Smoky mountain trip

Yesterday was a long day indeed ,

A distance of 571 almost 600 km in six ( took more than 8 to 10 hours ) with frequent stop overs 

From Charleston in West Virginia to Smoky mountains near Bryson city in North Carolina through well maintained roads except for stretches .

Sruthi and Achyuth had booked a log house in a woody hilly remote place after Bryson city .

It was in smoky mountain hills in begginings of some great hiking trails like the Appalachian trail .

A stop for breakfast in farm fresh Bob Evans  I had posted here ..

After that we stopped in many quaint little American towns with thier own branded and unbranded shops ,churches  municipal buildings houses .

The weather was generally cold outside the heated eight seater Hyundai Palisade driven in turns by Achyuth ,Sruthi ,and Shyam .

Though I had driven in UAE in right hand drives the long interval in Brunei and Cochin has reduced my confidence to even attempt US roads with its fast traffic .

Shyam had driven extensively in Australia and India and last six months in US too .

Sruthi has been driving in cold frozen Cleveland later in Houston while Achyuth had driven to many parts of the US on his work .

So I had the prime seat near driver as premila and Sruthi need to be near Tara kutty in her childrens seat and first long journey .

By evening we were all tired with Tara not comfortable at all .

Somehow we trudged along to reach our AIRBNB cottage .

The last stretch in dark of about ten km was to me treacherous of lonely steep hilly wooded roads with poor internet and failing GPS and not a soul around in places known for bear sightings .

I read accounts of poor souls lost for ever in the Appalachian trials and as a known paranoid panic person in family injected bit anxiety amongst the joking others .

And on and on of dark lanes abrupt curves which in daylight we were sure would have great views finally honed in on

ABOVE IT ALL !

The message talked a of a secret post box black in colour carrying a code which carried the key not at all the regular check ins I was used to .

Manichithrathaaz said I to the fun of all .

But all these were worth the efforts as we entered a magnificient luxury wooden cottage of three bedrooms an electronic fireplace ,plush leather furnitures and all kitchen paraphrenalia 

Tastefully selected coffee table books paperbacks on Bryson city mysteries etc in the voluminous hall cum dining ,huge kitchen and confortable bedrooms .

And we rested with gratitude to those who built such a cottage in such a place

 

Sprituality with Son

 With my dad leaving me at ten with unerasable memories for this life time ,being the scholar and intellectual he was I often wonder how our conversations would have been if he had lived till I was say around 28 years !

I am sure it would border on the fathomless truths undiscovered , for he a Sanskrit scholar ( self learned ) and a repository of Vedanta by his vast reading and innate intelligence would have a veritable ocean for me to plunge in but alas it was not to be .

But then I am happy my son more than makes up for it .

Whether he finds me intellectually stimulating Iam not sure but our conversations end up invariably in the profane and beyond borders of esoteric secrets .

Yesterday Shyam called me as it was Sunday morning in frigid New York and we connected over transatlatic borders as if by telepathy treading into unexplored vistas of the cosmic world and powers that direct us all .

It started with my asking him his present post doctoral work .

Shyam mentioned it was on earliest star formations in the universe known today by way of the James Webb telescope which took human insights way back to those times .

 He said it was surprising that the heavenly bodies then were much larger than ever thought , larger ,more luminescent ,more throbbing with power and potential ,

He would measure those inputs to chart out a simulators likelihood .

It was an individual foray but as part of a team probing into those uncharted waters .

This led to me asking him 

As a cosmic physicist doesn't the question of who is behind all this intrigue him ? 

He said it has to !

 Spell binding and startling truths always does .

Sadness suffering and separation seen by Doctors in thier practice also does .

And so we walked into the secret of life in our conversations .

Shyam said knowledge in philosophy or spirituality requires acceptance and  curiosity and not confirmation .

Being sure of something make one lose the possibility of alternatives .

Going in one path made one lose the others .

I countered him telling Adi Sankara in his Advaita had no niggling choices .

He had Supreme confidence in his mentioning that we all living beings are sparks of the one power from where we come and go back .

Shyam said yes but thats the disadvantage of confirmation in absolute beliefs ,while Sankara talked of there being an absolute power Buddha talked of Sunyam or nothingness beyond all .

We both agreed on the ancient Indian methodology of debating  which was by intellectual sparring of doctrines the famous tharkaas of logic  .

A brilliant Sankara or Buddha or Mahavira or Ramanuja or a Paninni won by conversations .

This was akin to ancient Greeks or Egyptians of the past or those from lost Mayan civilisations debating and knowing .

In stark contrast to forcible compulsion of shallow beliefs by physical threats or fear .

Thus Shyam gave me half an  hour of HIT REFRESH  to my ageing neurons .

Thanks dear .

Tissue is the issue

 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 tissue 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 .

Selective pathologies for immunotherapy to work 

over the years I still remember some eminent pathologists I had the opportunity to work with  .

The reputed madam Pushpa professor in lakeshore hospital in kochi was one when there 

The Dept had been very helpful when requested for an early report during 2003 to  2006 when I was working in med oncology for those whom we wanted to waste no time to start treatment like in young patients 

Iam sure its still so today .

I still rememebr getting a bone marrow report on same day ( not full one but what was needed to start treatment ) something which would never happen abroad !!

in Tawam hospital in Al Ain UAE 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 .

We used to have exhaustive monthly Hematology board meets like tumour boards in med oncology ( pathologists used to contribute thier inputs there too ) 

in the center I worked in Brunei The Brunei Cancer center  too we had a highly specialized and capable department of pathologists .

In  Ripas Govt  hospital the department of pathology was led by Prof Telesinghe  the main support structure in the diagnosis of our patients

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 ( Liquid biopsies)

so the kaleidoscopic world of starry cellular wonderland the home of pathologists is  dear to us too .

After all tissue is the issue