Birth of a painting

Long long ago, the famous Marathi writer, mostly satirist Mr Pu La Deshpande had wondered ‘Why XYZ becomes a station master at the station on odd railway line of Shenoli?’ Well is there really an answer? All Indians would attribute it to the fete. Is it or otherwise?

I wondered many a time, when none from my ancestral tree ventured anywhere near colours, brushes or any other art material, how come I developed an intense urge to draw odd lines on the canvas, and made it a reality in spite of being extremely busy in my profession. In a span of 40 years of practice as an Internist, I must have seen more than thousands of patients, having enough experience and material to write at least a few odd papers on many peculiar cases those I came across. But watching my colleagues literally doling out papers, mostly manipulating the observations, closely matching with what West has already come out with, and then just labelling it ‘Indian’ scenario, I felt, I just do not have it!

And then, not exactly out of blues, it happened. Colours started making rounds of my grey matter. Of course, it was there since childhood, in the form of getting cent per cent marks in most of the drawing classes, but to take it a concrete shape 20 years had to elapse. I tried my hand at oils when I was undergrad, painted few, but found it tedious as oils take longer time to dry though mixing and getting the correct shade is much easier than watercolours, other cheap option.

After a lull of about 25 years, circumstances practically forced me to take to colours again. My friend was instrumental in bringing back me in the fold. She presented me with art material worth in thousands and practically pushed me into it, this time though it was a different material, Acrylic and I fell in love with it.

The birth of a painting!

Why a writer writes? I too, so I can tell. The words take the form of an idea and almost take control of your brain practically leaving you sleepless in the bed because they keep on asking ‘What next?’ The words come lined up in sentences making the flow easier as you keep on delving deeper and deeper. And unless you jot it down that feeling of restlessness just keeps on lingering.

Painting too gives similar delivery pains, almost!

You chance to see a picture, a photograph, memory of passing as if through the dream is stored deep somewhere in the labyrinths, that suddenly surfaces and makes you see the picture being formed in your psyche, metaphorically and then really!

This one is actual photograph of Matheran taken from a distance. The mood of nature, about to go in fury has been caught on the camera so vividly that I had to paint it. The clouds posed the most problem. Forget the fury about to unfurl; mine looked like a cotton candy gone haywire. Layers after layer, shades after shades I tried, but to no avail. In the end, when about to give up on the painting, an idea struck me. I had acrylic spray cans. Covering the green part to be painted I gave two layers of spray, one grey and one light black from a distance and suddenly the clouds changed their attitude and started looking as if they are about to pour in a minute!

To bring the different shades of green on the paper too was another problem. The ‘You Tubes’ videos make it look so simple, but when you get at it, either the brush width is too broad or it just does not hold enough colour. Again after trials and trying I came somewhere near what I had envisaged!

Liberal but judicious use of spray cans got me what I had seen with the closed eyes. Here I used 3 media, Spray, acrylic tubes and simple sketch pens and the end result was phenomenal.The fog, the snow, the thin layer of ice on the blue waters, partially shaded blues skies, fern trees I loved doing it. It gives such a soothing effect to the eyes, that it almost calms down your agitated nerves!

I always longed to paint abstract human figures but did not know how to go about it. The background that has turned out so bright and vivid actually is the end result of many painting accidents. With a newfound fascination for sprays, I painted the upper half with light yellow almost creamish, mixing it with white, yellow, orange and red. And I realized, almost amounting to my folly that once you spray, you cannot mix the colours with the usual brushes, though shown on ‘YouTube’ practical.

After failed mixing with the brushes[ spoiling most of them in the end], I sprayed again. But over-spraying made the colours to drip like a leaky ceiling. In a hurry to stop the flow to reach the ‘Forbidden’[covered] area, I tried to wipe them off with cotton duster and lo, it made a distinct pattern of threads with free-flowing colours on the canvas that it took me though in absolute surprise, nonetheless, gave me something that was looking fascinating on the canvas. When young I was briefly in contact with the famous artist, painter B Prabha, so naturally, due to her influence, my human figures had to have long arms! Somehow I could not get the desired result with the brushes, so I mixed them with the tip of fingers freely. And was happy to have the eerie pattern on the torso. Rest was finished with sketch pens and I had given birth to a very distinct painting!

Dignity in Life, and Dignity in Death too !

Dignity in Life, Dignity in Death !

The incidences those prompted me to write about my mother’s courageous decision to die with dignity, made me ponder over the issues which all the doctors face, day in and day out!

I am going to make a very bold statement which definitely will not be palatable for today's children. Mostly from India and largely from the lower,  the lower middle and the middle classes, who do have access to the money, to some extent, but in the larger context they lack the text totally, "What's the  LIFE  all about and what does it teach !"

Otherwise how an energetic, eager to help young doctor is beaten almost to death when an elderly in his eighties, dies of purely natural causes!

Their obsessive attachment to their parents, especially and mostly mothers, almost borders on the pathological! Their mothers, kept on the pedestal only for being THEIR mothers, are flawless, [ mother can do no wrong!] insanely good human beings, inhuman- not in a bad way, but lack rationale at  most of the times and most of all, are immortal! And that bothers me the most because day in and day out I have to deal with this reality! Their immortality and the Death being the ultimate statement that cannot be altered or rewritten again!

As a practicing Internist I keep on admitting many critical cases who require intensive care so are either in the I.C.U or I.C.C.U [They are different.] The very fact that they have to be in the ICU means they are critical and their chances of survival are guarded. And I vouch with my heart firmly held in its place that we try, we do try to the fullest but the expectations of the relatives, especially children are beyond reason, any reason!

‘If I admit my mother in ICU and if I am spending hugely, she has to come out walking because she is my MOTHER and at any cost I do not want to lose her!’, is not a very outrageous statement, we hear it every day!

I have always said what India lacks squarely is ‘Scientific’ temperament! Medicine is not a commercial mall where if you pay more so you get a better TV!

I have seen children going, especially daughters, hysterical when the mothers lose a courageous battle either to cancer, that's going on for months, or to the un-treatable heart or lung ailment which makes their daily life not less than hell, patients’ and the children’s alike! Because for the patients, every breath  is a herculean effort or every step is a Himalayan task and for the children, innumerable rounds to the specialists’ cabins for their endless appointments, timeless wait in the queue for the Artificial Kidney Units or frequent admissions in ICU, which drain their coffers dry very fast!! They beg for the lives of their near and dear ones, in such situations too, and I don’t blame them for it, but when there is a tube in every orifice of the frail body, the heart is being run by the pacemaker, respiration is being taken care of by the ventilator support and kidneys’ role is taken over by a dialyzer, such type of expectations are not only unreasonable but are unjustifiable for the soul that’s nearly on the death bed, who in a real sense, is suffering the most if would have been conscious! Would anybody with a sane mind, really like to be in such an undignified status?

Maybe, because in such situations, it’s the reason that departs first and the hope, always expecting a miracle, that keeps the life going on!

I beg to differ here because ‘Reason takes you farther in life, Hope may just turn out to be an illusion. Here it’s mostly so!

In the end, when the bill comes from the accounts department, all the so-called well-wishers and relatives who make the kids take unwarranted decisions, mostly in the form of emotional blackmail, start making an inconspicuous exit, and then there is the grand entry of so-called ‘Social Workers’. Affiliated to some small political outfit mostly infamous for their nuisance value. And the tussle goes to a different level leaving 'The Dignity in Death' with an ugly face!

Maybe it's the guilt or the bickering by the so-called near and dear ones make them go through this rigmarole!

In such instances too there are good children who never forget that their parents in the end are human and they have to bid them farewell in life at some point of time or the other!

On getting the news from the newspaper that mother of one of our chaddi chums has left for the heavenly abode, I and my other common friend rushed to Pune the very next day, to offer our condolences. To our utter surprise, there was nobody in the home, everybody was at his/her respective workplace, schools or colleges, except his father, who was coolly reading the latest newspaper sitting on the sofa in the hall! There was not even a customary oil lamp burning when somebody departs in a Hindu home. Father just shook the head and said,’ She had lived her life fully, she had to go so we allowed her to go with dignity!’

Another doctor after seeing the valiant efforts on our part to save her mother, who had the least wish to live said,

" Doctor, why are you forcing her to live, even if this phase passes out, I know my mother, she will be a walking cadaver, let's have dignity in her death, I’ll sign the ‘No resuscitation form!" 

With a faint trace of tears in the eyes, she bade farewell to her mother and not only allowed her mother to live life with dignity but allowed to have dignity in her death, too! 

Dignity in Death

Like every other child, I too had a mother, the mother. Of course! Many may find this, a very stupid sentence, but hey wait, let me elaborate. Like every other Indian mother she too was quite normal, maybe, average be a better word, like doting her children, working hard for the family, trying to fit in the role assigned by the Indian Society for her, of a perfect mother, a perfect housewife aka cook, housemaid, sweeper, laundry washer,, a perfect woman, superwoman in fact, and she used to be, mostly successful in all the departments in parts, maybe below average in others. But yes, the most beautiful part about her in this respect was, she never felt guilty about it and spoke out her mind most frankly. But rather than all these usual characters, she was very unique in her own ways. She was one of the very few working mothers in mid or late fifties where most of the women of her era did not, could not look beyond their home, their family, totally submerging in the role assigned to them by the then Indian society! She completed her matriculation[ 10^th of the times] in the first attempt after leaving the school in the 40s and appearing for the exam 6 years after my birth, that is, 17 years after she left the school, to be given in marriage. She did not stop at that and took up a job in primary school as low grade, 1^st and 2^nd level, teacher! She was one of only other 3 or 4 mothers of the school friends who worked! Outside of their homes! That too wearing 9 yards typical Maharashtrian Sari!

She went through a bad marriage, but as was economically independent, most of the time holding her head high. But that’s not for what I remember her every day. Being in the profession that deals with life and death every day, her life and her death too gives, me a solid platform to counsel the children in similar situation!

Bogged down by the heavy diabetes, and like every other diabetic, she too was very fond of food, especially sweets, so she used to go through her daily meals like unavoidable ablutions. Her sugars always lingered above 250 to 300 in spite of having MD doctor at home. Hypertension, the twin of diabetes too made its presence felt. To make the matters worse she had fracture neck femur, what we in our parlance call, as the beginning of the end fracture, and a woman who had a fond social life in Pune, in terms of going for movies, frequent outings for Marathi dramas, visits to book libraries, Bhishi parties with colleagues and friends, came to an abrupt end in Mumbai where we stayed, as she was unable to do anything of above, without having a chaperon which none of us could be, because of our own tight schedules. She though went through all this and recovered very fast, but started losing the zest for life. Once, maybe after collecting all her strength, she asked me,

‘Son, will I be normal again and do everything like before? Or will it be just existence, with crutches of these 20 or so tablets and medicines, I have to take just to be alive?’

Being frank and straight forward just like her, though, it did hurt me, I had to say’ Apparently yes mother, that’s what it’s going to be!’ Without a deep heaving sigh, she said very composedly with utmost cool,

‘In that case, I have decided to stop all the medicines!’

 Not much of discussion thereafter, but explaining every aspect of the decision in detail, we came to the conclusion that, we’ll continue only those medicines which may prevent her sufferings.

 ‘Then let’s select a date, Gudi Padwa is in the next week, I’ll stop all the medicines on that day’

As decided, she stopped all her medicines on the selected day and bid her farewell within a week, very peacefully keeping her head on my thigh and her grandson, my son, by her side, she left her body, as if going in for deep sleep, forever!

And that taught me what’s The dignity in death!

Unemployment vis a vis Education !

It started with a patient, who during the medical interrogation, [history taking] accepted that he was not happy with life. Rather with the present job and presumed that he was cut for bigger things in life. Another victim of psychosomatic ailments. Digging further it turned out that he had done some, I don’t exactly remember, masters degree in either mechanical engineering or Business management, as far as my memory goes, he was an MBA. Mother provided the missing links. With all the money what a middle-class family could save they sought admission for him for MBA but in some college from the interiors of Maharashtra, that did not have any standing on the National MBA scene! And I realized where the problem was!

Being an MBA, though, from an obscure college, he subconsciously was putting himself on par with the candidates passing out from the IIMs. “I too am an MBA and why am not being considered for the plum jobs available on the market” was his prime concern! I was at large. Any amount of counselling was not going to help because the root of the problem was Unreasonable expectation with poor academics fuelled by middle-class aspirations of parents to see their ward on the higher wrung of the hierarchy which they could not achieve!  

At the same time, I came across a paper as fresh as published in March 2019, stating that “More than 90% of engineering, graduates are UNEMPLOYABLE!” The figures varied with different papers but the sphere widened when the MBAs were included! It was overwhelmingly 99% for Business management; in both the cases that 1 to 10% probably, mostly, belonged to the fresh ones coming either from IIMs or IITs! And the reports seemed authentic!

The rot is not limited to these two faculties alone but encompasses practically every educational faculty today.

Speaking about my own branch, Medicine, the rot started when Late Mr Vasantdada Patil initiated the move to start Private Medical Colleges, in Maharashtra which then had only one at Solapur. The notion was Noble[?]  The neighbouring state of Karnataka had many such already and so Maharashtra was losing on two fronts.1. Our meritorious students did not have sufficient seats and 2. The state was losing lots on the revenue, in the form of ‘Capitation fees’! There is no need even to guess, all the lucky ones who got the permission, even with bending many a rule, were from the Ruling party, Congress! What started with Medical colleges, spread to Engineering, B.Ed, Management, Computer sciences, say like a beehive gone berserk! Every Tehshil with a Congress leader as the head of his fiefdom had one or the other super speciality college that opened its doors to the gullible middle-class parents.

The move was very very clever. These Congress leaders, who started calling themselves as ‘Education Barons later, were very shrewd and were well aware of the mentality of the middle-class parents. At any cost, at times, taking loans, mortgaging their properties, selling the ancestral jewellery, at any any cost they will see to it that their wards would seek higher education which they could not because of a variety of factors but totally hoodwinking themselves about the fact that ‘Whether their ward really deserved it or not!’ “ I have money, so my child must be, take whatever you want, Doctor, Engineer, MBA, Computer Consultant, whatever!”

These colleges were so ill-equipped that at the time of farce named ‘Inspection‘ one borrowed equipment or machinery from the nearest college to pass the muster, and the cheating repeated every year, in the end, students passing out in the last year,never had chance to operate the instrument even once during the course of 4 years of degree course. On paper though ‘He was graduate’! Engineer to boot!

And thus the report says further that more than 200 engineering colleges have been shut down all over India due either to lack of infrastructure or for want of just gullible students! The experts say it’s because “Lack of faculty talking about industry application of concepts in class or students getting exposure through industry talks only, but not in colleges!”

In Medicine, while doing DNB courses in Surgery in Private hospitals, Medical graduate hardly touches the patient as the patient comes for the reputed name and not for getting operated from the faceless student. In government hospitals, surgical student do not get even time to bathe, even once in a week, but do not have access to the newest equipment, as the hospitals, simply do not have them or are defunct for years, for a variety of reasons, so by world standards he ends up being just a plumber!

Many of my friends do not teach, in Medical colleges, though qualified to do so, but are on the muster as faculty, because these are the norms required by the Indian Medical Council, to run the Medical College! The college management is informed about the “Surprise” inspection visit 'well in advance' so that all the faculty that’s just on the paper; makes themselves present in flesh and blood on the said day!

I don’t understand some recent policies drawn out by the Education Ministry. Nowadays there is no Merit list of the toppers declared in the newspapers for 10^th and 12^th examinations. I do agree that failure hurts but to deny the glory to one who stood 1^st with his herculean efforts is simply injustice. In the life’s race there always will be somebody who would be the 1^st and somebody, the last. But life does not stop! Is there not a race for the coveted post of CM? Or are there 15 PMs, because some who could not, would be psychologically scarred? Similarly, when one gets selected for the post of sweeper he is the first one from the list. Every child has to run the race of life, he has to put in lots of efforts to be there where he wants to be, then what’s the point in not having the merit list for them who deserve!

The entire education system has gone in the hands of the rascals. It’s money that’s more important now than the values and the education, THE EDUCATION, that enlightens. It’s always lamented that ‘Though I am a graduate, or whatever, I have to do the job that’s not apt for my standard of education.’ I would like to give an example of the most literate state of India, Kerala! If everybody from the state is either 12th pass or graduate, the rikshawala, or the sweeper too has to be at least 12^th pass! So one who scores least has to do the menial job!

Last but not least. Reservations. In highly competitive courses like IIT or IIM the dropout rate is phenomenal after 1^st year itself, thereby denying the really meritorious a seat, thus in the cost the nation dearly on intelligent jewels!

A lot of hue and cry is being raised about increasing [or is it alarming] rate of ‘Unemployment in the country. But If the one who stood 1^st in the Bihar secondary school examinations could not answer the most of the simplest questions, one can judge the quality of our education and thus what more can be expected than the increasing rate of unemployment.  Level of education and Unemployment is intertwined, unless we are strict we would be producing more in number but zero in quality, just like our population!   

Doctors Loot! Really?! Part 3

If anybody really loots in the health care Industry [?], hands down it’s, the pharmaceutical industry in India. Reasons are varied and multiple, some justifiable some totally freak! It’s most disorganized  industry though having many strict rules and regulations, our ingenious traders always find so many loopholes, some even big enough for an elephant to pass through!

India has neither invented nor manufactured so far a single molecule [apart from Ayurvedic medicines, which do not stand any scientific test on any account,!] on its own. All the medicines used by Modern Medicine practitioners,[ i.e. pain killers, antiallergics, and last but not the least antibiotics, which have brought infective diseases mostly under control], have been researched and invented by First World scientists, except few by Chinese who have been successful in beating whites in their own game.[They made a very effective drug for resistant Malaria using their knowledge of ancient Chinese medicinal system, that has been accepted by the entire world, of course including Western world!]. So we have to depend on the western world for molecules as well as for the technology thereby pushing the cost of the end product. medicine skywards!

All the Indian Pharmaceutical companies import raw materials, mostly from China,[Though besides the point,  it would be pertinent here, to know, for those who shout from the rooftops  against the use of Chinese goods, that it’s not about the Diwali lamps or two rupee toys, it’s about the import of Medicinal raw material from China if stopped, our Pharmaceutical industry will be defunct, the next second!], [Also stands for heavy goods like the machinery required to build the factories, Metro coaches etc] And these imports are in crores!  

Fortunately, the Indian Government has acted firm and wisely and stoically refused to patent the molecule but not the process, keeping the loophole that the molecule can be processed by any another method! Thus all these Ranbaxys, Reddys, Sun Pharma, Cipla and so many other Indian companies import raw material at the penultimate stage, process it differently and sell in India at much lesser price by the world standard! Had it been molecule being patented, a simple fever lowering pill, Paracetamol which costs only a few rupees, would have cost so much, almost breaking the ceiling and would have been well beyond the reach of a common man. And it’s the cheapest medicine!

The reason being given by the Western pharmaceutical companies, Mostly from the US of A, is really relevant. To bring out a single molecule useful for the mankind, at the same time financially viable, the company has to invest millions of dollars in research for hundred other molecules which may not turn out to be useful so the entire expenditure goes down the drain. Here it includes the remuneration of hundreds of researchers working on the molecule, ancillary staff, cost of the equipment, cost of raw material, taxes, oh so many other aspects. So the company has to recover the cost of this colossal waste from THE only “Molecule” that’s financially viable!  India at this stage just cannot afford such a sophisticated research system, at the most, she can buy the ready-made research and/or the technology and so the COST!

Another malady that plagues our Pharmaceutical industry is Authenticity. On this point, the score on the board is ZERO, big ZERO!

Many big names in the market, do not manufacture their own drugs. They outsource! So if you are buying a drug at an astronomical price because it’s branded, coming from a reputed a company, you are getting cheated, maybe, because THE Company outsources it to a smaller unit to cut the costs, but in the bargain compromising on the quality because the smaller manufacturing unit just doesn’t have the “Quality Control”. The flack may not stop here, Next It very well may be manufactured in a Gala, having a Horse stable next to it!  And the big companies? They are outsourced by their counterparts in Europe, mostly Italy because the labour is cheap in India!

I got to know from a very reliable source that out of 100s drug manufacturing units, he examined all over India, hardly 5 passed the muster!

And I believed him immediately. To show the transparency in dealings, every government institution has to float tenders to buy even the paper pins. By my misfortune I always had to be the part of it, being the most senior. Once a carton of Vit ‘B’ tablets arrived where there were no tablets in the strips, but if you open it, some yellowish powder flowed freely! [It must have come from some dubious firm having 'understanding' at the top levels, otherwise how would you explain?] On refusing to accept the indent; I was told bluntly that I was the one who had signed the final document! Even then I put my foot firmly on terra firma and said ‘No’! Maybe they showed the repent, which was façade! Definitely! RMO in charge of the drug purchases made student nurses peel off every strip and store the powder in a glass jar. The instruction doled out was, “whenever Dr Benurwar writes T. Vit B, give the patient a spoonful from the jar!” Aghast is a very mild word. After years of doing the job in a semi-government organization, I had realized that the nexus so vast and deep, was beyond me, the best option would be to keep mum! And I kept mum thereafter in every such dealing! In a juggernaut, if you are a small wheel, you have to rotate with the bigger one, if not, you are just deaxeled!

Barring few, 90% Indian pharmaceutical companies are small scale. They operate practically on the clandestine level but charge marginally less than the big sharks! None of the big operators is ready to bring out the medicines/drugs under Generic category fearing that they will lose the monies. The companies who have come out with generics, their credentials are a big question mark? All the government hospitals dispense medicines which are made available to them by someone sitting higher up [and having the hand in the deals], so if a patient is getting drug ‘X’ for his hypertension, next month he will get antihypertensive no doubt,but from a totally different group ‘G’ No consistency of supply, no authenticity, poor bioavailability, to be born in India as poor patient is a curse!

All in all, if entire expenses for the medical emergency are scrutinized, Doctors’ charges are always less than 10%. Majority of the chunk is taken away by the medicines, the investigations, hospital charges and other sundry expenses and the allegation is ‘Doctors Loot!’ If you have read the above blog carefully and with heart, you too would say,' Really?'

  

Doctors loot! Really?! Part 2

The Doctor has to take the flack for the allegation about the Astronomical [?]Charges in the health care because he is at the forefront. The very face of the Medical Profession. What really goes into it apart from him, either nobody knows or rather nobody wants to know!

To understand the breakup of charges, rather a big sum for a common man, one has to go into the economics of the Medical profession.

Right at the outset one has to know that even though it’s Noble profession in the eyes of the common man, none of the Corporations, Municipalities, for that matter even the so-called well-wisher Government of the people, for the people, does not think so. All of them charge all the Clinics, Hospitals big or small, or any other heath establishments like Diagnostic centres or Maternity Homes, for all the amenities provided, like water, electricity and other taxes like property tax, professional tax, at the “Commercial” rate! No concession here because it’s a Noble profession! The flak does not stop here. To start a nursing home even on the smallest scale, the Doctor has to procure umpteen numbers of licenses from hundreds of authorities. And once you enter the maze there is no way out. The inauguration of a prestigious hospital was stalled for more than a year because some officer in the corporation was not releasing the necessary certificate unless his palms were greased and because that did not fit in the policy of earnest proprietors, the hospital stood tall but vacant for a year or so! And mind you because you have to renew these licenses every now and then, lot of ‘Grease’ goes in the process!

Mind you, here we still have not considered the cost of the land or establishment. For a student coming from a modest background to purchase 200 sq ft gala to start his clinic or consulting room on a commercial basis is well nigh impossible in cities like Mumbai and/or Pune. At the most he can have lots of dreams in the eyes, zeal and zest to work hard, enormous hopes but pockets, still empty! From where does the lad in his twenties going to raise the money in crores? Banks offer loans, but not without their pound of flesh! Here I am talking strictly about the meritorious ones and not the ones for whom their fathers buy the degrees to run an already ready four-storied hospital or the ones, the pets of the government for whom everything is reserved from admission in an undergraduate course to PG degree and the jobs those are offered on the platter!

In bigger hospitals Doctor is the only answerable commodity, A Class four worker with the strength of Union backing him, knows ‘What’s NOT his work, but if you ask him, ‘What’s his work’, you draw a blank! Everybody has fixed hours of duties except Doctors, because theirs is a ‘Noble Profession’, they have to be on their toes even if the rest has eluded them for days together! In a poor area I have made umpteen number of night visits with peanuts as the fees because I myself was very well aware of the fact, that even if I ask for my legitimate rational fees, most of the patients are just not in position to afford them, thus I had to forgo it many a time, losing my precious sleep in the bargain because mine is a ‘Noble Profession’ and I am not supposed to get my dues as that amounts to looting!

If the patient has to pay from his pocket for the investigations, even if most necessary to diagnose the ailment, he is most reluctant and so will ask hundred times,

’Are they necessary, have they to be done now?’

I then have to be extremely patient and say.’ If not, why would I ask for them and you are having complaints NOW, so earlier the better.’

The same patient, if is insured will insist on getting the investigations which are absolutely not necessary. ‘I have never claimed before, so let’s get MRI done.’ ‘MRI for common colds? What for?’ is my exasperated reaction.

Second most expensive item in health care is ‘Investigations’. The most popular notion amongst the half-literate junta is, If Investigation comes negative, MONEY is WASTED! It’s extremely difficult to get the investigations done in such class!

Two important branches without which I as a consultant just can not come to conclusion are 1. Pathology with Biochemistry and 2. Radiology.

There are certain diseases, rather complications of diseases, which can be treated only on Biochemical parameters. Diabetic Coma for instance. The internal chemistry is so fucked up,[Sorry to use the word, but cannot recollect the apt alternative], that every minute, every hour Doctor has to keep on assessing the status very keenly, by asking for umpteen number of biochemical tests, that too repeatedly. Naturally the cost mounts. But the firm opinion is Doctors loot!

A drop of blood can give so much information about the person by doing myriads of tests, which may be or may not be having satisfactory treatment, but it’s going to cost all the same. To start pathological laboratory not only one has to have immense expertise but has to invest in the lab equipment in crores!

And if you talk about radiology? A single doctor just cannot afford to have highly sophisticated machinery. So in radiology either they have to have group practice or it’s institutionalized. Now here the economical mathematics is easy to understand.

If a particular instrument or equipment, say like Gastro scope costs about Rs 100,000/- and if it performs a finite number of procedures,[with each procedure few fibro-optic fibers break] say 100, then each procedure IS going to cost Rs 1000/-. Plus the doctor has to pay for the maintenance. He has to purchase a new one after the magic number of 100 is crossed, so provision to buy the new one has to be made from the procedures done by the previous one. Pay of the assistant, rent of the operation theatre where the procedure is performed and last but not the least, the fees of Doctor himself! Why not! So from the total sum spent by the patient, the Doctor gets the minimal!

And that’s why most of the time the equipment and instruments in government hospitals are defunct. The poor resident has to perform procedures 10 times more with the same machine because of the patient load and so the result….! Plus there is so much apathy about getting the machines repaired that it may take even six months just to float the tenders!

Third, and the largest chunk of the expenses is taken away for Medicines, but about that later…..

The Doctors Loot ! Really?

The reaction to one of my posts on FB was really beyond me. May be someone, from some brigade with the hot head but no reason, replied and what was it? Stupid, hilarious, ridiculous or downright insulting?! I really do not know where to put it. Putting down his version of looting, he has observed that, “When Intensivist takes a round in ICCU, he spends 15 minutes with patient No 1, charges in thousands and then moves on to the second one. After spending another 15 minutes, he charges AGAIN, in thousands and moves on to the third one. Thus if he sees 5 or 6 patients in the round, in the end, he amasses in thousands, coolly!”

Excuse me !!!

Every patient in ICCU is critically ill. In fact, that’s why he is in the ICCU. Every patient suffers from a different disease so requires a different approach. And those 15 minutes spent by the doctor are going to save his life, really a question of life and death. And to achieve this status, every doctor has to put in the efforts of years of studies. I remember, I literally used to study for 18 hours a day for my MD examination. One of the son’s friends developed Skin disease while doing residency because he did not get time to take a simple bath consecutively for 6 days, as the workload in Corporation Hospital was that high. Those 15 minutes spent are the culmination of, what we call in our culture, is really तपश्चर्या coming through commitment, hard work, immense experience and dedication!

And again these so called'Thousand' vary from Doctor to Doctor and from hospital to hospital! In the hospital where I give my services is run by right-minded social workers and the fees are really reasonable. But somebody or the other blame the management for charging astronomical fees! Again I will blame Nehruvian Socialism where people have lost the sense of proportion. We want 'Hinduja' like treatment at 'KEM' like cost! And If possible totally FREE! 

Though I do not feel like lowering myself to that level [I respect any profession which is carried out with dignity] but cannot help to cite the corollaries! The person is saying as if, if you buy potatoes from a vegetable vendor, why should he charge for the tomatoes!

The Supreme Court lawyers and advocates like, Mr Kapil Sibbal, Mr Manu Sanghavi, Mr Mahesh Jethmalani,[ His father late Mr Ram Jathmalani] charge in millions for one appearance in the court for defending something which could be totally untrue and people pay. People pay through nose for their own doing! At lower level too, people pay to the lawyers even if they very well know that they are on the wrong foot.

Is it so in the case of doctors? Patients come to the Specialist doctors [even qualified doctors in general], especially in India, as a last resort, mostly when the disease is in its advanced stage. Why, because as they do not want to spend money for the right cause, they try every remedy, including quacks, other pathies which do not have any scientific basis but only because they are cheap and last but not the least, the religious rituals! We Indians have thousands to spend on God, whose very existence is doubtful but money spent on maintaining the health is a colossal waste!

We save money to buy expensive gadgets, to better our residences, invest a lot for our trouble-free old age, money-wise, but do not save money for our illnesses of old age! Neither do we invest in our bodies by having regular exercises to face the old age which is inevitable. Most of the Indians have an absolutely unhealthy lifestyle. They do not exercise regularly nor do they have scientific knowledge of what they eat. I have come across umpteen families who have strong religious beliefs about their diet, that won’t stand the scrutiny of science even for a fraction of a second! And then if they land with an ailment worth visiting a doctor, admission in Hospital or worse in ICCU, they blame doctors, saying ‘Doctors Loot! Really?

I do not understand, why our profession, the only other one is Teachers', is put under the category of 'Noble'? Why not every other profession? Grocery vendor, even one at the corner to the one at mall who sells clothes with foreign brands has the right to loot, right, left and centre but when it comes to paying the legitimate rational fees to the doctor for well-deserving cause it becomes a loot?  

In India, everybody can make money in every damn way, right or wrong but the Teachers and the Doctors are like Caeser's wife, they can't, they loot!

The Accent

Though the medium in middle school was English, all the teachers who taught us were Marathis. So much was the influence that our English teacher, though he taught English excellently, [grammatically], made us go through it like reciting the hymns in Sanskrit. The rhythm still reverberates in my ears. The entire class used to repeat after him, 'I, Me, My, Mine’, a gap then ‘He, She, It’, again a bit longer gap and then with stress on every word, ‘They, Them, Their, Theirs!’ Why did it come to the mind? Remembered after years as if it was deeply buried somewhere in the abyss but surfaced, just on little fingering!

It so happened that 2 girls in their mid-twenties had come to stay with us on some exchange program, One American, total Yankee and the other very docile Chinese from Taiwan. I prided in speaking good English, , grammatically, so the verbal exchanges with American were quite lurid, lucid, enchanting and revealing. On the other hand, when I tried to have conversations with Taiwanese using even the simplest English, she used to stare blankly in my face! It was perplexing. I used to feel very awkward, at times taking that the poor one is poor in English! She then used to stare at American in askance with big question mark writ large on her face. And in a jiffy, they used to exchange a few fast sentences which used to go over my head! The reaction of the Taiwanese then used to be like’ ‘Oh Ho’’ as if, getting solved the most intriguing mysteries of the universe!  The duel thus used to go on painstakingly. Delving deeper I found to my amazement that Taiwanese was taught English by American 'English' professor in “THE” American accent with that so obvious Texan Drawl that she used to be at large with, though tried hard, but unable to wash off my ‘Marathi English’ accent!

That was not the only instance when I fell flat on the face due to this ‘Accent’ thing!

We were in Switzerland where they speak four languages, Italian, German, French and Romansh, a local Swiss one, effortlessly while shifting from one to another. English is spoken like icing on the cake, mostly for the tourists. Here too the accent changes, especially if you are speaking English, with every native speaker. After the conductor of the train to Jungfraujoch explained along with the information, itinerary and all, without break in languages, one after the other I just was totally confused about what exactly was happening. I was just going to ask him to explain everything in English, when my children started pulling me back and said, ‘Baba Don’t Baba please Don’t!’ Not knowing their intention I went ahead and asked him politely to explain in ‘English’

With a cool face and like a teacher of KG, he said almost icily but with mock politeness, ‘Sir I WAS speaking in English, Ask your children they will explain to you!’

In India, the scenario is beyond weird! Everybody from every state has such an accent, it’s difficult to fathom that it’s English. Especially the South Indian states! I don’t know what animosity they have with the alphabet ‘H’! They will put it when it’s not required and omit when it’s absolutely necessary. When somebody spells my name as ‘Sashikanth’ I really lose my marbles! In Roman English  ‘TH’ is pronounced in varied ways, like in This, That, Thug, Thief but never like soft ‘T’, which is correct for Shashikant, like in French. And when somebody from the south does that it gives me jitters!

Will, anybody tell me, whether it is Sridevi or Shridevi?

And here I come to the point immediately ‘Shridevi’ starrer ‘English Winglish’ was a well-made movie with a purpose and it was a decent commercial success too. But along the way, it lost its soul, the very crux of the entire narrative. English naïve, Shashi Godbole, from Pune learns English from blue-blooded English teacher native of 'THE' America. So with that base, why would Shashi speak in the climax with her staccato Indian English Accent? Contents might be broken but the accent has to be American because American taught her the English and Not any Kulkarni, Aiyyar or Singh from India.

Maybe it’s too late to write about ‘English Wiglish’ but I felt it’s pertinent so……..

Damn The Environmentalists !

Like every lad coming from lower-middle-class upbringing I too had a fascination to drive and own a car one day. Like every first thing in life, I too was in love with my first bought one, nearly 30 years ago and for me, the Mumbai roads then, did not have any bounds. 30 years down the lane and after owning 9 cars at different phases of my life, now I have come to a state where I detest Mumbai driving, thanks to many factors.

Like me, there were umpteen upwardly mobile youngsters, millennial, who too could do the same and it made Mumbai traffic, a moving traffic jam! Thanks to our technology which can send a rocket to the moon but cannot provide good drivable roads, two consecutive monsoons, a stretch of drive which normally should take 10 minutes, has now started taking more than an hour. And there came in the picture, the fast and rapid mode of transport. Metro! Being a Ghatkopar resident, and having to deal with Andheri many times, Metro Line 1 was/is actually a blessing. To cross Saki Naka about a few years ago was a nightmare, now you just hop in Metro and in a jiffy you are in Lokhandwala. I was hoping to have the same dream-like journeys all over Mumbai and thank God after waiting for aeons, the government planned many more Metro lines cress-crossing across Mumbai. And the work actually started!

But to every good thing, there’s always a black cloud hovering over the horizon. Here it was/is The Environmentalists!

A notorious species who always takes pleasure in halting every ongoing good thing. Tell me a project which they have not thrown a spanner in!

With the burgeoning population, the demand for electricity is bound to increase. Cite me any electricity-generating project which has been thrown open to the public in the last decade for the increasing demand. Electricity is not like money that can be stored, so to ask the people to conserve the electricity is bull shit. If the demand increases have more power stations, it’s that simple. But aha, there is the hitch. You think of ‘Hydroelectric power’, the species, THE SPECIES, calls hoarse, because the collection of large bodies of waters alters the ecology and is against nature. Give the alternative of Nuclear power. Oho, their eyebrows reach the sky. Absolute, No, No. “Chernobyl’! But conveniently forgetting that the Chernobyl is only one incidence amongst hundreds of other nuclear reactors which are giving cheap electricity to umpteen numbers of industries, households, commercial establishments all over the worlds over the years since its inception. Talk about Thermal Power? Most air polluting device, consuming coals and emitting CO2! And ask to use less electricity? “Why? Its’ government’s responsibility to provide us with Cheap electricity, no private sector here because ‘They loot us!’ In short, I want electricity, but power station of any kind “Not in my back yard!”

And this is not restricted to power stations alone. Take any industry that will help the nation, in the end, the man on the street, any highway that will bring two cities at stone’s throw distance, Bullet trains, airports, any damn project that in the long run will be a boost to the nation and its progress[ Remember Mumbai Pune Expressway Highway, same people same objections, but now won’t hesitate to use it because it’s so convenient], there are always these nay Sayers, who not only delay the project but allow to escalate the cost, which you, me and every taxpayer has to cough out in the end! 'Medha Patkar' fought for Sardar Sarovar, for few uprooted families,[ I must agree here that their rehabilitation is must!] forgetting the very fact that in a democracy it’s a larger number that counts, ultimately pushing the expenses skywards without achieving anything concrete, really!

The crux of the problem they cite is ‘Progress at what cost?’ To a certain extent, I agree with them, but if you want to go into the depth of the situation, the real development [and thus the destruction of the environment, in their parlance] started when THE man recreated the fire, invented the wheel and started building houses! All the homes, houses, buildings, skyscrapers standing on any land today, was once a jungle, a marshy land or the mountains! So where to have a cutting line? Due to a variety of reasons Nobody, Nobody can stop urbanization. So the Exodus from the interiors to the cities is going to continue. Now can anyone from the SPECIES stand up and give a real, real good alternative that will provide decent house to every migrant and make everybody happy? If slums are there, they crib about the subhuman existence of the fellow human beings. If the land is made available, they shout against the nexus between the builders and the Government. Ignoring conveniently the very fact that, to provide good houses, ‘Somebody has to be a builder!’ The onus goes to some extent to our Nehruvian Socialistic upbringing. WE want everything ‘Mostly free, not even at the reasonable cost!’

If really that’s the problem my answer would be ‘Stop Procreating!’ And if you can’t do that, the increasing population is going to require more and more amenities and solid working infrastructure. ‘A CITY means infrastructure!’ The ones lacking, are just villages. The one given to us by Britons, is already in doldrums and is not going to last us long, may collapse in very near future if the load on it is not decreased,[cracks are already showing], and the decay of the cities, especially overpopulated cities like Mumbai is going to continue.

Forget about the Pure air 100 years down the line, do something about the hell in which we are living NOW! That encompasses not only Aarey but the bad roads and worse living conditions. I will ask you to hold the responsible ones by their collar rather than hamper a step that will take Mumbai to a better place to commute!

Reservation: A step to social unrest ?

It would be almost 5 decades since I opted for Medicine, to be precise in June 1970. Though I was schooled in so-called Brahmanical school, the caste was never asked and was never a taboo. Many of my friends[ Whose castes I came to know much, much later in life] came to our home to play and then stayed over many times to have grub made by my mother. My mother too never hesitated to eat the food made by Muslim cooks even in those days. Because it was never thought in that direction ever.

I realized it for the first time that there exists something like ‘Caste System’ when I entered the Medical school. It so happened that, I saw somebody, who never scored good marks, [good enough to be in the merit], in the school and/or junior college taking admission along with me in the same queue. I was not flabbergasted or something that melodramatic but was curious. On exploring the details, I came to know that, He had secured the admission through the quota system. ‘Reservation’ in today’s parlance. My encounter with the ‘Caste system’ for the first time.

I do not want to cast any aspersions on anybody’s credentials but the group stood out like a sore thumb, as most of them came from the interiors, the diction while answering in the orals gave them away immediately. Again I would like to ascertain here, and without any bias whatsoever on my part, not their fault, because for want of the exposure they lacked the polish of the city-bred. The government too was discriminating. Rather than allotting them the rooms in general hostels, they had separate hostel making it amply clear their roots and origins. Like calling the ‘Untouchable’ ‘Harijans’

I got the first jolt when in spite of getting more than 65% of marks in Final MBBS I was not good enough to secure a seat in the Post Graduation course. And to my surprise, many from ‘the group’ just walked away with the premier seats though they had much, much fewer marks than me! It hurt, it did hurt because I too had not come from the wealthy family and was having an absolutely lower-middle-class existence. The upbringing was so spineless that there was no question of fighting the system!

I shifted to Mumbai for higher education and it turned out to be a blessing in disguise. Mumbai is such a big cauldron of variety of social layers that everything just melts in it. Your caste just does not matter. For everybody! So wives of the downtrodden, once get used to Mumbai potpourri, do not wish to return to their native villages for fear of losing the freedom from the clutches of the system that’s still prevalent and being practised mercilessly back home!

My PG studentship was uneventful because it used to be a big family, for every department. Seniors taking good care of the juniors and HODs keen in teaching us and guiding in difficult situations. Workload, always loaded!

The chasm was not apparent then, amongst the residents, at least caste wise! The one that I did not experience in student days, started showing its fangs when the Mandal Commission report was implemented. As the reservation went from 33% to around 50% suddenly, the resentment in the open merit candidates became palpable. When I was unit head, in casual conversations too, the boys had started taking their reservations for granted. It was turning very painful for me because in my opinion in any highly skilled  professions like Medicine and/or Engineering the only thing that must matter, is Merit! I also abhor the brats of wealthy parents who buy their seats in the auction!

The second generation of the reserved category is more aggressive. With the parents on the higher posts, mostly in the government, it enjoys all the luxuries and riches and is blatantly aware of their ‘Rights’ of reservation! When Open category student has to struggle at every step in LIFE, it’s like Red carpet treatment for Category students from A. Admissions. to 2. PG courses to 3. Government Jobs to 4. Promotions. Everything is as if offered on the platter and the worst thing is ‘They are aware of it!’

I had to take one particular candidate who was blacklisted in the previous interviews, only because that year the seat was reserved for his category! In such situations I did fear the backlash, so always opted for the soft options, keeping patient care last on the agenda! The worst was to come. One dejected resident who did not get the registrar’s post went ahead and lodged a complaint against the selected resident under atrocity act because he belonged to the higher caste! Entire management had extremely tough time to handle the situation!

I do feel sorry for the resident who lost her life, but this is the tip of the iceberg. There does not seem to be an end to the political appeasement on the government’s part.[ Dhangars, Patels, Jats in the waiting] It is simply sacrificing merit on the altar of caste. In certain branches If there is not going to be any post for the Open category, which is the most deserving one, merit wise, then out of frustration, these type of skirmishes amongst the residents are going to increase. Is it the beginning of Social Unrest?