is World Hospice and Palliative Care Day.
Palliative care is the branch of medicine that is about care beyond cure. It helps one live in pain-free comfort, with dignity, until death. And offers solace to the family that must live through the dying and beyond.
That may make more sense if you or someone dear to you is suffering. Or is dying. When the only hope left is for some quality of life (some peace, no pain, sufficient comfort, dignity retained) until life breathes. Quality of life is something that matters to all of us in every stage of life. Most so in the last stage.
I am fortunate to have two friends in professions that work to provide quality of life in different ways. Dr Priyadarshini Kulkarni is a palliative medicine specialist and the founder of Ease and Comfort. Lovaii Navlakhi is a certified financial planner and transitionist, and the founder of International Money Matters.
What has money got to do with palliative care? Or with quality of life when you are in no position to earn?
We will let them answer.
Dr Priyadarshini Kulkarni
“I know a family that has just two aging parents at home. They have multiple problems and are totally dependent on others for every little thing. They prefer to be at home. Among an array of people employed to help them is one person whose only job is to be with them and keep an eye on them. This person has no training as a caregiver. Yet, this help alone is costing them more than ₹50,000 every month. Imagine the total spend! How many families can afford that?”
“When we think money, we tend to focus on the quantity. The more we have, the happier we feel. I think what is more important is what your money is doing for you. Is the quantity of money you have giving you the quality of life you want? That is why responsible financial advisors first understand what you want to do in life, before working out the most prudent way to invest your money to help you reach those life goals.”
“Treatment of a major disease like cancer will drain a lot of money. As dementia progresses there will be an increasing need for constant care. It is not always about palliative or end-of-life care. As life expectancy lengthens, as more and more families turn nuclear, there is also an increasing need for independent, geriatric care. It is a long wait. That does not come cheap.”
“Insurance is important, but your health insurance policy may stop supporting you after a certain age. Your best bet when you grow old is your younger self, what your younger self wisely put away all those years ago.”
"In most cases, the role of palliative care is to ease pain and provide comfort. But what often hurts the most is the loss of dignity. There was a very successful entrepreneur, who was once the king of his domain. He was now helpless, terminal. He wanted to know if it was possible for me to speed up the end. What was unbearable for him was to have his wife and daughter-in-law, the only family he had at home, take complete care of him as he just lay there. He did not want to be at the mercy of others. The problem was solved by handing over all care to medical professionals. Fortunately, the family could afford that. How many of us can?”
“Parents are so eager to educate their children, get them married and set up a home for them that they start saving right from the time their child a born. What they forget is to provide for themselves. By the time they realize that, it is too late because the cost of care is always rising. They end up being what they never wanted to be—a burden on their children.”
Quality of life can mean different things to different people. Even for the same person, it can mean different things at different times as life goes through its inevitable phases and transitions.
We do not want to talk of death. Nor are we comfortable talking about money with family. We cannot escape either, death or money. Between the two, why not plan the reality that we have more control over—money?
Palliative care helps you live as well as possible until you die. And it preserves dignity by respecting one’s life till the end. Financial planning can facilitate this, for oneself and for others.
Maybe it is time for a couple of name changes. Let’s change financial planning to life quality planning. And let us celebrate today as World Quality of Life Day.
It is a long ride from the airport. The urban clutter and concrete begin to give way to frequent trees and occasional teashop isles.
Conversation keeps us both awake. He is happy to talk about his family (“my daughter will finish high school this year”) and point to some landmarks on the way (“this is where I used to work before I became a driver”).
Then we reach a road that is particularly scenic. Trees on both sides and vast green fields beyond. No other vehicle in sight. Beautiful! Peaceful!
I suggest, “Let us stop here for some time.” There is no response. He seems preoccupied, a little worried even. I suspect he has even speeded up a bit.
Soon, we are at the hotel. I invite him to join me for lunch. Reluctantly he does.
As we eat, he explains. “From where you come, that road must have looked beautiful. Here, such roads can be dangerous. Suddenly, five or six people would emerge from the tall grass or from behind a tree. That would have been the end of both of us. It is so common here. Nobody can do anything.”
That explanation brings me back to reality. I am not here for sightseeing. I had insisted on meeting some of the beneficiaries of my client before penning a script for them. They had developed an app to help the poor (underprivileged in corporate-speak) invest and borrow.
The driver is grateful for the lunch and the small tip. “I will buy something to take home. And don’t worry, I won’t be taking that road when I return.”
No, he has not heard of that app. He thinks it is a joke. How can his mobile become his bank?
Meet the market
A local representative of the client arrives later. He takes me to a village that can be accessed only on foot.
Alarmed by the warm welcome accorded to “the one who has come from the city”, I request the representative to please not bother with the introductions. I am here just to watch you at work. I am not a special guest. Please ignore me.
The meeting is about to start. Several women arrive, some of them carrying children. Most have their head and face covered. The men are at work or simply prefer to leave unproductive tasks like banking and technology to the women, so I would learn later.
I try to blend into the background. Not easy when you are the only one sitting on a chair. (Someone had procured it after seeing me struggle to fold my noncompliant legs, while bravely trying to sit on the floor, like the rest of them.)
A dog comes close enough to confirm this stranger is harmless. The cows and buffaloes on either side can’t care less.
The meeting progresses. Gradually I become friends with the accent. I notice something strange. The participants are all looking at me as they talk. Sitting right in front of them are two company people whom they already know well. They are here with mobiles and registers to ensure everything is in order. And the customers are looking at me, why?
Soon the answer is clear. I am the only one who is meeting their eyes and nodding sympathetically (“my son just wouldn’t go to school; we will need another loan soon; we took it all the way to the market but did not get a good price for our harvest”). The company guys are just too focused on their mobile screens, struggling with the poor mobile coverage in the area, ensuring their app captures all information right. They simply cannot afford to look up, meet eyes and chat.
Conversations with customers
Meeting over, we are in the car again, headed to the next location. We stop at a small teashop on the way. Everyone seems to know my companions. But some of them also appear to be wary of the two.
“Many of them were swindled in the past and lost a lot of money. After that they don't easily trust banks. And definitely not a bank inside a mobile,” my friend whispers a quick explanation.
The owner of the teashop is not laughing. He had kept the previous week’s earnings in a bag in the shop. Last night, a rat had chewed through the bag and some of the money.
“I keep telling you, open a bank account and deposit the money there,” advises my friend.
“And lose all of it?” the shopkeeper replies curtly. Obviously, he is not likely to be a client ever.
I am again at the receiving end of questions and comments after the meeting concludes at the next location.
“Some woman from their company talks to me on the phone. I don’t understand her. She does not understand me. Is she for real? Someone told me she is a machine. Is it safe to talk to a machine about my money?”
“Last time we trusted a mobile scheme, we lost all our money. Now, I don’t give my thumb print to anyone.”
“They keep advising us to save. How can we when we don’t have any money? The little money we have we use to repay the last loan. Then we take a fresh loan.”
“For these women, it is easier to take a loan. They try to save, their husbands come, beat them up and take away all the money. At least the money is safer inside the mobile.”
Back to urban tech
I am back the client’s office in the city. They are gearing up for a twin celebration. They have got a fresh round of funding, a few more millions. During the party, they also plan to unveil their new user interface.
I am taken on a tour of the sprawling office. My guide spends extra time at the tech section where all the programmers sit. As they tell me about the finer aspects of the cutting-edge software, I realize there is a lot that I need to learn.
What defines success in their domain? How do they manage to tame fickle technology so that they can prosper by supposedly helping someone managing the cows far, far away also prosper?
As we go to the next section, I cannot help wishing that some of those tech wizards most of whom had not bothered to look up from their monitors during the hour I was there, would abandon their machines and go. Go to some of the villages they are working hard to transform, to enrich.
Go there. Just be there, watch and listen. Understand their simple code of life. Then get back to your complex coding to help everyone.
Executive search firms are warning that companies persisting with a five-day work week may have to do with “leftover talent” as candidates may refuse to join or leave soon after.
Do we blame that virus again for this? Have all of us been spoilt by the commute-free experience of working from home?
When the WFH-WFO debate first hit the headlines, the virus villain was not part of the vocabulary at all. Instead, it was Marissa Mayer, the then new CEO of Yahoo who had garnered all the hits for abolishing the company’s work-at-home policy and ordering everyone to get back to the office.
Then, as now, what the headlines have missed is that I have been at home and productively working for more than a quarter century.
Then, as now, what really matters is not your location but if you feel at home where you work.
Home, work home
In my early days, entrepreneurship was a euphemism for glorious, uncertain, nail-biting unemployment. I would often land up in the office (he had one!) of a friend. I would pretend to have just come from a client meeting; he would pretend to be rushing off to another. After both of us got comfortable enough to shed our masks, the first question he asked was, “How do you manage to stay awake at home? I could never bring myself to leave the bed. That is why I splurged on this *&%#$ office.”
A young manager once sat me down to have a chat. When I told him I was not a management graduate, he looked at me as if I had just crawled out of the coffee vending machine. Just to make him comfortable, I assured him I came to office only two days a week, that too for a few hours. “It is just not professional,” he burst out.
My job of writing used to place me in offices full of interesting people for several hours a week. They are rarely so accommodating today. But I am fortunate to be still working with some very intelligent people (some of them are so good they reject my work and then offer tea to make me feel better).
I must understand all dimensions of an issue before I can attempt to resolve it for my client through my writing. That conversation used to happen in the office or, more commonly, in the conference room. Now, we meet on the monitor.
As for the actual writing, I have always done it at home. Which means I have always spent more hours at home than in various offices. Which makes the housemaid throw deadly looks at the leech shamelessly living off his poor wife, who must trudge to work every day to keep the family alive and pay the servant’s salary.
John Sullivan thinks I have the mix right. That old New York Times report about the Yahoo missive quotes this professor of management at San Francisco State University, who runs a human resource advisory firm. “If you want innovation, then you need interaction,” he said. “If you want productivity, then you want people working from home.”
Now you know what I mean when I insist I am “innovatively productive”.
Susan Cain writes in her book Quiet what collaboration meant for Steve Wozniak, the co-creator of Apple: “The ability to share a donut and a brainwave with his laid-back, nonjudgmental, poorly dressed colleagues—who minded not a whit when he disappeared into his cubicle to get the real work done.”
No client has yet shared a donut with me. They have been generous with the brainwaves, though. I lug it all and disappear into my cubicle—my home.
In the same book, Susan Cain talks about Pixar Animation Studios, where “the sixteen-acre campus is built around a football-field-sized atrium housing mailboxes, a cafeteria, and even bathrooms. The idea is to encourage as many casual, chance encounters as possible. At the same time, employees are encouraged to make their individual offices, cubicles, desks, and work areas their own and to decorate them as they wish.”
So, it is about creating little spaces where you feel “at home” in the office. That is exactly what I have been saying. You need a prudent mix of efficient home and homely office for optimum productivity.
Be anywhere, but work
I recently shared this idea with an entrepreneur, making it sound as if I had thought about it all by myself, well before time, even before the virus.
This company was among the many hit hard by work-from-home while their customers all seemed to have gone home.
When the skies cleared a bit, they experimented with a smiling come-to-work-when-you-can, later switching to a growling you-better-show-up-or-else. They went on to lose a bunch of people. Now they use work-from-anywhere-but-please-work-for-us as their prime recruitment strategy.
That reminds me. I have to prepare a presentation for them. I will start on that as soon as I finish chopping the vegetables. Ever since my wife restarted going to work, our maid has adopted a may-come-may-work strategy.
Before she could reach the toilet, Dadi soiled herself. With great difficulty, ignoring her protesting joints and constant fear of falling, she cleaned it up.
She did not want to wait for her servant to discover the mess she had made. Her servant scolded her loudly, especially when Dadi's son was not at home. She did not want her servant to abandon her. Dadi was so dependent on her servant for everything.
In Rani’s case, she was the servant, and she was the one who had been abandoned.
Dadi's news reminded me of Rani's story that I had heard some years ago.
Rani was 11 or 12 when an earthquake destroyed her home and family in a small town in north India. One year later, after he collected the earthquake relief money from the government, her uncle, the only other survivor, kicked her out.
Rani landed in Mumbai, where the people of the big city and their ways made her uncomfortable. Finally, she reached Pune and found employment with a family.
She became the full-time caretaker to the old woman of the house. They forged an affectionate bond. The old woman promised Rani better days and a better living. Rani’s prime years passed her by as she lived for her dreams.
Many years later, the old woman died. And Rani was back on the streets.
From street to destitute
She found a job at a school. After some years, she started working at the home of the head of the school.
When her bleeding and the pain in the abdomen did not ease, her employer took her to a government hospital. The diagnosis: cancer of the cervix, malignant and very advanced.
Her employer then brought her to what Rani thought was another hospital. At the time of admission, she reassured her employer, “I will come back and work as soon as I get better.” Her employer snapped back, “I never want you to come back.”
The palliative care centre admitted Rani as a destitute.
Finally, living her life
As the pain subsided and she started feeling better, Rani did not know how to deal with the attention she was getting. The nurse often found her sleeping on the floor at night. “The bed makes me feel like a queen. I am more comfortable here.”
Now that she had a new family, Rani suddenly became a child and started making fancy demands. Vada pav, puri bhaji, lassi and Coca Cola were among her favourites. “And please don’t get those from the canteen, buy it from outside.”
The raging cancer would not let her keep anything down. One bite and she would throw up. One sip, and she would apologetically close the bottle and keep it away, to try again later.
“No more fancy food; just eat what we give you,” the nurse said in mock anger. Rani laughed; the nurse helplessly joined in.
The attendant gave her a bath, combed her sparse hair, and tied it into a thin bun. The security guard came with a flower. Would it look nice on her hair?
One night, Rani died peacefully. She was 70.
Gone, troubling none
The employer sounded relieved on hearing of the death and reaffirmed that the institution was free to do what they thought fit.
The institution had a signed document that authorized them to do what they felt right with the destitute before and after her death. The police had endorsed the document.
The crematorium got a copy of the document too, along with the death certificate and a copy of the driver’s license of the person who took the body there.
They all took care to make sure they would not be in trouble later.
As for Rani, after some 50 years of serving others and 20 days of living for herself, she did not care anymore.
Rani was not her real name. And very few know Dadi's name. Everything else above is the truth. For Rani then as for Dadi now, every day that they do not cause trouble for others and get scolded, is precious. Those are the days they experience a little love and dignity and forget they are no longer useful to others.