Ketaki's pensieve: Book review #1TheSilent Patient by Alex Michaelide...

Ketaki's pensieve: Book review #1TheSilent Patient by Alex Michaelide...: Book review #1 The Silent Patient by Alex Michaelides About the book : Alicia Berenson’s life is seemingly perfect. A famous painter ma...

When I was a child, I looked forward to summer holidays. Summer holidays held their own charm. It was the time we would visit my nana nani’s place in Akola. They owned a huge palatial house, ground floor of which was hospital and first floor, the home. Me and my cousins would play in the big balcony overlooking the street below. We used to sit together on a big carpet on the terrace along with our grandmother, relishing mangoes. We would laze around on the floor of the living room with loads to rest on, watching 101 Dalmatians. We would eat freshly baked nankatai which the driver Ganpat would bearing from a nearby bakery. We would go on a long drive with our grandpa in their ambassador and he would show us the school where our moms had studied. We had also made a few friends in the colony. They would come in the evenings and we would play hide and seek. We would play cards with our mama who taught us all the tricks to cheat in the games and we loved him for that. We would enact small scenes or stories from our all time favorite comic tinkle. We would then assemble the adults for audience, wear proper costumes and perform those ‘skits’. I remember a story which we had enacted. There's a princess who is too proud and arrogant and insults any suitor who comes to ask her hand in marriage. She does the same at the ‘swayamvar’ arranged by her father. Her father, the king, is enraged and in order to teach her a lesson, takes an oath to marry her off to the first beggar that comes to the palace. When one such beggar comes to him, he really marries him off. The princess finds it hard to believe that her father would really keep his word. Then begin her hardships as she begins leaving a hand to foot life. But the beggar loves her and she begins to feel warmth for him. She understands how difficult life can be and learns her lesson. Then, she learns that the beggar is non other than the prince of the neighboring state whom she had insulted for some physical attribute at the swayamvar. It had been the plan of her father and the prince to show her the real world. Ashamed of herself, she apologizes to her husband and starts living a life without the previous arrogance.

We had once set a small play titled ‘modern ramayan’ where in the Ramayan takes place in this century. Instead of the deer, Seeta asks Ram to chase the latest motorbike, while she goes to the beauty parlor and then attends kitty. I remember I was King Dasharath as well as Raavan in this one. We had also set a dance to the Akshay Kumar Shilpa Shetty number ‘Churake dil mera….goriya chali’.

A girl lived in the neighborhood, whom we cousins disliked. I don't know why, but we tried to avoid her. But she never realized and would turn up again to play. Every time we made up some new reason. And ridiculous one at that. Once we were applying nail paint to each other's nails. We heard her coming. Immediately we painted our knees red with the red nail paint and when she came inside we told her we all had hurt ourselves and hence couldn't play with her. We even showed her our fake injuries. I still don't understand how we thought we could get away with something so gross! One more time when she came, to hide from her, we entered a room downstairs which was given on rent to a college going girl who used to come there for studying. All her books lay strewn on the bed, and she wasn't there. We heard the girl coming our way, and instinctively, sat on the bed, acting as if we were studying. When she came inside to call us, we told her we had a lot to study and didn't have time. This was another ridiculously hilarious excuse. We were hardly third or fourth graders while the books were of accountancy and business.

There was also a pair of twins, I don't recall their names. They were so identical, it was difficult to identify one from another. We used to have pot luck where in each one of us would bring one food item and we relished all preparations together either on our or their terrace.

To summarize, summer holidays were all about meeting cousins, eating mangoes, playing games, watching Vcd's and lazing around. Now, almost two decades later, things have changed.

First of all, summer holidays are no longer freedom holidays. They are no longer between two grades. Now kids behind their new grade in April and then have a summer break, with lots of homework. So disappointing! Secondly, children now don't seem to enjoy things which we used to do. They want something digital. Either a mobile or a MacBook or a note to play video games. And they can do so for hours together. Getting to watch TV was a rarity in our childhood. Now TV is not something which you get to watch as a reward. If we tell our kids what we did in our holidays, they find it boring. They find it hard to believe that once upon a time there was a world without internet. That once upon a time, there were no mobiles. That once upon a time, there was only Doordarshan. And that at that time, life was probably better.

                         Double crossed

 He should have been happy today. It was after all a big day. It was his wedding day. He got married today. Of course, he was happy. Avika was a beautiful girl, well educated, well spoken, well behaved. He was lucky to have her in life. But the guilt! It kept gnawing at the back of his mind. It would not allow him to remain peaceful. He had deceived her. Yes, it was deceit. Of course he had never lied to her. But hiding the truth is as good as, or better say, as bad as lying. He had hidden the truth from her. His family had hidden the truth from hers. But had they not, they might not have gotten married. After all, why would a girl like Avika marry a guy with a single kidney? Not that it mattered much, but why would she make compromise in an arranged marriage? Why would her parents marry their beautiful daughter to a disabled man? Yes, this certainly was a disability. And hence, they had decided they would not tell her family about it.

 He always felt guilty about it, right from the beginning. But his family was adamant. They had warned him that he would end up remaining single if he spilled the beans before marriage. There had been lots of discussions in his family over this matter. His mother was of the opinion that the fact that he developed acute kidney infection at a young age and his kidney had to be removed was not his fault. So why should he suffer. Secondly, the doctor had said that he could lead a normal life even with a single kidney. So then, how did it matter. But still, he knew, this was akin to fraud. The basis of a relationship between a husband and wife is trust. And he had breached it before it even began. Many times, while he was dating Avika after their marriage got fixed, he was tempted to tell her. But back then, the fear of losing her forever had prevented him from doing so. But now the guilt had gotten the better of him. He could not hide the truth now. He would tell her right away, on their first night.

 Avika was waiting for him in the decorated room upstairs. Whatever would happen now, he was determined to confide in her. Only then could he begin a happily married life. What if she decides to leave me? He brushed away the thought as he climbed the staircase. The door to the room was closed. He opened the door. Avika did not seem to notice. She was standing facing the window at the far end, her back towards him. He quietly tiptoed behind her, to take her by surprise. As he came near her, he realized she was speaking to someone in a hushed voice. And that was when he overheard her say, “But mom, some day they will come to know that my left ovary has been removed. Then what?”

What exactly is Anaesthesia???

I had written this article a long time back, for bringing awareness about anaesthesia among patients...thought of sharing it for all those who wonder what anaesthesia actually is...

Q 1: What is Anaesthesia?

A : Anaesthesia is a word derived from the Greek, meaning 'without sensation'. Anaesthesia is given to patients who are undergoing painful procedures such as surgery. By means of various drugs, all sensations (including pain sensation) of a part or whole of body are temporarily and reversibly blocked.

Q 2 : Who are anaesthetists?

A : Anaesthetists are fully trained medical doctors who have had training in anaesthesia. The anaesthetists work in partnership with the surgeon, providing a team approach to surgical care.

Q 3: Are there different types of Anaesthesia?

A : There are four types of anaesthesia:

1.      General Anaesthesia - This is a state of deep unconsciousness, where you are free of all sensation, including pain, during the operation. In this type of anaesthesia, you will be in a controlled state of unconsciousness, with muscles paralysed reversibly, and in a state of amnesia (loss of memory). Your respiration will be controlled by a ventilator by means of a tube which the anaesthetist introduces inside your trachea after you have become unconscious. Anaesthesia is usually started by an injection of medicine into a vein. Sometimes, a  mixture of gases can be breathed in to give the same effect. Your anaesthetist will stay with you, monitoring your vital functions, (heart rate, blood pressure and oxygen levels in your blood) and maintaining the correct level of unconsciousness. The process of anaesthesia will be reversed at the end of the operation. After reversal, you will be fully awake, with complete muscle power, but without any memory of the operation or any pain.

2.      Regional Anaesthesia - This is a technique where a local anaesthetic drug is used, to numb a group of nerves, and make a large part of the body, such as the legs, numb and pain free. This is achieved by injecting an anaesthetic drug inside your spinal canal (space around your spinal cord, inside the vertebral column). This technique is known as ‘Spinal Anaesthesia’. When the drug is injected in the outermost layer around spinal cord, in a space called epidural space, it is known as ‘Epidural Anaesthesia’.This can be used on its own, or with sedation or a general anaesthetic. This type of Anaesthesia is useful for operations on lower limbs or lower part of abdomen. The numbness wears off sometime after the operation, when other forms of pain relief are used. As with a general anaesthetic, you anaesthetist will be monitoring you continuously.

3.      Local Anaesthesia - Here the local anaesthetic drug is injected near a few nerves, or into the site of the operation. As with regional anaesthesia, the painful sensation is removed, but there may be some sensation of pressure or movement. For e.g, eye surgeries are generally performed under local Anaesthesia.

4.      Sedation - This is where a sedative drug is used to make you sleepy and comfortable during surgery. You may not remember much of what happens at this time, although your anaesthetist will be able to talk to you to confirm you are comfortable. Sedation is used during procedures that are uncomfortable rather than painful. Sedation can be administered in combination with other techniques and by trained doctors other than anaesthetists.

The anaesthetist chooses the type of anaesthetic, but your wishes will always be taken into account. Nothing will be done without your agreement.

Q 4: What is pre-anaesthetic check up? Why is it necessary?

A : A pre-anaesthetic check up is your health assessment conducted by the anaesthetist prior to your scheduled surgery. The anaesthetist determines your fitness for surgery, for your safety. You will be asked about presence of any chronic health problem, such as Diabetes, high blood pressure, heart disease, asthama, tuberculosis. You will be asked if you have previously undergone any surgery, and the previous anaesthesia details. You will be asked about smoking and alcohol intake, medicines you are taking, any allergies to medicines you have had, and whether you have received a blood transfusion before. The anaesthetist will record your heart rate, your blood pressure. He will go through the necessary blood investigations to see whether they are in the normal range. This will also allow the anaesthetist to plan the anaesthetic to suit your health, and the needs of surgery.

Q 5:What is monitoring?

A : The anaesthetist constantly looks after your body’s function during the anaesthetic. This “monitoring” usually includes using special machines, which measures blood pressure, the heart rate (ECG), and the amount of oxygen in your blood. Depending upon the requirement as dictated by the surgery, the anaesthetist may use other monitors such as those for measuring the amount of carbon dioxide in your exhaled gas, your level of unconsciousness, the degree of your muscle relaxation etc.

Q 6: What can I do to prepare myself for an anaesthetic?

A : Following measures should be taken by the patient to ensure a safe anaesthesia :

1.      Confide everything to your anaesthetist. Do not hide any health problem or any drug you are consuming, as this can adversely affect the anaesthetic management.

2.      Do not eat or drink anything for at least six hours before surgery. This is important to prevent you from choking while you are unconscious and from vomiting after you are out of anaesthesia.

3.      Stop smoking and consuming alcohol at least a month before surgery. This is important for your post operative recovery.

4.      Glasses and contact lenses should be removed before surgery, to prevent them getting damaged by the anaesthetic equipment.

5.      Dentures or false teeth need to be removed just before the anaesthetic, and the anaesthetist should be informed about any loose or crowned teeth. This is because the anaesthetic will relax your neck and mouth, and the anaesthetists will need to use equipment to help keep you breathing safely.

6.      Follow the instructions given by the anaesthetist properly, especially regarding your routine medications. For e.g, the anaesthetist will advise you to take your antihypertensive medicine with sips of water on morning of surgery, while he will ask you to omit your diabetes medicine on the morning of surgery. This is important for your intraoperative safety.

Q 7: Where will I go to sleep? Where will I wake up?

A : When it is time for your operation, you will be moved from the ward to the anaesthetic room next to the operating theatre. It is here that you will have a cannula, a narrow plastic tube through which injections are made, put into a vein and you will go to sleep. Occasionally, you may be anaesthetized in theatre.

Usually you will wake up in the Recovery area, which is near to the theatre. Sometimes, you will wake up before you get there, but your anaesthetist will only wake you when it is safe to do so. The Recovery area has specially trained staff to look after you following you operation, and  to make sure that any nausea, pain or discomfort is treated. The Anaesthetist continues to have a role in keeping you pain free, and looking after your fluid and drug requirements, on the ward afterwards.

Q 8: Is Anaesthesia safe?

A : Yes it is, but all operations and anaesthetics have some risk. The risk depends on various factors, such as the age of the patient, associated diseases like heart disease or lung disease, the type of surgery, whether surgery is emergency or planned, the duration of surgery, the site of surgery (heart and brain surgeries obviously carry greater risk than surgery of toe). The risks of a particular procedure to a particular patient will vary, and your anaesthetist will discuss any risks that are relevant to you before the operation. There are side effects of having an anaesthetic, such as drowsiness, nausea, muscle pains, headaches or a sore throat. These symptoms are usually short lived, and can be relieved by relevant drugs.

Q 9: They say Anaesthesia is safer now than it was previously. Is it true?

A : Certainly. Anaesthesia has evolved over years from use of cold ice to cause numbness to a variety of safe and efficient drugs. Drugs like Thiopentone Sodium, which caused nausea and delayed recovery have been replaced by Propofol, which is short acting, helping in faster recovery, as well as non nauseating. Newer and shorter acting muscle relaxants are now available. Inhalation drugs such as Ether, which was used in the past and had lots of side effects have now been replaced by newer and safer as well as more potent drugs like Sevoflurane and Desflurane. Various new pain killers are now available which can be used alone or in combination for intra operative and post operative pain relief. Pain killers are now available in various forms such as skin patches and lollipops. Overall anaesthesia has now become a pleasant experience. All anaesthetists strive to give their patients a ‘Balanced Anaesthesia’, which is a combination of Analgesia (loss of response to pain), Amnesia (loss of memory), Immobility ( loss of motor reflexes), Hypnosis (loss of consciousness) and skeletal muscle relaxation.

Q 10: Where else will I require services of an Anaesthetist?

A : Apart from surgeries, Anaesthetist is required in the following scenarios-

1.      Labor analgesia – By giving a drug in the epidural space (mentioned above) anaesthetist can help you achieve a painless normal delivery. Here you will be able to move both legs but you will have no sensation, and hence no pain.

2.      Chronic pain – chronic pain conditions such as cancer pain, neuralgias can be relieved by various nerve blocks. The anaesthetist injects a nerve ablating agent such as absolute alcohol around the nerve responsible for causing intractable pain resulting in permanent irreversible blockede of that nerve resulting in relief from pain.

3.      Diagnostic procedures – Anaesthetist is required for giving sedation or anaesthesia for children and un-cooperative patients undergoing diagnostic procedures e.g CT scan, MRI, TEE etc.

4.      Critical care – Anaesthetists are trained in management of post operative patients in intensive care units.

5.      Trauma management – Anaesthetists are trained in cardio pulmonary resuscitation and emergency management.

Jab tak hai patience

Jab tak hai jaan has all the masala ingredients that define a present day bollywood movie - two ultra glamorous heroines, bollywood’s biggest heartthrob (not mine though) in two versions, one, the young carefree boy next door with his trademark guitar in hands and the other older rough and tough guy with a well built body showing off through tight fitting tees, a stubble and no expressions, a story spanning three exotic countries, fantastic cinematography, songs that make you humm and few well planned emotional dialogues. But what it lacks is pure logic. Many questions remain unanswered, like what exactly is SRK doing in London (of all places)?, why Anupam Kher, who wants his daughter to learn speaking Punjabi, wants her to get married to a firangi? how a 28+ man with no background training gets selected as the chief of bomb disposing squad? how can a person discover self in a pub amidst a group of almost naked dancing drug addicts? what exactly is Anoushka doing moving about with the 4 soldiers 24x7 other than irritating them? why doesnt katrina’s father make any attempt to get her married in those ten years? etc etc etc. SRK looks as usual, gives the same expressions he has been giving in every romantic film since the last..what, twenty years? i guess so. There is a very fine line between bubbly and irritating, and unfortunately anoushka sharma manages to cross that line. Katrina is okay...but still her hindi dialogues seem forced. The characters of anupam kher, neetu singh, rishi kapoor are a waste. the end has been stretched till our patience snaps. Overall, this is not a trademark ’Yash chopra’ movie. I would suggest, if you want to pay him a tribute, watch DDLJ again, rather than wasting time and money on JTHJ.

My poem which was published in the Souvenir for Government Medical College Miraj, 50 years celebration.

MEMORIES UNFOLDED

I still remember my first day of college

The memories as vivid as though live

I had stepped into a whole new world of dreams

With the knowledge, I had a lot to strive

I fondly recall the Anatomy lecture hall

Where I first met my friends for lifetime

The corridors, the tutorial room, the dissection hall,

Still hold the essence of our being

The fun we had while pricking ourselves

During Physio Hematology sessions

Our fruitless efforts to byheart the Biochem cycles

Which was always an impossible mission

The freshers party that turned ragging

Into the most memorable affair

The crush we all girls commonly had

On this handsome senior, cute and fair

The fun rides in the clinic buses

To and fro from Sangli Civil

Partying till late and returning to the hostel

Under the warden’s watchful vigil

The hostel food which I better not describe

The fights for getting good rooms

The small catfights with best friends

Over wet clothes, buckets and brooms

The dozing off in lecture halls

Attending Post Mortems’s with horror

Byhearting the patho slides

By byhearting the slide number

Learing names of zillions of microbes and drugs

That really made us sick

The PSM visits to ‘interesting’ places,

Yet nothing short of a picnic

The visits to central library

Less to study, more to see people dating

To see Juliet’s fake surprise

To find their Romeo’s waiting

The yearly college trips

Where we would all have a blast

Only to come back to spot a notice of exam

With syllabus very very vast

The tension during exam time

Viva’s that terrified us to our core

The dreaded feeling that before uttering anything

The examiner would show us the door

The midnight birthday celebrations

The gatherings filled with excitement

The nights spent practicing dances and drama

For us, the perfect vent

The great teachers we had

Stalwarts in their respective fields

Who laid the foundation of our lives as doctors

And helped our sculptures to be built

The college taught us a lot more

Than just the medical stuff

It taught us to be calm and stable

During patches of life, rough

It taught us to be patient

When things didn’t seem our way

It taught us how to find, in utter darkness

That single hope ray

It taught us the way to deal

With the patients we treat

It molded us, from kids to individuals

Who could stand on their own feet

It helped us not only to become doctors

But better human beings

And fighters who can calmly face

Whatever life brings

What GMC has given us

We can never repay

I salute my alma-mater for what it is

On this special day…

My dear daughter Isha!!

Nine months I waited with baited breath

For the moment you would arrive

It was a heavenly feeling,

Within me you were alive

I used to count your kicks

Each one gave me such pleasure

Every time I felt you move

It was a moment to treasure

And finally the day dawned

When you saw the light of day

And from that moment my life has changed

In every single way

The first time I saw your beautiful face

Your innocent eyes, pink cheeks

Tears of happiness rolled down

As I touched your delicate lips

I cannot put in words

The overwhelming feeling I felt at that time

From that moment, in the song of our lives

You have become the rhyme

I could have really gone crazy

When you first recognized me

And my happiness knew no bounds

When you first smiled at me

Your babbles filled our house

We would die to hear your clatter

When we were with you

Nothing else would matter

Slowly you started sitting,

Then began crawling around

And when you took that first step of yours

You made us so proud!

Now each day brings with it

A new change in you

For our lives like a dried leaf

You are a drop of morning dew

Every new milestone you reach

Makes us, with joy, scream

For us, trapped in boring days

You are like a dream

You are like an oasis

In the vast expanse of sand

For any worries we have

Your smile is a magic wand

We all are in splits of laughter

When all over the house you run

Watching you play with your dolls

Is truly such pure fun

After an exhausting day

I die to see your face

You take us away into your own little world

Away from this life’s donkey race

You make me forget all worries,

All tensions in our lives

You make us believe,

That life is full of smiles

In the white canvas of our lives

You paint different hues

Between the sun and rains

You are the rainbow in our lives

The way you call me ‘Momma’

Makes my heart literally melt

This is very different feeling

Never before have I felt

I thank God for blessing me

With a lovely daughter like you

For showing me a new dimension in life

Which existed, I never knew!