Dramatic Surgeons

We all have funny anecdotes dotting our past lives
in many of my earlier posts I have narrated some where I have been the protaganist
Today  let me dwelve upon some  which happened when I was studying in medical college .( ages back )  ( kilpauk Medical College Chennai )

To begin with  I remember with fondness one of our surgical chiefs who I would term politely to be a trifle on the larger side with a roomy middle ,
he was a good showman and  in the large outpatient clinics we had ,he always had a flexible plastic knee hammer with a knob on one side and his habit was to twiddle the rod end ( soft ) on the patients tummy as the patient  lay in the centre of the whole crowd of students ,
As he continued to twiddle the patient would wriggle getting tickled ,suddenly our boss would take the rod and it would go straight into his mouth  as he absent mindedly  chewed on it with the stunned patient  looking speechless at this culinary preference of the physician and we all would  try to supress our giggles .

Once he dramatically asked a pateint during rounds
" Are you passing gas ?  "
The patient replied meekly
 "yas saar little little  "( Konjam Konjam in Tamil )
 "konjam konjam   ! what else do you expect you  want  to have a storm or what with lightening  and thunder " was his reply !
 ( pinna enna puyala adikkum ? ) .

He used to sit in a chair surrounded by all of us standing around trying to catch what he said and he had the habit of swinging his chair slowly backwards and one fine day he went all the way back and was rescued by two juniors just before he hit the floor
 The two juniors was at the wrath from  many of us for that untimely rescue !

There was another famous surgeon whose feats in the operation theatre were  woven into ballads ! like Keralas vadakkan pattus
this man was a no nonsense person
he was perfect in what he did and was an excellent surgeon
But he  made spines shudder when he was angry .

I remember him particularly well  in my final year exam clinicals
 One had to had to identify  gross pathology specimens  and  this part of the exam was called spotters .

The sight of the big man himselves  sitting unglaring in front of a floating tissue in glass would unerve anyone particulary a meek exam candiadte like me but that day I was brimming  with confidence as I knew what the specimen  was and was all ago to go at it and so I went on describing to him all about the testicular seminoma specimen  ( a testicular tumour ) which I thought was what the specimen was all about ,

Dr V ......made an interested listener nodding and even smiling at me benignly and prodding me on
I started imaging I was so good that he was seriously  considering to offer me  a surgical residency once i passed .
At the end of it  he brought me down to earth with a thud

" nice my dear fellow you know  a lot about the testicle and its seminoma but for your information this is a thyroid !!!! and not a testes !!!  "

Of course I got through that year but no surgical residency ever came my way !



The very same surgeon  is known to have been called recurrently by another famous surgeon who was known for his  teaching skills and also known for his poor operating skills whenever he got into catostrophies !
It was during my third year  we were all eagerly standing around with masked faces trying to peep into an operative field as the great man cut and snipped .
In the pecking order the third years were infants nay neonatals ,
The operation  theatre of   a teaching medical college is rigidly caste ridden !

In the front there were  the great chiefs who were like kings and emperors
The Assistant  profesors who were the only people who could contradict or converse with the king   in a somewhat equal term came second in heirachy.
There were  the post graduates whose only intent was to get maximum experience and learn and get into the good books of the kings and the Assistants
Then came the interns  or house surgeons who were always exhausted by thier continious work schedules They were bent on finishing thier jobs and going back to the  hostel  for a smoke or whatever they did for thier relaxation .
There were the Final year students  who had that studious exam  look carved into thier serious faces
 The  fourth years came next they  alternatively admired thier seniors while scorning thier juniors .

Of course we had the Anaesthetists who  were operating room creatures and kept  straying  in and out occasionaly playing with thier machines or  twiddling with  BP cuffs while cracking jokes with the surgeons and Assistants depending on thier intimacy levels with the kings
These men and women lived thier lives in the operation theatres rarely meeting thier pateints when awake !but were true professionals excellent in thier strenous jobs

There were also  homely  matrons who ruled  the operating room region with iron hands and even ticked off the kings for misdemenours at times !

There were  nurses who scampered around expect the big ones who assisted the emperors with sure confidence coming out of experience over the years
Each surgeon had his special team of nurses and Assistants .

We the third years amongst all this activity  were literally the outcastes banished to the outermost periphery pushed and jostled by the crowd .
we were literally non entities

Finding our what was happening in such a place was mostly by imagination and by auditory.more than visual inputs .
The clip and snip of a scissor or the slide of a scalpel  would let us know that the operation was well on its way .

In this dramatic scenario one of my classmates ,I  would just call him K ( by now he should some professor or director of some institute somewhere so why offend   by naming him  !  ).

K had a clever idea to view the proceedings that day .

He pulled a stool left by a wandering anesthetist and climbed  on it towering above all of us and with a wide grin from this lofty perch watched the proceedings with an aerial view bending down into the operative field itself  !

All went fine till the moment his spectacles sprung from its perk on his sweaty nose and dropped  plonk into the open abdomen of the poor patient .

All hell broke loose

V....stopped what he was doing and looked up aghast

all of us looked shocked and speechless

Then as a closing ceremony came a dark hand again sweaty and damp shooting  into the patient and retrieving the  lost property !!

You guessed it
it was the hand of K !

V ....went into apoplexy

Iam sure he broke an artery or two that day

an operative field is a highly sterile area and we third years too knew that but dont know what made K do what he did !

V yelled
he asphyxiated
he went into an apoplexy
his eyes were red and his face was purple with rage

 "kick him out kick him out I  dont want this fellow to ever come 100 metres near a theatre ! ever again  "

and then he yelled at the nurses

  "come on get the saline and irrigate the field fast fast "

 to undo the crime !

There was yet another surgeon who was known for his absent mindedness

Tales were told of how he left a newly married wife in the market in the city she never knew as he went pillion riding with a friend he met offhand later remembering to retrieve the crying wife after many hours .

This absent minded surgeon was also known for his hot temper and his anger was legendary .

Once  he forgot to wear the  pants portion of his surgical scrubs and just wore his shirt which to a certain extent covered his family jewels as he was very short .

As ususal he climbed on a stool ( he always needed a stool )  to start his surgery with this sexy outfit and hairy thighs

 that day there were lot of suppresed giggles but none dared to mention to the emeperor that he had  no clothes till the time a lady gynecology chief who was known to have a  fond eye on this surgeon came and started laughing  pointing to his middles  letting the cat out of the bag !

What after all   is life with no fun!

Feather in the Air

when loved ones disappear with no warning
the days ahead are filled with mourning
to all of us parting and losing are sad
and to never see the person again is really bad .


To each one of us the departed soul is different
to one he or she is the lover to some the loving parent
to many the person  is a dear friend
to some he or she could be just indifferent


all of us have to say one day goodbye
that after all is the rule dont ask me why
but still when people leave us  and go
we do feel the knawing vacum that  is again so


to me my Unnietan was not only an elder  brother (in law )
he was a friend I could and did  bother
how can a person so alive and kicking one day
becomes just an image and disappear like   a faded ray


Time alone can  let  lingering grief s settle
Time can make us forget the little rememebrances  which knell
with time and more time  persons and souls do disappear
And the  fond memories fly away like feathers realeased into thin air .......




( Unnietas 16th day rites are tomorrow )

Jumping Genes

Cancer is a disease that has a frightening tinge to it .

It creates apprehension and fear of impending death ,the advances in oncology notwithstanding death does play a big role in Cancer though its shadow is definitely being shortened day by day

We cannot group all Cancer into one it depends on the type ,the site the stage and the other problems associated with the patient ( we call it as comorbidities )

 it also depends on when it was diagnosed , by whom , and what kind of treatment was given and where it was given .

All this goes into what happens to somebody with the big C .

It is preventable to an extent by avoiding obvious risk factors like smoking and use of tobacco  , alcohol use beyond the limits .maintaining a healthy lifestyle with adequate exercise also helps to a great extent .

Preventive and early detection of certain cancers have also brought down the incidence

Finally the myths associated and the fears and barriers of the disease in society  should be broken down

With this morbid introduction let me take you through two discoveries in Cancer research which have made a paradigm shift to its outcomes .

One is in CML or Chronic Myeloid Leukemia and the other is  APML or Acute Promyelocytic Leukemia .

There are great similarities to both these types of Leukemias for once they were thought to be insurmountable mountains as far as treatment was concerned but advances in molecular medicine has made them as pygmy hills to be hopped over today  !

The Time magazine had as its cover when the secrets of  CML was discovered a picture of the capsule used in CML  with the title Cancer Conquered though that proved with time a little overconfident it was not totally wrong

.http://www.time.com/time/magazine/article/0,9171,999978,00.html

Let us find out what these two epoch making events were

Chronic Myeloid Leukemia is one amongst the four Leukemias ( blood cancer affecting the blood forming cells )

Chronic is the label given for the type of Leukemias with mature cells

 ( fully grown cells ) ( Chronic Myeloid or mature granulated white cells and Chronic Lymhoid Leukemia which had mature lymphoid cells ) and

Acute the type with immature growing cells ( called Blasts )

 ( Acute Lymphoblastic with predominantly lymphoblasts  and Acute Myeloid  Leukemias with myeloblasts or granulated cells )

Amongst the Acute Myeloid Leukemias of which there are several types there was one termed some years back as AML M3 and today called as APML  or Acute Promyelocytic Leukemia ( in short it is the type of Leukemia with predominantly promeylocytes or growing myelocytes )

 The bone marrow is our factory churning out these cells incessantly while millions of cells get killed every other minute ,

all it needs is  a small hitch and then something goes haywire in the assembly line .

Of course each cell has its genes carried in its chromosomes ( it would need a separate blog to explain this so let us leave it at that )

now in the APML affected cell there occurs a quirky switch from normal called Translocation

chromosome 17 in the cell is involved in a reciprocal translocation with the promyelocytic leukemia gene (PML) on chromosome 15, a translocation denoted as t(15;17)(q24;q21).

The fusion of PML and RAR creates a hybrid protein with altered functions.

This protien prevents further growth of promyelocytes into myelocytes and hence promyelocytes are produced in large numbers and are released into the blood stream .

These promyelocytes are abnormal and have toxic granules which burst out into the blood and this causes bleeding and clotting problems ( Diseeminated intravascular coagulation ) this can cause severe problems and can lead to sure death if not treated immediately .

Hence the importance of detecting APML in time which can be done only in centres trained to do so .

The RAR A is Retinoic acid gene ( Vitamin D is Retinoic Acid  ) and when several isomers of Retinoic acid was used in APML it was found that the cis isomer of Retinoic acid called ATRA just reversed the action casued by the fusion of PML RARa  and the promyelocytes started maturing into normal myelocytes !

Ooh la la

Suddenly the most fatal disease turned into most favourable one for treatment of course it wasn’t as simple as that as chemotherapy was also added to ATRA and  had to be continued in several forms for at least two years

 but fact is an incurable type of cancer become completely curable like magic .

Initially when ATRA was discovered it was available only in China and during the Tianamen episode in history  the supplies from China stopped

Roche the famous medical company produced its version and created history .

Similarly in CML there is a fusion between BCR and ABL genes forming a hybrid protien called BCR ABL which caused the mature myelocytes to go uncontrolled

Again a  specific medicne coming under the class Tyrosine kinase inhibitors called imatinib mesylate proved to be the magic pill turning the  CML from a dreaded disease into a manageable one .

Over time more versions of Imatinib came into being  like Dasatanib and Nilotinib

These targetted therapies ( they target only the cancer cells ) and monclonal Antibodies form the backbone of cancer research and treatment today leading us to the inevitable  day when Cancer would be even if not conquered become like say Diabetes or Hypertenison is today .

Let us pray for that day

Akale film /review

Sometimes ,no most of the times fine things come not by design but by chance .
surfing the channels on a lazy holiday made me see this classic movie by Director Shyamaprasad ,I would not have even known about it otherwise !

Akale is a very simple story of a north malabar anglo indian famly ,
Sheela the extrovert gregarious mother who hides her anxiety of a woman deserted by her husband , a sensitive mildy handicapped daughter Rose , and a son Neil  who is in a world of his own .
Neil   is  a lowly clerk but aspires to be a writer of fame  one day
.he often  escapes to the fantasies of a local cinema house to escape the constant grumblings of his mother who goads him to find a match for Rose .
Pritiviraj as Neil has done a low profile  and mature job even as a middle aged writer in the later half of the film .
Geethu Mohandas as Rose is really the star of the film ,she has brilliantly portrayed a fragile and sensitive young woman with an inferiorirty complex who hides her thoughts amongst her glass figurines .
she flowers open to Freddy , Neils friend who was also  her schoolmate and lets us all know how much could be behind such quite  people ,
like her  broken glass unicorn her dreams are shattered along with ours  once we come to  know Freddy the thoughtful and caring man is already engaged to someone else .
Rose slowly  retreats into a sanctuary to disappear altogether from this uncaring world
Sheila the veteran actress portrays her role with aplomb
The movie takes you to the world of Anglo indians , the piano cliniking in the background the sepia tinted photographs the echoes  of great parties in the  past and the porcelain dinner layouts .
The film ends with Freddy his wife  ,Neil and his mother , all remembering Rose and we too do that then .

Brilliant please watch 

getting heated up

It was 2007 July ,one of the hottest periods in the Gulf and I had the first taste of summer in Al Ain then
I reached U.A.E precisely on july 12th  and landed in Abu Dhabi Airport .
Tawam Hospital recieved thier staff on the first vist with a  friendly chaperone and a chauffuer driven vehicle .

Smiling Sidhu was my first glimpse of my Hospital hospitality and he made  a reasonably good impression .

As we sped through the smooth neat wide highway to Al Ain I was intrigued by the signs that came before me .
once in a while the board Abudhabi  came on my right side ! This was surprising for someone fresh from India as we expect it to be the opposite side of my travel as I was moving away from it later Sidhu filled me that this was the way one returned back by an underpass ,no u turns or junctions in highways ,it was one smooth ride of 140Km in an hour and a half .

we passed the huge horse roundabout as  we approached AlAin city and I  looked at  Tawam Hospital ,it was huge and sprawling with the Faculty of Medicine near by ,we sped swiftly into the flower bedecked roundabouts and  the neatly pavemented city of Al Ain went through the busy areas and reached the other side of the city and went into the Hilton my home for more than a month from then .
I was promptly deposited in my fifth floor room with a nice little balcony facing the main road and the speeding cars ,of course at that time of the year one wouldnt venture into open balconies for the sun  would fry one till it was late in the evening .
Slowly I learned to live in a hotel  commuting  to  the hospital in the official car and coming back in the evenings ,the long weekends of friday and saturday stretched in front on me with nothing much to do but gaze into the TV and think of home food ,it would be november by the time AlAin climate changed from torrid to warm to cold and nice in december     jan and february .
One weekend afternoon after a long nap I slided the glass door of my room moving aside the curtains and stepped into the verandah ,half sleepy
 I wanted to take a breath of fresh air and I then did something  which I regretted immediately .

I slided the door back and it promptly got locked into place from inside .

not a pleasant  proprosition to get caught in a blazing verandah under a fuming sun in a gulf summer and to add to my discomfiture I was ill dressed in a lungi without even a shirt to cover my chest  and a  growing paunch !
within minutes I was in sympathy with all the eggs I fried in my life as I went through similar experiences

The sun was just shining away in all its glory and  wickedly smiling at my agony ,I  could see my mobile lying on the bed far away behind the impentrable glass door and my voice sounded feeble and hoarse as I tried to beckon a taxidriver 5 stories below in front of the lobby ,he didnt even glance up why should he ? even no birds were in the sky !
my foot bare and  burning made me do some kuchipidi steps  as I attempted to withdraw into small patch of shade .
I had to look out for someone too to call in distress if  I   dindt want to die of sunstroke and be packed home in a steelbox
finally I  found my saviour,a posh Arab who got out from his BMW and gazed up .

He should have got a shock to see a half naked fakir gesticulating like a wild monkey on the fifth floor balcony making strange sounds .
He Hey whats up ?
Me Everything I mean me stuck here door locked by itself u know save me tell lobby pleeese
He : why the hell did you do that locked yourself out
ME dont know sure will tell you once I get the answer !
this made him chuckle
HE  Ha Ha you look burnt ha ha
ME I feel burnt too
HE  Shall I get a fireengine for a rescue what
ME easier way is to tell the manager please
HE   ha OK well should have had my camera missed it
ME  Ya what a photo op ? like a kingfisher model

Well the angel of an Arab did the right thing after giving me a smile ,he went straight in and out came the manager and his gang

    Manager and co    doctor it is you ha ha What made you something like that

I was sure producing all the humour Al Ain could get that summer and I felt i would become a  national celebrity by the evening

within minutes there a lot of banging and tapping in front of my room door double locked by the safe me before going for sleep

somehow they opened it and  then  opened my sliding door and  I  stepped into the bliss of AC

I collapsed into the sofa grinning with embarasmewnt at the amused waiters and manager one of them even bringing a thoughtful cool drink with him to dool my embers

 The manager  gave me a tut tut why in heavens did you do that my dear Doktor just imagine if no one had seen you what you would have done

slowly after lot of laughs and giggles they left me alone 

I collapsed into the bed thanking my stars that I was dressed not just in my lungi alone or else a lot of me would have fried that day !

Adaminte Magan Abhu

Some Malayalam films these days are showing the sensitivity that they are  known for and thier quality is improving  after a precipitous dip to crass masala recently .
Surprisingly two films Pranayam and Adhaminte magan Abhu have dealt with the seniors in society who are considered  not very market worthy in film commerce .
Adhaminte got the national award for acting for Saleem Kumar known for his comedy forte .

The story  is that of an old couples yearning for a pilgrimage to Mecca with thier meagre savings .
ignored by thier only son working  in the middle east
The couple find it difficult to gather the funds needed even by  selling thier loved few posessions like an old tree in the house  and a  cow and calf which provides them livelihood and to them  more like a child
 .
Good people are willing to help beyond the constraints of religon or blood relationships but Adham being a stickler to the laws of his faith and pilgrimage rules refuses them with love .
the couple almost prepare for thier trip at one time before disappointment sets in and go to people they know even to those who have done them harm and apologise for any wrongs committed by them which is said to be a prepilgrimage ritual ,and they find that the Almighty works in strange ways unfathomable to meagre mortals .

The trials and tribulations that fall on good men who stick to thier principles but  are stonewalled by poverty is depicted with finesse .
both Saleem Kumar and Zareena Wahab have essayed thier roles with grace and dignity the dark at time grotesque and sad eyes of Saleem strangely contrasting with those of the still beutiful Zarina
The wrinkles of Saleem in a tired  face breaking into myraid emotions and  eyes filled with love and devotion makes him worth the national award

The couple dont make it to Mecca but bring back thier cow and plant  a new sapling in thier house ,depicting a new beginning
A very good movie
hope more of this genre is made

The Case of the Missing Chauhan... Trip to the origin of River Yamuna

Chauhanji the central character in this post was the fulcrum of our trip up the mountains .
He was the organiser and part of Panikker Travels to whom our group the School of Bhagavad Geetha of Thiruvananthapuram had entrusted to conduct the tour .
They had conducted many such yatras over the years to Mt Kailas ,Amarnath and to the Chardhams for Swamiji and Chauhanji an old hand had always been its central piece .
Panniker travels itself known to many in India have been a travel agency in Delhi for many decades and have earned a name for reliability and efficiency ,for them Swamijis tours have been more than a business and more of a personal commitment .
Swami Sandeepanada Giri in youthful forties led many of these tours himself going every year even more than once to these holy but difficult terrains and taking many with him,an yeoman service to the many who longed to see such places safely .He is a very positive person full of mirth and fun and always encouraging people to go beyond their limits either in bathing in icy cold turbulent rivers or climbing high above the clouds feats that normally would not be dared at
.I dont think any other group would have this inspiration We also could listen to lectures on our  scriptures in elegant malayalam and also know the significance of every place and its details in our puranas this was mind lifting indeed
All our hardship in the tour melts when we see what we achieved and we are ever grateful to Swamiji for making this possible
now let me come back to our Chauhan ,in his forties Chauhan was a smart guy trim and slim he was full of energy ,climbing mountains was second nature to him as he is a native of the very Uttarkhand the abode of Gods we travelled to ,he knew tons of interesting information about every possible thing .
Chauhan had also been production mgr for many movie and shooting groups including that of Dil Se where he used to organise the hill parts .
We reached Barkhot our base stay from Rishikesh after a drive of more than 10 hours one can hardly paint a word picture of this drive with full justice as it needs to be experienced but still it was glorious and stupendous ,as we climbed u the narrow roads with loose pebbles draining in from the hill sides our tyres skirted nothing ness as our efficient drivers hung to their steering wheels  with concentration bit into  their profiles .
The landscape changed surely but slowly as the pines and deodars appeared and disappeared, terraced fields of golden maize winked at us while brilliantly coloured flowers nodded in the breeze the distant hills were blue and green , some bare and some wooded .Small villages went by with shepherds leading their flocks and chubby red faced children played on the sides. Small shops sold trinkets and eatables and the air was full of nip and cool winds .
we reached the gurgling Yamuna banks and its pebbled stones to walk and take an icy dip
The roads are built and maintained by our Border road Organisation which was like the army itself disciplined and talented they have built some of the best roads in the world .
The river dips in such places are very refreshing one has to be very careful as the current was very fast and one could get carried away in a jiffy as one amongst us a senior Urologist almost did.
 luckily we were many and he was caught in time before he went on a different yatra !

The first dip is always shocking to the system as it feels like an electric shock but then it is bliss as somehow one feels warm and comfortable the river waters come from melting glaciers carrying so many plants and herbs minerals and stones of much medicinal value down and bathing in such rivers somehow makes you feel reborn leave alone the spiritual part of it .
We then went up and up and reached Janakichatti where the road ends .

Janakichatti  was a small town full of shops ,there were lot of ponies waiting to take people up ,Dholies were chairs lifted by four people , there were also  small baskets called Pitthas which were carried on the backs and a person had to sit on it with legs leaning out !
 this was unimaginable specially for an obese person like me .
we opted to climb the hard way

The climb was steep initially and steeper later !
slowly many in the group were up while I trundled along gasping like a fish out of water
my wife was way up as I lagged behind slowly taking my photos and videos resting in small shops having tea and chitchatting with one of my friends Babu who like me was as slow climber .
hours of climbing gave us a far glimpse of a temple roof high up we thought we had reached the place but when we managed to reach that temple it was disappointing to know we still had more than 3 km of climb up and this was just another wayside temple
by the time I reached the top Premila my wife was waiting for me taking snaps of my exhausted climb she had already gone inside  the temple had a wash in the hot springs there and waiting for me to start her climb down !
I went up and into the crowded temple for mother Yamuna
Hinduism celebrates the holy rivers as mother divine .
After all every creation is from divinity including ourselves
So worshipping nature is worshipping God .
The place we as full of priests who lured people for several pujas to me a non believer of rituals the temple itself and its pristine surrounding s and the gurgling Yamuna with its steaming hot springs was soul filling .and I had no need for any pujas .
The limb back after some refreshments was tiring and knee breaking as we needed to put our brakes if we didnt want to tumble down like jill in jack and jill
After more than 3 hours of arduous climb with horses jangling us Dholies creating traffic jams and pittas making us gasp in surprise we reached janakichatti exhausted .
The plan was once filled the buses in our tour numbering three would start and go back to our hotel in Barkhot so that peole who returned early need not wait till  evening for others and can have their well earned rests
 2 buses had already left and the last one was waiting it was 5 pm already and slowly getting dark and colder .

one couple were yet to return .
We had been told that return should be before 6pm as the roads were  dangerous in the dark ,
there was no trace of the couple and Chauhan was anxious
 suddenly he decided to go up and find out ,but as he went up the couple came back in another route and he missed them .
we tried to call him by mobile but there was  no range and so we waited for Chauhan to return as the drivers would not budge without Chauhans saying so .
Now Chauhan was missing !
it became 7pm and Chauhan returned irritated at the whole episode as he had almost gone up to the top in search of the couple fearing many things .
all of us were at our nerves ends as he declared we would go down albiet the risk and we were praying loudly as the bus skirted narrrow corners in pitch darkness
 one single mistake would send us crashing down to wilderness below where we would not even find our remains
with the grace of God we reached Barkhot safely and an anxiously waiting group had a hot dinner and hit our beds for a deep slumber  to continue our yatra the next day
which would be in the next post of course