Spirituality of Healthcare.

Human existence is the ultimate Divine endowment, the mind being its celestial connection to cosmic authority. The physical body is the absolute expression and its biologic functioning an undeniable extension of the astounding energy that we call life. The role of mind and spirituality in dealing with health and illness is akin to that of electricity illuminating a city.
The ones who treat can only heal when they realize that critical reality.

Even though there is no universal definition for spirituality, almost all cultures and religions relate to the presence of a ‘living consciousness’, a spirit within every human being that is relevant to life within or beyond the celestial system. In a larger concept of ‘being’ and a broader realm of existence, it relates to the meaning of life, a soul beyond the physical body, an inter- connection between different beings and them with the Reality at large. In Hindu perception, spirituality covers the philosophy of Dharma, Karma, cycles of birth and death and the ultimate salvation (Moksha).
  Brilliant observations and inferences of the several genius philosophers and thinkers have educated us the many basic facts of life through recorded history. As we remain mesmerized by their wisdom and acknowledge their teachings with humility and gratitude, we also develop a certain sense of submission to an inconceivable authority that transcends beyond the reach of human comprehension, making our understanding more pristine and sublime. And such reflective experiences enrich our attitude and mold our minds through assimilation of a certain ‘obscure yet palpable element of spirituality’. As much as we can attribute all our materialistic developments to the courtesy of scientific inventions, when dealing with matters of life and that of mind, we are enforced to transcend our sphere of perception to a much loftier realm. Once we accept an entity that we call ‘soul’ and its nature as 288 justified and explained in our scriptures, we may become more at ease accepting a spiritual dominion beyond our reach. It is common knowledge that we have not even scratched the surface of that metaphysical plane, nor perhaps we never will.
     It is encouraging that modern science is gradually and graciously accepting an intellect beyond their grasp, even granting it to be a concession, facilitating an amicable synchronization between ‘science’ and ‘spirituality’. If human life and perhaps its soul is the ultimate entity in the ever evolving process of creation and evolution, it behooves us to imagine that there may be a vested purpose, a designated destiny, an imaginative intent, established, structured and manipulated by an Ultimate Reality which will always remain inconceivable to the miniscule ability and grasp of human intellect. At the same time, if the wealth of knowledge amassed by the spiritual minds can accommodate and take advantage of the scientific information accumulated through the human socio- cultural enhancement, this global human family of ours stands to benefit immensely. As we approach the subject of healthcare, a common and widespread perception is that of the biologic well-being of an individual, relating to the best possible working of the body under normal environmental conditions. Any disturbance or imbalance to such status of ‘health’ due to internal or external reasons would result in illness and when such cannot be mitigated by treatment or adjustments within the body itself, it will lead to death.
     Many of the old-world countries especially India and other Eastern concepts of health have always emphasized the role of the mind, its importance and of spirituality in the maintenance of a robust status of physical welfare. Western, ‘modern’ medicine for centuries hardly considered such philosophy as of any significance. Perhaps because of the systematic methodology of Allopathy that established its dominance and universal popularity through fundamental and corroborative research data before incorporating a certain modality of treatment, mind and its function was not recognized as crucial in the physiology and pathology of the body. Mind, consciousness, feelings and spiritual attitude not being measurable entities were often excluded as important in a person’s health and well-being. And as the west controlled governing most of the planet, the knowledge and wisdom of the rest of the old-world was pushed aside and often into oblivion. At least until very recently.
     Fortunately for all concerned, and due to a variety of reasons like technology helping to link distant continents and their wealth of knowledge, universal migration of people along with tolerant, unprejudiced acceptance of information have come to the benefit of improved healthcare. Thus the perception that spirituality occupies an integral aspect of human health has been established and is steadily gaining recognition. The dangers of drug-induced complications, the overuse, abuse and mixing of several drugs leading to unwarranted, iatrogenic manifestations have guided the caregivers to exploring safer means of management and harmless alternatives. Perhaps deviating from the subject but nevertheless of grave implications are the overwhelming chemical, nuclear, and several such sinister environmental dangers that impose threatening consequences on human cells leading to diseases. A spiritual approach and modification to adapt and combat such challenges are distinctly bound to enhance the existing health status.
     The incorporation of ‘Alternative Medicine’ as an accepted mode of treatment in the maintenance of health, prevention of diseases and treatment of many illnesses is a welcome addition. The introduction of Ayurvedic practices, the flourishing commercial popularity of yoga, the launching of even an International Yoga Day, understanding that prayer has a distinct role in the mental status of humans and consequently on physical health, institution of meditation as an essential addition and an acknowledged assumption of mind control are ample evidence of the universal approval of spirituality’s unquestionable significance in human functionality. It is established and accepted in the modern scientific field that there is a distinct interaction between the functions of the body and mind, that spiritual and religious commitments do influence our health, and that nature and God, health, illness, treatment and spirituality are all indisputably intermingled.
     In a holistic approach to health that is essentially based on the fundamental inclusion of the tenets of spirituality, the emphasis is on a balanced physical and spiritual well-being in which environmental factors, nutritional observance, as well as cultivating balanced physical, mental and spiritual disciplines are essential. To attain such an optimal global status it is imperative that we incorporate and integrate all the modern scientific understanding and the age-old wisdom that can adequately nurture the needs of the body and mind. Until recent times, practitioners of modern science often ignored the religious beliefs and spiritual practices of patients, considering them as inconsequential or superstitious in the healing process.
     The Institute of Spirituality and Health at the Texas Medical Center, established in 1954, recently commemorating its sixty years of growth, is a glorious example of pride and commitment in its meritorious service with its motto of ‘Faith and Meaning Impact Health and Healing’. Its challenge was to envision and build a religious program at the Texas Medical Center. In 2003, projecting a broader perspective, the name was changed to The Institute of Spirituality and Health. Its fundamental philosophy is based on the proof from research that a strong and consistent spiritual outlook is correlated with various measures of health and healing from physiological measures, to recovery time, and even to longevity. The institute has succeeded in its endeavors to initiate and continue to expand on 290 its efforts to educate the healthcare providers to instil and incorporate the element of spirituality in providing service. I have been very fortunate to be invited to serve on its board.
     And as we gain more information through advancement of scientific knowledge and as ongoing research illuminates intricate interaction between the fluctuations of the mind and its influence on bodily functions, maintenance of health and optimal standard of living are bound to improve. There is also huge potential from the developing fields of Behavioral sciences, Cybernetics, Molecular Genetics, Neuropsychic sciences, cell biology and possibly several more that are not even in the conceptual horizon at present.
     In summary, we are at the threshold of a momentous and promising breakthrough in our healthcare concept, of maintaining an optimum milieu of life, preventing diseases and treating illnesses incorporating the millennia old wisdom of our forefathers, that spirituality is essential and of supreme importance to tame the mind, and that the mind has an essential role to keep the body functioning at its best.

Guidance about Hinduism, for a Doctoral Thesis

Dear S,
     Now that I have a notion about your objective with the manuscript, I can say, that you have done well.
     Allow me to share some of my suggestions from a Hindu perspective since that is what you have expected from contacting me.
     If one is analyzing the behaviour of a human being from a spiritual angle that they have cultivated through the religion they follow, through the belief system they prefer and entrust, the analyzer would be more equipped and better prepared if they go a bit deeper into that particular belief system (‘religion’ for want of an alternate nomenclature), explore the fundamentals, origin, peculiarities, popularity and practice parameters of that religion. If one is searching the cabinets for a particular piece, it would be sensible to explore the lower shelves than reach out to the top ones straight away.
     Especially expedient would be to study the philosophy of that faith that would have a direct bearing to the follower’s functioning, and in this case within the context of their hedonic or eudaimonic well-being.
     ‘Hinduism’, to be blunt about it, is not a religion. It is ‘anadhi’, without a traceable origin, ‘apourusheya’, without a founder, and ‘Anantha’, endless with an 184 infinite ending. Based on the concepts of ‘Sanatana Dharma’, eternal righteousness, it is a discipline that follows a certain philosophy that guides the inquisitive ones towards understanding the ‘meaning of it all’, of ‘what it is all about’, who and where we are, and how best we can make it, if you are keen about it. ‘Hinduism’, preferably addressed as Sanatana Dharma, may be called the faith of those who remained following that philosophy bequeathed from its principles and derived from the teachings of the wise from the past, from the Vedas, Upanishads and such scriptures that predate the concept of true religion by millennia. Hinduism became a religion when others who preferred to be ‘others’ thrust such a name on them.
     If humanity were to be compared to passengers in a train getting on from some beginning and taking off to an unknown destination, several sets of the commuters opt to exit in different stations when enlightened guides attracted them to follow and accept their leadership. They all established, multiplied, enlisted others and settled as inhabitants of their chosen cities, that they called ‘regimented religions’. After many stations and many established ‘religions’, those who continued on the train remained as ‘Hindus’ following their scriptural indoctrination and cultivated philosophical habits. If one chooses, the train may be replaced by a space rocket, dropping passengers on different planets and moving on.
     As per the instructions followed by the Hindu scriptures, the ultimate goal of those ‘passengers’ is to attain ‘Moksha’, ‘Nirvrithi’, bliss, salvation, by blending with the ‘Absolute Consciousness’, the Brahman, the God factor, if you may. That ‘happiness’ is their ultimate destination, of no more births as they become part of the ONE ORIGIN. (Taittiriya Upanishad, 2.7.1). As per their Karma, they may have to take several trains to reach that goal. And through each of such rides, they gain or lose traction getting closer or falling farther back, until they reach the goal, if ever.
     According to Hinduism, during each life (or ride), there are three types of happiness; Physical (Bhouthika) comforts of life, sensual enjoyment and bodily pleasures, Mental (Manasika) sense of fulfillment, freedom from worries, afflictions, and anxieties, and Spiritual (Adhyatmika) freedom from the cycles of births and deaths, and union with self. (Hinduwebsite.com).
     Few thoughts about your article: Overall you have covered the essentials of Sanatana Dharma, touching upon the Atman, Brahman, Atma Sakshatkara, Absolute Consciousness and how to reach ultimate happiness, the Bliss.
     You have surmised that Arjuna enjoys happiness through the pride of his mastery in archery, pleasing his master Drona, but we feel that it is more with reference to his ego and false pride rather than to impress the teacher. Your 185 reference to Rama and his going on exile and thus resulting in his father’s death is totally off mark as per our teachings. He did it for two reasons; as a dutiful son protecting the father’s pride and dignity to keep his promise, and to be able to carry out the purpose of his incarnation to kill Ravana. And attaining wealth is encouraged, but only through moral pursuit. Bhagavad Gita (2.47) explicitly explains ‘Karmanye vaadhikaraste Ma Phaleshu Kada Chana’, you have the right to perform, but not entitled to the fruits of your action. Do your duty, but don’t be attached to the fruits of your labor. Your example of Duryodhana is a perfect lesson against immoral, unscrupulous, behavior and greed.
     Wishing you the very best with your dissertation and for a bright future.

Corona Conundrums – Reporting from Kerala.

“Trust the Wait. Embrace the uncertainty. When Nothing is Certain, Anything is possible”

     The lines by Mandy Hale, creator of the social media movement, ‘The Single Woman’, seem clairvoyant of pandemic Corona. We all may have endured extreme personal tribulations, but a global calamity of this magnitude threatening our way of life is unique; inimitable. As millions are affected, there are millions of anecdotes, from intense tragedies to trivial discomforts; of death, suffering, disruptions, confinements, and lost jobs, of heroics, sacrifice, and altruistic endeavors – the list is long and alarming.
     From my leisurely, retired life in Houston, our ‘annual pilgrimage’ to Kerala was about over, when the virus struck. We could have traveled, but some premonition prompted me, ‘better, don’t’. I am glad that we didn’t.
     My reflections are from a Kerala perspective relating to what I observed and heard of the ‘misadventures’ of Covid-19.
     The first Corona patient of India, a medical student from Wuhan, came to Kerala and experiencing sorethroat and a cough, reported to the local health inspector. She was immediately admitted to Thrissur General hospital. On January 30, she tested positive to Covid-19, was isolated, treated, offered emotional counseling, and was discharged on February 19, into home quarantine. Approached by the social media, she was concerned about her family having to face stigma and contacted the health authorities, who handled it discreetly. “I was afraid of my family members could be infected too”.
     Kerala is praised globally for its impeccable efficiency in handling the monstrous bug. After the recent debacles with the floods and Sabarimala controversy, the communist government is scrupulously managing the myriad of issues with the pandemic. The state is coordinating with the Center and its decisions of lockdowns, an efficient team implementing them, as applicable on a district level. The system is set up to record information from arriving people, screening them, ambulances taking the symptomatic ones to hospitals, others quarantined in designated places or own residences, food provided, and constantly kept in touch. The general public is receiving free ration packages, migrant workers sheltered with free food, and being gradually dispatched to their states. There are discussions by panels of agricultural, industrial, and economic specialists about handling the fallouts after the pandemic.
     Along with totally dedicated healthcare workers, DISHA tracking with phone Apps, social workers managing 24-hour tele-health helpline, CM’s helicopter service, ‘Break the Chain’ propaganda, NORKA for NRI’s, constantly updated information, educational institutions and public places closed, hotspots declared, Kerala has kept Corona under control, so far.
     Here is an instance to exemplify the leadership’s dedication. A nephew of mine, the accounting administrator of Southern Railways in Chennai gets a call from one Shailaja, and when he doesn’t seem to recognize, she admits, ‘I’m the Health Minister’ from Kerala. She searched and found a Malayalee Menon holding a responsible position in the railways and pleaded for help, in transporting stranded people to and from Kerala! The very same Shailaja teacher who contained the Nipah virus in 2018. And not by chance, the Health minister, DHS, DME, 11 out of 14 DMOs, and 65 percent of doctors in Kerala are females!
    Kerala nurses are legendary for efficiency and empathy. Sister Mridula had this to say; “today I know the scariest situation in life, being stuck in a room, wrapped up in protective gear, sweating, unable to drink, eat or use the restroom for hours, with no one to talk to and at risk of being the next victim”.
    Beyond wiping out human lives and testing the limits of expertise, farreaching tentacles of the microbe are infiltrating every filament of our established norms of life. Stories of parents dying with children unable to reach, events postponed indefinitely, single and old family members isolated, sick ones struggling to find a doctor, doctors coping with restrictions and frustrated patients, workers without jobs, disrupted schooling and several such are commonplace, poignant tales. The state is also receiving their share of criticisms, for not doing enough screening tests or research studies, and not adequately prepared for the influx of Pravasis; fear of impending cataclysm.
    Migrant workers are facing havoc, the states panicking, unable to handle them. Laborers, many with children walking hundreds of miles to their villages, with barely any food or drink, and when eventually making it, many are banned out of fear! Heart- breaking stories of a teenage daughter cycling for thousand miles with her sick father on the back carrier, or the son hand-carrying his father for miles, are routine.
    Keralites are passionately ‘self-convinced intellectuals’ with individual opinions, always a step ahead of others and authorities. In addition to party politics, there is abuse of social media spreading wrong information from ‘scientific gurus’ and criminal minds, disruptions out of ignorance, disobedience, impatience, disbelief in authority, foolishness, arrogance, and sheer personal situations that cannot be contained within the imposed restrictions. Even a Kollam sub-collector IAS officer, was suspended for violating the quarantine.
    Our friends stranded in Chennai managed to fly on US Consulate evacuation flight through Mumbai and Atlanta, landing in Houston after 36 hours. Their experience was ‘more grueling than their trip to Mt. Kailash’, with hours at the hot airports, congested lines, numerous forms to sign, $2000 promissory notes, and many screenings in India, yet none in the US. A lady who traveled from Mumbai to Kerala had nothing but praises for her home state.
    Shifting gear from the negatives and assumptions of doom, we need to divert our thoughts to comforting modes, discover creative ways to escape the misery; contemplate, introspect of what life is all about, rediscover relationships, cultivate compassion, and appreciate the abundance of nature. Do gardening, experiment with cooking, read books, write memoirs, enjoy music, or just ruminate.
    A situation offered to us or enforced on us is perhaps with a designated design, an intended purpose to make us better humans. Let us accept it that way. (May 26, 2020)

Covid 19 – Contemplations from India

Within the concept and contexts of a ‘Multiverse’, Mother Nature demands periodic, mandatory manipulations. Like geological adaptations and ecological assimilations, microbial invasions may be elemental impositions that She dictates to keep the ‘balance’, and for the ‘Act’ to continue.

The Covid-19 could be one such ‘obligatory adjustment’.

     India is ‘an equal opportunity’ participant in the ongoing saga of the Corona pandemic, a global calamity of the century, mercilessly muddling human lives from a multitude of established foundations. As the ‘microbial marathon’ got off the starting block, the country, quite surprisingly yet convincingly, was a cautious competitor. But as the race is entering ten months, and the destination-tape keeps shifting backwards, India is gathering a malevolent momentum, with the numbers spiking and the frightening anecdotes from them, surging.
     The first Corona patient of India, a medical student from Wuhan, China, came to Kerala, tested positive on January 30, 2020, admitted and discharged on February 19. The first death was of a 76-year-old Karnataka man on March 12. The initial hotspots were cities like Mumbai, New Delhi and Chennai, reporting crowded hospitals, mounting death-toll, shortage of healthcare workers and a dark cloud of terror cast over the nation.
     From July, the cases began spreading exponentially from metropolitan to rural areas, states like Maharashtra, Andhra Pradesh, Karnataka, Tamilnadu and UP leading the pack. From dignitaries to politicians, entertainers to sports personalities, rich or poor, irrespective of age or sex, the indiscriminate tsunami has been gobbling up our essential existence.
     Professor Ashish Jha, from Harvard Global Health Institute, (recently, Dean of Brown University), in an interview with Karan Thapar in June, referring to the Gu Model (YYG), implied the counts to be erroneous due to faulty data and may 152 far exceed the projections, eventually, half of India getting the Covid, with deathtoll into several millions. A more considerate SEIR model, though, predict the decline as early as mid-October. As of this writing and as per the Covid tracking App Arogya Setu, used by 160 million Indians, about 7 million are infected, almost a million active with around 80,000 daily new cases and the lives lost, exceeding 100,000.
     While the PCR (Polymerase Chain Reaction) being the gold standard diagnostic test, the Health Ministry through ICMR has introduced faster and cheaper tests like antibody tests, rapid antigen and other types, doing about 1.2 million tests per day. Different states resorting to their own choice of testing, add to statistical inconsistencies.
     Kerala State, reporting three of the first 6 cases in India, made global headlines containing the spread, despite its highest population density and old-age people.
     Health Minister Shailaja teacher and her remarkable team initiated the ‘disaster management’ policies ahead of the Center and other states, implementing the ‘break the chain’ campaign. But by October, Kerala reminded the ‘rabbit and turtle’ fable, with maximum active cases per million, obviously, some irresponsible crowding from many, unruly events reversing all the early accomplishments.
     Government of India ordered its first 21-day-lockdown on March 24, extending it often, and unlocking in stages based on updated situations. The National Disaster Management Authority restricted movement of people across states and districts, limiting large assemblies, closing shopping complexes, cinema halls, religious institutions, and public transportation. The lockdowns slowed down the spread, buying time to study the disease and getting closer to vaccine availability. Most worthy of India, the largest global manufacturer of vaccines, is the country’s promise to provide vaccines worldwide, as Adar Poonawalla, CEO of the Serum Institute of Poona referred to Sri Modi’s recent speech at UN Assembly, where the PM legitimately criticized UNGA for excluding India out of its decisionmaking structures.
     The Covid-19 has painfully hurt the Indian economy. GDP suffered a 24% drop in the April/June quarter, its domino effects infiltrating every segment of life and the nation predicted to have its worst recession since Independence. The government has liberally pumped in billions of dollars as financial aid, several other sources promising support.
     What lies ahead? Almost all the expert projections have been mirages in the mist. Each country has its own script, and so has India. The virus reaching into the vast and varied masses, our populous nation is still fighting its initial wave and struggling to contain and quash the infection. Following restrictions, anticipating herd immunity and availability of vaccine, the pandemic would eventually be 153 contained, though the lives compromised and damages inflicted before normalcy returns, would remain anybody’s guess.
     But the lessons we learned would hopefully jolt our conscience and common sense, waking us up into a ‘new beginning’, respecting Mother Nature, and adapting a harmonious and universally sustainable ‘Symbiotic Existence’.

Doctors, It’s Time for Us to Get Off the Side-lines

     The mighty United States is established and acknowledged as a country of immigrants, a melting pot and a flawless medley of many elements, ingredients. This is the one place on earth that distinguishes itself as the most chosen by humans from all over to arrive with hope and scope for improving their lives and that of their future generations.
     Indians originally landed as indentured farm laborers in the early 1900s but our real exodus occurred during the latter part of the twentieth century. Today, we are the second largest immigrant group after Mexicans, being highly qualified, proficient in English and contributing as doctors, engineers, computer specialists, research scientists, and excelling in a variety of technological fields and considered to be the “model minority”, and probably the most socioeconomically successful minority ethnic group in the USA. We have an undeniable role in the phenomenal progress of this country in the last half-century.Independent India focused heavily on medical education, creating several medical colleges to serve t the health needs of its people. Consequently, most of us received medical training almost free of cost, the expenses being heavily subsidized by the state. Many of us migrated to America, in search of advanced training and stayed on. As we filled the shortage of health care providers here, the irony of our diverting the investment by our mother country for selfish purpose often remains ignored. Some of us also remain guilty of deriding the primitive ways and means of the Third World that we ‘left behind for good’.
     Our generation boasts in our wisdom of choice and exalts watching our next generations excel in their vocations. But alarmingly, there seems to be a shift, the land of immigrants accusing the ‘inferior’ immigrants to be its ‘nemesis’, and responsible for the many damages and atrocities around. In spite of all the race crimes, mass shootings, and blatant prejudicial exhibitions, the ‘elite wasps’ are excluded for their atrocities and related discussions as if the natives adopted them as their worthy successors. To the xenophobes, shaded skin and turbaned heads remain substandard, out of place and polluting the purity of the stock, and being screamed at, ‘go back to your country’. We Indians are not as holy as we think.
     The significant role of us Indians in enhancing life in America is indisputable, whether we are teaching, keeping technology efficient or computers running, businesses thriving, protecting health, nursing the sick or saving lives. Hardly a whisper of appreciation is heard about such huge contributions. The bigoted don’t know or seem to care; to them, we will remain the ‘undesirable’.
     We can remain oblivious. The successful in our community are comfortable with an assumption that we are safe and would remain so forever. But it is our ‘Dharma’ to protect our own kind and ensure their safety, and that of our future. Organized establishments like AAPI must leverage our clout and protect our community, our status, our privileges, our future, and that of our descendants. The commoner must be informed about the substantial contributions of Indian professionals in today’s America, to be accepted and appreciated on the merits of our legitimate roles. We deserve it, but we need to demand it.
     For any machinery to be operational, all its parts have to be functional. Individual accomplishments may satisfy our personal ambitions, but unless our community is thus recognized, our job is not done. It is no more an option, but a dire, historical need, a mandatory duty.
(December 31, 2017)

McGovern Allergy Clinic – President’s Message

Annual Lunch – 2003

     Perhaps we are witnessing the greatest revolution happening in medical practice since the inception and evolution of Modern Medicine. A noble field of service has been taken hostage by a web of bureaucratic regulations which have seized control of Medicine from patients and physicians. Emphasis has shifted from lofty ‘Hippocrates Principles’ of helping the sick ones to a mess of legal manipulations, governmental commandments, and disturbing roadblocks. The numerous non-medical training sessions, circulating memos, privacy jargons, booklet handouts, computer upgrades, skyrocketing insurance, falling incomes and the overall fear of uncertainty are all the resultant fallouts from these regulatory burdens.
     We at McGovern Allergy and Asthma Clinic are celebrating 57 years of existence, providing quality care to many thousands of allergy sufferers. While many practices have succumbed to the ongoing external assaults, it is of great comfort that McGovern Clinic has stayed alive.
     Nevertheless, we should not be complacent about the steady decline of the number of patients and consequently, that of the revenue. It is crucial for us to go the extra mile in committing our best efforts in providing the most efficient service and care to every patient who comes to us for relief. Our success and our survival depend entirely on happy and contented patients. Each one of us as an important member of the ‘Team McGovern’ should proudly play their role. I do not have adequate words to express my appreciation and gratitude for the excellent job that you all are doing. Please keep up the good work; it is essential for our existence, more than ever before.
     The year 2003 has been hectic for our clinic in many ways, both professionally and personally. We moved from Administaff to Epix, survived the HIPPA challenge and upgraded our computer system to server and MS application. We have renewed the lease on our building for another five years, put up a new sign in front and have the parking garage renovated. After a long interval and exhaustive search, we have recruited a young, well qualified and pleasant young physician, Dr. Reddy. Carrie Kane has retired after devoting 29 years of excellent service to the clinic. Susan and Nancy had babies and few of us have new grandchildren. Dr. Thorne and Sandy and my daughter Kala got married and Sonia is getting ready to reaffirm the vows. We participated in numerous health fairs and asthma screening sessions.
     As we embark on the New Year 2004 and as we face and meet challenges in the ever-changing medical climate, we will remain confident, optimistic and assured, continuing to do what we always did well – providing quality care to our patients.
               Wishing you and your family members the very best of health and peace. May God bless you.

Venugopal K. Menon, M.D. (President) Christmas luncheon, 2003

AKMG Souvenir Editorial -2013

Dear AKMG members,

This souvenir is our annual traditional custom of family chatter served on a friendly platter as we meet, greet and communicate. Through this production we express our various moods, exchange information as it appeals to the writers and expect that it helps all of us to get to know perhaps a little more of each other. This edition is offered with a request to be received with the same sentiments with which it is created, that of friendship and of fondness. It is compiled with a sincere intent to make it attractive, informative, and interesting reading that may be worthy of a second look, even of a place on your shelf. We have tried to include items on a variety of topics from authors with diversity of talents, presenting their messages with their own inimitable skills, in styles and shapes of their unique choices.
     Association of Kerala Medical Graduates is meeting for the thirty-fourth time and celebrating our annual convention this year in Houston. What started out of a longing to meet friends in a lonely land, sharing the language, food, interests, experiences, frustrations and the vague uncertainty about a future focus, gradually evolved through many layers of manifestations and modifications to our present status and stature with perhaps no semblance of ambiguity that initially persuaded us to create such an entity. What used to be a basic theme of eager craving to meet and gratify our thirst of friendship has mostly transformed into many sections with diversity of settings, from joyous celebrations to senile contemplations with shades of variations in between.
     A few of our members have been here for more than half a century and many of us are fast closing in on our heels. The landscape into which we landed and the hardships that the pioneers had endured have gradually yet distinctly changed into fresh challenges and loftier horizons being conquered. What used to be an exclusive and apprehensive club of foreign medical graduates has been gradually and convincingly replaced by the credible, confident, domestic contenders of our roles, our worthy followers, our proud, young and laudable legacy.
     As much as we, as a group has changed, so has our professional setting, meeting with its own transformation. New understanding, novel application and an overwhelming adaptation to technology have, significantly replaced what we learned, the way we learned and how we applied our knowledge a few decades ago. The revolution in turn has succeeded in surpassing human limitations in identifying intricate pathologies and correcting previously impossible situations. And quite ironically, alongside the new inventions and innovative techniques on the leading edge, there is a passionate acceptance and adaptation to age-old Vedic methods of yoga, meditation, Ayurveda, and other ancient modalities by the mainstream of America. As a consequence, squashed between the high- tech technology and the antiquated ancient wisdom, both of which seem to make inroads into our personal confines in dealing with the sick ones, there is a concern that our sensitivities and compassion towards the patients may get compromised. But in reality, as long as the candidates as medical students are chosen for the right reasons, and that they are trained along lines of proper perspectives, we can rest assured that our profession will be guarded and sustained as sacred.
     Glancing back through the paths we have travelled and the pages we have created, this organization of physicians with connections to Kerala have plenty to be proud of and contented from, as we turn our heads and focus on the present and visualize the future. With anticipated and inevitable changes we foresee a glorious prospect that the new generation of AKMG is capable of and be committed to accomplish.
     All of us in the convention committee are proud and privileged to welcome you to our beloved city, famous for its space programs, world- renowned Medical Center and its larger-than-life Texas hospitality. We strive to make your stay comfortable, enjoyable, and memorable. We sincerely hope that you leave totally contented and with pleasant reminiscences of a lifetime.

Can we be helped, please?

     This is an open appeal to kind-hearted, sensible American citizens. It is a request to recognize and make others understand the present, precarious plight of many of us in this country, who have a different shade of skin color, an atypical accent, diverse social habits or food preference than the majority of ‘Americans’. We are first generation immigrants and our progeny who were born and brought up here. We are all legal residents or natural citizens.
     But we live in troubled times.
     The statement may be cliché, sporadically raised by apprehensive humans from different quarters, substantiated by diverse rationale, creating indifferent impacts, and never any solutions. But our concern is real and out of fear. It is recent, acute, and authentic. And we are at the mercy of the ‘real Americans’ who we hope can understand and empathize with our anxiety and apprehension.
     The unique status of America as the greatest nation on earth owes it to the original settlers from Europe, the white Anglo-Saxons, and the slaves they brought in who toiled over for centuries in building this republic. Its brilliant forefathers succeeded in establishing its effective governance through the solid foundations of its constitution, its staunch adherence to democracy, its federalism, its pride in labor and a total dedication and patriotism to the state. They built the essentials of a solid nation, created the infrastructure, cultivated the land, and manufactured the comforting needs with their brain, brawn, and tireless labor.
     But in the last several decades, the influx of the bright, elite intellectuals from the East with professional training played a substantial role in helping with education, healthcare, computer technology, engineering, and the like. Such skilled contributions are undeniably relevant and crucially inimitable in the progress of any country, and the immigrants from Asia have to be acknowledged for their role and admired without reservation.
     As a doctor who is retired after practicing in Houston for about forty years, I have my story. Physicians have had a reasonable life in this country; for many, much more than reasonable. Those of us foreign medical graduates who came in the sixties and seventies, managed to find often mediocre places for internship and residencies, underwent arduous training, got through the specialty boards and fellowships, earned state licenses, and settled in various available opportunities. We raised families, built homes, took vacations and our life in general was cozy and rewarding. We created several religious, philanthropic, cultural, and political organizations, our arts, music and culinary treats appealing to the mainstream. We brought in our unique, ethnic customs and traditions to this ‘melting pot’, and we contributed to enrich and enhance the already vivid and kaleidoscopic culture of America.
     But suddenly, the situation seems to be changing for the worse, and hence such an appeal. With the current commotions about immigration, attacks on people who look ‘different’ with shades of brown skin, with turbans on head or dots on their forehead, strange accents, food habits and social customs, we are forced to reevaluate our status and situation here, in the land we adopted to domicile. It is imperative action for our future generations as well. Even though it is from a miniscule minority, some ‘opinionated Americans’ see ‘our kind’ as unwanted, inferior, and worthless to live here. The recent incidents of hate crimes, airplane skirmish, harassment at schools and work places, random accusations and insults, shooting and killing innocent people may all be consequent to the xenophobic rhetoric of some irresponsible authorities. The United Air episode (Chronicle April 13, 14, 2017) of Dr. David Dao, a 69 year old Vietnamese physician being dragged out from his seat, is hard to be accepted as random, unruly act of a lawless passenger, considering the context of the ongoing bias and racial turmoil. Nor is the killing of Kuchibotla in Kansas City as he was peacefully having a drink with his friend.
     The plight of the two Indian neurologists Drs. Satija and Ummat in Houston, (Chronicle April 7, 2017) should alert and prepare many of us who may face the same predicament. Whether they were targets of the perverse pride of the immigration department or were overstepping the legal boundaries by illegally occupying the space is not the issue. It is obvious that some of the fear-mongering authorities seem to be on a rampage to evict our kind of people with the shades of skin and accent they consider undeserving to be included. And if the trend continues, several such incidents may ensue against worthy, productive and reputable professionals who have already proved their mettle, or are waiting to be regularized. It is quite understandable if inflow of immigrants is limited to suit our needs here, 126 but discrimination against the already working professionals is injustice, bias, prejudice. It is totally wrong.
     The hate perpetrators seem to have no clue about our contributions or commitment in this country. The level of their education or prejudicial upbringing limits their ability to realize that many of us are assets keeping America great. They do not care to know that most of us are much more productive than average citizens here, that we are law abiding, family oriented, tax paying, peaceful, loyal members who have put in more than we have taken out. And we did not sneak in to grab the place unlawfully; we were accepted as qualified professionals.
     There is another salient reality about many of the foreign professionals who opt to come to America. As a medical student in 1956, in one of the few government medical colleges in India, my annual tuition fee in today‘s dollars was less than $4. As difficult even that amount was to many families including mine, it was substantially subsidized by the government. Even though I served the state and the army for few years paying my obligation and arrears, I left India and spent the rest of my professional career in the USA, contributing to the care of patients in this country. As much as I was remunerated well, the major input to such healthcare offered to the patients of the United States was done as a compliment from the educational system of India, from the resources of that country, at the expense of the patients there who should have received that care, and against the intent with which such educational institutions were set up there. United States and its patients are immensely indebted to India and several such countries for the generosity that is seldom recognized and appreciated. And most of us who benefited from such free training and chose to migrate for better comforts in life remain oblivious, and often ungrateful to our mother countries.
     Very similar are the contributions from the countless number of scientists, engineers, computer professionals, teachers, and several other specialists that this country has lured to migrate. Being a land of immigrants, America has benefited and prospered from such help from foreigners and the brain drain from their motherland. It is noteworthy that neither did we leave India from its oppressive regimes, nor due to its political atrocities. We just looked out for greener and prosperous pastures to graze, against the interest of the country that trained us. Refining the ignorant and humanizing the racists should be a fundamental and essential step. And for that, sincere understanding, sympathy, and commitment from caring, sensible citizens of this country must come through. ‘The real Americans’ could and should educate the uninformed, the misguided and the prejudiced ones about the reality about migrants like us. They should realize the fact that when their drunken son crashes his car and is taken into the ER, the doctor who saves his life on the operating table may have brown skin under the mask; the college professor who lectures to their daughter in the chemistry class may have an 127 accent but is well qualified; many of the experts who designed their phone or laptop are very likely to have strange last names but are experts in their fields. The several professionals who came from outside are tirelessly involved in research in laboratories, hospitals, universities, corporations, computer industry, aeronautics, financial institutions and such, intent to improve the comforts in life or inventing cures to prolong precious lives. Several such people may look or act different, but they donate ‘in big ways’, to help ‘keep America great’.
     Only the sane and sensible people can offer that help and make a difference. Would you?

A Patient that I Lost

     Our life as doctors spanning over perhaps half a century would have touched thousands of lives, most of them in a positive way and a few with bitter endings. We may have processed the encounters as casual routine in our line of work; but there will be many who will ever remain grateful to what we have offered and how we had made a difference.
     As my specialty dealt with treating asthmatics and ones with a variety of allergy problems, I can claim to have kept a few of them alive, being able to breathe and leading a normal life. To many, allergy is just a nuisance or inconvenience, but to the few, it is a matter of life and breath.
    To pick the most memorable ones is not easy, out of the many who have left indelible impressions that will never fade from my memory. I want to share such an episode from my professional life.
     It was a routine evening on a moderate Houston spring, about twenty or so years ago. Had my dinner and was about to go to bed. Since I was not on call, I was expecting a good night’s rest.
     Then the phone rang. Surprised, I picked it up expecting to caution my answering service to contact my associate on duty that night. To my surprise, the call was not from my answering service. It was from the father of one of my patients, one of the few who had my residential telephone number. His voice was quietly stern, intense with fear and anxiety, yet, almost cold with a grim assumption.
     He spoke “ I just got a call from the ambulance people, Pradeep has been taken to Texas Children’s hospital from the Summit”. Then hurriedly, he added. “It doesn’t sound good”.
     I pulled my thoughts together in a hurry. Pradeep is not yet eighteen, a precocious freshman at the prestigious Rice university and would still be eligible to be treated at the Children’s. And Summit being a sports arena where professional basketball was being played, he must have been attending such a game.
    The father apprised me in short, gasping, agonizing bursts: He must have been exposed to a lot of smoke (this was before all the facilities were ruled by no smoking ordnance); his Proventil may have been old and expired, or even empty. I assured the father that I would rush to the hospital and meet him at the Emergency room of TCH. He was also on his way to the hospital.
    It took me about fifteen minutes to drive, park and get to the Emergency room. I made a quick glance at the parents in the waiting area, but I walked straight into the patient room. But it was all over. Pradeep was gone. He was on the rigid, steel ER cot, a white sheet covering his entire length, save his face. And his face! His face was still, staring straight up, cold, blue, bare, and vacant, with no life. He was gone, and nothing else mattered anymore.
    The reality was beyond bearable. The parents lost their only brilliant child. They lost all their hope, their life, and their future. I lost one of my pet patients, my satisfaction of having kept him well for many years, had suddenly become my professional letdown. But such failures teach you to be humble; it is the warning, a caveat that you are human.
    I stayed with the parents for a while. We did not speak. They were not even crying. They were stunned, stoned, and unable to think. …I did not go to the funeral. I could not.
    After a break of about three months, I received a subpoena from a couple of attorneys: Das vs. the Summit; Das vs. the ambulance company; Das vs. the insurance companies. I have never been more scared in my life. Only relief was that I was asked to report as the witness. I do not recall whose witness!
    The anticipation before giving the ‘deposition’ was torturous. I could not function without thinking of it even for a second.
Finally, the day came.
    The process was arranged in our elaborate conference room. I will never forget the clutter as I walked in. There were about twelve people in the room, but not the parents. All total strangers, with no smile on their faces. And absolutely no expression of friendliness. There were about three huge cameras with professionals handling them. There were many microphones set up to mop up all that I spilled. But I felt my mouth as dry as a rock, as if a blotting paper had wiped up all my saliva.
    I sat at the end of our huge table. The vultures circled around me. Eventually, the grilling began; and it continued for about three hours. They asked every imaginable question about my taking Pradeep as a patient, my qualifications, my background, where I learned Medicine, when I came to the US, if I could speak English, my training and my Board certifications, and then, what was the diagnosis, treatment, response, office visits, hospitalizations, his co-operation, his performance as a student, as a patient etc, etc.
    Fortunately, after the initial lump in my throat, and the nervous stammering, I grew comfortable, then confident, and eventually I was in charge. I felt, I am the doctor and the one who knew about Pradeep. I had given everything within my ability to help him as a patient, seen him as often as was needed, explained to him and his parents everything about asthma, instructed them about the various medications, their actions, technique of usage, the possible side effects; and the danger if he did not follow those instructions. I knew what I had done for him; and I wouldn’t let these lawyers intimidate me.
    I saw Pradeep initially as an eight-year-old, undernourished and diminutive with scaly eczematous skin, dry parched lips and an unoccupied, almost belligerent look. Slowly we became friends, the family remained very concerned about the proud, only possession in life. They followed the prescribed therapy with all the nuances. Pradeep was an exceptionally bright child, performing at the top of his class, and a gifted piano player who was invited to perform at the White House in front of the President of the United States. He was only 9 years old.
    I was wrong. He was rebelling, refusing to get treatment and to get refill of his inhalers and other medications. He thought visiting the doctor was not important.
    It turned out to be, that on that fatalistic day, the inhaler in his possession was too old or empty. He choked with the smoke filling that huge sports arena. By the time his friends realized and called the ambulance, the game was over, the basketball game and Pradeep’s game of life. The crowd of 16,000 was rushing through the many doors to get home or to their girlfriends or boyfriends. The ambulance people had a tough time to get in and navigate their way to Pradeep, who ran out of breathing, access to his little bronchioles totally tightened up, dry with mucus and swollen membranes. And finally, when they got to him, all that remained was mechanical routines. The epinephrine, the oxygen, the beta stimulants, the steroids, the Ambu bag, was all of no avail.
    But the verdict had to wait until they diagnosed it in the fully mechanized Emergency Room of Texas Children’s, equipped and ready to handle any emergency.

But this was a case, they couldn’t.
Pradeep was pronounced dead. Dead on arrival?
A young, promising life was extinguished before it started.
But the attorneys wanted to keep the story going.

The Twenty-five Year Difference!

          Many of us have been around ‘doing medicine’ for quite some time. The ‘art’ of medicine has perhaps seen more change during this period than any era in the past. Science and knowledge have dashed forward at an unprecedented pace. Modalities of treatment have made remarkable strides. The practice of medicine has mutated into an amalgam of technology and trade. Compassion and ethics as traits, as postulated by Hypocrites are taking a different dimension or are on the verge of extinction. As some of us have bowed out or are planning to quit, let us ruminate over the path of the ‘once noble discipline’ that we have trudged along.
          Where did we start and where are we today? There was a time when we bartered goods and services in exchange for health care; then it was cash, or insurance as good as cash. Now it is all credit cards, co-payments, and third-party payers. The financial accounts of p[patients were kept on simple ledger cards manually or with mechanical posting machines. Now it is computerized.
          CPT codes were never heard of; now you don’t get paid unless you use those codes. Insurance claims were sent in on the company provided forms; now HICFA 1500 forms are required or claims are submitted electronically. Patients have to get approval from the insurance companies before they get to see a doctor. Managed care and HMOs have become the nomenclature of the ‘new and improved’ insurance companies, the new bosses on the scene.
         Doctors used to work with ancillary facilities like laboratories, X-ray, physical therapy and pharmacy, to offer more services to patients. Now, many such groups have been swept under the umbrella of ‘physician management companies’ who have attracted them with the promise of help, efficiency and 118 secure income. The process has cost the doctors their autonomy, the advantages promised having never come their way.
        Back then, we used to be ‘doctors’, making independent decisions in the best interest of the patients. Now, the insurance companies call us ‘ providers’ and dictate all the ‘do’s and don’ts in the interest of their stockholders. Morale and satisfaction of the physicians are replaced by frustration and need for survival.
       Outside interference used to be limited or nonexistent in medical practice. Now, insurance companies, attorneys, government agencies and a myriad of bureaucracies want a piece of the pie, imposing regulations and restrictions. The regulatory terms HMO, HSG, OIG, OSHA, CLIA have pushed over the medical abbreviations like BID, COPD, ANA, FEV, and GERD.
       Physicians used to be alerted by the ‘code blue’ for a cardiac arrest on the hospital floor. Now they can be by a ‘code red’ by a team of FBI storming into their office. Terms of concerns like a ruptured aneurysm, paralytic ileus, tension pneumothorax, and ventricular tachycardia are struggling to survive against the new lexemes like corporate compliance alert, fraud and abuse citations, mandatory and permissive exclusions and cumulative sanctions.
       When a patient called a doctor’s office, a receptionist talked and assisted them; now they are welcomed by mechanical voices, mazes of options and uncertain choices. Secretaries took dictation by shorthand, typed them up and recorded them on charts; now it is all done by voice recognition devices and computer software.
      A medical record used to be what the doctor felt necessary for his style of practice. Now we are told to check the ‘bullets’, post the ‘codes’ and substantiate your services before a statement is billed, lest you end up getting fined or put behind bars. And the patient’s’ medical records used to be private and confidential; saved by the doctor who took care of them. Now, anyone who pays the claim can access their charts. Privacy now can be purchased for a price. Progress, like beauty, is in the eye of the beholder.