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Friday, December 01, 2017

Tissue is the issue

For non medicos Pathology is the study of cells microscopically in diseases states and histology is the same study in normal states !
Histology is microscopic anatomy of the human body at cellular level and is studied as a basic science in medical curriculum ie during the first or second year while pathology is generally done in third or fourth year after starting medicine surgery and gynecology and knowing about diseased states .
Forensic science is the study of dead tissues and post mortem examinations also are a part of pathology but of a more investigative approach associated with criminology and post mortem examination to find cause of death etc a totally different and vast field by itself as a medical student one went through that in fourth year ,
To us working in oncology or cancer medicine ,pathology is vital and pathologists are one of the most important specialists we work with as a team .
In these days of great advances in the molecular level of differentiation's pathology at many times decides on the treatment and the word of the pathologist is sacrosanct .
Getting a pathology or biopsy report for a patient too is very unnerving as it could be a diagnosis which would strike terror into his or her heart or rarely relieve him of his anxiety !
in oncology we always say tissue is the issue
we have in most centers multidisciplinary meets with pathologists to discuss cases as subtle difference can alter the whole management
in these days of highly specialized stains in immuno histochemistry and molecular tests and even genetic mutations the differentiation is so vast .
in the early days it was suffice to get a diagnosis of say in breast cancer what type of tissue it was either from glandular called adenocarcinoma or from connective tissue a type of sarcoma called malignant phylloides whose treatment were diametrically opposite today the sub classifications like the hormone status the aggressiveness by grade or by KI 67 range or specialized targets amenable to treatment like Her 2 or epidermal receptors ,the microscopical invasions into blood vessles lymph nodes or lymphatics or nerves are all vital
in hematology too the sub classifications of lymphomas or leukemia's deserve separate tomes and are in hundreds and each one is important for prognosis or outcomes ,
second opinions are taken at times when pathologists themselves are foxed over certain modulations in tissue
Transformation of the tissue from one type to another as tumor grows certain mutations that confer resistance to certain types of targeted treatment or monoclonal antibodies have all made pathology a highly specialized and meticulous science in oncology .
over the years i still remember some eminent pathologists i had the opportunity to work with
a reputed madam professor in lakeshore hospital in kochi who was very helpful when requested for an early report for those whom we wanted to waste no time to start treatment like in young patients
i still rememebr getting a bone marrow report on same day something which would never happen abroad !!
in Tawam hospital in Al Ain a John Hopkins hospital managed tertiary care center the pathology hematology had a great team there was an Italian hematologist who only specialized in lymphomas and he was an authority on that
in the center i work here now too we have a highly specialized and capable department of pathologists who are the main support structure in the diagnosis of our patient s
with newer forms of tissue sampling like circulating tumor cells and plasma based DNA detection the paucity of sampling from difficult areas like lung will be met better in future
so the kaleidoscopic world of starry cellular wonderland the home of pathologists is dear to us too .
After all tissue is the issue

Wednesday, November 29, 2017

Muchad Gadh and other stories review

Creativity is never listless if it comes from within, in music there’s a lovely Sanskrit word which describes it Bhaavam ,
In writing that makes all the difference
Like ripples on a flowing river there are pieces of the deep inside in a good writer that peeps through his or her works
So too in this book of short stories delivered with punch and panache there is pain pathos cynicism sadness and cheer in its subterranean depths if the reader doesn’t catch this he misses its soul

It’s difficult to select a best in such collections which are so different from each other though there is an infinite basement membrane of irony all along.
To me the first was the best, the despicable man, the hated one in that bus who proved to be the finest when fate delivered its righteous blow.
Goodness never needs to cry out loud it exists.
The Title story of the Rajasthan Moustache village was the light hearted banter a departure from the tragic overtones that colours this kaleidoscopic collection and the sprouting whiskers of the shaved alien grows to be a part of it, the end with no bend .
We often see Phulls in our lives those who overpower you with their presence but to know this Phull had aetiology behind his distressing personae made us pity him.

The characters in the book on the whole are etched with dark charcoal as caricatures in flesh and blood by words which is an art by itself, the happenings are very Indian except the Somalian pirate story with a trace of Captain Philips

Inspector Kewats obsession with the criminal ebbed him into the Neverland’s but with the mystery unraveled before he closed his eyes which wasn’t of any use of course
Cabinet committee is reliving our own housing committee’s meets and its idiosyncrasies
The cold hard nosed businessman Malik who could kill to rise reminded me of a Malayalam film Raktamillatha manushyan meaning bloodless man and in the end he meets the same fate as in the film

 The life inside a women’s prison and the find of a mother to love made Qaidi different and tender

The shocking pink is truly an exorcism of a torture suffered in life Such graphic word smithing cannot come otherwise; the urge to kick away the pink affliction is seen all along the dark depths of the collection
Block printing is an inside look of a Gujrat industry and the fatal disappointment of an old lullah

Sejals Guillotine was an axe over our head too painful to read
 Unexpected deaths repeatedly awaken the reader out of his sink into the routine
Oshbo would have been an easy one for an experienced journalist author Earth is again laughed at in the perfect suicide
Life reconquered is death won isn’t it ?
I love Begums of Ballimorans so I enjoyed the tale of men and women who live life to the fullest with taste
Murder of English language was more delicate and rhymed my thoughts
And the BC story a fitting finale on a journey traveled with fortitude and won and one keeps the slightly dark book down after reading it with hope in the horizon.!

Tuesday, November 14, 2017

Pullman in Miri

Miri in Pullman
It was two Georges one living in USA and many years later one from Europe who had started the famous railway coaches called Pullman
The US George had done it from Chicago
Another George a Belgian had visited US and travelled in Pullman trains and was impressed to start Pullman trains in Europe too and as the brand was became a hit Pullman hotels were also started by him ...
At present they are in all continents in many cities.
More than 173 hotels or resorts are available all over the world
Most of them are ultramodern five star hotels with high rise buildings, sleek modern lines of architecture and futuristic furniture.
We never knew all this as we booked to stay in a Pullman hotel in Miri ,Malaysia .
Me and friend Dr Yuvaraj had driven down to Miri on a weekend and it took 2 hours as we had to cross the border check post and immigration etc .

 It was wet and rainy as we sped along the wooded road leading to MIRI
Once we entered Miri city we had some difficulty in tracing where our hotel was as we had no mobile connection hence no WIFI to use GPS
Suddenly the tall Pullman building popped up and all we had to do was to go in its direction, easier said than done as ground directions are a bit different from say an aerial one, maybe if we had a helicopter we could have done that 

 We did manage to reach the hotel finally, it was downtown but in a quieter area and bordering the marina.

 We were checked in to the 16 floor room and ours was almost a suite
Thus we did stay a day in the famous Pullman!!
After a rest we hit the town and a snazzy bar called Mings café where great cocktails and music

lightened the dusk, the morning saw us going for a ride in our car unplanned, we wanted to visit a famous Buddhist temple nearby.
Most people in these places aren’t good in telling directions, we had to ask two as we had no GPS after plotting in a paper and looking at it for ages the lady recited a litany of confusing direction we felt she would also have never found the temple again in her life
The man proved to be almost same as he gave directions of a route through multiple traffic signals u turns, etc
We thought we would just go without any plans and drive till we reach somewhere
Funnily we just went straight through a couple of traffic lights and reached an old town area full of lovely colonial shops ,a huge market with vegetables and meat ,we managed to get a parking in that area a real feat indeed ,


 There were hot buns for sale amongst others
One of the vendors at last was a clever one when asked where the Buddhist temple was he said you are almost there just walk 500 meters and you will see it, and we did just that!
Later we returned for a couple of ice cold beers and checked out by 2pm on our way back to Brunei

Friday, November 10, 2017

The Lady with the hood

The lady with the hood ......

The dusk had fallen
The moon peeped through the white domes of the magnificient Sheikh Zayed mosque in Abu Dhabi
I quickened my pace to catch a glimpse of an etheral beauty in black purdah !
The cold of the desert on a december evening was felt in my bones ....
There was a sretch of fine sand I had to cross to reach the milling crowds , but by then the damsel had melded into them , disappearing like a mirage in the desert .
I waived my way through jostling the crowd to angry stares !!
No i cant miss her again !

It was my soul that was calling me not my mind for I was numb for long .
The long lines parted .
The sombre altar of spirituality was serene in its peace .
The marble reflected the purity of divinity .
There was an aura of inner solace undescribed in the bowels of the monument .
The whispering shuffle of foots on the Iranian carpets hardly broke the sepulchural silence .
The kaleidoscopy of the chandeliers reflected the multiplicity of humans milling below .
Where can I search for the elusive her in this hall of mirrors ?
It was like in a dream
The fog of time crept into eternity .
Awareness extended to infinity
I was lost in a trance .
I walked away
I came to stand in the moonlight .
For a change I was alone far from the crowd inside the mosque .
The dew of the grass touched my bare foot
It cooled my insides
I wanted to lie down
When I felt a presence
I knew who it was
It was her standing before me the veil removed with a beatific smile on her face !
We walked out our hands interwined gazing into the moonlight and dissapeared into the darkness .
( actually me and premila had visited Sheik zayed mosque in Abudhabi and she had to wear the Abhaya ..
.I saw this photo now and spun this story to bore you all )

Thursday, November 09, 2017


Today is Kamalahassans birthday .nov 7th
Though lately hes sounding senile with his idiotic comments as an attempt for a political launch ,to me hes one of the best actors we would see .
I would put him in the line of Dileep kumar ,Sanjeev kumar ,Sivaji Ganeshan ,Marlon brando and Mohanlal .
He was into films from childhood
As a wiry teen he was into chorus dancing and later choreography .
It needed a genius like K Balachander to recognise the talent in him and he was launched by this great man in Tamil .
One film that stands out amongst many is Apoorva ragangal where a young Kamal falls in love with a beautiful but much elder Sri vidya , this film was much ahead of its times with such a story but was accepted by the people ,it also introduced a sad shy Rajnikaanth who appeared in the last scene as the estranged husband of Srividya to the consternation of a bugged Kamal !
In the next film Kamal would be the proverbial simpleton to Rajnis sauve villainy in Padinnaru vayadinilee .
Balachanders varumayin niram sigappu or red is colour of poverty where this song comes was another gem .
I always felt Kamal was best paired with Sri devi .
Moonraam pirai later Saadma by Baalu Mahendra was another milestone in this actors career .
In the last scene one cannot forget Kamals running in the platform along the moving train in Ooty station and hitting an iron pillar and falling down ,that isnt acting its living the role .
Meendum kokila where Kamal is the verbal husband with a testosterone issue to his homely wife Sridevi also stands out.
Maro charitra the telugu original of Ek Duje Ke liye was the mother of romantic films .
Malayalam films recognised Kamal long before Tamil did and he was a hero in late seventies there in a score of films where he prances to the unforgettable tunes of a Salil chowdhry with the likes of Zarina Wahab,Sheela and Lakshmi a much welcome change from the staid prancing of a Prem Nazir .
The actor in Kamal has to wait for Mani Ratnams Nayagan where he enacted the erstwhile don of Mumbai ,Varadarajan mudaliar with the elan of a Brando in Godfather .
The scene where kamal emotes on his sons death is still a classic .
His comic timing was seen in many films like Michael madana kaama raasa
Doing different roles as a dwarf ,a woman , a feminine dance master , a drunkard one ,all came to kamal with ease
But to many of us of the same gen Kamal was always an inspiration as a romantic hero

Thursday, November 02, 2017

Dr Durandham

Dr Durandhams day
Kerala is a land of elephants .
Most temples had one or many more and in its festivals most malayalees are used to seeing tame elephants at close qaurters .
I know of some whose hobby is just elephant watching
Even some teenagers
Wonder why they select elephants with so many other things to be watched at thier age !
Each to his own
of course .
There is an engineer hes in infosys now who had spent 3/4 of his blessed childhood gazing at elephants in temple festivals all over kerala .
He would reel away on every single detail on every single elephant mentioning them with so much endearance as in describing a neighbours child studying in a local kindergarden .
There were mishaps too in these festivals when the tame ones went berserk which wasnt a rare occurence
By nature scooting came easy to Mallus and at these times most would shimmer up the nearest coconut tree and cling to its fronds with the agility of a frisky monkey .
Watching an elephant in the wild is a bit different but from watching them in a temple .
As long as one was far away it was fun which is how I would describe the two elephants we saw near the Siruvani dam when we went there for a family picnic .
But enroute to the forest bungalow the road was a thin ribbon with menacing tall thick bushes of elephant grass which hid the dense forests on both sides and where no light entered and the darkness hid its mysteries well.
Its encountering an elephant in such a place that could land one in trouble with a big T.
My co brother Pramodh a senior airline executive is a committed wild life enthusiast and with his years of wandering in several core forests in India was considered as the familys Jim Corbett
Pramodh knew a lot on wild animals .
Unlike me who knew only about the human wild .
He told us that elephants like all wild animals avoided humans unless they are in their way or threatened them in some manner .
Clever of them should learn the trick of avoiding humans from them
Usually in narrow roads when we see an elephant while driving we need absolute silence ....said Pramodh
no horns
sit still
Then the elephant may find a path to get out of the area and it will .
but if it doesnt find a way out it may charge.
then and only then please run fast he would proclaim !!
That made me run away almost immediately !
to the amusement of my family who had nicknamed me Dr Durandham or Dr Tragedy as I was pretty adept in creating fertile scenarios
For example i would say
shortly a rogue elephant would see us and think of us as so many footballs
or how a huge Tiger would spot us just when it didnt have its breakfast for one week .
Every turn on the narrow ribbon of the road my Ayyos created collective palpitations in inhabitants of both the cars of our caravan .
I was strongly advised to keep myself occupied with human pleasures in the forest bungalow instead of venturing out to sport by popular demand .
Pramodh also continued his grim exercise of analysing dungs on the road peering at them with the air of an expert weather forecaster
at times stopping the car and once even tapping a particularly dry specimen one that looked like dung from a constipated baboon !
then declaring with the elan of declaring the magna carta itself as the dung was tiger refuse 8 days old with the air of a proctologist on his thousandth colonoscopy .
His machinations would produce sighs of admiration from the bated audience at his animal academic brilliance .
Wow how come pramodh you know so much !
Well if we keep tasting sorry testing dung all along the way like this we too would be experts but dead ones ,
Dr Durandham yours faithfully would pipe in to a not so cheering family .
And so we would meander along till we reached a particularly dark corner full of tall bushes and since we couldnt see much of the road ahead
Pramodh stopped the car and the one behind driven by my niece who by genetics had aqquired the genes of her wild dad iam sorry wildlife dad pramodh also stopped .
The eerie silence was broken only by a strange munching sound ahead and my silent gesticulation of it being prudent to go back was finally listened to .
Pramodh too signalled for the beating retreat .
To reverse a car in a narrow forest road no to reverse two cars in a narrow forest road with whatever was hiding behind those bushes ready to jump at any moment needed nerves of steel and minds of casted iron not that of bendable aluminium which me Dr Durandham posessed.
Father and daughter did that gracefully and in minutes we were gliding back to safety
For once Harietta your warning proved right Pramodh would say and others too agreed
And thus Dr Durandham had his day too .

Monday, October 30, 2017

The making of an Idly

The making of the Idly

To me cooking is a pleasure
Its a conquest
Everytime the mistakes I make and finally achieving the sucess though not perfection is part of the joy .
I love to see how the curd I made has formed in the morning and am delighted every time I see a perfect solid Artic white curd with the  right sourness and with a smile I transfer it to the fridge .
The pleasure is even more than the eating and at times I think I  cook or make food more for the pleasure in it rather than the eating part .

The meticulous Basmati rice boiled to the exact cooked state and the aromatic curry and  layering for the dum and the slow wait with the reward that comes when I open the biriyani vessel and smell the heavenly ambrosia and give it a light mix and when my one more Biriyani is ready I love that moment .

I loved it the day I made a fluffy parotta with layers though that never lasted .
 The skill just sneaked away leaving me in disappointment !!

So was the time I could fry a crispy calicut style Banana chips but these days they flop like dogs ears too !

And another peak I wanted to conquer was the making of idly and dosa right from the raw matireals and not using the ready made dough .

 I managed to do it with the  help and instructions from my sister .my wife .my friend yuva in that order
Encouraged  to go ahead and google uncle of course and finally the lovely grinder my wife had kept here which I wouldnt even look at earlier .

So from the right mix of Boiled rice and Urad dhal which i bought from the Indian store in Gadong on a sunday morning  I foreplayed them with wetness and when they were soft to my seduction ground them well and let the soft mix overnight to bloom !
Just like a woman .
At 6am  I just couldnt resist to see if the dough had risen !!

Oh yes

It not only rose it bloomed ,out like a mini Tsunami and even spilled out of the vessel its soft frothy flavour filling me with a heavenly smell !

After tidying up I made reasonably soft idlis ,one imperfect dosa ,with some masala to go with  and freshly made  coconut dry chutney .
One more crown to dorn in my kitchen experiment
I could do it

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