Sunday, 3 December 2017

Book conversations: Fatal Margin

Fatal Margin
Umanath Nayak
Hachette India 2014

I had written about how rare it is to find a fellow doctor-writer, given the fact that doctors have to surrender themselves to their demanding schedules and recalcitrant patients.  Not only have I, through the course of my diverse readings, managed to unearth a gynaecologist-writer, but now I have discovered a surgeon-writer! 

And if the said writer happens to be a relative of a doctor colleague/family friend, the curiosity level reaches a new high. 

Fatal Margin, therefore, was a highly fascinating prospect for me; more so because Dr Umanath Nayak attempts to do the unthinkable: enter the realm of Robin Cook and churn out a medical thriller.  While this in itself is an admirable undertaking, Dr Nayak also manages to add to the premise such ill-discussed issues as medical-political-corporate intrigues, and nepotism and corruption in the medical world. 

The result is a heady mixture of medical protocols and statistics, political manoeuvring, and courtroom drama.  Dr Nayak utilises his considerable surgical oncology expertise to etch a character called Veer Raghavan who is an ambitious surgeon looking to establish the foremost cancer centre in the country.  In the process, he circumvents a few rules and rubs a few powerful people the wrong way, and courts trouble.  Rather, trouble takes him to the court! 

How he manages to save face and emerge victorious in the face of seemingly insurmountable evidence against him, is what the story, leading up to the climax is all about.  

More than the thriller and mystery elements, to me, the standout feature of the story is the courtroom debate about what constitutes truthful and untruthful, acceptable and unacceptable, and ethical and unethical practice of medicine. 

Is it alright to overlook a few medical errors for the sake of the larger good of society?  Is evidence-based medicine superior to and preferable to value-based medicine?  Dr Nayak tackles these issues, which fall within the medicolegal grey area, admirably.   

Lay readers can look forward to an introduction to medical jargon and standard medical practice.  Fatal Margin is a valuable addition to the cause of Indian medical-fiction.   

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Saturday, 25 November 2017

Who wants to be a doctor (in Karnataka)?

So the dust from the recent doctors' strike has settled, and the diluted KPME Act has been enacted quietly.

But Karnataka has got to be the worst place for a medical practitioner.  And the KPME Act has nothing to do with this.

The KPMEA is only the latest in a long list of insults that have been meted out towards the practitioners of the 'noble profession.'

As though the tough-as-nails medical course were not enough, each of us doctors has been through hell and high water to try and eke out a living.

Find that hard to believe?  I don't blame you; especially in these times when news channels proclaim striking doctors to be 'Yama's agents.'  

Consider the odds stacked against us: difficult course that one manages to scrape through; even more difficult PG entrance exams; bottle-neck in the form of dime-a-dozen medical UG colleges, but not enough PG seats; capitation fees to get into UG and PG courses; sleepless on-call nights; dog's work in the wards/OTs/OPDs; climbing mountains to establish oneself as a sought-out doctor, assaults on doctors, non-recognition of foreign PG degrees, etc, etc. 

During all this, family/social life goes for a toss and you can pretty much forget about hobbies, alternative interests, and life outside the daily medical grind.  By the time you get round to your hobbies and interests again, you are well past your prime. 

One can't even change jobs like those in technical professions can.  Once a doctor, always a doctor.  You got to struggle on endlessly, even if you earn a pittance in comparison to the IT-BT lot who easily earn twice or thrice as much. 

It is a strange dilemma that a doctor finds him/herself in: deficiency in the midst of plenty.  Indian economy is up and running, but the healthcare professional strangely finds him/herself left out of the Indian success story.  

Setting up a private practice is a case of hit or miss.  You may or may not click with the patients, who can be rather fickle when it comes to following up with you, and loath to pay consultation charges.  It takes years in any case to make a name for yourself. 

In the hospital set up, you need to tow the line of the management, and accept a pre-set salary or 'cuts' from the consultation charges, which are rather like seedless peanuts!

So you are left with a job that you do not enjoy, and that does not provide you with anything substantial to set up home and raise a family.  This is especially true if you happen to live in a high-cost city, such as Bengaluru. 

The effect of all this?  Disillusionment; burn out and drop outs.  I have seen many doctor friends leaving the country in search of a better deal.  Some have altogether dropped out of the profession and started business ventures.  Some have contemplated suicide.

Yes, we have encountered and are still putting up with many 'KPMEA's in our lives as doctors. 

Basically, the recent fiasco from the state government has highlighted three issues, as I see it:
  1. the general public wants first-class service at the lowest cost, preferably free of cost
  2. the doctors want a fulfilling career that provides them with financial security on par with other vocations
  3. the government (in the ideal world) would want a seamless primary and secondary care service that satisfies both stakeholders; public and healthcare professionals
At the moment, none of these three issues are being addressed, even with the implementation of the KPMEA. How can one put a cap on healthcare services without capping other non-essential services that are being allowed to jack up prices wantonly.  Go, for example, to a multiplex and see for yourself how much you have to shell out for the ticket and food. 

What is the solution?  There is none that is perfect, but we are looking at a scenario where the medical service is free to the public, but at the same time, the hospital and the healthcare providers are compensated suitably.

The state owned NHS of UK (even though many in that country find faults with it) comes to mind as a service that achieves just this.  Free healthcare funded for by the taxpayers' money that is deducted at source.  

On the other side of the pond, the US healthcare is largely privately provided, with insurance system covering the cost for the patient.

We need to look at these and other models to decide the best suitable healthcare delivery system that can be adapted to our conditions.  Mindlessly capping fees and charges in an increasingly capitalized and corporatized society is not going to cut it.

Somehow, I cannot see the present government of Karnataka making any thoughtful, pragmatic changes in this regard, given the fact that it has its eyes set on the upcoming state elections.

So, dreadful, populist measures such as Indira Canteen and KPME Act will continue to be inflicted on the unsuspecting populace, as this government attempts to revive the dynasty that has clearly done its time.  

Governments will come and go.  The doctor in Karnataka will continue to suffer.

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Saturday, 26 August 2017

Book conversations: Between the Serpent and the Rope

Between the Serpent and the Rope
Mukunda Rao
Harper Element, 2014

For those of us who are spiritual aspirants, it is common practice to familiarize ourselves with the various spiritual folds and tenets, especially in the early exploratory phase.  

This, in essence, is the subject matter of this book.  Mukunda Rao records his own experiences from his peregrinations of famous spiritually important places of South India.  

Rao moves from Kalady (birthplace of Adi Shankaracharya), to Arunachalam (Ramana Maharshi's place), to Auroville in Pondicherry (home of the Aurobindo movement), to Puttaparthi (the Satya Sai Baba stronghold), to Mata Amritanandamayi's ashram, to Sri Sri Ravi Shankar's Art of Living campus, to Adyar (Jiddu Krishnumurti's main place of work in India), to finally finish with U G Krishnamurti's timeless, dogma-less, disciple-less and ashram-less concept of spirituality.

In so doing, Rao combines the details of his stay at and encounter with the people of these places, the rise and fall of the prominent religious/spiritual figureheads of some of these places, and his own take on the philosophies expounded by each of these gurus.  The result is a book that is at once a travelogue, a series of biographies, and an elucidation of the different spiritual theories of South India. 

Intriguingly, Rao comments on the failure/modification/misinterpretation/inadequacy of some of these philosophies, and the blind hero-worship that persists even after the founder-philosopher is no more.  Thus the idea behind the movement assumes gigantic proportions, and subsumes and supersedes even the founder-philosopher (for example - and this is my own take - the two Abrahamic religions; Christianity and Islam). 

In many ways, the preceding chapters are a build up to U G Krishnamurti's simple yet radical and difficult-to-grasp take on enlightenment; or Natural State, as he called it.  The added advantage Rao has is that he has met and interacted with the great man himself.

For the sake of completion, Rao (though I understand that he did not visit these places) could have included the accounts of Swami Nityananda's palaver and Sadhguru Jaggi Vasudev's simple yet profound spiritual messages.  

To me, this work also goes to show the richness and variety of spiritual thoughts and practices that exist in this great land of ours for a spiritual aspirant explore and select from - and we are only talking South India here.

Eminently readable!

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Saturday, 19 August 2017

Old article on nepotism in Bollywood

Nepolitics and nepollywood

Nepotism: The practice among those with power or influence of favouring relatives or friends, especially by giving them jobs.

This is how the Oxford Dictionary defines the term that has been in the news lately.  I have already raised this prickly issue in Angst.

In Hindi we have a more colourful description of the term: Allah meherban to gadha pehelwan!

Politics and Bollywood (I prefer Hindi Film Industry, but this term fits in here) abound in instances of shameless use of power and influence in getting one's own kith and kin plum posts/roles.

There are countless examples.

Very recently, before they were ousted, two sons of a 'foddersome' politician had occupied prominent posts in a northeastern state.  One of them, if news reports are to be believed, was the health minister even though he had flunked his school exams.  His elder brother had tried his hand at cricket, found it too much hard work, and went... 'hey, never mind! there is always politics..!'

The grand-old-but-irrelevant-in-the-present-context party continues to hold on to the family that has usurped the Mahatma's surname.  That the 'young scion' is not only young anymore, but is also completely unfit to remain in public life, leave alone lead a party, doesn't seem to matter.

No prizes for guessing who I am referring to.

Cut to the land of dreams and glamour: Bollywood, or any of the umpteen 'woods' that have sprung up across the country.  The story is the same in each of these regional editions.

I need not go into the details since I have already written about this long ago.

Recently, a star-kid - a failed actor - had written that she barely survived Bollywood and the bad things it did to her.  Sorry, what?  Who asked her to be a part of it?  Is Bollywood some kind of family jagir that needs to be thrust upon the heirs against their will?  

These gadhas have a simple choice of saying 'no'.  Instead what most of them seem to do is to take the plunge - after all, when the apple is dangled in front of you, why not savour it?  If it works out, fine; if not - 'hey, it is such a bad field..!  I barely survived it!'

Another star-kid - a successful one - was reported to have said, 'it's a free world, there's opportunity for anybody to make it big.'  Sorry, lady; beg to differ!  A rank outsider who has no prior connections with Industry insiders, who has no godfather/mother to guide him/her, who has no chance of getting a well coordinated grand launchpad, has NO opportunity to make it big - not as much as a star-kid who is blessed with all these criteria (minus looks and talent), anyway.

What does this tell us about ourselves?  Nepotism that is so rife in our public life implies that when it comes to handing over the 'family heirloom', we would like to keep it in the family.  We like to pass on the baton to our own ilk as we feel insecure about somebody else gaining an upper hand in our chosen professions.  When there is an easy route available to instant fame, recognition, loads of moolah and power, how can one say no?

So, it's my family, my son, my daughter, my nephew, my niece, my jagir, my fiefdom, my constituency, my money, my fame, my big fat EGO... that's all that matters in the end.  Fairness be damned.  Merit be damned.  'Strugglers' - that hapless breed of wannabe actors who have to jump through hoops to land a bit-role - can take a walk! 

Reservations, newer castes and religions, demands for new states and secession from the mainland... as if these were not enough, you can add a couple of other exclusivist, divisionist, selfish phenomena to this list: nepolitics and nepollywood.

'Nepotism rocks!' did someone say?  

No sir, nepotism sucks!!

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Saturday, 22 July 2017

Book conversations: Afternoon Girl

Afternoon Girl: My Khushwant Memoir
Amrinder Bajaj
HarperCollins 2013

I must honestly admit right at the beginning, I bought this one on a whim - a) because I am a big Khushwant Singh fan, and b) because it was available at a discount on Flipkart.

There, off my chest...

Now for the content.  There is something about books that you do not expect much out of that pleasantly surprise you in the end.  Afternoon Girl is one such neat little gem.

The invitation to be a fly-on-the-wall witness of Bajaj's somewhat clandestine, sometimes disharmonious, but always engaging association with the grand old man of Indian literature grips you as soon as you start reading it.  I found myself going back to it with eagerness as soon as I could find some reading time.

Besides, there was an additional serendipitous allure for me in this book.  The peculiar trait that I share with the author: doctor who harbours literary ambitions.  Bajaj's candid admission of her struggle as a doctor who wants to be an established writer, her dismay at being rejected by several publishers, and her outpouring of literary woes in front of Khushwant Singh kept me riveted.  

These revelations also reassured me, as I have experienced similar woes myself after I decided to take up writing in addition to doing medical work.  At last I have found somebody who has gone through the pain of trying to appease the selfish mistress that is medical career, while (vainly) attempting to put pen on paper.  

As for the revelations, the graphic details of her personal life and the ribald jokes she shares with the grand old man may not suit everybody's sensibilities.  But as Bajaj explains, they sell.  And I am not judgmental, so that's fine.  

The grand old man certainly did not mind.  If anything, he always relished the earthier side of life.  I have always been in awe of Khushwant Singh's ability to boldly disclose the details of his lurid affairs with, and the profligate lifestyles of the rich and famous.  

The famous Khushwant Singh penchant for wine, women, sex and death is underscored once again in this work.  It is amusing to read of his interest in Bajaj's 'solitaire collection' even as she pampers him with gallons of Chivas Regal! 

Nitpicks: samples from the handwritten letters, and a few pictures of the author's meeting with Khushwant Singh and the several book release events she attended would have enhanced the appeal of the book.  

Also, since Bajaj repeatedly wished for Khushwant Singh to live for a 100 years, a postscript describing the master writer's last moments, and Bajaj's reaction to his passing away agonizingly short of 100 years would have been the icing on the cake.

As it is, Girl is a naughty, humorous, heart-warming account of a writer's encounters with her muse. 

I am mildly envious of Bajaj as she got to savour the grand old man's company: a dream come true for any writer.  

But at the same time, I am massively chuffed for her - a fellow doctor-writer!

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Saturday, 8 July 2017

Champions Trophy 2017: Just saying...

Okay, this is not a case of sour grapes...just saying...

The eventual 'winners' of the Champions Trophy 2017 had a rat's chance in hell of winning it...

Now I do know that cricket is a game of glorious uncertainties...

I know that any team on its day can turn the tables and cause an upset...

I also know the 'winners' are known to be a mercurial side, whose performance can yo-yo between 'also-turned-up' and 'champions'... 

Still...I can't help wondering...because they are capable of anything...

Consider these:
  • The 'winners' who lost their opening game miserably against us, went on to win the remaining games against all odds.  Consider the opposition they beat en route to the finals: South Arica, Sri Lanka (who beat us comfortably), England (in the semifinals, and England were pre-tournament favourites to win in home conditions), and India (in the finals, virtually decimating us).
  • The other favourites, India were going great guns...until the finals.  Apart from the match against Sri Lanka, they had one bad day, and it happened to be the finals.
  • In the finals, why did India win the toss and take bowling first, when conventional logic seemed to favour batting first..?
  • The Indian bowlers had had a great tournament up until the finals...they had troubled batsmen of all teams they played against and had given away very few wides, and hardly any no-balls.
  • Bumrah had bowled only one inconsequential no-ball before the finals.  But in the finals...he bowled that dreadful no-ball which as we know cost us the match...
  • How is it possible that all our extraordinary, gifted, in-form batting stalwarts failed to fire in the same match en masse?  Why did the top and middle order collapse like nine pins?  Were the conditions in the second innings so miserable for batting and bowling-friendly?  
  • By the way the highest successful run-chase in the same venue is 322, which is not far away from the 'winners' total.  If there was any batting lineup in the world that could have chased successfully, it was ours. 
What happened then?  An off day?  Indian team once again flattering to deceive? 

The unlikely result, inspite of the more benign reasons, cannot put a lid on the can of worms...the conspiratorial possibilities...

Is it the familiar betting/spot-fixing monster again?  Unlikely, given the serious repercussions that would follow if caught - ask Sreesanth!  And it would be tough to get South Africa, Sri Lanka and England players to agree to the scheme.

Or could it be...dare I say it...threats?  Because the one thing that the 'winners' have in their arsenal is the power of gun and bombs.  They are, after all, the epicentre of world terrorism.  The best of terror universities are based there.  

Did they get their brothers in arms - many of whom have found a safe haven in Britain - to threaten the other teams into submission..?

Far fetched..?  Paranoid..?

Maybe...  But I wouldn't put it past them...

Did I say that they are capable of anything..?

Just saying now...

(Note: If not the ICC, at the very least the BCCI should thoroughly investigate the debacle...)

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